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Noncommunicable Diseases and Injuries in South Asia

Posted by plosmedicine on 31 Mar 2009 at 00:01 GMT

Author: Ali Khan Khuwaja
Position: Assistant Professor
Institution: Departments of Family Medicine and Community Health Sciences, Aga Khan University, Karachi, Pakistan
Additional Authors: Riaz Qureshi, Zafar Fatmi
Submitted Date: November 13, 2006
Published Date: November 13, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We read with great interest the essay by Perel et al. [1] on the noncommunicable diseases (NCDs) and injuries in Latin America and the Caribbean (LAC) countries. The authors are to be congratulated for their excellent descriptive elaboration about the epidemic of NCDs and injuries in LAC region. We wish to comment on this growing epidemic of NCDs with reference to South Asian (SA) countries where the situation is much comparable with LAC region.

South Asia, which has one quarter of the world's population, is experiencing a rapid epidemiological transition similar to the LAC countries. The rising epidemic of NCDs in SA region is fuelled by demographic ageing and globalization resulting in changing lifestyle, eating habits and working patterns with less physical activity.

In 2000, 44% of the burden of disease in this region measured in disability adjusted life years (DALYs) lost was attributed to NCDs [2] and are figures are expected to rise. Nonetheless, to a greater extent, this growing epidemic is a neglected health issue in these countries. Cardiovascular diseases are the major contributors to the premature mortality and morbidity in SA region. The prevalence of diabetes has risen more rapidly in SA than in any region of the world. By the year 2030, India will have highest number of persons with diabetes (79.4 million). [3], similar trends are also projected for other countries of SA. Overall, prevalence of hypertension among Pakistani adults (greater than or equal to 15 years) is about 19% [4] and this is likely to be the pattern in other SA countries. In South Asia, one third of adult population is classified as obese and the trend is also increasing in SA children [5,6]. Large number of South Asians use tobacco in various forms it is estimated that up to 65% of all men use tobacco in some form [7]. Tobacco use is responsible for approximately half of the tumors in males [8]. South Asian have one of the highest rates of oral cancers reported worldwide, and the rates are still increasing [7,8]. Due to the lack of reliable data and under-reporting of injuries, it is difficult to estimate its prevalence and future projections; nevertheless, the burden is substantially high enough to be one of the major health concerns in SA. Only in Sri Lanka, a smaller SA country, road traffic injuries resulted in 2,000 deaths and 14,000 injuries each year [9].

NCDs are costly diseases to handle and SA countries which already have poor health and economic indicators can not afford this emerging costly epidemic. South Asians have a tendency to develop cardiovascular diseases at relatively earlier ages compared to other parts of the world resulting in the highest potential of loss of productive life years. For a low-income Indian family with an adult having diabetes, as much as 25% of family income may be devoted to diabetes care [10].

Like LAC region [1], SA countries have social and cultural disparities and inequalities as well. People with higher socio-economic status and men who are the major economic contributors of their families usually avail the best available health care facilities. As in case of LAC countries, South Asians with low socio-economic levels, have the highest prevalence of mental health problems. The SA countries, even are well-equipped with highly qualified human resources and having common culture and languages which enhance more meaningful research are often unable to produce quality research of significant level mainly due to lack of funding and financial resources. With some exceptions much of the research work on NCDs has been done descriptively or observational and at smaller scales. Hence, the existing research for the generalizibility of the whole region is questionable and translating this research into practice is also difficult.

Keeping in mind the frightening scenario of NCDs in countries of SA, the best option to tackle the epidemic is to take earlier action through comprehensive, multi-faceted and multi-sectoral preventive and interventional strategies. There is also a need for more NCDs population-based local research with more collaborations and networking. These all require innovation, funding, political will, and health partnership between individuals, communities, clinicians, public health practitioners, non-governmental agencies, policy-makers and governments of SA region.

1. Perel P, Casas JP, Ortiz Z, Miranda JJ (2006) Noncommunicable disease and injuries in Latin America and the Caribbean: Time for action. PloS Med 3(9): e344. DOI: 10.1371/journal.pmed.0030344.
2. World Health Organization (2002) Health situation in the South East Asia Region 1998 - 2000. New Delhi: World Health Organization regional office.
3. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27: 1047 - 1053.
4. Jaffar TH, Levey AS, Jafary FH, White F, Gul A, Rahbar MH, et al. (2003) Ethnic subgroup difference in hypertension in Pakistan. Journal Hypertension 21: 905 - 912.
5. Singh RB, Tomlinson B, Thomas GN, Sharma R (2001) Coronary artery disease and coronary risk factors: the South Asian paradox. J Nutr Environ Med 11: 43 - 51.
6. World Health Organization, International Obesity Task Force, International Association for the Study of Obesity (2000) The Asia-Pacific perspectives: redefining obesity and its treatment. Melbourne, Australia.
7. Center for Disease Control and Prevention (1997) Tobacco or health: a global status report. Available: via the Internet. Accessed 2006 November 03.
8. Bhurgri Y, Burgri A, Nishter S, Ahmed A, Usman A, Pervez S et al. (2006) Pakistan - country profile of cancer and cancer control 1995 - 2004. J Pak Med Assoc 56: 124 - 130.
9. Dharmaratne SD, Ameratunga SN (2004) Road traffic injuries in Sri Lanka: a call to action. J Coll Physician Surg Pak 14: 729 - 730.
10. World Health Organization (2002) Fact sheet No. 236. Diabetes: the cost of diabetes. Available: via Internet. Accessed 2006 July 07.

Competing interests declared: We declare that we have no competing interests. Funding: The authors received no funding for this article.