Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes and chronic respiratory diseases, are a global crisis and require a global response, according to the authors of this report. Yet, despite the threat to human development, and the availability of affordable, cost-effective and feasible interventions, most countries, development agencies and foundations are neglecting the crisis. The authors call on the United Nations, which will gather for its High-Level Meeting on NCDs in September 2011, to launch a coordinated global response to NCDs that is commensurate with their health and economic burdens. The report aims to answer four questions: is there really a global crisis of NCDs? How is NCD a development issue? Are affordable and cost-effective interventions available? And do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities, the authors argue, concluding that long-term success will require inspired and committed national and international leadership.
Equity in Health
This is the first-ever World Report on Disability (WRD) and it comes at a critical time, now that 150 countries have signed the UN Convention on the Rights of Persons with Disabilities (CRPD). One billion people in the world are experiencing disability – one in seven of the world’s population – and the numbers are rising. The report provides strong evidence of the need to equalise rights and opportunities for persons with disabilities in all aspects of life. The authors highlight the barriers and hardships faced by persons with disabilities, especially in low- and middle-income countries, such as increased unemployment (one in two men and four in five women with disabilities are unemployed globally), increased poverty (higher rates of food insecurity, poor housing, lack of access to safe water and sanitation, and inadequate access to health care), poor educational attainment, poor health outcomes and a higher risk of exposure to violence.
In this paper, the authors provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa They conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa from 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. Type 2 diabetes was found to account for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Screening studies identified high proportions (>40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. The authors argue that significant interactions between diabetes and important infectious diseases like HIV highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.
Cervical cancer is the second most common cancer among women in Africa, according to David Kerr, president of the European Society of Medical Oncology, yet there is a profound lack of reproductive health information for women and delayed access to treatment in rural areas in Africa. He notes that, in many parts of the continent, cancer is stigmatised as a death sentence, and he calls for a long-term strategy for vaccination, screening, treatment and awareness building. Although cancer is slowly receiving attention in Africa, the article notes that other diseases such as AIDS still absorb much of the health funding. The author also argues that many of the strategies aimed at preventing HIV could also help prevent the spread of the human papillomavirus too, which may play a role in the development of cancer. New research tackling AIDS and cancer simultaneously has shown that the anti-retroviral, lopanivir, can kill cells infected by HPV, while leaving healthy cells relatively unharmed. This might prove a useful way to prevent cervical cancer. Also, the drug could be used after a HPV infection, whereas vaccination is only effective prior to it – and is currently more expensive.
This report contains the twelfth annual Mothers’ Index, which documents conditions for mothers and children in 164 countries – 43 developed nations and 121 in the developing world – and shows where mothers fare best and where they face the greatest hardships. All countries for which sufficient data are available are included in the Index. Some countries from the east, central and southern African region fared poorly in the Index, notably the Democratic Republic of Congo (DRC), which was ranked 37th out of 42 least-developed countries (LDCs). The Central African Republic and Angola also performed poorly, positioned at 33 and 30 respectively. Rwanda, Lesotho, Malawi and Uganda were ranked highest among LDCs, surpassed only by the Maldives in the first place. South Africa’s performance was mediocre, as it was ranked at 19 out of 38 less-developed countries, far behind Cuba, which was ranked first.
In this paper, the authors investigate the cross-country determinants of health improvements and describe the implications for development policy. The authors argue that making improvements to health need not be expensive. Even very low income countries can make great strides with good technologies and good delivery, but the authors warn that this may take time. They argue that two major factors underlie improved global health outcomes: first,the discovery of cheap technologies that can dramatically improve outcomes; and second, the adoption of these technologies, thanks to the spread of knowledge. Other factors have played a role. Increased income not only allows for improved nutrition, but also helps to improve access to more complex preventative technologies. Institutional development is a second key to the spread of such complex technologies. Nonetheless, evidence of dramatic health improvements even in environments of weak institutions and stagnant incomes suggests that the role of institutional factors may be secondary.
Despite significant setbacks after the 2008-2009 economic downturn, exacerbated by the food and energy crisis, the United Nations notes that the world is on track to reach poverty-reduction targets, but also notes that progress has been inequitable. According to the United Nations. The number of deaths of children under the age of five declined from 12.4 million in 1990 to 8.1 million in 2009. The largest absolute drops in malaria deaths were in Africa, where 11 countries have reduced malaria cases and deaths by over 50%. New HIV infections are declining steadily, led by sub-Saharan Africa. Between 1995 and 2009, a total of 41 million tuberculosis patients were successfully treated and up to 6 million lives were saved, due to effective international protocols for the treatment of tuberculosis. In contrast, the report notes that progress has been inequitable: the poorest children have made the slowest progress in terms of improved nutrition, poor women and girls remain severely socially disadvantaged, and advances in sanitation often bypass the poor and those living in rural areas.
In this study, monthly pediatric admission data from five Ugandan hospitals and their catchments were gathered retrospectively across 11 years from January 1999 to December 2009. The researchers found that in four out of the five sites under study there was a significant increase in malaria admission rates. At all hospitals, malaria admissions had increased by 47% from 1999. Observed changes in intervention coverage within the catchments of each hospital showed a change in insecticide-treated net coverage from less than 1% in 2000 to 33% by 2009, but this was accompanied by increases in access to nationally recommended drugs at only two of the five hospital areas studied. The authors conclude that their findings show that the reported decline in malaria in Africa is not a universal phenomenon across the continent. More data is needed from a wider range of malaria settings to provide accurate data on progress of the impact of malaria interventions.
Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. The authors of this paper report that a third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services, the authors argue. Recommendations for research on diagnosis, treatment, and prevention include further use of molecular analysis of theMycobacterium leprae genome, implementation of BCG vaccination and administration of chemoprophylaxis to household contacts. The authors also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy.
A pilot study was conducted in one district of Zambia, in which maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. A total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood. In resource-constrained settings, authors note that the Investigate Maternal Deaths and Act (IMDA) approach promotes the use of existing systems to reduce maternal mortality, thereby strengthening the capacity of local health officers to use data to determine, plan and implement relevant interventions that address local factors contributing to maternal deaths. Monitoring actions taken against the defined recommendations within the routine performance assessment should help ensure sustainability.