Disease Prevention and Control
Prevention and control of diseases and pandemics is one of the most significant areas to be addressed in the domain of health. Cooperation in this area is a common interest of international community and all OIC member countries.
In this context, the OIC member countries have been taking various actions against diseases and pandemics in the context of both their national health programs/strategies and their partnerships at the international level. They have been striving to develop multifaceted prevention, care and treatment strategies and programs and emergency preparedness plans.
However, much more efforts are still needed to strengthen health infrastructures, capacity building of health professionals and improving access to essential medicine, including vaccines, especially in those member countries which lack the necessary resources to do so. This underlines the pressing need for closer collaboration at the regional and global levels with the involvement of relevant international institutions and initiatives in the area of health, such as the WHO and the Global Fund.
A cursory look at the general trends in the cause-specific morbidity and mortality (i.e. prevalence of and deaths due to communicable and non-communicable diseases, as well as injuries) is quite revealing. The average crude death rate is around 809 per 100,000 population in OIC countries (2011 or latest year’s figure, World Bank WDI). Although this is not significantly different from other developing and developed countries, the composition of underlying causes matters a lot. Over 90% of the 55.9 million deaths worldwide in 2008 was due to the pair of communicable and non-communicable diseases (27.8% and 63.3%, respectively), and the rest from injuries.
Communicable diseases still constitute a substantially larger portion of the total deaths (45.6%) in the OIC member countries than they do in other developing countries (26.4%). In developed countries, communicable diseases account for even less than one-tenth (6.8%) of total deaths. As far as the non-communicable diseases are considered, on average, almost 46.3% of the deaths in OIC countries are caused by non-communicable diseases, whereas this ratio is around 63.8% in other developing countries and as high as 87.2% in developed countries.
Apparently, there is a positive (negative) relationship between the level of development and the share of non-communicable (communicable) diseases in total mortality. That is, when the countries develop the necessary capacity and skills to combat communicable diseases and longevity increases, non-communicable diseases rapidly becomes more prevalent, so does the mortality due to them. Overall, this shifts the causality from one side to another (from communicable to non-communicable diseases, or vice versa) – with overall death rates remaining relatively unchanged.
In view of the above, this section of OIC SHPA 2014-2023 aims to give a quick overview of the current trends in the OIC countries pertaining to the prevalence, control and prevention of major communicable and non-communicable diseases and their risk factors. In doing so, the section aims to offer some recommendations for policy-making .
Prevention and control of communicable diseases is a global challenge and joint responsibility in today’s interconnected world – with OIC countries being no exception.
Communicable diseases threaten populations across national boundaries and regional divides, and any outbreak in one part of the world could rapidly spread to other regions within no time and lead to significant loss of lives while having a negative impact on the economies of the countries. Particularly in OIC countries, where there is not adequate infrastructure, human capacity and awareness of prevention in place, any late action can be big with consequences.
Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria are the top three single agents/diseases that claim most lives globally. According to the UNAIDS, in 2009, there were an estimated 32 million people in the world living with HIV/AIDS. With 9 million people living with HIV/AIDS, 43 OIC countries, for which the AIDS data are available, represented a 28% share in world total. In the same year, an estimated number of 1.7 million deaths in the world were AIDS-related. The same 43 OIC member countries accounted for 32% of these deaths – which is disproportionately high considering their share in the world population.
In responding to the HIV/AIDS challenge, OIC countries, despite having a comparable population-standardized number of facilities for treatment, lag behind other developing countries in the number of adult population who receive HIV/AIDS testing and counselling (i.e. lower number of population serviced per facility). On average, 2,025 adults per 100,000 adult population in 42 reporting OIC countries received HIV/AIDS testing and counselling in 2010. This is less than half of the average for other 65 reporting developing countries (4,558 adults).
In the same year, the estimated proportion of the people receiving antiretroviral therapy (ART) within the total estimated number of people living with HIV/AIDS in 41 reporting OIC countries was on average only 14% - as compared to 24% in other 68 developing countries and 59% in 13 developed countries with reported data. As of 2010, there was an estimated number of 3.7 million people in the OIC countries needing ART based on WHO 2010 guidelines – representing a 27% share in total number of people in the world classified as such.
According to the WHO’s World Malaria Report for 2011, out of the 106 malaria-endemic countries worldwide, 43 (41%) are OIC countries. In 2010, the average number of malaria-caused deaths reported in these 43 malaria-endemic OIC countries was around 5.5 per 100,000 population, which is twice the average of other 62 developing countries.
Despite a decrease by one-third over the last decade, the prevalence of tuberculosis is still highest in the OIC countries, as compared to other developing countries as well as the world as a whole. In 2000, 333 per 100,000 population in the OIC countries were suffering from tuberculosis. Although this number decreased to 214 in 2011, it was still above the world average of 171 and the average of other developing countries of 190.
Among the HIV-negative people in the member countries in 2011, a total of 320,191 lives were claimed by tuberculosis, representing 33.0% of the total tuberculosis deaths worldwide. In terms of the diagnosis of tuberculosis, developing countries lag far behind developed countries in their built-in capacity, with OIC countries again being no exception. According to the most recent data available from WHO, as of 2011, the average number of laboratories in OIC countries providing drug susceptibility testing (DST) for tuberculosis was only 0.64 per 5 million people– as compared to 1.00 in other developing countries and the world average of 2.29.
In developed countries, however, this rate is as high as 12.62. In a similar vein, the number of tuberculosis diagnostic laboratories using culture is on average 2.11 for each 5 million people in OIC countries – as compared to 3.85 in other developing countries and the world average of 5.35. In developed countries, this rate is 20.01.
Although a more optimistic picture is the case for the number of tuberculosis diagnostic laboratories using sputum smear microscopy – the cornerstone of tuberculosis diagnosis in developing countries – the latter is considerably insensitive and able to detect roughly 50% of all the active cases. Sensitivity can be as low as 20% in children and HIV-infected people.
Furthermore, smear microscopy cannot detect resistance to drugs (WHO, 2008). The lack of a robust network of tuberculosis laboratories with modern methods for diagnosis manifests itself in low tuberculosis detection rates. Over the last 5-year period, the OIC member countries has made little progress in phasing in more precise and sensitive detection methods and accordingly the proportion of estimated new and relapse tuberculosis cases detected remained at low levels – 61% in 2011 vis-à-vis 72% in other developing countries and 88% in developed countries.
Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year (WHO, 2011b). It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations.
According to the WHO data, in 2010, some 80-85% of the infants in OIC countries were able to be administered immunization agents against a number of infectious diseases, namely measles, diphtheria tetanus toxoid and pertussis, hepatitis B, haemophilusinfluenzae type B (Hib), tuberculosis (BacilleCalmette–Guérin or BCG vaccine), and polio.
Although this coverage ratio is comparable to, and in some cases even higher than, that of other developing countries, much has to be done to reach the average coverage levels of around 90-95% which are observed in developed countries.
The substantial increase in resources dedicated to health through development assistance and other sources in the last ten years is changing the trajectory of life-threatening infectious diseases. In this regard, the Global Fund, soon after its inception in 2002, became one of the main multilateral funders in global health by channelling almost 82% of all international financing for tuberculosis, 50% for malaria, and 21% of the international financing against HIV/AIDS.
According to the data obtained from the Fund, as of mid-2012, the Fund had approved a total of US$ 7.0 billion for grants in OIC member states – of which US$ 4.4 billion had already been disbursed. The total lifetime budget of the Fund for OIC member countries is US$ 10.4 billion.
Since the creation of the Fund until mid-2012, 52 OIC member states have benefited in the form of US$ 3.0 billion allocated for fighting HIV/AIDS (42.5% of the total approved amount), US$ 1.4 billion for tuberculosis (20.0%) and US$ 2.6 billion for malaria (37.7%). With the help of the Global Fund investments, OIC member states have been able to scale up a range of prevention, treatment and care services for HIV/AIDS, tuberculosis and malaria in recent years.
On the other hand, in 2012, only three countries worldwide, namely Afghanistan, Nigeria and Pakistan, remain polio-endemic (from 125 in 1988) – representing, by end-2011, the two-thirds and half of the reported cases in OIC countries (a total of 546 cases) and the world (a total of 673 cases), respectively. Polio cases worldwide have reached these levels after a decrease by over 99% from an estimated 350,000 cases in year 1988, marking the establishment of the Global Polio Eradication Initiative (GPEI). Between 2000 and 2010, polio immunization among one-year old infants in 56 OIC member countries for which data are available has increased substantially from 68% to 85%. The GPEI’s strategic plan for 2013–2018 put in place the target of ceasing and validating the cessation by end-2018.
Previously under the GPEI’s strategic plan for 2010–2012, the three remaining polio-endemic OIC countries reported launching of national polio emergency action plans, overseen in each case by the respective head of state, and the partner agencies of the GPEI also moved their operations to an emergency footing, working under the auspices of the Global Emergency Action Plan (EAP) 2012-2013. It is need of the hour that member countries in collaboration with OIC GS should stimulate and coordinate Muslim Community solidarity and support to the three remaining OIC member countries that have not yet interrupted polio transmission (Afghanistan, Nigeria and Pakistan) to also achieve polio eradication.
All in all, over the last few decades, OIC countries have made significant progress in the prevention and control of many infectious diseases which manifested itself through a significant increase in average life expectancy in the member countries and, in turn, the elevated risks of non-communicable diseases.
The 2012 World Health Statistics Report of the WHO highlights non-communicable diseases, also known as chronic or non-infectious diseases, as “a major health challenge of the 21st century”. The analysis in this section is indeed supportive of this argument, especially for the case of OIC countries. Of the estimated 55.9 million global deaths in 2008, 35.4 million (63.3%) were due to non-communicable diseases.
Population growth and increased longevity are leading to a rapid increase in the total number of middle-aged and older adults, with a corresponding increase in the number of deaths caused by non-communicable diseases. With the increasing upside risks, particularly with regard to the cardiovascular diseases and cancers, the total number of annual non-communicable disease deaths is projected by the WHO to reach 55 million by 2030 – largely offset by a decline in the annual infectious disease deaths over the next 20 years.
In 57 members of the OIC, an important health transition has taken place over the last half-century. Between 1960 and 2010, there has been on average a 17.4 years increase in life expectancy in OIC countries. As people in the OIC countries live longer, there has been a rapid rise of non-communicable diseases. This increase was mainly due to changing causality structure – i.e. increased resilience against infectious diseases through effective prevention and, in turn, higher prevalence of non-communicable diseases which basically prevail at later ages. In 2008, with 6.1 million cases, OIC countries accounted for 17% of the global deaths due to non-communicable diseases – with 35.3% of deaths occurring before the age of 60 as compared to 26.7% in other developing countries and 12.3% in developed countries.
The four leading causes of deaths due to non-communicable diseases are cardiovascular diseases, cancers, diabetes and chronic lung (respiratory) diseases, including asthma and chronic obstructive pulmonary disease. These four groups of diseases account for around 80% of the total deaths due to non-communicable diseases all around the world. More importantly, they all have four common risk factors: tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets. Moreover, the burden of non-communicable diseases is rising disproportionately among the developing countries in general and OIC countries in particular.
Behavioural risk factors, including tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, are estimated to be responsible for about 80% of coronary heart diseases and cerebrovascular diseases. Behavioural risk factors are associated with four key metabolic and/or physiological changes – raised blood pressure, increased weight leading to obesity, high blood glucose (hyperglycemia) and high cholesterol levels (hypercholesterolemia). These changes can have multiple effects.
For example, in addition to its direct role in diabetes, raised fasting blood glucose also increases the risk of cardiovascular deaths, and was estimated to cause 22% of coronary heart disease deaths and 16% of stroke deaths (WHO, 2012b). In terms of attributable deaths, the leading behavioural and physiological risk factors globally are raised blood pressure, followed by tobacco use, raised blood glucose, physical inactivity and being overweight or obese. It has been estimated by the WHO that that raised blood pressure causes 51% of stroke deaths and 45% of coronary heart disease deaths (WHO, 2009).
While the average age-standardized blood pressure9 for both males and females has been decreasing in developed countries since the last three decades, it has been stable or increasing in OIC countries. The upward trend in blood glucose over the last three decades also endangers the control and prevention of non-communicable diseases in OIC member countries. Moreover, the increase in mean fasting blood glucose levels in OIC countries has been more significant for females than for males. In terms of physical inactivity, based on 2008 data by WHO on a sample of 122 countries, the proportion of the 15+ aged adults in 31 OIC members with available data who were found to be physically inactive was 32.1%.
Although this compares favourably to 46.3% average of 27 developed countries in the sample, it is considerably higher than the 26% average of other 64 developing countries with available data. This indicates that insufficient physical activity is another important risk factor that necessitates the health policy-makers to pay utmost care. Moreover, in all country groups, including the OIC, physical inactivity among females is much more prevalent than among males.
On the other hand, the most recent available data indicate that the prevalence of tobacco use, especially among males, is considerably high in the member countries. Data extracted from the WHO shows that in 20 OIC countries out of 37 with available data, the prevalence of tobacco use among male adults was over 30%. As for prevalence among youth, Global Youth Tobacco Survey of the WHO reveals that in half of the 52 OIC countries with available survey data, in 2010, the prevalence of tobacco use among 13-15-year-olds was more than 20%. Notwithstanding this fact, most of the OIC countries have already ratified (51) or signed (45) the WHO Framework Convention on Tobacco Control.
Over the years, member countries strived very hard to contain this epidemic by taking some measures like controlling tobacco production, banning advertisement in media and discouraging consumption by levying high taxes on tobacco products. However, despite all these noble efforts, tobacco epidemic is on rise and it is recognized as one of the leading causes of premature preventable deaths across the OIC member countries.
Worldwide, 2.8 million people die each year as a result of being overweight or obese. Being overweight or obese can lead to adverse metabolic effects on blood pressure, cholesterol and triglyceride levels, and can result in diabetes.
Being overweight or obese thus increases the risks of coronary heart disease, ischaemic stroke, type 2 diabetes mellitus, and a number of common cancers. According to the 2008 data by WHO, one-third (33.7%) of the adults aged over 20 in OIC countries were overweight (indicated by a body mass index (BMI) value greater than or equal to 25) as compared to 28.3% in other developing countries. Prevalence of being overweight in females is significantly higher than in males all around the world except for the developed countries where the situation is exactly the opposite.
On the other hand, one out of every ten adults aged 20+ in OIC countries is facing obesity (11.8%) – indicated by a BMI value greater than or equal to 30. This is higher than the 8.9% average observed in other developing countries. On average, female obesity is again significantly higher than the male obesity in developing countries and almost twice as prevalent as the male obesity in OIC member countries.
It is particularly worth noting in this respect that obesity and being overweight are especially critical health issues for the OIC member countries in the MENA region. The lifestyle changes associated with the increase in wealth and rapid urbanization which have been accompanied by new technologies that promote sedentary lifestyles are some of the major contributing factors. In MENA region, 57.4% of the population is overweight – which is higher than the developed countries average of 55.9%. As far as the females are considered this level is even higher: 61.9%. As for obesity, 24.5% of the MENA population is classified as such and women in the region are significantly more likely to be obese than men: 31.8% vs. 17.6%.
Yet, health system response and capacity in OIC countries to prevent, combat and control non-communicable diseases are not at desired levels. According to the WHO 2010 Non-Communicable Disease Country Capacity Survey, more than half (in some cases around two-thirds) of the member countries lack operational policies, strategies and action plans for controlling cardiovascular diseases, chronic respiratory diseases and diabetes, as well as for addressing major underlying risk factors – such as alcohol use, unhealthy diet, overweight/obesity, and insufficient physical activity.
In terms of non-communicable-disease-related partnerships in the area of health as well as the promotion of health-related behaviour change, the same survey indicates that, almost one-fourth of the member countries have no partnerships or collaborations for implementing key activities related to non-communicable diseases, whereas one-third do not even implement fiscal interventions to influence behaviour change.
Around 95% of the 31 developed countries with available data reported the existence of both partnerships/collaborations and fiscal interventions. As far as the infrastructure for health system response and capacity is considered, almost one-fifth of the 54 reporting OIC countries indicated that they have no units (or departments) in their ministries of health which are responsible for non-communicable diseases. 95% out of other 99 developing countries with available data, however, indicated the existence of such units.