FAQS | | Diarrhoeal
Diseases In the WHO African
region, diarrhoeal diseases are still a leading cause of mortality and morbidity
in children under five years of age. It is estimated that each child in the Region
has five episodes of diarrhoea per year and that 800,000 die each year from diarrhoea
and dehydration. Undernutrition and measles are very commonly associated with
this mortality. The prevention of diarrhoea ultimately
depends on the improvement of water supplies and sanitation, which are very expensive
but will eventually occur. The prevention of death from dehydration arising from
diarrhoea is straightforward, using cheap oral rehydration salts or simple home-made
fluids. The skills required by workers in health facilities and by mothers at
home are easily learned. Standard case assessment and rehydration, promoted by
WHO and UNICEF, has become a part of the training of almost every health worker
in Africa. Since 1992, the Region has been facing a severe
epidemic of Shigella Dysentery. The bacteria causing this epidemic are rapidly
developing resistance to the first line antibiotics normally used for treatment.
The second line treatment is very expensive. In addition to killing children directly,
dysentery is a common cause of persistent diarrhoea, which is responsible for
15% of deaths from diarrhoea in children. Cholera also continues to affect the
region. Although the management of cases has improved greatly over the past five
years, cholera remains a public health problem. Starting
in 1996, some countries will be using the WHO/UNICEF Integrated Management of
Childhood Illness, which addresses the management of diarrhoea along with the
other major causes of child mortality. This aims to reduce mortality further by
ensuring that children receive coordinated treatment and preventive action for
their needs. WHO will continue, in close collaboration with national programmes,
its research and development efforts, looking for even more effective ways of
tackling this problem.
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Acute
Respiratory Infections Pneumonia
remains one of the three most important killer diseases of children in Africa.
It is estimated that of the 75 million children under five in Africa a million
and a half die each year of pneumonia. At least two thirds of this pneumonia is
caused by bacteria - particularly the pneumococcus and Haemophilus influenzae
- and the great majority of these cases will respond to treatment with simple
and cheap antibiotics given at home, following a treatment schedule developed
and promoted by WHO. The successful management of acute respiratory infections
(ARI) does not require an expensive, separate programme. The diagnosis and treatment
can be given by suitably trained workers in first level health facilities, provided
they are supplied with antibiotics. The management of severe cases calls for referral
of the child to hospital where oxygen and second line antibiotics are available. The
countries of Africa have been actively developing the ARI components of their
child care services over the past six years. There are now control activities
in 28 countries, and a further seven have prepared plans of action in readiness
to start training. Support has been provided by WHO and UNICEF and by several
donors. More than 700 doctors and 4500 nurses have been trained in ARI case management.
The effective management of pneumonia does need health workers and facilities,
and the main stumbling block in Africa is the sparse health services in many countries
of the Region. The survival of a child with pneumonia
depends to a great extent on the child being taken for care as soon as possible.
The ARI plans of action of all the countries include education of communities
and caretakers, both through the health workers and the mass media. WHO is assisting
with surveys to produce ethnographic data to guide the development of community
messages, and with training in the use of mass media. ARI
is one of the five conditions which account for more than 70% of child mortality
in Africa. Four countries in the Region, Ethiopia, Tanzania, Uganda and Zambia,
are now moving towards the introduction of the WHO approach to the integrated
management of childhood illness, which covers ARI, diarrhoea, malaria, measles
and malnutrition. It also takes the opportunity to ensure that children are fully
immunized and given prophylactic vitamin A and that their mothers receive counselling
on feeding. This approach, which other countries will follow in the next year,
will ensure not only that children receive adequate care for their illnesses,
including ARI, but that they are more likely to survive future attacks.
| | Malaria In
1993, some 90 countries or territories were considered malarious; almost half
of them are situated in Africa south of the Sahara. It has been estimated that
the incidence of malaria in the world may be in the order of 300-500 million clinical
cases each year, with countries in tropical Africa accounting for more than 90%.
Africa has the highest levels of endemicity in the world. Only about 7% of the
population in the WHO African Region live in areas with no or a negligible risk
of getting malaria. The vast majority of malaria
deaths occur among young children in Africa, especially in remote rural areas
with poor access to health services. Approximately one million deaths among children
under five years of age can be attributed to malaria alone or in combination with
other diseases. Mortality is concentrated in the younger
age groups. Among children referred to hospitals with severe malaria, case-fatality
rates of 10%-30% have been reported. In rural areas with little access to adequate
treatment these rates might be even higher. Even in non-fatal cases malaria produces
considerable impact on the health of young African children, increasing susceptibility
to other infections and hampering development.
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Hepatitis
B In the WHO Ninth General
Programme of Work, a target was set to reduce new hepatitis B carriers in children
by 80% by introducing hepatitis B vaccine into National Immunization programmes.
In May 1992, the World Health Assembly approved a target of introducing hepatitis
B vaccine in all countries by 1997. Following these recommendations, over 77 countries
have integrated hepatitis B vaccine into their immunization programmes. A number
of countries are either planning introduction or studying its feasibility. Hepatitis
B is highly endemic in Africa south of the Sahara. Serological evidence of prior
hepatitis B infection is present in 70%-90% of the population. The burden of the
disease is enormous: mortality from primary cancer of the liver ranks either number
one or two among cancer deaths in males in Africa. Primary cancer of the liver
is 100% fatal and kills at an average age of 35-45 years, causing families to
lose parents and wage earners at the most productive periods of their lives. It
is estimated that there are about 50,000 deaths from hepatitis B related cirrhosis
and about 130,000 deaths from hepatitis B related primary liver cancer annually
in sub-Saharan Africa. Hepatitis B vaccine is more than
90% effective in preventing hepatitis B infection of children. Despite the high
prevalence of infection and the enormous burden of disease, only a few African
countries use hepatitis B vaccine routinely with other childhood diseases vaccines.
To date, Botswana, Gambia, and South Africa are the only countries in the region
using hepatitis B vaccine as a universal infant immunization. Zimbabwe's hepatitis
B immunization programme was started in 1995 but was discontinued due to lack
of resources. There are a number of other African countries seriously considering
introduction of hepatitis B vaccine into their national immunization programmes. There
are a number of reasons for the lack of hepatitis B vaccine integration:
- Many countries are dependent on donors for their vaccine
supply.
- The cost of hepatitis B vaccine is higher compared to other childhood
diseases vaccines.
- Routine coverage of other childhood diseases vaccines
is low (30%-50%) in many African countries, and there is reluctance to add another
vaccine to their national immunization programmes.
The
WHO Regional Office for Africa has included introduction of hepatitis B vaccine
into its Immunization Plan of Action calling for: - introduction
of universal hepatitis B immunization into childhood programmes of all Member
States by 1997;
- attainment of at least 70% regional
coverage of one-year old with three doses of hepatitis B vaccine by the year 2000.
| | Poliomyelitis Since
1988, when WHO Member States collectively undertook to eradicate poliomyelitis,
the combined international effort has reduced the number of polio cases worldwide
by 80%. Although over 140 countries were polio-free in 1995, WHO estimates that
up to 100,000 new cases still occur each year in 67 polio endemic countries, mostly
in Asia and Africa. Polio-free zones are emerging
in Southern, Northern and Eastern Africa. A special project "Six Steps to
A Polio Free Africa" was launched by the WHO Regional Office for Africa in
1995. The six steps cover planning, coordination of all partners in the initiative,
certification of polio-free areas, focus on least successful countries as well
as full scale eradication activities. Some of the major
events in 1996 include the Kick Polio Out Of Africa initiative which will start
in August, National Immunization Days and other activities planned in 28 countries.
The aim of these campaigns is to interrupt the circulation of wild poliovirus.
About 80 million children will be vaccinated against polio through these initiatives. A
network of laboratories has been established which enables each case of suspected
polio to be tested. Three regional laboratories have been set up in Central African
Republic, Ghana, and Republic of South Africa. In addition, four national laboratories
constitute part of the network. The partnership between
WHO, Rotary International, UNICEF and the Centers for Disease Control and Prevention
will help national governments to generate US$ 60 million a year for vaccine provision
and operational support for National Immunization Days. Other United Nations agencies,
donor governments and non- governmental organizations are also expected to contribute
to this initiative. WHO is convening a Committee for
Polio Free Africa which will include current and former heads of state, First
Ladies of several African countries and other prominent African leaders. This
Committee will help to build the political commitment necessary in all the countries
to conduct National Immunization Days for three consecutive years. Also, Rotary
clubs of Africa backed by Rotary International, UNICEF and other partners will
provide the vital social mobilization role at country level.
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Measles The
World Summit for Children in 1989 set goals, subsequently endorsed by the World
Health Assembly in 1990, to achieve 95% reduction of measles deaths and 90% reduction
of measles cases, compared to pre-immunization levels, by 1995. There
is a 74% reduction of cases worldwide, from an estimated 95.5 million cases in
the pre-immunization period to the current level of 34.3 million. An 85% reduction
in measles deaths (from 5.3 to 1 million) has been achieved. However,
measles continues to be a tremendous burden through most of Africa. Countries
of the WHO Regional Office for Africa achieved a 45% case reduction and 71% death
reduction in 1995. Only five countries in the Regional
Office for Africa - Cape Verde, Malawi, Seychelles, St Helena and Swaziland managed
to reach the case reduction goal. Six countries were
successful in bringing down the number of measles deaths to five per cent as compared
to pre-immunization figures. These countries are: Cape Verde, Malawi, Mauritius,
Seychelles, St Helena, and Swaziland. In total, there
were 11 570 500 measles cases and 551 000 measles deaths estimated in 1995 from
the countries of the WHO Regional Office for Africa. There
is still much to be done regarding measles control in Africa. In countries where
measles still take a heavy toll on childhood mortality, particularly in major
urban centres, special acceleration of the programme through mass immunization
campaigns should be undertaken.
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| Neonatal
Tetanus In the African Region, neonatal
tetanus (NT) remains an important public health problem, being responsible for
10%-30% of all infant deaths in many countries. The regional NT mortality rate
is estimated at five to ten per 1000 live births resulting in 120,000 deaths annually.
Nevertheless, progress has been made in several countries. In 1993-1994, 18 countries
(Algeria, Benin, Botswana, Cape Verde, Comoros, Congo, Equatorial Guinea, Gabon,
Gambia, Lesotho, Mauritius, Namibia, Rwanda, Seychelles, South Africa, Swaziland,
Zambia and Zimbabwe) and two territories (Reunion and St Helena) representing
19% of the regional population reported national NT rates of less than one case
per 1000 live births. Impressive decreases in NT incidence rates were also reported
in Malawi (from 12/1000 live births in 1983 to 4.6/1000 live births in 1990) and
in the cities of Abidjan, Addis Ababa, Harare, and Maputo. However,
even in countries with high national levels of protection by tetanus toxoid or
clean deliveries, wide disparities exist in rural and urban areas. The
recommended "high risk approach", using available data to identify populations
at risk for neonatal tetanus and developing targeted and sustainable strategies
in these areas, has been initiated only in three countries (Kenya, Swaziland and
Tanzania) and in the capital cities of Nigeria and Zaire. Targeting women of childbearing
age for tetanus toxoid immunization in these districts is cost-effective. In
other countries, particularly in Central, Western and Sahelian Africa, high risk
populations are those dispersed in vast rural areas, and the current infrastructure
and available resources are largely inadequate to reach them. Continued efforts
are needed in all countries to strive for higher routine coverage with tetanus
toxoid and to ensure clean birth techniques
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Source:
WHO | |
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