Thought Leadership

Will Nigeria’s STEPwise Survey change the narrative around NCDs?

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Editor’s Note: Ahead of the 3rd UN High-level meeting on non-communicable diseases holding on September 27th in New York, Staff Writer Chibuike Alagboso highlights the prevalence of non-communicable diseases (NCDs)  in Nigeria and analyses the government’s recent steps towards understanding the data with the aim of monitoring trends and encouraging surveillance and regular data collection for NCDs.

It was about 7am on April 18, 2010, when my dad got a call from his cousin in the village. He was informed that his eldest brother, my easy going and energetic uncle, had been missing since they finished some communal work the day before. He hurriedly left for the village. The whole house was quiet and we were all worried as we played different scenarios in our heads, while waiting for updates. Around midday, I heard my mum scream and start crying. I didn’t run out immediately because I knew that her scream meant only one thing; My dear uncle was no more. I sat still and tried to process the unbelievable news.

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We later learned that after the communal work, he branched off into some foliage to ease himself, while the other men continued home. He never made it out. There were many explanations and theories about his death, but I was convinced he must have had a heart attack.

Even though I have made this assumption, as there was no autopsy to confirm the cause of death, speculations from other members of the family suggest that my uncle suffered from cardiovascular disease (CVD).

Cardiovascular Disease is one of the Non-Communicable Diseases (NCDs). NCDs accounts for 71% of all deaths globally. In absolute numbers, NCDs kill an estimated 41 million people annually and out of this, about 36% (15 million) were in the prime of their lives, between 30-69 years old. Yet, NCDs don’t usually get as much attention as communicable diseases, such as measles and tuberculosis. Could it be because of their chronic nature and tendency to progress slowly and without notice until they result in sudden deaths, which ends up being unexplained as the onset and progression was never detected?

There are four NCDs that account for the most deaths. Cardiovascular diseases account for the highest. The other three; diabetes, cancers and respiratory diseases share certain risk factors with cardiovascular diseases, which predisposes patients to having them. Some of these risk factors include tobacco use, harmful use of alcohol, physical inactivity and an unhealthy diet.

Image credit: Nigeria Health Watch

The World Health Organization (WHO) developed the STEPwise survey to help countries, especially low-and-middle-Income Countries (LMICs) that have the greatest global burden of NCDs at 32 million deaths, to monitor risk factor trends and prioritise interventions to check them. It is called the STEPS survey because it’s a three step-approach that involves collecting, analysing and disseminating data.

Countries are recommended to conduct the survey every 3 to 5 years, but Nigeria’s last survey was over two decades ago, in 1991/1992. The only existing survey for Nigeria is a sub-national survey done in Lagos in 2003. Other African countries such as Kenya, Ethiopia, Uganda and Rwanda have all conducted up to date surveys.

Thankfully, Nigeria’s Federal Ministry of Health (FMoH) with support from WHO and other partners has been putting structures in place to conduct the STEPS survey since 2016. At the last National Council on Health meeting in Kano, commissioners for health from various states committed to conducting the survey and advocating to their executives to commit funds for it.

Image credit: Nigeria Health Watch

At an event on the 6th of September, 2018, to update commissioners for health on the Survey’s progress, Honourable Minister of State for Health, Dr. Osagie Ehanire said “the STEPS survey is one of the tools for monitoring implementation of time-bound NCDs commitments made by heads of government at the 2nd United Nations High-Level Meeting (UN-HLM) held in 2014”. He added that, “the survey is to establish an NCD surveillance platform that collects baseline indicators on determinants of NCDs and their risk factors, for policy and planning purposes”.

Dr. Ehanire mentioned that the survey will provide evidence for federal and state ministries of health and other partners to address the increasing burden of NCDs in the country more scientifically. The entire world is experiencing an epidemiological transition from communicable to non-communicable diseases, which now constitutes one of the top ten causes of morbidity and mortality globally. To carry out the STEPS survey every state is required to contribute N7million in order to carry out the survey.

Dr. Nnenna Ezeigwe, National NCDs Coordinator at the Federal Ministry of Health, said the total budget for the STEPS survey is N354,048,503. The FMOH already budgeted N150 million for the survey so this leaves a funding gap of just over N204 million.

She said it is important for states to take ownership and redeem commitments they made at the NCH to fast-track the process of conducting the survey.

State commissioners for health, NCD state focal persons and other stakeholders with the Honourable Minister of State for Health at the NCDs Advocacy meeting. Photo credit: Nigeria Health Watch

Dr. Wondi Alemu, WHO Country Representative for Nigeria, said at the event that, “Every minute, 26 people die of non-communicable diseases and due to lack of data, we used to believe that NCDs are not common. We need to know the extent of the problem because showing the economic losses from people who get sick from NCDs is enough to ensure political commitment from the leaders.”

Each time I travel home, I wonder what would have happened if my state government understood the true burden of NCDs. Maybe they would have created targeted interventions to address these factors and my uncle would have benefitted. Perhaps he would be alive today to witness the birth of my two cousins, his grandchildren.

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