Global health challenges accelerate in conditions of poverty, poor economies, and geo-political uncertainty. Infectious diseases thrive in poverty, viruses do not respect boarders. It is therefore imperative that we discuss and explore measure to strengthen regional responses to health challenges in Southern Africa and improve health security for all. In analysing Global Health threats and challenges, Zimbabwe must be viewed in the broader context of region, an ecological view across the African landscape. The Cholera outbreak in 2008 in Zimbabwe became a regional challenge, just as the Ebola crisis defied all boundaries as it a spread across West Africa and beyond.
In Zimbabwe poor nutrition particularly in children and women has coincided with poor harvesting, drought and poor economic opportunities, this report draws on information gathered in clinical practices, observations and collaborations with non-governmental organisations in Zimbabwe.
The 2015 Demographic and Health Survey estimated that 27% of children under 5 years in Zimbabwe are stunted (chronically malnourished), with significant disparities between urban (22%) and rural (29%) areas, and between boys (30%) and girls (24%). 3% of children under 5 years are estimated to be wasted (acutely malnourished), with severe acute malnutrition at 1%. The rates of exclusive breastfeeding in the first 6 months currently stands at 48%. Only 8% of children 6–23 months are given a minimum acceptable diet. (Dfid Zimbabwe 2017)
The DFID Livelihoods and Food Security Programme (LFSP) aims to improve nutrition through promoting production and consumption of bio-fortified crops such vitamin A maize, iron and zinc enriched beans and millets; and providing trainings to smallholder farmers on good agricultural practices, various technologies (crops and livestock), good nutrition, and financial literacy. (Dfid Zimbabwe 2017)
There are significant nutritional disparities between rural 29% and urban areas 22%, which could be explained by the fact that people in rural areas have limited access to diverse means of income compared to urban areas, which is further complicated by poor health seeking behaviours, thresholds to seeking help and access to transport to access health care. Clinically patients presenting to health care services with nutritional problems are often presenting with co-morbidities and complex faceted medical complications such as HIV and poor nutrition or Diabetes and poor nutrition.
There are gender differences in poor nutrition, with boys presenting at 30% and girls at 28%, these differences have been observed across other low income countries and the evidence base for the difference is still weak.
In mental health terms, suicides amongst farmers are significantly high throughout the world, and suicides are highest in men, overall farmers are particularly vulnerable at times of poor harvest. Farmers tend to use highly poisonous methods which are at their disposal, eg pest controls which are more likely to be fatal in death. Poor nutrition will have implications on early marriages and gender violence; we are observing an increase in HIV infections amongst young women across the country which may be related with poor literacy and the desire to get married in search of better outcomes. Some patients in mental health hospitals may prefer to stay in hospital long after they are well and dischargeable because the conditions at home might be poorer than in hospital, this is further complicated by their disabilities and stigma and lack of food.
Africa’s middle class society is growing, in what many are coining ‘The Pot Belly Economy’ Globalisation means people are able to access information and model lifestyle behaviours from communities afar, the African middle class is modelling western lifestyles and indulging in fast foods at the cost of their health. In the wake of the HIV crisis, and in a culture where ‘big’ is much preferred than ‘thin’ which is opposite to the western phenomena, non communicable diseases such as diabetes, hypertension, and alcohol related conditions are the new threat and often neglected health challenge in the continent. Poor infrastructure compounds access to health and number of traffic related death and injuries is a public health concern.
More critically in these difficult economic times, poor people having to make tough choices between feeding their children or using the $1 they may have to travel to hospital for treatment. They are many female led households in Zimbabwe, headed by highly resilient and resourceful women, however the lack of economic enterprise compound their health and social outcomes, a growing concern for this highly vulnerable population.
There is a need to strengthen regional responses in the Southern Africa region, the East African region has become increasingly co-ordinated and coherent, economically culturally and socially, all this despite the challenges they continue to face. The Ebola crisis and response brought the West African response even closer and we are encouraged by the launch of the Africa Centre of Disease Control in Nigeria. Southern Africa region needs to be much more robust coherent regional planning and responses, we need to re-define SADC’s role and remit and strengthen where possible. We must leverage on the new appointment of Dr Tedros Ghebreyesus, WHO Director General, the first African to hold this post, an important development given that globally, Africa carries the heaviest burden of disease.
Thank you to Annabel Gerry and Dr Sajil Liaqat of DfiD, Zimbabwe
Nutrition in Clinical Practice, a Global Health perspective.
Global Mental Health Specialist
Britain Zimbabwe Society Conference 2017