Introduction Prevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.
Methods This study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.
Results Of 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.
Conclusions In Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.
- health policy
- quality in health care
- organisation of health services
- public health
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Contributors JD, MW, RN and IB conceived and designed the overall study. JD, TB, HW, RA and JL coordinated baseline data collection and preparation. JD, MW, RN and IB contributed to the design of the household survey. MLO conducted the analysis, and wrote and revised the manuscript. JD supervised the analysis, write up and development of the manuscript. All authors substantively reviewed manuscripts, inputted into revisions and approved the final manuscript.
Funding Support for the study was given by the Wellcome Trust, grant number 209921/Z/17/Z.
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Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was sought and given from the Sierra Leone Ethical and Scientific Review Committee and the BDM Research Ethics sub-committee at King’s College London (HR-17/18–7298).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data are not publicly available as consent was not given by participants for this to take place.
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