NCDs, including cancer, diabetes, heart and lung diseases, constitute the major reason for mortality globally and accounted for 72% of all deaths in 2016 of which nearly half were people younger than 60 years (so-called premature deaths). Nearly 3/4 of NCD deaths and most premature deaths (82%) occur in low and middle income countries (LMICs). The human toll taken by NCDs should be reason enough for taking urgent action; but the economic impacts of inaction underscore that the world cannot afford to stand by and watch NCDs destroy lives, families and communities.
At the broader NCD level, these diseases together pose the fastest growing disease burden and a development challenge in East Africa in the coming decades. While mortality due to infectious diseases decreased by 10% from 2000 to 2012, the mortality due to NCDs rose from 21% in 2000 to 30% in 2012. The World Health Organisation (WHO) projects that by 2030 in Sub Saharan African (which includes East Africa), NCDs will overtake infectious disease as the main cause of death from the current 30% to 42%, if nothing is done to reverse this trend. Researchers have noted that the East African regions is already experiencing rapid epidemiologic, demographic, and nutritional transitions, which abet the NCD scourge. Worryingly, it has been noted that in developing countries like East Africa, NCDs are also creating social inequality as the risk factors and cost burden are shifting towards the poor. All these indicators reflect a need for urgent action on diabetes and other NCDs in the East African region. Additionally, it is projected that ‘proportional change in number of people
with diabetes between 2013 and 2035’ will be 133%, 166.9% and 123.5% for Kenya, Uganda and Tanzania respectively. If this is to be extrapolated to include other countries of East Africa like Burundi for which there was no data, it would mean that the region is to experience an average of 141.1% increase in the number of diabetes cases by 2035 if no urgent action is taken.
NCDs are increasing rapidly in Burundi’s neighbouring countries, and everything points to the fact that NCDs are also increasing rapidly in Burundi. Burundi did not conduct a WHOs STEPS Survey, designed to document the prevalence of NCDs and risk factors, why the available data on NCDs is even lower in Burundi than elsewhere. However, the few studies that have been conducted point clearly to the fact that NCDs are already widespread. According to the World Food Program, 32% of Burundi’s population is chronically food insecure. As a result, underweight levels are 25% .This is due to low agricultural productivity, land degradation due to overuse, and poor farming methods. Investments in improved data are needed to assist policy makers and political leaders in making better decisions to address NCDs.
The burden of infectious diseases like HIV/AIDS, Malaria and tuberculosis is still overwhelming in Burundi and with the increase of NCDs the country is challenged by a double disease burden.
There is currently no political attention paid to NCDs in Burundi and only very limited donor attention on the matter. Perhaps less surprisingly, knowledge about NCDs and their risk factors is very low or non-existent amongst the general population.
A pilot survey made by the government (following pressure from civil society organisations) found that 25.2 % had hypertension and 1 % had diabetes. It also found that 20 % of the population used tobacco and staggering 88 % are drinking alcohol (although the quantities are not clear).Dr Francois NDIKUMWENAYO recently conduct a cross-sectional study in 2018 among 739 patients living with NCDs. The study found the morbidity linked to NCDs accounted for 31.40%, the admission rate of PLWNCD in internal medicine represented 93.78% compared to other diseases, the main risks factors associated to NCDs were as following, tobacco accounted 20.43%, alcohol represented 78.62%, overweight was 20.03%,the case fatality rate accounted to 43.71%,the age specific-death represented 71.94% with an average age about 59.37 years old.
NCD is a public health health challenge in Burundi and requires a multi-sectoral and a holistic approach to tackle them. This paper explores the implication of civil society organization in prevention and control of NCD in Burundi. Dr Alexis NIZIGIYIMANA ,who is working as the program manager at Burundi NCD Alliance(BNCDA), highlights the activities and solutions over a period of 2 years working in BNCDA .From this, The Burundi NCD Alliance (BNCDA) was established in 2015 (the original members being Burundi Asthma Association, Diabetes Association, Epilepsy Association and Cancer Association). As part of The East African NCD Alliance Sustainability Project.
Furthermore, BNCDA received financial and technical support from DNCDA and EANCDA to develop its constitution, action plan and broadening the membership base. As result, the membership recruitment activities were successful and the following member associations have now joined BNCDA: Burundi Heart Foundation, Burundi Mental Health Support, Burundi Tobacco Initiative and Unhealthy Diet, Burundi Action against Obesity, Christian initiative against Trauma Association and Burundian Medical Student Association. They also succeeded to recruit 20,000 individual members and around 500 young people living with diabetes from 2015 up to 2018. BNCDA has more than 100 active volunteers, including medical students, psychologists, economists, medical doctors, and lecturers at University, who volunteer their time to support BNCDA’s activities.
This start made it possible for BNCDA to get a CISU support to implement the Capacity for citizen driven advocacy for prevention of NCDs project in Burundi. This project trained board members and the project manager on governance and other relevant topics. Furthermore, 50 volunteers were recruited and trained and then led a number of NCD outreaches and community dialogues with people living with NCD activities. Other successes were massive media attention and engagement of MPs in the NCD movement and collaboration with Ministry of Health (MoH). The project entailed collection and publishing of patient stories and voices as well as screening of 1000 people in two rural provinces where 10.9% was diagnosed with diabetes and referred to the district hospitals. The current project supports 30 community dialogue meetings across the country, where 300 PLWNCD, neighbours, family members, friends and caregivers shared the stories and experiences perception and recommendations about NCD prevention and controls and access to essential medicine.
Additionally, this project succeeded to launch a NCD Media Forum (NMF), which is a group of medical doctors, medical students, bloggers and journalists committed to prevent and to control of NCDs , which is aiming to reach the large population to get access to health information on NCDs .
In conclusion, the chronic diseases is obviously becoming a global health issues particularly in developing countries including Burundi, which requires an urgent action ,partnership and global response with a multi-sectoral approach to address them. BNCDA, Government, NCD Media Forum, NGO, public and private sector should work together, and leverage on existing national health partnership including international agencies given their great resource.
We are grateful to the BNCDA, DNCDA, MoH and EANCDA for your support.
Authors: Dr Alexis Nizigiyimana, Anicet Ntisumbwa.
 The Lancet 2018, Bertram, Sweeny, Lauer, et al. Investing in NCDs: an estimation of the return on investment for prevention and treatment services.
 The cost of continued underinvestment in the fight against NCDS has been estimated at USD 47 trillion in lost GDP globally from 2011-2025 (world economic forum 2011, Bloom, Cafiero et.al. the global economic burden of NCDs),
 WHO, 2015 progress monitor
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 WFP CFSVA