=Paper=
{{Paper
|id=Vol-3789/Paper6
|storemode=property
|title=Distribution of Prevalence and Impact Factors of Cardiovascular Diseases in Benin
|pdfUrl=https://ceur-ws.org/Vol-3789/Paper6.pdf
|volume=Vol-3789
|authors=Aude-Elvis ODELOUI,Thierry Oscar Codjo EDOH,Joel T. Hounsou,Jules Degila,Ahmed S. Albahri
|dblpUrl=https://dblp.org/rec/conf/cita2/OdelouiEHDA24
}}
==Distribution of Prevalence and Impact Factors of Cardiovascular Diseases in Benin==
https://ceur-ws.org/Vol-3789/Paper6.pdf
Distribution of Prevalence and Impact Factors of
Cardiovascular Diseases in Benin⋆
Aude-Elvis ODELOUI1†, Thierry Oscar Codjo EDOH2,3*†, Joel T. Hounsou1†, Jules Degila1†,
Ahmed S. Albahri4,5†
1
Institute of Mathematics and Physics Sciences
2
RFW-Universität Bonn, Bonn, Germany
3
Ecole Supérieure Multinationale des Telecommunications; Dakar, Senegal
4
Technical College, Imam Ja’afar Al-Sadiq University, Baghdad, Iraq
5
Iraqi Commission for Computers and Informatics (ICCI), Baghdad, Iraq
Abstract
Cardiovascular diseases (CVDs) are among the leading causes of mortality worldwide, with an increasing
prevalence in low- and middle-income countries, particularly in sub-Saharan Africa. This article, part of an
ongoing study, utilizes artificial intelligence (AI) in predicting distribution of CVDs, evaluating their impact
factors, and proposing strategies for mitigating the prevalence of CVDs.
Aims and objectives: This part of the work focused only on understanding the contexts and impact factors
of the different regional factors by answering the related research questions and finally testing the
hypothesis on the statistical relationship between the prevalence and level and quality of medical
equipment available in the care units as well as the level of access to early detection and prevention of
CVDs in each region of the country.
Research methodology: A mixed methods approach was used to collect data (QUAN+QUAL) in a cross-
sectional field study. Studies and reports published between 2012, and the beginning of 2024 were searched
in academic databases and libraries of the Beninese Ministry of Health (MoH). Studies and reports on the
prevalence of CVDs worldwide, particularly in Benin, and reports on CVD (pre)-screening and prevention
in Benin were identified. Furthermore, quantitative data were collected through a survey (using a semi-
structured questionnaire) conducted at the National Program for the Prevention of Communicable Diseases
(PNLMT). The study involved 466 participants sampled from different regions and 36 care units across the
country.
Results: People living in rural regions are more severely affected by these diseases. Erdely people (50+
years) are at risk of developing the disease, mostly in rural regions. The research hypotheses were supported
by cross-sectional field research across different regions of Benin. The level of CVD incidence in Benin
differs from region to region and is correlated with the level and quality of medical equipment in regional
healthcare units and the extent to which early detection and prevention programs are implemented.
However, analyzing the factors impacting the regional prevalence of CVDs from the computer sciences
point of view reveals that awareness raising and early detection programs are poorly implemented. could
be supported by digital campaigns (remote care) to raise awareness about cardiovascular diseases.
Keywords
Prevalence of disease, Artificial Intelligence, noncommunicable disease, cardiovascular diseases,
Gamification, digital campaign
1. Introduction low awareness, and socio-economic challenges.
Investigating the prevalence and distribution of CVDs in
Cardiovascular diseases (CVDs) encompass a range of this region is critical for developing targeted
heart and blood vessel disorders, including coronary interventions.
artery disease, stroke, and hypertension. These Noncommunicable diseases (NCDs) are among the
conditions are a significant public health concern, leading causes of many deaths worldwide. NCDs kill 41
especially in sub-Saharan Africa, where the burden is million people every year, accounting for 71% of all
exacerbated by inadequate healthcare infrastructure,
Cotonou’24: Conférence Internationale des Technologies de l’Information
et de la Communication de l’ANSALB, June 27–28, 2024, Cotonou, BENIN 0009-0002-1962-0034 (Aude-Elvis ODELOUI), 0000-0002-7390-3396
∗
Corresponding author. (Thierry EDOH), 0000-0001-7301-3919 (Jules DEGILA), 0000-0003-3335-
†
These authors contributed equally. 457X (A. S. ALBHRI)
Aude-Elvis ODELOUI (aeodeloui@gmail.com), Thierry Oscar Codjo © 2024 Copyright for this paper by its authors. Use permitted under
Creative Commons License Attribution 4.0 International (CC BY 4.0).
EDOH (oscar.edoh@gmail.com), Joel T. Hounsou
(joelhoun@gmail.com), Jules Degila (julesdegila@gmail.com), Ahmed .
S. Albahri(ahmedbahri1978@gmail.com)
CEUR
ceur-ws.org
Workshop ISSN 1613-0073
Proceedings
deaths worldwide. Every year, more than 15 million infrastructure and equipment, individuals’ financial and
people die from NCDs between the ages of 30 and 69; economic situations play an important role in their poor
85% of these "premature" deaths occur in low- and access to healthcare services and pharmaceutical care
middle-income countries [1], [2]. [12]. In Benin, 51% of women live relatively close to a
Worldwide, cardiovascular diseases, such as NCDs, hospital, over 13% of women live at least 30 kilometers
are bearing a high burden of morbidity and mortality. from a hospital or comparable facility, and the rest have
Approximately 30–45% of adults worldwide are little or no access to medical care [13], [14]. Many
suffering from hypertension, the prevalence of which is regions in Benin have a low capacity to offer
increasing [3], [4], [5]. In Benin, a low-income country, cardiovascular disease prevention, early detection, early
the most common cardiovascular diseases (CVDs) are diagnosis, and management services (SARA survey1 -
hypertension, obliteration of the arteries of the lower 2018-).
limbs (AOMI), cerebrovascular accidents (CVA) and
heart failure (HF). Blood pressure (BP) was never
measured in approximately 68.2% of Beninese
individuals, and more than half of those with elevated
BP were unaware of their status [6]. Despite the
availability of low-cost antihypertensive drugs in Benin,
less than half of known hypertensive patients are
treated, and less than one-third achieve blood pressure
control at currently recommended targets [7]. Late
diagnosis of hypertension and poor BP control increase
the frequency of hypertensive complications.
Access to stroke exploration tools remains a real
problem, with high social inequalities and health
insurance mainly benefiting wealthy people. In Benin, it
is estimated that among patients, 109 (29.3%) have
suffered from stroke without knowing it, 121 (32.5%)
were diagnosed and had an electrocardiogram, and 31
(8.3%) benefited from a cardio ultrasound and 34
ultrasound scans of the neck vessels (9.1%) [8], [9]. This
undoubtedly affects the prognosis of patients who do
not receive optimal, specific treatment. Differences in
the level of healthcare accessibility are a consequence of
the medical structure of sub-Saharan African countries
and weak health infrastructure. Figure 1 shows the
pyramidal structure of the country public health system,
where health units at low levels are poorly equipped Figure 1: Beninese public health system structure.
with medical infrastructure [10]. Source [[15] Figure 1 updated]. The country has only a
Access to healthcare in general, particularly to few university hospitals. The majority of the population
cardiological care, is one of the main problems and is living relatively close to an medical primary care unit
challenges facing the public healthcare system in Benin,
a sub-Saharan country, due to its public health structure The lack of diagnostic and treatment services for
and infrastructure [11]. Medical facilities are often far cardiac arrhythmias is common in most sub-Saharan
from residential areas. Most rural populations live in African countries, leading to suboptimal care and a
areas devoid of municipal infrastructure, such as streets heavy burden of premature cardiac death[16]. This fact
and power supply systems. Access to healthcare is might be correlated with the prevalence of CVDs across
therefore dependent on the availability of local medical the country since early disease detection and prevention
resources. Access to healthcare therefore depends on require various strategies and technological support,
where one lives. Therefore, compared with urban such as prescreening for diseases [17], eHealth and
populations, rural populations face poor access to remote care infrastructures such as pervasive
healthcare [11]. In addition to poor medical infrastructure [18], medical equipment such as ECGs
1 https://www.afro.who.int/sites/default/files/2018- %20Report%20of%20the%20Regional%20Director%20-
08/The%20 Work%20of%20 %202017-2018%20-%20%20web%20version.pdf
WHO%20in%20the%20African%20Region%20%20-
[19], [20] and other medical tools. The lack of medical 2. Theoretical and practical
equipment might obstruct access to cardiac care
provision. background, motivation,
Telehealth care, in general, increases access to objectives, and hypotheses
health care providers [21] and enables care provision in
the case of limited physical contact, for example, during 2.1. Background
the COVID-19 crisis [22], [23], [24]. Remote cardiac care, Cardiovascular diseases are among the leading
as a discipline of telehealth care, extends access to noncommunicable diseases worldwide. Prior studies
cardiologic care, including patient monitoring and investigating the prevalence of cardiovascular diseases
education. Although the concept of telehealth care was (CVDs) in Benin have focused mostly on the national
coined in 1948 in Chester, where physicians started prevalence of the disease or on hospitals in certain
sending radiology images over the telephone and having contexts and/or cases. It is therefore difficult to provide
remote consultation with other physicians2, telehealth adequate and sustainable solutions to mitigate poor
is a relatively new topic in medicine and has gained access to CVD care services through early detection.
more significance during the last COVID-19 pandemic. Prevention awareness-raising programs.
Remote patient monitoring started in 1961, and in 1967, This section presents the outcomes of the literature
ECGs were sent via telephone. review on the prevalence of CVDs worldwide,
The overall objective of this ongoing study is using particularly in Benin, and early detection, prevention,
artificial intelligence to investigate the distribution of and awareness-raising programs in the country.
the prevalence of cardiac diseases across the country and
their impact factors, to assist in the design of novel 2.1.1. Prevalence of Cardiovascular Diseases
technology-based solutions to overcome poor medical
The incidence of cardiac diseases in sub-African
equipment and poor access to CVD care services,
countries is high[4]; in particular, blood pressure is
implement digital campaigns and enable them to
approximately 27% in sub-Saharan Africa[5].
sustainably mitigate the prevalence of CVDs across the
Many research studies have addressed the
country. Early detection and management of cardiac
prevalence of CVDs with a focus on cases such as the
diseases, particularly in regions with poor medical
prevalence of CVDs among certain population groups
resources, can help public health system providers
and inpatients suffering from certain diseases. These
reduce the disease prevalence. The present study,
studies have focused on determining CVD risk factors
therefore, specifically aimed to investigate the
in selected populations. Witchakorn et al. investigated
distribution and causes of disease prevalence in each
the incidence of CVDs among HIV patients in Asia-
region of the country using AI.
Pacific regions. A high prevalence of CVDs was found
Artificial intelligence (AI) has emerged as a powerful
among HIV patients compared with non-HIV patients.
tool in healthcare, offering advanced capabilities in data
Despite this result, the study concluded that a gap exists
analysis, predictive modeling, and decision-making
in HIV/CVD research [25]. According to this study, HIV
support. By leveraging AI, researchers and healthcare
seems to be a factor impacting the incidence of CVD.
providers can gain deeper insights into the distribution
Similarly, Huynh Van Minh et al. investigated the
of CVDs, identify key impact factors, and design more
prevalence of hypertension in a population of people
effective strategies to reduce the burden of these
aged ≥ 18 years in Vietnam [7], and Jérôme Boombhi et
diseases. This article examines the potential of AI in this
al. investigated the prevalence of CVDs and factors
context and discusses the role of information technology
associated with blood pressure (BP) in a population of
in enhancing these efforts.
hypertensive black patients in two hospitals in
The goal of investigating the distribution of cardiac
Cameroon and found that an alarming prevalence of
disease incidence is, on the one hand, regarding the
CVDs and a sedentary lifestyle in the population in
structure of the Beninese public health structure to
Cameroon were the main CVD risk factors [4]. Camille
assess the relation between medical equipment
Lassale et al. investigated the prevalence among people
(un)availability in cardiac care services and disease
using traditional medicine (TM) in 12 African countries.
prevalence in each region and, on the other hand, factors
The study revealed that the proportion of people with
to be technologically addressed to reduce the prevalence.
high BP using TM matches the incidence of CVDs in
sub-Saharan Africa reported in the literature [5].
2 https://blog.prevounce.com/history-of-remote-patient-
monitoring-how-it-began-and-where-its-going
In Benin, the prevalence of blood pressure was 25% et al., 2019),, which was conducted in Benin, revealed
in 2015 (Houehanou et al., 2022a).. Many previous similar awareness ratios and revealed differences
studies have investigated the prevalence of CVDs such between men and women in terms of disease awareness.
as blood pressure in Benin, with a focus on nationwide It was also reported in [8] that approximately 50% of
cardiac disease incidence [26], geographical region [3], people involved in a study of four sub-Saharan African
[27], or cardiac disease in certain population groups [8]. countries were not aware of their hypertension; in [9],
The distribution of CVD incidence in geographical 77.5% of the study participants were unaware of their
regions in Benin has been less investigated. In 2011, D.S. state. In [4], the authors state that the subjects are not
Houinato et al. investigated the prevalence of CVDs and aware of risk factors such as obesity and others. Based
associated risk factors. The study revealed that on these findings, it is worth investigating the extent to
department (region) and profession are not associated which disease awareness-raising campaigns or
with the prevalence of hypertension (HT) while age and programs are implemented in Benin.
obesity are significantly associated to HT [9]. Similarly, The national implementation of the WHO
Michael Ekholuenetale et al. investigated heart diseases PACKAGE OF ESSENTIAL NONCOMMUNICABLE
among women in Benin and reported a high prevalence (PEN) DISEASE INTERVENTIONS (WHOPEN) strategy
of heart and lung diseases in rich environments, unlike is still sporadic. However, in 2023, the WHO founded an
Houinato et al., who reported that geographical regions information campaign on cardiovascular and diabetes
are associated with heart and lung diseases among prevention in three departments, namely, Attacora,
women of reproductive age [8]. To the best of our Donga, and Mono. Many other awareness-raising
knowledge, this study is the only one that has campaigns and early detection programs were
investigated the prevalence of heart disease in conducted in the same year (2023). However, all these
geographical regions. However, only women and heart campaigns were addressed to some employees of some
diseases were considered among CVD patients. This fact national institutions. According to Amidou A. Salmane,
makes our study novel. the MoH is working on a strategy for public awareness
The prevalence of CVDs in Benin is estimated to be campaigns and early detection programs that could
27.5% for hypertension, 3.9% for lower limb artery benefit the entire population.
obligation, 4.6% for stroke, and 1.0% for heart failure3. Despite the adoption of WHOPEN, the country
Hypertension affects 25.9% of Beninese adults lacks a sustainable implementation of early disease
according to a national survey conducted in 2015 by the detection and prevention programs.
Ministry of Health using stepwise methodology from To the best of our knowledge, and according to the
the World Health Organization [26], [28]; different risk literature review on early detection and cardiological
and impact factors were investigated. However, we disease prevention programs in Benin, no program
found no studies that investigated the impact of the exists. However, according to Amidou A. Salmane5, the
level of medical equipment in healthcare units and Ministry of Health (MoH) has adopted the WHO
disease awareness among the population. package of essential noncommunicable (PEN) disease
interventions for primary health care (WHOPEN), a
2.1.2. Early detection and prevention of strategy for primary disease prevention and early
cardiovascular diseases detection defined by the World Health Organization
According to the information collected in the latest (WHO).
SARA survey4 (2018), some regions in Benin have a low Educating people in Benin on risk factors for all
capacity to offer cardiovascular disease prevention, cardiac diseases, detecting cardiac diseases early and
earlier detection, diagnosis, and management services. developing better strategies to manage cardiac diseases
Disease prevention requires knowledge about the might assist in reducing the risk of developing and
disease (health literacy) [17]. Most of the reviewed reducing the prevalence of cardiac diseases[29], which
articles reported an average level of CVD awareness is obviously caused by poor access to cardiac screening
among the studied populations; in [26], awareness was for early detection, diagnosis, and treatment. However,
slightly greater than half. The TAHES study (Desormais the Beninese public health structure is facing
infrastructural challenges[11] that could challenge the
3
https://benin.un.org/fr/298-oms-r%C3%A9duire-la- 4 https://www.afro.who.int/sites/default/files/2018-
pr%C3%A9valence-des-maladies-non-transmissibles- 08/The%20 Work%20of%20
WHO%20in%20the%20African%20Region%20%20-
au-benin
%20Report%20of%20the%20Regional%20Director%20-
%202017-2018%20-%20%20web%20version.pdf
5 PNLMNT: National Program for the Prevention of
Communicable Diseases
efficiency of initiatives to reduce the prevalence of 2.2.2. Research objectives, questions, and
cardiac diseases in Benin. hypotheses
2.2. Research Motivation, Objectives, The primary objective of this ongoing study is to
investigate to what extent information technology could
Questions, and Hypotheses assist in mitigating (reduce) the incidence of CVDs in the
2.2.1. Motivation country’s geographical regions. Therefore, our steps
toward this goal are to determine the causes underlying
This section discusses the research motivation or gap.
the prevalence and analyze them in the computer
Most prior research on the prevalence of CVDs in
sciences.
Benin has focused on the following:
This part of the research, therefore, aims to do the
1. Determining the prevalence of certain CVDS, following:
such as hypertension, in a certain group of
1. The prevalence of disease and impacting
individuals revealed that individuals suffering
factors in geographical regions of the country
from CVD are unaware of the disease [3], [8],
were assessed.
[9], [27]
2. The number and quality of medical equipment
2. CVD risk factors such as obesity and
cardiologic units in the districts were assessed.
comorbidities[25], [30]
3. Districts were classified according to their
3. Predicting the regional prevalence of CVDs
scores (prevalence and equipment level as well
based on collected historical data (risk factors,
as prediction and prevention programs), and
technical platform level, access to diseases
the prevalence of districts with similar medical
prevention programs, etc.,)
equipment levels, screening, and control
It is well known in the literature that individuals’ programs was compared.
disease awareness, also called health literacy, can be 4. Collected data were used to predict the
improved by educating them on disease risk factors and regional prevalence of the CVDs
pre-symptoms. Knowing the risks of disease could drive
Regarding the identified research gap, we define the
individuals to prevent the disease [31], [32] by following
research hypothesis as follows:
their health and lifestyle. We found in previous studies
[33], [34] that health or medical education might impact
H1. The level of prevalence in geographical regions is
individual health outcomes. It is, therefore, trivial that
statistically related to the level of population accessibility
knowing and having a good lifestyle may impact the
to early disease detection (prescreening), prevention
prevalence of the disease in a region.
programs and the number and quality of existing
Early detection of a disease requires access to care
cardiology equipment in regional care units.
services, whereas medical equipment is needed. It is well
known in the literature that access to care services is not
sufficient to impact individual health outcomes. The
3. Methodology and Study Design
quality-of-care services is another factor that amplifies 3.1. Study methodologies
health outcomes. Therefore, it is worth investigating the
role that the level and quality of medical equipment This study used quantitative and qualitative mixed-
could play in the prevalence and/or incidence of method research to collect data from several targets
diseases. All prior studies are limited in this regard. spread throughout Benin to identify and explain why
To the best of our knowledge, no previous study has certain regions are facing a higher incidence and
assessed the impact of medical equipment, early disease incidence of cardiovascular disease than others.
detection and prevention, and the implementation of A total of 398 studies published between 2012 and
disease awareness campaigns on the prevalence of the beginning of 2024 were identified in dedicated
CVDs in geographical regions of the country. Therefore, academic databases (PubMed, ScienceDirect, Web of
this study was motivated by this research gap and Science, CINAHL, Google Scholar, Scopus). Studies on
aimed to answer the question of “to what extent factors the incidence of cardiac diseases in Benin were
such as the level and quality of medical equipment, early identified and included in the study to assess the
disease detection and prevention, and disease awareness prevalence and impact factors of cardiac diseases.
raising campaigns could impact the level of geographical Reports from the Beninese Ministry of Health were
prevalence”. also reviewed.
Random forest was used on the collected data (rate
of risk factors in each, medical equipment level,
prevention programs, etc.) for predicting the regional ended questions (quantitative research) were used to
prevalence by classification. assess the level of perception, prevalence, and
involvement in the management of CVD in Benin. The
3.2. Sampling overall survey period runs from February 2023 to
November 2023.
The country is divided into 12 departments called
The survey used a web-based information-gathering
“prefectures” and 77 districts called “communes”.
form distributed via social networks to healthcare
Representative districts were selected in each
professionals, facility users, friends, and relatives
department following our selection criteria. The
throughout Benin.
selection criterion for each region was at least a
Illiterate people, on the other hand, were helped to
university hospital if it existed and/or was a well-visited
complete the questionnaire.
healthcare unit with at least a minimum level of
A further qualitative survey consisting of open-
cardiovascular medical equipment and cardiologists. On
ended questions with a focus group of healthcare
the other hand, care units in rural areas have CVD
professionals, including cardiology specialists, was
medical equipment, such as ECG devices.
conducted to analyze the outcomes of the mixed-
The participants (cardiologic patients living in large
methods study. This involved discussions during a
cities and rural regions) and cardiac care units were
workshop with professionals from each department,
sampled to investigate the distribution of CVD across
including a cardiologist (if possible), a general
Benin and to highlight the regions where there is a need
practitioner and a health center manager (nurse or
for infrastructure, medical equipment, and staff
midwife).
acquisition.
The aim of this workshop is to analyze the
A total of 466 participants (patients) quantitative results obtained after presenting the
participated in the survey from the start to the results of the quantitative mixed-method study and to
finish of the survey. Of these, 192 were women, explain, from care professionals’ perspectives, the
54.2% lived in rural areas and 44.3% lived in difference in prevalence between regions with the same
urban areas. It should be noted, however, that level of CVD medical equipment.
1.6% of these women did not specify their The following questions were addressed during the
living environment. discussions:
Similarly, there were 265 men, 66.4% of whom 1. What are the difficulties faced in caring for
lived in rural areas and 32.5% in urban areas, patients in general and those suffering from
while 1.1% did not specify their living cardiovascular disease in particular?
environment. In addition, 09 people who 2. How do you explain the difference in the level
participated in the survey did not specify their prevalence of cardiovascular disease in regions
gender. where there are no treatment facilities?
Participant Care Unit (N = 36), which provides 3. How do you explain the difference in the level
cardiological care, was selected according to prevalence of cardiovascular disease in regions
predefined criteria. The most visited care units where treatment facilities are available?
in the department were selected. 4. What can be done to achieve the same level of
care in all regions of Benin?
3.3. Data sources, collection, and
extraction 3.3.1. Mixed Methods Research Questions for
To explain the reasons underpinning the discrepancy in Descriptive Research Designs
cardiological care service provision across the country, Prevalence of cardiac disease and people’s
mixed-method research (quantitative followed by perceptions
qualitative data collection to explain the outcomes of the
quantitative study) and a qualitative survey were After assessing disease prevalence, people in the
conducted. selected regions were asked about their disease
The kobotoolbox tool was used to develop an online awareness, blood pressure control and participation in
data collection form. Participants can answer questions screening programs.
about discrepancies in CVD medical care services across
the country.
Online questionnaires, telephone interviews and
face-to-face interviews with open-ended questions
(qualitative research, generally subjective) and closed-
3.3.2. Mixed Methods Research Questions for
Causal-Comparative Research
Designs
1. Prevalence of cardiac disease and healthcare
professional perceptions
Health professionals were asked about factors related to
the level of disease prevalence in their regions.
Furthermore, they were asked about the adherence of
the population to medical control for early detection and
treatment.
2. Challenges and Issues Facing Screening
Programs
The medical equipment level was assessed where health
care professionals were asked about challenges and
issues faced in providing screening programs to detect
the disease early and thus prevent it early.
The questions mainly focused on the medical equipment
level of the care unit and how the population is
empowered to take part in the program.
3.3.3. Mixed Methods Research Questions for
Experimental Research Designs
1. Effect of remote cardiological care in regions
with a high prevalence
The effect will be assessed in the frame of an upcoming 4. Findings
empirical study. This section presents the results of the study on the level
and quality of medical equipment in healthcare units,
2. Effects of a Smart pervasive screening system
access to medical care for CVD, and the level of CVD
on prevalence
incidence in geographical regions with their associated
The effect will be assessed in the frame of an upcoming impact factors and, in addition, the strategy for early
empirical study. disease detection, prevention and awareness campaigns
in the country.
3.4. Data analysis We did not, unlike past studies, make any difference
between the different CVDs in the scope of this study.
Table 1 summarizes the data analyses carried out.
4.1. Prevalence in geographical regions
Table 1
Summary of the data analysis processes A total of 159 people out of 466 interviewed suffer from
cardiovascular disease, 39% of whom are women and
61% of whom are men (Figure 2). The greatest
proportions of participants suffering from the disease
were recorded in Donga (70%), Plateau (70%), Atacora
(63%) and Alibori (56%). On the other hand, the lowest
proportions of participants suffering from the disease
were recorded in the Ouémé (8.4%), Borgou (10.4%) and
Littoral (20%) departments. The other departments have
a significant proportion: 40.0% for Zou, 37.5% for Mono,
36.0% for Atlantique, 31.6% for Couffo, and 30.0% for
Collines.
The departments of Alibori and Atacora account for
27% and 25.2%, respectively, of the country's disease
burden. The latter contribute more to the emergence of
the disease in the country, while Zou's share of sufferers algorithms like decision trees, random forests, and
in Benin is the lowest (1.3%). This share is not as neural networks.
negligible for the other departments: 11.3% for One of the primary challenges in predicting CVD
Atlantique, 9.4% for Littoral, 4.4% for Ouémé, 3.8% for prevalence is the quality and availability of data. Many
Couffo and Mono, 3.1% for Borgou and 1.9% for predictive models rely on high-quality, longitudinal
Collines. data, which may not be available in all regions.
Elderly individuals (50+) are mostly affected by this Additionally, data discrepancies, especially in low-
disease. People living in rural Benin are more affected. resource settings, can lead to inaccurate predictions.
In Alibori, 65.1% of people are affected by the disease in Random forest aa supervised learning algorithm
rural areas, compared with 30.2% in urban areas. The requesting a labeled data set where people are
remaining 4.7% of the population represents the number diagnosed as suffering or not from CVDs was used.
of people in Alibori whose place of residence is not Independent features included in the labeled data set
specified. The rural areas of the Atacora department are 1) rate of the CVDs risk factors (12 levels), 2) medical
accounted for 92.5% of the department's patients, equipment level of each medical unit (5 levels), level of
compared with only 7.5% in urban areas. The other the accessibility to CVDs care (2 levels), level of the
departments where rural areas broke the record were accessibility to prevention services or prescreening.
Collines (66.7% vs. 33.3% in urban areas), Couffo (83.3%
vs. 16.7% in urban areas), Donga (85.7% vs. 14.3% in 4.3. Medical equipment
urban areas), Littoral (66.7% vs. 33.3% in urban areas),
The level of medical equipment is determined by the
Ouémé (57.1% vs. 42.9% in urban areas) and Plateau
amount and quality of medical equipment, such as ECG
(85.7% vs. 14.3% in urban areas). On the other hand, this
devices (Figure 3).
trend was reversed in the departments of Atlantique
Blood pressure equipment is available in almost all
(72.2% in urban areas vs. 27.8% in rural areas), Borgou
health centers. The full range of diagnostic equipment
(100% in urban areas) and Mono (66.7% in urban areas
required for the proper management of patients
vs. 33.3% in rural areas), where urban areas recorded a
suffering from CVD is available only in the departments
greater proportion than did rural areas.
of Borgou, Littoral and Ouémé, which have special
status in Benin.
Level of Prevalence in geographical Using documentation on the organization of Benin's
regions healthcare system and information from the National
Health Development Plan (PNDS) and the 2018 edition
80,0 30,0 of the Health Statistics Yearbook and then exploited in
60,0 20,0 the context of this work, it was found that the
40,0 healthcare system is organized into several types of
20,0 10,0
health facilities (FS) for the care of populations. These
0,0 0,0 SFs can be categorized according to departments as
Atlantiq…
Alibori
Atacora
Borgou
Couffo
Donga
Zou
Littoral
Mono
Oueme
Plateau
Collines
follows:
Level of medical equiment in geographical
Percentage of respondents suffering from
regions
the disease 100,0
Share of each department in the country in 80,0 Tensiome-ter
Number of devices
relation to the disease
Figure 2: Prevalence level in each selected region 60,0
40,0 MAPA
4.2. Prediction of the prevalence
Predictive analytics encompasses a variety of statistical 20,0
and machine learning techniques used to forecast future 0,0 Holtel
outcomes based on historical data. In the context of
CVDs, predictive models typically analyze patient data,
including demographic, clinical, and lifestyle factors, to Regions
predict the likelihood of developing cardiovascular
Figure 3: Medical equipment in the different regions.
conditions. These models range from traditional
Most of the care units are poorly equipped. Tensimeter
regression analyses to more complex machine learning
is the main equipment available at these units.
Table 2 summarizes the content Error! Reference
source not found. and classifies the medical As summarized in Table 3, care units in Borgou,
equipment. Littoral, and Ouémé are highly equipped and show a
low cardiac disease incidence, while Atlantic and Mono
Table 2 departments, which are equipped with almost all
Medical equipment availability per department devices, show an average prevalence.
The department of Zou, with average medical
equipment, shows an average prevalence level.
Moreover, Donga and Alibori, which have low levels of
medical equipment, have a low prevalence.
These results confirm that the level of prevalence is
associated with the level of medical equipment and
infrastructure in the region. However, even though the
medical equipment available for the Department of
Attacora* is like that available for the departments of
Atlantique and Mono, it is highly prevalent. This could
be explained by the fact that either
1. The existing medical equipment is defective. or
2. Qualified staff to use the equipment is missing,
or
3. The population is visiting other closer care
units in another neighboring department. For
example, Atacora and Borgou are neighboring
departments, and Borgou has a low incidence
of CVDs.
4. People mostly use traditional medicine. Lassale
C et al. stated in [5] that “The overall
proportion (24%) shows that selfreported use
of TM is common in patients with diagnosed
hypertension and matches the literature with a
mean prevalence of published studies in sub-
Saharan Africa of 27%.”
The case of the Department of Atacora revealed that
the quality of medical equipment, the availability of
qualified medical staff, and other factors are associated
with the prevalence.
In the department of Collines and Couffo, although
it has very low-level medical equipment, it has an
average prevalence. This could be explained by the fact
that the medical staff regularly raise awareness at home
The regional prevalence of CVDs revealed a with only the basic type of device (tension device) they
discrepancy between geographical regions (Table 3). have or that there could be other causal factors that
another study could identify.
Table 3
Categorization of care units based on medical equipment 4.4. Early detection and screening
programs
The country lacks appropriate campaigns for raising
public awareness. In 2021, USAID collaborated with the
government through the National Program for the
Prevention of Communicable Diseases (PNLMT). The
partnership aims to launch digital technology in the
Onchocerciasis Detection and Public Awareness A total of 24.7% said they lived more than 5 km
Campaign6. from the nearest health center.
We found that the country has not implemented
public awareness-raising campaigns for cardiovascular
disease, and no early detection or prevention programs
have been properly implemented.
We deduce that University Hospitals (HUs), whether
departmental or zone hospitals, are located within a
radius of 40 km of the Faculties of Health Sciences (FSS)
or medical schools. According to this categorization,
most cardiology services are available in hospitals of
classes 1, 2 and 3. Specialty services such as cardiology
are mostly available only in hospitals of these classes.
They are in urban areas, more specifically in the special-
status towns of Cotonou (Littoral), Porto-Novo (Ouémé)
and Parakou (Borgou).
4.5. Access to cardiological care
According to these quantitative results, the major
accessibility difficulties encountered by patients are
poor road conditions, excessive loss of time in line, no
time for consultations, and no money for the
consultation. All these difficulties become minor in the
departments of Borgou, Littoral and Ouémé.
Figure 4 presents the different causes of poor access
to healthcare services.
Regarding patients' statements on difficulties
accessing care (multiple-choice question), the survey Figure 4: Causes of poor care access. The main cause of
results revealed the following: poor access to CVD care is the lack of care units at the
residence place of the patients. Therefor, they face
Eighteen percent said they had no money to financial and economic issues to visit the next medical
make regular trips to the hospital for clinical unit
appointments.
A total of 26.2% said they had no money to pay 5. Analysis and Discussion
for consultations or medical procedures on a
regular basis. 5.1. Analysis
A total of 4.9% declared that they had mobility This section analyzes the results obtained above, with a
problems for reasons of health or old age. This view to determining the extent to which improving the
makes it difficult to reach the health center to technical platform for cardiology care using new
maintain appointments. technologies could have an impact on the cardiac health
A total of 26.8% said they had no time to of affected populations, irrespective of their
maintain regular clinic appointments. geographical and socioeconomic situation.
A total of 46.6% mentioned the difficulty of
maintaining clinical appointments due to poor 5.1.1. One factor impact on the prevalence of
road conditions. CVDs
A total of 24.7% said they lost too much time in 5.1.1.1. Impact of medical equipment on cardiac
line with hospital consultations. disease incidence
Hypothesis testing
6
https://www.usaid.gov/benin/news/feb-14-2022-
onchocerciasis-control-campaign-goes-digital-reach-
millions-benin
H1: The regional distribution of cardiovascular disease 5.1.1.2. Impact of cardiac disease prevention,
shows a statistical relationship between the prevalence of screening programs, and
the disease and the level and quality of medical equipment early detection on disease
used for cardiology diagnosis and management, depending incidence
on the region. H2: The incidence of cardiac disease is significantly related
to early cardiovascular disease detection, prevention
programs, and diseases awareness campaigns.
Hypothesis Testing
While the khi-deux test carried out on the collected data
reveals a weak relationship between the prevalence of
CVDs in certain geographical regions (example Atacora)
(p<10%), place of residence and suffering from the
disease are significantly related (p<1%). Though, the
hypothesis could be partially rejected since the
statistical relationship between both elements is weak
and seems to be affected by further factor(s).
5.1.2. Two factors impact on the prevalence
of CVDs
H3. The level of prevalence in geographical regions is
statistically related to the level of population accessibility
to early disease detection (prescreening), prevention
programs and the number and quality of existing
cardiology equipment in regional care units.
All geographical regions severely lack pre-
screening, prevention, and disease awareness
campaigns. The analysis of variance (2-way ANOVA)
shows that the prevalence of CVD in geographical
regions depends on two independent factors. The
analysis reveals high prevalences of CVD in regions
The F test statistic (23.23057) is greater than the F with high levels of medical equipment but of poor
critical (3.31583). Based on the test statistics, there is quality and benefiting from pre-screening campaigns
sufficient evidence to reject the null hypothesis, and the (example of Attacora).
P value of 8,04E-07 is less than the alpha α = 0.05.
5.2. Discussion
Rejection of the hypothesis
The present study investigated the prevalence of CVDs
The medical equipment level is not the sole factor in geographical regions and the statistical relationship
impacting the regional disease incidence. The between CVD incidence and medical equipment. It
departments of Coline and Couffo have a moderate further investigates factors (e.g., early disease detection
disease prevalence, and their care units are less equipped and treatment) amplifying the effects of medical
than the department of Attacora, which has a high equipment on the incidence of CVDs and additional
disease prevalence (Table 2). factors, such as disease awareness raising campaigns,
The high disease prevalence in Attacora could be which impact disease prevention and individuals’ health
explained by the poor quality of medical equipment in lifestyle behaviors.
its care units. However, why do the departments of The integration of AI and information technology in
Colline and Couffo, which have poor medical CVD management holds immense promise, particularly
equipment, have a moderate disease incidence, while in low-resource settings. AI-driven solutions can
Atlantique and Mono, which have high medical enhance the accuracy of CVD risk assessments, improve
equipment, have the same disease prevalence? patient outcomes through personalized interventions,
and reduce healthcare costs by preventing costly
complications. However, several challenges must be
addressed to fully realize the potential of AI in this
context. These include the need for high-quality data,
robust infrastructure, and trained personnel to The results revealed that the full range of CVD medical
implement and maintain AI systems. equipment is available only in the departments of
Moreover, ethical considerations related to data Borgou, Littoral and Ouémé, which are in classes 1, 2,
privacy and algorithmic bias must be carefully managed and 3, respectively. However, certain care units own the
to ensure that AI-driven interventions are equitable and full range of medical equipment but are classified as
do not exacerbate existing health disparities. Despite classes 2 and 3 because of the low amount of equipment
these challenges, the potential benefits of AI in reducing in each category (Mapa, ECG device, etc.). This situation
CVD prevalence are significant, particularly in regions not only disadvantages populations affected by
like sub-Saharan Africa, where the burden of these cardiovascular disease and located in rural areas but also
diseases is growing rapidly. reveals the uneven distribution of these services,
thereby disadvantaging their geographical accessibility
5.2.1. Theoretical Contribution to care.
The study highlighted four factors, namely, the level and According to the results and analysis, the regional
quality of medical equipment, early disease detection, prevalence of CVD is associated with people’s place of
disease prevention and health lifestyle behavior, and residence and the level and quality of medical
disease awareness raising campaigns, as building blocks equipment, which supports early disease detection and
impacting the regional prevalence level. Furthermore, treatment. Regions with low levels and/or low-quality
the fourth building block, disease awareness raising CVD medical equipment are mostly affected by the
campaigns, directly amplifies the effect of the third disease (with a high prevalence, we investigated the
building block (diseases prevention). The level and incidence of CVDs in these regions to obtain a complete
quality of medical equipment supports and impacts the picture of the issues).
effect of the second building block (early disease Although urban regions are favored over rural
detection and treatment). the level of the prevalence. regions, there is a difference between urban regions
Figure 5Error! Reference source not found. shows (CHUD of Porto-Novo and CHD of Abomey; CHUZ of
the theoretical model of the ecosystem for the Abomey Calavi and CHZ of Kandi); the same is true for
prevalence of CVDs. rural regions. This could be explained by the uneven
distribution of infrastructure and facilities for the
diagnosis and management of specialty care,
particularly for cardiovascular disease patients.
According to Amidou A. Salmane (PNLMNT), in
2023, a public awareness raising campaign was rolled
out in three departments, namely, Attacora, Donga, and
Mono. The objectives of the campaign were as follows:
Raising disease awareness
Early detection of the disease
Increased involvement of healthcare
professionals in
upgrading the technical platform (medical
equipment)
This campaign had a positive effect on the disease
prevalence in these departments. A more in-depth
analysis of the situation revealed that prevention, early
detection, and public awareness campaigns combined
with high-quality medical equipment impact the disease
incidence. According to Amidou A. Salmane, the
campaign failed to upgrade/improve the technical
platform in Attacora. This fact explains why despite the
pre-screening and prevention as well as diseases
awareness campaign, Attacora is still showing a high
Figure 5: Relationships between the number of building disease level, while the department of Zou shows a
blocks and the level of regional prevalence middle level of prevalence.
The departments of Colline and Couffo are thought
Level and quality of medical equipment to be less equipped but show a middle level of
prevalence. They benefit from the high quality of the The relationship between early disease detection and
existing medical equipment and local campaigns. disease prevention is well documented. We noted that
prescreening individuals at high risk of NCDs impacts
Access to CVD care their health status (T. Edoh, 2018; T. Edoh et al., 2018)..
Recent studies [37], [38], [39] have shown that early
Studies [11], [12], [13], [35], [36] that we conducted from disease detection enhances disease prevention through
early 2010 to 2017 to 2020 revealed poor access to health appropriate early medical treatment, which the present
care services in Benin. These issues remain unclear, and study identified as a building block impacting the
there is a slight need for improvement. This study prevalence of disease.
focused on the level of access to CVD care. Enormous The results show that the country lacks early CVD
difficulties remain in resolving the issue of affordability detection campaigns despite the presence of WHOPEN.
regarding cardiological care. In addition to consultation However, the analysis revealed that the lack of early
fees, patients face costs such as medical costs and disease detection campaigns is one of the factors
transportation to care units. All these costs are some of affecting the regional prevalence level. Regional care
the factors that impact access to CVD care. The units with high-quality medical equipment in their
transportation costs increase when the patient needs to entirety have a low prevalence rate, and medical
visit a remote care unit because the one closer to him or equipment supports care units in early disease detection
her lacks appropriate medical equipment and/or procedures.
adequate healthcare staff. Launching artificial intelligence-based noninvasive
Table 4 summarizes the obstacles to adequate access pervasive disease prescreening could help to overcome
to CVD care. the issues of poor medical equipment in certain regions
and thus increase the rate of pervasive early detection of
Table 4
Obstacles to accessing CVD care the disease. Mohammad Shafiquzzaman Bhuiyan et al.
conducted their recent study [39] on the use of machine
learning in the early detection of lung cancer by “…
there's a positive development in using machine
learning for early-stage detection, which proves highly
effective in diagnosing this disease”.
Promising disease awareness campaigns
The rationality of health perceptions depends on the
social and educational values of individuals. Compared
with illiterate people, well-educated people mostly self-
educate about diseases and have greater health literacy
[34], [40].
Educating people about disease increases their
awareness level and empowers them to follow a healthy
lifestyle[41], [42]. However, following a healthy lifestyle
may positively impact the prevalence of diseases.
However, the country has not implemented the
WHOPEN initiative, and only sporadic awareness-
raising campaigns have taken place at some institutions.
The results and analysis have shown that the level
and/or quality of medical equipment does not effectively
impact the prevalence of diseases. Further factors that
might co-impact the prevalence of disease have
determined health literacy as an amplifier of the effect
of medical equipment. However, disease awareness-
raising campaigns should be considered building blocks
to amplify the effects of medical equipment that
supports early disease detection and treatment.
Predicting the regional prevalence of
Early disease detection and prevention CVDs
The classifier with high sensibility identifies the diseases. Information technology plays a crucial role in
prevalence of CVDs, ranking the independent features supporting these efforts, providing the infrastructure
according to their importance to predict the prevalence and tools necessary to implement AI-driven solutions.
of the disease. The rate of the risk factors is the most Future research should focus on overcoming the
important feature. challenges associated with AI implementation and
exploring new ways to harness the potential of AI in
5.2.2. Practical Contribution CVD management.
The present study identified four building blocks that The study results reveal a discrepancy between the
impact the incidence of CVDs in geographical regions. different regions of the country in terms of the
Addressing these 4 levers simultaneously could prevalence of CVDs, where rural regions are more
significantly reduce prevalence rates. severely affected by the disease than are urban regions
or large cities. The different regional prevalences of
5.2.3. Implications for future research CVDs are impacted by the level and quality of medical
equipment, and the early disease detection or
Analysis from a computer sciences point of view prescreening of medical equipment could support and
revealed a lack of information or health education increase awareness of the programs implemented in the
material about CVDs to increase awareness about these region. However, early detection (prescreening) and
diseases. The adoption of digital disease awareness- prevention programs are poorly implemented. Regions
raising campaigns could assist in overcoming this gap are facing poor accessibility awareness-raising
and enhancing people’s healthy lifestyle behaviors. A programs.
digital learning program using gamification theory The prevalence of cardiovascular diseases in
could enhance people’s adherence to awareness-raising geographical regions in Benin is statistical related the
programs[43] and thus enhance their health literacy effectiveness of pre-screening, prevention programs,
(knowledge) about CVDs. This would support them in whose effects are amplified by the level and quality of
participating in early detection campaigns and medical equipment and disease awareness campaign in
prevention. the living environment of the affected population.
People living in remote areas and facing poor access
to care services such as early disease detection could be
provided with mobile prescreening systems such as
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