Dr. Yasin Abdi – August 2014
Africa as a continent accounts for 15% of the world’s population, yet bears 24% of the global disease burden according to World Health Organisation (WHO) figures. Despite the positive prognosis coming out of Africa in terms of its economic potential and growth, sadly Africa has the highest rates of infectious diseases such as Diarrhea, Malaria, Tuberculosis, Salmonellosis, shigellosis, Pneumonia, HIV/AIDS and Ebola haemoragic fever etc. Infectious diseases are responsible for 63-69% of all deaths in Africa; by comparison, in Europe infectious diseases trigger only 2% of deaths. The high rate of incidence of infectious disease shows in short life expectancy. On average, a resident of sub-Saharan Africa can expect to live only to the age of 46 years. It is the lowest for any region in the world, 14 years lower than in Asia, the next shortest-lived region.
The term ‘infectious disease’ refers to an illness due to harmful organisms (mostly micro-organisms) or their toxic products. Strictly speaking, communicable diseases are diseases than can be transmitted directly from person to person, however the terms ‘communicable’ and ‘infectious’ are used interchangeably. From a public health perspective, the distinctive feature of communicable diseases is an ability to spread from human to human by air, food, water, objects, insects, or by direct contact with an infected person. Some communicable diseases can occur in outbreaks that affect many people, especially if they can spread rapidly through person-to-person contact.
Africa faces unique challenges in the fight against infectious diseases. On-going fights against AIDS/HIV, tuberculosis, malaria and water-borne infectious diseases, acute respiratory tract infections, coupled with high human population growth (as of 2012, approximately 1, 07 billion people), rapid and unplanned urbanisation in multiplying the number of slum dwellers and contributing to extreme urban poverty, lack of clean water, poor sanitation, war and famine, present a difficult road ahead for African nations to keep people healthy. Africa faces also the epidemic of re-emerging and emerging infectious diseases as a result of poor implementation of public health programs, zoonotic infections, and travel, urbanisation and novel pathogens.
The international community has made very large investments in health over a long period of time in Africa. Unfortunately, these investments often come with requirements or priorities that do not reflect those of the local people or government. This donor-recipient mismatch has led to further frustration of local health experts while reinforcing the need for more sustainable solutions aimed at systematically connecting communities with national governments and ministries. This is more obvious in the prevention and control of infectious diseases, including but not limited to malaria, tuberculosis, HIV and yellow fever.
In the delivery of preventive health system, the microbiology and public health laboratory provides diagnostics and plays an important role in disease control, patient care and disease surveillance. However, public laboratory services remain the most neglected areas in sub-Saharan Africa and lacks trained staff, standardised infrastructure and inadequate equipment. Common challenges includes: weak supply chain management systems, lack of public health laboratories to address outbreaks, financing and allocation of resources to laboratories by Ministries of Health and funding research and development for control of infectious diseases.
Health threats in Africa and 21st century challenges include the new threats from emerging infectious diseases such as Severe acute respiratory syndrome (SARS), pandemic flu, Swine flu, avian flu (Bird flu), antimicrobial resistance or multi-drug resistance (MDR), Old diseases re-emerge (HIV/AIDS, Sexual Transmitted Infections, TB, food borne diseases) and the threats from bioterrorism. Africa without borders and free movements of goods and people will increase disease spreading within hours because of the globalised world and environmental changes.
Global epidemics of infectious diseases can be devastating to national economies. Epidemics can place intense demands on a nation’s healthcare system, through widespread illness and mortality, and can cause enormous social and economic disruption. SARS was first reported in Asia in February 2003. The illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the global outbreak was contained. It cost the global economy an estimated US $40 billion demonstrating that the true cost of global outbreaks is far in excess of the treatment of cases alone (see below table).
Table 1. Economic impact of selected infectious disease events
|1997||Hong Kong||‘bird flu’||22 million *|
|1990-8||United Kingdom||BSE+||38 billion|
|1999||Malaysia||Nipah virus||540 million*|
|1999||New York||West Nile Fever||Almost 100 million|
|1979-94||New York City||Tuberculosis||Over 1 billion|
*Conservative estimates +Bovine spongiform encephalopathy Source: WHO
Currently, Africa has no coordinated disease detection capability and monitoring mechanisms. For example, response to high-profile disease outbreaks such as Ebola and Marburg viruses is often handled largely by international organisations (WHO, CDC (USA) and ECDC (Europe) that fly in with the resources needed (such as personal protective equipment and rapid diagnostic tests) and then leave without having built significant infrastructure. In most cases, this marks the end of all activity in this arena until the next outbreak, which will find the local authorities again underfunded and unprepared.
In today’s world, communicable diseases can spread internationally with alarming speed. This was shown by the SARS outbreak in 2003 and more recently by the spread of a novel corona virus “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV) and current Ebola outbreak in West Africa. We all know that communicable diseases do not stop at borders and that we have to therefore, protect all our citizens in an efficient way. Africa has to establish its own disease control centre like other continents particularly America and Europe. Africa needs a regional public health agent that controls, eliminates and eradicates infectious diseases in African states.
I propose here that the Africa should start establishing an African Centre for Disease Control (ACDC) to coordinate the fight against threat of infectious diseases. The function of ACDC is to identify, assess and communicate current and emerging threats to human health posed by communicable diseases and to strengthen Africa’s defences against infectious diseases. ACDC is to focus initially the communicable diseases and public health strategies. The centre is to train infectious disease physicians, pathologists, public health specialist, epidemiologists, microbiologists, virologists, entomologists, biostatisticians, laboratory scientists, information technology professionals and healthcare leadership etc.
The centre’s work is to provide timely information to the African Union, the Member States, Community agencies and international organisations active within the field of public health and infectious disease control.
The proposed ACDC is to work in partnership with national health protection bodies across Africa to strengthen and develop continent-wide disease surveillance and early warning systems. By working with experts throughout Africa, ACDC pools Africa’s health knowledge to develop authoritative scientific opinions about the risks posed by current and emerging infectious diseases. The pan-African adoption of the ACDC approach requires a conscious effort to catalyse the shared priorities to fulfil our own healthcare needs.
The purpose of the proposal is to highlight how to address the infectious disease threats as we entered the new changing world. Infectious diseases present a major threat to health and society in Africa. What can we do?
Dr. Yasin Abdi DBMS
Senior Healthcare Scientist, Clinical Microbiologists at UK National Health Service (NHS)
BSc (Zoology and Applied Entomology), PGDip (Medical Laboratory Technology), PGDip (Clinical Microbiology), PGCer (Communicable Disease Control), MSc (Medical Microbiology), Doctor of Biomedical Science/DBMS (Clinical Microbiology).
Maqaalkan sannadkii 2014 ayaan kaga qayb qaatay kulan cilmi iyo talo wadaag ahaa oo lagu qabtay magaalada London. Qurbo joogga dhinaca caafimaadka ee qaaradda Africa ayaa kulankan kaga xaajoonayey dhibataada Afrika ka haysata xagga caafimaadka gaar ahaan cudurrada faafa).
Dhibaatada ka haysata Africa cudurrada faafa mid la mid ah ama ka daranba ayaa ka jirta geeska Africa sidaa darteed maqaalkan waxbadan baa laga baran karaa sidii looga gaashaaman lahaa dhibta iyo khatarta cudurrada faafa.