The burden of non-communicable diseases and its implications for Sustainable Development Goals across regions in Ethiopia

Abstract

Background

Non-communicable diseases (NCDs) are major global public health concerns that cause nearly three-quarters of the burden of mortality worldwide. Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes alone account for over eight out of ten NCD deaths. To alleviate this huge burden, the Sustainable Development Goals (SDG) aimed to reduce premature mortality from non-communicable diseases by one-third. 

However, the magnitude of NCDs at national and subnation levels is poorly documented in resource-constrained settings such as Ethiopia, making it difficult to track progress. We analyzed the burden of non-communicable diseases across regions to show the disparity, progress, and implications towards achieving SDG targets in Ethiopia.

Methods

This analysis is a component of the GBD 2019 study, which is a collaborative effort between the Ethiopian Public Health Institute and the Institute for Health Metrics and Evaluation for Ethiopia. The primary sources of data utilized for estimating the GBD included census data, demographic surveillance, cancer registration, household surveys, health service utilization, disease reporting, and verbal autopsy. Our assessment, conducted in accordance with the GBD protocol, focuses on reporting the incidence, mortality, disability-adjusted life years (DALYs) along with a 95% Uncertainty Interval (UI), and the progress of non-communicable diseases in Ethiopia.

Results

In 2019, 202 million new cases of NCDs (95% Uncertainty Interval (UI), 189 million-215 million), 219,000(197,000-241,000) deaths, 13 million (11-15) DALY of NCDs were exhibited in Ethiopia. In the same period, Incident rate, death rates, DALY rates of NCDs were 190,000 (180,000-200,000), 550 (500-600), and 12,200 (10,400-14,200) per 100,000 population, respectively. Overall, NCD prevalence accounted for 63.2% of total cases in Addis Ababa, 59.8% in Harari, and 55% in Somali regional states. 

Overall, NCD deaths accounted for 55% of total deaths in Addis Ababa, 51% in Tigray, 45% in Harari, 43% in Amhara, and 42% in Dire Dawa, while it was 29% to 33% of total deaths in Somali, Benishngul Gumuz and Afar regional states. From 2010-2019, the percentage change in death count was 21% (8-35%), incidence cases 25% (24-26%), and DALYs count was 17% (6-29%). In 2019, skin and subcutaneous diseases, neurological disorders, mental disorders, digestive diseases, musculoskeletal disorders, and neoplasms were the five leading causes of incidence rates in Ethiopia. 

In contrast, cardiovascular diseases, neoplasms, digestive diseases, chronic respiratory diseases, and diabetes mellitus were Ethiopia's leading causes of death rates. In 2019, modifiable risk factors accounted for 52% (48-56%) of all NCD-caused mortality.

Conclusion

This study showed a high burden and relatively stable trend of NCD-caused mortality and disability in Ethiopia. The epidemiological transition was not uniform across the regions. Current NCD strategies fail to address high-incidence NCDs that overburden the health care system while designed to address killer NCD types and their risk factors. Strategies and interventions could target modifiable risk factors such as high systolic blood pressure, dietary risks, air pollution, and high fasting plasma glucose, which contribute almost half of NCD mortality and disability. 

This study suggests the need to develop proclamations and strategies on risk factors, such as reducing sodium, fat, and sugar use to prevent and control non-communicable diseases in Ethiopia. This result may also call for tailored and innovative public health interventions across highly NCD-prevalent regions to progress on reducing NCD deaths by one-third at the end of 2030.