ACE NCD Thematic Areas

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Much of the increase in non-communicable diseases in Sub-Saharan Africa (SSA) is due to rapid unplanned urbanization, deteriorating environments, population ageing, and lifestyle changes such as decreasing physical activity, obesity, tobacco use, and increasing consumption of alcohol and unhealthy foods. Our approach to the prevention of NCDs is modelled after the WHO three-pronged approach that includes epidemiological surveillance, primary prevention, and secondary prevention targeted at preventing complications and improving the quality of life through medical, psychosocial and/or economic interventions. Interdisciplinary research shall interrogate the root causes and propose innovative interventions that make efficient use of existing resources.

Lead: Prof. Charles Nzioka, MA, PhD- University of Nairobi

There is a high prevalence of NCDs multi-morbidity, ‘the coexistence of more than one chronic non-communicable disease in an individual at any one point’. However, its aetiology, mechanisms and pathophysiology are poorly understood, with little data available. NCD health-seeking behaviour is symptom-driven, thus asymptomatic disease conditions receive little attention, both at an individual level and amongst health systems planners because the need is masked. There is a need to conduct research to understand the social determinants, the magnitude of the problem, characterize it, define pathways of progression of the disease conditions, detect the coexistence of and interactions between NCDs and infectious diseases.

Lead: Prof. C. F. Otieno, FRCP, Professor of Internal Medicine / Endocrinology Specialist Diabetologist

In order to manage and rationally prevent NCD multi-morbidity, it is necessary to understand the natural history of the contributing diseases and to define the mechanistic underpinnings of how these diseases interact in Sub-Saharan Africa (SSA). Potential mechanistic studies include the identification of the key interactions exacerbating the multi-morbid state, mapping of pathways and development of multi-morbid disease models. Epidemiological data can then be used to test these models.

Africa has, hitherto, been under-represented in the bio-banking revolution with the few available biobanks serving mainly as conduits of samples to the developed countries.

There have been inadequate efforts in the development of prevention, management, and control of NCD care models acceptable to the community and policymakers specific to SSA. Management of chronic conditions is a challenge for healthcare delivery systems globally but especially so in low-resource settings. Possible projects could include data mining of existing data sets, DHIS2, hospital data and women who have attended ANC (>90%), and/or key informant interviews with government (implementing arm such as county/district health authorities), community and industry to identify possible models of care.

There is inadequate data and trend analysis for the risk factors in nearly all African countries, especially among the target population of adolescents and youth. Developing effective risk-factor interventions for the target population requires current information on both the drivers and the trends, particularly of sub-age groups. Even where the data is available, there are substantial variations in how the indicators were collected, and samples drawn across populations. This makes comparison across and between different communities and countries very difficult. Large data sets shall form the basis of data-driven research that facilitates evidence-based decision and policy making. Example projects could include investigating avenues for building consensus, at least across ARUA countries on the selection, definition and measurement of a core set of cross-culturally, comparable and appropriate indicators.