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Original research article
Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa
  1. Selma Carlson1,
  2. Herbert C Duber2,3,
  3. Jane Achan4,
  4. Gloria Ikilezi3,4,
  5. Ali H Mokdad2,
  6. Andy Stergachis5,6,
  7. Alexandra Wollum2,
  8. Gene Bukhman7,8,
  9. Gregory A Roth1,2
  1. 1 Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2 Institute for Health Metrics and Evaluation, Seattle, Washington, USA
  3. 3 Division of Emergency Medicine, University of Washington, Seattle, Washington, USA
  4. 4 Medical Research Council Unit , The Gambia, Banjul, Gambia
  5. 5 Department of Pharmacy, University of Washington, Seattle, Washington, USA
  6. 6 Department of Global Health, University of Washington, Seattle, Washington, USA
  7. 7 Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  8. 8 Cardiovascular Division and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Selma Carlson, Division of Cardiology, University of Washington, 1959 Pacific St NE, Box 356422, Seattle WA, 98195, USA; selmad{at}


Objective Heart failure is a major cause of disease burden in sub-Saharan Africa (SSA). There is an urgent need for better strategies for heart failure management in this region. However, there is little information on the capacity to diagnose and treat heart failure in SSA. We aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions.

Methods We analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya). We report on the availability of cardiac diagnostic technologies and select medications for heart failure (β-blockers, ACE inhibitors and furosemide). Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities).

Results Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter.

Conclusions Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. Our findings call for increased investment in cardiac care to reduce the growing burden of heart failure.

  • CHF
  • Kenya
  • Uganda
  • public health
  • cardiology

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  • Contributors All authors contributed to the manuscript as follows:

    SC, JA, GI: conception, design, data collection.

    SC, AW, GAR: analysis and interpretation of data.

    SC: drafting the article.

    HCD, GAR, GB, AHM, AS: critical revision for important intellectual content.

    SC, GAR, HCD: final approval of the version to be published.

    All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The ABCE study data are available for free download at the Institute for Health Metrics and Evaluations Global Health Data Exchange website ().

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