By Oluwasola Samuel, Freelance Writer, with medical review and editorial support from The DLHA Team
Introduction
Many sub-Saharan African countries are still evolving economies on many fronts with growing health challenges that often go unnoticed. One of such challenges is the increasing prevalence of non-communicable diseases, also known as NCDs.
What are non-communicable diseases, you may want to ask?
According to WHO, non-communicable diseases are diseases that cannot be spread from one person to another through contact or infection. These diseases are often caused by poor lifestyle practices that pose a long-term threat to one's life.
NCDs can affect anyone regardless of their age, class, culture, religion, or country. But it's more prevalent in older people and some regions than others.
NCDs usually have a prolonged course of illness and are rarely completely cured. Cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases are making their presence felt in Africa's diverse societies.
Due to personal choices, many people lead riskier lifestyles, such as the harmful use of alcohol and tobacco, poor diet, and inactivity. These and more contribute significantly to the prevalence of NCDs in Africa.
In this piece, we will explore the landscape of non-communicable diseases in sub-Saharan Africa; the risk factors, socio-economic and cultural challenges, and steps that can be taken to reduce the prevalence of NCDs in the region.
Non-communicable diseases account for 74% of global deaths.1 These diseases are most prevalent in low- and middle-income countries. For instance, according to a WHO report in 2022 on NCDs in seven populous African countries, between 100,000 and 450,000 people die annually due to NCDs.2 This puts more pressure on a healthcare system that's already overstretched.
There are different non-communicable diseases, but some are more common than others. The common ones contribute to over two-thirds of global deaths.
The four major global types of NCDs include:
This is a disorder of metabolism where the body is unable to produce enough of a special hormone called insulin. Insulin regulates blood sugar in the body. Over time, if the poor regulation of blood sugar continues, the diabetes may cause further complications like blindness, nerve damage, kidney failure, or cardiovascular diseases.
The WHO estimates that 24 million people are living with diabetes in Africa, and it has a projected figure of up to 55 million by 2045; that's about a 129% increase.3 The reasons for these high numbers are because the region lacks adequate and equipped testing facilities, inadequate number of trained healthcare personnel, poor access to health facilities, and a low public awareness of the disease.
There are four major types of diabetes, and they include:
These groups of diseases or disorders affect the heart or blood vessels. It's the second-leading cause of death in Africa after communicable diseases. In 2019, there were over 1 million deaths from CVDs which summed up to 5.4% of all global CVD-related deaths and 13% of all deaths in Africa.4
Anyone with a heart or blood vessel may encounter any of the following issues:
The most common cardiovascular diseases in Africa include:
This is a disease that is characterised by the uncontrolled division and growth of abnormal cells. These cancerous cells may go on to invade nearby tissues, causing a metastatic (uncontrollable growth) condition and other serious health problems. Cancer can affect anyone regardless of age, sex, social status, race, or religion.
Cancer is the second-deadliest type of NCDs worldwide, claiming up to 9.3 million lives annually.1 In 2020, over 500,000 cancer deaths were estimated to have occurred in sub-Saharan Africa.5
According to research, it's projected that there will be an estimated 2.1 million new cases and 1.4 million cancer-related deaths by 2024.6 The researchers also noted that dietary and lifestyle changes, along with behavioural and environmental risk factors, are contributing to the increase.
In no particular order, the most common cancer-related deaths in Africa occur due to:
Chronic respiratory diseases affect a person's airways and other structures of the lungs, making it difficult to breathe properly due to a shortage of air volume in the lungs.7 They're more prevalent in low- and middle-income countries.
Some of the diseases included in this category of NCDs include:
CRDs are not curable, but they can be managed through lifestyle changes, medications, pulmonary rehabilitation, or oxygen therapy. In some cases, surgery may be advised if symptoms worsen and become life-threatening.
In Africa, non-communicable diseases have been on the rise for about two decades, and they're projected to overtake communicable, neonatal, maternal, and nutritional diseases by 2030. The risk factors responsible for the rise in NCDs in Africa include:
These risk factors are preventable; that's why they're called "behavioural risk factors", so lifestyle changes are advised.
If you have any of the metabolic risk factors, you should address them through medical treatment and lifestyle adjustments as may be recommended by your caregiver.
Sub-Saharan Africa is a vast and diverse region with different people and cultures and non-communicable diseases are shaped by medical, socioeconomic, and cultural factors that play a significant role in their prevalence and how they are addressed in different countries of the region.
Two important factors affect how NCDs are addressed in Africa, and they are:
1. Socio-Economic:
NCDs are common in low- or middle-income economies. In Africa, the widespread low financial power is a strong causal factor of limited access to healthcare, and the cost of treatment, medications, and checkups that are often paid out-of-pocket can be overwhelming for most people living in the region. Poor financial power most often causes unnecessary delay in seeking medical help that in turn make the condition worse and cause death in the end.
2. Cultural:
Africa is a continent with rich culture and values that are deeply rooted in the fabric of the respective societies. Africans hold culture in high esteem and can do anything to protect it. Some African delicacies tend to have high salt or sugar content, contributing to the development of non-communicable diseases like diabetes and hypertension.
Dietary habits, traditional beliefs, and lifestyle practices often contribute to the risk factors associated with NCDs, making it difficult to curb their prevalence. The healthcare system should collaborate with locals to educate them on the risks of NCDs while integrating traditional medicine with the modern healthcare system to have a better healthcare outcome for locals.
Non-communicable diseases are silent killers; sometimes they don't show symptoms until they have progressed to an advanced stage. This makes early detection and prevention top public health priorities in reducing the burden and impact of NCDs in sub-Saharan Africa.
Here are some of the steps that should be undertaken at personal and policy levels:
Note that successful implementation of the above-listed interventions calls for collaboration between respective tiers of government, healthcare providers, non-governmental organisations, communities, and many other local agents of influence.
While some African countries have made progress in detecting and treating non-communicable diseases at local healthcare facilities, many still face public health challenges with bringing these diseases under control. More research and innovative approaches are needed..
The African Union High-Level Panel on Emerging Technologies (APET) recognizes that digital health tools like mobile phones, apps, and social media can assist in preventing, diagnosing, treating, and managing non-communicable diseases (NCDs).8 APET believes that these innovative digital tools can enhance the quality of healthcare for NCD patients by helping to provide health information, and gather data for the development of preventive healthcare programs.
The adoption of technology in treating non-communicable diseases in Africa is just starting to gain attention, but has the potential to benefit people by enhancing access to care, reducing costs, and improving outcomes.
A few African countries, like Nigeria, are adopting new technologies for treating NCDs. For instance, they use tele-psychiatry (digital treatment) to offer mental health care in remote areas. Smartphones and text messages are used to assist those with diabetes and sickle cell anemia. Text messages remind patients to take their medications, and smartphones enable them to communicate with healthcare professionals for consultations.
The progressive increase of non-communicable diseases in Africa is a great challenge that requires collaboration and effort from governments, policymakers, health organizations, health professionals, communities, and the general public. NCDs are common in Africa because of financial constraints, cultural challenges, and a low awareness of the risk factors for the diseases.
For African countries to lower the burden of NCDs, there needs to be a great deal of investment in local research and innovations that help to find better and more cost effective locally developed methods to address the social determinants of health.
It's also imperative to note that addressing non-communicable diseases requires a holistic approach that includes health campaigns, seminars, education, and social insurance funded access to quality health care.
All efforts to create a more NCD-aware and conscious society will help to reduce its burden and impact in Africa positively.
1. Piovani D, Nikolopoulos GK, Bonovas S. Non-Communicable Diseases: The Invisible Epidemic. J Clin Med. 2022 Oct 8;11(19):5939. doi: 10.3390/jcm11195939.
2. World Health Organization (WHO). Deaths from Non-communicable diseases on the rise in Africa [Internet, April 11, 2022.. [cited 2023 Sep 2].
3. Integrated African Health Observatory/World Health Organization (WHO). Diabetes, a silent killer in Africa | Analytical Fact Sheet [Internet. March 2023]. [cited 2023 Sep 2].
4. World Heart Federation. Africa | Living with CVD in Africa. {Internet, n.d.}. [cited 2023 Sep 2].
5. Bray F, Parkin DM, African Cancer Registry Network. Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs. Lancet Oncol. 2022 Jun;23(6):719–28.
6. Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, et al. Mapping cancer in Africa: a comprehensive and comparable characterization of 34 cancer types using estimates from Globocan 2020. Frontiers in Public Health Vol. 10, 2022 | https://doi.org/10.3389/fpubh.2022.839835.
7. World Health Organization (WHO). Chronic respiratory diseases (Asthma, copd) [Internet, n.d.]. [cited 2023 Sep 2].
8. AUDA-NEPAD. Combating non-communicable diseases in Africa using smart technology. (Internet. Dec. 30, 2022) [cited Sept 2, 2023]
Published: September 15, 2023
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