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Curbing Death From Non-communicable Diseases: The Nigerian Burden

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Non-communicable diseases like stroke, cancer, diabetes and chronic lungs diseases, among others, are said to be collectively responsible for almost 70 per cent of all deaths worldwide. PATIENCE IVIE IHEJIRIKA and ODIRI UCHENUNU -IBE assess the growing burden of these diseases in Nigeria and what the government is doing to tackle the world’s biggest killers.

Until recently, the burden of non-communicable diseases (NCDs) was thought to be a problem afflicting only affluent countries. However, emerging evidence indicates otherwise. Today, the problem affects people in developing countries more than the developed ones.

With the decline in prevalence of many infectious diseases and a steady increment of NCDs as a major cause of death, Nigeria and other Sub-Saharan African countries are undergoing epidemiological transition.

LEADERSHIP Friday observed that despite these revelations, there is an inertia at curtailing the rising trend as evident by the lack of mention of NCDs even in the sustainable development goals.

In Nigeria, health experts argue that though the federal government, international health bodies and even some civil society groups, have intervened and shown commitment to combating non-communicable diseases in the country, progress is slow.

According to World Health Organisation (WHO) non-communicable diseases like heart disease, stroke, cancer, diabetes and chronic lungs disease, are collectively responsible for almost 70 per cent of all deaths worldwide.

The organisation says that almost three quarter of all non-communicable disease deaths and 82 per cent of the 16 million people who die prematurely, or before reaching 70 years, occur in low- and middle-income countries.

WHO non-communicable diseases 2016 profile of Nigeria estimated that NCDs caused approximately 617,300 deaths, representing 29 per cent of total deaths in the country.

Out of these, cancer and diabetes accounted for four per cent and two per cent respectively, which have claimed countless lives on a daily basis.

Take for instance, cancer statistics from WHO showed that in 2012, there were 14 million new cases and 8.2 million deaths, while in 2018 there were 18.1 million new cases and 9.6 million deaths.

According to another study released by the World Economic Forum (WEF), the global cost of five non-communicable diseases will reach over $47 trillion over the next 20 years – the diseases include CVD (cardiovascular disease), diabetes, mental illness, chronic respiratory disease and cancer.

According to the authors of the report, 70 per cent of lost output from non-communicable diseases are due to mental illness and cardiovascular diseases.

The report described cardiovascular diseases as those that affect the heart or blood vessels and include congenital heart disease, disorders of the peripheral vascular system, diseases of the aorta, endocarditis, orthostatic hypotension, hypertension, heart failure, arrhythmia, heart valve disease, coronary artery disease and arteriosclerosis.

The report, titled ‘The Global Economic Burden of Non-Communicable Diseases,’ analysed what the overall cost to the global economy non-communicable diseases (NCDs) might be.

Cardiovascular diseases: according to the report, cerebrovascular diseases (cerebrovascular, cardiac, and peripheral vascular diseases) are the most important cause of morbidity and mortality globally, accounting for 80 per cent of all deaths occurring in developing countries.

Nigeria, with an approximate population of 180 million, has an estimated proportional mortality attributable to CVD of 12 per cent. In 2008, the estimated mortality due to a combination of CVD and diabetes, was put at 435.9/100,000 and 475.7/100,000 for males and females, respectively.

Sadly, till date, Nigeria has not established a mechanism for community-wide data collection on NCD. Currently, WHO and local researchers have published hospital-based data on CVD in Nigeria. These reports and studies suggest a rising trend in CVD risk factors, such as systemic hypertension.

Furthermore, the morbidity and mortality of systemic hypertension-related complications are also on the rise in Nigeria. Other reports suggest an increase in morbidity and mortality associated with complications of hypertension, such as stroke, heart failure and renal failure.

The study further described diabetes mellitus as an increasing problem in sub-Saharan Africa, especially Nigeria, with type 2 DM being the most common.

The Framingham study revealed that the burden of DM, which also increases the risk for CVD, has remained fairly constant over the last 50 years. It said: “studies have shown that the risk of CVD mortality is higher in diabetic men compared with non-diabetic men having controlled for other CVD risk factors. Similar to other developing countries, Nigeria is experiencing a rise in the incidence of DM.

The current projected prevalence estimates of DM in Nigeria, based on the International Diabetes Federation figures, is 4.04 per cent.

On the other hand, endocrinologists have also raised alarm over the rising cases of diabetes in Nigeria, saying that diabetes is now a global emergency with associated complications.

To salvage the rising scourge of diabetes and diabetes foot complications which often leads to foot amputation in Nigeria, the managing director, Rainbow Specialist Medical Centre, Dr Afokoghene Isiavwe, said the training of more health personnel at the Primary Healthcare Cantres (PHCs) is sacrosanct.

In the same vein, Professor of Endocrinology and Diabetology, Department of Medicine, College of Health Sciences, University of Abuja Teaching Hospital, Felicia Anumah, stressed that diabetes has become a huge problem in Nigeria presently, with increasing complications which are most times, dangerous and could result to death of the affected individual, if not addressed on time.

According to Anumah who is also  the Dean, Faculty of Clinical Science, University of Abuja, the prevalence of diabetes foot varies from between 0.3 per cent and 19 per cent, depending on the type, with amputation rate as high as over 50 per cent.

“The plight of the common Nigerians is death due to lack of early detection, no funds, ignorance or refusal to commence immediate treatment of worst stage diabetes, which leads to amputation,” she maintained.

Anumah stressed that the reason for the above situation is that the National Health Insurance Scheme (NHIS) is still at the nursery stage, with a coverage of less than five per cent of the Nigerian population, which has encouraged an out-of-pocket system as far as health is concerned in Nigeria.

The  professor further  acknowledged that the cost of assessing diabetes  treatment is very expensive, with complications like kidney failure, heart attack, stroke and even amputation, which costs not less than N100, 000 a week for dialysis, and  about N360, 000 to N540, 000 for diabetes treatment and much more for amputation respectively.

Framingham study revealed also that chronic respiratory diseases represent a spectrum of airway ailments, ranging from reversible airway obstruction, like bronchial asthma (BA), to irreversible airway diseases like emphysema.

In the time span from 2006 to 2009, studies on respiratory disease prevalence in urban areas showed a prevalence of chronic bronchitis in Nigeria as 0.3 per cent with that of BA varying between 14 and 18 per cent.

LEADERSHIP Friday writes that though there is paucity of data on past prevalence of these diseases, lower prevalence is reported from rural areas and they can be used as surrogate indicators because rural localities are less exposed to elements of globalisation.

Whereas the cost of BA and COPD care in Nigeria has not been properly documented, figures from developed countries range from $300 to $1300 and $813 to $1522 per patient per year, respectively. These costs comprise direct and indirect economic costs contributed to by loss of man-hour at work, school absenteeism, and loss of earnings from early retirement.

Cancer is one of the major causes of death globally, with 7.6 million deaths, mostly from developing countries. Most cancers are linked to environmental and lifestyle changes; ironically, they are mostly preventable. While cigarette smoking is the main cause of the burden of global cancer mortality, other risk factors such as sedentary lifestyle, reduction of fruit and vegetable intake, and alcohol consumption also play major roles.

Reports of cancer prevalence in Nigeria is scanty and hospital based, due to paucity of cancer registers. Commonly occurring cancers in Nigeria include cervical, breast, prostrate, skin, and gastric cancers.

 

It is projected that by 2020, cancer incidence in Nigerian males will rise to 90.7/100,000 and for females to 100.9/100, 000.

A report showed earlier that only 10 per cent of diagnosed cancer cases in Nigeria have access to care. While only -five per cent of the reported figure has resources to access centers with specialised human and material resources, where they incur costs ranging from $10,000 to $15,000 for a course of radiotherapy.

WHO official in charge of Nigeria, Clement Peter, said an estimated 116,000 new cases of cancer and 41,000 cancer-related deaths were recorded in Nigeria last year. Peter expressed fear that if the current trend is maintained, cancer burden in Africa is projected to double from 1,055,172 new cases in 2018 to 2,123,245 by 2040.

A medical doctor, with Nyanya general hospital, Kingsley Sunday Azugo, is of the opinion that to arrest the rising incidence of NCDs, concerted efforts should be targeted at strengthening the Nigerian health system.

According to Dr Azugo, strengthening the capacity of Primary Health Care to carry out basic assessment of NCD risk factors and diseases such as blood pressure assessment, weight measurement and blood sugar checks, will reduce the burden of NCDs.

He advised that patients who have developed NCDs should have prompt commencement of therapy, as this has the beneficial effect of preventing or slowing the rate of progression to complications as well as reducing the overall cost of care.

Dr Azugo appealed to government at all levels to collaborate with multinational bodies, pharmaceutical firms and health insurance conglomerates to tackle the cost of NCD medication and diagnosis.

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