Non-communicable Diseases In Africa Research Articles

The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review.

Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.

Contribution of cardiovascular disease to the burden of non-communicable diseases in Africa: an analysis of data from Global Burden of Disease database, 1990–2019

Background and purpose: Disease burden of non-communicable diseases (NCDs) has been increasing in low- and middle-income countries, especially in African countries. Cardiovascular disease (CVD) is a common NCDs and the leading cause of death in Africa. Yet, evidence on the contribution of CVD to the total NCDs burden is scarce. This study aimed to investigate the contribution of CVD to the total disease burden caused by NCDs in Africa between 1990 and 2019. Methods: Data on NCDs, including CVD, were extracted from the Global Burden of Disease (GBD) database. Disease burden was measured by disability-adjusted life years (DALYs) and deaths. Results: From 1990 to 2019, the share of CVD in the total NCDs burden increased and remained as the first contributor. In 2019, NCDs caused 204 million DALYs and over 2.18 million deaths in the Africa Union, among which 49.1% of the total DALYs and 66.0% of deaths were caused by the traditional five NCDs, including CVD that accounted for the largest burden of NCDs (20.5% of DALYs and 35.2% of deaths). The proportion of CVD to the total NCDs burden was most considerable, reaching up to 32.4% and 52.4% in Northern Africa for DALYs and deaths, respectively. CVD were important contributors to NCDs burden in Africa, including ischemic heart disease (1334 DALYs per 100,000 and 27.79 deaths per 100,000) and intracerebral hemorrhage (632 DALYs per 100,000 and 13.53 deaths per 100,000) that were the top two causes of NCDs in 2019. Conclusions: CVD has been the biggest contributor to NCDs burden in the Africa Union over the thirty years. Given the increase in the share of NCDs burden attributable to CVD, it demands a close attention to implementing cost-effective policies and interventions for CVD to achieve an improvement in population health and reduction of health loss from NCDs.

Tackling noncommunicable diseases in Africa through football: The case of Malawi

AbstractThere is evidence that physical inactivity and dietary factors are more common among modifiable risk factors for noncommunicable diseases (NCDs) which are on the rise in Malawi. Football has been shown to have a wide range of health‐related benefits in health education programs, including the promotion of physical activity as a potential intervention in addressing NCDs. In Malawi, few football‐based health promotion programs have been implemented to address NCDs. Among the programs implemented were the Federation Internationale de Football Association 11 for Health initiative which was a school‐based health education program for the youth and the Malawi Ministry of Health's SPORTS FOR HEALTH initiative targeting civil servants. These programs produced significant improvement in physical activity in the participants and also increased their knowledge of both communicable and NCDs. However, these initiatives were not rolled out to many sites across Malawi. As Malawi is tackling rising cases of NCDs, football can be used as a powerful tool in promoting physical activity and it also provides an important platform for the delivery of NCDs’ health promotion messages to a wider audience. Such football‐based initiatives must be designed to directly address modifiable risk factors of NCDs. For successful implementation, there must be a good collaboration among the Ministries of Health and Sports, local football leagues, and other stakeholders.

Health literacy in low- and middle-income countries

Health literacy (HL) is defined as a person’s ability to access, understand, appraise, and apply health information in order to make sound health decisions. It has emerged as a key determinant of health outcomes, more particularly in noncommunicable diseases (NCDs). Low HL has been associated with lower use of health-care services and poorer health outcomes, including increased morbidity and mortality. During the second meeting of the EMAC-AOC Group (Epidemiology of Chronic Diseases – Central and Western Africa), HL and NCDs in low- and middle-income countries (LMICs) were discussed to explore options for interventional studies in sub-Saharan Africa on NCDs’ prevention and control. We reviewed how HL is defined, how it is associated with health outcomes and health inequities, and what instruments are available to assess it. Several published studies, systematic reviews, especially in LMICs, as well as national and international recommendations were discussed to explore potential approaches to improve HL in a study evaluating interventions for the prevention and control of NCDs in Africa.

A framework for advancing sustainable magnetic resonance imaging access in Africa.

Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings.

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review.

The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.

Editorial: Immune-Related Non-Communicable Diseases in Africa

Editorial: Immune-Related Non-Communicable Diseases in Africa

High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension.

Background:Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population.Objective:We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications.Methods:We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as <140 mm Hg systolic and <90 mm Hg diastolic at all visits, or at all but one visit. We calculated an antihypertensive non-adherence score based on self-report of missed doses at each visit (higher score = worse adherence) and used rank sum and chi-square tests to compare sociodemographic and clinical factors (including adherence) associated with blood pressure control over the year.Results:At study entry, 158 participants (23.5%) were on antihypertensive medication; participants had a median age of 51.0 years, were 66.5% female, and had a median of 6.9 years on ART. 19.0% (n = 30) achieved blood pressure control over the year of follow-up. Self-reported non-adherence to hypertension medications was the only factor significantly associated with uncontrolled blood pressure. The average non-adherence score for those with controlled blood pressure was 0.22, and for those with uncontrolled blood pressure was 0.61 (p = 0.009).Conclusions:Adults living with HIV and hypertension in our cohort had low rates of blood pressure control over one year associated with self-reported non-adherence to antihypertensive medications. Given the high prevalence and incidence of hypertension, interventions to improve blood pressure control are needed to prevent associated long-term cardio- and cerebrovascular morbidity and mortality.

Contributors

Contributors

Building Research Capacity in HIV and Noncommunicable Diseases in Africa: A Mentorship and Leadership Workshop Report.

Introduction:Few structured mentoring programs target early-stage investigators in Africa, creating a gap in mentorship skills where HIV burden is greatest. We describe findings from a Nigeria-based workshop for early-career physician scientists to build mentoring and leadership capacity in HIV and noncommunicable disease research.Methods:Baseline surveys captured participant demographics, confidence in implementing mentoring competencies, and perceived importance of workshop training domains. The workshop included didactic presentations, small group activities, and interactive discussions. Daily surveys evaluated sessions, and postworkshop surveys solicited overall course impressions.Results:Of the 33 participants, most were male (n = 21, 63.6%) and from medicine, laboratory sciences, and surgical specialties. “Building mentees' confidence” and “setting mentees' research goals” were ranked as areas where participants most believed they needed training. Sessions were rated favorably across five areas. Greatest improvements in mean scores were for confidence in identifying personal temperament styles, describing mentoring and leadership theories/frameworks, and developing mentoring plans. Additional identified workshop strengths were content relevance, leadership case series, interactive nature, and collegial atmosphere. All respondents indicated learning something new/useful/helpful in each session. At 6-month postworkshop, most respondents (25 of 26, 96%) had replicated or plan to replicate parts of the workshop in their departments/institutions.Discussion:Effective mentoring training initiatives targeting future academic leaders have the potential to create skilled academicians who can impart mentoring skills and competencies to their mentees.

The management of gout in Africa: challenges and opportunities.

The rise in non-communicable diseases in Africa presents challenges for health systems that are burdened by infectious diseases. Gout is one of those diseases that has seen an increase in numbers worldwide, including Africa. Gout is commonly associated with comorbidities and mortality. It directly impacts the quality of life, increases health costs, decreases physical function, and significantly increases the time from work, much of which is potentially avoided if treatment is instituted early. Despite advances in understanding the pathophysiology and outcomes of gout, the quality of care delivered to patients in Africa is still suboptimal. Existing data on gout in Africa reveals a general low index of suspicion due to limited knowledge of the disease by healthcare workers resulting in late diagnosis, with severe polyarticular tophaceous gout being a common presenting feature. These late presentations are associated with avoidable disability and increase the direct and indirect costs of managing gout. The challenges are related to lack of government budgetary support for staff training, infrastructure for diagnosis, and availing medicines. The picture of gout in Africa largely mirrors the west concerning risk factors, comorbidities, and burden of disease, but with some unique presentations seen in HIV, sickle cell disease, and vertigo. We discuss the challenges of gout diagnosis and management in Africa and propose a roadmap to improve gout outcomes across Africa.

Mounting an effective socio-ecological response to non-communicable diseases in Africa’s cities

ABSTRACT The burden of non-communicable diseases (NCDs) is rising rapidly in low-middle income countries. Poorly planned urbanization exponentially increases the burden of behavioral risk factors for NCDs. Contexts where people live, work, play and pray are not conducive to wellbeing, particularly the healthy behaviours people are often encouraged to adopt. An ecological framing of solutions is therefore needed to reduce non-communicable diseases across Africa. If the status quo continues, it will practically be impossible to cope with the continuing rise of NCDs on the continent. Health development in Africa must be proactive in addressing the externalities resulting from poorly planned urbanization. This commentary outlines opportunities for promoting health and wellbeing at multiple entry-points, for a robust response to NCDs. We recommend that a holistic lens continue to shape thinking, partnership-building, funding, and incentivizing action toward addressing NCDs in Africa.

Clean Energy Access for the Prevention of Non-Communicable Disease in Africa

S02: Harmonizing insights from intervention studies, contextual information and resource availability to develop policy advocacy for clean cooking and domestic fuel adoption in Africa, Room 417, Floor 4, August 27, 2019, 10:30 AM - 12:00 PM Background: In Sub-Saharan Africa, most cooking is undertaken using biomass fuels, posing significant health and environmental risks and inhibiting economic development, especially for biomass collectors unable to participate in the cash economy. In 2016, exposure to household air pollution (HAP) associated with solid fuel use resulted in an estimated 520,000 premature deaths (7% of total) in the region. Biomass burning also contributes to climate change, deforestation and perpetuating the poverty cycle particularly for women and children who share the majority of domestic responsibilities. Switching to clean burning fuels is recommended by the World Health Organization to reduce exposure to HAP and tackle climate change. Aims: Identify policy and intervention strategies to support more equitable and large-scale uptake of clean fuels across the population to inform national policy; estimate the health and climate impacts of scaled clean fuel adoption in line with government targets; develop capacity through health systems strengthening; facilitate public-policy exchange as research is undertaken alongside national policy implementation. Methods: The CLEAN-AIR(Africa) Global Health Research Group funded by the UK National Institute for Health Research is working directly with Cameroon, Ghana and Kenya government ministries who have made ambitious commitments to scale-up population access to Liquefied Petroleum gas (LPG) for the majority. Survey, quasi-experimental, ethnographic and qualitative methodologies will evaluate the anticipated reduction in personal exposures to HAP, explore factors influencing fuel stacking and clean fuel uptake and evaluate interventions that could facilitate more equitable adoption and sustained use of clean fuel (e.g. microfinance, pay-as-you cook). Anticipated outcomes: Through a multi-disciplinary program of research, capacity building and public, policy and stakeholder engagement, CLEAN-AIR (Africa) will work across health, energy and education sectors to deliver (i) impactful policy-relevant research, and (ii) develop bespoke training modules for health practitioners on the health impacts of HAP and prevention strategies to protect vulnerable groups.

Challenges and opportunities to tackle the rising prevalence of diet-related non-communicable diseases in Africa

Africa is experiencing a sharp rise in non-communicable diseases (NCD) related to rapid globalisation and urbanisation leading to shifts in dietary and lifestyle patterns characterised by increased energy intake and physical inactivity. However, unlike more resource-endowed regions, Africa has a double burden of disease: NCD co-exist with infectious diseases including lower respiratory tract infections, HIV/AIDS and diarrhoeal diseases. The African economy is also relatively weaker, making it difficult to cope with this burden. It is postulated that NCD will soon overtake infectious diseases as the number one cause of death in the African region. The recognition of NCD as diseases and obesity as a related risk factor is weak in Africa, compounded by stigma associated with wasting in HIV/AIDS and obesity being perceived as a sign of wealth, achievement and care. There is also a dearth of data on overweight and obesity in the region and little knowledge that infant feeding practices, such as breast-feeding, are linked to reduced risk of NCD in both children and mothers. While complex multi-sectoral approaches to address this NCD menace are needed, Africa may benefit from taking simple initial steps to address NCD risk factors including: (1) behaviour change communication to challenge perceptions on NCD; (2) promoting and protecting breast-feeding; (3) formulating policies and regulations limiting wide availability of unhealthy foods; (4) mainstream nutrition education in school curricula and (5) collection of accurate data based on indicators that can reflect the double burden of disease and malnutrition; and fostering multi-sectoral actions against NCD.

Synergies in the fights against HIV/AIDS and against noncommunicable diseases in Africa.

Synergies in the fights against HIV/AIDS and against noncommunicable diseases in Africa.

Objective measurement of physical activity: improving the evidence base to address non-communicable diseases in Africa

### Summary box The benefits of physical activity are wide ranging and associated with reduced disease risk and improved mental health. Strong evidence from high-income countries (HICs) has revealed a...

The significance of HIV and non-communicable diseases in Africa

No Abstract Keywords: Human Immunodeficiency Virus, communicable diseases, non-communicable diseases, Rwanda, sub-Saharan Africa

Evaluation of all African clinical practice guidelines for hypertension: Quality and opportunities for improvement.

Good-quality clinical practice guidelines (CPGs) provide recommendations based on current best-evidence summaries. Hypertension is a prevalent noncommunicable disease in Africa, with disastrous sequelae (stroke, heart, and kidney disease). Its effective management relies on good quality, current, locally relevant evidence. This paper reports on an all African review of the guidance documents currently informing hypertension management. Attempts were made to contact 62 African countries for formal guidance documents used nationally to inform diagnosis and management of hypertension. Their quality was assessed by using Appraisal of Guidelines for Research & Evaluation (AGREE) II, scored by 2 independent reviewers. Differences in domain scores were compared between documents written prior to 2011 and 2011 onward. Findings were compared with earlier African CPG reviews. Guidelines and protocols were provided by 26 countries. Six used country-specific stand-alone hypertension guidelines, and 10 used protocols embedded in Standard Treatment Guidelines for multiple conditions. Six used guidelines developed by the World Health Organization, and 4 indicated ad hoc use of international guidance (US, Portugal, and Brazil). Only 1 guidance document met CPG construction criteria, and none scored well on all AGREE domain scores. The lowest-scoring domain was rigour of development. There was no significant quality difference between pre-2011 and post-2011 guidance documents, and there were variable AGREE II scores for the same CPGs when comparing the African reviews. The quality of hypertension guidance used by African nations could be improved. The need for so many guidance documents is questioned. Adopting a common evidence base from international good-quality CPGs and layering it with local contexts offer 1 way to efficiently improve African hypertension CPG quality and implementation.

The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana.

Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services.

Driving a greater understanding of non-communicable diseases in Africa through collaborative research: the experience of the GSK Africa NCD Open Lab

# Background The majority of premature deaths from non-communicable diseases (NCDs) occur in low-income countries. However, clinical research in these patient populations is generally lacking. Thus, many treatment paradigms for NCDs are either absent or extrapolated from populations with different genetics, health needs, and socio-economic circumstances. # Methods To evaluate the outcomes from the first call for proposals from the GSK Africa NCD Open Lab. Funding was offered to research projects aiming to improve understanding and generate new knowledge of NCDs in African populations. Proposals were sought for projects relating to cancer, cardiovascular disease, diabetes, chronic respiratory disease or chronic kidney diseases. The proposal had to be led by African scientists from Cameroon, The Gambia, Ghana, Kenya, Cote d'Ivoire, Malawi, Nigeria or Uganda and include a capacity building component. # Results The 155 eligible proposals covered oncology (31.0%), cardiovascular disease (27.1%), metabolic disorders such as diabetes (20.6%), chronic respiratory disease (9.7%) and chronic kidney disease (6.5%). Most applications were from Nigeria (37.8%), Kenya (17.3%) and Uganda (13.5%). Following initial review, 23 proposals were considered by a Scientific Advisory Board, and ten were invited to submit full applications. Five projects were funded in cardiovascular disease, the interaction between cardiovascular disease and HIV infection, breast cancer, asthma and chronic kidney disease/diabetes. Principal investigators were from Nigeria, Uganda and Malawi with collaborators from Cameroon, Ethiopia, Kenya, Mozambique, South Africa, the UK, USA and the Netherlands. All of the projects involved research capacity strengthening elements. # Conclusions These projects have the potential to improve the understanding of the aetiology and natural history of specific NCDs, while also informing the development of clinical guidelines for the effective management of disease. However, far more needs to be done to address capacity building and funding for NCD research in Africa.