Cardiovascular diseases represent a major public health problem worldwide
[1]
.
Despite a downward trend in developed countries, the situation is worrying in emerging countries
[2]
.
They rank first among non-communicable diseases in Algeria
[2]
with a high prevalence of cardiovascular risk factors among young people and rural populations
[3]
.
Cardiovascular risk factors have been established for several decades and are becoming increasingly prevalent with a significant amount of data in the world in Africa
[4]
.
In Mali, little data is available on the prevalence of risk factors and cardiovascular diseases depending on the area of residence.
In Mali, traditional cardiovascular risk like hypertension, diabetes, smoking and obesity have been published
[5]
. In addition, data from extra-hospital population studies are rare or old
[6]
.
We initiated this work and our main objective was to assess the prevalence and create an epidemiological profile of CVD and CVRF within the rural and urban communities of the town of Bougouni and its surroundings (Mali).
Methods: We carried out a cross-sectional, descriptive study with retrospective collection of data from patients followed at the Bougouni Medical Center, between February 2, 2019 and March 31, 2024. All patients with symptoms suggestive of cardiovascular disease, with or without a known cardiovascular antecedent have been included. The aim was to assess the prevalence of common cardiovascular risk factors and cardiovascular diseases and to determine their profile in rural and urban areas. Data were collected from medical records. Incomplete files were excluded. The data collected on a survey sheet were entered and analyzed by the SPSS version 22 software.
2. Results
Sociodemographic data:
In this study, which involved 452 patients, the average age of the patients was 50 ± 19 years with a minimum of 1 year and a maximum of 90 years. Those over 60 represented 34.74% of cases (157 cases) and 33.18% (150 cases) were 40 or older. 267 cases (59.08%) were female and 185 (40.92%) were male; the sex ratio at 1.19 in favor of women. 70.35% of patients were living in rural areas (318 cases); 29.65% in urban areas (134 cases) and 64.82% were doing agropastoral activity (
Table 1
).
<xref ref-type="bibr" rid="scirp.136308-"></xref>Table 1. Characteristics of subjects who consulted the cardiology department.
Characteristics
Number (N = 452)
Percentage (%)
Sex
F
267
59.08
M
185
40.92
Age (years)
1 - 20
36
7.96
21 - 40
114
25.22
41 - 60
145
32.08
More than 60
157
34.70
Résidence
Rurale
318
70.35
urbaine
134
29.65
Occupation
Agro-pastoral
293
64.82
Office worker
23
5.09
other
136
30.09
Risk factors:
A history of hypertension was found in 42.70% of patients (193 cases) (
Graph 1
), this prevalence is higher in urban areas (47.01%) than in rural areas (41.50%) (
Graph 2
). Diabetes and smoking had a respective prevalence of 5.31% (24 cases) and 8.19% (37 cases) in our population (
Graph 1
) without a significant difference according to residence, with 5.97% in urban areas compared to 5.35% in rural areas (
Graph 3
). Active smoking was found in 8.49% of rural people compared to 6.72% of urban ones (
Graph 4
).
Regular alcohol consumption was found in 10 patients (2.21% of cases) (
Graph 1
) and the difference was not significant between the rural area and the urban area: Respectively (2.20%) and (2.24%) (
Graph 5
).
143 patients (31.63% of cases) had not any history nor cardiovascular risk factors (
Graph 1
).
Graph 1. Distribution of patients according to known cardiovascular history and risk factors.<xref ref-type="bibr" rid="scirp.136308-"></xref><p class="imgGroupCss_v"><img class=" imgMarkCss lazy" data-original="https://html.scirp.org/file/1911561-rId13.jpeg?20240926041828" /></p><xref ref-type="bibr" rid="scirp.136308-"></xref>Graph 2. Proportion of hypertension according to residence.<xref ref-type="bibr" rid="scirp.136308-"></xref><p class="imgGroupCss_v"><img class=" imgMarkCss lazy" data-original="https://html.scirp.org/file/1911561-rId14.jpeg?20240926041828" /></p>Graph 3. Proportion of diabetic patients according to residence. The proportion of known diabetic subjects is slightly higher in urban areas (5.97%) than in rural areas (5.35%).<xref ref-type="bibr" rid="scirp.136308-"></xref><p class="imgGroupCss_v"><img class=" imgMarkCss lazy" data-original="https://html.scirp.org/file/1911561-rId15.jpeg?20240926041828" /></p>Graph 4. Proportion of diabetic patients according to residence. The proportion of known diabetic subjects is slightly higher in urban areas (5.97%) than in rural areas (5.35%).<xref ref-type="bibr" rid="scirp.136308-"></xref><p class="imgGroupCss_v"><img class=" imgMarkCss lazy" data-original="https://html.scirp.org/file/1911561-rId16.jpeg?20240926041828" /></p>Graph 5. Proportion of alcoholism according to residence. The prevalence of alcoholism was not significantly different between rural and urban areas: (2.20%) in rural areas versus (2.24%) in urban areas.The reason for consultation:
The main reason for consultation was dyspnea.
252 patients (55.75% of cases) presented dyspnea of different stages, 62 patients (13.72%) came for atypical chest pain, 39 patients (8.63%) for headaches or dizziness and 99 patients (21.90%) presented other symptoms pointing towards other types of pathologies (
Table 2
).
<xref ref-type="bibr" rid="scirp.136308-"></xref>Table 2. Distribution of patients according to reason for consultation.
N
%
DYSPNEA
252
55.75
OTHER
99
21.90
HEADACHE OR DIZZINESS
39
8.63
PRECORDIALGIA
62
13.72
TOTAL
452
100
Dyspnea was the most reason of consultation, with 55.75% of cases.
The retained diagnosis:
Idiopathic dilated cardiomyopathy represented 23.45% (
Table 3
). And this prevalence was higher in rural areas (28.30%) than in urban areas (13.43%) (
Graph 6
). Uncomplicated hypertension was found in 102 patients (22.58% of cases).
<xref ref-type="bibr" rid="scirp.136308-"></xref>Table 3. Distribution of patients according to the retained diagnosis.
RETAINED DIAGNOSIS
N
%
Hypertension
102
22.58%
Idiopathic DCM
106
23.45%
PPCM
27
5.98%
Rheumatic valve diseases
10
2.21%
Other valvular diseases
17
3.76%
Ischemic heart disease
42
9.29%
CPH
18
3.98%
Congenital heart diseases
10
2.21
Pericarditis
12
2.65
Stroke
8
1.77
Other pathology
100
22.12
Total
452
100%
An idiopathic DCM was retained in 23.45% of patients.
Graph 6. Proportion of idiopathic DCM according to residence. The prevalence of idiopathic DCM was higher in rural areas (28.30%) than in urban areas (13.43%).30.37% of urban people were affected compared to 19.24% in rural areas. Ischemic heart disease was found in 42 patients (9.29% of cases). This prevalence is higher in rural areas (10.38%) than in urban areas (6.71%) (<xref ref-type="bibr" rid="scirp.136308-#g7">
Graph 7
</xref>). Postpartum heart disease represented 5.98% in our study: 5.68% among rural residents compared to 6.66% among patients residing in towns. Rheumatic valve diseases at 2.21%; other valvular diseases at 3.76%; with 2.84% in rural areas compared to 0.74% in urban areas. Chronic pulmonary heart at 3.98%. a stroke was found in 1.77% in our series; no significant difference between rural (1.89%) and urban (1.48%) areas. 100 patients (22.12% of cases) did not present cardiovascular pathologies (<xref ref-type="table" rid="table3">
Table 3
</xref>).<xref ref-type="bibr" rid="scirp.136308-"></xref><p class="imgGroupCss_v"><img class=" imgMarkCss lazy" data-original="https://html.scirp.org/file/1911561-rId18.jpeg?20240926041828" /></p>Graph 7. Proportion of ischemic heart disease according to residence. The prevalence of ischemic heart disease was higher in rural areas (10.38%) than in urban areas (6.71%).3. DiscussionThis study may contain some bias because of the retrospective data collection and this a preliminary study that could guide future studies on epidemiological transition in rural areas in Africa.We have included 452 patients in our study. Among them, 318 (70.35%) lived in rural areas and 134 (29.65%) in urban areas. 64.82% were farmers or breeders. This can be explained by the fact that the majority of our patients lived in rural areas. Our population was different to M. Brouri’s et al. in Algeria, most of whom lived in city (287 cases) compared to 124 patients from rural areas <xref ref-type="bibr" rid="scirp.136308-2">
[2]
</xref>. 59.08% of our population were women (318 women) and 40.92% were men (185 patients); this is close to M. Brouri finding with 262 women and 148 men <xref ref-type="bibr" rid="scirp.136308-2">
[2]
</xref> and A. Mbaye’s in Dakar, Senegal with 1052 women of 1411 cases <xref ref-type="bibr" rid="scirp.136308-7">
[7]
</xref>. The average age was 50.19 years; 34.74 of the patients were over 60 years old and 7.96% were 20 years old or less. 57.30% of consulting patients were aged 21 to 60 years. (<xref ref-type="table" rid="table1">
Table 1
</xref>). a little different from the A Mbaye’s finding in Senegal with an average age of 48.5 ± 12.68 years <xref ref-type="bibr" rid="scirp.136308-7">
[7]
</xref>. Most patients complained of dyspnea (55.75%); 13.70% for atypical chest pain and 8.63% for headache or dizziness (<xref ref-type="table" rid="table2">
Table 2
</xref>). This can be explained by the fact that, in general, rural populations in Africa haven’t easy access to health services, so they only go to the doctor when it’s serious. 42.70% of our patients had a known history of hypertension; these results are higher than the prevalence in sub-Saharan Africa (31%) <xref ref-type="bibr" rid="scirp.136308-1">
[1]
</xref> and Salimanou et al’s finding (31.8%) <xref ref-type="bibr" rid="scirp.136308-1">
[1]
</xref>; Brouini’s finding (39%) <xref ref-type="bibr" rid="scirp.136308-2">
[2]
</xref>. It was higher in urban areas (47.01%) than in rural areas (41.50%). Our results were close to those of Boulki in Algeria with 28% in urban areas and 16.8% in rural areas <xref ref-type="bibr" rid="scirp.136308-3">
[3]
</xref>, and BA HO in Bamako: 24.7% in urban areas and 21.10% in rural areas <xref ref-type="bibr" rid="scirp.136308-8">
[8]
</xref>. Our results differ from those of FOURCAGE, which reported almost similar in rural areas (30% to 40%) than in urban areas (40%) but for a population over 60 years old only <xref ref-type="bibr" rid="scirp.136308-9">
[9]
</xref>.Diabetes was found in 5.31%, our data are lower than the prevalence in the general population in sub-Saharan Africa (8%) <xref ref-type="bibr" rid="scirp.136308-1">
[1]
</xref> and the finding of Brouni in Algeria (25%) <xref ref-type="bibr" rid="scirp.136308-2">
[2]
</xref>, we did not observe a significant difference between the rural area (5.35%) and the urban area (5.97%), this is different from the results of BOULKI in Algeria which had a higher prevalence in urban areas (28%) than in rural areas ( 24.8%) <xref ref-type="bibr" rid="scirp.136308-3">
[3]
</xref>.Active smoking was found in 8.10% of our patients; lower than the overall prevalence in sub-Saharan Africa (12%) and the results of Salimanou in Benin (12.4%) <xref ref-type="bibr" rid="scirp.136308-1">
[1]
</xref>; this prevalence was slightly higher in rural areas (8.49%) than in urban areas (6.72%). Our results were close to those of Boulki in Algeria who did not observe a significant difference between rural and urban areas <xref ref-type="bibr" rid="scirp.136308-3">
[3]
</xref>.Regular alcohol having was found in 2.21% of the cases; lower than the general prevalence in sub-Saharan Africa (21%), This prevalence is also lower than the results from Salimanou in Benin (8%) <xref ref-type="bibr" rid="scirp.136308-1">
[1]
</xref> we didn’t observe a significant difference between rural population (2.20%) and urban one (2.24%). 31.63% of our population had no known cardiovascular risk factors; this was different to Brouni’s finding in Algeria, 91% of patients had at least 1 cardiovascular risk factor <xref ref-type="bibr" rid="scirp.136308-2">
[2]
</xref>.
Idiopathic dilated cardiomyopathy (DCM) accounted for 23.45% of cases in our study; that’s less than the results of EDGAR WENDPANGA in Burkina Faso (84.4%); this difference can be explained by the fact that he has included only patients with heart failure in this study
[10]
. The prevalence of DCM was higher in rural areas (28.30%) compared to 13.43% in urban areas. This could be explained by the fact of rural population don’t have easy access to the doctor in Mali. Ischemic heart disease accounted for 9.29% of cases, this was less than the results of El Ghazi in Morocco (30.60%)
[11]
. The proportion of ischemic heart disease was higher in rural areas (10.38%) compared to urban areas (6.71%). Rheumatic valve disease accounted for 2.21% of cases; the same thing for heart disease (2.21%).
4. Conclusion
This study highlighted a high prevalence of risk factors and cardiovascular diseases in the rural and urban population of Bougouni and its surroundings (Mali). However, the prevalence of some risk factors such as hypertension, diabetes, smoking and alcoholism is higher in urban areas than in rural areas. On the other hand, idiopathic dilated heart disease, ischemic heart disease and smoking have a higher prevalence in rural areas. These data could provide a basis for developing cardiovascular disease prevention strategies based on place of residence.
References
Amidou, S.A. (2018) Epidémiologie des maladies cardiovasculaires en population générale rurale au Bénin: Cohorte Tanvè Health Study. Thèse de Doctorat, Université de Limoges.
Brouri, M., Ouadahi, N., Nibouche, D., Benabbas, Y., El hassar, M., Bouraoui, S., et al. (2018) Facteurs de risque cardio-vasculaires en Algérie. Une analyse du sousgroupe de l’étude “Africa/Middle East Cardiovascular Epidemiological”. Annales de Cardiologie et d’Angéiologie, 67, 61-66. >https://doi.org/10.1016/j.ancard.2018.01.003
Boukli Hacène, L., Khelil, M.-A., Chabane Sari, D., Meguenni, K. and Meziane Tani, A. (2017) Prévalence des facteurs de risque cardiovasculaire au sein des communautés urbaine et rurale dans la Wilaya de Tlemcen (Algérie): l’étude de deux communes. Revue d'Épidémiologie et de Santé Publique, 65, 277-284. >https://doi.org/10.1016/j.respe.2017.01.121
Yusuf, S., Reddy, S., Ôunpuu, S. and Anand, S. (2001) Global Burden of Cardiovascular Diseases. Circulation, 104, 2746-2753. >https://doi.org/10.1161/hc4601.099487
Diarra, M.B., Diarra, A., Sanogo, K.M., Diakité, S., Tchintchui, N., Diall, I.B., Diallo, B.A. and Touré, M.K. (2007) Cardiopathies ischémiques en cardiologie à Bamako (A propos de 162 cas). Mali Médical, 22, 36-39.
Maiga, M.A., et al. (1989) Epidémiologie de l'hypertension artérielle en zone sahélienne dans le cercle de NARA (Mali). Médecine d’Afrique Noire, 36, 234-237.
Mbaye, A., Babaka, K., Ngaïde, A.A., Gazal, M., Faye, M., Niang, K., et al. (2018) Prévalence des facteurs de risque cardio-vasculaire en milieu semi-rural au Sénégal. Annales de Cardiologie et d’Angéiologie, 67, 264-269. >https://doi.org/10.1016/j.ancard.2018.04.005
Bâ, H.O., Camara, Y., Menta, I., Sangaré, I., Sidibé, N., Diall, I.B., et al. (2018) Hypertension and Associated Factors in Rural and Urban Areas Mali: Data from the STEP 2013 Survey. International Journal of Hypertension, 2018, 1-7. >https://doi.org/10.1155/2018/6959165
Fourcade, L., Paule, P. and Mafart, B. (2007) Hypertension Artérielle en Afrique Subsaharienne Actualité et Perspectives. Médecine Tropicale, 67, 559-567.
Ouédraogo, E.W.M., Ouédraogo, S., Bamouni, J., Banda, A., Yaméogo, N.V. and Zabsonr, P. (2022) L’Insuffisance Cardiaque à Fraction d’Éjection Altérée en Milieu Rural Africain: Caractéristiques Cliniques et Paracliniques à Ouahigouya (Burkina Faso). Health Sciences and Disease, 23.
Ghazi, I.E., Berni, I., Menouni, A., Kestemont, M., Amane, M. and Jaafari, S.E. (2018) Profil épidémiologique des maladies cardiovasculaires dans la Ville de Meknès (Maroc). European Scientific Journal, 14, 49-55. >https://doi.org/10.19044/esj.2018.v14n33p49