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Why Clinical Trials in Africa? The burden of disease...

HIV - At the end of 2010, there were an estimated 34 million people living with HIV – an increase on previous years. The sub-Saharan Africa bears a disproportionate share of the global HIV/Aids burden. It is estimated about 76% of all HIV-positive women in the world live in this region. South Africa has currently the highest absolute number of cases of HIV in the world.


Tuberculosis (TB) - Geographically, the burden of TB is highest in Asia and Africa. The African Region has 24% of the world’s cases, and the highest rates of cases and deaths per capita. Worldwide, 3.7% of new cases and 20% of previously treated cases were estimated to have MDR-TB. Asia and South Africa have almost 60% of the world’s cases of MDR-TB. Almost 80% of TB cases among people living with HIV reside in Africa.


Malaria – According to a WHO publication 2012, about half the world’s population is at risk of malaria, and an estimated 216 million cases in 2010 led to approximately 655 000 deaths – 86% of these in children under the age of five.



Hypertension – The World Health Organization estimate more than 30 million people in Africa suffer from hypertension. It is also predicted that by 2020, three-quarters of all deaths in Africa may be caused by high blood pressure.


Obesity – African countries are increasingly recording incidents of obesity. In South Africa, one in three men and more than a third of the women were said to be overweight in 2004. In 2010 a report released by GSK revealed that 61 percent of South Africans were overweight, obese or morbidly obese, with 17 percent of children under the age of nine overweight.


Rheumatic Heart Disease - Common causes of heart failure in Africa include rheumatic heart disease. "Across Africa and India it is widely known by cardiologists that many patients with RHD do not have access to the healthcare treatment they need. These results unfortunately show that even those that are being treated are not receiving the care they need, for a variety of reasons," said Dr. Liesl Züklhe, Paediatric Cardiologist, Red Cross Children's Hospital, University of Cape Town, South Africa.

Economic and population landscape:
Africa’s robust economic growth, averaging five percent a year over the last ten years, has placed the continent among the fasted growing regions in the world. According to the UN Population Fund report, the population of Africa had exceeded one billion in 2009, making Africa the second most populous continent on the planet, behind Asia. Africa Region is estimated to have 15.2% of the world’s population. According to the Africa Development Report 2012, the population of Africa is projected to more than double between 2010 and 2050, accounting for nearly half of the world’s population growth over this period.  By 2025, the population of Africa is projected to surpass that of China and, by 2030, will be more populous than India. By 2050, nearly one person in four on the planet will be an African.


Disease burden of HIV, TB and Malaria
Although the Africa Region accounts for just over 15% of the world’s population, the WHO Africa Region literature estimates that the continent has the highest burden of the people who live with HIV/AIDS. The World Health Statistics 2013 report estimates that around 34 million people are living with HIV worldwide, 23 million (70%) of them are in sub-Saharan Africa. The Africa Regional Health Report estimates that more than 90% of the estimated 300-500 malaria cases that occur worldwide every year are in Africans, mainly children under five years of age. According to WHO reports, South Africa has high TB burden, HIV burden and high MDR-TB burden. Africa is also facing the growing “double burden” of infectious and non-communicable disease. It charts Africa’s lesser-known toll of ill health, including a growing burden of cardiovascular diseases, malnutrition and obesity, cancer, injuries, blindness, mental illnesses, genetic and oral diseases. Some of these conditions are a consequence of infectious diseases, such as cervical cancer, while others, such as noma, are specific to this Region. 


The burden of Hypertension and diabetes in Africa:
In an editorial on heart disease in Africa published recently in British medical journal Heart, the University of Cape Town head of the department of medicine, Prof Bongani Mayosi, identified hypertension and diabetes as looming crises for Africa.  He argued, “Africa faces ‘tsunami’ of high blood pressure affecting more people than HIV/AIDS”. It is estimated that the number of people with hypertension in Africa will rise to 68% from 75 million in 2008 to 126-million in 2025. According to the article, about 7.5% (27.5 million) of people in the world, with diabetes, reside in Africa; by 2030 that figure is expected to reach 50-million.


South Africa as a gateway to Africa
It is common knowledge that South Africa has for long been regarded as the gateway to Africa. Evidence shows that all top global CRO have set up fully-fledged operation in South Africa to serve the continent. The donor communities that fund clinical research have strong representation in South Africa. The number of new clinical trials is increasing and bolstered by the promise of an improved regulatory environment and value for money. CROs and investigator sites involved in clinical research subscribe to international standards and norms of Good Clinical Practice (GCP)


Reference and Acknowledgement of sources:


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