33 Sub-Saharan Africa: Population Geography I – Infectious Disease

“Humankind is no stranger to calamitous outbreaks of diseases.”

• Ram Nath Kovind, Indian politician

Non-communicable diseases, such as cancer and heart disease, are responsible for most deaths in the developed world. In Europe, prior to the Covid pandemic, 85% of deaths were caused by such conditions, which are usually associated with advanced age. By comparison, such non-communicable diseases are responsible for just 20% of the deaths in Sub-Saharan Africa. This might seem like good news for a region that has so many troubles, but there is a disturbing reason for it. People in Sub-Saharan Africa don’t typically die of cancer or heart disease because they are healthier, but because something else kills them first. Sub-Saharan Africa is home to just 14% of the global population, but prior to the Covid pandemic, it accounted for 48% of the world’s annual deaths from infectious disease.

Infectious diseases are those that are communicable – that is, they are spread from person to person, or from animals to people. Infectious diseases are certainly found in the developed world, as any American who suffers from seasonal colds or the flu can attest. But until the Covid pandemic, deaths from infectious diseases in wealthy countries were comparatively rare. In Sub-Saharan Africa, however, they have long been a fact of life, and are one of the most problematic issues facing the region.

Some of the infectious diseases that are common Sub-Saharan Africa first evolved outside of the region, such as SARS, Covid, measles, and tuberculosis. But many of them originated in Africa, including HIV, monkeypox, yellow fever, malaria, the Ebola virus, the Zika virus, and Rift Valley fever. The latter three actually bear geographic names from Sub-Saharan Africa, referring to the places where they were first identified – the Ebola River in Congo, the Zika Forest in Uganda, and East Africa’s Great Rift Valley. Three recent disease outbreaks – of HIV, Ebola, and Covid – have garnered special attention.

The human immunodeficiency virus (HIV) was first detected in humans in the 1950s, although it may have been present years before. HIV positivity leads to a condition known as acquired immunodeficiency syndrome, or AIDS. It is spread through a variety of means, but primarily through sexual activity. Sub-Saharan Africa’s HIV epidemic peaked in the early 2000s. In the first decade of this century, the global HIV infection rate was just over 1%. In Sub-Saharan Africa, the infection rate was 9%, and the region accounted for 71% of the world’s HIV cases. The situation in southern Africa was especially dire. In Namibia, South Africa, and Zambia, more than 20% of the population was HIV-positive. In Botswana, Lesotho, Swaziland, and Zimbabwe, the infection rate was over 30%. The region’s annual death rate from AIDS was over 2 million, and more than 90% of the world’s children who were orphaned by AIDS lived in Sub-Saharan Africa. While HIV remains a major problem in the region, the situation has improved over the last decade. Rates of infection have declined by more than 40%, and annual deaths from AIDS have been cut in half.

The Ebola virus was first identified in the 1970s, but its most severe outbreak occurred in 2014, when thousands of people were infected. It is a highly contagious disease, spread through contact with bodily fluids such as sweat and saliva. With medical treatment, the disease has a mortality rate of 50%. Without treatment, the mortality rate was greater than 90%. Fortunately, the outbreak was contained relatively quickly, and largely confined to Guinea, Sierra Leone, and Liberia. Still, more than 5,000 deaths from Ebola were reported in those countries in less than a year.

One of the great ironies of the Covid pandemic is that Sub-Saharan Africa, despite its tragic relationship with infectious disease, has weathered this particular outbreak relatively well. In mid-2020, Europe’s Covid deaths stood at 1.87 million. North America was close behind at 1.44 million deaths. Africa has suffered just over 250,000 deaths from Covid, still a tragic number, but much lower than expected. It is quite possible that the region’s Covid death toll is higher, and that many Covid death were misdiagnosed, but there hasn’t been a substantial rise in overall mortality, so that is not likely. It is far more likely that Sub-Saharan Africa’s demographics have largely shielded it from Covid. The virus has been particularly lethal for the elderly, and Sub-Saharan Africa is by far the world’s youngest region.

There are, of course, significant reasons why infectious diseases are so common in Sub-Saharan Africa. The first is poverty. Many in the region are malnourished or undernourished, which compromises their immune systems and makes them more susceptible to disease. Another is environmental. Many of Sub-Saharan Africa’s infectious diseases are transmitted by mosquitoes, flies, and ticks, organisms that thrive in the region’s warm, wet environments. And as more of Africa’s population moves to urban environments that are crowded, marked by unclean water, and poor sanitation and drainage, the problem has gotten worse.

Another significant reason for the prevalence of infectious disease in Sub-Saharan Africa is the widespread consumption of wild game, commonly known as bushmeat. The hunting and consumption of bushmeat has been longstanding practice in rural Africa, but it is also a significant source of dietary protein in the region’s cities. Most urban markets in Sub-Saharan Africa feature a wide variety of bushmeat, including monkeys, rats, turtles, bats, porcupines, and antelopes. Although usually illegal, it is also possible to acquire the meat of endangered species such as elephants and gorillas. Nearly 6 million tons of bushmeat is harvested each year in the Congo basin, equivalent to 44% of the beef produced in the United States. Unfortunately, bushmeat is rarely subject to health and safety inspections, and many of the world’s most notorious infectious diseases, including HIV, Ebola, SARS, and Covid, were first introduced into the human population by the consumption of bushmeat. Despite the dangers, the consumption of bushmeat is unlikely to decline anytime soon. It is incredibly expensive to raise meat on farms, so for a poor region like Sub-Saharan Africa, wild game is often the only significant source of meat.

Political instability is another problem, as mass human displacements caused by conflict inhibit the ability of the region’s governments to effectively address infectious diseases. But the most significant problem is economic. Quite simply, the region suffers from a lack of money and a lack of physicians. In the European Union, there is one doctor for every 200 people, and annual health care expenditures are $3500 per person. In North America, there is one physician for every 400 people, and annual health care expenditures are $10,000 per person. In Sub-Saharan Africa, there is one doctor for every 10,000 people, and annual health care expenditures are $80 per person. Many of the region’s governments lack the resources to maintain public health institutions that predict, prevent, and manage outbreaks of infectious disease. Only fifteen of the region’s countries have something analogous to the United States’ Centers for Disease Control. The remaining countries are almost entirely dependent on international non-profit organizations to address epidemics, and while many of the efforts of these organizations have been heroic, they lack the resources to effectively combat the problem. As long as health care in Sub-Saharan Africa remains badly underfunded, infectious disease is likely to remain a significant problem.

Cited and additional bibliography:

chaouki. AIDS in Afrika. photo, 11 Apr. 2010. Flickr, https://www.flickr.com/photos/weltum/4508668799/. Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0).

vanVliet, Nathalie. CIFOR. Bushmeat. photo, 22 Apr. 2014. Flickr. https://www.flickr.com/photos/cifor/36416431340/. Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0).