38.4.5: Health Crises

Health Crises in Africa

A public health crisis is a difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality to the entire planet. Health crises generally have significant impacts on community health, loss of life, and the economy. They may result from disease, industrial processes, environmental disasters, or poor policy. Africa continues to be ravaged by multiple health crises, some of which are systemic (e.g., consistently high rates of maternal and infant deaths caused by lack of proper health care or poor nutrition), recurrent (e.g., famines caused by droughts), or caused by an outbreak of a particular diseases (e.g., malaria, Ebola, HIV/AIDS).

HIV/AIDS

HIV/AIDS is a major public health concern and cause of death in many parts of Africa. Although the continent is home to about 15%  of the world’s population, over 67% of the infected, more than 25.5 million individuals, were Africans according to data collected by the World Health Organization (WHO) and UNAIDS in 2015. Out of this number, nearly 19 million lived in eastern and southern Africa, while 6.5 million lived in western and central Africa (North Africa, grouped with the Middle East, recorded 230 thousand infected).  In the most affected countries of sub-Saharan Africa, AIDS has raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about 20 years. In fact, the life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life expectancy in some countries as low as 34 years.

High-risk behavioral patterns have been cited as largely responsible for the significantly greater spread of HIV/AIDS in sub-Saharan Africa than in other parts of the world. Chief among these are traditionally liberal attitudes espoused by many communities toward multiple sexual partners and sexual activity before or outside marriage. HIV transmission is most likely in the first few weeks after infection and the risk is increased when people have more than one sexual partner in the same time period. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to have concurrent sexual relations with more than one person. In addition, lack of AIDS-awareness education provided to youth and no access to proper health care contribute to the high rates of infections and deaths. Even if medical facilities are available, patents on many drugs have hindered the ability to make low-cost alternatives.

In 2015, UN reported that the leading cause of death among HIV-positive persons is tuberculosis; synergy between HIV and tuberculosis, termed a co-epidemic, is deadly. One in three HIV-infected individuals die of tuberculosis. “Tuberculosis and HIV co-infections are associated with special diagnostic and therapeutic challenges and constitute an immense burden on healthcare systems of heavily infected countries.” In many countries without adequate resources, the tuberculosis case rate has increased five to ten-fold since the identification of HIV. Without proper treatment, an estimated 90% of persons living with HIV die within months after contracting tuberculosis.

An HIV/AIDS educational outreach session in Angola, photo by USAID Africa Bureau. One of the greatest problems faced by African countries that have high prevalence rates is “HIV fatigue.” Africans are not interested in hearing more about a disease that has been debated for decades now. To address this, novel approaches are required. Yet lack of awareness and education remain a huge issues, especially among youth. 

Malaria

Malaria is a mosquito-borne infectious disease affecting humans and other animals. The disease is widespread in the tropical and subtropical regions that exist in a broad band around the equator, including much of sub-Saharan Africa, Asia, and Latin America. In 2015, there were 296 million cases of malaria worldwide resulting in an estimated 731,000 deaths. Approximately 90% of deaths occurred in Africa, where malaria is estimated to result in losses of US$12 billion a year due to increased healthcare costs, lost ability to work, and negative effects on tourism.

The WHO estimates that in 2015 there were 214 million new cases of malaria resulting in 438,000 deaths. Others have estimated the number of cases at between 350 and 550 million. The majority (65%) occur in children younger than age 15. In sub-Saharan Africa, maternal malaria is associated with up to 200,000 estimated infant deaths yearly. Efforts at decreasing the disease in Africa since the turn of millennium have been partially effective, with rates dropping by an estimated 40% on the continent. Although malaria is presently endemic not only in sub-Saharan Africa but also in a broad band around the equator, which includes many parts of the Americas and Asia, 85–90% of malaria fatalities occur in Sub-Saharan Africa.

Ebola

The West African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia, and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with a fatality rate reported at slightly above 70% although the rate among hospitalized patients was 57–59%. Small outbreaks occurred in Nigeria and Mali and isolated cases were recorded in Senegal. The number of cases peaked in October 2014 and then began to decline gradually following the commitment of substantial international resources. In March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred.

The outbreak left about 17,000 survivors of the disease, many of whom report symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to “hide” in a recovered survivor’s body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the strain of Ebola responsible for the West Africa outbreak. The vaccine has not yet had regulatory approval, but it is considered so effective that 300,000 doses have already been stockpiled.

An Ebola treatment unit in Liberia, photo by CDC Global End. In June 2014, it was reported that local authorities did not have the resources to contain the disease, with health centers closing and hospitals becoming overwhelmed. There were also reports that adequate personal protection equipment was not provided for medical personnel. The Director-General of MSF said: “Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.”

Food Shortages

Since 2000, a number of regions in Africa have experienced environmental disasters that led to food crises and famines. For example, a severe localized food security crisis occurred in some regions of Niger from 2005 to 2006. It was caused by an early end to the 2004 rains, desert locust damage to some pasture lands, high food prices, and chronic poverty. In the affected area, 2.4 million of 3.6 million people were considered highly vulnerable to food insecurity. An international assessment stated that of these, over 800,000 faced extreme food insecurity and another 800,000 in moderately insecure food situations were in need of aid.

The crisis had long been predicted after swarms of locusts consumed nearly all crops in parts of Niger during the 2004 agricultural season. In other areas, insufficient rainfall resulted in exceptionally poor harvests and dry pastures, affecting both farmers and livestock breeders. The fertility rate in Niger is the highest in the world at 7.6 children per woman. The consequence is that population of Niger is projected to increase tenfold in the 21st century to more than 200 million people in 2100. Experts predict population growth-induced famines in the 21st century, because the agricultural production cannot keep up with the population growth.

A major culprit of food shortages on the continent is drought, which in combination with ongoing civil wars may produce disastrous results. In 2006, an acute shortage of food affected the countries in the Horn of Africa (Somalia, Djibouti, and Ethiopia) as well as northeastern Kenya. The United Nations’s Food and Agriculture Organization (FAO) estimated that more than 11 million people in these countries were affected by widespread famine, largely attributed to a severe drought and exacerbated by military conflicts in the region. A large-scale, drought-induced famine occurred in Africa’s Sahel region and many parts of the neighboring Senegal River Area from February to August 2010. It is one of many famines to hit the region in recent times. The Sahel is the ecoclimatic and biogeographic zone of transition between the Sahara desert in the north of Africa and the Sudanian savannas in the south. Similarly, between July 2011 and mid-2012, a severe drought affected the entire East Africa region. Said to be “the worst in 60 years,” the drought caused a severe food crisis across Somalia, Djibouti, Ethiopia, and Kenya that threatened the livelihood of 9.5 million people. Many refugees from southern Somalia fled to neighboring Kenya and Ethiopia, where crowded, unsanitary conditions and severe malnutrition led to a large number of deaths. Other countries in East Africa, including Sudan, South Sudan, and parts of Uganda, were also affected by a food crisis. As of March 2017, Somalia and South Sudan are experiencing severe droughts and experts estimate famines will affect millions of people in both regions.

In addition to recurrent food crises, malnutrition is an endemic problem that affects massive numbers of Africans across the continent, which has had a particularly tragic impact on children. Globally, more than one third of under-5 deaths are attributable to malnourishment. In Africa, some progress has been registered over the decades but the situation in some regions remains dire. Sub-Saharan Africa accounted for 3,370,000 deaths of children under 5 in 2011 (WHO, 2012), which corresponds to 9,000 children dying every day and six children dying every minute. Out of 3 million neonatal deaths worldwide, approximately 1.1 million are found in sub-Saharan Africa (WHO, 2012).

Given that vitamin A is critical for proper functioning of the visual system and for maintaining immune defenses, its deficiency remains a public health issue. In Africa, vitamin A deficiency contributes to 23% of child deaths. In 2009, the prevalence of low serum retinol, associated with vitamin A deficiency, was 37.7% in Ethiopia, 49% in the Congo, and 42% in Madagascar. The immediate causes of this deficiency are the low rates of consumption of animal products, the poor bioavailability of vitamin A in cereal-based diets, the consumption of green leaves with low lipid content, and an increased bodily demand for vitamin A owing to the infections that frequently affect African children.

There are equally disturbing levels of zinc deficiencies, which has seriously adverse effects on growth, the risk and severity of infections, and level of immune function. Although the actual prevalence is unclear, zinc deficiency is recognized as one of the main risk factors for morbidity and mortality. It contributes to over 450,000 deaths per year among children under 5 years, particularly in sub-Saharan Africa. It affected 57% of children under 5 in Senegal, 72% in Burkina Faso, and 41.5% in Nigeria in 2004. The main causes of this deficiency in children are a lack of zinc-rich easily absorbed foods (such as meat, poultry, and seafood) and the over-consumption of foods that inhibit zinc absorption, such as cereals, roots, and tubers, which are among Africa’s staples.

Anemia is quite prevalent in Africa, especially among young children, due mainly to a diet that is low in animal-based foods. In 2006, about 67.6% of children under 5 and overall 83.5 million children were anemic. Through its effects on metabolic processes, iron deficiency retards growth and development. It impairs the immune response and increases susceptibility to infection, delays motor development, and diminishes concentration (impairing cognitive and behavioral capacities). It therefore prevents 40-60% of African children from attaining their full mental capacities. Moreover, of the 26 health risks reported by the WHO Global Burden of Disease project, iron deficiency is ranked ninth in terms of years of life lost.

Maternal Health

According to a UN report,

A woman’s chance of dying or becoming disabled during pregnancy and childbirth is closely connected to her social and economic status, the norms and values of her culture, and the geographic remoteness of her home. Generally speaking, the poorer and more marginalized a woman is, the greater her risk of death. In fact, maternal mortality rates reflect disparities between wealthy and poor countries more than any other measure of health. A woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialized countries.

The risk for maternal death (during pregnancy or childbirth) in sub-Saharan Africa is 175 times higher than in developed countries and risk for pregnancy-related illnesses and negative consequences after birth is even higher. Poverty, maternal health, and outcomes for the child are all interconnected. Poverty is detrimental to the health of both mother and child.

Attributions

• Health Crises
  • “West African Ebola virus epidemic.” https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic. Wikipedia CC BY-SA 3.0.
  • “2010 Sahel famine.” https://en.wikipedia.org/wiki/2010_Sahel_famine. Wikipedia CC BY-SA 3.0.
  • “HIV/AIDS in Africa.” https://en.wikipedia.org/wiki/HIV/AIDS_in_Africa. Wikipedia CC BY-SA 3.0.
  • “2017 Somalian drought.” https://en.wikipedia.org/wiki/2017_Somalian_drought. Wikipedia CC BY-SA 3.0.
  • “2017 South Sudan famine.” https://en.wikipedia.org/wiki/2017_South_Sudan_famine. Wikipedia CC BY-SA 3.0.
  • “Maternal health.” https://en.wikipedia.org/wiki/Maternal_health. Wikipedia CC BY-SA 3.0.
  • “2006 Horn of Africa food crisis.” https://en.wikipedia.org/wiki/2006_Horn_of_Africa_food_crisis. Wikipedia CC BY-SA 3.0.
  • “2011 East Africa drought.” https://en.wikipedia.org/wiki/2011_East_Africa_drought. Wikipedia CC BY-SA 3.0.
  • “Child health and nutrition in Africa.” https://en.wikipedia.org/wiki/Child_health_and_nutrition_in_Africa. Wikipedia CC BY-SA 3.0.
  • “Health crisis.” https://en.wikipedia.org/wiki/Health_crisis. Wikipedia CC BY-SA 3.0.
  • “Malaria.” https://en.wikipedia.org/wiki/Malaria. Wikipedia CC BY-SA 3.0.
  • “2005–06 Niger food crisis.” https://en.wikipedia.org/wiki/2005%E2%80%9306_Niger_food_crisis. Wikipedia CC BY-SA 3.0.
  • “Ebola_Treatment_Unit.jpg.” https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic#/media/File:Ebola_Treatment_Unit.jpg. Wikipedia CC BY 2.0.
  • “1280px-Angolan_community_members_at_HIV_AIDS_outreach_event_5686747785.jpg.” https://en.wikipedia.org/wiki/HIV/AIDS_in_Africa#/media/File:Angolan_community_members_at_HIV_AIDS_outreach_event_(5686747785).jpg. Wikipedia Public domain.