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Epidemiological Impact on the Economies of Poor Nations of Africa. Prof. P.E. Mugambi Retired Professor of Applied Mathematics Department of Mathematics Makerere University. Summary.
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Epidemiological Impact on the Economies of Poor Nations of Africa Prof. P.E. Mugambi Retired Professor of Applied Mathematics Department of Mathematics Makerere University
Summary • Infectious diseases are a major public-health problem in the developing world especially Africa but its economic impact is not well documented. • Adequately capturing the economic burden of infectious diseases in poor countries requires good epidemiological data and a better understanding of the long-term health and economic costs. • Prevention and control efforts are scare, and fail to adequately capture the benefits.
Diseases for the poor • Many infectious diseases are frequently referred to as diseases of the poor. At a macro level, there is clear evidence that the burden of infectious diseases is greatest among the poorest countries of the world, especially those in sub-Saharan Africa • Disease and poverty have taken such a serious toll on Africa that the death rate is constantly rising. Not to mention the great population that is also steady increasing at an alarming rate, creating more famine and disease to spread throughout the land.
Economic burden Information on the economic burden of infectious diseases in Africa can help to target interventions efficiently and equitably, and to justify investment in research and control. • Such data can inform our understanding of the financial and time burdens of illness episodes, the determinants of treatment-seeking behavior, and the differential economic impact on population subgroups.
Issues related to disease problems in Africa • Infectious diseases are on the rise and now kill 17 million people a year, particularly young people in the developing world. • The concern over new viruses, started with HIV causing AIDS, has been reinforced as other emergent viral diseases have been reported, including Ebola and Rift Valley Fever. • Growing drug resistance, new virulent strains, continuing poverty, the breakdown of public health measures, and increased human contact are leading to renewed outbreaks of other epidemic diseases. • Travel and urbanization are increasing human vulnerability to epidemics of both old and emerging diseases. • There is also concern that climate change may have significant effects on health.
Reduction in Life Expectancy • Tuberculosis is now the world's single largest cause of death from a single agent. At the rate TB is spreading, it could claim over 100 million lives over the next 50 years. The association of TB with the AIDS epidemic is one of the main reasons for the increase. • There are presently about 300-500 million clinical cases of malaria a year, 90 percent in Africa, and malaria deaths rose 5 percent in 1995, killing 2.1 million people, mostly children. • Global warming could cause another 50-80 million cases as disease-bearing mosquitoes move into new areas. • While life expectancy has generally been increasing for decades, there has been a sharp reversal in recent years in sub-Saharan Africa. Causes may include the stresses of economic transition, deteriorating health care, and possibly the toxic burden of decades of environmental contamination. • In Africa, the AIDS epidemic is expected to reduce average life expectancy by almost 8 years (WRI/UNEP/UNDP/WB, 1996).
Disease and Poverty • HIV/AIDS has already destroyed so many lives in Africa since the 1980’s and is continuing to demise a majority of the population. Sometimes people receive the disease because of the increased spread of poverty or a traditional family breakdown of support systems. So many people have contracted the disease but cannot afford to take on the medical expenses and end up suffering until their death. • Orphans roam the streets of Africa because many of their family members have passed away from the disease and they are left to survive on their own. Africa has the world’s highest and most rapidly increasing spread of HIV/AIDS with 40% of the population already contracted the disease being the ages of 15-49 years.
Vultures feasting on diseases • Some people in Africa do not want the diseases to be eliminated simply because they benefit from their existence. E.g. pharmacists, the doctors, governments, treatment facilities, local communities and regional leaders. • The governments receive huge amounts of donations to fight these diseases every year, and each year, the funds are diverted. A campaign to spray using DDT was strongly objected although this could eradicate diseases like malaria in no time. Some health workers are also reluctant to promote control and prevention measures against diseases.
Frustrated campaigns • Mark Grabowsky, wrote in Nature 451, 1051-1052 (28 February 2008) that “Several years ago, I was explaining the value of a measles-vaccination campaign to a doctor at a pediatric hospital in northern Uganda, where, at that time, measles was endemic. The proposed campaign would control the disease and potentially enable the hospital to close the measles ward. The doctor responded that if there was also a campaign that controlled malaria he could close the entire hospital" • Individuals too are also frustrating all campaigns, and retarding prevention measures in rural villages, due to ignorance and misinformation.
Why Africa is prone to infectious diseases • Long distances from health centers • Lack of funds to buy medicines • Self medication • Incomplete doses • Lack of drugs in health centers • High consultation fees • Ignorance,-some people don’t understand why sleeping under mosquito nets prevents malaria
Key barriers • Effective treatment is often inaccessible or costly for vulnerable groups. • In many places, health services are of poor quality, with long waiting times, inaccurate diagnosis, and inappropriate prescription and advice. • In addition, these services often do not have essential drugs in stock and, even if they are available, there are often high levels of parasite resistance to the drugs provided. • People often resort to the private commercial sector, which may be poorly regulated and offer inappropriate treatment, but where access costs may be lower. • The coverage of effective prevention is very limited, especially in areas with the highest transmission. • Most households rely on personal protection measures of limited effectiveness, such as burning mosquito coils or leaves.
The economic impact of diseases in Africa • Africa's economic problems have a medical solution. Infectious disease is much more than a health issue. They cost the continent billions of dollars a year. • Malaria kills three children per minute. This amounts to a quiet global catastrophe. Quiet, because it has been taking place for millennia and become a fact of everyday life. In Mozambique, malaria patients occupy 40% of the nation's hospital beds. And these are just the people fortunate enough to make it to a health centre. • Fighting disease must be a central, not ancillary, part of the economic strategy for Africa - on a par with debt relief and trade liberalization - if countries in Africa are to achieve the significant boost in economic growth, that all sides agree is critical to reducing extreme poverty. • Infectious diseases have crippled African efforts to achieve economic self-sufficiency for at least the last half-century - predating the debt crises, corruption and trade matters.
More disease burden • Many infectious diseases, especially Aids and TB, exact a heavy toll that goes beyond the pain and suffering that victims of these diseases endure. • The damage also manifests itself in a significant and quantifiable drag on Africa's GDP. Currently, 300 to 500 million cases of malaria occur every year. Of the estimated 2.7 million people killed by malaria every year, 75% are African children under the age of five. • When an individual dies, it takes a minimum of three days to make funeral arrangements, while the entire village is gathered at the home. The bereaved are obligated to feed the comforts, and house them as well. People are forced to borrow funds during times they are moaning their loved ones. More people take time off from work for burial ceremonies, while companies suffer shortage of workers during such times.
Diseases andGlobal warming: Global warming makes girls hot • It was reported in Kenya that global warming has stopped circumcisions. • Consequently, young men are not ready to marry anyone which is why the girls marry diseased older guys.
Uganda and Global warming • In Uganda, global warming causes a related problem, namely early marriages. It occurs because rich men are ready to marry young females. This is a conclusion of a scientific report funded by the United Nations that has identified "famine marriages", i.e. a new method for families to earn money and food by selling their daughters.
Famine marriages • "When people don't have food, they raid and sell their daughters and animals to get money to buy food. Whenever they raid, they bring along sick animals with strange diseases that affect the rest of the livestock and the young girls are married off to rich men with a lot of diseases," it was reported by a local newspaper, The Monitor.
Global warming: disease threat • More countries will be at risk from mosquito-borne diseases like malaria and dengue due to global warming, according to Global Health TV. • Rising temperatures could affect many countries that have not reported an outbreak of malaria in decades. • If temperatures and rainfall rise, mosquitoes would thrive for longer and breed more prolifically. • The threat of global warming has already sparked concerns in the Philippines, with health secretary foreseeing "a propensity for cholera, dengue, typhoid [fever] and malaria".
Way forward • If world leaders and their counterparts in Africa want to boost GDP, they should consider that diseases like malaria exact an enormous price not only in lives, but also in medical costs and lost labor, harming the economic well-being of entire families, communities and nations. Malaria shackles the poor to a continuous cycle of poverty. • The economic, social and development burden is staggering. According to a Harvard University study published in 2000, Africa's annual GDP would be 100bn (£66bn) more than it is today if malaria had been eliminated 35 years ago - many times more than all the development aid provided to the continent in any given year.
Way forward • Meaningful economic development in Africa cannot occur if addressing infectious disease is seen as a secondary goal rather than a critical part of the new vision for economic stability. This will require those responsible for implementing a new economic plan for Africa to broaden their notion of what constitutes a successful core macroeconomic strategy.
Conclusion • No one would argue with the need to reduce the human suffering caused by malaria, Aids, TB and neglected tropical diseases. But it is doubtful that infectious diseases will receive the attention they merit in the effort to lift African nations from poverty unless world leaders firmly link disease burden to economic development. • Failure to do so means that infectious disease will continue to rob Africa - a continent of more than 800 million people - of its economic potential.