Resurgence of non-communicable diseases in LMICs: a cause for concern?

This editorial is devoted solely to non-communicable diseases (NCDs) papers published in the 2019 June issue of African Health Sciences. This is a departure from AHS practice of having one editorial per issue. This time, we have decided to have three thematic editorials, which will help our readers focus attention on the themes of their choice. The other areas of interest in this June issue of African Health Sciences are sexual/reproductive and child health; as well as infectious diseases, which have had 2 separate editorials, written by Prof. Grace Ndeezi, and Dr. David Mukunya.

Now to NCDs

We begin with three interesting papers on the cardiovascular system. Adje and others¹, have written a research paper on cardiovascular risk assessment from a community in Nigeria.

In a study of adults aged 40–80 years, they found that up to 30% were hypertensive and a similar proportion was overweight, and had abnormal cholesterol levels. Scientists from China², on the other hand, carried out a meta-analysis, which showed that levels of triglyceride and glucose were the predisposing factors for ischemic stroke in the Asian population. Finally, Ifeluwa and others³ demonstrated impaired right ventricular systolic function of patients with heart failure secondary to hypertension in Ibadan Nigeria. These remind us that cardiovascular diseases are no longer the preserve of people in high income countries.

The next set of papers is on cancer, which has become ubiquitous and dominates conversations in the social media, clubs, restaurants, taxis, bodabodas, buses and work places in Africa! Hence, Mohammedi and others⁴ report on cyclin D1 over-expression in Algerian breast cancer women. They conclude that this could be considered for routine diagnosis of breast cancer. On the other hand, Indian scientists report on the association of inflammatory biomarkers with lung cancer in a North Indian population. They conclude that ‘CRP, TNF-α, IL-6 and IL-8 are the promising biomarkers in the identification of lung cancer patients’⁵. Cancer chemotherapy has unpleasant cytotoxic effects. In the next paper, the authors found that polysaccharides from mycelia of Cordycepsmilitarisa melioratedcytotoxic effects from doxorubicin⁶.

Another paper⁷ is on diabetes mellitus, and reports on the lack of association between vitamin D receptor gene BsmI polymorphism, and type 2 diabetes mellitus in Pakistani populations. An important negative finding!

Now to mental health and other issues

A study from Uganda reports on mental health professionals' views on exercise for people with mental illness⁸, while work from South Africa reports on the disuse of hearing aids in the elderly with presbycusis⁹. Other authors from South Africa assert that hospital-acquired acute kidney injury (AKI) in adults is associated with adverse patient outcomes. They recommend automated electronic alerts to empower health workers, detect and manage the AKI¹⁰. Saudi authors on the other hand report that aerobic exercise modulates cytokine profile and sleep quality in the elderly¹¹.

What follows is a diverse group of papers on several aspects of NCDs. From Turkey we have staff perceptions of patient safety culture and safety grades in general surgery departments¹².

Zimbabwean researchers found that A. stenophyllaaqueous extract increases glucose uptake partly through increasing the GLUT 4 mRNA and translocation potentially acting via the PI-3-K pathway¹³. The study confirms ‘the ethnopharmacological uses of A.stenophylla’ especially its potential for treating diabetes mellitus.

The next set of papers is relevant to education in NCDs. We have a paper on colour vision deficiency among students in Lagos State, Nigeria¹⁴, followed by a faculty's experiences of a formal mentoring programme¹⁵, and one on the effect of nutrient intakes on anthropometric profiles among university students in Malaysia¹⁶. Kose's paper on the effectiveness of basic life support training on nursing students' knowledge and basic life support practices is the jewel in the crown of this pedagogy section¹⁷. It is followed by a description of the challenges faced by student accoucheurs during clinical placement at the free state maternal health care institutions in South Africa¹⁸. Surprisingly, Ugandan researchers report that parental involvement was not associated with academic achievement among deaf children in Kampala¹⁹. They recommend a search for other factors associated with academic achievement in the deaf children. Nigerian authors report that using real time sonography as an anatomy teaching aid was the least popular method among undergraduate students²⁰. The implications are not clear given the lack of cadavers in medical schools worldwide. We end with a few case reports: one on rectus sheath hematoma and retroperitoneal bleeding due to rivaroxaban²⁰; and the other on diagnostic challenges and surgical management of osteoblastoma and aneurysmal bone cyst of the lumbar spine in a child²².

This treatise reflected on a wide range of non-communicable diseases, which reminds us that these NCDS are diverse. That they are on the rise in LMIC is an understatement. Individuals, researchers and policy makers need to keep on the alert, with a view to preventing the NCDs. Ensuring universal health access is a key priority, in line with the sustainable development goals.