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Momodou
Denmark
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 Posted - 15 Apr 2014 : 18:15:54
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Hypertension and diabetes are wreaking havoc in the Gambia National health agendas yawn on these silent killers
by Ousman Sillah
Foroyaa: Published on Monday, 14 April 2014
Alieu Jobe, 42 and unemployed, who lives in Serekunda, the country’s largest urban settlement, used to complain about dizziness, headaches and palpitations, according to his best friend, Assan Joof, a 45-year-old primary school teacher. In the last twelve months he visited the hospital four times and each time was diagnosed and treated for malaria.
Then late one night last July, Mr Joof’s cell phone rang.
He recognised Mr Jobe’s phone number on the handset, but when he answered, he heard an unexpected voice: a female crying.
“I heard his wife sobbing and telling me that the husband is in critical condition,” he said. Mr Joof ran to his friend’s house.
“We managed to rush him to the hospital, unfortunately he was pronounced dead on arrival by the doctor on duty,” Mr Joof said.
“The medical report stated that the cause of his sudden death was cardiac arrest resulting from hypertension. My friend has left a widow behind with four young children, the eldest being only fourteen years old,” he lamented. Scores of similar tragic cases are frequently taking place in the Gambia and throughout Africa mostly as a result of late medical intervention and inadequate access to health care.
Hypertension and diabetes are better known as “rich man’s illnesses,” diseases that more commonly afflict the affluent.
Until recently, they were rare in Africa, but now, as the continent rises and becomes more prosperous, its inhabitants are increasingly moving into cities and adopting lifestyles that include eating more processed foods and exercising less.
This has led to the speedy spreading of these and other non-communicable conditions that experts predict will soon overtake infectious diseases such as malaria, HIV/AIDS and tuberculosis as the most common causes of death on the continent.
About 12.1m adults suffered from diabetes in Africa in 2010, a number that could rise to 23.9m adults by 2030, or a 98% jump, according to estimates by the International Diabetes Federation (IDF), a worldwide alliance of some 200 diabetes associations in more than 160 countries and based in Belgium.
The UK based medical journal The Lancet in 2010 also reported that mortality attributable to diabetes was estimated at 6% of total mortality in Africa. High blood pressure or hypertension may affect more Africans than HIV/AIDS, according to Professor Bongani Mayosi, head of medicine of the Groote Schuur Hospital in South Africa and a leading expert on Non-Communicable Diseases (NCDs) in Africa, in a Business Day publication in May 2013.
HIV/AIDS is presently the second leading cause of death in Africa, according to the Sub-Saharan Africa Regional Edition on ‘The Global Burden on Disease: Generating Evidence, Guiding Policy’ of the Human Development Network of the World Bank in 2013. According to the UNAIDS Global and Regional statistics, 35. 3 million people were living with HIV globally in 2012 and of which 25 million were in Africa.
NCDs such as diabetes and hypertension are projected to become the most common causes of death by 2020 in Africa, according to a 2011 World Health Organisation report on non-communicable diseases.
Presently, the leading causes of death in sub-Saharan Africa are malaria and HIV, according to the 2013 Sub-Saharan Africa Regional Edition on ‘The Global Burden on Disease: Generating Evidence, Guiding Policy.’ Africa’s population is expected to rise from 1.1 billion today to at least 2.4 billion by 2050, according to the World Population Data Sheet 2013 of the US based Population Reference Bureau.
UN Habitat in its ‘State of African Cities’ 2010 Report found that 14 million people in sub-Saharan Africa migrate from rural to urban areas every year and predicts that with current trend, the urban population will increase to 1 billion in 2040 with 60% living in cities. The Gambia, a strip of land which is enveloped by Senegal on West Africa’s Atlantic Ocean Coast, is experiencing similar waves of rising populations, urbanisation and non-communicable diseases as the continent.
The Gambia has experienced a rapid increase in its population over the last ten years (1993 -2003) from 1.4m to 1.7m with an estimated annual population growth rate of 2.7 percent per year between 2010 to 2015, considered as very high (UNDP, 2011). There has been rapid and significant rural-urban migration; from 49% in 2000 to 57% in 2009, according to the Gambia Bureau of Statistics (GBoS).
According to a 2009 World Health Organisation (WHO) Country Strategy 2008-2013, hypertension and diabetes are the most common NCDs in the Gambia. Hypertension has a prevalence rate of 9.5% among adults and diabetes a prevalence rate of 8.6%, according to the report. About 61,000 or 4% of the Gambian population will be diabetic by 2030, according to a recent World Health Organisation (WHO) report on diabetes.
The results from the only study that investigated the prevalence of hypertension on 1% of the adult population in 1997 found a national prevalence of 24.2%, according to a more recent study of non-communicable diseases by Dr. Semeeh A. Omoleke, the UK’s Medical Research Council, The Gambia and published in the Pan African Medical Journal in 2013. Hypertension is a chronic medical condition in which the blood pressure in the arteries rises and forces the heart to work harder than normal to circulate blood.
It is major risk factor for stroke, heart attacks and other chronic arterial and kidney diseases. Diabetes mellitus is a life-long condition that increases sugar levels in the blood. It is either hereditary, often developing in young children also known as Type 1, or the result of a diet of unhealthy processed foods, usually diagnosed after the age of 40, or Type 2. It is this second type which affects 90% of diabetics in Africa, according to the International Federation of Diabetics. These non-communicable diseases can be prevented and managed.
They are acquired in similar circumstances: through genetic inheritance or diet. They can also be corrected with similar adjustments, a healthy diet and more physical exercise. Unfortunately, most health systems in Africa have limited resources and are too focused on infectious diseases thus leaving precious little time to treating diabetes and hypertension. Too often these diseases are misdiagnosed, not detected or detected very late.
“To be diagnosed and told by a medical doctor that you are diabetic [is] tantamount to a pronouncement of a death sentence,” explained Sainabou Sanneh, a woman in her mid-thirties who has Type 1 diabetes, which requires daily injections of insulin to survive.
Ms Sanneh is a street vendor who sells Ebbeh (a local delicacy) to children in her neighbourhood. She has a strong family history of this condition with her mother and three siblings also being diabetic.
“This is why many people fear going to test for diabetes, even including myself initially, because of the belief that having it means you will eventually end up with amputated limbs,” she admitted. About 12% of all diabetic patients have foot ulcers and about 7% of hospitalised patients lose their limbs, according to a study prepared for the Diabetes Leadership Forum Africa in 2010.
Amputation is not only physically disabling but also has an unsettling psychological effect. “My wife died shortly after the amputation of her leg due to both the excruciating pain she was suffering from and pride,” revealed Tijan Saidy, a self-employed auto-mechanic who lost his 39 year old spouse in March 2013 to diabetes.
In the year 2011/2012 in the public health facilities throughout the country, 111 deaths were recorded for hypertension of which 63 are male and 43 female, while 48 died from diabetes and of 25 were male and 43 female., according to the HMIS (Health Management Information System) data of the Ministry of Health.
The same data also reveals 79991 and 7735 Outpatient cases and 1521 and 514 Inpatient cases for hypertension and diabetes respectively during the said period. The study published in the Pan African Medical Journal revealed that mortality due to NCDs between 2008 and 2011 also rose by 23.4%, while morbidity and hospital admissions increased by 19.8% and 9.9% respectively.
According to Dr Musa Touray, a surgeon and director of the privately run Bijilo Medical Centre/Clinic in the outskirts of the capital city of Banjul, this unhealthy diet and lifestyle are causing more hypertension and diabetes in the country and that they make up 25% and 20% of the patients respectively in his clinic. “Some efforts are being made at the level of the main referral hospital (Edward Francis Small Teaching Hospital) where the diagnosed patients are registered to join a clinic that dispenses drugs to them,” explained Dr Touray.
“In addition to these efforts, there needs to be more trained medical personnel for proper care as well as an extensive awareness raising programme to encourage people to eat healthy and balanced food and engage in physical exercise.” But the Gambia’s national health focus is more on infectious diseases such as HIV/AIDS, malaria and tuberculosis.
Apart from malaria and tuberculosis, which are the leading causes of death in The Gambia, none of these communicable diseases affects the population more than diabetes and hypertension, according to the WHO Country Cooperation Strategy Brief updated in April 2009.
Dr Alieu G. Gaye, a physician who owns and operates the Pakala Clinic, the only private hospital in Banjul, disclosed that approximately 70% of his patients are either diabetic or hypertensive and of these at least 66% are female.
“About 30% of the diabetics diagnosed and treated at the clinic have Type 1 diabetes which is hereditary,” he added. “Both lack of awareness and access to medicine and technology such as blood pressure machines etc. are behind the growing numbers of patients with these two diseases, “Dr Gaye said.
“Type 2 diabetes is related to diet and lifestyle and is largely an urban and peri-urban (settlements at the periphery of the urban area) problem, while hypertension cuts across the entire country,” he added.
Dr Gaye said the health care system needs to adopt methods that ensure early detection of the two NCDs. “Its standard procedure in my clinic for every patient who is seen to be tested for both hypertension and diabetes. This is necessary to help the person to avoid having further complications,” he said.
Education is another vital component to prevent the diseases. “People are exposed daily to television adverts that encourage them to consume food that compromises their health.
If they were exposed to intense media programmes that explain what foods to avoid and which foods to eat, their life-styles would be healthier and they would be less prone to acquire these diseases,” Dr. Gaye added.
Comprehensive information on numbers on these two diseases are hard to come by in the Gambia and are mostly anecdotal, said Mr. Ebun John, secretary of the Gambia Diabetics Association.
“From the information we got through our collaboration with the main referral hospital, at least three new cases of diabetes are diagnosed every week at the out-patient department.
This means that there are 12 new cases of recorded diabetic cases every month and this excludes those who report at other health facilities and the unreported cases,” he said. He added that the majority of these cases are Type 2 diabetes.
A study published in May 2013 in the Pan African Medical Journal observed that most on-going health sensitization programmes in The Gambia on communicable diseases such as TB, HIV/AIDS, malaria and vaccine preventable diseases are initiated and or sponsored by donor funds.
Available information on the results of the first National Health Accounts for the fiscal years 2002 – 2004 has shown that 67% of the financing for the health sector came from donors, while 21% and 12% were from government and patients respectively, according to the WHO Country Strategy plan 2008-2013.
Health as a sector has the second largest share of the Gambia’s 2013 national budget, following education. It is allocated with 437m dalasi or $11m, which is more than 10% of the overall budget. Of this amount, however, only about 3% is allocated to the health promotion, while 9.2% is provided for the purchase of pharmaceuticals. Very little goes to education.
This clearly shows that awareness raising and prevention strategies are given scant attention in the overall national approach to health care. Poverty, stress and unawareness of how these diseases are contracted are major contributing factors to the spread of the two NCDs.
The average poor Gambian eats too much starchy polished rice with too much oil and not enough protein and vegetables.
This diet can lead to obesity which in turn is a risk factor for many diseases. In addition, more Gambians are abandoning manual agricultural work and adopting more sedentary jobs and lifestyles in the city.
Available information on the results of the first National Health Accounts for the fiscal years 2002 – 2004 has shown that 67% of the financing for the health sector came from donors, while 21% and 12% were from government and patients respectively, according to the WHO Country Strategy plan 2008-2013.
Health as a sector has the second largest share of the Gambia’s 2013 national budget, following education. It is allocated with 437m dalasi or $11m, which is more than 10% of the overall budget. Of this amount, however, only about 3% is allocated to the health promotion, while 9.2% is provided for the purchase of pharmaceuticals. Very little goes to education.
This clearly shows that awareness raising and prevention strategies are given scant attention in the overall national approach to health care. Poverty and unawareness of how these diseases are contracted are major contributing factors to the spread of the two NCDs.
The average poor Gambian eats too much starchy polished rice with too much oil and not enough protein and vegetables. This diet can lead to obesity which in turn is a risk factor for many diseases. In addition, more Gambians are abandoning manual agricultural work and adopting more sedentary jobs and lifestyles in the city. At present, there are no concrete policies, let alone programmes, in place in the Gambia to stem the emerging epidemic as well as available comprehensive data on chronic non-communicable diseases.
The state needs to evolve and implement a comprehensive strategic action plan that includes education and awareness.
The first task should be for government to commission a study on the nature, impact and extent of these two conditions amongst the population countrywide.
This should be followed by health education programmes, utilising the public media among other platforms to promote healthy eating and physical exercise as antidotes to the frequent sudden deaths resulting from cardiac arrests, stroke induced physical disabilities and other health complications.
In addition to this, efforts should be made for medication for hypertension and diabetics to be accessible at least at some health facilities to ease the congestion at the main referral hospital.
This story was researched and developed in late 2013.
Source: Foroyaa
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Hypertension and diabetes are wreaking havoc
