After years of wrangling and debates among African leaders, the movement to end female genital mutilation (FGM) is gaining real momentum, with a new action plan signed in August by the Pan African Parliament (PAP) representatives and the U.N. Population Fund (UNFPA) to end FGM as well as underage marriage. The UNFPA has already trained over 100,000 health workers to deal specifically with aiding victims of FGM, while tens of thousands of traditional leaders have also signed pledges against the practice. In some African countries, girls as young as eleven and twelve are forced to marry much older men, leading to an increase in serious health problems, including cervical cancer and a host of social problems. UNFPA East and Southern Africa Deputy Regional Director Justine Coulson said if the current trend continues, the number of girls under 15 who had babies would rise by a million – from two to three million. There are believed to be at least seven million child brides in Southern Africa alone. While underage marriage and childbirth is a major health risk, the Pan African Parliament UNFPA workshop also heard how FGM had led to an increased likelihood girls and women would be exposed to sexually transmitted diseases such as HIV/AIDS. Globally, an estimated 200 million girls and women alive today have undergone some form of FGM. In Africa, FGM is practiced in at least 26 of 43 African countries, with prevalence rates ranging from 98 percent in Somalia to 5 percent in Zaire. The buy-in of African political leadership is argued to be crucial if this latest move is to succeed, with up to 140 million women and girls in sub-Saharan Africa who’ve been forced to submit to FGM. The aim is to influence people on the ground as well as effect legislation banning the practice. There are no health benefits in the process and it can cause severe bleeding, problems urinating, cysts, infections and a host of childbirth complications. The PAP also agreed to work with the UNFPA in seeking to overturn the practice of marrying off children under the age of sixteen. In June 2016, the UNFPA worked with Southern African Development Community Parliamentary Forum representatives at a meeting in Swaziland which voted through a Model Law on eradicating child marriage.
Equity in Health
Independent monitoring and review of the implementation of the 2030 Agenda and its structural obstacles and challenges are key factors for the success of the SDGs. For this reason, the Reflection Group on the 2030 Agenda for Sustainable Development together with other civil society organisations and networks has produced the first annual Spotlight Report assessing the implementation of the 2030 Agenda and the structural obstacles in its realisation. The report puts a spotlight on the fulfilment of the 17 goals, with a particular focus on inequalities, responsibility of the rich and powerful, means of implementation and systemic issues. It raises the main obstacles to achieving the SDGs and explores transnational spill over effects that influence or even undermine the implementation of the goals. It comments on whether the current policy approaches, as reflected in the 2030 Agenda, are an adequate response to the challenges and obstacles or are part of the problem and discusses necessary policy changes.
Near the end of 2013, an outbreak of Zaire ebolavirus (EBOV) began in Guinea, subsequently spreading to neighbouring Liberia and Sierra Leone. As this epidemic grew, important public health questions emerged about how and why this outbreak was so different from previous episodes. This review provides a synthetic synopsis of the 2014–15 outbreak, with the aim of understanding its unprecedented spread. The authors present a summary of the history of previous epidemics, describe the structure and genetics of the ebolavirus, and review our current understanding of viral vectors and the latest treatment practices. They conclude with an analysis of the public health challenges epidemic responders faced and some of the lessons that could be applied to future outbreaks of Ebola or other viruses.
In 2010, the UN’s Population Division predicted that the African continent, the population of which is now 1·2 billion, will have 3·5 billion people by the year 2100. By 2015, the projection for the year 2100 had risen to 4·4 billion. In many ways this is good news for Africa—the population increase reflects impressive progress in reducing mortality, especially child mortality, and improving life expectancy. But the response to the news in developed countries has been of concern, often turning into panic. John Bongaarts, vice president of the Population Council, warned that “Most of these people are going to end up in slums. That’s not good news.” Mertule Mariam said: “Alarmingly, population growth in Africa is not slowing as quickly as demographers had expected...the number of Africans seeking a better life in Europe and other richer places is likely to increase several times over”. These reactions have revived discussions in developed countries on what should be done to alleviate the apparent crisis. Policy prescriptions in developed countries focus on family planning services and education of girls. The author argues that these recommendations might be sensible, but if Africans do not take the lead in framing the population discourse, their motivations and needs could be overlooked. New policies must consider African development. An African-led response to population change might begin with efforts to establish the size of the population Africa wants, in the context of broader developmental ambitions. Rather than being dictated by fears in developed countries of mass emigration, conflict, and environmental destruction, such a strategy would be based on the needs of African people. As well as national objectives, a continent-wide perspective on population goals led by the African Union, might be useful. Just as many of the drivers of population change are pan-national (eg, armed conflict, environmental damage, or economic pressures), so are some of its results. In consultation with their people, African Governments will no doubt propose further population policies that are closely tailored to the needs of their societies. What is important, the author poses, is that these objectives and policies are established by Africans.
The global health situation is facing many critical challenges, and multiple actions must be taken urgently to prevent crises from boiling over. This paper reflects on the 2016 World Health Assembly (WHA) as the world’s prime public health event, attended by 3,500 delegates, including Health Ministers from most of the 194 countries.World Health Organisation director-general Dr Margaret Chan gave an overview of what went right and what is missing in global health. 19,000 fewer children dying every day, a 44% drop in maternal mortality, the 85% cure rate for tuberculosis, and 15 million people living with HIV now receiving therapy, up from just 690,000 in 2000. Chan also described how health has become a globalised problem, with air pollution becoming a transboundary health hazard, and drug-resistant pathogens being spread through travel and food trade. The recent Ebola and Zika outbreaks showed how global health emergencies can quickly develop. The world is not prepared to cope with the dramatic resurgence of emerging and re-emerging infectious diseases. Chan said the global health landscape is being shaped by three slow-motion disasters: climate change, antimicrobial resistance and the rise of chronic non-communicable diseases. The assembly agreed that the WHO set up a new Health Emergencies Programme to enable it to give rapid support to countries and communities to prepare for, face or recover from emergencies caused by health hazards including disease outbreaks, disasters and conflicts. On anti-microbial resistance, many developing countries stressed the importance of funds and technology to help them develop national action plans by 2017. The WHA called on the WHO to develop an implementation plan and urged governments to develop national policies on marketing unhealthy foods to children. Two environment-related health issues were discussed. Air pollution accounts for eight million deaths worldwide annually – 4.3 million due to indoor and 3.7 million to outdoor air pollution. The assembly welcomed a new WHO road map for actions in 2016-19 to tackle the health effects of air pollution. A controversial issue is how the WHO should relate to “non-state actors”. After two years of negotiations, the WHA adopted the Framework of Engagement with Non-State Actors (FENSA), which provides the WHO with policies and procedures on engaging with non-governmental organisations, private sector entities, philanthropic foundations and academic institutions.
Vision impairment is a leading cause of disability, and a barriers to access education and employment, which may force people into poverty. This study determined the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. A cross-sectional study was conducted in 27 economically disadvantaged districts (74901 respondents) to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. The prevalence of self-reported vision difficulty was 11.2%. More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01). The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status).
Physical, emotional and sexual abuse of children is a major problem in South Africa, with severe negative outcomes for survivors. This study investigated the prevalence and incidence, perpetrators, and locations of child abuse in South Africa using a multicommunity sample. 3515 children aged 10–17 years (56.6% female) were interviewed from all households in randomly selected census enumeration areas in two South African provinces. Child self-report questionnaires were completed at baseline and at 1-year follow-up (97% retention). Prevalence was 56% for lifetime physical abuse (18% past-year incidence), 36% for lifetime emotional abuse (12% incidence) and 9% for lifetime sexual abuse (5% incidence). 69% of children reported any type of lifetime victimisation and 27% reported lifetime multiple abuse victimisation. Main perpetrators of abuse were reported: for physical abuse, primary caregivers and teachers; for emotional abuse, primary caregivers and relatives; and for sexual abuse, girlfriend/boyfriends or other peers. This is the first study assessing current self-reported child abuse through a large, community-based sample in South Africa. Findings of high rates of physical, emotional and sexual abuse demonstrate the need for targeted and effective interventions to prevent incidence and re-abuse.
Road traffic injuries are among the leading causes of death and life-long disability globally. The World Health Organization (WHO) reports road traffic injuries as the leading cause of death among young people aged 15–29 years globally and are among the top three causes of mortality among people aged 15–44 years. In Africa, the number of road traffic injuries and deaths have been increasing over the last three decades. According to the 2015 Global status report on road safety, the WHO African Region had the highest rate of fatalities from road traffic injuries worldwide at 26.6 per 100 000 population for the year 2013. In 2013, over 85% of all deaths and 90% of disability adjusted life years (DALYs) lost from road traffic injuries occurred in low- and middle-income countries, which have only 47% of the world’s registered vehicles. The increased burden from road traffic injuries and deaths is partly due to economic development, which has led to an increased number of vehicles on the road. Given that air and rail transport are either expensive or unavailable in many African countries, the only widely available and affordable means of mobility in the region is road transport. However, the road infrastructure has not improved to the same level to accommodate the increased number of commuters and ensure their safety and as such many people are exposed daily to an unsafe road environment. The 2009 Global status report on road safety presented the first regional estimate of a road traffic death rate, which was used to statistically address the under-reporting of road traffic deaths by countries with an unreliable death registration system. In the 2009 report, Africa had the highest estimated fatality rate at 32.2 per 100 000 population, in contrast to the reported fatality rate of 7.2 per 100 000 population. The low reported death rate is said to reflect missing data due to non-availability of road traffic data systems. This has a direct impact on health planning including emergency care and other responses by government agencies.
Diabetes prevalence is steadily increasing everywhere, most markedly in the world's middle-income countries. In many settings the environments and services do not enable the prevention and management of diabetes. As part of the 2030 Agenda for Sustainable Development, Member States have set an ambitious target to reduce premature mortality from non communicable diseases - including diabetes – by one third. This report presents trends in diabetes prevalence, in the contribution of high blood glucose (including diabetes) to premature mortality, and outlines actions governments are taking to prevent and control diabetes. From the analysis it is clear that stronger responses are needed not only from different sectors of government, but also from civil society and people with diabetes themselves, and also producers of food and manufacturers of medicines and medical technologies.
The 2016 South African Health Review presents evidence on the current legislative and policy framework guiding healthcare delivery, the challenges that underpin the performance of the health system, on water and food; and on personnel and programmes in the public health system. The report indicates that although tackling HIV targets will be daunting, they are likely to be affordable and cost-effective if implemented in a phased way and if annual increments to Government AIDS budgets are sustained. The report also discusses South Africa’s pharmaceutical pricing and transparency and the concept of and benefit from health research observatories. Finally the report provides a wide range of information on health trends, with a specific focus on the data needed to monitor non-communicable diseases.