Chronic Diseases Management (CDM)

Contribute to the evidence base for effective intervention strategies

Overview

Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both. Chronic diseases such as cardiovascular diseases (heart diseases), cancer, diabetes, chronic obstructive airway disease, mental disorders, neurological diseases, and arthritis are rapidly growing in sub-Saharan Africa, with related deaths expected to double by 2030.

Strategic Focus

The Chronic Diseases Management (CDM) Unit aims to address this challenge through generating evidence on chronic disease management as a systematic approach to coordinating healthcare interventions across levels (individual, organizational, local, and national).

The focus on “management” signals a shift away from the dominant notion of treatment and the intended outcome from “cure” to stewardship.

Our core mandate is to co-design and evaluate new interventions or new ways of delivering known interventions in various African populations for the prevention of chronic diseases or care of people with chronic diseases.

Key Research Questions

The CDM unit addresses three key questions:

What is the burden of, and forecast for, chronic diseases in Africa, and what are the context-specific environmental, behavioral, and genomic risk factors for chronic diseases in Africa?
What are the best approaches and new tools to deliver known cost-effective interventions for preventing and caring for chronic diseases in Africa?
How is the health system responding to manage chronic diseases, and what can be done to strengthen health systems to improve services for chronic diseases?

Focus Areas

The research in the CDM unit is grouped into five focus areas:

Interplay of risk factors for chronic diseases and prevention (CDRISK)
Food Environment Policy Action (FEP-ACT)
Cardio-Metabolic Diseases Management (CMD)
Mental Health and Neurological diseases (MEN)
Cancer Care Pathways (CANCER)

Interplay of Risk Factors of Chronic Diseases and Prevention (CDRISK)

Risk factors can cluster and interact, resulting in synergistic action for developing chronic diseases and related mortality. Such interactions are neither simple nor straightforward. Our research focuses on identifying the interplay of risk factors, including genomics and behavioral and environmental risks for chronic diseases, in individuals and communities to inform preventive interventions.

Many chronic diseases can be prevented by reducing common risk factors such as tobacco use, harmful alcohol use, physical inactivity, and eating unhealthy diets. In addition, prevention of infections that lead to NCDs can be achieved through vaccinations. Our research focuses on investigating the distribution of risk factors, identifying those most at risk, and designing interventions to reduce the risk of chronic diseases across all age groups. There are 7 ongoing projects under this focus area (CDRisk1-CDRisk 7)

Food Environment Policy Action (FEP-ACT)

Of the four modifiable risk factors for NCDs, including inadequate physical activity, exposure to tobacco smoke (and air pollutants), and excessive alcohol use, an unhealthy diet generates more disease than all the other risk factors combined. The food environment mainly drives unhealthy food consumption. Food environment is defined as the physical, economic, political, and sociocultural context in which each consumer engages with the food system.

The food environment influences food choices, food acceptability, and diets through physical and economic access to food (proximity and affordability); food promotion, advertising, and information. Our research focuses on robust measurements of the food environment using validated methods to generate evidence on how this is driving unhealthy food consumption. The evidence generated is then used to drive interventions promoting healthier diets for NCD prevention. There are 4 ongoing projects (FEN1-FEN4).

Cardio-Metabolic Diseases Management (CMD)

Globally, CMDs are the number-one cause of death and their prevalence is predicted to increase, especially in Low- and Middle-Income Countries (LMICs), where almost 80% of all adults living with diabetes are found and where 77% of all NCDs deaths occur. The current rapid epidemiological transition leading to the rise in CMDs places a high demand on a health workforce that is constrained, is inequitably distributed to serve people in vulnerable positions, and has limited strategies to provide prevention of and care for CMDs.

Our research focuses on identifying those at the highest risk of CMDs and ensuring they receive appropriate treatment to prevent premature deaths. We co-design both preventive interventions and health system-strengthening approaches that increase access to services, including the use of digital health technology, task-shifting, self-help, and self-care approaches. There is one ongoing project (CMD1).

Mental Health and Neuro-Degenerative Diseases (MEN)

Several common psychiatric and neurodegenerative diseases share epidemiologic risk and both conditions are rapidly increasing globally and attracting little attention in most low and middle-income countries. Our work focuses on estimating the burden and addressing major psychiatric disorders including major depressive disorder, bipolar disorder, schizophrenia, anxiety disorders, post-traumatic stress disorder, problematic alcohol use, and neurodegenerative diseases including Parkinson’s disease and Epilepsy. We co-design and evaluate interventions for the prevention and care of these diseases. We have three ongoing projects (MEN1-MEN3).

The food environment influences food choices, food acceptability, and diets through physical and economic access to food (proximity and affordability); food promotion, advertising, and information. Our research focuses on robust measurements of the food environment using validated methods to generate evidence on how this is driving unhealthy food consumption. The evidence generated is then used to drive interventions promoting healthier diets for NCD prevention. There are 4 ongoing projects (FEN1-FEN4).

Cancer Care Pathways (CANCER)

Cancer is the second-largest cause of death in low- and middle-income countries (LMIC). However, cancer outcomes remain much worse in LMICs than in high-income counties (HIC), largely due to delayed treatment. The research that has been done mostly concerns delays in presentation to formal health services.

Yet about half the delay between symptom and treatment initiation arises after the first presentation. Since more people with cancer are surviving better, there is a need to understand their needs and factors that may affect their quality of life and ultimately their experience of survivorship and quality of life.