By Tilahun Haregu and Peninah Masibo, APHRC via Conversation Africa
Non-communicable diseases are often described as lifestyle diseases because they are associated with the excesses of an ageing or privileged population. Not any more. One would be hard pressed today to find someone who has not been touched in some way by these diseases.
The list of these diseases is long, the most notable being cancer, diabetes and cardiovascular disease. Increasingly these non-communicable diseases are a major health threat worldwide: they’re responsible for more than 38 million deaths annually. Close to 75% occur in low- and middle-income countries.
Their emergence in Africa is a recent development. Rapid changes in lifestyles along with increasing urbanisation are fuelling the rise. Evidence suggests that the risk is accelerating in sub-Saharan Africa. However, the non-communicable disease problem is hidden under the infectious disease epidemic.
For low and middle income countries the rapid rise in these diseases is likely to lead to a greater social and economic burden. This is because many of these countries are also struggling with communicable diseases, resulting in a dual burden of disease.
This may have implications on poverty levels on a macro-level as greater resources are allocated to healthcare. At the household level, high healthcare costs associated with long-term management of non-communicable diseases can drive families into poverty.
Limitations of current research
Current research remains limited to assessing the extent or magnitude and drivers of specific noncommunicable diseases – often also referred to as NCDs – within a given population. The processes and procedures traditionally used to conduct public health research, which are typically applied to infectious diseases, must be modified to meet this challenge.
They should be modified so that they streamline the very nature of non-communicable diseases across all stages of the research process. Early career researchers need to be trained accordingly, with a focus on this emerging challenge.
If this does not happen, the current research practice will continue producing research focused more on the problem than the solution to NCDs. Moreover, the results would not lead to better policy options.
In developed countries, where routine health information systems are strong, NCD research can draw data directly from those sources to produce more robust evidence.
But this is not the case in low and middle income countries, which rely more on survey data. The new approach should be institutionalised at early stages of the research so that more informative data can be generated. The objective of this new approach is not about collecting more data. It’s about more useful data for action.
Trends in non-communicable diseases
The growing trend of non-communicable diseases coupled with the need for stronger counter-action in sub-Saharan Africa was the focus of a recent symposium in Kenya. It was the first dedicated to research on non-communicable diseases in a country where they account for 27% of total deaths and 50% of hospital admissions.
There are several reasons why the approach to researching non-communicable diseases must change.
Firstly non-communicable diseases share common risk factors – but there is no one-on-one relationship between the diseases and their risk factors. One risk factor may be related to many. One disease may be related to many risk factors. Alcohol use, for instance, is a risk factor for cardiovascular disease and some types of cancer, as well as diabetes.
Secondly, these diseases develop progressively over a person’s lifespan. People who are exposed to risk factors in childhood or adolescence may develop non-communicable diseases in adulthood or in old age. Research must therefore consider approaches to prevent and manage these diseases over the lifespan.
Equally, patients may require long-term care. So research needs to employ a cohort model that looks at long-term and continuous assessment of care and its outcomes.
Thirdly, non-communicable diseases typically do not occur in isolation. Associated illnesses (co-morbidities) are common. Research should examine co-existing conditions rather than a single disease in isolation.
Lastly, these diseases require a combination of multiple interventions – behavioural as well as clinical. The effectiveness of these in combination should be investigated.
It is also critical that patients are actively involved in their own care. They should be considered partners in the research process as they generate and use evidence.
Changing the research approach
Dealing with these challenges requires a thoughtful and deliberate realignment from an epidemiological research approach. Research will need to be contextually relevant to address the complex relationships at the core of prevention, management and response.
There are two other aspects that need to be addressed. One is to stimulate long-term career interest in non-communicable diseases among researchers across Africa. But equally important is the collaboration among research institutions, universities and government ministries to equip early and mid-career researchers with fresh approaches and relevant skill sets.
But widening this scope and approach to research requires innovation, courage and determination as well as a significant investment of financial resources. This should be underpinned by policy level involvement of all stakeholders -— departments of health, national treasuries, agriculture, labour, planning and education.