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Prevention and Control of Non-Communicable Diseases in Ghana

Prevention and Control of Non-Communicable Diseases in Ghana. William K Bosu NCDCP, GHS 8 March 2007. Annual Public Health Review Meeting, Erata Hotel. Introduction. Chronic NCDs in Africa. Chronic diseases are projected to account for 23% of all deaths

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Prevention and Control of Non-Communicable Diseases in Ghana

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  1. Prevention and Control of Non-Communicable Diseases in Ghana William K Bosu NCDCP, GHS 8 March 2007 Annual Public Health Review Meeting, Erata Hotel

  2. Introduction

  3. Chronic NCDs in Africa Chronic diseases are projected to account for 23% of all deaths Total projected deaths due to chronic NCDs in WHO AFRO, 2005 = ~2.5 million Over the next 10 years in WHO AFRO 28 m will die from a chronic disease Deaths from infectious diseases, maternal and perinatal conditions combined will increase by 6% Deaths from chronic NCDs will increase by 27%; deaths from diabetes will increase by 42%

  4. Scope of Work of NCDCP in Ghana • Cardiovascular diseases (CVDs) • Diabetes • Chronic respiratory diseases • Cancers • Sickle cell disease (SCD) • Injuries • Hearing impairment • Emergency Humanitarian Action

  5. The Problem? Risk factors start in childhood Evidence that some risk factors are increasing Age of onset of disease and death are declining Affect economically productive persons Major cause of illness and death High economic burden Largely asymptomatic - 70% of diabetics in Accra did not know they had the disease

  6. NCDs in Our Workforce During the annual Civil Servants Week in 1999 in Accra: 246 civil servants from the MOH and MOFEP were examined 56.5% had hypertension 12.6% had diabetes 33.8% of hypertensives were aware of their condition Only 3.6% hypertensives were adequately controlled Addo et al, 1999

  7. Detection, treatment and control of HPT in AR, GAR, Accra

  8. Diabetes Care in Ho

  9. Burden of NCDs in Ghana

  10. New OPD NCDs 2002-2005

  11. NCDs at OPD 1998-2005

  12. Top 10 diseases seen at OPD, Sogakope - 2005

  13. Top 10 diseases seen at OPD, Sogakope - 2006

  14. Causes of Admission 2006, Sogakofe District Hospital

  15. Causes of Death, Sogakofe District Hospital, 2006

  16. Top 10 Causes of Institutional Deaths In WR, 2006

  17. Top 10 Causes Of Hospital Reported Deaths 2005 And 2006 Compared in BAR

  18. Beware Annual Comparisons Health workers’ strike in 2006 Varying implementation of National Health Insurance Scheme Erratic flow of funds in 2006

  19. NCDs in Public Health Facilities Hypertension at OPD Ranks as 5th commonest new outpatient cases all ages, and 2nd commonest among adults Accounts for about 3% of the total new OPD cases Reported cases rose 4-fold from 60,399 in 1990 to 249,342 in 2005 SCD is leading cause of childhood admission at KATH after malaria and diarrhoea Leading causes of admission include injuries, hypertension, stroke, heart failure, SCD, DM

  20. Share of Mortality in Sentinel Health Facilities in Ghana, 2005

  21. NCD Risk Factors

  22. Chronic NCD Risk Factors and Outcomes • Modifiable Health Behaviours • Tobacco • Alcohol • Diet • Physical Inactivity • Determinants • Global/National • Globalization, • Urbanization • Development • Equity • Resources • Distribution • Trade • Environment • Food quality • Community • Social & • Cultural Norms • Access to Care • Income • Social Supports • Environmental • factors • Intermediate Risk Factors(physiological measures) • Excess Body Fat • High BP • Blood Glucose intolerance • Blood Lipids • Outcome • Coronary heart disease • Stroke • Diabetes • Peripheral vascular disease • Cancers • COPD/emphysema • Non-Modifiable Risk Factors • Age • Sex • Ethnicity

  23. Some Interventions

  24. Some Recent Activities Prepared draft strategic plans for CVDs, DM, asthma, cancers and SCD Sensitization of regional health teams on NCD Chronic NCD risk factor survey in GAR completed Various surveys on tobacco conducted Developed draft action plan for tobacco control

  25. Some Recent Activities 2 Lobbying for tobacco legislation Public awareness campaigns on NCDs including health walks, screening Mass media programmes Celebrate international and local events – tobacco, diabetes, heart Health education at health facilities and in mass media Data collection in Kumasi and Accra cancer registries started

  26. Key Challenges and Suggested Responses

  27. General Neglect and Low Priority; Low interest from development partners Include NCDs in national documents Annual Programme of Work MDGs/GPRS II List of neglected diseases Develop national SWAp indicators Include in regional action plans Service delivery and interventions should relate to disease burden Invest funds in NCDs

  28. NCD Surveillance and Information Management Health information assessment Health Metrics Network Include NCDs into Integrated Disease Surveillance and Response Monitor risk factors e.g. childhood and adolescent Maternal mortality ratio 214/100,000 derived from survey; so why not over-nutrition 25%

  29. Low Community Awareness Celebrate national, regional, global NCD events Develop health education materials Appoint regional focal persons for NCDs Build capacity for health promotion and care Build partnerships with NGOs – GDA, Sickle Cell Foundation, Asthma, Media Personnel, etc

  30. Late Reporting for Clinical Care; Recourse to Alternate Therapy Improve community awareness Screen for early detection – CHPS, health facilities, special events, work places, self-monitoring Secondary prevention – drugs and lifestyle to prevent complications among affected persons Promote use of aspirin, statins, etc Effective therapeutic guidelines

  31. High Cost of Clinical Care Expand scope of NHIS to cover all cancers? Subsidize insulin Herbs Use generic names

  32. Lifestyle Difficult to Change Legislation – nutrition, salt, tobacco Regulate advertising – alcohol, bitters, sweetened drinks Shift to work-based or school-based programmes (physical activity, diet)

  33. Missed Opportunities Screening at health facilities Body mass index – height, weight Blood pressure Blood sugar and lipids Breast, cervix and prostate examination for cancers Genetic counselling for SCDs

  34. Improve Programme Management National Steering Committee for NCDs Coordination with Regenerative Health Appoint national focal persons for separate NCDs – injuries, cancers, etc More funds and personnel Recognise NCDs as a public health problem; not as a clinical problem Arrange systematic evaluation of the NCD Control Programme

  35. Possible Outcome of Interventions

  36. WHO AFRO Estimates At least 80% of premature heart disease, stroke and type 2 diabetes, and 40% of cancer could be prevented through healthy diet, regular physical activity and avoidance of tobacco Cost-effective interventions exist, and have worked in many countries A 2% reduction in annual chronic disease death rates over and above existing levels would save almost 3 million lives in AFRO; 2 million of these in people <70 years

  37. Priorities for 2007

  38. Some Priorities in 2007 Finalise NCD Strategic Plan Prepare NCD Policy Sensitize media persons on NCDs Encourage and support regional NCD activities Prepare and distribute IEC materials Scale up some interventions e.g. SCD newborn screening Strengthen the cancer registries’ work Improve NCD surveillance – e.g. injuries

  39. Thank You

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