Nigeria has a population of about 140 million (NPC, 2006) and an annual gross domestic product (GDP) per capita of U.S. $1,085; with 5% total expenditure on the health sector. Despite an extensive public-sector–owned health care system, health expenditure is mostly (75%) by private-sector health care providers, with out-of-pocket payments making up the major source (92%) of private financing (www.who.int). In recent years, the federal Ministry of Health as well as at state levels has been heavily burdened with reproductive-health and infectious-disease issues as well as chronic diseases.

The main chronic diseases are heart disease, stroke, diabetes, cancer and some acute respiratory diseases. These are termed non communicable diseases (NCDs) as distinct from infectious diseases. Chronic diseases are particularly significant to the current health profile of human populations. The World Health Organization (WHO) estimates that NCDs are responsible for 47% of the global burden of disease and represent 60% of all deaths globally. Already, 80% of chronic disease deaths are occurring in low and middle income countries.

Recently gathered country-level data from the WHO indicates that NCDs can be regarded as a rising global epidemic. Most chronic diseases are triggered by common, preventable risk factors which are the leading cause of the death and disability burden in all countries, regardless of economic development status. These major risk factors account for around 80% of deaths from heart disease and stroke (Strong and Bonita, 2004).

Current situation of chronic diseases in Nigeria

Nigeria does not comprehensively address chronic diseases as part of national health agendas maybe because of lack of resources, limited capacity of the health system, and the threat that national-level programs will weaken local systems and compete with other health issues. There has been no systematic surveillance for risk factors of NCDs in Nigeria even though the Federal Ministry of Health has a National Expert Committee on NCD. The last published report was of a national survey in 1997 with most of the data collected from 1990 - 1995.

Several studies give a shocking picture of chronic diseases among Nigerians;

• Nigeria has the highest number of people approximately 5.1 million, with diabetes and impaired glucose tolerance in Africa. www.idf.org
• The crude prevalence of hypertension has been documented as 11.2% (based on BP threshold of 160/95mmhg) with age adjusted rate being 9.3% (Akinkugbe et al, 1997).
• The annual incidence of stroke in Nigerians has been reported as 26 per 100 000 (Osuntokun, 1994) with more recent reports suggesting an increase.
• According to the World Health Report 2002, cardiovascular disease accounted for 9.2% of total deaths in the African region in 2001, and hypertension, stroke, cardiomyopathy and rheumatic heart disease were most prevalent.
• At present, the estimated annual incidence of cancer is 100,000 and predicted to increase to 500,000 by 2010 with a current cumulative mortality of about 55,000 from the six functional cancer registries (Durosinmi, 2006).

 

Behavioural risk factors in Nigeria

 

A chronic disease "risk factor" refers to any feature or exposure of an individual, which increases the likelihood of developing a non-communicable disease. The major (modifiable) behavioural risk factors identified in the World Health Report (WHO, 2002) are: Tobacco use (smoking), harmful alcohol consumption, unhealthy diet, and physical inactivity. Together with raised blood pressure and obesity, the clustering of these risk factors significantly increases the risk of morbidity or mortality from chronic diseases especially heart diseases (Yusuf et al, 1998).

 

The rationale for including the major four chronic disease risk factors in a national surveillance is that; they have the greatest impact on chronic disease mortality and morbidity, their modification is possible through effective prevention, and measurement of these risk factors has been proven to be valid and can be obtained using appropriate ethical standards (Bonita et al., 2002)