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.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
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
Eastern Mediterranean
Western Paci�c
Global
44%
1%
23%
28%
54%
94%
45%
African
Eastern Mediterranean
Western Paci�c
South-East Asia
Americas
European
Global
African
South-East Asia
Eastern Mediterranean
Western Paci�c
European
Americas
Global
GlobalAfrican Region Global
African 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 : 76%
2015 MDG Target : 13%
2015 MDG Target : 75%
2015 MDG Target : 213
2015 MDG Target : 55
2015 MDG Target : 89%
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)
Immunization coverageamong 1-year-olds,
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%
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
Eastern Mediterranean
Western Paci�c
Global
44%
1%
23%
28%
54%
94%
45%
African
Eastern Mediterranean
Western Paci�c
South-East Asia
Americas
European
Global
African
South-East Asia
Eastern Mediterranean
Western Paci�c
European
Americas
Global
GlobalAfrican Region Global
African 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 : 76%
2015 MDG Target : 13%
2015 MDG Target : 75%
2015 MDG Target : 213
2015 MDG Target : 55
2015 MDG Target : 89%
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
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)
Immunization coverageamong 1-year-olds,
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
United Republic of Tanzania
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
Sao Tome and Principe
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
Outside WHOAfrican Region
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
South-East AsiaRegion
EasternMediterranean
Region
European Region
WesternPacificRegion
Region of theAmericas
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
Central African Republic
Democratic Republic of the Congo
Swaziland
Zambia
Guinea-Bissau
Mali
Nigeria
Sierra Leone
Burundi
Burkina Faso
Mozambique
Niger
Uganda
Cameroon
Equatorial Guinea
Malawi
South Africa
United Republic of Tanzania
Congo
Guinea
Kenya
Liberia
Côte d'Ivoire
Benin
Ethiopia
Mauritania
Rwanda
Gambia
Senegal
Togo
Comoros
Gabon
Madagascar
Botswana
Sao Tome and Principe
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
Democratic Republic of the Congo
Guinea-Bissau
Zambia
Mali
Sierra Leone
Swaziland
Burundi
Central African Republic
Nigeria
Burkina Faso
Mozambique
Niger
Uganda
Malawi
South Africa
United Republic of Tanzania
Cameroon
Equatorial Guinea
Guinea
Kenya
Liberia
Congo
Côte d'Ivoire
Mauritania
Rwanda
Togo
Benin
Ethiopia
Comoros
Gabon
Gambia
Madagascar
Senegal
Botswana
Ghana
Sao Tome and Principe
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
Central African Republic
Malawi
Rwanda
Angola
Niger
Cameroon
Côte d'Ivoire
Equatorial Guinea
United Republic of Tanzania
Guinea
Kenya
Liberia
South Africa
Congo
Botswana
Ethiopia
Ghana
Mauritania
Togo
Benin
Gabon
Gambia
Senegal
Madagascar
Namibia
Sao Tome and Principe
Eritrea
Comoros
Cape Verde
Seychelles
Mauritius
Algeria
Male Female
Democratic Republic of the Congo
4546
1 Health Statusand Trends
4
MortalityFigure 8: Adult mortality rate per 1000 population in the African Region, 2008
No data
Outside WHOAfrican Region
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
South-East Asia Region
Eastern Mediterranean Region
European Region
Region of the Americas
Western Pacific 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
South-East Asia Region
Eastern Mediterranean Region
European Region
Region of the Americas
Western Pacific 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
United Republic of Tanzania
Central African Republic
Chad
Uganda
Angola
Burundi
Nigeria
Democratic Republic of the Congo
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
Sao Tome and Principe
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
United Republic of Tanzania
Chad
Angola
Uganda
Central African Republic
Democratic Republic of the Congo
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
Sao Tome and Principe
Eritrea
Seychelles
Mauritius
Algeria
Male Female
1 Health Statusand Trends
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
Outside WHOAfrican Region
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
Eastern Mediterranean Region
South-East Asia Region
Western Pacific Region
Region of the Americas
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
Eastern Mediterranean Region
South-East Asia Region
Western Pacific Region
Region of the Americas
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
Democratic Republic of the Congo
Guinea-Bissau
Sierra Leone
Mali
Central African Republic
Burkina Faso
Burundi
Angola
Niger
Cameroon
Equatorial Guinea
Guinea
Mozambique
Zambia
Nigeria
Congo
Uganda
Côte d'Ivoire
Benin
Mauritania
Liberia
Rwanda
Malawi
United Republic of Tanzania
Comoros
Ethiopia
Gambia
Togo
Senegal
Zimbabwe
Kenya
Lesotho
Sao Tome and Principe
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*
*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.
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
Democratic Republic of the Congo
Chad
Sierra Leone
Guinea-Bissau
Central African Republic
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
United Republic of Tanzania
Ethiopia
Togo
Lesotho
Zimbabwe
Kenya
Gabon
Sao Tome and Principe
Swaziland
Senegal
Ghana
Botswana
South Africa
Madagascar
Eritrea
Namibia
Algeria
Cape Verde
Mauritius
Seychelles
2009 1990
1 Health Statusand Trends
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
EasternMediterranean
Region
South-East AsiaRegion
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
Outside WHOAfrican Region
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
Outside WHOAfrican Region
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
Outside WHOAfrican Region
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.
1 Health Statusand Trends
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
Eastern Mediterranean
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
Lower respiratory infections
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
Respiratory infections
Perinatal conditions
Unintentional injuries
Neuropsychiatric disorders
Maternal conditions
Nutritional deficiencies
Intentional injuries
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
Eastern Mediterranean
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
1 Health Statusand Trends
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
Democratic Republic of the Congo
Ethiopia
Burkina Faso
Mozambique
Burundi
Uganda
Nigeria
Kenya
United Republic of Tanzania
Central African Republic
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
Non-communicable conditions
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
Democratic Republic of the Congo
Mozambique
Nigeria
Burundi
Uganda
Congo
United Republic of Tanzania
Benin
Cameroon
Central African Republic
Equatorial Guinea
Togo
Guinea
Côte d'Ivoire
Madagascar
Senegal
Eritrea
Ghana
Mauritania
Gambia
Sao Tome and Principe
South Africa
Gabon
Comoros
Cape Verde
Algeria
Seychelles
Mauritius
Communicable disease
Non-communicable conditions
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
Eastern Mediterranean Region
South-East Asia Region
Region of the Americas
Western Pacific Region
European Region
Global
Communicable disease
Non-communicable conditions
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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
European Region
Region of the Americas
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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
European Region
Region of the Americas
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
Democratic Republic of the Congo
Eritrea
Zimbabwe
Central African Republic
Ethiopia
Sierra Leone
Guinea-Bissau
Niger
Comoros
Liberia
Mozambique
Madagascar
Mauritania
Malawi
Burundi
Guinea
United Republic of Tanzania
Côte d'Ivoire
Mali
Togo
Benin
Gambia
Burkina Faso
Chad
Kenya
Uganda
Zambia
Congo
Lesotho
Rwanda
Senegal
Cameroon
Ghana
Angola
Nigeria
Cape Verde
Sao Tome and Principe
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
Central African Republic
Madagascar
Côte d'Ivoire
Mauritius
Algeria
Sierra Leone
Cape Verde
Gabon
Kenya
Benin
Chad
Cameroon
Mozambique
Seychelles
Niger
United Republic of Tanzania
Gambia
Guinea
Botswana
Mali
Senegal
Democratic Republic of the Congo
Swaziland
Burkina Faso
Guinea-Bissau
Togo
Lesotho
Zambia
Uganda
Nigeria
Namibia
Ghana
South Africa
Zimbabwe
Malawi
Rwanda
Liberia
Sao Tome and Principe
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
Outside WHOAfrican Region
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
South-East AsiaRegion
Region of theAmericas
EasternMediterranean
Region
Western PacificRegion
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
EasternMediterranean
Region
South-East AsiaRegion
WesternPacificRegion
Region of theAmericas
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
Democratic Republic of the Congo
Nigeria
Equatorial Guinea
Togo
Kenya
Sierra Leone
Lesotho
Cameroon
Comoros
Seychelles
Zimbabwe
Swaziland
Mauritius
Uganda
Ethiopia
Cape Verde
Benin
Algeria
Ghana
South Africa
Central African Republic
Namibia
Gambia
Mali
Malawi
Senegal
Niger
Burundi
Mozambique
Botswana
Sao Tome and Principe
Burkina Faso
Chad
Gabon
Zambia
Madagascar
Liberia
United Republic of Tanzania
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
United Republic of Tanzania
Democratic Republic of the Congo
Eritrea
Ethiopia
Burundi
Guinea-Bissau
Zambia
Uganda
Sierra Leone
Burkina Faso
Central African Republic
Gambia
Kenya
Sao Tome and Principe
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
South-East Asia Region
Region of the Americas
Eastern Mediterranean Region
Western Pacific Region
European Region
Global
2007 2000
2007 2000
60
87
86
82
67
28
44
53
89
84
88
66
30
44
African Region
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
European Region
Region of the Americas
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
Democratic Republic of the Congo
Côte d'Ivoire
Togo
Nigeria
Cameroon
Guinea-Bissau
Liberia
Uganda
Sierra Leone
Central African Republic
Burundi
South Africa
Kenya
Namibia
Eritrea
Zimbabwe
Rwanda
Sao Tome and Principe
Gambia
Mauritius
Mali
Ghana
Benin
Niger
Senegal
Burkina Faso
Chad
Comoros
Zambia
Ethiopia
Lesotho
Malawi
Swaziland
Gabon
Mauritania
United Republic of Tanzania
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
Central African Republic
Benin
Algeria
Cameroon
Burkina Faso
Côte d'Ivoire
Togo
Mauritius
Ethiopia
Ghana
Senegal
Kenya
Equatorial Guinea
United Republic of Tanzania
Lesotho
Madagascar
Zambia
Seychelles
Burundi
Sao Tome and Principe
Sierra Leone
Guinea-Bissau
Liberia
Democratic Republic of the Congo
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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
European Region
Region of the Americas
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
Democratic Republic of the Congo
Guinea
Guinea-Bissau
Eritrea
Zimbabwe
Central African Republic
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
United Republic of Tanzania
Rwanda
Zambia
Lesotho
Senegal
Ghana
Congo
Sao Tome and Principe
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
Outside WHOAfrican Region
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
South-East AsiaRegion
EasternMediterranean
Region
Western PacificRegion
Region of theAmericas
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
Outside WHOAfrican Region
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
South-East AsiaRegion
EasternMediterranean
Region
Western PacificRegion
Region of theAmericas
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
United Republic of Tanzania
Angola
Benin
Burkina Faso
Central African Republic
Congo
Côte d'Ivoire
Democratic Republic of the Congo
Eritrea
Ghana
Guinea
Kenya
Lesotho
Mali
Mauritania
Senegal
Togo
Uganda
Zambia
Cameroon
Comoros
Madagascar
Swaziland
Zimbabwe
Equatorial Guinea
Gabon
Namibia
Botswana
Nigeria
Sao Tome and Principe
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
United Republic of Tanzania
Chad
Liberia
Madagascar
Malawi
Mozambique
Togo
Central African Republic
Rwanda
Senegal
Côte d'Ivoire
Democratic Republic of the Congo
Equatorial Guinea
Eritrea
Gambia
Guinea-Bissau
Lesotho
Burkina Faso
Comoros
Mauritania
Zambia
Zimbabwe
Benin
Congo
Ghana
Kenya
Angola
Cape Verde
Uganda
Cameroon
Nigeria
Sao Tome and Principe
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
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
Western Pacific 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
Democratic Republic of the Congo
Mozambique
Togo
Burkina Faso
Ghana
United Republic of Tanzania
Guinea-Bissau
Madagascar
Kenya
Malawi
Gambia
Eritrea
Central African Republic
Gabon
Lesotho
Cameroon
Congo
Rwanda
Botswana
Zambia
Equatorial Guinea
Algeria
Cape Verde
Swaziland
Comoros
Namibia
South Africa
Zimbabwe
Sao Tome and Principe
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
United Republic of Tanzania
Chad
Zambia
Uganda
Lesotho
Angola
Nigeria
Swaziland
Democratic Republic of the Congo
Mozambique
Equatorial Guinea
Niger
Guinea-Bissau
Guinea
Kenya
Sierra Leone
Central African Republic
Ghana
Mali
Côte d'Ivoire
Gambia
Senegal
Mauritania
Botswana
Benin
Burundi
Burkina Faso
Namibia
Sao Tome and Principe
Cameroon
Zimbabwe
Madagascar
South Africa
Togo
Congo
Rwanda
Comoros
Gabon
Cape Verde
Algeria
Mauritius
Seychelles
No data
Outside WHOAfrican Region
<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
Outside WHOAfrican Region
9–6566–138139–253254–585586–1049
174
13
12
11
5
5
African Region
South-East Asia Region
Region of the Americas
European Region
Eastern Mediterranean 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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
Global
37
50
33
32
19
7
36
54
54
32
34
93
2
53
African Region
Americas Region
Western Pacific Region
South-East Asia Region
European Region
Eastern Mediterranean 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
Central African Republic
United Republic of Tanzania
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
Central African Republic
Nigeria
Mauritius
Niger
Congo
Angola
Ghana
Algeria
Equatorial Guinea
Mauritania
Cameroon
Côte d'Ivoire
Togo
Guinea-Bissau
Mozambique
United Republic of Tanzania
Zimbabwe
Chad
Eritrea
South Africa
Uganda
Guinea
Burkina Faso
Malawi
Gabon
Kenya
Lesotho
Mali
Senegal
Benin
Swaziland
Zambia
Namibia
Botswana
Rwanda
Democratic Republic of the Congo
Ethiopia
2009 2007
3 Specific Programmes and Services
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
United Republic of Tanzania
Nigeria
Kenya
Ethiopia
Ghana
Senegal
Côte d'Ivoire
Lesotho
Uganda
Cameroon
Malawi
Burkina Faso
Zimbabwe
Swaziland
Sao Tome and Principe
Gambia
Togo
Central African Republic
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
Democratic Republic of the Congo
Nigeria
Mali
Burkina Faso
Guinea
Senegal
Central African Republic
Côte d'Ivoire
Ethiopia
Ghana
Mozambique
Cameroon
Benin
Congo
Cape Verde
Malawi
Zambia
Uganda
United Republic of Tanzania
Zimbabwe
Kenya
Swaziland
Rwanda
Namibia
Algeria
Burundi
Comoros
Equatorial Guinea
Eritrea
Gambia
Guinea-Bissau
Sao Tome and Principe
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
Central African Republic
Nigeria
Uganda
Ethiopia
Congo
Mali
Chad
Equatorial Guinea
Democratic Republic of the Congo
United Republic of Tanzania
Gabon
Mauritania
Guinea
Burkina Faso
Kenya
Senegal
Liberia
Gambia
Ghana
Madagascar
Guinea-Bissau
Cameroon
Niger
Angola
Cape Verde
Sao Tome and Principe
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
Democratic Republic of the Congo
Ethiopia
Burundi
Central African Republic
Kenya
Malawi
Mali
Mauritania
Uganda
Guinea
Nigeria
Angola
Chad
Liberia
Senegal
Gambia
Madagascar
Burkina Faso
Guinea-Bissau
Ghana
Cameroon
United Republic of Tanzania
Niger
Cape Verde
Equatorial Guinea
Sao Tome and Principe
Eritrea
Benin
Algeria
Comoros
Seychelles
Mauritius
2008 2000
3 Specific Programmes and Services
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
Democratic Republic of the Congo
Nigeria
South Africa
Chad
Botswana
Ethiopia
Senegal
Guinea
Burkina Faso
Lesotho
Mozambique
Madagascar
Central African Republic
Liberia
Gabon
Ghana
Congo
Gambia
Uganda
Niger
Malawi
Namibia
Cape Verde
Zambia
Guinea-Bissau
Angola
Kenya
Cameroon
Sao Tome and Principe
Benin
United Republic of Tanzania
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
Western Pacific Region
Americas Region
South-East Asia Region
Eastern Mediterranean 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
Democratic Republic of the Congo
Zambia
Botswana
Congo
Swaziland
Guinea
Niger
Uganda
United Republic of Tanzania
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
3 Specific Programmes and Services
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
Democratic Republic of the Congo
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
Central African Republic
Guinea-Bissau
Namibia
Equatorial Guinea
Botswana
Algeria
Eritrea
United Republic of Tanzania
South Africa
Swaziland
Sao Tome and Principe
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
Sao Tome and Principe
Zambia
Guinea-Bissau
Togo
Ethiopia
Senegal
Ghana
Sierra Leone
United Republic of Tanzania
Malawi
Benin
Central African Republic
Cameroon
Uganda
Burkina Faso
Burundi
Niger
Cote d'Ivoire
Democratic Republic of the Congo
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
Outside WHOAfrican Region
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
Sao Tome and Principe
Democratic Republic of the Congo
Burundi
Sierra Leone
Niger
Nigeria
Cote d'Ivoire
Ghana
Zambia
Guinea-Bissau
Togo
Burkina Faso
Benin
United Republic of Tanzania
Central African Republic
Cameroon
Gambia
Liberia
2005–2009 2000–2004
3 Specific Programmes and Services
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
Western Pacific Region
European Region
Eastern Mediterranean Region
Region of the Americas
South-East Asia Region
Global
2008 1990
72
72
82
92
95
95
82
57
70
71
74
78
94
75
African Region
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
European Region
Western Pacific 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
Democratic Republic of the Congo
South Africa
Madagascar
Zimbabwe
Mauritania
Burundi
Cape Verde
Kenya
Angola
Burkina Faso
Togo
United Republic of Tanzania
Congo
Namibia
Comoros
Lesotho
Mozambique
Ethiopia
Niger
Botswana
Rwanda
Uganda
Cameroon
Central African Republic
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
Central African Republic
Nigeria
Sierra Leone
Zimbabwe
Guinea-Bissau
Liberia
Uganda
Guinea
Niger
Benin
South Africa
Mali
Democratic Republic of the Congo
Mozambique
Côte d'Ivoire
Mauritania
Burkina Faso
Zambia
Angola
Comoros
Ethiopia
Madagascar
Lesotho
Namibia
Cameroon
United Republic of Tanzania
Kenya
Ghana
Senegal
Congo
Togo
Malawi
Burundi
Algeria
Swaziland
Botswana
Gambia
Eritrea
Rwanda
Cape Verde
Mauritius
Sao Tome and Principe
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
3 Specific Programmes and Services
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
South-East Asia Region
European Region
Eastern Mediterranean Region
Region of the Americas
Western Pacific 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
Democratic Republic of the Congo
Guinea
Mozambique
Côte d'Ivoire
Mauritania
Burkina Faso
Zambia
Comoros
Ethiopia
Madagascar
Angola
Cameroon
United Republic of Tanzania
Kenya
Lesotho
Ghana
Senegal
Congo
Cape Verde
Malawi
Algeria
Burundi
Botswana
Swaziland
Eritrea
Rwanda
Gambia
Mauritius
Sao Tome and Principe
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
Region of the Americas
Eastern Mediterranean Region
South-East Asia 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
Central African Republic
Namibia
Guinea-Bissau
Liberia
Mozambique
Kenya
Swaziland
Senegal
Democratic Republic of the Congo
Lesotho
Mali
Gambia
United Republic of Tanzania
Benin
Burundi
Guinea
Togo
Ethiopia
Madagascar
Sao Tome and Principe
Eritrea
Malawi
Cape Verde
Uganda
Zambia
Ghana
Rwanda
HIV/AIDS4%
Diarrhoea18%
Measles1%
Malaria17%
Pneumonia17%
Prematurity9%
Birth asphyxia8%
Neonatalsepsis
5%
Congenitalabnormalities
2%
Other diseases17%
Injuries2%
3 Specific Programmes and Services
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
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
European Region
Western Pacific 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
Central African Republic
Congo
Equatorial Guinea
Lesotho
Malawi
Angola
Democratic Republic of the Congo
Guinea
Togo
Burundi
Cameroon
Zambia
Zimbabwe
Botswana
Kenya
United Republic of Tanzania
Ghana
Swaziland
Sao Tome and Principe
Algeria
Cape Verde
Rwanda
Maternal and newborn health
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
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
Western Pacific 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
United Republic of Tanzania
Angola
Zambia
Mozambique
Mali
Madagascar
Rwanda
Senegal
Burkina Faso
Central African Republic
Malawi
Lesotho
Côte d'Ivoire
Gambia
Ghana
Mauritania
Comoros
Togo
Cameroon
Equatorial Guinea
Zimbabwe
Democratic Republic of the Congo
Swaziland
Benin
Cape Verde
Namibia
South Africa
Algeria
Mauritius
2000–2008 1990–1999
No data
Outside WHOAfrican Region
6–2829–4950–6364–8182–99
3 Specific Programmes and Services
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
South-East Asia Region
Eastern Mediterranean Region
European Region
Western Pacific Region
Region of the Americas
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
United Republic of Tanzania
Senegal
Liberia
Benin
Democratic Republic of the Congo
Kenya
Zimbabwe
Lesotho
Gabon
Côte d'Ivoire
Ghana
Botswana
Swaziland
Cape Verde
Namibia
South Africa
Mauritius
Maternal and newborn health
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
Central African Republic
Eritrea
Mali
Comoros
Mauritania
United Republic of Tanzania
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
United Republic of Tanzania
Zimbabwe
Cape Verde
Zambia
Ghana
2000–2009 1990–1999
3 Specific Programmes and Services
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
Central African Republic
Burundi
Ghana
Uganda
Comoros
United Republic of Tanzania
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
Outside WHOAfrican Region
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
EasternMediterranean
Region
South-East AsiaRegion
Region of theAmericas
WesternPacificRegion
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
South-East Asia Region
Region of the Americas
Western Pacific Region
Eastern Mediterranean 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
Democratic Republic of the Congo
Nigeria
Ethiopia
United Republic of Tanzania
Madagascar
Mozambique
Angola
Côte d'Ivoire
Liberia
Guinea
Ghana
Chad
Niger
Burkina Faso
Cameroon
Uganda
Comoros
Benin
Burundi
Senegal
Congo
Kenya
Central African Republic
Guinea-Bissau
Rwanda
Equatorial Guinea
Gabon
Lesotho
Botswana
Algeria
Sao Tome and Principe
3 Specific Programmes and Services
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
Western Pacific Region
European Region
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
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
United Republic of Tanzania
Swaziland
Sao Tome and Principe
Malawi
Mozambique
Zambia
Burkina Faso
Uganda
Senegal
Mali
Benin
Cape Verde
Eritrea
Chad
Côte d'Ivoire
Liberia
Democratic Republic of the Congo
Cameroon
Nigeria
Congo
Ghana
Ethiopia
Male Female
3 Specific Programmes and Services
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
Region of the Americas
Western Pacific Region
South-East Asia Region
Eastern Mediterranean 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
Sao Tome and Principe
United Republic of Tanzania
Swaziland
Angola
Burkina Faso
Cameroon
Equatorial Guinea
Botswana
Côte d'Ivoire
Zimbabwe
Liberia
Guinea-Bissau
Mauritius
Cape Verde
Gambia
Zambia
Congo
Democratic Republic of the Congo
Kenya
Lesotho
Central African Republic
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
Democratic Republic of the Congo
Mali
Angola
Nigeria
Comoros
Central African Republic
Mozambique
Guinea
Togo
Liberia
Benin
Rwanda
Namibia
Guinea-Bissau
Côte d'Ivoire
Mauritania
United Republic of Tanzania
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
Sao Tome and Principe
Swaziland
Namibia
Congo
Equatorial Guinea
Kenya
Zimbabwe
Cameroon
Sierra Leone
Mali
Uganda
Liberia
Guinea
Côte d'Ivoire
Nigeria
Eritrea
United Republic of Tanzania
Burkina Faso
Central African Republic
Benin
Chad
Lesotho
Democratic Republic of the Congo
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.
3 Specific Programmes and Services
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
Central African Republic
Nigeria
Botswana
Sierra Leone
Cameroon
Zimbabwe
Côte d'Ivoire
Congo
Zambia
Equatorial Guinea
Burkina Faso
Democratic Republic of the Congo
Lesotho
Rwanda
Mozambique
Madagascar
Ghana
Kenya
Gabon
Angola
Ethiopia
Uganda
United Republic of Tanzania
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
Eastern Mediterranean Region
South-East Asia Region
Region of the Americas
Western Pacific 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
Democratic Republic of the Congo
Burkina Faso
Chad
Malawi
Zambia
Angola
United Republic of Tanzania
Ethiopia
Mali
Mozambique
Senegal
Benin
Guinea
Guinea-Bissau
Kenya
Liberia
Madagascar
Nigeria
Sierra Leone
Eritrea
Gambia
Rwanda
Cameroon
Central African Republic
Congo
Côte d'Ivoire
Equatorial Guinea
Sao Tome and Principe
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
Democratic Republic of the Congo
Burkina Faso
Angola
Zambia
Guinea-Bissau
United Republic of Tanzania
Malawi
Mali
Benin
Guinea
Rwanda
Equatorial Guinea
Ethiopia
Nigeria
Sierra Leone
Gambia
Liberia
Mozambique
Senegal
Kenya
Central African Republic
Madagascar
Burundi
Cameroon
Côte d'Ivoire
Eritrea
Mauritania
Congo
Ghana
Togo
Comoros
Sao Tome and Principe
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
Eastern Mediterranean Region
South-East Asia Region
Region of the Americas
Western Pacific 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
Democratic Republic of the Congo
Equatorial Guinea
Madagascar
Mauritania
Togo
United Republic of Tanzania
Ethiopia
Kenya
Mozambique
Senegal
Burundi
Nigeria
Zambia
Cameroon
Côte d'Ivoire
Ghana
Guinea-Bissau
Mali
Comoros
Congo
Gabon
Guinea
Namibia
Central African Republic
Sao Tome and Principe
Cape Verde
Botswana
Algeria
South Africa
Lesotho
Swaziland
Mauritius
Seychelles
Zimbabwe
1998–2008 1988–1998
4 Key Determinants of Health
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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
European Region
Region of the Americas
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
Democratic Republic of the Congo
Liberia
Burundi
Guinea-Bissau
Eritrea
Niger
Central African Republic
Sierra Leone
Mozambique
Togo
Malawi
Ethiopia
Rwanda
Madagascar
Mali
Uganda
Burkina Faso
Chad
Comoros
Guinea
United Republic of Tanzania
Zambia
Gambia
Ghana
Benin
Côte d'Ivoire
Kenya
Senegal
Sao Tome and Principe
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
Democratic Republic of the Congo
Mozambique
Malawi
Burkina Faso
Uganda
Lesotho
United Republic of Tanzania
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
United Republic of Tanzania
�Cameroon
�Côte d'Ivoire
�Sierra Leone
�Liberia
�Congo
�Burkina Faso
Republic Democratic of the�Congo
�Chad
4 Key Determinants of Health
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
South-East Asia Region
Western Pacific Region
Eastern Mediterranean Region
Region of the Americas
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
United Republic of Tanzania
Liberia
Burundi
Rwanda
Mozambique
Malawi
Guinea
Madagascar
Niger
Nigeria
Zambia
Swaziland
Central African Republic
Chad
Democratic Republic of the Congo
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.
4 Key Determinants of Health
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
Democratic Republic of the Congo
Eritrea
BurundiMali
Senegal
Guinea-Bissau
Chad
Côte d'Ivoire
Mauritania
Ethiopia
Comoros
Gambia
RwandaGuinea
Sierra Leone
United Republic of Tanzania
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
Sao Tome and Principe
Ghana
Madagascar
Democratic Republic of the CongoCote d'Ivoire
Gambia
Kenya
Guinea-Bissau
Mali
Central African Republic
Benin
Botswana
Togo
Niger
Liberia
Malawi
Sierra Leone
Swaziland
Cameroon
Zambia
Zimbabwe
Burkina Faso
Gabon
Mauritius
Cape Verde
Ethiopia
Eritrea
SenegalMauritania
Seychelles
Lesotho
Namibia
United Republic of Tanzania
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
United Republic of Tanzania
Kenya
Nigeria
Algeria
Botswana
Democratic Republic of the Congo
Swaziland
Angola
South Africa
Namibia
Cape Verde
Mauritius
Gabon
Congo
Seychelles
Sao Tome and Principe
Zimbabwe
Equatorial Guinea
Male Female
4 Key Determinants of Health
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
Outside WHOAfrican Region
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
Eastern Mediterranean Region
South-East Asia Region
Western Pacific Region
Region of the Americas
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
South-East Asia Region
Eastern Mediterranean Region
Region of the Americas
Western Pacific 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
Democratic Republic of the Congo
Mozambique
Niger
Mauritania
Sierra Leone
Angola
Chad
United Republic of Tanzania
Mali
Nigeria
Kenya
Togo
Zambia
Eritrea
Guinea-Bissau
Rwanda
Central African Republic
Uganda
Liberia
Senegal
Swaziland
Congo
Guinea
Burundi
Cameroon
Benin
Burkina Faso
Côte d'Ivoire
Malawi
Ghana
Zimbabwe
Algeria
Cape Verde
Lesotho
Gabon
Sao Tome and Principe
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
Democratic Republic of the Congo
United Republic of Tanzania
Mali
Burundi
Guinea-Bissau
Kenya
Benin
Algeria
Cape Verde
Sierra Leone
Togo
Zambia
Guinea
Sao Tome and Principe
Ghana
Comoros
Uganda
Cameroon
Central African Republic
Senegal
Swaziland
Côte d'Ivoire
Burkina Faso
Congo
Gabon
Malawi
Gambia
Niger
Lesotho
Ethiopia
Botswana
Namibia
South Africa
Zimbabwe
Mauritius
Seychelles
Urban Rural
4 Key Determinants of Health
64
Figure 131: Percentage of the population using improved sanitation facilities in the African Region, 2008
No data
Outside WHOAfrican Region
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
South-East Asia Region
Eastern Mediterranean Region
Western Pacific Region
Region of the Americas
European Region
2008 1990
47
60
69
83
92
97
26
31
56
45
70
87
African Region
South-East Asia Region
Western Pacific Region
Eastern Mediterranean Region
Region of the Americas
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
Democratic Republic of the Congo
United Republic of Tanzania
Mauritania
Sao Tome and Principe
Lesotho
Congo
Kenya
Nigeria
Gabon
Namibia
Central African Republic
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
Democratic Republic of the Congo
Benin
Sierra Leone
Togo
Liberia
Kenya
Ethiopia
Sao Tome and Principe
Congo
United Republic of Tanzania
Burkina Faso
Gabon
Guinea
Niger
Côte d'Ivoire
Nigeria
Mozambique
Uganda
Lesotho
Central African Republic
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
4 Key Determinants of Health
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
Central African Republic
Chad
Angola
Guinea-Bissau
Niger
Ethiopia
Madagascar
Mozambique
Democratic Rep of the Congo
Benin
Rwanda
Comoros
Uganda
Malawi
United Republic of Tanzania
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
Sao Tome and Principe
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
Central African Republic
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
Democratic Republic of the Congo
MozambiqueMadagascar
Ethiopia
Cape VerdeNiger
Uganda
ZambiaMali
Burkina Faso
GambiaUnited Republic of Tanzania
Zimbabwe
GhanaMauritania
SenegalBenin
Central African Republic
ChadComoros
Nigeria
GuineaLesotho
Kenya
TogoSeychellesCameroon
Namibia
SwazilandAngola
Equatorial Guinea
Gabon
BotswanaCôte d'Ivoire
MauritiusAlgeria
South Africa
2005 1990
4 Key Determinants of Health
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
Sao Tome and Principe
Guinea-Bissau
Nigeria
Seychelles
Angola
Zimbabwe
Gambia
Algeria
Guinea
Burundi
Cameroon
Malawi
Mauritius
Lesotho
Mauritania
Cape Verde
Zambia
Democratic Republic of the Congo
Côte d'Ivoire
Ghana
Congo
Senegal
Eritrea
Sierra Leone
South Africa
Uganda
Mali
Swaziland
Benin
Madagascar
Gabon
Mozambique
Kenya
United Republic of Tanzania
Rwanda
Chad
Niger
Comoros
Burkina Faso
Togo
Ethiopia
Botswana
Central African Republic
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
Democratic Republic of the Congo
Nigeria
Kenya
Gabon
Algeria
Zimbabwe
Congo
United Republic of Tanzania
Ghana
Mauritius
Guinea
Cameroon
Mozambique
Zambia
Ethiopia
Senegal
Liberia
Mali
Togo
Chad
Mauritania
Madagascar
Uganda
Burkina Faso
Burundi
Seychelles
Central African Republic
Niger
Eritrea
Malawi
Benin
Guinea-Bissau
Gambia
Lesotho
Cape Verde
Rwanda
Botswana
Swaziland
Sierra Leone
Comoros
Sao Tome and Principe
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
Democratic Republic of the Congo
Chad
Niger
Central African Republic
Rwanda
Uganda
Guinea
Mozambique
Congo
United Republic of Tanzania
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
Sao Tome and Principe
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
Central African Republic
Niger
Rwanda
Comoros
Chad
Malawi
Madagascar
Zimbabwe
Uganda
Democratic Rep of the Congo
Burkina Faso
Liberia
Guinea-Bissau
Mali
Togo
Sao Tome and Principe
Mozambique
Benin
Zambia
Angola
United Republic of Tanzania
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
4 Key Determinants of Health
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
United Republic of Tanzania
South Africa
Sierra Leone
Seychelles
Senegal
Sao Tome and Principe
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
Democratic Republic of the Congo
Congo
Comoros
Chad
Central African Republic
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
Central African Republic
Ethiopia
Democratic Republic of the Congo
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
Sao Tome and Principe
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
Democratic Rep of the Congo
Algeria
Côte d'Ivoire
Zimbabwe
Kenya
Central African Republic
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
Democratic Republic of the Congo
Burundi
Angola
Eritrea
Rwanda
Ethiopia
Central African Republic
Sierra Leone
Chad
Mauritania
Togo
Côte d'Ivoire
Uganda
Congo
Senegal
Zimbabwe
Nigeria
Ghana
Cameroon
Algeria
Guinea
Kenya
United Republic of Tanzania
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
South-East Asia 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*
*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.
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
Democratic Republic of the Congo
Guinea-Bissau
Sierra Leone
Mali
Central African Republic
Burkina Faso
Burundi
Angola
Niger
Cameroon
Equatorial Guinea
Guinea
Mozambique
Zambia
Nigeria
Congo
Uganda
Côte d'Ivoire
Benin
Mauritania
Liberia
Rwanda
Malawi
United Republic of Tanzania
Comoros
Ethiopia
Gambia
Togo
Senegal
Zimbabwe
Kenya
Lesotho
Sao Tome and Principe
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
Eastern Mediterranean Region
South-East Asia Region
Americas Region
Western Pacific 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
5 Progress on the Health-Related MDGs
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
United Republic of Tanzania
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
MDG-6 (AIDS, malaria and TB)
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
5 Progress on the Health-Related MDGs
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
Central African Republic
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
United Republic of Tanzania
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
MDG-6 (AIDS, malaria and TB)
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
Eastern Mediterranean Region
Western Pacific Region
South-East Asia Region
Americas Region
European Region
Global
45
11
23
31
40
54
42
African Region
Eastern Mediterranean Region
European Region
Western Pacific Region
South-East Asia Region
Americas Region
Global
5 Progress on the Health-Related MDGs
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
Sao Tome and Principe
Zambia
Guinea-Bissau
Togo
Ethiopia
Senegal
Ghana
Sierra Leone
United Republic of Tanzania
Malawi
Benin
Central African Republic
Cameroon
Uganda
Burkina Faso
Burundi
Niger
Cote d'Ivoire
Democratic Republic of the Congo
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
Central African Republic
United Republic of Tanzania
Benin
Burkina Faso
Togo
Guinea-Bissau
Zambia
Ghana
Côte d'Ivoire
Nigeria
Niger
Sierra Leone
Burundi
Democratic Republic of the Congo
Sao Tome and Principe
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
MDG-6 (AIDS, malaria and TB)
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
Democratic Republic of the Congo
United Republic of Tanzania
Gambia
Burundi
Mozambique
Niger
Ghana
Sierra Leone
Namibia
Gabon
Benin
Central African Republic
Sao Tome and Principe
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
Democratic Republic of the Congo
Nigeria
South Africa
Chad
Botswana
Ethiopia
Senegal
Guinea
Burkina Faso
Lesotho
Mozambique
Madagascar
Central African Republic
Liberia
Gabon
Ghana
Congo
Gambia
Uganda
Niger
Malawi
Namibia
Cape Verde
Zambia
Guinea-Bissau
Angola
Kenya
Cameroon
Sao Tome and Principe
Benin
United Republic of Tanzania
Eritrea
Seychelles
Comoros
Equatorial Guinea
Mauritius
Algeria
2008 MDG target
5 Progress on the Health-Related MDGs
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
Democratic Republic of the Congo
Mali
Angola
Nigeria
Comoros
Central African Republic
Mozambique
Guinea
Togo
Liberia
Benin
Rwanda
Namibia
Guinea-Bissau
Côte d'Ivoire
Mauritania
United Republic of Tanzania
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
5 Progress on the Health-Related MDGs
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
Sao Tome and Principe
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
Central African Republic
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
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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
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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
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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,
Explanatory Notes
89
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,
6 Explanatory Notes
90
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
Explanatory Notes
91
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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92
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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93
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
Explanatory Notes
95
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
Methods of estimation: Empirical data only.
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
Explanatory Notes
97
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).
Methods of estimation: Empirical data.
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
Methods of estimation: Empirical data.
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
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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.
Methods of estimation: Empirical data only.
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.