Saturday, December 13, 2014

Why Uganda must wake up to the cancers and heart disease epidemics

This year is set to be a land mark year. In 2015, the UN will converge on New York to set new millenium development goals(MDGs) for the next 15 years. Reducing extreme poverty and maternal deaths were some of lofty goals set in the past 15 years. In all likelihood, Non-communicable diseases(NCDs) will form part of the next set of MDGs. Uganda has been slow in aligning its development agenda towards the budgeoning cases of cancers, heart diseases and diabetes. The World Bank and World Health Organization (WHO)have separately published major reports which come to the same conclusion. NCDs such as cancers and heart diseases will be the leading cause of death by 2030 in low and middle income countries such as Uganda. And yes they are projected to outstrip HIV,malaria and Tuberculosis. That is just 15 years from now. To be sure, infectious diseases such as HIV are still of emergency importance and in many ways we have a double-trouble situation where infectious and non-infectious epidemics are co-occurances. In some instances they are even interacting. Take the case of HIV-associated cancers such as skin cancers which have been on the rise at the Uganda Cancer Institute. Reading the reported causes of death of the majority of middle class Ugandans in the press in the last five years, one cant escape two facts. The majority of these deaths have been reported to be as a result of NCDs. The majority of the deaths have occured before the 70 year mark.When I was growing up in the 1980s and 1990s, people, on average, died much later in life. Last year I spent two months in South Africa and I believe what is happening there is instructive for Uganda. Universities have re-focussed alot of their research towards NCDs particularly diabetes and heart diseases. I attended several PhD research seminars and was astonished at how much research attention NCDs are getting. Remember South Africa has a much higher HIV burden and we were told in some rural villages, HIV prevalance is as high as 40% but they have not taken their eye off the ball regardless. Prof Shane Norris of Witwatersrand University talked about exciting research they are doing in Soweto which shows that newly born babies who gain weight in the first week after birth have been shown to have a higher risk of diabetes later in life. We were told that a study on sugary soft drinks done at Wits found that an ordinary bottle of soda contained 8 spoons of sugar. But there some challenges at the global level.The global health lobby is still largely focused on infectious diseases. The US has officially declared that combating HIV is in their national interest. Academia, researchers and 'big pharma' are all heavily invested in HIV and other infectious diseases even when the terrain is changing. Of course South Africa is a middle income country and Uganda is not but there is lots we can do. One of the problems we have is that there is not much national-level data on NCDs in Uganda and most NCDs dont give off symptoms until one has a really advanced condition. Most Ugandans with NCDs dont even know it. We need to strengthen the NCDs office in the Ministry of Health led by the dedicated Dr Gerald Mutungi. Health workers need to probe for NCDs when patients visit health facilities. NCDs prevention is a much more cost-effective approach when compared to treatment which in most cases is life-long and prohibitively expensive as many Ugandans who flock to India already know. Dr Joseph Babigumira of Washington university told us that Nigeria spends a billion dollars on treating its citizens abroad every year. Measures aimed at life style changes such as reducing salt and sugar-intake, raising tobacco taxes and increased physical activity are critical. On a policy and planning level, small incremental steps such as integrating NCDs in current infectious diseases programs such as HIV would be advisable.