HEALTH ISSUES IN THE GAMBIA

Cigarette Smoking

Cigarette smoking is a very bad habit. It is a greater cause of death and disability than any single disease. It is a known or probable cause of at least 25 diseases at present. Smoking kills 5 million people each year, and this figure is expected to double by the year 2020. In the Gambia, Lower respiratory tract infections caused the most deaths in all ages in 2002 (WHO). Could this be linked to the high numbers of cigarette smokers in the country? Of the 1.1billion smokers worldwide, about 800million live in developing countries like the Gambia.

Smoking and Cardiovascular Disease Smoking decreases the elasticity of the arteries, makes them harder and more susceptible to injury and blockage. In this sense, it increases ones the chances suffering a heart attack or a stroke. It can also compromise the blood supply to the extremities such as the legs and eventually lead to gangrene.

Smoking and Lung Cancer Men who smoke are 22 times more likely to die from lung cancer then those who don’t. Women smokers are 12 times more likely to die from the disease that those who don’t. Cigarette smoke contains irritants which can induce cancerous changes in the respiratory tract.

Smoking and Other Cancers Smoking also increases the risk of oral, uterine, liver, kidney, bladder, stomach, and cervical cancers, and leukaemia.

Smoking and Pregnancy Smoking in pregnancy greatly increases the risk of miscarriage, and is associated with lower birth weight babies. Smoking parents also increase the chances of their children developing respiratory problems such as pneumonia, bronchitis and colds.

CHRONIC DISEASES: THE MENACE OF THE MILLENIUM

Most developing countries (The Gambia included) are going through a transition as far as health conditions are concerned.

True, we still have our fair share of infectious diseases such as Malaria, Tuberculosis and HIV/AIDS. But also of concern is the growing number of non-communicable or chronic diseases such as Diabetes, Hypertension and Cancer.

There are many probable reasons for this apparent increase in chronic diseases:
1. More people are seeking medical attention these days, and so more of these conditions are being diagnosed.
2. We are making some progress in the fight against infectious diseases, and we are beginning to live longer as a result. Chronic diseases tend to manifest in the latter part of life.
3. The third and most disturbing fact is that our lifestyles are changing…for the worst! Chronic diseases are largely influenced by diet and personal habits.

A diet low on saturated fat, regular & tolerable exercise, and a change in personal habits such as smoking and excessive alcohol intake would go a long way in reducing the incidence of chronic diseases. But lifestyle changes have to be started early in life (late 20’s and early 30’s). In 2004, life expectancy at birth in The Gambia was 55.0yrs for males and 59.0yrs for females (World Health Organization, WHO)…A bit on the low side. And to move these figures upwards people are going to have to modify their lifestyles in order to prevent certain diseases from taking root.

It costs far less to prevent a disease than it does to treat it. And most of the time, treatment of chronic diseases is a life long event.

CANCERS IN THE GAMBIA

The pattern of diseases in The Gambia is similar to that in most sub-Saharan countries. In 2005 for example, 64.4% of deaths were due to communicable diseases (such as chest infections, malaria and Diarrhoel diseases), 18.2% were due to cardiovascular diseases (such as hypertension), 9.7% were due to injuries and 7.5% due to cancer. (World health Organization, non-communicable disease surveillance, 2007) Of the estimated 1,100 cancer deaths in 2005, 700 occurred in people under 70 years of age. The World Health Organization projects a 5.7% increase in the number of deaths due to cancer in the Gambia by the year 2030 (a total of 13.2%).

Liver cancer is one of the most common forms of cancer in The Gambia; it is the most common cause of cancer in Gambian men. There is a link between liver cancer and hepatitis B virus infection. .

Hepatitis B can be contracted by coming into contact with the body fluids of an infected person (mostly through the use of sharp objects such as needles or blades or through unprotected sexual intercourse). Excessive alcohol intake can also lead to liver cancer. Prostate cancer is the second most common cancer in Gambian men, followed by cancers of the respiratory system (such as lung cancer).

Cervical cancer is the most common form of cancer in Gambian women. There is a link between cervical cancer and Human Papilloma virus (HPV) infection. HPV can be contracted through unprotected sexual intercourse. The second and third most cancers in Gambian women are liver cancer and breast cancer respectively Certain practices such as the use of non-sterile instruments (during circumcision and tribal marking for instance), and unsafe sexual practices have a role to play in the incidence of cancers in The Gambia.

It is very important to know one’s hepatitis B status and that of your partner, and the addition of the hepatitis b vaccine in the Childhood Immunization programme will will go a long way in reducing the incidence of liver cancer in the Gambia.

Cervical cancer can be dealt with if detected early enough. This can be done by regular screening tests (a Pap smear test).

Please e-mail your comments, queries and suggestions to: mcham@medgambia.com