The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 51
BOX 7: Country Responses to NCD Challenges
In Namibia, a September 2012 report from the Ministry of Health and Social Services emphasized the manner in which
health systems need simultaneously to address the challenge of undernutrion and overnutrition [350]. An estimated 29
percent of Namibian children (under five years of age) are classified as stunted, with 17 percent classified as underweight,
and 8 percent classified as wasted. However, slightly more than 4 percent of Namibian children (under five) are classified
as overweight or obese – with this figure reaching 7 percent of children (under five years of age) in urban settings.
Among women 16-49 years of age, 6 percent were moderately or severely thin, in contrast to the 28 percent of women
considered either overweight or obese. Data based on health facilities indicates hypertension and diabetes as the first
and second causes of disability among adults, respectively. The proportion of NCD-related deaths was estimated at 8
percent in 2007. The Namibian Ministry of Health and Social Services is focusing on addressing these challenges within
the context of its broader efforts at developing the country’s health systems.
In Mauritius, recent data indicates that NCDs represent an estimated 80 percent of the total disease burden and account
for 85 percent of total deaths each year. Surveys on the prevalence of NCDs and risk factors indicate that among adults
30 years and older, there is a 19.3 percent prevalence of diabetes, 30 percent prevalence of hypertension, and 38 percent
of the population is either overweight or obese. In addition, 39.3 percent of the population smokes tobacco, and 19.1
percent have been classified as heavy drinkers. In response to such data, Mauritius is implementing a national strategy
to address NCDs, which involves the use of mobile clinics/medical teams to address primary prevention at community
level (including schools and workplaces), a community-based network of health centers and community health centers
to address prevention needs at the secondary level, and a structured prevention program at the tertiary level (involving
specialized units in all regional hospitals) [351].
In South Africa, the 2000 Burden of Disease Study indicates that NCDs accounted for 37 percent of deaths and 16 percent
of DALYs, while the leading causes of death were HIV/AIDS (30 percent), intentional injuries (7 percent), and unintentional
injuries (5.4 percent). It should be noted that the high coverage of the ART program has transformed HIV/AIDS into
a chronic disease as the needs of ART patient now resemble those of patients with NCDs. Additionally, the urban poor
bear the heaviest burden of NCDs, in addition to other diseases. Alcohol use, tobacco smoking, and excessive weight are
responsible for 13.9 percent of total DALYs and nutrition is a major challenge to South Africa’s NCD epidemic, with the
average diet high in sodium and fat consumption. Nationally, 60 percent of women and 31 percent of men are either
obese or overweight [352]. The South African heath system has responded to this challenge at the facility level through
the integration of care for NCD and communicable chronic conditions, expanded outreach by primary health care teams
at the community level, and with a greater focus on human resource management and health information programs to
support these initiatives [353].
In Kenya, NCDs are estimated to contribute 33 percent of total mortality and over half of the top 20 causes of morbidity
and mortality. About 53 percent of all hospital admissions in Nairobi are due to NCDs, with diabetes contributing 27.3
percent of this figure. Smoking prevalence is 26 percent among adult males and alcohol use prevalence estimated to be
20 percent. HPV prevalence in women is estimated to be 38 percent. The national strategic response to NCDs involves
strengthening health services for the integrated prevention and management of chronic diseases, as reflected in the
annual operating plans for the health sector and the integration of NCDs into the primary health care system. Achievements,
to date, include improved human resource capacity, provision of medical equipment and other supplies to address
NCDs, infrastructure improvement for expanded service delivery, and routine screening for NCD risk factors during
routine health facility visits [354].
In Ghana, stroke and hypertension have been among the leading causes of hospital deaths for over 20 years. The estimated
adult prevalence of diabetes in Accra increased from 0.4 percent in 1956 to nearly 7 percent between 1998 and
2002. By 2003, an estimated 35 percent of women in Accra were classified as obese, with 40 percent hypertensive and
23 percent hypercholesterolemic. Although the public health response to NCDs has been described as limited to date,
the government is now processing nine health-related bills (including a tobacco bill) into law [355]. There has also been
a fivefold expansion in the uptake of clients screened for cervical cancer using VIA in an Accra hospital, following an
intensive health educational campaign. The recently introduced District Health Information Management System is anticipated
to serve as an integral tool in capturing preventive and clinical service outputs, thereby enabling the collection
of more accurate and timely NCD-related data at decentralized levels in the future.