Article Text

Download PDFPDF

Original research
Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey
  1. Maria Lisa Odland1,
  2. Tahir Bockarie2,
  3. Haja Wurie3,
  4. Rashid Ansumana4,5,
  5. Joseph Lamin4,
  6. Rachel Nugent6,
  7. Ioannis Bakolis7,8,
  8. Miles Witham9,10,
  9. Justine Davies1,11
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
  2. 2Warwick Medical School, University of Warwick, Coventry, UK
  3. 3College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
  4. 4Mercy Hospital Research Laboratory, Bo, Sierra Leone
  5. 5School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
  6. 6RTI International, Seattle, Washington, USA
  7. 7Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  8. 8Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  9. 9AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
  10. 10Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
  11. 11Centre for Global Surgery, Department for Global Health, Stellenbosch University, Stellenbosch, South Africa
  1. Correspondence to Dr Maria Lisa Odland; m.l.odland{at}


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
  • epidemiology
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Twitter @MariaOdland, @ansumanar, @rachelnugent, @OlderTrialsProf, @drjackoids

  • 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.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • 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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.