NCDs disproportionately affect people in low- and middle-income countries, where more than 75% of global NCD deaths and 86% of premature deaths (death between 30 and 70 years) occur. In sub-Saharan Africa, NCDs have been projected to overtake communicable, maternal, neonatal, and nutritional diseases combined as the leading cause of mortality by 2030.
To tackle the burden of NCDs, the sustainable development goal (SDG) target 3.4 is set to reduce premature mortality from NCDs by one-third through prevention and treatment.
To achieve this reduction, it is essential that patients have a good understanding of their disease and have appropriate access to effective treatment. Healthcare workers (HCWs), by educating and caring for patients, play a crucial role in the prevention and treatment of NCDs. Despite this crucial role, working as a HCW is recognized as a high-risk occupation, as HCWs face regularly physical and mental stress from work shifts, overtime, as well as pressure through provision of care under life-and-death circumstances.
Working night shifts for example leads to a lack of time to prepare healthy meals and is linked to dyslipidemia. When it comes to risk behaviors, a study from Nigeria showed low physical activity levels among HCWs. Furthermore, HCWs in general continue to consume tobacco at high rates. These risk factors can be exacerbated by mental health issues. Indeed, HCWs are at higher risk for suicide and mental stress per se is linked to an increased risk for mortality due to associated physical health issues. A systematic review synthesizing evidence on HCWs in Africa found that 49% of frontline HCWs suffered from a mental health symptom during the COVID-19 pandemic.
HCWs are in high demand globally, but the most severe shortage is experienced in the African region. With an average of 1.3 HCWs per 1,000 population, the African region is far below the average of 4.5 per 1,000 required for the SDGs with a forecasted shortage of 6.1 million by 2030.
This unprecedented shortage is further exacerbated when HCWs are absent for long periods due to chronic diseases and results in excessive workload, burnout, and mental stress for the available few. Data on the health status of HCWs across the African region are scare, but indicate the need for detailed epidemiological data to address the burden of NCDs. Across sub-Saharan Africa many NCDs are rising, but data are hardly available on country level. Recent studies from Ghana, Mozambique, and Zimbabwe reported a double burden of NCDs and infectious diseases in the general population. A scoping review from 2019 found hypertension as the most commonly reported NCD followed by obesity and diabetes with a prevalence range from 17.5 to 37.5% among HCWs. Small studies suggest that 16% of HCWs in Ghana and 37.1% in Nigeria suffer from hypertension, whereas in South Africa, 73% of HCWs have been found to be overweight or obese. A study from Nigeria found, that only about 40% of hypertensive HCWs were on therapy, underlining the need for appropriate management of NCDs in HCWs.
In the context of constrained resources and shortage of HCWs, information about the prevalence and management of NCDs in HCWs is essential to treat and protect HCWs, to promote them as educators and role models of healthy behaviors for patients, as well as to safeguard them as an essential workforce that provides healthcare for patients, ultimately contributing to the achievement of the SDG target 3.4.
Within the framework of a larger study on the prevalence of SARS-CoV-2 and vaccine coverage in HCWs, we assessed the self-reported burden of NCDs, associated factors and their treatment among HCWs in four African countries in an attempt to provide health authorities and decision makers with the evidence to help protect HCWs.
Data on the prevalence of self-reported NCDs among HCWs were collected through a transnational cross-sectional multisite survey. As part of a larger study on the burden of COVID-19, data collection took place between February and December 2022 as a collaboration between the Robert Koch Institute, Berlin Germany, and four institutions in sub-Saharan partner countries: Center Hospitalier et Universitaire de Bouaké (Côte d'Ivoire), Institut National de la Recherche Biomédicale (Democratic Republic of the Congo), Laboratoire d’Analyze Médicale Malagasy (Madagascar), and Nigeria Center for Disease Control and Prevention (Nigeria).
A Guest Editorial