Stroke in Africa: profile, progress, prospects and priorities.

Stroke and high blood pressure are major causes of death and disability worldwide. Although comprehensive stroke surveillance data for Africa are lacking, the available data show that age-standardised mortality, case...

The rising burden of non-communicable diseases in sub-Saharan Africa

Because of the urbanization, demographic transition and influence of globalization, the lifestyle of people in many of the low and middle income countries (LMIC) is changing; heading to unhealthy dietary habit, physical inactivity and use of cigarette and alcohol.The lifestyle changes on the background of earlier malnutrition, inevitably leads to central obesity.This with the stressful situation caused by the competitive environment catalyzes the surge of Non Communicable Diseases (NCDs).Reports showed that the burden of NCDs in LMICs is on the rise.As a result, NCDs are responsible for two-thirds of the world's deaths-80% in low-and middle-income countries.In sub-Saharan Africa, NCDs contribute a third of the disability-adjusted life year burden.However, resources allocated to prevent and treat NCDs in LMICs are none or little (1).Until recently, communicable diseases remained the sole priority for health policy though they do not constitute the major contributor to the burden of disease in terms of disability-adjusted life years or mortality in any region of the world apart from sub-Saharan Africa (2, 3).Though essential to reduce the future disease burden, prevention interventions will do little for those people who have already developed NCDs, and who are essentially being used to validate investments that will come too late to help them.While working on limiting the number of future NCD patients, an important duty is to ensure that people with NCDs receive quality care today.Investing to improve primary care to shoulder NCD services-the main entry point to health services for most people in resource-limited settingshas the potential to overcome some of these problems (4).From the successful experience gained in delivering interventions for communicable diseases such as HIV, tuberculosis

HIV infection, a communicable disease, and noncommunicable diseases (NCDs) are among the major health concerns worldwide. An estimated 33 million people live with HIV, two-thirds of them in sub-Saharan Africa, where three-fourths of all AIDS-related deaths occur.

Improving responsiveness of health systems to non-communicable diseases

Traditionally, biomedical research endeavors in low to middle resources countries have focused on communicable diseases. However, data collected over the past 20 years by the World Health Organization (WHO) show a significant increase in the number of people suffering from non-communicable diseases (e.g. heart disease, diabetes, cancer and pulmonary diseases). Within the coming years, WHO predicts significant decreases in communicable diseases while non-communicable diseases are expected to double in low and middle income countries in sub-Saharan Africa. The predicted increase in the non-communicable diseases population could be economically burdensome for the basic healthcare infrastructure of countries that lack resources to address this emerging disease burden. Biomedical research could stimulate development of healthcare and biomedical infrastructure. If this development is sustainable, it provides an opportunity to alleviate the burden of both communicable and non-communicable diseases through diagnosis, prevention and treatment. In this paper, we discuss how research using biomedical technology, especially genomics, has produced data that enhances the understanding and treatment of both communicable and non-communicable diseases in sub-Saharan Africa. We further discuss how scientific development can provide opportunities to pursue research areas responsive to the African populations. We limit our discussion to biomedical research in the areas of genomics due to its substantial impact on the scientific community in recent years however, we also recognize that targeted investments in other scientific disciplines could also foster further development in African countries.

Background: In sub-Saharan Africa, communicable diseases have long been among the most prominent contributors to disease burden. However, like most low-income and middle-income countries across the globe, countries in sub-Saharan Africa are experiencing a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles featuring an increasing predominance of chronic, non-communicable diseases (NCDs). Objective : The main objective of this study is to investigate the magnitude of non-communicable chronic diseases at the Chantal Biya Foundation in Yaoundé. Design and participants: This is an institution-based and cross-sectional study conducted from january to december 2018. Participants were in and out patients who visited the institution and whose a medical condition was clearly diagnosed. Results : Of the 643 medical records, leading causes of visit were infectious diseases (51.1%), followed by NCDs (48.9%). Diagnosed NCDs range from sickle cell disease (5.7%), injuries (9.8%), cardiovascular diseases (12.0%), to cancers (25.0%). Conclusion There is a significant burden of NCDs among adolescents in Yaoundé. Then, interventions for primordial prevention (ie, actions to inhibit the emergence of NCD risk factors) and primary prevention (ie, actions on existing NCD risk factors), as well as educational programmes on leading modifiable behavioural risk factors and metabolic risk factors are crucial.

Cancer and palliative care in Africa.

NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

Background: The prevalence of non-communicable diseases (NCD) is increasing in recent years in low income countries in sub-Saharan Africa because of changing disease patterns following socioeconomic development. Nevertheless, communicable diseases (CD) still remain the predominant health problem. At present, non-communicable diseases are not a high priority in sub-Saharan Africa but the probability of death from a NCD is higher in sub-Saharan Africa than in the developed world. It is therefore important to know the existing disease burden due to NCD with a view to alerting policy makers and health workers of the trend of disease in our environment. Objectives: To determine the pattern of admission of paediatric patients seen at the children\'s ward of the University of Port Harcourt Teaching Hospital (UPTH) and ascertain the pattern of non-communicable diseases. Methods: The study was retrospective and involved analysis of data from the admission records of the children\'s wards of the UPTH from February 2004-November 2005. Patients with non-communicable diseases were analysed for this study. Results: A total of two thousand four hundred and fourteen (2414) children were admitted during the period of study. Out of these, 479 (19.8%) had non-communicable diseases consisting of 279 (58.2%) males and 200 (41.8 %) females with a male: female ratio of 1.4:1. The top five non-communicable diseases were sickle cell disease (SCD) (17.1%), malignancies (14.8%), renal diseases (12.9%), tetanus (10.2%) and malnutrition (10.0%). Conclusion: This study suggests a concomitant rise in NCD with four of them being among the top 10 disease burden when combined with communicable diseases. This poses a risk of a \'double burden\' of disease which we cannot afford in our country which is fraught with poor government policies, poverty and poor funding of the health sector. Effective strategies are needed to control the risk factors for NCD. Keywords: Childhood, Non-communicable disease, Double burden, Port HarcourtPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 204-210

Noncommunicable diseases (NCDs) cause more than half of all deaths in low- and middle-income countries, claiming an estimated 29 million lives each year (of 36 million NCD deaths worldwide).1 About 30% of these deaths occur before the age of 60. Death and disability due to NCDs are rising in all regions of the world but most rapidly in sub-Saharan Africa, where the projected increases in NCDs will outpace reductions in infectious diseases (contributing to a rising “double-burden” of disease).2 In sub-Saharan Africa, women aged 15–49 are already dying from NCDs at a rate four times higher than women living in high-income countries.1 This burden of premature mortality and disability poses a threat to human, social and economic development. More than half of all tuberculosis deaths in India are attributed to tobacco, and over a quarter of new tuberculosis cases in countries with the highest burden are attributed to tobacco use and diabetes.3 Where public health systems are weak, payment for care can trap poor households in cycles of debt and illness. In India, for example, treatment for diabetes costs an affected person on average 15–25% of household earnings.4 A World Bank study showed that cardiovascular disease leads to catastrophic expenditure for 25% of Indian families and drives 10% of families into poverty.5 People with NCDs are also more likely to miss work, become unemployed or retire early.6 In view of such evidence, the World Economic Forum has ranked NCDs as among the top global threats to economic development.7 Scientists agree that a comprehensive package of primary prevention, health-care interventions and improved surveillance can substantially reduce the burden of NCDs.8,9 Building on this evidence, the 193 WHO Member States adopted a global strategy for the prevention and control of NCDs at the World Health Assembly in 2000. Subsequently, WHO has adopted the Framework Convention on Tobacco Control, the Global Strategy on Diet, Physical Activity and Health, and the Global Strategy to Reduce the Harmful Use of Alcohol. Tools are thus in place to reduce the burden of NCDs, enshrined in WHO’s 2008–2013 Action Plan for the implementation of the global strategy.10 Reducing the burden of NCDs is no longer just a technical issue, but a political problem.11 Health ministers and policy-makers in developing countries are aware of the burden and the existence of cost-effective interventions. Yet, thus far, donors and the international development community have been slow to respond, in part because NCDs are not among the Millennium Development Goals. Despite repeated donor commitments such as the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, NCDs receive less than 3% of development assistance for health even though they cause more than one-third of all premature deaths.12 WHO’s Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases provides the roadmap for change.13 Since its adoption in 2008, a global movement has begun to emerge around its shared goals, led by leaders from developing countries. For example, the Doha Declaration on Noncommunicable Diseases and Injuries called for the integration of NCD prevention and control into the global development agenda. Discussions during the United Nations Economic and Social Council meeting in July 2009 led to a United Nations General Assembly Resolution in May 2010, requesting the United Nations convene a high-level meeting in September 2011 with the participation of heads of state and government.14 Just as the HIV/AIDS high-level meeting in 2001 marked a turning point in the HIV epidemic,15 this meeting provides an opportunity to raise the priority given to NCDs within the global development agenda. Preparations for the high-level meeting have already begun through regional consultations in all six WHO regions. These consultations have resulted in declarations or outcome documents that identify priorities for action against NCDs and outline the expectations of Member States. Based on the regional consultations, some of these expectations include: a greater commitment from policy-makers to NCD prevention; more effective mechanisms and monitoring of intersectoral action; greater accountability of non-health sectors; and scaling-up of WHO’s Action Plan. Ultimately the outcomes of the high-level meeting will depend on the expressed priorities of Member States. At the very least, the meeting should increase awareness of NCDs among policy-makers and achieve higher levels of political commitment. The involvement of the health profession is crucial to ensure that countries prepare well for the high-level meeting and focus their discussions on intensifying preventive action against NCDs and strengthening health-care interventions. If the health profession provides leadership and support to global and national initiatives to address NCDs, their active involvement will play a pivotal role in altering the course of the epidemic and averting millions of premature deaths.

Background: Definitive information on the strength of association between various risk factors and cardiovascular disease in Africa is lacking. Objective: We conducted a systematic review of studies investigating risk factors for acute myocardial infarction (AMI) and stroke in Africa. Data sources: We searched Medline and Embase as well as the reference lists of the included articles. Study eligibility criteria: We included case-control and cohort studies conducted in an African country, which assessed risk factors for first episodes of (AMI) or stroke in people of any age. Methods: Two independent reviewers screened studies for eligibility, extracted data and assessed study quality. We described measures of association (odds ratios) with confidence intervals of risk factors for AMI and stroke separately. Results: Twelve articles reporting results from five case-control studies met our inclusion criteria but only one study (INTERHEART ) investigated risk factors for AMI. No eligible cohort studies were identified. The direction of association for established risk factors for AMI and stroke seem to be similar globally but the strength of association of various risk factors varies between countries and within African ethnic groups. In Africa, diabetes and hypertension had the highest risk associated with AMI and hypertension was the strongest risk factor for stroke. Overall, the quality of the included case-control studies was good. Conclusions and implications: Our results confirm the urgent need for prospective studies investigating risk factors for AMI and stroke in African populations. A few high quality case-control studies exist but these do not adequately represent the cultural and genetic diversity in Africa, or the influence of infections on cardiovascular outcomes. Dynamic risk factors that rely on self-report such as diet, physical activity and stress will be better assessed through longitudinal cohort studies.

Noncommunicable diseases (NCDs) are a major and increasing global health issue. The World Health Organization (WHO) estimates that NCDs represent 63% of all global deaths of which 3.9 million are due to chronic respiratory diseases (CRDs) and Chronic Obstructive Pulmonary Disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of these deaths occur in Low and Middle Income Countries (LMICs). COPD affects 329 million people, almost 5% of the world's population. In addition, asthma affects 334 million people, again representing almost 5% of the world's population. There is limited literature published on the epidemiology of COPD and Asthma from Sub-Saharan Africa (SSA) and Middle East and North Africa (MENA). Both diseases are under-diagnosed and underestimated in both SSA and MENA regions. The burden of COPD in sub-Saharan Africa is disputed and reports offer variable prevalence estimates, ranging from 4.1% to almost 22.2%. SSA and MENA countries report similar mortality rates from COPD of 18 per 100,000 population (2001 data). Asthma is a less common cause of death than COPD but is a major cause of morbidity; WHO estimates that there are 250,000 deaths per year from asthma, mainly in LMICs and it remains in the top twenty causes of disability in children globally. Risk factors for CRD are genetic and environmental; the latter dominated by air pollution exposures including tobacco smoke, household air pollution, outdoor air pollution and occupational exposures.

Introduction: The prevalence of chronic kidney disease (CKD) in Africa is generally higher than global averages. Moreover, the management of patients with CKD suffers huge disparities compared to the rest of the world. We reviewed the literature on the major challenges in the management of kidney disease in Africa and suggest ways to bridge the gap for better kidney care on the African continent. Results and recommendations: The prevalence of CKD in Africa is 15.8%. Kidney failure is associated with increased morbidity and mortality as a result of limited infrastructure and out-of-pocket payment for renal replacement therapy in most parts of the continent. The increasing prevalence of CKD results from epidemiological transition with increasing non-communicable diseases (NCDs) and established communicable diseases. Furthermore, Africa has unique risk factors and causes of kidney disease such as sickle cell disease, APOL1 risk alleles, and chronic infections such HIV, and hepatitis B and C. Challenges facing kidney care in Africa include poverty, weak health systems, inadequate primary health care, misplaced priorities by political leaders, a relatively low nephrology workforce, poor identification of acute kidney injury (AKI), low transplantation rates as well as a lack of sustainable prevention policies and renal registries. To bridge the gap to better kidney care, there should be more community engagement, advocacy for increased government support into kidney care, comprehensive renal registries, training of a greater nephrology workforce, task shifting of nephrology services to non-nephrologists, expanded access to renal replacement therapy and promotion of organ donation. Conclusion: Africa needs greater investment in kidney health. Keywords: chronic kidney disease, Africa, sub-saharan Africa, Kidney failure, kidney health

Background and purposeStroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized.MethodsWe conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist’s examination to estimate the prevalence of stroke.ResultsOur survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO’s world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25–34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7–6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0–2.6], p = 0.045) were more prevalent in people with stroke.ConclusionsThe age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.