By A. Onu*
In September 2000, 189 Heads of State adopted the UN Millennium Declaration. It was a roadmap setting out goals (Millennium Development Goals) to be reached by 2015. There are eight goals, 18 targets and 48 indicators to measure the MDGs. Three out of the eight goals and eight of the 18 targets relate directly to health. These are:
· Goal 4: Reduce child mortality
· Goal 5: Improve maternal health
· Goal 6: Combat HIV/AIDS, malaria, and other diseases.
Targets related to the goal of combating HIV/AIDS, malaria, and other diseases are:
· Have halted by 2015 and begun to reverse the spread of HIV/AIDS
· Have halted by 2015 and begun to reverse the incidence of malaria and other serious diseases.
How far have we gone down the road towards achieving these goals with just eight years left to that all-important deadline?
There has been some progress. However, nearly 11 million children under the age of five die every year globally. In 16 countries, 14 of which are in Africa, levels of under-five mortality are higher than in 1990. More than 500,000 women die in pregnancy and childbirth each year and maternal death rates are 1000 times higher in sub-Saharan Africa than in high income countries.1
A growing awareness of malaria’s heavy toll, matched with a greater commitment to curtail it has helped to spur key malaria control interventions, particularly insecticide-treated net use and access to effective antimalarial drugs. Resistance has now developed to all classes of antimalarial drugs except artemisinin and its derivatives. When used correctly in combination with other antimalarial drugs, artemisinin is nearly 95% effective in curing malaria. The rationale is that when two drugs with different modes of action are given simultaneously they attack different targets in the parasite. If a mutation should occur to make the parasite resistant to one of the drugs, the second drug will kill it.
In just four years (1999-2003), distribution of insecticide-treated mosquito nets increased 10-fold in sub-Saharan Africa. Despite this progress, urban dwellers are six times more likely to use the nets than their rural counterparts, according to data available from a number of countries in the region. Similarly, the richest fifth of the population are 11 times more likely to use them than the poorest fifth.2
There were an estimated 8.8 million new tuberculosis (TB) cases in 2005, including 7.4 million in Asia and sub-Saharan Africa. More than 1.6 million people died of TB, including 195,000 patients infected with HIV. The number of new tuberculosis cases is growing by about 1% per year, with the fastest increases in sub-Saharan Africa. More ominous has been the emergence of extensively drug resistant tuberculosis (XDR-TB).1, 3, 4
Fortunately, it has not been all doom and gloom. Recently comes a World Bank Report which states that the AIDS pandemic is on the decline in countries such as Rwanda, Uganda and Ethiopia. The infection in West Africa has not reached the high levels it was feared that it might reach. It cannot also have been bad that the recently concluded G8 summit at Heiligendamm, Germany promised $60 billion dollars to combat the spread of HIV/AIDS and other diseases affecting Africans.
Certainly with the right combination of commitment and aid, there is still enough time to achieve the Millennium Development Goals.
1. United Nations Department of Economic and Social Affairs. The Millennium Development Goals Report 2006; New York, United Nations June 2006.
2. Year in Review 2006. Geneva; World Health Organization 2007.
3. Global Tuberculosis control: surveillance, planning, financing. WHO report 2007. Geneva, World Health Organization, 2007 (WHO/HTM/TB/2007.376)
4. Raviglione MC, Smith IM. XDR Tuberculosis- Implications for Global Public Health. N Engl J Med 2007; 356 (7): 656-9.
*Dr. A. Onu is of the Department of Family Medicine of the Jos University Teaching Hospital and Editor-in-Chief of the Jos Journal of Medicine. This piece is the editorial of the current issue of the Journal. I am an Associate Editor of the Journal.
