The new crisis after HIV/AIDS knocks at the door
Pini Bothoko | Friday April 28, 2017 14:54
Non-Communicable Diseases (NCDs) such as cardiovascular diseases, cancer, stroke, diabetes and chronic respiratory disorders such as chronic obstructed pulmonary disease and asthma, are ballooning in Botswana at a rate so alarming that even the highest health authorities are calling them the “new HIV/AIDS”.
By some reports, NCDs account for 37% of deaths from diseases annually in Botswana!
The burden of disease attributable to NCDs in Botswana is increasing relentlessly and impacting people at younger age groups, unlike in the past where such diseases were more commonly associated with the elderly.
Low health literacy levels also continue to influence unhealthy behaviours, while the fact that Batswana are travelling the world more is exposing more to communicable and emerging diseases.
After that tragic day in Selebi-Phikwe in 1985 when the first AIDS case was diagnosed in Botswana, champions were forced to rise and battle a rapidly spreading, ferocious enemy who seemed unstoppable.
Joy Phumaphi’s name is forever etched in many people’s minds as being in the vanguard of the fight against HIV/AIDS at its height, during her tenure as Health Minister.
This time around, a new sinister beast once again poses an existential threat to Batswana and new champions are required.
Current Health Minister, Dorcus Makgato, has taken the vanguard and is leading the charge for the interventions and changes required to fight NCDs.
At every event, Makgato expresses her worry about the spread of NCDs in Botswana and issues a clarion call for greater awareness and action.
At the University of Botswana last week, Makgato said the latest data supported the theory that NCDs are a greater threat to Batswana, than HIV/AIDS.
“Batho ba nonne, ba ntse mahura. I like to walk around town and I seldom see people walking as well. Many drive, they don’t walk.
“The majority of women are also overweight! Since I became the Health Minister, I too have started taking care of my body and I’m confident I’ve lost weight.
“I want to be the Minister of Health not the Minister of Sickness.
“Many people are failing to regularly exercise, putting themselves them at the risk of NCDs,” Makgato said.
A study conducted by the Institute for Health Metrics and Evaluation at the University of Washington between 1980 and 2013 confirms Makgato’s statement.
The data, sourced from self-reports, examination surveys, healthcare providers and existing literature, shows that in Botswana in 2013, 53% of adult women were overweight and within that, 24% were classified as obese.
Among adult men or those aged 20 years and older, 22% were classified as overweight, with six percent in the obese extreme.
Increasing abuse of tobacco and alcohol, as well as high intake of salt, sugar and fats are driving NCDs. Many men are tobacco users, one out of three people have raised blood pressure and a large proportion of women are overweight.
Experts agree that the time is now that Botswana appreciate the key risk factors in NCDs, which include obesity, smoking tobacco products and alcohol abuse.
Health awareness programmes, urban planning that facilitates physical activity and taxation strategies that seek to reduce demand for tobacco, are all good starting points.
Experts say the health ministry should develop policy frameworks that reflect the national burden of disease, funding constraints and the nature of the healthcare system while also taking cultural factors into account.
“Addressing the underlying drivers of NCDs, which are mainly behavioural, is bound to bring conflicts, even between the mandates of different sectors such as trade and public health.
“In fact, I could say the bulk of what leads to NCDs in Botswana are food items imported from other countries,” Makgato told her UB audience.
The Minister’s statements strike to the heart of the debate on processed and traditional diets, as well as their impact on health. Many Batswana, even outside of urban areas, are consuming diets largely made up of processed, imported food items with low nutritional value, high fat, salt and sugar.
Coupled with the sedentary lifestyle associated with growing white-collar jobs, more Batswana spend their days sitting in the office working and nights in restaurants, or at home indulging bad food habits and watching television.
Local dieticians will welcome Makgato’s approach to NCDs, as they have long been calling for interventions in the food industry.
A few years ago, a local clinical dietician at Bokamoso Private Hospital, John Nderitu, called on government to compel the local food industry to reduce the amount of salt it uses, saying high doses were among factors driving the country’s obesity emergency.
“There is a relationship between high salt intake and weight gain,” Nderitu told Mmegi.
“High salt makes one thirsty due to dehydration and for this reason, food stores make their wings and others salty so that the client would also buy a fizzy or juice to go with to quench the thirst that follows.
“This increases calories taken from sugar.
“High salt also is linked to high blood pressure and kidney failure that are also on the rise in Botswana.”
The dietician said his own studies and lifestyle analysis had shown that among adults, drivers of obesity include high sugar intake and large carbohydrate portions such as four to six cups of motogo with three tablespoons of sugar and madila.
In addition, high intake of fatty meats or fatty cuts cooked with plenty of oil, lack of exercise and missing breakfast are also factors.
“(One would) miss breakfast and buy foods at 10am (which consist of) fat cakes and serobe which are rich in oil and sugar,” he said.
“(Other drivers include) eating out where healthy choices are more expensive and excessive alcohol intake.”
Delivering appropriate NCD care to patients requires addressing multiple challenges as they encompass insufficient access to medical care and to healthcare facilities and professionals, hence a challenge to the government to invest more funds in health ministry.
While the country continues to fight against infectious diseases such as HIV/AIDS, tuberculosis, malaria and now NCDs, there is growing pressure for Government to rethink the allocation of resources for health.
Sadly, the rapidly increasing burden of these diseases affects everyone regardless of their age or body size and it also contributes to widening health and quality of life inequalities. It also weighs heavily on businesses and national economies as productivity goes down.
It remains to be seen whether Makgato will be successful in galvanising the community to the fight, in the way, Phumaphi rallied troops on the battlefield years ago.