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Heart-related diseases increase

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As you read this, chances are that you have consumed too much carbohydrates and fats; components of food that put most Malawians at high risk of suffering from cardiovascular diseases (CVD). PETER KANJERE highlights some of the non-communicable diseases that are silent killers.

There is increased awareness in Malawi to the dangers of non-communicable diseases such as hypertension, diabetes and stroke.

Such awareness manifests in gyms in every location, especially in urban areas where children—as young as five—men and women access such facilities to keep fit and shed off weight.

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Yet, not too long ago, high blood pressure and diabetes were common among the affluent.

Not now. Excess consumption of carbohydrates, westernised lifestyles and increased fats’ intake put most Malawians at high risk of suffering from cardiovascular disease (CVD), Blantyre-based nutritionist Honest Chirwa has warned.

“As of 2016, Malawi’s obesity rate was at 5.8 percent of the population. Most of the obese population is in urban areas. There is a link between lifestyle in urban areas and obesity. We have gone more into western diets. We eat more fast foods, chiwaya chips, fizzy drinks, and snacking in between meals,” Chirwa said.

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“We also eat many foods rich in carbohydrates, which are stored into our bodies and, in turn, we become obese. We are too busy for our own life. We don’t have time to exercise. We are killing ourselves slowly while we think we are living at our level best. We eat more fried foods as compared to a simple meal.

“We consume more of refined nsima and other refined foods thinking we are taking the best diet and yet it is the worst diet. Most people don’t value water in-take. We drink water because we are thirsty, not because it is healthy. It is time to act. Nutrition is not valued. Prevention is not highly considered. We service our cars but we cannot “service’ our bodies.

“We put the right fuel in our cars but not the right food in our bodies. We spend more money on the purchase of medicines and think less on prevention so that, in return, we save. People who are obese are at risk of suffering from diabetes. No wonder, cases of diabetes are on increase in Malawi. People are also at risk of having cardiovascular disorders and high blood pressure,” she said.

Chirwa, Managing Director at Healthcare Nutrition Centre, said people should balance up their diet, which can be done through civic education.

“We need nutritionists in public hospitals. So far, there is only one at Kamuzu Central Hospital,” he said.

Former principal secretary in the Department of Nutrition, HIV and Aids, Mary Shaba, who is also a nutritionist, seemed to agree with Chirwa.

“We take more carbohydrates with little nutrients. Our diet is not balanced. Our diet should be balanced. Our intake of nsima is very high. In Malawi, we were eating nsima from other types of crops such as millet and sorghum. Maize was introduced by the missionaries and, soon, it became a political weapon. People could stand on the podium and say ‘grow more maize’,” she said.

A report which Matthew Gowshall and Taylor Robinson published, titled ‘The Increasing Prevalence of Non-communicable Diseases in Low- Middle Income Countries: The View from Malawi’, sheds more light on the connection between the above mentioned factors to such diseases.

“CVD (including peripheral vascular disease and stroke) has a prevalence of 8.9 percent in Malawi and is responsible for 12 percent of all deaths,” the report, sourced on www. dovepress.com, reads.

“There is a higher age-standardised mortality rate for CVD in Malawi than in many developed countries, including the United Kingdom, which has an ASMR of 100–175 per 100,000 compared to Malawi’s 250–325.

“Hypertension is highly prevalent in Malawi with nearly a third of 25- to 64-year-olds having raised blood pressure or taking antihypertensive medication.”

The research findings cite overeating of carbohydrates as being among the root cause of heart-related diseases.

“Aside from calorie excess, additional dietary factors have been associated with diabetes risk and are prevalent in Malawi. Data from the Nurses’ Health Study showed that participants with a diet of high glycemic load or glycemic index in addition to low cereal fiber intake had an approximately 50 percent increased risk of developing diabetes.

“In Malawi, the staple carbohydrate dish nsima is made from ground maize (cornmeal) and water; it has both a high glycemic index (94.06 in 1 study) and low cereal fiber content.”

The research says there is need for Malawians to balance up their diet by eating other types of food.

“Fiber and antioxidant (especially vitamin C) intake from fruit and vegetables has shown associations with decreased diabetes risk in observational studies but the exact significance is unclear. In the Malawi STEPS survey, fruit and vegetable intake was low with 97.5 percent of people eating fewer than five servings of fruit and vegetables per day, the average being 2.1 servings a day.

“Sugar sweetened beverages (SSBs) or “soft drinks” are widely consumed in Malawi and are available for lower prices than bottled water at many retailers. Consumption is increasing—especially in young people, with 1 study of Malawian schoolchildren reporting that 50 out of 60 (83.3 percent) were consuming SSBs at least once a day,” the report says.

These findings are corroborated by a research which Elsayed Z Soliman carried out in September 2008, titled ‘Cardiac Disease Patterns in Northern Malawi: Epidemiologic Transition Perspective’.

“We retrospectively analysed the data recorded in the register of the cardiac clinic in Mzuzu Central Hospital—the only cardiac clinic run by a cardiologist in Malawi—from 2001 through 2005.

“The findings were interpreted in the context of the epidemiologic transition theory. Out of the 3,908 new Malawian patients included in the five-year period register, 34 percent had valvular heart disease (mainly rheumatic heart disease (RHD)); 24 percent, hypertensive heart disease; 19 percent, cardiomyopathies; and 14 percent, pericardial diseases,” it says.

In response to the increase in non-communicable diseases in the country, the Ministry of Health has developed the Non-Communicable Diseases and Mental Health strategic plan (2017-22).

World Health Organisation (WHO) estimates that 17.9 million people die annually from (CVD), 75 percent of them occur in low and medium income countries such as Malawi and 85 percent of such deaths are due to heart attacks and stroke.

To prevent such diseases, WHO cites tobacco use, an unhealthy diet and physical inactivity as being the leading causes of heart attacks and stroke.

As a solution, WHO recommends that people must engage in physical activity for at least 30 minutes every day of the week, eating five servings of fruit and vegetables daily and limiting salt intake to less than one teaspoon a day.

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