Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016-2018

Abstract

Background: Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018.

Methods: We abstracted data from several sources, including: the WHO African Region's weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources.

Data analysis: We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5-9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports.

Results: Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis.

Conclusions: The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.

Keywords: African region; Disaster; Epidemic; Event; International health regulations; Public health emergency; Public health emergency of international concern; World Health Organisation.

Fig. 1

Bubble plots showing temporal trends of all epidemics from all diseases (Left Panel); Epidemics caused by Cholera, Measles, Meningitis and Viral Haemorrhagic Diseases (Crimean Congo, Dengue, Ebola, Lassa, Marburg, Rift Valley Fever, Yellow Fever and Viral Haemorrhagic Fever of unknown or unspecified origin) (Middle Panel); and epidemics caused by Viral Haemorrhagic Diseases (Right Panel) that occurred between 2016 and 2018 in the WHO African Region

Fig. 2

Map showing the number of epidemics and other public health emergencies in the WHO African region, 2016–2018

Fig. 3

Map showing the spatial distribution of epidemics and other public health emergencies in the WHO African region, 2016–2018

Fig. 4

A stacked bar graph of all the epidemic events by disease in the countries of the WHO African region, 2016–2018

Fig. 5

A stacked bar graph of all the other public health emergencies by countries of the WHO African region, 2016–2018