The health system in Uganda suffers the distressing effects of a seemingly pleasurable substance, tobacco. More than 80% of the Ugandan population is youthful. Recent statistics, however, indicate that over 17% of this segment uses tobacco in the various forms ranking highest in East Africa.
Despite the high unemployment rate (about 15%) among this group, tobacco unfortunately takes up a big chunk of their money.
World Health Organisation (WHO) estimates that, among tobacco users, more than 10% of household income is used on tobacco.
One of the most devastating effects of tobacco use is poverty. In the end, one may need not less than sh3m to seek medical attention for tobacco related illnesses in a year. It is undoubtedly less costly to avoid tobacco.
The Uganda Non-Communicable Diseases Alliance (UNCDA) joined Uganda’s Ministry of Health on May 31, 2018, to mark the World No-tobacco Day with a theme; “Tobacco and Heart disease.” The link between tobacco and cardiovascular diseases has for long been widely unknown.
In a strategic move to go beyond marking the international day in Kampala, UNCDA rolled out the anti-tobacco campaign in partnership with the various district health Offices in 10 districts (UNCDA Branches) of; Amuria, Arua, Gulu, Kasese, Luuka, Mubende, Nakasongola, Serere, Sheema and Tororo.
The District leadership in each of these UNCDA branches was actively engaged. These include; District Health Officers, Chief Administrative Officers, Town Clerks, Mayors, District Chairpersons and Resident District Commissioners.
Some were volunteers constituting the UNCDA branch executive teams while others participated in community mobilisation, sensitisation and screening.
Screening tests for 3 main NCDs (Heart disease, Cancer, Diabetes) were carried out including random blood sugar test, blood pressure, cervical cancer and breast examination, as well as weight and height for to rule out overweight/obesity.
Of more than 1,086 people who were screened (mean age 38 years, ranging between 11&102 years), 58% (624 people) were female while 42% (462 people) were male.
Of the 1,052 individuals for whom the Body Mass Index (BMI) was calculated, about 58.5% had normal BMI (18.5-24.9) and 31.3% were overweight and obese (BMI≥25). Also, 27.4% of 1,001 individuals screened had raised systolic pressure (sBP≥140mmHg), 21.9% had raised diastolic blood pressure (dBP) (dBP≥89mmHg) while 15.4% had raised systolic and diastolic pressure.
About 69.5% and 27.3% of 931 individuals had normal (4-5.9mmol/L) and raised blood glucose (≥6.5mmol/L) respectively.
On-site screening revealed statistically significant differences in systolic blood pressure (Pvalue=0.004, 95%CL) between male and female participants. While differences among male and female diastolic blood pressure (Pvalue=0.25, 95%CL) and random blood sugar (Pvalue=0.82, 95%CL) levels were not statistically significant different.
Sensitization about the effects of tobacco was also carried out through open sensitization at various venue and during radio talk shows aired at; Delta FM- 97.0 (Soroti), Voice of Serere-89.4FM (Serere), Kasese Guide Radio-100.5FM (Kasese) Heart FM-103.1 (Mubende) and Arua One FM-88.7 (Arua).
Whereas tobacco was the main agenda, the need to reduce other risk factors was emphasized. For example in Kasese district, UNCDA inaugurated an aerobics club aimed at promoting physical activity in the district. This was in support of the district health office, and volunteers from various organizations working in the Kasese District.
Local communities exhibit high demand for NCD screening services yet health facilities are overburdened. As a pilot therefore, UNCDA together with the District Health Officers have selected health facilities mainly health centers III and IV in the respective districts where NCD corners are/will be hosted and NCDs screening services provided.
The Health facilities include Kasese Municipal Council H/C III in Kasese District, Iyolwa H/C III in Tororo District, Bukanga Health Center III in Luuka district, Arapai H/C IV in Serere District, Amuria H/C IV in Amuria, Kiganda H/C IV in Mubende District, Badege HCIII in Gulu and Nakasongola HCIV in Nakasogola.
The NCD corner is a strategy that provides basic NCD screening and information integrated within the general operations of the health facility. This is aimed at increasing access to NCDs services and awareness on; NCDs risk factors, services availability and referral network within the mainstream health system.
UNCDA strongly hopes that the NCDs corners will encourage NCDs screening for all individuals who seek medical care for other illnesses.
Community knowledge, attitudes and practices
It is evident that a lot needs to be done in Uganda to combat non-communicable diseases. Sadly though, one of the major challenges impeding progress is that health facilities as big as health centre IV are short in supply of some essential NCDs services including; medicines, testing equipment and trained personnel amidst the overwhelming numbers seeking NCDs services and persons living with NCDs.
The levels of awareness are also wanting for example; a large segment of the public is not informed about the tobacco control Act that was passed in 2015.
Much as majority of the people are very willing to adhere to lifestyle changes, this has been rather difficult, many accord more importance to avoiding alcohol and tobacco than having a good diet and physically active life regarding NCD prevention and risk reduction.
Yet, ideally the same focus should be given to reduction of all risk factors given their synergistic interaction. This calls for continuous multi-dimensional awareness campaigns against NDCs.