rates of tuberculosis and high HIV prevalence rates. Dengue, filariasis, leishmaniasis and onchocerciasis (river blindness) are other diseases carried by insects that also occur in the region. Angola has one of the highest infant mortality rates in the world and one of the world's lowest life expectancies. A 2007 survey concluded that low and deficient niacin status was common in Angola. Demographic and Health Surveys is currently conducting several surveys in Angola on malaria, domestic violence and more. In September 2014, the Angolan Institute for Cancer Control (IACC) was created by presidential decree, and it will integrate the National Health Service in Angola. The purpose of this new centre is to ensure health and medical care in oncology, policy implementation, programmes and plans for prevention and specialised treatment. This cancer institute will be assumed as a reference institution in the central and southern regions of Africa. In 2014, Angola launched a national campaign of vaccination against measles, extended to every child under ten years old and aiming to go to all 18 provinces in the country. The measure is part of the Strategic Plan for the Elimination of Measles 2014–2020 created by the Angolan Ministry of Health which includes strengthening routine immunisation, a proper dealing with measles cases, national campaigns, introducing a second dose of vaccination in the national routine vaccination calendar and active epidemiological surveillance for measles. This campaign took place together with the vaccination against polio and vitamin A supplementation. A yellow fever outbreak, the worst in the country in three decades began in December 2015. By August 2016, when the outbreak began to subside, nearly 4,000 people were suspected of being infected. As many as 369 may have died. The outbreak began in the capital, Luanda, and spread to at least 16 of the 18 provinces. Education Although by law education in Angola is compulsory and free for eight years, the government reports that a percentage of pupils are not attending due to a lack of school buildings and teachers. Pupils are often responsible for paying additional school-related expenses, including fees for books and supplies. In 1999, the gross primary enrollment rate was 74 per cent and in 1998, the most recent year for which data are available, the net primary enrollment rate was 61 per cent. Gross and net enrollment ratios are based on the number of pupils formally registered in primary school and therefore do