48 Chapter 3 Introduction Background The global pandemic caused by the novel coronavirus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all countries and territories of the world (1, 2). High daily cases and mortality have been recorded in the United States of America, India and Brazil, closely followed by countries in Europe and Asia (3, 4). Mortality data indicated a high mortality rate in patients with comorbidities such as diabetes mellitus (DM), cardiovascular and respiratory diseases, kidney and liver diseases, those recovering from transplants and the critically ill (2, 4, 5). This indicates that non-communicable diseases (NCDs) have a propensity to coexist and complicate other disease conditions, most times, negatively altering the prognosis. Thus, the development of an appropriate context-specific method of managing commonly occurring non-communicable diseases is vital in the context of infectious disease. In the last two decades, tuberculosis (TB) and HIV infection gained attention from global leaders, healthcare workers, researchers, and non-governmental organizations. This was due to their impact on the economy of high-burden countries, the health of individuals and pressure on the health system. With concerted efforts from different stakeholders, the prevalence of these two diseases has been controlled in high-income countries while some low and middle-income countries are gradually achieving epidemic control with stable infrastructures for a sustained response (6, 7). While all efforts concentrated on curtailing the impact of HIV/TB with visible results of its reduction globally, the NCDs, diverse with insidious onset, gradually increased and are now the highest cause of mortality globally (8, 9). NCDs now account for about 71% of global mortality (10). This can partly be attributed to less-developed structures to combat NCDs with far less funding for NCD programs compared to TB and HIV, especially in low and middle-income countries which also have the highest incidence and prevalence of infectious diseases with high levels of poverty and social inequality (11). This neglect of NCDs has become evident as the countries with a high burden of infectious diseases now record high mortality from NCDs. This indicates that both conditions (NCDs and infectious diseases) coexist in the community with each disease acting as an enabler for the other (9, 11, 12). Major NCDs accounting for increased morbidity and mortality globally include cardiovascular diseases (17.9 million deaths - 44%), cancers (23%), respiratory diseases (10%) and DM (1.5%) (10, 13). The coexistence of infectious diseases, particularly TB, with NCDs such as DM and hypertension has long been recognized by researchers with varying concepts of managing these conditions in the midst of dwindling resources for healthcare services
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