Where health care has no access: the nomadic populations of sub-Saharan Africa.

This paper reviews the literature describing the relationships between mobility and health among nomadic people in sub-Saharan Africa and considers ways of providing them with appropriate health care. Although nomadic and settled populations in rural Africa are exposed to the same kind of health problems the frequency of occurrence of specific diseases significantly differs between nomads and settlers. Nomads appear to be generally healthier than their settled neighbors but have much less access to health care safe drinking water and formal education. Infant mortality is higher among nomadic than among the settled populations which is usually caused by diarrhea respiratory infections malaria and measles. However childhood malnutrition is less frequent. Most of the diseases suffered by nomads such as tuberculosis trachoma and guinea worm disease are due to the particular environment in which they live. In order to avoid diseases they have developed the traditional coping mechanism of moving away and avoiding exposure. The existing health care systems seldom have access to the nomads due to cultural political and economic obstacles. This paper further describes a primary health care system based on nomadic community health workers and presents an example of a successful tuberculosis control project.