Fifteen years have passed since the first edition of Disease and Mortality in Sub-Saharan Africa (DMSSA-1) was published. Its main purpose was to assist the World Bank's work in the health sector by describing conditions and diseases that contributed most to the overall burden of disease and by identifying ways to prevent and manage these causes of ill health. The volume was timely because of the adverse effect the economic downturn of the early 1980s had on health in Africa and because of the need to evaluate the impact of primary health care strategies that had been promoted in the preceding decade. Epidemiologic information coming from demographic surveillance sites that had not previously been fully compared and disseminated provided a new source for assessing trends in mortality. All this occurred against a backdrop of increasing concern about how the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), then still a relatively new and geographically more limited disease, could potentially affect health and development in Africa.

In the years since the publication of DMSSA-1 in 1991, epidemiological and demographic changes have occurred that require an update if the volume is to remain useful for policy makers in addressing key concerns. The most significant impact on disease and mortality in Africa has been the growth of the HIV/AIDS epidemic, which has infected more than 30 percent of adults in some countries while spreading across the continent. Its impact has changed trends in many of the diseases covered in this volume and dramatically worsened the overall level of mortality in many African countries. The potential impact of HIV/AIDS was anticipated in DMSSA-1; the current volume documents the burden the disease is currently inflicting on Africa.

Contents

• Acknowledgments
• Foreword
• Contributors
• Abbreviations and Acronyms
• Chapter 1. Changing Patterns of Disease and Mortality in Sub-Saharan Africa: An Overview
  Florence K. Baingana and Eduard R. Bos.
  • Approach
  • Conditions Not Covered in DMSSA-1
  • Key Developments Since DMSSA-1
  • References
• Chapter 2. Levels and Trends in Mortality in Sub-Saharan Africa: An Overview
  Jacob Adetunji and Eduard R. Bos.
  • Indicators of Mortality Levels and Trends
  • Mortality Levels and Trends
  • References
• Chapter 3. Trends in Child Mortality, 1960 to 2000
  Kenneth Hill and Agbessi Amouzou.
  • Data Sources and Methods
  • Results
  • Discussion
  • Appendix 3A: Methodology and Detail Results
  • Appendix 3B: Estimates of U5MRs and IMRs and Data Sources
  • References
• Chapter 4. Levels and Trends of Adult Mortality
  Debbie Bradshaw and Ian M. Timaeus.
  • Sources of Data
  • Mortality Levels
  • Trends in Adult Mortality
  • Conclusion
  • References
• Chapter 5. Causes of Death
  Chalapati Rao, Alan D. Lopez, and Yusuf Hemed.
  • Data Sources
  • Results and Discussion
  • Conclusion
  • References
• Chapter 6. Population and Mortality after AIDS
  Rodolfo A. Bulatao.
  • Approach and Data
  • Effects on Population Size, Decomposed
  • Life Expectancy
  • Conclusion
  • References
• Chapter 7. Levels and Patterns of Mortality at INDEPTH Demographic Surveillance Systems
  Osman A. Sankoh, Pierre Ngom, Samuel J. Clark, Don de Savigny, and Fred Binka.
  • Levels of Mortality at INDEPTH Network Sites
  • INDEPTH Network Mortality Patterns
  • Conclusion
  • References
• Chapter 8. Trends and Issues in Child Undernutrition
  Todd Benson and Meera Shekar.
  • What Causes Undernutrition?
  • Indicators of Child Undernutrition: Outcomes and Inputs
  • Status and Trends in Child Undernutrition
  • Discussion
  • References
• Chapter 9. Diarrheal Diseases
  Cynthia Boschi-Pinto, Claudio F. Lanata, Walter Mendoza, and Demissie Habte.
  • Methods
  • Data Sources and Literature Review: Morbidity
  • Data Sources and Literature Review: Mortality
  • Data Source and Literature Review: Etiology
  • Reviews and Estimations
  • The Role of Risk Factors for Diarrheal Disease in the African Region
  • Some Additional Comments
  • The Role of Interventions to Control Diarrheal Diseases
  • Conclusion
  • References
• Chapter 10. Developmental Disabilities
  Geoff Solarsh and Karen J. Hofman.
  • Medical and Social Models of Disability
  • The Changing Burden of Disease in Childhood
  • Prevalence and Incidence
  • Determinants and Risk Factors
  • Infection
  • Nutrition
  • Environmental Toxins
  • Accidents and Injuries
  • Interventions
  • Evaluation and Cost-Benefit Analyses
  • Conclusion
  • References
• Chapter 11. Acute Respiratory Infections
  Shabir A. Madhi and Keith P. Klugman.
  • The Epidemiology of ARI and LRTI
  • The Impact of the HIV Epidemic on the Epidemiology of LRTI
  • The Etiology of LRTI
  • The Impact of WHO Management Strategy
  • The Impact of Hib Conjugate Vaccines in Preventing LRTI
  • The Impact of S. pneumoniae Conjugate Vaccines in Preventing Pneumonia in Children
  • Other Potential Intervention Strategies in Reducing the Burden of LRTI
  • Other Potential Ways to Prevent LRTI
  • Conclusion
  • References
• Chapter 12. Vaccine-Preventable Diseases
  Mark A. Miller and John T. Sentz.
  • History of Vaccination in Africa
  • The Vaccine-preventable Disease Burden
  • Future Vaccines
  • Vaccination Programs
  • Adoption of New Vaccines
  • Vaccination: Problems and Barriers
  • Financial Implications, GAVI, and the Vaccine Fund
  • Conclusion
  • References
• Chapter 13. Tuberculosis
  Christopher Dye, Anthony D. Harries, Dermot Maher, S. Mehran Hosseini, Wilfred Nkhoma, and Felix M. Salaniponi.
  • Microbiology, Transmission, and Pathogenesis
  • Clinical Manifestations and Diagnosis
  • Epidemiology
  • Conclusion
  • References
• Chapter 14. Malaria
  Robert W. Snow and Judy A. Omumbo.
  • Plasmodium falciparum Distribution in Africa
  • Direct Malaria Mortality
  • Consequential Mortality
  • Indirect Mortality
  • Malaria and Poverty
  • Trends in Malaria Mortality
  • Conclusion
  • References
• Chapter 15. Onchocerciasis
  Uche Amazigo, Mounkaila Noma, Jesse Bump, Bruce Benton, Bernhard Liese, Laurent Yaméogo, Honorat Zouré, and Azodoga Seketeli.
  • Transmission
  • The Disease Burden
  • The Socioeconomic Toll
  • Rapid Epidemiological Mapping of Onchocerciasis
  • Population at Risk and Population Infected
  • Onchocerciasis Control Programs
  • Conclusion
  • References
• Chapter 16. Maternal Mortality
  Khama O. Rogo, John Oucho, and Philip Mwalali.
  • Measurement and Data Sources
  • Levels and Trends in Maternal Mortality
  • Causes and Correlates of Maternal Mortality
  • Reducing Maternal Mortality: Priority Interventions and Lessons
  • Conclusion
  • References
• Chapter 17. HIV/AIDS
  Souleymane Mboup, Rosemary Musonda, Fred Mhalu, and Max Essex.
  • Development of the AIDS Pandemic
  • Rates of HIV/AIDS in Africa
  • Retroviruses
  • Regional Variation
  • Progression of Infection
  • Prevention
  • Vaccines and Microbicides
  • Therapy
  • Conclusion
  • References
• Chapter 18. Lifestyle and Related Risk Factors for Chronic Diseases
  Krisela Steyn and Albertino Damasceno.
  • Antenatal Influences on the Emergence of Risk Factors for Chronic Diseases
  • Tobacco Use
  • Nutrition in Transition
  • Aerobic Exercise
  • Obesity
  • Hypertension
  • Dyslipidemia
  • HHealth Services' Requirements for the Management of NCD Risk Factors
  • Policy Initiatives to Promote a Healthy Lifestyle
  • Conclusion
  • References
• Chapter 19. Diabetes Mellitus
  Jean-Claude Mbanya and Kaushik Ramiaya.
  • Sources of Data
  • Epidemiology of Diabetes
  • Prevalence and Incidence of Type 1 Diabetes
  • Prevalence of Type 2 Diabetes
  • Complications of Diabetes
  • Mortality Associated with Diabetes
  • Cost of Diabetes
  • Strategies for Control
  • Diabetes Health Care
  • Conclusion
  • References
• Chapter 20. Cancers
  Freddy Sitas, Max Parkin, Zvavahera Chirenje, Lara Stein, Nokuzola Mqoqi, and Henry Wabinga.
  • Cervical Cancer
  • Breast Cancer
  • Kaposi's Sarcoma
  • Stomach Cancer
  • Liver Cancer
  • Prostate Cancer
  • Non-Hodgkin's Lymphoma
  • Cancer of the Esophagus
  • Other HIV-associated Cancers
  • Tobacco-related Cancers
  • Conclusion
  • Acknowledgments
  • References
• Chapter 21. Cardiovascular Disease
  Anthony Mbewu and Jean-Claude Mbanya.
  • The Epidemiological Transition
  • Sources of Data
  • The Changing Prevalence, Incidence, and Pattern of Cardiovascular Disease
  • Epidemiology of the Various CVDs
  • Determinants, Behaviors, and Risk Factors
  • Prevention, Rehabilitation, and Cure of Cardiovascular Disease
  • Impact on the Health Care System in Africa and Strategies for Control and Prevention
  • Conclusion
  • References
• Chapter 22. Mental Health and the Abuse of Alcohol and Controlled Substances
  Florence K. Baingana, Atalay Alem, and Rachel Jenkins.
  • The Scope of Mental Disorders
  • Measurement and Data Sources
  • Epidemiology
  • Interventions
  • A Framework for Research
  • Policy Issues
  • References
• Chapter 23. Neurological Disorders
  Donald Silberberg and Elly Katabira.
  • Measurement and Data Sources
  • Epidemiology
  • Etiology and Determinants
  • Consequences of Neurological Disorders
  • Resource Issues
  • Interventions: What Has Worked?
  • A Framework for Research
  • Policy Issues
  • References
• Chapter 24. Violence and Injuries
  Brett Bowman, Mohamed Seedat, Norman Duncan, and Olive Kobusingye.
  • Data Sources
  • Intentional Injuries
  • Unintentional Injuries
  • The Experiences of South Africa and Uganda
  • Risk Factors
  • Strategies for Control: What Practices Exist?
  • Conclusion
  • References

This volume is a product of the staff of the International Bank for Reconstruction and Development / The World Bank. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent.

The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.