Abstract
The expected growth in NCDs in cities is one of the most important health challenges of the coming decades in Sub-Saharan countries. This paper aims to fill the gap in our understanding of socio-economic differentials in NCD mortality and risk in low and middle income neighborhoods in urban Africa. We use data collected in the Ouagadougou Health and Demographic Surveillance System. 409 deaths were recorded between 2009–2011 among 20,836 individuals aged 35 years and older; verbal autopsies and the InterVA program were used to determine the probable cause of death. A random survey asked in 2011 1,039 adults aged 35 and over about tobacco use, heavy alcohol consumption, lack of physical activity and measured their weight, height, and blood pressure. These data reveal a high level of premature mortality due to NCDs in all neighborhoods: NCD mortality increases substantially by age 50. NCD mortality is greater in formal neighborhoods, while adult communicable disease mortality remains high, especially in informal neighborhoods. There is a high prevalence of risk factors for NCDs in the studied neighborhoods, with over one-fourth of the adults being overweight and over one-fourth having hypertension. Better-off residents are more prone to physical inactivity and excessive weight, while vulnerable populations such as widows/divorced individuals and migrants suffer more from higher blood pressure. Females have a significantly lower risk of being smokers or heavy drinkers, while they are more likely to be physically inactive or overweight, especially when married. Muslim individuals are less likely to be smokers or heavy drinkers, but have a higher blood pressure. Everything else being constant, individuals living in formal neighborhoods are more often overweight. The data presented make clear the pressing need to develop effective programs to reduce NCD risk across all types of neighborhoods in African cities, and suggest several entry points for community-based prevention programs.
Highlights
Non-communicable diseases (NCDs) account for more than half of the global burden of disease and this share is expected to continue to increase in the coming decades [1]
Only half of all adult deaths are due to NCDs in informal areas
The most common causes of death after age 35 in formal areas are cardiovascular diseases (35.4% of all deaths), followed by cancers (21.7%), whereas in the informal areas these account for 16.1% and 23.7%, respectively
Summary
Non-communicable diseases (NCDs) account for more than half of the global burden of disease and this share is expected to continue to increase in the coming decades [1]. The greatest increase is expected in Africa, where deaths from NCDs are expected to exceed deaths from communicable diseases by 2030 [2, 3]. This shift in the balance of causes of death has several roots. The on-going fertility decline further changes the age composition, toward more adults than children. Overlaying these demographic trends, are the important economic, social, and cultural transformations in low income countries which propel more individuals to adopt less healthy habits. Unhealthier diets, and increases in tobacco and alcohol intake, lead to higher levels of blood pressure, cholesterol and obesity, and to more NCDs [2, 5]
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