World Health Report on Africa
World Health Organization (WHO) marks its 75th anniversary on 7 April 2023.
On this day in 1948, the United Nations fulfilled its ambition to create a global health body in a bid to make the world safer and to serve those most in need. Every year since, the date has been observed as World Health Day.
In the African region, the noteworthy milestone of WHO’s 75th anniversary provides an opportunity to celebrate the many public health successes that have significantly improved quality of life over the years. It also serves as a poignant moment to redouble commitment to tackling the current and future health challenges confronting the region and steering it towards a brighter tomorrow.
But for all the hard-won gains that have been made over the past 75 years, more than 100 health emergencies still occur in the African Region annually, including outbreaks of cholera, yellow fever, meningitis, measles and Ebola. These emergencies still pose a significant threat to the health, well-being and development of African countries.
The COVID-19 pandemic has also cast a long shadow, causing widespread disruptions to essential services such as routine immunizations and setting back the efforts to control or eliminate health threats, as well as stalling progress towards universal health coverage.
As many countries simultaneously confront the intersecting crises of climate change, conflict and rising food insecurity, the need to bolster resilience and capacity to respond to health emergencies has never been more urgent.
WHO is entirely committed to helping countries tackle the health challenges of today ̶and tomorrow. Seventy-five years since the Organization’s creation, our work remains as important as ever.
Neglected tropical diseases
Africa according to WHOs report has made great strides towards neglected tropical diseases elimination goals. Leprosy has all but been eliminated as a public health problem, 41 countries have been certified free of Guinea worm, and five countries have eliminated trachoma as a public health problem. In the African region, Benin, Rwanda and Uganda have been validated as having eliminated sleeping sickness as public health problem. Despite the progress, challenges remain, including inadequate government ownership of the neglected tropical disease control and elimination programmers’, low level of integration of these diseases in the mainstream health programmers and insufficient funding.
Polio eradication
Huge efforts have been made towards polio eradication in the region. In 2020, African was declared free of indigenous wild poliovirus. WHO’s long-standing support has helped to avert 900 000 polio-related deaths and ensure that 19.4 million people have been spared from disability. WHO has supported more than 20 African countries in rolling out over 500 million doses of the novel oral polio type 2 (nOPV2) vaccine. As a result, 80% of countries that have used the new tool have seen no further transmission of circulating variant poliovirus type 2 (the most prevalent form of polio) after 2 immunization rounds.
Health for all
Substantial progress has been made in the region’s bid to achieve universal health coverage. Universal health service coverage index rose to 46 in 2019, up from 24 in 2000 (the maximum is 100). Scaling up essential health services and coverage has yielded remarkable results. For example, between 2011 and 2021, new HIV infections in the region fell by 44% and AIDS-related deaths by 55%. TB deaths declined by 26% between 2015 and 2021. Although most countries have integrated the attainment of universal health coverage as a central goal of their national health strategies, progress remains varied in translating this into equitable and quality services as well as increasing financial protection for the population.
Life expectancy
Healthy life expectancy increased on average by 10 years between 2000 and 2019, the highest increase globally in that period. More people are now living healthier, longer lives with less risk from disease and with better access to care and prevention services. This is due to improvements in the provision of essential health services, gains in reproductive, maternal, newborn and child health, as well as progress in the fight against infectious diseases—thanks to the rapid scale-up of HIV, tuberculosis, and malaria control measures from 2005—helped to extend healthy life expectancy.
Maternal health
The region has made notable progress in maternal health. For example, maternal mortality rate declined from 857 deaths per 100 000 live births in 2000 to 525 per 100 000 live births in 2017. Despite the drop, huge efforts needed to accelerate progress towards the 2030 SDG target of ensuring 70 or fewer maternal deaths per 100 000 live births.
COVID
The Engagement of Civil Society Organizations in the COVID-19 Response in the WHO African Region
Recognizing the key role of civil society organizations (CSOs) in the response to public health emergencies, the World Health Organization (WHO) has built new and operational partnerships with these non- State actors. While WHO’s main mission is to support the ministries of health (MoH), the inclusion of CSOs opens new perspectives to improving the response to public health emergencies both at the national and community levels.
Cholera
In 2019, WHO designed a new pilot initiative to better engage CSOs in the response to outbreaks. The “CSO Engagement Initiative” has been implemented in the six WHO Regions. Meanwhile in 2020, the COVID-19 pandemic shed a new light on the critical role of CSOs to ensuring that communities understand and accept the public health response measures targeting in particular vulnerable people
Cholera in the WHO African Region: Weekly Regional Cholera Bulletin: 05 April 2023
The cholera outbreak in the WHO African Region continues to evolve, with 14 countries currently affected. The Kingdom of Eswatini declared a new cholera outbreak on 4 April 2023 following confirmation of the disease in a traveler from a neighboring country who arrived on 27 March 2023. This highlights the need for Member States to enhance readiness, heighten surveillance and institute preventive and control measures at the points of entry to prevent and mitigate cross border infection. The concurrent climate-induced natural disasters such as cyclone and flooding in the southern African region and drought in the Horn of Africa threatens to impede the progress made in controlling the ongoing outbreaks. The cholera trends are being closely monitored as response and readiness measures are ramped up.
In week 13, there was a 40.7% decrease in incidence cases, with 6 464 cases recorded from seven countries compared with 10 896 cases reported from 11 countries in week 12. There was also a 29.8% decrease in deaths recorded during the same period, as 40 deaths occurred in week 13 compared with 57 in week 12 of 2023.
Cumulatively, 160 756 suspected cholera cases have been reported, including 3288 deaths (case fatality ratio (CFR = 2.1%)) as of 4 April 2023 (Table 1). Malawi accounts for 35% (56 763) of the total cases and 52% (1722) of all deaths reported, and together with Cameroon, Democratic Republic of the Congo, Mozambique, and Nigeria contribute to 78% (125 837) of the overall caseload and 91% (2984) of cumulative deaths from 1 January 2022 to 4 March 2023.
The cholera outbreaks in the African Region are happening in the context of natural disasters such as cyclones (Mozambique, Malawi), flooding (Mozambique, Malawi), drought (Kenya and Ethiopia), conflict (Cameroon, Democratic Republic of the Congo, Nigeria, Ethiopia) and multiple disease outbreaks including Mpox, wild polio, measles, COVID-19 pandemic, etc. Many countries have limited and strained resources, shortage of medical commodities, including cholera kits and Oral Cholera Vaccine (OCV). Poor sanitation and unreliable water supplies with increased cross-border movements also serve as driving factors for the outbreak across the region.
Malaria
Malaria is a mosquito-borne infectious disease that affects humans, caused by protozoan parasites belonging to the genus Plasmodium. Four species account for almost all human infections but the species P falciparum causes the majority of infections in Africa and is responsible for the most severe forms of the disease, with the highest mortality rate. When an infected mosquito bites a human therefore, it can introduce the parasite from its saliva into the person’s blood. Many different species of mosquito transmit malaria in this way. Each of the malaria-transmitting mosquito species has different lengths of life-cycle, preferred aquatic habitat, and preferred feeding. The long lifespan and strong human-biting habit of the African species that carry malaria are the main reasons for the high incidence of malaria in Africa. Despite the fact it is easily preventable and treatable, malaria continues to have a devastating impact on people’s health and livelihoods around the world.
Symptoms
Symptoms manifest between eight and 25 days after infection, and are typically flu-like: they include headaches, fever, shivering, joint pain, vomiting, jaundice, retinal damage and convulsions. Paroxysm – feeling suddenly cold and uncontrollable shivering followed by fever and sweating – is extremely common.
People with severe malaria – usually caused by P. falciparum – display symptoms such as abnormal posture, inability to turn the eyes in the same direction, seizures, or even falling into a coma. If malaria is not treated quickly, it can progress to severe illness, often leading to multiple organ failure in adults, or even death. Malaria in pregnant women can cause stillbirths, infant mortality, and low birth weight.
The best way to fight malaria is to prevent infection in the first place. WHO recommends that all people living in malaria transmission areas practise protection against malaria. Two common methods are: using insecticide-treated mosquito nets and indoor spraying. By forming a physical barrier between mosquitos and humans, nets are a simple and effective means of preventing infection, particularly if people sleep underneath one, as mosquitos emerge to feed at dawn and dusk. More people in Africa are benefiting from insecticide-treated nets. Today, more than half of people at risk from malaria sleep under these nets, whereas in 2010 only 29% of those at risk did so.
Fumigating homes on an annual or semi-annual basis can also rapidly reduce malaria transmission. However, this method is not widely used in many sub-Saharan countries. This is because mosquitos are increasingly resistant to earlier, less expensive forms of insecticide, and for some people, the newer, more effective forms are prohibitively expensive.
Medicines can also be used for the prevention of malaria, especially for particularly at-risk population groups. These at-risk groups include young children, pregnant women, and travelers from malaria-free parts of the world who might not have built up any residual immunity. WHO recommends that pregnant women in areas of Africa with moderate and high malaria transmission rates take an anti-malarial medicine like sulfadoxine-pyrimethamine. More vulnerable people are receiving this potentially life-saving treatment in Africa each year. Across the 33 African countries which had been carrying out this treatment, an estimated 22% of eligible pregnant women received the recommended three or more doses, compared with 17% in 2015 and 0% in 2010.
- can also be prevented by using seasonal malaria chemoprevention. In 2017, a total of 15.7 million children in 12 countries in Africa’s Sahel region were protected through seasonal malaria chemoprevention (SMC) programsb. However, about 13.6 million children who could have benefited from this intervention were not covered, mainly due to lack of funding.
When malaria infection does occur, it is important that it be quickly diagnosed and treated. This means that a mild case can be stopped from developing into something more dangerous, even fatal, and it can also prevent malaria from spreading further. WHO recommends taking four key steps for the effective diagnosis and treatment of malaria:
First, the patient with suspected malaria should have it confirmed either using microscopy or a rapid diagnostic test (RDT);
Next, simple infections should be treated with fast-acting artemisinin-based combination therapy (ACT);
In areas with low malaria rates, a single dose of primaquine should be added to this treatment to reduce the chance of malaria spreading further;
Severe cases of malaria should be treated with injectable artesunate for at least 24 hours. Once the patient can take oral medicines, they should complete a three-day course of artemisinin-based combination therapy.
WHOs African initiative against Malaria
The current response of WHO to the threat posed by malaria is contained in the Global Technical Strategy for Malaria 2016-2030 adopted by the World Health Assembly in May 2015. The strategy provides comprehensive technical guidance to countries and development partners. It set the ambitious target of reducing the global malaria burden by 90% by 2030 through implementation of its three pillars with two supporting elements.
Pillar One: Ensure universal access to malaria prevention, diagnosis and treatment
Pillar Two: Accelerate efforts towards elimination and attainment of malaria-free status
Pillar Three: Transform malaria surveillance into a core intervention
Supporting Element 1: Harnessing innovation and expanding research
Supporting Element 2: Strengthening the enabling environment.
In August 2016, the WHO Regional Committee for Africa adopted the “Framework for implementing the Global Technical Strategy for malaria 2016–2030 in the African Region”. This framework guides implementation of the GTS in the WHO African Region.
At the World Health Assembly in May 2018, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, announced a redoubling of efforts to combat malaria. Six months later, a new strategy known as “high burden to high impact” was launched. This approach will be driven by the eleven countries most affected by malaria. Ten of these countries – Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania – are in sub-Saharan Africa. In 2017, these countries reported increases in malaria cases over the previous year. The “high burden to high impact” strategy advocates a country-led approach, and rests on the following four key elements: ensuring political will exists to reduce malaria deaths; improving information and data analysis to maximize impact; better guidance, policies and strategies; and ensuring a coordinated malaria response at the national level.
https://www.afro.who.int/health-topics/malaria
https://www.afro.who.int/health-topics/coronavirus-covid-19
HIV/AIDS/COMMUNICABLE DISEASE
Preventing and Responding to HIV Drug Resistance in the African Region: Regional action plan 2019-2023
Global action to combat HIV/AIDS has had an immense impact in the African Region. By the end of 2017, 15.3 million people living with HIV (PLHIV) in the African Region were accessing life-saving antiretroviral drugs (ARVs), representing 70% of the 21.7 million people accessing antiretrovirals (ARV) globally.
WHO and the Joint United Nations Programme on HIV/ AIDS (UNAIDS) have set the target of 90% of people living with HIV on antiretroviral therapy (ART) achieving virological suppression by 2020. However, the potential positive impact from the scale-up of ART is under threat from an increase in the prevalence of HIV drug resistance (HIVDR). As the prevalence of HIVDR in the African Region increases, the impact on society, the economy and on health could be severe (2,3). If the prevalence of pretreatment HIV drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) in sub-Saharan Africa exceeds 10% and NNRTIs continue to be used in first-line ART regimens, over a five-year period, NNRTI PDR may be responsible for a cumulative 135 000 AIDS-related deaths, 105 000 new HIV infections and an additional US$ 650 million will be spent on ARVs in sub-Saharan Africa.
Communicable, or infectious diseases, are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Some are transmitted through bites from insects while others are caused by ingesting contaminated food or water.
A variety of disease-producing bacteria and viruses are carried in the mouth, nose, throat and respiratory tract. Conditions such as leprosy, tuberculosis (TB) and different strains of influenza (flu) can be spread by coughing, sneezing, and saliva or mucus on unwashed hands.
Sexually transmitted infections (STIs) such as HIV and viral hepatitis are spread through the exposure to infective bodily fluids such as blood, vaginal secretions and semen. Hepatitis is a significant concern in the African Region and the majority of people living with hepatitis B and C are unaware of their infections.
Insects play a significant role in the transmission of disease. Bites from Anopheles mosquitoes transmits malaria parasites that can wreak havoc on high-risk populations such as children under age 5 and pregnant women. Yellow fever has also seen resurgence due to reduced vaccination efforts. Many neglected tropical diseases are caused by unsafe water, poor housing conditions and poor sanitation in the Region.
https://www.afro.who.int/health-topics/hivaids
EBOLA
Ebola diseases (EBOD) are rare, but severe and often fatal viral diseases that affects humans and other primates. There are six species in the genus Ebolavirus, three of which (Bundibugyo, Sudan and Zaire) have previously caused large outbreaks. Ebolaviruses are transmitted to people from wild animals such as fruit bats, porcupines and non-human primates. They spread in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g., bedding, clothing) contaminated with these fluids.
The first cases of Ebola diseases were detected in two concomitants outbreaks in Sudan and in Zaire (now the Democratic Republic of the Congo) in 1976. Since then there have been several outbreaks in many countries. Outbreaks have since occurred in the Democratic Republic of the Congo, Gabon, Guinea, Liberia, Republic of the Congo, Sierra Leone, Sudan and Uganda. In Africa, imported cases have also been found in Mali, Nigeria, Senegal and South Africa. The 2014–2016 outbreak in West Africa was the largest and most complex ever recorded, with widespread cases and a heavy death toll.
Ebola case fatality rates have varied from 25% to 90% in past outbreaks. However, with the currently available effective treatment, patients have a significantly higher chance of survival if they are treated early and given supportive care.
Symptoms
Ebola diseases symptoms can be sudden. They include fever, fatigue, muscle, pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases internal and external bleeding (e.g., oozing from the gums, blood in the stool). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
It can be difficult to clinically distinguish Ebola diseases symptoms from other infectious diseases such as malaria, typhoid fever and meningitis. A range of diagnostic tests have been developed to confirm the presence of the virus.
The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days. A person infected with an Ebolavirus cannot spread the disease until they develop symptoms.
Treatment
Supportive care—rehydration with oral or intravenous fluids—and treatment of specific symptoms improves survival. A range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.
During the 2018–2020 Ebola virus disease (EVD) outbreak caused by Zaire ebolavirus in the Democratic Republic of the Congo, the first-ever multi-drug randomized control trial was conducted to evaluate the effectiveness and safety of drugs used in the treatment of EVD patients under an ethical framework developed in consultation with experts in the field and the DRC.
Two monoclonal antibodies (Inmazeb and Ebanga) were approved for the treatment of Zaire ebolavirus infection in adults and children by the US Food and Drug Administration in late 2020.
WHOs report on Ebola
The cholera outbreak in the WHO African Region continues to evolve, with 14 countries currently affected. The Kingdom of Eswatini declared a new cholera outbreak on 4 April 2023 following confirmation of the disease in a traveller from a neighbouring country who arrived on 27 March 2023. This highlights the need for Member States to enhance readiness, heighten surveillance and institute preventive and control measures at the points of entry to prevent and mitigate cross border infection. The concurrent climate-induced natural disasters such as cyclone and flooding in the southern African region and drought in the Horn of Africa threatens to impede the progress made in controlling the ongoing outbreaks. The cholera trends are being closely monitored as response and readiness measures are ramped up.
In week 13, there was a 40.7% decrease in incidence cases, with 6 464 cases recorded from seven countries compared with 10 896 cases reported from 11 countries in week 12. There was also a 29.8% decrease in deaths recorded during the same period, as 40 deaths occurred in week 13 compared with 57 in week 12 of 2023.
Cumulatively, 160 756 suspected cholera cases have been reported, including 3288 deaths (case fatality ratio (CFR = 2.1%)) as of 4 April 2023 (Table 1). Malawi accounts for 35% (56 763) of the total cases and 52% (1722) of all deaths reported, and together with Cameroon, Democratic Republic of the Congo, Mozambique, and Nigeria contribute to 78% (125 837) of the overall caseload and 91% (2984) of cumulative deaths from 1 January 2022 to 4 March 2023.
The cholera outbreaks in the African Region are happening in the context of natural disasters such as cyclones (Mozambique, Malawi), flooding (Mozambique, Malawi), drought (Kenya and Ethiopia), conflict (Cameroon, Democratic Republic of the Congo, Nigeria, Ethiopia) and multiple disease outbreaks including Mpox, wild polio, measles, COVID-19 pandemic, etc. Many countries have limited and strained resources, shortage of medical commodities, including cholera kits and Oral Cholera Vaccine (OCV). Poor sanitation and unreliable water supplies with increased cross-border movements also serve as driving factors for the outbreak across the region.
https://www.afro.who.int/health-topics/ebola-disease
SUBSTANCE ABUSE
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. One of the key impacts of illicit drug use on society is the negative health consequences experienced by its members. Drug use also puts a heavy financial burden on individuals, families and society.
The evolution of the complex global illicit drug problem is clearly driven by a range of factors. Sociodemographic trends are influential such as the population’s gender, age and the rate of urbanization.
Cannabis remains the most widely used illicit substance in the African Region. The highest prevalence and increase in use is being reported in West and Central Africa with rates between 5.2% and 13.5%.
Amphetamine-type stimulants (ATS) such as "ecstasy" and methamphetamine now rank as Africa’s second most widely abused drug type. Other substances that were used by children and youth surveyed in Sierra Leone, included benzodiazepines such as diazepam, chlorpromazine and different inhalants, while 3.7% were injecting drugs.
Injecting drugs carries a high risk of infection with bloodborne viruses such as HIV, hepatitis B and hepatitis C, and the sharing of contaminated needles and syringes is an important mode of transmission for those viruses.
We know what can and needs to be done to help reduce the burden of psychoactive substance use. Therefore, WHO is committed to assisting countries in the development, organization, monitoring and evaluation of treatment and other services.
The harmful use of alcohol results in 3.3 million deaths each year.
On average every person in the world aged 15 years or older drinks 6.2 litres of pure alcohol per year.
Less than half the population (38.3%) actually drinks alcohol, this means that those who do drink consume on average 17 litres of pure alcohol annually.
At least 15.3 million persons have drug use disorders.
Injecting drug use reported in 148 countries, of which 120 report HIV infection among this population.
https://www.afro.who.int/health-topics/substance-abuse
TRADITIONAL MEDICINE
Traditional medicine refers to the knowledge, skills and practises based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness.
Traditional medicine is often termed alternative or complementary medicine in many countries. Herbal treatments are the most popular form of traditional medicine and 70% to 80% of the Region has used a form as primary health care.
One third of the population lacks access to essential medicines and the provision of safe and effective traditional and alternative remedies could become an important way of increasing access to health care services.
Tried and tested methods and products:
Acupuncture has been proven effective in relieving a variety of pain disorders, high blood pressure, depression and morning sickness. It can also alleviate postoperative pain and adverse reactions to chemotherapy.
The Chinese herb Artemisia annua has been found to be effective against resistant malaria and could create a breakthrough in preventing almost 1 million deaths annually.
In South Africa, the plant Sutherlandia microphylla is being studied for use in HIV patients. The plant may increase energy, appetite and body mass in people living with HIV.
https://www.afro.who.int/health-topics/traditional-medicine
