We all need more (GI) news and data from Africa
Review by Prof. Eamonn Quigley (USA)
Study Summary
It is estimated that by the year 2030 (only 4 years away) the population of Africa will have grown to approximately 1.7 billion—an increase of 400 million in just six years, with the most rapid population growth occurring in Sub-Saharan Africa. Furthermore, over 60% of the African population is under 30 years of age. Urbanization proceeds at a rapid pace with associated dramatic changes in diet, sanitation, and other socioeconomic conditions. These changes are reflected by sudden shifts in disease prevalence, most vividly exemplified by very noticeable upticks in obesity and related diseases, as well as breast and colon cancer. Yet for many common gastrointestinal (GI) disorders, there are simply little or no data. Two recent articles, one on inflammatory bowel disease and another on infectious complications of cirrhosis, highlight this knowledge vacuum. Given what we know of the role of dietary and environmental factors in the pathogenesis of IBD and the very rapid and dramatic changes (“Westernization”) in these factors, Africa should be the laboratory for the study of the cause(s) of IBD. The reality is very different. Omede and colleagues performed a systematic review of studies on the burden and epidemiology of IBD in Africa and found that “data were sparse,” with most studies emanating from North Africa and South Africa with very little in between (i.e., from Sub-Saharan Africa).1 Most disappointing was the lack of data on contributions of genetic and environmental factors from this region—the area witnessing the most dramatic changes in demographics and living conditions. The data that are available suggest that there is a true increase in incidence of IBD across Africa with varying reports on the relative prevalence of ulcerative colitis and Crohn’s disease. Access to modern therapies such as biologics is very limited. Paintsil and colleagues examined global trends in anti-microbial resistance among patients with cirrhosis who developed bacteremia. Around the world, the pooled rate of bacteremia was 20% with 31% being multi-drug resistant.2 This is clearly a problem, but their study also exposed an even greater dilemma: “no single study was conducted solely in an African country.” We know that Africa has a high burden of chronic liver disease, so where are the data?
Commentary
Taken together, these papers illustrate a problem that should concern us all—a glaring lack of medical research across much of Africa. How often do you see a color-coded map depicting the global incidence of a disease where increasing incidence is depicted by ever-deepening color, yet, where the rest of the world resembles a multi-colored patchwork, Africa looks almost blank. Even when it comes to the very rudiments of clinical research, defining disease prevalence and changes over time, the data are simply not available. This part of the world faces many challenges—rapid population growth, economic disruption, climate change, rapid urbanization, dietary shifts, internal strife and external wars with resultant population displacement, and health care systems of varying quality and efficacy. In this environment, medical research may seem a luxury, but progress in promoting the health of its residents will be impossible without a fundamental understanding of what is being faced and how it might be tackled. For us in the affluent “West,” we are missing a once in a millennium opportunity to study “our” disease as they appear and evolve rapidly in Africa. We can all benefit by promoting and supporting GI research in Africa.
Citation
Omede M, Itam-Eyo A, Park A, Ikobah J, Ibrahim MK, Chukwudike E, Ali-Ibrahim A, Lydston M, Asombang AW, Ananthakrishnan AN. Epidemiology, Natural History, and Treatment of Inflammatory Bowel Disease in Africa: A Scoping Review. Clin Gastroenterol Hepatol. 2026;24:41-56.
Paintsil EK, Adu-Asiamah CK, Kronsten VT, Ntuli Y, Shawcross DL. Global Trends in Antimicrobial Resistance Among Cirrhosis Patients With Bacteremia: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2026;24:69-80.
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