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Analytical summary - Non-communicable diseases and conditions

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In Malawi, noncommunicable diseases are increasingly becoming significant causes of morbidity and mortality in adults and are thought to be the second leading cause of deaths in adults after HIV/AIDS.

A STEPS survey[1] conducted in Malawi in 2009 clearly demonstrates that noncommunicable diseases and their risk factors are a significant public health problem. A total of 32.9% of individuals aged 25–64 years are hypertensive, while 8.9% suffer from cardiovascular diseases. Over 75% of those with hypertension are unaware that they are hypertensive. The prevalence of diabetes is estimated at 5.6%, while injuries, other than road traffic accidents, are at 8.9%. The prevalence of cardiovascular diseases is 8.9% and that of asthma is 5.1%. The prevalence of road traffic accidents is estimated at 3.5%.

However, there has been limited high-level commitment for noncommunicable diseases at national level and noncommunicable disease prevention and control programmes continue to be underfunded.

Chronic respiratory diseases such as asthma are becoming a public health problem in Malawi among the population aged 18 years and above. According to the World Health Report 2004, Malawi has an estimated asthma prevalence of 5.1%, yet there are no specific programmes for the prevention and control of asthma. Diabetes is increasingly becoming a public health problem among adults aged 25 years and over. The magnitude of sickle-cell and other genetic diseases is not known as data are collected but not reported at the national level. The Ministry of Health needs to make efforts to introduce prevention and control measures for these diseases.

Provision of dental services in Malawi is concentrated more in urban areas than rural areas. Emphasis on service provision is on curative services. However, there is provision of early detection and accurate diagnosis and management of the oral manifestation of HIV/AIDS by oral health care providers. Some information, education and communication materials are available with support from Colgate Palmolive. Health education to schools, orphan care centres and the community at large has usually been provided in the form of stereotyped information to passive audiences, regardless of their perceived need for oral health care.

Dentistry in Malawi is being challenged by inadequately skilled personnel, inadequate functional dental equipment to cover the wide range of clinical services and inadequate dental supplies and other consumables. Provision of dental services in Malawi is further compounded by the absence of a national oral health policy to guide development of dental services.

Mental illness is increasingly becoming a public health problem, accounting for 4% of the total burden of disease. The prevalence of mental illness is an important measure of the health and economic burden of disease and provides a baseline for evaluating the effectiveness of measures to control and manage mental illness over time.

Violence, abuse and exploitation of children are reported to be widespread. A total of 48% of Malawian women reported that they have experienced intimate partner violence, with 3.1 million children witnessing and experiencing its negative effects.[2] Victimization of Malawian children is common; 65% of girls and 35% of boys have experienced violence and 24% of schoolchildren report having sex against their will.[3]

With an estimated prevalence rate of blindness of 1%, Malawi has about 136 000 blind people. Up to 80% of all blindness is due to preventable or treatable conditions. A number of community-based and hospital-based surveys conducted in Malawi and neighbouring countries estimate that cataract is the major cause of blindness, contributing to 50% of all blindness. Other causes of blindness include glaucoma (15%) and trachoma (15%), while childhood blindness resulting from congenital cataract, vitamin A deficiency, measles and harmful traditional practices contributes 6%.

Malawi has developed a Second National Action Plan for the Prevention of Blindness in Malawi for 2011–2016. It has been developed within the context of Vision 2020: Right to Sight global campaign and Malawi's Health Sector Strategic Plan, which includes eye care as one of the core care conditions. The action plan elaborates the essential eye care interventions that the Ministry of Health will facilitate to be implemented as part of the 6-year Health Sector Strategic Plan (2011–2016).[4]

The prevalence of disability in Malawi is 4.2%. The most common types of disabilities are physical (43%) followed by visual (23%), hearing (16%), intellectual/emotional (11%), communication (3%) and old age (1%). The other major causes of disability are natural/from birth (17%) and from accidents (10.6%).

Most people with disability have problems in accessing services. In terms of health services, even though people with disabilities require the services, a significant proportion of them do not receive the services. For example, while 84% of the respondents were aware of health services and about the same proportion expressed the need for such a service, only 61% received health services.

References

  1. Malawi national STEPS survey for chronic non-communicable diseases and their risk factors. Final report (pdf 1.45Mb). Lilongwe, Government of Malawi, Ministry of Health, and WHO, 2010
  2. United Nations Children's Fund, 2010
  3. London, Department for International Development, 2005
  4. Malawi Health Sector Strategic Plan 2011–2016. Moving towards equity and quality (pdf 3.69Mb). Lilongwe, Government of Malawi, Ministry of Health, 2011