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8 Reasons for Optimism

Researcher Peter Winch finds positive trends in African Health

By Peter Winch


Rates of under-5 mortality have fallen in many countries in Africa, particularly in countries like Ghana and Tanzania where health services, including Integrated Management of Childhood Illness (a WHO/UNICEF initiative to reduce the leading causes of childhood mortality), and access to primary education have improved. From 1970 to 2004, under-5 mortality in sub-Saharan Africa fell from 244 deaths per 1,000 to 171. Significant and concerted long-term commitment at all levels will be needed to accelerate or even maintain this trend.



Public health education is increasingly emphasized in many African countries. New or expanded programs (many through collaboration with the Bloomberg School) can be found in Ghana, Nigeria, Zimbabwe, Rwanda, Uganda and Tanzania.



In November 2005, Ellen Johnson-Sirleaf became the first woman elected president of an African country. Her victory in Liberia is one sign of women's growing empowerment. Another: 16.6% of parliament members in sub-Saharan Africa are now women. (In the U.S., 15.3% of members of the House of Representatives and the Senate are women.)



Recent advances in treatment promise new hope against persistent diseases. These treatments include artemisinin combination therapy for malaria; intermittent presumptive treatment for malaria in pregnant women; antiretroviral therapy for AIDS treatment and prevention of mother-to-child transmission; azithromycin for trachoma; and low-osmolarity oral rehydration solution and zinc treatment for childhood diarrhea.



Public health efforts have achieved significant reductions in the prevalence and incidence of several important infectious diseases. Increased vaccinations have reduced measles deaths in Africa from 500,000 in 1999 to 200,000 in 2004. The polio vaccination campaign has been successful as well. Mass treatment has pared back the impact of onchocerciasis ("river blindness") and trachoma. In addition, education, water filters and improved water supplies are pushing Guinea worm to the brink of eradication.



Africa is benefiting from a "communications dividend." Cell phones, the Internet and mass media link Africans to each other and the global information storehouse (including the latest in research breakthroughs). Less than 3% of Africans currently access the Internet, but usage soared by more than 400% in the last five years, according to one estimate.



With a few notable exceptions, the "strong man" dictator who seized power in many African countries after the 1950s and '60s independence movements is slowly fading away. Diverse opinions are increasingly seen in the press, and the institutions of civil society (such as non-governmental organizations and community groups) are growing in strength and influence in most countries.



Though HIV prevalence among adults in sub-Saharan Africa remains at 7.2%, in many countries the rate is either increasing more slowly or has reached a plateau. Some are witnessing an apparent decrease in HIV prevalence. A number of countries are making a concerted effort to make voluntary counseling and testing, prevention of mother-to-child transmission and antiretroviral treatment available on a large scale, while preventive interventions have grown more sophisticated.