Subsaharan Africa

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• Subsaharan AfricaSubsaharan Africa– Development colonial legacyDevelopment colonial legacy– Medical geography & diseaseMedical geography & disease– Cultural patternsCultural patterns

Colonial Legacy

• Boundaries & intertribal antagonism (e.g., Rwanda)

• Transportation network• Interior to coastal ports

• Dual economy• 70% of labour force in agriculture • Cash crops for export: cocoa, coffee, tea, cotton• Subsistence agriculture (maize, millet, sorghum, tubers, plantain)• Land tenure issues, need for land reform

• Colonial institutions• Government and legal framework

Medical Geography

• Epidemiology

• Africa is uniquely vulnerable– High disease incidence and diffusion– Widespread nutritional deficiencies– Vectors and hosts

• Spread of disease– Endemic– Epidemic– Pandemic

Medical Geography

• Endemic disease• Infects large numbers without rapid death• Equilibrium & persistent ill-health• Typically endemic to a region

– Hepatitis– STDs or STIs (formerly venereal diseases)– Parasites e.g. hookworm – chronic anemia– Schistosomiasis (Bilharzia)

• snail borne blood fluke

– River Blindness (Onchocerciasis)• parasitic worm vectored by black fly

Medical Geography

• Epidemic • Local or regional dimensions, • Often acute onset• Distribution often depends on vector

– Sleeping Sickness• Vectored by tsetse fly• Endemic in wildlife but kills Bos indicus/Bos taurus• No ‘domestic’ cattle breeds on African savannah

Medical Geography• Pandemic

• Spread is “worldwide”

– Mosquito borne:• Yellow Fever• Malaria

– DDT

Medical Geography• Imminent Pandemic?

– Spanish influenza 1918-19• H1N1: 20-50 million deaths worldwide

– Avian influenza?• H5N1

• AIDS– Pandemic since 1990s– ARV drugs in developed countries e.g. AZT– 80% of 37 million infected are in Africa– Shifted from equatorial belt to southern Africa

• Botswana, Namibia, Zimbabwe• 25% of 15-49 population infected• Life expectancy is declining• Impact on labour force and economic development• Population declines of 10-20%

– Bubonic plague in Europe

– Small pox among indigenous people of Americas

MEDICAL GEOGRAPHY

AIDS Transmission in the U.S.

SOURCE: UNAIDS, 2000

Growing Incidence of AIDS in Africa

CULTURAL PATTERNS

• Population distribution• African languages

– Colonial lingua franca• Swahili• Hausa

– Multilingualism

• Religions– Christianity– Islam– Tribal religions

POPULATIONDISTRIBUTION

Traumatized children after massacre of 1,000 in Congo

Reprise

GeneralizedLanguage Regions of

Africa

REGIONS OF SUBSAHARAN AFRICA