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Review
June 2016

Peripheral Arterial Disease in Sub-Saharan AfricaA Review

Author Affiliations
  • 1Department of Surgery, University of Virginia, Charlottesville
  • 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Department of Surgery, University of Washington, Seattle
  • 4Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • 5Komfo Anokye Teaching Hospital, Kumasi, Ghana
  • 6Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
  • 7Department of Surgery, University of Bouake, Bouake, Cote d’Ivoire
  • 8Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 9Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville
  • 10Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 11Surgeons OverSeas, New York, New York
  • 12Department of Surgery, Columbia University, New York, New York
JAMA Surg. 2016;151(6):564-572. doi:10.1001/jamasurg.2016.0446
Abstract

Importance  Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood.

Objective  To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemiology and management of PAD could be described and recommendations offered.

Evidence Review  A systematic search in PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Google Scholar for reports pertaining to the epidemiology and/or management of PAD in sub-Saharan Africa was performed. Reports that met inclusion criteria were sorted into 3 categories: population epidemiology, clinical epidemiology, and surgical case series. Findings were extracted and described.

Findings  The search returned 724 records; of these, 16 reports met inclusion criteria. Peripheral arterial disease epidemiology and/or management was reported from 10 of the 48 sub-Saharan African countries. Peripheral arterial disease prevalence ranged from 3.1% to 24% of adults aged 50 years and older and 39% to 52% of individuals with known risk factors (eg, diabetes). Medical management was only described by 2 reports; both documented significant undertreatment of PAD as a cardiovascular disease risk factor. Five surgical case series reported that trauma and diabetes-related complications were the most common indications for vascular surgery.

Conclusions and Relevance  The prevalence of PAD in sub-Saharan Africa may be equal to or higher than that in high-income countries, exceeding 50% in some high-risk populations. In addition to population-based studies that better define the PAD burden in sub-Saharan Africa, health systems should consider studies and action regarding risk factor mitigation, targeted screening, medical management of PAD, and defining essential vascular care.

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