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1991.03.21 :  Child Health in Sub-Sahara Africa

Contact:  Campbell Gardett (202) 245-6343
James Kunder USAID Press Office (202) 647-4200
March 21, 1991

     Child health has improved in recent years throughout much of
sub-Saharan Africa, but severe problems remain, including
malnutrition, malaria and vaccine-preventable disease, according
to a report to the President released today.
     The report concludes that United States assistance has
helped enhance child health, and such assistance can be extended
and improved.  But at the same time, the report says, both AIDS
and rapid population growth pose growing threats to health,
social and economic conditions in Africa.
     The report was presented by HHS Secretary Louis W. 
Sullivan, M.D., and Ronald W. Roskens, Ph.D., administrator of
the U.S. Agency for International Development, following their
mission to Africa on behalf of President Bush.  The President
announced the mission in his speech to the United Nations Summit
for Children last September.  The delegation, including HHS and
USAID experts on child health, visited seven African nations from
Jan. 4-18.
     "The United States is committed to a long-term partnership
with the nations of Africa to improve child health and child
survival," Secretary Sullivan said in releasing the report.  "The
findings and recommendations in this report will help to target
and strengthen our assistance and increase the effectiveness of
our cooperative efforts."
     Administrator Roskens said that "efforts to improve child
health go hand in hand with the whole range of other development
activities, including the hopeful movement toward democratization
and economic reform that is taking place in so many African
countries.  The nations we visited exhibited a self-help attitude
toward overcoming the impediments to improved child health, and
we are committed to assist them toward those goals."
     Recommendations in the report included the following:

  o  U.S. policy should continue to emphasize broad-based
     economic growth to create an environment in which health
     programs will be sustainable and effective.

  o  Strong primary health care policies and systems must
     undergird shorter-term health interventions.  U.S.
     assistance should continue to support targeted child
     survival activities while promoting policies that advance
     primary health care systems and which integrate disease
     prevention activities, including immunization programs and
     broad health education.

  o  U.S. assistance should be intensified in combating malaria,
     "the forgotten killer."  Of the 110 million cases of malaria
     reported annually, 90 million occur in Africa, and strains
     of the disease which are chloroquine-resistant are
     increasingly prevalent.  Malaria is the leading killer of
     children in many African countries.  U.S. assistance can
     help in applied and basic research and malaria control
     programs.

  o  Behavior change is the key to breaking the AIDS transmission
     chain.  U.S. programs should support additional
     interventions to promote behavior change, encourage social
     marketing of condoms and the control of sexually transmitted
     diseases, and support research on other means to reduce HIV
     transmission, including vaccines.

  o  Rapid population growth can overwhelm health care efforts. 
     The U.S. should intensify assistance for improved
     reproductive health and family planning in Africa and should
     include efforts to increase the range of choice of
     contraceptive methods.

  o  Information technology can be more effectively harnessed in
     the battle to save children's lives.  The U.S. should
     explore additional means to assure that African
     professionals have access to public health information,
     technical assistance and training in epidemiology, disease
     surveillance, computer science and data use.

  o  Stronger institutional linkages can improve the health of
     Africans and Americans.  American academic, philanthropic,
     health and civic institutions can be of assistance to health
     programs in Africa, including linkages with American medical
     research and training institutions.

     Among the findings of the delegation highlighted in the
report were the following:

  -- Progress has been made in child survival in Africa despite
     worsening economic conditions, including a 15 percent drop
     in per capita income in some two-thirds of sub-Saharan
     nations over the past decade.  With improved primary care
     systems, many countries have increased access to
     immunization, family planning services and oral rehydration
     therapy for the treatment of life-threatening diarrheal
     diseases.

  -- High fertility and rapid population growth are among the
     greatest threats to child survival in Africa.  With a
     population of 640 million today, sub-Saharan Africa is
     expected to increase by 1 billion by the year 2025

  -- Infant mortality rates in Africa remain among the highest in
     the world.  Of 30 countries with infant mortality higher
     than 100 deaths per 1,000 live births, 23 are in sub-Saharan
     Africa.

  -- Malnutrition is present in an estimated 30 percent of
     African children between 12-23 months, an important
     contributor to childhood mortality. 

  -- HIV infection is rapidly becoming one of the major causes of
     death for children in sub-Saharan Africa.  The prevalence of
     HIV infection in pregnant women is as high as 20-30 percent
     in some countries, and about a third pass the infection to
     their unborn child.  During the last decade, according to
     the World Health Organization, some 500,000 infants in
     Africa were born with HIV infection.  It is expected that by
     the end of the 1990s there will be an additional 10 million
     HIV-infected children in Africa.  In addition, an estimated
     10 million children are expected to become orphans in Africa
     during this decade because of the death of one or both
     parents from AIDS.  It is estimated that infant and child
     mortality rates in some African countries will increase by
     50 percent due to AIDS.

     The delegation visited Nigeria, Cote d'Ivoire, Uganda,
Malawi, South Africa, Zimbabwe and Senegal, and met with the
health minister of Namibia.

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