It is known that a virus like Ebola finds an ideal breeding ground of infection in weak healthcare systems. However, the fear of a large-scale European contagion is spreading. Although it is true that Ebola is really frightening, it is equally true that a comparison between a country such as Italy and countries like Liberia, Sierra Leone and Guinea is at least difficult to maintain. Tuberculosis, Malaria, HIV, low rates of vaccinations: the African ecosystem in which Ebola has developed is crippled, and the majority of its inhabitants are highly exposed to infections. How much crippled? The WHO data describe the incidence of major infectious diseases in the area and of the systems of vaccination.
As we have already pointed out, three out of the four affected nations – Guinea, Liberia and Sierra Leone – are among the poorest in the world, with much of the population without a salary. Three countries in which the health expenditure in 2012 has been less than 200 dollars per capita, while a country like Italy has spent 3,040 dollars per capita in the same year.
Moreover, as pointed out on August 5th by James Ball of The Guardian,“Since the beginning of the Ebola outbreak in February, around 300.000 people have died from malaria, while tuberculosis has likely claimed over 600.000 lives. Ebola might have our attention, but it’s not even close to being the biggest problem in Africa right now.”
Tuberculosis is the first infectious disease in the world. It is estimated that TB killed over half a million people in the Region in 2013. But the biggest danger is given when it combined with other infectious diseases, as HIV, and in this sense in Africa this kind of contagious is very diffused. Another danger arises when TB develops resistance to the antimicrobial drugs used to cure the disease. In fact, the bacteria that cause tuberculosis could develop resistance to the antimicrobial drugs used to cure the disease. In these cases, TB does not respond to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
Actually, tuberculosis is also present in Italy: 3,142 reported cases in 2012. The difference with African countries is that in Africa the percentage of the population affected is about an order of magnitude greater. In Liberia, 0.19 percent of the population suffers from tuberculosis, 0.22 percent in Sierra Leone and about 0.1 percent in Guinea, while in Italy the percentage is 0.05 percent.
One of the greatest dangers of daily life in Africa is called malaria.
Malaria is the most important parasitic disease, and the second in the world for infectious disease morbidity and mortality after tuberculosis, with 500 million new clinical cases per year and one million deaths per year. Malaria is an infectious disease caused by protozoa of the genus Plasmodium and is transmitted to humans by female mosquitoes of the genus Anopheles.
Malaria is present in over 100 countries around the world, but more than 90 percent of the cases and the great majority of deaths occur in tropical and equatorial countries. Within the three countries most affected by Ebola, according to the latest WHO estimates, the highest incidence was recorded in Guinea, with 38,333 cases per 100 thousand inhabitants. Liberia follows with 27.793 cases, and Sierra Leone with 19.027 cases.
HIV and AIDS
The numbers provided by the World Health Organization are clear: at the end of 2013, 11.7 million people had access to antiretroviral therapy in low and middle-income countries and 35 million people were living with HIV in 2013.
According to recent estimates, 60 percent of AIDS patients in the world live in Africa, and a considerable amount of them are children. Most of the children living in sub-Saharan Africa were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Over 240,000 children became newly infected with HIV in 2013.
Moreover, as we have said above, HIV is the strongest risk factor for developing active disease as TB. In 2012, approximately 320 thousand deaths from tuberculosis occurred among people living with HIV: one fifth of the estimated 1.6 million deaths from HIV in that year. In this sense, the majority of people living with both HIV and TB reside in sub-Saharan Africa, about 75 percent of cases worldwide.
Even if in our country the debate on this topic is still fervent, in Italy 95 percent of children are now vaccinated against the major infectious diseases. On the contrary, in Africa, especially in countries affected by the Ebola virus, vaccination rates are much lower. In Guinea, for example, the percentage of children vaccinated under one year of age in the last years does not exceed 60 percent. Four out of 10 children are not vaccinated against the most common infections like measles or whooping cough.
The Ebola outbreak is scary. But even more frightening is the mingling of diseases that live in sub-Saharan Africa and the weakness of the populations and health systems involved, which makes Ebola even more dangerous.