Africa Needs To Upgrade Approach On Lifestyle Diseases Studies
Lifestyle diseases are associated with the excesses of an ageing or privileged population. The list of these diseases is long, the most notable being cancer, diabetes and cardiovascular disease. Increasingly these non-communicable diseases are a major health threat worldwide. They are responsible for more than 38 million deathsannually. That record is close to 75% occur in low and middle-income countries.
The emergence of the lifestyle diseases in Africa is a recent development. Rapid changes in lifestyles along with increasing urbanisation are fuelling the rise. Evidence suggests that the risk is accelerating in sub-Saharan Africa. However, the non-communicable disease problem is hidden under the infectious disease epidemic.
This may have implications on poverty levels on a macro-level as greater resources are allocated to healthcare. At the household level, high healthcare costs associated with long-term management of non-communicable diseases can drive families into poverty.
Current research remains limited to assessing the extent or magnitude and drivers of specific non-communicable diseases - often also referred to as NCDs - within a given population. The processes and procedures traditionally used to conduct public health research, which are typically applied to infectious diseases, must be modified to meet this challenge.
The growing trend of non-communicable diseases coupled with the need for stronger counter-action in sub-Saharan Africa was the focus of a recent symposium in Kenya. It was the first dedicated to research on non-communicable diseases in a country where they account for 27% of total deaths and 50% of hospital admissions.
These are reasons why should the approach to researching non-communicable diseases must change.
Initially, non-communicable diseases share common risk factors - but there is no one-on-one relationship between the diseases and their risk factors. One risk factor may be related to many. One disease may be related to many risk factors. Alcohol use, for instance, is a risk factor for cardiovascular disease and some types of cancer, as well as diabetes.
Secondly, these diseases develop progressively over a person's lifespan. People who are exposed to risk factors in childhood or adolescence may develop non-communicable diseases in adulthood or in old age. Research must therefore consider approaches to prevent and manage these diseases over the lifespan.
Equally, patients may require long-term care. So research needs to employ a cohort model that looks at long-term and continuous assessment of care and its outcomes.
Thirdly, non-communicable diseases typically do not occur in isolation. Associated illnesses (co-morbidities) are common. Research should examine co-existing conditions rather than a single disease in isolation.
Lastly, these diseases require a combination of multiple interventions - behavioural as well as clinical. The effectiveness of these in combination should be investigated.
It is also critical that patients are actively involved in their own care. They should be considered partners in the research process as they generate and use evidence.
Research will need to be contextually relevant to address the complex relationships at the core of prevention, management and response. Hence, dealing with these challenges requires a thoughtful and deliberate realignment from an epidemiological research approach.
Thus, as much as research is concerned, widening this scope and approach to research requires innovation, courage and determination as well as a significant investment of financial resources. This should be underpinned by policy level involvement of all stakeholders - departments of health, national treasuries, agriculture, labour, planning and education.