In this paper, the authors provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa They conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa from 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. Type 2 diabetes was found to account for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Screening studies identified high proportions (>40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. The authors argue that significant interactions between diabetes and important infectious diseases like HIV highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.
Equity in Health
South Africans are likely to live, on average, seven years longer in 2040 than they do now, but the country will see only modest improvement in its global ranking as longevity increases worldwide, according to a study published in the Lancet. SA had an average life expectancy of 62.4 years in 2016, and ranked 171 among 195 countries. If recent health trends continue, SA could see life expectancy increasing to 69.3 years. But it will only rise two places in the global rankings, to 169, as life expectancy is expected to increase in most countries. The authors of the study forecast a range of scenarios for each country, which for SA show that life expectancy could increase by as much as 12.9 years to 75.3 years if the country stepped up its efforts to improve the health of the nation. But in the worst-case scenario, life expectancy could fall by as much as 8.1 years. The study forecast a large global shift in deaths from infectious diseases to deaths from noncommunicable diseases such as diabetes, chronic obstructive pulmonary disease, kidney disease and lung cancer. The top 10 causes of death in SA in 2016 were HIV/Aids, lower respiratory infections, road injuries, interpersonal violence, tuberculosis, diabetes, ischemic heart disease, diarrhoeal diseases, stroke and premature birth complications. By 2040, however, diabetes will be the leading cause of death, followed by road injuries, lower respiratory infections, HIV/AIDS, interpersonal violence, ischemic heart disease, tuberculosis, chronic kidney disease, stroke and diarrhoeal diseases.
The number of people infected with tuberculosis in sub-Saharan Africa has risen dramatically in the past 15 years, largely due to HIV infection. Bloodstream infection with Mycobacterium tuberculosis (mycobacteraemia) is a common cause of fever in sub-Saharan Africa, but diagnosis requires the help of specialists and a lengthy incubation period. Cheap and practical tests for eye disease such as the examination of the back of the eyeball (ophthalmoscopy) for choroidal granulomas could be an efficient alternative in the diagnosis of mycobacteraemia.
Prior to the World Social Forum in Nairobi, as people from African and Asian countries in “the South” we met and discussed over two days our conditions, our experience and how we can work to construct an Africa and an Asia where we can control our resources and make decisions in the interests of ordinary people.
The ongoing outbreak of human Ebola virus in West Africa, the largest and most extensive recorded, began in forest villages across four districts in southeastern Guinea as early as December 2013. The authors argue that the shifts in land use in Guinée forestière where the virus originated are also connected to government policies promoting neoliberal structural adjustment that, alongside divesting public health infrastructure, opened domestic food production to global capital with Ebola’s latest spillover arising due to massive expansion in the land allocated to corporate production of oil palm, taking over farmland, and bringing a a variety of disturbance-associated fruit bats attracted to oil palm plantations into more direct contact with informal pickers and contract farmers. Deforestation, including from oil palm planting, changes foraging behavior of the bat and expands interfaces among bats, humans and livestock. The authors suggest that deforestation, de-development, population mobility, peri-urbanization, cycle migration, and an inadequate health system that failed to recognize and isolate cases may have contributed, and that the the present outbreak signals the need to characterise the ecosystems on which humanity must routinely be reminded it depends.
Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country’s progress, or lack thereof, toward more equitable RH and MH service coverage. The authors used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014 in both relative and absolute equity. Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.
This paper highlights gender as a very important factor in determining vulnerability in Disaster Risk Reduction (DRR). The degree of vulnerability to disaster is determined by social variables like gender, age, health status, ethnicity, religion and socio-economic status and understanding these is necessary to identify the underlying causes of disasters and thus try to prevent them. In most countries, women are particularly at risk from disasters. Subsequently, understanding why women are often vulnerable and taking appropriate steps can make a huge difference on impact. The paper looks at DRR in relation to livelihoods. People, especially in developing countries are particularly vulnerable to disasters as they often live in high-risk areas, have lower coping capacities, and have no form of insurance or other safety nets. Furthermore, they are heavily dependent on climate-sensitive primary industries like agriculture and fishing. A disaster can eradicate livelihoods or years of local development efforts in a very short time.
In the first half of 2000, the German national AIDS organization Deutsche AIDS-Hilfe e.V. (DAH) in Berlin presented the results of a study into international entry and residence regulations and the availability of medical treatment for people with HIV infection and AIDS. DAH had succeeded in collecting information from 166 countries. The results are disturbing.
Zimbabwe could face zero population growth next year due to the rising death rate caused by HIV/AIDS, state television reported Saturday."It is hitting us where it hurts most," said Health Minister Timothy Stamps, noting that AIDS is killing the country's skilled and productive youth. According to Stamps, 100,000 people died of AIDS last year in Zimbabwe. Official statistics put the weekly AIDS death toll at 2,000 in Zimbabwe, where one-fourth of the population is infected with HIV.
Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa has large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, the authors use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation and 47 percentage points less likely to use private facilities. Racial differentials in the likelihood of having a health consultation or an attended birth persist even after controlling for confounders. The results have two policy implications: minimizing the distance that poor South Africans must travel to obtain health care and improving the quality of care provided in poorer areas will reduce inequality.