4 January 2013

Nigeria: Global Burden of Disease 2010 and Impact On National Health


The Lancet medical journal dedicated its December 15 edition to the publication of the global burden of disease (GBD2010) study carried out in 2010.

The five-year collaborative effort was launched in 2007, involving 486 scientists from 302 institutions in 50 countries from across the globe. The exercise involved seven consortia of partners: Harvard University, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Johns Hopkins University, University of Queensland, Imperial College, London, the University of Tokyo and the World Health Organization. Overall, the exercise produced a comprehensive list of diseases and risk factors affecting over 6 billion inhabitants of this planet in 2010. The result of this exercise could best be described as an extraordinary human achievement looking at the mathematical, statistical and computing complexities of the processes and procedures involved, let alone the management of so many scientists and institutions.

What are the major findings of this study and how does it affect us as ordinary Nigerians and policy makers? One of the major findings of this study is that, although there was increase in number of people dying between 1990 (46.5 million) and 2010 (52.8 million), there was a general improvement in the health of people as measured using life expectancy at birth; the study emphasized, "The progress of nations is often measured in terms of reduction in mortality rates, summarized by life expectancy at birth". For the 187 countries involved in the study, all had increased their life expectancies at birth between 1970 and 2010 excepting HIV/AIDS ravaged nations of Zimbabwe and Lesotho; and alcohol-crisis countries of Ukraine and Belarus. For Haiti, its life expectancy slumped to 32.5years in 2010 from 57.7years in 2000 due to January 2010 earthquake. For Nigeria, there has been steady increase in life expectancy from 47.6years in 1980 to 58.8years in 2010 (for men) and from 50.9years in 1970 to 60.4 years in 2010 (for women). The obvious policy implications for these findings are clear: there shouldn't be any form of complacency in our fight against HIV/AIDS and we should design strong and evidence-based policy to tackle health effects of alcohol right now. We should learn from Ukraine and Belarus just as the report recommended that developing countries should not make the mistakes of developed of not controlling tobacco smoking as they did in the 1960s and 70s. Furthermore, despite this improvement in life expectancy, Nigeria is no better than our continental rival, Ghana with 63.2 years for males and 66.1 for females.

Second important finding of this research is the list of diseases causing death and disability (ill-health) and risk factors that puts one at increased chance of getting a disease condition. Globally, there is a shift from diseases such as infections, maternal, neonatal and nutritional to non-communicable diseases such ischemic heart diseases, cancers; and injuries. In 2010, the leading diseases affecting majority of people are ischemic heart disease, lower respiratory infections, stroke, diarrhea, HIV/AIDS in that order. Road injury from road traffic accident occupies the 10th position. Of importance is the fact that 40% of road injury deaths are in pedestrians in sub-Saharan Africa. This pattern of death from road injury is different from what is obtained in Southeast and East Asia where 20% of road injury deaths involved motorized two-wheel vehicles. Coming closer home in West Africa, the leading disease burden is due malaria, lower respiratory infections, diarrheal diseases, HIV/AIDS and infections among the newborn; road injury is occupying the 9th position. Related to diseases are risk factors for these diseases. At global level, the five leading risk factors causing poor health in 2010 were high blood pressure, tobacco smoking, alcohol use, household air pollution and diets low in fruits. These mainly cause adult chronic diseases especially cardiovascular diseases and cancers. At the 10th position is physical inactivity or sedentary lifestyle. In West Africa, the leading risk factors for poor health are: childhood underweight, household air pollution, sub-optimal breastfeeding, iron deficiency and alcohol use. Others are high blood pressure, ambient particulate matter pollution, vitamin A deficiency, poor environmental sanitation and tobacco smoking in that order. Again, this list of risk factors has several policy implications for health experts. Firstly, we are seeing concomitantly presently risk factor causing both infectious/communicable diseases as well as non-communicable diseases.

Dr Dahiru is of the Department of Community Medicine, Ahmadu Bello, University, Zaria

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