Health Challenges and Opportunities across Africa

Introduction

To conduct effective scientific research and hence advance science for improving medical care and public health, the context, disease burden and problems hindering good medical research must be clearly identified before designing and conducting any such research in an African community. Demographics and cultural factors are some of the critical factors that must be taken into account for any research data to be valid and hence helpful in advancing medical science in Africa. Disease burden in Africa has been well characterized by previous epidemiological and public health research over the past seventy years. In addition to infectious disease, non-communicable diseases such as Burkitt’s lymphoma, endomyocardial fibrosis, Buruli ulcer, the biomedical science of heart transplant, etc have been well characterized in previous studies in Africa. Despite these stellar works in disease characterization, ground breaking scientific advances have been few and far between and have been the exception, despite considerable funding. No science and research projects seem to have had an enduring impact or multiplier effect to alleviate disease burden and improve public health.

Demographics

According to the United Nations World Population Prospect Report, in 2018, Africa’s population was estimated at 1.3 billion compared to 1.4 billion for India and 1.5 billion for China. In 2050 the continent is predicted to be home to 2.5 billion people and 1.7 billion people are expected to call India home, compared to 1-3 billion in China. Evidently Africa’s population is expected to double by 2050 while China will experience a population short fall and India would have made only a modest population increase. These demographic shifts will have a profound impact on health, economic and social conditions on the African continent.

Spectrum of Health Problems

While infectious disease is still the prepoderant public health problem deserving of heightened scientific effort, non-communicable diseases such as hypertension, heart disease, diabetes and malignancy are on the the ascendency and demand sustained interest from the African Scientific community. Even genetic and metabolic disorders hitherto considered esoteric on the continent are increasingly attracting considerable attention from the scientific community within and outside Africa. Further maternal, neonatal and infant mortality are still major public health problems that exert quite some strain on African health systems. Furthermore, injuries remain among the top causes of death on the African continent. These constellation of medical and public health problems require a comprehensive, concerted and coordinated pan African scientific, government and private enterprise effort for better understanding of the problems, and developing better strategies for decreasing disease burden to society. Wheb executed correctly, such effort will lead to lessening of disease burden and socioeconomic strains to individuals, families, communities, government and society as a whole.

Infectious Disease

HIV/AIDS continues to be a major public health problem on the African continent, which has 11% of the world’s population but reportedly 60% of the people with HIV/AIDS. The WHO states that HIV/AIDS remains the leading cause of death for adults, but progress in medical research and development of cheaper medications has made it possible for more and more people to receive life-saving treatment. It is reported that the number of HIV-positive people on antiretroviral medicines increased eight-fold, from 100 000 in December 2003 to over 1, 000 000 in December 2018.

Malaria afflicts 250-450 million Africans, mainly children under five years of age, yearly. Malaria is endemic in 42 African countries. Of these 33 have adopted artemisinin-based combination therapy—the most effective antimalarial medicines available today—as first-line treatment.

River blindness has been eliminated as a public health problem in most African countries, and guinea worm control efforts have resulted in a 97% reduction in cases since 1986. Leprosy is close to elimination—meaning there is less than one case per 10 000 people in the Africa region.

According to the WHO, most countries are making good progress on preventable childhood illness. Polio is close to eradication, and 37 countries are reaching 60% or more of their children with measles immunization. Overall measles deaths have declined by more than 50% since 1999. In 2005 alone 75 million children received measles vaccines.

Maternal and Childhealth

Maternal, newborn and infant mortality remains high overall in Africa. The WHO reports that of the 20 countries with the highest maternal mortality ratios worldwide, 19 are in Africa, and the region has the highest neonatal death rate in the world.

Noncommunicable Diseases

Noncommunicable diseases, such as hypertension, heart disease, diabetes and malignancies are on the rise. Even such esoteric disorders as genetic and metabolic disorders are now a major public health problem in certain areas. A recent report of an “outbreak” of sickle cell disease (SCD) “epidemic” in new born babies in several counties in the Acholi region of Northern Uganda is a unique public health problem. SCD is an autosomal recessive genetic disease, which means both parents must be carriers of the gene to conceive an affected offspring. SCD was the first genetic disease to be completely characterized at a molecular level. Being a carrier is of the SCD gene is protective against the deadly falciparum malaria. The prevalence of SCD (determined in the late 1950s and early 1960s) is high among the Acholi and Madi peoples of Northern Uganda. The most plausible explanation for the SCD “epidemic” in the Acholi region of Northern Uganda is that, over a generation or two, the poor and inadequate health services in the region including inadequate malaria control measures led to gradual depletion of the non-carrier population due to early death from malaria. This means that most of the survivors, and currently fecund 16 to 26 year olds, are carriers of the sickle cell gene and hence are likely to have an affected child. That is the explanation of the “epidemic” of sickle cell disease in newborn babies in the area – the vast majority of the reproductive segment of the population are carriers. This unique epidemiological phenomenon is a clear illustration of the impact of poor public health services on community health.

Then there is the strain on African health systems imposed by the high burden of life-threatening communicable diseases coupled with increasing rates of noncommunicable diseases such as hypertension and coronary heart disease. Basic sanitation needs remain unmet for many: only 58% of people living in sub-Saharan Africa have access to safe water supplies. Noncommunicable diseases, such as hypertension, heart disease, diabetes and are on the rise; and injuries remain among the top causes of death in the Region.

Medical Research in Africa: Challenges, Hurdles and Pitfalls

The challenges of doing research in Africa, in any discipline, is captured in the below article which appeared in the Bulletin of the Royal Society of Tropical Medicine and Hygiene, U.K. The article is reproduced with permission.

Although the comments focus on medical research, the gist of the authors views can be applied to research in Agriculture, Metallurgy and Mining, Basic and Applied research, Biomedical Science, Biotechnology, Engineering, Fisheries, the Environment etc.

This article appeared in the Bulletin of the Royal Society of Tropical Medicine and Hygiene, UK, and is reproduced with kind permission of the authors

It is close to 30 years since most countries in sub-Saharan Africa gained independence. During this period, some of these countries have put considerable financial investment into education and health, particularly the training of health workers and research scientists. Sadly, the impact of this investment on research productivity and overall improvement of health standards in these countries has been negligible. In terms of publications, for example, most of the significant contributions from sub-Saharan Africa come from either collaborative work with scientists from the ‘West’, or institutions with a large presence of scientists from the “West”.

While this in itself is not a bad trend, it is a worrying situation from the perspective of African scientists working in their own countries who are able to attract independent funding for research. When stripped of collaborations, Africa’s scientific ‘drought’ is evident. Clearly, something is wrong and needs to be addressed.

The problems of medical research in Africa can be broadly categorized as follows:

• Infrastructural (laboratories, equipment, etc.).
• Institutional, i.e., career structure for trained scientists or those wishing to go into medical research.
• Financial, i.e., research funds and personal remuneration.
• Educational, i.e., curricula for medical and allied health professions.

Some of these problems are closely related, although they are considered separately in this article.

Infrastructural problems such as lack of proper laboratories and equipment for research, and poor communication facilities are major factors hampering medical research in Africa, and are largely related to lack of available funds.

In many African countries, there are no proper career structures within medical schools or biomedical research institutions. Highly trained biomedical scientists find themselves doing routine administrative jobs, which have little or no bearing on their training. These scientists are unlikely to be productive in their research and this is a contributing factor to the never-ending brain-drain from Africa. At the same time, partly because of problems of infrastructure, the curricula for biomedical science courses in many African universities do not reflect recent advances in the field of medicine – not the best way to inspire students to consider a career in medical research.

Medical research scientists, like many other professionals in sub-Saharan Africa, are often poorly remunerated. After spending so many years in training, most are unlikely to be happy to spend the rest of their working life earning a salary hardly large enough to make ends meet. This is another contributing factor to the brain-drain from Africa.

The end result of these problems is that, despite years of investment in biomedical education and training in some African countries, the conditions on the ground have not changed. We suggest the following as some potential solutions.

Despite economic hardship, governments in Africa need to recognise the important role of medical research in the overall economic and social development of their respective countries, and thereby give special attention to increased allocation of funding, particularly for key basic research programmes. Governments can do so by part sponsorship and by sourcing funds from bilateral donors that are targeted specifically towards medical research and made open to competitive funding according to priority areas of research.

Although structures for funding exist on a limited basis, it would be helpful to strengthen further and expand funding in various categories to target scientists at different levels of career development. For example, there would be schemes targeting the training of scientists at Masters degree level, at PhD level, at post doctoral level and the more experienced scientist. Funding for research proposals should go hand in hand with the strengthening of government departments that deal with interpretation and implementation or research findings so that further funding may be justified.

Training curricula in colleges and universities need to re-emphasize the place of medical research in the career development of students who may be thinking about joining research later in life. Some students graduating from these institutions remain ignorant about careers in research. It would be a good idea for, example on university open days to invite prominent research scientists to talk about career opportunities in medical research.

There is a lack of African role models and the apparent disillusionment among role models may have led to some prospective candidates being discouraged from taking up research as a career. Again this is tied in with a lack of funding for most of those already in research which gives the impression that a career in research is not worthwhile.

It is vital that funding of research in Africa be tied to the improvement of remuneration of scientists to be equivalent to that of scientists from the developed countries if they are expected to develop and compete for funding at the international level. This would release more valuable time for dedicated research work, better research outcomes and better prospects at the international level.

Donors funding research in Africa should make available resources in research materials, including access to the internet in African universities and research institutions, so that scientists don’t lag behind developments in scientific research and funding opportunities. This would also include setting aside funds by major scientific conference organizers targeting support and scholarships to enable scientists from Africa to attend and present their research findings.

Active institutional collaboration between scientists from resource-rich countries and African scientists should be further strengthened in order to draw more research funding to the continent.

In summary, we believe that there is a great potential for the development and growth of scientific research in Africa by Africans and it is our sincere hope that all stakeholders will play their role in making this a reality.

Authors (Gilbert Kokwaro – Gkokwaro@wtnairobi.mimcom.net and Samuel Kariuki – Skariuki@wtrl.or.ke).