Over the past decade, the Sierra Leonean public health community has dedicated immense resources to combating deadly infectious disease outbreaks, including Ebola virus disease, Lassa fever, and COVID-19. This fight has coincided with efforts to reduce maternal and child mortality, tackle malaria, and strengthen healthcare systems.

However, a quieter crisis is emerging: a rapid rise in non-communicable diseases (NCDs) including heart disease and stroke. Previously viewed as diseases of wealthier nations, these conditions now rank among Sierra Leone’s leading causes of death, but receive limited attention and resources.

Given the unprecedented high rates of NCDs reported in sub-Saharan Africa (SSA) over the past decade, dismissing this issue as just another statistic would be a grave error. Even in a country accustomed to health crises, the neglect of cardiovascular disease presents a significant new challenge. Heart disease causes about a quarter of all deaths in Sierra Leone. High blood pressure, the main risk factor for heart disease, often goes unnoticed until serious events like stroke occur. Alarmingly, strokes are affecting younger populations in Sierra Leone and lead to higher rates of death and disability than in high-income countries.

Diagnosing and treating these conditions is a challenge. The country has only a handful of functioning CT scanners, and blood pressure monitors often cost more than a typical household earns in a month.  As a result, hypertension remains largely undiagnosed and untreated until severe complications arise.

The built environment further compounds cardiovascular risk. Urban planning rarely prioritizes health: there are few parks, walkable streets, or bicycle lanes, and access to clean air, clean water, and nutritious food is limited. These factors restrict physical activity and healthy diets, both essential to preventing NCDs.

Encouragingly, there are examples of progress. A recent World Bank grant of $50 million aims to support urban development and disaster risk management in Sierra Leone. While this initiative doesn’t explicitly address physical activity, it represents an opportunity to design healthier, more active urban environments. Embedding health promotion, such as green spaces and pedestrian-friendly streets, into infrastructure development could help reduce the NCD burden.

Public health interventions can offer effective solutions. Campaigns modelled after successful malaria awareness initiatives could significantly raise awareness of cardiovascular risks, emphasizing early detection and preventive lifestyle changes. Simple interventions like routine blood pressure checks during clinic visits can drastically reduce cardiovascular morbidity. Ensuring essential medications for hypertension and cholesterol control are consistently available and affordable is crucial.

Moreover, expanding medical training programs to equip local healthcare providers to manage cardiac emergencies and strokes is essential. Collaboration with international partners through telemedicine or visiting specialist programs could bridge critical healthcare gaps.

These interventions have a direct impact on Sierra Leone’s disease burden. From 2018 to 2020, cardiovascular disease accounted for 42.4% of all deaths in Sierra Leone among individuals aged 15 to 69 years. Reducing this burden would not only improve health outcomes but also enhance workforce productivity and economic resilience.

Importantly, Sierra Leone is not without a plan. The Ministry of Health and Sanitation launched a National Strategic Plan for NCDs (2020–2024), outlining goals for prevention, early detection, and integrated care. However, implementation has been limited, with persistent challenges in financing, infrastructure, and public awareness. Acknowledging the existence of this strategy is crucial, but so too is recognizing that it has not yet translated into widespread change.

Moving forward, a multi-sectoral approach is essential. Health cannot be addressed in clinics alone. It must be integrated into housing, transportation, education, and agriculture. Investment in cardiovascular health is an investment in Sierra Leone’s future. With coordinated leadership and support from international partners, the country can chart a different course, one where heart disease and stroke are no longer silent killers.

This is not just another health concern. It is a pressing challenge that demands immediate and sustained action. To delay is to lose lives. To act is to save them.

Authors:

Mohamed Bella Jalloh is a research fellow at McMaster University. A medical doctor from Sierra Leone, he holds a master’s degree in international health from the University of Oxford. His work focuses on implementation science and clinical trials, with an active research portfolio in health policy and systems, as well as global health.

Tahir Bockarie is an Overseas Development Institute, Global Fellow at Sierra Leone’s Ministry of Health. A PhD graduate from the University of Warwick with extensive research management experience at UKRI, NIHR, and Russell Group universities, he specializes in non-communicable disease prevention and health policy.

Asad Naveed currently serves as the Manager, Research Program at Sault Area Hospital. He is a medical doctor originally from Sierra Leone and holds a master’s degree in public health from the University of Washington. Notable field experience during the Ebola outbreak in Sierra Leone.

Competing interest: None

Handling Editor: Neha Faruqui