The growing chronic diseases epidemiology in the context of SDGs from public health point of view in Ethiopia

NCDs are the leading causes of death globally. Currently, NCD kills 36 million people a year, a number that by some estimates is expected to rise by 17–24% within the next decade. Non-communicable disease is creating a looming problem on both developing and developed countries. While it was actually assumed to be the problem of the developed countries few decades back, it is now posing an additional burden on the disease epidemiology of developing countries already dominated by communicable diseases creating a double burden scenario. Among the different types of NCDs the four major ones on the rise in developing countries are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. If present growth trends are maintained, by 2020, NCDs will attribute to 7 out of every 10 deaths in developing countries, killing 52 million people annually worldwide by 2030.

Given the global population distribution, almost 80% of deaths due to chronic NCDs worldwide now occur in low- and middle-income countries, while only 20% occur in higher income countries. In addition to the magnitude of the burden, the economic and social pressure from these non-communicable diseases is also going to be more marked in middle- and low-income countries where the health care delivery is not well equipped to bear the impact.
The third SDG for 2030 states “Ensure healthy lives and promote well-being for all at all ages”. This goal cannot be realized unless due attention is given on the mitigation of the impact of NCDs. In order to mitigate the effect of NCDs in developing countries there are certain measures that needs to be taken as early as possible before things are out of control. Community awareness creation is the most important first step.

The society should be educated about the risk factors, prevention methods and treatment options of major NCDs. Most importantly avoiding of risk factors such as cigarette smoking, alcohol drinking, sedentary life style should be emphasized. Weight reduction and healthy diet should instead be promoted. Promotion of life style modification would definitely help in ameliorating the cardiovascular disease and diabetes pandemic that is being observed currently.

In addition to the above systematic screenings of major NCDs should be in place at health care delivery points for the most vulnerable group of the community. For example, screening for raised blood pressure, blood sugar should be routinely done at local health post and health centers. In addition to this, screening systems for some of the most common cancers like breast, cervical and prostatic cancer can help in the early detection of NCDs. The very least that can be done before establishing well organized screening system is community is awareness creation through campaigns and mass media about the early signs and symptoms of the most common cancers. For example, simple measures such as advocacy of self- examination of the breast in women might help in early detection of breast cancer.

Early detection of such NCDs in turn would enable early treatment resulting in less morbidity and mortality from the disease. However, such actions might require coordinated effort from different stake holders such as governmental and non- governmental health care delivery, policy makers, non-governmental organization and the community at large.
Chronic respiratory disease is the other rising non-communicable disease in the developing countries. In the majority of developing countries particularly in Africa, biomass fuel remains to be the major source of domestic energy consumption.

Long term exposure to biomass fuel is said to increase the risk of COPD and other respiratory diseases. In addition to this, the number of people who smoke cigarette is increasing from time to time. Air pollution from the rapidly growing industries and increasing number of motor vehicles is additionally contributing to the increasing number of patients affected by chronic lung disease. In order to halt this, utilization of alternative energy sources should be advocated. Not only cigarette smoking in public should be banned but also the ban should be enforced. The government should also control the specifications of imported motor vehicles and monitor carbon emissions from various industries.

However, the health sector should not only focus on the prevention of NCDs. Even if effective preventive measures are in place it is impossible to completely eliminate the impact of NCDs. Therefore, the other important thematic area to focus on will be equipping our health care institutions with the right diagnostic and treatment capacities for NCDs. For example, in Ethiopia cancer treatment is only being given in few centers nationally. Such treatment centers should be expanded to regional and zonal hospitals. By the same token, comprehensive cardiovascular care with advanced interventions is being given only intermittently in one or two centers nationally.
Hence, in addition of equipping the existing centers, building new specialized centers with a capacity of delivering specialized care is also of paramount importance. Concurrently, man power development should also be given due attention. Capacity building of health care professionals in order to make them able to deliver these specialized services is equally important if not more.
In conclusion, the Federal Ministry of Health should strengthen measures already started such as dedicating a directorate for NCDs control in order to halt the impact of NCDs nationally. As it is the highest national policy making body coordinating health related tasks, it should take the initiative of coordinating efforts of governmental and non-governmental institutions, professionals and professional associations and domestic and international funders and lead in a more coordinated and timely manner to work for the betterment of both the preventive and curative service against NCDs.

Author: Dr. Lalise Gemechu
Internist and Hematology fellow at AAU, TASH

NB: This article was written in January 2021

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