Swaziland Health Research - Research Topics #3

Research Agenda

Research Areas: Non-Communicable Diseases

Non-Communicable diseases (NCDs) represent a major threat to human health and development in today's world. The four main types are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such a chronic obstructed pulmonary disease and asthma) and diabetes. The NCDs risk factors include tobacco use, harmful consumption of alcohol, obesity, unhealthy diet and physical inactivity. The aim of research is to reduce the burden of NCDs and improve health outcomes.

1. Research Priorities for Cardiovascular Disease (CVD) (including hypertension)
Assessment of burden and determinants:
  • Quantify the magnitude and monitor trends of CVD morbidity, mortality and risk factors.
  • Develop observational cohorts to study social, cultural and economic determinants of behavioural and other cardiovascular risk factors.
  • Estimate economic and social costs of CVDs for use in advocacy for placing CVD high on the development agenda and for policy development.

Research to Improve Existing Interventions:
  • Investigate and define barriers and solutions to develop and implement health-supporting policies in sectors outside health, e.g. agriculture, education, industry and trade.
  • Investigate and define health system-related opportunities and barriers to care and develop feasible approaches to apply cost-effective interventions for primary and secondary prevention of CVDs with a special focus on primary care and non-physician health workers.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Evaluate the effectiveness of policies and programmes geared at reducing incidence of CVDs
  • Conduct economic evaluation of priority health interventions, including behavioural change interventions to prevent lifestyle diseases.
  • Assess the effectiveness of community education campaigns, community participation and multisectoral action for CVD prevention.
  • Validate cost-effective screening approaches, risk prediction methodologies and clinical algorithms for CVDs.

Development of new capacities (tools and products):
  • Develop contextualized models of combinations of interventions (policy, environmental, health systems) to address cardiovascular risk factors and evaluate their effectiveness.
  • Develop and validate screening programmes based on absolute risk in an intervention trial using fixed-dose combinations at different thresholds of coronary risk.
  • Develop appropriate resource allocation models for medical technologies required for CVD interventions in order to maximize health benefits and equity.


2. Research Priorities for Diabetes
Assessment of burden and determinants:
  • Determine the prevalence of diabetes and previously diagnosed and undiagnosed type 2 diabetes, including cross-sectional assessment of complications and prevalence and risk factors of gestational diabetes.
  • Monitor trends in rates of major complications of type 1 and type 2 diabetes, including lower extremity amputations and blindness and end-stage renal disease

Research to Improve Existing Interventions:
  • Investigate how to identify and overcome barriers to translation of evidence-based knowledge into improved management of diabetes (medication use, technologies, health systems, culture, gender, literacy).

Research to Improve Effectiveness and Cost-Effectiveness:
  • Develop models for optimal delivery of diabetes education and clinical management in testing and comparing different models and assessing cost-effectiveness.

Research to develop new capacities (tools and products):
  • Develop low-cost, reliable, non-invasive tests and clinical algorithms for risk prediction.
  • Develop low-risk prevention programmes with lifestyle intervention in high-risk individuals.
  • Develop a programme for prevention and management of gestational diabetes with lifestyle intervention during pregnancy and after delivery.


3. Research Priorities for Cancer
Assessment of burden and determinants:
  • Measure trends of the cancer burden and risk factors.
  • Quantify the direct and indirect economic cost of cancer.

Research to Improve Existing Interventions:
  • Collect data (e.g. staging, treatment, use of opiates, human resources for cancer control) needed to strengthen cancer registration and programmes.
  • Assess health system capacities to prevent and manage cancer.
  • Develop means to train health professionals on all aspects of cancer control, including leadership and management of cancer control programmes with a public health approach at the national and regional levels.
  • Develop methods for applying cancer prevention strategies in relation to local culture and local resources, including primary prevention, effective early detection, vaccination programmes.
  • Develop innovative ways to facilitate the development/reinforcement of cancer control programme.
  • Identify the determinants that result in cancer being diagnosed at an advanced stage.
  • Identify means to reduce barriers to access to diagnosis, treatment, rehabilitation for curable and palliative care for non-curable cancers.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Assess effectiveness and cost-effectiveness of cancer diagnosis, prevention and management interventions, including modalities of different surgical procedures and radiotherapies.

Develop new capacities (tools and products):
  • Develop cost-effective and feasible models of alternative technologies for tele-imaging and tele-pathology as tools for improved diagnosis and education.


4. Research Priorities for chronic obstructive pulmonary disease (COPD) including tobacco use
Assessment of burden and determinants:
  • Estimate attributable fraction of risk of chronic respiratory disease related to tobacco smoke, solid fuel combustion, outdoor air pollution, allergens and other environmental factors
  • Determine the prevalence of asthma, COPD and occupational respiratory diseases and track the disease burden, risk factors and comorbidities.
  • Assess the direct and indirect economic impacts of tobacco use and control.
  • Collate data on the use of various tobacco products, contribution of tobacco use to NCDs, implementation and enforcement of tobacco control policies, and activities of tobacco industry (marketing, pricing, lobbying, etc.).

Research to Improve Existing Interventions:
  • Assess gaps in access to and affordability of essential technologies and medicines for asthma and COPD.
  • Develop evidence-based approaches for early diagnosis and treatment of asthma and COPD through a primary health care approach with a special focus on children and elderly groups
  • Develop evidence-based approaches for early detection of occupational chronic respiratory disease and interventions to prevent progression of disability

Research to Improve Effectiveness and Cost-Effectiveness:
  • Estimate the impact of early detection of occupational chronic respiratory disease and interventions to prevent disability.
  • Study the feasibility and effectiveness of low-cost and integrated prevention and management approaches of chronic respiratory diseases through a primary health care approach concomitant with other NCDs.
  • Evaluate the impact of interventions for reducing the use of solid fuels and mitigating their effects in cooking and heating in homes and outdoor air pollution.
  • Estimate impact of interventions to reduce morbidity and mortality due to severe or uncontrolled asthma in children and disadvantaged populations.
  • Assess the benefits and costs of large-scale community education campaigns and community participation in the prevention and control of chronic respiratory disease in different cultural and economic settings.
  • Generate information about tobacco taxation and pricing, including specific estimates of price elasticity.
  • Study the interrelationships between tobacco use and poverty, including the role of tobacco use in causing poverty and compromising other spending and the differential effect of tobacco control policies and programmes on the poor


5. Research Priorities for mental health
Assessment of burden and determinants:
  • Quantify the burden and risk factors of mental health disorders.
  • Measure the economic burden of mental health disorders to use in advocacy.

Research to Improve Existing Interventions:
  • Review health systems capacities for detection and management of mental health disorders.
  • Develop strategies to early detection and management of mental health disorders.
  • Develop effective communication strategies for raising community awareness of causes, prevention and management of mental health disorders.
  • Develop strategies to integrate mental health into existing maternal and child health programmes.
  • Develop strategies to reduce alcohol consumption in high risk groups thus reducing the burden of alcohol abuse.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Effectiveness and cost effectiveness of school-based mental health interventions, including for children with special needs.
  • Effectiveness and cost effectiveness of dispensing anti-psychotic drugs by general community health workers on relapse.
  • Effectiveness and cost effectiveness of culturally appropriate community level interventions for mental disorders.


6. Research Priorities for injuries
Assessment of burden and determinants:
  • Measure the burden and trend of intentional and accidental injuries.

Research to Improve Existing Interventions:
  • Develop interventions that can be integrated into community settings (e.g. schools) to address gender-based violence

Research to Improve Effectiveness and Cost-Effectiveness:
  • Assess impact of programmes that aim to keep girls in school longer through measures such as conditional cash transfers on the prevalence of gender-based violence.
  • Feasibility, effectiveness and sustainability of the training of community-based health workers on identification and referral of cases of domestic violence and injuries.

Development of new capacities (tools and products):
  • Develop school health strategies to reduce gender-based violence.


7. Research Priorities for other major NCD risk factors
Assessment of burden and determinants:
  • Adapt surveillance methods for physical inactivity and sedentary behaviours to collect population prevalence and trend data for use in estimating disease burden attributable to physical inactivity.
  • Monitor the individual, social and environmental determinants of physical inactivity and sedentary behaviours across the life course.

Research to Improve Existing Interventions:
  • Develop feasible and affordable methodologies to monitor individual intakes of salt, fruit and vegetables, red meat, total energy, fats and fatty acids and total carbohydrate quality and quantity.
  • Develop methods to ensure that nutrition interventions achieve sustainable changes in behaviour.
  • Study the appropriate use of food regulation, legislation and price controls to improve nutrition and reduce the risk of obesity.
  • Analyse the roles that the public and private sectors could play in improving nutrition in the community and identify potential positive contributions.
  • Develop and validate health promotion approaches to improve nutrition programmes in schools, worksites and government institutions.
  • Develop mechanisms to reduce the impact of marketing of energy-dense, nutrient-poor foods to children.
  • Develop community-based multicomponent approaches to increase physical activity and reduce sedentary behaviour.
  • Develop methods to ensure that physical activity interventions achieve sustainable changes in behaviour.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Develop economic models of structural change and behavioural programmes to demonstrate the potential benefits of specific actions to improve nutrition at the population level.
  • Develop models of impact of different sectoral policies on nutrition (e.g. agriculture, trade, transport, social welfare).
  • Determine effectiveness, economic viability and differential social impact of programmes and policies for inclusion in a portfolio of actions to improve dietary quality and food security and prevent weight gain and obesity.
  • Determine the effects of folic acid and vitamins B12, A and D on the development and prevention of major NCDs.
  • Determine the role of specific food products on the development and prevention of major NCDs (dairy products, meat).
  • Evaluate effect of changes in urban and peri-urban environments on physical activity and sedentary behaviours.

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