Changing Patterns of Disease and Mortality in Sub-Saharan Africa: An Overview

Fifteen years have passed since the first edition of Disease and Mortality in Sub-Saharan Africa (DMSSA-1) was published. Its main purpose was to assist the World Bank's work in the health sector by describing conditions and diseases that contributed most to the overall burden of disease and by identifying ways to prevent and manage these causes of ill health. The volume was timely because of the adverse effect the economic downturn of the early 1980s had on health in Africa and because of the need to evaluate the impact of primary health care strategies that had been promoted in the preceding decade. Epidemiologic information coming from demographic surveillance sites that had not previously been fully compared and disseminated provided a new source for assessing trends in mortality. All this occurred against a backdrop of increasing concern about how the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), then still a relatively new and geographically more limited disease, could potentially affect health and development in Africa.

In the years since the publication of DMSSA-1 in 1991, epidemiological and demographic changes have occurred that require an update if the volume is to remain useful for policy makers in addressing the "Key Concerns" shown in box 1.1. The most significant impact on disease and mortality in Africa has been the growth of the HIV/AIDS epidemic, which has infected more than 30 percent of adults in some countries while spreading across the continent. Its impact has changed trends in many of the diseases covered in this volume and dramatically worsened the overall level of mortality in many African countries. The potential impact of HIV/AIDS was anticipated in DMSSA-1; the current volume documents the burden the disease is currently inflicting on Africa.