The Double Burden of Disease: Gambia
Non-communicable diseases (NCDs) among developing countries have been increasing at an alarming rate. The increase in trend is due to increased access to high energy, high fat foods and drink, along with the continued prevalence of infectious diseases such as cholera, and HIV/AIDS. The result is what has been termed the “double burden” of infectious and non-infectious disease.
If this trend persists, the WHO predicts that by 2020, NCDs will account for 80% of the global burden of disease (1). Among non-communicable diseases, special attention is devoted to cardiovascular disease, obesity, diabetes, cancer and chronic pulmonary disease (1).
Infectious diseases are still seen as the major cause of mortality within developing countries. Diseases such as tuberculosis, cholera, meningitis, hepatitis, malaria, dengue, yellow fever, HIV/AIDS, Ebola, and SARS are still prevalent among populations in developing countries (2). Apart from using mortality rates to quantify such diseases, disability adjusted life years (DALYs) have been used to estimate the amount of healthy life lost due to such diseases.
One DALY is thought of as one lost year of healthy life (3).
Gambia is one such country in West Africa that has been brought to its knees when dealing with rising rates of obesity and infectious diseases. Gambia like any other developing country is also in its early phases of the demographic and nutrient transition (4) and this has led to the alarming increases in obesity.
Initially, obesity rates were low among both men and women from rural and urban backgrounds in 1996–1997. However, one decade later obesity is now rapidly infiltrating those living in rural areas as well (5).
One of the main contributing factor is the Gambian diet which is a staple among the poor and is rich in carbohydrates, high in oil content, low in protein and vegetables. In addition, obesity levels among urban dwellers have also increased exponentially due to the rise in processed food and sweetened drinks. Therefore, both urban and rural dwellers are at risk of obesity, which predisposes them to several chronic diseases (6).
On the other hand, due to the lack of healthcare, vaccines and proper sanitation. Gambia is still plagued by infectious diseases which are currently not as prevalent in developed countries. The diseases are:
· Hepatitis A
· Malaria
· Typhoid
· Yellow Fever
· Cholera
Therefore, the double burden of disease grows rampant in a country like Gambia and the prevalence of obesity and infectious disease results in a heavier burden on both the country and its population. The poor availability of healthcare and vaccination is something that must be addressed. However, reducing NCDs like obesity involves different processes to infectious diseases, including promoting awareness, proper education on food consumption and increases in physical activity. If this is successful it could reduce the double burden of disease and allow them to tackle more pressing issues (e.g. Infectious diseases) and possibly increase life expectancy.
1. Organization WH. The world health report 2002: reducing risks, promoting healthy life. World Health Organization; 2002.
2. Organization WH. Global defence against the infectious disease threat. World Health Organization; 2002.
3. Murray CJ, Lopez AD. Global burden of disease. Harvard University Press Boston; 1996.
4. Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their determinants. International journal of obesity. 2004;28:S2-S9.
5. Prentice AM. The emerging epidemic of obesity in developing countries. International journal of epidemiology. 2006;35(1):93–99.
6. Omoleke SA. Chronic non-communicable disease as a new epidemic in Africa: focus on the Gambia. Pan African Medical Journal. 2013;14(1).
7. Featured Image 1: Webb F, Prentice A. Obesity amidst poverty. International journal of epidemiology. 2006;35(1):24–30
8. Featured Image 2: 7. Webb F, Prentice A. Obesity amidst poverty. International journal of epidemiology. 2006;35(1):24–30
