Figure 1

<p>Study flow diagram.</p

Acute Myocardial Infarction in Sub-Saharan Africa: The Need for Data

<div><p>Background</p><p>Trends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this systematic review was to describe the prevalence of acute myocardial infarction in sub-Saharan Africa.</p><p>Methods</p><p>We searched PubMed, EMBASE, Global Health Archive, CINAHL, and Web of Science, and conducted reference and citation analyses. Inclusion criteria were: observational studies, studies that reported incidence or prevalence of acute myocardial infarction, studies conducted in sub-Saharan Africa, and studies that defined acute myocardial infarction by EKG changes or elevation of cardiac biomarkers. Studies conducted prior to 1992 were excluded. Two independent reviewers analyzed titles and abstracts, full-texts, and references and citations. These reviewers also performed quality assessment and data extraction. Quality assessment was conducted with a validated scale for observational studies.</p><p>Findings</p><p>Of 2292 records retrieved, seven studies met all inclusion criteria. These studies included a total of 92,378 participants from highly heterogeneous study populations in five different countries. Methodological quality assessment demonstrated scores ranging from 3 to 7 points (on an 8-point scale). Prevalence of acute myocardial infarction ranged from 0.1 to 10.4% among the included studies.</p><p>Interpretation</p><p>There is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. Well-designed registries and surveillance studies that capture the broad and diverse population with acute myocardial infarction in sub-Saharan Africa using common diagnostic criteria are critical in order to guide prevention and treatment strategies.</p><p>Registration</p><p>Registered in International Prospective Register of Systematic Reviews (PROSPERO) Database #CRD42012003161.</p></div

Prevalence of MI among study populations of included studies.

<p>Prevalence of MI among study populations of included studies.</p

Figure 3

<p>Locations of studies of AMI in Sub-Populations of Sub-Saharan Africa.</p

Figure 2

<p>Methodological quality assessment of included studies.*Blue cells indicate a score of “1” (present) and white cells indicate a score of “0” (absent).</p

Figure 1

<p>Study flow diagram.</p

Studies characteristics.

<p>*Indicates whether all subjects were screened with an objective test (EKG or cardiac biomarkers) or if screening was performed only for those patients whom the clinician felt had symptoms concerning for possible AMI.</p

Confirmed and probable leptospirosis cases, Moshi Urban and Moshi Rural Districts residents, Kilimanjaro Christian Medical Center (KCMC) and Mawenzi Regional Hospital (MRH), Tanzania 2007–2008.

<p>KCMC = Kilimanjaro Christian Medical Centre, MRH = Mawenzi Regional Hospital.</p>*<p>Confirmed or probable cases based on testing of paired sera. For adjusted case calculations these cases were multiplied by a ‘MAT sensitivity multiplier’ of 1.00.</p>†<p>Probable cases based on testing of acute serum only. For adjusted case calculations these cases were multiplied by a ‘MAT sensitivity multiplier’ of 2.05.</p

Africa, Tanzania and Kilimanjaro Region.

<p>Moshi Rural District shown in dark gray and Moshi Urban District in black in the Kilimanjaro Region inset.</p

Reported health care seeking behavior among household survey respondents and calculated multipliers, Moshi Urban and Moshi Rural Districts, Tanzania, 2011.

<p>KCMC = Kilimanjaro Christian Medical Centre, MRH = Mawenzi Regional Hospital.</p>*<p>Number of respondents who chose KCMC as their first or second choice for health care in response to respective questions.</p>†<p>Number of respondents who chose MRH as their first or second choice for health care in response to respective questions.</p>‡<p>Inverse of proportion of respondents who select KCMC for care in response to respective questions.</p>§<p>Inverse of proportion of respondents who select MRH for care in response to respective questions.</p