A looming epidemic: tackling non-infectious disease in sub-Saharan Africa
When we think of health problems in Africa, we generally focus on infectious diseases (such as HIV and malaria), malnutrition, and maternal and childhood mortality. By contrast, non-communicable diseases (NCDs) such as obesity, heart disease and cancer are frequently referred to as ‘diseases of affluence’, and thus thought only as a problem of rich, developed countries. However, did you know that 80% of all deaths due to NCDs actually occur in developing countries, including those in sub-Saharan Africa? Although infectious diseases are still a major problem in Africa, these countries are also battling with a substantial and rapidly growing burden of NCDs. In South Africa, for example, cardiovascular disease is the second leading cause of death after HIV, accounting for up to 40% of deaths among adults. By 2030, NCDs are projected to overtake infectious disease as the most common cause of death in Africa. So what can be done to tackle this looming epidemic of non-infectious diseases in sub-Saharan Africa? One of the major obstacles we face in developing appropriate preventative strategies at a national level in Africa is a lack of reliable, high quality health information on NCDs. Since treatment and management for long-lasting or recurrent diseases is very expensive and requires strong and stable healthcare systems, prevention programmes may be a more cost-effective strategy for resource-poor countries. However, in order for governments to plan and implement prevention and control strategies, they need good quality data on disease burden and risk. Uganda In 2010, I set off to rural Uganda to work with a Ugandan project leader and team to set up and coordinate an epidemiological study on NCDs. The purpose of the study was to address this need for more information about the magnitude, distribution and determinants of these diseases in sub-Saharan Africa. The study was a collaboration between the University of Cambridge, Wellcome Trust Sanger Institute, and Medical Research Council Uganda/Uganda Virus Research Institute (MRC/UVRI). I joined as a PhD student to help coordinate the design and delivery of the project. I thus had the unique opportunity to work and live from the study field station in rural Uganda for a year, observing the project first-hand. Piggybacking on the already well-established MRC/UVRI long-running study of HIV, we surveyed 8,000 rural Ugandans on their lifestyle (such as smoking, physical activity, and diet), physical measurements (such as obesity, blood pressure and cholesterol), and took blood samples (for tests such as for cholesterol and genetic analysis). This was not an easy feat. Imagine trying to measure someone’s height and weight on uneven, unpaved ground, or explain to participants what you plan to do when there isn’t a local word for blood pressure. How do you ensure that adequate follow-up medical care is given to those identified with health problems in a setting where no national guidelines exist on how to treat high cholesterol and the only suitable healthcare facilities for some conditions are far away and expensive? There may be challenges to doing high quality large-scale NCD research in a low-resource setting, but it is possible! During my time in Uganda I learnt the importance of working together with collaborators, local staff, local leaders, and the community, in order to overcome such challenges together. All collaborators put a lot of emphasis on ensuring that everyone was well informed, enthusiastic, and engaged in what we were trying to achieve. Disease risk We successfully finished the study in 2011 and I then settled back into a slightly chillier life in Cambridge. I have since been seeing what the data has to tell us. I’m focusing on social determinants of risk factors such as smoking, obesity, blood pressure, and cholesterol, as well as evaluating how we define disease ‘risk’ for African populations. Are the tools we use to identify those at increased risk of diabetes or cardiovascular disease really internationally applicable? For example, what does it mean to be obese for Africans? Will they have the same level of risk of disease for a given amount of body fat as those of European descent? We continue to have a strong working relationship with our collaborators in Uganda (and indeed others across Africa) and research on a wide-range of topics is on-going. I am very excited by the opportunity to work in such a new and growing area of research. This global health work has allowed me to merge my academic background in molecular medicine with my experience in international development. Ultimately I hope that this work can help to inform healthcare policy and prevention programmes, allowing Africa to achieve healthy and prosperous social and economic development. *Georgina Murphy  is a PhD student in the Genetic Epidemiology group at the Wellcome Trust Sanger Institute and the International Health Research Group at the University of Cambridge. A research paper on the project she has been working on is published in the International Journal of Epidemiology. This blog was first published on the Sanger Institute blog.