African Unification Front
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OVERVIEW OF INFECTIOUS DISEASE CONTROL
Control of infectious diseases is dependent on many factors, the most critical of which are:-
[1] Access to clean water
[2] Access to appropriate nutrition
[3] Access to safe housing
[4] An Africa-centred medical management infrastructure
Also there is a remarkable correlation between infectious diseases and political unrest. All of Africans major epidermics have taken place under circumstances of extreme social and political distress. Break-down in community relations, the subsequent undernourishment, and the failure of social institutions all inevitably lead to disease and epidermics. The more extreme the political distress, the more virulent and sustained the epidermic.
At the bottom of this page are the reviews of the Algerian Relapsing Fever and Typhus epidermics in th mid 1940s, as well as the study of the Sleeping Sickness Epidermic in Central Africa under the rubber plantation regime of Leopold II. These epidermics illustrate the relationship between politics and disease.
There are also demographic and geographic issures to consider in the management of infect. Many of the people who make up the mountain communities of Africa have access to water that is free of bilharzia river infection and mosquitoes of the lowlands. The highlands of East, Central and Southern Africa tend to be cold and crisp, with clear mountain streams. However, these areas do not usually have good pastures so that herding communities tend to stay in the valleys while cultivators live on the slopes.
AUGMENTING AFRICAN MEDICINE
There is an increasing realization that the state of Tropical Medicine needs overhauling and that African medicine has been severely damaged by dependence on the purified, single-action drugs. The separation of medicine from food, and the separation of food into pure categories such as protein, lipids, carbohydrates and vitamins ignores the network of plant toxins whose consumption provides Africans with defence against disease.
Whereas traditional African remedies went a long way in suppressing disease and boosting the immunity, the insistence of eradication of tropical pathogens by Western medicine does not take into account the cyclical nature of infection (according to seasons). The ability to retain and manage low caseloads of tropical pathogens as a defence against weak immunity has not been studied sufficiently, but most infections used to disappear "naturally" until the advent of colonial medicine.
Modern drugs are single compound drugs with one mechanism of action. The disadvantage of this is the development of drug resistance, which happens because the "single mechanism" approach stimulates the parasite to form counter-strategies. Natural plant remedies may contain dozens of different compounds with different levels of activity and different effects on the parasite. Some of the bioactive compounds may act to paralyze the pathogen, inhibit movement, prevent egg laying, and other compounds are toxic. Suppressing disease by the use of multi-pronged attack may defeat the development of resistance among parasites.
African traditional healing is gaining resurgence, howeverm, it is very poor and uncoordinated. This may result in many failures and the discarding of a perfectly effective means of controlling tropical pathogens. The failure of Western medical concepts in Africa have resulted in the overall reduction of African immunity to disease.
THE POLITICAL ANATOMY OF INFECTION
A PLAGUE OF TSETSE FLIES & AN EPIDERMIC OF SLEEPING SICKNESS
Early records by explorer David Livingston and others indicate that tsetse flies were only responsible for transmitting Nagana (sleeping sickness) to animals. As early as 1857 Livingston was certain humans were immune to the sleeping sickness.
Before 1895, this parasitic disease had long been endemic in the Congo river basin. Following the collapse of pre-slavery and precolonial patterns of living, in 1895 disease-carrying tsetse flies infested the Congo region and attacked people moving along the waterways. By 1906 the epidermic of sleeping sickness (trypanosomiasis) had killed 500,000 people in south-central Africa.
From 1878 to 1884, when Henry Morton Stanley was the economic development chief for King Leopold II, he contributed to the spread of the disease in the central and easter regions of the Congo, by established trading stations; river boats carried infected persons, as well as flies, into the developing population centers.
By 1896 the disease had killed up to 5,000 Africans in the environs of Lukolela on the Congo. The mortality figures were gained through the efforts of Roger Casement, British consular agent in the Congo Free State (1901-04), who found only 352 survivors of the disease in Lukolela in 1903. In a letter to the governor-general of the Congo State in 1904, Casement reported appalling, unsanitary conditions at Lukolela, where the sick were left untreated medically.
After being bitten by the diseased tsetseflies, Africans in the Congo complained of low-grade fever, chills, severe headaches, lesions, rashes, and insomnia; sometimes behavioral and personality changes occured, with hallucinationsand delusions. Without medical help, increased wasting and somnolence occured until inevitable death. At the time, drug treatment was experimental and inadequate; the main effort of the Congo government was directed toward locating infected people and then isolating them in special hospitals (lazarets or lazarettos).
In the main towns near Malebo Pool (whre Kinshasa is located), thousands of Africans of the Teke community died from sleeping sickness; patients who tried to flee the area spread the infection. By 1903 Leopoldville (Kinshasa), the capital, was left with less than 100 Africans.
In 1903 King Leopold II intervened to try and end the epidermic by inviting a team of physicians from the School of Tropical medicine to the colony to study the disease. In 1908 the Belgian parliament took over the Congo Free State from King Leopold. By 1912, along with a changes in the government policies and marked reduction in exploitation, the sleeping sickness (known then as Negro Lethargy) had abated.
By late 1920 sleeping sickness had advanced into northern Nigeria via the Congo, which was again ravaged by the disease a few years later, with mortality rates as high as 30 percent. By 1939 almost ever country in West Africa had been infected by the disease.
CO-INFECTION & MULTIPLE EPIDERMICS
TB, HIV/AIDS, STDs and others have become a major concern today. Multiple epidermics have become more prevalent as a result of the overall social and political unrest in Africa. The association of multiple epidermics may be as a result of the disease process (such as STDs) enhancing the spread of HIV such as STDs, or HIV leading to an increased frequency of TB. STDs have been shown to increase the transmission of HIV and possibly other immunity problems, and that the control of STDs can impact positively on the incidence of HIV.
A study done in Mwanza, Tanzania is an example that the occurrence of STDs in a population is a reliable indicator of unprotected sex and highlights the need for education and information.
TB case rate has increased in Zambia since the advent of the AIDS epidermic in Zambia. The association between HIV and TB has led to a resurgence in the notification rates of TB in many countries, particularly in sub-Saharan Africa. HIV appears to be the strongest risk factor for the development of TB from a latent infection. Not all patients exposed to TB mycobactene develop infection with establishment of an infection. Similarly, not all people infected with the TB mycobactene develop active clinical disease.
In the presence of an active immune system the patient has a 10 per cent lifetime chance of developing clinical disease. In the presence of HIV infection with its attendant immune suppression, the risk of developing disease from a latent infection increases from 8 - 10 per cent to 50 per cent in the life time.
Zambia has experienced a fourfold increase in the rate of notification of TB since 1985. The rate has increased from 100 to over 500 per 100,000 population in 1996. National AIDS/STDs and TB Control Programme Co-ordinator Dr Moses Sichone said there were over 40,000 cases of TB in 1996 from 8,000 in 1985. "As many as two-thirds of TB patients may be HIV positive. HIV infection weakens the immune system of otherwise healthy adults. Many perhaps half, of all adults in Southern Africa carry a latent TB infection which is suppressed by a healthy immune system... When that immune system is weakened by HIV, it can no longer control the TB infection and overt TB disease can develop," according to a Ministry of Health study.
Without AIDS, TB cases may have been limited to about 8,000 to 11,000 in 1996. But with AIDS, TB cases will continue to rise. With the AIDS epidemic, annual TB cases could reach about 50,000 by the year 2005. The numbers could be higher as the TB cases could transmit to others and because of emerging drug-resistant strains. Dr Mwinga says while some of this increase may be linked to declining socio-economic conditions, the HIV seroprevalance of 70 per cent in newly diagnosed TB patients parts to co-infection with HIV being paramount.
Co-infection with HIV has affected the ability to diagnose TB using the usual methods available. There is also an associated increase in rates of relapses and mortality in the dually infected individual. The explosive situation globally caused by the interaction between HIV and TB led the World Health Organisation to declare TB a global emergency in 1993.
The impact of HIV infection on TB is a serious problem because TB is contagious through casual contact. Because of HIV the entire population is threatened with TB. The problem has been worsened by the cost of TB drugs due to the increased figures.
Follow ups are difficult as health workers are over stretched. Patients are followed up for three years after receiving six months preventive treatment. Some patients do finish treatment and therefore increasing the re-occurrence rate. Drug resistant strains of TB are reappearing among the HIV infected and uninfected people. This makes it more difficult and expensive to treat. TB treatment is costly and this puts a strain on the national health budget.
AIDS patients with TB stay longer in hospital than other AIDS patients. TB in health institutions threatens as the health of other patients especially HIV-positive patients.
However, with a prompt and appropriate treatment programme, TB is treatable even in PLWHAs. People living with HIV/AIDS who receive preventive therapy develop TB much less than those who did not.
Click for: EPIDERMICS THROUGH AFRICA'S HISTORY
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