The fourth paper focuses on the emerging chronic diseases epidemic in SA, and is written by Professor Bongani Mayosi, Groote Schuur Hospital, Cape Town, SA, and colleagues. They urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess, and implement integrated care interventions for chronic infectious and non-communicable diseases.
The authors say: "Evidence of a rise in mortality and morbidity from non-communicable diseases in all strata of South African society is compelling. These findings represent the most advanced end of the range of rural and urban sub-Saharan transitions. Further, there is good evidence regarding the rise of vascular disorders—including hypertension, stroke, and ischaemic heart disease—elsewhere in east and west Africa, suggesting that complex health transitions are underway in several settings. The widely held perception that the burden of disease in sub-Saharan Africa is composed largely of communicable diseases is thus flawed."
The number of people aged 60 or over (7.3% at 2001 census) is likely to treble between now and 2025, which will in turn result in a doubling of cardiovascular deaths by 2040. The rising burden of non-communicable diseases is shown by an increasing number of deaths from diabetes, chronic kidney disease, and cancer of the prostate and cervix, and by the increasing proportion of disability-adjusted life years attributed to neuropsychiatric disorders. The burden of these diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from HIV/AIDS.
The authors conclude: "The scale of the challenge posed by the combined and growing burden of HIV/AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services."
Professor Bongani Mayosi, Groote Schuur Hospital, Cape Town, SA T) +27-21-406-6200 /+27-21-531-0388 /+27-82-372-7655 E) Bongani.Mayosi@uct.ac.za
Full paper 4: http://press.thelancet.com/saser4.pdf
Journal
The Lancet