Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review

Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review J HEALTH POPUL NUTR 2014 Mar;32(1):1-13 ©INTERNATIONAL CENTRE FOR DIARRHOEAL ISSN 1606-0997 $ 5.00+0.20 DISEASE RESEARCH, BANGLADESH REVIEW ARTICLE Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review Awoke Misganaw, Damen Haile Mariam, Ahmed Ali, Tekebash Araya College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ABSTRACT Impact of non-communicable diseases is not well-documented in Ethiopia. We aimed to document the prevalence and mortality associated with four major non-communicable diseases in Ethiopia: cardiovascu- lar disease, cancer, diabetes, and chronic obstructive pulmonary disease. Associated risk factors: hyperten- sion, tobacco-use, harmful use of alcohol, overweight/obesity, and khat-chewing were also studied. System- atic review of peer-reviewed and grey literature between 1960 and 2011 was done using PubMed search engines and local libraries to identify prevalence studies on the four diseases. In total, 32 studies were found, and half of these studies were from Addis Ababa. Two hospital-based studies reviewed the prevalence of cardiovascular disease and found a prevalence of 7.2% and 24%; a hospital-based study reviewed cancer prevalence and found a prevalence of 0.3%; two hospital-based studies reviewed diabetes prevalence and found a prevalence of 0.5% and 1.2%; and two hospital-based studies reviewed prevalence of asthma and found a prevalence of 1% and 3.5%. Few community-based studies were done on the prevalence of diabe- tes and chronic pulmonary obstructive disease among the population. Several studies reviewed the impact of these diseases on mortality: cardiovascular disease accounts for 24% of deaths in Addis Ababa, cancer causes 10% of deaths in the urban settings and 2% deaths in rural setting, and diabetes causes 5% and chronic obstructive pulmonary disease causes 3% of deaths. Several studies reviewed the impact of these diseases on hospital admissions: cardiovascular disease accounts for 3%-12.6% and found to have increased between 1970s and 2000s; cancer accounts for 1.1%-2.8%, diabetes accounts for 0.5%-1.2%, and chronic obstructive diseases account for 2.7%-4.3% of morbidity. Overall, the major non-communicable diseases and related risk factors are highly prevalent, and evidence-based interventions should be designed. Key words: Cancer; Cardiovascular disease; Chronic obstructive pulmonary disease; Diabetes; Risk factors; Ethiopia INTRODUCTION diseases, cancers, diabetes, and chronic lung diseas- es. The combined burden of these diseases is rising Non-communicable diseases are the leading causes fastest among the lower-income countries, popula- of death globally, killing more people each year tions, and communities (2). than all other causes combined. Contrary to popu- lar opinion, available data demonstrate that nearly World Health Organization (WHO) estimated in 80% of deaths due to non-communicable diseases 2011 that 34% of Ethiopian population is dying occur in low- and middle-income countries (1). from non-communicable diseases, with a national Of the 57 million deaths that occurred globally in cardiovascular disease prevalence of 15%, cancer 2008, thirty-six million were due to non-commu- and chronic obstructive pulmonary disease preva- nicable diseases comprising mainly cardiovascular lence of 4% each, and diabetes mellitus prevalence of 2%. Communicable maternal, perinatal and Correspondence and reprint requests: nutritional conditions accounted for 57% of the Dr. Awoke Misganaw Addis Ababa Mortality Surveillance Program deaths. This WHO estimation is comparable with College of Health Sciences East African countries, such as Kenya, Uganda, and Addis Ababa University Eritrea (3). The resulting double burden of non- Addis Ababa communicable diseases, with higher prevalence Ethiopia of pre-existing communicable, maternal, perinatal Email: asterawoke2007@gmail.com and nutritional conditions, constrains the already- Fax: +251115517701 Epidemiology of non-communicable diseases Misganaw A et al. meagre health resources and hinders economic de- factors’, ‘physical exercise’, ‘diet’, and ‘Ethiopia’. velopment in Ethiopia (4) . The references of included articles were scanned to identify additional articles of interest and used Similarly, Global Burden of Disease (GBD) stud- websites of the HINARI and Google Scholar, World ies estimated age-standardized death rates of 800 Bank, and World Health Organization to access ar- per 100,000 population for non-communicable ticles. Grey literature was searched from Addis Aba- diseases in Ethiopia, of which higher death rates ba and Jimma University Libraries and Ethiopian (approximately 450 per 100,000) were attributed Federal Ministry of Health (Figure). to cardiovascular disease and diabetes, 150 per 100,000 attributed to cancer, and 100 per 100,000 Selection of studies to chronic obstructive pulmonary disease (5). The inclusion criteria used were: (i) articles with These estimations were much higher than in many clear objectives and methodologies; (ii) articles pub- developed countries. Although these estimates of lished from 1960 to 2011; (iii) articles addressing cardiovascular disease, cancer, diabetes mellitus, one or more of the four major non-communicable and chronic obstructive pulmonary disease look diseases (prevalence of cardiovascular diseases, can- higher in Ethiopia, estimations by WHO and GBD cer, diabetes mellitus and chronic obstructive pul- studies are highly uncertain because the causes of monary diseases); (iv) articles published in English deaths were predicted using cause-of-death models language; and (v) articles for which full texts were due to lack of information on the level of mortal- obtained for this review (Figure). ity or cause of death at the country level, which should be substantiated by national evidences (6). Data extraction Despite the above estimations for global prevalence We developed a draft data extraction checklist and of the four major non-communicable diseases, car- piloted it on 10 randomly-selected journals. The diovascular disease, cancer, diabetes mellitus, and checklist was revised and further tested on another chronic obstructive pulmonary disease were not randomly-sampled 10 journals, and further refine- well-documented in Ethiopia. On the other hand, ments were made. In the checklist, information was accurate information on the prevalence of major included on title, author, year of publication, year public-health importance is required to have in- of data collection, study design, study setting (hos- formed health policy decision (7,8). Therefore, it is pital or community, urban/rural, or mixed), region, crucial to document prevalence estimations for the population, sample-size and sampling procedure, major non-communicable diseases for the purposes data-collection procedures, mean age of the study of research and interventions. We reviewed pub- participants, percentage prevalence of cardiovas- lished and grey literature aiming to document the cular diseases/cancer/diabetes/chronic pulmonary prevalence and mortality associated with the four diseases (or number of cases), diagnostic criteria, major non-communicable diseases in Ethiopia: car- percentage of smokers/alcohol-users/khat-chewers/ diovascular disease, cancer, diabetes, and chronic hypertensive patients. obstructive pulmonary disease and the associated risk factors, such as hypertension, tobacco-use, RESULTS harmful use of alcohol, overweight/obesity, and khat-chewing. In total, 32 studies were found to meet the inclu- sion criteria. Almost half of the studies were from MATERIALS AND METHODS Addis Ababa, the capital city of Ethiopia. Fifteen studies were on cardiovascular diseases, 11 each Search strategy were on cancer and diabetes mellitus, and 9 were A systematic review of peer-reviewed and grey lit- on chronic obstructive pulmonary disease (Figure). In this review, community- and hospital-based erature was undertaken to identify studies that es- timated the prevalence of cardiovascular diseases, studies were used for indicating population preva- cancer, diabetes mellitus, and chronic obstructive lence, and mortality and hospitalization studies pulmonary disease in Ethiopia between 1960 and were used for showing severities of the diseases. 2011. We used MeSH of PubMed search engines, Cardiovascular diseases using the medical subject titles ‘cardiovascular diseases’, ‘stroke’, ‘hypertension’, ‘myocardial in- Population prevalence farction, ‘heart disease’, ‘diabetes mellitus’, ‘neo- plasm’, ‘cancer’, ‘asthma’, ‘burden of disease’, ‘non Community-based studies: We did not find studies communicable diseases’, combined with the term on population prevalence of cardiovascular dis- ‘smoking’, ‘tobacco’, ‘alcohol’, ‘khat chewing’, ‘risk eases (Table 1). JHPN 2 Epidemiology of non-communicable diseases Misganaw A et al. Figure. Sum mary of literature search 965 records identified through 5 additional records identified through database searching hand-searching 652 records after duplicate removal 559 records, non-relevant to 652 records screened the topic, excluded 61 articles excluded for incoherence 93 full-length articles with the inclusion criteria assessed for eligibility 16 studies on cardiovascular diseases, 11 on malignant neoplasm, 11 on diabetes mellitus, and 9 studies on chronic obstructive pulmonary diseases were included in the qualitative synthesis Hospital-based studies: Five hospital-based studies study of sampled deaths in Amhara region, 6.5% on the prevalence of cardiovascular diseases and of deaths were attributed to cardiovascular diseases their subtypes were found (Table 1). In a study of among all age-groups (15). Congestive heart failure sampled patients conducted in the eastern part of was reported to have caused 2.5% of deaths among the country, an estimated prevalence of 7.2% for all age-groups in the third sampled hospital-based cardiovascular diseases and 2.4% for hypertensive mortality study (16) (Table 1). heart disease was documented among all age- Hospitalization: Fourteen studies investigated hos- groups (9). In contrast, a study in the capital city es- pitalization of patients with cardiovascular diseas- timated 24% prevalence of cardiovascular diseases es. The hospitalization differs considerably by age, among the sampled outpatient visits by adults (10). region, and subtypes of cardiovascular diseases. In In a rural hospital study with sampled outpatient a study from Addis Ababa, the highest hospitaliza- visits, an estimated 0.5% hypertension prevalence tion was reported (31% of admissions in a hospital was found among adults aged 15 years and above (11). In the fourth and fifth studies conducted in for patients aged 60 years and above) (17). Hos- the capital city, hypertensive heart disease preva- pitalization of patients with all categories of car- lence was estimated to be 12% among adolescents diovascular diseases ranged from 3% in Amhara and adults aged 11 years and above (12) and 6.7% to 12.6% in Oromia region (16,18-20). A study among older adults (13) (Table 1). among all age-groups for admissions in Medical Intensive Care Unit (MICU) in the capital city Severity of the disease reported an 8.8% prevalence of hospitalization for acute myocardial infarction (AMI), and the Mortality: Three studies investigated mortality second study from Oromia region reported 9.8% among patients with cardiovascular diseases: two (21,22). The prevalence of cardiovascular diseases population-based studies with the verbal autopsy appears to have increased over time among hospi- technique and one hospital-based mortality study. talized patients, with studies in the 1970s report- In the first study, with randomly-sampled adult ing prevalence of 4.4% while studies in the 2000s deaths in the capital city, 24% of deaths were attrib- reporting 12.6% (18,23) (Table 1). uted to cardiovascular diseases (14) and, in a second | | Volume 32 Number 1 March 2014 3 Epidemiology of non-communicable diseases Misganaw A et al. JHPN Table 1. Literature review of the prevalence of cardiovascular diseases from hospital-based studies in Ethiopia, 1962-2006 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw et al. (14) Addis Ababa Urban Community-based 3,709 deaths Cardiovascular 24.0 Verbal autopsy (>15 years) disease 2006 Melaku Z et al. (21) Addis Ababa Mixed All age-groups 3,548 MICU admis- AMI disease 9.8 Physicians’ sion diagnosis 2006 Andarge B et al. (18) Oromia Mixed All age-groups 3,99 all admission Cardiac disease 12.0 Physicians’ diagnosis 2004 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Cardiovascular 6.5 Verbal autopsy (all age-groups) diseases 2001 Mamo Y et al. (22) Oromia Mixed All age-groups 2,313 MICU admis- AMI disease 8.8 Physicians’ sion diagnosis 1995 Hussein K (20) Oromia Mixed >10 years 1,440 all admission Cardiovascular 10.5 Physicians’ diseases diagnosis 1994 Pauletto P et al. (11) Oromia Rural >15 years 5,277 outpatients Hypertension/ 0.5 Physicians’ heart disease diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Cardiovascular 11.7 Physicians’ sion disease diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Cerebrovascular 8.1 Physicians’ sion accident diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Congestive 5.6 Physicians’ sion heart failure diagnosis 1983 Tekelu B (13) Addis Ababa Urban Adults 2,145 outpatients Hypertension/ 6.7 Physicians’ heart disease diagnosis 1982 Lester FT (12) Addis Ababa Mixed >60 years 200 medical admis- Cardiovascular 31.0 Physicians’ sion disease diagnosis 1982 Abraham G (19) Addis Ababa Mixed 13-82 years 5,667 medical ad- Cardiovascular 6.6 Physicians’ missions disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 3,611 all admissions Cardiovascular 3.0 Physicians’ disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 238 deaths Congestive 2.5 Physicians’ heart failure diagnosis 1974 Lainovic D (26) Addis Ababa Mixed >15 years 9,330 medical ad- Cardiovascular Physicians’ 6.0 missions disease diagnosis Contd. Epidemiology of non-communicable diseases Misganaw A et al. Cancer Prevalence in population Community-based studies: We did not find studies on prevalence of cancer in population (Table 2). Hospital-based studies: One study on hospital-based prevalence of cancer was found. In this urban hos- pital study through physicians’ diagnosis, a preva- lence of 0.3% was estimated among outpatient adults aged 20 years and above (24) (Table 2). Severity of the disease Mortality: Four studies investigated mortality for patients with cancer: three population-based stud- ies with the verbal autopsy technique and one hos- pital-based mortality study. In the first study, with randomly-sampled adult deaths in the capital city, 10% prevalence of mortality was attributed to can- cer among deaths of those aged 15 years and above (14). In the second study, with sampled deaths in the Amhara region, 2% prevalence of mortality was attributed to cancer among all age-groups (15). The third study of community-based rural sampled deaths in the Southern region of Ethiopia esti- mated a cancer mortality prevalence of 1.5% (25). A hospital-based study among patients sampled through physicians’ diagnosis also identified a can- cer mortality prevalence of 2.9% in all age-groups (16) (Table 2). Hospitalization: Six studies investigated hospital- ization for patients with cancer, and three more reported pathological investigations. The highest hospitalization was reported in a study from Ad- dis Ababa: 14.5% of admissions in a hospital for patients aged 60 years and above (17). Hospitaliza- tion of patients with cancer ranged from 1.1% to 2.8% in Addis Ababa (23,26). Hospital-based patho- logical studies estimated cancer prevalence ranging from 8.3% to 27.9% (27,28) (Table 2). Diabetes mellitus Population prevalence Community-based studies: Two community-based studies on population prevalence of diabetes were found. A study with urban and rural sampled population in the Southern region estimated the prevalence of diabetes mellitus (type 1 and 2) to be 4.9% among adults aged 18 years and above (29). The second study, with urban sampled population in the Oromia region, estimated the prevalence of type 2 diabetes mellitus to be 5.3% among adults aged 40 years and above (30) (Table 3). | | Volume 32 Number 1 March 2014 5 Table 1.—Contd. Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 1973 Lester FT (12) Addis Ababa Mixed >11 years 2,103 outpatients Hypertension/ Physicians’ 12.0 heart disease diagnosis 1971 Teklu B et al. (34) Addis Ababa Urban 17-64 years 460 outpatients Cardiovascular Physicians’ 24.0 disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Cardiovascular Physicians’ 4.4 missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Hypertension/ Physicians’ 2.5 missions heart disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Rheumatic val- Physicians’ 0.7 missions vular disease diagnosis 1962 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Cardiovascular Physicians’ 7.2 disease diagnosis 1962 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Hypertension/ Physicians’ 2.4 heart disease diagnosis AMI=Acute myocardial infarction, MICU=Medical Intensive Care Unit Epidemiology of non-communicable diseases Misganaw A et al. JHPN Table 2. Literature review of the prevalence of malignant neoplasm in Ethiopia, 1970-2011 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw A et al. (14) Addis Ababa Urban Community-based 3,709 deaths Malignant neo- 10 Verbal autopsy (>15 years) plasm disease 2004 Bezabih M (27) Oromia Mixed Hospital-based 3,200 specimens Malignant neo- 8.3 Pathological (all age-groups) plasm disease 2001 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Malignant neo- 2 Verbal autopsy (all age-groups) plasm disease 1990 Shamebo M (36) Addis Ababa Mixed Hospital-based 7,969 medical ad- Leukaemia 2.3 Physicians’ 14-80 years missions diagnosis 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 875 deaths Malignant neo- 1.5 Verbal autopsy (all age-groups) plasm disease 1986 Aseffa A et al. (28) Amhara Mixed Hospital-based 1,668 specimens Neoplastic 27.9 Pathological (all age-groups) disease 1986 Aseffa A et al. (28) Amhara Mixed Hospital-based 1,668 specimens Malignant neo- 14.6 Pathological (all age-groups) plasm disease 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Malignant neo- 0.3 Physicians’ plasm diagnosis 1982 Lester FT (17) Addis Ababa Mixed Hospital-based 200 medical admis- Neoplasm 14.5 Physicians’ (>60 years) sions disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed Hospital-based 3,611 all admissions Neoplasm 2 Physicians’ disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed Hospital-based 238 deaths Hematoma 2.9 Physicians’ (all age-groups) mortality diagnosis 1974 Lainovic D (26) Addis Ababa Mixed Hospital-based 9,330 medical ad- Neoplasm 1.1 Physicians’ (>15 years) missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed Hospital-based 3,922 medical ad- Neoplasm 2.8 Physicians’ (>16 years) missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed Hospital-based 3,922 medical ad- Primary carcino- 2.3 Physicians’ (>16 years) missions ma of the liver diagnosis SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. | | Volume 32 Number 1 March 2014 7 Table 3. Literature review of prevalence of diabetes mellitus (DM) in Ethiopia, 1963-2007 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw A et al. [14] Addis Ababa Urban Community-based 3,709 deaths Diabetes mel- 5 Verbal autopsy ( >15 years) litus 2011 Giday A et al. (29) SNNPR Mixed Community-based 979 sampled popu- Diabetes mel- 4.9 Laboratory tests (>18 years) lation litus 2007 Yemane et al. (30) Oromia Urban Community-based 576 sampled popu- Type 2 diabetes 5.3 Laboratory tests (>40 years) lation mellitus 2006 Melaku Z et al. (21) Addis Ababa Mixed All age-groups 3,548 MICU admis- Diabetic kitoaci- 10.7 Physicians’ sions dosis diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Diabetic kitoaci- 9.7 Physicians’ sions dosis diagnosis 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Diabetes mel- 1.2 Physicians’ litus diagnosis 1982 Lester FT (17) Addis Ababa Mixed >60 years 200 medical admis- Diabetes mel- 11.5 Physicians’ sions litus diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 3,611 medical ad- Diabetes mel- 1.7 Physicians’ missions litus diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 238 deaths Diabetes mel- 1.3 Physicians’ litus diagnosis 1974 Lainovic D (26) Dire Dawa Mixed >15 years 9,330 medical ad- Diabetes mel- 6 Physicians’ missions litus diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Diabetes mel- 1.8 Physicians’ missions litus diagnosis 1963 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Diabetes mel- 0.5 Physicians’ litus diagnosis MICU=Medical Intensive Care Unit; SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. Hospital-based studies: Two studies on hospital- monary diseases (14). In the second study, which based prevalence of diabetes were found. In these took sampled deaths in the Southern region of studies, the prevalence of diabetes was estimated to Ethiopia, 5.2% of deaths were attributed to chronic be 0.5% in all age-groups and 1.2% among patients obstructive pulmonary diseases among people aged aged 20 years and above (9,24) (Table 3). 15-49 years (33) (Table 4). Its subtype—asthma— was estimated to have caused 0.6% of deaths in a Severity of the disease sampled community-based study (25). Mortality: Two studies examined mortality of pa- Hospitalization: Two studies investigated hospital- tients with diabetes. In the first study, with ran- ization for patients with chronic obstructive pul- domly-sampled adult deaths in the capital city, monary diseases. These studies from Addis Ababa 5% of deaths were attributed to diabetes (14). A estimated 2.7% and 4.3% prevalence of hospital- hospital-based study with sampled deaths in the ization for chronic obstructive pulmonary diseases Amhara region estimated diabetes-related mortal- (23,32) (Table 4). ity prevalence of 1.3% in all age-groups (16) (Table 3). Prevalence of risk factors of the four non-communicable diseases Hospitalization: Four studies investigated hos- pitalization of patients with diabetes, and two Reviewed studies that have been conducted on the more studies investigated one of its complica- major non-communicable diseases since 1984 have tions called diabetic kitoacidosis. The highest mainly addressed the urban population and the hospitalization was reported by a study from adult group (15 years and older). As for risk factors, Addis Ababa: 11.5 % of admissions in a hospital these studies have dealt with hypertension, high- for patients aged 60 years and above (17). Hospi- er glucose level (diabetes mellitus), tobacco-use, talization of patients with diabetes ranged from harmful use of alcohol, being overweight/obese, 0.5% in all age-groups to 6% for patients aged and khat-chewing (Table 5). 15 years and above (9,26). Studies estimated the In the capital city Addis Ababa, hypertension prev- prevalence of diabetic kitoacidosis to be 9.7% for alence ranged from 4.1% among adult workers in patients aged 10 years and above (31) and admit- 1984 to 30% among a sampled population in 2009 ted to Medical Intensive Care Unit (MICU); the (6,34). In the regions, hypertension prevalence ac- figure for all age-groups for the same disease was counted for about 10% in the Southern Nations, 10.7% (21) (Table 3). Nationalities, and Peoples Region (SNNPR) in 2011 Chronic obstructive pulmonary diseases (29), and 1.8% in the rural Amhara populations in the mid-1980s (35) (Table 5). Prevalence in population Similarly, the prevalence of being overweight in the Community-based studies: One study on population population of Addis Ababa accounted for 25.1% prevalence of chronic obstructive pulmonary disease (36) among adult workers in particular and 30.5% subtype called ‘asthma’ was found. In this study, (6) of the adult population in general in 2009. One which used an urban/rural sampled population and of the regions, viz. SNNPR, accounted for 8.7% the verbal autopsy technique, 0.6% prevalence was of the study population aged 18 years and above estimated in all age-groups (25) (Table 4). (29). The same studies further indicated an obesity prevalence of 5.3% (36) and 7.2% (6) respectively Hospital-based studies: Two studies on hospital- among adult workers in particular and the adult based prevalence of asthma were found. In these population in general in Addis Ababa (Table 5). studies, the prevalence of asthma was estimated to be 1% and 3.5% among patients aged 20 years and Regarding excessive alcohol-use, the prevalence above (24,32) (Table 4). ranged from 23% to 62% in Addis Ababa (6,36) while the figure for SNNPR was 6.5% (29). On the Severity of the disease other hand, current smoking in Addis Ababa was Mortality: Five community-based studies examined reported to range from 2.2% to 9% (6,36) while the mortality for patients with chronic obstructive lifetime prevalence of smoking in the SNNPR was pulmonary diseases and asthma, using the verbal reported to be 2.1% (29). A higher khat-chewing autopsy technique. In the first study, with random- prevalence of 9.2% was reported from SNNPR (29) ly-sampled adult deaths in the capital city, 3% of and, in Addis Ababa, it ranged from 7.3% to 8.5% deaths were attributed to chronic obstructive pul- (6,36) (Table 5). JHPN 8 Epidemiology of non-communicable diseases Misganaw A et al. | | Volume 32 Number 1 March 2014 9 Table 4. Literature review of the prevalence of chronic obstructive pulmonary diseases in Ethiopia, 1970-2001 Prevalence Diagnostic Region in Urban/ Targets Sample-size Outcome Year Author (%) criteria Ethiopia Rural 2011 Misganaw A et al. (14) Addis Ababa Urban Community based 3,709 deaths COPD 3 Verbal autopsy (>15 years) 2001 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Asthma 2 Verbal autopsy (all age-groups) 2004 Lulu K et al. (33) SNNPR Mixed Community-based 515 deaths COPD 5.2 Verbal autopsy (15-49 years) 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 875 deaths Asthma 0.6 Verbal autopsy (all age-groups) 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 575 patients Asthma 2.3 Algorithm (all age-groups) 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Asthma 3.5 Physicians’ diagnosis 1977 Lester FT (32) Addis Ababa Mixed >20 years 5,900 medical ad- Asthma 2.7 Physicians’ missions diagnosis 1977 Lester FT (32) Addis Ababa Mixed >20 years 26,314 outpatients Asthma 1 Physicians’ diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Asthma 4.3 Physicians’ missions diagnosis COPD=Chronic obstructive pulmonary diseases; SNNPR= Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. DISCUSSION Main findings Despite the limitations of our review as we did not conduct quality assessment for studies and poten- tial publication bias with limitation of generaliz- ability, we feel that the published and unpublished data we have presented reflect the comparative sparse data for Ethiopia and future direction for re- search on non-communicable diseases. This review indicates that major non-communi- cable diseases—cardiovascular disease, cancer, dia- betes mellitus, and chronic obstructive pulmonary disease—are causing higher proportions of morbid- ity and mortality, impacting both in the rural and urban populations of Ethiopia. These findings sup- port evidences from sub-Saharan Africa where non- communicable diseases pose a substantial burden (37). The prevalence of certain non-communicable diseases, such as cardiovascular disease, diabetes, cancer, and chronic obstructive pulmonary disease, is increasing rapidly, particularly in the urban areas of sub-Sahara Africa, and that significant demands are being made on the health services by patients with these diseases (37). Studies also indicated that an epidemiological transition is occurring in Arica, especially in the urban population while people are also hard-hit by HIV/AIDS and tuberculosis (38,39). This in- crease in non-communicable diseases is expected in the future, especially in relation to ‘Westerniza- tion’ of people’s diet and lifestyle changes in the urban setting of Africa (38). In our review, the im- pact of major non-communicable diseases might vary with type of disease, age, and region in Ethio- pia. This burden is becoming a big challenge to the healthcare delivery system of the country (4). Increased diagnosis of non-communicable dis- eases will lead to a corresponding need for greater capacity of the existing health facilities, which are currently over-stretched to diagnose and treat these conditions and also a need for aggressive pri- mary programmes as late diagnosis leads to poor health outcomes (5). Risk factors of the major non-communicable dis- eases, such as tobacco-use, excessive alcohol-use, hypertension, being overweight/obese, higher glucose level, and khat-chewing, were highly prevalent among the urban population and peo- ple aged 15 years and above. According to WHO, non-communicable diseases are caused, to a large extent, by four behavioural risk factors that are JHPN Table 5. Literature review of the prevalence of NCD risk factors from community based studies in Ethiopia, 1984-2011 Over- Region in Urban/ Population Sample- Alcohol- Lifetime Current Khat- Year Author HTN weight Ethiopia Rural (age in years) size use smoking smoking chewing /Obesity 2011 Giday A et al. (29) SNNPR Mixed Community-based 979 9.9 8.7/1 6.5 2.1 NA 9.2 (>18 years) 2010 Tran A et al. (36) Addis Ababa Urban Institution-based 1,935 17.8 25.1/5.3 23 13 9.0 8.5 adult workers 2009 Tesfay F et al. (6) Addis Ababa Urban Community-based 3,713 30 30.5/7.2 62 NA 2.2 7.3 (25-64 years) 1986 Zain A et al. (35) Amhara Rural Community-based 478 1.8 NA NA NA NA NA (>15 years) 1984 Tekelu B (34) Addis Ababa Urban Institution-based 933 4.1 NA NA NA NA NA adult workers HTN=Hypertension; NA=Not available; SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. pervasive aspects of economic transition, rapid Conclusions and recommendations urbanization, and lifestyles of the 21st century: We feel that the published and unpublished data tobacco-use, unhealthy diet, insufficient physi- we have presented reflect the comparative sparse cal activity, and excessive alcohol-use (40). Esti- data for Ethiopia and future direction for research mations indicate a national prevalence of 2.4% on major non-communicable diseases despite cer- current daily tobacco smoking and an adult per- tain limitations of our review. capita consumption of 4.1 litre of pure alcohol in Ethiopia. These behavioural risk factors subse- Cardiovascular disease, cancer, diabetes mel- quently lead to four key metabolic/physiological litus, and chronic obstructive pulmonary disease changes: raised blood pressure, raised blood glu- are highly prevalent and causing higher propor- cose, overweight, and obesity. A national preva- tions of morbidity and mortality, impacting both lence of raised blood pressure was estimated to in the rural and urban population of Ethiopia. Their be 35.2%, overweight 7.4%, and obesity 1.1% in impact varies with type of disease, age, and region. Ethiopia (3). Hospitalization impacts of cardiovascular diseases Strengths and weaknesses have increased over time within the last five de- cades. This burden is becoming a big challenge to In the absence of vital statistics system, epidemi- the healthcare delivery system of the country. Their ological studies on non-communicable diseases, risk factors: tobacco-use, harmful use of alcohol, with a variety of designs and in-depth analysis hypertension, overweight/obesity, higher glucose of risk factors and the effects of interventions, level, and khat-chewing were also highly prevalent, could provide a better understanding of the situ- mainly in the urban population aged 15 years and ations in Ethiopia and provide information to above. We believe that proactive thinking is essen- healthcare policy-making. Although this review tial in order to mitigate the effects of these hidden includes many hospital-based studies which are or latent epidemics. Therefore, we recommend the largely non-representative of the community, it following: can highlight gaps on the understanding of the major non-communicable diseases in the coun- • Funding for researchers to conduct large popu- try. Future research priorities for the country lation-based prevalence studies should include better quantification of the major non-communicable diseases and locally-impor- • Designing population-wide interventions to tant risk factors. There is a need for comprehen- address the major non-communicable diseases sive investigation of population prevalence of • Capacity-building of the primary healthcare cardiovascular diseases, cancer, diabetes mellitus, delivery system to prevent and control the epi- chronic obstructive pulmonary disease and their demics of non-communicable diseases. risk factors in the country. ACKNOWLEDGEMENTS Implications of findings We thank Ato Legesse Alemayehu who contributed The prevalence of major non-communicable dis- in the literature search. eases in Ethiopia is high, with probable under- reporting, and will certainly increase in the up- REFERENCES coming years. We believe that proactive thinking is essential in order to mitigate the effects of this 1. World Health Organization. Global status report on hidden or latent epidemic and to provide critical noncommunicable diseases 2010. Geneva: World data for formulating evidence-based health policy Health Organization, 2011. 162 p. and interventions. Moreover, primary prevention 2. Alwan A, MacLean DR, Riley LM, d’Espaignet ET, integrated with the primary healthcare system Mathers CD, Stevens GA et al. Monitoring and sur- could be the best way to reduce the burden both veillance of chronic non-communicable diseases: in the rural and urban settings of the country. Pri- progress and capacity in high-burden countries. Lan- mary prevention mechanisms, such as increasing cet 2010;376:1861-8. awareness and strengthening legislative measures 3. World Health Organization. Noncommunicable dis- (e.g. tobacco) and health promotion measures, can eases country profiles 2011. Geneva: World Health enhance healthy behaviours and mitigate the rise Organization, 2011. 207 p. in the incidence of major non-communicable dis- eases in the country. 4. Berhane Y, Mariam H, Kloos H, editors. Epidemiology | | Volume 32 Number 1 March 2014 11 Epidemiology of non-communicable diseases Misganaw A et al. and ecology of health and disease in Ethiopia. Addis 20. Hussien K. Pattern of medical admission to Jimma Ababa: Shama Books, 2006:704-47. Hospital. Bull Inst Health Sci 1997;7:51-62. 21. Melaku Z, Alemayehu M, Oli K, Tizazu G. Pattern of 5. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases admissions to the medical intensive care unit of Ad- dis Ababa University Teaching Hospital. Ethiop Med J in low-income and middle-income countries. Lancet 2006;44:33-42. 2007:370:1929-38. 22. Mamo Y, Seid E, Adams S, Gardiner A, Parry E. A 6. Tesfaye F, Byass P, Wall S. Population based preva- primary healthcare approach to the management lence of high blood pressure among adults in Addis of chronic disease in Ethiopia: an example for other Ababa: uncovering a silent epidemic. BMC Cardiovasc countries. Clin Med 2007;7:228-31. Disord 2009;9:39. doi: 10.1186/1471-2261-9-39. 23. Pavlica D. Analysis of medical admissions to the 7. Dalal S, Beunza JJ, Volmink J, Adebamowo C, Baju- armed forces hospital in Addis Ababa from January nirwe F, Njelekela M et al. Non-communicable dis- 1966 to January 1970. Ethiop Med J 1970;193-200. eases in sub-Saharan Africa: what we know now. Int J Epidemiol 2011;40:885-901. 24. Teklu B. Chronic disease prevalence in Ethiopian bank employees. Ethiop Med J 1982;20:49-54. 8. Giles WH. Preventing non-communicable diseases in sub-Saharan Africa. Glob Health Promot 2010;17(Suppl 25. Abdulahi H, Mariam DH, Kebede D. Burden of disease 2):3-5, 53-6, 92-7. doi: 10.1177/1757975910363946. analysis in rural Ethiopia. Ethiop Med J 2001;39:271- 9. Blahos J, Kubastova B. The survey of 11,170 patient treated in the Ras Mekonnen Hospital in Harar. Ethi- 26. Lainovic D. Morbidity study in Dire Dawa. Ethiop op Med J 1963;1:190. Med J 1974;12:13-24. 27. Bezabih M. Superficial malignant neoplasms in 10. Teklu B, Parry EH, Pavlica D. Ethiopian cardiovascu- lar studies. X. Normal variations of the electrocardio- southwestern Ethiopia: a cytopathological approach. Diagn Cytopathol 2004;31:347-51. gram in Ethiopians. Ethiop Med J 1971;9:133-9. 28. Aseffa A, Ahmed Z, Stiehl P. Neoplasms in Gondar. 11. Pauletto P, Caroli M, Pessina AC, Dal Palù C. Hyper- Ethiop Med J 1986;24:133-6. tension prevalence and age-related changes of blood- pressure in semi-nomadic and urban Oromos of Ethi- 29. Giday A, Tadesse B. Prevalence and determinants of opia. Eur J Epidemiol 1994;10:159-64. hypertension in rural and urban areas of southern Ethiopia. Ethiop Med J 2011;49:139-47. 12. Laster FT. Blood pressure levels in Ethiopian outpa- tients. Ethiop Med J 1973;11:145-54. 30. Yemane T, Belachew T, Asaminew B, Befekadu O. Type II diabetes mellitus in Jimma Town, southwest 13. Teklu B. Hypertension amongst bank employees in Ethiopia. Ethiop J Health Sci 2007:17. urban Ethiopia. Ethiop Med J 1983;21:217-21. 31. Bahta Y, Fikreyesus Y. Analysis of admissions to the 14. Misganaw A, Mariam DH, Araya T. The double mor- medical intensive care unit of a teaching hospital in tality burden among adults in Addis Ababa, Ethiopia, Addis Ababa. Ethiop Med J 1988;26:61-7. 2006-2009. Prev Chronic Dis 2012;9: E84. 32. Lester FT. Bronchial asthma in Addis Ababa. Ethiop 15. Fantahun M, Degu G. Burden of diseases in Amhara Med J 1977;15:95-9. region, Ethiopia. Ethiop Med J 2004;42:165-72. 33. Lulu K. Determinants and causes of adult mortality 16. Habte-Gabr E, Girma B, Mehrete M, Mehari A, Tekle in Butajira. Piazza: Addis Ababa University, 2000. 132 E, Belachew K et al. Analysis of admissions to Gondar p. (MA Thesis). Hospital in North-Western Ethiopia, 1971-1972. Ethi- op Med J 1976;14:49-59. 34. Teklu B. Hypertension screening amongst bank em- ployees in Addis Ababa. Ethiop Med J 1984;22:1-5. 17. Lester FT. Medical Diseases in the elderly Ethiopians. Ethiop Med J 1982;20:55-61. 35. Zein ZA, Assefa M. Blood-pressure levels and hyper- tension in rural Ethiopian communities. Ethiop Med J 18. Andgre B, Bezabih M, Haileamlak A. Patterns of mor- 1986;24:169-77. tality in Jimma University Specialized Hospital dur- 36. Tran A, Gelaye B, Girma B, Lemma S, Berhane Y, ing September 2001 to August 2002: retrospective Bekele T et al. Prevalence of metabolic syndrome study. Ethiop J Health Sci 2006;16:47-57. among working adults in Ethiopia. Int J Hypertens 19. Abraham G. Pattern of cardiovascular diseases 2011;2011:193719. doi: 10.4061/2011/193719. among adult hospitalized Ethiopians. Ethiop Med J 37. Unwin N, Setel P, Rashid S, Mugusi F, Mbanya J-C, 1982;20:63-8. JHPN 12 Epidemiology of non-communicable diseases Misganaw A et al. Kitange H et al. Noncommunicable diseases in sub- 39. Caselli G, Meslé F, Vallin J. Epidemiological transi- Saharan Africa: where do they feature in the health tion theory exceptions. Citeseer 2002;58:1-34. (http:// research agenda? Bull World Health Organ 2001;79:947- www.demogr.mpg.de/papers/workshops/020619_ 53. paper40.pdf, accessed on 10 October 2011). 38. Mufunda J, Chatora R, Ndambakuwa Y, Nyarango P, 40. World Health Organization. Global health risks: mor- Chifamba J, Kosia A et al. Prevalence of noncommu- tality and burden of disease attributable to selected nicable diseases in Zimbabwe: results from analysis of major risks. Geneva: World Health Organization, data from the National Central Registry and Urban 2009. 62 p. Survey. Ethn Dis 2006;16:718-22. | | Volume 32 Number 1 March 2014 13 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Health, Population, and Nutrition Pubmed Central

Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review

Journal of Health, Population, and Nutrition , Volume 32 (1) – Mar 1, 2014

Loading next page...
 
/lp/pubmed-central/epidemiology-of-major-non-communicable-diseases-in-ethiopia-a-HITEjj4C20

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Pubmed Central
Copyright
© INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH
ISSN
1606-0997
eISSN
2072-1315
Publisher site
See Article on Publisher Site

Abstract

J HEALTH POPUL NUTR 2014 Mar;32(1):1-13 ©INTERNATIONAL CENTRE FOR DIARRHOEAL ISSN 1606-0997 $ 5.00+0.20 DISEASE RESEARCH, BANGLADESH REVIEW ARTICLE Epidemiology of Major Non-communicable Diseases in Ethiopia: A Systematic Review Awoke Misganaw, Damen Haile Mariam, Ahmed Ali, Tekebash Araya College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ABSTRACT Impact of non-communicable diseases is not well-documented in Ethiopia. We aimed to document the prevalence and mortality associated with four major non-communicable diseases in Ethiopia: cardiovascu- lar disease, cancer, diabetes, and chronic obstructive pulmonary disease. Associated risk factors: hyperten- sion, tobacco-use, harmful use of alcohol, overweight/obesity, and khat-chewing were also studied. System- atic review of peer-reviewed and grey literature between 1960 and 2011 was done using PubMed search engines and local libraries to identify prevalence studies on the four diseases. In total, 32 studies were found, and half of these studies were from Addis Ababa. Two hospital-based studies reviewed the prevalence of cardiovascular disease and found a prevalence of 7.2% and 24%; a hospital-based study reviewed cancer prevalence and found a prevalence of 0.3%; two hospital-based studies reviewed diabetes prevalence and found a prevalence of 0.5% and 1.2%; and two hospital-based studies reviewed prevalence of asthma and found a prevalence of 1% and 3.5%. Few community-based studies were done on the prevalence of diabe- tes and chronic pulmonary obstructive disease among the population. Several studies reviewed the impact of these diseases on mortality: cardiovascular disease accounts for 24% of deaths in Addis Ababa, cancer causes 10% of deaths in the urban settings and 2% deaths in rural setting, and diabetes causes 5% and chronic obstructive pulmonary disease causes 3% of deaths. Several studies reviewed the impact of these diseases on hospital admissions: cardiovascular disease accounts for 3%-12.6% and found to have increased between 1970s and 2000s; cancer accounts for 1.1%-2.8%, diabetes accounts for 0.5%-1.2%, and chronic obstructive diseases account for 2.7%-4.3% of morbidity. Overall, the major non-communicable diseases and related risk factors are highly prevalent, and evidence-based interventions should be designed. Key words: Cancer; Cardiovascular disease; Chronic obstructive pulmonary disease; Diabetes; Risk factors; Ethiopia INTRODUCTION diseases, cancers, diabetes, and chronic lung diseas- es. The combined burden of these diseases is rising Non-communicable diseases are the leading causes fastest among the lower-income countries, popula- of death globally, killing more people each year tions, and communities (2). than all other causes combined. Contrary to popu- lar opinion, available data demonstrate that nearly World Health Organization (WHO) estimated in 80% of deaths due to non-communicable diseases 2011 that 34% of Ethiopian population is dying occur in low- and middle-income countries (1). from non-communicable diseases, with a national Of the 57 million deaths that occurred globally in cardiovascular disease prevalence of 15%, cancer 2008, thirty-six million were due to non-commu- and chronic obstructive pulmonary disease preva- nicable diseases comprising mainly cardiovascular lence of 4% each, and diabetes mellitus prevalence of 2%. Communicable maternal, perinatal and Correspondence and reprint requests: nutritional conditions accounted for 57% of the Dr. Awoke Misganaw Addis Ababa Mortality Surveillance Program deaths. This WHO estimation is comparable with College of Health Sciences East African countries, such as Kenya, Uganda, and Addis Ababa University Eritrea (3). The resulting double burden of non- Addis Ababa communicable diseases, with higher prevalence Ethiopia of pre-existing communicable, maternal, perinatal Email: asterawoke2007@gmail.com and nutritional conditions, constrains the already- Fax: +251115517701 Epidemiology of non-communicable diseases Misganaw A et al. meagre health resources and hinders economic de- factors’, ‘physical exercise’, ‘diet’, and ‘Ethiopia’. velopment in Ethiopia (4) . The references of included articles were scanned to identify additional articles of interest and used Similarly, Global Burden of Disease (GBD) stud- websites of the HINARI and Google Scholar, World ies estimated age-standardized death rates of 800 Bank, and World Health Organization to access ar- per 100,000 population for non-communicable ticles. Grey literature was searched from Addis Aba- diseases in Ethiopia, of which higher death rates ba and Jimma University Libraries and Ethiopian (approximately 450 per 100,000) were attributed Federal Ministry of Health (Figure). to cardiovascular disease and diabetes, 150 per 100,000 attributed to cancer, and 100 per 100,000 Selection of studies to chronic obstructive pulmonary disease (5). The inclusion criteria used were: (i) articles with These estimations were much higher than in many clear objectives and methodologies; (ii) articles pub- developed countries. Although these estimates of lished from 1960 to 2011; (iii) articles addressing cardiovascular disease, cancer, diabetes mellitus, one or more of the four major non-communicable and chronic obstructive pulmonary disease look diseases (prevalence of cardiovascular diseases, can- higher in Ethiopia, estimations by WHO and GBD cer, diabetes mellitus and chronic obstructive pul- studies are highly uncertain because the causes of monary diseases); (iv) articles published in English deaths were predicted using cause-of-death models language; and (v) articles for which full texts were due to lack of information on the level of mortal- obtained for this review (Figure). ity or cause of death at the country level, which should be substantiated by national evidences (6). Data extraction Despite the above estimations for global prevalence We developed a draft data extraction checklist and of the four major non-communicable diseases, car- piloted it on 10 randomly-selected journals. The diovascular disease, cancer, diabetes mellitus, and checklist was revised and further tested on another chronic obstructive pulmonary disease were not randomly-sampled 10 journals, and further refine- well-documented in Ethiopia. On the other hand, ments were made. In the checklist, information was accurate information on the prevalence of major included on title, author, year of publication, year public-health importance is required to have in- of data collection, study design, study setting (hos- formed health policy decision (7,8). Therefore, it is pital or community, urban/rural, or mixed), region, crucial to document prevalence estimations for the population, sample-size and sampling procedure, major non-communicable diseases for the purposes data-collection procedures, mean age of the study of research and interventions. We reviewed pub- participants, percentage prevalence of cardiovas- lished and grey literature aiming to document the cular diseases/cancer/diabetes/chronic pulmonary prevalence and mortality associated with the four diseases (or number of cases), diagnostic criteria, major non-communicable diseases in Ethiopia: car- percentage of smokers/alcohol-users/khat-chewers/ diovascular disease, cancer, diabetes, and chronic hypertensive patients. obstructive pulmonary disease and the associated risk factors, such as hypertension, tobacco-use, RESULTS harmful use of alcohol, overweight/obesity, and khat-chewing. In total, 32 studies were found to meet the inclu- sion criteria. Almost half of the studies were from MATERIALS AND METHODS Addis Ababa, the capital city of Ethiopia. Fifteen studies were on cardiovascular diseases, 11 each Search strategy were on cancer and diabetes mellitus, and 9 were A systematic review of peer-reviewed and grey lit- on chronic obstructive pulmonary disease (Figure). In this review, community- and hospital-based erature was undertaken to identify studies that es- timated the prevalence of cardiovascular diseases, studies were used for indicating population preva- cancer, diabetes mellitus, and chronic obstructive lence, and mortality and hospitalization studies pulmonary disease in Ethiopia between 1960 and were used for showing severities of the diseases. 2011. We used MeSH of PubMed search engines, Cardiovascular diseases using the medical subject titles ‘cardiovascular diseases’, ‘stroke’, ‘hypertension’, ‘myocardial in- Population prevalence farction, ‘heart disease’, ‘diabetes mellitus’, ‘neo- plasm’, ‘cancer’, ‘asthma’, ‘burden of disease’, ‘non Community-based studies: We did not find studies communicable diseases’, combined with the term on population prevalence of cardiovascular dis- ‘smoking’, ‘tobacco’, ‘alcohol’, ‘khat chewing’, ‘risk eases (Table 1). JHPN 2 Epidemiology of non-communicable diseases Misganaw A et al. Figure. Sum mary of literature search 965 records identified through 5 additional records identified through database searching hand-searching 652 records after duplicate removal 559 records, non-relevant to 652 records screened the topic, excluded 61 articles excluded for incoherence 93 full-length articles with the inclusion criteria assessed for eligibility 16 studies on cardiovascular diseases, 11 on malignant neoplasm, 11 on diabetes mellitus, and 9 studies on chronic obstructive pulmonary diseases were included in the qualitative synthesis Hospital-based studies: Five hospital-based studies study of sampled deaths in Amhara region, 6.5% on the prevalence of cardiovascular diseases and of deaths were attributed to cardiovascular diseases their subtypes were found (Table 1). In a study of among all age-groups (15). Congestive heart failure sampled patients conducted in the eastern part of was reported to have caused 2.5% of deaths among the country, an estimated prevalence of 7.2% for all age-groups in the third sampled hospital-based cardiovascular diseases and 2.4% for hypertensive mortality study (16) (Table 1). heart disease was documented among all age- Hospitalization: Fourteen studies investigated hos- groups (9). In contrast, a study in the capital city es- pitalization of patients with cardiovascular diseas- timated 24% prevalence of cardiovascular diseases es. The hospitalization differs considerably by age, among the sampled outpatient visits by adults (10). region, and subtypes of cardiovascular diseases. In In a rural hospital study with sampled outpatient a study from Addis Ababa, the highest hospitaliza- visits, an estimated 0.5% hypertension prevalence tion was reported (31% of admissions in a hospital was found among adults aged 15 years and above (11). In the fourth and fifth studies conducted in for patients aged 60 years and above) (17). Hos- the capital city, hypertensive heart disease preva- pitalization of patients with all categories of car- lence was estimated to be 12% among adolescents diovascular diseases ranged from 3% in Amhara and adults aged 11 years and above (12) and 6.7% to 12.6% in Oromia region (16,18-20). A study among older adults (13) (Table 1). among all age-groups for admissions in Medical Intensive Care Unit (MICU) in the capital city Severity of the disease reported an 8.8% prevalence of hospitalization for acute myocardial infarction (AMI), and the Mortality: Three studies investigated mortality second study from Oromia region reported 9.8% among patients with cardiovascular diseases: two (21,22). The prevalence of cardiovascular diseases population-based studies with the verbal autopsy appears to have increased over time among hospi- technique and one hospital-based mortality study. talized patients, with studies in the 1970s report- In the first study, with randomly-sampled adult ing prevalence of 4.4% while studies in the 2000s deaths in the capital city, 24% of deaths were attrib- reporting 12.6% (18,23) (Table 1). uted to cardiovascular diseases (14) and, in a second | | Volume 32 Number 1 March 2014 3 Epidemiology of non-communicable diseases Misganaw A et al. JHPN Table 1. Literature review of the prevalence of cardiovascular diseases from hospital-based studies in Ethiopia, 1962-2006 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw et al. (14) Addis Ababa Urban Community-based 3,709 deaths Cardiovascular 24.0 Verbal autopsy (>15 years) disease 2006 Melaku Z et al. (21) Addis Ababa Mixed All age-groups 3,548 MICU admis- AMI disease 9.8 Physicians’ sion diagnosis 2006 Andarge B et al. (18) Oromia Mixed All age-groups 3,99 all admission Cardiac disease 12.0 Physicians’ diagnosis 2004 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Cardiovascular 6.5 Verbal autopsy (all age-groups) diseases 2001 Mamo Y et al. (22) Oromia Mixed All age-groups 2,313 MICU admis- AMI disease 8.8 Physicians’ sion diagnosis 1995 Hussein K (20) Oromia Mixed >10 years 1,440 all admission Cardiovascular 10.5 Physicians’ diseases diagnosis 1994 Pauletto P et al. (11) Oromia Rural >15 years 5,277 outpatients Hypertension/ 0.5 Physicians’ heart disease diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Cardiovascular 11.7 Physicians’ sion disease diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Cerebrovascular 8.1 Physicians’ sion accident diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Congestive 5.6 Physicians’ sion heart failure diagnosis 1983 Tekelu B (13) Addis Ababa Urban Adults 2,145 outpatients Hypertension/ 6.7 Physicians’ heart disease diagnosis 1982 Lester FT (12) Addis Ababa Mixed >60 years 200 medical admis- Cardiovascular 31.0 Physicians’ sion disease diagnosis 1982 Abraham G (19) Addis Ababa Mixed 13-82 years 5,667 medical ad- Cardiovascular 6.6 Physicians’ missions disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 3,611 all admissions Cardiovascular 3.0 Physicians’ disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 238 deaths Congestive 2.5 Physicians’ heart failure diagnosis 1974 Lainovic D (26) Addis Ababa Mixed >15 years 9,330 medical ad- Cardiovascular Physicians’ 6.0 missions disease diagnosis Contd. Epidemiology of non-communicable diseases Misganaw A et al. Cancer Prevalence in population Community-based studies: We did not find studies on prevalence of cancer in population (Table 2). Hospital-based studies: One study on hospital-based prevalence of cancer was found. In this urban hos- pital study through physicians’ diagnosis, a preva- lence of 0.3% was estimated among outpatient adults aged 20 years and above (24) (Table 2). Severity of the disease Mortality: Four studies investigated mortality for patients with cancer: three population-based stud- ies with the verbal autopsy technique and one hos- pital-based mortality study. In the first study, with randomly-sampled adult deaths in the capital city, 10% prevalence of mortality was attributed to can- cer among deaths of those aged 15 years and above (14). In the second study, with sampled deaths in the Amhara region, 2% prevalence of mortality was attributed to cancer among all age-groups (15). The third study of community-based rural sampled deaths in the Southern region of Ethiopia esti- mated a cancer mortality prevalence of 1.5% (25). A hospital-based study among patients sampled through physicians’ diagnosis also identified a can- cer mortality prevalence of 2.9% in all age-groups (16) (Table 2). Hospitalization: Six studies investigated hospital- ization for patients with cancer, and three more reported pathological investigations. The highest hospitalization was reported in a study from Ad- dis Ababa: 14.5% of admissions in a hospital for patients aged 60 years and above (17). Hospitaliza- tion of patients with cancer ranged from 1.1% to 2.8% in Addis Ababa (23,26). Hospital-based patho- logical studies estimated cancer prevalence ranging from 8.3% to 27.9% (27,28) (Table 2). Diabetes mellitus Population prevalence Community-based studies: Two community-based studies on population prevalence of diabetes were found. A study with urban and rural sampled population in the Southern region estimated the prevalence of diabetes mellitus (type 1 and 2) to be 4.9% among adults aged 18 years and above (29). The second study, with urban sampled population in the Oromia region, estimated the prevalence of type 2 diabetes mellitus to be 5.3% among adults aged 40 years and above (30) (Table 3). | | Volume 32 Number 1 March 2014 5 Table 1.—Contd. Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 1973 Lester FT (12) Addis Ababa Mixed >11 years 2,103 outpatients Hypertension/ Physicians’ 12.0 heart disease diagnosis 1971 Teklu B et al. (34) Addis Ababa Urban 17-64 years 460 outpatients Cardiovascular Physicians’ 24.0 disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Cardiovascular Physicians’ 4.4 missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Hypertension/ Physicians’ 2.5 missions heart disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Rheumatic val- Physicians’ 0.7 missions vular disease diagnosis 1962 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Cardiovascular Physicians’ 7.2 disease diagnosis 1962 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Hypertension/ Physicians’ 2.4 heart disease diagnosis AMI=Acute myocardial infarction, MICU=Medical Intensive Care Unit Epidemiology of non-communicable diseases Misganaw A et al. JHPN Table 2. Literature review of the prevalence of malignant neoplasm in Ethiopia, 1970-2011 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw A et al. (14) Addis Ababa Urban Community-based 3,709 deaths Malignant neo- 10 Verbal autopsy (>15 years) plasm disease 2004 Bezabih M (27) Oromia Mixed Hospital-based 3,200 specimens Malignant neo- 8.3 Pathological (all age-groups) plasm disease 2001 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Malignant neo- 2 Verbal autopsy (all age-groups) plasm disease 1990 Shamebo M (36) Addis Ababa Mixed Hospital-based 7,969 medical ad- Leukaemia 2.3 Physicians’ 14-80 years missions diagnosis 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 875 deaths Malignant neo- 1.5 Verbal autopsy (all age-groups) plasm disease 1986 Aseffa A et al. (28) Amhara Mixed Hospital-based 1,668 specimens Neoplastic 27.9 Pathological (all age-groups) disease 1986 Aseffa A et al. (28) Amhara Mixed Hospital-based 1,668 specimens Malignant neo- 14.6 Pathological (all age-groups) plasm disease 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Malignant neo- 0.3 Physicians’ plasm diagnosis 1982 Lester FT (17) Addis Ababa Mixed Hospital-based 200 medical admis- Neoplasm 14.5 Physicians’ (>60 years) sions disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed Hospital-based 3,611 all admissions Neoplasm 2 Physicians’ disease diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed Hospital-based 238 deaths Hematoma 2.9 Physicians’ (all age-groups) mortality diagnosis 1974 Lainovic D (26) Addis Ababa Mixed Hospital-based 9,330 medical ad- Neoplasm 1.1 Physicians’ (>15 years) missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed Hospital-based 3,922 medical ad- Neoplasm 2.8 Physicians’ (>16 years) missions disease diagnosis 1970 Pavlica D (23) Addis Ababa Mixed Hospital-based 3,922 medical ad- Primary carcino- 2.3 Physicians’ (>16 years) missions ma of the liver diagnosis SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. | | Volume 32 Number 1 March 2014 7 Table 3. Literature review of prevalence of diabetes mellitus (DM) in Ethiopia, 1963-2007 Region in Urban/ Prevalence Diagnostic Year Author Targets Sample-size Outcome Ethiopia Rural (%) criteria 2011 Misganaw A et al. [14] Addis Ababa Urban Community-based 3,709 deaths Diabetes mel- 5 Verbal autopsy ( >15 years) litus 2011 Giday A et al. (29) SNNPR Mixed Community-based 979 sampled popu- Diabetes mel- 4.9 Laboratory tests (>18 years) lation litus 2007 Yemane et al. (30) Oromia Urban Community-based 576 sampled popu- Type 2 diabetes 5.3 Laboratory tests (>40 years) lation mellitus 2006 Melaku Z et al. (21) Addis Ababa Mixed All age-groups 3,548 MICU admis- Diabetic kitoaci- 10.7 Physicians’ sions dosis diagnosis 1988 Bahta Y et al. (31) Addis Ababa Mixed >10 years 917 MICU admis- Diabetic kitoaci- 9.7 Physicians’ sions dosis diagnosis 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Diabetes mel- 1.2 Physicians’ litus diagnosis 1982 Lester FT (17) Addis Ababa Mixed >60 years 200 medical admis- Diabetes mel- 11.5 Physicians’ sions litus diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 3,611 medical ad- Diabetes mel- 1.7 Physicians’ missions litus diagnosis 1976 Habte-Gabr E et al. (16) Amhara Mixed All age-groups 238 deaths Diabetes mel- 1.3 Physicians’ litus diagnosis 1974 Lainovic D (26) Dire Dawa Mixed >15 years 9,330 medical ad- Diabetes mel- 6 Physicians’ missions litus diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Diabetes mel- 1.8 Physicians’ missions litus diagnosis 1963 Blahos J et al. (9) Harrar Mixed All age-groups 11,170 outpatients Diabetes mel- 0.5 Physicians’ litus diagnosis MICU=Medical Intensive Care Unit; SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. Hospital-based studies: Two studies on hospital- monary diseases (14). In the second study, which based prevalence of diabetes were found. In these took sampled deaths in the Southern region of studies, the prevalence of diabetes was estimated to Ethiopia, 5.2% of deaths were attributed to chronic be 0.5% in all age-groups and 1.2% among patients obstructive pulmonary diseases among people aged aged 20 years and above (9,24) (Table 3). 15-49 years (33) (Table 4). Its subtype—asthma— was estimated to have caused 0.6% of deaths in a Severity of the disease sampled community-based study (25). Mortality: Two studies examined mortality of pa- Hospitalization: Two studies investigated hospital- tients with diabetes. In the first study, with ran- ization for patients with chronic obstructive pul- domly-sampled adult deaths in the capital city, monary diseases. These studies from Addis Ababa 5% of deaths were attributed to diabetes (14). A estimated 2.7% and 4.3% prevalence of hospital- hospital-based study with sampled deaths in the ization for chronic obstructive pulmonary diseases Amhara region estimated diabetes-related mortal- (23,32) (Table 4). ity prevalence of 1.3% in all age-groups (16) (Table 3). Prevalence of risk factors of the four non-communicable diseases Hospitalization: Four studies investigated hos- pitalization of patients with diabetes, and two Reviewed studies that have been conducted on the more studies investigated one of its complica- major non-communicable diseases since 1984 have tions called diabetic kitoacidosis. The highest mainly addressed the urban population and the hospitalization was reported by a study from adult group (15 years and older). As for risk factors, Addis Ababa: 11.5 % of admissions in a hospital these studies have dealt with hypertension, high- for patients aged 60 years and above (17). Hospi- er glucose level (diabetes mellitus), tobacco-use, talization of patients with diabetes ranged from harmful use of alcohol, being overweight/obese, 0.5% in all age-groups to 6% for patients aged and khat-chewing (Table 5). 15 years and above (9,26). Studies estimated the In the capital city Addis Ababa, hypertension prev- prevalence of diabetic kitoacidosis to be 9.7% for alence ranged from 4.1% among adult workers in patients aged 10 years and above (31) and admit- 1984 to 30% among a sampled population in 2009 ted to Medical Intensive Care Unit (MICU); the (6,34). In the regions, hypertension prevalence ac- figure for all age-groups for the same disease was counted for about 10% in the Southern Nations, 10.7% (21) (Table 3). Nationalities, and Peoples Region (SNNPR) in 2011 Chronic obstructive pulmonary diseases (29), and 1.8% in the rural Amhara populations in the mid-1980s (35) (Table 5). Prevalence in population Similarly, the prevalence of being overweight in the Community-based studies: One study on population population of Addis Ababa accounted for 25.1% prevalence of chronic obstructive pulmonary disease (36) among adult workers in particular and 30.5% subtype called ‘asthma’ was found. In this study, (6) of the adult population in general in 2009. One which used an urban/rural sampled population and of the regions, viz. SNNPR, accounted for 8.7% the verbal autopsy technique, 0.6% prevalence was of the study population aged 18 years and above estimated in all age-groups (25) (Table 4). (29). The same studies further indicated an obesity prevalence of 5.3% (36) and 7.2% (6) respectively Hospital-based studies: Two studies on hospital- among adult workers in particular and the adult based prevalence of asthma were found. In these population in general in Addis Ababa (Table 5). studies, the prevalence of asthma was estimated to be 1% and 3.5% among patients aged 20 years and Regarding excessive alcohol-use, the prevalence above (24,32) (Table 4). ranged from 23% to 62% in Addis Ababa (6,36) while the figure for SNNPR was 6.5% (29). On the Severity of the disease other hand, current smoking in Addis Ababa was Mortality: Five community-based studies examined reported to range from 2.2% to 9% (6,36) while the mortality for patients with chronic obstructive lifetime prevalence of smoking in the SNNPR was pulmonary diseases and asthma, using the verbal reported to be 2.1% (29). A higher khat-chewing autopsy technique. In the first study, with random- prevalence of 9.2% was reported from SNNPR (29) ly-sampled adult deaths in the capital city, 3% of and, in Addis Ababa, it ranged from 7.3% to 8.5% deaths were attributed to chronic obstructive pul- (6,36) (Table 5). JHPN 8 Epidemiology of non-communicable diseases Misganaw A et al. | | Volume 32 Number 1 March 2014 9 Table 4. Literature review of the prevalence of chronic obstructive pulmonary diseases in Ethiopia, 1970-2001 Prevalence Diagnostic Region in Urban/ Targets Sample-size Outcome Year Author (%) criteria Ethiopia Rural 2011 Misganaw A et al. (14) Addis Ababa Urban Community based 3,709 deaths COPD 3 Verbal autopsy (>15 years) 2001 Fantahun M et al. (15) Amhara Mixed Community-based 200 deaths Asthma 2 Verbal autopsy (all age-groups) 2004 Lulu K et al. (33) SNNPR Mixed Community-based 515 deaths COPD 5.2 Verbal autopsy (15-49 years) 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 875 deaths Asthma 0.6 Verbal autopsy (all age-groups) 1998 Abdulahi H et al. (25) SNNPR Mixed Community-based 575 patients Asthma 2.3 Algorithm (all age-groups) 1982 Tekelu B (24) Addis Ababa Urban >20 years 2,854 outpatients Asthma 3.5 Physicians’ diagnosis 1977 Lester FT (32) Addis Ababa Mixed >20 years 5,900 medical ad- Asthma 2.7 Physicians’ missions diagnosis 1977 Lester FT (32) Addis Ababa Mixed >20 years 26,314 outpatients Asthma 1 Physicians’ diagnosis 1970 Pavlica D (23) Addis Ababa Mixed >16 years 3,922 medical ad- Asthma 4.3 Physicians’ missions diagnosis COPD=Chronic obstructive pulmonary diseases; SNNPR= Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. DISCUSSION Main findings Despite the limitations of our review as we did not conduct quality assessment for studies and poten- tial publication bias with limitation of generaliz- ability, we feel that the published and unpublished data we have presented reflect the comparative sparse data for Ethiopia and future direction for re- search on non-communicable diseases. This review indicates that major non-communi- cable diseases—cardiovascular disease, cancer, dia- betes mellitus, and chronic obstructive pulmonary disease—are causing higher proportions of morbid- ity and mortality, impacting both in the rural and urban populations of Ethiopia. These findings sup- port evidences from sub-Saharan Africa where non- communicable diseases pose a substantial burden (37). The prevalence of certain non-communicable diseases, such as cardiovascular disease, diabetes, cancer, and chronic obstructive pulmonary disease, is increasing rapidly, particularly in the urban areas of sub-Sahara Africa, and that significant demands are being made on the health services by patients with these diseases (37). Studies also indicated that an epidemiological transition is occurring in Arica, especially in the urban population while people are also hard-hit by HIV/AIDS and tuberculosis (38,39). This in- crease in non-communicable diseases is expected in the future, especially in relation to ‘Westerniza- tion’ of people’s diet and lifestyle changes in the urban setting of Africa (38). In our review, the im- pact of major non-communicable diseases might vary with type of disease, age, and region in Ethio- pia. This burden is becoming a big challenge to the healthcare delivery system of the country (4). Increased diagnosis of non-communicable dis- eases will lead to a corresponding need for greater capacity of the existing health facilities, which are currently over-stretched to diagnose and treat these conditions and also a need for aggressive pri- mary programmes as late diagnosis leads to poor health outcomes (5). Risk factors of the major non-communicable dis- eases, such as tobacco-use, excessive alcohol-use, hypertension, being overweight/obese, higher glucose level, and khat-chewing, were highly prevalent among the urban population and peo- ple aged 15 years and above. According to WHO, non-communicable diseases are caused, to a large extent, by four behavioural risk factors that are JHPN Table 5. Literature review of the prevalence of NCD risk factors from community based studies in Ethiopia, 1984-2011 Over- Region in Urban/ Population Sample- Alcohol- Lifetime Current Khat- Year Author HTN weight Ethiopia Rural (age in years) size use smoking smoking chewing /Obesity 2011 Giday A et al. (29) SNNPR Mixed Community-based 979 9.9 8.7/1 6.5 2.1 NA 9.2 (>18 years) 2010 Tran A et al. (36) Addis Ababa Urban Institution-based 1,935 17.8 25.1/5.3 23 13 9.0 8.5 adult workers 2009 Tesfay F et al. (6) Addis Ababa Urban Community-based 3,713 30 30.5/7.2 62 NA 2.2 7.3 (25-64 years) 1986 Zain A et al. (35) Amhara Rural Community-based 478 1.8 NA NA NA NA NA (>15 years) 1984 Tekelu B (34) Addis Ababa Urban Institution-based 933 4.1 NA NA NA NA NA adult workers HTN=Hypertension; NA=Not available; SNNPR=Southern Nations, Nationalities, and Peoples Region Epidemiology of non-communicable diseases Misganaw A et al. pervasive aspects of economic transition, rapid Conclusions and recommendations urbanization, and lifestyles of the 21st century: We feel that the published and unpublished data tobacco-use, unhealthy diet, insufficient physi- we have presented reflect the comparative sparse cal activity, and excessive alcohol-use (40). Esti- data for Ethiopia and future direction for research mations indicate a national prevalence of 2.4% on major non-communicable diseases despite cer- current daily tobacco smoking and an adult per- tain limitations of our review. capita consumption of 4.1 litre of pure alcohol in Ethiopia. These behavioural risk factors subse- Cardiovascular disease, cancer, diabetes mel- quently lead to four key metabolic/physiological litus, and chronic obstructive pulmonary disease changes: raised blood pressure, raised blood glu- are highly prevalent and causing higher propor- cose, overweight, and obesity. A national preva- tions of morbidity and mortality, impacting both lence of raised blood pressure was estimated to in the rural and urban population of Ethiopia. Their be 35.2%, overweight 7.4%, and obesity 1.1% in impact varies with type of disease, age, and region. Ethiopia (3). Hospitalization impacts of cardiovascular diseases Strengths and weaknesses have increased over time within the last five de- cades. This burden is becoming a big challenge to In the absence of vital statistics system, epidemi- the healthcare delivery system of the country. Their ological studies on non-communicable diseases, risk factors: tobacco-use, harmful use of alcohol, with a variety of designs and in-depth analysis hypertension, overweight/obesity, higher glucose of risk factors and the effects of interventions, level, and khat-chewing were also highly prevalent, could provide a better understanding of the situ- mainly in the urban population aged 15 years and ations in Ethiopia and provide information to above. We believe that proactive thinking is essen- healthcare policy-making. Although this review tial in order to mitigate the effects of these hidden includes many hospital-based studies which are or latent epidemics. Therefore, we recommend the largely non-representative of the community, it following: can highlight gaps on the understanding of the major non-communicable diseases in the coun- • Funding for researchers to conduct large popu- try. Future research priorities for the country lation-based prevalence studies should include better quantification of the major non-communicable diseases and locally-impor- • Designing population-wide interventions to tant risk factors. There is a need for comprehen- address the major non-communicable diseases sive investigation of population prevalence of • Capacity-building of the primary healthcare cardiovascular diseases, cancer, diabetes mellitus, delivery system to prevent and control the epi- chronic obstructive pulmonary disease and their demics of non-communicable diseases. risk factors in the country. ACKNOWLEDGEMENTS Implications of findings We thank Ato Legesse Alemayehu who contributed The prevalence of major non-communicable dis- in the literature search. eases in Ethiopia is high, with probable under- reporting, and will certainly increase in the up- REFERENCES coming years. We believe that proactive thinking is essential in order to mitigate the effects of this 1. World Health Organization. Global status report on hidden or latent epidemic and to provide critical noncommunicable diseases 2010. Geneva: World data for formulating evidence-based health policy Health Organization, 2011. 162 p. and interventions. Moreover, primary prevention 2. Alwan A, MacLean DR, Riley LM, d’Espaignet ET, integrated with the primary healthcare system Mathers CD, Stevens GA et al. Monitoring and sur- could be the best way to reduce the burden both veillance of chronic non-communicable diseases: in the rural and urban settings of the country. Pri- progress and capacity in high-burden countries. Lan- mary prevention mechanisms, such as increasing cet 2010;376:1861-8. awareness and strengthening legislative measures 3. World Health Organization. Noncommunicable dis- (e.g. tobacco) and health promotion measures, can eases country profiles 2011. Geneva: World Health enhance healthy behaviours and mitigate the rise Organization, 2011. 207 p. in the incidence of major non-communicable dis- eases in the country. 4. Berhane Y, Mariam H, Kloos H, editors. Epidemiology | | Volume 32 Number 1 March 2014 11 Epidemiology of non-communicable diseases Misganaw A et al. and ecology of health and disease in Ethiopia. Addis 20. Hussien K. Pattern of medical admission to Jimma Ababa: Shama Books, 2006:704-47. Hospital. Bull Inst Health Sci 1997;7:51-62. 21. Melaku Z, Alemayehu M, Oli K, Tizazu G. Pattern of 5. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases admissions to the medical intensive care unit of Ad- dis Ababa University Teaching Hospital. Ethiop Med J in low-income and middle-income countries. Lancet 2006;44:33-42. 2007:370:1929-38. 22. Mamo Y, Seid E, Adams S, Gardiner A, Parry E. A 6. Tesfaye F, Byass P, Wall S. Population based preva- primary healthcare approach to the management lence of high blood pressure among adults in Addis of chronic disease in Ethiopia: an example for other Ababa: uncovering a silent epidemic. BMC Cardiovasc countries. Clin Med 2007;7:228-31. Disord 2009;9:39. doi: 10.1186/1471-2261-9-39. 23. Pavlica D. Analysis of medical admissions to the 7. Dalal S, Beunza JJ, Volmink J, Adebamowo C, Baju- armed forces hospital in Addis Ababa from January nirwe F, Njelekela M et al. Non-communicable dis- 1966 to January 1970. Ethiop Med J 1970;193-200. eases in sub-Saharan Africa: what we know now. Int J Epidemiol 2011;40:885-901. 24. Teklu B. Chronic disease prevalence in Ethiopian bank employees. Ethiop Med J 1982;20:49-54. 8. Giles WH. Preventing non-communicable diseases in sub-Saharan Africa. Glob Health Promot 2010;17(Suppl 25. Abdulahi H, Mariam DH, Kebede D. Burden of disease 2):3-5, 53-6, 92-7. doi: 10.1177/1757975910363946. analysis in rural Ethiopia. Ethiop Med J 2001;39:271- 9. Blahos J, Kubastova B. The survey of 11,170 patient treated in the Ras Mekonnen Hospital in Harar. Ethi- 26. Lainovic D. Morbidity study in Dire Dawa. Ethiop op Med J 1963;1:190. Med J 1974;12:13-24. 27. Bezabih M. Superficial malignant neoplasms in 10. Teklu B, Parry EH, Pavlica D. Ethiopian cardiovascu- lar studies. X. Normal variations of the electrocardio- southwestern Ethiopia: a cytopathological approach. Diagn Cytopathol 2004;31:347-51. gram in Ethiopians. Ethiop Med J 1971;9:133-9. 28. Aseffa A, Ahmed Z, Stiehl P. Neoplasms in Gondar. 11. Pauletto P, Caroli M, Pessina AC, Dal Palù C. Hyper- Ethiop Med J 1986;24:133-6. tension prevalence and age-related changes of blood- pressure in semi-nomadic and urban Oromos of Ethi- 29. Giday A, Tadesse B. Prevalence and determinants of opia. Eur J Epidemiol 1994;10:159-64. hypertension in rural and urban areas of southern Ethiopia. Ethiop Med J 2011;49:139-47. 12. Laster FT. Blood pressure levels in Ethiopian outpa- tients. Ethiop Med J 1973;11:145-54. 30. Yemane T, Belachew T, Asaminew B, Befekadu O. Type II diabetes mellitus in Jimma Town, southwest 13. Teklu B. Hypertension amongst bank employees in Ethiopia. Ethiop J Health Sci 2007:17. urban Ethiopia. Ethiop Med J 1983;21:217-21. 31. Bahta Y, Fikreyesus Y. Analysis of admissions to the 14. Misganaw A, Mariam DH, Araya T. The double mor- medical intensive care unit of a teaching hospital in tality burden among adults in Addis Ababa, Ethiopia, Addis Ababa. Ethiop Med J 1988;26:61-7. 2006-2009. Prev Chronic Dis 2012;9: E84. 32. Lester FT. Bronchial asthma in Addis Ababa. Ethiop 15. Fantahun M, Degu G. Burden of diseases in Amhara Med J 1977;15:95-9. region, Ethiopia. Ethiop Med J 2004;42:165-72. 33. Lulu K. Determinants and causes of adult mortality 16. Habte-Gabr E, Girma B, Mehrete M, Mehari A, Tekle in Butajira. Piazza: Addis Ababa University, 2000. 132 E, Belachew K et al. Analysis of admissions to Gondar p. (MA Thesis). Hospital in North-Western Ethiopia, 1971-1972. Ethi- op Med J 1976;14:49-59. 34. Teklu B. Hypertension screening amongst bank em- ployees in Addis Ababa. Ethiop Med J 1984;22:1-5. 17. Lester FT. Medical Diseases in the elderly Ethiopians. Ethiop Med J 1982;20:55-61. 35. Zein ZA, Assefa M. Blood-pressure levels and hyper- tension in rural Ethiopian communities. Ethiop Med J 18. Andgre B, Bezabih M, Haileamlak A. Patterns of mor- 1986;24:169-77. tality in Jimma University Specialized Hospital dur- 36. Tran A, Gelaye B, Girma B, Lemma S, Berhane Y, ing September 2001 to August 2002: retrospective Bekele T et al. Prevalence of metabolic syndrome study. Ethiop J Health Sci 2006;16:47-57. among working adults in Ethiopia. Int J Hypertens 19. Abraham G. Pattern of cardiovascular diseases 2011;2011:193719. doi: 10.4061/2011/193719. among adult hospitalized Ethiopians. Ethiop Med J 37. Unwin N, Setel P, Rashid S, Mugusi F, Mbanya J-C, 1982;20:63-8. JHPN 12 Epidemiology of non-communicable diseases Misganaw A et al. Kitange H et al. Noncommunicable diseases in sub- 39. Caselli G, Meslé F, Vallin J. Epidemiological transi- Saharan Africa: where do they feature in the health tion theory exceptions. Citeseer 2002;58:1-34. (http:// research agenda? Bull World Health Organ 2001;79:947- www.demogr.mpg.de/papers/workshops/020619_ 53. paper40.pdf, accessed on 10 October 2011). 38. Mufunda J, Chatora R, Ndambakuwa Y, Nyarango P, 40. World Health Organization. Global health risks: mor- Chifamba J, Kosia A et al. Prevalence of noncommu- tality and burden of disease attributable to selected nicable diseases in Zimbabwe: results from analysis of major risks. Geneva: World Health Organization, data from the National Central Registry and Urban 2009. 62 p. Survey. Ethn Dis 2006;16:718-22. | | Volume 32 Number 1 March 2014 13

Journal

Journal of Health, Population, and NutritionPubmed Central

Published: Mar 1, 2014

References