Non communicable diseases in Tanzania: a call for urgent action

Globally there is evidence of the growing burden of Non Communicable diseases (NCDs) especially in developing countries including Tanzania. This paper summarises the review of published papers on the magnitude of Non Communicable Diseases in the country. Current opportunities for management and control of NCDs are also explored. In this review diseases such as diabetes and hypertension have been shown to have increased over the years. Prevalence of risk factors such as obesity, dyslipidemia and smoking has been shown to be high with clear gender and urban rural differences. Generally there is paucity of national representative data on the burden of risk factors and prevalence of non-communicable diseases. The main risk factors for NCDs namely smoking, alcohol intake, unhealthy diet and low physical activity are prevalent in both rural and urban communities. The socio-demographic and economic transition has a big role in the current rise of non-communicable diseases in Tanzania. There are initiatives to control the burden of non-communicable diseases in the country. However there is need to focus more on primary prevention at population level targeting interventions to reduce exposure to tobacco, reduce alcohol intake, reduce salt intake, promote healthy diets and physical activity. For the prevention and control of NCDs, there needs to be a continuum from primary to tertiary prevention and a scope of interventions from the community level up to the national level. Community-based interventions are needed targeting the risk factors for primary prevention. In addition, secondary prevention measures are needed targeting those at high risk to ensure that they are identified early through a high risk targeted screening for early identification and appropriate care. Effective policies are needed to support such interventions

Noncommunicable and Communicable Diseases: Finding Common Ground

As the world grapples with unprecedented health challenges, such as coronavirus disease 2019 (COVID-19) and now monkeypox, the focus on traditional concerns, like maternal and child health, and relatively newer pandemics, e.g., diabetes and obesity tend to get diluted. This is especially concerning in countries which face a dual challenge of both communicable and noncommunicable diseases (NCDs). In this article, we list the factors that are common to both communicable disease and NCDs, and suggest measures to integrate procedures for their screening, management and prevention

Noncommunicable and Communicable Diseases: Finding Common Ground

As the world grapples with unprecedented health challenges, such as coronavirus disease 2019 (COVID-19) and now monkeypox, the focus on traditional concerns, like maternal and child health, and relatively newer pandemics, e.g., diabetes and obesity tend to get diluted. This is especially concerning in countries which face a dual challenge of both communicable and noncommunicable diseases (NCDs). In this article, we list the factors that are common to both communicable disease and NCDs, and suggest measures to integrate procedures for their screening, management and prevention

Microbial prevalence and antibiotic susceptibility pattern in hospitalized patients in a tertiary care hospital

Background: Antimicrobial resistance is among the top ten global threats as declared by WHO in 2019. Irrational use of antibiotics has led to the evolution of resistant microbes. There is limited data in our setting regarding microbes and their antibiotic susceptibility patterns. This study determines predominant bacterial isolates, their susceptibility pattern and current practices among prescribers regarding change of empirical to definitive treatment following antibiotic susceptibility test (AST) results. Method: A retrospective observational study involving 171 culture and AST reports of inpatients admitted between Jan-Dec 2020 in a tertiary-care hospital in Dar-es-Salaam. Results: Of 171 specimens, 52.6% were culture-positive. The frequently isolated organisms included Klebsiella species (21.1%), Escherichia coli (18.9%) and Staphylococcus aureus (14.4%). Of these, Gram-negative isolates showed high rates of resistance against third-generation cephalosporins (71.7%) whereas Gram-positive isolates showed high rates of resistance against penicillins (100%). More than half (58.1%) of the patients with positive culture had changes in antibiotics from empirical to definitive treatment that did not match the AST results. Conclusion: Varied rates of resistance to fourth-generation cephalosporin by the majority of bacterial isolates are alarming. This calls for the establishment of antimicrobial stewardship programs to cater for optimal and rational use of antibiotics by consumers and prescribers

Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality.

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from non-communicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10,313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD

Controlling diabetes and hypertension in sub-Saharan Africa: lessons from HIV programmes.

The prevalences of diabetes and hypertension have risen sharply in sub-Saharan Africa, but only a minority of people living with these conditions receive regular care and among those who do, glycaemia and blood pressure are generally poorly controlled. Diabetes and hypertension can be effectively controlled, but complications from these two conditions are estimated to be responsible for up to 2 million premature deaths in sub-Saharan Africa each year. Diabetes and hypertension programmes in Africa could learn lessons from HIV programmes that are also relevant for other non-communicable diseases in low-income and middle-income settings

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

Introduction Antiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension. Methods The framework for scoping reviews developed by Arksey and O'Malley and updated by Peter et al was applied for this review. The databases PubMed, Web of Science and Cochrane library were searched. Broad search terms for HIV, NCDs (specifically type 2 diabetes and hypertension) and healthcare integration were used. As the review aimed to identify definitions of patient perspectives, they were not included as an independent term in the search strategy. References of included publications were searched for relevant articles. Titles and abstracts for these papers were screened by two independent reviewers. The full texts for all the publications appearing to meet the inclusion criteria were then read to make the final literature selection. Results Of 5502 studies initially identified, 13 articles were included in this review, of which 11 had a geographical origin in sub-Saharan Africa. Nine articles were primarily focused on HIV/diabetes healthcare integration while four articles were focused on HIV/hypertension integration. Patient’s experiences with integrated care were reduced HIV-related stigma, reduced travel and treatment costs and a more holistic person-centred care. Prominent concerns were long waiting times at clinics and a lack of continuity of care in some clinics due to a lack of healthcare workers. Non-integrated care was perceived as time-consuming and more expensive. Conclusion Patient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. There is a paucity of evidence and further longitudinal and interventional evidence from a more diverse range of healthcare systems are needed

Association Between Tuberculosis, Diabetes and 25 Hydroxyvitamin D in Tanzania: A Longitudinal Case Control Study.

Vitamin D level is inversely associated with tuberculosis (TB) and diabetes (DM). Vitamin D could be a mediator in the association between TB and DM. We examined the associations between vitamin D, TB and DM. Consecutive adults with TB and sex- and age-matched volunteers were included in a case-control study in Dar es Salaam, Tanzania. Glycemia and total vitamin D (25(OH)D) were measured at enrolment and after TB treatment in cases. The association between low 25(OH)D (<75 nmol/l) and TB was evaluated by logistic regression adjusted for age, sex, body mass index, socioeconomic status, sunshine hours, HIV and an interaction between low 25(OH)D and hyperglycemia. The prevalence of low 25(OH)D was similar in TB patients and controls (25.8 % versus 31.0 %; p = 0.22). In the subgroup of patients with persistent hyperglycemia (i.e. likely true diabetic patients), the proportion of patients with low 25(OH)D tended to be greater in TB patients (50 % versus 29.7 %; p = 0.20). The effect modification by persistent hyperglycemia persisted in the multivariate analysis (pinteraction = 0.01). Low 25(OH)D may increase TB risk in patients with underlying DM. Trials should examine if this association is causal and whether adjunct vitamin D therapy is beneficial in this population

Diabetes in sub-Saharan Africa: from clinical care to health policy.

Rapid demographic, sociocultural, and economic transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs) in sub-Saharan Africa. The impacts of these transitions and their health and economic consequences are evident. Whereas, in 1990, the leading causes of death in sub-Saharan Africa were HIV/AIDS, lower respiratory infections, diarrhoeal diseases, malaria, and vaccine-preventable diseases in children, in more recent years, cardiovascular diseases and their risk factors are replacing infectious diseases as the leading causes of death in this region, and rates of increase of cardiovascular risk factors are predicted to be greater in sub-Saharan Africa than in other parts of the world. Thus, sub-Saharan Africa—which contains a high proportion of the world\u27s least developed countries—will face the multifaceted challenge of dealing with a high burden of infectious diseases and diseases of poverty, while also addressing the increasing burden of cardiovascular disease and its risk factors. At present, many of the health systems in sub-Saharan Africa struggle to cope with infectious diseases. Meeting the goals of the UN high-level meeting on NCDs (to reduce premature mortality from NCDs by 25% by 2025) and Sustainable Development Goals (SDGs; to reduce premature mortality from NCDs by a third by 2030) requires a coordinated approach within countries, which starts with a firm consideration of disease burden, needs, and priorities