Noncommunicable Diseases: An often silent pandemic in developing nations

As an ongoing global pandemic, unfortunately, rages as we start the new year, I wanted to shed more light on the issues many in developed nations outside of public health/healthcare may not be as aware of, noncommunicable diseases (NCD).

Simply put, noncommunicable diseases are diseases that cannot be spread from person to person and generally encompass chronic diseases that tend to result from a combination of genetic, physiological, environmental, and behavioral factors. Examples include cancers, cardiovascular diseases, diabetes, asthma, and other chronic respiratory conditions.

According to research conducted at John Hopkins, an estimated 36 million people die from such diseases each year representing 2/3 deaths globally. An alarming 80% of these deaths occur in developing countries shedding light on limited access to treatment in many of these nations. A large number of these deaths are preventable and the death toll has overtaken that of infectious disease contributing to a sense of urgency surrounding this issue.

It is important to note that often we associate deaths from many noncommunicable diseases with older individuals which is true in developed or high-income nations. This may draw some confusion, as lower life spans are often seen in these developing/lower-income nations. However, in developing nations, NCD onset often occurs at a younger age and individuals tend to have lower rates of adequate access to clinics or hospitals that are equipped to address the needs of those chronically ill. The lack of access to treatment options is just as alarming as the lower ages of onset. According to WHO (2016 report), The proportion of NCD mortality presenting in persons younger than 60 is 44% in low-income countries – nearly quadruple the rate of 12% in high-income countries. It is clear that the health of a nation impacts societal and economic health and development. Health concerns can perpetuate poverty and on this scale may prevent the necessary growth in these economies.

With the growing concern of the developmental impact NCDs have on low-income nations, this has been established as in the 2030 Agenda for Sustainable Development by the United Nations shedding not only more light on the top but creating plans to combat the issue at hand. I really look forward to the programs put in place by the United Nations and their subsequent outcomes.

This is a photo of me, my mom, and my cousins in Nigeria. Both of my female cousins in the photo grew up to be nurses who are working on the front lines of the covid pandemic along with the NCD one.

Lessons from the Ebola Outbreak

Nwaanyi muta ite ofe mmiri mmiri, di ya amuta ipi utara aka were suru ofe.

As the pandemic rages in the United States and other developing nations, I can’t help but think of how important a properly run healthcare infrastructure is to curb health crises. I would like to touch upon COVID-19 in a later post pertaining to the unraveling of years of global public health efforts ensuring childhood vaccinations. For now, let’s dive into a great example of how curbing one pandemic lead to a win against another epidemic within that same region. (But if you are dying to read about COVID-19’s impact and risk mitigation ideas/strategies I would recommend Dr. Scott Gottlieb’s Washington Post Op-Eds and frankly his twitter account. I did an externship at the FDA while he was the commissioner and he was and still is very well respected. I even missed a photo-op with him and my fellow PharmDs which I still grumble about today!) I think I have a tiny-bit of COVID-19 burnout so I’ll spare you temporarily.

Now, I have been reflecting on the impact that health crisis preparedness has on emerging healthcare systems. I was first introduced to the ideas and topics surrounding strengthening healthcare systems during pharmacy school when I worked as a United Nations volunteer that lobbied congress and the house for increased funding to the UN. Specifically working for the Shot@Life campaigns where we partly focused on educating lawmakers on the impact of vaccination efforts on the global economy. I basically went door to door with other volunteers to lobby for maintained/increased funding to the United Nations. I learned so much about the UN’s work around the globe pertaining to vaccination campaigns.

During my time there, I was made aware of the Polio eradication efforts (beginning in 2012) in Nigeria that were repurposed to ultimately combat and prevent an Ebola outbreak between (2014-2016). It was a relatively simple idea; To record Polio vaccination efforts, a simple surveillance system was created. Android phones equipped with GPS were given to local government workers in charge of traveling across Nigeria to administer Polio vaccines. The phones automatically sent location updates to the server which kept a record of what regions were targeted for vaccines. This gave a rough geographic estimate of vaccine coverage. A direct result from these efforts moved Nigeria from containing 50% of Polio cases (endemic) to no longer being classified as a Polio endemic region in 2019.

Utilizing the same infrastructure as the Polio vaccination efforts, the same surveillance system was used to contact-trace and find cases during the 2014-16 Polio outbreak in West Africa. This provided daily mapping of between links of identified sources of transmissions. The knowledge and familiarity of the tools used efficiently controlled the outbreak at a scale unseen in other West African nations. Nigeria had a total of 19 laboratory-confirmed cases (20 suspected, probable, and confirmed cases) in which 8 individuals sadly passed away. In stark contrast, a total of 28,616 cases of Ebola and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone. An additional 36 cases and 15 deaths that occurred when the outbreak spread outside of these three countries. The loss of life and economic impact on the world, particularly West Africa is significant and cannot be overlooked.

Just the response in itself cost the global economy 3.61 Billion dollars (primarily the US, Germany, and UK funded). The human cost was overwhelming with about 17,000 children orphaned in Guinea, Liberia, and Sierra Leone. Lastly, the impact of Ebola on unprepared healthcare systems was disheartening. For example, Liberia lost 8% of its doctors, nurses, and midwives. Sierra Leone lost 7% and Guinea lost 1% of theirs respectively. Any nation cannot afford to lose healthcare workers. That’s why the case of Nigeria’s response is so important to study and understand. It’s not enough to fund, but a sustainable infrastructure should be attained. The 2014 Ebola outbreak resulted in an unnecessary loss of life. However, the response in Nigeria gives hope that we as a global community can work towards progressing healthcare systems in every nation.

Now I picked this quote because of the meaning: One should learn to change tactics to suit a situation. There is a huge importance of building upon the knowledge and general preparedness for the future health crises that will inevitably occur. I think this short and relatively positive example provides a good look at how much can be accomplished and lives saved from relatively simple tools. I hope you learned something today, as I did!

Again, I’m writing this blog to delve into my personal interest in public health on global scales. I will get an MPh that will feed more into my knowledge. But I hope to learn more about the topic and improve my writing skills along the way. I welcome any helpful, respectful critiques and corrections. Cheers!

Quote Translation: If a woman decides to make the soup watery, the husband will learn to dent the foofoo before dipping it into the soup. (https://steemit.com/nigeria/@leopantro/50-igbo-proverbs-and-idioms)

Sources:

1. Tracking Vaccination Teams During Polio Campaigns in Northern Nigeria by Use of Geographic Information System Technology: 2013–2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818548/

2. Cost of the Ebola Epidemic: https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/cost-of-ebola.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvhf%2Febola%2Foutbreaks%2F2014-west-africa%2Fcost-of-ebola.html

3. Nigeria is now free of Ebola virus transmission. https://www.who.int/mediacentre/news/ebola/20-october-2014/en/index2.html

4. Polio is no longer endemic in Nigeria – UN health agency: https://www.un.org/africarenewal/news/polio-no-longer-endemic-nigeria-%E2%80%93-un-health-agency

5. 2014-2016 Ebola Outbreak in West Africa: https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html#:~:text=On%20March%2029%2C%202016%2C%20the,%2C%20Liberia%2C%20and%20Sierra%20Leone.

Taken in 2018 in Pretoria. I choose this photo because it’s a reminder that I’ll be back on this continent (country & timing loading). My work will pull me there.