Managing noncommunicable diseases in Africa: what can we learn from TB control?

Jun 10, 2008

Non-communicable diseases (NCDs), such as heart disease, diabetes, stroke, asthma, epilepsy, and mental illness, are becoming a major burden in sub-Saharan Africa but are often poorly managed in routine health care settings, say Anthony Harries from the Malawi Ministry of Health and colleagues in this week's PLoS Medicine. The authors argue that better management could be achieved by learning from the success of tuberculosis (TB) control programs.

Sub-Saharan Africa faces frequent stock interruptions of essential drugs for managing non-communicable diseases, say the authors. Untreated hypertension is blamed for high rates of illness and death from stroke in urban and rural Tanzania and rural South Africa, and across the continent only a small proportion of patients with epilepsy receive drug treatment at any one time, mainly due to poor health care delivery systems and unavailability of drugs.

There is a growing burden of diabetes and its complications, and many patients with type 1 diabetes mellitus have extremely short life expectancies in sub-Saharan Africa. Even in specialist centers, patients with asthma may still receive sub-standard care and have poor access to essential medications.

Dr Harries and colleagues propose a solution to the problem of managing these diseases—health professionals and policy makers should learn from TB control programs. In particular, they should learn from a five-point TB control framework called "DOTS" ("directly observed therapy, short course"). The five-point policy package of DOTs involves political commitment; finding cases of TB by testing the sputum of patients presenting to health care facilities; a standardized, short-course of medications for treating TB with one of the drugs (rifampicin) given under direct observation by a health care worker, community, or family member; a monitoring and evaluation system; and an interrupted drug supply.

These five points, say the authors, provide lessons for NCD control. Human and financial resources—and therefore political commitment—are needed to develop, implement, and supervise standardized approaches to managing NCDs. The only feasible and affordable way of identifying patients with NCDs is to diagnose and treat those who present to health facilities. These facilities should adopt standardized ways of treating NCDs, as well as monitoring and evaluating them, and systems should be in place to ensure regular drug supply.

"Within a country," say the authors, "the DOTS paradigm for NCDs should be piloted in one or two facilities, and lessons learnt in these facilities should be used to assist national roll-out within the public sector."

Citation: Harries AD, Jahn A, Zachariah R, Enarson D (2008) Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa. PLoS Med 5(6): e124. -- www.plos.org/press/plme-05-06-harries.pdf

Source: Public Library of Science

Explore further: Adolescent lifestyle not strongly tied to later muscular pain

Related Stories

Me and my world: The human factor in space

23 hours ago

The world around us is defined by how we interact with it. But what if our world was out of this world? As part of NASA's One-Year Mission, researchers are studying how astronauts interact with the "world" ...

Major step for implantable drug-delivery device

Jun 29, 2015

An implantable, microchip-based device may soon replace the injections and pills now needed to treat chronic diseases: Earlier this month, MIT spinout Microchips Biotech partnered with a pharmaceutical giant ...

A gel that can make drugs last longer

Jun 26, 2015

Researchers at the Institute of Bioengineering and Nanotechnology (IBN) of A*STAR have developed a drug-delivering hydrogel to treat chronic diseases such as hepatitis C, a liver disease that kills around ...

FDA allows marketing of vision aid via tongue for blind

Jun 23, 2015

This month Wisconsin-based company Wicab announced that the US Food and Drug Administration cleared a nonsurgical vision aid for the profoundly blind. The safety and effectiveness of their product, BrainPort ...

I always feel like somebody's watching me…

Jun 25, 2015

What power can individuals have over their data when their every move online is being tracked? Researchers at the Cambridge Computer Laboratory are building new systems that shift the power back to individual ...

Recommended for you

Why can't we stop cholera in Haiti?

3 hours ago

In early February, when Jenniflore Abelard arrived at her parents' house high in the hills of Port-au-Prince, her father Johnson (names have been changed) was home. He was lying in the yard, under a tree, vomiting. When Jenniflore ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.