Temporal trends in the burden of non-communicable diseases in countries with the highest malaria burden, 1990-2019: Evaluating the double burden of non-communicable and communicable diseases in epidemiological transition

Abstract

Background: Non-communicable diseases (NCDs) are rapidly increasing in sub-Saharan African countries, where 96% of global malaria deaths occur. This study aimed to investigate the disease burden of NCDs in countries with the current highest malaria mortality.

Methods: Data for this study were obtained from the Global Burden of Disease 2019 study (1990-2019). We selected the ten countries with malaria's highest age-standardised mortality rate (ASMR) and identified and ranked the five NCDs with the highest ASMR in each country. Measures of the NCDs disease burden included ASMR, age-standardised disability-adjusted life-years (DALY), years of life lost (YLL) and years lost due to a disability (YLD). The Estimated annual percentage change (EAPC) was used to examine the trends of the NCDs disease burden from 1990 to 2019.

Results: As of 2019, the ASMR of chronic liver disease, kidney disease, diabetes mellitus, Alzheimer's disease and other dementias, hypertensive heart disease and stroke were higher than the global average. From 1990 to 2019, the ASMR for Alzheimer's disease and other dementias, type II diabetes mellitus, and chronic kidney disease increased by 3.0%, 10.8%, 13.3%, and the age-standardised DALY rate increased by 3.7%, 27.6%, 6.3%, and the increases tended to be in younger populations.

Conclusion: The double burden of non-communicable and communicable diseases is crippling the health systems of many sub-Saharan African countries and is often neglected. The prevention, surveillance, and control of diseases require an integrated strategy, with governments and non-government organisations aligned and supported by the global initiative.

Keywords: Double burden of disease; Malaria; Non-communicable disease.

Fig. 1

Top ten countries with the highest malaria mortality rates in 2019, which were Nigeria, Liberia, Burkina Faso, Niger, Cote d’Ivoire, Benin, Sierra Leone, Togo, Cameroon and Mozambique. It is worth noting that these countries with the highest burden of malaria deaths are all located in the African Region

Fig. 2

Age-standardized death rates for the eight leading NCDs in the ten selected countries, 2019. Including ischemic heart disease, stroke, diabetes mellitus, chronic liver diseases, chronic kidney disease, Alzheimer’s disease and other dementias, chronic obstructive pulmonary disease, and hypertensive heart disease. Of these eight diseases, ischemic heart disease, stroke and diabetes mellitus were the most common leading causes of death in all ten countries. The contribution (%) of the top five NCDs with the highest mortality rate to the total mortality rate of each selected country and the world is shown in Appendix 1

Fig. 3

The long-term mortality trends (1990–2019) of the eight leading NCDs in the ten countries During 1990 and 2019, among the selected countries, the ASMR of chronic liver disease, kidney disease and diabetes mellitus were higher than the global average. As of 2019, in addition to the above three diseases, the ASMR of Alzheimer’s disease and other dementias, hypertensive heart disease and stroke also exceeded the global average From 1990 to 2019, the ASMR for Alzheimer’s disease and other dementias, diabetes mellitus, and chronic kidney disease increased by 3.0%, 8.6%, 13.3%

Fig. 4

Trends of the age-standardized DALYs due to the eight leading NCDs in the ten countries, 1990–2019. From 1990 to 2019, the age-standardized DALY rate for Alzheimer’s disease and other dementias, diabetes mellitus, and chronic kidney disease increased by 3.7%, 24.4%, 6.3%