WHO’s Concern of Swine Flu Spreads in Africa

originally published in the Daily Nation

The World Health Organisation opened a weeklong summit in Kigali Monday focusing on HIV/Aids transmission, malaria, and child-survival techniques.

But the conference – attended by representatives from 46 African countries – comes amidst deepening fears throughout the continent that this year’s swine flu (H1N1 flu virus ) pandemic will sweep through Africa virtually undetected as it begins its crawl inland from ashore.

“This is a very important meeting where people will come together to discuss major issues such as Millennium Development Goals, Primary Health Care, the AIDS pandemic as well as the current pandemic of influenza,” said the Organisation’s Director General Margaret Chan upon her arrival in Kigali for the country.

Travelling across Africa in the early weeks of the swine flu outbreak was like surfing along crests of precaution. From ports in Burundi to Ethiopia to Egypt, health ministries responded hastily to screen travellers: Some of the poorest countries printed out questionnaires directly from personal computers, while the virus remained a ghost far away.

Now, the World Health Organisation is saying some of those measures have not been as successful as reported. As swine flu – and the long rainy season – finally settles in and inches closer to Africa’s congested heart, public health officials are holding their breath. They say higher pregnancy rates and prior illnesses will elicit more dramatic results than seen elsewhere.

Last week in Uganda, Dr Chan said that, due to mediocre surveillance, caseloads were in fact much higher than reported, and that difficulty tracking the viruses as it traverses Africa would continue. Officially, 11 people have died in a reported 3855 cases in 21 countries.

“It probably does not reflect the true picture on the ground,” said Dr Mark Katz, leading researcher on influenza for the Centre for Disease Control in Nairobi, Kenya. “Are we off by the thousands or tens of thousands? It’s hard to say.”

Due to the Avian Flu outbreaks in the mid 2000s, some countries, such as Rwanda, were able to develop surveillance systems and health facilities. The country has won international praise for its innovations in healthcare and access to medicine. But Dr Katz said there were many in Africa today that still had no way of detecting the current outbreak.

Rwanda and Burundi, in the central cool highlands, are the only two countries outside of West Africa yet to report a case of swine flu. They are among the poorest and most densely-populated places on Earth. Like in other African countries, nearly half of the population is below the age of 15 and doses of malaria and HIV are forecast to play a role in how the flu manifests itself. A more understated worry is the high pregnancy rates, which can leave women weak when the virus attacks.

“Most severe outcomes are associated with underlying conditions,” says Dr Justin Lessler, a researcher of infectious disease at Johns Hopkins University. “This usually means existing disease, but perhaps pregnancy as well.” So far, half of South Africa’s 20 Swine Flu deaths have been pregnant women.

While doctors said it was difficult to put a figure on how many this would affect, the risk was clear. “It may tip some people with chronic disease over the top,” said Dr Katz.

The tiny Indian Ocean island of Mauritius has emerged as a cautionary example, where five have died out of 40 cases.

“People working in public health fear it will ultimately have a very severe outcome on this continent,” said Dr. Katz, “because of all the other public health issues going on here.”