0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Peripheral Arterial Disease in Sub-Saharan Africa A Review

Lily E. Johnston, MD, MPH1,2; Barclay T. Stewart, MD, MscPH3,4,5,6; Herve Yangni-Angate, MD, FWACS7; Martin Veller, MBBCh, FCS, MMe8; Gilbert R. Upchurch Jr, MD9; Adam Gyedu, MD, MPH4,5; Adam L. Kushner, MD, MPH10,11,12
[+] 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.
Text Size: A A A
Published online

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.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
PRISMA Diagram of Report Selection
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Risk Factors Related to Peripheral Arterial Disease in Sub-Saharan Africa

The odds ratios and 95% CIs in blue represent reports included in this study, and the odds ratios and 95% CIs in orange represent from a meta-analysis6 that examined risk factors in low- and middle-income countries more broadly.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

281 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Peripheral Arterial Disease

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Peripheral Arterial Disease

brightcove.createExperiences();