Disease Patterns of 190060

The most explosive and most destructive epidemic ever to strike Africa was the influenza pandemic of 1918-19. Introduced at Sierra Leone in late August 1918, and to ports around the continent in the next several weeks, the disease spread rapidly inland over the newly constructed colonial roads, railroads, and river transport systems. Diffusion was especially rapid on the southern African rail system and on the river steamers in the Belgian Congo. Indeed, so quickly did the disease move by these means, that places in the Congo only 100 miles from the coast were first attacked by way of the Union of South Africa. Almost every inhabited spot on the continent was struck in a matter of 6 or 7 months, graphic proof that the old isolation was gone forever and that the continent was an epidemiological unit closely linked to the rest of the world. Approximately 2 million people - about 2 percent of the population - died during the epidemic.

The demographic balance began to shift by the 1920s in much of West and South Africa, and by the 1930s elsewhere. The harsher aspects of colonial rule were being mitigated, famine relief was made more effective with better transportation, and medical measures began to have some effect. Progress was most rapid in the Belgian and British colonies and in French West Africa; medical services were slower to develop in Portuguese territories and in French Equatorial Africa.

Colonial medicine had little to offer Africans for many years, except for surgery, yaws therapy, and smallpox vaccination. But by the 1930s, efforts to control smallpox, cerebrospinal meningitis, tuberculosis, louse- and tick-borne relapsing fever, and other epidemic diseases were beginning to have some impact. Plague broke out in several territories in the early twentieth century, but public health measures prevented serious loss of life. Extensive efforts to contain trypanosomiasis, primarily by vector control in the British colonies and by chemical treatment and prophylaxis in the French territories, had considerable success. The growing cities continued to function as nodes for the diffusion of infectious diseases into the countryside, but measures to improve water supplies and waste disposal, control malarial mosquitoes, provide vaccinations, and treat patients began to have a positive impact in almost all urban areas by 1940. Ironically, improved water supplies meant that fewer people were exposed to polio virus as small children when they were most likely to have mild or asymptomatic cases. Postponement of infection until adolescence created an increase in the number of paralytic cases in the post-World War II period - an unintended by-product of incomplete sanitary reform.

The advent of sulfa drugs in the late 1930s and especially the antibiotics in the 1940s provided a revolution in the effectiveness and, consequently, the popularity of the colonial medical services. Africa's rapid demographic growth dates from the late 1940s and is partially the result of the success of most colonial medical services in lowering death rates from bacterial diseases. Populations are growing at rates that will double the numbers of people in most countries in around 20 years, a situation that is already placing grave strains on medical services and food supplies.

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