Non-communicable diseases and conditions
This analytical profile on noncommunicable diseases and conditions is structured as follows:
Noncommunicable diseases (NCDs) and conditions represent a significant burden in Sierra Leone. However, there is a dearth of up-to-date information on the prevalence of NCDs such as hypertension and other cardiovascular diseases, diabetes mellitus and sickle-cell disease.
Shifting the conventional mode of addressing NCDs from the tertiary care level to primary care and focusing on risk reduction is a necessary but difficult approach for their prevention and control. Mental health and substance abuse, disability, injuries, malnutrition and micronutrient deficiency represent a significant burden to the health and people of the country.
The Ministry of Health and Sanitation is exploring the possibility of establishing a cancer registry for the prevention and control of cancer. The head of the forensic department of the Connaught Hospital has been designated as the focal person for this and he and other technical staff have already participated in training activities towards establishing the cancer registry. Even in the absence of a cancer registry, individuals and private institutions are providing screening services for cervical and breast cancer in Sierra Leone. These efforts need to be coordinated and strengthened.
While NCDs are estimated to account for 18% of all deaths in Sierra Leone, the capacity of the country to address and respond to NCDs is limited. Apart from a Ministry department with responsibility for NCDs and the fact that the national health reporting system includes information on NCD cause-specific mortality and morbidity, there are no facilities for a national, population-based cancer registry. The Ministry has no specific policy, programme or action plan that is currently operational for the prevention and control of cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, sickle-cell disease and other genetic disorders, alcohol or tobacco.
Sierra Leone has a huge substance abuse problem. About 90% of admissions to the only psychiatric hospital in Sierra Leone are due to drug-related illnesses. Substances that are not under international control, such as alcohol, tobacco and sedatives, are also widely used.
Sierra Leone has developed a Mental Health Policy. However, the capacity for effective implementation of the policy remains a challenge. The country´s one psychiatric hospital resumed operation only in 2006 after the rebel war and is currently functioning under severe human resource constraints. Furthermore, there are only three drug rehabilitation centres in the country: two located in Freetown and one in Kenema.
There are four major eye hospitals in the country. Although ophthalmic nurses are now being trained at the College of Medicine and Allied Health Sciences, training for eye specialists is not available in Sierra Leone.
Ear health care is provided in government facilities as well as in private health facilities. Only one of the three ear, nose and throat specialists in the country is working in government service. The others have retired from the civil service and are now in private practice.
The civil war left the country with over 7000 amputees who needed immediate physical rehabilitation and community reintegration. A national strategy on prosthetics and orthotics has been developed. A draft national policy on disability has been developed and two districts are practising community-based rehabilitation as part of primary health care.
The Ministry of Health and Sanitation and the Ministry of Social Welfare, Gender and Children's Affairs have instituted the National Disability Forum where partners discuss disability issues and share best practices. A national coordinating body has also been established and the Ministry of Health and Sanitation is gradually taking over the responsibilities of the operation of the secretariat of this body. Major challenges in disability management include the absence of a national database on disability, and training of more districts on community-based rehabilitation and its integration into primary health care.