Dual Burden of Disease  This is when a defined area (region, territory, country, etc.) is having to deal with both centuries-old communicable disease problems like infectious diarrhea and under-nutrition as well as the modern non-communicable disease problems like obesity, heart disease and smoking

 MYTH: that communicable diseases like malaria, tuberculosis and HIV/AIDS affect the developing world, while NCDs like heart disease, diabetes and cancer are largely confined to the developed world.  REALITY: Due to climate change, increased urbanization and the spread of globalization, more countries than ever will face the dual disease burden. The same factors that enable the spread of infectious disease—poverty, unclean water, poor sanitation and weak health systems—exacerbate the chronic conditions.

 Sub-Saharan Africa is the only region of the world in which infectious diseases still out number chronic diseases as a cause of death.  In adults, age specific mortality rates from chronic diseases are higher in younger adult age groups, than in most high income countries.  Of the 36 million people NCDs kill each year, 9 million die before age 60.  Ninety percent of these deaths occur in low and middle-income countries.

In a Nigerian Study in Uyo (Ekpenyong et al)  Of 2,780 participants, prevalence of  obesity was 25%,  hypertension-14.4%,  diabetes mellitus-12.7%,  musculoskeletal disorders-20.1% and  respiratory disorders-10%.  Obesity, diabetes mellitus and musculoskeletal disorders - were more prevalent in women  while hypertension and respiratory disorders were more in men

Unhealthy Lifestyles and Poor habits  poor dietary habits- obesity-DM/HTN  physical inactivity- obesity- DM/musculoskeletal diseases  smoking habits- Cardiovascular disease, cancers  alcohol abuse- Liver disease, pancreatitis

Other Variables  Age - Age related insulin resistance was an independent predictor of all clinical events. In the Nigerian study, highest prevalence was recorded among participants within the ages  Obesity : cardiovascular disease risk is double if BMI is > 25 and nearly quadrupled if the BMI is > 29, the risk of developing diabetes was 40 times with BMI > 35 (Mohammed, 2003). Obesity was more pronounced in women than men.  Family History : Obesity and DM have family predispositions.

Other Variables Contd.  Area of Residency : The urban dwellers have a higher rate of NCDs than rural dwellers.  Work Stress : The higher the work stress, the higher the risk of NCDs  Education : Unfortunately the higher the education (by western parameters), the more likely to suffer from NCDs. Presumably the higher educated the person is, the more successful, and a higher socio- economic status and more likely to indulge in unhealthy lifestyles.

In 2008, the proportion of premature deaths due to NCD in population under 60 years of age  low–income countries was 41%,  in lower middle–income countries 28%, and  in high–income countries only 13%. The most frequent causes of death included cardiovascular diseases, diabetes, cancers and chronic lung disease, and the main underlying risk factors were increased blood pressure (13% of deaths globally), tobacco use (9%), elevated blood glucose levels (6%), physical inactivity (6%), and overweight and obesity (5%).

Communicable Diseases  remain difficult to control, especially in young children  necessary effective and affordable tools and knowledge about their prevention, treatment and control are available. They do not always reach those who need them. Four communicable diseases still account for nearly 50% of global child mortality:  - acute respiratory diseases,  - diarrhea,  - neonatal sepsis  - and malaria.

Double Burden of malnutrition  consisting of under-nutrition among children and over-nutrition in adults.  as much as 35% of child deaths could be attributed to macro– and micro–nutrient under- nutrition. In addition to its effect on mortality, under-nutrition also affects human development in many aspects.  A driving force behind the shift from under-nutrition in childhood to over-nutrition in adulthood in LMIC was the rapid increase in  -economic development,  -globalization,  -and urbanization

Double Burden of malnutrition  The occurrence of under-nutrition and obesity result in the opposite manifestations of malnutrition even within a single household.  An underweight child and an overweight mother within the same household were observed in 11% of the households in rural areas in Indonesia and 4% in Bangladesh.  The figures were even worse in the refugee population living in Western Sahara, where 24.7% of pairs of children (aged 6–59 months) and mothers (aged 15–49 years) were affected by this ‘double burden of malnutrition’. In the study 29.1% of the children were stunted and 18.6% were underweight, while among the women, 53.7% were overweight or obese.

Double Burden of malnutrition  Double burden of malnutrition’ is an important driver of the double burden of disease.  Under-nutrition in fetal life and among children predisposes to infectious diseases, but also increases the NCD burden, mainly through overweight and obesity and related co– morbidities.  On the other hand, over-nutrition in pregnant overweight women closes the circle.

Top 20 Causes of Death in Nigeria (WHO 2011) TOP 20 CAUSES OF DEATHRateWorld Rank 1.Influenza & Pneumonia HIV/AIDS Stroke Coronary Heart Disease Diarrheal diseases Tuberculosis Malaria Diabetes Mellitus Lung Disease Maternal Conditions Hypertension Kidney Disease Breast Cancer Birth Trauma Low Birth Weight Road Traffic Accidents Meningitis Endocrine Disorders Asthma Violence

Nigerian Total Deaths By Cause (WHO 2011) PERCENT TOP 20 CAUSES Deaths% 1.Malaria219, HIV/AIDS213, Influenza & Pneumonia 213, Diarrheal diseases173, Tuberculosis97, Stroke87, Coronary Heart Disease 71, Birth Trauma68, Low Birth Weight67, Maternal Conditions 50, Diabetes Mellitus34, Meningitis33, Pertussis32, Lung Disease25, Road Traffic Accidents 24, Congenital Anomalies 19, Violence18, Kidney Disease16, Hypertension14, Other Injuries14,

What is The Solution?  Political will is lacking in African countries. The real challenge for any call to action is to develop and implement a plan for achieving its goals.  Experts endorse plans and policies that simultaneously address -structural (including policy, fiscal, industry and private businesses, international collaboration), -community (including mass media, voluntary organization, institutions, primary healthcare) and -individual (including behavioral and pharmacological interventions).

Solution?  South Africa, Mauritius, Tanzania and Cameroon are among the few African countries that have responded to the call for action.  In the majority of countries, there is a gap between policy makers' recognition of a national chronic disease burden and the development and implementation of chronic disease policies and plans

Solution? A second problem is a weak culture of knowledge transfer.  While production of chronic disease research in Africa remains low compared to the rest of the world, research does exist on the causes and effects of chronic diseases in the region.  This limited body of work provides important insights for practice and policy. The challenge is in undertaking the sorts of analyses that enable appropriate knowledge transfer and knowledge exchange.

Solution?  Education- weight loss programs; teach and encourage exercise programs, smoking cessation programs, etc.  Encourage and produce more and better trained primary care providers.  Instead of building more roads, build alternative modes of transportation as in the public transport system. Make such more desirable. People will walk more. They have to walk to the bus or train station as opposed to getting out of the house and into the car to the office/destination and vice versa.  Immunization programs have yielded the most significant changes in child health in the last few decades.. At least 2 million children still die each year from diseases for which vaccines are available at low cost. Similarly, for diarrheal disease, there exists a simple, inexpensive and effective intervention: oral rehydration therapy.  Among maternal conditions, obstructed labor, sepsis and unsafe abortion were among the ten leading causes of death and disability among women aged 15– 44 years in developing countries.