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Beating non-communicable diseases to safeguard African children

Emeka Ahanonu and Ugo Alilionwu are from the same family. Following frequent hospital admissions in early childhood, they were later diagnosed with sickle cell disease.

Their family, living in a village in the eastern part of Nigeria, did as much as they could to manage their condition.

With time, cost of medication and care became burdensome for the poor family, coupled with the rising cost of living.

Meeting up with medications, hospital appointments, adequate nutrition and observing other conditions necessary to manage the condition became tougher.

Sadly, Ahanonu and Alilionwu passed on within an interval of about four years, at the ages of 11 and 14, respectively.

In a related development, Chisom Chukwuneke, 17, who was the best candidate in the 2019 West African Senior Secondary Certificate Examination in her school, died after a battle with blood cancer.

At her demise, her father, Mr Felix Chukwuneke, wrote, ‘As restless and worried as I can be, I promised to do everything humanly possible. We wen
t to South Africa. We were happy at your initial recovery, not knowing the war was just to begin.’

Young Chukwuneke died in 2020.

Again, Onome Eka’s family got to know she had Type 1 Diabetes when was 12 years old.

Keeping up with her treatment with insulin was an ordeal. It was expensive. Payment was out of the pocket. Getting needed treatment as and when due was difficult. Thus, Eka passed away some months later.

However, Akida Abdul, 10, and Emmanuel Anga,15, of Kondoa District in Tanzania have been able to live with SCD and Type 1 Diabetes respectively, having access to a PEN-Plus clinic in their community.

In spite of their families’ lack of funds for their treatments, the clinic has been able to bridge the gaps in financing, accessibility and other issues that could have limited them from having access to care.

The World Health Organization (WHO) approach to addressing severe Non-Communicable Diseases (NCDs) through an integrated outpatient service at first-level hospitals is called integrated PEN
-Plus (package of essential interventions for severe NCDs).

It aims to mitigate the burden of severe NCDs among the poorest children and young adults by increasing accessibility particularly in low and middle-income countries.

On Aug. 23, 2022, the 47 member-states of the WHO/Afro region voted to adopt PEN-Plus strategy to address severe NCDs at first-level referral facilities.

According to WHO, NCDs such as cancer, cardiovascular diseases and diabetes, are increasingly becoming the main cause of mortality in sub-Saharan Africa.

NCDs, also known as chronic diseases, are non-transmissible diseases of often long duration. Examples of NCDs include mental health conditions, stroke, heart disease, cancer, diabetes, sickle cell disorder, and chronic lung disease.

They are driven largely by behaviours that usually start during childhood and adolescence. Such behaviours include physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.

However, sometimes, they are genetic or congenital.

The d
iseases are accountable for 37 per cent of deaths in 2019, rising from 24 per cent in 2000 largely due to weaknesses in the implementation of critical control measures including prevention, diagnosis and care.

In Africa, between 50 per cent and 88 per cent of deaths in seven countries, mostly small island nations, are due to non-communicable diseases, according to the 2022 World Health WHO NCDs Progress Monitor.

Globally, it is estimated that one in two disability-affected lives and one in five deaths among adolescents are caused by NCDs.

In the Africa, the number of people living with diabetes, for example, is expected to reach 47 million by 2045, up from 19 million in 2019.

‘The growing burden of NCDs poses a grave threat to the health and lives of millions of people in Africa: over a third of deaths in the region are due to these illnesses.

‘What is particularly concerning is that premature deaths from non-communicable diseases are rising among people younger than 70 years,’ said Dr Matshidiso Moeti,
WHO Regional Director for Africa.

Highlighting the gravity of the situation, Moeti, who joined the International Conference on PEN-Plus in Africa (ICPPA2024) virtually, said it was time to prioritise person-centred approach to NCDs.

The four-day conference, from April 23 to April 25, 2024, had the theme, ‘Prioritising Person-Centered Approach to Chronic and Severe NCDs – Type 1 Diabetes, Sickle Cell Diseases, and Childhood Heart Diseases.’

It was hosted by the Tanzania Ministry of Health and the World Health Organization African Region (WHO-Afro), in partnership with the HELMSLEY Charitable Trust and NCDI Poverty Network.

The meeting centred around inequitable access to prevention, diagnosis, treatment and ongoing care, seeking commitment to advocate increased focus on chronic and severe non-communicable diseases within existing healthcare delivery systems.

Moeti said: ‘The surge in the number of NCDs on our continent over the past two decades is driven by increasing incidences of risk factors, such as u
nhealthy diets, reduced mental activity, obesity, and air pollution.’

She urged African governments to step up efforts and embrace the PEN-Plus initiative to ensure that targets would be met.

‘Severe NCDs such as Type 1 Diabetes, rheumatic heart disease and sickle cell disease, more frequently affect children and young adults, the majority of Africa’s population.

‘Africa must invest more now in addressing NCDs with adequate and sustained resources.

‘We are continuing to invest in reducing the high burden of premature mortality from chronic and severe disease within the context of Universal Health Coverage.

‘Despite our member-states’ efforts, we have a huge challenge in NCDS in Africa,’ she said.

According to the official, data from low-income countries shows that 26 per cent of total health spending is due to NCDs, second only to infectious and parasitic diseases.

‘This means it is urgent to give these often-neglected diseases the priority and attention they deserve.”

She said that the rapid evoluti
on with a higher mortality rate had not been adequately recognised because of inadequate investment and lack of diligence in knowing the diseases.

Also, Elke Wisch, UNICEF Representative in Tanzania, who represented the UN Resident Coordinator in Tanzania, noted that children had become at great risk of NCDs.

‘Beyond the general picture of NCDs, we also have severe conditions that pose acute stages in individuals affected by these conditions.

‘Diseases such as sickle cell anemia, rheumatic heart diseases and Type 1 Diabetes do not only affect adults but also impact children and adolescents in significant numbers here, in Tanzania, and other countries in Africa.”

Wisch said that the diseases, if not priority attention, would remain a cause of mortality in children and adolescents.

‘The United Nations system is consciously aware of the profound impact that NCDs have on individuals, families and entire societies and nations.

‘These diseases, including cardiovascular diseases, cancer diabetes and chronic r
espiratory diseases, pose significant challenges to our healthcare systems and the well-being of our countries.’

Recognising the gravity of the consequences of not addressing NCDs, especially for children and adolescents, Mr James Reid of Helmsley Charitable Trust, suggested ways to address the situation.

He advised that all efforts and investments in addressing NCDs should be focused on integrating NCD care seamlessly into existing health systems.

‘The key to achieving UHC lies in expanding primary healthcare, especially in low-resource and humanitarian settings.

‘Collaborative, cross-sector strategies, innovative investments and a focus on integrating NCD care into existing health systems are all keys to achieving health for all,” he said.

He said that successful models such as PEN-Plus had demonstrated the effectiveness of empowering nurses and mid-level providers to integrate NCD care into the ongoing continuum of primary healthcare.

Through the PEN-Plus initiative, governments in the African regio
n are working on strengthening preventive measures, promoting healthy lifestyles and ensuring access to quality healthcare services at the primary healthcare levels where many people seek healthcare services.

Also, SDG 3.4 calls for all member-states to reduce premature deaths from NCDs by one-third in 2030 through prevention, treatment and promoting mental health and well-being.

However, a number of low- and middle-income countries are not on track to actualising SDG target 3.4 to reduce NCD mortality.

From the Africa Centres for Disease Control and Prevention (Africa CDC), the same indices resonate, with NCDs and other conditions rising and threatening the continent’s vision of achieving and building an integrated, prosperous and peaceful Africa driven by its own citizens.

However, as highlighted in the AU Agenda 2063, addressing the menace will also involve addressing these conditions with a multi-faceted approach.

Dr Mohammed Abdulaziz, Head, Division of Disease Control and Prevention, Africa CDC, af
firmed that a multi-faceted and integrated approach to solving some of the major health system obstacles in the delivery of NCDs Treatment and Prevention and Control Plan, was needed.

‘Our approach must prioritise the individual and families impacted by NCDs.

‘We must ensure equitable access to essential medicines and services for everyone for everyone.”

According to him, as agreed by the AU heads of state, there is need to set up a pool procurement mechanism to strengthen and see if this will help in getting essential medication and access to health products for these high-burden diseases.

Also, he stressed the need for the integration of data which should be collected nationally, through surveillance.

Achieving these goals, he said, also required bridging the funding gap for Africa for the NCDs programmes across the continent.

‘We have no choice but to also push for domestic finance. We know that very few of our countries are reaching the 15 per cent mark budget for health, the Abuja declaration.

f we can show to all what we are doing, that our government should, in putting more funding into health, put more in the area of NCDs, it will be good to help us reach that target”.

In conclusion, the path ahead toward addressing NCDS requires collaboration, communication, innovation and a human-centred approach.

There is need for increased investment toward prevention, research and care for childhood NCDs, with access to equitable care and support given priority attention, leaving no one behind.

These can be achieved when governments and leaderships are committed to stepping up efforts and embracing initiatives such as the PEN-Plus initiative, to ensure that targets are met.

In so doing, aside adults, African children and adolescents can hope for a brighter future without the scare of living with or sliding into eternity with NCDS, when it could have been prevented or optimally-managed.

At present, 20 countries in Sub-Saharan Africa are at various stages of initiating, implementing or scaling up PEN-Pl

It is estimated that no fewer than 10,000 people are receiving treatment for severe NCDs in PEN-Plus Clinics across 11 Sub-Saharan countries.

By 2030, the WHO’s goal is for 70 per cent of African region member-tates to have national plans for integrated care, NCD training for health workers, and essential medicines in district hospitals.

Source: News Agency of Nigeria