Angola's Disease Spread: Understanding The Factors

Angola's location and climate make it susceptible to many tropical diseases. The country has a narrow coastal plain that rises into a high interior plateau, with rainforests in the north and dry land in the south. The prevalence of diseases such as malaria, schistosomiasis, and yellow fever, as well as high rates of maternal and child mortality, contribute to Angola's poor health status. The country's civil war from 1975 to 2002 also left the healthcare system in disarray, with limited infrastructure and rapid urbanization creating challenges in addressing basic health needs. International efforts are now focused on improving access to safe water, distributing mosquito nets, and providing vaccines and medications to prevent and control the spread of diseases.

Mosquito-borne diseases, such as malaria and yellow fever

Angola is currently facing its worst yellow fever outbreak in 30 years, with more than 355 people infected and 159 deaths. The yellow fever virus is transmitted by the bite of infected Aedes and Haemogogus mosquitoes.

Malaria is another disease spread by mosquitoes in Angola. It is common in tropical regions and is widespread throughout the country. Symptoms of malaria include fever, nausea, vomiting, and other flu-like symptoms. Severe or untreated malaria can lead to health complications such as organ failure and even death. Malaria causes almost half of under-five deaths in Angola, making it a major problem in the country.

The World Health Organization is planning to launch emergency vaccination campaigns against yellow fever in Angola in response to a vaccine shortage. Travellers to and from countries where yellow fever occurs should be vaccinated and carry their certificate of vaccination.

Poor maternal health

Angola has one of the highest maternal death rates in the world. The country's civil war from 1975 to 2002 devastated its healthcare system, infrastructure, and economy, and the government has been slow to rebuild. The World Health Organization lists the leading causes of maternal death as severe bleeding, infections, high blood pressure during pregnancy, obstructed labor, and unsafe abortions, which account for approximately 80% of all maternal mortalities worldwide. Other factors that contribute to maternal death include malaria, anemia, and HIV/AIDS during pregnancy.

The high maternal death rate in Angola is influenced by a range of factors unique to the country and the Sub-Saharan African region. One significant factor is the lack of access to healthcare, with 54% of the population lacking access to improved water sources and 60% lacking access to improved/shared sanitation as of 2012. The distance to healthcare facilities is also a critical issue, with women in rural areas facing significantly higher risks of maternal death. Additionally, poverty discourages women from seeking healthcare during childbirth, as they often choose to give birth at home to avoid hidden or ad hoc fees at hospitals.

The high prevalence of infectious diseases in Angola, such as malaria, HIV/AIDS, and yellow fever, also contributes to poor maternal health. These diseases can have severe complications during pregnancy and increase the risk of maternal death. Furthermore, social conditions such as poverty, inadequate nutrition, unclean water, poor sanitation, and unsafe healthcare play a significant role in the prevalence of HIV/AIDS and other infectious diseases.

To improve maternal health in Angola, various international programs and interventions are being developed and implemented. These include training midwife providers, improving the continuum of care through the Maternal and Child Health handbook, and investing in education and healthcare. Non-governmental organizations, such as the Christian Children's Fund Angola, are also playing a crucial role in addressing malnutrition and providing emergency obstetric care. Despite these efforts, there is still a lack of Angolan-based studies on maternal health, and the country continues to struggle with inadequate documentation and surveillance of maternal deaths.

HIV/AIDS

Angola has a large HIV/AIDS-infected population, but it has one of the lowest prevalence rates in Southern Africa. As of 2016, it was estimated that 280,000 people were living with HIV/AIDS in Angola, which corresponds to a prevalence percentage of approximately 2.2% among adults aged 15–49 years old. HIV/AIDS is more prevalent in the female population, with an estimated 160,000 women living with the disease, compared to 110,000 men.

The low rate of infection in Angola is partly due to its 27-year civil war, which ended in 2002, during which large parts of the country were inaccessible to people infected with the virus. However, since the end of the war, transportation routes within and between countries have reopened, providing a greater potential for the spread of HIV/AIDS.

There are several factors that contribute to the spread of HIV/AIDS in Angola:

• Lack of knowledge and education: Comprehensive knowledge of HIV/AIDS among Angolans aged 15–49 is low, with only 47.7% demonstrating a good understanding of the virus.
• Low condom use: There is a considerable lack of access to condoms in Angola, and a high incidence of sexually transmitted infections.
• Multiple sexual partners: HIV is primarily transmitted through heterosexual sex with multiple partners in Angola.
• Contaminated needles and medical equipment: Contaminated needles, medical devices, and blood transfusions are the second largest spreaders of HIV/AIDS in the country.
• Early sexual activity: A 2003 survey revealed that approximately 43% of young people were having sex by the age of 15, one of the highest rates in the world.
• Gender inequality: Women in Angola are often expected to stay at home and assist their families, causing them to miss out on health education. Additionally, Angolan men often marry much younger women, leaving these women at greater risk of contracting HIV/AIDS.

To combat the spread of HIV/AIDS, Angola has implemented several measures:

• The National AIDS Control Program was established in 1987 to fight against the HIV/AIDS epidemic.
• The National AIDS Commission was established in 2002 to bring greater governmental attention to the epidemic.
• In 2004, a comprehensive HIV/AIDS law was passed to protect the rights of individuals living with HIV/AIDS, including the right to employment, free public healthcare, and confidentiality within the healthcare system.
• The Angolan government has partnered with international organizations such as the CDC and received aid from other countries, including the United States through programs like PEPFAR, to help control the spread of HIV/AIDS.

While progress has been made, there are still challenges to ensuring effective diagnosis and treatment of HIV/AIDS in Angola, including limited access to antiretroviral drugs outside of the capital city of Luanda.

Poor sanitation and lack of access to safe drinking water

In Angola, an estimated nine million people lack access to safe drinking water. This means that many Angolans have no choice but to drink contaminated water, which can carry deadly diseases. Contaminated water is a major cause of waterborne illnesses such as cholera, diarrhoea, dysentery, and typhoid fever. These diseases can have devastating consequences, particularly for young children, who are especially vulnerable to infection.

The lack of safe drinking water also contributes to poor sanitation practices. Without access to clean water, basic hygiene practices such as handwashing become difficult, if not impossible. This further increases the risk of disease transmission, as hands can become vectors for pathogens.

The consequences of poor sanitation and inadequate access to safe drinking water are severe. In addition to the immediate health impacts, there are also long-term effects on health and development. For example, repeated diarrhoeal episodes due to waterborne illnesses can lead to malnutrition and stunting in children, impairing their physical and cognitive development.

Furthermore, inadequate sanitation and water supply can hinder economic growth and poverty reduction efforts. When water is scarce and unsafe, people may spend significant time and effort collecting it, reducing their productivity and opportunities for education and income generation.

To address these issues, international organisations such as USAID and WaterAid are working with the Angolan government and communities to improve access to safe water. These efforts are crucial to reducing the burden of waterborne diseases and improving the overall health and well-being of the Angolan people.

Malnutrition

Angola's recent history of conflict has also played a significant role in the prevalence of malnutrition. The civil war that lasted from 1975 to 2002 resulted in approximately one million deaths and caused internal displacement and mass migration. The war hindered the development of infrastructure and effective healthcare systems, leaving many without access to basic necessities and healthcare. The displacement of people during the conflict also disrupted agricultural practices and reduced access to land, leading to a decline in food production.

The consequences of malnutrition are dire, especially for children. In the town of Negage, the hospital struggles to accommodate the high number of malnourished children, with some sleeping three to a cot. The condition affects not only their physical health but also their cognitive development. Psychologists play a crucial role in helping children regain mobility, cognition, and confidence after being in a critical condition due to severe malnutrition.

To address the malnutrition crisis, organisations like Doctors Without Borders/Médecins Sans Frontières (MSF) and World Vision International (WVI) have been working alongside local health authorities and the government of Angola. MSF provides mobile clinics, outpatient programs, and medication to treat malnutrition and associated conditions like malaria. They also train community health workers to identify and manage mild cases of malnutrition and refer severe cases to health facilities. WVI, in partnership with the Angolan government, implements the PFSS (Programa de Fortalecimento do Sector Saúde) to address drought and malnutrition in several provinces. Despite these efforts, the challenge persists, and Angola continues to grapple with the dual crisis of malnutrition and infectious diseases.

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