Screening for Atrial Fibrillation in Zambia’s Western Province

BACKGROUND: The prevalence of atrial fibrillation (AF) is increasing in sub-Saharan Africa and contributes to significant morbidity and mortality from stroke and other cardiovascular diseases. Case finding in some areas of the country, such as in rural Zambia is especially challenging with limited availability of ambulatory electrocardiogram monitoring devices. Moreover, there is very little qualitative research exploring Zambian patients’ experiences living with AF.

AIMS: The two-fold purpose of this study was i) to explore the use of a screening tool for detecting AF in Western Province, Zambia and ii) to understand the patient experience of living with AF.

SETTING: Mongu and Limulunga Districts in the Western Province of Zambia.

METHODS: Mixed methods. Convenience sampling for both quantitative and qualitative arms of the study was used to recruit participants attending public ‘Health Checks.’ Quantitative data were collected by means of an interview-administered survey and qualitative data were obtained through individual interviews.

RESULTS: An irregular manual pulse was found in 12.6% (n=33) of Zambians who attended the Health Checks and two participants were confirmed to have AF. Zambians with an irregular pulse had a significantly higher prevalence of hypertension and were significantly less sedentary than those without pulse irregularities. Two themes emerged from the interview with two patients diagnosed with AF: symptoms and healthcare access.

CONCLUSION: Hypertension continues to be a problem in adult Zambians and is an independent risk factor for stroke and, when diagnosed in conjunction with AF, further compounds stroke risk. Access to screening and diagnostic care for AF is essential, especially in currently underserved rural areas. In addition, participants presented with unique risk factors, such as consolidated periods of exercise, that require further research to determine context and seasonal variation so as to improve education and prevention strategies