Epidemiology of peripartum cardiomyopathy in Africa

Abstract

Peripartum cardiomyopathy (PPCM) is a disease that primarily affects Black African women. The history of peripartum cardiac failure in Africa dates to the 1960s, before the availability of echocardiography. With the availability of echocardiography in the late 1970s, studies on well-characterized PPCM began to be reported. To date, there is no population-based PPCM study in Africa. However, hospital-based studies have reported incidence rates as high as 1:100 deliveries in Nigeria and representing up to 52% of all cardiomyopathies. For reasons that are not yet very clear, there are obvious wide disparities in incidence and prevalence within and between African Countries. Likewise, prevalence of suggested risk factors for the disease such as increased age, gravidity or parity, twin pregnancy, obesity, poor socioeconomic status/malnutrition and selenium deficiency vary widely between studies. However, the disease seems to be more common among the poor rural population. Clinical outcomes are much worse in Africa than in Western Europe and North America. Mortality rates as high as 24.2% at 6 months and 47.4% at 1 year of followup had been recorded in Kano, Nigeria, 48.3% over 4 years in Burkina Faso, 11.6% over 6 months in Zimbabwe and 13.0% over 6 months in South Africa. It is hoped that the ongoing peripartum cardiomyopathy in Nigeria (PEACE Registry) and the worldwide EURObservational Research Programme on PPCM will soon shed more light on the epidemiology of PPCM in Africa. The present article aimed to review the epidemiology of the disease in Africa, where the disease is relatively more common.