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

An Overview 15
Types of Disease Reflect Stage of Development
FIGURE 6: ASMR by Cause in Countries of SSA, 2008
The relative burden and types of NCDs that are present
reflect to some extent the stage of epidemiological
transition of a country or its population (Figure 5). In
countries at the earliest stages of development, circulatory
diseases due to nutritional deficiency or infections
(such as rheumatic heart disease) predominate.
As countries develop, circulatory diseases related to
hypertension (such as hemorrhagic stroke) become
more common. With high-fat diets, sedentary lifestyles,
and increased tobacco use, mortality from
atherosclerotic CVD (such as IHD) predominates,
especially in those below the age of 50 years [34]. The
prevalence of and complications from diabetes also
increase during this disease transition. Differences
can co-exist within countries – for example rural
versus urban populations – and obesity can be seen
alongside under-nutrition even in the same household
[35]. Trends in these risk factors in SSA, and
their drivers, are discussed further in Section 3.
Figure 6 shows the relative burden of communicable
disease, NCDs, and injuries by country in SSA,
as measured by age-standardized mortality rate
(ASMR). The number of countries in which NCDs
and injuries dominate may surprise many readers.
Table 2 shows ASMR by country for the main
NCDs focused on in this report (cancer, CVD, diabetes,
and chronic respiratory diseases), with countries
organized by World Bank Income Group (WBIG).
FIGURE 5: Epidemiological Transition for CVD in
Developing Countries
80
70
60
50
40
30
20
10
0
Starvation
& Infection
(RHD)
Pestilence
and Famine
Public Health,
Nutrition, Hypertension
(Hem. Stroke)
Receding
Pandemics
Life expectancy (years)
Tobacco,
Obesity/Lipids/DM
(IHD, Stroke)
Degenerative
and Man-made
Diseases
Prevention
Treatment
(IHD, Stroke, CHF)
Delayed
Degenerative
Diseases
Percentage of deaths due to CVD
Mauritius 7%
Seychelles 19%
Sao Tome and Principe 30%
Cape Verde 26%
Eritrea 28%
Madagascar 35%
Comoros 35%
Gambia, The
39%
Senegal
41%
Mauritania
41%
Benin
41%
Rwanda
42%
Togo
45%
Guinea
42%
Gabon
42%
Ethiopia
41%
Ghana
43%
Namibia
41%
Congo
42%
Liberia
49%
Kenya
44%
Uganda
43%
Nigeria
48%
Guinea-Bissau
47%
Cote d'Ivoire
45%
Cameroon
47%
Burkina Faso
47%
Angola
46%
Niger
51%
Zambia
46%
United Republic of Tanzania
47%
Mozambique
47%
Mali
51%
Democratic Republic of the Congo
48%
Burundi
49%
Malawi
49%
Chad
51%
Central African Republic
51%
Botswana
51%
Sierra Leone
55%
Swaziland
53%
South Africa
58%
Source: [32]
Lesotho
Zimbabwe
Communicable diseases, maternal and
perinatal conditions, nutritional deficiencies
59%
69%
88%
75%
65%
65%
63%
60%
59%
55%
54%
53%
53%
52%
51%
51%
51%
51%
50%
49%
49%
48%
48%
47%
47%
47%
47%
47%
47%
47%
46%
45%
45%
45%
45%
44%
44%
43%
43%
42%
42%
40%
38%
Noncommunicable
diseases
38%
35%
28%
6%
6%
5%
9%
9%
5%
6%
5%
5%
6%
6%
6%
7%
6%
8%
6%
10%
9%
8%
10%
4%
4%
4%
6%
9%
6%
6%
6%
8%
7%
8%
4%
8%
7%
8%
6%
7%
7%
5%
9%
4%
7%
Injuries
3%
3%
Source: [36]