Everyone is familiar with infections spread by germs as well as non-communicable diseases (NCDs), which may be chronic or not.
However, the burden of NCD in Malawi keeps increasing. They include heart attacks, stroke, cancers, diabetes and chronic respiratory diseases such as chronic obstructive pulmonary disease and asthma.
A third of patients in Malawi seek medical attention for diabetes and high blood pressure. Diabetes increases the risk of chronic kidney diseases.
Gone are the days NCDs were thought to be “rich and noble diseases” of townspeople.
Currently, there is a huge spread and impact of these silent killers in rural communities. NCDs do not spare anyone.
In sub-Saharan Africa, including Malawi, infectious diseases—mainly Aids, tuberculosis and malaria—are the leading killers.
However, a parallel increase in patients of NCDs has exposed severe gaps in national healthcare systems, including clinical laboratory networks.
This threatens the health and well-being of the population and economic growth.
Unlike most infectious diseases caused by a single germ that can be effectively controlled through vaccines and drugs, chronic NCDs cannot be cured and may have no effective control because of their complicated origins.
As such, the death rates and burden of NCDs continues to increase.
The most effective strategy to manage chronic NCDs lies in early diagnosis, allowing for lifestyle changes and early intervention.
Early detection often relies on simple and inexpensive laboratory medicine tests performed close to the patient. This includes measuring blood glucose to diagnose diabetes.
Sadly, laboratory infrastructure in public hospitals remains insufficient and distances to clinics for laboratory tests are long.
Yet laboratory medicine is crucial not only in the diagnosis of NCDs, but also follow-ups and management of individual patients.
In communities, laboratory tests provide vital data to establish the commonness of NCDs, detect increases and estimate the geographical distribution of specific conditions.
Diagnosing NCDs in remote settings is difficult without well-equipped clinical laboratories and trained staff. At worst, laboratories lack electricity, safe water, reagents and biomedical engineers to repair equipment.
Currently, most rapid tests at community level target infectious diseases such as HIV and malaria—not simple chemical tests for NCDs.
Knowing whether one has NCDs is further complicated by poor roads, poverty, long travels to clinics and low understanding of disease processes.
Old people are mostly accused of witchcraft when one does not understand the cause of illness or death. Many patients are not diagnosed at all and may die without health officials knowing the cause.
Others seek treatment at an advanced stage of chronic illnesses when symptoms are prevalent.
International guidelines for diagnosis of NCDs are seldom followed in Malawi as there is little primary care screening and testing.
Malawi Health Equity Network executive director George Jobe once lamented that Malawi’s healthcare budget cannot adequately accommodate NCDs because so much attention is given to HIV and Aids.
This is due to the country’s failure to implement the Abuja Declaration, which requires the government to allocate 15 percent of the national budget towards healthcare.
Inadequate fund the fight against NCDs means that most patients struggle to access laboratory services.
Investing in routine medical check-ups at local level, with requisite laboratory testing, will improve early diagnosis of NCDs and reduce the risks of advanced stages of chronic diseases.
This will also reduce the high cost of managing the complications of NCDs.
Many NCDs are deadly but preventable.
However, screening, early detection and good case management contribute to quality life and reduce debilitating illnesses and deaths.
Therefore, comprehensive but priority-driven healthcare reforms that focus on all health system functions, including strengthening laboratory networks, are essential.
This will save lives of millions of Malawians who require diagnosis, monitoring and risk factor management of NCDs in the next decade.