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

An Overview 67
death statistics to WHO, of which only one is of high
quality [79]. There are a few recent signs of progress
nationally and internationally: for example, South
Africa increased coverage of birth and death registrations
to nearly 90 percent by 2008, and the Statistical
Commission of Africa has prioritized strengthening
of civil registration and vital statistics for the
period 2012-17 [467]. All the main health and disease
programs draw from the same data sources and
share common problems. Rather than develop separate
solutions, there is opportunity for shared action
and benefit. For example, improved global reporting,
oversight, and accountability for women’s and
children’s health could lead to the strengthening of
civil registration systems [468].
NCD mortality and morbidity surveillance is
largely hospital-based and only 59 percent of countries
report having a cancer registry. However, there
is growing use of NCD risk-factor surveys to measure
health determinants [6]; for example, by 2012
more than 20 African countries had carried out
STEPS surveys, some more than once, and most included
physical and biochemical measurements enabling
assessment of the prevalence of hypertension
and diabetes [469]. And, while health information
capacity in general and for NCDs may be low, there
may be the possibility of adapting and exploiting
some of the existing systems set up for communicable
diseases [435]. Possibly three important and
transferrable lessons for NCDs from the history
of AIDS are: the need to pull evidence together to
convince politicians to take action; the need for reliable
ways to measure success accurately; and that
vertical initiatives need system investment for sustainability
[466].
Better epidemiological data is called for and a vigorous
effort needed to gather more evidence that
decision makers, including politicians, can absorb;
including data about prevalence, demography, incidence
trends, and costs to governments and donors.
Better knowledge is needed about NCDs in Africa
to underpin the design of contextualized NCD strategies.
A tremendous contribution could be made
by the international donor and scientific communities,
for example: DHS surveys could be expanded
to include NCD prevalence and risk factors such as
measurement of adult obesity, glycaemia, and blood
pressure; demographic surveillance sites could expand
NCD surveillance; donors could fund more
STEPS surveys; and partners could strengthen local
capacity for NCD surveillance and epidemiology
[470-471]. A good example is the ongoing effort
in South Africa to develop a strategic surveillance
system for NCDs involving vital statistics, population-based
health statistics, health facility data, and
health facility audits. Taking into account recent
WHO recommendations, indicators are being revised,
alongside the strengthening of the analysis
and reporting capacity to ensure that information
can be used for monitoring and planning, and the
development of a strategy to strengthen research in
the field of NCDs [472].
There have been moves to overcome health information
limitations: estimates of mortality and
disease burden have been calculated and composite
NCD and road safety country profiles developed
to assist countries’ needs assessments [473-476].
There are rapid assessments for health systems for
a number of diseases [477], and manuals exist to assist
countries systematically work through the steps
involved, for example in assessing road safety management
capacity [269]. Community members can
be engaged in diagnosis of problems and solutions.
Under-reporting of RTIs is also a problem, with
data quality affected by political influences, competing
priorities, and the availability of resources;
the number of crashes involving vulnerable road
users and non-motorized vehicles are thought to be
greatly under-reported [117]. A population-based
survey in Dar es Salaam, Tanzania, found that police
reports for RTIs were only filed 50 percent of
the time [478]. An assessment of RTIs in Zambia
by the Road Traffic Safety Agency, Police, Ministry
of Health, and World Bank, showed that current
registries of RTIs lack adequate use of standard
codification (such as ICD-10), making it impossible
to determine the number of pre-hospital
deaths and deaths after arrival at an emergency
room [479]. The hospital registries also lack the
underlying causes of injury or death classified under
the WHO International Classification of Diseases
(ICD-10 – Chapter 20) which are needed for
effective public health interventions and related
preventive measures.