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Analytical summary - Non-communicable diseases and conditions

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Evidence shows that NCD’s, long thought to be the burden of high-income populations, are affecting more low-and middle-income countries, including Namibia. According to the demographic health survey series, non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular diseases and chronic respiratory illnesses are among the top 10 diseases and top 15 causes of death in Namibia. Diabetes alone is emerging as one of the greatest threats to health.

Between July 2010 and July 2011, 3,650 new cases of the disease were recorded in the country’s public health facilities. To date, the major focus of health interventions in Namibia has been on communicable diseases, but in response to prevalence figures the health sector has now made the prevention of NCDs a priority. An integrated multi-sectoral NCD Task Force under the leadership of the MoHSS is now in place an NCD strategy is under development.

Reducing risk factors is being pursued as one of the best ways to prevent chronic diseases. The National Policy on Health Promotion, which is currently being drafted, outlines ways for reducing risk factors while improving health services to address the situation. The policy calls for a ‘whole-government’ approach, which is fundamental to addressing the crosscutting issues and underlying socio-economic determinants of health, such as the regulatory environment around alcohol and tobacco.

NDHS figures from 1992 to 2007 show an increasing trend in overweight and obesity, which is linked to cardiovascular diseases and diabetes. Smoking is the main cause of chronic obstructive pulmonary disease (COPD) and causes lung cancer. The Tobacco Products Control Bill (2010) provides for a reduction in demand for and supply of tobacco products as well as protection from exposure to tobacco smoke.

Alcohol abuse, which is linked to liver cirrhosis and other NCDs, is prevalent in Namibia, and presents a growing problem among the youth. In January 2011 the MoHSS and Coalition on Responsible Drinking (CORD) established the National Alcohol Traders Programme to help ensure compliance with regulations on alcohol sales and advertising.

There is a Cancer Care Centre at Windhoek Central Hospital, but most cancer patients seek medical care at an advanced stage and the only realistic treatment option is palliative care. This underlines the need for improved health promotion in this area. There is currently no focus on sickle cell disease and other genetic disorders prevention and control.

Oral and dental services are being rendered in fifteen (44%) out of the 34 health district hospitals across the country. The other areas are served by an outreach programme on a rotational basis. Oral health was included in the guidelines for the Health Promoting School Initiative, which needs to be implemented more extensively. Mental illness is a major cause of morbidity as well as some mortality amongst the population of Namibia.

The Mental Health Act is under development and will provide the necessary human rights and legal protection of this vulnerable group. Opportunities to minimise mental health problems and disability at school level are hampered by the insufficient coverage of adolescent health.

Injury is an increasing problem in Namibia and is an important cause of disability, while others are due to infections, and metabolic and congenital conditions. Although the MoHSS implements a Disability Prevention and Rehabilitation Programme, the needs of disabled people are not met sufficiently as services for disabled people are centralised and inadequate, and there is little systematic involvement of communities in rehabilitation efforts.

In Namibia, public information on injuries and violence centres on road accidents, gender-based violence (in particular violence against women) and child abuse. There is a need for the adoption and implementation of policies on improved road safety as well as the management of road trauma through mass casualty management systems and emergency medical services at community and health facility levels.

There is an eye clinic in Windhoek State Hospital as well as a number of private not-for-profit clinics in other regions, but more are needed. There is a serious need to create awareness amongst the population about preventable and non-preventable eye diseases. Eye damage can be caused by severe vitamin A deficiency (VAD), and since 1996 vitamin A supplementation has reached a coverage of above 80%.

Adequate data is essential for proper planning of interventions to address NCDs, but there is currently a lack of population-based data on noncommunicable diseases and conditions. The IDSR Technical Guidelines, which include a focus on key NCDs, are being updated to improve district-level capacity for disease surveillance and response.

The main constraints to the effective prevention and control of NCDs and conditions in Namibia are the shortage of specialist health professionals, equipment and transport, including ambulance services, especially in rural areas. Increased investment of funds for facilities, training and equipment are needed for improved interventions. For mental health and disabilities/rehabilitation, improved coordination is required between health and social services and in the health sector as a whole. Prevention of all NCDs through a multi-sectoral effort needs to be emphasised.