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IAEA THEMATIC PLANNING MEETING ON
THE ROLE OF ISOTOPIC MOLECULAR TECHNIQUES IN THE
CONTROLE OF COMMUNICABLE DISEASES
Vienna, Austria, 3-7 Feb. 2003
CONTROL OF COMMUNICABLE DISEASE IN THE
AFRICAN REGION: WHO/AFRO INVOLVEMENT
Dr Bernard LALA/CLT-AFRO
A. OVERVIEW
1.
Communicable diseases are by far the most important causes of
mortality,morbidity and disability in Africa; they account for over
60% of the burden of disease. Almost 95% of deaths caused by
communicable diseases can be attributed to a few but most prevalent
diseases. These are HIV/AIDS, Malaria, Respiratory Infections,
diarrhea diseases, tuberculosis and the vaccine preventable childhood
diseases i.e measles, maternal/neonatal tetanus, pertusis and
poliomyelitis.
Vast majority of the victims are among the poorest and most
vulnerable people to whom access to drugs and health settings for
prevention and cure is steadily denied. Furthermore in addition to
suffering and death, communicable diseases perpetuate poverty through
a vicious cycle of poverty and ill health and increase social instability.
Sustainable development is hardly feasible if those diseases are not
brought under control; that makes the communicable diseases a matter
of national security for any affected country.
WHO Regional Office for Africa (AFRO) is involved into the quest for
appropriate response to these diseases through its Division of Prevention
and Control of Communicable Diseases (DDC) and a broad partnership
with International Institutions, governmental and non governmental
organizations, other UN Agencies,Donor groups, etc… DDC mission is to
provide technical orientation and support to countries of the Region
based on the resolutions and recommendations of the Governing Bodies
regarding prevention and control of communicable diseases.
Technical Support to countries is provided in the setting of norms,
standards, guidelines and tools for communicable diseases prevention and
control, in activities related to communicable diseases surveil ance,
including strengthening of laboratory capacities, for the management,
implementation, monitoring and evaluation of communicable diseases, and
in epidemic preparedness, prevention and control.
DDC Division also develops a computerised database for surveil ance of
communicable diseases of major public health importance; it is promoting
a sustainable sharing of information by circulating the Regional
Epidemiological Bulletins; and finally it makes provision of material and
technical means to back up country eradication/elimination programmes.
MOST PREVALENT COMMUNCABLE DISEASES AND WHO/AFRO
RESPONSE

6. HIV/AIDS

The magnitude: HIV/AIDS is the leading cause of mortality and
morbidity in the African Region. About 10% of those aged 15 to 49
years are infected, and in Southern Africa at least 20% are infected.
Seventy percent of the World dayly 14 000 new infections occur in
Africa;it looks like “Africa is experiencing 11 September casualties two
fold, everyday”. New infections amount to 3 million yearly; that puts
the case load already at 30 mil ion. An estimated 2,3 million African
died of AIDS in 2001. This also resulted into more than 12 mil ion
children orphaned and left without love, care and support.
WHO/AFRO response: Continuous advocacy by WHO resulted in growing
commitment from African Ministers of Health, Heads of States and the
International Community; it also help to build up strong partnership and
mobilize resources for fight against HIV-AIDS.
WHO/AFRO trained nationals on the relevant strategies to combat the
epidemic; it provided necessary support including seed money to
countries to set up comprehensive programmes according to the Regional
HIV/AIDS strategy framework and played an important role in
discussions with pharmaceutical industries to secure access to the ARV
for treatment of poor people living with HIV/AIDS.
HIV1-HIV2 are present in Africa with type1 prevailing by 99%.
Strategies for laboratory detection of an HIV infection were promoted,
with a Belgium WHO Collaborative Centre in charge of assessing reagent
liability before use in screening or diagnosis. A Regional Network of
HIV-AIDS Public Health Laboratories was established in 2001, in view
of helping to properly monitor the efficacy of the ARV treatment.

7. TUBERCULOSIS
The magnitude: Tuberculosis remains an important cause of adult and
childhood morbidity and mortality in the African Region: about 200
million persons are infected with the tubercle bacil us and approximately
1.6 million cases of infectious diseases occur each year with 600.000
dead. In several African countries the number of reported TB cases
has doubled, even trebled in the past decade, mainly due to the HIV
epidemic: 50% to 80% of TB cases are attributable to HIV in dual
infection; 40% of deaths of people living with HIV/AIDS is due to TB.
WHO/AFRO response: Through the Global Stop TB Initiative which is a
coalition of partners from international agencies, governmental and non-
governmental organisations and civil society including Research
Institutions, Industry and donors, WHO is promoting the DOTS
strategy, the most effective strategy available for controlling TB today.
DOTS means “directly observed treatment, short course” Treatment
success under DOTS strategy range from 56% to 83% with drop in
treatment interruptions from 23% to 2%. All 46 countries of the Region
are implementing the DOTS strategy.
First line laboratory tests for screening remain crucial at community
level. Laboratory settings play an important role in diagnosing dual
infections for correct care and in the follow-up of the dreaded problem
of multi-drug resistant TB (MDR-TB).

8. MALARIA

The magnitude: Malaria is a major public health problem in Africa:
population living in areas at risk of malaria is about 500 mil ion ;
population prone to malaria epidemics and non-immune to the malaria
parasite nears 110 million in 23 countries. An estimated 270-480
million cases of the disease occur in the continent annually and cause
about one million deaths with 70% among children under 5. Pregnant
women, seasonal workers and refugees are most vulnerable to malaria.
WHO/AFRO response: The World Bank and WHO-AFRO have developed
a long-term col aboration to fight malaria since 1995. Advocacy efforts
have resulted in high commitment at al levels. Examples are: The OAU
Summit in 1997 which established the African Initiative for Malaria
Control in the 21st Century. In 1998 the DG of WHO launched Roll
Back Malaria Project; a special summit of Heads of States and
Governments adopted the “Abuja Declaration” linked to a plan of Action.
Main interventions are focussing on capacity building, promotion and use
of Insecticide Treated Nets (ITN), drug policy and case management,
monitoring and evaluation of malaria programme.
Laboratory tests are needed for parasite detection in the blood and
measurement of anemia and hemoglobin.

9. ACUTE RESPIRATORY INFECTIONS AND DIARRHEA DISEASES

The magnitude: They are part of the six childhood diseases. 80% of
children who visit health services are suffering from one of them. OF
the 3 mil ion childhood deaths, pneumonia accounts for 15%, diarrhea
diseases for 12%.
WHO response: AFRO is promoting the Integrated Management of
Childhood Illness (IMCI), known as a cost-effective strategy
contributing to the reduction of morbidity and mortality in children.

10. VACCINE PREVENTABLE DISEASES

The magnitude: They are major causes of morbidity, mortality and
disability among children in the African Region. Poor routine
immunisation (EPI) performance for many years has resulted in one
million deaths attributable to measles, Hib disease, hepatitis B and
pertusis, neonatal tetanus, meningococcal diseases and yel ow fever.
Annually there are 445000 deaths from measles, 110.000 from
maternal and neonatal tetanus, 106 000 to 190 000 from pertusis, 30
000 from yellow fever and 150 000 from Hib diseases
WHO/AFRO response: Based on immunisation system strengthening
through strong partnership with UNICEF, THE ROTARY, WORLD BANK
and donors from the civil society, social mobilisation is focussing on polio
eradication with countries conducting, National Immunisation Days (NID)
with OPV. For follow up and control, AFP surveillance is organised with
laboratory investigation of all cases for confirmation of genuine polio
infection.Measles is also registered for elimination.

11. OTHER TROPICAL DISEASES

The magnitude: Five tropical diseases i.e lymphatic filariasis,
schistosomiasis, human Africa trypanosomiasis, soil-transmitted
helminths and onchocerciasis are responsible for a substantial proportion
of disease burden in the African Region.

LYMPHATIC FILARIASIS (LF), also known as Elephantiasis, puts more
than 500 mil ion people at risk in Africa; close to 28 million are already
affected and incapacitated by the disease. Its prevalence is on the
increase trend.
HUMAN AFRICA TRYPANOSOMISIS (HAT) also known as sleeping
sickness, threatens over 60 million people in 36 countries of Sub-
Saharan Africa. Only three or four mil ion people at risk are under
surveil ance. Most people with sleeping sickness die before being
diagnosed at a health facility. There are 300 000 – 500 000 cases
occurring each year and most of them are not reported. In DR Congo
and Angola HAT is a leading cause of mortality in some areas.
SCHISTOSMIASIS (or Bilharziasis) is endemic in 41 countries in Africa,
infecting more than 150 million people in rural Agricultural and peri-
urban areas. Out of these, 10 to 15 million are symptomatic. In many
areas schistosomiasis affects a large proportion of children under 15
years of age. An estimated 300-400 mil ion people in Africa are at risk
from the disease.
ONCHOCERSIASIS, also known as River Blindness is present in 30
countries in Sub-Saharan Africa: 18 million are infected, 6,5 million
suffer from severe itching or dermatitis and 270 000 are blind.
SOIL-TRANSMITTED HELMINTHS (STH) or intestinal worms which
include ascaris (roundworm), trichuris (whipworm) and hookworms are
widespread. Transmission is boosted by lack of sanitary facilities and
poor hygienic practices. Two billion people (mostly children) are
affected worldwide, 300 million remain chronically ill and 155 000 die
annually.
WHO/AFRO response: Lymphatic filarasis is registered for elimination
by 2020. Trypanosomiasis is under close surveillance since 1982
according to resolution passed by the World Health Assembly.
Schistosomisis is taken up by a chemotherapy campaign using
praziquantel.
The Onchocerciasis Control Programme (OCP), sponsored by WHO, World
Bank, UNDP, FAO and more than 20 donors, and launched in 1974 to
cover 7 countries in West Africa, succeeded in wiping out onchocerciasis
from 11 countries. Since December 1995 it is replaced by the African
Programme for Onchocerciasis Control (APOC) which is non-vertical and
uses ivermectin through community based strategy in mass campagn.

12. LEPROSY

The magnitude: As of December 2000, 57516 cases were registered,
that puts the prevalence at 0,92 per 10 000 inhabitants. Twelve
countries were concerned with seven in Africa. Since 1991 Leprosy is
registered for elimination as a public health problem.
WHO/AFRO response: WHO is collaborating with a Global Alliance
including the Sassakawa Memorial Health Foundation of Japan,
Novartis/Novartis Foundation, International NGO, DANIDA and the
World Bank. Through this partnersip dapsone,rifampicin and clofazimine
are made available and freely accessible to all patients who can be
traited according to the recommended standard MDT treatment
protocol.

13. EPIDEMIC PRONE COMMUNICABLE DISEASES

♦ CHOLERA may occur every where in Africa in the context of civil
strifes, population movements and war destructions with poor
hygienic conditions and lack of sanitation facilities. About 150 000-
200 000 cases are reported every year with 2000 - 3000 deaths.
♦ MENINGOCOCCAL MENINGITIS with recurrent epidemics in
countries of the meningitis belt. New threat is born with the W 135
strain, not covered by the current vaccine. There are yearly 50
000-120 000 cases occurring with 5000-8000 deaths.
♦ SHIGELLOSIS due to shigel a dysenteriae type 1 is always present
at very low rate which goes up quickly when living conditions worsen.
Every year case load amounts to 130.000-300.000 with 500-1000
deaths.
♦ HAEMORRAGIC FEVERS
LASSA FEVER with 10-70 cases and up to 100% mortality
EBOLA FEVER with risk of epidemic outbreaks deeply rooted in
the rain forests of Central Africa.Case management has improved
with time and lessons learned from previous outbreaks.
YELLOW FEVER against which a good vaccine is available.
Nonetheless about 20-45 cases are reported each year with less
than 10 deaths.
♦ PLAGUE, still a public health problem in the DRC and Madagascar.
Over 400.000 cases reported each year and 300-600 deaths.
LABORATORY SERVICES IN THE AFRICAN REGION

14. African Region is bearing the world heaviest burden of disease mainly
due to communicable diseases.Of course the laboratory services should play
a pivotal role in the control of these diseases if they could efficiently
deliver reliable tests everywhere they are needed for acurate diagnosis and
correct management of patient care.Actually laboratory performance in the
Region is impaired by resource constraints even if the health laboratories
are operating at al levels of the national health system.

15. In 1998 following a deadly epidemic in the countries of the meningitis
belt,Ministers of Health in Central and Western Africa met and agreed on
more cordination at sub-regional level among national laboratories and a
flow of information necessary for proactive measures in tackling future
epidemics.From then on all efforts to enforce the lab services and improve
their performance have focussed on four points:

16. –setting up a genuine institutional framework which can promote a
national laboratory policy with a central board and advisory and technical
units.

17. –creating a national laboratory network based on solidarity and
complementarity between laboratories at different levels of the national
health system,with a national reference laboratory responsible for the
coordination of all activities within the network.

18. –in clarifying the laboratory mission at each level of the national health
system, identifying and establishing a minimum package of tests/procedures
linked to the appropriate equipments for the district laboratory.

19 –training lab technicians on quality management to apply quality control
procedures and register to external quality assessment schemes,
disseminating norms and promoting standardisation.

Source: http://www-tc.iaea.org/tcweb/abouttc/strategy/thematic/pdf/presentations/CommunicableDiseases/ControlofCommunicableDiseasesinAfricanRegion-RoleofWHO-AFRO.pdf