title: An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective.
abstract: BACKGROUND
  Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems.
  
  
  OBJECTIVE
  The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors.
  
  
  METHODS
  We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included.
  
  
  RESULTS
  The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts.
  
  
  CONCLUSIONS
  Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.
authors.affiliation: Department of Health Policy and Administration, 604 Ford Building, The Pennsylvania State University, University Park, PA, USA.
authors.forename: Rhonda
authors.initials: R
authors.lastname: BeLue
authors.forename: Titilayo A
authors.initials: TA
authors.lastname: Okoror
authors.forename: Juliet
authors.initials: J
authors.lastname: Iwelunmor
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Taylor
authors.forename: Arnold N
authors.initials: AN
authors.lastname: Degboe
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe