Cardiovascular Disease Surveillance And Control In The Nigeria

Abstract

CHAPTER ONE

INTRODUCTION

• BACKGROUND TO THE STUDY

Globally, there is an uneven distribution of cardiovascular disease (CVD) mortality rates, the lowest are in the advanced industrialized countries and parts of Latin America. Whereas the highest rates today are found in Eastern Europe and a number of low and middle income countries (World Health Organization, 2011). According to Lim, Vos, and Flaxman (2010), these mortality rates generally appear to be closely linked to a country’s stage of epidemiological transition. The developing countries in Africa are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors which in turn raised the incidence of non-communicable diseases especially cardiovascular diseases (Mozaffarian, Fahimi, & Singh, 2014). Cardiovascular disease is an umbrella term that refers to any of a number of disease affecting the heart and blood vessels, and it is the leading cause of worldwide preventable morbidity and mortality (Mendis, Puska & Norrving, 2011). Cardiovascular disease is largely driven by preventable risk factors and these risk factors are classified as modifiable and non-modifiable risk factors. Age, sex and family history of the disease are non-modifiable whereas tobaccosmoking, insufficient physical activity, abnormal cholesterol level, hypertension, obesity and diabetes mellitus are some of the modifiable risk factors (Olamide, Ogunmola, Adeleke, Olutoyin, & Oluwole 2013).

Cardiovascular disease is largely driven by preventable risk factors and these risk factors are classified as modifiable and non-modifiable risk factors. Age, sex and family history of the disease are non-modifiable whereas tobaccosmoking, insufficient physical activity, abnormal cholesterol level, hypertension, obesity and diabetes mellitus are some of the modifiable risk factors (Olamide, Ogunmola, Adeleke, Olutoyin, & Oluwole 2013). Worldwide certain risk factors have been found to account for up to 90% of cardiovascular disease and a large percentage are preventable through the reduction of the modifiable risk factors. In terms of attributable deaths, the leading CVD risk factor globally is raised blood pressure (to which 13% of global death is attributed), followed by tobacco use (10%), raised blood glucose (6%), physical inactivity (6%) and obesity (5%) (American Heart Association 2012). In Nigeria, reports on the prevalence of CVD risk factor are scarce and the important component of the socioeconomic gradient in CVD and its risk factors has not been clearly elucidated (Oguoma, Nwose, Skinner, Digban, Onyia & Richards 2014).

Disease surveillance is the continuous scrutiny of occurrence of diseases and health-related events to enable prompt intervention for the control of diseases.¹ It involves the ongoing systematic collection, collation, analysis and interpretation of data on disease occurrence and public health related events and dissemination of the information obtained from such data for prompt public health action.^2,3 However disease notification involves the official and timely reporting of the occurrence of specific diseases and conditions to designated public health authorities by clinicians and other health personnel for action using designated reporting tools.⁷ Disease notification is an important source of data collection for an effective and efficient disease surveillance system.⁷ Disease surveillance and notification (DSN) have been recognized as an effective strategy for the prevention and control of diseases most especially epidemic prone diseases. It is crucial to note that disease outbreak do not give notice before its occurrence neither do they respect the borders of nations. When they eventually occur, they are likely to diagnosis like wildfire and often resulting in high morbidity and case fatality rate with consequent economic impact. An effective and efficient disease surveillance and notification system allows early detection of disease outbreaks that will prompt intervention for the reduction of morbidity and mortality that may result from the epidemics of these infectious diseases.⁸ Levels of disease surveillance and notification can be individual, local, national and international. National disease surveillance and notification system often depends on effective district/Local Government Area (LGA) disease monitoring and control mechanism with the clinicians’ actively involved.^1,8

In Nigeria, surveillance and notification of diseases involve the immediate notification of epidemic prone diseases, diseases targeted for elimination and eradication and monthly notification of other diseases of public health importance.² For a disease surveillance and notification system at the district/LGA level to be functional and effective in early detection of epidemic-prone diseases, clinicians remain indispensable to effective reporting because they can detect unusual disease manifestations and conditions that rely on clinical signs not related to laboratory testing, clusters of illnesses through patient interview and clinical judgments.⁹

Presently in Nigeria, the collection, collation, analysis and interpretation of disease-related data in public health institutions are often incomplete and untimely partly because of poor awareness among clinicians of the importance of their role in disease surveillance and notification activities for the prevention of infectious disease outbreaks.⁷ Many outbreaks which have occurred in Nigeria over the years have been attributed to clinicians either not reporting or reporting late when the index cases of epidemic prone diseases present in the various health institutions across the country.¹⁰ From previous studies on disease surveillance and notification, it is pertinent to note that failure in mandatory reporting of notifiable diseases among clinicians have been attributed to lack of awareness of the existence of a surveillance network for notifiable diseases including the requirement for reporting, which diseases are notifiable, how, when and to whom reporting should be done.^7,11,12,13

This paper therefore seeks to identify opportunities for an increased engagement of clinicians in disease notification activities by describing various notifiable diseases in Nigeria using their surveillance case definitions, outlining the reporting channel for notifiable diseases and highlighting the roles of clinicians in the current disease surveillance and notification network for early disease outbreak detection and public health response in Nigeria.

• STATEMENT OF PROBLEM

Cardiovascular diseases has had a rapid global diagnosis because of closer international integration and transmission through carriers without symptoms which is very different from dynamics of past epidemics. Healthcare workers are central in the fight against cardiovascular disease as they offer treatment, which makes them vulnerable to the disease. Their knowledge, attitude, and practice of  the preventive measures may play important role in  limiting the disease among Aged population and reducing the diagnosis to patients, family, and the community. Inadequate knowledge among health care workers will lead to an increase transmission among staff and further diagnosis in the communities (Olum et al 2020). This has made necessary a study to divulge  This will help inform relevant authorities on what considerations to make as it works at adjusting its policies to prevent the diagnosis of Cardiovascular Diseases.

• RESEARCH QUESTIONS

This research intends to address the following questions:

• What is the level of knowledge of health care workers towards Cardiovascular diseases?
• What is the perception of health care workers towards risk factors associated with Cardiovascular diseases?
• What surveillance and control measures can be taken to prevent the prevalence of CVD in Nigeria?

1.4 OBJECTIVES OF THE STUDY

The main objective of this study is to examine cardiovascular disease surveillance and control in Nigeria.

1.4.1. SPECIFIC OBJECTIVES

• Determine the level of knowledge of health care workers towards Cardiovascular diseases.
• Ascertain the attitude of health care workers towards risk factors associated with Cardiovascular diseases.
• Obtain the perception of health care workers on how fatal cardiovascular diseases is and how can it be prevented

1.5 SIGNIFICANCE OF THE STUDY

The outcome of the study will guide health institutions, the Ministry of health, policy makers in government and relevant authorities to draft policies that will help promote the health sector through the current panic situation caused by corona virus pandemic. The study will also come out with recommendations that can be taken to depress the diagnosis of  CVD pandemic in order to enhance  national development. Furthermore, it would serve as reference documents to the academics and researchers and to all those interested in this area of research.

1.6 SCOPE AND LIMITATIONS OF THE STUDY

The study will examine the cardiovascular disease surveillance and control in Nigeria. Among the limitation of this study is the fact that only health care workers in University of Port Harcourt Teaching Hospital (UPTH) are covered. Second is the difficulty in gathering data and information, much of which is considered sensitive. The researcher was also limited by the reluctance of some respondents to comply with the study.

1.8 ORGANIZATION OF THE STUDY

The study is organized into five chapters. Chapter one is the introduction of the study and it includes the background description, problem definition, objectives of the study, significance of the study, scope, limitations of the study and research methodology. Chapter two is the literature review of the study and the theoretical framework. This reviews relevant literatures of authors and other researchers relating to the research topic. Chapter three deals with the research methodology which looks at methods adopted in carrying out the study. Chapter four focuses on data presentation and analysis whiles chapter five presents a summary of the study, findings and conclusions drawn from the findings and recommendations of the study.

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