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HEALTH-ANGOLA: War, Plague, Pestilence and Death

Mario de Queiroz

LISBON, Feb 16 2007 (IPS) - Nearly five years after the advent of peace in Angola, following four decades of war which cost a million lives, the new killers in this Southern African country are cholera, malaria and AIDS.

Last week alone there were 111 deaths, to be added to the 3,017 fatalities among the 76,823 cholera cases detected since the outbreak of the disease on Feb. 13, 2006, according to figures from the World Health Organisation (WHO) delegation in Luanda, published in Lisbon this week by the Portuguese press.

There was a rise in the number of cases after mid-October, the start of the rainy season. Luanda was particularly affected by flooding, which accelerated the spread of cholera, an acute intestinal infection caused by bacteria producing an enterotoxin which causes severe diarrhoea. Infection spreads by consuming contaminated water or food.

The Angolan government says the cholera epidemic is under control, and that the help it is receiving from the WHO is sufficient.

“We, at least, who collaborate closely with Portuguese-speaking countries, have not received any requests for help from Angola, in contrast to Guinea-Bissau, where we cooperated in fighting the epidemic that broke out a couple of years ago,” Dr. Jaime Simoes Nina of the Lisbon Institute of Tropical Medicine (IMT) told IPS.

Officially, malaria is still the disease that causes most deaths among Angolans. But IMT estimates indicate that AIDS has overtaken it as a cause of death in this vast former Portuguese colony with an area of nearly 1.3 million square kilometres and a population of 16 million.

Malaria is caused by Plasmodium parasites in the blood, transmitted by the bite of Anopheles mosquitoes. There is no vaccine, and preventive drugs based on quinine do not provide complete protection.

In Angola, malaria is the reason for 35 percent of consultations for health care and 20 percent of hospital admissions. Its mortality rate is between 15 and 30 percent, depending on the type and severity, according to statistics from the Health Ministry.

Director of the National Malaria Control Programme Filomeno Fortes announced in late 2006 that from January to October 2005, malaria claimed 11,648 lives in Angola.

Although statistics for 2006 are not yet available, experts consider that the number of victims will not have changed much, because the high death rate is due to the malaria parasite’s resistance to treatments based on chloroquine and amodiaquine.

“To combat this situation, the Health Ministry will begin to use a drug called Coartem, based on artemisinin, throughout the country,” Fortes announced on the Portuguese Catholic Church radio station Renasceça.

Simoes Nina, one of the world’s outstanding experts on tropical diseases, told IPS in an interview on Thursday that “the fight against malaria must be carried out according to the new WHO strategy, using combination therapies, like Coartem.”

The IMT researcher and clinician at the infectious disease unit of Lisbon’s Egas Moniz Hospital said that his institute was conducting malaria projects with all the members of the Community of Portuguese-Speaking Countries (CPLP), which are Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Mozambique, Portugal and Sao Tomé and Príncipe.

“In October we had a meeting of all the CPLP countries, to coordinate our policies to fight malaria,” said Simoes Nina, “and in Angola we have teams of Portuguese doctors constantly in the field, working closely with our Angolan colleagues.”

“The Angolan government maintains that malaria is the main cause of death in the country, but many of us suspect that it is now in second place, not because of fewer infections or improved recovery from malaria, but because it is being displaced by the tremendous explosion of AIDS cases,” Simoes Nina said.

Ana Maria Filgueiras, president of REDEsida, a network coordinating action against AIDS in CPLP countries, echoed Simoes Nina’s suspicions. She told IPS that the spread of AIDS in Angola was largely due to “the wars, and to prevention programmes getting off to a late start.”

AIDS is caused by the human immunodeficiency virus (HIV), which is contracted by sexual relations with an infected person, contact with infected blood, or transmitted from mother to child during pregnancy, childbirth or breastfeeding.

The spread of HIV is fuelled by the armed conflicts that are so widespread in Africa, said Dr. Filgueiras, 56, a Portuguese-Brazilian who has divided her professional life between Lisbon and Rio de Janeiro, and also has extensive work experience in Luanda, Maputo – the capital of Mozambique – and the islands of Sao Tomé and Príncipe, off the African coast.

Angola suffered armed conflict for 41 years, from the outbreak of war against the Portuguese colonial army in 1961 to the cessation of hostilities in 1974, followed by independence in 1975, when civil war broke out and lasted until rebel leader Jonas Savimbi was killed in combat on Feb. 22, 2002.

During the whole period of the wars, “blood transfusions were performed arm-to-arm between Angolans and foreigners, many of whom were mercenaries, with no sanitary controls,” Filgueiras said.

With the arrival of peace, in 2002, “thousands of United Nations ‘blue helmets’ arrived, recruited mainly from neighbouring countries that had high HIV infection rates, at a time when Angola did not have an ongoing prevention programme,” Filgueiras said.

Officially AIDS incidence is 2.5 percent of the population, although Filgueiras doubts the accuracy of this figure. “It’s an under-estimate, as there is no epidemiological surveillance system, the only method that can provide reliable results.”

For example, she said, “in the province of Cunene, on the border with Namibia, the official, and optimistic, figure for AIDS incidence is nine percent.” Another major factor in spreading HIV in war-torn countries is rape, the activist pointed out.

“Besides Luanda, where promiscuity is as widespread as in all other big cities, the main impact of AIDS in Angola is being experienced in border regions where people are moving back and forth. Until recently there were 4.2 million displaced people in Angola, nomads in their own country,” Filgueiras said.

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