Abstract
Background
Cardiovascular diseases (CVDs) are a leading cause of death globally, particularly in low- and middle-income countries. While data on heart disease prevalence in Somaliland is limited, the 2020 Somaliland Demographic and Health Survey (SLDHS) provides a valuable opportunity to assess this critical public health issue.
Methods
This study analyzed data from the 2020 SLDHS, a nationally representative cross-sectional survey. We included 18,930 individuals after data cleaning and variable selection. Heart disease was the outcome variable, while demographic and socioeconomic factors, including age, sex, region, residence, wealth, tobacco use, diabetes, and hypertension, were analyzed as predictors using STATA version 17.
Results
The prevalence of heart disease in Somaliland was 0.7 % (95 % CI [0.6 %, 0.9 %]). Significant associations were observed with: Sool region (AOR 1.86–6.821, p = 0.000), female sex (AOR 1.086–2.508, p = 0.019), older age groups (AOR 1.182–9.621, 1.073–11.247, 1.899–19.504 and 4.126–38.282, p = 0.023, 0.038, 0.002, 0.000 respectively), rural residence (AOR 1.025–2.198, p = 0.037), tobacco use, diabetes, and hypertension.
Conclusion
This study highlights the importance of regional disparities, gender differences, and the impact of modifiable risk factors like tobacco use, diabetes, and hypertension in influencing heart disease prevalence in Somaliland. These findings emphasize the need for targeted interventions and public health strategies to address these factors and improve cardiovascular health outcomes in the region.
Introduction
Heart diseases includes a number of diseases such as peripheral arterial disease, rheumatic heart disease, coronary heart disease, and cerebrovascular disease, according to the Centers for Disease Control and Prevention (CDC) These medical conditions fall into the larger group of disorders called cardiovascular diseases (CVDs), which impact blood vessels and the heart
Cardiovascular diseases (CVDs) are non-communicable diseases and are becoming more widely recognized as the leading cause of death globally. In the twenty-first century, globalization has caused a paradigm shift in people’s modernity and lifestyle across many global areas and sub regions; this paradigm shift has contributed to the rapid rise in CVDs globally. Recent studies show that NCDs are becoming more prevalent worldwide and are posing a threat to human life in particular According to World Health Organization projections for 2017, cardiovascular diseases (CVDs) are responsible for 17.9 million deaths globally, with more than 75 % of these deaths occurring in low- and middle-income countries (LMICs). , CVDs will take the lives of around 22.2 million people yearly by 2030
In low-income countries, cardiovascular disease (CVD) is the leading cause of disease burden, accounting for more deaths and morbidities than infectious diseases such as HIV/AIDS, TB, respiratory infections, malaria, and diarrhea. , Despite this change in the disease landscape, communicable diseases still receive the most portion of health spending in the majority of sub-Saharan African countries The load is currently growing faster than we can manage it, and the prevalence of type 2 diabetes, obesity, poor diet, and high blood pressure is all too high.
It is well known that estimating the prevalence of CVD in a population is difficult since it requires data on those who do not visit the hospital. Because different countries report prevalence using different approaches, which makes interpretation difficult, it is challenging to determine the prevalence of CVD worldwide The health care system will confront major issues as this group grows since senior persons in low- and middle-income countries (LMIC) have a high risk of cardiovascular disease (CVD). Conditions affecting people 60 years of age or older accounted for 25 % of the global burden of disease (GBD). In the older population in 2010, cardiovascular diseases (CVDs) constituted 30.3 % of all illnesses
Many factors, including high-energy meals, diabetes, high cholesterol, sedentary lifestyle, obesity, overweight, family history, fasting plasma glucose (FPG), cholesterol, high-density lipoprotein, age, gender, marital status, lifestyle, and anthropometric data ( p ≤ 0.05), all play a role in cardiovascular disease (CVD). The age group with the highest risk of CVDs was 65 to 70 years old. Heart disease is associated with men, married status, increasing cell phone use, and cigarette smoking. Low physical activity (PA), a body mass index (BMI) of more than 30, systolic blood pressure (SBP) of less than 140 mm Hg, FPG of between 100 and 126 mg/dl, FPG of more than 126 mg/dl, and ethnicity were also linked to an increased risk of cardiovascular diseases (CVDs). Diabetes and a sedentary lifestyle were highly prevalent in both men and women. Moreover, dyslipidemia, obesity, and overweight were very common. Men had higher estimated risk levels of CVD in the community than women did
Numerous studies carried out on a population-based basis in less developed countries have demonstrated a correlation between sociodemographic characteristics and cardiovascular disease (CVD), wherein older age groups, female sex groups, and poorer levels of education are consistently associated with increased prevalence of CVD. Additionally, behavioral risk factors for CVD, such as smoking and alcohol use, insufficient fruit and vegetable diet, and low levels of physical exercise, are indicated by epidemiological data. Considered a significant risk factor for CVD is hypertension.
According to a Canadian study, among those aged 12 and above, 5.0 % had heart disease, 2.1 % had experienced a heart attack, 1.9 % had angina, and 1.0 % had congestive heart failure. There is a noticeable difference in the prevalence of heart disease and other specific cardiac disorders depending on the age, sex, and geographic region. Heart disease is not as frequent in people under 50 years old, but it becomes more common in older adults and is more common in males than in women. At least one in four men and one in five women over the age of 70 report having heart disease. There were notable variations in the prevalence of heart disease between the provinces, territories, and health regions
Previous studies have shown that developing nations have high rates of heart disease due to a variety of underlying causes. These factors can be divided into three categories: environmental factors (noise, air pollution, second-hand smoke, occupational toxins, smoking), modifiable factors (high blood pressure, cholesterol, diabetes, obesity, inactivity, unhealthy diet, smoking, alcohol, and stress), and non-modifiable factors (age, gender, and family history). , These variables are frequently interrelated, and social, economic, and cultural changes like urbanization, population aging, and globalization amplify their influence Heart disease has also been linked to things like living in poverty, having poor living conditions, and having limited access to healthcare.
In Somaliland there are a lack of data according to non-communicable diseases (NCDs) including heart disease and the factors that increase their risk. The Ministry of Health of Somaliland reports that unhealthy lifestyle choices like smoking, chewing khat, and physical inactivity have contributed to an increase in NCDs We have previously reported that the prevalence of overweight and obesity was significantly higher among Somalis in Oslo, Norway compared to Hargeisa, Somaliland In sub-Saharan Africa, the rising frequency of NCDs and related risk factors has been linked to urbanization The urban population of Hargeisa may have adapted a new, sedentary lifestyle, and the diaspora’s return may have brought unfavorable parts of Western lifestyles, raising the risk of NCDs among the populace Information on how common certain risk factors are for given that Somaliland is rapidly urbanizing and experiencing epidemiological shifts, NCDs are significant in the nation. ,
However, the availability of Somaliland demographic and health survey offers a great chance to gather the information on heart disease and investigate its prevalence and contributing variables. According to SLHDS 2020 data 7 % of Somalilanders have long-term medical conditions. At 41 %, blood pressure is the most severe chronic condition. Diabetes is next at 19 %, renal failure is at 9 %, and heart disease is at 7 %. The study intends to close this gap by examining the prevalence and risk factors of cardiac disease in Somaliland’s adult population.
Methods
Study design
Data
Somaliland Demographic and Health Survey 2020 (SLDHS) data is utilized in this study, which is the first nationwide demographic and health survey data collected by Ministry of Planning and Development, in collaboration with various international organizations between 2018 and 2019. It covers a wide range of topics including fertility, maternal and child health, household information water and sanitation, and key health indicators and other vital socioeconomic characteristics After the data cleaning process, the final sample size was 18,930, following the exclusion of observations with missing data on key variables.
Study variables
The dependent variable (DV) in this study was derived from survey respondents who were directly asked whether they suffer from various diseases, including heart disease. Responses were recorded as “YES” or “NO,” allowing for a straightforward assessment of the prevalence of heart disease within the dataset. In addition, the study includes several independent variables to examine their associations with the heart disease among Somaliland population using SLDHS 2020. Firstly, a new variable, “Use of drugs,” was created based on responses to questions regarding smoking cigarettes/tobacco and chewing khat/miraa, categorizing individuals as “YES” if they answered affirmatively to one or both of the questions, and “NO” if both were negative. Age was recategorized into specific groups: less than 15, 15–24, 25–34, 35–44, 45–54, 55–64, and above 64, allowing for a clearer analysis of age-related trends. Additional independent variables considered in the analysis include region, type of residence, wealth quantile, education level, sex, marital status, as well as health indicators such as diabetes and blood pressure. These variables collectively provide a comprehensive framework to assess the factors influencing the study’s outcomes.
Statistical analysis
In the statistical analysis of this study, all computations were performed using STATA 17. The analysis began with the calculation of the proportion of heart disease with the standard error and 95 % confidence interval (95 % CI). Next, univariate analysis was conducted to determine the frequencies and percentages for each variable’s classes. Following this, bivariate analysis was performed to examine the relationships between the outcome and predictors using Chi-square ( X 2 ) test with a-value and showing frequencies and percentages of each class of DV against each class of the IVs. Finally, multivariable binary logistic regression was employed to provide insights into the associations, presenting odds ratios, standard errors, p -values, and 95 % confidence intervals. A significance threshold of 0.05 was consistently applied throughout the analysis to determine statistical significance.
Results
Prevalence of heart disease
In this study, data from a sample of 18,930 individuals from the SLDHS 2020 dataset were analyzed. The results revealed that the prevalence of heart disease was 0.7 % (95 % CI [0.6 %, 0.9 %]), while 99.3 % of the participants were free from heart disease (95 % CI [99.1 %, 99.4 %]). The minimal standard errors associated with these estimates indicate a high level of precision in the findings.
Demographic and socioeconomic characteristics of respondents
Demographic and socioeconomic characteristics of the respondents are shown in Table 1 , regarding region, the largest portion of the population resides in Sanaag (22.50 %), followed by Sool (21.70 %) and Togdheer (16.58 %). Smaller populations are found in Awdal (14.38 %), Marodijeh (13.26 %), and Sahil (11.58 %). In addition, the majority of respondents are urban residents (37.24 %), while rural and nomadic inhabitants were 30.50 % and 32.26 % respectively. In terms of wealth category, the largest group falls in the lowest wealth quantile (41.35 %), while the smallest portion belongs to the second quantile (10.39 %). Other groups include middle (12.61 %), fourth (17.37 %), and highest (18.29 %) quantiles. Regarding age, the largest age group is 15–24 years (31.77 %), followed by those aged below 15 years (16.41 %). The next largest group is 25–34 years (17.99 %), and progressively smaller proportions are seen in older age groups, with those above 64 years making up just 7.01 % of the study population. In terms of sex, females represent a higher proportion (56.98 %) compared to males (43.02 %). Marital status shows that nearly half of the population is married (46.07 %), while those never married make up 45.70 %. Smaller percentages are widowed (4.74 %), divorced (2.55 %), or abandoned (0.94 %). For education, a significant portion of the population has not attended school (59.61 %), while 39.41 % have attended. In terms of tobacco use, a large majority of the population does not use tobacco (95.48 %), while a small portion does (4.52 %). Finally, in terms of chronic diseases, diabetes is rare, with 98.59 % of respondents reporting they do not have diabetes, while 1.41 % do. Similarly, most respondents do not have high blood pressure (95.16 %), with only 4.84 % affected ( Table 2 ).
| n = 18,930 | ||||
|---|---|---|---|---|
| Heart disease | Proportion | Standard error | 95 % Confidence interval | |
| No | 0.993 | 0.001 | 0.991 | 0.994 |
| Yes | 0.007 | 0.001 | 0.006 | 0.009 |
| Variable | Levels | Frequency | Percentage |
|---|---|---|---|
| Region | Awdal | 1925 | 14.38 |
| Marodijeh | 1775 | 13.26 | |
| Sahil | 1550 | 11.58 | |
| Togdheer | 2220 | 16.58 | |
| Sool | 2905 | 21.70 | |
| Sanaag | 3012 | 22.50 | |
| Type of residence | Urban | 4985 | 37.24 |
| Rural | 4083 | 30.50 | |
| Nomadic | 4319 | 32.26 | |
| Wealth Quantile | Lowest | 5535 | 41.35 |
| Second | 1391 | 10.39 | |
| Middle | 1688 | 12.61 | |
| Fourth | 2325 | 17.37 | |
| Highest | 2448 | 18.29 | |
| Age | less than 15 | 3107 | 16.41 |
| 15-24 | 6014 | 31.77 | |
| 25-34 | 3406 | 17.99 | |
| 35-44 | 2308 | 12.19 | |
| 45-54 | 1693 | 8.94 | |
| 55-64 | 1075 | 5.68 | |
| Above 64 | 1327 | 7.01 | |
| Sex | Male | 8143 | 43.02 |
| Female | 10787 | 56.98 | |
| Marital Status | Married | 8721 | 46.07 |
| Divorced | 482 | 2.55 | |
| Abandoned | 178 | 0.94 | |
| Widowed | 898 | 4.74 | |
| Never Married | 8651 | 45.70 | |
| Attended School | Yes | 7460 | 39.41 |
| No | 11285 | 59.61 | |
| Don’t Know | 185 | 0.98 | |
| Use of tobacco | No | 18074 | 95.48 |
| Yes | 856 | 4.52 | |
| Diabetes | No | 18663 | 98.59 |
| Yes | 267 | 1.41 | |
| Blood Pressure | No | 18014 | 95.16 |
| Yes | 916 | 4.84 |
Bivariate analysis: Chi-square test results
Table 3 presents the association between various socioeconomic and demographic factors and the prevalence of heart disease. Chi-square results shows that region variable is significantly associated with heart disease, where the highest prevalence of heart disease is in Sool (1.22 %), while the lowest is in Awdal (0.45 %). Other regions show variations, with prevalence rates ranging from 0.46 % to 0.87 %. Also, type of residence is significant and the heart disease is more prevalent in rural areas (1.11 %) compared to urban (0.76 %) and nomadic (0.35 %) populations. In terms of wealth quantiles, this variable did not show a significant relationship with heart disease with a p -value of 0.3929, as the prevalence rates across wealth categories are similar, ranging from 0.62 % to 1.02 %. On the other hand, age has shown a strong association with heart disease. The prevalence increases with age, especially in those above 64 years (3.69 %), compared to younger age groups, where the prevalence is below 1 %. Further, sex shows a significant relationship with heart disease more common among females (0.90 %) compared to their counterparts (0.53 %). Once again, marital status is strongly associated with heart disease, where widowed individuals have the highest prevalence (3.23 %), while those never married have the lowest (0.39 %). School variable was also significant with a higher prevalence among those who did not attend school (0.88 %) compared to those who did (0.54 %). Furthermore, tobacco use is associated with heart disease where smokers have a higher prevalence (1.52 %) compared to non-smokers (0.70 %). Diabetes has also shown a strong association with heart disease with a much higher prevalence among those with diabetes (5.24 %) compared to those without (0.68 %). In addition, the heart disease is more common in individuals with high blood pressure (4.80 %) compared to those without (0.53 %). Overall, age, region, type of residence, sex, marital status, attending school, tobacco use, diabetes, and blood pressure are all significantly associated with heart disease. Wealth quantile, however, does not show a significant association.
