Africa now faces a new double burden

Sunday April 5 2020


By Syriacus Buguzi @buguzi

Dar es Salaam. In the wee hours of March 19--three months since the world began fight on the novel coronavirus—news began spreading like bushfire across the world that Congolese music legend, Aurlus Mabélé, had died aged 61 in France after being diagnosed with Covid-19.

However, Mabélé, the all-time musician, had long been in silence as he battled throat cancer. He wasn’t an anti-cancer advocate though, if you were wondering why this story speaks of him prominently. It’s just that his battle epitomised the pain of many across the world who are still fighting for their health and life due to cancer and other chronic diseases.

Reports of Covid-19 deaths from ministries of health across Africa, have mainly revealed patients who had contracted the coronavirus but also who had pre-existing medical conditions, just like the late Mabele. In East Africa, Kenya was the first to report a Covid-19-related death whereby Health Minister Mutahi Kagwe said that the victim was a 66-year-old man who had a long-term health condition. The same followed for Tanzania. Elsewhere in Africa, the trend is somewhat the same. In Burkinafaso, Martial Ouedraogo, the Burkina’s national coordinator of the coronavirus response reported a Covid-19 death saying, “We recorded the death overnight of a female patient aged 62, who suffered from diabetes and was in intensive care.” The trend has been somewhat similar in the reported and in subsequent deaths.

The victims leave behind a continent that is struggling to overcome an overwhelming virus that threatens the already-fragile health systems. More still, a system whose experts and policymakers were still learning how to accommodate the burden of non-communicable diseases like the cancer on top the existing communicable diseases such as TB, malaria and HIV.

The Covid-19 outbreak which has so far affected all continents, afflicted over a million people and killed thousands across the world, is yet another proof that viral diseases are a threat to global health security, yet the disease, according to preliminary evidence, is taking a bigger toll on the elderly and those already affected by underlying non-communicable diseases(NCDs) such as diabetes, cancer and BP.

It was in this context that the President of the Medical Assocation of Tanzania (MAT), Dr Elisha Osati, recently intervened when he urged authorities and health insurance stakeholders to consider decongesting of routine clinic services in hospitals across the country as part of the measures to prevent the spread of the novel coronavirus.


Dr Osati, who is also a specialist physician at Muhimbili National Hopsital (MNH), says most clinics are highly congested with patients seeking routine treatment for long-term diseases, yet the same patients also face a higher risk of Covid-19 infection due to their high vulnerability to the virus, as evidenced by studies in China and Italy.

Subtly, this is suggesting that as countries continue battling Covid-19, there is a pressing need to scale up interventions against NCDs. It’s at this point that Covid-19 comes a “new double burden.” It’s a new in a sense that it has come at a time when NCDs were already a burden to economies in the low and middle income countries but also qualifies as a “new double burden” because NCDs were already a double burden to countries already overwhelmed by communicable diseases like TB.

Since 2010 when the World Health Organisation (WHO) released a Global Health Status Report and—for the first time—raised a global alarm on NCDs, the low and middle income nations were put on the spotlight. Ten years after the report was released, the world has now started battling the novel coronavirus with anecdotal evidence showing that people with NCDs are more vulnerable to the new virus.

The WHO report, which said, at that time, that 80 percent of global NCDs burden affected low and middle income countries, set off a series of discussions and intervention efforts by policymalers, researchers and health investors, terming the NCDs as a “double burden.”

Until recently, the campaigns against NCDs had been heightened on social media, in forums and major conferences in Africa and across the world. In Tanzania alone, end-of-last year’s major health conferences, such as the National Health Conference by MAT held in Dodoma in collaboration with the National Institute for Medical Research (Nimr), were themed: Walking together in prevention, care, and management of noncommunicable diseases in Tanzania. The annual Tanzania Health Summit (THS) too, raised the profile of NCDs in forums.

Stakeholders in Tanzania agreed on a major campaign against NCDs alongside the fight against co-morbidites such as TB, HIV and malaria. The NCDs fight was in top gear by the end of last year, after Tanzania launched the five year NCD Action Plan (2020-2025)

Social media campaigns, aimed at educating the public on how to prevent NCDs were beginning to pick up in the country. This was also palpable in other countries in Africa. However, until the beginning of this year, the campaigns have trailed off due to heightened vigilance on the fast-spreading coronavirus which has so far affected over one million people globally and killed thousands, including a Tanzanian man who passed away recently.

Dr Fredrick Mashili, a physiology lecturer from Muhimbili University of Health and Allied Scenices (Muhas) who has been leading a physical fitness campaign against NCDs on social media, says the Covid-19 vigilance and interventions around the country seem “to have put on hold all issues related to health education on NCDs.” “Which is bad because NCDs require regular communication,’’ he suggests.

But for an oncologist Heri Tungaraza who runs a wellness organization based in Tanzania, AfyaPal, the battle against Covid-19 means many things to cancer patients who now will be facing an additional challenge. Dr Tungaraza says that cancer patients and caregivers in Tanzania and world over should be particularly concerned because the novel coronavirus attacks a person’s body defence system –the immune system or rather the body’s ability to fight disease.

“As experts in the field and members of the society, we are duty-bound to show that we care by adopting behaviours that will prevent the virus from spreading further,’’ he says, urging, “This requires doing just the basic things: social distancing, hand-washing, wearing of masks for those who are infected and coughing, being honest enough to show up for testing and going into isolation once we discover that we have been exposed to the virus in any way.”

From the economic point of view, he says, cancer is a very expensive disease to treat. Adding a novel coronavirus infection to it, is likely to add up on the burden of cost for the patients or the-already-stretched health financing mechanisms of the country.

“In such circumstances, it’s important that we, as experts, are fully aware of how the viral pandemic will alter the way we treat cancer patients and of course, other subgroups of patients who have been identified as risk groups, for instance those battling diabetes and heart disease,’’ he suggests.