Introduction
In the 21st century, there is a challenge of fighting against a dramatic rise in non-communicable diseases (NCD). These diseases, including cardiovascular diseases of which stroke and ischaemic heart diseases are the most common in terms of mortality, diabetes, hypertension, and cancer. In developing countries, the increasing burden of NCD threatens the already-stretched health services. In Tanzania, the Adult Morbidity and Mortality Project (AMMP) in three local areas: Dar es Salaam City, Hai District and Morogoro Rural District, demonstrated a high risk of dying from non-communicable diseases during adulthood (15-59 years) compared to developed countries.

In 2000, the 53rd World Health Assembly (WHA) passed a

resolution on the prevention and control of NCD with the goal of supporting Member States in their efforts to reduce the toll of morbidity, disability and premature mortality related to NCD. Hence, a WHO global report – “Preventing chronic diseases: a vital investment”.


The status of non communicable diseases in Tanzania
Cardiovascular diseases, which include coronary heart disease (CHD), stroke, rheumatic heart disease, are the leading causes of death and an important factor contributing to disability among NCD.

According to WHO, Hypertension is defined as a systolic blood pressure of 140 mmHg or greater and/or a diastolic blood pressure of 90 mmHg or greater in subjects who are not taking antihypertensive medication. Hypertension was once considered to be rare or nonexistent in indigenous Africans throughout sub-Saharan Africa. The prevalence of Hypertension in Tanzania varies from 2.6% in rural Mara Region to 10.4% in Dar es Salaam. In certain occupational groups the prevalence of hypertension goes as high as 48.9% in high African executives.


Cancer a disease characterized with abnormal proliferation of cells in the affected part of the body with the capacity to grow beyond their usual boundaries, invade adjoining tissues, and may spread to secondary organs or tissues as metastases. Sign and symptoms depend on type, site, size, and stage of the cancer. Cancer is the second leading cause of mortality from NCD. Cancer particularly cervix, uterine and breast cancer among women and lung and prostate cancer among men.

World Health Organization (WHO) estimates that there are approximately 20,000 new cancer patients annually in Tanzania. National cancer statistics are lacking but using data from Ocean Road Cancer Institute (ORCI), a fifty fold increase in the number of patients reporting for treatment at ORCI has been noted from 1975 – 2000. Currently ORCI attends to only 10% of the WHO estimate. In general up to 65% of all the patients attending ORCI are women with cancer of the cervix.

Diabetes mellitus is characterized by increased blood glucose level, and disturbances of carbohydrate, fat and protein utilization that are associated with absolute or relative deficiency in insulin action and / or insulin secretion. Characteristic core symptoms are:-

• Excessive thirst (polydipsia)

• Excessive food intake (Polyphagia)

• Excessive urination ( Polyuria)

The prevalence of diabetes mellitus is 0.6-12.2%. The contribution of diabetes to all causes of mortality due to NCD in adult males ranged from 0.7 – 2.6%, and in female 0.2 – 1.8% (MOH 2001).


Risk factors for NCD

NCD share several common, related risk factors:

• Smoking.

• Excessive alcohol consumption.

• Unhealthy eating habit.

• Physical inactivity.

• Obesity.

• Raised blood pressure.

• Raised blood lipids.

• Raised blood sugar.

Hypercholesterolemia, obesity, impaired glucose tolerance and diabetes, which can be regarded both as disease and a risk factor for cardiovascular diseases; physical inactivity, smoking, and unhealthy eating habits including high fat consumption.

Prevention and control of NCD

The main goals for national NCD prevention and control programmes are to prevent as far as possible the development of NCD in susceptible individuals and communities through modification of :-

Diet:

• Limit pure sugars in food and drinks.

• Encourage consumption of whole meal cereals, vegetables and fresh fruits.

• Restrict the use of animal fats and encourage the use of fish and vegetable oils (except refined palm oil and coconut oil).

• Restrict the addition of salt to prepared food.

Hint:- The advice given should be based on the available type of foods within a community and eating habits within the household.

Weight reduction and maintenance:

Individuals should be encouraged to maintain a normal Body Mass Index (18.5-25kg/m²).

Exercise:

All individuals should be encouraged to undertake regular physical activity at least five times per week.

Health education:

• Harmful effects of smoking and excessive alcohol intake should be emphasized and advice given.

• To provide NCD education for health promotion and self referral to health care professionals.

• To maintain the health and quality of life of individuals with NCD through effective patient care and education. Particular attention should be given to the importance of seeking of medical attention.

• The importance of regularly attending follow-up clinics and compliance with prescribed treatment and advice should be emphasized.

• To prevent and treat obese patients with NCD and thereby decrease morbidity, mortality.

• Screening for early detection of cases.

• Public education.

• Tobacco control through increased taxation and health education is mandatory.