Health transition in Africa: practical policy proposals for primary care

Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS; tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example; age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people; primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well; within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa; they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition

Epidemiological experience in the mission of the United Nations Transition Assistance Group (UNTAG) in Namibia

Epidemiological data have rarely been generated during United Nations (UN) missions to Third World countries, even in situations where there is hardly any combat involvement. Continuous surveillance was therefore carried out during the 12-month stay of UN personnel in Namibia in 1989-90. In this population of 7114 persons, mostly young men, the mortality rate was 255 per 100,000; death was mainly due to traffic accidents. Hospitalization was chiefly because of fever of unknown origin or trauma. Repatriation to the country of origin was necessary in 46 patients, frequently for psychiatric reasons including alcoholism. Over this one-year period there were, on average, 2.7 new consultations per person for treatment (mostly for dental problems), and 0.8 per person for prophylactic measures. The extremely high mortality due to traffic accidents indicates a need for prevention. In the selection process for future missions, more emphasis should be given to the psychological and dental health of volunteers. All military contingents and civilian groups should learn about effective preventive measures prior to their arrival, and adhere to them

Under-five mortality trends in Africa: reconstruction from demographic sample survey

The study presents a reconstruction of under-five mortality trends derived from data provided by the Demographic and Health Surveys (DHS) and World Fertility Surveys (WFS) in sub-Saharan Africa from 1950 to 2000. Death rates were first calculated by single years for each of the 64 surveys available. When several surveys were available for the same country; they were combined for each of the overlapping years. Then the series was analyzed to identify periods of monotonic trends; whether they were declining; steady; or increasing. Changes in trends were tested using a linear logistic model. All calculations were done at the national level and by urban-rural residence. Among the 33 countries studied; which account for some 80 percent of the sub-Saharan population; only eight had monotonic or quasimonotonic mortality trends; which indicate a smooth health transition. Another eight countries had periods when mortality rose significantly for a variety of reasons. In at least eight other countries mortality increased through 1985-90-the most recent period covered in the study as a result of increasing levels of AIDS mortality. Reconstructed levels and trends are compared with other estimates made by international organizations. These estimates are usually based on indirect methods. Results indicate that in sub-Saharan Africa; progress was made in the health transition during the second half of the twentieth century. However; improvement was slower than expected; with an average decline in mortality of -1.7 percent per year. The transition was not smooth in more than half of the countries; and cases of reversals in mortality trends occur that appear to be linked to political; economic; and epidemiological crises; particularly the HIV/AIDS pandemic