Analytical summary - Non-communicable diseases and conditions
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The prevalence of blindness in Liberia is estimated at 1%, with an estimated total of 35 000 blind people. Cataract is the major cause of blindness in Liberia, with an estimated backlog of 17 500 people or 50% of the total blind population. An additionally 3% of the total population (10 500 people) suffers from visual impairment (WHO 2002 figures).
Owing to the high burden of morbidity caused by blindness and its bidirectional link to poverty, the Ministry of Health and Social Welfare is committed to working with new and existing partners to ensure that eye health services are integrated into all county health systems, including school health services.
Epidemiological studies indicate high rates of mental illness, as well as high rates of exposure to sexual violence, post-traumatic stress disorder and substance abuse. However, there is only one practising psychiatrist in the country and only a handful of trained mental health nurses. Clinical mental health services remain centralized and there are no outpatient or inpatient treatment options available at health clinics or health centres; only Grant Hospital has an inpatient psychiatric ward.
To begin to address these issues, the National Mental Health Policy was established in 2009. The Policy mandates a decentralized approach to integrate mental health and neuropsychiatric care into the primary health care system. It provides for increasing the clinical capacity of mental health professionals and the primary health care workforce to meet the mental health needs of the population, as well as for basic epidemiological research to inform training, policy and practice in a culturally appropriate context.
Recent data indicate significant mental health and substance abuse issues in Liberia. While national prevalence studies have not been completed, various multicounty epidemiological studies point to high rates of major depression (40%), exposure to sexual violence (42%–73%), post-traumatic stress disorder (44%), and high rates of substance abuse (12%–44% among female and male ex-combatants, respectively).
Although the Basic Package of Health Services highlighted the need for mental health services, the implementation of these was challenging in facilities located in Bong, Grand Gedeh and Montserrado counties. Only 18% of health care facilities had clinicians trained to provide mental health services (Basic Package of Health Services accreditation, 2011).
Research related to noncommunicable diseases is underdeveloped and there is underreporting on these conditions from health facilities, which only represents the tip of the iceberg.
The noncommunicable risk survey (STEPS survey) conducted in 2011 provides a great opportunity for further investigation into the prevalence of diabetes, hypertension, cancer and other noncommunicable diseases. The STEPS survey shows the proportion of respondents with hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg), including those currently on medication, was 30.7%. On the other hand, those with hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) who were not currently on medication was 88.2%.
The health management information system report shows that hypertension accounted for 2.9% of inpatient admission.
The STEPS survey results also indicated a significant proportion of the respondents (91.5%) had never measured their glucose level. The mean fasting blood glucose, including those currently on medication for diabetes, was 96.7 mg/dl and the percentage of respondents currently on medication was 19.2%.
For stroke, cardiovascular disease, cancer, chronic respiratory diseases and sickle-cell anaemia, available data are scanty and do not represent the magnitude of the situation.