The prevalence and correlates of target organ damage in rural Kenya and The Gambia: a cross-sectional study

Background Sub-Saharan Africa (SSA) is experiencing a substantial and growing burden of cardiovascular disease (CVD), characterized by early-onset events and poorer prognoses compared to Europe and North America.1–3 The lack of accurate CVD detection systems tailored to rural, low-resource SSA settings exacerbates disease burden and healthcare costs.4 While assessing target organ damage (TOD) is a cornerstone of cardiovascular risk stratification, epidemiological data on TOD from rural SSA remain scarce.5 Objective To determine the prevalence and correlates of TOD in two distinct rural settings in SSA. Methods We conducted a population-based, cross-sectional study using random sampling in rural Kenya and The Gambia (July 2023–December 2024).6 Detailed demographic and clinical data were collected from 1,212 participants. Blood pressure (BP) was assessed via 24-hour ambulatory monitoring. TOD was evaluated using reference-standard electrocardiography, speckle-tracking echocardiography, and aortic pulse wave velocity. Results The mean age was 56.8 years (62.9% female). TOD was highly prevalent across all age groups, with an overall prevalence of 56.8%. Multivariable analysis identified age (40–49 years: OR 1.43, 95% CI 0.92–2.21; >70 years: OR 6.24, 95% CI 3.86–10.10, vs. 30–39 years) and BP status as defined by ESC 2024 guidelines (elevated BP: OR 1.70, 95% CI 1.06–2.74; hypertension: OR 4.52, 95% CI 2.68–7.61, vs. non-elevated BP) as independent predictors of TOD. Participants in The Gambia had a higher prevalence of TOD compared to those in Kenya (OR 1.99, 95% CI 1.50–2.63). Functional cardiac TOD—including abnormal global longitudinal strain and left ventricular systolic dysfunction—was further associated with elevated low-density lipoprotein cholesterol (OR 1.64, 95% CI 1.12–2.40) and abnormal body mass index (underweight: OR 1.79, 95% CI 1.10–2.91; overweight/obesity: OR 1.89, 95% CI 1.23–2.89). Modelling showed a clear positive relationship between increasing SBP and the probability of TOD (Figure 1). Notably, even at the lowest age group (30–39 years) and systolic BP (100 mmHg), the predicted probability of having TOD for both females and males was >25%. Conclusions We report a high prevalence of TOD among apparently healthy adults with low reported comorbidities, highlighting major limitations in current risk stratification tools. While age and BP are universal correlates, the high TOD burden in younger groups, geographic variation, and the impact of lipids and body composition on cardiac function have significant policy implications for CVD screening and treatment strategies in resource-limited African settings.