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

2. BURDEN OF NCDs AND RTIs
This section considers the question, “How is the
growing burden of NCDs and RTIs changing the epidemiology
of SSA?”. It covers:
• An overview of the health perspective in the region,
including:
– The relative burden of disease in Africa;
– The rising epidemic of NCDs and RTIs;
– The types of disease that reflect the stage of a
country’s development; and
– An examination of specific NCDs (CVDs, cancers,
diabetes, chronic respiratory diseases and
others) and RTIs; as well as
• A look at the consequences of NCDs and RTIs on
the economic and social development of SSA.
2.1. A Health Perspective
The Relative Burden of Disease in Africa
For some time, much of the health focus in the SSA
region has been understandably directed towards
communicable diseases, maternal, perinatal, and
nutritional causes of mortality and morbidity. These
all remain among the leading five causes of disability-adjusted
life years (DALYs) for the sub-regions of
SSA in 2010, accounting for 67-71 percent of DALYs
in Eastern, Western, and Central SSA [16]. TB, HIV/
AIDS, and malaria were responsible for 22 percent
of all deaths in SSA in 2010, other communicable
diseases account for another 23 percent. These figures
are already slightly exceeded by the 25 percent
share of deaths caused by NCDs (Figure 1).
HIV was the leading cause of DALYs in Southern
and Eastern SSA in 2010 [16]. In recent years, the
dramatic increase in anti-retroviral therapy (ART)
coverage, helped by increases in safer sex and condom
use, have contributed to a decline in HIV incidence
in the region[18].
Nine of the world’s 22 high-burden countries for
TB are African (Democratic Republic of Congo,
Ethiopia, Kenya, Mozambique, Nigeria, South Africa,
Uganda, Tanzania, and Zimbabwe) [19]. Six
African countries (Nigeria, Democratic Republic of
Congo, Burkina Faso, Mozambique, Cote d’Ivoire,
and Mali) account for 60 percent of malaria deaths
in the world [20], and malaria was the leading cause
of DALYs lost in Central and Western SSA in 2010
[16]. Nigeria is one of only three polio-endemic
countries in the world (with Pakistan and Afghanistan).
Close to 60 percent of global maternal deaths occur
in SSA which has the highest maternal mortality ratio
(MMR) in the world [21]. The main specific causes
are unsafe abortion, sepsis, hemorrhage, obstructed
labor, and hypertensive disorders. Africa has a high
stunting rate – 40 percent of children under five years
old are underweight for their age – and the rate is falling
much more slowly than in other regions [22].
Little attention has been paid to the extent to
which these conditions contribute, directly or indirectly,
to the growing burden of NCDs. In this
context it must be remembered, for example, that
FIGURE 1: Proportion of Deaths by Cause in
SSA, 2010
25%
3%
15%
6%
Source: Authors from [17]
4%
12%
23%
13%
Tuberculosis
HIV/AIDS
Malaria
Other communicable
diseases
Maternal, perinatal
and nutritional causes
Noncommunicable
diseases
Road traffic injuries
Other injuries
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