Monitoring cardiovascular disease in Zimbabwe: a review of needs and options.

The relative and absolute importance of cardiovascular disease (CVD) in countries of sub-Saharan Africa is assumed to be increasing, but information on morbidity, mortality and prevalence of risk factors is scant. This paper reviews available information on CVD in Zimbabwe; in particular, which type of CVD is important, which segments of the population are affected, which risk factors are relevant and at what levels they are present. Based on the findings, options for monitoring CVD rates and risk factors in Zimbabwe are discussed. For the purpose of identifying risk groups and monitoring secular trends, CVD morbidity data derived from the National Health Information System are insufficient in terms of completeness, accuracy and precision of diagnosis. Useful vital registration data are available for Harare, where persons aged 45 to 64 years experience a relatively high mortality from hypertensive sequelae and a low mortality from ischaemic heart disease. This finding, however, cannot be generalised. Clinical studies confirm a high prevalence of hypertension; it is presently the most important risk factor for CVD. Smoking rates, however, appear to be increasing. Little is known about CVD rates and levels of risk factors in poor and rural population strata and in ethnic minorities. Options to improve monitoring of CVD morbidity and risk factor levels include establishing community registries of stroke and repeatedly examining representative population samples. Nation wide vital registration would be desirable to monitor CVD mortality but appears not to be feasible at present; maintaining a sample registration system would be prohibitively expensive.