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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 77-83

Interrelationship between noncommunicable diseases, COVID-19 and sociodemographic index in the economic community of West African States


1 Department of Community Medicine, University of Ibadan; Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
2 Department of Community Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria

Date of Submission07-Apr-2021
Date of Acceptance13-May-2021
Date of Web Publication16-Jul-2021

Correspondence Address:
Miss. Aanuoluwapo Adeyimika Afolabi
Department of Community Medicine, University of Ibadan, Ibadan, Oyo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_16_21

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  Abstract 


Background: Noncommunicable diseases (NCD) increase COVID-19 morbidity and mortality.
Objective: This study aimed to describe the interrelationship between NCD, COVID-19, and sociodemographic index (SDI) in the Economic Community of West African States (ECOWAS).
Methods: We extracted data from the global burden of disease (GBD) estimates. The GBD was used to estimate variations in epidemiologic data sources, model predictions, and 95% corresponding uncertainty intervals (UIs) for disability-adjusted life years (DALY). COVID-19 data were extracted and collated from web-based repositories as of December 18, 2020. We assessed the strength of association between the number of COVID-19 cases per thousand population, COVID-19 deaths, case-fatality rate, SDI, and DALY due to NCD using Pearson's correlation test. The level of statistical significance was P < 0.01.
Results: Ghana's SDI of 0.56 and DALY% (95% UI) due to NCD of 40.66 (36.05–44.98) was the highest. Ghana had 177 COVID-19 cases/100,000 population while Niger has 11 cases/100,000 population as of December 18, 2020. Niger's SDI of 0.16 and DALY% (95% UI) due to NCD of 21.22 (16.72–25.6) were the minimum. We found a strong positive correlation between COVID-19 cases per thousand population and DALY due to NCD (r = 0.870, P<0.001, n = 15) and a strong positive correlation between SDI and DALY due to NCD (r = 0.647, P = 0.009, n = 15).
Conclusion: Countries with higher SDI and DALY due to NCD experienced higher COVID-19 cases. NCD prevention and control should be promoted to reduce COVID-19–related mortality and morbidity in the ECOWAS.

Keywords: Chronic disease, coronavirus disease, health promotion, socioeconomic factors, West Africa


How to cite this article:
Ilesanmi OS, Afolabi AA. Interrelationship between noncommunicable diseases, COVID-19 and sociodemographic index in the economic community of West African States. Int J Non-Commun Dis 2021;6:77-83

How to cite this URL:
Ilesanmi OS, Afolabi AA. Interrelationship between noncommunicable diseases, COVID-19 and sociodemographic index in the economic community of West African States. Int J Non-Commun Dis [serial online] 2021 [cited 2021 Aug 5];6:77-83. Available from: https://www.ijncd.org/text.asp?2021/6/2/77/321619




  Introduction Top


The Coronavirus disease, a global pandemic, has been rapidly transmitted across the globe.[1],[2],[3],[4],[5] As of April 7, 2021, 133,196,728 COVID-19 cases and 2,889,730 COVID-19 deaths had been recorded globally, of which West Africa accounts for 3.5% of cases and 4% of COVID-19 deaths.[6] The symptoms of COVID-19 include fever, headache, cough, and breathing difficulties; and isolation at home or in health facilities has been recommended.[7],[8],[9],[10] Fifty percent of households in the low socioeconomic class lack hygiene facilities, a factor that increases their vulnerability to COVID-19 and other infections.[11],[12],[13],[14] Underlying conditions also increase individual susceptibility to COVID-19 and other illnesses and place other members of the household at a higher risk of being infected.[15] This linkage has been suggested as the underlying factor for many diseases in the Economic Community of West African States (ECOWAS). The lingering vulnerability of the ECOWAS therefore makes the region more susceptible to both noncommunicable diseases (NCD) and COVID-19.

The global burden of disease (GBD) from 2015 study introduced the sociodemographic index (SDI), a measure that combines information on education, income per capita, and fertility.[16] A comparison of SDI and disability-adjusted life years ( DALY) in the literature shows that age-standardized DALY rates for many communicable diseases declined over time, while improved SDI correlated strongly with the increasing importance of NCD.[17] It has been validated in the literature that the differences in the incidence of COVID-19 cases and deaths are principally influenced by NCD and SDI.[18],[19],[20] Understanding the intricacies between NCD, COVID-19, and SDI in the ECOWAS region would be important to implement national policies and strategies to address these diseases. This study therefore aimed to describe the interrelationship between NCD, COVID-19, and SDI in the ECOWAS region.


  Methods Top


The ECOWAS refers to countries within the West African subregion with socioeconomic and political ties. The alliance was inaugurated in 1975 and currently has 15 member states with an estimated total population of 386.91 million population as of 2020.[21] These countries also have subregional health infrastructure that can be harnessed in improving the health and the development of their countries. The 15 ECOWAS member states include Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo.[21]

Global burden of disease 2019 study

The GBD 2019 study methods and results have been described in extensive detail elsewhere, including a description of the analytical estimation framework used to measure deaths, years of life lost (YLL), years lived with disability (YLD), and DALY.[22] The methodological components and SDI calculation are summarized below.

Global burden of disease cause list

The GBD study provides a standardized approach for estimating incidence, prevalence, and YLD by cause, age, sex, and year. In the GBD study, the causes and their sequelae are organized into hierarchical levels. Level 1 contains three broad cause groups: communicable; maternal, neonatal, and nutritional diseases; NCD and injuries.[22]

Data sources

We extracted and collated COVID-19 data from web-based repositories of the Oxford University Blavatnik School of Government as of December 18, 2020.[23]

The process for nonfatal estimation began with the compilation of data sources from a diverse set of possible sources, which included 21 possible Global Health Data Exchange (GHDx) data types ranging from scientific literature to survey data to epidemiological surveillance data. All results are available via the GBD Compare website (https://vizhub.healthdata.org/gbd-compare/), and all input data are identified via the GHDx website (http://ghdx.healthdata.org/). The study was performed in compliance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) for reporting health estimates.[22]

Sociodemographic index

The SDI is a composite indicator that includes income per capita, average educational attainment over age 15, and total fertility rate under age 25.[22] The SDI has a value that ranges from zero; representing the lowest income per capita, lowest educational attainment, and highest fertility under age 25 observed across all GBD geographies from 1980 to 2019, to one; representing the highest income per capita; highest educational attainment, and lowest fertility under age 25 that are no longer associated with health outcomes.

Disability-adjusted life years

The DALY is a summary metric of diseases or injuries, defined as the number of years lost due to ill-health, disability, or premature death and was computed as the sum of YLL and YLD for each year and age.[22]

Uncertainty analysis

We apply the same technique for propagating uncertainty as used elsewhere in the GBD study design.[22] The distribution of every step in the computation process is stored in 1000 draws that are used for every other step in the process. The distributions are determined from the sampling error of data inputs, the uncertainty of the model coefficients, and the uncertainty of severity distributions and disability weights. Final estimates are computed using the mean estimate across 1000 draws, and the 95% uncertainty intervals (UI) are determined based on the 25th and 975th ranked values across all 1000 draws.

Guidelines for Accurate and Transparent Health Estimates Reporting compliance

This study complies with the GATHER recommendations. The analyses were conducted in DisMod-MR 2.1; the GBD meta-regression tool that adjusts for variations in epidemiologic data sources and other parameters, including model predictions, as well as propagates uncertainty around the estimates. DisMod-MR 2.1 also estimated 95% corresponding UI for all death, YLL, YLD, and DALY.[22]

Data analysis

Data were entered and analyzed using SPSS version 23, Armonk, New York, Unites States.[24] Pearson's correlation test was conducted to assess the strength of association between the number of COVID-19 cases per thousand population, COVID-19 deaths, COVID-19 case-fatality rate (CFR), SDI, and DALY due to NCD. The level of statistical significance was set at P < 0.01.


  Results Top


Benin has an SDI of 0.35. In Benin, the DALY% (95% UI) due to Group 1 diseases is 66.45 (62.49–70.99), DALY% (95% UI) due to NCD is 28.09 (23.94–31.82), and the DALY% (95% UI) due to injury equals 5.46 (4.65–6.26). The Gambia has an SDI of 0.40. In The Gambia, the DALY% (95%UI) due to group 1 diseases equals 52.91 (47.53–57.87), DALY% (95% UI) due to NCD is 41.40 (36.06–46.29), and the DALY% (95% UI) due to injury is 7.04 (5.78–8.19). Nigeria has an SDI of 0.52. In Nigeria, the DALY% (95% UI) due to Group 1 diseases is 68.74 (64.27–73.33), DALY% (95% UI) due to NCD equals 26.78 (22.40–30.85), and the DALY% (95% UI) due to injury is 4.47 (3.70–5.33). Group I diseases and total NCD percent of total DALY for other countries in the ECOWAS region for 2019 are as shown in [Table 1].
Table 1: Group I diseases and total noncommunicable disease percent of total disability-adjusted life years in the economic community of West African States region for all ages and both sexes, 2019

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In Benin, 26 COVID-19 cases/100,000 population and a total of 2090 COVID-19 cases have been recorded as of December 18, 2020. The CFR is 1.4%, and a total of 44 COVID-19 deaths have been recorded in Benin as of the reference date. In The Gambia, 172 COVID-19 cases/100,000 population and a total of 3786 COVID-19 cases have been recorded as of December 18, 2020. The CFR is 3.2%, and 123 COVID-19 deaths have been recorded in The Gambia as of December 18, 2020. In Nigeria, 38 COVID-19 cases/100,000 population and a total of 76,207 COVID-19 cases have been recorded as of December 18, 2020. The CFR is 1.6%, and 1201 COVID-19 deaths have been recorded in Nigeria as of the reference date. The COVID-19 experience and CFR across other countries in the ECOWAS region are as shown in [Table 2].
Table 2: Coronavirus disease-2019 experience and case fatality rate across countries in the economic community of West African States region as of December 15, 2020

Click here to view


From [Table 3], we found a strong positive correlation between the number of COVID-19 cases per 100,000 population and the DALY due to NCD (r = 0.870, P<0.001, n = 15). Further, a strong positive correlation existed between SDI and DALY due to NCD (r = 0.647, P = 0.009, n = 15).
Table 3: Correlation between number of cases of coronavirus disease-2019 positives per thousand population, coronavirus disease-2019 deaths, case-fatality rate, sociodemographic index, and percentage disability-adjusted life years due to noncommunicable diseases

Click here to view



  Discussion Top


In 2019, we found that all the countries in the ECOWAS region, except Cape Verde, had high DALY from Group 1 diseases. A reverse was observed from NCD and injuries where all countries, except Cape Verde, had low DALY values. We found a strong positive correlation between SDI and DALY from NCD. Increase in SDI has been linked to increased affordability of unhealthy diets. Unhealthy diets, such as, inadequate vegetable intake, sugar and fatty foods, could result to obesity, and these have been reported as risk factors for NCD, e.g., coronary heart disease. The impacts of unhealthy dietary pattern during childhood linger well into adulthood and could increase the likelihood of occurrence of NCD.[25] Similarly, literature has reported risk variables for injury to include high sugar intake, increased tendency for sedentary life, high salt and fat intake, excessive sitting, and general obesity.[26] From 2017 till date, Cape Verde has had one of the highest SDIs in the ECOWAS region. These arrays of evidence could therefore provide understanding to the high DALY from NCD and injury recorded in Cape Verde.

The low DALY from Group 1 diseases in Cape Verde suggests that the high level of health infrastructures and workforce help avoid many preventable disabilities due to malaria, diarrhea, maternal, and neonatal diseases. Therefore, other countries in the ECOWAS region should work toward self-development to ensure that productive years of individuals are not lost to preventable causes. Further, health education sessions should be regularly organized, especially for women of child-bearing age and their spouses. In addition, community health workers and traditional birth attendants should be empowered to adequately educate pregnant women in rural communities on the prevention of malaria, diarrhea, and other illnesses in their children after delivery. Furthermore, health facilities should be adequately equipped with skilled workforce and material resources, such as insecticide-treated nets for regular distribution in health facilities and communities. As countries strive toward advancing national wealth, it is essential that nutrition-focused health interventions are organized. Recommendations on healthy food combinations should be regularly provided. This will ensure that national development does not adversely influence dietary intake to increase the risks for NCD among the members of the population.[27]

Findings from this study revealed a strong positive association between the number of COVID-19 cases per 100,000 population and the DALY due to NCD. This implies that the higher the DALY due to NCD in each country in the ECOWAS region, the higher the number of COVID-19 cases. NCD have been identified as risk factors for morbidity and mortality due to severe acute respiratory syndrome Coronavirus 2, and this is buttressed by our findings. In lieu of this, the reduction of individual vulnerability to both COVID-19 and NCD should be adequately communicated on a nationwide level across both the traditional and modern media. Regarding COVID-19, residents of the ECOWAS should be well informed on public health safety measures, such as hand hygiene, use of face masks at all times outside the home, and social distancing (at least 1 m) to prevent COVID-19.[3] In addition, the need for voluntary testing and testing locations for contacts of confirmed COVID-19 cases (that is, eligible COVID-19 cases) and symptomatic persons (with one or more symptoms such as fever, coughing, and sneezing persisting for up to 3 days) should be broadcast with simplicity and understanding.[28]

For NCD, public health campaigns on timely and regular body checkup in health facilities should be conducted. During some global public health events, e.g., breast cancer awareness observed annually in October, breast cancer screening exercises are being conducted at subsidized costs. Instances of these laudable events have been recorded in Nigeria and Ghana and should be adopted in other countries.[29],[30] The subsidy placed on health interventions during this period overcomes the financial difficulties associated with their uptake compare to other periods in the year, thus enhancing community-wide acceptance. However, it is needful that health freebies are not restricted to celebration of public health events. Rather, government and corporate bodies in each country should partner to organize regular health interventions and provide referral services for persons in need of such.

Limitations

Our analysis had some limitations. First, as SDI and time are correlated, we may have over-interpreted SDI as a driver of change as it could well be driven largely by other factors changing over time.

Second, major limitations of the cause-of-death data are: Low or absent coverage of vital registration or verbal autopsy data in many parts of the subregion and incompleteness of death certification systems.


  Conclusion Top


The pattern of COVID-19 reflects a positive relationship with DALY from NCD. In addition, increase in SDI increases DALY from DALY due to NCD. Therefore, we recommend an increased awareness on COVID-19–preventive measures (such as use of face masks, regular hand hygiene, and social distancing) on traditional media, e.g., radio and television, and modern media, e.g., social media. Willingness to undergo COVID-19 testing should be encouraged in community settings. For individuals and communities in the West African subregion, the COVID-19 vaccine should be widely acceptable as a potent preventive measure for COVID-19 when it becomes available. In this regard, community stakeholders should be actively involved in debunking falsehood surrounding the COVID-19 vaccine. Equitable distribution of the COVID-19 vaccine should be prioritized by policymakers. For NCD, the consumption of healthy home-made foods should be increasingly adopted. The practice of subsistence agriculture in homes to ensure availability of vegetables and fruits at limited costs should be widely accepted. Further, public health campaigns on timely and regular body checkup in health facilities and during public health events should be conducted. Policies should be implemented to ensure the availability of screening services for illnesses, e.g., breast cancer. On the walk toward development, policies should likewise be implemented to remove inequalities in vaccine accessibility and affordability. In addition, increased availability of skilled health personnel, empowerment of traditional birth attendants and community health workers, and increased availability of health infrastructure should be prioritized across all countries in the ECOWAS region.

Paper context

Empirical studies suggest that the differences in the incidence of COVID-19 cases and deaths are principally influenced by NCD and SDI. This study found a strong positive correlation between the number of COVID-19 cases per 100,000 population, SDI, and the DALY due to NCD. Policies such as nutrition education should be implemented to prevent and control NCD mortality and morbidity due to COVID-19 in West African countries.

Data availability statement

Information about the data presented in this study could be obtained from Oxford University Blavatnik School of Government (https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker#data). ORCID identifiers: 0000-0003-0827-6442, 0000-0001-9928-2252.

Ethical approval statement

This study used secondary data for analysis. Thus, ethical approval was not required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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