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The Rise and Rise of Chronic Diseases in Africa

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Africa is confronting a daunting new healthcare challenge while it continues to struggle against many of its longtime nemeses.

Health systems on the continent have always strained under pressure from deadly infectious diseases like HIV, malaria, tuberculosis, cholera, dysentery and hemorrhagic fevers like Ebola and yellow fever. Today, however, globalization and economic change have brought the added burden of a sharp rise in non-communicable diseases like diabetes, cancer, and heart and lung diseases.

Such diseases, known as NCDs, kill 41 million people every year, accounting for 71% of deaths around the world, according to the World Health Organization (WHO).

In 2015, communicable conditions in Africa accounted for 5.2 million of deaths (56.4%), down from 5.7 million deaths in 2010 (61.4%). Non-communicable diseases, traditionally associated with urbanisation and higher standards of living, accounted for 3.1 million deaths (33.5% of all deaths), rising from 29.4% in 2010.

And the situation in Africa is deteriorating. WHO estimates that NCDs will rise by 27% over the next 10 years in the region, resulting in 28 million additional deaths. That compares with a global rise of 17% over that period. By 2030, deaths from NCDs in Africa “are projected to exceed deaths due to communicable, maternal, perinatal and nutritional diseases combined.”

Increased spending and awareness and improvements in the availability of effective medicines have helped reduce the burden of infectious diseases in Africa since 2000, the World Bank reports. But infectious diseases remain a top cause of premature death in Africa, and the WHO warns that action must be taken to deal with what it calls a health transition to a “double burden of communicable and non-communicable diseases.”

Economic growth in Africa is set to grow 3.1% in 2018, and 3.6% the following year. But complications come with progress.

As Africa’s economies modernize, its societies have evolved. Rural people have moved to cities, where life is more complicated and often more toxic. Pollution is rife in sprawling urban areas, and the increasing availability of consumer goods has changed habits, often for the worse. Processed foods have replaced whole foods in urban diets, and the increased exposure to marketing and availability of alcohol and tobacco has increased the instance of cancer and heart and lung conditions.

The WHO warns that NCDs “are the result of a combination of genetic, physiological, environmental and behavioral factors. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.” Air pollution is also a critical risk factor, the organization notes.

Insufficient prevention and screening leads to poor or late diagnoses, said Khama Rogo, head of the World Bank Group's Health in Africa Initiative, at a conference in Nairobi in March. And late diagnosis increases the cost of treatment. “Noncommunicable disease management is one of the most inefficient areas of expenditure on this continent,” Dr. Rogo said.

The catastrophic effects of NCDs start with poor families, and, inevitably, children. Money earners lose their ability to work and resources drain away quickly when such diseases strike. This forces more families into poverty and can create a downward spiral, the WHO warns. “To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed requiring all sectors, including health, finance, transport, education, agriculture, planning and others.”

Diet is of particular concern in Africa, as economic and societal changes in Africa have led to an enormous spike in obesity. Eight of the 20 countries with the fastest growing rates of obesity are in Africa.

The epidemic of diabetes in Sub-Saharan Africa threatens severe economic and health consequences, a 2017 report, Diabetes in sub-Saharan Africa: from clinical care to health policy found.

Diabetes can lead to other chronic conditions like heart disease, stroke, and kidney failure, and “its increasing prevalence could propel a huge wave of chronic disease in many countries in sub-Saharan Africa,” Rifat Atun, a Harvard professor who was one of the authors of the report said.

The report found that more than 90% of diabetes cases in sub-Saharan Africa were type 2 diabetes. That suggests that behavioral changes like exercise or improved diets could help alleviate the epidemic. But without a proper diagnosis, effective treatment is impossible. The report found that only half the people with the disease were diagnosed, with only 1 in 10 receiving treatment.

Community health workers need increased training in diabetes, and new technology to help in screening, monitoring and treatment, the report recommended.

Technology could indeed prove to be a powerful weapon in the African healthcare arsenal.

African technology companies like the Kenyan mobile payments provider M-Pesa have long been global pioneers in connecting people in areas with poor infrastructure, and that trend is likely to continue.

The mobile telephone revolution that transformed connectivity in Africa will continue to evolve in the next two years with further penetration by ultra-low-cost mobile devices. The proliferation of connectivity into semi-urban and rural parts of Africa will be a powerful force to reduce the 'digital divide,' which is one of the biggest social issues in Africa.

Virtual medical appointments, or e-visits, are at an early stage in Africa, but creating a better system for collecting, storing and distributing health data could push the technology into the mainstream. “A well-implemented e-visit program can reduce costs, increase patient satisfaction and engagement, increase care access and improve clinicians' productivity, which are highly sought-after benefits in emerging markets like Africa.’’

Mobile technology “can strengthen the capacity of clinicians, enhance disease training, diagnosis and treatment, and improve compilation of patient information,” Adebayo Alonge, a Nigerian entrepreneur. “Without access to data and tools to reach patients in remote and rural regions, African healthcare systems will remain ill equipped to correctly diagnose cancer patients and administer the proper course of treatment.”

Sanofi, a longtime contributor to African healthcare initiatives, is pushing hard for progress.

“What we’re really excited about is that technology can enable us to do things in underprivileged countries that don’t have the same access to medicine, healthcare, and diagnostics,” Ameet Nathwani, Chief Medical Officer at Sanofi, said at the Vivatech technology conference last month. “We really believe that startups for health and technology brought to Africa can change medicine fundamentally and equalize.”

Sanofi’s efforts at Vivatech, the international tech fair in Paris, focused on promoting African solutions to telemedicine, early diagnosis, and overall improved healthcare access. Sanofi has worked with communities across Africa for more than 60 years to improve health for all through initiatives including vaccination programs and training of healthcare professionals.

Today we are using the latest technology to bring improved healthcare to rural communities. In Algeria, Sanofi has equipped one mobile clinic with technology to broaden the reach of screening and treatment, and in collaboration with the local authorities is opening a second. In Nigeria, special coding has been added to medicines to help patients protect themselves against falsified and substandard product (Fake).