Life expectancy has been increasing over the past two decades across the world with several nations in Sub sub-Saharan Africa rebounding from high death rate due to HIV/AIDS.
In Botswana women have a longer life expectancy than men, living to an average of 68.4 years compared to 63.6 for men. Between 2005 and 2016, death rates from HIV/AIDS decreased by 42% and malaria by 43% while Pre- birth complications and maternal disorders decreased by 30% and 29% respectively. However, this progress is said to be threatened by increasing number of people suffering health challenges related to obesity, high blood sugar, alcohol and drug abuse. This is according to a health research conducted at the University of Washington’s Institute for Health Metrics and Evaluation (IHME).
The study, which examined the Global Burden of Disease (GBD), injuries and risk factors, the years that one lives in good health and those that one lives with an injury or illness, analyzed 300 illnesses and injuries in 195 countries between 1990 and 2016. The results were published on Thursday in the journal, The Lancet.
For most countries, changes in healthy life expectancy for males and females between 1990 and 2016 were positive, but in dozens of others, including Botswana, Belize and Syria, healthy life expectancy in 2016 was not significantly higher than in 1990. Healthy life expectancy takes into account not just death rates but the impact of non-fatal conditions and considers years lived with disability and years lost due to premature mortality.
According to the study, in 2016 Botswana’s disease burden was found to arise from unsafe sex, high fasting plasma glucose, high systolic blood pressure, high body-mass index and alcohol use.
HIV, respiratory infections, diarrhea and tuberculosis were the diseases most prevalent among men. For women, lower respiratory infections (such as pneumonia and bronchitis), and congenital anomalies were the most prevalent illnesses. Congenital illnesses are conditions that one is born with, which can affect one’s development and general well-being.
Maternal and child Deaths
The study has also found that from 1980 to 2016, giving birth has gotten less safe for mothers in Botswana. The ratio of maternal deaths grew from 74 per 100,000 live births in 1990 to 118 in 2016. Globally, the ratio of maternal deaths fell 30% over the same time period, from 282 to 196 per 100,000 live births. One of the co-researchers of the study, Dr Charles Shey Wiysonge, said it was encouraging that Batswana are living longer. However, he lamented that the high number of maternal deaths, “have overshadowed significant gains against HIV/AIDS”.
Dr Wiysonge is a GBD collaborator from South Africa who serves as a Professor of Clinical Epidemiology at the Faculty of Medicine and Health Sciences, Stellenbosch University. Dr. Nicholas Kassebaum, Assistant Professor, IHME said, “in many nations, improvements in maternal health are accelerating, but in others, women face daunting challenges, including the absence of trained professionals to assist with pregnancy and childbirth, and deal with life-threatening emergencies. As a result, reproductive health care must be a higher priority, including the expansion and improvement of reproductive health and family planning services and, for complications in childbirth, more advanced obstetric care.”
The study says that in 2016,1550 children under the age of 5 died, a ratio of 28.2 deaths per 1,000 live births. This ratio has been falling by 2.6 % each year since 1990. On the global level, 5.8 million children under age 5 died, representing a 52% decline in the number of under-5 deaths since 1990. In 2010 for example, the highest risk factor to good health among children under the age of five was being underweight, while among those aged between 15 and 49, the highest risk factor was alcohol abuse.
The researchers also examined the role that socio-demographic status – a combination of income, age, fertility rates and average years of schooling – plays in determining health. They noted that socio-demographic status is much less responsible for the variations seen for ailments, including cardiovascular disease and diabetes.
“Factors including income and education have an important impact on health but don’t tell the full story. Looking at healthy life expectancy and health loss at the country level can help guide policies to ensure that people everywhere can have long and healthy lives no matter where they live.” said IHME Director Christopher Murray.
ON LIVING WITH A BLOOD DISEASE
Bubbly James Nkomo still exudes oodles of a positive spirit and is not deterred by a genetic blood condition that predisposes him to frequent bleeding. He has since found a way to live life fully with haemophilia, a condition he was diagnosed with when he was only one year old.
Born in Maitengwe, Nkomo remembers outgrowing his mother’s and grandmother’s laps to explore the exciting world around him. “Crawling was painful; my knee joints ached endlessly and navigating outside was worse. I always had bruises that bled longer than usual and also took longer to heal,” says Nkomo. The swellings were worse and would take ages to heal; little Nkomo was discouraged from playing with his peers. Not long after, further medical investigations led to a diagnosis of haemophilia.
His mother and grandmother were told by the doctor to ensure that he did not engage in play that predisposed him to injuries, since the ability of his blood to clot was severely reduced, causing him to bleed severely even from slight injury. However, these medical warnings only made a growing Nkomo less popular among his friends. “Playing the ‘soft’ games was not fun at all. I was always isolated because if I got injured, my grandmother would reprimand my friends,” he says, recalling that this only led him to rebel against his family.
“I wandered beyond our homestead and got involved in the dangerous games to prove that I was a worthy playmate. However, I would go home with swollen ankles and lots of bruises that gave way to painful nights,” he says.And the play got dangerous. When Nkomo was eight years old, together with adrenaline-filled peers, they would hang on the back of a pick-up to quell their desire for adventure.
“As we were enjoying our free ride, the driver noticed us and took emergency breaks to discourage us. I hit my chin against one of the metallic guards of the vehicle, leading to uncontrolled bleeding of my gums,” he says. His friends deserted him and when he got home, he paid the price for defying authority. “I could not be treated at the local clinic and was referred to the Princess Marina Hospital where I got a series of stitches and was admitted for one month to ensure the wounds were well-healed,” says Nkomo.
He had to learn to take up more favourable pastimes like swimming that gave him even more gratification than an aggressive game of football. “Haemophilia is a painful disease yet learning how to cope provides an almost normal lifestyle,” says Nkomo, a human resource practitioner. At 34 years of age, married and father to six-year-old Tiffany, Nkomo has also taken up the role of being mentor and big brother to his male cousin who also has the same genetic condition.
Nkomo cites the need to create nationwide awareness on the condition in order to improve the quality of life for individuals living with it and for families unaware of how to cope with it.
“Once you know what you are dealing with, a normal life is possible,” he says. Haemophilia is a rare disorder in which the blood clot does not clot normally because it lacks sufficient blood clotting proteins.
A patient with haemophilia may bleed for a longer time after an injury than he/she would, if the blood clotted normally. This internal bleeding can damage organs and tissues, and may be life-threatening. Some symptoms of haemophilia include, excessive bleeding from cuts or injuries or after surgery or dental work, prolonged menses in women, many large and deep bruises.
Plans underway to eliminate Malaria in 6 endemic districts
Health Minister Dr Alfred Madigele has urged Batswana to make proper use of available malaria interventions to reduce the rate of infections and death by Malaria.
Addressing the nation on radio during the World Malaria Day themed; ‘Zero Malaria Starts with Me’ Dr Madigele said malaria was still a disease of significant public health importance in Botswana, with high morbidity and infection rates, and that although deaths, due to the disease have reduced considerably, there was still a long way to go.
The theme, he said seeks to empower individuals across the world to make a personal commitment to saving million more lives, and help communities and economies to thrive by ending malaria.
“This global movement seeks to re-energise the fight to eliminate the disease, which still threatens half of the global population and kills one child every two minutes”.
The African region is the worst hit by the killer disease in the world. In the World Malaria Report 2018, WHO estimates that we still have more than 4.4 million cases in the region and sub-Saharan Africa accounted for 93% (404,550) of the global malaria deaths.
Botswana has made incredible progress towards malaria elimination in the last decade, but Dr Madigele said sustaining gains will take extra effort until the job is finished and malaria has been eliminated.
“We have managed to reduce the incidence of malaria from 28.7/1000 population in 2001 to 0.24/1000 population by 2018. While efforts are on course to conduct active and passive case detection, notify, investigate, list and map all cases and deaths, resource limitation becomes a big challenge in the area of malaria surveillance and rapid response to contain secondary cases and outbreaks.
Nevertheless, we have also managed to introduce modern technology for rapid notification of cases and mapping of malaria transmission areas,” he shared.
He indicated that available interventions had proven to work and urged the public to support the National Malaria Elimination Programme (NMEP)’s strategies of using the Long-Lasting Insecticide Treated Nets (LLINs), Indoor Residual Spraying, and Intermittent Preventive Treatment of pregnant women (IPTp) to prevent being infected.
Others, he said, include vector control intervention designed to destroy the mosquito larvae conducted in three districts of Tutume, Bobirwa and Boteti. The country has also introduced a radical anti-malaria therapy for effective treatment of malaria.
To address the challenge of low community response, participation, ownership and ultimately low uptake of malaria elimination interventions, Dr Madigele said the NMEP with the support from the Global Fund adopted the Communities Acting Together to Eliminate Malaria (CATTEM) in 2018.
“This is an approach that seeks to involve community leadership and other community structures to drive malaria elimination in their communities; resonating well with this year’s theme that drives for personalisation of malaria elimination by all,” he said. The approach is being implemented in the 6 endemic Districts with plans to expand to the whole country.
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