Non-communicable diseases in Sub-Saharan Africa : the case for cohort studies

Holmes, Michelle D. ; Dalal, Shona ; Volmink, Jimmy ; Adebamowo, Clement A. ; Njelekela, Marina ; Fawzi, Wafaie W. ; Willett, Walter C. ; Adami, Hans-Olov (2010-05-11)

CITATION: Holmes, M. D., et al. 2010. Non-communicable diseases in Sub-Saharan Africa : the case for cohort studies. PLoS Medicine, 7(5): 1-8, doi: 10.1371/ journal.pmed.1000244.

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We believe there is an urgent need for longitudinal cohorts based in sub-Saharan Africa (SSA). This conclusion is drawn from the fact that non-communicable diseases (NCDs) cause a large and growing disease burden (please see Box 1) [1–6]. In the past, public health in SSA has focused on communicable diseases. The advent of HIV/AIDS reinforced this image of infections as SSA’s major health burden. However, NCDs, including cardiovascular diseases, mental illnesses, trauma, cancer, and diabetes, are now major sources of morbidity and mortality and are projected to overtake infectious diseases by 2030 [7,8]. We argue that SSA lacks adequate resources to respond to this problem. Prospective cohort studies can be used to study multiple complex diseases and risk factors simultaneously over an individual’s lifetime. Such studies have proved crucial in understanding the etiology, course, and outcome of NCDs in other populations and have informed the design of prevention programs. In addition, cohort studies provide an incomparable resource for the training of public health researchers. Because the payoff from cohort studies continues—and often grows—over time, they are a long-term investment in public health. In order to highlight the potential impact of cohort studies in SSA, we compared published literature on NCDs from longitudinal studies in high-income countries to publications from Africa. Further, we estimated the costs of establishing cohort studies in SSA and describe the response needed to correct the disparities in research investment between SSA and the world’s more wealthy regions.

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