Feasibility of a population-based cardiovascular cohort in Sub-Saharan Africa: experience of TAHES study.

International audienceBackground: Sub-Saharan Africa (SSA) is facing a growing burden of cardiovascular diseases (CVD) due to increasing urbanization and changing lifestyle. Available tools for prediction of CVD are adapted from western regions data. So, there is a need for building appropriate tools from SSA population-based cohorts.Purpose: The aim of the pilot phase of TAHES was to explore the feasibility of CVD cohort study in a rural setting in SSA.Methods: TAHES is a prospective cohort ongoing since February 2015 among all people aged 25 years or above living in a village. Risk factors data were collected using a standardized questionnaire adapted from the WHO STEPS instrument through a baseline door-to-door survey, followed by annuals visits. A daily medical network surveillance was implemented for recording events of interest: lower extremity artery disease (LEAD), myocardial infraction, stroke, congestive heart failure and deaths. To offset the low coverage and limited use of modern health services, a community-based surveillance through household and traditional healers weekly visit was added. Community agent notified events and administrated a verbal autopsy in case of death. Lack of street-address and civil registration were fixed by collecting geographic data for each household and identifying each subject using a composite 8 digit ID number, including specifics numbers for area (1 digit), house number (3 digits), household number (2 digits) and individual number (2 digits).Results: During 3 years, 1793 participants were enrolled, equaling to 4068.7 persons years of follow-up. Women represented 61.1% and the mean age was 42.7±16.5 years. Baseline prevalence was 2.3% (95% CI: 1.7%-3.2%) for smoking, 9.15% (95% CI: 7.9%-10.6%) for harmful use of alcohol, 9.3% (95% CI: 8.0%-10.8%) for obesity, 32.1% (95% CI: 29.9%-34.3%) for hypertension, and 3.5% (95% CI: 2.7%-4.5%) for diabetes.Surveillance recorded 9 non-fatal events and 55 deaths. Non-fatal events were stroke (6) and congestive heart failure (3). Causes of death were stroke (14.5%), congestive health failure (9.0%), sudden death (3.6%), LEAD (1.8%), infectious diseases (25.4%), others noncommunicable diseases (25.4%) and undetermined causes (20,0%). The mean age at death occurrence was 71.4±25.2 years. Overall incidence of CVD events was 25 cases equaling to 6.1 cases per 1000 person-year. The CVD mortality rate was 48,0%.Conclusion: A CVD is possible in rural SSA but need adaptation to face local specific challenges. The burden of CVD was high and associated with a high mortality rate