Wednesday, November 29, 2023
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Perceptions enable earlier emergence of NCDs

Traditionally viewed as diseases of old age, non-communicable diseases (NCDs) like heart disease, diabetes and lung cancer are stealthily imposing their growing burdens onto younger populations in unexpected ways. Failing to recognize physiology’s shortened deadlines, communities’ limited perceptions have enabled NCDs to slip into realms once thought shielded from chronic illness.

As risk factors interact in populations across its lifespan, Ethiopia now witnesses diseases normally confined to later adulthood emerging below thirty years of age. This generational shift raises urgent questions about social awareness, prevention methods, and healthcare readiness in a nation where awareness lags as health hazards hijack more prime years.

NCDs are the leading causes of premature death globally, killing more people each year than all other causes combined. About 80 percent of NCD deaths occur in low- and middle-income countries (LMIC), with the highest proportion of deaths in people under age 60. This raises their premature death rate to 28 percent, which is more than twice the proportion of deaths in high-income countries.

In low-income countries, the proportion of premature NCD deaths under age 60 was 41 percent, which is three times the proportion in high-income countries.

According to the World Health Organizations (WHO) projections, the number of deaths due to NCDs will significantly increase in the coming decades. NCD deaths were projected to increase by 15 percent globally between 2010 and 2020 (to 44 million deaths). More than six in 10 (63 percent) of global deaths in 2008 (i.e., 36 million of the 57 million global deaths) resulted from NCDs. It is estimated that 29 million people died from NCDs in LMICs, of which 80 percent were NCD-related deaths worldwide in 2008.

By 2030, a 50 percent increase is expected. 

The numbers of deaths from NCDs were expected to rise from 28.1 million in 1990 to 49.7 million by 2020, an increase of more than 75 percent. Similarly, projections on sub-Saharan Africa in 2004 showed that NCDs are expected to surpass infectious diseases by 2030, and among these populations almost two-thirds will be young and adult.

This increase is attributed to population growth, aging, rising age-specific prevalence, and their interaction. The burden was high in both urban and rural areas among study participants. In Ethiopia, the prevalence of obesity among children is there percent, according to the 2016 EDHS report. We are also witnessing high body mass indexes among adolescents, mainly females, who will become the mothers of future generations.

There are various reports worldwide and in Ethiopia depicting a decline in the age of entry of non-communicable diseases. The illnesses are expanding and increasing in communities faster than expected, mostly among urban dwellers.

In Ethiopia, non-communicable diseases such as cardiovascular (ischemic heart disease, stroke) and respiratory (chronic obstructive pulmonary disease, lower respiratory infections) are among the leading causes of death. According to the health atlas of Ethiopia, the top three causes of years lived with disability in the country are non-communicable diseases such as cardiovascular and respiratory.

Metabolic syndrome, which precedes the actual occurrence of non-communicable diseases, has been reported to have increased in Ethiopians. For instance, the first Ministry of Health (MoH)-led NCD national study reported that the prevalence of raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) was 16 percent among men and 16.5 percent among women. 5.9 percent had increased blood glucose levels greater than 110 mg/dl, with six percent among men and 5.8 percent among women.

About half of those living with NCD’s are unaware of their illness. As stated above, an individual may have either raised blood glucose levels or raised blood pressure but may not have apparent clinical manifestations. Here, I mean there are high numbers of pre-diabetic and pre-hypertensive cases hidden and undiagnosed in communities.

This scenario, combined with inadequate health care seeking behavior and a lack of annual medical checkups, raises the prevalence of unrecognized illnesses. This situation ultimately leads to a high frequency of undiagnosed illness that often is not detected until the individual presents to medical facilities with severe complications.

NCD’s hugely impact particular population groups. Women are increasingly suffering from hypertension, mental illnesses, diabetes, breast cancer, and cervical cancer. They also impact those with certain characteristics—for instance, women during pregnancy.

Reports indicate that approximately 16, six, six, and six percent prevalence of raised blood pressure, raised blood glucose level, overweight, and elevated blood cholesterol level, respectively, among the general population aged 30-69 years, indicating a 10-year cardiovascular disease risk over 30 percent.

The mortality rate due to NCDs in Ethiopia is approximately 204 per 100,000 population. Accordingly, the atlas further indicates prevalence rates for diabetes, mortality rates due to diabetes, prevalence rates of hypertension, and incidence rates of cervical cancer of approximately 1,327, 12, 92, and 26, respectively.

NCDs result in premature death and loss of productivity. According to recent data from the Global Burden of Disease Study 2021, nationally the three leading causes of years lived with disability and years of life lost in Ethiopia are attributed to high blood pressure for both sexes, comprising three non-communicable diseases: diabetes mellitus, stroke, ischemic heart disease, and hypertensive heart disease. Maternal death due to severe complications of maternal hypertensive disorders is a common phenomenon in Ethiopia.

The average age of entry is now not limited to ages in the fifties—it has declined to under thirty years of age. This global trend has also become a daily phenomenon both in clinical settings and among the public in Ethiopia.

NCDs have emerged as a public health issue prior to when exponential human life growth typically plateaus, which caused physiological disorders before actual maturity. NCDs can no longer be considered solely geriatric diseases—they have become common public health challenges. They are no longer silent killers.

The perception of NCDs among the youth and adult is further increasing the magnitude of unrecognized NCDs. They perceive that NCDs only follow genetic patterns. However, non-communicable diseases such as heart disease, diabetes mellitus, and mental illnesses are highly occurring before the age of thirty years in Ethiopia irrespective of genetic exposure. This means an adult who does not have a maternal or paternal genetic exposure to NCDs is still at escalating risk.

The community’s view of these diseases being attributable only to modifiable factors is also problematic for advocacy of pre-NCD screening. If we randomly ask an adult who may not drink alcohol to get their blood pressure checked, they may resist stating their behavior. However, it is not uncommon for an individual without alcohol intake to have one of the NCDs.

Furthermore, the lack of exposure no longer ensures full protection. Modifiable behavioral risk factors are not entirely predictive of NCD risk; rather, unmodifiable risk factors like age are becoming more common risk factors. Age of entry has significantly lowered to encompass youth and adults.

According to the Global Burden of Disease Study 2022 data from the Institute for Health Metrics and Evaluation, myocardial infarction, non-rheumatic calcific aortic valvular disease, and heart disease are among the top three major causes of death in Ethiopia. Similarly, in Nigeria in the same year, more than half of the estimated causes of death occurred among the adult population, comprising alcoholic cardiomyopathy, non-rheumatic degenerative mitral valve disease, and pulmonary arterial hypertension as the main three causes. This also signifies the merging and expanding additional burden of non-communicable diseases for adult populations in both countries.

Thus, reducing salt and fatty, unhealthy alcohol intake, eating more fruits and vegetables, participating in aerobic physical exercise, and avoiding cigarette smoking can help delay the declining age of entry of non-communicable diseases. This will help foster a longer, productive life among healthy citizens in Ethiopia. As T.S. Eliot said, “We are mature enough to die at birth.” However, we can delay death by preventing avoidable causes of mortality.

Contributed by Bedilu Abebe

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