The Socio-economics of Plague in Africa: A growing ecological problem or a mere indicator of increasing deprivation? - PowerPoint PPT Presentation

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The Socio-economics of Plague in Africa: A growing ecological problem or a mere indicator of increasing deprivation?

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Title: The Socio-economics of Plague in Africa: A growing ecological problem or a mere indicator of increasing deprivation?


1
  • The Socio-economics of Plague in Africa A
    growing ecological problem or a mere indicator of
    increasing deprivation?

Dr S.R. Belmain Natural Resources Institute,
University of Greenwich, Central Avenue, Chatham
Maritime, Kent ME4 4TB, UK
2
Historical importance of Africa and Plague
First known pandemic in the year 541 Origin in
Egypt Losses between 50 and 60 in Europe, North
Africa and Central Asia
Second pandemic in 1346 Origin in Southeastern
Europe Caspian/Baltic depression? spread slowly
among villages by rats/people and more quickly
along trade routes causing extended outbreak of
more than 100 years and human losses of 20-30
million.
Third pandemic 1855 Origin in China Spreading
quickly through ports, with known entry to Africa
from eight different ports with subsequent spread
along overland trade routes
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Importance of Africa and Plague
In the period 19801997 human plague was reported
from 13 African countries (Angola, Botswana, DR
Congo, Kenya, Libya, Madagascar, Malawi,
Mozambique, South Africa, Uganda, Tanzania,
Zambia, Zimbabwe) with a total of 19,349 cases
and 1,781deaths, 66.8 and 75.8 of the world
total, respectively.
African yearly average of 1,073 cases and 99
deaths (9.2 mean casefatality rate).
Madagascar and Tanzania accounted for 62.5 of
the total plague cases in Africa.
5
Importance of Africa and Plague
In 2002 a total of 1822 cases with 171 deaths,
representing 94.6 and 96.6 of the corresponding
world totals.
In 2003, a total of 2091 cases with 180 deaths,
representing 98.7 and 98.9 of the
corresponding world totals.
6
Importance of Africa and Plague
Socio-economic cost of plague historical
depopulation
Annual number of reported cases and deaths is
relatively low
Monitoring infrastructure under-reporting
Resource diversion during outbreaks
Crisis management of outbreaks
Public panic and tourism
Surveillance costs?
Treatment costs?
7
African conditions and traditions
The decrease in the incidence of plague today is
due primarily to the improvement of living
standards and health services in many countries,
to the extent that the possibility of outbreaks
of anthroponotic bubonic and primary pneumonic
plague, the most epidemic forms of the disease,
has been reduced nearly to zero.
WHO Plague Manual Epidemiology, Distribution,
Surveillance and Control.
8
African conditions and traditions
Since the early 1990s, an increased incidence of
human plague has been observed, which was
particularly apparent in Africa. The reasons for
such a trend may be associated with both an
actual increase in plague activity in its natural
foci and an improvement of notification to WHO by
Member States.
WHO Plague Manual Epidemiology, Distribution,
Surveillance and Control.
9
African conditions and traditions
Landscape and climatic factors associated with
highly seasonal rainfall patterns, dry seasons,
and semi-arid ecology of savannahs, grassland,
desert, steppe
10
African conditions and traditions
Primary natural foci of plague well-established
in African environments not all foci are
well-documented
11
African conditions and traditions
Sylvatic and commensal rodents living in close
proximity. Land use changes, urbanisation,
agricultural intensification causing increased
species interactions
12
African conditions and traditions
Living conditions proximity to rodents
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African conditions and traditions
Without doubt hunting wild animals, particularly
rodents, increases plague transmission risks.
Hunting is common in all African plague- enzootic
foci
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Rat bites are a strong indicator of rodent
proximity
  • In Lushoto, recently collected data shows strong
    correlations (gt0.75) between rat bites among
    family members of a household and.
  • The household undertaking rodent and flea
    control
  • The household incidence of plague

Data from Morrumbala and Mutarara is currently
being analysed, and appears to show the same
correlations
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African conditions and traditions
Hygiene
Traditional beliefs of hygiene and disease
persist among the majority of Africans. These
vary among cultures and differ from modern
scientific views.
Local notions of hygiene may be rooted in
concepts of internal dirt, not external dirt.
Emphasis on tidiness rather than removal of
environmental dirt.
Among young it may relate to keeping ones body
clean and among older people to keeping a tidy
kitchen.
Not clear to many that food and water may carry
disease e.g. river water always clean, cooked
food left out uncovered over night, wild animals
clean.
28
African conditions and traditions
Hygiene
Plague is often not associated with dirty
environments or poor hygiene
29
African conditions and traditions
Witchcraft and traditional medicine
Belief in witchcraft, and that illnesses are
derived from bad luck, spells and curses is
widespread throughout Africa Traditional healers
can have supernatural powers (for good and bad)
through spells and potions that go beyond their
administering of herbal remedies to the
sick. Rats are implicated in the spread of
witchcraft in many cultures. Because rats are
fast, they are believed to be used to bewitch
others and make them ill - as a vessel of the
curse sent by the witch. Both the Zulu and
Venda of South Africa believe that rats carry a
mental illness called thuri which is sent via
witchcraft.
30
African conditions and traditions
Witchcraft and traditional medicine
Illnesses are not only treatable by modern
medicine, some preferentially seeking out
traditional healers who deal with the curse
causing the illness. In Lushoto, some people
believe plague is kuvunja vyungu (pot breaking
illness caused by the curses of a jealous/angry
woman) or by usinga (tail end of a wildebeest
worn by traditional healers). In Mbuzi there is
a legend that a local chief (zumbe) first sent
plague through rodents by witchcraft. Traditional
healers often approached first with modern
medical treatment seen as a last resort.
31
African conditions and traditions
  • Living conditions are not significantly improving
    in Africa
  • Poor awareness about disease risks and hygiene
    issues
  • Knowledge necessary to effectively use rodent
    management tools is absent among end users
    leading to treatment failure, frustration, apathy
    and acceptance of rodents

32
The RatZooMan Project
INCO-DEV water and sanitation programme. Project
focuses on public health risks of rodents as
disease vectors and the role they play in the
spread and transmission of many diseases.
  • Climate change
  • Urbanisation
  • Rural expansion
  • Increased connectivity
  • Sanitation

33
Socio-economics of plague
Mozambique 1977 - Out of 77 patients placed under
medical supervision during a plague epidemic, 70
were women and children (under age 14). Kenya
1978 - Mainly in women and children, were
diagnosed in Kitui district of the Eastern
Province. Botswana 1990 - 72 of patients were
under 15 years old. WHO Weekly Epidemiology
Record
Tanzania - Higher susceptibility among women and
children. Makundi, et al 2005. Ecosystem Health
Project Report.
Madagascar 2003 - The gender distribution (MF)
was 1.48, and the average age of patients was 15
years (range 072 years). WHO Weekly
Epidemiology Record
Madagascar - Plague was more prevalent in males
(MF sex ratio 1.31) and patients under 20
years. Chanteau, et al. 2000. Microbes and
infection. 2 25-31.
34
Socio-economics of plague
Why are gender and age factors important
explanatory variables?
Hunting (young male biased activity), processing
wild animals for food (female biased activity)
Differential sleeping and community gatherings
resulting in women and children sleeping on floor
mats
Women and children generally spend more time
around the house, children play in the bush,
women do the household cleaning
Occupational hazards shepherds,
hunter/gatherers, low-intensive farming
35
Socio-economics of plague
Social stigmas and family decision making
processes
Self-medication with inappropriate antibiotics
Community cohesion levels - acceptance, apathy,
dependence
Social conservatism traditional treatments and
behaviour
36
Conclusions
Economics of rodent proximity
Rodent immigration potential
Thatched roof
Food inside house
Hygiene
Tolerance of rodents
37
Conclusions
There is socio-economic potential for bubonic
plague to increase and spread in Africa
38
  • The End
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