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

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