CHRONIC RESPIRATORY DISEASES and NON COMMUNICABLE … · CHRONIC RESPIRATORY DISEASES and NON...
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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.
Division, Prevention & Control of Non Communicable Diseases - DNC3 |
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.
Division, Prevention & Control of Non Communicable Diseases - DNC4 |
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
Division, Prevention & Control of Non Communicable Diseases - DNC5 |
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
Division, Prevention & Control of Non Communicable Diseases - DNC6 |
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)
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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)
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IssuesIssuesIssuesIssuesIssuesIssuesIssuesIssues
�� RiskRisk factorsfactors of of todaytoday are are NCDsNCDs inclincl
Chronique Chronique RespiratoryRespiratory DiseasesDiseases of of
tomorrowtomorrow
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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
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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..
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ISSUESISSUESISSUESISSUESISSUESISSUESISSUESISSUES
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))
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ISSUESISSUESISSUESISSUESISSUESISSUESISSUESISSUES
�� 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
Division, Prevention & Control of Non Communicable Diseases - DNC13 |
ISSUESISSUESISSUESISSUESISSUESISSUESISSUESISSUES
�� 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
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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
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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
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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)
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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
regionregionregionregionregionregionregionregion
�� 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
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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
regionregionregionregionregionregionregionregion
�� 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 ?
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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.