1. Today More causes of Sub-Saharan Africa & (under)Development
Role of disease (again)
The role of development aid
Role of debt & “Structural Adjustment”
Women and development
Structure of African economies

2. Last Time Sub-Saharan Africa & Development
The characteristics of the least developed
Causes of (under)development
Remnants of colonialism
SS African environments and human uses
Role of conflict
Importance of population & demography
Agricultural production

3. The Burden of Disease (again)
HIV/AIDS (again)
TB (Tuberculosis)
G I tract diseases (diarrheas)
Malaria
Some of the rest
Measles
African sleeping sickness
Yellow Fever
Schistosomiasis
Onchocerciasis (River blindness)

4. Reduction in production in a household with an AIDS death, Zimbabwe
Crops
Reduction in output •
Maize
Cotton
Vegetables
Groundnuts
Cattle owned
49%
37%
29%
47%
61% • • • •
Source: Stover & Bollinger, 1999

5. TB: re-emerging killer
1.6 million new cases of TB in Africa yearly
600,000 TB deaths occur every year
TB is the leading cause of death in people with HIV in Africa
Drug resistance increasing
WHO estimates that approximately 2 billion people , about 1/3 of the world’s population.
Documented history that dates back 3,000 years.
Latent in all but about 5 % – 10 % of those infected, as long as immune system is healthy. Active infection damage to organs. Transmitted when exposed to an infected individuals cough or sputum.
Immune systems compromised with HIV and poor nutrition.
Africa has been hit very hard. Of the 15 countries with the highest TB rates, 13 are in Africa million Africans become infected annually, with 540,000 deaths.
Economic toll is huge, with a loss of from 4 % - 7 % of GDP in the hardest hit countries.

6. HIV/AIDS is Fueling the TB Epidemic
HIV/AIDS Prevalence in sub-Saharan Africa Estimated percent of adults living with HIV/AIDS
TB High Burden Countries
10% +
3-9%
1-3%
TB Incidence
0-99 per 100,000
per 100,000
> 300 per 100, 000
You can see the geographic overlap with HIV. In those countries most heavily impacted by HIV (left), we see the highest incidence rates of TB.
We thought we had TB under control in the 70s, and scientists and public health community, began to concentrate on other issues.
Resistance is emerging in many places around the world, DOTS
Source: UNAIDS Report, July 2002; WHO Report, 2002, Global TB Control

7. G. I. Tract Diseases
1.8 billion cases/yr of infant/kid diarrheas, intestinal parasites, cholera, various types of dysentery
Most are in SS Africa
Infants and kids who are just weaning are especially susceptible due to impure water
Many if not most deaths (perhaps 1 million/ yr in the world) can be averted with adequate treatment (Oral Rehydration Therapy)
To improve => provide adequate sanitation: in rural Africa only about 20% has access to adequate sanitation

9. Malaria
Also related to water since mosquito vector needs warm stagnant water
World wide annual toll
More than 1 million deaths
90 % of cases in SS Africa
500 million attacks of acute illness
50,000 cases of neurological damage
400,000 episodes of severe anemia in pregnancy – 400,000 LBW babies
Drugs expensive & resistance increasing

11. Malaria transmission Mosquito life cycle (period 1 – 3 weeks)
Gut phase:
Female Anopheles mosquito feeds on malarious human
Mosquito ingests circulating male and female gametocytes
Gametocytes mature and effect fertilization
Zygote invades gut wall and forms an oocyte
Oocyte grows into a cyst and ruptures
Sporozoites released and enter Salivary Glands of the Mosquito
Salivary gland phase:
Sporozoites travel to salivary glands where they are transmitted to humans
Hype-endemic areas:
Less than or equal to 50 % of population is parasitemic
Transmission is constant or sustained
High percentage of population has immunity
Immunes have reduced clinical manifestations
Mortality seen in Infants and younger children
Non-immune adults who travel into the area
Non hyper-endemic areas
Transmission is intermittent or sporadic, Low percentage of population has immunity, clinical manifestations are not reduced, population suffers repeated epidemics, often seasonal patterns, people of all ages susceptible

12. The Malaria Challenge Death rates reduced in Asia but rising in Africa
World
Africa
3.0
Asia
China
Central & S.America
2.0
Annual Deaths from Malaria
(millions)
N.America & Europe
1.0
0.1
(R.Carter,1999)

13. Duration of transmission
They are based on the theoretical suitability of local climatic, and therefore the potential duration, onset and end of the malaria transmission season, in the average year.
In the Months of Risk model, malaria transmission is strongly seasonal to epidemic (yellow = 1-3 months), seasonal and endemic (light green = 4-6 months) or perennial and endemic (dark green = 7-12 months). Some areas shown as "No transmission" (white) may actually have endemic malaria because of the presence of surface water in an area where there is little or no rain.

14. Resistance to Chloroquine - 1960
Source: FHI

15. Resistance to Chloroquine - 2000
This pattern of resistance is troubling and occuring again with new Malaria treatments.
Recently, the WHO issued a statement regarding concerns about Artemisinin an important new drug in the fight against Malaria. The new WHO guidelines malaria must be treated with artemisinin combination therapies (ACTs). WHO is concerned about the decreased sensitivity to the drug in SEA, a region that has traditionally been a birthplace for anti malarial resistance.
In Thailand, sulfadoxine-pyrimethaninme (SP) was initially considered 100 % effective when it was introduced in in But within 5 years, it was curing only 10 % of the cases.
Source: FHI

16. Many others
African sleeping sickness — transmitted to humans and livestock by the tsetse fly — endemic in much of SS Africa
Yellow fever — more epidemic than endemic in most all lowland Africa
Schistosomiasis (also called bilharzia) — absent only in highland areas
Onchocerciasis (also called river blindness) — common in savanna zones

18. Onchocerciasis

19. Aid and underdevelopment
Aid applied according to development theories & ideologies current at the time – or for geopolitical goals
Often not well enough thought out
Much US aid to Egypt, Israel for example
Results often aided the Global N or Trans National Corporations
NGOs, smaller, may have better record, but still have their own agenda

20. Debt & underdevelopment
Post-independence (1960s-70s)
Good prices for primary sector exports
Encouraged international investment (debt financed)
Investments were often poorly thought out
1980s bust in prices => lower income
But debt still needed to be paid
By 1980s debt service (interest + capital) = 25% of all governmental income

21. Debt and underdevelopment II
Inefficient and corrupt governments
“Structural adjustments” (IMF & World Bank) force governments to reduce spending to pay debts
Loss of social security nets
Loss of subsidies to agriculture (e.g., for fertilizer)
Recently some re-organization and call for debt forgiveness etc.

22. World Bank & IMF
Created after United Nations Monetary and Financial Conference ( )
Loans and grants to ~ 184 members, almost the entire UN
Focused on Global South
Human development
Agriculture and rural development
Environmental protection
Infrastructure & Governance
Borrowers must launch reforms

23. Criticisms of World Bank & IMF
A tool of the Global N imposing policies that support Its interests
Supports international corporate interests over local ones
Neo-liberal economic principles (privatization & markets)
Required repayment no matter what (structural adjustment)
Governance based on level of financial contribution (from Global N)
US 16.4%; Japan 7.9%; Germany 4.5%
Major policy shift requires 85% yes; thus, US controls

24. Women and development
Cycle of Overwork – poverty – and demands of child rearing =>
Elevated infant mortality
Elevated maternal mortality
Slower fertility decline Close birth spacing =>
Poor levels of female education

26. Maternal Mortality Ratio*
Western Africa
1,040
Eastern Africa
1,340
North Africa
460
Central Africa 1,020
Southern Africa
360
Sub-Saharan Africa 1,100
South Asia 430
East Asia/Pac. 140
LA & C
Developing
Countries
This map gives an indication of maternal mortality throughout geographical regions in Africa. As you can see, the average MMR in SSA is 2.5 times higher than the average in South Asia, almost 6 times higher than in LAC, and almost 8 times higher than in East Asia/Pacific. Maternal Mortality is unacceptably high in SSA.
*Maternal deaths per 100,000 live births
Source: Kenneth Hill, Carla Abou Zahr, & Tessa Wardlaw: Estimates of maternal mortality for Bulletin of the World Health Organization, vol.79, no.3,

27. Ratio of Girl’s to Boy’s Primary Education

28. Structure of economy & development
Narrowly focused economies often have troubles
Primary sector (such as agriculture or mining) economies have most problems
Recall the least developed countries
A risky primary sector economy => little opportunity to create a more diverse economy

29. Agricultural pastoral economies
West Africa: Liberia, Cote d’Ivoire (Ivory Coast)
East Africa: Tanzania
Central Africa: Congo, Cameroon, C. African Republic
Southern Africa: Madagascar, Mozambique, Malawi

30. Agricultural pastoral economies

31. African Crop Land
Navin Ramankutty, Nicholas J. Olejniczak, and Jonathan A. Foley
Center for Sustainability and the Global Environment

32. Problems for ag-pastoral economies
Commercial/export ag
often benefits only a few
usually occupies best lands
Ag/pastoral sector
usually less rapidly growing
at risk to environmental fluctuations
at risk to land degradation and loss of productive potential
Great competition among ag sector primary product exporters tends to lower prices to producers (e.g., many countries world-wide export coffee)

33. Mostly mineral extraction-based primary/extractive economies
West Africa:
Nigeria
Central Africa:
Zaire/Democratic Congo Republic, Gabon
Southern Africa:
Zambia, Botswana, Namibia, Angola

34. Mineral extraction-based primary/extractive economies

35. Problems with mineral-export economies
Price fluctuations often extreme
Minerals are a “wasting” resource
Often mines are foreign owned and controlled
Environmental problems in places
Corruption seems to accompany mineral wealth

36. Dual - Sector Economies: agricultural/pastoral and minerals
West Africa:
Mauritania, Senegal, Guinea, Ghana
Southern Africa:
Zimbabwe, Swaziland and Lesotho
Problems
Still primary sector based => low rates of growth and productivity

37. Dual - Sector Economies

38. Diverse economies — not just primary sector
Kenya
Yet Kenya’s GNI/capita still very low
South Africa

39. Diverse economies

40. Themes for SS Africa Development/Underdevelopment
Environmental uncertainty
Disease
Population growth
Food production shortfalls
Conflict
Debt
Structure of economy
All work together in geographic complexity!