Last week, Rwanda Non Communicable Diseases Alliance (RNCDA) in collaboration with Rwanda Biomedical Centre (RBC) conducted an evaluation and training workshop for medical healthcare volunteers.

Held in Kigali, the workshop aimed at reflecting on the past Car Free Day (CFD) healthcare activities over the year and assessing the achievements, challenges faced, and finding new opportunities to improve and expand the impact.

Alphonse Mbarushimana, the executive secretary of Rwanda NCD Alliance, and project manager of the CFD initiative, says RNCDA as the union of the national organisations that work on NCDs, has trained the volunteers over the last year to help NCDs screening and counselling services for Kigali Car Free Day activities.

He says the goal is to expand the impact of national advocacy and awareness on NCDs based on the experience of Kigali Car Free Day through innovative approaches among healthcare volunteers.

"We intend to increase knowledge and skills on NCDs, their risk factors and preventive measures among volunteers. Also, to establish improved coordination and participation of the healthcare partners in CFDs activities,” he says.

BURDEN OF NCDs

Hypertension is still the most common primary detect in clinical practice, worldwide.

The reported prevalence of hypertension in Africa ranges from 25 per cent to 35 per cent in adults aged 25 to 64 years, and increases with advancing age.

Experts say the prevalence of hypertension in Rwanda is high and there is still need for prevention and control interventions aimed at decreasing the occurrence, taking into consideration the risk factors that lead to this.

Whereas recent statistics from RBC indicate that 19.1 per cent of men and 7.1 per cent of women are tobacco smokers; alcohol consumption is common with more than half of men and almost one third of women identified as current drinkers.

30 per cent of men and 17 per cent of women had binged on alcohol in the past 30 days; however, the frequency, duration and intensity of physical activity in Rwanda is high, and this is likely to be protecting Rwandans from NCDs.

Edison Rwagasore, Senior Officer — Diabetes, Chronic Diseases and Other Metabolic Diseases at RBC, says the majority of physical activity is work related; 75 per cent  of participants are within a healthy weight range while 17.1 per cent  of participants are overweight or obese, with the highest prevalence in women and in urban areas.

Car Free Day health activities are not just for screening purposes, but to create awareness to educate people on healthy lifestyle choices in general./File photo

WHAT TO KNOW ABOUT NCDS

According to a World Health Organisation (WHO) 2016 description, health education is any combination of learning experiences designed to help individuals and communities to improve their health and lifestyle, by increasing their knowledge and awareness to health conditions and diseases; which influence their attitudes and encourage them towards positive behaviour change.

Professor Joseph Mucumbisti, a paediatrician at Oshen-King Faisal Hospital in Kigali, cardiologist and president of Rwanda Heart Foundation, says significant progress has been made in the NCDs response at the global level.

He says the Ministry of Health has played an instrumental role in setting national health strategies that reflect the unique context of our country.

"NCDs are an emerging trend of the diseases that are affecting humans at different ages, according to their lifetime encounters,” he says.

He says historically, NCDs have been considered ‘diseases of the rich and elderly’. However, NCDs are severely affecting people in low and middle income countries, including Rwanda.

For instance, he says, four out of five people with an NCD live in a low or middle income country.

Private Kamanzi, a nutritionist and member of RNCDA, says NCDs are largely driven by four main modifiable risk factors.

These, he says, include tobacco use, unhealthy diets, physical inactivity, and use of alcohol.

He says there is need for primary healthcare as a preventive measure by raising NCDs awareness, their risk factors, their complications and early detection that will ensure early management.

Participants during a previous Car Free Day exercise. /Courtesy

MORE EFFORT NEEDED

Mucumbisti says to improve on Car Free Day health activities, community screening should be done.

He says the main goal is not for NCDs diagnosis, but also for awareness to educate people on healthy lifestyle choices in general.

"Those above the age of 35 for women and 40 for men should do annual check-ups. This is even easier and cheaper because health insurance for patients is covered, what is needed is to just make it a routine,” he says.

Mucumbisti says that people shouldn’t just show up for screening only during Car Free Day, but use the opportunity to visit a medical centre to ensure they are healthy and on the right track.

Mucumbisti explains that at health centres, they do more than just screening, which is helpful, whereby one is able to be checked on their cholesterol level, haemoglobin A and C to see the progress of diabetes, among others, which can’t all be done during Car Free Day.

Cardiovascular diseases and stroke are the number one killers worldwide with 17.3 million people dying annually, followed by diabetes and its complications, while a group of cancers and respiratory diseases, including asthma, come in third and fourth respectively.

"If people focus on the main risk factors, such as tobacco use, obesity, physical inactivity, harmful use of alcohol and unhealthy diets, controlling them can help prevent 80 per cent of all the NCDs from happening,” says Mucumbisti.

He adds that it’s very important to focus on prevention because the cost of treating NCDs is expensive.

For instance, Mucumbisti notes that cardiac surgeries, radiotherapy and all treatment of cancer costs between USD10, 000 and 25,000. He says instead, people should invest that money in prevention.

SCREENING AND WHY IT’S IMPORTANT

Elise Hirwa Musabimana, a RNCDA volunteer and student at University of Rwanda’s School of Public Health in the College of Medicine and Health Sciences, says what is normally screened during Car Free Day is glucose levels or diabetes, blood sugar and pressure, and body mass index because this is an associated factor for non-communicable diseases.

Others that are screened include eye defect diseases and also oral diseases.

She says that the importance of this is to find out people that are at risk of NCDs.

"After being screened and found to have a problem, individuals are counselled and guided, especially on lifestyle modification,” she says.

However, Musabimana says that even those found with no problem are taken into counselling and advised on how to continue staying healthy.

Kamanzi says the problem with NCDs is that people can have a problem unknowingly. This is because some of the signs and symptoms sometimes surface later in their advanced stage.

"The only way to be saved from this is getting screened, this helps detect the problem and makes the process of managing and treatment easier and less costly,” Kamanzi says.

He adds that screening also aims at making the community aware of NCDs, to be informed of the possible risk factors so that they stay away from them.

Rwagasore says the number of undiagnosed people is alarming, where people go for late consultation with symptoms related to diabetes and hypertension that leads to complicated outcomes.

He says that to prevent this, the only solution is to get screened.

He says that the Government has put in place strategies to enable the population with community-based health insurance, especially females aged 35 and males aged 40, to undergo medical check-ups at least every year.

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