The spectrum of heart disease in adults in Malawi: A review of the literature with reference to the importance of echocardiography as a diagnostic modality

Malawi, like many developing countries, is in a state of health transition from predominately infectious diseases to predominately noncommunicable diseases (NCDs).1–3 This transition has caused many countries to have a “double burden” of disease, with high levels of both communicable and noncommunicable pathologies.4,5 The transition has coincided with increasing affluence and life expectancy among Malawians. Between 2003 and 2013, life expectancy in Malawi has increased from 37 to 53 years,6 with an adjusted life expectancy of 77 years for Malawians who survive to age 60.7 Cardiac diseases related to infection may present at any age, but those related to NCDs predominate in older age groups. The spectrum of heart disease can provide an indicator of the health transition from infectious to non-infectious diseases. Echocardiography is a noninvasive modality for gaining both structural and functional information about the heart. Echocardiography can be used to identify infection-related pathology, such as valvular heart disease following rheumatic fever or tuberculous pericardial effusion,8 and noncommunicable pathologies such as hypertensive heart disease or cor pulmonale. The information gained can lead to life-saving changes in management. This review will describe the spectrum of adult cardiac disease in Malawi, including changes over time, especially the impact of the HIV epidemic and the health transition from communicable to noncommunicable diseases. Selected studies from the sub-Saharan region will be reviewed to illustrate the usefulness of echocardiography in diagnosing heart disease when other investigations are not available.