Africa Will Not Meet Target To Reduce Pre-mature Non-Communicable Diseases

Africa will not achieve the United Nations Sustainable Development Goals (SDG) 3.4, targeted to reduce premature Non-Communicable Diseases (NCD), because mortality remains inadequate therefore there is an urgent need for accelerated policy action, investment in prevention, and decentralised models of primary health care, to confront the escalating crisis across the continent, says a new study.

The authors said there is the need for a coordinated and integrated global, regional, as well as national collaboration, which encompass targeted reduction of attributable risk factors, early detection and treatment. In addition, the situation calls for systematic risk stratification for screening, which are essential to achieve equitable cardiovascular care as well as reducing the disparity in persistent cardiovascular disease burden across Africa.

What has come to be known as NCDs, or chronic diseases, according to the World Health Organisation (WHO), include, cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. They disproportionately affect people in low- and middle-income countries, where nearly three quarters of global NCD deaths (32 million) occur.

From what the WHO said, people of all age groups, regions and countries are affected by NCDs. However, some of these conditions are often associated with older age groups, but about 18 million NCD deaths occur before the age of 70 years.

They cause more deaths in this age group than all other causes of death combined. Of these premature deaths, 82% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke, the harmful use of alcohol or air pollution. To fight these diseases, the UN SDG target 3.4, calls for a one-third reduction in premature NCD deaths by 2030 compared with 2015 rates. Unfortunately, Africa seems to be way off target.

In their study, Burden of cancer in Africa, ‘1990–2023’: a systematic analysis from the Global Burden of Disease Study 2023, published in the Lancet journal last month, the authors found that NCD-attributable deaths accounted for approximately 45% of all deaths in Africa. The continent suffered about 4·70 million NCD-attributable Disability-Adjusted Life Year (DALYs) representing 38% of all DALYs and 263 million in 2023

The authors said, “this pattern reflects the continent’s triple burden of disease, with NCDs rising alongside persistent communicable, maternal, neonatal, and nutritional conditions, as well as injuries.”

“These findings highlight the growing challenge of NCDs in resource-constrained settings, where health systems remain under pressure from competing priorities. The global health community should prioritise equitable NCD-control efforts, ensuring that prevention, early detection, and treatment strategies are adapted to the realities of African populations”, the authors said, adding that, “without accelerated action, Africa risks seeing widening disparities in NCD outcomes compared with global progress.”

In working on the study, they applied the Global Burden of Disease (GBD) 2023 methodology to estimate fatal and non-fatal outcomes of cancer alongside risk attributable burden from 88 modifiable risk factors, across all 54 African countries. The estimation of cancer burden attributable to risk factors followed the comparative risk assessment framework.

Estimates of incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and DALYs were stratified by age, sex, location, and year (1990–2023) and reported as counts and age-standardised rates per 100 000 population. Mean estimates represent the mean across 250 draws, with 95% uncertainty intervals calculated from the 2·5th and 97·5th percentiles.

They found that, in 2023, cancer, including non-melanoma skin cancer, accounted for an estimated 1·54 million (95% uncertainty interval 1·37–1·75) incident cases, 923 000 (824,000–1,020,000) deaths, and 33·9 million of DALYs across all ages and both sexes in Africa, of which 98·2% were attributable to YLLs.

In Africa, 10·7 million DALYs and 306,000 cancer deaths in 2023 were attributable to the 88 risk factors assessed in GBD 2023, equivalent to 31·6% of total DALYs and 33·1% of total cancer deaths across all ages and both sexes.

Between 1990 and 2023, deaths attributable to risk factors increased by 216·0% for both sexes combined. In the same year, incident cancer cases in females numbered 960,000, with breast and cervical cancers together accounting for 53·5% of all female incident cases.

In males, prostate, liver, tracheal, bronchus and lung, and colorectal cancers were the leading types, together accounting for 44·8% of all male cancers in Africa in 2023. Childhood cancer (ages 0–19 years) in Africa accounted for 104,000 incident cases and 54,700 deaths, representing 27·7% of global incidence and 38·0% of global deaths.

The authors said within three decades, atherosclerotic cardiovascular diseases have risen sharply, with ischaemic heart disease increasing by 150% and stroke by 85%, which was associated with rapid population growth, ageing, and rising prevalence of elevated Body Mass Index (BMI) and fasting plasma glucose.

“Africa’s age-standardised stroke death rate (152 per 100 000) remains approximately twice the global average (76 per 100 000), consistent with previous GBD analyses, and reflects critical gaps in diagnostic imaging, emergency transport, acute treatment, and rehabilitation infrastructure,” they added.

They said neoplasms ranked as the second-leading Level 2 cause of death and third-leading cause of DALYs in Africa in 2023, with absolute deaths and DALYs more than doubling since 1990, adding that, “unlike global and high-Socio-demographic Index (SDI) regions, where age-standardized cancer mortality and DALY rates are declining, Africa shows stable or rising trends, reflecting inequities in prevention, detection, and treatment.”

The study said survival rates remain very low due to poor access to surgery, chemotherapy, and radiotherapy, and they called for strengthening cancer control, which requires developing national cancer control plans, implementing WHO “Best Buys,” - which is cost effective, evidence-based policy options and interventions to help member states control NCDs – as well as improving prevention, diagnosis, treatment, and palliative care.

Other measures required to fight the scourge, the authors said, might include a set of tobacco control interventions, hepatitis B vaccination to prevent liver cancer, screening and treatment for precancerous cervical lesions, as well as HPV vaccination to prevent cervical cancer.

In addition, they recommended the treatment of early-stage cervical cancer, diagnosis and treatment for early breast cancer, diagnosis and treatment for selected highly curable childhood cancers and palliative care, including, at a minimum, opioid drugs for severe pain control.