Use of mathematical modelling to estimate the impact of interventions and risk factors on cardiovascular diseases in Africa: A scoping review

Wingston Felix Ng’ambi^1,2*, Janne Estill¹, Adamson Sinjani Muula^3,4,5, Olivia Keiser¹

1. Institute of Global Health, University of Geneva, Geneva, Switzerland
2. Health Economics and Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Lilongwe, Malawi
3. Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM), Kamuzu University of Health Sciences, Blantyre, Malawi
4. Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
5. Professor and Head, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health
   Sciences, Blantyre, Malawi
   *Corresponding Author: Wingston Felix Ng’ambi; E-mail: wingston.ngambi@gmail.com

Abstract
Background
Achieving health-related Sustainable Development Goals (SDGs) in Africa is increasingly threatened by the rising burden of cardiovascular diseases (CVD), exacerbated by limited healthcare infrastructure and constrained resources. Mathematical modelling offers a powerful tool for informing CVD prevention and control strategies; however, its application in Africa remains poorly understood. This scoping review aims to map existing modelling studies, identify methodological and contextual gaps in the literature, and inform future model development for effective decision-making.
Methods
This scoping review followed Levac et al.’s framework and PRISMA-ScR guidelines to explore how mathematical models have been used to study CVD in Africa. We included studies published since 2000 that used structured models to simulate how CVD progresses and responds to risk factors or interventions. Our search, conducted in PubMed and Google Scholar, focused on models relevant to local settings and policy. Data were extracted and analysed thematically. As the review used only publicly available data, no ethical approval was needed. The protocol was registered with the Open Science Foundation.
Results
CVD modelling studies in Africa span nearly two decades, with a geographic concentration in South Africa, Nigeria, and Kenya, while many low-resource and fragile settings remain underrepresented. A range of modelling approaches were used, including decision-analytic models, microsimulation, and WHO-CHOICE frameworks, with recent studies increasingly incorporating dynamic and stochastic elements. Interventions modelled included pharmacological treatments (e.g., statins, antihypertensives), lifestyle modifications (e.g., salt reduction, increased physical activity), and community-level prevention strategies. Many models assessed combinations of interventions and accounted for multiple risk factors. However, limitations in local data availability led to reliance on extrapolated estimates, assumptions about treatment effects, and expert-informed parameterization. Few studies calibrated models to
local epidemiological data or disaggregated outcomes by equity dimensions such as gender, income, or geography.
Conclusion
While CVD modelling in Africa has progressed, its utility for informing real-world policy remains limited by insufficient incorporation of health system constraints and equity considerations. To maximize impact, future efforts should prioritize the development of context-specific microsimulation frameworks that integrate system dynamics, reflect local implementation realities, and use country specific data for calibration.
KEYWORDS: Mathematical modelling, cardiovascular diseases, cost-effectiveness, CVD, Africa, scoping review