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AFRICA
Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S40
response to a growing problem of NCD in the country.
17
The
purpose of the plan is to help achieve preventative national
goals and establish collaboration with ministries, other
relevant governmental and non-governmental agencies,
interested partners and the public at large.
Results from the STEPS survey were incorporated
into the national NCD strategic plan, along with various
guidelines and policy documents that were developed.
Examples are the WHO global action plan, the Health
Sector Strategic Plan IV of 2015–2020, and Global
Sustainable Goals to curb the growing NCD problem.
12
In 2012, the STEPS survey on NCD risk factors revealed
that the burden of diabetes and CVD was high, with the
prevalence of hypertension estimated to be around 26%.
Hyperglycaemic disorders (pre-diabetes and diabetes)
were high at all ages, with an estimated total prevalence of
around 20%.
19
Locally relevant (national or sub-national)
clinical guidelines for the detection and management of
AF and atrial flutter are incorporated in the integrated
standard guidelines.
14
Non-governmental organisations such as the Heart
Foundation of Tanzania (HFT) play a very active role
in advocacy for CVD policies and programmes. The
involvement of civil society, such as the TTCF,
6
assisted in
the development and implementation of a national tobacco
control plan. Legislation regarding tobacco control is also in
effect about banning smoking in indoor workplaces, public
transport, indoor public places and other public places.
A law mandating clear and visible warnings on foods
that are high in calories, sugar and saturated fats has also
been implemented. Since 2019 Tanzania has introduced
taxes on sugar-sweetened beverages. Other civil society
involvement includes the development and implementation
of a national CVD prevention and control plan as well as
the national multi-sectoral co-ordination mechanism for
NCD/CVD through the Tanzania NCD alliance,
26
HFT and
Tanzania Diabetes Association.
Threats
The WHO STEPS survey, which was carried out in the
country in 2012, showed that the levels of NCD risk factors
are high.
19
These risk factors included the prevalence of
diabetes, hypertension, obesity, and alcohol consumption.
Low levels of PA and eating less than five servings of fruit
and/or vegetables were also reported.
19
Although the global data reflecting the total percentage of
deaths caused by CVD is 31.8%, Tanzania's was almost 13%
in 2017.
5
Mortality caused by hypertensive heart disease was
1.43%, which was slightly lower compared to the 1.65% of
the global data (infographic).
Weaknesses
Although surveillance and monitoring of NCD in East
Africa, which includes Tanzania, have been implemented,
NCD are still not sufficiently integrated into national health
information and management systems.
27
There is also a
limited capacity of health personnel for surveillance and data
collection on NCD.
27
The Standard Treatment Guidelines and National
Essential Medicines List are available, but these have not yet
been implemented. In 2017, CVD essential medicines were
not available at the public health level.
14
Aspirin, metformin
and insulin were available at the dispensary level, while ACE
inhibitors and β-blockers were the only drugs available at a
primary healthcare level. Of the eight CVD essential drugs,
simvastatin, warfarin and clopidogrel were available only at
the hospital level.
14
No data are available on policies that ensure equitable
nationwide access to healthcare professionals and facilities
or which ensure screening of individuals at high risk of CVD.
According to the executive director of the TTCF, Ms
Kagaruki, Tanzania is behind other African countries in
its progress towards implementing the WHO framework
convention on tobacco control. Yet more than 10 years have
elapsed since approval, with no legislation passed to replace
the outdated 2003 Act.
29
Legislation banning the marketing of unhealthy foods
to minors and policy interventions that promote a diet that
reduces cardiovascular risk or facilitate PA are not yet in
place.
Priorities
The objectives of the national NCD programme launched
on 14 November 2019 include training physicians, nurses
and community health workers and rolling out an NCD
screening programme. Furthermore, they include reviewing
and amending existing health policies in the country,
establishing patient record systems, and awareness-raising
and mobilisation at the community level.
NCD burden
To reduce the burden of NCD through health promotion, and
reduction, prevention, treatment and monitoring of their risk
factors, particular attention should be given to interventions
and surveillance to address this problem.
30
Diabetes
Tanzania introduced strategic interventions to reduce
modifiable NCD and their risk factors by 2020.
17
One of the
goals was to ensure a 10% relative reduction in the prevalence
of diabetes from baseline, along with a 20% reduction in the
overall mortality rate from diabetes. Actions to enable these
reductions are:
• community sensitisation on a healthy diet and PA
• early detection and appropriate management of diabetes at
all levels
• early detection and management of acute and chronic
complications (foot, diabetic ketoacidosis, infections).
17
Cardiovascular disease
Goals for reducing CVD to be met by 2020 were also
introduced.
17
These are a 25% relative reduction in the
prevalence of raised BP from baseline, 10% reduction from
baseline of TC, and 20% reduction in the overall mortality
from CVD (hypertension, heart failure, stroke, rheumatic
fever, RHD).