Tropical Diseases in Africa Four Phases • Devastation • Discovery • Development • Deployment Pre-colonial & early colonial era Deaths of Europeans in West Africa
Expedition Year Europeans Deaths Mungo Park 1805 44 39 Tuckey 1816 44 21 Clapperton 1825-7 5 4 MacGregor-Laird 1832-4 41 32 Trotter 1841 145 42 Take care and beware of the Bight of Benin For few come out, though many go in Arab
African
Mixed
Meningitis in Africa
Meningitis Belt
Countries >15 cases per 100,000 population Seasonal Epidemics in Meningitis Belt Discovery •Trypanosomiasis •Yellow Fever •Malaria •Kwashiokhor Trypanosomiasis Milestones
• 1902 Ford and Dutton, identified Trypanosoma brucei gambiense . • 1903 Castellani in Uganda parasite in CSF • 1903 David Bruce –tsetse fly as the vector • 1906 Ayres Kopke - arsenic drug, Atoxyl. • 1924 Tryparsamide less toxic than Atoxyl, • 1932 Atoxyl blinded 700 patients became Friedheim developed melarsoprol
Numerous Tsetse Flies Yellow Fever Americas • Finlay – mosquito transmission • Walter Reed – viral agent, extrinsic incubation period in Aedes Aegypti Africa • Noguchi - Accra • Stokes - Lagos Live vaccine developed Tools for Disease Control
Few remedies until mid-20th century • Salvarsan - syphilis • Antrypol -trypanosomiasis, onchocersiasis), • Pamaquine, chloroquine, primaquine, and pyrimethamine - malaria • Penicillin - yaws • Dapsone - leprosy Colonial Health Research
• Expeditions • Colonial Medical Services • Research Institutes • Schools of Tropical Medicine in Europe • International Research Institutes European Scientists in Africa
Outstanding world class scientists • Robert Koch • Aldo Castellani • George MacDonald Dr. Cecily Williams Jamaican, 1893-1992 1923 Graduated in Medicine, …Oxford University 1929-36 Served in Gold Coast Learnt Twi Identified Kwashiokhor 1936- Worked in 58 countries 1941-45 Prisoner of war
“Health Education is listening to the people” Major C. R. Ribbands Journ. Royal Army Medical Corps, 1941
Role of African Scientists
Colonial Era • Little training until close to independence • Mainly menial tasks – Bottle washers – Fly catchers • Little interest in building capacity of African scientists and institutions Nigerian Scientists: Colonial Era •Sir Samuel Manuwa – Splenomegaly -MD thesis 1934 – Ulcer scalpel • Dr. Sanya Onabamiro – Copepods - biology/ecology – Guineaworm transmission Copepods Identified & Characterised By Dr. Sanya Onabamiro
• Tropocyclops onabamiroi Lindberg, 1950 • Halicyclops korodiensis Onabamiro, 1952 • Tropocyclops mellanbyi Onabamiro, 1952 • Tropocyclops wellanbyi Onabamiro, 1952 • Tropocyclops confinis awiensis Onabamiro 1957, • Tropocyclops prasinus shagamiensis Onabamiro 1957 • Thermocyclops iwoyensis Onabamiro, 1952 Recent Publications Citing Onabamiro
• GUTIÉRREZ-AGUIRRE, M.A. and SUÁREZ- MORALES, E, (2001) A new species of Mesocyclops (Copepoda, Cyclopoida, Cyclopidae) from Southeastern Mexico J. Limnol., 60(2): 143-154
• LANSAC-TÔHA, F. A., VELHO, L. F. M., HIGUTI, J. and TAKAHASHI, E. M. (2002) Cyclopidae (crustacea, copepoda) from the Upper paraná river floodplain, Brazil Braz. J. Biol., 62(1): 125-133 Eliminating Guineaworm from Nigeria
Onabamiro started it! Kale is finishing it
Thousands Immediate Post-Independence
• Colonial research institutes floundered • Breakdown of sub-regional networks • Growth of research capacity in universities • Recovery of some research institutes MEDLINE 1966-2002 No. of Publications Togo 561 Benin 882 Cameroon 2040 Ghana 2393 Kenya 6670 Nigeria 12248 South Africa 18450 Democracy Number of Publications Medline Search “Nigeria” 700
600
500
400
300
200
100
0 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Key Contributions Nigerian Scientists
Glaucoma Olurin (OO) Hypertension Akinkugbe Tropical neuropathy Osuntokun Alzheimer’s disease Osuntokun, Ogunniyi, et al Schistosomiasis Lucas, Oyediran Goitre surgery Olurin (EO) Maternal Mortality Kelsey Harrison
Professor B.O. Osuntokun Publications
SUBJECT No. NEUROLOGY 243 1 in 40 of • Tropical Neuropathy 51 Nigerian Publications • Dementias 22 • Diabetes 13 • Other Neurological 157 RESEARCH POLICY 26 HEALTH POLICY 12 MEDICAL EDUCATION 8 TOTAL 319 Establishing Norms
Growth & Longitudinal studies Janes et al development Twinning rate Community studies Nylander
Biochemical Serum electrolytes, Edozien norms proteins, etc. Bone structure Anatomical variants Cockshott
Blood pressure Distribution – age, Akinkugbe rural/urban Electrocardiogram Normal variants Oyediran Epidemiological Studies
School age Epidemiological Oduntan children survey Chronic diseases Hypertension, Akinkugbe diabetes, etc. Goitre Field Surveys Olurin, Ekpechi, Oluwasanmi Hospital data • Admissions Ogunlesi, Brown • Autopsy Sexual Community Orubuloye networking based studies Diseases of Local Interest
• Tropical Ataxic Neuropathy • “Ijesha Shakes” • Rhino-entomophthoromycosis • Histoplasmosis duboisii Social & Behavioural Studies
African women's control over their sexuality in an era of AIDS. A study of the Yoruba of Nigeria. Orubuloye IO, Caldwell JC, Caldwell P. Health Transition Series, 1991
Sexual abstinence patterns in rural Western Nigeria: evidence from a survey of Yoruba women. Orubuloye IO. Soc Sci Med. 1993 Cross-National Studies
• Atheroma - coronary, cerebral • Senile dementias • Diabetes • Parkinson’s Disease GradingGrading AtherosclerosisAtherosclerosis Nigerians
Age Percentage with Zero Score Comparative Study of Dementias
Dementias
Alzeheimer's
0123456 Per Cent
Ibadan Indianapolis Delivery of Health Care
Community Mental Health Lambo, Aro Growth Monitoring Morley, Imesi-Ile Prevention of Maternal International Network Mortality Financing Health Care International Health Policy Programme Social Marketing of Family Ladipo Planning Growth Chart -- Developed at Imesi-Ile Preventive and Curative Services
Iodine in Salt Prevents Goitre
Kind Courtesy of Professor E.O. Olurin
Major Conclusions
• Tremendous potential for health research • Urgent health challenges in Africa • Regional as well as global impact • Inadequate support from governments • Missed opportunities • Neglect by regional bodies like African Union, West African Health Organization Trends in life expectancy by region, 1950-1990
80 Established Market Economies ) Formerly Socialist rs 75 Economies of ea
y Europe
( 70 Latin America and h the Caribbean rt i 65 b China t a Middle Eastern Crescent
cy 60 n a 55 India ect
p Sub-
ex 50 Saharan e
f Africa i
L 45 40
5 0 5 0 5 0 50 95 96 96 97 97 8 85 90 19 1 1 1 1 1 19 19 19 Year
World Development Report, 1993
r 0 e
p 00 e 36 90 11
t 870 390 690 430
Ra 100, 0 al 0
s 00 00 00 0 0 0 0 200 400 n h 500 r t e a 3, 1, 23, 235, 323, 585, De Mat a c l n i r a a a t e c e
on i o
i b r a
g i b e T i Am n d r pe l m n a
Re ca o r a i e i A r Af As Eur Lati & Ca N. Oc Wo LifetimeLifetime RiskRisk OfOf DyingDying FromFrom PregnancyPregnancy AndAnd ChildbirthChildbirth Region Risk of Dying Africa 1 in 16 Asia 1 in 65 Latin America & Caribbean 1 in 130 Europe 1 in 1,400 North America 1 in 3,700 We are not winning!
B ot s wana S out h A fri c a Zi m babw e Ke ny a S waz i l and 1990 Cam eroon 2002 Cot e d' Ivoi re Tanz ani a Rwanda Za m b i a 0 50 100 150 200 250 Under 5 M ortal ity R ates/ 1000 Li ve B irths
Myasthenia Gravis
Dr. Mary Broadfoot Walker • St. Alfege's Hospital, Greenwich, UK • 1934 Physostigmine injection • Temporary reversal of paralysis Physostigma venenosum
CALABAR
•Esere Beans - trial by ordeal •1865 Eserine (Physostigmine) identified Health Research in Africa Major Constraints • Funding • Translation of knowledge to practice University College Hospital, IBADAN, Nigeria ComplementaryComplementary && AlternativeAlternative MedicineMedicine
Frontier Medicine ¾therapeutic prayer ¾spiritual healing ¾bioelectromagnetic therapy ¾biofield and energy healing ¾homoeopathy
Collect systematic, scientifically structured information on widely practised, intangible therapeutic approaches for which we have essentially no mechanistic understanding. HEALING
HEALING Reconciling religion & health Mutual accommodation Health Care Units Religious Groups • Promote concept of • Promote healthy ‘WORK & PRAY’ interventions • Provide facilities for • Provide facilities for religious support medical care • Negotiate safe • Establish indications compromises for referrals Work & Pray