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.
Equity in Health
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.
Annual global estimates of perinatal mortality show Malawi among sub-Saharan Africa with the highest rates. Targeted interventions are required to reduce this mortality. This study aimed to quantify small-scale geographical variations in perinatal mortality, and estimate risk factors associated with perinatal mortality in Mchinji district. Factors associated with reduced perinatal mortality were: previous pregnancy; early and consistent use of antenatal care; syphilis test; abdominal examination; pregnancy danger signs advice; skilled birth attendant; normal labour duration; gestation period of at least 9 months; and normal delivery. Perinatal babies whose mothers had a blood test were associated with high probability of dying. Perinatal babies from mothers between 16 and 40 years had reduced prevalence of dying while those aged less than 16 years and greater than 40 years were associated with higher prevalence of dying.
This paper assesses the risk factors of and neighborhood inequalities in diarrhoeal morbidity among under-5 year old children in selected countries in sub-Saharan Africa over the period 1990–2013, using DHS data from selected countries. The findings showed that the proportion of diarrhoeal morbidity among under-5 children varied considerably across the cohorts of birth from 10% to 35%, with increasing inequalities across DHS rounds. The main risk factors were the child’s age, size of the child at birth, the quality of the main floor material, mother’s education and her occupation, type of toilet, and place of residence.
Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in life expectancy(LE), disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies. This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007–2010. Disability was measured with the activity of daily living instrument.. The disability prevalence ranged from 13% in China to 54% in India. Women were more disadvantaged with higher prevalence of disability across all age groups. Though women had higher LE, their proportion of remaining LE free from disability was lower than men. There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.