Global Health Lecture Series 22 April 2015 Meeting the Challenge of Cardiovascular Disease in Africa Ed Havranek, MD Denver Health Medical Center University of Colorado School of Medicine
Acknowledgments Zimbabwe: James Hakim, Jonathan Matenga Colorado: Tom Campbell, Larry Allen, Tom Maddox, Joe Schuller, David Katz, David Kao, Dan Bessesen, Alex Benson
Medical Education Partnership Initiative (MEPI) Ethiopia Nigeria Uganda Zambia Botswana Kenya Tanzania Mozambique Zimbabwe South Africa
Figure 7 Regions sized by burden of disease Regions sized by healthcare workforce The Lancet 2010; 376:1923 1958
Zimbabwe Historical Context The British Empire 1893-1965 Rhodesia 1965-1980 Robert Mugabe 1980 -
Zimbabwe Historical Context 2000 Land redistribution begins. Inflation. 2005 Economic downturn accelerates. 2008 Contested election. Power sharing. 2008 Hyperinflation. Cholera epidemic. 2009 Zimbabwean dollar withdrawn
Zimbabwe Historical Context First 10 Medical Schools Senegal 1918 South Africa 1919 1919 1943 1956 Uganda 1923 Nigeria 1948 Cote d Ivoire 1962 Zimbabwe 1963 Angola 1963 Adult Literacy Rates Zimbabwe 84.5% Lesotho 79.4% Cameroon 62.5% Uganda 58.4% Nigeria 54.9% Benin 32.6% Burkina Faso 17.6% Niger 13.2%
CHF, HTN, RHD Initiative Strategy (CHRIS) Statement of the Problem 2010 Cardiology manpower and infrastructure in Zimbabwe severely limited medical school faculty shortage (vacancy rate >60%) 2 physicians with advanced training in cardiology no invasive cardiology or open heart surgery. Non communicable disease is highly prevalent in southern Africa
Contribution of Changes in Population Growth, Population Aging, and Rates of Age-Specific Cardiovascular Death to Changes in Cardiovascular Mortality, 1990 2013. Roth GA et al. N Engl J Med 2015;372:1333 1341.
Contribution of Changes in Population Growth, Population Aging, and Rates of Age-Specific Cardiovascular Death to Changes in Cardiovascular Mortality, 1990 2013. Roth GA et al. N Engl J Med 2015;372:1333 1341.
Clinical Epidemiology 1 st 10 general medical admissions 4/7/15 Age Gender Diagnosis Underlying Condition(s) 1 42 M Stroke Hypertension 2 24 F GI Bleed Jaundice/hepatitis 3 46 F Subacute meningitis HIV, DM 4 79 F Heart failure Hypertension 5 36 M Nephrotic syndrome HIV 6 33 F Dyspnea at rest 2 wks post partum 7 40 M Mitral stenosis, new AF HIV 8 59 M Myocardial infarction Hypertension 9 20 F? sepsis HIV 10 50 M TTP HIV
Clinical Epidemiology 1 st 10 general medical admissions 4/7/15 Age Gender Diagnosis Underlying Condition(s) 1 42 M Stroke Hypertension 2 24 F GI Bleed Jaundice/hepatitis 3 46 F Subacute meningitis HIV, DM 4 79 F Heart failure Hypertension 5 36 M Nephrotic syndrome HIV 6 33 F Dyspnea at rest 2 wks post partum 7 40 M Mitral stenosis, new AF HIV 8 59 M Myocardial infarction Hypertension 9 20 F? sepsis HIV 10 50 M TTP HIV
Cardiovascular Disease in Zimbabwe Uncontrolled hypertension Hypertensive heart disease Stroke Peripartum Cardiomyopathy 1:1000 in South Africa, 1:4000 in US 1 Rheumatic heart disease Global annual mortality 233k (HIV 1.5M) 2 1 Sliwa et al. Lancet 2006; 368: 687 2 Essop et al. Circ 2014; 130: 2181
Cardiology Education in Zimbabwe More intensive mentoring of selected postgraduates Clinical skills Research skills
Cardiology Education in Zimbabwe Objective: develop a small group of junior faculty with basic region specific qualifications in cardiology Methods: 1 month rotation in Cape Town 2 week attachment in Denver Didactic and clinical teaching from visiting faculty 8 wks/yr Completion of a clinical/outcomes research project in cardiology Concentrated exposure to cardiology inpts/outpts Teaching skills workshops
Cardiology Education in Zimbabwe Clinical skills Echocardiography ECG and arrhythmia detection Pacemaker implantation Outpatient management
Cardiology Education in Zimbabwe Research skills Patient registries o Inpatient stroke o Pediatric RHD o Peripartum cardiomyopathy o Inpatient CHF 30 d mortality Atrial fibrillation Ventricular arrhythmias Surveys o Rheumatic heart disease in schoolchildren
Cardiology Education in Zimbabwe Cardiovascular physiology lectures for 2d year medical students
Cardiology Education in Zimbabwe Clinical cardiology lectures for 5 th year medical students
Cardiology Education in Zimbabwe Outcomes to date PG Pediatric cardiology Senior registrar. 1 yr fellowship in SA July 2015. GF Adult cardiology Lecturer in medicine. Pacemaker implantation. AM Adult neurology Senior registrar. Lecturer in 2016. EG Adult cardiology Registrar. CM Adult cardiology Registrar. TZ Adult cardiology Registrar. TC Adult cardiology MMed GM Endocrine/diabetes MMed GJ Endocrine/diabetes MMed FM Adult Pulmonary MMed EM Adult Pulmonary MMed