The Challenge of Non-Communicable Diseases and Road Traffic ...
The Challenge of Non-Communicable Diseases and Road Traffic ...
The Challenge of Non-Communicable Diseases and Road Traffic ...
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3. THE DRIVERS AND<br />
DETERMINANTS OF NCDs<br />
Changes in the magnitude <strong>and</strong> distribution <strong>of</strong> the<br />
risk factors <strong>and</strong> determinants for NCDs, alongside<br />
demographic change <strong>and</strong> economic development,<br />
are driving the trends in the disease burden [24, 35,<br />
77]. In considering the question, “What determines<br />
<strong>and</strong> drives the NCD <strong>and</strong> RTI burden, <strong>and</strong> what are<br />
the commonalities with communicable diseases?”<br />
this section covers:<br />
• NCD risk factors in SSA (nutrition, tobacco, alcohol,<br />
<strong>and</strong> physical activity <strong>and</strong> travel);<br />
• <strong>The</strong> drivers <strong>of</strong> NCD trends (growing urbanization<br />
<strong>and</strong> the impact <strong>of</strong> demographic changes);<br />
• Socio-economic determinants <strong>and</strong> distributions;<br />
<strong>and</strong><br />
• Commonalities between NCDs <strong>and</strong> other risk<br />
groups.<br />
3.1. NCD Risk Factors<br />
Over the period 1990-2010 globally <strong>and</strong> in Sub<br />
-Saharan Africa, there has been a shift in the contribution<br />
<strong>of</strong> different risk factors to the disease burden<br />
away from risks for communicable diseases in children<br />
towards those for non-communicable diseases<br />
in adults [78]. Leading risk factors for SSA regions<br />
in 2010 can be found in Table 4. In 2010 in Central,<br />
Eastern, <strong>and</strong> Western SSA, childhood underweight,<br />
household air pollution from solid fuels, <strong>and</strong> suboptimal<br />
breastfeeding continue to be leading causes <strong>of</strong><br />
disease, but their contribution to the disease burden<br />
has fallen substantially since 1990. A much larger<br />
share <strong>of</strong> the disease burden can be attributed to risk<br />
factors for NCDs <strong>and</strong> injury, most notably alcohol<br />
use <strong>and</strong> high blood pressure. Since 1980 mean blood<br />
pressure has been stable or been increasing in most<br />
African countries: by 2008, the prevalence <strong>of</strong> raised<br />
blood pressure 6 in the WHO African Region, at 36.8<br />
percent (34.0-39.7 percent) <strong>of</strong> adults aged 25 years<br />
<strong>and</strong> over, was highest <strong>of</strong> any region [79]. In Southern<br />
SSA in 2010, alcohol use was the leading risk factor,<br />
followed by high blood pressure <strong>and</strong> high body mass<br />
index, with smoking also in the top five.<br />
Nutrition<br />
Countries in SSA are undergoing a nutrition transition<br />
[80]. More than half <strong>of</strong> them are still at an early<br />
stage, experiencing a high prevalence amongst children<br />
<strong>of</strong> stunting or being underweight for their age,<br />
a low prevalence <strong>of</strong> overweight <strong>and</strong> obesity amongst<br />
women, <strong>and</strong> low intakes <strong>of</strong> energy, protein, <strong>and</strong> fat.<br />
For a few countries, changes in dietary patterns<br />
are affecting health outcomes in a large portion <strong>of</strong><br />
the population; for example, South Africa, Ghana,<br />
Gabon, Cape Verde, <strong>and</strong> Senegal have relatively<br />
high levels <strong>of</strong> obesity/overweight, <strong>and</strong> low levels <strong>of</strong><br />
underweight in women, as well as high intakes <strong>of</strong><br />
energy <strong>and</strong> fat. In several countries, overweight <strong>and</strong><br />
obesity have reached substantial proportions with<br />
levels <strong>of</strong> 30-50 percent amongst adults <strong>and</strong> higher in<br />
women [81]. Among a sample <strong>of</strong> recent mothers in<br />
31 SSA countries more women were overweight or<br />
obese than underweight (Figure 10) [82].<br />
Where measured, cholesterol levels are generally<br />
low except for the wealthier countries such as Mauritius,<br />
where elevated cholesterol levels have been seen<br />
in 30 percent <strong>of</strong> the population [49]. A high intake<br />
<strong>of</strong> sodium is common in SSA, with salt being used to<br />
preserve food <strong>and</strong> add taste [83], but salt intake generally<br />
does not make the 15 top-ranked risk factors<br />
for attributable disease burden in SSA regions.<br />
6 Systolic blood pressure (SBP) <strong>of</strong> 140mmHg or above or diastolic<br />
blood pressure (DBP) <strong>of</strong> 90mmHg or above.<br />
21