Year : 2021 | Volume
: 6 | Issue : 3 | Page : 99--101
Noncommunicable diseases and COVID-19 in Africa: A call for universal health coverage
Davison Munodawafa1, Adele Webb2, Prebo Barango3, David Houerto4, Mosoka Fallah5, Aminata Kobie6,
1 Department of Community Medicine, Faculty of Medicine and Health Sciences, Midlands State University, Gweru, Zimbabwe
2 Strategic Education, Inc., Ohio, USA
3 World Health Organization, Regional Office for Africa, Harare, Zimbabwe
4 School of Public Health, University of Parakou, Parakou, Benin
5 Refuge Place International, Joshua Morrison, Monrovia, Liberia
6 Risk Communication and Community Engagement, WHO Regional Office for Africa, Brazzaville, Congo
Prof. Davison Munodawafa
Department of Community Medicine, Faculty of Medicine and Health Sciences, Midlands State University, Gweru
|How to cite this article:|
Munodawafa D, Webb A, Barango P, Houerto D, Fallah M, Kobie A. Noncommunicable diseases and COVID-19 in Africa: A call for universal health coverage.Int J Non-Commun Dis 2021;6:99-101
|How to cite this URL:|
Munodawafa D, Webb A, Barango P, Houerto D, Fallah M, Kobie A. Noncommunicable diseases and COVID-19 in Africa: A call for universal health coverage. Int J Non-Commun Dis [serial online] 2021 [cited 2021 Nov 27 ];6:99-101
Available from: https://www.ijncd.org/text.asp?2021/6/3/99/330913
The burden of noncommunicable diseases (NCDs) in Africa remains high. With deaths from NCDs numbering nearly 3 million, the WHO projects the growth of this disturbing number by nearly 30% over the next decade. The impact of COVID-19 and a weak health system across the continent threatens to derail all gains that have been realized among African countries. According to Anjorin et al., the COVID pandemic demands that attention should be paid to the effect of NCDs on COVID-19 specifically its impact on morbidity and mortality.
While, at first, it was predicted that Africa would be the hardest hit by the virus, this was not the case. Over time, though, Africa became like much of the globe and cases began to rise. Cases of COVID-19 have declined in every region of the world except Africa. In fact, as recently as June 16th COVID cases jumped by 44% in 1 week. When considering the possibilities around the exponential growth in cases, one must examine the disease burden of NCDs and how that burden relates to the spread of the COVID virus and its associated morbidity and mortality.
Worldwide, NCDs kill about 42 million people each with a surge being reported in NCDs in sub-Saharan Africa. The four top killers which account for about 80% of all premature NCD deaths are cardiovascular disease, cancers, respiratory disease, and diabetes. These findings are supported by Mudie et al who state that NCDs are responsible for a large, growing burden of morbidity and mortality in sub-Saharan Africa. Common NCDs reported were hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cervical cancer, and breast cancer.
Research has demonstrated that preexisting NCDs worsen the prognosis of those infected with COVID-19. This is especially true for those with cardiovascular, respiratory, and metabolic conditions. Concerns about a causal relationship between those who suffer from overweight and obesity and a difficult trajectory of the COVID virus make it imperative that we, as providers, seek to understand the dynamics of overweight and obesity in African countries and begin to address this NCD risk factor with programs and strategies to both prevent and address this issue. Conversely, we know that undernutrition is high among African children and the elderly. Given that there is a higher risk of adverse outcomes in the undernourished and the elderly, the onus is on us to find solutions to address this condition.
One of the fastest growing global health emergencies of this century is diabetes mellitus. The International Diabetes Federation reported that for every 100 diabetic patients worldwide, four of them are African. The metabolic processes of diabetes contribute to a higher risk of infection by COVID-19 leading to more adverse outcomes. Hypertension has also been shown to be a predictor of COVID-19 adverse outcome. Countries in the African region are among those with highest prevalence of hypertension. Of concern is that over 80% of adults with hypertension are either not diagnosed or on optimal control of the condition. Therefore, policymakers and providers must seek innovative and sustainable service delivery approaches to address this health emergency in African nations.
Ssentongo et al. identified preexisting comorbidities that had a significantly greater risk of mortality from COVID-19 through a meta-analysis of 25 studies. NCDs known to lead in the increase of morbidity and mortality during COVID-19 infection include cardiovascular disease, hypertension, diabetes, congestive health failure, chronic kidney disease, and cancer. Given the epidemic proportions of NCDs across African nations, immediate attention and action are required to ensure universal access by all to health-care services as well as upskilling and re-skilling of providers to identify, prevent, and treat these conditions.
Attention to the prevention, recognition, and treatment of NCDs in Africa is imperative in view of the burden of NCDs and the rise in COVID-19 cases. Policymakers need to place Universal Health Coverage (UHC) as the cornerstone of the health delivery system. A sustainable health financing policy option is a prerequisite to UHC to allow for health-care providers to be up-skilled on the issues inherent in NCDs as they relate to population health and the social determinants of health. Ultimately, tackling the social determinants of health across settings and population groups will lead to successfully addressing the COVID-19 pandemic. Anjorin et al. argue that a one-size-fits-all response in addressing COVID-19 comorbidities in view of the differences in epidemiology and health-care delivery factors is not ideal. This is so because there are broad lessons relating to social, behavioral, cultural, economic, and political peculiarities that should be considered according to Airhihenbuwa et al. Furthermore, Fawcett et al. concur that many interventions fail to account for the complex interplay of historical, social, economic, and political contexts that are shaped by social structures and cultures.
Despite efforts by the WHO and the World Health Assembly to reduce deaths from NCDs, the health equity gap within and between African countries remains disturbingly wide, largely because the major drivers of health inequities and inequalities exist outside the health sector as captured in the WHO Commission Report on Social Determinants of Health of 2008. These disparities are evident in the current COVID-19 response in Africa which is premised, largely around the WHO Guideline. These guidelines call for (a) putting on mask when one is outside, (b) hand hygiene through frequent washing using running water or application of hand sanitizers, (c) keeping social and physical distance of 1 m from the other person, (d) reporting any high fever, loss of appetite, headache, or other signs and symptoms linked to COVID-19 infection. Vaccines have been introduced globally and have brought renewed hope even in Africa. However, due to the inequitable distribution of resources and money, only the developed countries of Europe and the United States of America have had unlimited access to vaccines. The vaccines are yet to reach the African continent in quantities deemed to be significant and therefore talk of vaccines on the continent remains a pipe dream. Therefore, the African continent continues to rely solely on behavior change among individuals, households, and communities to halt or reverse the rampaging COVID-19 infections. The African people cannot continue to bemoan what is missing but rather the continent should invest in what is available at the individual, household, and community levels which is collective solidarity to achieve sustainable behavior change and UHC.
As COVID-19 cases continue to rise in terms of both morbidity and mortality across the African continent against the backdrop of a weak health system, it could be time for the continent to rethink its policies and strategies for not only addressing COVID-19 but also the overall health-care delivery. Rather than depending solely on the outside for solutions, COVID-19 presents an opportunity for the continent to look inside for solutions from among its own people and other resources. The COVID-19 comorbidities linked to NCDs and their risk factors, namely obesity and overweight, cardiovascular disease, renal disease, hepatic disease, and diabetes mellitus are preventable through behavior change. Fundamental to the success of reducing COVID-19 comorbidity factors from NCDs, African countries should invest in UHC as recommended by Moeti and Munodawafa. Such an investment in health is justifiable, as it seeks to adequately address gaps in finance and human resources including prevention and management of NCDs and public health threats from COVID-19 and other health emergencies. Furthermore, the COVID-19 pandemic while exposing the chronic neglect and poor resourcing of NCD prevention and control measures that have been agreed at several regional and global meetings provides an opportunity for the re-orientation of the health system to prioritize the inclusion of cost-effective interventions, as part of efforts to build back better through UHC.
|1||Moeti MR, Munodawafa D. Required actions to place NCDs in Africa and the global south high on the world agenda. Health Educ Behav 2016;43 1 Suppl: 14S-6S.|
|2||Anjorin AA, Abioye AI, Asowata OE, Soipe A, Kazeem MI, Adesanya IO, et al. Comorbidities and the COVID-19 pandemic dynamics in Africa. Trop Med Int Health 2021;26:2-13.|
|3||Mendez R. Available from: http://Africasees. 44%.spike.in.new.Covid.infections, 20%.increase.in.deaths (cnbc.com). [Last accessed on 2021Aug 11].|
|4||Olumade TJ, Uzairue LI. Clinical characteristics of 4499 COVID-19 patients in Africa: A meta-analysis. J Med Virol 2021;93:3055-61.|
|5||Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet 2019;7:E1295-6.|
|6||International Diabetes Federation. Diabetes Atlas; 2019. Available from: https://diabetesatlas.org/en/sections/worldwide-toll-of-diabetes.html. [Last accessed on 2021Aug 11].|
|7||Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba D, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. Public Libr Sci One 2020;15:e0238215.|
|8||Airhihenbuwa C, Iwelunmor J, Munodawafa D, Ford C, Oni T, Agyemang C, et al. Culture matters in communicating the global response to COVID-19. Prev Chronic Dis 2020;17:200245.|
|9||Fawcett S, Abeykoon P, Arora M, Dobe M, Galloway-Gilliam L, Liburd L, et al. Constructing an action agenda for community empowerment at the 7th Global Conference on Health Promotion in Nairobi. Glob Health Promot 2010;17:52-6.|
|10||World Health Organization Report of the Commission on Social Determinants of Health. Available from: https://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf. [Last accessed on 2021 Aug 11].|