Slow growth in health sector spending is projected in Sub-Saharan Africa as reported in a study published in the open access journal, PLOS Global Public Health. The decline is expected to continue to 2050, according to Angela E Apeagyei and researchers at the Institute for Health Metrics and Evaluation, University of Washington, Seattle, and is driven by tepid growth in the share of government spending that is allocated to health and reductions in development assistance for health.
The research analyses data from databases covering development assistance for health, global health spending and gross domestic spending (GDP) per capita as well as an expected health spending database which provides projected health spending data to 2050. It finds that except for central and eastern Europe and Central Asia, around the world total health spending is expected to rise as a share of GDP, but in Sub-Saharan Africa (except in southern sub-Sahara Africa) it is expected to decrease.
Beyond the challenge of a low prioritisation of the health sector in the government budget, another major driver of this decline is a reduction in development assistance for health. The Millennium Development Goals led to a period of growth in health funding, and development assistance for health grew on average 11.1% annually from 2000 until 2015. It has since dropped to just 4.6% and was particularly hit by the global economic issues caused by the COVID pandemic and subsequent economic shocks such as the war in Ukraine. Although government spending on health in Sub-Saharan Africa has increased, and is expected to continue to rise, the gap left by decreases in development assistance will not be met.
Without improvements, this trend will pose a significant challenge to meeting health-related Sustainable Development Goals and the African Union’s Africa Agenda 2063. The authors hope that their analysis will help policymakers understand future health spending patterns and can translate the insights into tangible actions that can help navigate the region’s complex economic and health challenges.
The authors add: “For countries in sub-Saharan Africa, the projected growth in donor and government funding for health is expected to be significantly lower compared to countries in other regions. This worrying trend underscores the need to prioritise innovative financing strategies to strengthen health systems in line with the region’s economic growth and the broader health needs of its population.”
Diarrhoea remains one of the leading causes of death, ill health and disability among children under five years of age in developing countries,1 accounting for 19% of deaths of under-fives in South Africa and for 46% on the African continent.1 Globally, diarrhoea is the second leading infectious cause of death, accounting for 9.2% of deaths in under-fives.1
The high incidence of malnutrition in South Africa2 adds to this toll. The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea may lead to malnutrition, while malnutrition may aggravate the course of diarrhoea.3 Diarrhoea is more common and more severe in children with malnutrition (ie, undernutrition), and malnourished children often have persistent or repeated diarrhoea.4 In addition, malnourished children are more likely to develop severe diarrhoea and die from it.4 Vulnerable groups such as pregnant women and children under five years of age are the most affected by malnutrition, especially in rural areas.5
Identifying children at risk
The Centres for Disease Control advises that caregivers should be trained to recognise signs of illness or treatment failure that necessitate medical intervention.6 Infants with acute diarrhoea are more prone to becoming dehydrated than older children,6 and healthcare workers or parents of infants with diarrhoea should promptly seek medical evaluation as soon as the child appears to be in distress. Reports of changing mental status in the child are of particular concern.6
When the child’s condition is in doubt, immediate evaluation by a healthcare professional is recommended.6 Clinical examination of the child provides an opportunity for physical assessment, including vital signs, degree of dehydration, and a more detailed history, and for providing better instructions to the caregivers.6
Treatment
The treatment emphasis for acute diarrhoea in children is the prevention and management of dehydration, electrolyte abnormalities and comorbid conditions.3 The objectives of diarrhoeal disease management are to prevent weight loss, encourage catch-up growth during recovery, shorten the duration and decrease the impact of the diarrhoea on the child’s health.3
A number of studies have shown that probiotics shorten the duration of diarrhoea and prevent recurrence of other episodes.7 Furthermore, probiotics can prevent diarrhoea from infection in infants with malnutrition.7
Momeena Omarjee, Consumer Healthcare Country Head: Scientific Affairs, at Sanofi South Africa says: “Good gut health is crucial for one’s wellbeing – and healthcare professionals should encourage parents to give children a daily, regular probiotic which could go a long way in preventing diarrhoea and illness.”
How can the risk of diarrhoea be reduced?
Breastfeeding, a clean safe water supply, appropriate hand-washing and good sanitation will prevent most cases of diarrhoea.8
Research shows that diarrhoea is closely linked to socioeconomic status and has the most adverse effects in South Africa’s impoverished communities.9 South African children living in poverty are approximately 10 times more likely to die from diarrhoea than their more privileged counterparts.9
Says Omarjee: “Many of these under-privileged children in South Africa do not have adequate access to clean, potable water and quality early childcare and development, and they experience limited access to health and nutrition services. KwaZulu-Natal (KZN), for example, is experiencing outbreaks of diarrhoea and other water-borne diseases due to the recent floods.”
Although government and NGOs have been working tirelessly to distribute clean, potable water to affected areas in the province, many communities continue to face challenges and intervention is needed to not only provide clean water to the communities, but also to manage the high risk of diarrhoea and related water-borne diseases.
“Sanofi has therefore embarked on an ambitious campaign, in partnership with a non-profit organisation, Save the Children South Africa, from October 2022 to assist these areas in need, and to impact over 2,000,000 lives through hygiene education and access to water,” says Omarjee.
Sanofi, working together with Save the children South Africa, will donate water tanks to Early Childhood Care and Development (ECCD) centres in the communities identified, based on Save the Children’s baseline assessment, and will ensure access to clean, potable water.
The provision of information, counselling, education and support to children and their caregivers is also limited, which translates into low use of services and uptake of practices promoting good health. Education campaigns on healthy hygiene habits will be rolled out to children and their caregivers and will be run through the Child Health Awareness Days (CHAD) events, training of ECCD centres practitioners, and community health workers.
Sanofi is committed to ensuring that no child dies of a preventable disease, especially when there are effective treatments available. Says Omarjee: “Healthcare professionals need to encourage parents and caregivers to act promptly and seek assistance when instances of diarrhoea in children under age five do not abate swiftly.”
Awotione, O.F., et al. 2016. Systematic review: Diarrhoea in children under five years of age in South Africa (1997-2014). Tropical Medicine and International Health, 21(9), 1060-1070.
Cleary, K. 2020. In-depth: The long shadow of malnutrition in South Africa. Available from: https://www.spotlightnsp.co.za, accessed 29 September 2022.
Nel, E. 2010. Diarrhoea and malnutrition. South African Journal of Clinical Nutrition, 23, suppl 1, 15-18.
Child Healthcare. n.d. What is the relationship between diarrhoea and malnutrition? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
Govender, L., et al. 2021. Assessment of the nutritional status of four selected rural communities in KwaZulu-Natal, South Africa. Nutrients, 13(9), 2920.
Centers for Disease Control. 2003. Managing acute gastro-enteritis among children. MMWR, 52(RR16), 1-16.
Solis, B. et al. 2002. Probiotics as a help in children suffering from malnutrition and diarrhoea. European Journal of Clinical Nutrition, 56, S57-59.
Child Healthcare. n.d. How can the risk of diarrhoea be reduced? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
Chola, L., et al. 2015. Reducing diarrhoea deaths in South Africa: costs and effects of scaling up essential interventions to prevent and treat diarrhoea in under five children. BMC Public Health, 15, 394.
It’s estimated that the majority of the expected 73% increase in the global demand for meat by 2050 will come from sub-Saharan Africa (SSA). Since human and environmental health concerns are likely to become more prominent with this increased consumption, plant-based meat alternatives have been touted as a possible alternative. But it may take some time before consumers in the region substitute their juicy steak of chicken wings for a vegan burger.
A review on plant-based meat alternatives in SSA published recently in Scientific African shows that before there can be any large-scale adoption of plant-based meat products in the region, we will first have to determine the social implications of eating less meat, the barriers to eating plant-based meat analogues, consumers’ acceptance of these products, and strategies that could get people to supplement their meat intake with plant-based alternatives. Plant-based meat analogues are foods designed to mimic the appearance, flavour, and texture of meat products. These can include, among others, burgers, sausages, nuggets, mince and meatballs.
The review was conducted by Omamuyovwi Gbejewoh and Dr Jeannine Marais from the Department of Food Science at Stellenbosch University and Dr Sara Erasmus from the Food Quality & Design Group at Wageningen University & Research in The Netherlands. They examined the available literature on the production and consumption of plant-based meat alternatives by searching the Web of Science and Scopus databases for academic papers and Google for news or popular articles.
Ahead of World Food Day on 16 October, the researchers say their review has shown that there are certain barriers to consumers’ acceptance of plant-based meat analogues even though worldwide, plant-based meat product sales accounted for $12.1 billion in 2019 and are likely to increase by 15% to reach $27.9 billion by 2025 and $149 billion by 2029. They do point out, however, that different versions of plant-based meat products have been available in South Africa and the rest of SSA over the past 25 years.
Barriers
“Consumers’ preference for meat is the most significant barrier to eating plant-based meat products or following a plant-based diet. In addition, meat has important socio-cultural connotations such as status, power, hierarchy, and subjugation of others.
“For example, studies in Zambia revealed that eating and sharing of meat, and even the type of meat that is served connote economic prosperity, power and respect. Chicken was more popular for regular consumption and entertaining guests because it is more readily accessible and relatively cheaper. On the other hand, beef is reserved for important visitors and landmark celebrations as it usually implies wealth because it is more expensive and usually eaten by well-to-do households.
“Other studies found that different ethnic groups in South Africa have various meat cuisines made from different types of domesticated and free-roaming wild animals.”
The researchers add that price is another significant barrier to the adoption of plant-based meat.
“In South Africa, for example, plant-based meat alternatives are considered expensive niche products associated with status and class.”
When it comes to the environmental and health risks associated with eating meat from domesticated animals regularly, the researchers point out that while consumers will acknowledge these risks, they are still unlikely to eat less meat. This phenomenon is known as the “meat paradox”.
‘Halo effect’
“Our review has shown that the ‘halo effect’ (consumers’ perception that plant products are more environmentally friendly) afforded to plant-based meat is not completely warranted because researchers are (un)knowingly discounting the processed nature of meat alternatives in any environmental or health risk assessment.”
“While the reduced environmental impacts of meat alternatives are apparent, a ‘cradle to grave’ environmental assessment needs to be carried out to ensure that the environmental burden is not shifted to other stages of the production cycle.”
The researchers say the review also found that plant-based meat products are similar in nutrient composition to meat, although differences in essential nutrients warrants caution.
“In terms of nutritional composition between traditional meat and meat alternatives, there is inconclusive evidence on which is healthier.”
According to them, the available literature is replete with strategies to reduce traditional meat consumption and to try plant-based meat alternatives. These include, among others, meatless days, partially substituting traditional meat with plant-based ingredients (e.g., “hybrid burgers”), cultural and lifestyle changes, food labelling, consumer education, and taxes on traditional meat or subsidies on plant-based meat.
“However, some of these strategies are not without drawbacks. For instance, food labels on the health and environmental benefits of plant-based meat may contain too much information that could confuse the consumer.
“If consumers in SSA are to be convinced to eat less meat and/or substitute it for plant-based alternatives, the latter should not be marketed as a replacement for traditional meat products but as a complement. Marketing strategies should be tailored to different sections of consumers because such a contextual approach is bound to provide more favourable and long-term results than a ‘one- size-fit-all strategy.”
The researchers emphasise the need for a comprehensive environmental and health impact assessment of meat alternatives in the region.
The world’s first malaria vaccine will soon be available across sub-Saharan Africa, according to PATH, partners of the vaccine developers, as positive results from the pioneering jab pile up.
The vaccine, known as RTS,S/AS01E and commercialised under the brand name Mosquirix, targets children as over three quarters of malaria deaths occur in under-five-year olds, according to the latest report from the WHO.
Findings from a WHO pilot held in Ghana, Kenya and Malawi, showed that the pioneering vaccine caused a significant reduction in severe malaria and hospitalisation among vaccinated children.
It means more countries in sub-Saharan Africa will soon receive the vaccine, says John Bawa, Africa lead for vaccine implementation at Program for Appropriate Technology in Health (PATH).
These findings pave the way for an expanded distribution scheme that will see countries like Mozambique, Nigeria and Zambia receive the vaccines, said Bawa during a webinar held in commemoration of World Malaria Day.
“The next is to deploy the vaccine to other endemic countries. Countries that are interested in the vaccine are expected to apply to GAVI from June to September,” he said at the webinar organised by the African Media and Malaria Research Network (AMMREN), PATH and Kintampo Health Research Centre (KHRC).
“Countries like Mozambique, Uganda, Zambia and Nigeria have already written officially to express interest for the vaccine,” Bawa said.
He said malaria vaccine coverage in Malawi was at 88% in 2020 and 93% in 2021. In Ghana, it was 71% in 2020 and 76% in 2021 and in Kenya, it was 69% in 2020 and 83% in 2021.
“These numbers indicate strong community demand and capacity of childhood vaccination platforms to effectively deliver the vaccine to children,” said Bawa.
Currently, 1 million children in Ghana, Kenya and Malawi have received at least one dose of the first malaria vaccine.
These vaccines were distributed in a pilot scheme organized by WHO. The organisation has now recommended the vaccine for use among children in areas with moderate to high transmission rate of malaria.
“This vaccine is not just a scientific breakthrough, it is life-changing for families across Africa. It demonstrates the power of science and innovation for health,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said.
Vaccine procurement
In an arrangement to boost vaccine supply and coverage, GlaxoSmithKline, producers of the RTS,S vaccine, will transfer technology and patent to Bharat Biotech in India to manufacture the vaccines.
The WHO, in a press release, said more than US$155 million has been secured from to support the introduction, procurement and delivery of the malaria vaccine for Gavi-eligible countries in sub-Saharan Africa.
The organisation said it would provide guidance for countries that are considering the use of vaccines for the reduction childhood illnesses and deaths from malaria.
“For some countries, Gavi is paying about 80% [of the] cost of the vaccine, while it is expected that the country’s government would pay the [remaining] 20%,” Bawa said.
Wellington Oyibo, director of the Centre for Malaria Diagnosis, Research, Capacity Building and Policy at the University of Lagos, urged African leaders to ensure that their counterpart funds are available to purchase the vaccine.
He said the Nigerian government and the Prince Ned Nwoko Foundation malaria eradication project have applied to purchase the vaccine for Nigerian children.
Oyibo said while the initial rollout of the vaccine may not go around the country, the Nigerian government selected states with the highest malaria burden to begin with.
Ghanaian health tech startup mPharma is building a network of community pharmacies across Africa as it plans to be the go-to primary healthcare service provider for millions of people. Drug supply in Africa is often unaffordable and counterfeits are rife.
The startup’s community (Mutti) pharmacies are essentially mini-hospitals offering affordable services, ranging from medical consultation to diagnostic and telehealth services.
The company plans more Mutti pharmacies to extend its reach ater raising $35 million, bringing the total amount raised by mPharma to $65 million.
According to mPharma co-founder and CEO Gregory Rockson told TechCrunch, the new financing will be used to ramp up its infrastructure, staff and expansion into African markets.
“We are hiring over 100 engineers to build all our technology in-house and this includes a massive data infrastructure we are creating. We are also investing in other skilled talent like doctors and nurses, professionals that are critical in the work we do,” Rockson told TechCrunch.
Originally founded in 2013, mPharma aims to manage prescription drug inventory for pharmacies and their suppliers, retail pharmacy operations and to provide market intelligence to hospitals, pharmacies and patients.
In October 2021, the startup added telehealth services to its portfolio, catching the telemedicine wave brought in by the COVID pandemic. Rockson told TechCrunch the startup was planning to have 100 virtual centres after six months. The number of virtual centres is primed to grow further alongside mPharma’s plan to increase its community pharmacies from 200 to over 2000 in three years.
Patients in Ghana, Nigeria, Kenya, Zambia, Malawi, Rwanda and Ethiopia, where mPharma has a presence, can access these virtual services. Startups like mPharma aim to address healthcare gaps in Africa.
Sub-Saharan African countries have an average of 0.23 doctors for every 10 000 people against the best ratio of 84.2 doctors in some of the most developed countries. In addition, healthcare infrastructure remains critically underdeveloped.
“COVID showed us that the best form of care is local, it is in the community, and the closest thing in communities are pharmacies. We believe that the pharmacy of the future, which is what we are creating, is one built around longitudinal care not episodic care,” said Rockson.
“We are transforming community pharmacies into the foundation of a modern health system in Africa. We will have a Mutti pharmacy in every community on the continent, guarantee the availability and safety of medicines for each community and utilise the physical infrastructure of Mutti pharmacies to expand Mutti Doctor (the telemedicine service), creating the largest network of doctor offices and diagnostic centres.”
The World Health Organization (WHO) is recommending widespread use of a new malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The vaccine, known as the RTS,S/AS01 (RTS,S or Mosquirix), has been trialled in three countries in a pilot programme involving 800 000 children.
Though the vaccine only offers moderate protection against malaria, with 36% protection against malaria cases among children. One study estimated that even with realistic vaccine coverage, at a constraint of 30 million doses, 5.3 million cases and 24 000 deaths could be prevented among children under five, .
“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”
This comes amid stagnation in progress in recent years against the deadly disease. In sub-Saharan Africa, malaria remains a primary cause of childhood illness and death. More than 260 000 African children under the age of five die from malaria annually.
“For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”
The WHO recommends that in the context of comprehensive malaria control the RTS,S malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by the WHO. This vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.
The outcome of the pilots informed the recommendation based on data and insights generated from two years of vaccination in child health clinics in Ghana, Kenya and Malawi. Findings include:
Vaccine introduction is feasible, improves health and saves lives, with good and equitable coverage of RTS,S seen through routine immunization systems. This occurred even in the context of the COVID pandemic.
RTS,S enhances equity in access to malaria prevention.
Data from the pilot programme showed that more than two-thirds of children in the 3 countries who are not sleeping under a bednet are benefitting from the RTS,S vaccine.
Layering of tools results in over 90% of children benefitting from at least one preventive intervention (insecticide treated bednets or the malaria vaccine).
Strong safety profile: To date, more than 2.3 million doses of the vaccine have been administered in 3 African countries – the vaccine has a favorable safety profile.
No negative impact on uptake of bednets, other childhood vaccinations, or health seeking behavior for febrile illness. In areas where the vaccine has been introduced, there has been no decrease in the use of insecticide-treated nets, uptake of other childhood vaccinations or health seeking behavior for febrile illness.
High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.
Highly cost-effective: Modelling estimates that the vaccine is cost effective in areas of moderate to high malaria transmission.
Next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies.
The pilot programme was financed through collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.
