Health Situation Analysis in the African Region · 2012-09-27 · AFRO Library Cataloguing-in-Publication Data Atlas of Health Statistics of the African Region 2011 1. Health Systems

Health SituationAnalysis in theAfrican RegionAtlas of Health Statistics, 2011

Health SituationAnalysis in theAfrican RegionAtlas of Health Statistics, 2011

Health Situation Analysis in the African RegionAtlas of Health Statistics, 2011

AFRO Library Cataloguing-in-Publication Data

Atlas of Health Statistics of the African Region 2011

1. Health Systems2. Health Information Systems3. Health Policy4. Health Services Coverage and Accessibility 5. Africa

ISBN: 978 929 023 1769 (NLM Classification: W16 and W17)

© World Health Organization. Regional Office for Africa, 2011

Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Publication and Language Services Unit, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: [email protected]). Requests for permission to reproduce or translate this publication – whether for sale or for non-commercial distribution – should be sent to the same address.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

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All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use.

This report was edited and produced by a team from the Royal Society of Medicine Press, London, UK. RSM Press would like to thank the following for use of photographs in this report: Tropical Health Education Trust (THET); The Butabika Link (Hannah Maule-ffinch); and The Jimma-Nottingham Link.

Typeset by Phoenix Photosetting, Chatham, Kent

Printed and bound in India by Replika Press Pvt. Ltd.

More information about this publication can be obtained from:African Health Observatory (www.aho.afro.who.int)African Health Observatory and Knowledge Management UnitOffice of the Assistant Regional DirectorWHO - Regional Office for AfricaBrazzaville/Republic of Congo

iii

List of Figures ..............................................................................................................vMessage from the Regional Director ............................................................................. ixOverview of Profile of the African Region .......................................................................xOverview of Progress on the Health-related MDGs in the African Region ........................xiIntroduction ................................................................................................................ xii

1 Health Status and Trends ....................................................................................... 1

Life expectancy ....................................................................................................... 1Mortality ................................................................................................................ 4Burden of disease ................................................................................................. 10

2 The Health System .............................................................................................. 14

Health financing ................................................................................................... 14Health workforce ................................................................................................... 22Medical products and equipment ............................................................................ 25Health information – Civil registration coverage ......................................................... 27Health research .................................................................................................... 28

3 Specific Programmes and Services ........................................................................ 29

HIV/AIDS ............................................................................................................. 29Tuberculosis ......................................................................................................... 33Malaria ................................................................................................................ 36Vaccine-preventable diseases .................................................................................. 38Child and adolescent health ................................................................................... 41Maternal and newborn health ................................................................................. 42Sexual and reproductive health ............................................................................... 46Neglected tropical diseases .................................................................................... 47Non-communicable diseases and conditions ............................................................. 48Risk factors for health ............................................................................................ 49Food and nutrition ................................................................................................. 51

Contents

iv

Contents

4 Key Determinants of Health .................................................................................. 53

Demography ......................................................................................................... 53Resources and infrastructure ................................................................................... 56Poverty and income inequality ................................................................................ 58Gender inequity ..................................................................................................... 60Education ............................................................................................................. 61Environment ......................................................................................................... 62Global partnerships and financial flows.................................................................... 67Science and technology ......................................................................................... 69Emergencies and disasters ..................................................................................... 71

5 Progress on the Health-Related MDGs ................................................................... 72

MDG-4 (Child health) ............................................................................................ 72MDG-5 (Maternal health) ....................................................................................... 74MDG-6 (AIDS, malaria and TB) ............................................................................... 77MDG-1 (Malnourished children)............................................................................... 82MDG-7 (Water and sanitation) ................................................................................ 83MDG-8 (Develop a global partnership for development) ............................................. 84

6 Explanatory Notes ................................................................................................ 85

v

Figure A: The countries of the WHO African Region and the Inter-Country Support Teams (ICST) xiiFigure B: Population size (in thousands) of countries of the African Region, 2008 xiiiFigure 1: Life expectancy at birth in years in the African Region, 2008 1Figure 2: Life expectancy at birth in years in WHO Regions, 2008 and 1990 1Figure 3: Life expectancy at birth in years in WHO Regions, by sex, 2008 1Figure 4: Life expectancy at birth in years in the African Region, by country, 2008 and 1990 2Figure 5: Life expectancy at birth in years in the African Region, by country and sex, 2008 2Figure 6: Healthy life expectancy at birth in years in WHO Regions, by sex, 2007 3Figure 7: Healthy life expectancy at birth in years in the African Region, by country and sex, 2007 3Figure 8: Adult mortality rate per 1000 population in the African Region, 2008 4Figure 9: Adult mortality rate per 1000 population in WHO Regions, 2008 and 1990 4Figure 10: Adult mortality rate per 1000 population in WHO Regions, by sex, 2008 4Figure 11: Adult mortality rate per 1000 population in the African Region, by country, 2008 and 1990 5Figure 12: Adult mortality rate per 1000 population in the African Region, by country and sex, 2008 5Figure 13: Under-5 mortality rate per 1000 live births in the African Region, 2009 6Figure 14: Under-5 mortality rate per 1000 live births in WHO Regions, both sexes, 2009 and 1990 6Figure 15: Infant mortality rate per 1000 live births in WHO Regions, 2009 and 1990 6Figure 16: Under-5 mortality rate per 1000 live births in the African Region, by country, 2009 and 1990 7Figure 17: Infant mortality rate per 1000 live births in the African Region, by country, 2009 and 1990 7Figure 18: Maternal mortality ratio per 100 000 live births in WHO Regions, 2008 and 1990 8Figure 19: Maternal mortality ratio per 100 000 live births in the African Region, by country, 2008 and 1990 8

Figure 20: Age-standardized death rates per 100 000 population due to communicable diseases in the African Region, 2004 9Figure 21: Age-standardized death rates per 100 000 population due to non-communicable diseases in the African Region, 2004 9Figure 22: Age-standardized death rates per 100 000 population due to injuries and violence in the African Region, 2004 9Figure 23: Total burden of disease in DALYs per 1000 population in WHO Regions, 2004 10Figure 24: Leading causes of burden of diseases shown as percentage of total DALYs in the African Region, 2004 10Figure 25: Distribution of burden of diseases as percentage of total DALYs by group in the African Region, 2004 11Figure 26: Distribution of burden of diseases as percentage of total DALYs by broader causes in WHO Regions, 2004 11Figure 27: Distribution of burden of diseases as percentage of total DALYs by broader causes in the African Region, by country, 2004 12Figure 28: Distribution of years of life lost by broader causes in WHO Regions, 2004 13Figure 29: Distribution of years of life lost by broader causes in the African Region, by country, 2004 13Figure 30: Per capita total expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 14Figure 31: Total expenditure on health as percentage of GDP in WHO Regions, 2007 and 2000 14Figure 32: Per capita total expenditure on health (PPP int. $) in the African Region, by country, 2007 and 2000 15Figure 33: Total expenditure on health as percentage of GDP in the African Region, by country, 2007 and 2000 15Figure 34: General government expenditure on health as percentage of total expenditure on health in the African Region, 2007 16Figure 35: General government expenditure on health as percentage of total government expenditure, 2007 16Figure 36: General government expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 17Figure 37: External resources for health as percentage oftotal expenditure on health in WHO Regions, 2007 and 2000 17

List of Figures

List of figures

vi

Figure 38: General government expenditure on health as percentage of total government expenditure in the African Region, by country, 2007 and 2000 18Figure 39: External resources for health as percentage of total expenditure on health in the African Region, by country, 2007 and 2000 18Figure 40: Private expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 19Figure 41: Out-of-pocket expenditure as percentage of private expenditure on health in WHO Regions, 2007 and 2000 19Figure 42: Private expenditure on health as percentage of total expenditure on health in the African Region, by country, 2007 and 2000 20Figure 43: Out-of-pocket expenditure as percentage of private expenditure on health in the African Region, by country, 2007 and 2000 20Figure 44: Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 21Figure 45: Per capita government expenditure on health (PPP int. $) in the African Region, by country, 2007 and 2000 21Figure 46: Physician-to-population ratio (per 10 000 population) in the African Region, 2000–2009 22Figure 47: Physician-to-population ratio (per 10 000 population) in WHO Regions, 2000–2009 22Figure 48: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in the African Region, 2000–2009 23Figure 49: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in WHO Regions, 2000–2009 23Figure 50: Physician-to-population ratio (per 10 000 population) in the African Region, by country, 2000–2009 24Figure 51: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in the African Region, by country, 2000–2009 24Figure 52: Median percentage availability of selected generic medicines in a sample of health facilities in the African Region, countries with data, 2001–2008 25Figure 53: Median consumer price ratio of selected generic medicines (ratio of median local unit price to management sciences for health international reference price), countries with data, 2001–2008 25Figure 54: Hospital beds per 10 000 population in WHO Regions, 2000–2009 25Figure 55: Hospital beds per 10 000 population in the African Region, by country, 2000–2009 26Figure 56: Percentage of civil registration coverage for births in the African Region, by country, 2000–2008 27Figure 57: Percentage of civil registration coverage for deaths in the African Region, 2000–2008 27Figure 58: Institutional level policies in research 28Figure 59: Roles of Ministry of Health (MOH) and other central policy setting and implementing bodies in the African Region as percentage, 2007 28

Figure 60: HIV/AIDS mortality rate (per 100 000 population) in the African Region, 2007 29Figure 61: HIV/AIDS mortality rate (per 100 000 population) in WHO Regions, 2007 29Figure 62: Prevalence of HIV (per 100 000 population) among people aged 15 years or more in WHO Regions, 2007 30Figure 63: Percentage of antiretroviral therapy among people with HIV/AIDS in need of treatment in WHO Regions, 2009 32Figure 64: Percentage of people 15–49 years of age living with HIV in the African Region, by country, 2007 and 2001 31Figure 65: Percentage of people receiving antiretroviral therapy in the African Region, by country, 2009 and 2007 31Figure 66: Percentage of men and women aged 15–24 years of age who used a condom at last high-risk sex, African Region, 2002–2006 32Figure 67: Population aged 15–24 years of age with comprehensive knowledge of HIV/AIDS 32Figure 68: Tuberculosis death rate per 100 000 population per year in the African Region, by country, 2007 and 2000 33Figure 69: Tuberculosis incidence rate per 100 000 population per year in the African Region, by country, 2008 and 2000 33Figure 70: Tuberculosis prevalence per 100 000 population per year in the African Region, by country, 2008 and 2000 34Figure 71: Percentage of tuberculosis detection rate under DOTS in WHO Regions, 2007 and 2000 34Figure 72: Percentage of tuberculosis detection rate under DOTS in the African Region, by country, 2007 and 2000 35Figure 73: Noti�ed cases of malaria, in thousands, in the African Region, by country, 2008 36Figure 74: Percentage of children under 5 years of age sleeping under insecticide-treated bed nets in the African Region, by country, 2005–2009 and 2000–2004 36Figure 75: Malaria mortality rate per 100 000 population in the African Region, 2008 37Figure 76: Proportion of children under 5 years of age with fever being treated with antimalarial drugs in the African Region, by country, 2005–2009 and 2000–2004 37Figure 77: Percentage of neonates protected at birth against neonatal tetanus in WHO Regions, 2008 and 1990 38Figure 78: Percentage immunization coverage among 1-year-olds for DTP3 in WHO Regions, 2008 and 1990 38Figure 79: Percentage of neonates protected at birth against neonatal tetanus in the African Region, by country, 2008 and 1990 39Figure 80: Percentage immunization coverage among 1-year-olds for DTP3 in the African Region, by country, 2008 and 1990 39Figure 81: Immunization coverage among 1-year-olds for HepB3 in WHO Regions, 2008 40

vii

List of Figures

Figure 82: Immunization coverage among 1-year-olds for HepB3 in the African Region, by country, 2008 40Figure 83: Distribution of causes of death among children aged under 5 years, 2008 41Figure 84: Percentage of infants exclusively breastfed for the �rst 6 months of life in WHO Regions, 2000–2009 41Figure 85: Percentage of infants exclusively breastfed for the �rst 6 months of life in the African Region, by country, 2000–2009 41Figure 86: Percentage of low-birthweight newborns in WHO Regions, 2000–2008 42Figure 87: Percentage of low-birthweight newborns in the African Region, by country, 2000–2008 42Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, 1990–1999 and 2000–2008 43Figure 89: Percentage of births attended by skilled health personnel in the African Region, 2000–2008 43Figure 90: Percentage of births attended by skilled health personnel in the African Region, by country, 2000–2008 and 1990–1999 43Figure 91: Percentage of births by caesarean section in WHO Regions, 2000–2008 44Figure 92: Percentage of births by caesarean section in the African Region, by country, 2000–2008 44Figure 93: Percentage of antenatal care coverage, at least one visit, in the African Region, by country, 2000–2009 and 1990–1999 45Figure 94: Percentage of antenatal care coverage, at least four visits, in the African Region, by country, 2000–2009 and 1990–1999 45Figure 95: Percentage of current contraceptive use (any method) among married women 15–49 years of age in the African Region, by country, 2000–2008 and 1990–1999 46Figure 96: Adolescent fertility rate (per 1000 girls, 15–19 years of age) in the African Region, 2000–2007 46Figure 97: Total fertility rate per woman in WHO Regions, 2008 and 1990 46Figure 98: Number of reported cases of leprosy in WHO Regions, 2008 47Figure 99: Number of reported cases of leprosy in the African Region, by country, 2008 47Figure 100: Distribution of causes of non-communicable burden of diseases (percentage of total DALYs) in the African Region, 2004 48Figure 101: Distribution of causes of intentional and non-intentional injuries (percentage of total DALYs) in the African Region, 2004 48Figure 102: Distribution of causes of neuropsychiatric burden of diseases (percentage of total DALYs) in the African Region, 2004 48Figure 103: Percentage of current tobacco use in persons 15 years of age or older in WHO Regions, 2006 49Figure 104: Percentage of current tobacco use in persons 15 years of age or older in the African Region, by country, 2006 49

Figure 105: Alcohol consumption (litres per person) among adults aged 15 years of age or older in WHO Regions, 2005 50Figure 106: Alcohol consumption (litres per person) among adults aged 15 years of age or older in the African Region, by country, 2005 50Figure 107: Percentage of underweight children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999 51Figure 108: Percentage of stunted children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999 52Figure 109: Percentage of overweight children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999 52Figure 110: Age distribution of the population in WHO Regions, 2008 53Figure 111: Age distribution of the population in the African Region, by country, 2008 54Figure 112: Total fertility rate per woman in the African Region, by country, 2008 and 1990 54Figure 113: Annual growth rate (in %) of population in WHO Regions, 1998–2008 and 1988–1998 55Figure 114: Annual growth rate (in %) of population in the African Region, by country, 1998–2008 and 1988–1998 55Figure 115: Gross national income per capita (PPP int. $) in WHO Regions, 2008 and 1990 56Figure 116: Gross national income per capita (PPP int. $) in the African Region, by country, 2008 and 1990 56Figure 117: Electri�cation rate in the African Region, by country, 2000–2005 57Figure 118: Paved roads as percentage of all roads in the African Region, by country, 2000–2007 57Figure 119: Percentage of the population living under $1 (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, 2000–2007 58Figure 120: Percentage of the population living under $1 (PPP int. $) a day (i.e. in absolute poverty) in the African Region, by country, 2000–2007 58Figure 121: Share of incomes by poorest and richest section of the population in the African Region, by country, 1989–2005 59Figure 122: Percentage of female and male combined gross enrolment ratio for primary–secondary–tertiary education in the African Region, by country, 2005 60Figure 123: Percentage of seats held by women in national parliaments in the African Region, by country, 2009 and 2001 60Figure 124: Adult literacy rate (percentage aged 15 and older) in the African Region, by country and sex, 1995–2005 61Figure 125: Percentage of the population aged 15–24 years who can both read and write (i.e. youth literacy rate) in the African Region, by country, 2000–2007 and 1990–1999 61

List of figures

viii

Figure 126: Percentage of the population using improved drinking water sources in the African Region, 2008 62Figure 127: Percentage of the population using improved drinking water sources in WHO Regions, 2008 and 1990 62Figure 128: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, 2008 62Figure 129: Percentage of population using improved drinking water sources in the African Region, by country, 2008 and 1990 63Figure 130: Percentage of urban and rural population with access to improved drinking water sources in the African Region, by country, 2008 63Figure 131: Percentage of the population using improved sanitation facilities in the African Region, 2008 64Figure 132: Percentage of the population using improved sanitation facilities in WHO Regions, 2008 and 1990 64Figure 133: Percentage of the population using improved sanitation facilities in WHO Regions, urban and rural, 2008 64Figure 134: Percentage of the population using improved sanitation facilities in the African Region, by country, 2008 and 1990 65Figure 135: Percentage of the population using improved sanitation facilities in the African Region, by country, urban and rural, 2008 65Figure 136: Percentage of the population living in urban areas in the African Region, by country, 2008 and 1990 66Figure 137: Percentage of urban population living in slums in the African Region, by country, 2005 and 1990 66Figure 138: Per capita of�cial development assistance received (US$) in the African Region, by country, 2005 67Figure 139: Of�cial development assistance received as percentage of GDP in the African Region, by country, 2005 and 1990 67Figure 140: Total debt service as percentage of GDP in the African Region, by country, 1990 and 2005 68Figure 141: Total external debt stocks (in millions of current US$) in the African Region, by country, 2007 68Figure 142: Percentage of population with telephone in the African Region, by country, 2005 and 2000 69Figure 143: Percentage of population who are cellular or mobile subscribers in the African Region, by country, 2006 and 2000 69Figure 144: Percentage of population who are telephone (�xed and mobile) subscribers in the African Region, by country, 2007 70Figure 145: Percentage of the population who are Internet users in the African Region, 2007 70Figure 146: Total number of internally displaced people (thousands) in the African Region, by country, 2006 71Figure 147: Total number of refugees (in thousands) in the African Region, by country of origin, 2006 71

Figure 148: Trend in under-5 mortality rate in the WHO African Region, 1990–2009 72Figure 149: Under-5 mortality rate (per 1000 live births) in WHO Regions, both sexes, 2008 and 1990 72Figure 150: Under-5 mortality rate (per 1000 live births) in the African Region, by country, 2008 and the MDG target 73Figure 151: Trend in maternal mortality ratio (per 100 000 live births) in WHO African Region, 1990–2008 74Figure 152: Trend in maternal mortality ratio (per 100 000 live births) in WHO Regions in 2008 74Figure 153: Maternal mortality ratio (per 100 000 live births) in the African Region, by country, 2008 and the MDG target 75Figure 154: Percentage of unmet need for family planning in the African Region, by country, 2000–2007 and 1990–1999 76Figure 155: Percentage of HIV-positive pregnant women 15–24 years of age for 13 countries with trend data in the African Region, 2004–2007 and 2000–2003 77Figure 156: Percentage of population in need of treatment with access to antiretroviral drugs in the African Region, by country, 2009 and 2007 78Figure 157: Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy, 2007 79Figure 158: Percentage of pregnant women living with HIV infection who are receiving antiretroviral therapy for preventing mother-to-child transmission, 2008 79Figure 159: Percentage of children under 5 years of age sleeping under insecticide-treated bed nets in the African Region, 2005–2009 and 2000–2004 80Figure 160: Percentage of children under 5 years of age with fever being treated with antimalarial drugs in the African Region, 2005–2009 and 2000–2004 80Figure 161: Malaria mortality rate (per 100 000 population) in the African Region, by country, 2008 and 2006 81Figure 162: Prevalence of tuberculosis (per 100 000 population) in the African Region, by country, 2008 and the MDG target 81Figure 163: Trend in children aged under 5 years that are underweight 82 Figure 164: Percentage of underweight children under 5 years of age in the African Region, by country, 2000–2009 and the MDG target 82Figure 165: Percentage of the population using improved drinking water sources in the African Region, by country, 2008 and the MDG target 83Figure 166: Percentage of the population using improved sanitation facilities in the African Region, by country, 2008 and the MDG target 83Figure 167: Total debt service as percentage of exports of goods, services and income, 2007 and 1990 84

ix

Basic data and statistics are at the core of all health systems. Without them, it would be impossible to analyse evidence and extract action-oriented knowledge for decision making.

Clearly, the data should be of the highest quality possible. They should be timely, valid, accurate, derived and analysed by sound methods, consistent, comparable, and repeatable.

This publication presents in numerical and graphical formats the best data available for key health indicators in the 46 countries of WHO’s African Region. Although there have been considerable improvements in data collection and analysis and notable examples of success, this is not the case with all the data collected in the Region. Countries have worked long and hard, and with varying degrees of success, on strengthening their national health information systems. Nevertheless, there continue to be gaps in the system.

One approach to strengthening health information systems that is currently underway is the development of an African Health Observatory and national health observations. The overall objective of the African Health Observatory is to contribute to regional and country efforts to narrow the knowledge gap and to strengthen health systems in the African Region by providing easy access to high-quality information, evidence and knowledge, as well as facilitate their use for policy and decision making. The Observatory will monitor regional health status and trends and provide in-depth analysis by priority themes for attainment of the United Nations’ Millennium Development Goals and other global and regional commitments, and will identify inequities in health and use evidence-based information in the formulation of public health policies and programmes. The Observatory aims to facilitate the generation, sharing and application of information, evidence and knowledge. It will also serve as the focus for building networks, including communities of practice, around data collection and processing. Systematic reviews and evidence will be drawn from the Observatory’s resources and packaged for, and disseminated to, key target audiences. It is essential to enhance and promote the use of evidence for policy and action. The Observatory will also link to national health observatories and all data collection activities in WHO country of�ces, Inter-Country Support Teams and the Regional Of�ce in a two-way support system, as a way of strengthening national health information systems.

With the continued input and collaboration of the countries, future editions of this publication will be produced as a signi�cant information product of the Observatory.

While thanking all Member States and those in charge of their health information systems for their cooperation in providing country data, I encourage all countries to continue collaborating with WHO to improve the availability and use of information through the African Health Observatory.

Dr Luis Gomes Sambo Regional Director WHO – Regional Of�ce for Africa

Message from the Regional Director

x

MDG-1: Children aged < 5 years underweight

MDG-5: Trend in maternal mortality ratio (per 100,000 live births)

MDG-6: Prevalence of HIV among adults aged 15–49 years, by region (2007)

MDG-6: Malaria mortality rate per 100,000 poplation, by region (2006) MDG-6: Prevalance of tuberculosis (per 100,000 population), by region

MDG-7: Population using improved sanitation

30% 34%

2015 MDG Target : 65%

52%

1990 19902008

African Region

104

4.9%

480

2008

2000470

220290

150260

110220

3953

2542

170220

0.5%

0.5%

0.3%

0.2%

0.1%

0.8%

8

2

1

0

...

17

African

Eastern Mediterranean

South-East Asia

Americas

Western Paci�c

European

Global

African

Americas

European

South-East Asia


Western Paci�c

Global

44%

1%

23%

28%

54%

94%

45%

African


Western Paci�c

South-East Asia

Americas

European

Global

African

South-East Asia


Western Paci�c

European

Americas

Global

GlobalAfrican Region Global

African Region Global


20081990 2008 1990 2008

1990–19991990

850

165

25%22%

...

22%

147131

121 118

830780

690

620

1995 2000 2005 2008 2015

1990 20001990–1999 2000–2009 1990–1999 2000–2009 2005 2008 2009 2015

2000–2007 1990–1999 2000–2007

60%50%

26.4%24.3%

10.8%

...

61%

77% 87%

MDG-7: Population using improved drinking water sources

MDG-6: Percentage of population living with advanced HIV infectionwho are receiving antiretroviral therapy, by region (2007)

MDG-5: Percentage of unmet need for family planning

MDG-4: Trend in under-5 mortality rate (probability of dying by age 5;per 1,000 live births)




2015 MDG Target : 213



Male

41.1%

14.5%

8.7%

7.9%12.3%

39.7%

71.1%

48.0%

12.4% 42.4%

15.9%

11.4%

10.1%

5.4%

5.2%

4.0%

3.1%

2.5%

11.2%

8.6%

8.2%

3.6%

3.6%

3.0%

2.9%

1.9%

1.9%

HIV/AIDS

Lower respiratory infections

Diarrhoeal diseases

Malaria

Neonatal infections andother conditions

Birth asphyxia andbirth trauma

Prematurity and lowbirth weight

Tuberculosis

Road tra�c accidents

Protein-energy malnutrition

Infectious andparasitic diseases

Noncommunicableconditions

Respiratory infections

Perinatal conditions

Unintentional injuries

Neuropsy chiatricdisorders

Maternal conditions

Nutritional de�ciencies

Intentional injuries

21.0%

15.4% 28

1114

2

9.6%

73%72%

Antenatal carecoverage (%) at least

four visits

Contraceptiveprevalance

Immunization coverageamong 1-year-olds,

DTP3

Utilization of health services (2008)

Health workforce (2000–2009)General government expenditure on health(as % of total government expenditure)

Distribution of causes of death among childrenaged <5 years (2008)

Prevalence of smoking any tobacco productamong adults aged ≥ 15 years (2006)


measles

Nursing and midwiferypersonnel density (per

10,000 population)

Communicablediseases

Distribution of burden of diseases as % of total DALYs bybroader causes (2004)

Leading causes of burden of diseases(as % of total DALYs) (2004)

Burden of disease (% of total DALYs)by groups of disorders and

conditions (2004)

All data sources are given inthe African Health Observatoryat www.aho.afro.who.int

Injuries

Population size (in thousands)

African Region

Selected indicators**

Global

Population living in urban areas (%)

Gross national income per capita (PPP int. $)

Per capita total expenditure on health (PPP int. $)

Adult mortality rate (probability of dying between 15 and 60 years per 1000 population)

Life expectancy at birth (years), both sexes

2008200820001990200819902008199020072000200820001990

804,8653734295351

39237113786

2,2791,5061,319

6,737,4805047436864

180210863568

10,2906,9404,862

Non-communicablediseases

Physician density (per10,000 population)

83%82%

48% 44%

24%

62%

17.7%

8.9%

2.8%

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

HIV/AIDS4%

Neonatal5%

Malaria16%

Pneumonia17%

Diarrhoea18%

Measles1%

Congenital2%

Injuries2%

Other17%

Prematurity9%

Asphyxia8%

GlobalAfricanRegion

Global

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

Global

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

Global

Female

2000 2007

Overview of Profi le of the African Region

xi

MDG-1: Children aged < 5 years underweight

MDG-5: Trend in maternal mortality ratio (per 100,000 live births)

MDG-6: Prevalence of HIV among adults aged 15–49 years, by region (2007)

MDG-6: Malaria mortality rate per 100,000 poplation, by region (2006) MDG-6: Prevalance of tuberculosis (per 100,000 population), by region

MDG-7: Population using improved sanitation

30% 34%


52%

1990 19902008

African Region

104

4.9%

480

2008

2000470

220290

150260

110220

3953

2542

170220

0.5%

0.5%

0.3%

0.2%

0.1%

0.8%

8

2

1

0

...

17

African


South-East Asia

Americas

Western Paci�c

European

Global

African

Americas

European

South-East Asia


Western Paci�c

Global

44%

1%

23%

28%

54%

94%

45%

African


Western Paci�c

South-East Asia

Americas

European

Global

African

South-East Asia


Western Paci�c

European

Americas

Global

GlobalAfrican Region Global



20081990 2008 1990 2008

1990–19991990

850

165

25%22%

...

22%

147131

121 118

830780

690

620

1995 2000 2005 2008 2015

1990 20001990–1999 2000–2009 1990–1999 2000–2009 2005 2008 2009 2015

2000–2007 1990–1999 2000–2007

60%50%

26.4%24.3%

10.8%

...

61%

77% 87%

MDG-7: Population using improved drinking water sources

MDG-6: Percentage of population living with advanced HIV infectionwho are receiving antiretroviral therapy, by region (2007)

MDG-5: Percentage of unmet need for family planning

MDG-4: Trend in under-5 mortality rate (probability of dying by age 5;per 1,000 live births)







Overview of Progress on the Health-related MDGs in the African Region

Male

41.1%

14.5%

8.7%

7.9%12.3%

39.7%

71.1%

48.0%

12.4% 42.4%

15.9%

11.4%

10.1%

5.4%

5.2%

4.0%

3.1%

2.5%

11.2%

8.6%

8.2%

3.6%

3.6%

3.0%

2.9%

1.9%

1.9%

HIV/AIDS


Diarrhoeal diseases

Malaria

Neonatal infections andother conditions

Birth asphyxia andbirth trauma

Prematurity and lowbirth weight

Tuberculosis

Road tra�c accidents

Protein-energy malnutrition

Infectious andparasitic diseases

Noncommunicableconditions




Neuropsy chiatricdisorders

Maternal conditions

Nutritional de�ciencies


21.0%

15.4% 28

1114

2

9.6%

73%72%

Antenatal carecoverage (%) at least

four visits

Contraceptiveprevalance


DTP3

Utilization of health services (2008)

Health workforce (2000–2009)General government expenditure on health(as % of total government expenditure)

Distribution of causes of death among childrenaged <5 years (2008)

Prevalence of smoking any tobacco productamong adults aged ≥ 15 years (2006)


measles

Nursing and midwiferypersonnel density (per

10,000 population)

Communicablediseases

Distribution of burden of diseases as % of total DALYs bybroader causes (2004)

Leading causes of burden of diseases(as % of total DALYs) (2004)

Burden of disease (% of total DALYs)by groups of disorders and

conditions (2004)

All data sources are given inthe African Health Observatoryat www.aho.afro.who.int

Injuries

Population size (in thousands)

African Region

Selected indicators**

Global

Population living in urban areas (%)

Gross national income per capita (PPP int. $)

Per capita total expenditure on health (PPP int. $)

Adult mortality rate (probability of dying between 15 and 60 years per 1000 population)

Life expectancy at birth (years), both sexes

2008200820001990200819902008199020072000200820001990

804,8653734295351

39237113786

2,2791,5061,319

6,737,4805047436864

180210863568

10,2906,9404,862

Non-communicablediseases

Physician density (per10,000 population)

83%82%

48% 44%

24%

62%

17.7%

8.9%

2.8%

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

HIV/AIDS4%

Neonatal5%

Malaria16%

Pneumonia17%

Diarrhoea18%

Measles1%

Congenital2%

Injuries2%

Other17%

Prematurity9%

Asphyxia8%

GlobalAfricanRegion

Global

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

Global

AfricanRegion

GlobalAfricanRegion

GlobalAfricanRegion

Global

Female

2000 2007

xii

Introduction

The African Region is one of the six regions in which the World Health Organization (WHO) collaborates with countries in public health. With over 730 million inhabitants in 46 countries (see Figures A and B), it accounts for about one-seventh of the world’s population.

This statistical atlas describes the health status and trends in the countries of the African Region, the various components of their health systems, coverage and access levels for specific programmes and services, and the key determinants of health in the

Figure A: The countries of the WHO African Region and the subregions

Algeria

Mauritania Mali Niger

Nigeria

Algeria

Mauritania

CapeVerde

SenegalGambia

Guinea-BissauGuinea

Sierra LeoneLiberia

GhanaTogo

Benin

Congo

AngolaZambia

Zimbabwe

Madagascar

Comoros

Seychelles

Mauritius

Mozambique

Malawi

United Republic of Tanzania

RwandaBurundi

UgandaKenya

Ethiopia

Eritrea

CentralAfrican

Republic

DemocraticRepublic ofthe Congo

Swaziland

Lesotho

Namibia

BotswanaSouthAfrica

Sao Tome and Principe

Burkina FasoCôte d´Ivoire

CameroonEquatorial Guinea

Gabon

Mali Niger

Chad

Nigeria

WHO African Regionand the subregions

WestCentralSouth-East

Outside WHOAfrican Region

xiii

Introduction

Figure B: Population size (in thousands) of countries of the African Region, 2008

151 212

80 713

64 25749 668

42 48438 765

34 373

31 65723 351

22 38320 59119 111

19 08818 021

15 234

14 84614 704

12 70612 62012 463

12 21110 914

983397218662

80746459

5560

49274339

37933615

3215

21302049

192116601575

14481280

1168661659499

16084

Nigeria

Ethiopia

Democratic Republic of the Congo

South Africa


Kenya

Algeria

Uganda

Ghana

Mozambique

Côte d'Ivoire

Madagascar

Cameroon

Angola

Burkina Faso

Malawi

Niger

Mali

Zambia

Zimbabwe

Senegal

Chad

Guinea

Rwanda

Benin

Burundi

Togo

Sierra Leone

Eritrea

Central African Republic

Liberia

Congo

Mauritania

Namibia

Lesotho

Botswana

Gambia

Guinea-Bissau

Gabon

Mauritius

Swaziland

Comoros

Equatorial Guinea

Cape Verde


Seychelles

Region, and the progress made on reaching the United Nations’ Millennium Development Goals (MDGs).

Each indicator is described, as appropriate, by place (WHO Regions and countries in the African Region), person (age and sex) and time (various years) using maps and graphs. The aim is to give a comprehensive overview of the health situation in the African Region and its 46 Member States.

The main source for the data is WHO-AFRO’s integrated database based on the World Health Statistics 2010. Other UN agency databases have been used when necessary. All the data and figures in this atlas can be accessed through the African Health Observatory (www.aho.afro.who.int).

1

Life expectancy

1Health Status and Trends

No data

≤ 42

43–50

51–56

57–65

+ 66


Figure 1: Life expectancy at birth in years in the African Region, 2008

Figure 2: Life expectancy at birth in years in WHO Regions, 2008 and 1990

53

65

65

75

75

76

68

51

58

61

72

69

71

64

African Region

South-East AsiaRegion

EasternMediterranean

Region

European Region

WesternPacificRegion

Region of theAmericas

Global

2008 1990

52

63

63

71

72

73

66

54

66

66

79

77

79

70

African Region



Region

European Region



Global

Male Female

Figure 3: Life expectancy at birth in years in WHO Regions, by sex, 2008

1 Health Status and Trends

2

Figure 4: Life expectancy at birth in years in the African Region, by country, 2008 and 1990

Figure 5: Life expectancy at birth in years in the African Region, by country and sex, 2008

53

42

46

46

47

48

48

48

48

49

49

49

49

50

51

51

52

52

53

53

53

53

53

54

54

54

54

56

57

58

58

58

59

59

59

60

60

60

61

61

62

63

65

71

71

72

73

51

61

42

49

61

51

49

63

52

45

44

46

41

50

49

42

39

47

55

49

47

63

52

60

46

60

36

54

51

48

57

50

54

54

55

57

62

52

67

61

58

65

36

66

67

69

69

African Region

Zimbabwe

Angola

Chad

Lesotho



Swaziland

Zambia

Guinea-Bissau

Mali

Nigeria

Sierra Leone

Burundi

Burkina Faso

Mozambique

Niger

Uganda

Cameroon

Equatorial Guinea

Malawi

South Africa


Congo

Guinea

Kenya

Liberia

Côte d'Ivoire

Benin

Ethiopia

Mauritania

Rwanda

Gambia

Senegal

Togo

Comoros

Gabon

Madagascar

Botswana


Ghana

Namibia

Eritrea

Algeria

Cape Verde

Seychelles

Mauritius

2008 1990

52

42

44

45

46

47

47

47

48

48

48

49

49

49

51

51

51

51

52

52

52

53

53

53

53

53

54

55

56

56

56

57

57

58

58

58

58

58

60

60

60

61

63

66

68

69

70

54

42

49

48

47

50

51

49

50

50

48

51

48

49

52

51

53

53

54

55

53

53

54

55

55

55

55

56

59

59

61

58

60

62

62

61

61

61

62

64

62

66

67

74

76

77

72

African Region

Zimbabwe

Lesotho

Angola

Chad


Guinea-Bissau

Zambia

Mali

Sierra Leone

Swaziland

Burundi


Nigeria

Burkina Faso

Mozambique

Niger

Uganda

Malawi

South Africa


Cameroon

Equatorial Guinea

Guinea

Kenya

Liberia

Congo

Côte d'Ivoire

Mauritania

Rwanda

Togo

Benin

Ethiopia

Comoros

Gabon

Gambia

Madagascar

Senegal

Botswana

Ghana


Namibia

Eritrea

Cape Verde

Seychelles

Mauritius

Algeria

Male Female

Life expectancy

3

*Healthy life expectancy (HALE) at birth represents the average number of years that a person could expect to live in ‘good health’ by taking into account years lived in less than full health due to disease and/or injury. As a result, it captures both fatal and non-fatal health outcomes and disabilities.

45

55

56

64

65

65

58

46

57

57

70

69

69

61

African Region

Eastern Mediterranean Region

South-East Asia Region

European Region

Region of the Americas

Western Pacific Region

Global

Male Female

Figure 6: Healthy life expectancy* at birth in years in WHO Regions, by sex, 2007

Figure 7: Healthy life expectancy at birth in years in the African Region, by country and sex, 2007

34

38

39

40

40

40

41

41

42

42

42

42

42

43

43

43

44

44

44

45

45

45

45

46

47

47

47

48

49

49

49

49

49

50

50

50

50

51

52

52

54

55

59

60

61

62

37

41

40

40

43

38

43

44

43

43

42

42

42

42

44

44

47

46

45

45

48

46

45

48

48

49

48

49

48

51

50

52

52

50

53

53

52

53

53

54

56

58

64

65

65

63

African Region

Sierra Leone

Lesotho

Zambia

Chad

Guinea-Bissau

Zimbabwe

Mali

Uganda

Burkina Faso

Burundi

Mozambique

Nigeria

Swaziland


Malawi

Rwanda

Angola

Niger

Cameroon

Côte d'Ivoire

Equatorial Guinea


Guinea

Kenya

Liberia

South Africa

Congo

Botswana

Ethiopia

Ghana

Mauritania

Togo

Benin

Gabon

Gambia

Senegal

Madagascar

Namibia


Eritrea

Comoros

Cape Verde

Seychelles

Mauritius

Algeria

Male Female


4546

1 Health Statusand Trends

4

MortalityFigure 8: Adult mortality rate per 1000 population in the African Region, 2008

No data


132–185186–307308–393394–520521–772

Figure 9: Adult mortality rate per 1000 population in WHO Regions, 2008 and 1990392

218

203

149

126

113

180

371

274

242

157

162

165

210

African Region



European Region



Global

2008 1990

Figure 10: Adult mortality rate per 1000 population in WHO Regions, by sex, 2008412

252

231

208

162

142

213

374

183

172

90

90

83

146

African Region



European Region



Global

Male Female

Mortality

5

392

772

685

620

520

515

481

470

458

457

446

436

421

411

411

407

404

403

403

393

386

381

372

371

361

361

359

340

336

327

323

320

307

303

301

290

276

273

269

263

258

247

228

185

172

160

132

371

285

251

230

271

352

400

480

385

353

375

475

489

377

405

384

194

321

426469

427

271

387

267

329

375497

717

410

240

320

213

389

408355

290

327

276

323

343

289

253

774

189

225

193181

African Region

Zimbabwe

Lesotho

Swaziland

South Africa

Zambia

Malawi

Mozambique



Chad

Uganda

Angola

Burundi

Nigeria


Botswana

Cameroon

Guinea-Bissau

Sierra Leone

Mali

Congo

Burkina Faso

Kenya

Côte d'Ivoire

Equatorial Guinea

Niger

Liberia

Guinea

Gabon

Togo

Namibia

Ethiopia

Rwanda

Benin

Mauritania

Gambia

Ghana

Senegal

Madagascar

Comoros


Eritrea

Cape Verde

Seychelles

Mauritius

Algeria

2008 1990

Figure 11: Adult mortality rate per 1000 population in the African Region, by country, 2008 and 1990

Figure 12: Adult mortality rate per 1000 population in the African Region, by country and sex, 2008

412

812

758

631

563

538

498

485

475

465

460

451

448

443

436

425

424

422

419

412

405

389

388

382

374

367

366

356

353

353

352

351

330

329

318

312

300

298

293

286

286

274

271

266

232

214

144

374

752

633

616

479

498

468

458

444

429

383

424

467

373

370

401

399

368

394

365

403

374

361

364

340

354

356

290

328

301

320

296

281

286

262

291

253

247

247

240

231

115

227

197

109

104

119

African Region

Zimbabwe

Lesotho

Swaziland

South Africa

Zambia

Malawi

Mozambique


Chad

Angola

Uganda



Guinea-Bissau

Burundi

Nigeria

Sierra Leone

Botswana

Mali

Cameroon

Congo

Burkina Faso

Kenya

Niger

Côte d'Ivoire

Equatorial Guinea

Namibia

Liberia

Gabon

Guinea

Togo

Rwanda

Ethiopia

Mauritania

Benin

Gambia

Ghana

Senegal

Madagascar

Comoros

Cape Verde


Eritrea

Seychelles

Mauritius

Algeria

Male Female


6

*Source: Levels and Trends in Child Mortality; Report 2010. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. UNICEF, WHO, The World Bank and United Nations DESA/Population Division. New York: UNICEF, 2010.

No data


12–3233–8485–128129–171172–210

Figure 13: Under-5 mortality rate per 1000 live births in the African Region, 2009*

127

72

59

21

18

13

60

179

104

114

46

41

34

89

African Region





European Region

Global

2009 1990 Figure 14: Under-5 mortality rate per 1000 live births in WHO Regions, both sexes, 2009 and 1990*

80

54

46

18

15

12

42

109

77

80

36

32

28

62

African Region





European Region

Global

2009 1990 Figure 15: Infant mortality rate per 1000 live births in WHO Regions, 2009 and 1990*

Mortality

7

127

209

199

193

192

191

171

166

166

161

160

154

145

142

142

141

138

128

128

119

118

117

112

111

110

108

104

104

103

98

93

90

84

84

78

73

69

69

62

58

57

55

48

32

28

17

12

179

201

199

240

285

250

175

201

189

258

305

148

198

231

232

179

212

104

184

152

184

129

247

171

218

162

128

210

153

150

151

81

99

93

95

92

93

120

62

167

60

150

73

61

63

24

15

African Region

Chad


Guinea-Bissau

Sierra Leone

Mali


Burkina Faso

Burundi

Angola

Niger

Cameroon

Equatorial Guinea

Guinea

Mozambique

Zambia

Nigeria

Congo

Uganda

Côte d'Ivoire

Benin

Mauritania

Liberia

Rwanda

Malawi


Comoros

Ethiopia

Gambia

Togo

Senegal

Zimbabwe

Kenya

Lesotho


Swaziland

Gabon

Ghana

South Africa

Madagascar

Botswana

Eritrea

Namibia

Algeria

Cape Verde

Mauritius

Seychelles

2009 1990

Figure 16: Under-5 mortality rate per 1000 live births in the African Region, by country, 2009 and 1990*

Figure 17: Infant mortality rate per 1000 live births in the African Region, by country, 2009 and 1990*


80

126

124

123

115

112

101

101

98

96

95

91

88

88

86

86

83

81

80

79

78

76

75

75

74

70

69

68

67

64

61

56

55

52

52

52

51

47

43

43

41

39

34

29

23

15

11

109

126

120

166

142

115

114

139

153

155

91

110

120

137

126

108

105

67

165

111

104

144

111

90

81

103

129

99

124

89

74

54

64

68

62

67

73

76

46

48

102

92

49

51

49

21

13

African Region


Chad

Sierra Leone

Guinea-Bissau


Burundi

Mali

Angola

Mozambique

Cameroon

Burkina Faso

Equatorial Guinea

Guinea

Nigeria

Zambia

Côte d'Ivoire

Congo

Liberia

Uganda

Gambia

Niger

Benin

Comoros

Mauritania

Rwanda

Malawi


Ethiopia

Togo

Lesotho

Zimbabwe

Kenya

Gabon


Swaziland

Senegal

Ghana

Botswana

South Africa

Madagascar

Eritrea

Namibia

Algeria

Cape Verde

Mauritius

Seychelles

2009 1990


8

*Source: Trends in Maternal Mortality: 1990 to 2008. Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO, 2010.

620

1200

1000

990

970

970

850

840

830

820

790

790

680

670

610

600

580

560

550

550

540

530

530

510

470

470

470

440

430

420

410

410

410

400

350

350

340

280

280

260

190

180

120

94

36

850

1300

1200

1100

1200

1300

880

1100

1200

1400

880

390

1200

900

1000

680

460

770

780

1000

1100

380

370

910

690

990

390

710

670

260

790

750

230

750

630

650

530

1000

930

260

83

180

250

230

72

African Region

Chad

Guinea-Bissau

Liberia

Burundi

Sierra LeoneCentral African

RepublicNigeria

Mali

NigerUnited Republic

of TanzaniaZimbabwe

GuineaDemocratic Republic

of the CongoAngola

Cameroon

Congo

Burkina Faso

Mauritania

Mozambique

Rwanda

Kenya

Lesotho

Malawi

Côte d'Ivoire

Ethiopia

Zambia

Madagascar

Uganda

Swaziland

Benin

Senegal

South Africa

Gambia

Ghana

Togo

Comoros

Equatorial Guinea

Eritrea

Gabon

Botswana

Namibia

Algeria

Cape Verde

Mauritius

2008 1990

Figure 19: Maternal mortality ratio per 100 000 live births in the African Region, by country, 2008 and 1990*

620

320

240

66

51

21

260

850

430

580

110

130

44

400

African Region


Region


Americas Region

Western PacificRegion

European Region

Global

2008 1990

Figure 18: Maternal mortality ratio per 100 000 live births in WHO Regions, 2008 and 1990*

Mortality

9

No data


52–360

361–758

759–1157

1158–1602

1603–2598

Figure 20: Age-standardized death rates* per 100 000 population due to communicable diseases in the African Region, 2004

No data


513–594

595–731

732–868

869–967

968–1071

Figure 21: Age-standardized death rates per 100 000 due to non-communicable diseases in the African Region, 2004

Figure 22: Age-standardized death rates per 100 000 due to injuries and violence in the African Region, 2004

No data


43–73

74–99

100–130

131–173

174–250

*Rates are age-standardized to WHO’s world standard population. Ahmad OB, Boschi-Pinto C, Lopez AD et al. Age Standardization of Rates: A New WHO Standard. Geneva: WHO, 2001. Available at: www.who.int/healthinfo/paper31.pdf.


10

Burden of disease

Figure 23: Total burden of disease in DALYs* per 1000 population in WHO Regions, 2004

511

273

265

171

164

152

African Region


South-East Asia

Europe

Americas

Western Pacific

12.4

11.2

8.6

8.2

3.6

3.6

3

2.9

1.9

1.9

HIV/AIDS


Diarrhoeal diseases

Malaria

Neonatal infections and other

Birth asphyxia and birth trauma

Prematurity and low birth weight

Tuberculosis

Road traffic accidents

Protein–energy malnutrition

Figure 24: Leading causes of burden of diseases shown as percentage of total DALYs in the African Region, 2004

*The disability-adjusted life-year (DALY) provides a consistent and comparative description of the burden of diseases and injuries needed to assess the comparative importance of diseases and injuries in causing premature death, loss of health and disability in different populations. The DALY extends the concept of potential years of life lost due to premature death to include equivalent years of ‘healthy’ life lost by virtue of being in states of poor health or disability. One DALY can be thought of as one lost year of ‘healthy’ life, and the burden of disease can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability. WHO. Burden of Diseases Update 2004. Geneva, July 2008.

Burden of disease

11

42.4

15.9

11.4

10.1

5.4

5.2

4.0

3.1

2.5

Infectious and parasitic diseases

Noncommunicable conditions




Neuropsychiatric disorders

Maternal conditions

Nutritional deficiencies


Figure 25: Distribution of burden of diseases as percentage of total DALYs by group in the African Region, 2004

71%

44%

42%

18%

17%

10%

21%

41%

44%

69%

69%

77%

8%

15%

14%

13%

14%

13%

African Region


South-East Asia

Western Pacific

Americas

Europe

Communicable diseases, maternal and perinatal conditions,and nutritional deficiencies

Non-communicable conditions

Injuries

Figure 26: Distribution of burden of diseases as percentage of total DALYs by broader causes in WHO Regions, 2004


12

71%

80%

79%

78%

78%

76%

76%

76%

75%

75%

75%

75%

74%

74%

74%

74%

74%

73%

73%

73%

72%

72%

72%

71%

71%

70%

69%

69%

69%

68%

68%

68%

66%

64%

64%

63%

62%

62%

61%

60%

58%

56%

41%

34%

16%

15%

21%

15%

15%

16%

15%

16%

17%

18%

17%

20%

19%

18%

18%

19%

17%

17%

20%

20%

20%

18%

17%

21%

20%

21%

20%

22%

25%

24%

25%

24%

25%

24%

21%

27%

29%

28%

30%

31%

29%

28%

32%

35%

46%

55%

71%

77%

8%

5%

5%

6%

7%

8%

7%

6%

7%

5%

6%

7%

7%

7%

9%

10%

6%

7%

7%

9%

10%

7%

8%

8%

9%

8%

6%

7%

7%

8%

7%

8%

13%

8%

8%

9%

8%

7%

10%

11%

10%

8%

13%

12%

13%

8%

African Region

Malawi

Niger

Zambia

Zimbabwe

Liberia

Sierra Leone

Mali

Rwanda

Lesotho

Guinea-Bissau

Botswana

Swaziland

Chad

Angola


Ethiopia

Burkina Faso

Mozambique

Burundi

Uganda

Nigeria

Kenya



Equatorial Guinea

Namibia

Cameroon

Benin

Congo

Togo

Guinea

Côte d'Ivoire

Senegal

Madagascar

Mauritania

Gambia

Ghana

Eritrea

South Africa

Gabon

Comoros

Cape Verde

Algeria

Seychelles

Mauritius

Communicable diseases, maternal and perinatal conditions, andnutritional deficiencies


Injuries

Figure 27: Distribution of burden of diseases as percentage of total DALYs by broader causes in the African Region, by country, 2004

Burden of disease

13

Figure 29: Distribution of years of life lost by broader causes in the African Region, by country, 2004

80

87

86

86

85

85

84

84

83

83

83

83

83

82

82

82

82

82

81

81

81

81

80

80

79

79

78

78

78

78

78

77

74

74

74

73

73

73

72

71

69

68

66

53

43

17

10

13

8

10

10

9

8

10

9

12

11

10

11

10

12

12

12

11

11

11

10

12

13

11

10

13

13

16

15

13

15

16

16

14

19

18

16

20

18

21

18

19

21

25

31

42

63

78

7

5

5

4

6

6

7

7

5

5

7

6

7

6

6

6

8

6

8

9

7

6

9

10

8

8

6

7

9

7

7

7

12

8

8

11

7

9

8

11

12

11

9

16

15

19

12

African Region

Malawi

Lesotho

Niger

Zambia

Zimbabwe

Botswana

Liberia

Guinea-Bissau

Mali

Rwanda

Sierra Leone

Swaziland

Burkina Faso

Chad

Ethiopia

Kenya

Namibia

Angola


Mozambique

Nigeria

Burundi

Uganda

Congo


Benin

Cameroon


Equatorial Guinea

Togo

Guinea

Côte d'Ivoire

Madagascar

Senegal

Eritrea

Ghana

Mauritania

Gambia


South Africa

Gabon

Comoros

Cape Verde

Algeria

Seychelles

Mauritius

Communicable disease


Injuries

*Years of life lost (YLL) take into account the age at which deaths occur by assigning greater statistical weight to deaths occurring at younger ages and lower statistical weight to deaths occurring at older ages.

80

56

52

25

24

12

51

13

30

31

55

57

70

34

7

15

17

20

19

18

14

African Region





European Region

Global

Communicable disease


Injuries

Figure 28: Distribution of years of life lost* by broader causes in WHO Regions, 2004

14

2The Health System

Health financing

Figure 30: Per capita total expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000

137

104

271

531

1875

3046

863

86

61

180

298

1220

1983

568

African Region




European Region


Global

2007 2000

6.2

3.6

4.1

6.5

8.8

13.6

9.7

5.9

3.7

4.2

6.8

8.4

12.0

9.2

African Region




European Region


Global

2007 2000 Figure 31: Total expenditure on health as percentage of GDP in WHO Regions, 2007 and 2000

Health financing

15

137

17

20

20

30

30

32

33

35

37

39

39

41

47

50

51

62

63

67

67

68

70

71

72

72

72

74

79

90

92

95

99

104

113

131

131

148

183

287

338

467

502

543

650

762

819

1094

86

8

33

26

26

20

18

35

16

27

39

26

30

35

37

22

46

29

82

50

43

55

56

41

49

51

46

50

60

69

25

57

73

67

55

59

100

203

188

252

299

135

529

357

551

856

African Region


Eritrea

Zimbabwe


Ethiopia

Sierra Leone

Guinea-Bissau

Niger

Comoros

Liberia

Mozambique

Madagascar

Mauritania

Malawi

Burundi

Guinea


Côte d'Ivoire

Mali

Togo

Benin

Gambia

Burkina Faso

Chad

Kenya

Uganda

Zambia

Congo

Lesotho

Rwanda

Senegal

Cameroon

Ghana

Angola

Nigeria

Cape Verde


Swaziland

Algeria

Namibia

Mauritius

Equatorial Guinea

Gabon

Botswana

South Africa

Seychelles

2007 2000

Figure 32: Per capita total expenditure on health (PPP int. $) in the African Region, by country, 2007 and 2000

Figure 33: Total expenditure on health as percentage of GDP in the African Region, by country, 2007 and 2000

6.2

2.1

2.4

2.4

2.5

3.3

3.3

3.8

4.1

4.1

4.2

4.2

4.4

4.4

4.5

4.6

4.7

4.8

4.8

4.9

4.9

5.1

5.3

5.3

5.5

5.6

5.7

5.7

5.7

5.8

6.0

6.1

6.1

6.1

6.2

6.2

6.3

6.6

7.6

8.3

8.6

8.9

9.9

10.3

10.6

11.2

13.9

5.9

1.9

2.1

2.8

2.4

2.8

5.5

4.3

3.8

3.7

5.3

3.8

3.5

4.9

4.6

4.5

4.5

4.6

6.3

4.5

5.9

5.3

3.5

3.8

5.8

5.3

4.4

6.3

4.4

3.7

5.7

5.1

6.2

4.8

6.7

5.7

6.6

4.6

6.1

7.2

8.5

10.0

6.1

4.2

9.2

10.2

7.2

African Region

Equatorial Guinea

Congo

Mauritania

Angola

Comoros

Eritrea

Ethiopia


Madagascar

Côte d'Ivoire

Mauritius

Algeria

Sierra Leone

Cape Verde

Gabon

Kenya

Benin

Chad

Cameroon

Mozambique

Seychelles

Niger


Gambia

Guinea

Botswana

Mali

Senegal


Swaziland

Burkina Faso

Guinea-Bissau

Togo

Lesotho

Zambia

Uganda

Nigeria

Namibia

Ghana

South Africa

Zimbabwe

Malawi

Rwanda

Liberia


Burundi

2007 2000

2 The Health System

16

No dataOutside WHOAfrican Region

11.00–31.30

31.31–42.10

42.11–52.80

52.81–66.20

66.21–81.60

Figure 34: General government expenditure on health as percentage of total expenditure on health in the African Region, 2007

No data


4.00–6.50

6.51–9.30

9.31–12.10

12.11–14.99

15.00–19.50

Figure 35: General government expenditure on health as percentage of total government expenditure, 2007

Health financing

17

45

37

47

56

68

76

60

44

31

45

53

73

75

58

African Region




Region


European Region

Global

2007 2000 Figure 36 : General government expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000

6.9

1.8

1.7

0.1

0

0

0.2

5.4

1.0

0.9

0.1

0.1

0.1

0.1

African Region


Region




European Region

Global

2007 2000 Figure 37: External resources for health as percentage of total expenditure on health in WHO Regions, 2007 and 2000

2 The Health System

18

9.6

4.0

4.2

4.7

4.8

5.1

5.3

5.3

6.4

6.5

6.9

7.7

7.8

7.8

7.9

8.1

8.4

8.9

8.9

9.1

9.3

9.8

10.2

10.5

10.7

10.7

10.7

10.8

11.0

11.1

11.6

11.8

11.9

12.1

12.4

12.5

12.6

13.0

13.2

13.3

13.8

14.0

14.5

14.8

16.6

18.4

19.5

8.7

2.3

4.0

4.0

7.2

4.8

3.2

6.5

0.4

4.2

7.8

8.0

11.6

7.6

6.5

6.4

9.5

8.4

10.7

11.6

8.7

7.3

8.5

9.6

11.3

9.0

10.8

10.9

10.1

13.1

8.8

9.5

8.6

8.8

10.3

7.9

17.9

6.9

9.0

8.9

13.1

14.0

9.4

14.0

9.0

9.1

8.2

2007 2000

African Region

Guinea-Bissau

Eritrea

Guinea

Côte d'Ivoire

Congo

Angola

Mauritania


Nigeria

Equatorial Guinea

Togo

Kenya

Sierra Leone

Lesotho

Cameroon

Comoros

Seychelles

Zimbabwe

Swaziland

Mauritius

Uganda

Ethiopia

Cape Verde

Benin

Algeria

Ghana

South Africa


Namibia

Gambia

Mali

Malawi

Senegal

Niger

Burundi

Mozambique

Botswana


Burkina Faso

Chad

Gabon

Zambia

Madagascar

Liberia


Rwanda

6.9

74.9

59.9

57.8

57.7

52.3

49.9

47.8

46.5

43.9

40.0

35.0

33.1

31.6

31.3

28.3

25.9

24.3

24.1

21.7

21.3

20.9

19.8

17.8

15.5

13.3

11.5

11.3

10.8

10.6

10.3

10.1

8.5

7.9

5.4

5.2

5.0

4.8

4.0

3.7

2.2

2.2

1.8

1.5

0.8

0.2

0.1

5.4

40.2

26.9

26.4

5.6

52.0

27.8

3.7

24.6

16.5

16.3

46.5

17.8

28.3

19.6

13.9

22.9

22.2

8.3

28.6

16.0

26.4

7.8

20.1

13.5

23.6

3.1

24.9

9.0

3.8

9.5

6.6

17.2

5.5

4.6

4.1

5.1

9.5

0.5

3.6

16.2

5.6

1.4

1.5

0.3

1.3

0.1

African Region

Niger

Malawi

Mozambique

Liberia

Rwanda



Eritrea

Ethiopia

Burundi

Guinea-Bissau

Zambia

Uganda

Sierra Leone

Burkina Faso


Gambia

Kenya


Benin

Comoros

Mali

Madagascar

Cape Verde

Mauritania

Lesotho

Chad

Guinea

Namibia

Ghana

Togo

Senegal

Swaziland

Congo

Cameroon

Côte d'Ivoire

Equatorial Guinea

Botswana

Angola

Nigeria

Seychelles

Mauritius

Gabon

South Africa

Zimbabwe

Algeria

2007 2000

Figure 38: General government expenditure on health as percentage of total government expenditure in the African Region, by country, 2007 and 2000

Figure 39: External resources for health as percentage of total expenditure on health in the African Region, by country, 2007 and 2000

Health financing

19

55

63

53

45

32

24

40

57

69

55

47

27

25

42

African Region





European Region

Global

2007 2000

2007 2000

60

87

86

82

67

28

44

53

89

84

88

66

30

44

African Region




European Region


Global

Figure 40: Private expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000

Figure 41: Out-of-pocket expenditure as percentage of private expenditure on health in WHO Regions, 2007 and 2000

2 The Health System

20

Figure 42: Private expenditure on health as percentage of total expenditure on health in the African Region, by country, 2007 and 2000

Figure 43: Out-of-pocket expenditure as percentage of private expenditure on health in the African Region, by country, 2007 and 2000

55

89

79

76

75

75

74

74

74

74

69

65

62

59

58

58

55

54

53

53

52

51

49

48

48

47

44

44

44

43

42

42

42

40

38

36

35

34

34

30

30

28

25

25

20

20

18

57

88

99

75

70

67

79

84

85

73

57

59

62

60

52

31

50

47

61

64

66

48

67

59

52

46

63

60

58

46

49

46

49

56

41

32

29

57

34

25

42

28

39

27

21

50

27

African Region

Guinea


Côte d'Ivoire

Togo

Nigeria

Cameroon

Guinea-Bissau

Liberia

Uganda

Sierra Leone


Burundi

South Africa

Kenya

Namibia

Eritrea

Zimbabwe

Rwanda


Gambia

Mauritius

Mali

Ghana

Benin

Niger

Senegal

Burkina Faso

Chad

Comoros

Zambia

Ethiopia

Lesotho

Malawi

Swaziland

Gabon

Mauritania


Madagascar

Seychelles

Congo

Mozambique

Botswana

Cape Verde

Angola

Equatorial Guinea

Algeria

2007 2000

60

100

100

100

100

100

100

100

100

100

96

96

96

95

95

95

95

91

89

84

82

81

79

79

77

76

75

69

68

68

63

61

59

59

56

52

52

51

50

48

44

42

42

30

28

27

6

53

100

100

100

100

100

100

100

100

99

88

96

93

95

100

97

94

94

91

87

75

79

80

92

80

90

84

73

53

81

63

71

56

75

61

52

97

57

46

54

41

42

45

25

42

36

18

African Region

Angola

Comoros

Congo

Eritrea

Gabon

Mauritania

Cape Verde

Guinea

Mali

Niger

Chad

Nigeria


Benin

Algeria

Cameroon

Burkina Faso

Côte d'Ivoire

Togo

Mauritius

Ethiopia

Ghana

Senegal

Kenya

Equatorial Guinea


Lesotho

Madagascar

Zambia

Seychelles

Burundi


Sierra Leone

Guinea-Bissau

Liberia


Uganda

Zimbabwe

Gambia

Rwanda

Swaziland

Mozambique

South Africa

Malawi

Botswana

Namibia

2007 2000

Health financing

21

63

36

137

330

1401

1437

493

38

18

85

190

901

896

320

African Region




European Region


Global

2007 2000

63

4

7

8

9

9

10

10

10

16

17

17

18

19

20

21

27

27

28

30

30

31

33

34

34

36

40

40

41

45

46

54

56

58

63

86

105

110

180

196

246

276

340

419

436

568

768

38

6

6

17

14

11

6

8

20

11

13

9

9

12

14

16

20

19

24

16

25

20

19

16

26

16

21

12

10

26

35

21

28

34

43

74

119

174

156

138

223

359

67

218

644

African Region


Guinea

Guinea-Bissau

Eritrea

Zimbabwe


Liberia

Sierra Leone

Côte d'Ivoire

Ethiopia

Togo

Niger

Burundi

Uganda

Comoros

Cameroon

Madagascar

Mozambique

Kenya

Malawi

Mauritania

Nigeria

Gambia

Mali

Benin

Burkina Faso

Chad


Rwanda

Zambia

Lesotho

Senegal

Ghana

Congo


Angola

Cape Verde

Swaziland

Namibia

Mauritius

Algeria

South Africa

Gabon

Equatorial Guinea

Botswana

Seychelles

2007 2000

Figure 44: Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000

Figure 45: Per capita government expenditure on health (PPP int. $) in the African Region, by country, 2007 and 2000

2 The Health System

22

Health workforce

No data


0.49–1.00

1.01–3.00

3.01–5.00

5.01–8.00

8.01–15.0

2

5

10

14

23

33

14

African Region



Region



European Region

Global

Figure 46: Physician-to-population ratio (per 10 000 population) in the African Region, 2000–2009

Figure 47: Physician-to-population ratio (per 10 000 population) in WHO Regions, 2000–2009

Health workforce

23

No data


0.49–4.00

4.01–10.00

10.01–26.00

26.01–50.00

50.01–79.00

Figure 48: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in the African Region, 2000–2009

11

11

14

21

55

68

28

African Region



Region



European Region

Global

Figure 49: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in WHO Regions, 2000–2009

2 The Health System

24

Figure 50: Physician-to-population ratio (per 10 000 population) in the African Region, by country, 2000–2009

Figure 51: Nursing and midwifery personnel-to-population ratio (per 10 000 population) in the African Region, by country, 2000–2009

2

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

2

2

2

2

2

3

3

3

4

4

5

6

8

11

12

15

African Region

Burundi

Chad

Ethiopia

Gambia

Guinea-Bissau

Liberia

Malawi

Mozambique

Niger

Rwanda

Sierra Leone


Angola

Benin

Burkina Faso


Congo

Côte d'Ivoire


Eritrea

Ghana

Guinea

Kenya

Lesotho

Mali

Mauritania

Senegal

Togo

Uganda

Zambia

Cameroon

Comoros

Madagascar

Swaziland

Zimbabwe

Equatorial Guinea

Gabon

Namibia

Botswana

Nigeria


Cape Verde

South Africa

Mauritius

Algeria

Seychelles

11

0.5

1

2

2

2

2

2

3

3

3

3

3

3

4

4

4

5

5

5

6

6

6

6

7

7

7

7

7

8

8

10

12

13

13

13

16

16

19

19

26

31

37

41

50

63

79

African Region

Guinea

Niger

Burundi

Ethiopia

Mali

Sierra Leone


Chad

Liberia

Madagascar

Malawi

Mozambique

Togo


Rwanda

Senegal

Côte d'Ivoire


Equatorial Guinea

Eritrea

Gambia

Guinea-Bissau

Lesotho

Burkina Faso

Comoros

Mauritania

Zambia

Zimbabwe

Benin

Congo

Ghana

Kenya

Angola

Cape Verde

Uganda

Cameroon

Nigeria


Algeria

Botswana

Namibia

Mauritius

South Africa

Gabon

Swaziland

Seychelles

Medical products and equipment

25

Figure 52: Median percentage availability of selected generic medicines in a sample of health facilities in the African Region, countries with data in 2001–2008

Figure 53: Median consumer price ratio of selected generic medicines (ratio of median local unit price to management sciences for health international reference price), countries with data, 2001–2008

18

20

21

23

26

31

38

53

56

58

81

45

80

31

48

36

14

72

88

22

53

70

72

Ghana

Uganda

Congo

United Republicof Tanzania

Nigeria

Chad

Kenya

Ethiopia

Sao Tome andPrincipe

Cameroon

Mali

South Africa

Public Private

6.5

3.9

3.5

2.4

2.4

2.2

2.0

1.8

1.3

1.3

11.5

15.1

4.3

3.8

13.8

13.6

3.3

5.4

6.5

2.2

2.6

2.7

Congo

Chad

Nigeria

Ghana

Sao Tome andPrincipe

Cameroon

Kenya

Mali

South Africa

Ethiopia

Uganda

United Republicof Tanzania

Public Private

Figure 54: Hospital beds per 10 000 population in WHO Regions, 2000–2009

9

11

12

24

38

63

27

African Region





European Region

Global

Medical products and equipment

2 The Health System

26

Figure 55: Hospital beds per 10 000 population in the African Region, by country, 2000–2009

9

2

3

3

3

4

4

4

4

4

5

5

6

7

7

8

8

8

9

9

9

9

10

10

11

11

11

12

12

13

13

15

16

17

18

19

19

19

21

21

22

27

28

30

32

33

39

African Region

Ethiopia

Guinea

Niger

Senegal

Uganda

Côte d'Ivoire

Mauritania

Sierra Leone

Chad

Benin

Nigeria

Mali

Liberia

Burundi

Angola


Mozambique

Togo

Burkina Faso

Ghana


Guinea-Bissau

Madagascar

Kenya

Malawi

Gambia

Eritrea


Gabon

Lesotho

Cameroon

Congo

Rwanda

Botswana

Zambia

Equatorial Guinea

Algeria

Cape Verde

Swaziland

Comoros

Namibia

South Africa

Zimbabwe


Mauritius

Seychelles

Health information – Civil registration coverage

27

Health information – Civil registration coverage

Figure 56: Percentage of civil registration coverage for births in the African Region, by country, 2000–2008

Figure 57: Percentage of civil registration coverage for deaths in the African Region, 2000–2008

4

7

8

9

10

21

26

29

30

30

31

31

32

32

39

43

48

48

49

51

53

55

55

55

56

58

60

60

64

67

69

70

74

75

78

78

81

82

83

89

90

90

90

90

Liberia

Ethiopia


Chad

Zambia

Uganda

Lesotho

Angola

Nigeria

Swaziland


Mozambique

Equatorial Guinea

Niger

Guinea-Bissau

Guinea

Kenya

Sierra Leone


Ghana

Mali

Côte d'Ivoire

Gambia

Senegal

Mauritania

Botswana

Benin

Burundi

Burkina Faso

Namibia


Cameroon

Zimbabwe

Madagascar

South Africa

Togo

Congo

Rwanda

Comoros

Gabon

Cape Verde

Algeria

Mauritius

Seychelles

No data


<2525–4949–7575–8990–100

2 The Health System

28

Health research

Figure 58: Institutional level policies on research

Figure 59: Roles of Ministry of Health (MOH) and other central policy setting and implementing bodies in the African Region as percentage, 2007

43%

37%

27%

Requirement of ethical reviewfor all research involving human

subjects conducted anywhere inwhich researchers of institution

participate

46%

34%

25%

Availability of a written policy onethical review for all research

involving human subjects withininstitution by staff (faculty,

researchers, or others)

49%

49%

29%

Availability of written policiesrequiring that researchers obtain

the informed consent ofparticipants

High research activity (n=279)

Medium research activity (n=194)

Low research activity (n=161)

28.641.2

50

National guidelines issued byprofessional associations

92.970.6

25MOH carries out benchmarking

13100

87.5MOH carries out strategic planning

14.341.2

12.5

Physicians are required toundertake continuing medical

education (CME) to remain licensed

42.958.8

25

Physicians are licensed byanother body

64.329.4

62.5MOH licenses physicians

Western Subregion (14 countries)

Southern/Eastern Subregion (17 countries)

Central Subregion (8 countries)

5058.8

37.5

National accrediation is carried outby another body

57.147.1

50

MOH carries out nationalaccreditation of medical

schools/hospitals

64.323.5

37.5

MOH maps knowledge sourcesand flows for policy making

35.729.4

37.5

This is an explicit knowledgemanagement framework in MOH

29

3Specific Programmes

and ServicesHIV/AIDS

Figure 60: HIV/AIDS mortality rate (per 100 000 population) in the African Region, 2007

Figure 61: HIV/AIDS mortality rate (per 100 000 population) in WHO Regions, 2007

No data


9–6566–138139–253254–585586–1049

174

13

12

11

5

5

African Region



European Region


Western Paci�c Region

3 Specific Programmes and Services

30

Figure 62: Prevalence of HIV (per 100 000 population) among people aged 15 years or more in WHO Regions, 2007

Figure 63: Percentage of antiretroviral therapy among people with HIV/AIDS in need of treatment in WHO Regions, 2009*

*Source: WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector – Progress Report 2010.

5700

448

336

295

202

89

644

African Region

Americas Region

European Region




Global

37

50

33

32

19

7

36

54

54

32

34

93

2

53

African Region

Americas Region



European Region


Global

All Pregnant women

31

4.9

26.1

23.9

23.2

18.1

15.3

15.3

15.2

12.5

11.9

6.3

6.2

5.9

5.4

5.1

4.9

3.9

3.5

3.5

3.4

3.3

3.1

2.8

2.1

2.0

2.0

1.9

1.8

1.7

1.7

1.7

1.6

1.6

1.5

1.3

1.3

1.2

1.0

0.9

0.8

0.8

0.1

0.1

0.1

6.2

26.3

26.5

23.9

16.9

14.6

26.0

15.4

10.3

13.3

6.4

7.0

5.6

7.9

6.0

7.7

6.0

3.4

4.4

3.7

3.6

3.2

4.3

1.6

3.5

2.4

2.3

1.8

1.4

0.3

1.3

2.1

1.2

1.5

1.3

1.2

1.3

0.4

0.9

0.7

0.7

0.1

0.1

0.1

African Region

Swaziland

Botswana

Lesotho

South Africa

Namibia

Zimbabwe

Zambia

Mozambique

Malawi



Gabon

Uganda

Cameroon

Kenya

Cote d'Ivoire

Chad

Congo

Equatorial Guinea

Togo

Nigeria

Rwanda

Angola

Burundi

Ethiopia

Ghana

Guinea-Bissau

Liberia

Mauritius

Sierra Leone

Burkina Faso

Guinea

Mali

Democratic Rep of the Congo

Eritrea

Benin

Senegal

Gambia

Mauritania

Niger

Algeria

Comoros

Madagascar

2007 2001

Figure 64: Percentage of people 15–49 years of age living with HIV in the African Region, by country, 2007 and 2001

Figure 65: Percentage of people receiving antiretroviral therapy in the African Region, by country, 2009 and 2007*

*Source: WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector – Progress Report 2010.

1417

24

1818

18

1923

1820

2126

1921

2210

2222

2425

2317

2520

2415

2523

2531

2828

2825

3020

2919

3031

3024

3613

3417

3728

3713

4027

3933

4635

4635

4838

4742

5041

4826

5349

5156

6446

5942

8379

7688

24

29

8871

37

30African Region

Madagascar

Liberia

Comoros

Gambia

Sierra Leone

Burundi


Nigeria

Mauritius

Niger

Congo

Angola

Ghana

Algeria

Equatorial Guinea

Mauritania

Cameroon

Côte d'Ivoire

Togo

Guinea-Bissau

Mozambique


Zimbabwe

Chad

Eritrea

South Africa

Uganda

Guinea

Burkina Faso

Malawi

Gabon

Kenya

Lesotho

Mali

Senegal

Benin

Swaziland

Zambia

Namibia

Botswana

Rwanda


Ethiopia

2009 2007


32

Figure 66: Percentage of men and women aged 15–24 years who used a condom at last high-risk sex, African Region, 2002–2006*

Figure 67: Population aged 15–24 years with comprehensive correct knowledge of HIV/AIDS

*Source: United Nations Statistical Division, MDG Database, June 2010.

125

2517

3329

3617

3616

3726

3718

3833

4026

4528

4634

4624

4725

5028

5242

5236

5339

5353

5553

57626040676468427054

20

25

39

41

50

54

56

44

32African Region

Madagascar

Chad

Mozambique

Mali

Congo

Guinea

Niger

Zambia

Rwanda

Benin


Nigeria

Kenya

Ethiopia

Ghana

Senegal

Côte d'Ivoire

Lesotho

Uganda

Cameroon

Malawi

Burkina Faso

Zimbabwe

Swaziland


Gambia

Togo


Guinea-Bissau

Burundi

Sierra Leone

Male Female

1619

1613

197

1927

2115

2118

2218

2315

2317

2621

2717

2818

3320

3325

3320

3427

3516

3526

363636

2437

3438

3240

4546

4447

345252

6265

5451

4

13

17

18

18

28

30

37

39

44

30

23African Region

Madagascar

Niger

Chad

Lesotho


Nigeria

Mali

Burkina Faso

Guinea

Senegal


Côte d'Ivoire

Ethiopia

Ghana

Mozambique

Cameroon

Benin

Congo

Cape Verde

Malawi

Zambia

Uganda


Zimbabwe

Kenya

Swaziland

Rwanda

Namibia

Algeria

Burundi

Comoros

Equatorial Guinea

Eritrea

Gambia

Guinea-Bissau


Sierra Leone

Togo

Male Female

Tuberculosis

33

Tuberculosis

Figure 68: Tuberculosis death rate per 100 000 population per year in the African Region, by country, 2007 and 2000*

*Source: United Nations Statistical Division, MDG Database, June 2010.

Figure 69: Tuberculosis incidence rate per 100 000 population per year in the African Region, by country, 2008 and 2000*

90

317

265

263

230

194

149

138

128

128

127

115

102

102

102

100

93

93

92

90

90

90

8782

78

76

75

7069

65

65

62

55

52

48

44

3938

33

31

27

18

16

6

5

4

2

83

362

185

76183

8497

122

125

118

111

255

87

87

126

113

86

103

79

43

85

73

44

7389

86

78

46

63

114

50

6565

55

41

43

56

36

75

42

30

17

14

9

5

4

2

African Region

Swaziland

Zimbabwe

Lesotho

South Africa

Botswana

Sierra Leone

Togo

Côte d'Ivoire

Rwanda

Mozambique

Zambia

Namibia

Burundi

Malawi


Nigeria

Uganda

Ethiopia

Congo

Mali

Chad

Equatorial Guinea



Gabon

Mauritania

Guinea

Burkina Faso

Kenya

Senegal

Liberia

Gambia

Ghana

Madagascar

Guinea-Bissau

Cameroon

Niger

Angola

Cape Verde


Benin

Eritrea

Comoros

Seychelles

Mauritius

Algeria

2007 2000

350

1200

960

760

750

710

640

610

470

450

440

420410

390

390

380

370

360

340

330

320

320

320

310

300

300

290

290

280

280

260

260

220

220

200

190

190

180

150

130

99

97

92

58

40

32

22

320

800

580

680

670

640

550

380600

250

370

380

370

350

350

340

330

320

300

400

420

300

280

340

200

270

250

260

240

240

230

220

200

190

210

170

240

150

160

0110

85

85

48

56

37

24

African Region

Swaziland

South Africa

Zimbabwe

Namibia

Botswana

Lesotho

Sierra Leone

Zambia

Gabon

Togo

Mozambique

Côte d'Ivoire

Congo

Rwanda


Ethiopia

Burundi


Kenya

Malawi

Mali

Mauritania

Uganda

Guinea

Nigeria

Angola

Chad

Liberia

Senegal

Gambia

Madagascar

Burkina Faso

Guinea-Bissau

Ghana

Cameroon


Niger

Cape Verde

Equatorial Guinea


Eritrea

Benin

Algeria

Comoros

Seychelles

Mauritius

2008 2000


34

Figure 71: Percentage of tuberculosis detection rate under DOTS in WHO Regions, 2007 and 2000

480

1200

930

790

770

750

730

720

700

670

660

610

610

580

560

560

560

550

490

490

470

430

420

420

410

400

390

390

340

330

310

290

280

260

220

190

180

150

150

130

130

82

75

65

63

40

15

470

820

810

470

530

650

620

600

450

520

650

600

470

510

300

540

460

380

410

220

540

350

440

480

230

420

270

300

380

310

410

250

300

350

280

360

500

270

150

130

180

35

41

99

0

38

15

African Region

Sierra Leone

Togo

Zimbabwe

Swaziland

Mali

Côte d'Ivoire

Rwanda

Mauritania

Burundi


Nigeria

South Africa

Chad

Botswana

Ethiopia

Senegal

Guinea

Burkina Faso

Lesotho

Mozambique

Madagascar


Liberia

Gabon

Ghana

Congo

Gambia

Uganda

Niger

Malawi

Namibia

Cape Verde

Zambia

Guinea-Bissau

Angola

Kenya

Cameroon


Benin


Eritrea

Seychelles

Comoros

Equatorial Guinea

Mauritius

Algeria

2008 2000

47

77

73

69

60

51

63

36

37

43

18

25

12

28

African Region


Americas Region



European Region

Global

2007 2000

Figure 70: Tuberculosis prevalence per 100 000 population per year in the African Region, by country, 2008 and 2000

Tuberculosis

35

Figure 72: Percentage of tuberculosis detection under DOTS in the African Region, by country, 2007 and 2000*

47

98.4

101.8

91.4

83.6

78.1

72.1

69.5

68.7

66.2

63.9

60.7

58.3

57.2

55.7

54.7

53.5

52.8

50.9

50.5

49

48.3

44

42.2

41.4

39.3

36.9

35.9

34.5

28.1

26.8

26.6

25.4

22.9

22.6

18.5

18.4

16.5

15.1

36

127.3

32.7

82

62.6

52.9

88.3

46.8

73.2

90.1

54.7

40.7

51.2

52.4

47

53.5

33.7

44

33.3

38.3

43.3

31

44.8

32.3

17.1

12.1

15.8

77.8

11.6

African Region

Algeria

Angola

Cameroon

Namibia

South Africa

Kenya

Madagascar

Mauritius

Gabon

Gambia


Zambia

Botswana

Congo

Swaziland

Guinea

Niger

Uganda


Mozambique

Senegal

Cape Verde

Côte d'Ivoire

Malawi

Mauritania

Sierra Leone

Ghana

Eritrea

Ethiopia

Burundi

Zimbabwe

Rwanda

Mali

Nigeria

Chad

Burkina Faso

Lesotho

Togo

2007 2000


36

Malaria

Figure 74: Percentage of children under 5 years of age sleeping under insecticide-treated bed nets in the African Region, by country, 2005–2009 and 2000–2004*

*Source: World Malaria Report 2009. Geneva: WHO, 2009.

11 030

5371

4987

4831

3790

3432

3200

3080

2834

2533

2039

2034

1651

1344

1004

933

898

840

772

727

701

509

479

422

353

201

188

152

149

120

63

18

12

11

10

8

6

2

0

Uganda


Malawi

Mozambique

Burkina Faso

Angola

Ghana

Zambia

Nigeria

Ethiopia

Burundi

Niger

Cameroon

Côte d'Ivoire

Zimbabwe

Sierra Leone

Togo

Kenya

Rwanda

Liberia

Senegal

Gambia

Chad

Guinea

Madagascar

Mauritania

Gabon


Guinea-Bissau

Namibia

Equatorial Guinea

Botswana

Algeria

Eritrea


South Africa

Swaziland


Cape Verde

55.7

51.4

49.0

48.9

46.7

45.8

41.7

41.1

39.0

38.4

33.1

29.2

28.2

25.8

25.7

23.0

20.1

15.1

13.1

9.7

9.6

8.3

7.4

5.9

5.8

5.5

0.6

4.3

2.6

14.7

4.2

2.9

0.2

22.5

1.1

7.4

2.0

1.5

1.7

3.5

1.5

16.0

2.8

7.4

1.5

1.3

0.2

1.6

1.3

1.0

1.1

0.7

1.2

0.1

Rwanda

Liberia

Gambia

Eritrea

Kenya

Madagascar


Zambia

Guinea-Bissau

Togo

Ethiopia

Senegal

Ghana

Sierra Leone


Malawi

Benin


Cameroon

Uganda

Burkina Faso

Burundi

Niger

Cote d'Ivoire


Nigeria

Swaziland

2005–2009 2000–2004

Figure 73: Noti�ed cases of malaria, in thousands, in the African Region, by country, 2008

Malaria

37

Figure 75: Malaria mortality rate per 100 000 population in the African Region, 2008

Figure 76: Proportion of children under 5 years of age with fever being treated with antimalarial drugs in the African Region, by country, 2005–2009 and 2000–2004

No data


0.38–4.484.49–11.1011.11–19.7719.78–30.9130.92–52.52

5.6

9.1

9.5

13.1

19.7

20.3

23.0

23.5

23.9

24.7

29.8

30.0

30.1

33.0

33.2

36.0

43.0

43.3

45.7

47.7

48.0

54.0

56.7

57.0

57.8

62.6

67.2

9.2

36.2

3.0

3.6

34.2

14.4

14.9

26.5

28.4

61.2

52.0

31.3

60.7

48.1

33.9

57.5

62.8

51.9

58.4

60.0

49.6

60.4

58.2

68.8

66.1

55.2

58.8

Rwanda

Senegal

Ethiopia

Eritrea

Madagascar

Namibia

Mozambique

Kenya

Malawi



Burundi

Sierra Leone

Niger

Nigeria

Cote d'Ivoire

Ghana

Zambia

Guinea-Bissau

Togo

Burkina Faso

Benin



Cameroon

Gambia

Liberia

2005–2009 2000–2004


38

Vaccine-preventable diseases

Figure 77: Percentage of neonates protected at birth against neonatal tetanus in WHO Regions, 2008 and 1990

Figure 78: Percentage immunization coverage among 1-year-olds for DTP3 in WHO Regions, 2008 and 1990

78

71

72

79

81

86

81

43

42

21

57

51

76

60

African Region


European Region




Global

2008 1990

72

72

82

92

95

95

82

57

70

71

74

78

94

75

African Region




European Region


Global

2008 1990

Vaccine-preventable diseases

39

78

71

58

64

69

73

75

75

76

76

77

78

78

78

79

79

81

81

82

82

83

83

83

84

84

85

85

85

86

86

86

86

86

87

87

88

90

91

91

92

92

92

94

96

97

43

75

14

32

58

84

53

45

57

24

67

75

60

34

55

47

77

60

78

37

24

17

59

85

41

19

69

60

63

81

61

45

62

85

33

48

36

45

40

27

85

African Region

Algeria

Chad

Nigeria

Equatorial Guinea

Gabon


South Africa

Madagascar

Zimbabwe

Mauritania

Burundi

Cape Verde

Kenya

Angola

Burkina Faso

Togo


Congo

Namibia

Comoros

Lesotho

Mozambique

Ethiopia

Niger

Botswana

Rwanda

Uganda

Cameroon


Eritrea

Ghana

Swaziland

Malawi

Mauritius

Senegal

Zambia

Gambia

Liberia

Benin

Côte d'Ivoire

Mali

Guinea-Bissau

Guinea

Sierra Leone

2008 1990

72

20

33

38

54

54

60

62

63

64

64

66

66

67

67

68

69

72

74

74

79

80

81

81

81

82

83

83

84

84

85

87

88

89

89

91

92

93

95

96

96

97

97

98

99

99

99

57

20

77

78

82

56

88

61

45

17

22

74

72

42

35

46

54

33

66

91

24

94

49

46

82

48

78

84

58

51

79

77

87

86

89

89

92

92

84

88

85

9299

African Region

Chad

Equatorial Guinea

Gabon


Nigeria

Sierra Leone

Zimbabwe

Guinea-Bissau

Liberia

Uganda

Guinea

Niger

Benin

South Africa

Mali


Mozambique

Côte d'Ivoire

Mauritania

Burkina Faso

Zambia

Angola

Comoros

Ethiopia

Madagascar

Lesotho

Namibia

Cameroon


Kenya

Ghana

Senegal

Congo

Togo

Malawi

Burundi

Algeria

Swaziland

Botswana

Gambia

Eritrea

Rwanda

Cape Verde

Mauritius


Seychelles

2008 1990

Figure 79: Percentage of neonates protected at birth against neonatal tetanus in the African Region, by country, 2008 and 1990 Figure 80: Percentage immunization coverage among

1-year-olds for DTP3 in the African Region, by country, 2008 and 1990


40

Figure 81: Immunization coverage among 1-year-olds for HepB3 in WHO Regions, 2008

Figure 82: Immunization coverage among 1-year-olds for HepB3 in the African Region, by country, 2008

67

41

76

81

88

89

69

African Region


European Region




Global

67

10

24

38

41

60

62

64

67

67

68

68

69

71

72

74

74

79

80

81

81

82

83

84

84

85

85

87

88

89

91

91

91

92

93

95

97

97

99

99

99

99

African Region

Chad

Togo

Gabon

Nigeria

Sierra Leone

Zimbabwe

Liberia

Benin

South Africa

Mali

Uganda


Guinea

Mozambique

Côte d'Ivoire

Mauritania

Burkina Faso

Zambia

Comoros

Ethiopia

Madagascar

Angola

Cameroon


Kenya

Lesotho

Ghana

Senegal

Congo

Cape Verde

Malawi

Algeria

Burundi

Botswana

Swaziland

Eritrea

Rwanda

Gambia

Mauritius


Seychelles

Child and adolescent health

41

Child and adolescent health

Figure 84: Percentage of infants exclusively breastfed for the �rst 6 months of life in WHO Regions, 2000–2009

Figure 83: Distribution of causes of death among children aged under 5 years, 2008

Figure 85: Percentage of infants exclusively breastfed for the �rst 6 months of life in the African Region, by country, 2000–2009

31

23

31

36

43

36

African Region

European Region




Global

31

7

2

4

5

7

7

10

11

11

13

19

19

21

21

22

23

24

28

29

30

32

32

34

36

36

38

41

41

43

45

48

48

49

51

51

52

57

60

60

61

63

88

African Region

Algeria

Chad

Côte d'Ivoire

Gabon

Burkina Faso

South Africa

Niger

Angola

Sierra Leone

Nigeria

Congo

Mauritania

Cameroon

Comoros

Zimbabwe


Namibia

Guinea-Bissau

Liberia

Mozambique

Kenya

Swaziland

Senegal


Lesotho

Mali

Gambia


Benin

Burundi

Guinea

Togo

Ethiopia

Madagascar


Eritrea

Malawi

Cape Verde

Uganda

Zambia

Ghana

Rwanda

HIV/AIDS4%

Diarrhoea18%

Measles1%

Malaria17%

Pneumonia17%

Prematurity9%

Birth asphyxia8%

Neonatalsepsis

5%

Congenitalabnormalities

2%

Other diseases17%

Injuries2%


42

Maternal and newborn health

Figure 86: Percentage of low-birthweight newborns in WHO Regions, 2000–2008

Figure 87: Percentage of low-birthweight newborns in the African Region, by country, 2000–2008

14

24

21

8

6

6

15

African Region




European Region


Global

14

34

27

25

24

24

22

20

20

19

19

17

17

16

16

15

15

15

14

14

14

14

14

14

13

13

13

13

13

12

12

12

12

11

11

11

11

10

10

10

9

9

8

6

6

6

African Region

Mauritania

Niger

Comoros

Guinea-Bissau

Sierra Leone

Chad

Ethiopia

Gambia

Mali

Senegal

Côte d'Ivoire

Madagascar

Burkina Faso

Namibia

Benin

Mozambique

South Africa

Eritrea

Gabon

Liberia

Mauritius

Nigeria

Uganda


Congo

Equatorial Guinea

Lesotho

Malawi

Angola


Guinea

Togo

Burundi

Cameroon

Zambia

Zimbabwe

Botswana

Kenya


Ghana

Swaziland


Algeria

Cape Verde

Rwanda


43

Figure 90: Percentage of births attended by skilled health personnel in the African Region, by country, 2000–2008 and 1990–1999

Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, 1990–1999 and 2000–2008

Figure 89: Percentage of births attended by skilled health personnel in the African Region, 2000–2008

47

49

59

92

92

96

66

48

40

43

87

85

95

62

African Region





European Region

Global

2000–2008 1990–1999

47

6

14

18

28

38

39

39

42

42

42

46

46

47

47

48

49

51

52

52

54

54

54

55

57

57

57

61

62

62

63

63

69

74

74

78

78

81

91

95

99

48

12

18

21

31

42

44

38

39

23

47

44

40

47

26

47

42

46

50

40

45

44

40

52

51

55

69

70

64

89

68

84

77

99

African Region

Ethiopia

Chad

Niger

Eritrea

Guinea

Guinea-Bissau

Nigeria

Kenya

Sierra Leone

Uganda

Liberia


Angola

Zambia

Mozambique

Mali

Madagascar

Rwanda

Senegal

Burkina Faso


Malawi

Lesotho

Côte d'Ivoire

Gambia

Ghana

Mauritania

Comoros

Togo

Cameroon

Equatorial Guinea

Zimbabwe


Swaziland

Benin

Cape Verde

Namibia

South Africa

Algeria

Mauritius

2000–2008 1990–1999

No data


6–2829–4950–6364–8182–99


44

Figure 92: Percentage of births by caesarean section in the African Region, by country, 2000–2008

Figure 91: Percentage of births by caesarean section in WHO Regions, 2000–2008

3.4

7.6

11.8

19.0

23.9

30.8

13.9

African Region



European Region



Global

3.4

0.4

0.7

1

1

1

1.6

1.7

1.8

1.9

2

2.1

2.7

2.9

3.1

3.1

3.2

3.2

3.2

3.3

3.5

3.6

4

4

4.8

5.1

5.6

6.4

6.9

7.7

7.9

10.7

12.7

20.6

37

African Region

Chad

Burkina Faso

Ethiopia

Madagascar

Niger

Mali

Guinea

Nigeria

Mozambique

Cameroon

Zambia

Eritrea

Rwanda

Malawi

Uganda

Congo

Mauritania


Senegal

Liberia

Benin


Kenya

Zimbabwe

Lesotho

Gabon

Côte d'Ivoire

Ghana

Botswana

Swaziland

Cape Verde

Namibia

South Africa

Mauritius


45

Figure 94: Percentage of antenatal care coverage, at least four visits, in the African Region, by country, 2000–2009 and 1990–1999

Figure 93: Percentage of antenatal care coverage, at least one visit, in the African Region, by country, 2000–2009 and 1990–1999

73

39

46

58

69

70

70

75

75

76

80

82

84

84

85

85

86

87

88

89

89

90

90

92

92

92

94

94

94

95

96

71

23.4

30.1

56.5

66.9

48.9

46.9

84.5

48

62.2

78.2

78.8

80.3

82

58.6

83.2

37

73.6

57.6

58

71.4

85.7

90.6

94.9

89.7

89

91.2

92.4

93.1

87.2

94.4

African Region

Chad

Niger

Nigeria


Eritrea

Mali

Comoros

Mauritania


Madagascar

Cameroon

Benin

Togo

Burkina Faso

Côte d'Ivoire

Equatorial Guinea

Senegal

Guinea

Algeria

Mozambique

Ghana

Lesotho

Kenya

Malawi

South Africa

Uganda

Zambia

Zimbabwe

Namibia

Rwanda

2000–2009 1990–1999

44

15

18

18

35

40

40

41

45

45

49

52

53

56

60

61

62

71

72

72

78

47

11

23

15

26

40

64

27

36

47

46

61

37

73.1

52

54

70

64.3

63.9

71

62

African Region

Niger

Burkina Faso

Chad

Mali

Madagascar

Senegal

Eritrea

Côte d'Ivoire

Nigeria

Guinea

Kenya

Mozambique

South Africa

Cameroon

Benin


Zimbabwe

Cape Verde

Zambia

Ghana

2000–2009 1990–1999


46

Sexual and reproductive health

Figure 95: Percentage of current contraceptive use* (any method) among married women 15–49 years of age in the African Region, by country, 2000–2008 and 1990–1999

*Percentage of women aged 15–49 married or in union who are currently using, or whose sexual partner is using, at least one method of contraception, regardless of the method used. For details, see Reproductive Health Indicators: Guidelines for their Generation, Interpretation and Analysis for Global Monitoring. Geneva: WHO, 2006 (available at: http://who.int/reproductivehealth/publications/rhindicators/guidelines.pdf) or the website http://www.un..org/esa/population/unpop.html.

24

3

6

8

8

8

9

9

10

11

11

12

15

15

17

17

18

19

20

24

24

26

26

27

36

37

39

41

41

44

55

60

60

61

76

19

4

8

8

7

3

2

4

4

7

5

6

6

8

12

15

16

15

21

10

17

21

23

33

15

13

48

29

48

56

51

75

African Region

Chad

Angola

Eritrea

Mali

Sierra Leone

Guinea

Mauritania

Guinea-Bissau

Niger

Liberia

Senegal

Ethiopia

Nigeria

Mozambique

Burkina Faso

Gambia


Burundi

Ghana

Uganda

Comoros


Madagascar

Rwanda

Lesotho

Kenya

Zambia

Malawi

Botswana

Namibia

Zimbabwe

South Africa

Algeria

Mauritius

2000–2008 1990–1999

Figure 96: Adolescent fertility rate (per 1000 girls, 15–19 years of age) in the African Region, 2000–2007

No data


4.0–54.0

54.1–101.0

101.1–128.0

128.1–159.0

159.1–199.0

Figure 97: Total fertility rate per woman in WHO Regions, 2008 and 1990

4.9

3.4

2.6

2.2

1.8

1.6

2.5

6.2

5.5

3.8

2.7

2.4

1.9

3.3

African Region


Region




European Region

Global

2008 1990

Neglected tropical diseases

47

Neglected tropical diseases

Figure 98: Number of reported cases of leprosy in WHO Regions, 2008

Figure 99: Number of reported cases of leprosy in the African Region, by country, 2008

29 814

167 505

41 891

5835

3938

248 983

African Region





Global

6114

4899

4170

3276

1763

1313

1184

998

777

664

557

549

486

452

406

345

336

298

275

257

217

167

141

78

34

27

24

7

0

0

0


Nigeria

Ethiopia


Madagascar

Mozambique

Angola

Côte d'Ivoire

Liberia

Guinea

Ghana

Chad

Niger

Burkina Faso

Cameroon

Uganda

Comoros

Benin

Burundi

Senegal

Congo

Kenya


Guinea-Bissau

Rwanda

Equatorial Guinea

Gabon

Lesotho

Botswana

Algeria



48

Non-communicable diseases and conditions

Figure 100: Distribution of causes of non-communicable burden of diseases (percentage of total DALYs) in the African Region, 2004

Figure 101: Distribution of causes of intentional and non-intentional injuries (percentage of total DALYs) in the African Region, 2004

3.8

2.5

1.9

1.6

1.5

1.5

0.8

0.7

0.6

0.6

0.2

0.2

0.1

0.0

Cardiovascular diseases

Sense organ disorders

Respiratory diseases

Malignant neoplasms

Congenital abnormalities

Digestive diseases

Endocrine disorders

Musculoskeletal diseases

Diseases of the genitourinary system

Diabetes mellitus

Skin diseases

Oral diseases

Other neoplasms

Others

5.4

1.9

1.6

1.9

2.5

1.7

0.5

0.3

0.0

Unintentional

Road traffic accidents

Poisoning, fires, drownings, falls

Others

Intentional

Violence

War and conflict

Self-inflicted injuries

Others

Figure 102: Distribution of causes of neuropsychiatric burden of diseases (percentage of total DALYs) in the African Region, 2004

3.4

1.2

0.6

0.5

0.5

0.2

0.2

0.1

0.9

0.5

0.2

0.1

0.1

0.0

0.8

Psychiatric disorders

Unipolar depressive disorders

PTSD, OCD and panic disorders

Bipolar affective disorder

Schizophrenia

Alcohol use disorders

Drug-use disorders

Dementias

Neurological disorders

Epilepsy

Multiple sclerosis

Insomnia (primary)

Migraine

Parkinson’s disease

Other neuropsychiatric conditions

Risk factors for health

49

Risk factors for health

Figure 103: Percentage of current tobacco use in persons 15 years of age or older in WHO Regions, 2006

Figure 104: Percentage of current tobacco use in persons 15 years of age or older in the African Region, by country, 2006

18

57

45

39

32

27

41

3

5

24

5

4

17

9

African Region


European Region




Global

Male Female

18

34

34

33

32

30

29

29

27

26

24

24

23

22

21

21

21

21

19

19

18

18

16

16

15

14

13

13

12

12

11

10

9

3

1

5

4

6

9

3

0

12

2

10

4

3

10

5

3

5

10

4

1

3

2

5

1

2

2

2

2

1

1

1

1

African Region

Mauritius

Mauritania

Zimbabwe

Seychelles

South Africa

Gambia

Algeria

Comoros

Kenya

Namibia


Swaziland


Malawi

Mozambique

Zambia

Burkina Faso

Uganda

Senegal

Mali

Benin

Cape Verde

Eritrea

Chad

Côte d'Ivoire

Liberia


Cameroon

Nigeria

Congo

Ghana

Ethiopia

Male Female


50

Figure 105: Alcohol consumption (litres per person) among adults aged 15 years of age or older in WHO Regions, 2005

Figure 106: Alcohol consumption (litres per person) among adults aged 15 years or older in the African Region, by country, 2005

4.3

9.5

6.7

4.7

0.7

0.3

4.4

African Region

European Region





Global

4.3

11.9

11.9

9.7

7.9

7.0

7.0

6.5

6.5

6.2

5.4

5.2

5.0

4.7

4.7

4.7

4.6

4.5

4.5

3.8

3.5

3.2

2.6

2.5

2.4

2.3

2.0

2.0

1.9

1.9

1.6

1.5

1.5

1.1

1.1

1.0

0.8

0.8

0.6

0.6

0.5

0.4

0.3

0.2

0.2

0.1

0.1

African Region

Seychelles

Uganda

Nigeria

Gabon

Rwanda

South Africa

Namibia

Sierra Leone

Burundi



Swaziland

Angola

Burkina Faso

Cameroon

Equatorial Guinea

Botswana

Côte d'Ivoire

Zimbabwe

Liberia

Guinea-Bissau

Mauritius

Cape Verde

Gambia

Zambia

Congo


Kenya

Lesotho


Ghana

Mozambique

Benin

Malawi

Togo

Eritrea

Madagascar

Ethiopia

Algeria

Mali

Chad

Senegal

Comoros

Guinea

Mauritania

Niger

Food and nutrition

51

Food and nutrition

Figure 108: Percentage of stunted* children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999

Figure 107: Percentage of underweight* children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999

22

40

39

37

37

35

35

34

28

28

28

27

25

22

21

21

21

20

20

18

18

17

17

17

17

17

17

17

16

16

16

15

15

14

14

11

4

25

45

34

36

38

34

31

38

37

27

22

23

28

21

23

23

27

24

22

18

20

25

18

14

18

22

23

24

20

22

20

12

15

11

12

African Region

Niger

Burundi

Burkina Faso

Madagascar

Ethiopia

Eritrea

Chad


Mali

Angola

Nigeria

Comoros


Mozambique

Guinea

Togo

Liberia

Benin

Rwanda

Namibia

Guinea-Bissau

Côte d'Ivoire

Mauritania


Cameroon

Lesotho

Kenya

Uganda

Gambia

Malawi

Zambia

Senegal

Ghana

Zimbabwe

Botswana

Algeria

Cape Verde

2000–2009 1990–1999

16

20

24

26

27

28

28

29

29

29

30

30

31

35

36

36

36

37

39

39

39

40

40

41

44

44

45

45

45

45

45

46

46

47

47

51

51

52

53

53

55

63

23

34

50

30

36

31

35

36

37

34

37

36

45

45

34

32

40

44

48

46

40

35

45

50

51

58

41

45

62

57

56

56

47

Algeria

Senegal

Mauritania

Gabon

Togo

Gambia

Guinea-Bissau

Ghana

Botswana


Swaziland

Namibia

Congo

Equatorial Guinea

Kenya

Zimbabwe

Cameroon

Sierra Leone

Mali

Uganda

Liberia

Guinea

Côte d'Ivoire

Nigeria

Eritrea


Burkina Faso


Benin

Chad

Lesotho


Zambia

Comoros

Mozambique

Ethiopia

Angola

Rwanda

Madagascar

Malawi

Niger

Burundi

2000–2009 1990–1999

*Percentage of children underweight describes how many children under 5 years of age have a weight-for-age below minus two standard deviations of the National Center for Health Statistics (NCHS)/WHO reference median. Percentage of children stunted describes how many children under 5 years of age have a height-for-age below minus two standard deviations of the NCHS/WHO reference median.


52

Figure 109: Percentage of overweight* children under 5 years of age in the African Region, by country, 2000–2009 and 1990–1999

13

22

11

11

11

11

11

10

10

10

9

9

9

8

8

8

7

7

7

6

6

6

6

6

5

5

5

5

5

54

4

4

3

2

2

1

13

4

10

3

6

3

10

4

8

11

5

12

2

4

6

3

3

8

2

5

3

25

3

5

1

4

1

Algeria

Guinea

South Africa

Togo

Comoros

Benin

Swaziland

Malawi


Nigeria

Botswana

Sierra Leone

Cameroon

Zimbabwe

Côte d'Ivoire

Congo

Zambia

Equatorial Guinea

Burkina Faso


Lesotho

Rwanda

Mozambique

Madagascar

Ghana

Kenya

Gabon

Angola

Ethiopia

Uganda


Mali

Namibia

Chad

Liberia

Niger

Gambia

Senegal

Eritrea

Burundi

2000–2009 1990–1999

*Percentage of children overweight describes how many children under 5 years of age have a weight-for-height above two standard deviations of the NCHS/WHO reference median.

53

4Key Determinants

of Health Demography

Figure 110: Age distribution of the population in WHO Regions, 200842

35

31

25

21

18

27

53

59

61

62

67

63

62

5

6

8

13

12

19

11

African Region





European Region

Global

Aged under 15 (%) Aged 15–59 (%) Aged over 60 (%)

4 Key Determinants of Health

54

Figure 112: Total fertility rate per woman in the African Region, by country, 2008 and 1990

Figure 111: Age distribution of the population in the African Region, by country, 2008

42

28

50

49

47

46

46

46

46

45

45

44

44

44

44

43

43

43

43

43

43

43

43

42

42

42

41

41

41

41

41

41

40

40

40

40

39

39

39

38

37

37

37

34

31

24

23

53

65

46

47

49

51

50

49

49

51

50

51

52

51

52

52

52

52

53

52

52

52

53

54

53

54

54

53

53

53

55

54

56

55

55

54

57

55

54

57

57

57

58

60

62

65

66

5

7

4

4

4

3

4

5

5

4

5

5

4

5

4

5

5

5

4

5

5

5

4

4

5

4

5

6

6

6

4

5

4

5

5

6

4

6

7

5

6

6

5

6

7

11

11

African Region

Algeria

Niger

Uganda


Burkina Faso

Chad

Malawi

Zambia

Angola


Ethiopia

Mali

Mozambique

Senegal

Benin

Guinea

Guinea-Bissau

Kenya

Liberia

Madagascar

Nigeria

Sierra Leone

Eritrea

Gambia

Rwanda

Cameroon


Congo

Côte d'Ivoire

Equatorial Guinea


Mauritania

Swaziland

Togo

Zimbabwe

Burundi

Ghana

Lesotho

Comoros

Cape Verde

Gabon

Namibia

Botswana

South Africa

Seychelles

Mauritius

Aged under 15 (%)

Aged 15–59 (%)

Aged over 60 (%)4.9

7.1

6.3

6.2

6.0

5.9

5.8

5.8

5.7

5.6

5.5

5.5

5.4

5.4

5.4

5.3

5.3

5.3

5.2

5.1

5.1

5.1

5.0

4.9

4.8

4.7

4.6

4.6

4.6

4.6

4.5

4.4

4.3

4.3

4.0

3.8

3.5

3.4

3.4

3.3

3.3

2.9

2.7

2.5

2.4

1.9

1.8

6.2

7.9

7.1

6.7

7.1

6.8

7.2

6.5

5.9

6.2

7.0

6.4

6.7

6.7

6.8

5.9

7.1

6.6

5.5

6.1

6.5

6.2

6.7

6.0

5.8

6.3

6.6

5.9

6.3

6.2

5.9

5.4

5.6

6.3

5.5

5.4

5.7

5.2

5.2

5.2

4.9

4.7

5.3

3.7

4.7

2.7

2.2

African Region

Niger

Uganda

Chad


Burkina Faso

Angola

Zambia

Guinea-Bissau


Malawi

Mali

Benin

Guinea

Rwanda

Equatorial Guinea

Ethiopia

Nigeria

Sierra Leone

Gambia

Liberia

Mozambique

Senegal

Kenya


Madagascar

Burundi

Cameroon

Côte d'Ivoire

Eritrea

Mauritania

Congo

Ghana

Togo

Comoros


Swaziland

Namibia

Zimbabwe

Gabon

Lesotho

Botswana

Cape Verde

South Africa

Algeria

Seychelles

Mauritius

2008 1990

Demography

55

Figure 113: Annual growth rate (in %) of population in WHO Regions, 1998–2008 and 1988–1998

Figure 114: Annual growth rate (in %) of population in the African Region, by country, 1998–2008 and 1988–1998

2.5

2.1

1.5

1.2

0.8

0.2

1.3

2.7

2.5

1.8

1.5

1.2

0.3

1.5

African Region





European Region

Global

1998–2008 1988–1998

2.5

4.4

3.7

3.6

3.6

3.3

3.2

3.2

3.2

3.2

3.1

2.9

2.9

2.8

2.8

2.8

2.72.7

2.7

2.6

2.6

2.6

2.6

2.5

2.4

2.4

2.3

2.3

2.3

2.3

2.3

2.2

2.1

2.1

2.0

2.0

1.9

1.7

1.6

1.5

1.5

1.3

1.2

1.2

0.9

0.6

0.2

2.7

0.9

1.2

3.3

–0.3

3.1

3.3

2.8

0.3

3.3

3.8

2.9

2.5

3.4

3.4

3.02.7

2.8

3.1

3.2

3.1

2.6

2.8

1.6

2.5

2.9

2.7

3.3

2.7

2.5

1.9

2.4

2.4

3.0

3.4

2.9

2.5

2.0

2.2

2.7

2.1

2.1

1.6

2.6

1.2

1.3

2.2

African Region

Liberia

Eritrea

Niger

Rwanda

Chad

Benin

Burkina Faso

Sierra Leone

Uganda

Gambia

Angola

Malawi


Equatorial Guinea

Madagascar

Mauritania

Togo


Ethiopia

Kenya

Mozambique

Senegal

Burundi

Nigeria

Zambia

Cameroon

Côte d'Ivoire

Ghana

Guinea-Bissau

Mali

Comoros

Congo

Gabon

Guinea

Namibia



Cape Verde

Botswana

Algeria

South Africa

Lesotho

Swaziland

Mauritius

Seychelles

Zimbabwe

1998–2008 1988–1998


56

Resources and infrastructure

Figure 116: Gross national income per capita (PPP int. $) in the African Region, by country, 2008 and 1990

*Gross national income (GNI) is the sum of value added by all resident producers plus any product taxes (less subsidies) not included in the valuation of output plus net receipts of primary income (compensation of employees and property income) from abroad. GNI per capita is GNI divided by mid-year population For further details, see www.unicef.org/infobycountry/stats_popup1.html.

Figure 115: Gross national income* per capita (PPP int. $) in WHO Regions, 2008 and 1990

2279

3043

3805

8958

22 849

24 005

10 290

1319

994

2981

2824

11 546

11 833

4862

African Region




European Region


Global

2008 1990

2279

290

300

380

530

630

680

730

750

770

820

830

870

1010

1040

1090

1140

1160

1160

1170

1190

1230

1230

1280

1430

1460

1580

1580

1760

1780

1940

2000

2180

3090

3450

5010

5020

6270

7940

9780

12 270

12 480

13 100

19 770

21 700

1319

1210

400

340

490

480

570

430

270

600

440

390

510

720

540

400

520

690

880

620

590

820

760

630

790

1170

990

950

1110

1430

2060

1230

2660

1840

2920

4340

5440

9700

4110

4860

9460

1330

African Region

Mauritania


Liberia

Burundi

Guinea-Bissau

Eritrea

Niger


Sierra Leone

Mozambique

Togo

Malawi

Ethiopia

Rwanda

Madagascar

Mali

Uganda

Burkina Faso

Chad

Comoros

Guinea


Zambia

Gambia

Ghana

Benin

Côte d'Ivoire

Kenya

Senegal


Nigeria

Lesotho

Cameroon

Congo

Cape Verde

Swaziland

Angola

Namibia

Algeria

South Africa

Gabon

Mauritius

Botswana

Seychelles

Equatorial Guinea

2008 1990

Resources and infrastructure

57

*Paved roads are those surfaced with crushed stone (macadam) and hydrocarbon binder or bituminized agents, with concrete, or with cobblestones, as a percentage of all the country’s roads, measured in length.

†Source: http://data.worldbank.org/indicator/IS.ROD.PAVE.ZS.

Figure 117: Electri�cation rate in the African Region, by country, 2000–2005

Figure 118: Paved roads* as percentage of all roads in the African Region, by country, 2000–2007†

31

6

6

7

7

9

11

11

14

15

15

15

17

19

20

20

22

33

34

34

39

46

47

48

49

50

70

94

98

African Region


Mozambique

Malawi

Burkina Faso

Uganda

Lesotho


Kenya

Madagascar

Angola

Ethiopia

Togo

Zambia

Congo

Eritrea

Benin

Senegal

Namibia

Zimbabwe

Botswana

Nigeria

Cameroon

Gabon

Ghana

Côte d'Ivoire

South Africa

Mauritius

Algeria

100

96

76

70

69

68

45

33

32

30

29

28

27

23

22

22

20

19

19

19

19

18

18

17

15

15

14

13

13

12

10

10

10

10

10

9

8

8

8

6

5

4

2

1

�Mauritius

�Seychelles

�Comoros

Algeria

�Cape Verde

�Sao Tome and Principe

�Malawi

�Botswana

�Togo

�Swaziland

�Senegal

�Guinea-Bissau

�Mauritania

�Uganda

�Eritrea

�Zambia

�Niger

�Gambia

�Mozambique

�Rwanda

�Zimbabwe

�Lesotho

�Mali

�South Africa

�Ghana

�Nigeria

�Kenya

�Ethiopia

�Namibia

�Madagascar

�Angola

�Benin

�Burundi

�Gabon

�Guinea


�Cameroon

�Côte d'Ivoire

�Sierra Leone

�Liberia

�Congo

�Burkina Faso

Republic Democratic of the�Congo

�Chad


58

Poverty and income inequality

Figure 119: Percentage of the population living under $1 (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, 2000–2007

Figure 120: Percentage of the population living under $1 (PPP int. $) a day (i.e. in absolute poverty) in the African Region, by country, 2000–2007

53

41

17

12

7

4

26

African Region





European Region

Global

53

89

84

81

77

75

74

70

68

66

64

64

63

62

62

59

57

54

54

53

52

51

49

47

46

43

39

39

34

34

33

30

26

23

21

21

20

5

African Region


Liberia

Burundi

Rwanda

Mozambique

Malawi

Guinea

Madagascar

Niger

Nigeria

Zambia

Swaziland


Chad


Burkina Faso

Angola

Congo

Sierra Leone

Uganda

Mali

Guinea-Bissau

Benin

Comoros

Lesotho

Ethiopia

Togo

Gambia

Senegal

Cameroon

Ghana

South Africa

Côte d'Ivoire

Mauritania

Cape Verde

Kenya

Gabon

Poverty and income inequality

59

Figure 121: Share of incomes by poorest and richest section of the population in the African Region, by country, 1989–2005*

2

1

1

1

1

2

2

2

2

2

1

2

3

3

3

4

5

1

3

2

2

4

1

4

5

5

5

4

5

6

5

5

6

3

5

6

7

5

5

7

7

7

6

6

6

7

7

7

9

52.1

78.7

65.1

66.5

65

62.2

63.4

56.3

55.7

53.6

53.4

55.1

53

52.5

53.4

53.5

50.9

53.3

50.7

49.1

48.4

49.2

48

47.2

46.6

46.1

46.6

46.6

45.7

44.5

42.4

42.6

39.4

36.1

64.5

51

48.3

47.7

44.7

43.6

40.7

40.3

39.4

39.3

38.8

38.2

37.7

37

36.6

35.4

35.4

34

33.9

33.4

33.2

32.8

32.2

31.8

30.7

30.2

30

29.5

29

26.9

26.8

25.5

1

2

1

2

2

2

3

3

2

2

3

2

3

3

3

African region 1989–2005

Namibia 1993

Botswana 1993

Lesotho 1995

Central African Republic 1993

South Africa 2000

Sierra Leone 1989

Swaziland 2000–2001

Zimbabwe 1995–1996

Mozambique 2002–2003

Guinea-Bissau 1993

Zambia 2004

Rwanda 2000

Uganda 2002

Gambia 1998

Madagascar 2001

Cameroon 2001

Niger 1995

Côte d'Ivoire 2002

Kenya 1997

Senegal 2001

Nigeria 2003

Burundi 1998

Burkina Faso 2003

Malawi 2004–2005

Guinea 2003

Mali 2001

Ghana 1998–1999

Mauritania 2000

Benin 2003

United Republic of Tanzania 2000–01

Algeria 1995

Ethiopia 1999–2000

Poorest 10% Poorest 20% Richest 20% Richest 10%

*Source: World Bank, 2010.


60

Gender inequity

Figure 122: Percentage of female and male combined gross enrolment ratio* for primary–secondary–tertiary education in the African Region, by country, 2005†

Figure 123: Percentage of seats‡ held by women in national parliaments in the African Region, by country, 2009 and 2001†

*Number of students enrolled in primary, secondary and tertiary levels of education, regardless of age, as percentage of the population of official school age for the three levels. The gross enrolment ratio can be greater than 100% as a result of grade repetition and entry at ages younger or older than the typical age at that grade level (UNDP definition).

†Source: United Nations Statistical Division, MDG Database, June 2010.

‡Number of seats held by women expressed as a percentage of all occupied seats. Women’s representation in parliaments is one aspect of women’s opportunities in political and public life, and it is therefore linked to women’s empowerment. For additional information, see the website www.milleniumindicators.un.org/unsd/mdgsmetadata

54

26

28

3336

39

41

42

42

42

45

47

47

4748

50

51

51

52

52

52

53

5454

58

59

6161

62

62

63

6364

64

64

64

65

65

67

68

69

7273

76

77

81

46

19

24

2523

28

29

34

31

37

29

28

32

4536

4951

38

38

49

48

4851

48

42

5851

59

5866

5852

62

4662

67

65

66

57

70

6874

75

77

84

42

African region

Niger

Angola

Burkina Faso

Central African Rep


Eritrea

BurundiMali

Senegal

Guinea-Bissau

Chad

Côte d'Ivoire

Mauritania

Ethiopia

Comoros

Gambia

RwandaGuinea

Sierra Leone


Ghana

Congo

Zimbabwe

Mozambique

Benin

MadagascarNigeria

Kenya

Swaziland

Namibia

Zambia

Equatorial Guinea

Malawi

Togo

Uganda

LesothoSao Tome and Principe

Cape Verde

Cameroon

Botswana

Gabon

Algeria

Mauritius

South Africa

Seychelles

Male Female

16.7

7.7

3

5.2

6

7

7.3

7.3

7.9

7.9

8.4

8.9

9.4

9.8

10

10.2

10.5

10.8

11.1

11.1

12.4

12.5

13

13.2

13.8

13.9

15.2

15.2

15.3

16.7

17.1

18.1

21.9

22

22

22.1

23.5

25

26.9

30.4

30.5

30.7

33

34.8

37.3

56.3

10.4

3.4

2.4

5

3.4

12

9.1

8

2

3.6

7.8

12.2

7.3

6

17

4.9

1.2

7.8

9.3

8.8

3.1

5.6

10.1

9.3

8.1

9.2

5.7

11.1

7.7

14.7

12.1

3.8

23.5

3.8

25

14.4

17.8

29.8

30

15.5

25.7

8.8

African region

Algeria

Comoros

Chad

Equatorial Guinea

Nigeria

Congo


Ghana

Madagascar

Democratic Republic of the CongoCote d'Ivoire

Gambia

Kenya

Guinea-Bissau

Mali


Benin

Botswana

Togo

Niger

Liberia

Malawi

Sierra Leone

Swaziland

Cameroon

Zambia

Zimbabwe

Burkina Faso

Gabon

Mauritius

Cape Verde

Ethiopia

Eritrea

SenegalMauritania

Seychelles

Lesotho

Namibia


Burundi

Uganda

South Africa

Mozambique

Angola

Rwanda

Guinea

2009 2001

Education

61

Education

*The youth literacy rate reflects the outcomes of primary education over the previous 10 years or so. As a measure of the effectiveness of the primary education system, it is oµen seen as a proxy measure of social progress and economic achievement. The literacy rate for this analysis is simply the complement of the illiteracy rate. For details, see the websites www.unescobkk.org/infores/efa2000/tech.html and www.uis.unesco.org.

†Source: UNESCO Institute for Statistics, 2007.

‡Source: United Nations Statistical Division, MDG Database, June 2010.

Figure 125: Percentage of the population aged 15–24 years who can both read and write (i.e. youth literacy rate*) in the African Region, by country, 2000–2007 and 1990–1999‡

75

29

31

38

39

39

51

52

53

54

59

61

66

70

70

72

72

73

74

78

78

78

80

83

86

87

88

90

91

93

93

94

95

95

95

96

97

97

98

98

99

69

24

34

17

20

40

47

51

54

75

76

70

71

77

67

88

89

94

94

91

93

88

95

94

99

Arican Region

MaliEthiopia

ChadNiger

Burkina FasoSenegal

BeninMozambiqueSierra Leone

Central African RepublicCote d'Ivoire

MauritaniaMadagascar

Democratic Republic of the CongoLiberiaAngola

BurundiTogo

United Republic of TanzaniaRwanda

GhanaKenyaMalawi

UgandaNigeria

SwazilandComoros

Guinea-BissauAlgeria

NamibiaBotswana

Equatorial GuineaSao Tome and Principe

South AfricaMauritius

GabonCape Verde

ZimbabweCongo

Seychelles

2000–2007 1990–1999

Figure 124: Adult literacy rate (percentage aged 15 and older) in the African Region, by country and sex, 1995–2005†

67

31

33

41

43

43

47

48

50

50

51

55

60

60

6164

65

66

67

69

71

72

74

75

76

77

77

77

78

78

78

80

80

81

81

83

84

87

88

88

89

91

91

92

93

93

49

17

16

13

18

15

24

23

50

23

29

25

43

60

39

34

50

52

39

60

72

90

54

60

65

58

60

62

70

60

60

82

54

78

54

81

84

76

81

80

7992

78

86

81

64

African Region

Burkina Faso

Mali

Chad

Guinea

Niger

Sierra Leone

Benin

Gambia

Ethiopia

Senegal

Mozambique

Mauritania

Guinea-Bissau

Côte d'Ivoire

Comoros

Central African Rep

Ghana

Burundi

Togo

Rwanda

Eritrea

Lesotho

Malawi

Zambia

Madagascar

Uganda

Cameroon


Kenya

Nigeria

Algeria

Botswana


Swaziland

Angola

South Africa

Namibia

Cape Verde

Mauritius

Gabon

Congo

Seychelles


Zimbabwe

Equatorial Guinea

Male Female


62

Environment

Figure 127: Percentage of the population using improved drinking water sources* in WHO Regions, 2008 and 1990

Figure 126: Percentage of the population using improved drinking water sources in the African Region, 2008

*An improved drinking water source, by nature of its construction and design, is likely to protect the source from outside contamination, in particular from faecal matter. Improved drinking water sources include piped water into dwelling, plot or yard; a public tap or stand pipe; a tube well or borehole; a protected dug well; and protected spring and rainwater collection. For additional information, see the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation website: www.wssinfo.org/en/welcome.html.

No data


38–5050.1–6161.1–7676.1–8787.1–99

61

83

86

90

96

98

87

50

85

73

71

91

96

77

African Region





European Region

Global

2008 1990

Figure 128: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, 2008

84

93

93

98

98

99

96

48

83

76

85

83

94

78

African Region





European Region

Global

Urban Rural

Environment

63

Figure 129: Percentage of population using improved drinking water sources in the African Region, by country, 2008 and 1990

Figure 130: Percentage of urban and rural population with access to improved drinking water sources in the African Region, by country, 2008

61

38

41

46

47

48

49

49

50

50

54

56

58

59

60

60

61

61

65

67

67

68

69

69

71

71

72

74

75

76

80

80

82

82

83

84

85

87

89

91

92

92

95

95

99

50

17

31

45

36

35

30

36

38

55

29

47

43

49

49

43

68

58

43

58

61

52

70

50

56

41

76

40

54

78

94

61

83

74

64

93

87

African Region

Ethiopia

Madagascar


Mozambique

Niger

Mauritania

Sierra Leone

Angola

Chad


Mali

Nigeria

Kenya

Togo

Zambia

Eritrea

Guinea-Bissau

Rwanda


Uganda

Liberia

Senegal

Swaziland

Congo

Guinea

Burundi

Cameroon

Benin

Burkina Faso

Côte d'Ivoire

Malawi

Ghana

Zimbabwe

Algeria

Cape Verde

Lesotho

Gabon


South Africa

Gambia

Namibia

Botswana

Comoros

Mauritius

2008 1990

84

52

60

67

71

74

75

77

77

79

80

80

81

83

83

83

84

85

85

86

87

87

89

89

90

91

91

92

92

92

92

93

95

95

95

95

96

96

97

98

99

99

99

99

100

100

48

47

38

44

29

57

42

29

62

51

28

45

44

71

51

52

69

79

82

26

41

46

61

88

74

97

64

51

51

52

61

68

72

34

41

77

86

39

81

26

90

88

78

72

99

African Region

Mauritania

Angola

Chad

Madagascar

Eritrea

Nigeria

Mozambique

Rwanda

Liberia



Mali

Burundi

Guinea-Bissau

Kenya

Benin

Algeria

Cape Verde

Sierra Leone

Togo

Zambia

Guinea


Ghana

Comoros

Uganda

Cameroon


Senegal

Swaziland

Côte d'Ivoire

Burkina Faso

Congo

Gabon

Malawi

Gambia

Niger

Lesotho

Ethiopia

Botswana

Namibia

South Africa

Zimbabwe

Mauritius

Seychelles

Urban Rural


64

Figure 131: Percentage of the population using improved sanitation facilities in the African Region, 2008

No data


9–1717.1–2626.1–3636.1–6767.1–95

Figure 132: Percentage of the population using improved sanitation facilities in WHO Regions, 2008 and 1990

Figure 133: Percentage of the population using improved sanitation facilities in WHO Regions, urban and rural, 2008

34

40

61

62

87

94

30

26

53

49

81

94

African Region





European Region

2008 1990

47

60

69

83

92

97

26

31

56

45

70

87

African Region





European Region

Urban Rural

Environment

65

Figure 134: Percentage of the population using improved sanitation facilities in the African Region, by country, 2008 and 1990

Figure 135: Percentage of the population using improved sanitation facilities in the African Region, by country, urban and rural, 2008

34

9

9

11

11

12

12

12

13

13

14

17

17

19

21

23

23

24

26

26

29

30

31

32

33

33

34

36

36

44

46

47

48

49

51

54

54

55

56

57

60

67

77

91

95

30

6

5

6

8

5

4

13

7

9

11

11

9

20

9

24

16

32

26

37

25

11

17

26

43

44

47

39

46

38

23

42

25

36

69

91

88

African Region

Chad

Niger

Burkina Faso

Madagascar

Benin

Ethiopia

Togo

Ghana

Sierra Leone

Eritrea

Liberia

Mozambique

Guinea

Guinea-Bissau

Côte d'Ivoire



Mauritania


Lesotho

Congo

Kenya

Nigeria

Gabon

Namibia


Comoros

Mali

Zimbabwe

Burundi

Cameroon

Uganda

Zambia

Senegal

Cape Verde

Rwanda

Swaziland

Malawi

Angola

Botswana

Gambia

South Africa

Mauritius

Algeria

2008 1990

47

15

18

23

23

24

24

24

25

27

29

30

31

32

33

33

34

34

36

36

38

38

40

43

45

49

49

50

50

50

51

52

56

56

59

60

61

65

68

69

74

84

86

93

97

98

26

10

7

4

23

4

6

3

4

32

8

19

29

21

6

30

11

4

11

28

4

49

25

28

32

46

9

30

9

55

57

4

35

37

43

17

53

38

65

38

39

65

18

90

88

African Region

Madagascar

Ghana

Chad


Benin

Sierra Leone

Togo

Liberia

Kenya

Ethiopia


Congo


Burkina Faso

Gabon

Guinea

Niger

Côte d'Ivoire

Nigeria

Mozambique

Uganda

Lesotho


Mali

Burundi

Guinea-Bissau

Comoros

Mauritania

Rwanda

Malawi

Eritrea

Cameroon

Zimbabwe

Zambia

Namibia

Swaziland

Cape Verde

Gambia

Senegal

Botswana

South Africa

Angola

Mauritius

Seychelles

Algeria

Urban Rural


66

Figure 136: Percentage of the population living in urban areas in the African Region, by country, 2008 and 1990

Figure 137: Percentage of urban population living in slums* in the African Region, by country, 2005 and 1990†

*A slum household is defined as a group of individuals living under the same roof lacking one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living area, durability of housing, and security of tenure. However, since information on secure tenure is not available for most of the countries, only the first four indicators are used to define a slum household, and then to estimate the proportion of urban population living in slums. The indicator is intended to provide an overview of the share of the urban population living in conditions of poverty and physical and environmental deprivation. For details, see the United Nations Human Settlements Programme (UN-HABITAT) Global Urban Observatory, Nairobi (available at the website: www.unhabitat.org/programmes/guo).

†Source: United Nations Statistical Division, MDG database, June 2010.

37

10

13

16

17

18

19

20

21

22

25

25

25

27

28

29

30

32

34

34

35

37

37

37

38

39

39

41

41

42

42

42

48

49

50

54

57

57

57

60

60

60

61

61

61

65

85

29

6

11

15

13

5

12

14

16

18

14

23

19

21

28

24

28

23

28

28

39

21

28

29

33

37

35

34

40

44

39

30

35

40

36

49

37

41

38

42

44

45

54

44

52

52

69

African Region

BurundiUganda

NigerEthiopiaRwanda

MalawiBurkina Faso

EritreaKenya

Lesotho

SwazilandUnited Republic of Tanzania

ChadComoros

MadagascarGuinea-Bissau

MaliDemocratic Republic of the Congo

GuineaZambia

MozambiqueNamibia

ZimbabweSierra Leone

Central African RepublicEquatorial Guinea

BeninMauritania

MauritiusSenegal

TogoNigeria

Côte d'IvoireGhana

SeychellesAngola

CameroonGambia

BotswanaCape Verde

LiberiaCongo

Sao Tome and PrincipeSouth Africa

AlgeriaGabon

2008 1990

62

97

94

91

87

83

83

82

81

80

76

72

72

69

67

66

66

66

66

66

64

62

60

57

56

55

53

47

46

45

45

39

38

35

34

29

18

77

91

94

99

83

93

96

99

91

95

52

80

82

62

94

95

99

89

94

80

83

81

81

72

51

70

85

62

80

67

80

56

78

50

42

46

4

African Region

Sierra Leone


Chad

Angola

Guinea-Bissau

Niger

Ethiopia

Madagascar

Mozambique


Benin

Rwanda

Comoros

Uganda

Malawi


Equatorial Guinea

Mali

Nigeria

Burundi

Togo

Burkina Faso

Zambia

Cote d'Ivoire

Kenya

Congo

Cameroon

Guinea

Gambia

Ghana

Gabon

Senegal

Lesotho

Namibia

South Africa

Zimbabwe

2005 1990

Global partnerships and financial flows

67

Global partnerships and financial flows

Figure 139: Of�cial development assistance received as percentage of GDP in the African Region, by country, 2005 and 1990

*Official Development Assistance (ODA) is defined as those flows to countries and territories on the DAC List of ODA Recipients (available at www.oecd.org/dac/stats/daclist) and to multilateral development institutions (1) that are provided by official agencies, including state and local governments, or by their executive agencies; and (2) each transaction of which is (a) administered with the promotion of the economic development and welfare of developing countries as its main objective and (b) concessional in character and conveys a grant element of at least 25% (calculated at a rate of discount of 10%).

†Source: OECD–DAC 2007; World Bank, 2007.

Figure 138: Per capita of�cial development assistance* received (US$) in the African Region, by country, 2005†

63

317

223

204

81

81

78

65

64

62

62

61

59

51

50

50

50

49

48

45

42

42

41

41

40

39

39

39

38

38

37

32

28

28

27

26

25

24

22

19

16

14

11

7

51

362

African region

Congo

Cape Verde

Seychelles


Zambia

Eritrea

Equatorial Guinea

Mozambique

Rwanda

Sierra Leone

Mauritania

Namibia

Senegal

Mali

Ghana

Madagascar

Guinea-Bissau

Burkina Faso

Nigeria

Burundi

Malawi

Comoros

Uganda

Benin

Swaziland

Botswana

Tanzania (United Republic of)

Chad

Gabon

Lesotho

Gambia

Niger

Congo (Democratic Republic of the)

Zimbabwe

Angola

Ethiopia

Mauritius

Cameroon


Kenya

Guinea

South Africa

Togo

Algeria

Côte d'Ivoire

13

46

45

37

29

29

28

27

26

26

19

18

17

16

15

14

13

13

13

13

12

11

10

10

8

8

7

7

7

7

6

5

4

4

3

3

2

2

1

1

1

1

1

1

0

0

17

94

9

8

27

11

52

10

41

13

8

31

16

14

20

11

31

27

4

10

23

14

15

17

18

18

1

10

23

14

16

10

4

5

6

3

46

2

4

6

4

0

23

15

0

African region

Burundi

Sao Tome and PrincipeEritrea

Sierra Leone

CongoMalawi

RwandaGuinea-Bissau


MozambiqueMadagascar

Ethiopia

Cape VerdeNiger

Uganda

ZambiaMali

Burkina Faso

GambiaUnited Republic of Tanzania

Zimbabwe

GhanaMauritania

SenegalBenin


ChadComoros

Nigeria

GuineaLesotho

Kenya

TogoSeychellesCameroon

Namibia

SwazilandAngola

Equatorial Guinea

Gabon

BotswanaCôte d'Ivoire

MauritiusAlgeria

South Africa

2005 1990


68

Figure 140: Total debt service as percentage of GDP in the African Region, by country, 1990 and 2005*

Figure 141: Total external debt stocks† (in millions of current US$) in the African Region, by country, 2007‡

*Source: World Bank, 2010.

†Total external debt is debt owed to non-residents repayable in foreign currency, goods or services. Total external debt is the sum of public, publicly guaranteed and private non-guaranteed long-term debt, use of IMF credit and short-term debt. Short-term debt includes all debt having an original maturity of 1 year or less and interest in arrears on long-term debt.

‡Source: World Bank, Global Development Finance

3

11

9

8

7

7

6

6

5

5

5

5

5

4

3

3

3

3

3

2

2

2

2

2

2

2

2

2

2

1

1

1

1

1

1

1

1

1

1

1

1

0

0

5

5

412

6

3

5

12

14

6

4

5

7

7

4

14

2

6

4

12

6

19

6

3

3

3

5

2

7

3

3

9

4

1

1

4

0

1

5

2

3

2

4

14

4

African region


Guinea-Bissau

Nigeria

Seychelles

Angola

Zimbabwe

Gambia

Algeria

Guinea

Burundi

Cameroon

Malawi

Mauritius

Lesotho

Mauritania

Cape Verde

Zambia


Côte d'Ivoire

Ghana

Congo

Senegal

Eritrea

Sierra Leone

South Africa

Uganda

Mali

Swaziland

Benin

Madagascar

Gabon

Mozambique

Kenya


Rwanda

Chad

Niger

Comoros

Burkina Faso

Togo

Ethiopia

Botswana


Equatorial Guinea

2005 1990 43 380

13 938

12 738

12 283

8934

7355

5746

5541

5293

5156

5063

4479

4253

3268

3162

3105

2789

2634

2588

2475

2018

1968

1797

1704

1661

1611

1461

1456

1308

973

972

875

870

857

744

733

680

599

496

402

393

348

291

169

South Africa

Côte d'Ivoire

Angola


Nigeria

Kenya

Gabon

Algeria

Zimbabwe

Congo


Ghana

Mauritius

Guinea

Cameroon

Mozambique

Zambia

Ethiopia

Senegal

Liberia

Mali

Togo

Chad

Mauritania

Madagascar

Uganda

Burkina Faso

Burundi

Seychelles


Niger

Eritrea

Malawi

Benin

Guinea-Bissau

Gambia

Lesotho

Cape Verde

Rwanda

Botswana

Swaziland

Sierra Leone

Comoros


Science and technology

69

Science and technology

Figure 142: Percentage of population with telephone in the African Region, by country, 2005 and 2000*

Figure 143: Percentage of population who are cellular or mobile subscribers in the African Region, by country, 2006 and 2000*

*Source: International Telecommunication Union, September 2009.

3.3

0.0

0.0

0.0

0.1

0.2

0.3

0.3

0.3

0.3

0.4

0.4

0.4

0.4

0.5

0.6

0.6

0.7

0.7

0.7

0.8

0.8

0.8

0.8

0.9

0.9

1.0

1.2

1.3

1.4

1.5

2.0

2.1

2.3

2.7

2.8

2.8

2.9

3.4

4.5

6.8

7.7

7.8

10.0

15.0

26.5

28.7

3.0

0.2

0.4

0.0

0.1

0.2

0.3

0.2

0.3

0.3

0.5

0.8

0.5

0.3

0.3

0.6

0.5

0.4

0.5

0.9

0.4

0.5

0.8

1.0

0.8

0.5

0.8

0.9

0.7

1.8

1.1

1.4

1.0

2.2

1.2

2.2

3.2

2.7

3.2

3.3

6.2

8.3

5.8

10.9

12.6

26.7

23.5

African Region

Liberia

Sierra Leone


Chad

Niger


Rwanda

Uganda

Guinea

Mozambique

Congo


Burundi

Madagascar

Cameroon

Angola

MaliBurkina Faso

Guinea-Bissau

Ethiopia

Malawi

Zambia

Kenya

Eritrea

Nigeria

Benin

Togo

Mauritania

Côte d'Ivoire

Ghana

Equatorial Guinea

Comoros

Senegal

Lesotho

Zimbabwe

Gabon

Gambia

Swaziland


Namibia

Botswana

Algeria

South Africa

Cape Verde

Seychelles

Mauritius

2005 2000

20.9

0.0

0.0

1.1

1.4

2.6

2.7

3.4

3.4

4.5

4.7

5.3

5.5

6.5

6.7

7.4

7.5

8.3

9.6

10.9

11.2

11.5

11.6

12.1

14.0

14.3

14.8

18.9

19.4

20.0

20.9

21.0

22.0

23.1

24.1

24.3

25.0

26.0

27.2

29.7

33.6

46.8

61.5

63.0

63.9

83.3

86.5

2.8

0.3

0.6

0.0

0.0

0.2

0.1

0.0

0.5

0.0

0.1

0.5

0.4

2.3

0.5

0.0

0.2

0.1

0.0

0.1

1.1

0.0

0.3

0.9

0.9

0.2

0.3

0.7

2.4

1.2

0.4

4.5

3.2

0.7

0.0

3.3

2.6

0.5

1.1

4.6

0.6

13.5

15.1

0.3

9.8

18.3

33.6

African Region

Sierra Leone

Guinea

Ethiopia

Eritrea

Burundi


Niger

Rwanda

Comoros

Chad

Malawi

Madagascar

Zimbabwe

Uganda


Burkina Faso

Liberia

Guinea-Bissau

Mali

Togo


Mozambique

Benin

Zambia

Angola


Cameroon

Congo

Lesotho

Kenya

Cape Verde

Cote d'Ivoire

Ghana

Nigeria

Swaziland

Senegal

Gambia

Equatorial Guinea

Namibia

Mauritania

Botswana

Mauritius

Algeria

Gabon

South Africa

Seychelles

2006 2000


70

Figure 144: Percentage of population who are telephone (�xed and mobile) subscribers in the African Region, by country, 2007*

*Source: International Telecommunication Union, September 2009.

†Source: United Nations Statistical Division, MDG database, June 2010.

Figure 145: Percentage of the population who are Internet users in the African Region, 2007†

31

2

2

3

3

3

5

7

7

7

8

9

11

12

12

12

14

15

16

18

20

21

22

22

22

23

24

24

25

28

29

30

31

32

34

42

49

50

55

68

72

88

90

90

97

African Region

Uganda

Togo

Swaziland


South Africa

Sierra Leone

Seychelles

Senegal


Rwanda

Nigeria

Niger

Namibia

Mozambique

Mauritius

Mauritania

Mali

Malawi

Madagascar

Liberia

Lesotho

Kenya

Guinea-Bissau

Guinea

Ghana

Gambia

Gabon

Ethiopia

Eritrea

Equatorial Guinea

Côte d'Ivoire


Congo

Comoros

Chad


Cape Verde

Cameroon

Burundi

Burkina Faso

Botswana

Benin

Angola

Algeria

5.48

0.22

0.28

0.32

0.35

0.37

0.52

0.53

0.58

0.59

0.60

0.77

0.81

0.93

0.95

0.99

1.00

1.08

1.55

1.63

1.66

1.70

2.23

2.26

2.47

2.51

2.56

2.93

3.49

3.75

4.08

4.87

5.03

5.07

5.31

5.87

6.16

6.62

6.75

7.68

7.99

8.16

10.12

10.34

14.59

26.95

36.95

African Region

Sierra Leone

Niger


Ethiopia


Guinea

Liberia

Madagascar

Burkina Faso

Chad

Burundi

Mali

Mozambique

Mauritania

Tanzania

Malawi

Rwanda

Equatorial Guinea

Côte d'Ivoire

Benin

Congo

Cameroon

Guinea-Bissau

Eritrea

Uganda

Comoros

Angola

Lesotho

Ghana

Swaziland

Namibia

Zambia

Togo

Botswana

Gambia

Gabon

Senegal

Nigeria

Cape Verde

Kenya

South Africa

Zimbabwe

Algeria


Mauritius

Seychelles

Emergencies and disasters

71

Emergencies and disasters

Figure 146: Total number of internally displaced* people (thousands) in the African Region, by country, 2006 Figure 147: Total number of refugees (in thousands) in

the African Region, by country of origin, 2006†

*Internally displaced people (IDP) are ‘persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border.’ For more information, see www.internal-displaced.org.

†Source: UNHCR, 2007.

6114

1450

1100

1000

750

570

431

212

190

113

100

64

62

43

19

8

2

African Region

Uganda


Algeria

Côte d'Ivoire

Zimbabwe

Kenya


Ethiopia

Chad

Burundi

Senegal

Angola

Eritrea

Guinea

Congo

Togo

1738

402

397

207

187

93

83

72

43

36

33

27

26

22

21

15

13

13

10

10

8

7

5

2

1

1

1

1

1

1

African Region


Burundi

Angola

Eritrea

Rwanda

Ethiopia


Sierra Leone

Chad

Mauritania

Togo

Côte d'Ivoire

Uganda

Congo

Senegal

Zimbabwe

Nigeria

Ghana

Cameroon

Algeria

Guinea

Kenya


South Africa

Namibia

Gambia

Mali

Guinea-Bissau

Niger

72

5Progress on the

Health-Related MDGsMDG-4 (Child health)

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-5 mortality rate

Figure 148: Trend in under-5 mortality rate in the WHO African Region, 1990–2009

Figure 149: Under-5 mortality rate (per 1000 live births) in WHO Regions, both sexes, 2008 and 1990

165

200

100

0

147

131121 118

55

2015200920082007200520001990

2015 MDG target

125

121

52

23

62

55

29

17

30

African Region


European Region

Global

2008 MDG target

MDG-4 (Child health)

73

Figure 150: Under-5 mortality rate (per 1000 live births) in the African Region, by country, 2008 and the MDG target*


127

209

199

193

192

191

171

166

166

161

160

154

145

142

142

141

138

128

128

119

118

117

112

111

110

108

104

104

103

98

93

90

84

84

78

73

69

69

62

58

57

55

48

32

28

17

12

60

67

66

80

95

83

58

67

63

86

102

49

66

77

77

60

71

35

61

51

61

43

82

57

73

54

43

70

51

50

50

27

33

31

32

31

31

40

21

56

20

50

24

20

21

8

5

African Region

Chad


Guinea-Bissau

Sierra Leone

Mali


Burkina Faso

Burundi

Angola

Niger

Cameroon

Equatorial Guinea

Guinea

Mozambique

Zambia

Nigeria

Congo

Uganda

Côte d'Ivoire

Benin

Mauritania

Liberia

Rwanda

Malawi


Comoros

Ethiopia

Gambia

Togo

Senegal

Zimbabwe

Kenya

Lesotho


Swaziland

Gabon

Ghana

South Africa

Madagascar

Botswana

Eritrea

Namibia

Algeria

Cape Verde

Mauritius

Seychelles

2009 MDG target

5 Progress on the Health-Related MDGs

74

MDG-5 (Maternal health)

Target 5.A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

Figure 151: Trend in maternal mortality ratio (per 100,000 live births) in WHO African Region, 1990–2008

Figure 152: Trend in maternal mortality ratio (per 100,000 live births) in WHO Regions in 2008

850200

3 00

0

830780

620

213

2015201020082005200019951990

2015 MDG target

690

600

620

320

240

66

51

21

260

213

108

145

28

33

11

100

African Region



Americas Region


European Region

Global

2008 MDG target

MDG-5 (Maternal health)

75

*Source: Trends in Maternal Mortality: 1990 to 2008. Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO, 2010.

Figure 153: Maternal mortality ratio (per 100 000 live births) in the African Region, by country, 2008 and the MDG target*

620

1200

1000

990

970

970

850

840

830

820

790

790

680

670

610

600

580

560

550

550

540

530

530

510

470

470

470

440

430

420

410

410

410

400

350

350

340

280

280

260

190

180

120

94

36

213

325

300

275

300

325

220

275

300

350

220

300

225

250

170

115

193

195

250

275

95

93

228

173

248

178

168

65

198

188

58

188

158

163

133

250

233

65

21

45

63

58

18

African Region

ChadGuinea-Bissau

LiberiaBurundi

Sierra LeoneCentral African Republic

NigeriaMali

Niger

United Republic of TanzaniaZimbabwe

GuineaDemocratic Republic of the Congo

AngolaCameroon

CongoBurkina Faso

MauritaniaMozambique

RwandaKenya

LesothoMalawi

Côte d'IvoireEthiopiaZambia

MadagascarUganda

Swaziland

BeninSenegal

South Africa

GambiaGhana

TogoComoros

Equatorial GuineaEritreaGabon

Botswana

NamibiaAlgeria

Cape VerdeMauritius

2008 MDG target


76

Target 5.B: Achieve, by 2015, universal access to reproductive health

Figure 154: Percentage of unmet need for family planning* in the African Region, by country, 2000–2007 and 1990–1999

24

41

38

34

32

31

30

29

28

27

27

25

24

23

22

21

20

17

16

13

7

4

26

29

40

39

28

26

26

29

36

28

33

36

35

9

30

25

22

21

19

15

24

6

African Region

Uganda

Rwanda

Ghana

Senegal

Mali

Benin

Burkina Faso

Malawi

Eritrea

Zambia

Kenya

Madagascar

Chad


Guinea

Cameroon

Nigeria

Niger

Zimbabwe

Namibia

Mauritius

2000–2007 1990–1999

*The proportion of women of reproductive age (15–49 years) who are married or in union and who have an unmet need for family planning, i.e. who do not want any more children or want to wait at least 2 years before having a baby, and yet are not using contraception. Further details can be found on the websites http://www.unfpa.org and http://www.un.org/esa/population/unpop.html.

MDG-6 (AIDS, malaria and TB)

77


Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Figure 155: Percentage of HIV-positive pregnant women 15–24 years of age for 13 countries with trend data in the African Region, 2004–2007 and 2000–2003

13.3

5.5

1.7

2.1

3.0

4.6

10.4

17.9

16.2

25.2

24.2

34.4

33.2

14.3

15.5

1.7

1.8

2.5

4.0

5.6

14.7

14.9

15.3

16.8

25.9

27.1

Malawi

Burundi

Benin

Eritrea

Ghana

Rwanda

Ethiopia

Namibia

Zambia

Zimbabwe

Lesotho

Swaziland

Botswana

2004–2007

For these two countries, theprevalence has increasedbetween 2000 and 2007

2000–2003


78

Target 6.B: Achieve, by 2015, universal access to treatment for HIV/AIDS for all those who need it

2

14

18

18

18

19

19

4

17

18

20

23

21

Madagascar

Liberia

Comoros

Gambia

Sierra Leone

Burundi


Countries with coverage rate of 20% or less

21

22

22

23

24

24

25

25

25

28

28

29

30

30

26

22

10

17

25

15

20

31

23

25

28

19

24

203031

Nigeria

Mauritius

Niger

Congo

Angola

Ghana

Algeria

Equatorial Guinea

Mauritania

Cameroon

Côte d’Ivoire

Togo

Mozambique

Guinea-Bissau


Countries with coverage rate of 21–30%

2009 2007

2009 2007 2009 2007

37

34

35

1736

1337

1337

2839

3340

2746

3546

3547

4248

3848

2650

4151

5653

4959

4264

4676

8883

7988

71

African Region

Zimbabwe

Chad

Eritrea

South Africa

Uganda

Guinea

Burkina Fasi

Malawi

Gabon

Kenya

Lesotho

Mali

Senegal

Benin

Swaziland

Zambia

Namibia

Botswana

Rwanda

Countries with coverage rate of 31% or more.Botswana and Rwanda have reached in 2009 theUniversal Access target of 80%

Figure 156: Percentage of population in need of treatment with access to antiretroviral drugs in the African Region, by country, 2009 and 2007


79

Figure 157: Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy in 2007

Figure 158: Percentage of pregnant women living with HIV infection who are receiving antiretroviral therapy for preventing mother-to-child transmission, 2008

44

1

23

28

54

94

45

African Region




Americas Region

European Region

Global

45

11

23

31

40

54

42

African Region


European Region



Americas Region

Global


80

Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Figure 159: Percentage of children under 5 years of age sleeping under insecticide-treated bed nets in the African Region, 2005–2009 and 2000–2004

Figure 160: Percentage of children under 5 years of age with fever being treated with antimalarial drugs in the African Region, 2005–2009 and 2000–2004

4.3

2.6

14.7

4.2

2.9

0.2

22.5

1.1

7.4

2.0

1.5

1.7

3.5

1.5

16.0

2.8

7.4

1.5

1.3

0.2

1.6

1.3

1.0

1.1

0.7

1.2

0.1

55.7

51.4

49.0

48.9

46.7

45.8

41.7

41.1

39.0

38.4

33.1

29.2

28.2

25.8

25.7

23.0

20.1

15.1

13.1

9.7

9.6

8.3

7.4

5.9

5.8

5.5

0.6

Rwanda

Liberia

Gambia

Eritrea

Kenya

Madagascar


Zambia

Guinea-Bissau

Togo

Ethiopia

Senegal

Ghana

Sierra Leone


Malawi

Benin


Cameroon

Uganda

Burkina Faso

Burundi

Niger

Cote d'Ivoire


Nigeria

Swaziland

2005–2009 2000–2004

57.8

57.0

56.7

54.0

48.0

47.7

45.7

43.3

43.0

36.0

33.2

33.0

30.1

30.0

29.8

24.7

23.9

23.5

19.7

9.1

5.6

67.2

62.6

23.0

20.3

13.1

9.5

66.1

68.8

58.2

60.4

49.6

60.0

58.4

51.9

62.8

57.5

33.9

48.1

60.7

31.3

52.0

61.2

28.4

26.5

34.2

36.2

9.2

58.8

55.2

14.9

14.4

3.6

3.0

Cameroon



Benin

Burkina Faso

Togo

Guinea-Bissau

Zambia

Ghana

Côte d'Ivoire

Nigeria

Niger

Sierra Leone

Burundi



Malawi

Kenya

Madagascar

Senegal

Rwanda

Liberia

Gambia

Mozambique

Namibia

Eritrea

Ethiopia

2005–2009 2000–2004

These six countries have shown an increasing trend in coverage between2000 and 2009


81

*Source: World Malaria Report 2009. Geneva: WHO, 2009.

Figure 161: Malaria mortality rate (per 100 000 population) in the African Region, by country, 2008 and 2006*

Figure 162: Prevalence of tuberculosis (per 100 000 population) in the African Region, by country, 2008 and the MDG target

14.9

52.5

51.4

45.5

41.2

40.2

30.9

30.0

29.5

29.3

24.3

23.4

19.8

16.7

16.7

15.7

11.1

10.8

10.6

10.5

10.0

9.7

9.6

9.1

7.5

7.1

6.1

6.1

5.8

5.7

4.5

3.1

2.1

1.9

1.4

1.3

1.2

0.8

0.6

0.4

104

128

178

95

113

116

180

121

158

98

106

94

92

229

109

154

47

96

146

100

19

201

173

171

145

36

80

103

59

156

164

0

51

10

12

0

0

0

220

0

African Region

Angola

Burkina Faso

Malawi

Togo

Cameroon

Guinea-Bissau

Zambia



Gambia

Burundi

Mozambique

Niger

Ghana

Sierra Leone

Namibia

Gabon

Benin



Mali

Chad

Liberia

Uganda

Comoros

Senegal

Côte d'Ivoire

Rwanda

Nigeria

Guinea

Swaziland

Ethiopia

Zimbabwe

Madagascar

Cape Verde

Botswana

South Africa

Equatorial Guinea

Eritrea

2008 2006

480

1200

930

790

770

750

730

720

700

670

660

610

610

580

560

560

560

550

490

490

470

430

420

420

410

400

390

390

340

330

310

290

280

260

220

190

180

150

150

130

130

82

75

65

63

40

15

169

232

351

205

314

320

146

95

292

144

138

141

384

126

172

156

190

121

90

112

144

184

159

238

179

266

104

175

103

159

190

325

224

218

202

257

63

94

173

70

107

123

57

94

84

27

22

African Region

Sierra Leone

Togo

Zimbabwe

Swaziland

Mali

Côte d'Ivoire

Rwanda

Mauritania

Burundi


Nigeria

South Africa

Chad

Botswana

Ethiopia

Senegal

Guinea

Burkina Faso

Lesotho

Mozambique

Madagascar


Liberia

Gabon

Ghana

Congo

Gambia

Uganda

Niger

Malawi

Namibia

Cape Verde

Zambia

Guinea-Bissau

Angola

Kenya

Cameroon


Benin


Eritrea

Seychelles

Comoros

Equatorial Guinea

Mauritius

Algeria

2008 MDG target


82

MDG-1 (Malnourished children)

Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Figure 164: Percentage of underweight children under 5 years of age in the African Region, by country, 2000–2009 and the MDG target

Figure 163: Trend in children aged under 5 years that are underweight

22

40

39

37

37

35

35

34

28

28

28

27

25

22

21

21

21

20

20

18

18

17

17

17

17

17

17

17

16

16

16

15

15

14

14

11

4

13

23

17

18

19

17

15

19

19

14

11

12

14

11

12

11

13

12

11

9

10

13

9

7

9

11

12

12

10

11

10

6

8

6

6

African Region

Niger

Burundi

Burkina Faso

Madagascar

Ethiopia

Eritrea

Chad


Mali

Angola

Nigeria

Comoros


Mozambique

Guinea

Togo

Liberia

Benin

Rwanda

Namibia

Guinea-Bissau

Côte d'Ivoire

Mauritania


Cameroon

Lesotho

Kenya

Uganda

Gambia

Malawi

Zambia

Senegal

Ghana

Zimbabwe

Botswana

Algeria

Cape Verde

2000–2009 MDG target

25%

22%

30%

10%

0%

13%

20152000–20091990–1999

2015 MDG target

20%

MDG-7 (Water and sanitation)

83

MDG-7 (Water and sanitation)

Target 7.C: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation

Figure 165: Percentage of the population using improved drinking water sources in the African Region, by country, 2008 and the MDG target

61

38

41

46

47

48

49

49

50

50

54

56

58

59

60

60

61

6165

67

67

68

69

69

71

71

72

74

75

76

80

80

82

82

83

84

85

87

89

91

92

92

95

95

99

75

59

66

73

68

68

65

50

68

69

78

65

74

72

75

75

72

5084

79

72

79

81

50

5076

85

75

78

7188

70

7789

97

50

81

50

50

92

87

82

97

94

100

African Region

Ethiopia

MadagascarDemocratic Republic

of the CongoMozambique

Niger

Mauritania

Sierra Leone

Angola

ChadUnited Republic

of TanzaniaMali

Nigeria

Kenya

Togo

Zambia

Eritrea

Guinea-Bissau

RwandaCentral African

RepublicUganda

Liberia

Senegal

Swaziland

Congo

Guinea

Burundi

Cameroon

Benin

Burkina Faso

Côte d'Ivoire

Malawi

Ghana

Zimbabwe

Algeria

Cape Verde

Lesotho

GabonSao Tome and

PrincipeSouth Africa

Gambia

Namibia

Botswana

Comoros

Mauritius

2008 MDG target

34

9

9

11

11

12

12

12

13

14

17

17

19

21

23

23

24

26

29

31

32

33

33

34

36

36

44

46

47

48

49

51

54

54

56

57

60

67

77

91

95

65

53

53

53

54

53

52

57

54

55

56

56

55

50

60

55

62

58

66

63

69

50

63

56

59

63

72

72

74

70

73

69

50

62

71

63

68

50

85

96

94

African Region

Chad

Niger

Burkina Faso

Madagascar

Benin

Ethiopia

Togo

Ghana

Eritrea

Liberia

Mozambique

Guinea

Guinea-Bissau

Côte d'IvoireDemocratic Republic

of the CongoUnited Republic

of TanzaniaMauritania

Lesotho

Kenya

Nigeria

Gabon

NamibiaCentral African

RepublicComoros

Mali

Zimbabwe

Burundi

Cameroon

Uganda

Zambia

Senegal

Cape Verde

Rwanda

Malawi

Angola

Botswana

Gambia

South Africa

Mauritius

Algeria

2008 MDG target

Figure 166: Percentage of the population using improved sanitation facilities in the African Region, by country, 2008 and the MDG target


84

MDG-8 (Develop a global partnership for development)Target 8.D: Deal comprehensively with debt problems of developing countries for national and international measures in order to make debt sustainable in the long term

Figure 167: Total debt service as percentage of exports of goods, services and income

5.4

103.8

13.7African Region

Liberia

Burundi


Guinea

Gambia

Seychelles

Cameroon

Angola

Lesotho

Kenya

South Africa

Senegal

Côte d'Ivoire

Ethiopia

Benin

Rwanda

Cape Verde

Niger

Mali

Ghana

Mauritius

Zambia

Uganda

Swaziland

Sierra Leone

Tanzania

Nigeria

Togo

Mozambique

Congo

Botswana

Algeria

Madagascar

Guinea-Bissau

Mauritania

Malawi

Zimbabwe


Burkina Faso

Gabon

Chad

Comoros

2007 1990

2.3

4.3

6.4

6.8

13.2

23.1

29.3

29.8

31.1

45.5

63.4

4.30.1

1.034.6

1.126.2

1.211.9

1.422.6

1.532.9

1.910.0

1.95.4

2.181.4

2.514.7

2.98.5

2.938.1

2.912.3

3.117.4

4.04.8

4.013.4

4.28.2

4.339.0

4.435.4

4.419.9

5.5

5.735.4

6.94.2

9.88.1

10.020.4

12.48.9

12.722.2

12.920.0

39.234.4

40.043.4

85

6Explanatory Notes

The following provides the definition of the health statistics categories included in this volume, as well as the rationale for their inclusion and the estimation methods used in their production.

⦁ HEALTH STATUS

1. Life expectancy at birth

Rationale for use: Life expectancy at birth reflects the overall mortality level of a population. It summarizes the mortality pattern that prevails across all age groups, children and adolescents, adults and the elderly.

Definition: Average number of years that a newborn is expected to live if current mortality rates continue to apply.

Methods of estimation: WHO has developed a model life table based on about 1800 life tables from vital registration judged to be of good quality. For countries with vital registration, the level of completeness of recorded mortality data in the population is assessed and mortality rates are adjusted accordingly. Where vital registration data for 2003 were available, these were used directly to construct the life table. For countries where the information system provided a time series of annual life tables, parameters from the life table were projected using a weighted regression model, giving more weight to recent years. Projected values of the two life table parameters were then applied to the modified logit life table model, where the most recent national data provided an age pattern, to predict the full life table for 2003. In case of inadequate sources of age-specific mortality rates, the life table is derived from estimated under-5 mortality rates and adult mortality rates that are applied to a global standard (defined as the average of all the 1800 life tables using a modified logit model).

Source: Life Tables for WHO Member States. Geneva, WHO, 2010. Available at: www.who.int/whosis/database/life_tables/life_tables.cfm.

2. Healthy life expectancy (HALE)

Rationale for use: Substantial resources are devoted to reducing the incidence, duration and severity of major diseases that cause morbidity but not mortality and to reducing their impact on people’s lives. It is important to capture both fatal and non-fatal health outcomes in a summary measure of average levels of population health. Healthy life expectancy (HALE) at birth adds up expectation of life for different health states, adjusted for severity distribution, making it sensitive to changes over time or differences between countries in the severity distribution of health states.

Definition: Average number of years that a person can expect to live in ‘full health’ by taking into account years lived in less than full health due to disease and/or injury.

Methods of estimation: Since comparable health state prevalence data are not available for all countries, a four-stage strategy is used. Data from the WHOGBD study are used to estimate severity-adjusted prevalence by age and sex for all countries. Data from the WHOMCSS and WHS are used to make independent estimates of severity-adjusted prevalence by age and sex for survey countries. Prevalence for all countries is calculated based on GBD, MCSS and WHS estimates. Life tables constructed by WHO are used with Sullivan’s method to compute HALE for countries.

HALE estimates use methods described in the statistical annex to the World Health Report 2004.

Estimates for 2007 have been revised to take into account the Global Burden of Disease estimates for Member States for the year 2004 and may not be entirely comparable with those for 2002 published

6 Explanatory Notes

86

in World Health Statistics 2007. Income-group aggregates are based on the 2008 World Bank list of economies.

3. Life table (see Life expectancy at birth)

Data sources: (i) civil or sample registration: mortality by age and sex is used to calculate age-specific rates. (ii) Census: mortality by age and sex is tabulated from questions on recent deaths that occurred in the household during a given period preceding the census (usually 12 months). (iii) Census or surveys: direct or indirect methods provide adult mortality rates based on information on survival of parents or siblings.

Methods of estimation: Empirical data from different sources are consolidated to obtain estimates of the level and trend in adult mortality by fitting a curve to the observed mortality points. However, to obtain the best possible estimates, judgement needs to be made on data quality and how representative it is of the population. Recent statistics based on data availability in most countries are point estimates dated by at least 3–4 years, which need to be projected forward in order to obtain estimates of adult mortality for the current year. When no adequate source of age-specific mortality exists, the life table is derived as described in the life expectancy indicator.

4. Probability of dying (per 1000) between ages 15 and 60 years (adult mortality rate)

Rationale for use: Disease burden from non-communicable diseases among adults – the most economically productive age span – is rapidly increasing in developing countries owing to ageing and health transitions. Therefore, the level of adult mortality is becoming an important indicator for the comprehensive assessment of the mortality pattern in a population.

Definition: Probability that a 15-year-old person will die before reaching his/her 60th birthday.

Mortality data: World Health Organization, 2010 (www.who.int/healthinfo/statistics/mortality/en/).

5. Probability of dying (per 1000) under age 5 years (under-5 mortality rate)/Probability of dying (per 1000) under age one year (infant mortality rate)

Rationale for use: Under-5 and infant mortality rates are leading indicators of the level of child health and

overall development in countries. They are also MDG indicators.

Definition: The under-5 mortality rate is the probability of a child born in a specific year or period dying before reaching the age of 5, if subject to age-specific mortality rates of that period. The infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one, if subject to age-specific mortality rates of that period.

Methods of estimation: Empirical data from different sources are consolidated to obtain estimates of the level and trend in under-5 mortality by fitting a curve to the observed mortality points. However, to obtain the best possible estimates, judgement needs to be made on data quality and how representative it is of the population. Recent statistics based on data availability in most countries are point estimates dated by at least 3–4 years, which need to be projected forward in order to obtain estimates of under-5 mortality for the current year. Those are then converted to their corresponding infant mortality rates through model life table systems: the one developed by WHO for countries with adequate vital registration data and Coale–Demeny model life tables for the other countries. It should be noted that the infant mortality data from surveys are exposed to recall bias; hence their estimates are derived from under-5 mortality, which leads to a supplementary step to estimate infant mortality rates.

6. Maternal mortality ratio (per 100 000 live births)

Rationale for use: Complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age in developing countries. The maternal mortality ratio (MMR) represents the risk associated with each pregnancy, i.e. the obstetric risk. It is also an MDG indicator for monitoring Goal 5 of improving maternal health.

Definition: Number of maternal deaths per 100 000 live births during a specified time period, usually one year.

Methods of estimation: Measuring maternal mortality accurately is difficult except where comprehensive registration of deaths and their causes exists. Elsewhere, censuses or surveys can be used to measure levels of maternal mortality. Data derived from health services records are

Explanatory Notes

87

problematic where not all births take place in health facilities, because of biases whose dimensions and direction cannot be determined. Reproductive-age mortality studies (RAMOS) use triangulation of different sources of data on deaths of women of reproductive age, including record review and/or verbal autopsy, to accurately identify maternal deaths. Based on multiple sources of information, RAMOS are considered the best way to estimate levels of maternal mortality. Estimates derived from household surveys are usually based on information retrospectively collected about the deaths of sisters of the respondents and could refer back up to an average 12 years, and they are subject to wide confidence intervals. For countries without any reliable data on maternal mortality, statistical models are applied. Global and regional estimates of maternal mortality are developed every 5 years, using a regression model.

Sources: (i) Towards Reaching Health-Related Millennium Development Goals: Progress Report and Way Forward. Report of the Regional Director. Brazzaville: WHO Regional Office for Africa, 2009. (ii) Maternal Mortality in 2005. Estimates Developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: WHO, 2008. Available at: http://whqlibdoc.who.int/publications/2007/9789241596213_eng.pdf.

7. Age-standardized death rates per 100 000 by cause

Rationale for use: The numbers of deaths per 100 000 population are influenced by the age distribution of the population. Two populations with the same age-specific mortality rates for a cause of death will have different overall death rates if the age distributions of their populations are different. Age-standardized mortality rates adjust for differences in population age distribution by applying the observed age-specific mortality rates for each population to a standard population.

Definition: The age-standardized mortality rate is a weighted average of the age-specific mortality rates per 100 000 persons, where the weights are the proportions of persons in the corresponding age groups of the WHO standard population.

Rates are age-standardized to WHO’s World Standard Population. See Age Standardization of Rates: A New WHO Standard. Geneva, WHO, 2001 (GPE Discussion Paper Series No. 31). Available at: www.who.int/healthinfo/paper31.pdf.

8. Years of life lost (percentage of total)

Rationale for use: Years of life lost (YLL) take into account the age at which deaths occur by giving greater weight to deaths at younger age and lower weight to deaths at older age. The years of life lost (percentage of total) indicator measures the YLL due to a cause as a proportion of the total YLL lost in the population due to premature mortality.

Definition: YLL are calculated from the number of deaths multiplied by a standard life expectancy at the age at which death occurs. The standard life expectancy used for YLL at each age is the same for deaths in all regions of the world and is the same as that used for the calculation of disability-adjusted life-years (DALYs). Additionally, 3% time discounting and non-uniform age weights that give less weight to years lived at young and older ages were used as for the DALY. With non-uniform age weights and 3% discounting, a death in infancy corresponds to 33 YLL, and deaths at ages 5–20 to around 36 YLL.

Source: Mortality and Burden of Disease Estimates for WHO Member States in 2004. Geneva, WHO, 2009. Available at: www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls. Communicable diseases include maternal causes, conditions arising during the perinatal period and nutritional deficiencies. Income-group aggregates are based on the 2004 World Bank list of economies. Individual percentages may not add up to 100% owing to rounding

9. The disability-adjusted life-year (DALY)

Rationale for use: DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of ‘healthy’ life lost by virtue of being in states of poor health or disability. DALYs for a disease or health condition are calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition.

Methods of estimation: Life tables specifying all-cause mortality rates by age and sex for 192 WHO Member States were developed for 2002 from available death registration data, sample registration systems (India and China) and data on child and adult mortality from censuses and surveys. Cause-of-death distributions were estimated from death registration data for 107 countries, together with data from population-based epidemiological

6 Explanatory Notes

88

studies, disease registers and notification systems for selected specific causes of death. Causes of death for populations without useable death registration data were estimated using cause-of-death models together with data from population-based epidemiological studies, disease registers and notification systems for 21 specific causes of death.

10. Causes of death among children under 5 years of age (%)

Rationale for use: MDG4 consists in the reduction of under-5 mortality by two-thirds in 2015, from its level in 1990. Child survival efforts can be effective only if they are based on reasonably accurate information about the causes of childhood deaths. Cause-of-death information is needed to prioritize interventions and plan for their delivery, to determine the effectiveness of disease-specific interventions, and to assess trends in disease burden in relation to national and international goals.

Definition: The cause(s) of death (CoD) as entered on the medical certificate of cause of death in countries with civil (vital) registration system. The underlying CoD is being analysed. In countries with incomplete or no civil registration, causes of death are those reported as such in epidemiological studies that use verbal autopsy algorithms to establish CoD.

Methods of estimation: CoD data from civil registration systems were evaluated for their completeness. Complete and nationally representative data were then grouped by ICD codes into the cause categories, and their proportions to total under-5 deaths were then computed. For countries with incomplete or no data, the distribution of deaths by cause was estimated in two steps. In the first step, a statistical model was used to assign deaths to one of three broad categories of causes: communicable diseases; non-communicable diseases; or injuries and external causes.

In a second step, cause-specific under-5 mortality estimates from the Child Health Epidemiology Reference Group (CHERG), WHO Technical Programmes and the Joint United Nations Programme on HIV/AIDS (UNAIDS) were taken into account in assigning the distribution of deaths to specific causes. A variety of methods, including proportional mortality and natural history models, were used by CHERG and WHO to develop country-level cause-specific mortality estimates. All CHERG working groups developed comparable and

standardized procedures to generate estimates from the databases.

Source: Mortality Data. Geneva, WHO, 2010. Available at: www.who.int/healthinfo/statistics/mortality/en/.

⦁ THE HEALTH SYSTEM

Health Financing

11. Total expenditure on health as percentage of gross domestic product (GDP)

12. General government expenditure on health as percentage of total general government expenditure

13. Per capita total expenditure on health at international dollar rate

Rationale for use: Health financing is a critical component of health systems. National health accounts (NHAs) provide a large set of indicators based on the expenditure information collected within an internationally recognized framework. NHAs are a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources to the distribution of funds across providers and functions of health systems and benefits across geographic, demographic, socioeconomic and epidemiological dimensions.

Definitions: ⦁ Total health expenditure as percentage of GDP ⦁ Percentage of total general government

expenditure that is spent on health ⦁ Per capita total expenditure on health at

international dollar rate

Methods of estimation: Only about 95 countries either have produced a full NHA or report expenditure on health to the Organisation for Economic Co-operation and Development (OECD). Standard accounting estimation and extrapolation techniques have been used to provide time series. The principal international references used are the International Monetary Fund (IMF) Government Finance Statistics and International Financial Statistics; OECD Health Data and International Development Statistics; and the United Nations National Accounts Statistics. National sources include national health accounts reports,

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public expenditure reports, statistical yearbooks and other periodicals, budgetary documents, national accounts reports, statistical data on official websites, central bank reports, non-governmental organization reports, academic studies, and reports and data provided by central statistical offices and ministries.

Source: WHO National Health Accounts (NHA), Country Health Expenditure Database. Geneva: WHO, February 2010. Available at: www.who.int/nha/country/. The regional, income and global figures are calculated using Purchasing Power Parity (PPP) terms. When the number is smaller than 0.05%, the percentage may appear as zero. For per capita expenditure indicators, this is represented as <1. In countries where the fiscal year begins in July, expenditure data have been allocated to the later calendar year (for example, 2008 data will cover the fiscal year 2007–08). Absolute values of expenditures are expressed in nominal terms (current prices). National currency units per US$ are calculated using the average exchange rates for the year. For 2008, the use of yearly average exchange rates (compared with year-end exchange rates) may not fully represent the impact of the global financial crisis.

14. General government expenditure on health as percentage of total expenditure on health

15. General government expenditure on health as percentage of total government expenditure

16. External resources for health as percentage of total expenditure on health

17. Out-of-pocket expenditure as percentage of private expenditure on health

18. Per capita total expenditure on health at average exchange rate (US$)

19. Per capita government expenditure on health at average exchange rate (US$)

20. Per capita government expenditure on health at international dollar rate

Rationale for use: Health financing is a critical component of health systems. NHAs provide a large

set of indicators based on the expenditure information collected within an internationally recognized framework. NHAs are a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources to the distribution of funds across providers and functions of health systems and benefits across geographic, demographic, socioeconomic and epidemiological dimensions.

Definitions: Key indicators for which the data are available:

⦁ Level of total expenditure on health as percentage of GDP, and per capita health expenditures in US dollars and in international dollars.

⦁ Distribution of public and private sectors in financing health and their main components, such as:

○ Extent of social and private health insurance ○ Burden on households through out-of-pocket

spending ○ Reliance on external resources in financing

health

Associated terms:

⦁ Gross domestic product (GDP) is the value of all goods and services provided in a country by residents and non-residents. This corresponds to the total sum of expenditure (consumption and investment) of the private and government agents of the economy during the reference year.

⦁ General government expenditure (GGE) includes consolidated direct outlays and indirect outlays, such as subsidies and transfers, including capital, of all levels of government social security institutions, autonomous bodies, and other extrabudgetary funds.

⦁ Total expenditure on health (THE) is the sum of general government health expenditure and private health expenditure in a given year, calculated in national currency units in current prices. It comprises the outlays earmarked for health maintenance or for restoration or enhancement of the health status of the population, paid for in cash or in kind

⦁ General government expenditure on health (GGHE) is the sum of outlays by government entities to purchase health care services and goods. It comprises the outlays on health by all levels of government and by social security agencies, and direct expenditure by parastatals and public firms. Expenditures on health include final consumption,

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subsidies to producers and transfers to households (chiefly reimbursements for medical and pharmaceutical bills). It includes both recurrent and investment expenditures (including capital transfers) made during the year. Besides domestic funds, it also includes external resources (mainly as grants passing through the government or loans channelled through the national budget).

⦁ Social security expenditure on health (SSHE) includes outlays for purchases of health goods and services by schemes that are mandatory and controlled by government. Such social security schemes that apply only to a selected group of the population, such as public sector employees only, are also included here.

⦁ External resources health expenditure (ExtHE) includes all grants and loans, whether passing through governments or private entities for health goods and services, in cash or in kind.

⦁ Private health expenditure (PvtHE) is defined as the sum of expenditures on health by the following entities:

○ Prepaid plans and risk-pooling arrangements (PrepaidHE) are the outlays of private insurance schemes and private social insurance schemes (with no government control over payment rates and participating providers, but with broad guidelines from government)

○ Firms’ expenditure on health are the outlays by private enterprises for medical care and health-enhancing benefits other than payment to social security or other prepaid schemes.

○ Non-profit institutions serving mainly households are the outlays of those entities whose status do not permit them to be a source of financial gain for the units that establish, control or finance them. This includes funding from internal and external sources.

○ Household out-of-pocket spending (OOPS) comprises the direct outlays of households, including gratuities and in-kind payments made to health practitioners and to suppliers of pharmaceuticals, therapeutic appliances, and other goods and services. This includes household direct payments to public and private providers of health care services, non-profit institutions, and non-reimbursable cost sharing, such as deductibles, copayments and fee for services.

⦁ Exchange rate is the annual average or year-end number of units at which a currency is traded in the banking system.

⦁ International dollars are derived by dividing local currency units by an estimate of their Purchasing Power Parity (PPP) compared with the US dollar, i.e. the measure that minimizes the consequences of differences in price levels between countries.

Methods of estimation and sources: About 100 countries either have produced full national health accounts or report expenditure on health to the OECD. Standard accounting estimation and extrapolation techniques have been used to provide time series (1998–2004). Ministries of Health have responded to the draµ updates sent for their inputs and comments.

For details on sources and methods, see www.who.int/nha.

Health Workforce

21. Number of:

⦁ physicians per 10000 population ⦁ nurses per 10000 population ⦁ midwives per 10000 population

Rationale for use: The availability and composition of human resources for health is an important indicator of the strength of the health system. Even though there is no consensus about the optimal level of health workers for a population, there is ample evidence that worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival.

Definitions: ⦁ Physicians: includes generalists and specialists. ⦁ Nurses: includes professional nurses, auxiliary

nurses, enrolled nurses and other nurses, such as dental nurses and primary care nurses.

⦁ Midwives: includes professional midwives, auxiliary midwives and enrolled midwives. Traditional birth attendants, who are counted as community health workers, appear elsewhere.

⦁ Dentists: includes dentists, dental assistants and dental technicians.

⦁ Pharmacists: includes pharmacists, pharmaceutical assistants and pharmaceutical technicians.

⦁ Public and environmental health workers: includes environmental and public health officers, sanitarians, hygienists, public and environmental health technicians, district health officers, malaria

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technicians, meat inspectors, public health supervisors, and similar professions.

⦁ Community health workers: includes traditional medicine practitioners, faith healers, assistant/community health education workers, community health officers, family health workers, lady health visitors, health extension package workers, community midwives, institution-based personal care workers and traditional birth attendants.

⦁ Laboratory health workers: includes laboratory scientists, laboratory assistants, laboratory technicians and radiographers.

⦁ Other health workers: includes a large number of occupations such as dieticians and nutritionists, medical assistants, occupational therapists, operators of medical and dentistry equipment, optometrists and opticians, physiotherapists, podiatrists, prosthetic/orthotic engineers, psychologists, respiratory therapists, speech pathologists, and medical trainees and interns.

⦁ Health management and support workers: includes general managers, statisticians, lawyers, accountants, medical secretaries, gardeners, computer technicians, ambulance staff, cleaning staff, building and engineering staff, skilled administrative staff, and general support staff.

Methods of estimation: No methods of estimation have been developed.

Source: WHO Global Atlas of the Health Workforce. Geneva: WHO, 2009. Available at: http://apps.who.int/globalatlas/default.asp. See this source for the latest updates, time-trend statistics and disaggregated data, as well as metadata descriptors. In general, the denominator data for health workforce density (i.e. national population estimates) were obtained from the World Population Prospects Database of the United Nations Population Division. In some cases, official reports provided only workforce density indicators, from which estimates of the absolute numbers were calculated. Depending on the organization of national health systems and means of monitoring, data may not be exactly comparable across countries. Data from the years prior to 2000 were excluded from this edition.

Medical Products and Equipment

22. Number of hospital beds per 10 000 population

Rationale for use: Service delivery is an important component of health systems. To capture availability,

access and distribution of health services delivery, a range of indicators or a composite indicator is needed. Currently, there are no such data for the majority of countries. Inpatient bed density is one of the few available indicators on a component of level of health service delivery.

Definition: Number of inpatient beds per 10 000 population.

Methods of estimation: Empirical data only, with possible adjustment for underreporting (e.g. missing private facilities). Additional data are compiled by the WHO Regional Office for Africa.

Health Information – Civil Registration Coverage

23. Coverage of vital registration of deaths

Rationale for use: Health information is an essential component of health systems. The registration of births and deaths with causes of death, called ‘civil registration (vital registration)’, is an important component of a country’s health information system.

Definition: Percentage of estimated total deaths that are ‘counted’ through a civil registration system.

Methods of estimation: Expected numbers of deaths by age and sex are estimated from current life tables, based on multiple sources. Reported numbers are compared with expected numbers by age and sex to obtain an estimate of coverage of the vital registration system.

Sources: (i) United Nations Demographic Yearbook 2007. New York: United Nations Statistics Division, 2009. Available at: http://unstats.un.org/unsd/demographic/products/dyb/dybsets/2007%20DYB.pdf; (ii) WHO Mortality Database: Tables. Geneva: WHO, 2009. Available at: www.who.int/healthinfo/morttables.

⦁ SPECIFIC PROGRAMS AND SERVICES

24. Estimated rate of adults (15 years and older) dying of HIV/AIDS (per 1000)/Estimated rate of children below 15 years of age dying of HIV/AIDS (per 1000)

Rationale for use: The mortality rates for adults and children below 15 are leading indicators of the level

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of impact of the HIV/AIDS epidemic and the impact of interventions, especially scale-up of treatment and prevention of mother-to-child transmission in countries.

Definition: Estimated mortality due to HIV/AIDS is the number of adults and children that have died in a specific year based in the modelling of HIV surveillance data using standard and appropriate tools.

Methods of estimation: Empirical data from different HIV surveillance sources are consolidated to obtain estimates of the level and trend in adult and child mortality by using standard methods and tools for HIV estimates appropriate to the level of HIV epidemic. However, to obtain the best possible estimates, judgement needs to be made on data quality and how representative it is of the population. UNAIDS/WHO produce country-specific estimates every 2 years.

Source: Based on the 2008 Report on the Global AIDS Epidemic. Geneva, UNAIDS and WHO, 2008. See Annex: HIV and AIDS Estimates and Data, 2007 and 2001. Available at: http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp211_234_en.pdf. Ranges of estimates are available from this document. WHO regional and global figures are updates for the year 2008. Income-group aggregates are based on the 2008 World Bank list of economies.

25. HIV prevalence among the population aged 15–49 years

Rationale for use: HIV/AIDS has become a major public health problem in many countries, and monitoring the course of the epidemic and the impact of interventions is crucial. Both the MDGs and the United Nations General Assembly Special Session on HIV and AIDS (UNGAS) have set goals for reducing HIV prevalence.

Definition: Percentage of people with HIV infection among all people aged 15–49 years.

Methods of estimation: HIV prevalence data from HIV sentinel surveillance systems, which may include national population surveys with HIV testing, are used to estimate HIV prevalence using standardized tools and methods of estimation developed by UNAIDS and WHO in collaboration with the UNAIDS Reference Group on Estimation, Modelling and Projections. Tools for estimating the level of HIV infection are different for generalized epidemics, and concentrated or low-level epidemics.

26. People with advanced HIV infection receiving antiretroviral (ARV) combination therapy (%)

Rationale for use: As the HIV epidemic matures, increasing numbers of people are reaching advanced stages of HIV infection. ARV combination therapy has been shown to reduce mortality among those infected, and efforts are being made to make it more affordable even in less-developed countries. This indicator assesses the progress in providing ARV combination therapy to everyone with advanced HIV infection.

Definition: Percentage of people with advanced HIV infection receiving ARV therapy according to nationally approved treatment protocol (or WHO/Joint UN Programme on HIV and AIDS standards) among the estimated number of people with advanced HIV infection.

Methods of estimation: The denominator of the coverage estimate is obtained from models that also generate the HIV prevalence, incidence and mortality estimates. The number of adults with advanced HIV infection who need to start treatment is estimated as the number of AIDS cases in the current year times 2. The total number of adults needing ARV therapy is calculated by adding the number of adults who need to start ARV therapy to the number of adults who are being treated in the previous year and have survived into the current year.

Source: Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in The Health Sector: Progress Report, 2008. Geneva: WHO, Joint United Nations Programme on HIV/AIDS, United Nations Children’s Fund, 2008. WHO regional and global figures are updates for the year 2008. Income-group aggregates are based on the World Bank 2008 list of economies.

27. Incidence of tuberculosis

Rationale for use: Incidence (cases arising in a given time period) gives an indication of the burden of TB in a population, and of the size of the task faced by a national TB control programme. Incidence can change as the result of changes in transmission (the rate at which people become infected with Mycobacterium tuberculosis, the bacterium that causes TB) or changes in the rate at which people infected with M. tuberculosis develop TB disease (e.g. as a result of changes in nutritional status or of HIV infection). Because TB can develop in people

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who became infected many years previously, the effect of TB control on incidence is less immediate than the effect on prevalence or mortality. MDG6, Target 8 is ‘to have halted by 2015 and begun to reverse the incidence of’ TB. WHO estimates that in 2004 the per capita incidence of TB was stable or falling in 5 out of 6 WHO Regions, but growing globally at 0.6% per year. The exception was the African Region, where incidence is apparently still increasing, but less rapidly each year. Implementation of the Stop TB Strategy, following the Global Plan to Stop TB 2006–2015, is expected to reverse the rise in incidence globally by 2015.

Definition: Estimated number of TB cases arising in a given time period (expressed as per capita rate). All forms of TB are included, as are cases in people with HIV.

Methods of estimation: Estimates of TB incidence, prevalence and mortality are based on a consultative and analytical process in WHO and are published annually. Estimates of incidence for each country are derived using one or more of four approaches, depending on the available data:

incidence = case notifications/proportion of cases detected

incidence = prevalence/duration of condition

incidence = annual risk of TB infection × Stýblo coefficient

incidence = deaths/proportion of incident cases that die

Data are for all forms of tuberculosis, including tuberculosis in people with HIV infection.

Source: Global Tuberculosis Control: A Short Update to the 2009 Report. Geneva: WHO, 2009 (WHO/HTM/TB/2009.426). Available at: www.who.int/tb/publications/global_report. WHO region, income group and global aggregates include territories.

28. Prevalence of tuberculosis

Rationale for use: Prevalence and mortality are direct indicators of the burden of TB, indicating the number of people suffering from the disease at a given point in time and the number dying each year. Furthermore, prevalence and mortality respond quickly to improvements in control, as timely and effective treatments reduce the average duration of disease (thus decreasing prevalence) and the likelihood of dying from the disease (thus reducing

disease-specific mortality). MDG6 is ‘to combat HIV/AIDS, malaria and other diseases’ (including TB). This goal is linked to Target 8, ‘to have halted by 2015 and begun to reverse the incidence of malaria and other major diseases’, and MDG Indicator 24, ‘prevalence and mortality rates associated with TB’. The Stop TB Partnership has endorsed the related targets of reducing per capita TB prevalence and mortality by 50% relative to 1990, by the year 2015. There are few good data with which to establish TB prevalence and mortality, particularly for the baseline year of 1990. However, current best estimates suggest that implementation of the Global Plan to Stop TB 2006–2015 will halve 1990 prevalence and mortality rates globally and in most regions by 2015, though not in Africa and Eastern Europe.

Definition: The number of cases of TB (all forms) in a population at a given point in time (sometimes referred to as ‘point prevalence’) expressed in this database as number of cases per 100 000 population.

Methods of estimation: Estimates of TB incidence, prevalence and mortality are based on a consultative and analytical process in WHO and are published annually. The methods used to estimate TB prevalence and mortality rates are described in detail elsewhere. Country-specific estimates of prevalence are, in most instances, derived from estimates of incidence, combined with assumptions about the duration of disease. The duration of disease is assumed to vary according to whether the disease is smear-positive or not; whether the individual receives treatment in a DOTS programme or non-DOTS programmes, or is not treated at all; and whether the individual is infected with HIV.

29. Tuberculosis: DOTS case detection rate

Rationale for use: The proportion of estimated new smear-positive cases that are detected (diagnosed and notified to WHO) by DOTS programmes provides an indication of how effective national TB programmes are in finding people with TB and diagnosing the disease.

Methods of estimation: Estimates of incidence are based on a consultative and analytical process in WHO, and are published annually. The DOTS detection rate for new smear-positive cases is calculated by dividing the number of new smear-positive cases notified to WHO by the estimated number of incident smear-positive cases for the same year.

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30. Tuberculosis: DOTS treatment success

Rationale for use: Treatment success is an indicator of the performance of national TB control programmes. In addition to the obvious benefit to individual patients, successful treatment of infectious cases of TB is essential to prevent the spread of the infection. Detecting and successfully treating a large proportion of TB cases should have an immediate impact on TB prevalence and mortality. By reducing transmission, successfully treating the majority of cases will also affect, with some delay, the incidence of disease.

Definition: The proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriological evidence of success (‘cured’) or without (‘treatment completed’). At the end of treatment, each patient is assigned one of the following six mutually exclusive treatment outcomes: cured; completed; died; failed; defaulted; and transferred out with outcome unknown. The proportions of cases assigned to these outcomes, plus any additional cases registered for treatment but not assigned to an outcome, add up to 100% of cases registered.

The treatment-success rate is the percentage of new smear-positive patients registered for treatment who were cured (with laboratory confirmation) or who completed their course of treatment.

Source: Global TB Control: A Short Update to the 2009 Report. Geneva: WHO, 2009 (WHO/HTM/TB/2009.426). Available at: www.who.int/tb/publications/global_report. WHO Regional, income group and global aggregates include territories.

31. Tuberculosis mortality

Rationale for use: Prevalence and mortality are direct indicators of the burden of tuberculosis (TB), indicating the number of people suffering from the disease at a given point in time and the number dying each year. Furthermore, prevalence and mortality respond quickly to improvements in control, as timely and effective treatment reduces the average duration of disease (thus decreasing prevalence) and the likelihood of dying from the disease (thus reducing disease-specific mortality).

Definition: Estimated number of deaths due to TB in a given time period. It is expressed in this database as deaths per 100 000 population per year. Includes

deaths from all forms of TB, and deaths from TB in people with HIV.

Methods of estimation: Estimates of TB incidence, prevalence and mortality are based on a consultative and analytical process in WHO and are published annually. The methods used to estimate TB mortality rates are described in detail elsewhere. Country-specific estimates of TB mortality are, in most instances, derived from estimates of incidence, combined with assumptions about the case fatality rate. The case fatality rate is assumed to vary according to whether the disease is smear-positive or not; whether the individual receives treatment in a DOTS programme or non-DOTS programmes, or is not treated at all; and whether the individual is infected with HIV.

These are classified as deaths from tuberculosis according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Geneva, WHO, 1992.

Source: Global Tuberculosis Control: A Short Update to the 2009 Report. Geneva, WHO, 2009 (WHO/HTM/TB/2009.426). Available at: www.who.int/tb/publications/global_report. WHO Regional, income group and global aggregates include territories.

32. Children under 5 years of age with fever who received treatment with any antimalarial therapy (%)

Rationale for use: Prompt treatment with effective antimalaria drugs for children with fever in malaria risk areas is a key intervention to reduce mortality. In addition to being listed as a global MDG indicator under Goal 6, effective malaria treatment is also identified by WHO, UNICEF and the World Bank as one of the four main interventions to reduce the burden of malaria in Africa: (i) use of insecticide-treated nets (ITNs); (ii) prompt access to effective treatments in or near the home, (iii) provision of antimalaria drugs to symptom-free pregnant women in stable transmission areas; and (iv) improved forecasting, prevention and response, essential to respond quickly and effectively to malaria epidemics. In areas of sub-Saharan Africa with stable levels of malaria transmission, it is essential that access to prompt treatment be ensured. This requires drug availability at household or community level and, for complicated cases, availability of transport to the nearest equipped facility. Reserve drug stocks, transport and hospital capacity are needed to mount an appropriate response to malaria cases and prevent

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the onset of malaria from degenerating to a highly lethal complicated malaria picture.

Definition: Percentage of population under 5 years of age in malaria-risk areas with fever being treated with effective antimalaria drugs.

Methods of estimation: For prevention, the indicator is calculated as the percentage of children under 5 years of age who received effective antimalaria drugs upon a fever episode. The information is obtained directly from household surveys. The empirical values are directly reported without further estimation.

33. Children under 5 years of age sleeping under insecticide-treated nets (%)

Rationale for use: In areas of intense malaria transmission, malaria-related morbidity and mortality are concentrated in young children, and the use of insecticide-treated nets (ITNs) by children under 5 years of age has been demonstrated to considerably reduce malaria disease incidence, malaria-related anaemia and all-cause under-5 mortality. Vector control through the use of ITNs constitutes one of the four intervention strategies of the Roll Back Malaria Initiative. It is also listed as an MDG indicator.

Definition: Percentage of children under 5 years of age in malaria-endemic areas who slept under an ITN the previous night, ITN being defined as a mosquito net that has been treated within 12 months or is a long-lasting insecticidal net (LLIN).

Methods of estimation: Empirical data only.

Source: World Malaria Report 2009, Annex 6. Geneva: WHO, 2009. Available at: www.who.int/malaria/world_malaria_report_2009/mal2009_annex6_0010.pdf.

34. Number of poliomyelitis cases

Rationale for use: the 1988 World Health Assembly (WHA) called for the global eradication of poliomyelitis. The number of poliomyelitis cases is used to monitor progress towards this goal and to inform eradication strategies. Countries implement strategies supplementing routine immunization (e.g. national immunization days and sub-national campaigns) or more targeted mop-up activities, depending on the levels of poliomyelitis cases.

Definition: Suspected polio cases (acute flaccid paralysis (AFP), other paralytic diseases, and

contacts with polio cases) that are confirmed by laboratory examination or are consistent with polio infection.

Methods of estimation: Estimates of polio cases are based exclusively on unadjusted surveillance data.

Source: Data from WHO Polio Eradication Initiative, as of 12 January 2010. Updated information can be found at: www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm. Confirmed polio cases refer to any circulating polioviruses (wild poliovirus and circulating vaccine-derived poliovirus (cVDPV)).

35. One-year-olds immunized with:

⦁ one dose of measles (%) ⦁ three doses of diphtheria, tetanus toxoid and

pertussis (DTP3) (%) ⦁ three doses of hepatitis B (HepB3)(%)

Rationale for use: Immunization coverage estimates are used to monitor immunization services and to guide disease eradication and elimination efforts, and are a good indicator of health systems performance.

Definition: Measles immunization coverage is the percentage of 1-year-olds who have received at least one dose of measles containing vaccine in a given year. For countries recommending the first dose of measles among children older than 12 months of age, the indicator is calculated as the proportion of children less than 24 months of age receiving one dose of measles containing vaccine. DTP3 immunization coverage is the percentage of 1-year-olds who have received three doses of the combined diphtheria and tetanus toxoid and pertussis vaccine in a given year. HepB3 immunization coverage is the percentage of 1-year-olds who have received three doses of Hepatitis B3 vaccine in a given year.

Methods of estimation: WHO and UNICEF rely on reports from countries, household surveys and other sources such as research studies. Both organizations have developed common review process and estimation methodologies. Draµ estimates are made, reviewed by country and external experts and then finalized.

Sources: Unless otherwise stated, data are derived from Demographic and Health Surveys (DHS) conducted since 2000. The DHS figures were extracted using STATcompiler soµware (www.measuredhs.com/). When not available using STATcompiler soµware, figures were extracted directly

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from DHS reports. For some countries and some of the indicators, there were differences in the figures extracted from the country reports and STATcompiler. In these cases, following discussions with staff from the MEASURE DHS implementation group (ICF Macro), data from the country reports were used. Further information regarding the source of individual country data can be obtained on request from WHO.

36. Antenatal care coverage (%)

Rationale for use: Antenatal care coverage is an indicator of access and utilization of health care during pregnancy.

Definition: Percentage of women who utilized antenatal care provided by skilled health personnel for reasons related to pregnancy at least once during pregnancy as a percentage of live births in a given time period.

Methods of estimation: Empirical data from household surveys are used. At global level, facility data are not used.

Source: UNICEF Global Database on Maternal Health. New York: UNICEF, 2010. Available at: www.childinfo.org/antenatal_care_country.php.

37. Births by caesarean section (%)

Rationale for use: The proportion of births by caesarean section is an indicator of access to and utilization of health care during childbirth.

Definition: Percentage of births by caesarean section among all live births in a given time period.

Methods of estimation: Empirical data from household surveys.

38. Births attended by skilled health personnel (%)

Rationale for use: All women should have access to skilled care during pregnancy and at delivery to ensure detection and management of complications. Moreover, because it is difficult to measure maternal mortality accurately, model-based maternal mortality ratio (MMR) estimates cannot be used for monitoring short-term trends. The proportion of births attended by skilled health personnel is used as a proxy indicator for this purpose.

Definition: Percentage of live births attended by skilled health personnel in a given period of time.

Methods of estimation: Empirical data from household surveys are used. At a global level, facility data are not used.

Source: WHO Global Database on Maternal Health Indicators, 2009 update. Geneva: WHO, 2009. Available at: www.who.int/reproductive-health/global_monitoring/index.html. In order to enhance comparability over time, the reported figures are derived, to the extent possible, from broadly comparable data sources. Therefore, reported figures may not refer to the most recently available data. Refer to the source for more complete information on time trends and metadata.

39. Contraceptive prevalence (%)

Rationale for use: Contraceptive prevalence is an indicator of health, population, development and women’s empowerment. It also serves as a proxy measure of access to reproductive health services that are essential for meeting many of the MDGs, especially the child mortality, maternal health, HIV/AIDS and gender-related goals.

Definition: Contraceptive prevalence is the proportion of women of reproductive age who are using (or whose partner is using) a contraceptive method at a given point in time


Source: World Contraceptive Use 2009. New York: Population Division, Department of Economic and Social Affairs, United Nations Secretariat, 2009 (POP/DB/CP/Rev2009).

40. Condom use at higher-risk sex among young people aged 15–24 years (%)

Rationale for use: Consistent correct use of condoms within non-regular sexual partnerships substantially reduces the risk of sexual HIV transmission.

Definition: Percentage of young people aged 15–24 years reporting the use of a condom during the last sexual intercourse with a non-regular partner among those who had sex with a non-regular partner in the last 12 months.

Methods of estimation: Empirical data only. Survey respondents aged 15–24 years are asked whether they have commenced sexual activity. Those who report sexual activity and have had sexual intercourse with a non-regular partner in the last 12 months are further asked about the number of non-regular partners

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and condom use the last time they had sex with a non-regular partner.

Source: Data are from Demographic and Health Surveys (DHS) and exclude country-reported data. 2008 Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS, WHO, 2008. Available at: www.unaids.org/en/ KnowledgeCentre/HIVData/GlobalReport/2008/ 2008_Global_report.asp. See Annex 2: Country Progress Indicators.

41. Children under 5 years of age with acute respiratory infection and fever (ARI) taken to facility

Rationale for use: Respiratory infections are responsible for almost 20% of all under-5 deaths worldwide. The number of under-5s with ARI who are taken to an appropriate health provider is a key indicator for both coverage of intervention and care-seeking and provides critical inputs to the monitoring of progress towards the child-survival-related MDGs and strategies.

Definition: Proportion of children aged 0–59 months who had presumed pneumonia (ARI) in the last 2 weeks and were taken to an appropriate health provider.

Methods of estimation: Empirical data.

42. Children under 5 years of age with diarrhoea who received ORT

Rationale for use: Diarrhoeal diseases remain one of the major causes of under-5 mortality, accounting for 1.8 million child deaths worldwide, despite all the progress in their management and the undeniable success of oral rehydration therapy (ORT). Therefore, the monitoring of the coverage of this very cost-effective intervention is crucial for the monitoring of progress towards the child-survival-related MDGs and strategies.

Definition: Proportion of children aged 0–59 months who had diarrhoea in the last 2 weeks and were treated with oral rehydration salts or an appropriate household solution (ORT).


43. Children 6–59 months of age who received vitamin A supplementation

Rationale for use: Vitamin A supplementation is considered a critically important intervention for child

survival owing to the strong evidence that exists of its impact on child mortality. Therefore, measuring the proportion of children who have received vitamin A in the last 6 months is crucial for monitoring coverage of interventions towards the child-survival-related MDGs and strategies.

Definition: proportion of children 6–59 months of age who have received a high-dose vitamin A supplement in the last 6 months


Source: Data compiled by WHO from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), January 2010. Available at: www.measuredhs.com and www.unicef.org/statistics/index_24302.html .

44. Prevalence of current tobacco use in adolescents (13–15 years of age)

Rationale for use: The risk of chronic diseases starts early in childhood, and tobacco use continues to adulthood. Tobacco is an addictive substance, and smoking oµen starts in adolescence, before the development of risk perception. By the time the risk to health is recognized, the addicted individuals find it difficult to stop tobacco use.

Definition: Prevalence of tobacco use (including smoking, oral tobacco and snuff) on more than one occasion in the 30 days preceding the survey, among adolescents 13–15 years old.

Source: WHO/CDC Global Youth Tobacco Survey (GYTS). Geneva: WHO, 2010. Available at: www.cdc.gov/tobacco/global/GYTS/results.htm. Data relate to tobacco use in any form in the past 30 days.

45. Prevalence of current (daily or occasional) tobacco smoking among adults (15 years and older) (%)

Rationale for use: Prevalence of current tobacco smoking among adults is an important measure of the health and economic burden of tobacco, and provides a baseline for evaluating the effectiveness of tobacco control programmes over time. While a more general measure of tobacco use, including both smoked and smokeless products, would be ideal, data limitations restrict the present indicator to smoked tobacco. Occasional tobacco smoking constitutes a significant risk factor for tobacco-related disease, and is therefore included along with daily tobacco smoking.

6 Explanatory Notes

98

Definition: Prevalence of current tobacco smoking (including cigarettes, cigars, pipes or any other smoked tobacco products). Current smoking includes both daily and non-daily or occasional smoking.


Source: Based on WHO Report On The Global Tobacco Epidemic, 2009: Implementing Smoke-Free Environments. Geneva: WHO, 2009. Available at: www.who.int/tobacco/mpower/en/. See Appendix VII: Age-Standardized Prevalence Estimates for WHO Member States, 2006. ‘Smoking’ is defined as smoking at the time of the survey of any form of tobacco, including cigarettes, cigars, pipes, bidis, etc. and excluding smokeless tobacco. These figures represent age-standardized prevalence rates for smoking tobacco, and should only be used to draw comparisons of prevalence between countries and between men and women within a country. They should not be used to calculate the number of smokers in a country, region, income group or globally.

46. Children under 5 years of age

⦁ stunted for age (%) ⦁ underweight for age (%) ⦁ overweight for age (%)

Rationale for use: All three indicators measure growth in young children. Child growth is internationally recognized as an important public health indicator for monitoring nutritional status and health in populations. In addition, children who suffer from growth retardation as a result of poor diets and/or recurrent infections tend to have greater risks of illness and death.

Definition: Percentage of children stunted describes how many children under 5 years have a height-for-age below minus two standard deviations of the National Center for Health Statistics (NCHS)/WHO reference median. Percentage of children underweight describes how many children under 5 years have a weight-for-age below minus two standard deviations of the NCHS/WHO reference median. Percentage of children overweight describes how many children under 5 years have a weight-for-height above two standard deviations of the NCHS/WHO reference median.

Methods of estimation: Empirical values. Several countries have limited data for recent years and current estimations are made using models that make projections based on past trends.

Source: Global Database on Child Growth and Malnutrition. Geneva: WHO, 2009. Available at: www.who.int/nutgrowthdb/database/en. Prevalence estimates are based on WHO standards.

47. Newborns with low birthweight (%)

Rationale for use: the low-birthweight rate at the population level is an indicator of a public health problem that includes long-term maternal malnutrition, ill-health and poor health care. On an individual basis, low birthweight is an important predictor of newborn health and survival.

Definition: Percentage of live-born infants with birthweight less than 2500 g in a given time period. Low birthweight may be subdivided into very low birthweight (less than 1500 g) and extremely low birthweight (less than 1000 g).

Methods of estimation: Where reliable health service statistics with a high level of coverage exist, percentage of low-birthweight births. For household survey data, different adjustments are made according to the type of information available (numerical birthweight data or subjective assessment by the mother).

Source: UNICEF Global Database on Low Birthweight. New York: UNICEF, 2009. Available at: www.childinfo.org/low_birthweight_table.php (November 2009 update).

48. Prevalence of adults (15 years and older) who are obese (%)

Rationale for use: The prevalence of overweight and obesity in adults has been increasing globally. Obese adults (BMI ≥ 30.0 kg/m2) are at increased risk of adverse metabolic outcomes, including increased blood pressure, cholesterol, triglycerides and insulin resistance. Subsequently, an increase in BMI exponentially increases the risk of non-communicable diseases (NCDs), such as coronary heart disease, ischaemic stroke and type 2 diabetes mellitus. Raised BMI is also associated with an increased risk of cancer.

Definition: Percentage of adults classified as obese (BMI ≥ 30.0 kg/m²) among total adult population (15 years and older).

Methods of estimation: Estimates are still under development and will be published later in 2006.

Explanatory Notes

99

Only nationally representative surveys with either anthropometric data collection or self-reported weight and height (mostly in high income countries) are included in the 2006 World Health Statistics.

Comparisons between countries may be limited owing to differences in sample characteristics or survey years.

Source: Global Database on Body Mass Index. Geneva, WHO, 2010. Available at: www.who.int/bmi.

⦁ KEY DETERMINANTS OF HEALTH

49. Population with:

⦁ sustainable access to an improved water source (%) ⦁ access to improved sanitation (%)

Rationale for use: Access to drinking water and improved sanitation is a fundamental need and a human right vital for the dignity and health of all people. The health and economic benefits of improved water supply to households and individuals (especially children) are well documented. Both indicators are used to monitor progress towards the MDGs.

Definition: Access to an improved water source is the percentage of the population with access to an improved drinking water source in a given year. Access to improved sanitation is the percentage of the population with access to improved sanitation in a given year.

Methods of estimation: Estimates are generated through analysis of survey data and linear regression of data points. Coverage estimates are updated every 2 years.

Source: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Geneva: WHO and UNICEF, 2010. Available at: www.wssinfo.org/en/welcome.html.

50. Population using solid fuels (%)

Rationale for use: The use of solid fuels in households is associated with increased mortality from pneumonia and other acute lower respiratory diseases among children, as well as increased mortality from chronic obstructive pulmonary disease and lung cancer (where coal is used) among adults. It is also an MDG indicator.

Definition: Percentage of population using solid fuels.

Methods of estimation: The data from surveys and censuses are used as reported in the surveys and censuses. All countries with a Gross National Income (GNI) per capita above US$ 10 500 are assumed to have made a complete transition to cooking with non-solid fuels. For low- and middle-income countries with a GNI per capita below US$ 10 500 and for which no household solid fuel use data are available, a regression model based on GNI, percentage of rural population, and location or non-location within the Eastern Mediterranean Region is used to estimate the indicator.

These estimates use methods developed and implemented by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Where solid fuel use information is available for two or more separate years (spaced at least 5 years apart) linear regression is performed. The linear regression line is extrapolated up to 2 years aµer the latest survey point and up to 2 years before the earliest survey point. Outside these time limits, the extrapolated regression line is flat for 4 years in either direction. Where coverage reaches 0% or 100%, a horizontal line is drawn from the year before coverage reaches 0% or 100%. For countries with solid fuel use at less than 5%, 0% is assumed for the calculation of regional or global aggregates; for countries with more than 95%, 95% is assumed in the calculation of the aggregate.

Source: WHO Household Energy Database. Geneva: WHO, 2010. Available at: www.who.int/indoorair/health_impacts/he_database/en/.

Basic data and statistics are at the core of all health systems. Without them, it would be impossible to analyse evidence and extract action-orientated knowledge for decision making.

The development of an African Health Observatory and national health observatories aim to narrow the knowledge gap and strengthen health systems in the African Region by providing easy access to high quality information, evidence and knowledge, as well as facilitate their use for policy and decision making.

WHO Health Situation Analysis in the Africa Region: Atlas of Health Statistics, 2011 presents in numerical and graphical formats the best data available for key health indicators in the 46 countries of WHO’s African Region.

With the continued input and collaboration of the African countries, this publication and its future editions will be a signicant, constantly updated information product of the Observatory.

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Health Situation Analysis in the African Region · 2012-09-27 · AFRO Library Cataloguing-in-Publication Data Atlas of Health Statistics of the African Region 2011 1. Health Systems