Transcript XML - International Journal of Education Policy

Dual Burden of Disease
This is when a defined area (region,
territory, country, etc.) is having to deal
with both centuries-old communicable
disease problems like infectious
diarrhea and under-nutrition as well as
the modern non-communicable
disease problems like obesity, heart
disease and smoking
MYTH: that communicable diseases like malaria,
tuberculosis and HIV/AIDS affect the developing
world, while NCDs like heart disease, diabetes and
cancer are largely confined to the developed world.
REALITY: Due to climate change, increased
urbanization and the spread of globalization, more
countries than ever will face the dual disease burden.
The same factors that enable the spread of infectious
disease—poverty, unclean water, poor sanitation and
weak health systems—exacerbate the chronic
conditions.
Sub-Saharan Africa is the only region of the world
in which infectious diseases still out number
chronic diseases as a cause of death.
In adults, age specific mortality rates from chronic
diseases are higher in younger adult age groups,
than in most high income countries.
Of the 36 million people NCDs kill each year, 9
million die before age 60.
Ninety percent of these deaths occur in low and
middle-income countries.
In a Nigerian Study in Uyo (Ekpenyong et al)
 Of 2,780 participants, prevalence of
 obesity was 25%,
 hypertension-14.4%,
 diabetes mellitus-12.7%,
 musculoskeletal disorders-20.1% and
 respiratory disorders-10%.
 Obesity, diabetes mellitus and musculoskeletal disorders - were more
prevalent in women
 while hypertension and respiratory disorders were more in men
Unhealthy Lifestyles and Poor habits
poor dietary habits- obesity-DM/HTN
physical inactivity- obesityDM/musculoskeletal diseases
smoking habits- Cardiovascular
disease, cancers
alcohol abuse- Liver disease,
pancreatitis
Other Variables
 Age- Age related insulin resistance was an independent predictor of all clinical events. In
the Nigerian study, highest prevalence was recorded among participants within the ages
34-64.
 Obesity: cardiovascular disease risk is double if BMI is > 25 and nearly quadrupled if the
BMI is > 29, the risk of developing diabetes was 40 times with BMI > 35 (Mohammed, 2003).
Obesity was more pronounced in women than men.
 Family History: Obesity and DM have family predispositions.
Other Variables Contd.
 Area of Residency: The urban dwellers have a
higher rate of NCDs than rural dwellers.
 Work Stress: The higher the work stress, the higher
the risk of NCDs
 Education: Unfortunately the higher the education
(by western parameters), the more likely to suffer
from NCDs. Presumably the higher educated the
person is, the more successful, and a higher socioeconomic status and more likely to indulge in
unhealthy lifestyles.
In 2008, the proportion of premature deaths due to
NCD in population under 60 years of age
low–income countries was 41%,
in lower middle–income countries 28%, and
in high–income countries only 13%.
The most frequent causes of death included
cardiovascular diseases, diabetes, cancers and
chronic lung disease, and the main underlying risk
factors were increased blood pressure (13% of
deaths globally), tobacco use (9%), elevated blood
glucose levels (6%), physical inactivity (6%), and
overweight and obesity (5%).
Communicable Diseases
 remain difficult to control, especially in young children
 necessary effective and affordable tools and knowledge about their prevention,
treatment and control are available. They do not always reach those who need them.
Four communicable diseases still account for nearly 50% of global child mortality:
 -
acute respiratory diseases,
 -
diarrhea,
neonatal sepsis
-and malaria.
 -

Double Burden of malnutrition
 consisting of under-nutrition among children and over-nutrition in adults.
 as much as 35% of child deaths could be attributed to macro– and micro–nutrient undernutrition. In addition to its effect on mortality, under-nutrition also affects human
development in many aspects.
 A driving force behind the shift from under-nutrition in childhood to over-nutrition in
adulthood in LMIC was the rapid increase in
 -economic development,
 -globalization,
 -and urbanization
Double Burden of malnutrition
 The occurrence of under-nutrition and obesity result in the opposite
manifestations of malnutrition even within a single household.
 An underweight child and an overweight mother within the same
household were observed in 11% of the households in rural areas in
Indonesia and 4% in Bangladesh.
 The figures were even worse in the refugee population living in Western
Sahara, where 24.7% of pairs of children (aged 6–59 months) and mothers
(aged 15–49 years) were affected by this ‘double burden of malnutrition’.
In the study 29.1% of the children were stunted and 18.6% were
underweight, while among the women, 53.7% were overweight or obese.
Double Burden of malnutrition
 Double burden of malnutrition’ is an important
driver of the double burden of disease.
 Under-nutrition in fetal life and among children
predisposes to infectious diseases, but also
increases the NCD burden, mainly through
overweight and obesity and related co–
morbidities.
 On the other hand, over-nutrition in pregnant
overweight women closes the circle.
Top 20 Causes of Death in Nigeria
(WHO 2011)
TOP 20 CAUSES OF DEATH
1.
Influenza &
Pneumonia
2.
HIV/AIDS
3.
Stroke
4.
Coronary Heart
Disease
5.
Diarrheal diseases
6.
Tuberculosis
7.
Malaria
8.
Diabetes Mellitus
9.
Lung Disease
10.
Maternal
Conditions
11.
Hypertension
12.
Kidney Disease
13.
Breast Cancer
14.
Birth Trauma
15.
Low Birth Weight
16.
Road Traffic
Accidents
17.
Meningitis
18.
Endocrine
Disorders
19.
Asthma
20.
Violence
Rate
173.78
World Rank
18
170.23
148.61
121.60
18
32
80
101.48
85.05
79.28
55.40
41.90
36.71
19
15
11
47
42
10
25.57
25.01
24.69
23.99
23.64
21.55
102
51
17
9
22
65
18.77
17.75
18
32
15.55
14.87
37
56
Nigerian Total Deaths By Cause (WHO
2011)
PERCENT TOP 20 CAUSES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Malaria
HIV/AIDS
Influenza &
Pneumonia
Diarrheal diseases
Tuberculosis
Stroke
Coronary Heart
Disease
Birth Trauma
Low Birth Weight
Maternal
Conditions
Diabetes Mellitus
Meningitis
Pertussis
Lung Disease
Road Traffic
Accidents
Congenital
Anomalies
Violence
Kidney Disease
Hypertension
Other Injuries
Deaths
219,833
213,667
213,099
%
12.88
12.52
12.49
173,878
97,669
87,717
71,732
10.19
5.72
5.14
4.20
68,213
67,212
50,867
4.00
3.94
2.98
34,528
33,935
32,386
25,241
24,850
2.02
1.99
1.90
1.48
1.46
19,116
1.12
18,422
16,892
14,829
14,392
1.08
0.99
0.87
0.84
What is The Solution?
 Political will is lacking in African countries. The real challenge for any call to
action is to develop and implement a plan for achieving its goals.
 Experts endorse plans and policies that simultaneously address
-structural (including policy, fiscal, industry and private businesses, international
collaboration),
-community (including mass media, voluntary organization, institutions, primary
healthcare) and
-individual (including behavioral and pharmacological interventions).
Solution?
South Africa, Mauritius, Tanzania and
Cameroon are among the few African
countries that have responded to the call
for action.
In the majority of countries, there is a gap
between policy makers' recognition of a
national chronic disease burden and the
development and implementation of
chronic disease policies and plans
Solution?
A second problem is a weak culture of
knowledge transfer.
 While production of chronic disease research in Africa remains low
compared to the rest of the world, research does exist on the causes and
effects of chronic diseases in the region.
 This limited body of work provides important insights for practice and policy.
The challenge is in undertaking the sorts of analyses that enable
appropriate knowledge transfer and knowledge exchange.
Solution?
 Education- weight loss programs; teach and encourage exercise programs,
smoking cessation programs, etc.
 Encourage and produce more and better trained primary care providers.
 Instead of building more roads, build alternative modes of transportation as in
the public transport system. Make such more desirable. People will walk more.
They have to walk to the bus or train station as opposed to getting out of the
house and into the car to the office/destination and vice versa.
 Immunization programs have yielded the most significant changes in child
health in the last few decades. . At least 2 million children still die each year
from diseases for which vaccines are available at low cost. Similarly, for
diarrheal disease, there exists a simple, inexpensive and effective intervention:
oral rehydration therapy.
 Among maternal conditions, obstructed labor, sepsis and unsafe abortion were
among the ten leading causes of death and disability among women aged 15–
44 years in developing countries.