Mounting Burden of non-communicable diseases in the middle belt of Ghana and its implications on livelihood

The value of good health is unquestionable when one has been sick for just a day. Every aspect of our lives depends on good health. The burden of dealing with a particular condition for the rest of your life can rob you of the joy of living in the moment and that is exactly what non-communicable diseases (NCDs) does.

According to a report from the WHO in 2021, NCDs kill 41 million people globally each year, and that accounts for 71% of all deaths globally. About 15 million people between the ages of 30 and 69 years die from NCDs worldwide according to the WHO report.

A report released by Lancet on October 16, 2020, stated that NCDs disabilities emerged as the biggest contributor to the global burden of diseases. Gone were the days when NCDs were considered the disease of the rich but today, NCDs have emerged as the major health issue in low and middle-income countries (LMICs) like Ghana. 

The Global Burden of Diseases (2019) report noted that “LMICs’ health systems are less equipped to tackle the rapidly growing burden of NCDs. A BMC report in 2014 noted that it will be highly difficult for a country like Ghana to achieve universal health coverage due to the rising burden of chronic non-communicable diseases. The report also noted that the dual burden of infectious and NCDs weakens the already compromised health system.

A 2021 report in BMC Public Health observed that, in Ghana, people barely pay attention to non-communicable diseases until the advanced stage of the condition because the knowledge of the general public on non-communicable diseases in Ghana is very limited.

I had an opportunity early this year to help a friend collect data on patients with diabetes and hypertension on their knowledge of the condition, and I observed that most of the participants associated their condition with an evil spirit. 

What then is a non-communicable disease?

 In general terms, a non-communicable disease (NCD) is a medical condition that is none infectious. These diseases slowly progress and last for a very long time. Hypertension, stroke, diabetes, and cancers are a few examples of NCDs. Non-communicable diseases can be categorized into two which are:

Diseases caused by food deficiency such as anemia, Kwashiorkor, Malnutrition, scurvy
Diseases that result from growth or change in the body cells such as cancers, cardiovascular disease, diabetes.

Cancers: The leading cause of death globally is cancer and it accounts for nearly 10 million deaths. Cancers occur as a result of mutations of cells in the body viruses, most cancers are determined by genetics and environmental factors. Not every disease has obvious causes to avoid but taking care of factors you can control can go a long way.

It is important to do regular checks to identify pre-cancer cells. Getting a vaccine such as the HPV vaccine can help prevent the occurrence of the disease. Living a healthy lifestyle and avoiding the use of harmful substances like tobacco can prevent certain cancers.

Chronic respiratory diseases: These diseases may damage the lungs and airways permanently if proper care is not taken. Asthma and chronic obstructive pulmonary diseases (COPD) are the most common chronic respiratory diseases. The impact on the lungs is long-term and may not dwindle. Avoiding smoking and alcohol intake can go a long way to preventing and reducing the damages that comes with chronic respiratory disorders. Healthy lifestyle and healthy dietary intake can help control, manage, and prevent chronic respiratory disorder

Cardiovascular diseases: Heart attack, stroke, and coronary heart disease are forms of cardiovascular diseases. It can be life-threatening and even alter the quality of life if left untreated. The third 2012 NCDs policy aims at the primary prevention of diseases expanding on tobacco, diet, physical activity, alcohol, and immunization.

Diabetes: the inability of the body to regulate sugar levels. It is estimated that in Ghana, between 3.3% and 6% of the population has diabetes. A healthy planned diet coupled with intake of the recommended medication can prevent diabetes from worsening. All the five key focuses of the 2012 NCDs should be adhered to in dealing with diabetes but to prevent diabetes, the first point which focuses on primary prevention should be the first point of call.

The rise of non-communicable diseases in the middle belt of Ghana.

A 2018 country profile report estimated that 43% of deaths in Ghana are caused by NCDs. Cancer, diabetes, stroke, and hypertension are part of the top 10 causes of the deaths.

During the launch of the 2012 World Physiotherapy Day celebration in Kumasi, Dr. Aaron Offei who was the Ashanti regional health director stated in his speech delivery that, "Ghana is going through an epidemiological transition and NCDs are getting a growing concern.".

According to Dr. Offei, NCDs kill an estimated number of 86,200 persons in Ghana per year with ages ranging from 15 to 59 years and that is a cause for alarm because that is the most reproductive age range for economic development.

The current data shows that NCD death is affecting people below 50 years and in the productive years in general. The Director of nursing and midwifery at the Ministry of Health, Dr. Barnabas Kwame Yeboah said, “this is alarming as it impacts the socio-economic fabric of every society.

WHO identifies globalization, urbanization, weak health system, aging population, and sedentary lifestyle as some of the leading causes of NCDs.

“Mapping Obesogenic Food Environments in South Africa and Ghana: Correlations and Contradictions", a study that looked into the food environment in Ghana (Ashanti region) and South Africa discovered that several Ghanaians buy and consume food that is unhealthy. According to the study, the consumption of bread and sugar-sweetened beverages was high.

Non-communicable diseases (NCDs) pose a growing public health threat globally, and the Middle Belt region of Ghana is no exception. The burden of NCDs in the Middle Belt region of Ghana is increasing. Lifestyle behaviours such as unhealthy diets, physical inactivity, tobacco use, and alcohol consumption are prevalent within the middle belt of Ghana and contribute significantly to the incidence and prevalence of NCDs.

The lack of access to healthcare services and inadequate public health interventions exacerbates the burden of NCDs in the Middle Belt region. A recent study conducted by Aryeetey et al. (2021) investigated the burden of NCDs in the Middle Belt region of Ghana.

The study reported a high prevalence of NCDs, with hypertension being the most prevalent, affecting about one in three adults. Diabetes and obesity were also prevalent, affecting approximately one in ten adults. Additionally, the study found that the prevalence of NCDs increased with age, with older adults being more affected than younger adults.  A study by Dosoo, (2019) to assess the prevalence of hypertension in the middle belt of Ghana, hypertension was found to be 28.1% and the study concluded that about one-quarter of adults living within the middle belt of Ghana were hypertensive.

These findings highlight the urgent need for public health interventions to address the burden of NCDs in the Middle Belt region of Ghana.

The Impact of NCDs on livelihood

Economic

Dr. Koku Awoonor, Director for Policy Planning Monitoring and Evaluation division-Ghana Health Service in 2019 stated that “the consistent increase rate of NCDs in Ghana is posing a major threat to families and the government in the achievement of family and national goals. Significant among these goals is economic growth”.

Hypothetically, NCDs reduce the supply of labor and productivity.  As the mental and physical capacity of the worker deteriorates due to NCD morbidity, the level of productivity and efficient use of technology and machinery diminishes.  

NCD-related morbidity and sickness in the labor force imply that more workers will be out of the workforce to get their treatment while mortality will permanently reduce the size of the skilled labor force. In this context, the firms endure an additional cost of training and hiring new workers for the positions left vacant by workers suffering from a particular type of NCD. Additionally, NCD-related morbidity increases the healthcare cost and decreases capital investment since individuals suffering from NCDs use savings for treatment.

Goal 1,2,3 and 4 of the Sustainable Development Goals (SDGs) are poverty reduction, zero hunger, good health, and well-being, and quality education respectively. Among these SDGs, the poverty reduction strategy stands as the bedrock on which all the other goals are built-in that, low-income earners stand a higher risk of getting sick and dying from NCDs due to increased risk of exposure to negative behaviors and lifestyles such as poor eating habit, tobacco use, alcohol consumption resulting in the use of household finance for healthcare cost.

The global economic burden of NCDs reported that NCDs are likely to cause about US$47trillion in output loss within the next two decades.

A study by Macroeconomist also noted that NCDs have a downward effect on economic output and growth through the conduit of labor and capital accumulation. NCDs are estimated to reduce the quality and quantity of the workforce which will reduce national income.

For instance, workers with NCDs are likely to be physically weak and frequently fall sick leading to absenteeism, and inefficient use of machinery and equipment in production. All these will eventually affect the output of work. Also, the family capital stock will be affected since savings would have to be used for healthcare instead of investments as a result of NCDs.

Also, mortality due to NCDs will reduce the number of skilled and unskilled workforce and will have a long-term effect on economic growth. This implies that money will be required to train human capital for replacement.

Health

A safer population is less susceptible to infectious diseases. Non-communicable diseases affect the immune system of the person with the condition. A person with uncontrolled diabetes is more susceptible to infectious diseases like the coronavirus, tuberculosis, and malaria. Smoking tobacco increases the risk of developing all leading NCDs. NCDs generally increase the risk of acquiring any form of infectious disease and even high risk of mortality from the infectious diseases.

A health care system that pays attention to NCDs can equally be the line of defense for non-communicable diseases. An increase in NCDs will overburden the health systems. The middle belt of Ghana is already overburdened with the existing challenges of the healthcare system such as communicable diseases, inadequate health care professionals, poor infrastructures, and inadequate health equipment.

WHO recommends that; the ratio of doctors to patients should be 1:200 but the ratio of doctors to patients in Ghana is 1:1000 according to World Bank 2020 report.

Sociocultural

The various forms of culture look at diseases and illnesses differently.  The beliefs of people in society make them look at you differently when you are suffering from a particular disease.  Epilepsy was considered a cursed disease for a few years back in Ghana.

We were made to believe that going close to someone with epilepsy can affect you.  Akua 46-year-old hypertensive woman at the Tafo hospital in Kumasi refused all forms of treatment and interventions because she was made to believe that her condition was spiritual and herbal treatment is the best for her. Good education and health promotion will go a long way in managing and preventing NCDs.

The influence of sociocultural practices is affecting the whole care process of NCDs. Most NCDs may lead to impairment and disability which may affect their self-esteem due to how society looks down on people with disability. NCDs account for about 48% of disability-adjusted life years. Disability hinders an individual’s ability to participate in social activities leading to self-isolation, depression, and a short life.

The way forward

The government of Ghana and NGOs have launched a considerable number of programs in the fight against NCDs.

In 2018, the Ghana NCD Alliance was launched to help reduce NCDs. Dr. Kaluwa in his speech at the launch said “the primary role and responsibility for the prevention and controlling of NCDs lie with governments, while efforts and engagement of sectors of society, international collaboration and cooperation are essential for success.

He also said that effective NCD prevention and control requires leadership and coordinated multi-stakeholder engagement at the governmental level and a wide range of actors to bring appropriate “health-in-all policies” across the ministerial sectors.

In the fight against NCDs, health promotion and proper education are very important. During our interview with Mrs. Dorah, she said, “I had no idea about anything like this until the doctors told me. I moved from one church to another because I thought I could get my healing and move on but after 10 years of living with the condition, I came to terms with it and I live my life.” She added.

The national policy for NCDs was launched in 2012 with five key areas of focus in tackling NCDs in Ghana: 

Primary prevention; Tobacco, diet, physical activity, alcohol, and immunization
Early detection and clinical care: Early detection, Provision of treatment services
Health system strengthening; Training of health workers and developing human resource capacity; Provision of essential drugs and supplies, Integration of NCD plans into wider health systems planning, ensuring financial mechanisms for improved allocation and efficient use of funds
Research and development
Surveillance of NCDs and their risk factors.

The above key strategies require proper teamwork from all of us if we all want to see good results in the fight against NCDs.  It is necessary that the ministry of health and all agencies with keen interest in health will collaborate and focus on the NCD’s policies backed with action to tackle NCDs.


Currently, a team of Public Health Advocates known as the Advocating for Health (A4H) Coalition comprising Academia, Civil Society Organizations, Public Health Associations and Nutrition/Dietetic Professional Group are advocating for the creation of a favourable environment and stakeholder buy-in for food-related fiscal policies in Ghana. The coalition is concerned, troubled and alarmed by the soaring health costs and deaths linked to NCDs in Ghana.




The Writer

Dr. Charles Apprey-Nutritional Biochemist

Department of Biochemistry and Biotechnology, KNUST

[email protected]/[email protected]

Email: [email protected]

Twitter: @A4H_Project