Chronic Disease Focus of New Strategy
72nd WHO Regional Committee for Africa

Ministers and government officials took on noncommunicable diseases, sickle cell disease, health system reforms in response to the COVID-19 pandemic, and measures to fight tuberculosis among children in Africa during their meeting of the 72nd WHO Regional Committee for Africa this week.

In an effort to curb Africa’s chronic disease crisis, African health ministers adopted a new regional strategy to improve the diagnosis and treatment of severe forms of NCDs in district hospitals and first level referral facilities where care is often unavailable today.

The new regional strategy for NCDs is known as PEN-PLUS.

It addresses cardiovascular diseases, diabetes, cancer, and chronic lung disease that are responsible for almost 70% of all premature deaths worldwide – and a fast growing proportion of premature deaths in Africa.

In addition, African nations face a special burden from sickle cell disease, which can cause severe anaemia and premature death if left untreated.

In Africa, mortality from NCDs increased from 24% of total premature deaths in 2000 to more than 37% as of 2019. But many African countries lack adequate capacity to diagnosis and treat NCDs at the primary health care level, and most are only equipped to treat severe NCDs at tertiary health facilities, meaning big hospitals, located in large cities.

The probability of premature death (age 30-70) from NCDs.

This, WHO says, puts care beyond the reach of rural and poorer patients who typically rely on district hospitals and local health centres that lack the capacity and resources to effectively manage severe NCDs.

Just 36% of countries have public hospitals stocked with basic NCD medications

chronic disease
Knowing your blood pressure supports NCD prevention, diagnosis, and early treatment.

PEN-PLUS, developed by WHO in collaboration with African health ministers over the past two years, offers a roadmap for countries to institute standardised programs to tackle chronic and severe NCDs by ensuring that essential medicines, technologies and diagnostics are available and accessible at district hospitals.

It also encourages African governments to improve training and treatment protocols for chronic NCDs and to ensure that people at private hospitals can access services for severe NCDs

Currently, just 36% of countries in the African region have public hospitals stocked with the medicines needed to treat NCDs, and private hospitals also must provide such services, according to WHO.

In Liberia, Malawi, and Rwanda, where the strategy is already deployed, WHO says there has been a significant increase in the health and numbers of patients treated for severe chronic NCDs.

In Africa, the most prevalent NCDs include Type 1 and 2 Diabetes, hypertension, heart disease and asthma, as well as sickle-cell disease, a genetic disorder, according to WHO data. 

Related to the drive against chronic NCDs, new campaign on sickle cell disease

Health ministers also launched a campaign to tackle sickle cell disease, an inherited blood disorder that causes anaemia and can shorten lifespans, if left untreated.

More than 66% of the 120 million people worldwide affected by sickle cell disease live in Africa, and approximately 1,000 African children are born with the disease every day. 

In 2019, the number of sickle cell disease deaths in the African region rose to 38,403 — a 26% increase from 2000.

This rise in disease burden is attributed to a lack of investment in disease-fighting tools including prevention, early detection and proper care, according to WHO.

The level of care has also been hampered by inadequate personnel and services, particularly at lower-level facilities. 

The campaign aims to shore up political will, engagement and financial resources for sickle cell disease prevention and control across the region.

It draws on financial support and resources from the World Bank, U.S. Department of Health and Human Services, Novartis Foundation, Global Blood Therapeutics, and the Sickle in Africa consortium.

Chief targets are schools, communities, health institutions and news media outlets.

WHO notes that progress on controlling the disease in Africa is hindered by the absence of newborn screening programmes and surveillance, lack of accurate and reliable data on sickle cell disease and no data collection for sickle cell disease in most national surveys.

“We need to shine the spotlight on this disease and help improve the quality of life of those living with it,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Revamping Africa’s health systems in the wake of the pandemic

Dr Matshidiso Moeti, WHO Regional Director for Africa, spoke at the session on childhood tuberculosis

At the meeting, countries also agreed to institute other reforms in the region’s health systems in response to the COVID-19 pandemic, placing more emphasis on improved disease surveillance, as well as prevention and vaccination. 

“Domestic investment in health, including health research, has significant economic returns, while promoting resilience and sustainability; healthy populations translate to healthy economies,”  Moeti said.

Senegal’s Health Minister, Dr Marie Khemesse Ngom Ndiaye, said that due to the pandemic, her nation’s health system put more emphasis on resilience and investment.

That “considerably strengthened disease prevention and management capacities,” she said.

Fighting tuberculosis among children 

In terms of infectious diseases, long the major focus of African health programmes, more comprehensive and immediate measures are needed to fight tuberculosis among children in Africa, said representatives of WHO and the African Union, at the meeting.

Their comments were echoed by the Stop TB Partnership and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). 

Currently, two-thirds of children with TB in WHO’s African Region fail to get diagnosed for the disease, WHO says, leading to an increased risk of rapid disease progression and mortality, especially in younger children.

Among children under age five believed to have TB, just 32% in the African Region are adiagnosed and treated, the smallest proportion for that age group globally. 

Seventeen of the world’s 30 countries with the highest tuberculosis burden globally are in Africa, where 322,000 children and young adolescents under 15 years of age are affected.

Minata Samate Cessouma, Commissioner for Health, African Union

“There is an urgent need for innovative interventions to integrate ‎tuberculosis diagnosis in nutrition programs to identify the disease ‎in children quickly,” said Minata Samate Cessouma, African Union Commissioner for Health, Humanitarian Affairs and Social ‎Development.

“Children with tuberculosis are almost never spreading the disease and are always infected by an adult,” said Dr Lucica Ditiu, Executive Director of Stop TB Partnership, “so their suffering is a metric of our failures to diagnose and treat tuberculosis in children.”

A child dies of tuberculosis somewhere in the world every two minutes, even though it is curable and preventable, she noted. .

Tackling Malawi’s cholera outbreak

At the meeting, WHO and UNICEF also announced joint plans to ramp up efforts to contain a  cholera outbreak recently announced in Malawi.

The outbreak has grown to 1,483 cases and 58 deaths in the northern and central regions, where it affects lakeshore communities and crowded, urban areas with insufficient water and sanitation facilities.

The UN agencies say they will increase surveillance for early detection and management; improve the quality of case management at cholera treatment units; and provide critical supplies needed to manage cholera cases.

They also plan to help improve water treatment, personal hygiene and household water storage.

WHO’s Country Representative for Malawi, Dr Neema Rusibamayila Kimambo, stressed that every death from cholera is preventable.

The UN health agency will offer additional support to Malawi’s Health Ministry to “help ensure that lives continue to be saved and a resilient health system is maintained during and beyond the current outbreak,” Kimambo said.

UNICEF Malawi’s Representative, Rudolf Schwenk, said it’s urgent to help Malawi’s already overburdened public health services and health care delivery systems.

“The good news is that we know the solutions,” Schwenk said. “We are on the ground providing humanitarian assistance in the affected districts, but we need more support to further scale up our response.”

Image Credits: WHO, NCD Alliance, Twitter/Matshidiso Moeti, Twitter/WHO AFRO.

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