Burden Of Chronic Non-communicable Diseases Research Articles

Research on health transition in Africa: time for action

With rapidly increasing globalization, trends towards unhealthy diets, obesity, sedentary lifestyles and unhealthy habits are resulting in an increased worldwide burden of chronic non-communicable diseases (NCDs). In Africa this means that health systems face the challenge of an increasing burden of NCDs and of continuing high morbidity and mortality from communicable diseases. This health transition represents an enormous challenge to Africa as the region with the least resources for an effective response. Whereas previous epidemics, including HIV, have caught Africa unprepared, the opportunity now arises to take the advancing wave of health transition in Africa seriously. Health research has a key role to play in meeting health and development goals, and must be responsive to changing disease patterns, such as health transition. There is an urgent need for research on health transition in Africa to enable countries to respond effectively to rapidly changing health needs.Key areas of research include the following: epidemiological research so that a good understanding of the distribution in Africa of communicable and non-communicable diseases can inform health planning; research on the interactions between communicable and non-communicable diseases; health system research with a particular focus on new approaches to improve the primary care response to health transition; and policy research to evaluate the more upstream measures addressing the population-level determinants of NCDs. It is time to capitalise on the global policy environment, which is becoming more favourable to action on health transition in Africa, and implement a research agenda for health transition. Alliances have a key role to play in Africa as well as in other regions in implementing the research agenda on health transition by building research capacity and mobilizing the necessary investments.

Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda

Although chronic non-communicable diseases are traditionally depicted as diseases of affluence, growing evidence suggests they strike along the fault lines of social inequality. The challenge of understanding how these conditions shape patterns of population health in Latin America requires an inter-disciplinary lens. This paper reviews the burden of chronic non-communicable diseases in the region and examines key myths surrounding their prevalence and distribution. It argues that a social justice approach rooted in the idea of health inequity needs to be at the core of research in this area, and concludes with discussion of a new approach to guide empirical research, the 'average/deprivation/inequality' framework.

Chronic non-communicable diseases in Cameroon - burden, determinants and current policies

Cameroon is experiencing an increase in the burden of chronic non-communicable diseases (NCDs), which accounted for 43% of all deaths in 2002. This article reviews the published literature to critically evaluate the evidence on the frequency, determinants and consequences of NCDs in Cameroon, and to identify research, intervention and policy gaps. The rising trends in NCDs have been documented for hypertension and diabetes, with a 2-5 and a 10-fold increase in their respective prevalence between 1994 and 2003. Magnitudes are much higher in urban settings, where increasing prevalence of overweight/obesity (by 54-82%) was observed over the same period. These changes largely result from the adoption of unfavorable eating habits, physical inactivity, and a probable increasing tobacco use. These behavioral changes are driven by the economic development and social mobility, which are part of the epidemiologic transition. There is still a dearth of information on chronic respiratory diseases and cancers, as well as on all NDCs and related risk factors in children and adolescents. More nationally representative data is needed to tract risk factors and consequences of NCDs. These conditions are increasingly been recognized as a priority, mainly through locally generated evidence. Thus, national-level prevention and control programs for chronic diseases (mainly diabetes and hypertension) have been established. However, the monitoring and evaluation of these programs is necessary. Budgetary allocations data by the ministry of health would be helpful, to evaluate the investment in NCDs prevention and control. Establishing more effective national-level tobacco control measures and food policies, as well as campaigns to promote healthy diets, physical activity and tobacco cessation would probably contribute to reducing the burden of NCDs.

Global Pharmaceutical Development and Access: Critical Issues of Ethics and Equity

The article presents global data on access to pharmaceuticals and discusses underlying barriers. Two are highly visible: pricing policies and intellectual property rights; two are less recognized: the regulatory environment and scientific and technological capacities. Two ongoing transitions influence and even distort the problem of universal access to medications: the epidemiologic transition to an increasing burden of chronic non-communicable diseases; and the growing role of biotechnology products (especially immunobiologicals) in the pharmacopeia. Examples from Cuba and Brazil are used to explore what can and should be done to address commercial, regulatory, and technological aspects of assuring universal access to medications.

Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years.

BackgroundThe burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon.MethodsOf the 75 NPC facilities in the area, 69 (87%) received basic equipment and training in hypertension and diabetes care. Effectiveness was assessed after two years on status of equipment, knowledge among trained NPCs, number of newly detected patients, retention of patients under care, treatment cost to patients and changes in blood pressure (BP) and fasting plasma glucose (FPG) among treated patients.ResultsTwo years into the programme, of 54 facilities (78%) available for re-assessment, all possessed a functional sphygmomanometer and stethoscope (65% at baseline); 96% stocked antihypertensive drugs (27% at baseline); 70% possessed a functional glucose meter and 72% stocked oral anti-diabetics (15% and 12% at baseline). NPCs' performance on multiple-choice questions of the knowledge-test was significantly improved. During a period of two years, trained NPCs initiated treatment for 796 patients with hypertension and/or diabetes. The retention of treated patients at one year was 18.1%. Hypertensive and diabetic patients paid a median monthly amount of 1.4 and 0.7 Euro respectively for their medication. Among hypertensive patients with ≥ 2 documented visits (n = 493), systolic BP decreased by 22.8 mmHg (95% CI: -20.6 to -24.9; p < 0.0001) and diastolic BP by 12.4 mmHg (-10.9 to -13.9; p < 0.0001). Among diabetic patients (n = 79) FPG decreased by 3.4 mmol/l (-2.3 to -4.5; p < 0.001).ConclusionsThe integration of hypertension and diabetes into primary health care of NPC facilities in rural Cameroon was feasible in terms of equipment and training, accessible in terms of treatment cost and showed promising BP- and FPG-trends. However, low case-detection rates per NPC and a very high attrition among patients enrolled into care, limited the effectiveness of the programme.

Excess Weight and Adiposity in Children and Adolescents in Havana, Cuba: Prevalence and Trends, 1972 to 2005

Rising prevalence of excess weight in children and adolescents is a serious public health problem in both developed and developing countries, associated with a growing burden of chronic non-communicable diseases in youth and adults. In Cuba, population-based growth and development surveys have been conducted since the 1970s, the latest in 2005. Estimate prevalence of overweight, obesity and high adiposity in children and adolescents aged -19 years in Havana, Cuba, in 1972, 1993 and 2005, and describe secular trends in these conditions in the periods observed. A retrospective, descriptive study examined data from growth and development surveys conducted in Havana in 1972, 1993 and 2005, which obtained Body Mass Index (BMI) and left mid-arm fat area (MAFA) in the population aged < or =19 years using probabilistic sampling and comparable methods of anthropometric measurement and data verification, processing and analysis. Age- and sex-specific percentiles were used as cutoff points for diagnosing overweight, obesity and high adiposity in 3 age groups (early childhood: <5 years; childhood: 5-9 years; and adolescence: 10-19 years). Descriptive statistics were used to calculate prevalence, expressed as a percentage of the population surveyed in each nutritional status category, by sex, age group and survey year. Trends were established by comparing prevalence in 3 periods: 1972-1993, 1993-2005 and 1972-2005. Statistical significance of the percentage differences between survey years in each period was calculated using 95% confidence intervals (CI). Prevalence of excess weight (overweight + obesity) in the study population was 15.3% in 1972, 9.6% in 1993, and 16.4% in 2005, and was more frequent in males but varied by age group and survey year. Prevalence of high adiposity decreased from 13.3% in 1972 to 12.7% in 1993, increasing significantly to 28.8% in 2005. High adiposity was more frequent in males and decreased as age increased, except in children aged <5 years, who had lowest adiposity in 1972. While excess weight predominated over high adiposity in 1972 (15.3% and 13.3%, respectively), this relationship was reversed in 1993 (9.6% excess weight vs 12.7% high adiposity) and continued as a growing trend in 2005 (16.4% excess weight vs 28.8% high adiposity). Prevalence of excess weight and high adiposity generally declined during economic crisis and scarcity, and rose as the economy improved. Continued monitoring is required to detect sustained or rising prevalence of these conditions and to develop interventions to reduce health risks.

The effect of an educational intervention on patients' knowledge about hypertension, beliefs about medicines, and adherence

Background The burden of chronic noncommunicable diseases continues to rise in South Africa, leading to high rates of morbidity and mortality. The control of hypertension is far from optimal because of factors such as inadequate patient understanding of the condition and its therapy, as well as poor adherence to prescribed regimens. Objective This study investigated the effect of an educational intervention on selected hypertensive participants' levels of knowledge about hypertension, their beliefs about medicines, and adherence to antihypertensive therapy. Method Participants took part in an educational intervention that provided them with information about hypertension and its therapy through presentations, monthly meetings, and a summary information leaflet. The participants' levels of knowledge about hypertension and its therapy as well as their beliefs about medicines were measured using interviews and/or self-administered questionnaires. Levels of adherence were assessed using pill counts, self-reports, and punctuality in collecting medication refills. Paired t tests for dependent samples were performed to compare the participants' levels of knowledge about hypertension and its therapy, beliefs about medicines, and levels of adherence to antihypertensive therapy before and after the educational intervention. Results There were significant increases in the participants' levels of knowledge about hypertension and its therapy ( P < .0001). Most of the parameters used to indicate beliefs about medicines were significantly modified in a positive manner ( P < .01 for concerns about medicines, P < .01 for beliefs about the harmful nature of medicines, and P < .01 for the necessity-concerns differential). Conclusion Results of this study show that the educational intervention led to an increase in the participants' levels of knowledge about hypertension and a positive influence on their beliefs about medicines. Despite these positive changes, adequate time is required before anticipated behavioral changes, such as increased adherence, can be observed.

Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries

BackgroundChronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in low-middle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach.ObjectiveThis paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia.MethodsThis multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25–64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame.ResultsA total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATA Version 10.ConclusionThis multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities.

An average/deprivation/inequality (ADI) analysis of chronic disease outcomes and risk factors in Argentina

BackgroundRecognition of the global economic and epidemiological burden of chronic non-communicable diseases has increased in recent years. However, much of the research on this issue remains focused on individual-level risk factors and neglects the underlying social patterning of risk factors and disease outcomes.MethodsSecondary analysis of Argentina's 2005 Encuesta Nacional de Factores de Riesgo (National Risk Factor Survey, N = 41,392) using a novel analytical strategy first proposed by the United Nations Development Programme (UNDP), which we here refer to as the Average/Deprivation/Inequality (ADI) framework. The analysis focuses on two risk factors (unhealthy diet and obesity) and one related disease outcome (diabetes), a notable health concern in Latin America. Logistic regression is used to examine the interplay between socioeconomic and demographic factors. The ADI analysis then uses the results from the logistic regression to identify the most deprived, the best-off, and the difference between the two ideal types.ResultsOverall, 19.9% of the sample reported being in poor/fair health, 35.3% reported not eating any fruits or vegetables in five days of the week preceding the interview, 14.7% had a BMI of 30 or greater, and 8.5% indicated that a health professional had told them that they have diabetes or high blood pressure. However, significant variation is hidden by these summary measures. Educational attainment displayed the strongest explanatory power throughout the models, followed by household income, with both factors highlighting the social patterning of risk factors and disease outcomes. As educational attainment and household income increase, the probability of poor health, unhealthy diet, obesity, and diabetes decrease. The analyses also point toward important provincial effects and reinforce the notion that both compositional factors (i.e., characteristics of individuals) and contextual factors (i.e., characteristics of places) are important in understanding the social patterning of chronic diseases.ConclusionThe application of the ADI framework enables identification of the regions or groups worst-off for each outcome measure under study. This can be used to highlight the variation embedded within national averages; as such, it encourages a social perspective on population health indicators that is particularly attuned to issues of inequity. The ADI framework is an important tool in the evaluation of policies aiming to prevent or control chronic non-communicable diseases.

Overweight, Obesity, Central Adiposity and Associated Chronic Diseases in Cuban Adults

Introduction Prevalence of overweight and obesity is increasing worldwide in parallel with the growing burden of noncommunicable chronic diseases. According to the World Health Organization, in 2005 approximately 1.6 billion individuals aged ≥15 years were overweight and at least 400 million were obese; by 2015 these figures will almost double. Central distribution of adiposity has also been associated with higher rates of cardiovascular diseases and other conditions. Objective Determine the prevalence of overweight, obesity and central adiposity, and their association with noncommunicable chronic diseases and related lifestyle risk factors in Cuban adults. Methods The Second National Survey on Risk Factors and Chronic Diseases (ENFRENT II), conducted in 2000-2001, surveyed a representative sample of males and females aged ≥15 years using a stratified, multi-stage cluster sampling design. Data from a sub-sample of 19,519 individuals aged ≥20 years were analyzed and prevalence calculated for diabetes, hypertension, cardiovascular and cerebrovascular diseases, and for each of these variables in association with overweight, obesity and central distribution of adiposity, and with the presence of sedentary lifestyle, smoking, alcohol consumption, eating regular daily meals and daily breakfast. Results Estimated prevalence of overweight and obesity in the adult population was 30.8% (CI: 30.1-31.5) and 11.8% (CI: 11.2-12.4), respectively. Obesity prevalence was twice as high in women (15.4%; CI: 14.5-16.3) as in men (7.9%; CI: 7.3-8.6). Obesity was significantly more frequent in diabetics, hypertensives and people with heart disease, while central adiposity was significantly associated with a higher prevalence of diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, obesity and overweight. Smoking and alcohol consumption were low among overweight and obese subjects, who exhibited a higher prevalence of irregular and inadequate eating patterns. Conclusions Prevalence of overweight, obesity and central adiposity, and comorbidity with diabetes mellitus, hypertension and heart disease, are growing public health problems in Cuba. A multi-sector strategy is needed to develop comprehensive food and nutrition policies and programs aimed at halting these trends, including interventions that encourage healthy eating patterns and regular physical activity in adults and children.

Academic community medicine in 21 st century: Challenges and opportunities

Academic community medicine in 21^st century: Challenges and opportunities

WHO global strategy on diet, physical activity and health: How can Codex Alimentarius take action to support its implementation?

A profound shift in the balance of the major causes of death and disease, described as the epidemiological transition, has already occurred in developed countries and is underway in many developing countries. Globally, the burden of chronic non-communicable diseases (NCDs) has increased rapidly. In 2001, NCDs accounted for almost 60% of the 56 million deaths annually and 47% of the global burden of disease.