Health Care Fieldwork in South Africa

Health Care Fieldwork in South Africa

Julie Sklar ’18
Hometown: Denver, Colorado
Major: Sociology
Minor: Poverty and Human Capability Studies

Q: Tell us a little bit about your summer opportunity.
I attended the University of Virginia Field School for Public Health Research in South Africa and worked with Dr. Christopher Colvin, a medical anthropologist and epidemiologist. The program provided an in-depth and mentored experience in public health research. While in South Africa, I was enrolled in two courses: one that focused on research methodology and the other a practicum in which I completed research in the field with five other students.

In South Africa, I conducted my fieldwork in Khayelitsha, which is the largest township in South Africa. Within Khayelitsha, I researched residents of Town Two (a specific area of Khayelitsha) who lived with Type 2 diabetes and hypertension. As there are many organizations focusing on HIV/AIDS and tuberculosis in the area, my research group was interested in focusing on Type 2 diabetes and hypertension, diseases in that area that are not often discussed. The culmination of our research was a 45-minute presentation at the town hall, in which we invited all of our research participants, as well as community members, to attend.

My time in South Africa was made possible through funding from the Leyburn Scholars Fund and a Johnson Opportunity Grant.

Q: What has been your favorite aspect of your summer abroad?
Cape Town provides an incredible place to study and further my study of sociology and anthropology, as it is a city of ethnic, racial, and socioeconomic diversity. Cape Town tells a complex story between the rich and the poor, as some people in Cape Town suffer from malnutrition and the paralyzing epidemic of HIV, while others have access to state-of-the-art biomedicine. These discrepancies make Cape Town one of the most fascinating places in the world to study public health. Additionally, while I was stationed in Cape Town, I had the opportunity to travel to Zweletemba, a largely rural township that faces its own social and health challenges.

Q: What did an average day for you look like?
Every morning I traveled from Cape Town, where I was living, to the township of Khayelitsha, about a 30-minute bus ride. I began each morning with a Xhosa language class, which is an African click language that is spoken throughout the Western Cape. After class, most of the day was spent conducting research. That involved spending time in the local store trying to grasp prices of produce to interviewing a life-orientation teacher at the local secondary school to interviewing people living with Type 2 diabetes and hypertension about their lived experience with the disease and asking them to keep a photo diary of the food they ate.

Q: What has been the most rewarding and fulfilling part of your experience?
My favorite part of the program was my three-day homestay in the rural township of Zweletemba. During that time, I had no formal plans, which allowed me to truly immerse myself in my surroundings. My time in Zweletemba contrasted my time in Cape Town, a fast-paced, worldly city.

Q: What was the biggest challenge you faced?
The language component was undoubtedly the most challenging. The mother tongue of those living in Khayelitsha is Xhosa. And while some people spoke English, it was crucial to learn the basics of the Xhosa language to be able to communicate on a daily basis. The Xhosa language is an intricate African language that incorporates clicks on the letters x, c, and q. While I was only in South Africa for a short period, knowing the basics of the language proved essential, especially when asking people to open up about the most intimate and emotional details about living with a chronic illness.

Q: Who has served as a mentor to you this summer, and what have they taught you?
In Cape Town, I had the opportunity to work and study under Dr. Christopher Colvin, a medical anthropologist and epidemiologist whose research interests include HIV/AIDS, anti-retroviral treatment and masculinity; psychological trauma and storytelling; and community mobilization and health activism. During the research process, my group was assigned a field guide who was a respected member of the area, who helped introduce us to the local culture and research participants, as well assisting us with translation. Additionally, there were four research mentors each with graduate degrees in public health, who provided feedback throughout the research process.

Q: What have you learned at W&L that helped you in this endeavor, and what will you bring back to your life on campus?
Last semester, I had the opportunity to take Medical Anthropology with Professor Harvey Markowitz, a class that challenged me to think how we could integrate Western medicine into non-Western communities, saving lives while promoting and preserving cultural diversity. In Cape Town, I was able to better understand the complexity that underlies the blanket terms of “health” and “wellness,” as good health is multidimensional and is composed of biological, psychological, political, environmental, and social and cultural factors. While I have begun to learn how these factors intersect in a given society in my anthropology classes, having field experience monumentally deepened my understanding. Additionally, one of my favorite classes I have taken at W&L is Professor Novack’s Deviance course. In the field, I appreciated my background in this area, as certain medical diagnosis come with social stigma.

Q: Has this experience impacted your studies or future plans in any way?
This experience further cemented my interest in the field of public health. I plan to pursue a master’s in public health.

Q: Why is this kind of experience important to W&L students?
Washington and Lee has provided me a strong liberal arts background and has given me exposure to many different disciplines. However, having the opportunity to experience in real life the concepts and theories I have read and discussed in class has brought my understanding to the next level. My summer experience certainly demonstrated that the most rewarding moments come from venturing out of your comfort zone.

Q: Describe your summer adventure in one word:

Donate medical supplies for World First Aid Day

Donate medical supplies for World First Aid Day

Get your red and white clothing ready and help stock up first aid kits for those less fortunate in our community in celebration of World First Aid Day on Saturday, September 9.

The Princess Charlene of Monaco Foundation (PCMF), Ballito have teamed up with IPSS Medical Rescue and SA Life Saving and asked schools and the community to take part in the celebration of the World First Aid Day in the following ways:

1. Pupils in North Coast schools need to wear red and white on Friday and in lieu of giving money, rather donate first aid products which will go towards first aid boxes to be donated to orphanages, creches and community centres.

2. The PCMF’s team will be delivering a morning of talks, videos and first aid demonstrations at iThemba Labasha Creche, Shakashead on Saturday to raise awareness of the risks associated with water in and around the home and introduce young people to essential first aid and water safety skills.

IPSS Medical Rescue will be chatting about basic first aid and how to avoid or deal with accidents at home.

The highlight of the day will be the presence of a KDM fire engine.
PCMF project manager, Dominique Donner-Rodd said the planned activities surrounding the International Red Cross Day aim to unite all sectors of the emergency services in a common cause to educate the underprivileged communities about the potential hazards associated with water in and around the home and how to respond in an emergency situation.

“Within urban environments in South Africa, approximately 50% of drowning incidents occur in and around the home and in children under the age of 5, it’s about 70%, predominantly in buckets, bathtubs and swimming pools,” said Donner-Rodd.

“We would like to thank Vision 153 for collaborating with iThemba Labasha Creche and KwaMama Care Centre and allowing us the use of their facilities and playing field to host this initiative.”

Can doctors predict if you will have a prem baby?

Can doctors predict if you will have a prem baby?

An early birth can be a traumatic event for the mother as well as the baby. According to statistics published in the South African Medical Journal, premature birth accounts for 40% of all newborn deaths worldwide. Parent24 previously reported that approximately 14% of all babies born in private care in South Africa are premature, with as much as 23% of babies born premature in the public sector.

But it seems that there could be a way to establish whether a mother is prone to a premature birth.

By learning more about the immune system changes that occur during pregnancy, scientists hope they can someday predict if babies will be born prematurely.

Immune system changes

“Pregnancy is a unique immunological state. We found that the timing of immune system changes follows a precise and predictable pattern in normal pregnancy,” said study senior author Dr Brice Gaudilliere. He’s an assistant professor of anaesthesiology, perioperative and pain medicine at Stanford University School of Medicine in California.

If scientists can identify immune-system changes predicting premature birth, they say they might eventually develop a blood test to detect it.

“Ultimately, we want to be able to ask, ‘Does your immune clock of pregnancy run too slow or too fast?'” Gaudilliere said in a university news release.

According to a report on South African births, 35% of newborn deaths are because of complications of premature births. Currently, doctors have no reliable way to predict which babies will be born prematurely.

Immunity ‘algorithm’ could predict birth

For the study, which was published in Science Immunology, the researchers collected blood samples from 18 women who had full-term pregnancies. The women gave one sample during each trimester and another six weeks after childbirth. The researchers used samples from another group of 10 women who also had full-term pregnancies to verify the findings.

Using a technique called mass cytometry, the researchers simultaneously measured up to 50 properties of each immune cell in the blood samples. The investigators counted the types of immune cells, determined which signalling pathways were most active in each cell, and assessed how the cells reacted when exposed to compounds that mimic bacterial or viral infection.

The research team then used advanced statistical modelling to document the immune system changes occurring throughout pregnancy. (These adjustments keep the mother’s body from rejecting the unborn baby.)

“This algorithm is telling us how specific immune cell types are experiencing pregnancy,” Gaudilliere said.

The study confirmed that natural killer cells and certain white blood cells have enhanced action during pregnancy. The researchers also found that a signaling pathway among helper T-cells increases on a precise schedule.

Exciting outcome

“It’s really exciting that an immunological clock of pregnancy exists,” said study lead author Nima Aghaeepour, an instructor in anaesthesiology, perioperative and pain medicine.

“Now that we have a reference for normal development of the immune system throughout pregnancy, we can use that as a baseline for future studies to understand when someone’s immune system is not adapting to pregnancy the way we would expect,” Aghaeepour added.

A vision for digital health at the Healthcare Innovation Summit Africa 2017

A vision for digital health at the Healthcare Innovation Summit Africa 2017

We live in an unprecedented era of technological innovation. Digital breakthroughs are empowering healthcare organisations to improve labour productivity, clinical outcomes and human experience. How we adapt technology to the people who use it – patients, health insurers and providers – is going to define the future of health.

AI’s widening ambit

Among the factors set to remake the digital healthcare ecosystem is Artificial Intelligence (AI). AI is changing from a back-end tool for healthcare organisations to being at the forefront of both consumer and clinician experience. AI-powered technologies can suggest relevant options based on user behaviour as well as guide patients and doctors toward optimal outcomes.

Data curation and orchestration also fall within AI’s widening ambit, meaning that AI will partner increasingly with clinicians, helping to support diagnoses without substituting for clinical judgement. By equipping healthcare providers with information at speed, the use of AI will come to mean that more time can be spent on activities that add value to patient experience – human-human interactions machines cannot replace.

Human-focused tech

To this point, the deployment of tech within the healthcare space necessitates a human-centric approach. Designing technology to account for human experience benefits consumers, clinicians and administrators.

Moreover, technology’s increasing abilities mean that healthcare organisations have an unprecedented opportunity to transform their relationships with all stakeholders. Human-focused tech also provides consumers with a better opportunity to access care and information in a way and at a time that they want to.

Plug into and play within the broader ecosystem

Critically, the currently fragmented healthcare players will need to find ways to work together to meet rising expectations within this new technology-enabled ecosystem. Historically, healthcare service providers including hospitals, pharmacies and insurers focused purely on the functions within their control. Now, these players are beginning to understand the ways in which they depend on and will need to work with others who provide patient care either before or after they do.

For healthcare enterprises, integrating core functions with digital platforms is set to make it easier to plug into and play within the broader ecosystem. Collaboration between players also has the potential to improve clinical outcomes, lower costs, improve market share and maximise productivity.

Healthcare is the sum of many parts, including systems that pay for, coordinate and deliver care. There are also systems that help people self-manage a lifestyle goal or specific medical condition. Platforms can provide the connected infrastructure that enables service providers and consumers to exchange the necessary value and data.

To enable their future business ecosystems, healthcare enterprises will need to develop a robust portfolio of digital partners. The healthcare ecosystem of the future is complex, set to extend beyond technology, connecting the capabilities, expertise and services that affect healthcare organisations, consumers and clinicians.

Many healthcare organisations have already begun to integrate their core business functionalities with third parties and their platforms. In order to deliver optimal patient outcomes in a changing world, healthcare leaders will need to leverage these relationships and tools intelligently.

UBTH Gets New Chief Medical Director

UBTH Gets New Chief Medical Director

The federal government has approved the appointment of Dr. Darlington Obaseki as the substantive Chief Medical Director (CMD) of the University of Benin Teaching Hospital (UBTH).

The appointment, which is for a four-year tenure was contained in a letter signed by the Minister of Health, Prof. Isaac Adewole which takes effect from August 17, 2017.

Obaseki was born in 1968, and attended Asoro Grammar School, Benin City, where he obtained his West African School Certificate (WASC). He later proceeded to the University of Benin for his M.B.B.S and a Fellow of Medical College of Pathology.

He has held various positions which include, Head, Department of Pathology; Coordinator, UBTH Cancer Registry; Assistant Secretary, Medical and Dental Consultants Association of Nigeria; Secretary, Medical and Dental Consultants Association of Nigeria; Deputy Chairman, Medical Advisory Committee; Coordinator/Director, Cancer Registry, UBTH; and Special Adviser on Sports, School of Medicine, UBTH.

Obaseki also has to his credit, numerous scientific publications and international journals. Besides, he is also a member of learned societies which include Nigeria Medical Association, Medical and Dental Consultants Association of Nigeria, Society of Gastroenterology and Pathology in Nigeria, West Africa Division of the International Association of Pathologists and Society of Cancer Research of Nigeria.

Until his appointment, Obaseki was the Acting Chief Medical Director and as Associate Professor in the Department of Pathology of University of Benin.

Phones and drones transforming healthcare

Phones and drones transforming healthcare


In the developing world, basic healthcare is often a challenge — let alone expensive medical screening or tests for easily treatable, preventable illnesses.

TEDGlobal, an annual conference devoted to “ideas worth spreading” taking place in Tanzania this week, heard of new technologies that could revolutionise healthcare for the poor.

Algorithms to detect diseases

Infectious diseases are fast being overtaken by afflictions such as cancer as the biggest health problem in Africa, where some countries have only one pathologist per one million people.

Sierra Leonean roboticist David Sengeh believes training more specialists is not enough, and is working with his team at IBM Africa on artificial intelligence (AI) algorithms that can predict a cancer’s progression.

AI software can be trained with a database of images to detect colour changes inside the cervix that point to patients at high risk for cervical cancer, which can be treated if caught in time, but which kills 60,000 women in Africa a year.

Addressing a similar problem, Pratik Shah of the Massachusetts Institute of Technology (MIT) has developed a system to use simple cellphone or camera pictures — instead of expensive MRI or CT scans — to identify biomarkers that point to oral cancer.

He told AFP that while AI systems typically need tens of thousands of data points to function, he has found a way to use only 50 images to train algorithms to identify a specific disease.

“We believe our approach could be used to massively reduce the amount of data an AI algorithm currently consumes, and empower physicians to diagnose patients using simple images,” he said.

Both Shah and Sengeh are new members of the TED Fellows Programme which aims to spread the ideas of young innovators.

‘Eye-phones’ and mobile hearing

More than 1.1 billion people worldwide live with hearing loss — half of which is preventable, according to the World Health Organization.

American ear surgeon Susan Emmett said most of these are in low and middle-income countries where traditional hearing tests are a challenge. Malawi, for example, has only two ear surgeons and 11 audiologists.

Emmett is currently testing South African-developed mobile screening technology in rural Alaskan communities that has replaced the need for an audiologist, permanent equipment and a soundproof room.

The technology, costing 10 times less than traditional solutions, involves noise-isolating headphones and an adaptor attached to a mobile phone used to examine a patient’s ears.

Another speaker, Kyle DeCarlo, who is deaf, wishes the world would be more concerned with giving the deaf access to language rather than sound. He has developed a semi-transparent surgical mask so that deaf patients can read the lips of their doctors in hospitals.

The audience was also shown a video by eye surgeon Andrew Bastawrous who won a Rolex Award in 2016 for Peek, an “eye-phone”, or smartphone app he developed for use in Kenya, which uses a low-cost clip-on device to take images of the back of the eye to test sight.

Drone blood delivery

In Rwanda, a system launched last year to fly blood via drones from a central distribution centre to hospitals around the hilly nation has saved numerous lives, said robotics entrepreneur Keller Rinaudo, whose company Zipline runs the system.

The drones, which drop boxed packs of blood slowly to the earth via a paper parachute, now deliver 20 percent of blood supply outside the capital Kigali.

In one case a 24-year old woman bleeding out after childbirth was saved after several emergency flights in a row delivered more blood than is contained in one human body — which was all transfused into her.

Last week, Tanzania’s health ministry announced they would use the same technology to deliver a variety of medical products from four distribution centres via drone in what is set to be the largest autonomous delivery system anywhere in the world.

This Company Uses Drones to Deliver Blood in African Countries

This Company Uses Drones to Deliver Blood in African Countries

Drone delivery is not yet as popular in the United States as some might like, but it’s a booming business in other parts of the world. Zipline is one of the companies leading the charge, and right now, it’s mainly doing business in Africa.

For those who might be wondering, Zipline is a California-based robotics company that has managed to put itself on the radar by delivering blood via drones in Rwanda. The company recently announced that it has plans to kick start business in Tanzania by early 2018.

Zipline is hoping to work in close collaboration with the Tanzania Ministry of Health and the Medical Stores Department in a bid to open up to four distribution centers in the country over a four-year span. The idea here is to use drones to deliver blood to many public health locations in Tanzania.

Delivering blood is just the tip of the iceberg

The company is hoping it will get the go ahead in the future to provide regular medical supplies, HIV medication, vaccines, anti-malaria drugs, among others.

Keller Rinaudo, co-founder of Zipline, spoke in an interview with The Verge where he said the goal is to deliver medical products despite the fact that emergency restocks might not come off as exciting to some. He went on to add that medical supply delivery in emergency situations has been a problem for a hundred years, and global health experts have only been trying to fix it for the past 50-years.

Zipline launched its services for the first time in Rwanda in 2016, and so far, the company is experiencing relative successes. The launch is Rwanda’s first national drone delivery service, and this has allowed Zipline to accumulate over $35 million in funding.

Here’s the thing then, Rinaudo made it clear that his company has made 1,400 flights since going making its presence felt in the African country. So far, Zipline has delivered 2,600 units of blood, and a quarter of that number was produced for emergency cases.

Zipline builds its own drones

The impressive thing about this drone delivery company is the fact that it makes its own drones. The weight of the drones is around 25-pound, and they can fly up to fly up to 150 kilometers. Additionally, these devices, which are called Zips, can carry a payload of up to 1.5 kilograms.

Health organizations looking to have medical supplies delivered to their location can contact Zipline via mobile phones or even from WhatsApp. It takes around 30-minutes on average for supplies to be delivered, which isn’t too bad.

We’re guessing it depends on how far the destination is from Zipline’s location.

“The cool thing is now that we’ve shown that this can be done safely, operate at national safety levels,” Rinaudo said. “There’s a lot of evidence and data that we can show.”

The company is looking to deliver medical supplies in the United States, but drone regulation is much higher than in the African countries it’s currently doing business.

United States to give Ethiopia $91 million in drought aid for food and medicine

United States to give Ethiopia $91 million in drought aid for food and medicine

The United States will provide an additional $91 million in humanitarian aid for Ethiopia to cope with a third straight year of drought, the top U.S. official in charge of assistance said Thursday.

The extra funding brings U.S. aid for food and medical care in Ethiopia to $454 million this year, said Mark Green, the new administrator of the U.S. Agency for International Development. An extra $210 million in U.S. aid has gone to development projects.

Green announced the additional aid after he met with Ethiopian Prime Minister Hailemariam Desalegn. In a statement that he read to reporters, Green said he had also urged the Ethiopian leader to take “concrete steps to create political space for all voices to be heard and to uphold constitutional and guaranteed rights.”

In August, Ethi­o­pia lifted a 10-month state of emergency imposed after deadly clashes between security forces and anti-government protesters who were alleging human rights abuses and political cronyism.

“What I said to him is, ‘We look at what countries need around the world to strengthen their ability to deliver for their people,’ ” Green told reporters later.

“Responsive governance, and a place for people to come together from different points of view and to share ideas openly and publicly, history shows is vitally important,” he said. “Our view is the government should continue to foster that, and do more and more.”

According to USAID spokesman Clayton McCleskey, Green told Desalegn he was concerned that conditions were deteriorating for people affected by the drought and encouraged the government to “show greater leadership and invest more resources to combat a worsening humanitarian crisis.”

Green, on his first trip abroad since starting the job three weeks ago, is in Ethiopia to highlight U.S. efforts to help impoverished countries emerge from crises such as drought and famine, and to be better prepared to weather future setbacks.

Drought in Ethiopia’s lowlands bordering Somalia has sent herders farther afield in search of grazing land.

On Wednesday, Green said Ethiopia would be one of 12 countries to receive focused attention from Feed the Future programs, even if Congress approves deep cuts in USAID’s budget. The Trump administration has proposed halving Feed the Future’s total budget for agricultural development programs from more than $1 billion this year to $500 million next year. Ethiopia’s $78 million share of the funds would also be cut in half. Anticipating having less money to spend, USAID dropped seven countries from the original 19 on which it had planned to focus.

The United States has been the principal international donor to Ethiopia as the country has struggled through a devastating series of droughts. In recent years, U.S. aid has been used to try to help herders become farmers, has provided seed money for small businesses, and has funded job-skills training for impoverished Ethiopians and provided nutritional education.

While Green assured Desalegn that the United States remains committed to helping Ethiopia develop agriculturally and economically, he underscored that Washington expects the Ethiopian government to contribute more money to humanitarian efforts. During a drought in 2015 and 2016, Ethiopia spent about $700 million on food for the affected population. This year, it has pledged only $110 million and so far has spent far less than that.

“The United States will continue providing assistance for vulnerable people, but we all agree host-country partners must be willing to step up during crises, and the prime minister indicated that he was looking to do so,” Green said.

How Africa is Leapfrogging The World — Using Drone Medical Deliveries By Zipline

How Africa is Leapfrogging The World -- Using Drone Medical Deliveries By Zipline

“Africa can be the disruptor. These small agile economies can leapfrog with newer and better systems,” says Keller Rinaudo whose Zipline drones have proved just that by delivering life-saving blood in Rwanda within 30 minutes of an emergency call.

Zipline is a remarkable company that uses small, lightweight plane-shaped drones to deliver emergency medicine or blood from its base outside the Rwandan capital Kigali, in arguably the best demonstration of both innovative use of new technologies and what’s possible when a government is willing to experiment with them.

Such life-saving blood deliveries are the key to providing essential medical services in the mountainous East African country, where Zipline has delivered 2,400 blood units since the project began in October 2016.

“Most of that blood is going to mothers with postpartum haemorrhage (PPH),” Rinaudo, the CEO and co-founder, told TEDGlobal in Arusha, Tanzania. Some 30% of it is going to children with anaemia from malaria, the disease which remains the leading cause of mortality in Africa.

This remarkable delivery system, which takes 15-30 minutes to arrive at the hospital after the call is received, solves the particularly challenging problems of storing blood.

“Blood is challenging. It has a very short shelf life and is really hard to predict demand before patients need it. You are always trading off waste against access. To solve waste you want to keep the blood [or medicine] centralized. If you want to have lots of access, you keep lots of medicine at clinics. But if it expires it wastes a lot of money.”

Using Zipline’s system, Rwanda is able to keep the blood storage centralized and still get it to hospitals within in 30 minutes. He says the Rwandan government has been able to break the cycle of wastage, and zero units of blood have expired since the project began. “That’s an amazing result. That has not been achieved by any other healthcare system on the planet.”

Rinaudo described a scenario where a 24-year-old mother began haemorrhaging after a c-section to deliver her baby and Zipline made numerous flights to deliver lifesaving blood, plasma and platelets, which ultimately saved her life.

HIV/AIDS Is No Longer The Biggest Killer In Africa

HIV/AIDS Is No Longer The Biggest Killer In Africa

Complications from HIV/AIDS are no longer the biggest killer in Africa and deaths from malaria are down. However, it isn’t all good news.

Although this is undoubtedly an optimistic development, the latest statistics show an unwelcome rise in “lifestyle diseases”, much like the ones we see throughout the Western world.

The data, processed by the fact-checking NGO Africa Check, comes from the World Health Organization’s (WHO) latest available information on deaths in the Africa region.

In 2012, more than 1.1 million people in Africa were known to have died due to complications from HIV/AIDS. By 2015, this number declined to an estimated 760,000 deaths due to HIV/AIDS complications (the latest data available). Much of this is thanks to the huge amount of time and money put into raising awareness, changing perceptions, contraception, and medical treatments.

HIV/AIDS complications remain a prominent threat and are still the second-leading cause of death in Africa. The leading cause of death is now lower respiratory tract infections, such as bronchitis and pneumonia, which kill over 1 million Africans each year.

The third highest cause of death was diarrhea, although figures are down to 643,000 deaths per year compared to 725,000 in 2010. Worldwide, 88 percent of diarrhoeal deaths are caused by a virus, bacteria, or parasite picked up from drinking unsafe water, poor sanitation, or insufficient hygiene.

At number four, stroke deaths increased over the past five years from 406,595 (4.4 percent of deaths) to 451,000 deaths (4.9 percent) in 2015.

Malaria, now accounting for just 403,000 deaths, is no longer in the “top 5” leading causes of death. However, taking its place in the top 5 is ischaemic heart disease. This is a condition in which the flow of blood is restricted to the heart muscle due to the narrowing arteries and build up of fatty deposits. Lifestyle factors, such as smoking or high cholesterol, are strongly associated with it. It remains one of the biggest causes of death across many Western nations.

Along with strokes and heart disease, another noncommunicable disease on the up is liver cirrhosis, most often associated with heavy drinking. Unfortunately, these kinds of “lifestyle diseases” often go hand-in-hand with increased urbanization and improved standards of living, just as Africa has seen over the past decades.

The next leading causes of death in the region were tuberculosis (456,000), malaria (403,000), pre-term birth complications (344,000), birth asphyxia or trauma (321,000), and road injury (269,000).