Africa:The Good News

Windhoek – Africa is about war, disease and poverty. Or so we are often told.

The international media rarely carry good news about the “Dark Continent”, preferring instead to focus on the negatives.

As such, the recent report on the state of Africa’s healthcare provision makes refreshing reading.

The report is titled “The Global Burden of Disease: Generating Evidence, Guiding Policy” and comes from the Institute for Health Metrics and Evaluation and the Human Development Network at the World Bank.

In summary, the report documents the immense strides Africa has made since 1990 to catch up with the rest of the world.

All is not rosy; with the World Health Organisation recently pointing out that 36 African countries are in need of 820 000 doctors to meet the ratio of 2.3 health experts per 1 000 citizens.

Nonetheless, the World Bank study, in its main findings for Africa south of the Sahara, notes: “Despite the fact that disease patterns in Sub-Saharan Africa have changed less than in other parts of the world over the past 20 years, most African countries have made impressive progress in reducing mortality rates for children under the age of 5 …

“Countries such as Botswana, Rwanda, Senegal, Sierra Leone, and Uganda made the most rapid progress out of all the Sub-Saharan African countries.

“Other countries including Angola, Eritrea, Kenya, Republic of the Congo, and Swaziland also made substantial strides in this area.”

On the issue of HIV and AIDS, there is also some good news.

Yes, the pandemic continues to take its toll on Africa’s citizens, but there is a suggestion that peak mortality attributable to HIV and AIDS has already been reached.

This means the various interventions initiated by governments and their partners are beginning to bear fruit.

“While HIV/AIDS has exacted a devastating toll on many countries in Sub-Saharan Africa, increasing by 328 percent in terms of healthy years lost from 1990 to 2010, the epidemic appears to have peaked in 2004.

“The number of years lost to premature death and disability declined by 22 percent between 2005 and 2010. This success is largely attributable to the massive scale-up in antiretroviral therapy over the past decade.”

Related to that is the crucial matter of maternal deaths.

“Between 2005 and 2010, maternal mortality declined by 11.4 percent, in part due to scale-up of antiretroviral therapy.

“Delving deeper into trends at the country level, Rwanda stands out as a major success story. While other countries in Sub-Saharan Africa have made progress in saving mother’s lives, Rwanda is the only country on track to achieve MDG 5 (slashing maternal mortality to below 75 deaths per 100 000).

“Between 1990 and 2010, Rwanda reduced maternal deaths by 62 percent.”

In that same two-decade period, African countries have succeeded in decreasing premature death and disability from some communicable, newborn, nutritional, and maternal causes – especially from diarrhoeal diseases and lower respiratory infections.

And the good news does not end there. Gains have been registered in battling malaria.

“Another encouraging area of progress is the reduction in the number of deaths from malaria in Sub-Saharan Africa.”

Major declines in prevalence of measles and tetanus: neither of the two is now found in the top ten causes of health loss in the region.

“While lower respiratory infections and diarrheal diseases still accounted for a substantial amount of health loss in the region, from 1990 to 2010, these diseases caused a half-million fewer deaths among children under the age of 5,” it has been noted.

Overall, the disease burden associated with many communicable, newborn, maternal, and nutritional causes declined in Sub-Saharan Africa at a similar rate to the rest of the world between 1990 and 2010; these trends hold particularly true for diarrheal diseases and lower respiratory infections. These conditions account for a large portion of childhood deaths and illnesses, and regional improvements in these disease areas have helped to drive down childhood mortality throughout Sub-Saharan Africa.

The Challenges

While Africa on the whole, as noted by the World Bank, scored “overall progress in reducing mortality and prolonging life since 1970”, in some countries there were more deaths “within certain age groups and for sexes”.

“Mozambique, for example, has seen rising mortality rates among women aged 25 to 29…

“Although their relative burdens have declined, communicable, newborn, nutritional, and maternal causes such as diarrhoeal diseases, lower respiratory infections, and protein-energy malnutrition remained the top drivers of health loss in most Sub-Saharan Africa countries, especially in lower-income countries like Niger and Sierra Leone.”

And, worrisomely, a range of diseases often associated with better standards of living have emerged as serious threats to cutting short people’s lives.

“Between 1990 and 2010, disease burden from many non-communicable causes increased, particularly stroke, depression, diabetes, and ischemic heart disease among upper-middle-income countries in the region.”

Another threat to human health in Africa that has come with development is that of traffic casualties: early death and/or injury from road traffic accidents increased by 76 percent between 1990 and 2010.

In countries like the DRC, violence and civil strife are hampering progress with lives being needlessly lost.

On the disability front, the World Bank reports that: “In most of Sub-Saharan Africa, a larger percentage of healthy years were lost due to disability in 2010 compared to 1990.

“The leading causes of disability in the region, such as depression and low back pain, were largely consistent with the leading causes at the global level; however, communicable diseases like HIV/AIDS and malaria accounted for a larger proportion of disability in Sub-Saharan Africa than the world as a whole.”

Health loss attributable to some communicable diseases also increased.

The incidence of neonatal sepsis increased by 34 percent, maternal disorders by 32 percent, neonatal encephalopathy by 29 percent, and pre-term birth complications by 19 percent.

“The burden associated with non-communicable diseases also rose, with diabetes, low back pain, and depression increasing by 88 percent, 65 percent, and 61 percent, respectively, from 1990 to 2010.

“This trend of heightened health loss due to non-communicable conditions is particularly striking among the upper-middle-income countries in Sub-Saharan Africa; for instance, between 1990 and 2010, Namibia experienced a 123 percent increase in diabetes and the small island of Mauritius recorded a 186 percent jump in the disease.”

The matter of food security has been talked about often at various fora by African leaders and policymakers, but it seems converting that political will into action is proving difficult.

As such, nutritional deficiencies remained higher in Africa than anywhere else in the world in the period covered by the World Bank study.

In fact, nutritional deficiencies “accounted for nearly twice the health loss in Sub-Saharan Africa than they did globally”.

However, this was a trend largely driven by the situation in lower-income countries and was not evident in other places like Mauritius and The Seychelles.

“Under-nutrition and household air pollution were among the leading risk factors for premature death and disability in Sub-Saharan Africa.”

But even amidst such grave shortcomings, there are some success stories.

“In most countries, substantial progress has been made in reducing risks like childhood underweight, suboptimal breastfeeding, and vitamin deficiencies, such that their burdens have declined between 30 percent and 50 percent in the last 20 years.

“Nonetheless, these risk factors remain among the top three contributors to health loss throughout the region, especially among lower-income countries.”

Further, Ethiopia, Kenya, Mozambique and Tanzania were singled out for making headway in combating increasingly burdensome non-communicable diseases like stroke and heart disease.

Other major health risks for people living south of the Sahara Desert were high blood pressure, alcohol and abuse and tobacco use.

Another report, this one by Thomas Butler of Ross University School of Medicine in Dominica, says of the 21 725 cases of human plague reported globally between 2000 and 2010, 97 percent of the cases were from Africa.

The DRC had the highest incidence of plague, followed by Madagascar, Zambia, Uganda, Mozambique, Tanzania, China, Peru, Malawi and Indonesia. The United States placed 11th on the list.

Doctor Shortage

The gains made thus far face a threat from the low number of doctors working in Africa.

WHO Country Representative for Nigeria, Dr Rui Vaz, recently said 36 countries in Africa need 820 000 doctors, nurses and midwives.

The world health body has identified a minimum density of 2.3 doctors, nurses and midwives per 1 000 people.

Dr Vaz said, “In addition, internal and external migration of qualified health workers; inadequate remuneration and incentive mechanisms; mal-distribution of the available health workers; underinvestment in the production of sufficient health workers, inadequate capacity … and; low implementation of most of the existing strategies and plans are identified as the main causes of the present situation which poses major impediments to meeting the needs for delivering healthcare for all.”

Living Longer

Be that as it may, the World Bank report found that people are now living longer than they did in the 1970s.

“Since 1970, the average age of death has increased by 20 years globally.

“During this period in Asia, Latin America, and the Middle East, the average age of death increased by 30 years or more.

“Sub-Saharan Africa, however, has not made nearly as much progress as other developing regions …

“Overall, Sub-Saharan Africa has made moderate progress in increasing its average age at death between 1970 and 2010, achieving an average gain of about 11 years in each country.

“However, great variation exists within the region, with Cape Verde leading the greatest gain (about 28 years) and Chad documenting the smallest improvement (about 1.4 years).

“Income categorization does not appear to be a major driving force behind these differences, as upper-middle-income and lower-middle-income countries had gains averaging nine years and 12 years, respectively, and the average gain in low-income countries in the region was about 10 years.”

September 2013
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