Toll of AIDS, tuberculosis and malaria: The African reality


AIDS newsWITH a Doctorate degree in medicine from Tufts University, a Masters degree in International Public Health from Harvard University, and a Bachelor of Science degree in Molecular Biology from Lehigh University, Dr. Akudo Anyanwu Ikemba is one of the notable Nigerian scientists committed to the cause of African development currently undermined by the devastation of AIDS, Tuberculosis and Malaria.

AS the CEO of Friends Africa and a director with the Center for Global Health and Economic Development at the Earth Institute of Columbia University, as well as former Fellow of the Centre for Diseases Control (CDC) Atlanta, USA, and former lecturer at Tufts University School of Medicine, she is at the forefront of a positive effort towards altering the future of Africa in the prevention and treatment of the threat posed by HIV/AIDS, TB and Malaria.
In this encounter, she sheds light on... Excerpts.

“IN 1946, The World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” More recently, this has been expanded to include the ability to lead a “socially and economically productive life.” Many have argued that this definition is an ideal which is very far from reality, as can be seen in Africa, a continent plagued by many difficulties including poverty, illiteracy, war, sickness and disease.

These conditions, which by the way are inter-related, increase the health burden of Africa, making the available healthcare services ineffective in the fight against the deteriorating health situation. For example, poverty increases vulnerability to sickness and limits access to good health care. Illiteracy encourages the fatal combination of folklore and local ‘alternative’ remedies for treating diseases, e.g. the erroneous belief in some parts of the world, that having sexual intercourse with a virgin could cure a person with AIDS, and war leads to poverty, epidemics, and a breakdown in social law and order.

Top on the list of diseases that constitute the greatest danger are AIDS, Tuberculosis (TB) and Malaria which, together, account for about six million deaths annually in Africa alone. According to WHO’s 2005 malaria report, this preventable and curable disease leads to the death of about one million people globally. In some areas, like Nigeria, Malaria is so prevalent that we pay little or no attention to it; yet, a disease so dangerous that it is fatal for many pregnant women and children under the age of five.

The gravity of the situation is apparent considering the figures for Africa in the August 2006 Epidemiology Fact Sheet on HIV/AIDS and Sexually Transmitted Infections developed by WHO in collaboration with UNICEF and UNAIDS. The report puts the average maternal mortality rate at 596/100,000 live births while the average infant mortality rate is 135/1,000 live births.

The advent of HIV-AIDS has compounded the disease burden in Africa, attacking the active and productive popu-lation, mostly between the ages of 15 to 49 years. This disease greatly hinders sustainable development in Africa as it takes its greatest toll on people in their prime, the workers and parents. This situation increases the poverty level as many homes are left without the bread winner, and many children are orphaned. On a health care system perspective, already under-funded and inadequate health systems are left overwhelmed and unable to respond to the epidemic.

In Nigeria, for instance, about four million adults were living with HIV in 2005 with 330,000 dying from AIDS in the same year. With only 71 treatment centers offering AIDS treatment and counseling, only 6 per cent of those who needed help were covered in 2005. The figures from war torn Liberia are even better at 19%, while that of South Africa is 26%. To achieve these dismal figures, domestic spending on HIV stood at about US$6million in Nigeria and US$355million in South Africa.

HIV/AIDS has also led to an increase in the rate of TB infection as HIV positive people are more susceptible, as a result of the breakdown of their immune system. To compound matters, a new strain of TB tagged Multi-Drug-Resistant (MDR) which is resistant to available medication has been discovered, making the picture even gloomier for the 8.8 million people who become affected each year.

The 2005 Malaria Report states that HIV impairs the ability of pregnant women to deal with infection, making them more vulnerable to clinical and placental malaria and severe malarial anemia which leads to the death of more pregnant women who have the dual HIV/Malaria infection than those who have either HIV or malaria. In 2003, it was estimated that about 440,000 pregnant women who had malaria in Sub-Saharan Africa were already infected with HIV.

Obviously, lifestyle is a key factor in maintaining health as transmission of HIV and other STDs are driven by behavior. Those at greatest risk of contacting HIV include those with multiple sex partners and users of intravenous drugs.

The spread of malaria is also determined by our attitude to our environment. There is a higher prevalence of malaria epidemics in high population density areas with poor living conditions which provide ample breeding grounds for mosquitoes. If people are enlightened and encouraged to get rid of stagnant pools of water around their neighborhoods, keep their homes clean and well ventilated and to sleep under insecticide treated nets, the spread of this disease will be greatly curtailed.

Mosquito nets are an economical and effective way for families who live in malaria-endemic areas to avoid the disease. The decision to sleep under a mosquito net was one I made with no hesitation once I discovered I was pregnant in June of 2005. Knowing the implications of contacting malaria for me and my unborn baby, I chose to sleep under an insecticide treated net throughout those nine months to keep the mosquitoes away. Now, my son is 7 months old and sleeps under a mosquito net every night. With this technology, we have been able to reduce the incidence of malaria in my family to zero.

One of the challenges we have seen with malaria in the last few years has been an increasing resistance to the traditional quinine based medications which were very cheap. In some parts of Nigeria, resistance to this drug is as high as 75 per cent. For this reason, the Nigerian government recently changed the national malaria treatment policy to Artemisinin-based combination, commonly known as Artesunate.

The next step is to make sure that this treatment is available and affordable to those who need it. Various agencies, including the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), are working to ensure that there is more health coverage in the areas with greatest incidence of these diseases including Asia and Africa.

GFATM was created to increase resources to fight three of the world’s most devastating diseases, and to direct those resources to areas of greatest need.
A partnership between governments, civil society, the private sector and affected communities, the Global Fund represents an innovative approach to international health financing.

The Friends of the Global Fund Africa (Friends Africa), which was launched in Abuja in May 2006, will complement the efforts of the GFATM in Africa by working with other multilateral and bilateral organizations to optimize the performance of Global Fund grants and attract funding which can be channeled towards providing integrated healthcare services for HIV, TB and Malaria.

Just like its counterparts in Japan, USA and Europe, Friends Africa was founded in order to create and sustain visibility and awareness for the Global Fund across the African continent, as well as to build political and financial support for the organization. Friends Africa will also serve as a monitoring arm to ensure that the goals of the Global Fund are achieved in the area of reducing the disease burden in Africa.

The Global Fund to Fight AIDS, TB and Malaria (GFATM), has, today, committed $4.8 billion in grants across more than 130 countries. In Africa this has resulted in significant impact: provision of life-extending antiretroviral medications to 272,000 Africans with AIDS, treatment of 421,000 tuberculosis patients and distribution of 5.2 million insecticide-treated bed nets to protect children and families from malaria.

We all have a part to play in the fight against AIDS, Tuberculosis and Malaria by participating at various levels of sponsorship, advocacy and implementation. As more of us get involved in improving the health indices on our continent, we will move further towards achieving the health standard advocated by WHO, ensuring that more people have the ability to lead a “socially and economically productive life.”