Epidemiological Impact on the Epidemiological Impact on the Economies of Poor Nations of Economies of Poor Nations of

AfricaAfrica

Prof. P.E. MugambiProf. P.E. Mugambi

Retired Professor of Applied MathematicsRetired Professor of Applied Mathematics

Department of Mathematics Department of Mathematics

Makerere UniversityMakerere University

SummarySummary

Infectious diseases are a major public-health Infectious diseases are a major public-health problem in the developing world especially Africa problem in the developing world especially Africa but its economic impact is not well documented. but its economic impact is not well documented.

Adequately capturing the economic burden of Adequately capturing the economic burden of infectious diseases in poor countries requires good infectious diseases in poor countries requires good epidemiological data and a better understanding epidemiological data and a better understanding of the long-term health and economic costs. of the long-term health and economic costs.

Prevention and control efforts are scare, and fail Prevention and control efforts are scare, and fail to adequately capture the benefits. to adequately capture the benefits.

UGANDAN HEALTH STATS (UNICEF)UGANDAN HEALTH STATS (UNICEF)

Major infectious diseases > Degree of risk

Very highVery high

Drug access 50%50%

HIV AIDS > Adult prevalence rate 4.1%4.1%

HIV AIDS > Deaths 78,00078,000

Hospital beds > per 1,000 people 0.920.92

Malaria cases > per 100,000 4646

Physicians > per 1,000 people 0.080.08

Life expectancy at birth, years > Total population

4949

Maternal mortalityMaternal mortality 510 per 100,000510 per 100,000

Children living with AIDS (per Children living with AIDS (per

capita)capita) 4.03388 per 1,000 people 4.03388 per 1,000 people

Diseases for the poorDiseases for the poor

Many infectious diseases are frequently referred Many infectious diseases are frequently referred to as diseases of the poor. At a macro level, there to as diseases of the poor. At a macro level, there is clear evidence that the burden of infectious is clear evidence that the burden of infectious diseases is greatest among the poorest countries diseases is greatest among the poorest countries of the world, especially those in sub-Saharan of the world, especially those in sub-Saharan AfricaAfrica

Disease and poverty have taken such a serious Disease and poverty have taken such a serious toll on Africa that the death rate is constantly toll on Africa that the death rate is constantly rising. Not to mention the great population that is rising. Not to mention the great population that is also steady increasing at an alarming rate, also steady increasing at an alarming rate, creating more famine and disease to spread creating more famine and disease to spread throughout the land.throughout the land.

Economic burden Economic burden

Information on the economic burden of infectious Information on the economic burden of infectious diseases in Africa can help to target interventions diseases in Africa can help to target interventions efficiently and equitably, and to justify investment in efficiently and equitably, and to justify investment in research and control. research and control.

Such data can inform our understanding of the Such data can inform our understanding of the financial and time burdens of illness episodes, the financial and time burdens of illness episodes, the determinants of treatment-seeking behavior, and the determinants of treatment-seeking behavior, and the differential economic impact on population differential economic impact on population subgroups.subgroups.

Issues related to disease Issues related to disease problems in Africaproblems in Africa

Infectious diseases are on the rise and now kill 17 Infectious diseases are on the rise and now kill 17 million people a year, particularly young people in the million people a year, particularly young people in the developing world.developing world.

The concern over new viruses, started with HIV The concern over new viruses, started with HIV causing AIDS, has been reinforced as other emergent causing AIDS, has been reinforced as other emergent viral diseases have been reported, including Ebola and viral diseases have been reported, including Ebola and Rift Valley Fever.Rift Valley Fever.

Growing drug resistance, new virulent strains, Growing drug resistance, new virulent strains, continuing poverty, the breakdown of public health continuing poverty, the breakdown of public health measures, and increased human contact are leading measures, and increased human contact are leading to renewed outbreaks of other epidemic diseases. to renewed outbreaks of other epidemic diseases.

Travel and urbanization are increasing human Travel and urbanization are increasing human vulnerability to epidemics of both old and emerging vulnerability to epidemics of both old and emerging diseases.diseases.

There is also concern that climate change may have There is also concern that climate change may have significant effects on health.significant effects on health.

Reduction in Life ExpectancyReduction in Life Expectancy

Tuberculosis is now the world's single largest cause of death from a 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 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 million lives over the next 50 years. The association of TB with the AIDS epidemic is one of the main reasons for the increase.AIDS epidemic is one of the main reasons for the increase.

There are presently about 300-500 million clinical cases of malaria a There are presently about 300-500 million clinical cases of malaria a year, 90 percent in Africa, and malaria deaths rose 5 percent in year, 90 percent in Africa, and malaria deaths rose 5 percent in 1995, killing 2.1 million people, mostly children.1995, killing 2.1 million people, mostly children.

Global warming could cause another 50-80 million cases as disease-Global warming could cause another 50-80 million cases as disease-bearing mosquitoes move into new areas.bearing mosquitoes move into new areas.

While life expectancy has generally been increasing for decades, While life expectancy has generally been increasing for decades, there has been a sharp reversal in recent years in sub-Saharan there has been a sharp reversal in recent years in sub-Saharan Africa. Causes may include the stresses of economic transition, Africa. Causes may include the stresses of economic transition, deteriorating health care, and possibly the toxic burden of decades deteriorating health care, and possibly the toxic burden of decades of environmental contamination. of environmental contamination.

In Africa, the AIDS epidemic is expected to reduce average life In Africa, the AIDS epidemic is expected to reduce average life expectancy by almost 8 years (WRI/UNEP/UNDP/WB, 1996).expectancy by almost 8 years (WRI/UNEP/UNDP/WB, 1996).

Disease and PovertyDisease and Poverty

HIV/AIDS has already destroyed so many lives in Africa since the HIV/AIDS has already destroyed so many lives in Africa since the 1980’s and is continuing to demise a majority of the population. 1980’s and is continuing to demise a majority of the population. Sometimes people receive the disease because of the increased Sometimes people receive the disease because of the increased spread of poverty or a traditional family breakdown of support spread of poverty or a traditional family breakdown of support systems. So many people have contracted the disease but cannot systems. So many people have contracted the disease but cannot afford to take on the medical expenses and end up suffering until afford to take on the medical expenses and end up suffering until their death. their death.

Orphans roam the streets of Africa because many of their family Orphans roam the streets of Africa because many of their family members have passed away from the disease and they are left to members have passed away from the disease and they are left to survive on their own. Africa has the world’s highest and most survive on their own. Africa has the world’s highest and most rapidly increasing spread of HIV/AIDS with 40% of the population rapidly increasing spread of HIV/AIDS with 40% of the population already contracted the disease being the ages of 15-49 years.already contracted the disease being the ages of 15-49 years.

Vultures feasting on Vultures feasting on diseasesdiseases

Some people in Africa do not want the Some people in Africa do not want the diseases to be eliminated simply because diseases to be eliminated simply because they benefit from their existence. E.g. they benefit from their existence. E.g. pharmacists, the doctors, governments, pharmacists, the doctors, governments, treatment facilities, local communities and treatment facilities, local communities and regional leaders. regional leaders.

The governments receive huge amounts of The governments receive huge amounts of donations to fight these diseases every donations to fight these diseases every year, and each year, the funds are diverted. year, and each year, the funds are diverted. A campaign to spray using DDT was A campaign to spray using DDT was strongly objected although this could strongly objected although this could eradicate diseases like malaria in no time. eradicate diseases like malaria in no time. Some health workers are also reluctant to Some health workers are also reluctant to promote control and prevention measures promote control and prevention measures against diseases.against diseases.

Frustrated campaignsFrustrated campaigns

Mark Grabowsky, wrote in Nature 451, 1051-1052 (28 February Mark Grabowsky, wrote in Nature 451, 1051-1052 (28 February 2008) that “Several years ago, I was explaining the value of a 2008) that “Several years ago, I was explaining the value of a measles-vaccination campaign to a doctor at a pediatric hospital in measles-vaccination campaign to a doctor at a pediatric hospital in northern Uganda, where, at that time, measles was endemic. The northern Uganda, where, at that time, measles was endemic. The proposed campaign would control the disease and potentially enable proposed campaign would control the disease and potentially enable the hospital to close the measles ward. The doctor responded that if the hospital to close the measles ward. The doctor responded that if there was also a campaign that controlled malaria he could close the there was also a campaign that controlled malaria he could close the entire hospital" entire hospital"

Individuals too are also frustrating all campaigns, and retarding Individuals too are also frustrating all campaigns, and retarding prevention measures in rural villages, due to ignorance and prevention measures in rural villages, due to ignorance and misinformation.misinformation.

Why Africa is prone to Why Africa is prone to infectious diseasesinfectious diseases

Long distances from health centersLong distances from health centers Lack of funds to buy medicinesLack of funds to buy medicines Self medicationSelf medication Incomplete dosesIncomplete doses Lack of drugs in health centersLack of drugs in health centers High consultation feesHigh consultation fees Ignorance,-some people don’t Ignorance,-some people don’t

understand why sleeping under understand why sleeping under mosquito nets prevents malariamosquito nets prevents malaria

Key barriers Key barriers

Effective treatment is often inaccessible or costly for vulnerable groups. Effective treatment is often inaccessible or costly for vulnerable groups.

In many places, health services are of poor quality, with long waiting In many places, health services are of poor quality, with long waiting times, inaccurate diagnosis, and inappropriate prescription and advice. times, inaccurate diagnosis, and inappropriate prescription and advice.

In addition, these services often do not have essential drugs in stock 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 and, even if they are available, there are often high levels of parasite resistance to the drugs provided. resistance to the drugs provided.

People often resort to the private commercial sector, which may be People often resort to the private commercial sector, which may be poorly regulated and offer inappropriate treatment, but where access poorly regulated and offer inappropriate treatment, but where access costs may be lower.costs may be lower.

The coverage of effective prevention is very limited, especially in areas The coverage of effective prevention is very limited, especially in areas with the highest transmission. with the highest transmission.

Most households rely on personal protection measures of limited Most households rely on personal protection measures of limited effectiveness, such as burning mosquito coils or leaves. effectiveness, such as burning mosquito coils or leaves.

The economic impact of The economic impact of diseases in Africadiseases in Africa

Africa's economic problems have a medical solution. Infectious Africa's economic problems have a medical solution. Infectious disease is much more than a health issue. They cost the continent disease is much more than a health issue. They cost the continent billions of dollars a year. billions of dollars a year.

Malaria kills three children per minute. This amounts to a quiet Malaria kills three children per minute. This amounts to a quiet global catastrophe. Quiet, because it has been taking place for global catastrophe. Quiet, because it has been taking place for millennia and become a fact of everyday life. In Mozambique, millennia and become a fact of everyday life. In Mozambique, malaria patients occupy 40% of the nation's hospital beds. And these 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.are just the people fortunate enough to make it to a health centre.

Fighting disease must be a central, not ancillary, part of the Fighting disease must be a central, not ancillary, part of the economic strategy for Africa - on a par with debt relief and trade economic strategy for Africa - on a par with debt relief and trade liberalization - if countries in Africa are to achieve the significant liberalization - if countries in Africa are to achieve the significant boost in economic growth, that all sides agree is critical to reducing boost in economic growth, that all sides agree is critical to reducing extreme poverty.extreme poverty.

Infectious diseases have crippled African efforts to achieve Infectious diseases have crippled African efforts to achieve economic self-sufficiency for at least the last half-century - economic self-sufficiency for at least the last half-century - predating the debt crises, corruption and trade matterspredating the debt crises, corruption and trade matters..

More disease burdenMore disease burden

Many infectious diseases, especially Aids and TB, exact a heavy toll Many infectious diseases, especially Aids and TB, exact a heavy toll that goes beyond the pain and suffering that victims of these diseases that goes beyond the pain and suffering that victims of these diseases endure.endure.

The damage also manifests itself in a significant and quantifiable drag The damage also manifests itself in a significant and quantifiable drag on Africa's GDP. Currently, 300 to 500 million cases of malaria occur 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 every year. Of the estimated 2.7 million people killed by malaria every year, 75% are African children under the age of five.year, 75% are African children under the age of five.

When an individual dies, it takes a minimum of three days to make When an individual dies, it takes a minimum of three days to make funeral arrangements, while the entire village is gathered at the home. funeral arrangements, while the entire village is gathered at the home. The bereaved are obligated to feed the comforts, and house them as The bereaved are obligated to feed the comforts, and house them as well. People are forced to borrow funds during times they are moaning well. People are forced to borrow funds during times they are moaning their loved ones. More people take time off from work for burial their loved ones. More people take time off from work for burial ceremonies, while companies suffer shortage of workers during such ceremonies, while companies suffer shortage of workers during such times.times.

Diseases andDiseases and Global Global warming: Global warming warming: Global warming makes girls hotmakes girls hot It was reported in Kenya It was reported in Kenya

that global warming has that global warming has stopped circumcisions. stopped circumcisions.

Consequently, young Consequently, young men are not ready to men are not ready to marry anyone which is marry anyone which is why the girls marry why the girls marry diseased older guys.diseased older guys.

Uganda and Global Uganda and Global warmingwarming In Uganda, global warming causes a related problem, namely early In Uganda, global warming causes a related problem, namely early

marriages. It occurs because rich men are ready to marry young marriages. It occurs because rich men are ready to marry young females. This is a conclusion of a scientific report funded by the females. This is a conclusion of a scientific report funded by the United Nations that has identified "famine marriages", i.e. a new United Nations that has identified "famine marriages", i.e. a new method for families to earn money and food by selling their method for families to earn money and food by selling their daughters.daughters.

Famine marriagesFamine marriages

"When people don't have food, they raid and "When people don't have food, they raid and sell their daughters and animals to get sell their daughters and animals to get money to buy food. Whenever they raid, they money to buy food. Whenever they raid, they bring along sick animals with strange bring along sick animals with strange diseases that affect the rest of the livestock diseases that affect the rest of the livestock and the young girls are married off to rich and the young girls are married off to rich men with a lot of diseases," it was reported men with a lot of diseases," it was reported by a local newspaper, The Monitor.by a local newspaper, The Monitor.

Global warming: disease Global warming: disease threatthreat

More countries will be at risk from mosquito-borne diseases like More countries will be at risk from mosquito-borne diseases like malaria and dengue due to global warming, according to Global malaria and dengue due to global warming, according to Global Health TV.Health TV.

Rising temperatures could affect many countries that have not Rising temperatures could affect many countries that have not reported an outbreak of malaria in decades.reported an outbreak of malaria in decades.

If temperatures and rainfall rise, mosquitoes would thrive for longer If temperatures and rainfall rise, mosquitoes would thrive for longer and breed more prolifically.and breed more prolifically.

The threat of global warming has already sparked concerns in the The threat of global warming has already sparked concerns in the Philippines, with health secretary foreseeing "a propensity for Philippines, with health secretary foreseeing "a propensity for cholera, dengue, typhoid [fever] and malaria".cholera, dengue, typhoid [fever] and malaria".

Way forwardWay forward

If world leaders and their counterparts in Africa want to If world leaders and their counterparts in Africa want to boost GDP, they should consider that diseases like malaria boost GDP, they should consider that diseases like malaria exact an enormous price not only in lives, but also in exact an enormous price not only in lives, but also in medical costs and lost labor, harming the economic well-medical costs and lost labor, harming the economic well-being of entire families, communities and nations. Malaria being of entire families, communities and nations. Malaria shackles the poor to a continuous cycle of poverty. shackles the poor to a continuous cycle of poverty.

The economic, social and development burden is The economic, social and development burden is staggering. According to a Harvard University study staggering. According to a Harvard University study published in 2000, Africa's annual GDP would be 100bn published in 2000, Africa's annual GDP would be 100bn (£66bn) more than it is today if malaria had been (£66bn) more than it is today if malaria had been eliminated 35 years ago - many times more than all the eliminated 35 years ago - many times more than all the development aid provided to the continent in any given development aid provided to the continent in any given year.year.

Way forwardWay forward

Meaningful economic development in Africa Meaningful economic development in Africa cannot occur if addressing infectious disease is cannot occur if addressing infectious disease is seen as a secondary goal rather than a critical seen as a secondary goal rather than a critical part of the new vision for economic stability. part of the new vision for economic stability. This will require those responsible for This will require those responsible for implementing a new economic plan for Africa to implementing a new economic plan for Africa to broaden their notion of what constitutes a broaden their notion of what constitutes a successful core macroeconomic strategy.successful core macroeconomic strategy.

ConclusionConclusion

No one would argue with the need to reduce the human No one would argue with the need to reduce the human suffering caused by malaria, Aids, TB and neglected suffering caused by malaria, Aids, TB and neglected tropical diseases. But it is doubtful that infectious tropical diseases. But it is doubtful that infectious diseases will receive the attention they merit in the effort diseases will receive the attention they merit in the effort to lift African nations from poverty unless world leaders to lift African nations from poverty unless world leaders firmly link disease burden to economic development. firmly link disease burden to economic development.

Failure to do so means that infectious disease will Failure to do so means that infectious disease will continue to rob Africa - a continent of more than 800 continue to rob Africa - a continent of more than 800 million people - of its economic potential.million people - of its economic potential.

Thank you