Talal Hussien, 29, has a full health check-up every six months following the devastating car accident he sustained seven years ago. He has had a metal plate in his right leg following a four-month period he spent bedridden to recover.

The businessman cites the incident as a wake-up call to regularly check up on his health.

"Nothing else matters if you are unhealthy," he said.

Talal has quit eating at restaurants and exercises regularly. He pays approximately 4,000 Br each round for the specific menu of tests he prefers to take, which include imaging scans, blood tests and renal examinations.

"Prevention is how I pray now," he told Fortune.

He insists that everyone should incorporate routine scans at hospitals as a part of their lifestyle.

"A severe disease is a burden for an entire family," Talal noted in a cautionary tone.

While a resolution to get a grasp on health is a goal for many following the beckoning of a new year, few maintain it as a lifestyle.

Meanwhile, the conflation of sedentary lifestyles and poor diets is leading to ever-increasing rates of non-communicable diseases (NCDs). It is the leading cause of mortality accounting for as high as 34pc of all morbidities in some regional states, with some estimates putting it at 52pc.

As Ethiopians are met with an urbanisation rate averaging two per cent annually, the adoption of frequent trips to the doctor for checkups has yet to take up mass adoption while diagnostics laboratories report getting more frequent visitors over the years.

Established in 1958 by Arshavin Terizian (MD) around the Piassa area, Arsho offers over 1,000 tests at its 12 branches across the city. Tsega Derbew has been a laboratory technician at the 50-year-old Arsho Medical Laboratories serving as a manager at the Meskel Flower Branch.

Through his decade-long stay, Tsega observed the number of people coming for checkups incline with traffic for self-initiated examinations growing at the dawn of New Year celebrations and at the end of the fasting season.

Their branch conducts around 150 tests daily, with referrals coming from health centres across the country starting with 95 Br for checking sugar levels for diabetes all the way up to fungal cultures, which are exclusive and some tests exported to affiliates in Germany and England for hundreds of dollars.

He considers regular health checkups and monitoring as necessary routines in modern life.

"Most people wait till it's too late to go to the doctor," Tsega told Fortune.

A study which conducted meta-analyses on over 180 research papers in Ethiopia by the American National Institute of Health indicates that cardiovascular deaths account for about a third of all deaths in most regional states.

The burden of diabetes is also increasing, with more than 68pc of people remaining undiagnosed and with a death rate of 32pc in the country, according to another 2022 study published at the American Library of Medicine.

"There is a definite increase in the number of diabetics," says Bereket Mekonen, project manager at the 80,000-member-strong Ethiopian Diabetics Association (EDA).

The three-decade-old Association works with health centres through its 76 branches, providing insulin vials for type 1 diabetes, oral tablets for type 2 patients and giving training to health professionals.

Berket noted a tragic development in the Somali Regional State as expired sugar-rich products are transferred by businesses to unsuspecting consumers in rural areas.

While the project manager pointed to the proliferation of diabetic patients nationally, he noted that urban areas are becoming hotbeds for type two patients arising from sedentary lifestyles and a voluminous consumption of sweetened foods.

The silent epidemic sweeping through the nation has been noted by some within the medical community while largely absent from the purview of the wider public.

Aklilu Getnet is the director of the 25-year-old Health Development & Anti-malaria Association (HDAMA), which recently conducted an awareness campaign on the proliferation of non-communicable diseases in Ethiopia.

He said the country loses up to 31 billion Br annually due to burdens arising from factors associated with non-communicable diseases while accounting for about half of all mortality.

"It's a public health crisis," he passionately told Fortune.

The Association successfully lobbied to usher in a proclamation that banned the advertising of alcohol on broadcast media and enshrined strict regulation on the sale of tobacco products despite the director suggesting a gap in implementation.

Akliu claims that smoking kills more people annually than HIV, malaria and tuberculosis combined. He said the onslaught is worsened by local cuisine, of which 97pc contains more salt amount than the World Health Organization (WHO) recommends, exacerbated by waxing consumption of packed foods.

The average intake of salt in Ethiopia is 8.3gm a day, far above the WHO's recommended limit of five grams per day which translates to about one teaspoon.

Aklilu emphasised the importance of regular health checkups, cutting out alcohol and tobacco, an active lifestyle and prudent dietary preference to mitigate the sweeping silent epidemic.

While Ethiopia lags behind in several aspects of the development of medical infrastructure, the numbers are absolutely shocking.

A publication by the Ethiopian Public Health Institute last month also indicated that only half of the health facilities in the country had guidelines for the diagnosis and management of non-communicable diseases. Availability of trained staff within health facilities remains low as only 15pc, 16pc and 18pc of staff are able to serve diabetes, cardiovascular and chronic heart disease, respectively.

Sintayehu Abebe (MD) is president of the Ethiopian Society of Cardiac Professionals, who recommends regular blood pressure checkups for anyone above 30 years old.

Primordial prevention, which entails the adjustment of diet and the infusion of exercise into one's routine before the onset of symptoms, is the best bet against heart problems, according to the physician.

Sintayehu pointed to limitations in cardiac surgeons, which are only seven in the country, along with the concentration of all professionals in the capital as posing a serious issue in accessibility to secondary care.

"Early prevention is the best bet," Sintayehu told Fortune.

He has observed a shift from rheumatic valvular heart disease (damage to valves) to ischemic heart disease (narrowing of arteries ) occurring in Ethiopia. The risk of the latter can largely be prevented by quitting smoking, regular exercise and eating a heart-healthy diet.

The sentiment is also shared by Endale Gebre, president of the Ethiopian Heart Association, who said widespread consumption of excessive alcohol due to slick marketing along with the unabated number of smokers piles on the dietary and lifestyle issues.

The Association, with a little over 2,500 members, engages in the provision of medical support and financial support to hundreds of cardiac patients. He recommends regular hospital check-ups should include examinations.

"Everyone needs to be mindful of their diet," Endale told Fortune, emphasising that most non-communicable diseases are silent killers.

Officials at the City Health Bureau seem to be lax under the narrative that a comprehensive data set on either the number of people living in cities or their health status is missing since Ethiopia has not conducted a national census for the last 16 years.

"There is a worldwide proliferation," said Getu Bisa who heads Disease Prevention & Health Promotion Directorate at the Bureau. He indicated that they are working to prevent the growing numbers by ushering in free blood pressure screenings at all state-owned health facilities.

Getu characterised the urban lifestyle, which entails moving from a car straight to an office without incorporating any exercise as "a box-to-box lifestyle," acknowledging that the combination of pollution in cities, a diet rich in packed foods and the lack of exercise as leading to the growing number of NCD instances.

He noted that the Bureaus' initiative to close down certain main roads during weekends to incentivise walking, as another indication of the government's effort to curtail diseases.

A systematic meta-analysis research that looked at the epidemiology of hypertension among adults in the capital estimated the prevalence of hypertension in Addis Abeba to be between 15 and 30pc.

After suffering from an ischemic stroke six years ago, Mekbeb Getachew has been taking daily walks for up to 30 minutes and has completely changed his diet. The 61-year-old former engineer now uses a cane as the left part of his body is partially numb.

Mekbeb has cut out alcohol and salt-rich foods from his life and takes medications to deal with some of his symptoms.

"Most people ignore their health until something goes wrong," he told Fortune.

He realised the importance of exercise and proper nutrition in the aftermath of his health problems, noting that health checkups should be frequented by people as they get older.

"It's not getting the deserved attention," he said.

Recognising the need for healthy food options in the capital, the private sector has seen an opportunity to turn the looming crisis into a business opportunity.

A local company has started offering delivery services of low-carb, protein-rich healthy meals three times a day for monthly subscriptions of 24,000 Br. Maed Nutrition was founded by Sofonias Nebiyu, a physical trainer with aspirations to provide healthy alternatives to help people in their fitness journey.

While initially started to help people with a desire to lose weight, the company now caters to specific customer needs after taking into account their weight, health status and personal needs.

"We provide a nutritionist, a chef and a delivery service,"  Sofonias told Fortune.

He has observed a growing adoption of their service by people with hypertension, diabetes or on a doctor-prescribed diet. The meals are delivered each morning in microwaveable use-and-throw lunch boxes each morning to the customers' preferred location.

"Business will grow as people adopt healthier lifestyles," Sofonias told Fortune.

Experts indicate that the reformation of the national health policy needs to put non-communicable diseases among its highest priorities.

Getasew Amare a health economist at Gonder University, notes the expansion of these ailments from typically affecting urbanites to now impacting people even in rural communities.

Getasew indicated that the national health policy, currently being revised, has to incorporate directions for nutrition policies and lifestyle orientations. He noted increased regard being given by health officials, while the lack of overall resources still hampers the wide-scale implementation of preventive measures.

"Prioritisation in resource allocation is critical," he told Fortune.

While Getasew recognises the importance of regular visits to the doctor, he emphasises that the health of the populace directly relates to its productivity as every sector relies on a fully functional workforce capable of delivering output at a high rate.

"The cost of living forces people to push down health amongst their priorities," he said.

PUBLISHED ON Sep 02,2023 [ VOL 24 , NO 1218]

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