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John Perino
Ms. Barnhart
AP Literature and Composition
16 December 2015
African Health Research Paper
Research Issue:

What are the current causes and potential solutions behind the lower
life expectancies and lack of health care on the African continent?

Given the multifarious reasons behind sub-Saharan Africas modern


health crisis, a combination of vaccination and education will most

effectively assuage infectious diseases and increase life expectancies.


Vaccination and education may prove too costly to be an effective



Introduction: Background Information

a. Full Circle Example
i. Mdecins Sans Frontires - Coalition of doctors that traveled to
underprivileged countries around the world, including 2,400 doctors that
set out to help people of the Central African Republic (Central African
b. Intro to Humanitarian Issues

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i. African lifespan is, on average, 14 years shorter than the world average,
and 21 years shorter than the European average (The State of Healthcare)

Subtopic 1: Causes of Disease

a. Paragraph #1: Sanitation
i. Number of people without access to sanitation has grown from 430
million in 1990 to 589 million in 2006 (A Snapshot of Sanitation)
ii. In 2006, 25% of African population practicing open defecation (A
Snapshot of Sanitation)
1. Link to fecal-oral transmission of poliovirus (Miller and Sentz)
iii. Sub-Saharan Africa water coverage at only 61% (International Decade
for Action)
b. Paragraph #2: Lack of Workforce
i. In addition to the limits on numbers joining the workforce, population
growth in sub-Saharan Africa has outstripped the supply of health
professionals (Dovlo)
1. Long-term trend has not changed; in 1960, the Central African
Republic had 2.8 physicians per 100,000 people; in 1998, rose only
to 3.5 per 100,000 people (Dovlo)
2. Compare to the 1998 number in the US, which was 279 physicians
per 100,000 people (Dovlo)
ii. Physician training more suited for industrialized, Western-style health care
and may not be suitable for the social and geographic differences in Africa

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Subtopic 2: Solution of Vaccination

a. Paragraph #1: Successful history of vaccination
i. Case of Polio
1. Global efforts toward polio eradication have included vaccination
campaigns and active surveillance. The annual incidence of
paralytic polio was reduced from an estimated 350,000 in 1988 to
about 1,000 from 2001 to 2004 (Miller and Sentz)
2. Consider: risk of VAPP, or vaccine-associated paralytic
poliomyelitis (Miller and Sentz) - may be used as a
ii. Function in paper: used to show that vaccination is historically successful
- lead to current case
b. Paragraph #2: Cost Effectiveness
i. The WHO created the Expanded Program on Immunization (EPI) in 1974
as a means to continue the great success that had been achieved earlier
with the eradication of smallpox. At that time less than 5 percent of the
world's children in the developing world were receiving immunizations.
The six diseases chosen to be tackled under this new initiative were
tuberculosis, diphtheria, tetanus, pertussis, polio, and measles (Miller and
ii. These six vaccines cost approximately US$.50 per capital (Miller and
iii. Counterargument

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1. New vaccines are much more costly to produce and therefore
distribute, making large-scale implementation more difficult
2. Reality is that prevention is cheaper than treatment
iv. Without vaccination, HBV, Hib, SP, and rotavirus contribute to more
than 1 million deaths in each successive birth cohort in Africa. Routine
scheduled use of HBV, Hib, SP, and rotavirus vaccines could potentially
prevent most of these deaths. Incorporation of these vaccines into routine
vaccination programs was estimated to cost between US$29 and US$150
per life year saved. Based on these evaluations, HBV and Hib should be
considered for integration into all national immunization programs
(Miller and Sentz)

Subtopic 3: Solution of Education/Research (be sure to qualify the definition of

education or whatever word that is used; its a combination of medical research,
exploration, and scientific inquiry from the top down, and the bottom up so I need
to acknowledge these different layers to the word I use)
a. Paragraph #1: The HIV/AIDS Case
i. Intro to Problem:
1. Eastern and Southern Africa the epicenter of epidemic; 48% of
AIDS related deaths worldwide occur here (HIV and AIDS:
2. HIV prevalence of 26.0% in Swaziland, and 5.6 million cases in
South Africa; both the highest figures in the world (HIV and
AIDS: Overview)

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ii. Effectiveness of Solutions:
1. Antiretroviral therapy, while proven to reduce prevalence of HIV,
is difficult to consistently administer and increases the risk of drug
resistance (Stevens, Kaye, and Corrah)
2. In recent years, a number of countries in sub-Saharan Africa
(such as Botswana, Kenya, Uganda, Malawi and Rwanda) have
implemented national campaigns to encourage uptake of HIV
testing. In 2013, 6.4 million people were tested for HIV in Kenya
compared to just 860,000 in 2008 ("HIV and AIDS)
b. Paragraph #2: Metagenomics
i. The availability of sequencing data from infectious pathogens represents
a unique opportunity for the identification of new drug and vaccine
targets, which potentially have value for disease management and control.
These data have, however, been predominantly benefiting researchers,
institutions and laboratories in North America, Australia, Europe and Asia,
contributing to the increasing economic, scientific and genomics
knowledge gap between these geographic regions and Africa (Folarin, A
Happi, and C Happi)
ii. ACEGID and H3Africa
1. By building capacity for state-of-the-art genome sequencing and
field-deployable genetic tools for microbial infection in Africa, we
can support clinical care of the most devastating diseases and
enable a surveillance network for some of the worlds greatest

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health threats. ACEGID will establish research programs for
African scientists to pursue high-impact projects not only to bring
regional academic and research success for African science, but
also to contribute to the improvement of global public health and
economic development. (Community Building)
iii. Counterargument - the idea of metagenomics is a new one, meaning it has
yet to see a definitive success story - but this is a promising method of
studying febrile illness

Conclusion Ideas:
a. Quick Recap of Ideas
i. Serious deficits in all aspects of health care, ranging from cleanliness to
water access to health care workers
b. Why Does It Matter?
i. While its obvious that these are human lives that can be saved, readers
already know that going into the paper. So what alternatives exist?
1. Theres also a clear economic benefit for reducing disease and
improving sanitation more lives means greater production from
African countries that havent been industrialized yet
2. Also possible to bring it back to the idea of the Mdecins Sans
Frontires and how it represents the Western effort to bring Africa
out of this crisis: example of human generosity? But that doesnt
necessarily concern the rest of the paper

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Works Cited
Central African Republic. Mdecins Sans Frontires. Mdecins Sans Frontires, 3 September
2015. Web. 10 December 2015.
Community Building and Tech Transfer: Bench to Bedside. Africa Center of Excellence for
Genomics of Infectious Diseases. Redeemers University, 2015. Web. 23 Nov. 2015.
Dovlo, Delanyo. The Health Workforce in Africa: Challenges and Prospects. Global Health
Workforce Alliance. World Health Organization, Sept. 2006. Web. 7 Dec. 2015.
Folarin, Onikepe A., Anise N. Happi, and Christian T. Happi. Empowering African Genomics
for Infectious Disease Control. Genome Biology. BioMed Inc., 7 Nov. 2014. Web. 14
Dec. 2015.
"HIV and AIDS in Sub-Saharan Africa Regional Overview." Averting HIV and AIDS. AVERT, 1
May 2015. Web. 11 Nov. 2015.
"HIV and AIDS: Overview." UNICEF Eastern and Southern Africa. UNICEF, n.d. Web. 11
Nov. 2015.
International Decade for Action Water for Life 2005-2015. UN Water. United Nations
Department of Economic and Social Affairs, 16 May 2014. Web. 14 Dec. 2015.
Miller, Mark A., and John T. Sentz. Disease and Mortality in Sub-Saharan Africa. 2nd ed.
Washington, DC: n.p., 2006. NCBI Bookshelf. National Institute of Health. Web. 15 Nov.
A Snapshot of Sanitation in Africa. Rep. World Health Organization, United Nations Children's
Fund, 20 Feb. 2008. Web. 11 Nov. 2015.
The State of Healthcare in Africa. Rep. KPMG, 2012. Web. 16 Oct. 2015.

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Stevens, Warren, Steve Kaye, and Tumani Corrah. Antiretroviral Therapy in Africa. US
National Library of Medicine. National Institutes of Health, 31 Jan. 2004. Web. 23 Nov.