CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the

United States. The term “CVDs” comprises of the constellation of coronary artery disease,

peripheral vascular disease and heart failure. The INTERHEART study has highlighted

53years as the middle age for the first presentation of acute myocardial infarction (MI)

among the South Asian population as compared to 63years in other populations around the

world (Lemos and Agudelo-Vélez, 2018). The occurrence of CVDs a decade earlier and 5-

10% MI in age less than 40years among Indians is ominous and has resulted in substantial

loss of productive life-years (Joshi, 2007). The drift from infectious diseases towards non-

communicable diseases (NCDs) is attributed to the constellation of genetics, metabolic risks,

sedentary lifestyle, socio-economic and psychological stress, fewer intakes of vegetables and

fruits, increased consumption of fast foods, tobacco and alcohol intakes. This unhealthy

epidemiological transition is now prevalent in all socio-economic strata and both urben and

rural areas despite the demographic heterogenecity prevalence of risk factors (Valiathan,

1984). The Framingham Heart study has suggested that the risk factors do not act in isolation

and minor abnormalities in several risk factors may act synergically to effectuate a high risk

of diseases (Anderson, 2019). In developing countries, CVDs are becoming an increasing

public health problem with serious economic and social consequences. The percentage of

deaths attributed to cardiovascular diseases increased in recent decades due to increased life

expectancy and the adoption of unhealthy lifestyles. The increase of cardiovascular diseases

in developing countries demands an urgent public health response, utilizing available

knowledge on management and possible complications. Also these diseases can arise as a

result of inadequate intakes of fruits and vegetables, increased salt intake, cigarette smoking

and alcohol consumption (Joshi et al, 2007). Hence it is crucial to screen the population so as

to get rid of these diseases or avoid these complications which may become irreversible over

time. It has been proven that adolescents and young adults are more susceptible to these

diseases in both developing and developed countries (Odunaiya, Grimmer and Louw, 2015).

Nearly all deaths from cardiovascular diseases occur among young people in Africa than in

Europe and North America. Current diagnostic testing for CVDs usually rest on either

physiological or anatomical measurements. Multiple tests must then be combined to arrive to

a conclusion regarding management of a specific pathology; much of the diagnostic decisions

currently are based on rough estimates of outcomes often derived from gross anatomic

observations. Thus, interventions for these diseases are highly required in order to prevent

complications. At the beginning of the 20th century, CVDs were responsible for fewer than

10% of all deaths worldwide but today, this figure is about 30% with about 80% of the

burden now occurring in developing countries. About 38% of men and 40%of women aged at

18years or older were overweight in 2014 and this this figure is more than the rate between

1990 and 2016 (Yuyun et al, 2020) in Nigeria and the prevalence of overweight and obesity

is 26.8% and 6.5% respectively according to WHO (Ejike and Ijeh, 2012). Through proper

management, the National Health Policy of 2017 has outlined to achieve 25% reduction of

complications of cardiovascular diseases as well as reducing the rate of premature mortality.

These include early screening of known hypertensive and diabetic individuals to maintain,

control disease status by the year 2025 (Malambo et al, 2016), coexisting ailments like

diabetes mellitus and dyslipidemia etc, accelerates CVDs progression which account for

enormous health expenditure on household as well as national economy.

 Globally, not more than 55% of total men and women were sufficiently physically active

in 2018. In order to reduce cardiovascular diseases complications such as stroke, heart attack,

heart failure, those with elevated blood pressure or cholesterol are given hypertensive

medications (HTN). More recently, generic statins have been added to the WHO essential

drugs list and have become available in many countries. Recommendations for management

of cardiovascular diseases have evolved over time by improving ability to quantify and

identify those at higher risk for any complications. Adequate awareness of cardiovascular

diseases and their possible complications may help reduce population’s exposure and thereby

contribute to effective management measures. There is limited data on the knowledge and

perception among the general population In Cameroon regarding cardiovascular diseases.

The main point to know is whether Cameroonians are aware of the fact that though they may

have the disease and with the help of health personnel, they can carry out those activities

which can contribute to control (management) of these diseases as well as provide a baseline

data for the scope and need for preventing any form of complications. The little data on the

spectrum of heart diseases in Cameroon has been so far limited to major cities. We sought to

describe the pattern of heart diseases in Buea, in the South West region of Cameroon, a semi

urban setting. Between June 2016 and April 2021, the echocardiography register of the

Regional Hospital of Buea was surveyed and out of 529 patients who underwent

echocardiography, 239 (45.2%) had a definite heart disease. There were 137 (57.3%) females

and the mean age was 58years. The most common diagnosis were hypertensive heart disease,

dilated cardiomyopathies, ischemic heart diseases and cor pulmonale. Hypertensive heart

disease is the most common cardiac disease in this region of Cameroon. Management control

measures should equally focus on mass screening and treatment.

1.2 PROBLEM STATEMENT

Cardiovascular diseases (CVDs) are an important and leading public health concern , it is

one of the leading causes of morbidity and mortality worldwide (Amini, Zayeri and

Salhi, 2021). There has been a rise in the prevalence and incidence of CVDs and its

complications in developing countries with high mortality rate among younger people

than in developed countries. This can be attributed to the lack of knowledge about

CVDs, its associated complications, risk factors and effective management strategies.

This paucity of information about the diseases constitute a barrier to effective

implementation of a management program among the population and also adequate

knowledge is the first step towards effective management mechanism against the burden

of CVDs amongst any population (Akintunde and Opadijo, 2015). Studies have

identified children, adolescents and young adults as the target population for

management program (Odunaiya, 2021). There are limited programs from Cameroon in

the general population and studies have shown that the development of targeted

community, health education and promotion programs may require assessment of

population knowledge about these CVDs (Jafary, 2005). Hence, we sought in this study

to estimate current levels of awareness regarding CVDs, its perception as well as explore

knowledge of risk factors and warning signs for CVDs among young and middle age

adults in the Ndongo community.

1.3 RATIONALE

Cardiovascular diseases on its own calls for attention and thus seen as serious health

problem. This can be related to lack of information by the individuals, it is in this light

that a study to determine the knowledge and perception on management and

complications of cardiovascular diseases was deemed necessary.

1.4 RESEARCH QUESTIONS

 i. What knowledge do patients have on cardiovascular diseases?

ii. What is the perception of patients towards cardiovascular diseases and practice towards

its prevention?

iii. What knowledge have patients on complications and challenges in the prevention of

cardiovascular diseases?

1.5 OBJECTIVES

1.5.1 GENERAL OBJECTIVES

To investigate the knowledge of risk factors and warning signs for cardiovascular

diseases among young and middle age adults in the Ndongo community.

1.5.2 SPECIFIC OBJECTIVES

1. To access knowledge of cardiovascular diseases.

2. To ascertain their knowledge on perception about cardiovascular diseases and

practice towards cardiovascular diseases prevention.

3. To determine knowledge on the challenges faced and effects on cardiovascular

diseases.

1.6 SIGNIFICANCE OF STYUDY

It is aimed that this study will go a long way to help the general population to share

their knowledge and thus assist them to develop baseline in the management of heart diseases

while also enriching their minds and enlighting them about the factual truths regarding the

prevention of CVDs as it is known that the awareness of a disease condition influences

patient’s perception and practice improves compliance to treatment and leads reduction in

prevalence and aversion of complications. The results of the study may be used enrich and

also contribute to the knowledge and practice of students, nurses and other health workers in

the hospital regarding the management of CVDs. It should help to develop theory and
contribute to the existing literature on complications of CVDs in Buea and Cameroon in

general as there have been limited studies done on CVDs complications and management in

the country. This study may also help in formulating a guideline that may be used during

treatment or providing health education to patients regarding management of these

conditions. Finally it will also contribute to the validation of existing management strategies

of CVDs and could be used by future researchers.

1.7 SCOPE OF STUDY

This study was conducted from November 2023 to amongst young and middle age adults

in the Ndongo at the time of study.

1.8 OPERATIONAL DEFINITION OF TERMS

-Cardiovascular diseases (CVD): These are a group of disorders affecting the heart and blood

vessels (WHO, 2021).

-knowledge: These refers to the sum total of information an individual possesses about a

particular issue and in turn makes use of it in order to achieve a particular goal or objective

(Elsevier, 2009).

-Perception: This refers to the way an individual analysis and interprets particular event as a

function of the way the stimuli or sensation are emitted from his or her environment (Tingle,

2008).

-Complications: It is an unsuspected medical condition that arise during the treatment of a

patient in a hospital making the situation difficult or harder to deal with.

-Management: It is the act of forecasting, planning, organizing, commanding, coordinating

and controlling others activities.

-Morbidity: It is the state of being unhealthy for a particular disease or situation ( Njike,

2016).

-Mortality: It is the number or frequency of deaths that occur within a population (Yuyun,

2014).