Roselyn Sachiti Features, Health & Society Editor
Africa has been stalked by disease outbreaks over many years. Last year alone, the continent battled with diseases that include cholera, monkey pox, Ebola, Rift Valley fever and listeriosis among others.
For example, Zimbabwe, Niger, the Democratic Republic of Congo, Cameroon, Somalia, Mozambique, Algeria and Tanzania were hit by cholera in 2018.
In Somalia, 6 669 cases and 45 associated cholera deaths were reported in the country since December 2017, and Zimbabwe, with 8 340 infections and 50 reported deaths as of October 2018.
In 2018, there was an Ebola outbreak in the DRC.
Then in South Africa an outbreak of listeriosis — a serious food-borne infection — was reported in one of the worst outbreaks of this disease.
In 2017, Kenya, Nigeria and Zambia reported cases of cholera.
Between 1970 and 2011, African countries reported 3 221 050 suspected cholera cases to the World Health Organisation (WHO), representing 46 percent of all cases reported globally, according to the National Centre for Biotechnology Information (NCBI).
It indeed has been a bumpy road for African countries with lasting solutions urgently needed.
Last week, African health ministers adopted a 10-year regional strategy that aims to strengthen integrated disease surveillance and response and mitigate the devastating impact of outbreaks, such as Ebola.
With an acute public health event reported every four days on the continent, it is more important than ever before for African countries to be able to respond to health emergencies.
Africa has more outbreaks and other health emergencies than any other region of the world, and many of them could be prevented or controlled through proven public health interventions.
Worryingly, recent analysis by WHO indicates that emerging and re-emerging infectious diseases and other public health emergencies are on the rise, predictably in certain areas and unpredictably in other places.
This increase is largely attributed to the growth of cross-border movements and international travel, increasing human population density and informal settlements along with climate change impacts and changes in the way humans and wild animals interact. More than 80 percent of the public health emergencies in the WHO African Region between 2016 and 2018 were due to infectious diseases.
The new strategy aims to ensure that countries can cope with major outbreaks and other health emergencies. It is crucial for all countries to have an effective surveillance system, which can track common diseases and set off alarms for the timely containment of disease epidemics or for early detection and investigation of any abnormal clustering of cases or deaths of a new event.
The Regional Strategy for Integrated Disease Surveillance and Response 2020-2030 was adopted by health ministers during the 69th session of the WHO Regional Committee for Africa, which took place in Brazzaville, the Republic of Congo. The Regional Committee is the governing mechanism involving health ministers from all 47 member states of the WHO African Region.
The new strategy builds on more than 20 years of working with a comprehensive, evidence-based integrated surveillance system that ensures countries stay a step ahead of many dangerous pathogens.
“The current Ebola outbreak in the Democratic Republic of the Congo is a poignant reminder of the importance of a strong surveillance system,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
“Only when every case is promptly detected, quickly hospitalised and offered timely medical care — and all close contacts vaccinated and properly monitored — will the Ebola outbreak end. Equally important, devastating outbreaks can be ‘nipped in the bud’ if cases are quickly detected before they widely spread in communities.”
The regional strategy urges the 47 WHO member states to establish and sustain robust public health surveillance and resilient health systems and to commit the necessary financial resources (domestic and external) for priority interventions, including: ensuring good leadership and vigorous accountability frameworks, promoting the availability of skilled health workers at all levels, providing feedback to communities and sharing information among member states, strengthening high-quality community-based surveillance for the early detection and reporting of priority diseases and improving national laboratory systems.
A WHO progress report looking at the past five years of integrated disease surveillance and response finds that countries have made significant advances. Chief among the progress highlighted is the multidisciplinary regional workforce in place that has been instrumental in responding to major outbreaks. Additionally, a large number of countries in the WHO African Region have a public health emergency operation centre and have conducted risk profiling and mapping. By 2018, 38 member states had conducted voluntary joint external evaluations of their emergency response capabilities.
Member states are signatories to the International Health Regulations (IHR) (2005) and thus are legally bound to work together to stop the international spread of disease. In 2017 and 2018, all 47 member states submitted their IHR annual reports, compared with only 22 member states in 2016. Great concern remains that no member state meets all the required IHR capacities, and thus no country has the full capacity needed to prevent outbreaks from spreading beyond their borders.
Only six countries have mobilised adequate resources to implement IHR, and fewer than a third of the member states have a functional laboratory system.
“With this new blueprint for strengthening Africa’s surveillance and response to disease in hand, we hope countries will make the investments needed to beef up their capacities,” said Dr Moeti.
“Paying now for robust surveillance will create a huge dividend in better health for Africans, not only now but in the future.”
The new strategy calls on WHO and partners to provide technical and financial support for its implementation and to document progress.
At the same meeting, a strategic plan to reduce the double burden of malnutrition in the African Region was adopted.
“The plan outlines the urgent and accelerated action that we must take if we are to meet our goal of ending hunger and all forms of malnutrition by 2030,” Dr Moeti added.
“The WHO Secretariat will be developing and implementing a resource mobilisation plan, supporting research collaborations and mounting high-level advocacy for increased investment to reach 90 percent coverage of the 10 highest-impact nutrition interventions that must be taken to meet the malnutrition challenges in our region,” she added.
The double burden of malnutrition is particularly prevalent in countries undergoing “nutrition transformation” in which undernutrition and overweight or obesity coexist, often because of the increasing consumption of cheap, processed foods that are high in energy, fat and salt content but low in nutrient quality.
This diet, which is common in Africa, fails to address chronic undernutrition and micronutrient deficiencies and contributes to increased obesity and diet-related non-communicable diseases.
The strategic plan aims to strengthen evidence-based policies and national capacity and contains clear targets to be achieved by 2025. Priority interventions include reinforcing legislation and food safety standards, using fiscal measures to incentivise healthy food choices and integrating essential nutrition actions in health service delivery platforms.
The number of undernourished people in Sub-Saharan Africa rose from 181 million in 2010 to almost 222 million in 2016. Among children, although the prevalence of stunting decreased from 38,3 percent in 2000 to 30,3 percent in 2017, the numbers affected increased from 50,6 million to 58,7 million due to population growth. The rate of wasting in 2017 was 7,1 percent or 13,8 million children, of whom 4 million were severely wasted.
Overweight rates are also increasing. The number of children younger than five years who are overweight increased from 6,6 million in 2000 to 9,7 million in 2017. For children aged 5-19 years, obesity rates doubled between 2006 and 2016, while for adults, overweight and obesity increased from 28,4 percent in 2000 to 41,7 percent in 2016.
The Regional Committee is the governing mechanism involving health ministers from all 47 member states of the WHO African Region.