Noncommunicable diseases in sub-Saharan Africa: where do they feature in the health research agenda?

There is no doubt that communicable diseases will remain the predominant he alth problem for the populations in sub-Saharan Africa, including adults, f or the next 10-20 years. Concern has been expressed that the available reso urces to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substa ntial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market E conomies. There is also evidence that the prevalence of certain noncommunic able diseases, such as diabetes and hypertension, is increasing rapidly, pa rticularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases. To ignore the nonco mmunicable diseases would inevitably lead to an increase in their burden; t he provision of health services for them would be largely undirected by iss ues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests. Improv ed surveillance of all diseases within sub-Saharan Africa is needed in orde r to place noncommunicable diseases properly within the context of the over all burden of disease. Research is needed to guide improvements in the clin ical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate prevent ive measures.