chronic respiratory diseases and non communicable … · chronic respiratory diseases and non...

CHRONIC RESPIRATORY DISEASES CHRONIC RESPIRATORY DISEASES

and and NON COMMUNICABLE NON COMMUNICABLE

DISEASES in THE WHO AFRICAN DISEASES in THE WHO AFRICAN

REGIONREGION

Boureima Hama SAMBO, MD, PhD

Regional Advisor, Non Communicable Diseases Management

DNC WHO/AFRO, Brazzaville

GARD General Meeting, Istanbul, GARD General Meeting, Istanbul, TurkeyTurkey 30 May 200830 May 2008

Division, Prevention & Control of Non Communicable Diseases - DNC2 |

NCD situationNCD situationNCD situationNCD situationNCD situationNCD situationNCD situationNCD situation

CCardiovascular diseases, cancer, mental health, diabetes, ardiovascular diseases, cancer, mental health, diabetes,

chronic respiratory disease, genetic disorders and injuries are chronic respiratory disease, genetic disorders and injuries are

increasing in the WHO African Region.increasing in the WHO African Region.

Lack of reliable information on Lack of reliable information on NCDsNCDs inclincl CRDsCRDs contributing to contributing to

low prioritization in countries.low prioritization in countries.

Rapid epidemiological transition: growing NCD burden added to Rapid epidemiological transition: growing NCD burden added to

existing communicable diseases existing communicable diseases �� the Region face a double the Region face a double

burden of disease.burden of disease.


NCD situationNCD situationNCD situationNCD situationNCD situationNCD situationNCD situationNCD situation

Majority of Majority of NCDsNCDs share some behavioural, environmental or share some behavioural, environmental or

genetic risk factors e.g. smoking; environment; obesity; high genetic risk factors e.g. smoking; environment; obesity; high

alcohol consumption; physical inactivity; diabetes and lipid alcohol consumption; physical inactivity; diabetes and lipid

disorders. disorders.

NCDsNCDs, urbanization and poverty interconnected in a vicious cycle , urbanization and poverty interconnected in a vicious cycle

and related to changes in lifestyles.and related to changes in lifestyles.

Aware of the rising burden of chronic diseases, a few countries Aware of the rising burden of chronic diseases, a few countries

are adopting integrated approaches to curbing the epidemic.are adopting integrated approaches to curbing the epidemic.


STEPS DataSTEPS DataSTEPS DataSTEPS DataSTEPS DataSTEPS DataSTEPS DataSTEPS Data

EBSEBS

EBPEBP

ObesityObesity

AlcoholAlcohol

TobaccoTobacco

%%

10101.41.466664.94.9

30.930.932.1132.1127.627.621.721.733.133.117.617.62525161632.532.529.129.122.422.4

7.17.115.715.714.114.19.19.17.17.12.422.4218183.33.38.68.616.416.420.920.9

61.661.627.427.474.774.7717177.277.242.542.5111139.639.662.562.55.15.1--

4.64.619.519.512.112.19.59.518.718.72020448814.414.412.812.818.918.9

ETHETHBTWBTWZWEZWECIVCIVMOZMOZMDGMDGCMRCMRERIERICOGCOGDZADZAMAUMAU


Percentage of students who drank so much alcohol that they Percentage of students who drank so much alcohol that they

were really drunk one or more times were really drunk one or more times

42.8

15.218

31.8

23.220.9

16.5

0

5

10

15

20

25

30

35

40

45

Zam

bia

Uganda

Swaziland

Nam

ibia

Kenya

Botsw

ana

Zim

babwe

GSHS ( Studentsaged 13–15 years)


Percentage of students who spent three or more hours per day Percentage of students who spent three or more hours per day

sitting and watching television, playing computer games, talkingsitting and watching television, playing computer games, talking

with friends, or doing other sitting activitieswith friends, or doing other sitting activities

32.6

27.531

40.9

34.5

43.8

0

5

10

15

20

25

30

35

40

45

Zambia

Uganda

Nam

ibia

Kenya

Botsw

ana

Zimbabw

e

GSHS ( Studentsaged 13–15 years)


IssuesIssuesIssuesIssuesIssuesIssuesIssuesIssues

�� RiskRisk factorsfactors of of todaytoday are are NCDsNCDs inclincl

Chronique Chronique RespiratoryRespiratory DiseasesDiseases of of

tomorrowtomorrow


ISSUES ISSUES ISSUES ISSUES ISSUES ISSUES ISSUES ISSUES

Cancer

If no interventions are put in place, it is projected that

in the year 2020 the number of new cancer cases will

be 804,000 and the number of deaths due to cancer will

be 626,400


ISSUESISSUESISSUESISSUESISSUESISSUESISSUESISSUES

Cardiovascular diseasesCardiovascular diseases

�� Hypertension Hypertension

�� It is estimated that more than 20 million people are It is estimated that more than 20 million people are

affected in the African Region, mainly in urban areas. affected in the African Region, mainly in urban areas.

�� Prevention and control of hypertension could avoid at Prevention and control of hypertension could avoid at

least 250 000 deaths per yearleast 250 000 deaths per year..



DiabetesDiabetes (20(20--79 age group)79 age group)

�� Number of people with diabetes Number of people with diabetes

�� 20072007

�� 10.4 (millions)10.4 (millions)

�� 20252025

�� 18.7 (millions18.7 (millions))



�� Injuries and violence are leading causes of premature Injuries and violence are leading causes of premature

death and disability in Africa, esp. 5death and disability in Africa, esp. 5--44 years 44 years

�� In some countries road traffic injuries are the 2In some countries road traffic injuries are the 2ndnd leading leading

cause of death in males 15cause of death in males 15--44 years44 years

�� Disabilities from all causes (congenital, wars, other Disabilities from all causes (congenital, wars, other

injuries, diseases e.g. polio, diabetes, stroke, cancer) are injuries, diseases e.g. polio, diabetes, stroke, cancer) are

high and increasinghigh and increasing

�� Number of people with visual impairment in subNumber of people with visual impairment in sub--Saharan Saharan

Africa is 27 million, of whom 6.8 million are blindAfrica is 27 million, of whom 6.8 million are blind



�� Increased Tobacco consumptionIncreased Tobacco consumption

�� Market expansion of trans national tobacco companiesMarket expansion of trans national tobacco companies

�� Less than 30% of Member States have a tobacco control Less than 30% of Member States have a tobacco control

plan of actionplan of action

�� According to the latest estimates, more than 80% of the 8.3 According to the latest estimates, more than 80% of the 8.3

million deaths attributed to tobacco and projected to the million deaths attributed to tobacco and projected to the

year 2030 will occur in lowyear 2030 will occur in low--income and middleincome and middle--income income

countriescountries


The RealityThe RealityThe RealityThe RealityThe RealityThe RealityThe RealityThe Reality

�� Global recognition and response has not kept paceGlobal recognition and response has not kept pace

�� Most countries in Africa lack data on the magnitude, Most countries in Africa lack data on the magnitude,

causes, and consequencescauses, and consequences

�� Misunderstandings can be dispelled by the strongest Misunderstandings can be dispelled by the strongest

evidenceevidence

�� Chronic diseases affect mostly high income countriesChronic diseases affect mostly high income countries

�� Low and middle income countries should control Low and middle income countries should control

infectious diseases before chronic diseasesinfectious diseases before chronic diseases


NCD InterventionsNCD InterventionsNCD InterventionsNCD InterventionsNCD InterventionsNCD InterventionsNCD InterventionsNCD Interventions

Primary preventionPrimary prevention based on comprehensive populationbased on comprehensive population--based based

interventions; cinterventions; commonommon approach to common risk factorsapproach to common risk factors

Improved information systems & surveillanceImproved information systems & surveillance to inform action to inform action

(STEPS, tobacco surveys, IDSR integration, cancer (STEPS, tobacco surveys, IDSR integration, cancer

registers)registers)

IDSRIDSR (CD, EPD, DE) revised to include (CD, EPD, DE) revised to include CRDsCRDs (asthma) and (asthma) and

NCDsNCDs evidence based decision makingevidence based decision making

Treatment & careTreatment & care, integrated into primary health care with , integrated into primary health care with

improved accessimproved access


CRDsCRDsCRDsCRDsCRDsCRDsCRDsCRDs and and and and and and and and NCDsNCDsNCDsNCDsNCDsNCDsNCDsNCDs in the WHO African in the WHO African in the WHO African in the WHO African in the WHO African in the WHO African in the WHO African in the WHO African

regionregionregionregionregionregionregionregion

CRDsCRDs one of the major one of the major NCDsNCDs, is of growing burden in Sub, is of growing burden in Sub--

Sahara Africa. Sahara Africa. Number of CRD are increasingNumber of CRD are increasing

CRDsCRDs increase due to environmental pollution, tobacco, increase due to environmental pollution, tobacco,

infections harmful use of alcohol, unhealthy diet, physical infections harmful use of alcohol, unhealthy diet, physical

inactivity and the AIDS pandemic.inactivity and the AIDS pandemic.

CRDsCRDs risk factors are highest among individuals with least risk factors are highest among individuals with least

education.education.

CRDsCRDs assessment toolassessment tool to be developed (COD, asthma) to be developed (COD, asthma)


CRDsCRDsCRDsCRDsCRDsCRDsCRDsCRDs priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African


�� CRDsCRDs prevention and control policies, legislation and prevention and control policies, legislation and

regulations, regulations, fundamentalfundamental to increase access to services in to increase access to services in

countries. countries. Regional Strategies.Regional Strategies.

�� Comprehensive national Comprehensive national CRDsCRDs control programmescontrol programmes incl. incl.

primary, secondary & tertiary prevention with screening, primary, secondary & tertiary prevention with screening,

early diagnosis, curative therapy and palliative care.early diagnosis, curative therapy and palliative care.

�� Community mobilisationCommunity mobilisation

�� Advocacy, resource mobilization and appropriate Advocacy, resource mobilization and appropriate

allocationallocation


CRDsCRDsCRDsCRDsCRDsCRDsCRDsCRDs priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African priorities in the WHO African


�� Capacity development Capacity development toto improve knowledge & skills of improve knowledge & skills of

care providers at primary, secondary and tertiary levels of care providers at primary, secondary and tertiary levels of

health system, managers, decisionhealth system, managers, decision--makers. makers.

�� Strategic information, surveillance and researchStrategic information, surveillance and research –– for for

advocacy, programme development/adjustment, etc. advocacy, programme development/adjustment, etc.

�� Mobilization Mobilization andand coordination of partnerscoordination of partners’’ actions, actions, based based

onon clear definition of their areas of contribution, predictability clear definition of their areas of contribution, predictability

& relevance of their support in line with national priorities. & relevance of their support in line with national priorities.

CRDsCRDs partners (DM, CVD, cancer) / NGOs on the field ? partners (DM, CVD, cancer) / NGOs on the field ?


Integrated NCD approachIntegrated NCD approachIntegrated NCD approachIntegrated NCD approachIntegrated NCD approachIntegrated NCD approachIntegrated NCD approachIntegrated NCD approach

In very limited resource settings, from individual disease In very limited resource settings, from individual disease

programmes to programmes to NCDsNCDs integrated programme.integrated programme.

Anticipated integrated programme benefits are the driving force Anticipated integrated programme benefits are the driving force

behind these actions. Longbehind these actions. Long--term programme success is term programme success is

expected from collaborative integration initiatives.expected from collaborative integration initiatives.

WHO AFRO (region, countries) is committed to working WHO AFRO (region, countries) is committed to working

collaboratively in international and national alliances, collaboratively in international and national alliances,

networks and partnerships. networks and partnerships.

Thank youThank you

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