Economic Brief - Mortality in Africa The Share of Road ... · road traffic accidents affected more...

This brief was prepared by the Statistics De-partment in the Chief Economist Vice Presi-dency of the African Development Bank. Its findings reflect the opinions of the authors and not necessarily those of the African De-velopment Bank, its Board of Directors or the countries they represent. Designations employed in this report do not imply the ex-pression of any opinion on the part of the African Development Bank Group concerning the legal status of any country or territory, or the delimitation of its frontiers. While every effort has been made to present reliable in-formation, the African Development Bank accepts no responsibility whatsoever for any consequences of its use.

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AfDBChief Economist Complex

Mortality in Africa: The Share of Road Traffic Fatalities † Market Brief

Statistics Department, June 2013, AfDB Chief Economist Complex

www.afdb.org

Key Findings

» Deaths due to road traffic accidents are highest among the most economically active population (15-59 years).

» Men are three times more likely to be involved in road traffic accidents than females in the 15-59 age group.

» Nearly one in ten deaths of men (15-59 years) in North African countries can be attributed to road traffic accidents; 10% in Libya and Tunisia, 8% in Egypt and 7% in Sudan and Morocco.

» Road traffic accidents constitute 25% of all injury-related deaths in the Africa.

» In Egypt, Tunisia, and Morocco, road traffic accidents account for more than half of injury-related deaths (Egypt – 64%, Tunisia – 58%, Morocco – 51%).

» Nearly twice as many males aged 15-59 die from injury-related causes (road traffic accidents, violence and others) than those that die from tuberculosis (20% vs. 10%), respiratory infections (20% vs. 6%), cancers (20% vs. 5%) while deaths due to HIV/AIDS were only slightly higher than those for injury related deaths (22% vs. 20%).

» Strategies that can be adopted by governments to reduce the number of fatalities and injuries due to road traffic accidents include: improved road infrastructure; speed limits; compulsory seatbelts and child restraints; drink-driving laws, bans on the use of cellphones while driving; legal requirement for motor-cyclists to wear helmets.

» Enforcement of road safety measures is generally weak across the continent.

A f r i c a n D e v e l o p m e n t B a n k

Table of Contents

1. Introduction: Mortality among population aged 15 and over 2

2. Injury-related deaths 2

3. Road traffic accidents: Who is most at risk 3

4. Road safety issues: Facing up to the challenge 4

5. Conclusion 5

Mthuli NcubeChief Economist & Vice President, ECON, [email protected], +216 7110 2062

Charles L. LufumpaDirector, Statistics Department (ESTA), [email protected], +216 7110 2175`

Steve Kayizzi-MugerwaDirector, Development Research Department (EDRE), [email protected]+216 7110 2064

Victor MurindeDirector, African Development Institute (EADI), [email protected]+216 7110 2075

Layout and production by Phoenix Design Aid A/S, Denmark

† Alice Nabalamba, Assistant to the Director, Statistics Department (ESTA), [email protected], +216 7110 2342

AfDB African Development Bank

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Mortality in Africa: The Share of Road Traffic Fatalities †

1. Introduction: Mortality among population aged 15 and over

The focus of this brief is on the population aged 15 years and over, as this comprises the major victims of road traffic accidents. In 2008, nearly 7 million deaths due to any cause were recorded in Africa among pop-ulation aged 15 and above. This is equiv-alent to approximately 1,151 deaths per 100,000 population (Annex II, Table 1). One-third of deaths were due to infectious and parasitic diseases, including tubercu-losis, HIV/AIDS, malaria, and respiratory infections. Non-communicable conditions accounted for 50% of all deaths, of which cardiovascular diseases accounted for 48%, with a slight gender differential (22% male vs. 26% female) (Global Burden of Disease, 2004 Update, WHO 2008; see Tables 1 & 2 in Annex II).

Africa is a continent of such diversity that it is no surprise to find wide variations

in mortality rates among countries. For example, deaths due to any cause ranged between 183 per 100,000 population in São Tomé & Príncipe to 1,642 per 100,000 population in Swaziland for those aged 15-59 (see Annex I, Figure A.1) in 2008. In general, countries in the Southern African sub-region recorded the highest death rates, due to the high prevalence of HIV/AIDS and related conditions. The death rate for males in this age group ranged from 109 per 100,000 in São Tomé & Príncipe to 915 per 100,000 in Malawi. Among women, deaths due to any cause ranged from a low of 63 per 100,000 in Tunisia to a high of 820 per 100,000 in Swaziland (Annex I; Figure A.3). For pop-ulation aged 60 years and over, the differ-ential in mortality rates dues to any cause among countries was also pronounced, ranging from 3,886 per 100,000 in Tunisia

to 6,726 per 100,000 in Malawi (Annex I, Figure A.2).

In the African region generally, mortal-ity rates for men are slightly higher than for women, which is due entirely to inju-ry-related deaths. Women have higher mortality rates than men for HIV/AIDS, which in 2008 caused a third of the deaths of females in the age group 15-59, com-pared to a death rate of 22% for men in the same age group (see Annex II, Table 2). Maternal conditions related to pregnancies and births were associated with 11.4% of deaths of women in the age group 15-59 for the same year, which is significantly less than deaths caused by HIV/AIDS (31.7%) for women in the same age category (see Annex II, Table 2).

2. Injury-related deaths

In 2008, injuries of any kind accounted for 9% of all deaths among those aged 15 years or over, but with major differences between young/old and males/females. Injury-related deaths were highest among the population aged 15–59 years and par-ticularly among men. Injuries accounted for 20% of deaths among men aged 15–59, compared to just 6% among females in the same age group (see Annex II, Table 1). Nearly twice as many males in this age

group died from injury-related causes (20%) than from tuberculosis (10%), car-diovascular diseases (11%), cancers (6%), or respiratory infections (4%). Even deaths due to HIV/AIDS were close to those due to injury-related deaths (22%) among men. The number of deaths due to injury also far exceeded malaria-related deaths (at just 0.4%) for the male population in this age group. On the other hand, for females aged 15–59, injury-related deaths (at 6%

of total deaths due to any cause) were far below deaths due to HIV/AIDS (32%), maternal conditions (11%) and cancers (8%) (see Annex II: Table 2). Data on the WHO African Region (which does not include Morocco, Tunisia, Libya, Egypt, Sudan, Djibouti, Eritrea or Somalia) shows that injury-related deaths are concentrated in the 15-29 male age group, where they account for more than one-third of deaths (see Annex II, Table 4).

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Market Brief . June 2013 AfDBMortality in Africa: The Share of Road Traffic Fatalities †

3. Road Traffic Accidents: Who Is Most at Risk?

The most economically active people (aged 15–59) are at the greatest risk of dying as a result of road accidents. For this age group, road traffic accidents affected more than three times as many males as females. Overall, 5% of deaths among males aged 15-59 are attributable to road traffic acci-dents, but this percentage rises to 6.5% for males in the 15-29 age group in Sub-Saharan Africa.(Annex II, Table 4). Deaths due to road traffic accidents among males aged 15–59 far exceed those due to malaria, diabetes mellitus, respiratory or digestive diseases. For females, however, almost all other causes of deaths carry more weight than road traffic accidents (the exceptions being malaria and violence).

While road traffic accidents account for about one-quarter of injury-related deaths in the continent overall, in the North African countries of Egypt, Tunisia, and Morocco, they caused more than half of all injury-related deaths in 2008 (Egypt, 64%; Tunisia, 58%; Morocco, 51%). In Libya, Djibouti, Mauritius, Namibia and Niger, road traffic accidents also exacted a heavy toll, accounting for more than one-third of injury-related deaths (Libya, 43%; Djibouti, 42%; Mauritius, 37%; Namibia, 36% and Niger, 34%.) (Annex II: Tables 3 and 4).

In 2008, road traffic accidents caused approximately 158,000 deaths and were the 13th ranked cause of fatalities, account-ing for 2.3% of all deaths on the conti-nent (Figure 1). At present trends, with no effective mitigation, it is projected that globally by 2030, road traffic injuries will rank as the 5th leading cause of death after cancer, cardiovascular disease, COPD (chronic obstructive pulmonary disease), and acute respiratory infections (WHO 2009). Road traffic accidents account for 10% of all deaths in Libya and Tunisia, 8% in Egypt, and 7% in Sudan and Morocco

among the population aged 15-59. These five countries have the highest road traffic fatality rates in Africa, jointly accounting for nearly one-fifth of the continent’s total death toll. While Nigeria and Ethiopia also contributed to a high proportion (23%) of road accident-related deaths to the conti-nent’s overall tally, road accidents repre-sented less than 3% of deaths occurring in these countries. Thus Northern African countries (including Sudan) still stand out as having the highest death rates due to road traffic accidents.

Among the elderly population, road traffic accidents account for 30% of all injury-related deaths, compared to falls, which account for only 9% of injury-related deaths. There is though a narrow sex dif-ferential for this age group: road fatalities

account for 32% of all injury-related deaths among males and for 27% among females aged 60 years and over. The death toll due to road traffic accidents among elderly individuals in North African countries is even more alarming: 44% in Libya, 56% in Tunisia and Morocco, and 70% in Egypt.

Assessing the Social and Economic Costs of Road Traffic AccidentsThe high death toll due to road traffic accidents needs to be tackled as a matter of urgency by national governments, not least because of the economic and social costs they impose. This is especially chal-lenging to many African countries with relatively weak health care systems and where social protection for those surviving with life-changing injuries is limited.

The high level of road traffic fatalities is of particular concern since this affects the younger segment of population (aged 15-29) the hardest, who constitute the most economically active population. However, estimating the economic costs related to road traffic accidents is

Figure 1: Leading Causes of Death in Africa, Population Aged 15 years and over, 2008

Source: Global Burden of Disease (GBD) 2004 Update, WHO (2008).

0 100 200 300 400 500 600 700 800 900 1000 1100 1200

HIV/AIDS

Ischaemic heart disease

Cerebrovascular disease

Cancers

Lower respiratory infections

Tuberculosis

Repiratory diseases

Digestive diseases

Diarrhoeal diseases

Diabetes mellitus

Maternal conditions

Violence

Road traffic accidents

Neuropsychiatric conditions

In Africa, almost one in ten deaths of young men (aged 15-29) are caused by road

traffic accidents.


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problematic. Projections are even more difficult to make in low-income countries in Sub-Saharan Africa, where records of economic activity and other vital statistics necessary to compute economic and social costs are not well documented. Similarly, large proportions of the population are employed in either the informal econ-omy or in non-remunerative work and often their contribution to the economy is uncounted. What is clear is that econom-ically disadvantaged families are hardest hit by the loss of an economically active family member, or by disabilities if the accident is not fatal.

The burden of deaths due to road traffic accidents can be understood as comprising

two main components: indirect costs and the value of mortality. Indirect costs rep-resent “the value of economic output lost because of premature death” (WHO 2008). They are often measured in terms of lost potential earnings resulting from early mortality.

The value of mortality is much more dif-ficult to assess, although methods have been developed to value death in utility terms, such as potential years of life lost (PYLL). PYLL is the number of years of potential life not lived when a person dies “prematurely.” The indicator provides a way of weighting deaths occurring at younger ages, which are, a priori, preventable. It takes into account the number of deaths

at each age at which deaths occur by giv-ing greater weight to deaths at a younger age and lower weight to deaths at an older age. The number of deaths at each age is then multiplied by the global standard life expectancy at which death occurs. Thus, automobile accidents comprise a signif-icantly higher proportion of years of life lost than total deaths, because they occur with greater frequency in young than in older people.

4. Road Safety Issues: Facing up to the Challenge

According to the 2013 WHO Global Status Report on Road Safety, strategies already exist in many countries to reduce the num-ber of fatalities and injuries due to road traffic accidents. Measures adopted include compulsory seatbelt use, drink-driving laws, speed limits, particularly in residen-tial and commercial areas, and compulsory use of helmets for motorcyclists, among others. Several countries (e.g. Egypt, Kenya, South Africa, Uganda and Zimbabwe) have banned the use of hand-held devices such as cellphones whilst driving. But the enforcement of these strategies remains very weak in many countries. As a result, the number of deaths related to road traffic accidents has remained stubbornly high. It is estimated that globally 1.24 million peo-ple are killed in road traffic accidents each year and another 50 million are injured or disabled permanently (WHO 2009; WHO 2013). In Africa, an estimated 157,875 peo-ple aged 15 and over were killed in road traffic accidents in 2008 (the majority of them in the 15-59 year age group).

A number of factors contribute to the high number of road traffic accidents in Africa. These can be categorized into 3 main groups: road environment fac-tors, vehicle factors, and human factors. Whereas human factors rank highest in contribution, all need to be addressed in promotion of road safety. Road envi-ronment factors may include poor road maintenance such as overgrown vegetation on road verges that impair visibility and road failures that constrict the road way; poor road layout such as road curvatures, unsuitable road layout for the traffic using it, and poor provision or lack of segrega-tion of traffic types. Vehicle factors may include poor mechanical state, dangerously loaded vehicles which pose a danger to other road users, overloading of vehicles (axle-load non-conformity) which promote damage to the road and exacerbate prob-lems of road maintenance. Human factors include speeding, non-compliance with seatbelt use, drink-driving, increased use of hand-held devices such as cellphones

while driving, and an increase in auto-mobile ownership in many countries. In Africa alone, automobile ownership increased from below 50 to about 60 cars per 1,000 persons between 2002 and 2007. In countries such as Tunisia, Swaziland, South Africa, Botswana, Mauritius, and Seychelles, an estimated 1-2 of every 10 persons now owns an automobile (AfDB Data Portal, 2013). It is therefore no coin-cidence that in middle-income countries of Tunisia, South Africa and Mauritius, the proportion of injury-related deaths attrib-utable to road traffic accidents exceeds the African average (Annex II: Tables 5 and 6)..

The high number of road traffic accidents involving pedestrians, or persons riding

38% of all road traffic deaths in Africa occur among

pedestrians.

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motor cycles or bicycles, is indicative of deficiencies in both the infrastructure, as well as in road safety enforcement in Africa. With expanding road infrastructure net-works in Africa, it is imperative that greater attention be paid to road safety measures to reduce the high number of accidents. As the WHO Global Status Report on Road Safety 2013 (p. 6) makes clear: “38% of all African road traffic deaths occur among pedestrians.” However, most countries do not have policies in place to protect these road users. Moreover in many countries, there is an increased use of motorbikes for public transport, and often these are

in poor mechanical state and are usually overloaded. Public transport needs to set high safety standards.

Public awareness campaigns on the need to use seat-belts and child restraints to avoid death and severe injuries would assist in changing attitudes toward car safety. Legislation should make it compulsory for both drivers and passengers to wear seat-belts. Taxis too, should also be fitted with seat-belts for passengers.

The public also needs to be educated (e.g. through posters, TV advertisements and

other advocacy programs) on the dan-gers of speeding, driving while under the influence of drink or drugs, backed by reg-ulatory fines commensurate with traffic offences for those found to be in breach of the law. To this end, more equipment (e.g. breathalyzers, speed detectors) should be introduced and traffic officers trained in their use. Finally, owners of cars over a cer-tain age (e.g. 3 years) should be required to hold an annual road-worthiness certificate for their vehicles. Such measures could sig-nificantly reduce road deaths and improve road safety although they would require financing, particularly in the set-up phases.

5. Conclusion

Mortality rates due to any cause is high in Africa compared to other global regions. Infectious and parasitic diseases such as malaria, diarrheal diseases, HIV/AIDS and tuberculosis constitute a large proportion of these deaths, particularly because of their high prevalence in young children and young adults. Mortality rates caused by these diseases (as shown in the tables and figures) remain high, even when those aged below 15 years of age are excluded. Cardiovascular diseases on the other hand are more prevalent in the older population.

Increasingly, however, the question of how to reduce the level of road traffic accidents is presenting a challenge for African econ-omies and societies, especially in view of the high growth rate of the population, increasing urbanization and high automo-bile congestion in larger cities. Available data show that deaths due to road traf-fic accidents are highest within the 15-59 and more specifically in the 15–29 year

age group. This age category comprises people who are just entering post-primary schooling, post-secondary training, and completing post-secondary education. This population group also comprises a significant proportion of the economically active population in Africa, and those just starting their careers.

However, the availability, quality, and relia-bility of data limit a comprehensive assess-ment of road traffic accidents and their social and human costs. Data on deaths, injuries, disabilities, (including whether the victim was an occupant in an automobile or a pedestrian/cyclist), and the number of licensed and unlicensed drivers involved in road traffic accidents are not consistently collected or compiled into harmonized databanks at present for all countries. Similarly, data on accidents caused by road environment failures or other infrastruc-ture problems are not well captured. This impacts governments’ capacity to develop

improved road safety policies and other preventative measures and to monitor their effectiveness over time. More importantly, information on the true economic cost related to road traffic accidents will need to be compiled at regular intervals in as many African countries as possible.

The need for reliable and updated data on road traffic mortalities is dependent on robust national statistical systems and a skilled staff to compile and maintain the data needed by both governments and international organizations, and other data users. In this respect, development partners like the AfDB, WHO, and others should continue to lend their assistance through funding and technical assistance, including capacity-building to strengthen disease, death, injury and disability reg-istries, road infrastructure and other transport statistics, and national statis-tical systems in general.


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References

WHO. 2013. Global Status Report on Road Safety: Supporting a Decade of Action. WHO, Geneva.

WHO African Region. 2010. Status Report on Road Safety in Countries of the WHO African Region, 2009. WHO Regional Office for Africa, Brazzaville, Republic of Congo.

WHO. 2008. Global Burden of Disease, 2004 Update. WHO, Geneva. http://www.who.int/healthinfo/global_bur-den_disease/GBD_report_2004up-date_part2.pdf

Annex I: Figures

Figure A.1: Mortality due to any cause per 100,000 population aged 15-59, by country, 2008.

Figure A.2: Mortality due to any cause per 100,000 population aged 60 and over, by country, 2008

Figure A.3: Mortality caused by road traffic accidents per 100,000 population, males and females, 15-59 years, by country, 2008

Figure A.4: Comparative mortality rates for road traffic accidents, cardiovascular

disease, and HIV/AIDS per 100,000 pop-ulation aged 15-59 years, 2008

Annex II: Tables

Table 1: Africa: Cause of death per 100,000 population aged 15 years and over, 2008

Table 2: Africa: Cause of death for popu-lation aged 15 years and over, 2008 (as % of total deaths)

Table 3: WHO African Region: Cause of death in population 15 -80 years and over, 2008

Table 4: WHO African Region: Cause of death in population 15 - 80 years and over, 2008 (% of total deaths)

Table 5: Africa: Deaths due to injuries and road traffic accidents per 100,000 popula-tion aged 15-59, 2008

Table 6: Africa: Deaths per 100,000 popu-lation aged 60 years and over due to injuries and road traffic accidents, 2008

Notes for Figures A1, A2, A3, A4:(*): Reasonably complete death registra-tion data available with underlying cause of death coded using ICD-9 or ICD-10 without excessive use of inappropriate or non-specific codes.

(+) Incomplete death registration data, and/or other forms of nationally represent-ative information on causes of death (e.g. verbal autopsy, sample registration data) available. Cause of death models may be used to adjust for biases due to incomplete

population coverage, other adjustments made using country-specific information for specific causes.

For all other countries, information on all causes of death were not available. Cause of death modeling was used to estimate broad distribution of causes of death for Communicable Diseases, Non-communicable Diseases and Injuries, by age and sex for the country level of all-cause mortality and per capita income. Cause of death patterns within the three major cause groups were based on death registration data from other countries in the region. Further country-level information and data on specific causes listed was also used. Separate specific multi-cause models were used for the major causes of child death.

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Figure A.1: Mortality due to any cause per 100,000 population aged 15-59, by country, 2008

Source: Global Burden of Disease (GBD) 2004 Update, WHO (2008).

0 200 400 600 800 1000 1200 1400 1600 1800

São Tomé and Príncipe

Tunisia

Morocco

Algeria

Libya

Egypt (+)

Cape Verde

Mauritius (*)

Eritrea

Seychelles (*)

Senegal

Niger

Madagascar

Comoros

Mali

Rwanda

Gambia

Mauritania

Sudan

Djibouti

Gabon

Benin

Togo

Ghana

Kenya

Burkina Faso

Congo

Liberia

Angola

Nigeria

Dem. Rep. Congo

Equatorial Guinea

Tanzania

Sierra Leone

Somalia

Guinea

Chad

Burundi

Ethiopia

Cameroon

Botswana

Guinea-Bissau

Uganda

Namibia

Central African Republic

Zambia

Mozambique

Côte d’Ivoire

South Africa

Zimbabwe

Lesotho

Malawi

Swaziland


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Figure A.2: Mortality due to any cause per 100,000 population aged 60 and over by country, 2008

Source: Global Burden of Disease (GBD) 2004 Update, WHO 2008.

0 2000 4000 6000 8000

Malawi

Equatorial Guinea

CAR

Uganda

Côte d'Ivoire

Somalia

Burundi

Cameroon

Guinea-Bissau

Congo

Zambia

Ethiopia

Mozambique

Dem. Rep. Congo

Chad

Swaziland

Lesotho

Guinea

Angola

Gabon

Rwanda

Nigeria

Zimbabwe

Namibia

Liberia

Comoros

Tanzania

Ghana

Sudan

Benin

Kenya

Madagascar

Africa

Togo

Burkina Faso

Sao Tome & Principe

Mali

Sierra Leone

Mauritania

Djibouti

South Africa

Botswana

Cape Verde

Niger

Gambia

Egypt (+)

Senegal

Eritrea

Algeria

Seychelles (*)

Libya

Mauritius (*)

Morocco

Tunisia

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Figure A.3: Mortality caused by road traffic accidents per 100,000 population, males and females, 15-59 years, by country, 2008


- 10 20 30 40 50 60 70 80 90 100 110 120

Namibia

Malawi

Swaziland

Mozambique

Sudan

Congo

Zambia

Ethiopia

Djibouti

Central African Rep

Uganda

Lesotho

Angola

Guinea

Equatorial Guinea

Côte d'Ivoire

Guinea-Bissau

Cameroon

Burkina Faso

Tanzania

Ghana

Sierra Leone

Chad

Burundi

Africa

Libya

Benin

Dem. Rep. Congo

Kenya

Egypt (+)

Mauritania

Botswana

South Africa

Gabon

Rwanda

Cape Verde

Nigeria

Comoros

Liberia

Tunisia

Mauritius (*)

Eritrea

Gambia

Zimbabwe

Togo

Morocco

Mali

Madagascar

Senegal

Algeria

Seychelles (*)

Sao Tome and Principe

Niger

Somalia

Deaths due to Road Traffic Accidents per 100,000 Population

Female

Male

Both sexes


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Figure A.4: Comparative mortality rates for road traffic accidents, cardiovascular disease, and HIV/AIDS per 100,000 population aged 15-59 years, by country, 2008


0 100 200 300 400 500 600 700 800 900 1000 1100 1200

Namibia

Malawi

Swaziland

Mozambique

Sudan

Congo

Zambia

Ethiopia

Djibouti

CAR

Uganda

Lesotho

Angola

Guinea

Equatorial Guinea

Côte d'Ivoire

Guinea-Bissau

Cameroon

Burkina Faso

Tanzania

Ghana

Sierra Leone

Chad

Burundi

Libya

Benin

Dem. Rep. Congo

Kenya

Egypt +

Mauritania

Botswana

South Africa

Gabon

Rwanda

Cape Verde

Nigeria

Comoros

Liberia

Tunisia

Mauritius *

Eritrea

Gambia

Zimbabwe

Togo

Morocco

Mali

Madagascar

Senegal

Algeria

Seychelles *

Sao Tome & Principe

Niger

Somalia

Deaths by Cause per 100,000 Population

Road Traffic Accidents

Cardiovascular diseases

HIV/AIDS

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Table 1: Africa: Cause of death per 100,000 population aged 15 years and over, 2008

Both Sexes Male Female



Cause of deathAll Ages

15+All Ages

15+All Ages

15+ 15 - 59 15 - 59 15 - 59 60+ 60+ 60+

All Causes 1,151.00 1,212.20 1,091.20 728.9 779.8 678.4 5,474.40 6,019.40 5,013.10

Communicable, maternal, perinatal and nutritional conditions

466.4 460.2 472.5 403.8 381.6 425.7 1108.1 1333.1 917.7

Infectious and parasitic diseases

344.8 361.6 328.4 322.3 333 311.7 575.7 680.1 487.4

Tuberculosis 61.8 87.2 36.9 57.1 80.7 33.8 109.3 160.3 66

HIV/AIDS 182.1 163.7 200.1 193.8 172.5 214.9 63.1 66.4 60.3

Diarrheal diseases 38.8 40.6 37 21.9 23.8 20 211.6 226.9 198.6

Malaria 4.1 3.7 4.5 4 3.5 4.4 5.7 5.6 5.7

Respiratory infections 78.3 91.1 65.8 36.8 43.2 30.5 503.1 623.3 401.4

Maternal conditions 35.5 … 70.2 39 … 77.5 … … …

Non-communicable diseases

579.4 590 569.1 228 244.5 211.6 4178.5 4429.8 3965.7

Cancers 83 80.4 85.6 48.4 41.8 54.9 437.4 509 376.8

Diabetes mellitus 35.7 29.7 41.6 11.7 10.9 12.5 281.7 238.8 318

Cardiovascular diseases 277.4 268.9 285.8 81.8 89 74.6 2281.2 2268.9 2291.7

Ischemic heart disease 94 108.1 80.2 24.5 32.8 16.3 805.3 944.9 687.2

Cerebrovascular disease 92.6 84 101 28.4 29.6 27.2 750 688.8 801.8

Respiratory diseases 59.9 72.7 47.4 23.5 27.3 19.7 432.9 577.1 310.8

Digestive diseases 53.8 62.2 45.6 29.3 36.7 22 304.3 345.4 269.5

Injuries 105.2 162.1 49.6 97.1 153.6 41.1 187.8 256.5 129.7

Road traffic accidents 27 41.3 13 24.1 37.6 10.7 56.7 82.6 34.9

Violence 27.7 46.7 9 28.1 47.4 8.9 23.4 39.3 10

Source: Global Burden of Disease (GBD) 2004 Update, WHO 2008. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html


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Table 2: Africa: Cause of death for population aged 15 years and over, 2008 (as % of total deaths)




Cause of deathAll Ages

15+All Ages

15+ All Ages

15+ 15- 59 15 - 59 15 - 59 60+ 60+ 60+

Percentage of all causes

All causes … … … … … … … … …

Communicable, maternal, perinatal and nutritional conditions

40.5 38 43.3 55.4 48.9 62.7 20.2 22.1 18.3

Infectious and parasitic diseases

30 29.8 30.1 44.2 42.7 45.9 10.5 11.3 9.7

Tuberculosis 5.4 7.2 3.4 7.8 10.3 5 2 2.7 1.3

HIV/AIDS 15.8 13.5 18.3 26.6 22.1 31.7 1.2 1.1 1.2

Diarrheal diseases 3.4 3.3 3.4 3 3.1 2.9 3.9 3.8 4

Malaria 0.4 0.3 0.4 0.5 0.4 0.7 0.1 0.1 0.1

Respiratory infections 6.8 7.5 6 5 5.5 4.5 9.2 10.4 8

Maternal conditions 3.1 … 6.4 5.3 … 11.4 … … …

Non-communicable diseases

50.3 48.7 52.2 31.3 31.4 31.2 76.3 73.6 79.1

Cancers 7.2 6.6 7.8 6.6 5.4 8.1 8 8.5 7.5

Diabetes mellitus 3.1 2.4 3.8 1.6 1.4 1.8 5.1 4 6.3

Cardiovascular diseases 24.1 22.2 26.2 11.2 11.4 11 41.7 37.7 45.7

Ischaemic heart disease 8.2 8.9 7.3 3.4 4.2 2.4 14.7 15.7 13.7

Cerebrovascular disease 8 6.9 9.3 3.9 3.8 4 13.7 11.4 16

Respiratory diseases 5.2 6 4.3 3.2 3.5 2.9 7.9 9.6 6.2

Digestive diseases 4.7 5.1 4.2 4 4.7 3.2 5.6 5.7 5.4

Injuries 9.1 13.4 4.5 13.3 19.7 6.1 3.4 4.3 2.6

Road traffic accidents 2.3 3.4 1.2 3.3 4.8 1.6 1 1.4 0.7

Road traffic accidents as % of injury related deaths

25.7 25.5 26.2 24.8 24.5 26.0 30.2 32.2 26.9

Violence 2.4 3.9 0.8 3.9 6.1 1.3 0.4 0.7 0.2

Source: Global Burden of Disease (GBD) 2004 Update, WHO 2008. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html

13



Tabl

e 3: W

HO A

frica

n Re

gion

*: Ca

use o

f dea

th in

popu

latio

n 15

year

s and

over,

2008

B

OTH

SE

XES

MA

LEFE

MA

LE

To

tal

15-8

0 +

15-2

930

-44

45-5

960

-69

70-7

980

+M

ALE

15

-80

+

15-2

930

-44

45-5

960

-69

70-7

980

+FE

MA

LE

15-8

0 +

All

Cau

ses

1245

.438

9.6

1121

.520

94.6

4174

.085

25.2

1834

4.4

1308

.043

2.2

1027

.514

25.0

2966

.569

03.0

1606

7.8

1184

.5

Co

mm

un

icab

le, m

ater

nal

, per

i-n

atal

an

d n

utr

itio

nal

co

nd

itio

ns

562.

318

3.4

701.

996

8.1

1263

.519

77.6

3822

.855

5.0

324.

978

3.9

639.

376

6.1

1349

.228

33.4

569.

5

Infe

ctio

us a

nd p

aras

itic

dise

ases

419.

816

9.8

645.

375

6.3

716.

093

9.4

1524

.343

8.7

212.

362

6.8

486.

547

5.6

671.

911

51.6

401.

3

Tub

ercu

losi

s74

.355

.613

5.7

168.

217

7.4

231.

325

5.9

105.

332

.150

.648

.580

.580

.971

.744

.0

HIV

/AID

S22

6.8

68.6

410.

133

8.0

122.

127

.44.

120

3.8

123.

351

4.4

279.

710

8.3

35.9

4.3

249.

2

Dia

rrho

eal d

isea

ses

46.9

11.2

28.6

87.3

210.

935

5.3

731.

448

.717

.518

.158

.916

0.8

318.

464

8.7

45.2

Mal

aria

4.9

4.4

3.4

5.3

6.6

7.5

10.1

4.5

5.4

4.6

5.8

6.7

7.8

9.2

5.4

Resp

irato

ry in

fect

ions

92.4

12.1

48.2

191.

152

9.0

988.

621

76.5

107.

515

.324

.312

3.8

272.

263

5.7

1582

.777

.7

Nut

ritio

nal d

efici

enci

es9.

21.

58.

420

.618

.649

.612

1.9

8.8

4.6

6.0

18.5

18.3

41.6

99.1

9.6

No

n-c

om

mu

nic

able

dis

ease

s56

9.5

65.3

225.

591

2.5

2661

.161

92.5

1409

2.0

575.

070

.420

3.8

729.

520

98.5

5372

.312

879.

256

4.3

Can

cers

82.9

11.4

38.2

147.

637

5.4

663.

111

36.8

77.6

9.8

56.2

206.

336

6.1

432.

251

5.2

88.1

Dia

bet

es m

ellit

us39

.61.

28.

356

.617

9.3

401.

965

1.5

32.7

1.9

8.2

61.4

225.

752

9.4

856.

946

.3

Neu

rop

sych

iatr

ic c

ondi

tions

23.2

10.7

19.1

40.8

81.0

206.

158

3.0

28.3

7.2

7.9

16.1

40.9

143.

551

2.6

18.2

Car

diov

ascu

lar d

isea

ses

265.

317

.067

.537

7.1

1211

.331

12.7

7900

.725

4.3

20.8

64.4

283.

610

07.1

3118

.483

05.2

276.

0

Resp

irato

ry d

isea

ses

67.0

6.5

27.6

127.

242

0.0

967.

218

50.6

82.1

11.3

23.4

58.9

183.

947

2.6

1069

.752

.3

Dig

estiv

e di

seas

es46

.49.

841

.210

2.8

207.

336

5.7

628.

553

.39.

522

.757

.314

0.3

288.

857

0.8

39.7

Gen

itour

inar

y di

seas

es20

.63.

912

.833

.494

.723

7.5

706.

124

.13.

78.

720

.549

.814

4.2

412.

117

.1

Inju

ries

113.

514

0.8

194.

121

4.0

249.

435

5.1

429.

617

8.0

36.9

39.8

56.1

102.

018

1.6

355.

250

.7

Ro

ad tr

affic

acci

den

ts27

.125

.449

.462

.871

.411

2.0

112.

642

.28.

310

.414

.830

.642

.757

.712

.5

Viol

ence

32.6

54.7

59.8

55.3

53.2

43.1

45.3

55.8

10.5

8.0

10.4

12.3

12.2

16.6

10.0

Sour

ce: G

loba

l Bur

den

of D

iseas

e, 20

04 U

pdat

e, W

HO

(200

8)*N

otes

: The

WH

O A

fric

an R

egio

n do

es n

ot in

clud

e M

oroc

co, T

unisi

a, L

ibya

, Egy

pt, S

udan

, Djib

outi,

Erit

rea

or S

omal

ia


14



Tabl

e 4: W

HO A

frica

n Re

gion

*: Ca

use o

f dea

th in

popu

latio

n 15

year

s and

over,

2008

(% of

tota

l dea

ths)

B

OTH

SE

XES

MA

LEFE

MA

LE

To

tal

15-8

0 +

15-2

930

-44

45-5

960

-69

70-7

980

+M

ALE

15

-80

+

15-2

930

-44

45-5

960

-69

70-7

980

+FE

MA

LE

15-8

0 +

All

Cau

ses

……

……

……

……

……

……

……

…

Co

mm

un

icab

le, m

ater

nal

, per

i-n

atal

an

d n

utr

itio

nal

co

nd

itio

ns

45.2

47.1

62.6

46.2

30.3

23.2

20.8

42.4

75.2

76.3

44.9

25.8

19.5

17.6

48.1

Infe

ctio

us a

nd p

aras

itic

dise

ases

33.7

43.6

57.5

36.1

17.2

11.0

8.3

33.5

49.1

61.0

34.1

16.0

9.7

7.2

33.9

Tub

ercu

losi

s6.

014

.312

.18.

04.

32.

71.

48.

17.

44.

93.

42.

71.

20.

43.

7

HIV

/AID

S18

.217

.636

.616

.12.

90.

30.

015

.628

.550

.119

.63.

60.

50.

021

.0

Dia

rrho

eal d

isea

ses

3.8

2.9

2.6

4.2

5.1

4.2

4.0

3.7

4.1

1.8

4.1

5.4

4.6

4.0

3.8

Mal

aria

0.4

1.1

0.3

0.3

0.2

0.1

0.1

0.3

1.3

0.4

0.4

0.2

0.1

0.1

0.5

Resp

irato

ry in

fect

ions

7.4

3.1

4.3

9.1

12.7

11.6

11.9

8.2

3.5

2.4

8.7

9.2

9.2

9.9

6.6

Nut

ritio

nal d

efici

enci

es0.

70.

40.

71.

00.

40.

60.

70.

71.

10.

61.

30.

60.

60.

60.

8

No

n-c

om

mu

nic

able

dis

ease

s45

.716

.820

.143

.663

.872

.676

.844

.016

.319

.851

.270

.777

.880

.247

.6

Can

cers

6.7

2.9

3.4

7.0

9.0

7.8

6.2

5.9

2.3

5.5

14.5

12.3

6.3

3.2

7.4

Dia

bet

es m

ellit

us3.

20.

30.

72.

74.

34.

73.

62.

50.

40.

84.

37.

67.

75.

33.

9

Neu

rop

sych

iatr

ic c

ondi

tions

1.9

2.7

1.7

1.9

1.9

2.4

3.2

2.2

1.7

0.8

1.1

1.4

2.1

3.2

1.5

Car

diov

ascu

lar d

isea

ses

21.3

4.4

6.0

18.0

29.0

36.5

43.1

19.4

4.8

6.3

19.9

33.9

45.2

51.7

23.3

Resp

irato

ry d

isea

ses

5.4

1.7

2.5

6.1

10.1

11.3

10.1

6.3

2.6

2.3

4.1

6.2

6.8

6.7

4.4

Dig

estiv

e di

seas

es3.

72.

53.

74.

95.

04.

33.

44.

12.

22.

24.

04.

74.

23.

63.

3

Gen

itour

inar

y di

seas

es1.

71.

01.

11.

62.

32.

83.

81.

80.

90.

81.

41.

72.

12.

61.

4

Inju

ries

9.1

36.1

17.3

10.2

6.0

4.2

2.3

13.6

8.5

3.9

3.9

3.4

2.6

2.2

4.3

Ro

ad tr

affic

acci

den

ts2.

26.

54.

43.

01.

71.

30.

63.

21.

91.

01.

01.

00.

60.

41.

1

Ro

ad tr

affic

acci

den

ts a

s %

of

inju

ry r

elat

ed d

eath

s23

.918

.025

.429

.328

.631

.526

.223

.722

.626

.126

.430

.023

.516

.224

.6

Viol

ence

2.6

14.1

5.3

2.6

1.3

0.5

0.2

4.3

2.4

0.8

0.7

0.4

0.2

0.1

0.8

Sour

ce: G

loba

l Bur

den

of D

iseas

e, 20

04 U

pdat

e WH

O (2

008)

.*N

ote:

The

WH

O A

fric

an R

egio

n do

es n

ot in

clud

e M

oroc

co, T

unisi

a, L

ibya

, Egy

pt, S

udan

, Djib

outi,

Erit

rea

or S

omal

ia.

15



Table 5: Africa: Deaths due to injuries and road traffic accidents per 100,000 population aged 15-59, 2008

Injury-related Deaths Motor Road AccidentsRoad Traffic Accidents as Percentage of all Injuries

Total Male Female Total Male Female Total Male Female

Africa 97 154 41 24 38 11 25 24 26

Namibia 179 298 64 65 55 10 36 18 16

Malawi 226 386 71 49 40 9 22 10 13

Swaziland 228 375 91 47 36 11 20 10 12

Mozambique 174 304 55 42 34 7 24 11 13

Sudan 166 207 124 41 23 18 25 11 15

Congo 145 211 80 40 28 12 27 13 15

Zambia 199 331 67 38 30 8 19 9 11

Ethiopia 145 229 63 37 28 9 26 12 14

Djibouti 87 135 39 36 30 6 42 22 16

Central African Rep. 153 221 87 36 24 12 24 11 14

Uganda 196 354 38 35 31 4 18 9 10

Lesotho 151 236 81 35 23 12 23 10 14

Angola 106 169 45 33 26 7 31 16 15

Guinea 138 207 68 33 26 7 24 13 11

Equatorial Guinea 121 174 69 32 23 8 26 13 12

Côte d’Ivoire 200 315 79 30 23 6 15 7 8

Guinea-Bissau 110 166 55 29 22 6 26 13 12

Cameroon 111 132 90 29 18 11 26 14 12

Burkina Faso 104 192 18 28 26 2 27 13 13

Tanzania 115 222 10 27 25 1 23 11 14

Ghana 89 136 41 26 20 6 29 15 14

Sierra Leone 81 131 35 25 20 5 31 15 15

Chad 112 167 58 25 19 6 22 11 11

Burundi 107 161 56 25 17 7 23 11 13

Libya 53 83 21 23 20 3 43 24 16

Benin 84 135 31 23 19 4 27 14 12

Dem. Rep. Congo 146 237 57 22 17 5 15 7 9

Kenya 106 195 18 22 21 2 21 11 10

Egypt + 34 55 14 22 18 4 64 33 27

Mauritania 84 94 74 22 13 9 26 14 12

Botswana 91 127 55 20 13 7 22 10 13

South Africa 74 117 32 19 14 5 26 12 17


16





Gabon 71 101 41 19 14 5 26 14 12

Rwanda 75 124 30 19 14 4 25 12 15

Cape Verde 71 119 27 19 16 3 27 13 12

Nigeria 66 96 36 18 14 4 27 14 11

Comoros 69 87 52 18 12 6 25 14 11

Liberia 55 92 19 18 15 3 32 16 15

Tunisia 30 52 8 18 16 2 58 30 25

Mauritius * 46 78 14 17 15 2 37 20 11

Eritrea 83 134 35 16 12 4 20 9 12

Gambia 60 81 40 16 11 5 27 14 13

Zimbabwe 64 110 23 14 11 3 22 10 15

Togo 53 76 29 14 11 4 27 14 12

Morocco 27 39 15 14 10 3 51 26 23

Mali 50 97 6 13 13 1 27 13 12

Madagascar 47 74 21 13 10 3 28 14 13

Algeria 35 47 22 10 7 3 28 14 14

Senegal 47 65 30 12 9 4 26 13 12

Seychelles * 57 97 17 9 6 3 16 6 19

Sao Tome & Principe 31 53 9 8 6 1 24 12 15

Niger 21 38 5 7 6 1 34 17 16

Somalia 213 305 124 7 4 3 3 1 2

Source: Global Burden of Disease (GBD) 2004 Update, (WHO 2008). http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html

17



Table 6: Africa: Deaths per 100,000 population aged 60 years and over caused by injuries and road traffic accidents, 2008.



Africa 188 256 130 57 83 35 30 32 27

Egypt + 57 83 34 40 60 22 70 72 65

Tunisia 106 138 77 60 84 37 56 61 49

Morocco 126 172 86 70 102 42 56 60 48

Djibouti 125 182 77 58 90 30 46 50 39

Libya 174 232 111 76 110 39 44 48 35

Sierra Leone 158 221 99 60 86 34 38 39 35

Niger 137 189 90 50 74 30 37 39 33

Liberia 154 228 93 56 88 30 36 39 32

Gambia 160 216 111 55 78 34 34 36 31

Angola 197 261 146 68 100 41 34 38 28

Senegal 145 196 98 49 71 30 34 36 30

Burkina Faso 173 259 112 59 95 33 34 36 30

Madagascar 150 204 101 51 74 29 34 37 29

Mauritania 163 221 121 55 80 37 34 36 30

Benin 168 250 109 56 91 32 33 36 29

Togo 161 224 111 54 81 32 33 36 29

Mali 160 235 96 53 83 28 33 35 29

Cameroon 206 265 155 68 96 44 33 36 29

Guinea-Bissau 189 265 125 62 94 35 33 35 28

Ghana 183 236 133 59 83 37 33 35 28

South Africa 153 215 110 49 68 36 32 32 33

Comoros 172 230 124 55 81 34 32 35 27

Algeria 167 187 151 53 69 40 32 37 26

Equatorial Guinea 229 282 185 71 99 47 31 35 25

Gabon 237 267 209 72 95 52 31 36 25

Cape Verde 165 221 135 49 80 33 30 36 24

Congo 283 376 205 84 119 55 30 32 27

Sao Tome & Principe 134 190 91 40 59 24 30 31 27

Mauritius * 91 140 55 27 41 17 29 29 30

Chad 223 295 162 65 95 41 29 32 25

Nigeria 177 237 124 51 76 29 29 32 24

Ethiopia 254 360 162 73 105 45 29 29 28


18



Rwanda 225 312 165 65 96 43 29 31 26

Lesotho 282 379 211 79 115 53 28 30 25

Zimbabwe 217 315 143 60 94 35 28 30 24

Sudan 178 232 130 49 66 34 28 28 26

Central African Rep. 306 397 233 84 116 58 27 29 25

Guinea 171 233 121 47 70 27 27 30 23

Tanzania 243 363 145 65 100 37 27 28 25

Burundi 252 363 178 68 103 44 27 28 25

Eritrea 214 305 154 58 85 39 27 28 26

Malawi 261 392 145 69 106 35 26 27 24

Kenya 269 365 185 71 104 41 26 29 22

Botswana 283 317 257 74 91 61 26 29 24

Namibia 316 411 242 80 119 50 25 29 21

Mozambique 243 341 169 60 91 37 25 27 22

Zambia 261 371 167 64 95 38 25 26 23

Swaziland 340 430 273 81 112 58 24 26 21

Dem. Rep. Congo 311 436 211 66 96 42 21 22 20

Uganda 260 377 165 52 80 30 20 21 18

Côte d’Ivoire 265 332 187 44 58 28 17 18 15

Somalia 313 386 251 33 43 25 11 11 10

Seychelles * 88 170 27 0 0 0 0 0 0

Source: Global Burden of Disease (GBD) 2004 Update (WHO 2008.) http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.htm

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