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.

Declining Childhood Vaccinations Rates Amid The COVID-19 Pandemic

Eze mbe si na ihe ya ji-achiri ihe egwu ya aga njem bu maka ya ezu ndiegwu.

Can we just take a moment to celebrate the recent news in which the continent of Africa has been declared free from Polio! What an achievement for everyone on that great continent that had a hand in it. https://www.who.int/news-room/detail/25-08-2020-global-polio-eradication-initiative-applauds-who-african-region-for-wild-polio-free-certification

On a more personal note, the next few months are filled with birthdays of so many family members (which is why my budget whines a little around this time till January) including my niece who turns one. Being a pharmacist by training, my sister reached out pretty early in the pandemic to talk about a potentially disrupted vaccination schedule and how she, my brother in law and the pediatrician planned on proceeding. At the time the pediatrician’s office was completely closed, but we talked about the little bit of flexibility available to her around the timing. Luckily, it worked out in the end, and her vaccinations are on schedule. Reflecting on the access to healthcare here in the US brings a sense of gratitude but also a concern for others in less ideal situations, especially in underdeveloped nations. I have seen a few articles pop up about the declining vaccination rates that may result from this pandemic especially in nations with less sophisticated and unstable infrastructure.

Prior to the COVID-19 pandemic, global vaccination rates for Diphtheria-Tetanus-Pertussis (DTP3) and measles were far from perfect despite great progress over the past few decades. There was only a 20% chance of children born today being fully vaccinated by the age of five in 2019.

In recent months both WHO and the United Nations have warned of a declining number of children receiving routine vaccinations. COVID-19 which has claimed 869,000+ lives worldwide to date has disrupted healthcare systems in place that would normally provide these services. This ultimately is posed to setback efforts made in developing regions whose healthcare systems are not as stable.

Initial immunization reports show significant drops in the number of children completing three doses of vaccine against diphtheria tetanus and pertussis (DTP3). According to the World Health Organization, this would be the first time in 28 years that the world could see a reduction in DTP3 coverage. The coverage of DTP3 also serves as a marker for immunization coverage within and across countries. The latest data on vaccine coverage from WHO and UNICEF for 2019 can be found here: https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/

COVID-19 is ultimately disrupting these vaccination campaigns in many developing nations. A pulse poll was conducted in June 2020 by UNICEF, GAVI, and WHO in collaboration with the Sabin Vaccine Institute’s Boost Community and the International Vaccine Access Center (IVAC) at Johns Hopkins and the Global Immunization Division/United States Centers for Disease Control and Prevention (CDC). This survey sought to quantify the disruptions to immunizations. Poll questions surveyed vaccinations service current statuses explained in more detail here: https://www.who.int/immunization/monitoring_surveillance/immunization-and-covid-19/en/

The pulse survey sheds light on various causes that have halted childhood vaccination efforts. A number of responses were recorded ranging from individuals reporting an ability to access services due to quarantine mandates, fear of leaving home, the economic impact of COVID-19 preventing travel, among others. Lack of personal protective equipment and restrictions on travel also plague healthcare workers on the front line.

Unfortunately for many of these nations, COVID-19 continues to plague their communities. However global health organizations are fighting to help reverse these disruptions and hopefully expand childhood vaccination outreach. Both UNICEF and WHO have been on the front lines are supporting low and middle-income countries to alleviate issues through the following objections republished directly from WHO’s site. Restoring services, aiding health workers, rectifying coverage and immunity gaps, and expanding routine services to reach missed communities. Personally, my only hope is that proper funding for these global health organizations remains intact, as we are truly a globalized world. When one nation suffers the effects can reverberate back to the comfort of developed nations. My hope is that we as a global community continue to fight for preventative global health actions.

In closing, this brings me to the quote I chose that teaches which translates to, The tortoise said that it always travels with its musical instrument in case it meets other musicians.

This quote means, Stressing a state of maintaining a state of preparedness. Very relevant to the goals and values that surround vaccination efforts.

1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE)  https://coronavirus.jhu.edu/map.html

2. WHO and UNICEF warn of a decline in vaccinations during COVID-19 https://www.who.int/news-room/detail/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19

This was my very first birthday party taken in my father’s compound in Nigeria. Everyone else pictured is a cousin of mine. My two older sisters are in the mix as well. Filled with a sense of gratitude for each day on earth and also hoping to make a difference in others’ lives so children can grow up free of preventable illnesses.

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.