Past, present and future perspectives


In sub-Saharan Africa, 61 per cent of the population lives in ecologically vulnerable areas characterized by a high degree of sensitivity and low degree of resilience (IDS 1991). This is not necessarily by choice, but by force of circumstance, because other options are either unavailable or have been exhausted.

Perhaps one of the major threats to people of the state of the environment is malaria-a major killer in the region. Between 300 million and 500 million cases of malaria-which involve mostly the poor-are recorded in Africa annually. They cause between 1.5 to 2.7 million deaths, of which more than 90 per cent are children under 5 years of age (World Bank 2000c, Nchinda 1998). Malaria slows economic growth in Africa by up to 1.3 per cent each year and, according to statistical estimates, the gross domestic product (GDP) of sub-Saharan Africa would be up to 32 per cent greater if malaria had been eliminated 35 years ago (WHO 2000b).

It is estimated that, by 1999, malaria had cost Africa about US$100 000 million in lost economic opportunities-or nearly five times more than all development aid provided to the region in 1999 (IRIN 2001). According to a report by the World Health Organization (WHO), Harvard University, and the London School of Hygiene and Tropical Medicine, malaria slows economic growth in Africa by up to 1.3 per cent each year. This slowdown in economic growth due to malaria is over and above the more readily observed short-term costs of the disease. With a GDP of about US$300 000 million, the short-term benefits of malaria control in sub-Saharan Africa are estimated at between US$3 000 million and US$12 000 million per year (WHO 2000b). According to UNICEF, the average cost for each nation in Africa to implement malaria control programmes is estimated to be at least US$300 000 a year. This amounts to about six US cents (US$0.06) per person for a country of 5 million people.

Some of the causes of malaria are summarized in Box 3.6, which also indicates the areas on which health programmes could focus in order to fight the disease.

Box 3.6 Malaria: factors related to human vulnerability

A number of factors,many of them relating to various dimensions of human vulnerability, appear to be contributing to the resurgence of malaria:

  • the rapid spread of resistance of malaria parasites to chloroquine and other quinolines; .
  • frequent armed conflicts and civil unrest in many countries, forcing large populations to settle under difficult conditions, sometimes in areas of high malaria transmission;
  • migration of non-immune populations-for reasons of agriculture, commerce and trade-to areas where malaria transmission is high;
  • changing climatic conditions, especially rising temperatures and rainfall patterns;
  • water development projects, such as dams and irrigation schemes, which create new mosquito breeding sites;
  • adverse socio-economic conditions, leading to a much-reduced health budget and gross inadequacy of funds for drugs;
  • high birth rates, leading to a rapid increase in the susceptible population of those younger than 5 years of age; and .
  • changes in the behaviour of the vectors, particularly in biting habits, from indoor to outdoor biters.

(Nchinda 1998)

The health crisis situation in Africa has been summarized in Table 3.1, which indicates the high percentage of the population of the region who are undernourished, and who have HIV/AIDS, malaria and tuberculosis. During 1992, cholera affected almost every country in the region of the South African Development Community (SADC), claiming hundreds of lives.

Table 3.1 Health crisis and challenges in Africa
Sub-region (countries) Undernourished people as % of total population 1996-98
People living with HIV/AIDS
Malaria cases (per 100 000 people) 1997 Tuberculosis cases (per 100 000 people) 1998
Adult (age 15-49) 1999 Women (age 15-49) 1999 Children (age 0-14) 1999
Northern Africa (6) 6.8* 0.24* - - 1 321* 51.5
Western Africa 22.9 3.5 176 600 15 303 9 275.7 69.4
Central Africa 34.8 5.8 160 937 13 254 3 240 98
Eastern Africa 48 7.59 534 978 48 439 6 759 167
Southern Africa 35.7 19 525 818 34 409.1 16 838 301
IOC 23 0.12 5800 (Madagascar) 450 (Madagascar)    

* Note: More than 50 per cent of undernourished and more than 95 per cent of all HIV/AIDS and malaria cases for North Africa are from the Sudan.

Source: JES-Preparation WSSD 2001

Climate change, and human activities which transform habitats and create conditions suitable for parasites and disease organisms to breed, have a significant impact on the distribution and prevalence of vector-borne diseases (VBDs) in Africa. Climate change affects vector survival primarily through minimum temperatures, impacting the latitude and elevation of distribution, as well as the length of season permissive to transmission of VBDs (IPCC 1998). Meteorological variables, subject to climate variability and global atmospheric change, can therefore create conditions conducive to the spread of disease or, in the case of flooding or drought, clusters of outbreaks.