Strategies to maintain health in the Third World

Abstract

International cooperation with Third World countries aims at reducing the high morbidity and mortality of the population to a tolerable level. The main health problems are caused by poverty. Thus, the range of diseases in tropical countries can be explained more readily by the socio-economic situation than solely by the climate. Health services, in Africa in particular, have had to reduce drastically their budgets in the last ten years and now have only approximately 1/1000th of the funds usually available in industrialised countries. High population growth reduces the resources available per head, increases infection potential and worsens living conditions. Control strategies must take account of these circumstances in order to achieve the required sustained effect within the framework of primary health care. The example of the control of several infectious diseases, such as schistosomiasis, pneumonia, malaria and AIDS, is used to show that control programmes can be effective but, in the current conditions, can hardly be maintained without outside support. In the future, diseases caused by environmental problems and new life styles as a result of industrialization, urbanization and slum growth will move dramatically into the foreground.

PIP: In Germany maternal mortality related to pregnancy, birth and child-bed is only about 11 women/100,000. In some African countries mortality is up to 100 times as high, UNICEF reported in 1991. The causes of high infant and maternal mortality are poverty, inadequate hygiene, and lack of preventive medical care and timely treatment of diseases for 60% of the population in the least developed countries. Countries in sub-Saharan Africa currently have the world's highest population growth rates of 3-4%/annum. Diarrheal and respiratory diseases are the most common causes of death, but recently tuberculosis has reappeared. Acute respiratory infection (ARI) causes at least 4 million deaths/year or 11,000/day. Each year about 800 million malaria infections occur worldwide. Although antimalarial drugs have reduced mortality, resistant Plasmodium strains have made therapy difficult. Schistosomiasis is endemic in 74 countries: about 200 million people are infected and more than 600 million people are at risk. Central and East Africa are the areas worst affected by the AIDS pandemic. In some cities more than 1/4 of men and women in the 20-40 age group are infected with HIV. Up to 90% seroprevalence rates have been found among female prostitutes. Perinatal transmission is becoming prevalent where 20% or more of the pregnant women are infected. In some regions of Africa prevalence rates can reach 505 and more for the adult population. By the early 1990s AIDS will be the leading cause of mortality in the 20-40 age group in some regions. A 1991 forecast for the Mbeya Region of Tanzania predicted that the 15-44 year age group would decline from 41% to 37% during 1988-94, while infant mortality may increase by 50-100/1000 live births. The only control measures of HIV transmission remain the avoidance of infected blood or infected medical equipment, and prevention is through education and information.