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Analysis Commentary

As African countries lock down, how will the next epidemic look like?

Egypt reported Africa’s first case of COVID-19 on 14th, February, 2020.  Thereafter, almost all African countries (excluding Comoros and Lesotho) have reported cases. As of writing, the World Health Organisation Africa regional office had reported 13,240 confirmed cases with 3,432 and 613 recoveries and deaths respectively. 

As the crisis unfolds elsewhere and in their own countries, African governments including Nigeria, South Africa and Ghana have taken a painful decision of locking down their countries. Ghana has extended its initial two-week lockdown by another week (Ghana has since lifted the lockdown). In Nigeria, President Muhammadu Buhari has announced a two-week extension of lockdown in Lagos, Abuja and Ogun states. Furthermore, South Africa is on lockdown until the end of April. In Malawi, however, a high court has blocked a lockdown. 

It could be argued that the lockdown measure has slowed the spread of COVID-19 in Africa. South Africa, for example, appears to have flatten the COVID-19 curve. Based on disease modelling trajectories of other countries, the country should have recorded 4000 confirmed cases by 2 April.   By 14th April, South Africa had 2415 confirmed cases. Now, there are calls for relaxing the lockdown. 

But there has been a downside to this seemingly successful feat. In South Africa, Nigeria, Ghana, and Zimbabwe, cases of state police and military brutalities have been on the surge. Globally, there has been an increase in intimate partner violence. As Olayinka Omigbodun & Jibril Abdulmalik have argued in African Arguments, everyone, people of all ages, is at risk of mental health illness during this time. 

The lockdowns present a unique environment. People are more likely to be less physically active, might tend to eat more energy dense foods and at higher frequency. When University of North Carolina’s W. R. Kenan, Jr. Distinguished Professor of nutrition Barry Popkin coined the term ‘nutrition transition’ in the early 1990s to describe the rising over-nutrition problem in the global south, he stated that the nutritional shift has interconnected relationships with demographic and epidemiological transitions.  Demographic shift has to do with the transition from high fertility and mortality to low fertility and mortality whereas epidemiological transitions refer to the shift from infectious diseases to non-communicable ones. 

 In the nutrition transition model, he described five stages; hunter-gatherer lifestyles, early labour-intensive agriculture with periods of famine, receding famine as agriculture becomes more industrialised and incomes rise, ‘Western’-style diets typified with high calories, sugar, animal fat and processed foods, and sedentary lifestyles and healthier diets and more active lifestyles. Many countries in the global south at the ‘’’Western’’-style diet’ stage.  

Using an ecological model, Lang and Rayner expanded on Popkin’s original dietary model to include physical environment and culture. Their original contribution was that dietary, physical environment and culture inter-depend on one another to produce a nutrition shift. 

If we are to take the models altogether, the lockdown occasioned by COVID-19 gives a similar picture of obesity drivers over these recent years; less physical activity, and excessive consumption of ‘western’ diet.  These lockdowns are mainly taking place in urban areas where the food environments have been found to be obesogenic. 

Over with the years as economic prosperity has come to Africa, obesity, the abnormal or excessive fat accumulation in the human body, has been on the rise. According to the World Health Organisation, the global obesity prevalence more than doubled between 1980 and 2014. Much of the obesity burden occurred in low- and middle-income countries, particularly in urban settings. 

In South Africa, it estimated that about  70%  and a third of all women and men respectively in the country are either overweight or obese. Furthermore, a fifth of girls under 9 years are overweight. From a metanalysis, 43% of Ghanaian adults were either overweight or obese.  According to the Ghana Demographic and Health Surveys (GDHS, 1993- 2014), prevalence of obesity among Ghanaian women (15–49 years) increased from 3.4% to 15.3%. In 2017, it was reported from the Ghana Maternal Micronutrient Survey that 39% of non-pregnant, non-lactating women were either overweight or obese. 

Obesity is an important public health issue because it shares intermediary mechanisms with diseases including diabetes, hypertension, generally, metabolic syndrome and even, infectious diseases. These intermediary mechanisms include pro-oxidative and inflammatory responses. For example, it has been suggested that obesity is linked to severe COVID-19, particularly among under 60s. While the exact mechanism of interaction has not been established, it is possible that chronic, low-grade inflammation and an increase in circulating, pro-inflammatory cytokines in obesity might exacerbate COVID-19. This might also explain why the African-American and whites of lower socioeconomic status have been hardly hit because of their high prevalence of obesity. In addition, obesity tends to be more prevalent in micronutrient-deficient individuals. 

Even if the lockdowns are not extended, there is a tendency that people might become comfortable with their present condition of staying indoors and being less active. Obesity predictors have been demonstrated among social, material and cultural factors. 

But obesity is a class problem. Unlike in the US, Africa’s obesity is pro-rich. While the rich might have easy access to food during the lockdown, the poor would have to contend with food insecurity and its consequent health outcomes including infectious diseases. Evidence from national surveys in Africa shows that under-nutrition has been reducing. That increased gap between obesity and underweight in Africa in a way is a problem of socioeconomic inequality. 

The next epidemic after COVID-19 will not be what the virus did. The virus is just excavating what has been buried in our social fabric. In the end, it will be an epidemic of socioeconomic inequalities.


Kwabena Agyare Yeboah

Kwabena A. Yeboah is a journalist who reports on the arts, culture, health and science and politics in Ghana.

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