Atlas of African health statistics 2022: Health situation analysis of the WHO African Region

The population of the World Health Organization's (WHO) African Region was estimated to be 1 120 161 000 in 2020 and about 14.4% of the world's population of 7 758 157 000. It was 8 billion in 20211 . It is the third largest population among the WHO regions after South-East Asia and the Western Pacific. Between 2019 and 2020, the population differential was equivalent to that of a state of more than 28 million inhabitants. The five most populated countries account for more than 45% of the Region's population. Among these, Nigeria and the Democratic Republic of the Congo represent about 50% of the population of the West African and Central African subregions, respectively, and Ethiopia represents about 20% of the population of the East and Southern Africa subregions. The average annual population growth in Africa was 2.5% in 2020. If the heterogeneity of the population growth between the regions of the world and between countries in the same subregion is considered, countries from and East and Southern Africa subregions seem to have lower population growth rates than countries in other large subregions, which show significantly higher increases. The current population density of Africa is low, estimated to be 36 inhabitants per km2 for the whole continent. However, many areas are uninhabitable and some countries have relatively large populations. High population density is a concern that must be addressed through policies, because it could generate surges and high concentrations of populations in mega cities and urban slums, which can be an issue when it comes to accessing various qualitative services. Gross domestic product (GDP) reflects a country's resources and therefore its potential to provide access to services to its people, particularly health services. This dynamic creates a circle, with healthier people going to work and contributing to the production of wealth for the benefit of the country. The most vulnerable people live from agriculture in rural areas, or in conflict-affected states. Difficulties in accessing health services, low education and inequalities between men and women are additional obstacles to poverty reduction. The population of sub-Saharan Africa is expected to almost double over the next three decades, growing from 1.15 billion in 2022 to 2.09 billion in 2050. The world's population is expected to grow from 7.94 billion at present to 8.51 billion in 2030 and 9.68 billion in 2050. The demographic dividend2 for African countries will emanate from the acceleration of economic growth following a de crease in fertility with a change in the structure of the age pyramid where the active population, that is those aged 18­65 years, will be more important, reaching a certain optimum to make positive the ratio between the population able to finance health and education systems and the population that benefits from these systems. This is the human capital for development at a given moment. The demographic dividend appears to be an opportunity and an invitation to action, but it is also a real challenge, that of creating sustainable jobs to generate the development to activate the economic growth lever.

Atlas des statistiques sanitaires africaines 2022: Analyse de la situation sanitaire de la Région africaine ­ Profils Pays

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Analysis of trends in SMART Nutrition Survey datafrom South Sudan between 2004 and 2016

Introduction: Emergency levels of Global Acute Malnutrition (GAM) persist in former Northern Bar el Ghazal State in South Sudan despite ongoing interventions. Reasons for long-term trends in GAM in South Sudan have not been explored despite decades of nutrition and health interventions. Objective: This project aimed to identify and analyse changes in patterns of malnutrition and key factors associated with malnutrition from 2004 to 2016.Methods: Secondary data analysis was carried out using Standardized Monitoring and Assessment of Relief and Transitions (SMART) nutrition surveys. Anthropometric data collected from children under five years of age from 2004 to 2016 were analysed to estimate seasonal differences in the prevalence of GAM (weight-for-height z-score (WHZ) <-2) and severe acute malnutrition (WHZ <-3). Risk factors for GAM were explored using data collected in 2014 and 2015 and analysed using logistic regression. Adjusted Wald tests investigated which variables were associated with GAM (p<0.05).Results: In Aweil West and North a reduction in GAM was observed between September 2004 (21.0%, CI 18.2-23.9) and November 2009 (16.2%, CI: 13.7-18.9). However, this apparent decline likely reflects a seasonal difference because the 5-year overall mean GAM was 20.4% (SD: 0.403) and 17.5% (SD: 0.380) in pre- and post-harvest seasons respectively. In multivariable linear regression modelling, not having been sick in the past two weeks (aOR 0.78, 95% CI 0.61, 0.99, p=0.047), and not having consumed juice (aOR 0.67, 95% CI 0.45, 0.99, p=0.045) were protective against GAM after adjusting for all potential confounders.Conclusion: This study highlights the impact of instability on the nutritional status of a generation, with the high prevalence of GAM and severe acute malnutrition remaining unchanged since 2004. Regular collection of representative nutrition data is useful to inform decision making. The results of this study suggest that a focus on care seeking behaviours and hygiene practices would be beneficial. The persistent prevalence of GAM identifies a need, not just for nutrition programmes but also effective prevention programmes

Routine Immunization in the WHO African Region: Progress; Challenges and Way Forward

Tremendous progress has been made in expanding immunization in the African Region over the last four decades. And immunization; together with other primary health care and development interventions; has impacted significantly on the annual number of deaths among children under five. However; an estimated 22 (4.3 million) of the infants globally remaining unimmunized are located in four countries of the African Region (Democratic Republic of the Congo; Ethiopia; Nigeria and South Africa). Challenges remain in reaching an estimated 20-30 of children across the Region. In addition to the traditional vaccines (DTP; measles; polio and tuberculosis) newer ones; such as for PCV and rotavirus; are being rolled out in the Region but uptake and coverage is slow and patchy both within and between countries. The new regional strategic plan for immunization 2014-2020 is intended to provide policy and programmatic guidance to Member States; in line with the 2011- 2020 GVAP; in order to optimize immunization services and assist countries to further strengthen their immunization programmes

Laws and Regulations Associated with Ownership of Human Biological Material in South Africa

Ownership with regard to human biological material (HBM) is addressed to some extent within South African law; specifically in chapter eight of the National Health Act (NHA) and its associated regulations. However; members of the legal fraternity struggle to conceptualise ownership of such materials without objectifying a person or people and risking reducing such individuals to a state of property. This then infers a reduction in human dignity by rendering one-self or parts of that same self as a commodity. The complexity of the issue raises much debate both legally as well as ethically

Saúde, estilo de vida e urbanização em Moçambique: problemas e perspectivas / Health, Lifestyle and urbanization in Mozambique: problems and perspectives

A irreversibilidade do processo de urbanização da população mundial está a atingir Moçambique de uma forma abrupta com múltiplas consequências para a saúde e bem, estar. Entre outros, o aumento da mecanização, o tempo de televisão, o uso do automóvel e o recurso a alimentação artificial, está a transformar, em poucos anos, uma população activa em pessoas sedentárias sujeitas à poluição e níveis de ansiedade até então desconhecidos. Os estudos disponíveis demonstram de forma clara uma enorme redução dos espaços para a recreação activa e uma concomitante redução do dispêndio energético por actividade física habitual. Como consequência, os dados epidemiológicos indicam um aumento, nas cidades, da obesidade, hipertensão e diabetes em adultos. Por seu turno, as crianças em idade escolar estão a conhecer um crescimento em todos os factores de risco de doença cardiovascular e uma redução do seu nível de desenvolvimento motor. A falta de planeamento no crescimento urbano está a ter consequências catastróficas na saúde da população urbana. Neste quadro, a denominada transição epidemiológica acontece sob a forma de acumulação, dado que a população continua muito permissiva a doenças transmissíveis e sofre agora a acumulação de um grupo de patologias associadas ao sedentarismo e desiquilíbrio nutricional.

The process of urbanization of the world population is reaching Mozambique rather abruptly with multiple consequences for the health and well-being. Increased mechanization, screen time, car use and use of fast food are causing, in a short time period, a dramatic changing in lifestyle. Population is reducing their activity levels, that used to be high, the stress levels are increasing as well as the environmental pollution. The available studies demonstrate a huge reduction of spaces for active recreation and a concomitant reduction of energy expenditure for physical activity. As a consequence, epidemiological data indicate an increase in the prevalence of obesity, hypertension and diabetes in adults. In turn, studies are demonstrating that the school aged children are increasing prevalence in all risk factors for cardiovascular disease and a reduction in their level of motor development. Lack of urban planning on urban growth seems to cause disastrous consequences on the health of the urban population. Thus, the so-called epidemiological transition are happening in the form of accumulation since the population remains very permissive to transmissible diseases adding to them an increased in the sedentary lifestyle and nutritional imbalance related diseases.

Polio Eradication Initiative (PEI) Emergency Plan: A Panacea for Polio Eradication in Nigeria

BACKGROUND.Nigeria has persistently fallen short of the goal to halt and eradicate the transmission of the poliomyelitis virus. The most recent failure of yet again another major polio eradication program under the Global Polio Emergency Initiative 2010-2012 calls for a review of the Nigerian Polio Eradication Initiative Emergency Plan developed under this scheme and time period. This is to determine whether the deployed strategies were optimum to tackle and surmount the intractable problem of sub- optimal vaccine coverage which has remained a critical bottleneck in the successful eradication of the polio virus in Nigeria. It becomes pertinent therefore; to appraise this latest effort to avoid a recurrence of failure in subsequent polio eradication programs.METHODS.A review of related and available literature was conducted on the subject matter using the Google search engine; Google Scholar; and PubMed using the key words polio; eradication; Nigeria; and Global Polio Eradication Initiative.RESULT.Much progress has been made towards achieving the required coverage threshold to completely eradicate polio but the inherent weaknesses and gaps in the Polio Eradication Initiative Emergency Plan plugs eradication efforts back into the vicious cycle of recurrent failure.CONCLUSION. Successful polio eradication efforts through the Polio Eradication Initiative Emergency Plan need to target realistic goals. Current efforts and strategies need to be scaled up and sustained to permanently address the persistent issue of sub optimal coverage of polio immunization

Challenges Faced by Older Women in Botswana in Accessing Services that Address Sexual and Reproductive Health; and Family Planning Needs; in Botswana

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs. Design; setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata); using probability proportional to size. Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services); unmet need for family planning and factors inhibiting use of these services. Results: The study revealed that 25 of the older women used some type of FP method. Of this number; 67.9 were aged 50-59 years; 17.4 60-69 years; 10.1 70-79 years; and 72 had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome; sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy; lack of education; financial constraints; a perception that healthcare planners limited SRH needs to antenatal and obstetrical services; a cultural reluctance to discuss SRH in public and domestic issues.Conclusion: The study recommends comprehensive public health education for older women on human sexuality and fertility; contraceptive use; access to services; effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services

Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa

The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions; or to avoid all breastfeeding; based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission; adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However; one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children

Strengthening the monitoring of progress on the health-related MDGs in the African Region

There is an emerging view that progress on achieving the Millennium Development Goals (MDGs) in the African Region may be better than what is currently being reflected by official statistics. This is believed to be a result of the lack of recently updated data on the MDGs in the Region. In order to strengthen the monitoring of the MDGs; it is important to look for viable options for the timely collection; processing; analysis of relevant and quality data; and the dissemination of information products based on this data. It is essential to improve the institutional capacities in countries in order to overcome the weak data sources and data management. The monitoring of progress on the MDGs could be strengthened by: improving the content; frequency; quality and efficiency of national health surveys; strengthening birth and death registration and cause of death scertainment; improving the availability of demographic data by completing the 2010 census round; improving surveillance and service statistics; enhancing the monitoring of health systems strengthening; and; strengthening country analytical and evaluation capacity; and data use for decision-making. The latter requires the establishment and strengthening of national health observatories charged with health statistics analysis; synthesis; dissemination; sharing; and use of information and evidence

Progress on the Health-related MDGs in the African Region

Progress towards the achievement of the health-related MDGs in the African Region is slow. Currently six African countries are on track to achieve the MDG target of reducing child mortality. There is no progress on the MDG target on reducing maternal mortality. Eleven countries have started to observe declines or stabilization in HIV prevalence trends among the 13 countries that have complete trend data. A third of the population with advanced HIV infection had access to antiretroviral drugs in 2007. There were increases in the proportions of children under fi ve sleeping under insecticide treated bednets between 1999 and 2006 in all 18 countries with trend data; although coverage rates were lower than 50. Few countries have shown suffi cient progress on targets related to reducing hunger; use of improved water and sanitation facilities. Countries and their partners should increase resources significantly to strengthen health systems; maternal and child health services; combat HIV/AIDS; malaria; and TB; tackle the broader determinants of health. Measures to monitor country progress towards the MDGs should also be improved by a major effort at strengthening data sources and capacity for data management

Strengthening public health laboratories in the WHO African Region: a critical need for disease control

Despite the progress and efforts being made to strengthen laboratory capacities in the Region; challenges remain. The purpose of this document is to raise awareness on the need to strengthen public health laboratory services and propose actions for building national laboratory capacity

Migration; Pastoralists; HIV Infection and Access to Care: the Nomadic Fulani of Northern Nigeria

The burden of HIV infection among the nomadic Fulani of northern Nigeria is unknown. Migration - a way of life for this population - is known to increase the rate of HIV transmission and may limit individuals' access to treatment and care. Many of Africa's other traditional; pastoral societies are similarly affected. This paper explores cultural practices and factors among the Fulani that may influence HIV transmission; vulnerability to infection; sustainability and challenges to treatment access; and avenues and models for outreach services; lastly; we proffer some solutions and recommendations. An extensive literature search with cross-referencing was done; and relevant publications on similar themes were reviewed. Three cases of Fulani nomads with HIV are presented to illustrate the challenge of providing a care continuum as well as to demonstrate successes when appropriate HIV interventions are employed. Patient interviews provide valuable insight and information on living and coping with HIV. Community mobility limits opportunities for counselling; testing and diagnosis; as well as HIV-related care access and maintenance. Consanguinity and certain cultural practices among the Fulani have clear amplification potential for HIV transmission. Treatment support through the use of coaches and life partners improves adherence to antiretroviral therapy (ART). Existing programmes for nomads afford opportunities for absorption and integration of HIV services. Nomadic communities should be provided with basic HIV-related services; including risk-reduction education and methods; counselling and testing; ART; medication adherence counselling; access to laboratory tests and health monitoring. These services should be taken to nomadic communities using novel approaches such as mobile units; extension services; case management; directly observed care; and treatment supporters linked to neighbouring health facilities in a hub-and-spoke model. Stronger collaborations are recommended between programmes for nomads and HIV services; and also between veterinary and public health services. Community participation and leadership should be encouraged to ensure the sustainability of HIV-related care delivery. More research is needed on the epidemiology and sociology of HIV infection and the best ways to provide services to hard-to-reach nomadic populations

Bridging the Gap between VCT and HIV/AIDS Treatment Uptake: Perspectives from a Mining-Sector Workplace in South Africa

This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa; with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign; the group nature of the campaign; and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this; the study revealed barriers to uptake of VCT in the workplace; including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors; including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake; there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive; which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness; which precluded medical care. A combination of the current annual; opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company

Progress in Implementing the Child Survival Strategy in the African Region

Under-five mortality rate in the African Region was estimated at 145/1;000 live births in 2007. These deaths were the result mainly of preventable or treatable conditions. A child survival strategy for the African Region was developed by WHO; UNICEF and World Bank and adopted by the fifty-sixth WHO Regional Committee in 2006 to address this high mortality rate.1 This report; which is a review made using reports and the results of a questionnaire sent to countries; summarizes progress in implementing the strategy as at December 2009 and proposes next steps for action. Significant achievement has been made in the areas of policy; strategy and plandevelopment; capacity building; partnerships and communication strategies; operations research; documentation and monitoring and evaluation. Also in scalingup of child survival interventions such as measles vaccination coverage; insecticidetreated nets use in children and provision of antiretroviral drugs to prevent motherto-child transmission of HIV. Currently; 21 countries are implementing the Integrated Management of Childhood Illness strategy in more than 75of the districts. Despite the achievements in some areas; coverage of some eff ective interventions remains low. Various health system challenges hamper the progress of child survival. These include inadequate country-level funding for scaling-up effective interventions; inadequate monitoring of coverage of interventions and human resource limitations. In order to increase coverage of eff ective child survival interventions and accelerate progress in implementation of the regional child survival strategy; the paper recommends several actions including the improvement of coverage of key child survival interventions and mobilization and allocation of resources to implement national child survival scale-up strategies and plans

The Effort to Attain Measles Pre-elimination Targets by 2012 and to Eliminate Measles in the African Region by 2020

Reduction in measles mortality contributes significantly towards attaining the Millennium Development Goal 4 (MDG 4); which aims to reduce overall under-five childhood deaths by two thirds by 2015; compared with 1990 levels. Routine measles immunization coverage is a key indicator for measuring progress towards attainment of this goal. Implementation of measles mortality reduction strategies in the African Region has led to major achievements; notably a reduction of estimated measles deaths by 92between 2000 and 2008. Despite the progress made; renewed commitment by countries is required to attain the pre-elimination targets and subsequently reach the ultimate goal of measles elimination by 2020. Countries will need to strengthen their immunization systems through ensuring that quality immunization services reach the hard-to-reach populations in addition to scaling up implementation of proven approaches and strategies such as the Reaching-Every-District approach. Gaps in the mobilization of resources have had a negative impact on the ability of countries to attain and sustain a high level of routine immunization and supplemental immunization activities coverage. Countries will also need to adopt a stepwise approach towards achieving the measles elimination goal by 2020; beginning with the attainment by 2012 of the proposed pre-elimination targets

Planning for district health services: a review of structures; processes and tools

Following the enactment of the National Health Policy (NHP) in 1999 and the Health Sector Strategic Plan (HSSP) in 2000; the district's role health service provision has fundamentally changed. In pursuit of these re-defined roles; the structures and processes that enable the districts balance the often competing top-down demands of the central government with the demands from the communities are usually lacking. The situation is made more complex by inadequate co-ordination of donor assistance and actions of vertical programs and projects. This paper seeks to highlight the different issues emerging in the health planning system at the district level; particularly focusing on structures and processes of planning for the district health services. It is based on the findings of a study focussed on highlighting districts: 1. Capacity to ensure equitable provision of services that are relevant to the needs of the intended population. 2. Capacity to ensure efficient use of the limited resources available; 3. Effectiveness of health plans at guiding implementation of planned services. The paper aims at investigating the health planning structures and processes of Uganda with the purpose of identifying and recommending viable actions for improvement. The above criteria were implied rather than strengthening and/or establishing of appropriate structures and institutions for the district health planning. Masindi district was used as the case study district. The study reviewed the district health planning system focusing on structures and processes; using the criteria of equity; relevance; efficiency and effectiveness. The methodology was to review local district and national documents related to district health planning as well as published international literature on related subjects. The paper focuses on key issues affecting the district health planning system ranging from national level policies and strategies to those locally inherent within the district health system and local governments. the issues discussed are the planning; budgeting and information system; personnel and financing of district health services