tag:theconversation.com,2011:/global/topics/non-communicable-diseases-40747/articlesNon Communicable Diseases – The Conversation2023-08-06T08:48:25Ztag:theconversation.com,2011:article/2100022023-08-06T08:48:25Z2023-08-06T08:48:25ZLiving in Nairobi’s slums is tough – residents are 35% more likely to suffer from high blood pressure than those in rural areas<figure><img src="https://images.theconversation.com/files/540442/original/file-20230801-29-5f1zo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Slum-dwellers with high blood pressure struggle to get proper treatment</span> <span class="attribution"><span class="source">AlexanderXXI/Shutterstock</span></span></figcaption></figure><p>Hypertension, commonly referred to as high blood pressure, is a non-communicable disease that occurs when there is a sustained elevation in the pressure of the blood that flows through the arteries. </p>
<p>Adults in low- and middle-income countries account for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979614/">75%</a> of the global cases. </p>
<p>High blood pressure is a manageable condition through regular monitoring, lifestyle changes and treatment. However, untreated blood pressure, also known as uncontrolled hypertension, can lead to damage to organs such as the kidneys, heart and brain. All this increases the risk for heart attack, stroke and other serious health issues.</p>
<p>Globally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964205/">uncontrolled hypertension</a> is a leading contributor to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388856/">death</a>. </p>
<p>In Kenya, the 2014-2015 <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">national survey on non-communicable diseases</a> showed that high blood pressure contributed to a significant burden of disease. About <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">one in four people</a> have high blood pressure in the country. The hypertension prevalence for <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">Kenya (24.5%)</a> is slightly lower than that of neighbouring countries such as <a href="https://web.archive.org/web/20220401033113/http://www.who.int/ncds/surveillance/steps/UR_Tanzania_2012_STEPS_Report.pdf#page=48">Tanzania (26%)</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138991">Uganda (26.4%)</a>.</p>
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Read more:
<a href="https://theconversation.com/hypertension-diabetes-stroke-they-kill-more-people-than-infectious-diseases-and-should-get-a-global-fund-195479">Hypertension, diabetes, stroke: they kill more people than infectious diseases and should get a Global Fund</a>
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<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883228/">Research</a> suggests that urban slum residents are 35% more likely to be hypertensive than people living in rural areas. In Nairobi, Kenya’s capital city, around <a href="https://unhabitat.org/sites/default/files/2020/09/un-habitat_and_the_kenya_slum_upgrading_programme_-_strategy_document.pdf#page=12">60% of the population</a> lives in slums or slum-like conditions. <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-015-0112-1">Previous</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2610-8">research</a> in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1177">Kenya’s urban slums</a> shows high uncontrolled hypertension rates. </p>
<p>In our <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">recent study</a>, my colleagues and I wanted to understand the range of factors that put these people at risk for uncontrolled hypertension or protects them from it. </p>
<p>We found that the low socio-economic status of the slum residents, coupled with high medication prices, limited treatment. </p>
<h2>Gaps in care persist in urban areas</h2>
<p>Nairobi’s slum dwellers experience sub-optimal access to essential services. They face conditions that make informal settlements vulnerable to emergencies such as disease outbreaks and natural disasters. </p>
<p>Even though there are effective treatments for hypertension, gaps in care persist in urban areas in Kenya, particularly among the poorest communities.</p>
<p>Our research aimed at understanding the barriers to blood pressure control at various levels – individual, family and community, health system and policy. </p>
<p>We collected data through interviews and focus groups in two Nairobi slums: Korogocho and Viwandani. We interviewed people who had uncontrolled hypertension, aiming to understand their experiences and perspectives about their care. </p>
<p>Healthcare providers were interviewed to gather information about their prescription practices, adherence to national guidelines and knowledge of hypertension. </p>
<p>We also interviewed decision-makers and policymakers to gain their views on the challenges faced in getting hypertension care in the study community. </p>
<p>The research identified barriers to blood pressure control across all the levels studied. Major bottlenecks were the high cost of hypertension medicines, the constant unavailability of medicines at health facilities, and an unsupportive family and environment.</p>
<p>In this <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">study</a>, access to medication was a major barrier to blood pressure control.</p>
<p>Countries such as <a href="https://jhpn.biomedcentral.com/articles/10.1186/s41043-017-0090-4">Eritrea</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830110/">South Africa</a> provide free hypertension medications at the community level.</p>
<p>In Kenya, however, free medication is provided only at higher-level health facilities. Slum residents have access to lower-level facilities which are not mandated to provide hypertension medications. </p>
<h2>So what can be done?</h2>
<p>A viable approach is to implement programmes with interventions capable of addressing the complex array of factors influencing hypertension care. </p>
<p>For instance, the provision of free or subsidised medicines would remove barriers that hinder patients’ access to hypertension medication. </p>
<p>It’s also essential to implement policies and directives to ensure equitable care for all, including those in slum communities seeking care at lower-level health facilities.</p><img src="https://counter.theconversation.com/content/210002/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shukri F. Mohamed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hypertension is a manageable condition – but left untreated, it can damage organs such as the kidneys, heart and brain.Shukri F. Mohamed, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1844822022-07-06T13:35:37Z2022-07-06T13:35:37ZAfricans make up a tiny portion of genomics data: why there’s an urgent need for change<figure><img src="https://images.theconversation.com/files/471412/original/file-20220628-22-v51h6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigeria provides an excellent lens to look at the genetic diversity of African people.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sample-being-pipetted-into-a-eppendorf-tube-for-royalty-free-image/1140201417?adppopup=true">Getty Images </a></span></figcaption></figure><p><em>A group of Nigerian scientists, in conjunction with the London School of Hygiene and Tropical Medicine, <a href="https://www.nature.com/articles/s41588-022-01071-6">established</a> the Noncommunicable Diseases Genetic Heritage Study consortium in February 2020. The aim is to produce a comprehensive catalogue of human genetic variation in Nigeria and assess the burden of noncommunicable diseases in 100,000 adults in the country. The Conversation Africa asked genetic epidemiologist <a href="https://www.lshtm.ac.uk/aboutus/people/fatumo.segun">Segun Fatumo</a>, one of the leaders of the consortium, to explain what they are doing and why.</em> </p>
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<h2>How does Africa feature in global genomics?</h2>
<p>Until recently, only about <a href="https://www.nature.com/articles/538161a">3% of genomic data</a> being used for genome-wide association studies came from people of African descent. Unfortunately, this proportion has fallen even further, <a href="https://www.nature.com/articles/s41591-021-01672-4">to 1.1% in 2021</a>. This means people of African descent may miss out on the potential benefits of genomic research, including early detection of disease and rational drug design. </p>
<p>The current lack of genomic diversity has led to major scientific opportunities being missed. <a href="https://www.nature.com/articles/ng1509">One study</a> which included people of African descent discovered a gene called <em>PCSK9</em> which helps in lowering bad cholesterol. This study led to new drugs that help prevent heart disease. This benefits everyone irrespective of their ancestry populations. It wouldn’t have been possible without including people of African descent. </p>
<p>Africans have the most diverse genomes of all the human populations because modern <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953791/">humans originated in Africa</a> and then spread across the globe over the past 80,000 years. Therefore, studying the genome of Africans could uncover genetic variants not found in other populations. Such genes could yield new ways to diagnose, prevent and treat diseases for everyone. </p>
<h2>What does the consortium plan to do?</h2>
<p>We teamed up with <a href="https://54gene.com/">54gene</a>, a health technology platform company that’s building diverse datasets to unlock scientific discoveries. Together we established the <a href="https://www.nature.com/articles/s41588-022-01071-6">NonCommunicable Diseases Genetic Heritage Study consortium</a>. One aim is to develop a catalogue of human genetic variation in 100,000 adults in Nigeria. This will be the largest genomic data resource ever to come from continental Africa. It will be of great value to genomics researchers globally and may help in the prevention and control of noncommunicable diseases in sub-Saharan Africa.</p>
<p>The other aim is to assess Nigeria’s burden of disease. We’re looking at things like haematological cancers and cardiovascular, neurodegenerative, metabolic, kidney function and sickle cell disorders.</p>
<p>Our consortium could serve as a template for large-scale genomics across the continent. We hope it will advance precision medicine and offer insights that will improve the health and well-being of African and global populations. </p>
<p>The consortium has five points on its agenda:</p>
<ul>
<li><p>address health issues of concern for Africans and other populations</p></li>
<li><p>ensure projects meet the highest ethical, legal and socially appropriate standards for research</p></li>
<li><p>generate, process, store and use large genomic datasets</p></li>
<li><p>build research capacity</p></li>
<li><p>develop leaders for genomics in Africa.</p></li>
</ul>
<p>The first step is to collect samples. A minimum of 100,000 research participants have been recruited and samples of biological material like blood and urine have been stored for further genomic studies. </p>
<p>Next is to design a small chip that is able to capture a picture of somebody’s DNA sequence. There are three billion base pairs in any human genome. The chip will capture at least one million genetic variants that are important for different diseases. We are also developing other studies using the whole-genome DNA sequence of all three billion base pairs.</p>
<p>We will also be fostering a scientific community that will empower African genomics scientists to be leaders in the genomic world. We want more people in Africa to be in a position to write the continent’s own genomics agenda.</p>
<h2>Why focus on Nigeria?</h2>
<p>First, Nigeria has one of the most diverse ethnolinguistic concentrations in the world, with more than <a href="http://rogerblench.info/Language/Africa/Nigeria/Atlas%20of%20Nigerian%20Languages%202020.pdf">300 ethnic groups and 500 languages</a>. This diversity is taken as a proxy for potential genetic diversity, as seen in other populations. Data from the Nigerian population provides an excellent lens to look at the genetic diversity of African people. This will ensure that most genetic variations are captured.</p>
<p>Second, with <a href="https://www.statista.com/statistics/1122838/population-of-nigeria/#:%7E:text=As%20of%202022%2C%20Nigeria's%20population%20was%20estimated%20at%20around%20216.7%20million.">over 200 million people</a>, Nigeria represents a quarter of the African population. We are recruiting people from across the six geopolitical zones in Nigeria.</p>
<p>With 100,000 research participants, we will be able to estimate the prevalence of noncommunicable diseases in the population, and understand the associated risk factors. </p>
<p>We are poised to provide information that could be used to develop tools for the <a href="https://pubmed.ncbi.nlm.nih.gov/31537347/">early detection of diseases</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/31537368/">disease prevention strategies</a> and <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1595">treatment options</a>. </p>
<h2>What other initiatives are there on the continent?</h2>
<p>Our effort will complement other initiatives like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138491/">H3Africa</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0092867419311201">Uganda Genome Resource</a> and a few others.</p>
<p>H3Africa was launched in 2012. It has recruited close to 100,000 research participants for genomic research in the last decade and trained over 1,000 African scientists, including me. </p>
<p>The <a href="https://acegid.org/">African Centre of Excellence for Genomics of Infectious Diseases</a> is another successful Nigerian-based initiative. It is making an impact through training, discovery and surveillance of infectious pathogens.</p>
<p>The <a href="http://www.nbgnetwork.org/">Nigerian Bioinformatics and Genomics Network</a> is another. It is fostering genetic research collaboration and provides opportunities for career development in genomics and bioinformatics.</p>
<p>The Uganda Genome Resource is currently <a href="https://theconversation.com/what-weve-learnt-from-building-africas-biggest-genome-library-126293">one of the largest</a> and most successful genomic initiatives in Africa. In 2019, a rich, diverse resource was <a href="https://www.sciencedirect.com/science/article/pii/S0092867419311201">published</a> using data from 6,400 Ugandans. It includes whole genome sequencing of nearly 2,000 people.</p>
<p><em>Aminu Yakubu and Babatunde Olusola helped research this article.</em></p><img src="https://counter.theconversation.com/content/184482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Segun Fatumo received consultancy fees from 54gene Nigeria Ltd.</span></em></p>A new study hopes to produce a catalogue of human genetic variation and assess the burden of noncommunicable diseases in 100,000 adults in Nigeria.Segun Fatumo, Associate Professor of Genetic epidemiology & Bioinformatics, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227932019-09-04T04:42:44Z2019-09-04T04:42:44ZSix things to know about cancer: from suicidal cells to hair loss from chemotherapy<figure><img src="https://images.theconversation.com/files/290522/original/file-20190902-175682-ml7tw4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cancer cells in 3D.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>News of the discovery of herbal cancer treatments has always piqued people’s interest. Recently, the media in Indonesia extensively reported claims of a <a href="https://www.thejakartapost.com/news/2019/08/14/central-kalimantan-high-schoolers-win-invention-olympic-gold-medal-in-south-korea-for-cancer-medication.html">cancer cure made from a plant native to Borneo</a> and the use of <a href="https://www.liputan6.com/health/read/3599684/8-manfaat-daun-sirsak-yang-sudah-direbus-untuk-kesehatan">soursop leaves as a form of alternative treatment</a>.</p>
<p>This is not surprising as cancer kills <a href="https://www.liputan6.com/health/read/4043285/kematian-akibat-kanker-tinggi-menkes-nila-ingatkan-cerdik?related=dable&utm_expid=.9Z4i5ypGQeGiS7w9arwTvQ.1&utm_referrer=https%3A%2F%2Fwww.google.co.id%2F">over 200,000 people per year</a> in Indonesia. Treatment costs are high, while survival chances remain slim.</p>
<p>Although certain plants can be used to make drugs, the ingredients have to pass <a href="https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/what-clinical-trials-are/phases-of-clinical-trials">a series of rigorous screenings and studies</a>. After it’s <a href="https://theconversation.com/mengapa-kita-perlu-kritis-dan-berhati-hati-dengan-heboh-obat-kanker-dari-bajakah-122045">declared safe and its health benefits scientifically proven</a>, only then can the drug be mass produced and marketed commercially.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/UopUxkeC4Ls?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What is cancer?</span></figcaption>
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<p>To understand this further, this article explains the biological process behind cancer, a disease <a href="http://theconversation.com/kanker-yang-membunuh-faktor-risiko-lingkungan-dan-gaya-hidup-lebih-dominan-ketimbang-genetik-111517">triggered mostly by lifestyle choices and made worse by unhealthy environments</a>.</p>
<h2>1. Trillions of cells multiply inside our bodies</h2>
<p>Cancer is what happens when cells divide in an excessive and uncontrollable manner.</p>
<p><a href="https://bscb.org/learning-resources/softcell-e-learning/cell-structure-and-function/">Cells are the smallest parts of our body</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23829164">At least 37 trillion individual cells</a> live inside us.</p>
<p>Each cell is a “body” of its own. Cells can generate energy, regulate their own “homes”, expel waste, defend themselves, multiply and “commit suicide” when they’re injured or grow old.</p>
<p>Shortly after fertilisation, cells can <a href="https://embryo.asu.edu/pages/embryonic-differentiation-animals">grow to become a number of possible organs</a>. They can develop into skin cells, nerve cells, muscle cells, bone cells or other body parts.</p>
<p>After being “assigned” to become a specific kind of cell, it will develop the capacity to have memories. The cell will then grow and multiply, generating identical cells with the same task. Complex instructions from our brains are sent so that these cells grow at a normal rate and work according to their assigned jobs.</p>
<p>For instance, the cells that are assigned to become <a href="https://www.hematology.org/Patients/Basics/">blood cells</a> will multiply into more blood cells. They multiply and grow no more than they need to. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289039/original/file-20190822-170910-p2ohnn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our immune system cells contain the spread of cancer cells.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2NjQ5MjYxNiwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTQxMjk5NDk0IiwiayI6InBob3RvLzE0MTI5OTQ5NC9tZWRpdW0uanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJyOEhyMGU2QkRESnVabEcxK3IxVkxsd2p3NWMiXQ%2Fshutterstock_141299494.jpg&pi=33421636&m=141299494&src=SBO3l2VW38c15qiG8XN_sw-1-16">Jovan Vitanovski/Shutterstock</a></span>
</figcaption>
</figure>
<p>Since the only role of red blood cells is to transport oxygen around our body, they encounter only minor challenges and thus their damage can be predicted. These cells will die after 3-4 months. Red blood cells multiply at the rate needed to continually replace these dying cells.</p>
<p>White blood cells, on the other hand, have an important role in defending our body from foreign threats. When there are no “enemies” such as bacteria or viruses, then these white blood cells multiply slowly. Once enemies appear, their production speeds up as they must eliminate them as soon as possible.</p>
<h2>2. Cell suicide happens regularly</h2>
<p>Once in a while, cell divisions can encounter problems and disrupt the “supply and demand” of our bodily functions. During situations like this, cells can detect <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117903/">anomalies</a>. These abnormal cells have to be disposed of, so the suicide of these cells stops the abnormal growth.</p>
<p>These problems occur rather often inside our bodies, but we never realise it as our body is programmed to deal automatically with these problems.</p>
<p>However, at times, <a href="https://www.cancerprogressreport.org/Pages/cpr18-understanding-cancer-development.aspx">this “regulatory suicide” process can fail to do its job</a>. The defective cells then remain undetected and left to grow. They continue to multiply uncontrolled, and this is what we call cancer.</p>
<h2>3. They look like crabs and can ‘walk around’</h2>
<p>At first, the number of defective cells is only limited.</p>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069504/">breast cancer</a> cases, at first when the area is touched there would seem to be no irregularities. But, after a while, the cell grows into a clump as big as a seed, and then as large as a marble. Eventually, the cells will multiply so much that it becomes the size of an egg. (That’s why women are advised to regularly <a href="https://www.nationalbreastcancer.org/breast-self-exam">self-examine their breasts</a> so these cases can be detected much earlier.)</p>
<p>When the clumps of defective cells are only as large as seeds, these clumps still remain idle and hang around other healthy cells.</p>
<p>However, because these cells are abnormal, they ignore their growth limitations and instead multiply at an uncontrolled rate. Our body will interpret these abnormal growths as sites requiring extra food, and networks of “toll roads” are created in the form of blood vessels to deliver nutrients straight to these cells.</p>
<p>After receiving fresh supplies of oxygen and nutrients, these defective cells multiply even faster, and can no longer sit close to normal cells as the clump needs more and more space to grow. With a <a href="https://www.nature.com/articles/onc2013304">network of blood vessels meeting their “nutritional needs”</a>, the defective cells then grow tentacles reaching out in every direction. </p>
<p>Picture a crab monster with many claws and feet. Due to this form, those cells are referred to as cancer cells. <a href="https://www.omicsonline.org/history-of-cancer-ancient-and-modern-treatment-methods-1948-5956.100000e2.php?aid=273">Cancer</a> is the Latin word for crab.</p>
<p>During the next phase, the defective cells keep multiplying and other cells in their paths (such as our skin) are exterminated. These cancer cells grow, while the skin cells give up. This results in wounds caused by attacks from the cancer cells.</p>
<p>Sometimes, some of these defective cells <a href="https://www.cancer.gov/types/metastatic-cancer">detach from the rest of the group and circulate in our bloodstream</a> or through lymphatic vessels. These cells can end up in our lungs, bones, brain, liver or other organs. They settle down and continue to grow, pushing away normal cells.</p>
<h2>4. Understanding cancer stages</h2>
<p>We often hear cancer mentioned in terms of its stage. It’s called <a href="https://www.cancer.ca/en/cancer-information/cancer-101/what-is-cancer/stage-and-grade/staging/?region=on">stage 1 cancer</a> if the defective cells are relatively small and can still hang around healthy cells.</p>
<p>When the cells start to grow larger, doctors usually refer to this as stage 2 cancer. </p>
<p>If the defective cells then start to spread and aggressively push away healthy cells, it becomes stage 3 cancer.</p>
<p>Stage 4 cancer is when those defective cells spread to other locations, such as when breast cancer cells spread and grow in our lungs or bones.</p>
<h2>5. The causes of cancer</h2>
<p>Many things <a href="https://www.cancer.org/cancer/cancer-causes.html">contribute to the growth of cancer cells</a>, including toxic substances in cigarettes, sunlight, substances used in food preservation, artificial flavours and food dyes, repetitive injury, virus infections, dangerous chemicals and many more.</p>
<p>In essence, those incidents disrupt our cells one way or another, and our bodies try to heal the damage. But because the damage is dealt over and over again, the regenerative process has to keep up even faster, to the point that it might lose its ability to detect damaged or defective cells.</p>
<p><a href="https://www.alodokter.com/9-kandungan-rokok-yang-berefek-mengerikan-untuk-tubuh">Poisonous compounds within cigarette smoke</a>, for example, damage lung cells over time. At first these damaged cells will regenerate. But, because the toxins keep getting reintroduced into the body, at one point it will fail to detect damage to the lung cells. This is the start of cancer cell growth.</p>
<p>This cycle repeats over a long time, often years. That’s why it takes years for smoking or consumption of other toxic substances to cause cancer.</p>
<p>Consuming preserved snacks for only a couple of days won’t lead to cancer, but if consumed repeatedly and in excessive amounts for years and years, the risk of cancer increases.</p>
<p><a href="https://www.ykaki.or.id/index.php/mengenai-kanker-pada-anak/gejala-dan-tanda-tandanya">Cancer can also happen to children</a>, although the process is a little different than in adults. In children, cancer cells usually derive from genetic disorders that render their cells less likely to detect defective cells.</p>
<h2>6. Cures, and what it does to our hair</h2>
<p><a href="https://www.cancer.gov/about-cancer/treatment/types">Cancer treatment</a> usually aims to eradicate the defective cells. When these cells are relatively small and isolated, they can be removed through surgery. Chemotherapy is sometimes then used to ensure the tiny cells that are left behind are destroyed completely.</p>
<p>If the cancer cell growth is large, radiation is usually a preferred method. It aims to kill the cells developing in surrounding areas. Once the size of the cancerous clump has been reduced, doctors can then proceed to perform surgery and chemotherapy. </p>
<p>However, if the cancer cells have spread to too many areas, the chances of successful treatment become very slim. At this stage doctors usually give up and do their best to help patients live the rest of their lives the best they can. </p>
<p>Because cancer cells are “rebellious cells” that escape the aforementioned “regulatory suicide” process, whatever drugs kill them will usually also kill other healthy cells. This is what happens during chemotherapy. Normal cells are also destroyed, including hair follicles. It’s why we often see in movies <a href="https://www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/hair-loss/art-20046920">patients go bald after chemo procedures</a>.</p>
<p>To reduce the casualties among normal cells, experts have crafted chemo drugs that target only certain cells. The latest chemo drugs <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2019/cancer-immunotherapy-investigating-side-effects">make us feel less nauseous</a> and reduce the damage to our hair follicles.</p>
<p>This is why if you hear about wonder drugs or ingredients that are claimed to be effective in curing all types of cancer, you should be sceptical, and also remain cautious about their equally dangerous side effects.</p>
<p>However, if there’s someone out there who claims to have discovered an anti-cancer drug that can perhaps <em>prevent</em> all types of cancer, then it’s a bit more believable. The way it might work is by strengthening our immune system, upgrading its ability to detect and destroy defective cells, before it can grow into the crab monster we all pray we never have to face.</p><img src="https://counter.theconversation.com/content/122793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yulia Sofiatin tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>If you hear about wonder drugs or ingredients that are claimed to be effective in curing all types of cancer, we must beware of their equally dangerous side effects.Yulia Sofiatin, Lecturer of Epidemiology dan Biostatistics, Departement of Societal Health, Universitas PadjadjaranLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/880452017-11-26T10:08:18Z2017-11-26T10:08:18ZSouth Africa moves one step closer to a sugar tax – and a healthier lifestyle<figure><img src="https://images.theconversation.com/files/196211/original/file-20171123-17978-1bkyk3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>South Africa has joined only a handful of countries in the world close to imposing a <a href="https://theconversation.com/sugar-tax-is-not-nanny-state-its-sound-public-policy-59059">sugary drinks tax</a>. A new bill that imposes a tax on sugary drinks has cleared the first of three hurdles in South Africa’s law-making process. One of two houses of parliament has <a href="https://www.businesslive.co.za/bd/national/2017-11-22-national-assembly-approves-sugar-tax/">approved</a> what is being called a health promotion levy. The bill is expected to be passed by the other, The National Council of Provinces, and then signed in by the President. Implementation is expected in April 2018, but industry interference may still have an impact. The Conversation Africa’s Health and Medicine Editor Candice Bailey spoke to Karen Hofman and Aviva Tugendhaft about the tax.</em></p>
<p><strong>How important is the sugary drinks tax and why?</strong></p>
<p>The decision by South Africa’s Parliament is a very far sighted decision. It shows that the country’s parliamentarians fully understand the health implications of a product that is excessively high in sugar and has <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105287">no nutritional value</a>. </p>
<p>The sugary drinks tax – or health promotion levy – is <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3085-y">expected</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648571/">prevent a wide-range of obesity related</a> non-communicable diseases. These include diabetes, cancer, stroke and heart disease. This is important because South Africa’s public health sector is severely overburdened. Public hospitals are seeing on average of 25 000 new hypertensive cases a month as well as <a href="https://www.dailymaverick.co.za/article/2017-03-12-health-e-news-diabetes-moves-up-the-killer-charts/#.Whfw67T1XeQ">10 000 new diabetic patients</a> each month. These are estimated to be only half of the real numbers because both are silent conditions. </p>
<p>The effect of the reduction in the prevalence of non-communicable diseases will be twofold: it will help the country to implement <a href="https://theconversation.com/south-africa-needs-to-spend-more-on-healthcare-to-achieve-universal-cover-52231">National Health Insurance (NHI)</a> as an overwhelmed health system will be a barrier to NHI. And it will reduce the negative effect that chronic non-communicable diseases have on economic growth because of the impact on the workforce due to increased absenteeism and decreased productivity. </p>
<p>Already, there are signs that obesity related diseases are affecting the country’s <a href="http://www.samj.org.za/index.php/samj/article/view/8727/6218">economic growth rate</a>. </p>
<p>The sugary drinks tax will also help people make healthier choices. In Mexico, after a sugary drinks tax was implemented <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163463">soda consumption decreased</a> by between 7% and 10% and water consumption increased. </p>
<p>Lastly, tackling chronic noncommunicable diseases will ensure that South Africa doesn’t lose the gains it has made in life expectancy after the introduction of antiretrovirals to treat HIV infections. Life expectancy has <a href="https://africacheck.org/reports/yes-south-africa-has-the-worlds-largest-antiretroviral-therapy-programme/">improved</a> to 62.5 years of age after falling as low as 52.1 at the height of the AIDS pandemic in 2003. Without further policies to promote health, the country’s life expectancy is likely to reverse. This has been seen in countries like <a href="https://www.ncbi.nlm.nih.gov/pubmed/28746656">Brazil</a>.</p>
<p><strong>The initial lobby was for a 20% sugar tax. But in the end it was only 11%. Is it good enough?</strong></p>
<p>It’s a start. The sugar tax is similar to the one introduced in <a href="https://theconversation.com/what-the-world-can-learn-from-mexicos-tax-on-sugar-sweetened-drinks-56696">Mexico</a> which <a href="http://www.bmj.com/content/352/bmj.h6704.long">contributed to</a> a 17% reduction in the consumption of sugary beverages among poor people. </p>
<p>Once the tax is implemented in South Africa it will be monitored and an evaluation will be done to establish if it has helped. </p>
<p><strong>What will this levy mean for consumers?</strong></p>
<p>The industry is clearly against the tax. This was illustrated by the fact that the chairperson of the finance committee in parliament, Yunus Carrim, <a href="https://www.iol.co.za/ios/mp-reveals-some-not-so-sweet-tactics-as-sugar-tax-bill-passed-12110528">spoke out</a> about industry interference in the process. </p>
<p>The beverage industry sees South Africa and sub-Saharan Africa as their <a href="https://www.ncbi.nlm.nih.gov/pubmed/26494269">growth market</a> This means that they will continue to find a way to increase profits. We’re expecting to see the industry change their products in an effort to ensure their bottom line is not affected. The tax will be levied on sugar content, which will hopefully encourage industry to lower the sugar content in its drinks and create healthier alternatives. </p>
<p><strong>The sugar tax has been criticised because it deals with only one factor among a myriad that lead to obesity. What’s your response?</strong> </p>
<p>This is true. But that criticism only stands if you view it as a single event. The levy is the first step in a very long journey of a range of different interventions that will need to happen. </p>
<p>This was also the case with tobacco. The first step was a tobacco tax. This <a href="http://www.who.int/tobacco/training/success_stories/en/best_practices_south_africa_taxation.pdf">halved smoking rates</a> over two decades. It was followed by the banning of advertisements and very clear labelling about the dangers of tobacco. </p>
<p>The health promotion levy – which <a href="http://www.who.int/elena/bbc/ssbs_adult_weight/en/">research shows</a> is by far the most effective mechanism – will need to be followed by clear and transparent labelling. We need to move away from just having sugar levels listed in grams on the back of cans. There should be labels in large letters on the front of cans informing consumers about the number of teaspoons of sugar they’re drinking. </p>
<p>The second intervention should be marketing and advertising regulations of these drinks, particularly to children.</p><img src="https://counter.theconversation.com/content/88045/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the South African Medical Research Council and The Bill and Melinda Gates Foundation. In the past she has also received funding from the IDRC (Canada), the WHO and UNFPA. She is a member of the board of directors of The Soul City Institute for Health and Development Communication.</span></em></p><p class="fine-print"><em><span>Aviva Tugendhaft receives funding from the Bill and Melinda Gates Foundation and the SA medical research council.</span></em></p>South Africa has one last hurdle to cross before it implements a sugar tax to prevent a wide-range of obesity related non-communicable diseases.Karen Hofman, Program Director, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the WitwatersrandAviva Tugendhaft, Deputy Director, PRICELESS, Faculty of Health Sciences, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827642017-08-31T14:11:15Z2017-08-31T14:11:15ZTraditional versus contemporary medicine: mental illness in Zimbabwe<figure><img src="https://images.theconversation.com/files/183957/original/file-20170830-23692-1i2pp3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional medicine should be recognised in the treatment of mental disorders.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In many parts of the world, policymakers, health professionals and the public are wrestling with questions about <a href="http://www.euromedinfo.eu/how-culture-influences-health-beliefs.html">culture and mental health services</a>. Some have argued that <a href="https://www.ncbi.nlm.nih.gov/pubmed/20218488">African traditional medicine</a> might be a more appropriate way to meet mental health needs in Africa. In some Asian countries like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142200/">Pakistan</a>, traditional healers are widely consulted for the treatment of depression.</p>
<p>One argument is that traditional medicine is more <a href="http://apps.who.int/medicinedocs/documents/s19582en/s19582en.pdf">accessible</a> and affordable than contemporary medicine. Patients find it easier to accept and this can be seen as an easy way out for governments in low and middle income countries that can’t provide other types of care.</p>
<p>But many Western medical professionals, even those in countries with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/19582328">strong history of traditional medicine</a>, have <a href="https://www.ncbi.nlm.nih.gov/books/NBK44249/">strong reservations </a>. They don’t believe that such treatment has benefits. </p>
<p>Our <a href="http://www.opastonline.com/wp-content/uploads/2016/10/why-do-people-use-traditional-healers-in-mental-health-care-in-zimbabwe-IJP-16-007.pdf">study</a> explored why some people in Zimbabwe use traditional medicine for the treatment of mental disorders. </p>
<h2>Cultural and spiritual connection</h2>
<p>The mental health facilities are limited to Harare Central Hospital and Annex Psychiatric Unit at <a href="http://www.parihosp.org/">Parirenyatwa Hospital</a> in the capital and Ngomahuru in Bulawayo, the second largest city. Both are government run facilities operating with skeletal staff of about four psychiatrists.</p>
<p>The research showed that traditional medicine was more favoured because it addressed cultural and spiritual issues, and because it focused on the comprehensive person of the mind, body and spirit which biomedicine could not provide. <a href="http://www.open.edu/openlearn/body-mind/health/health-studies/what-biomedicine">Biomedicine</a> explains health in terms of biology and it’s often referred to as modern, western or scientific medicine.</p>
<p>We concluded that African traditional medicine, known as <em>Hun’anga</em> in the Shona language, could help patients take up mental health treatment. This could expand and improve mental health care in the country, an opportunity for traditional treatment to be integrated into biomedical treatment.</p>
<p>The findings suggest that supernatural and psycho-social factors play a major role in people seeking help for mental health problems. Rehabilitation for mental health patients should focus on these factors in addition to what is generally treated in biomedicine.</p>
<p>This suggests that the use of traditional medicine should be recognised as an important resource in African settings. This has happened in other settings such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/2118211">Nigeria</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652795/">South Africa</a> and <a href="https://www.omicsonline.org/proceedings/research-advances-in-sudanese-traditional-medicine-opportunities-constrains-and-challenges-14400.html">Sudan</a> and the results are encouraging.</p>
<p>It should be supported by government and made complementary to contemporary medicine in the treatment of mental disorders.</p>
<h2>What we found</h2>
<p>We interviewed 18 community members, 30 former patients and 30 traditional healers who were registered with the <a href="https://relzim.org/?s=Zimbabwe+National+Traditional+Healers+Association">Zimbabwe National Traditional Healing Association</a>. About 76% of the people we interviewed said mental health illnesses were caused by cultural and spiritual issues, failure to observe one’s culture, or aggrieved spirits. This encouraged their preference for traditional healers.</p>
<p>About 80% expressed the belief that ancestral spirits caused unhappiness, confusion and depression. This could lead in some cases to patients becoming unconscious.</p>
<p>One of the community members described a friend’s illness: </p>
<blockquote>
<p>The healing spirit (mudzimu) first makes the host ill to alert relatives. My friend doesn’t want to talk with anyone and looks sad all the time with tears all over the place.</p>
</blockquote>
<p>The respondents said they preferred traditional medicine over contemporary medicine because traditional healers understood the culture, witchcraft and other underlying supernatural causes.</p>
<p>A community member person believed the unclear diagnosis was caused by an evil spirit:</p>
<blockquote>
<p>When we went to see the doctors, we were told the diagnosis was not clear, because the person was molested by evil spirits.</p>
</blockquote>
<p>The community members also believed that the traditional healers provided care to the body, spirit and mind. </p>
<p>A patient described this connection: </p>
<blockquote>
<p>Some traditional healers start by chanting (kudeketera) to your ancestral spirits (midzimu) for their support in the treatment before they start healing. This is different from the hospitals, where ancestors are not recognised.</p>
</blockquote>
<h2>The gaps</h2>
<p>Both traditional medicine and biomedicine are used to treat mental illness in Zimbabwe. Biomedicine is evidence based, but lacks cultural sensitivity, which discourages people from choosing that treatment. </p>
<p>In addition, there are only a few specialists who are unaffordable for most people. As a result traditional medicine attracts more patients. But because traditional medicine isn’t evidence based it’s not supported by the government and the scientific community. There are some legal/human rights issues that should be addressed.</p>
<p>Little research has been done on traditional medicine in Zimbabwe. Some work has been done in <a href="http://digitalcommons.library.tmc.edu/dissertations/AAI1495488/">Nigeria</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233225/">South Africa</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150105/">Zambia </a>. The results showed that traditional medicine is beneficial since it relieves pain generally and for mental health in particular, Findings from a study in Zimbabwe also showed that biomedicine practitioners are perceived to be <a href="http://www.tandfonline.com/doi/abs/10.1080/17542863.2015.1106568?src=recsys&journalCode=rccm20">mistrustful and hostile</a>.</p>
<p>Efforts should be made by the relevant government authorities to incorporate cultural knowledge into mental health treatment by, for example, adopting traditional medicine in a multidisciplinary approach to mental health treatment. This would strengthen doctor patient relationships, which is likely to increase the use of health services. This collaborative approach has worked in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1540435/">Zambia</a> in the management of HIV/AIDS.</p>
<p>The model will need to be tested to address the challenges facing mental health delivery service in Zimbabwe. The efficacy of traditional methods in treating mental health.</p>
<p>But before any major policy shift, more research is needed to establish the efficacy of traditional medicine methods since we don’t really know yet how it works. </p>
<h2>Way forward</h2>
<p>There is a need for a more inclusive approach that involves anthropologists, public health practitioners, psychiatrists and other mental health experts to advise on the most beneficial way to reap the benefits from both worlds of traditional and contemporary medicine.</p><img src="https://counter.theconversation.com/content/82764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lazarus Kajawu receives funding from AMARI. </span></em></p>Traditional medicine is believed to be accessible and affordable but should be made complimentary to contemporary medicine in the treatment of mental disorders.Lazarus Kajawu, Post-doctoral Fellow, University of ZimbabweLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/813392017-08-08T19:43:19Z2017-08-08T19:43:19ZWhy it’s so difficult to tackle diabetes in sub-Saharan Africa<figure><img src="https://images.theconversation.com/files/181118/original/file-20170806-23233-gbzex9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>In the 1990s diabetes was seen as a condition that mainly affected rich people in high income countries. Nowadays, it’s one of the leading contributors to death in all countries in the world, driven by increases in national and personal wealth resulting in people having more disposable income. In addition, urbanisation has led to more and more people living sedentary lifestyles. A commission of experts, which was set up in 2014 to tackle the challenge in Africa, have recently released their <a href="http://press.thelancet.com/diabetesafrica.pdf">findings</a>. Health and Medicine Editor Candice Bailey spoke to Professor Justine Davies about the importance of the commission and what good it can do.</em></p>
<p><strong>What do we know about diabetes in Africa? Why is there a concern?</strong></p>
<p>About 95% of cases around the world are type 2 diabetes, which is associated with obesity. The impact of diabetes is becoming much greater in poorer countries and regions. Sub-Saharan Africa is home to 34 of the world’s 48 least developed countries. In lower-income countries, even though national and personal wealth is increasing, health systems are not developed enough to cope with the increasing numbers, or the long-term consequences of diabetes such as heart attacks, strokes, blindness, and kidney failure.</p>
<p>The health fraternity has a good idea that diabetes rates on the continent are increasing but they don’t know enough about the number of people with the disease. For example, a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext">recent study</a> found that there is no information about people with diabetes in 21 countries. Added to this, the Commission also found that – in countries where the burden of diabetes is known – only about half of the people with it in populations across Africa are aware that they have the disease. Of these only one in 10 – or 11% – receive the <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(17)30181-X/fulltext">drugs they need</a>.</p>
<p><strong>What are the costs?</strong></p>
<p>There are two costs affiliated with diabetes: treatment costs and economic costs.</p>
<p>Diabetes itself can be treated very cheaply as it only requires medications (usually tablets) to lower glucose. But the long-term consequences, for example, heart attacks, strokes, blindness, and kidney failure, require specialists and specialist equipment to treat. These are very expensive. The consequences are also more likely to lead to people not being able to work.</p>
<p>The Commission calculated that southern African countries accounted for two-thirds of the US $12.1billion spent on diabetes in sub-Saharan Africa in 2015. Wealthier countries, particularly South Africa, were spending more because they’re going through more societal changes. Less than a tenth of the costs (US $1.7 billion) originated from poorer countries in western Africa.</p>
<p>And looking ahead, projections show that by 2030 southern Africa is likely to see the greatest increases in annual health care and personal costs: between US $17.2 billion and US $29.2 billion. In east Africa spending is expected to increase from US $3.8 billion in 2015 up to $16.2 billion in 2030.</p>
<p>The Commission report estimates that the total costs to economies and individuals in sub-Saharan Africa in 2015 was US $19.5 billion.</p>
<p>More than half of this economic cost (56%, $10.8 billion) was from treatments, including medication and hospital stays. Other costs included out-of-pocket expenses paid for by the patients and productivity losses, mostly from shortened life expectancy as well as people leaving the workforce early ($0.5 billion), taking sick leave ($0.2 billion) and being less productive at work due to poor health ($0.07 billion).</p>
<p><strong>In which way are health systems ill-prepared to deal with chronic diseases like diabetes? Are there countries that are worse off or better? And why?</strong></p>
<p>The impact of diabetes is greater in countries and regions that are poorer. In lower-income countries, health systems have focused on tackling infectious diseases for the last 15 to 20 years. The increase in diabetes cases hasn’t been seen as a priority. This has led to several gaps in care, including a lack of equipment for diagnosing and monitoring diabetes, lack of treatment, and lack of knowledge about the disease among health care providers. </p>
<p>Many infectious diseases can be cured relatively quickly, which means that the systems for treating chronic, lifelong, diseases like diabetes are rare. </p>
<p>But there’s a lot we can learn from countries that have developed systems to deal with high burdens of HIV. Lessons are being drawn from them to provide care for other chronic conditions in Africa. </p>
<p>Another reason for health care systems in Africa not being able to cope with diabetes - or many other illnesses - is that they haven’t been given the level of investment needed to provide good quality care for all.</p>
<p><strong>How could the challenges around diabetes be tackled effectively?</strong></p>
<p>It is critical that we establish the true burden of diabetes and the burden of other risk factors associated with diabetes, like high blood pressure and abnormal cholesterol.</p>
<p>The Commission’s analysis demonstrates a clear need for improvements at all levels of diabetes care. And interventions that have been successfully trialled in sub-Saharan African countries need to be scaled up. This includes community-based care for high blood pressure, patient education, home glucose monitoring, and more education about diabetes for health care professionals.</p>
<p>The Commission also pointed out that the response needs to come from many different levels; from individuals, to society, to health care planners, health care providers and governments.</p>
<p>The researchers note that prevention is critical to improving health and avoiding further economic burden. This is because managing type 2 diabetes and its risk factors (such as obesity and physical inactivity) is much simpler and cheaper than treating complications that develop in the later stages of the disease.</p><img src="https://counter.theconversation.com/content/81339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine Davies was the lead author on The Lancet Diabetes & Endocrinology Commission on diabetes in sub-Saharan Africa.</span></em></p>To tackle the increasing burden of diabetes in Africa, health systems on the continent need to be strengthened.Justine Davies, Professor in Global Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808982017-07-16T10:20:56Z2017-07-16T10:20:56ZAfrican academics set out what Dr Tedros needs in his toolbox to tackle health ills<figure><img src="https://images.theconversation.com/files/178244/original/file-20170714-3488-1i1rcen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New World Health Organisation Director-General De Tedros Adhanom Ghebreyesus. </span> <span class="attribution"><span class="source">Reuters/Denis Balibouse</span></span></figcaption></figure><p>Africa has the highest burden of HIV/Aids and malaria with escalating rates of non-communicable diseases. How will the World Health Organisation’s Director-General Dr Tedros Ghebreyesus deal with the mounting challenges? The Conversation Africa asked academics across the continent what impact his appointment will have, and for advice on what he needs to do, to manage the challenges.</p>
<hr>
<p><strong>What is the significance of his appointment?</strong></p>
<p><em><strong>Dr Thumbi Mwangi, Washington State University, Kenya Medical Research Institute:</strong></em> It’s two fold. As an African he has been closely involved in the battle against <a href="https://parasitesandvectors.biomedcentral.com/articles/10.1186/1756-3305-5-240">neglected tropical diseases</a> like rabies, trachoma, guinea worm and others which affect <a href="http://www.who.int/mediacentre/news/releases/2017/ntd-report/en/">1 billion</a> people. He was <a href="http://www.reuters.com/article/us-health-who-idUSKBN18J278">health minister</a> in Ethiopia where neglected tropical diseases are common. He needs no lectures on why the WHO must remain at the forefront of fighting them.</p>
<p>Secondly, his ownership of the agenda as set out in his campaign <a href="http://www.drtedros.com/">manifesto</a> – to work towards “a world where everyone can lead healthy and productive lives, regardless of where they are or where they live” – should be seen and felt.</p>
<p><em><strong>Dr Andrew Githeko, Kenya Medical Research Institute:</strong></em> Dr Tedros
brings a <a href="http://www.who.int/dg/tedros/en/">wealth of experience</a> and skills in governance, diplomacy, advocacy and resource mobilisation.</p>
<p>His efforts as <a href="https://www.usaid.gov/news-information/frontlines/child-survival-ethiopia-edition/interview-dr-tedros-adhanom-ghebreyesus">health minister</a> in Ethiopia produced measurable and significant outcomes. He’s familiar with addressing infectious diseases like malaria as well as non infectious diseases.</p>
<p>He also led <a href="http://www.drtedros.com/publications/">research</a> into effective ways of controlling malaria and greatly improved the ways in which it’s prevented and controlled.</p>
<p>On top of this, he played a momentous role in bilateral and multilateral malaria initiatives including those supported by <a href="http://www.rollbackmalaria.org/">The Roll Back Malaria Partnership</a> and the <a href="https://www.theglobalfund.org/en/">Global Fund</a>. </p>
<p>As a researcher he will be sympathetic to the plight of researchers from developing countries.</p>
<p><em><strong>Dr Karen Daniels, South African Medical Research Council:</strong></em> Dr Tedros comes from The Horn of Africa which remains a politically fragile setting, vulnerable to the impact of conflict and natural disasters. What this means is that he’s been in the health care trenches, like many of us who live and work in health settings across the continent. This is precisely where it’s been shown that Africa can find African solutions to African problems. </p>
<p>A leader like this is needed at the helm of the WHO. Dr Tedros will understand that Africans can be included in partnerships rather than dominated in the quest to find solutions to the unique challenges that the continent faces. </p>
<p>From an African health policy and systems research perspective, there are many reasons to laud his appointment. He brings the combined perspective of having been a researcher, a health systems manager, minister of health for Ethiopia, and a policymaker. </p>
<p><em><strong>Professor Bob Mash, Stellenbosch University:</strong></em> Dr Tedros is the first WHO director-general to have firsthand knowledge of the challenges facing African countries and health systems. One of his priority areas is “health for all” and providing universal health coverage. This implies a commitment to the strengthening of health systems, particularly primary health care. </p>
<p>This should stimulate research on disease orientated programmes as well as cross cutting systematic issues like the primary care workforce, access to care, patient-centredness, community orientated primary care as well as continuity, coordination and comprehensiveness of care. </p>
<p>But his experience in Ethiopia may not have sensitised him as much to the global problem of non-communicable diseases that’s also becoming a problem on the African continent. One of my concerns is whether he will give sufficient attention to the epidemic of diseases such as hypertension and diabetes.</p>
<p><strong>What are three biggest challenges facing him? What should he tackle first?</strong></p>
<p><em><strong>Dr Mwangi, Washington State University, Kenya Medical Research Institute :</strong></em> The WHO has faced <a href="http://www.who.int/topics/financial_crisis/financialcrisis_report_200902.pdf">financial constraints</a> addressing global health challenges including outbreaks of emerging infections.</p>
<p>Countries that are adversely affected by <a href="http://www.who.int/neglected_diseases/diseases/en/">neglected tropical diseases</a> need his voice and the diplomacy of his organisation to keep these diseases high on the global agenda, as well as top priority in affected countries.</p>
<p>Dr Tedros needs to make three focused commitments while he’s at the helm. </p>
<p>The first is domestic financing: for a long time countries affected by neglected tropical diseases have relied mainly on external funds. He needs to urge them to commit their own budgets to these diseases. Domestic budgets can help significantly. We need relatively low cost solutions such as drug tablets that are out of patent, improved hygiene for the affected populations and existence of effective vaccines.</p>
<p>Dr Tedros should also encourage partners to keep their commitments.</p>
<p>Secondly, there should be a deliberate effort to integrate the detection, surveillance and treatment of these diseases into the health system. Countries stand a much better chance of reducing and finally eliminating neglected tropical diseases if the interventions are embedded in primary health care systems.</p>
<p>The <a href="http://apps.who.int/iris/bitstream/10665/43485/1/9789241594301_eng.pdf">One Health</a> concept that brings together the human and animal health perspectives should also be practised. Dr Tedros supports this <a href="http://www.sciencedirect.com/science/article/pii/S0140673610614651">concept</a>. His challenge will be how to break the current silos in individual sectors. </p>
<p>Innovations offer important toolkits to consider. This includes <a href="http://www.sciencedirect.com/science/article/pii/S0277953613006485">mobile phones</a> to diagnose and report diseases as well as attempts such as use of <a href="http://www.gavi.org/library/news/gavi-features/2016/rwanda-launches-world-s-first-national-drone-delivery-service-powered-by-zipline/">drones</a> to supply emergency medical care and use of <a href="https://news.wsu.edu/2016/10/24/rabies-vaccine-effective-warm/">rabies vaccine</a> that needs little refrigeration that can be delivered by community health workers.</p>
<p><em><strong>Dr Githeko, Kenya Medical Research Institute:</strong></em> When it comes to malaria his greatest challenge will be to sustain – and increase – resources to the various control programmes, particularly in sub Saharan Africa.</p>
<p><a href="http://www.who.int/malaria/areas/drug_resistance/overview/en/">Resistance</a> to malaria medicines is a global health threat. Dr Tedros should support malaria endemic countries to expand and accelerate national efforts to control and eliminate malaria.</p>
<p>The WHO should urge member states to improve the training of health workers so that they closely follow the protocols in the treatment and management of malaria. This will save more lives.</p>
<p>The infrastructure in health facilities should also be improved to test for malaria, and to treat it more efficiently. This can only be achieved through concerted efforts and commitments by WHO member states.</p>
<p>The research wings in various countries need to be supported to encourage novel research of drug and insecticide resistance. Support for research will be critical to address scientific, behavioural, and socioeconomic factors that affect malaria control.</p>
<p><em><strong>Dr Karen Daniels, South African Medical Research Council:</strong></em> There is a vicious cycle in which the burden of increased communicable and non-communicable diseases weaken health systems. Dr Tedros has the challenge of strengthening these systems, something he’s already committed to. </p>
<p>This has to be supported by sound health policy and systems research, to help find solutions to the continent’s health challenges. But better home grown solutions need more investment in national and Pan African centres of excellence. Dr Tedros could help by enabling greater WHO investment in health policy and systems research. These centres of excellence should be founded on close collaboration between researchers, health systems managers, health systems policymakers, as well as communities and civil society organisations. </p>
<p>Centres of excellence could facilitate closer collaboration between health policy, the research community and the WHO. This could help ensure that research is more closely aligned to the real challenges faced in our own countries. We will hopefully begin to reduce the “know-do gap” where research evidence exists, but isn’t taken up in implementation.</p>
<p><em><strong>Professor Mash, Stellenbosch University:</strong></em> One of his greatest challenges will be strengthening health systems at primary health care level. Governments need to be convinced to invest in primary health care as the hub and not the marginalised periphery where poorly trained and low level health care workers offer fragmented and poor quality care. Strong multidisciplinary teams should include a family physician.</p>
<p>Strong primary health care is a prerequisite for providing universal health coverage. Ideally this should be through a national health insurance or systems that – at the very least – don’t impoverish people or increase inequality.</p><img src="https://counter.theconversation.com/content/80898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bob Mash receives funding from European Union to strengthen primary health care through primary care doctors and family physicians in South Africa.</span></em></p><p class="fine-print"><em><span>Karen Daniels is a Specialist Scientist for the Health Systems Research Unit of the South African Medical Research Council, and a member of the Health Systems Global Board. The opinions expressed here are based on her own independent thoughts and views.</span></em></p><p class="fine-print"><em><span>Thumbi Mwangi receives funding from Wellcome Trust, GAVI and World Health Organisation.</span></em></p><p class="fine-print"><em><span>Andrew Githeko does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How will the World Health Organisation’s Director-General Dr Tedros Ghebreyesus deal with the mounting challenges? Africa’s academics have some tips.Andrew Githeko, Chief Research Officer, Kenya Medical Research InstituteBob Mash, Division of Family Medicine and Primary Care, Stellenbosch UniversityKaren Daniels, Specialist Scientist, Health Systems Research Unit, South African Medical Research CouncilThumbi Mwangi, Clinical assistant professor, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.