Non-Communicable Diseases

Ethiopia’s Big Worry

In Ethiopia, non-communicable diseases (NCDs) account for 46Pct of causalities. This is largely attributed to the rise in the prevalence of cardiovascular diseases—a group of disorders of the heart and blood vessels—and cancer. Although NCDs are preventable by reducing tobacco, alcohol, and unhealthy diets as well as increasing physical activity, this does not seem to be achievable anytime soon. World Health Organization (WHO) predicted Ethiopia needs to invest ETB242.2 billion over the next 15 years to prevent one million premature deaths caused by NCDs. EBR’s Ermias Mulugeta spoke with patients, government officials, and health professionals to shed light on the matter.

Dereje Girma, 52, is best known for being an effective mechanic of heavy-duty machines in Hawassa, 279km away from Addis Ababa. He mostly spends his time working by rolling under greasy machines and solving technical complications of heavy printing machines and other sophisticated appliances. It is not just a few times that Dereje, having numerous customers, has worked for 48 hours straight. Committed to his work, he regularly sits for an hour while working bent over and in bad form. Such eagerness, however, did not save him from encountering back pain and other health complications, eventually forcing him to undergo surgery on his spinal cord, and later quit his work.

Even worse, Dereje’s health situation is now in a critical stage after he was diagnosed with a cardiac problem. “I was not surprised when I was diagnosed with a heart attack as I have been smoking and chewing khat for over two decades to stay awake and be productive,” says Dereje, who spent 330,000 Birr thus far to find a cure but to no avail. “Now, it is my friends who are covering my medical expenses and financially helping my family as I am not able to do so.”

People like Dereje are not few in Ethiopia. With the burden of non-communicable diseases growing swiftly, many are going through similar unfortunate experiences, and even dying after long years of suffering. NCDs causing premature deaths have become more and more common and survivors suffer as they lose their ability to work, or at least work at reduced capacity. This is evidenced by the life of patients who have come to light lately.

In fact, in recent times, it has become very normal to witness patients suffering from NCDs, unable to cover medical expenses, and begging for help on the streets of Addis. Even WHO has admitted that nothing has tested the very foundations of public health as overwhelmingly as the rise of chronic (NCDs), which was once linked with high-income earning societies, but has now become global. Tobacco and alcohol use, unhealthy diets, and physical inactivity are major risk factors of NCDs.

An increase of such factors has overburdened the country where one hospital bed, on average, is used by 3,150 people, while premature deaths caused by NCDs keep mounting with no end in sight. NCDs have already overtaken communicable, maternal, neonatal, and nutritional diseases combined as the leading cause of mortality. In Ethiopia, NCDs cause higher casualties than any other group of diseases, accounting for 46Pct of deaths, according to a study conducted by WHO in partnership with the Ministry of Health (MoH), published last year.

Left unchecked, the figure could reach 70Pct by 2040, if the prediction of MoH turns out to be true. “There is a tendency to point a finger on the change in lifestyle, but the major causes are lack of for physical exercise habits, while diet is another issue that needs to be changed. The prevalence of smoking has had a share for the rise in prevalence of NCDs,” says Brook (MD), who has specialized in internal medicine. “Hypertension is another worrying problem causing deaths and is responsible for the spread of NCDs.”

Data obtained from the Central Statistical Agency indicates that an Ethiopian citizen has an almost one in five risk of dying prematurely before the age of 70 from one of the four main NCDs. In particular, death from NCDs is largely attributed to cardiovascular diseases, which are a group of disorders of the heart and blood vessels, in addition to cancer. In 2015, an estimated 65,000 cases of cancer occurred in Ethiopia, two thirds of which were in women, while cardiovascular diseases accounted for 15Pct of deaths related to NCDs. The problem is felt across the world.

NCDs killed 41 million people yearly, with 15 million dying between the ages of 30 and 70. “While its impact is well understood in developed countries, which are taking different measures to prevent its growth, the prevalence of NCDs is growing in less developed nations as a result of the proliferation of risk factors,” says Shitaye Alemu, Professor of medical science.

Beyond its direct impacts on health care, NCDs bring forth high economic losses. Just a year ago, research conducted by WHO found that economic losses resulting from NCDs in Ethiopia is around ETB31.3 billion, around 1.8Pct of GDP. Even more, if indirect damages are included, the figure could reach as high as ETB58.2 billion. What’s more, annual government expenditure on NCDs is around ETB15 billion, almost equal to the annual defence budget.

But studies conducted by WHO conclude that the negative economic impacts of NCDs are too often overlooked during budget allocation and in the weighing of the pros and cons for stronger fiscal and regulatory action in Ethiopia. This is despite the fact that NCDs and their risk factors lead to a loss of productivity, threatening household income and eventually pushing people to live under poverty.

Based on a national strategic framework developed on the prevention and control of NCDs and their risk factors in 2010, the government has prepared a detailed national and sub-national strategic action plan (NSAP) in 2014. The three-year action plan has outlined the major NCDs that should fetch higher priority and their risk factors. While cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are listed as the most lethal NCDs, their risk factors are tobacco, physical inactivity, unhealthy diet, khat consumption, and excessive alcohol use, according to the action plan.

Although the action plan was expected to be a road map for the prevention and control of NCDs in Ethiopia, little has been achieved in this regard. For instance, there is no standard intervention for physical activity and national strategy for healthy eating, sugar intake, and salt reduction, although all are recommended by WHO to reduce the prevalence of NCDs. Another gap is the absence of policies and legislation that restrict or eliminate trans-fats in the food chain. All in all, there is no integrated NCD program currently in Ethiopia, while existing policies are not being implemented properly in a cost-effective and preventive manner based on WHO standards.

On a positive note, in a bid to fight NCDs, the government has taken different measures over the past 12 months, including the enacting new legislation targeted at reducing the consumption of tobacco and alcohol. Particularly the new tobacco law, approved just a year ago, prohibited outdoor use of tobacco near bars, hotels, government institutions, and education institutions, among other places.

The sale of alcohol is also prohibited in such places and the minimum age limit was raised from 18 to 21 to reduce consumption, while a drunk driving law was also introduced for the same purpose. In similar fashion, in a bid to reduce exposure to another risk factor for NCDs—physical inactivity—periodic car-free days were introduced in Addis Ababa and other cities since last year.

Beyond such attempts, Kunuz Abdella, Advisor to the Minister of Health, hopes raising the awareness of the public about the benefits of regular medical checkups would play a big role in preventing NCDs in the future. “To do so, the presence of over 400 health centers and 16,000 health posts in the country would help authorities to reach a larger portion of the population and intervene based on their culture, age, and living style,” he concludes.

Further, WHO predicted that Ethiopia is required to invest ETB242.2 billion for selected intervention packages over the next 15 years which are expected to prevent more than one million premature deaths upon being fully implemented. However, this does not seem to be attainable for Shitaye, the Professor.

“Economically speaking, the country is not in a position to invest so much, while the capacity of authorities is also questionable. Yet, I believe the government must balance the necessary revenue-loss arising from the different bans put on risk factors of NCDs, such as tobacco, khat, and alcohol, and their adverse impact on the health of people.”

For WHO, however, as long as the country has a national multi-sectoral NCD coordination mechanism, which it believes is necessary to coordinate, preventing further infections of NCDs would be impossible .EBR

9th Year • Mar.16 – Apr.15 2020 • No. 84