No more disease silos for sub-Saharan AfricaBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5812 (Published 31 August 2012) Cite this as: BMJ 2012;345:e5812
All rapid responses
Rapid urbanisation with adoption of Western diets and lifestyles are increasing rates of chronic, non-communicable disease in China, as well as Africa (1). Many gynaecological, and some gastroenterological diseases, result from injuries to autonomic nerves (2). Common causes of injuries to pelvic autonomic nerves are straining at stool, difficult vaginal deliveries, and, excessive traction to the pregnant cervix at surgical termination of pregnancy (3). Preventive policies will have limited effects unless directed to the precise causes of these conditions.
Refined Western diets have resulted in the obesity epidemic, and, reductions in stool weights with concomitant increases in straining at stool (4). Western porcelain toilets are replacing traditional squat toilets in many buildings in southern Chinese cities that also promote straining at stool (2). High Caesarean section rates in China may mitigate morbidity associated with prolonged labours, epidural and operative vaginal delivery rates, at the expense of the immediate surgical morbidity (3). High rates of surgical abortion in China already contribute significantly to reproductive ill-health (2). Reducing excessive rates will prevent ensuing morbidity that may include subfertility, miscarriage, ectopic pregnancy, endometriosis and chronic pelvic pain (3).
Enacting preventive policies that improve specific aspects of diets and bowel habits, intrapartum policies, and, reducing rates of surgical abortion, may prevent further increases in the burden of chronic, non-communicable diseases in developing countries, that are already epidemic in the West.
(1) No more disease silos in Africa.
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Competing interests: No competing interests