Abstract
BackgroundThe emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed.ResultsOver 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors.ConclusionsIt is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.
Highlights
The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases
The lessons learnt from the international response to human immunodeficiency virus (HIV) and successful scale-up of public health based antiretroviral treatment (ART) programmes, despite limited infrastructure in the region, with concomitant decreases
Traditional risk factors are likely to play a part in Africa as in other places but there are few data on the distribution of these factors or the strength of their associations with non-communicable diseases (NCD) in this setting
Summary
The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. The lessons learnt from the international response to HIV and successful scale-up of public health based antiretroviral treatment (ART) programmes, despite limited infrastructure in the region, with concomitant decreases. To understand better the distribution of NCDs in SSA will require exploration of other factors that may have unique importance in the region, including potential interactions between NCDs and communicable diseases (such as HIV and its treatment), as well as understanding the relationship between malnutrition ( in early life) and risk of NCDs later in life [17,18,19]
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