Africa Health Analysis– selected data from World Health Report 2002

In 2002 communicable diseases continued to be the main causes of death in Africa. Five conditions accounted for over 50% of all deaths, HIV/AIDS, lower respiratory infections, Malaria, diarrhoeal diseases and childhood diseases.

The HIV/AIDS epidemic continued to be the greatest threat to Africa’s health in 2002. Its presence was felt everywhere. A UNAIDS update revealed that HIV/AIDS and related illnesses killed more than 2 million people in 2002. There were over 29 million people with HIV, an increase of more than a million from the same time in 2001. HIV/AIDS is now the number one killer in Africa.

At the same time the HIV/AIDS epidemic continued to ravage Africa, it was also playing a deadly part in another unfolding tragedy in Africa. Once again it was Southern Africa that was impacted. HIV/AIDS, man-made and natural disasters combined in the worst way to precipitate famine that threatened the lives of millions. By the end of 2002, over 14 million people in Southern Africa were facing starvation.

Main Causes of Mortality in Africa in 2001

In 2001 almost two thirds of deaths, were from communicable diseases, compared to 1999 when communicable diseases accounted for over three in five deaths in Africa. All of these diseases, including HIV/AIDS are preventable. In many cases these conditions are treatable and with the implementation of low cost, prevention programs could be controlled.

Major health risks in Africa - 2002 

The “World Health Report 2002 Reducing Risks, Promoting Healthy Life” focused on the risks in life that pose a danger to health to people all over the world. The report identified the top ten risks, globally and regionally, in terms of the burden of disease they cause.  The ten leading risk factors globally are: underweight; unsafe sex; unsafe water, sanitation and hygiene; iron deficiency; high blood pressure; tobacco consumption; alcohol consumption;  indoor smoke from solid fuels; high cholesterol; and obesity.

The report shows that a relatively small number of risks cause a huge number of premature deaths and account for a very large share of the global burden of disease. For example, at least 30% of all disease burden occurring in many developing countries, such as those in sub-Saharan Africa results from fewer than five of the ten risks listed. In fact in Africa, iron deficiency and underweight could be lumped together as nutritional deficiencies, reducing the major risks

Attributable mortality is defined as the amount of mortality (the number of deaths) that would be eliminated if a particular risk were removed. Table 2 shows the calculated attributable mortality by risk factor in Africa in 2002.

For example if the total risk for unsafe sex, in Africa were to be removed, it would eliminate more than 2 million deaths (20% of mortality).  Unsafe sex is the greatest contributory risk factor for HIV/AIDS.

One of the major risks to health not mentioned specifically, but is alluded to throughout the report, is poverty. Poverty is a strong underlying determinant of many of the health risks that continue to remain as pervasive problems in Africa.

 Underweight alone accounts for over three million childhood deaths a year in developing countries according to the WHO. All ages are at risk, but underweight is most prevalent among children under five years of age, and It was a contributing factor in 60% of all child deaths in developing countries. The WHO estimates that approximately 27% of children in this age group are underweight. This caused an estimated 1.8 million deaths in Africa.

Nutritional conditions accounted for less than 2% of deaths directly in 2001.  In 2002, with almost 28 million Africans facing the prospect of starvation, 14 million of which are in Southern Africa; it seems certain that nutritional deficiencies will feature prominently as an associated factor in the coming year.

Unsafe water, sanitation and hygiene, is associated with 1.7 million deaths a year worldwide mainly through infectious diarrhoea. Nine out of ten such deaths are in children, and virtually all of the deaths are in developing countries. In Africa this translated into more than 6 hundred thousand deaths.

Elimination or reduction of childhood and maternal under nutrition combined with provision of safe water, sanitation and hygiene could reduce the burden of ill health in Africa by up to a third (33%)

Unsafe sex, is the main factor in the spread of HIV/AIDS, and as result has a major impact in the poor countries of Africa. HIV/AIDS is the leading cause of death in Africa, and is now the world’s fourth biggest cause of death. Currently 29.4 million (70%) of the 40 million people with HIV infection are found in Africa. 

There were more than 2 million deaths attributable to unsafe sex in Africa, with current estimates suggesting that more than 99% of the HIV infections prevalent in Africa in 2001 are attributable to unsafe sex. Globally, there were 2.9 million deaths attributable to unsafe sex.

Other health Indicators in Africa - 2002

The basic health indicators for Africa were typical for developing countries. High population growth rates with high dependency ratios indicating a high burden on services and economies. Life expectancy, at 51 years is relatively short (for Sub Saharan Africa it is now 47 years only. Without AIDS it would have been 62 years.  HIV/AIDS is visible everywhere across Africa and is now considered the greatest threat to African development especially in Sub Saharan Africa.

• Almost 30 million African men, women and children (70%) out of a global total of 42 million were infected with HIV

• There were almost 3.5 million new HIV infections in Africa.
• There were an estimated 2.4 million deaths in Africa, almost three quarters of deaths from AIDS (74.4%)
• By the end of this decade more than 50 million Africans will have died from AIDS.

Taken together, high total fertility rates lead to high population growth rates, result in high dependency ratios. The Dependency ratio is defined as: A measure of the portion of a population which is composed of dependents (people who are too young or too old to work). 

A high dependency ratio is a concern in many countries because it means the burden on the working population to provide for the non-working population is high. In Sub Saharan Africa, HIV/AIDS is killing mainly 15-49 year olds, the backbone of the working population. 

This means that the dependency ratio and the burden on society is increasing further, such that even countries that were relatively well off with low population growth rates are suffering as seen in Table 4. For example South Africa, Botswana and Zimbabwe have low population growth rates compared to other African countries, but the HIV/AIDS rates are extremely high. The Southern African region is also in the grips of a famine partially precipitated by the AIDS epidemic that has decimated the farmers and families in the rural areas.

As parents die and children are orphaned, the burden on families increases. It falls to the aged grand parents to take up the burden of looking after the orphaned children. Children who are orphaned suffer from a basic lack of access to health, nutrition, education and other services. They are more likely to have poorer health outcomes, suffer poor growth. This means in the long term the overall health indices for these nations will decline as the consequences are passed on to succeeding generations.

Spending on Health in 2002

The majority of African (56%) nations spend less $10 dollars per person per year on health.

• 6 (11%) of governments spent less than $4 dollars per person per year on health
• 24 (45%) of governments spent between $4 dollars and $10 dollars per person per year on health
• 12 (23%) of governments spent between $10 dollars and $28 dollars per person per year on health

Only 11 countries spent over $28 dollars per person per year on health. (see Table 5 below)

Across Africa government spending on total health spending varied from almost as high as 80%  (Nigeria) to as low as 16% (Tunisia) with a converse proportion of private spending Nigeria (12%), Tunisia (84%). However such data should be interpreted with caution.  Tunisia spent $113 per capita compared to Nigeria’s $2 per person according to the WHR Report 2002

Total health expenditure as a proportion of averaged 4.3% for African countries. It varied from a low of 1.3% ($19) in Somalia to 8.8% (255) in South Africa.

References:

1. UNAIDS/WHO. (2002) AIDS epidemic update December 2002
2. WHO. (2002) World Health Report 2002 Reducing Risks, Promoting Healthy Life, December