The burden of HIV Tuberculosis Malaria Hypertension Obesity Hepatitis C (HVC) Diabetes

According to the United Nations report, "More than half of global population growth between now and 2050 is expected to occur in Africa. Of the additional 2.4 billion people projected to be added to the global population between 2015 and 2050, 1.3 billion will be added in Africa." Africa has a young population in an ageing world.

There is a high disease burden in Africa, however there is low volume of clinical trials conducted in the continent. Communicable diseases such as Malaria, HIV/AIDS, Tuberculosis account for almost two-third of the disease burden in Sub-Sahara Africa.

Neglected Tropical Diseases (NTDs) such as Guinea worm, Buruli ulcer, Human African trypanosomiasis are endemic to Africa with hundreds of millions at risk.

In South Africa the three leading causes of natural deaths in 2014 were tuberculosis, diabetes mellitus and cerebrovascular diseases.

HIV - Globally, 36.7 million people were living with HIV at the end of 2015. East and Southern Africa is the region that is hardest hit by HIV. It is home to 6.2% of the world's population but has 19 million people living with HIV, over 50% of the total number of people living with HIV in the world. In 2015, there were 960,000 new HIV infections, 46% of the global total.

South Africa accounted for 40% of the region's new infections in 2015, with another 50% occurring in eight countries: Ethiopia, Kenya, Malawi, Mozambique, Uganda, the United Republic of Tanzania (Tanzania), Zambia and Zimbabwe.

Tuberculosis (TB) - The WHO reports that Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2015, 87% of new TB cases occurred in the 30 high TB burden countries. Six countries accounted for 60% of the new TB cases: India, Indonesia, China, Nigeria, Pakistan, and South Africa. In a February 2017 report, Statistics South Africa reported that tuberculosis maintained its rank as the number one leading cause of death in South Africa.

TB-HIV Co-infection - The WHO reports that at least one-third of people living with HIV worldwide in 2015 were infected with TB bacteria. People living with HIV are 20 to 30 times more likely to develop active TB disease than people without HIV. In 2015 about 0.4 million people died of HIV-associated TB. About 35% of deaths among HIV-positive people were due to TB in 2015. In 2015 there were an estimated 1.2 million new cases of TB amongst people who were HIV-positive, 71% of whom were living in Africa.

Hepatitis C (HVC) - The WHO reports that globally, an estimated 71 million people have chronic hepatitis C infection. Approximately 399 000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma.

According to a Lancet study, East Africa has one of the highest levels of hepatitis C virus (HCV) infections among HIV-positive people in sub-Saharan Africa. Kenya and Tanzania are among countries with the highest HCV-HIV co-infections in sub-Saharan Africa.

Non-communicable diseases - The Lancet report estimates that the number of annual deaths has increased from roughly 48 million in 1990 to almost 56 million in 2015. 70% (40 million) of global deaths in 2015 were due to non-communicable diseases (NCDs including ischaemic heart disease, stroke, diabetes, chronic kidney disease, Alzheimer's disease and other dementias, and drug use disorders). In 2017, Statistics South Africa reported: "the three leading causes of natural deaths in 2014 were tuberculosis, diabetes mellitus and cerebrovascular diseases. Non-communicable diseases continue their rise in the rankings of top 10 leading causes with diabetes mellitus moving from third position in 2014 to second position in 2015. Non-communicable diseases formed 60% of the ten leading underlying natural causes of death. In addition to diabetes mellitus; cerebrovascular diseases, other forms of heart disease, hypertensive diseases, chronic lower respiratory diseases and ischaemic heart diseases contributed to the rise in non-communicable diseases."

Malaria - According to the 2016 WHO estimates, there were 212 million cases of malaria in 2015 and 429 000 deaths. The report states that the African Region continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Some 13 countries - mainly in sub-Saharan Africa - account for 76% of malaria cases and 75% deaths globally.

Hypertension - In Africa, however, more than 40% (and up to 50%) of adults in many countries are estimated to have high blood pressure, according to The World Health Statistics 2012 report.

Obesity - WHO estimated 2% of the world's population, is considered obese. South Africa has the highest overweight and obesity rate in sub-Saharan Africa: seven out of 10 women and four out of 10 men have significantly more body fat than what is deemed healthy, according to the Lancet in 2014. Sub-Saharan African countries such as Namibia (19.8%), Lesotho (24.1%) and Zimbabwe (33.5%) have significantly smaller proportions of obese women than South Africa. The WHO predicts that in the next 20 years, obesity-driven diabetes across sub-Saharan Africa will double.

Diabetes - In 2014 387 million people worldwide live with diabetes. By 2013 at least 592 million people worldwide will be living with diabetes. Africa accounts for 0.3% of diabetes. Prevalence of Diabetes in sub-Saharan Africa in 2013 - Nigeria (3.9%) , Ghana (3.6), Kenya (4.2%), Tanzania (2.6%), Cameroon (4.4%), South Africa in 2012 (13%), and Malawi (5.6%).

It is common knowledge that South Africa has for long been regarded as the gateway to Africa. Evidence shows that all top global CRO have set up fully-fledged operation in South Africa to serve the continent. The donor communities that fund clinical research have strong representation in South Africa. The number of new clinical trials is increasing and bolstered by the promise of an improved regulatory environment and value for money. CROs and investigator sites involved in clinical research subscribe to international standards and norms of Good Clinical Practice (GCP)

LT Clinical Research is the right CRO poised to assist sponsor companies and other channel partners to conduct clinical studies across Africa.

LT Clinical Research management and staff subscribe to total ethical conduct of clinical trials across Africa. We will always strive to ensure patient safety and uphold patient rights.

• Africa's population of 1.1 billion is roughly 15 percent of the world's population, and is projected to rise to 2.4 billion by 2050.
• Africa is often referred to as the world's second-largest continent and has the youngest population - almost 200 million people aged between 15 and 24 - according to the World Bank.
• The UN says that by the end of this century half of all children, and 40% of humanity, will be African.
• HIV, tuberculosis and malaria research studies continue to dominate the research landscape in sub-Saharan Africa.
• Non-communicable diseases including cancer, diabetes, hypertension and cardiovascular diseases are projected to account for 65 percent of mortality in Africa by 2020.
• According to a 2015 McKinsey report, Africa's pharmaceutical market, valued at $20.8 billion in 2013, will be worth as much as $60 billion by 2020.
• LT Clinical Research management and staff subscribe to total ethical conduct of clinical trials across Africa.
• LT Clinical Research management and staff will always strive to ensure patient safety and uphold patient rights.