COVID-19 will widen digital divide in Africa - What are the solutions?

By Esther Nakkazi

There is no doubt that the COVID-19 pandemic will increase the digital divide in sub-Saharan Africa and the quality and inequality of education could widen further for learners at all levels.

The digital divide will be widened because not all the learners will have uniform access to gadgets like laptops or phones, the cost of data packages is a deterrent, with one gigabit (GB) of data, which is enough to stream a standard film for one hour costing nearly an average of a monthly wage for people living in sub-Sahara. The World Bank says 85% of Africans live on less than $5.50 a day.

Education experts discussing at an e-learning webinar organized by Axiom learning solutions held on 28th April agreed that the digital divide is further widened by inequality between the rich and poor, the rural and urban, women and men.

According to UNESCO, only 47% of households are connected to the internet in developed countries and 19% in the least developed countries. Globally, women are 23% less likely than men to use mobile internet. The gap is widest in South Asia, followed by sub-Saharan Africa.

Experts recommend that specifically after COVID-19 higher education has to be considered as a business to be effective and efficient. A case in point is the Botho University, which in 2008 implemented a policy to equip all its students with laptops with a purpose to integrate distance learning into the campus learning approach.

“Owning a laptop was not a luxury but a pre-requisite for learning. Giving them laptops as learning gadgets in 2008 is what has put us at an advantage today,” explained Aravinda Ram, the Deputy Pro-Vice-Chancellor for Employability and Technology, Botho University, the largest private tertiary education provider in Botswana.

“We bring the advantages of running a corporate into the education sector,” said Ram who said they are running the university as a business.

What are the solutions to addressing the digital divide?

"The future of education is different after COVID-19 and may require traditional in-person classroom learning to be complemented with virtual reality learning experiences," said Mansur Liman, the Director-General of Federal Corporation of Radio Nigeria (FCRN).

The solution to the digital divide is to deliver the lectures online or offline, broadcast through TV, and especially through radio, which is used by about 80-90 households in sub-Saharan Africa.

Professor Aziz EL Hajir the program specialist, ICT4E & ICT4D at the Islamic Educational, Scientific and Cultural Organization (ISESCO) said after COVID-19 education could permanently be shifted towards online and open education.

Liman who argued that the solution to the digital divide is radio, which is affordable since television sets could be pricey for poor families and electricity for access could be unavailable to rural residents also said production costs for instructors for TV programs could also be a problem further widening the digital divide.

Radio is a powerful mass media and has been used by traditional BBC for learning English since April 4, 1924, when the first national education program aired.

However, although radio could be a solution to create equity the issue of it being a ‘one-way’ with limited feedback from students and what would happen to subjects that require the students to do practicals.

“Radio is a virtual classroom but you have to combine it with another form of technology to make it a reality. The radio may solve the digital divide but it needs to have add-ons like texts, SMS,” said Liman. Lecturers have created WhatsApp groups where students can reach them.

“There will need to segment the markets because there is no size fits all,” advised Mr. Ade Adekola, an advisory board member at Axiom Learning Solutions. Adekola said the pandemic may divert scarce resources and will take a while before we get policy change but opportunities exist which shall require Africa to leapfrog and benefit from new technology.

Assessment:

Although education could be shifted online and complemented with classroom experience the issue of assessing students knowing that their parents and other relatives are supporting them remains a critical concern. If teaching is done online it will be difficult to know what marks to give the students.

Aravinda Ram cited using quizzes, online lessons for assessment, and plagiarism software. However, for students in rural areas, Africa could rely on postal services to deliver the paper-based assessments. She advised that a lot of consultation along the way needed to be done by the government, for the students, parents, and all stakeholders.

Professor Aziz said continuous assessment has to be done to maintain fairness and equity but the solution for the digital divide has to be driven from the grassroots.

“The digital divide will leave some students behind but those can be assessed on a case-by-case basis but we have to move on,” said Aravinda Ram.

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China approves herbal treatment for Coronavirus disease

By Esther Nakkazi

China has certified three patented traditional medicines for treatment of the novel coronavirus disease (COVID-19).

The three Chinese patented medicines -Jinhua Qinggan Granule, Lianhua Qingwen Capsule and Xuebijing Injection prescriptions were developed by the Traditional Chinese medicine (TCM) and have been clinically proven effective for COVID-19 treatment, China media reports.

Jinhua Qinggan Granule was developed during the 2009 H1N1 influenza pandemic and is effective in treating mild and moderate COVID-19 patients. Lianhua Qingwen capsule is also effective in treating mild and moderate patients, especially in improving symptoms like fever, cough and fatigue. Xuebijing Injection is used in treating severe and critically ill patients. It can increase the recovery rate and reduce the deterioration rate, the researchers said. 

Jinhua Qinggan and Lianhua Qingwen Capsules have their recommended use detailed in China’s Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia.

Li Yu, the director of the Department of Science and Technology at the National Administration of TCM said they have enacted a task force charged with advancing TCM research – this will target medium and long term mechanisms of integrating traditional Chinese Medicine and western medicine for the prevention and control of infectious diseases.

The task force has an expert group, which is composed of academicians, the Chinese Academy of Engineering and the Chinese Academy of Sciences, TCM masters and experts, and pharmaceutical experts, said Li Yu.

The task force will also look into research with traditional medicine to research on cases that have been cured by this treatment and the asymptomatic cases.

Zhang Boli, an academician of the Chinese Academy of Engineering and president of Tianjin University of TCM said one of the three medicines, Lianhua Qingwen capsule, has won approval to enter the Thai market, and French researchers plan to conduct clinical research into using it to treat patients.

“After more than two months of clinical research, we have chosen the three medicines out of hundreds of TCM medicines that are effective in treating cold and flu,” he said. “By introducing the medicines abroad, we hope that they can save more people as the pandemic continues to worsen globally.”

Wang Rongbing, director physician with Beijing Ditan Hospital, said the prescription has been used at 28 provincial regions in treating COVID-19 patients in all stages with various symptoms, yielding good outcomes.

Wang said of the 1,265 confirmed cases in 66 designated hospitals in 10 provincial regions that have used the Xuebijing Injection none has shown worsened symptoms with 99% of patients discharged by March 23, Wang said at a news conference.

The Chinese government has acknowledged the important role TCM has played in treating COVID-19 patients and has added treatment of the virus to the specifications of three traditional medicines.
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Who safeguards journalists against the coronavirus pandemic

By Esther Nakkazi

Zimbabwe's first death from Covid-19 is a journalist. A fine broadcaster Zororo Makamba, 30, was  Zimbabwe's second reported positive Covid-19 patient, health and child care minister Obadiah Moyo said on Saturday.

Makamba died three days after admission with 'severe respiratory distress' at the Wilkins Infectious Diseases hospital in Harare, the city’s only Covid-19 facility media reports say.

The journalist traveled to New York on February 29 returning on March 12th. The trip was either private or for work or for both we are not sure. Most likely Makamba contracted Covid-19 from the journey, it is unexplained. On his return to Harare, his movements were unrestricted. He met some bankers for 15 minutes, one bank revealed.

The current Coronavirus pandemic has journalists worldwide highly exposed to Covid-19 as any frontline workers in any public service delivery.

Unfortunately, in Africa, more-so in Uganda a few media houses have provided their staff with personal protective gear or equipment (PPE) as they gather Covid-19 updates. It is worse with freelance journalists. Without choice, they work unprotected. It is frustrating.

The Health Journalists Network in Uganda (HEJNU) founded in 2011, with about 80 members, who cover science and based at different media houses around the country has a WhatsApp group with about 70 health/science reporters.

The daily practice is that HEJNU members share information, contacts, and anything related to the media or health and science only. Since the coronavirus outbreak more members take time to share their stories, tips, and frustrations. Lack of personal protective equipment is a sore spot.

Today, one member shared a TV story he recorded working without wearing protective gear. The HEJNU member was covering a story about quarantined Chinese nationals who had refused to
undergo the 14 days mandatory self-isolation.

Besides admiring his fearlessness members rebuked him for not wearing protective gear and risking his health - all echoing  'no story worth your life'. Media houses have a duty to provide journalists with protective gear!

At HEJNU we all cautioned ourselves to work from home in the absence of protective gear and share information (which is hard, but times are tough).

Ida Jooste, an Internews media trainer and global health media adviser says now journalists need to rethink how they work; from home, asking trusted sources to send comments, doing interviews through calls among other tasks.

As journalists now more than ever, during the coronavirus pandemic we should consider sharing video footage, tips, contacts, audio recordings, few media houses will provide protective gear although they should put our safety ahead of stories and counting eyeballs.

We owe the public accurate and, timely updates about the pandemic. These can only be provided by healthy journalists.

RIP- Zororo Makamba

Observed reduced air pollution over China amidst COVID-19

By Esther Nakkazi

As a result of the reduction in daily traffic and industry activities in China since the COVID-19 outbreak, climate monitoring services have noticed a reduction in air pollution.

The Copernicus Atmosphere Monitoring Service (CAMS) reports that it observed a decrease of fine particulate matter (PM2.5) for the month of February relative to the previous three years. PM2.5 is one of the most important air pollutants regarding health impacts according to the World Health Organization (WHO).

PM2.5 is used to describe particles that are 2.5 micrometres and smaller in size. These particles, either solid, gas or liquid in composition, have potential to pose serious health problems when inhaled into the respiratory system and are known to trigger or worsen chronic diseases and other respiratory problems.

When comparing the difference between the monthly average for February 2020 and the mean of monthly averages for February 2017, 2018 and 2019, it clearly shows that these analyses indicate a reduction of about 20-30 % in surface PM2.5 over large parts of China in February 2020 based on information from the satellite observations, says the CAMS. 

The reduction in PM2.5 can likely be attributed in part to the slow-down in activity due to measures against the COVID-19 spread, the report says.

Vincent-Henri Peuch, Director of CAMS said they do not discount other variables next to the shutdown potentially playing a role in the decrease. For instance, China has actively been trying to reduce emissions, and meteorological variability between different years.

"To subtract these variables out of the equation, we set the duration of three years 2017-2019 to estimate the ‘business as usual’ conditions as a compromise to have a representative estimate of February’s monthly mean, while not considering too long of a period over which emissions vary substantially because of long-term trends,” said Peuch.

CAMS monitors PM2.5 over China by combining observations from satellites with detailed computer models of the atmosphere resulting in daily analyses.

To further substantiate this finding, CAMS also produced the same difference between February 2020 and the February mean for 2017-2019 without using the satellite observations. Because the PM2.5 values are in this case only dependent on the prescribed emissions and the meteorological conditions, it can provide a reference for the difference where satellite information was used as well. 

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Bending the Curve on Child Mortality

By Esther Nakkazi

More children in Uganda, Rwanda and Malawi are living to see their fifth birthdays and get a healthy start to life than ever before. These countries are bending the curve on child mortality leading the way with the fastest decreases in under-5 mortality since 2000.

In Uganda, under-5 mortality has reduced by 6.4% from 148 to 46 deaths per 1,000 live births from 2000 to 2018. On child mortality, Uganda has the 3rd fastest rate of reduction among 54 countries in Africa.

Rwanda has reduced under-5 mortality by 9.1% from 183 deaths per 1,000 live births to only 35 and Malawi by 6.9% from 173 deaths per 1,000 live births to only 50 from 2000 to 2018 according to the Africa regional child health Universal Health Coverage (UHC) new scorecard report by the Tunisian Center for Public Health.

Universal Health Coverage (UHC) Day happens every 12 December and brings attention to the global goal to ensure that all people, everywhere, can get the quality health services they need without facing financial hardship. It is a fundamentally political goal, rooted in the right to health. It is also one of the smartest investments any country can make.

The countries have been able to bend the curves through a combination of interventions including increased breastfeeding, a dramatic scale-up of lifesaving vaccines, sanitation, and hygiene measures, to oral rehydration therapy and zinc, as well as new innovations like kangaroo mother care.

As more countries in the region work toward or achieve universal health coverage, this progress in child health will continue, says the report.

However, more than a quarter-million children are still consistently being missed with lifesaving interventions and new challenges like obesity, combined with ongoing poor vaccination coverage, are threatening to overwhelm already fragile health systems. 

Immunization in Uganda: 

Immunization saves 2-3 million lives globally each year from completely preventable diseases, such as measles, tetanus, and polio. Vaccines are safe. Vaccines work. However, nearly one in five infants miss out on the basic vaccines they need to stay healthy and keep their communities safe and over 1.5 million children around the world die each year from vaccine-preventable diseases.

In Uganda, 253,633 children are still missing out on life-saving vaccines. To bridge the gap in vaccination, it is important to target the poorest and most marginalized communities, the report recommends.

Uganda has a multi-year plan for immunization and a standing technical advisory group on immunization as well as a national system to monitor adverse events following immunization.

In 2018, 84% of districts had 80% or more coverage for the DTP3 vaccine. 57% of districts had 80% or more coverage for the MCV1 vaccine.

Uganda has every vaccine recommended by the WHO in its national immunization program, besides the measles second dose vaccine. No case of wild poliovirus has been recorded since 2010 but difficulty reaching marginalized communities and increased vaccine hesitancy have contributed to multiple measles outbreaks in Uganda and make vaccination campaigns challenging.

In October 2019, Uganda launched the measles and rubella vaccination campaign with the goal of immunizing over 18 million children under 15 (approximately 43% of the population). This campaign was a launchpad for introducing the measles-rubella vaccine into the national immunization program.

Uganda has seen multiple measles outbreaks and has taken steps to respond including by organizing the measles and rubella vaccination campaign in 2019.

Uganda launched a nationwide HPV vaccine rollout in 2015 for girls age 10 protecting millions from cervical cancer and other diseases. At present 3.6% of women in Uganda have HPV type 16 or 18, which cause over 70% of cervical cancers and pre-cancerous cervical lesions.

Annually, 54.8 per 100,000 women get cervical cancer, the first leading cause of female cancer in Uganda.

Vaccines Funding: 

Gavi has invested over US$400 million into vaccination in Uganda ensuring funds remain in place to cover the cost of vaccines is key to maintain progress on child survival. 38% of funding for routine immunizations is provided by the government.

For every US$1 spent on immunization, US$21 are saved in healthcare costs, lost wages and lost productivity due to illness. If we take into account the broader benefits of people living longer, healthier lives, the return on investment rises to US$54 per US$1 spent.

However, there are increased vaccine hesitancy, misinformation, and mistrust although progress in how vaccines are stored has helped increase access in the hardest to reach communities.

But countries have a duty to keep vaccines cold and safe until they reach children, countries must invest in their health systems to maintain progress on vaccine coverage and make sure no children fall through the cracks.

Child Obesity in Uganda:

10 percent of school-aged children are overweight and obese, putting them at a lifelong risk of serious health complications. On child obesity, Uganda has the 3rd lowest rate among 54 countries in Africa.

Over 41 million infants and young children are overweight or obese around the world, and in the African region, the number of overweight or obese children has more than doubled since 1990. Childhood obesity is a global epidemic.

Obese children are more likely to continue to be obese through to adulthood, putting them at a lifelong risk of serious health complications and illnesses like diabetes and heart disease.

In addition to immunization, a child’s health and life prospects hinge on nutrition. While nearly half of deaths in children under five are due to poor nutrition, developing countries face a rapidly growing epidemic of childhood obesity. Undernutrition and overnutrition can exist at the same time in the same community.

Breastfeeding in Uganda:

Breastfeeding is crucial for child development and reduces child mortality by protecting against disease. It is the best source of nourishment for infants and young children and has health benefits that extend into adulthood.

In Uganda, 66 percent of infants receive breastmilk within 1 hour of birth, which is crucial to protect against disease. On early initiation of breastfeeding, Uganda has the 10th highest rate among 54 countries in Africa.

However, gobally only 40% of infants under six months of age are exclusively breastfed. Initiation of breastfeeding within the first hour of life, exclusive on-demand breastfeeding for the first six months and then breastfeeding alongside appropriate foods for two years are all crucial for child development.

Health Care professionals:

Uganda has 0.4 health professionals per 1,000 people, compared to WHO’s recommended minimum of 4.45 per 1,000 people to meet the SDGs by 2030. Uganda must fill this gap and invest in its health workforce.

By strengthening its health system and addressing vaccine-preventable diseases, child obesity, breastfeeding, health workforce shortages and more, Uganda can make great strides toward UHC.

Sources and additional data can be found here: http://bit.ly/2D0n0sw

Sources and additional data can be found here: http://bit.ly/34Cyxdz

PrEP Uganda App launched for HIV prevention and management

By Esther Nakkazi

A user-friendly app used to access information about HIV prevention and a daily pill that can prevent HIV has been developed. The Pre Exposure Prophylaxis (PrEP) app called 'PrEP Uganda' assessed on smartphones was initiated by Charles Brown the executive director Preventive Care International (PCI).

PrEP is a daily pill taken by someone who is HIV negative (Uninfected) before they are exposed to HIV. The PrEP Uganda app will be used for adherence and retention and it has a feature that allows the user to get all information about PrEP including - the nearest sites offering PrEP within that location.

It is also mainly targeted for people who are stigmatized, key populations and meant to empower young people to champion the end of new HIV infections through the PrEP Uganda mobile app.

"For any medication to be effective, the person taking it must adhere well. This mobile app enables a person taking PrEP to set reminders for daily swallowing of the pill. A person can also set a reminder to pick drug refills," Brown told journalists attending a media science cafe organized by the Health Journalists Network in Uganda (HEJNU) held on 26th November.

The mobile app that can be assessed for free through the google app store (play store) for all Android users has an interactive session that allows the user to ask questions about PrEP and HIV prevention and get answers from an expert. The version for IOS (iPhone) users is being developed.

Uganda has made great progress towards ending HIV and achieving the 95,95,95 targets but infections among key and priority populations are still high averaging 2 to 4 times the national prevalence.

As high as 570 new infections per week happen among adolescent girls and young women (AGYW) in Uganda. Prompted by the findings from the studies and WHO recommendations, Uganda
adopted PrEP as an additional strategy for HIV prevention.

Roll out of PrEP started in July 2017 and to date over ninety (90) facilities are implementing PrEP across the country. Over 16,000 individuals at substantial risk of acquiring HIV have been enrolled on PrEP including discordant couples, Sex workers, Men who have Sex with Men (MSM) and People who use drugs (PWUD), Transgender, Fisherfolks, adolescent girls and young women (AGYW) among others.

Despite reaching several clients with PrEP, the program has experienced a number of challenges including myths and misconceptions, the stigma associated with the use of ARVs among others. These can be addressed through user-friendly technologies like mobile Apps that someone can use to access information.

"As we celebrate World Aids day, we need to make all options for HIV prevention available to everyone to choose what is preferred. We need to create safe spaces for adolescent girls and young women to freely access HIV prevention and reproductive health services. We need to involve AGYW, Key and Priority populations in planning and delivery of services," said Brown.

"Together with duty bearers we need to focus on eliminating all forms of stigma towards people living with HIV and support them to adhere and achieve viral load suppression. Science has proven that when people living with HIV achieve viral load suppression to an undetectable level they can not pass on the virus to other people (Undetectable = Untransmittable). A combination of these interventions while not living anyone behind will enable us to achieve epidemic control," Brown told HEJNU journalists.

In Uganda, an estimated 1.3 million people are living with HIV and 52,000 people become newly infected with the virus annually. According to the National HIV and AIDS Strategic Plan (NSP), 2015/16 – 2019/20, the prevalence of HIV has a geographical heterogeneity with urban residents being more affected. The prevalence of HIV differs among the different subcategories with key and priority populations being affected more than the general population.

Invest in Vaccine Preventable Diseases Surveillance or endure $22.4 billion economic burden - WHO warns Africa

By Esther Nakkazi

The World Health Organisation (WHO) has launched an Investment Case for Vaccine-Preventable Diseases Surveillance in the African Region 2020-2030.

It encourages countries to invest in disease surveillance efforts – including a US$22.4 billion economic burden over the next decade and sets forth an ambitious vision for Vaccine-preventable disease (VPD) surveillance in the African region by 2030.

The announcement was made at the high-level “Reaching the Last Mile Forum” in Abu Dhabi on 19 November, by Dr. Matshidiso Moeti, WHO Regional Director for Africa. She called on governments to invest in strong disease surveillance systems that will ensure early detection and response to risks and outbreaks.

“Strong surveillance is the backbone of a functioning health information system, empowering health workers with timely, quality evidence to inform decision-making. To curb the spread of life-threatening diseases, governments must invest in strong and functioning surveillance systems,” said Dr. Moeti. 

With the African Region on the brink of polio eradication, VPD surveillance remains an issue yet to be prioritized by many health leaders. The burden of VPDs and associated outbreaks remain a major threat to people across Africa.

“Despite extraordinary progress boosting vaccine coverage around the world in the past two decades, one and a half million people are still dying from vaccine-preventable diseases every year,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.

The Investment Case further indicates that if current disease surveillance efforts are not maintained, there is a risk to reverse progress made, leading to more than 900,000 deaths. 

 More investment in surveillance: 

The WHO Investment Case outlines the need for increased domestic investment for surveillance activities under the overall umbrella of integrated disease surveillance and response, from countries in the African Region as well as mobilization of international resources, in order to ensure strong disease surveillance. 

At least $470 million in operating costs will be needed over the next decade to reach this ambition. WHO predicts that the investment would save over 700,000 lives, prevent 20 million people from falling ill due to vaccine-preventable diseases, and save US$21 billion over 10 years – estimated to be a 44.6-fold return on investment.

It is notable that resources for VPD surveillance have declined markedly over the past two years – and domestic surveillance expenditure in the African Region remains low. 

“The fact that most countries in the African Region continue to rely on external funding for VPD surveillance is a strong indicator of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Immunization and Vaccine Development at the WHO Regional Office for Africa. “Governments have a central role to play to fill upcoming funding gaps and ensure immunization programs and surveillance remain strong and vigilant.”

A private sector firm has already pledged $5 million over the next five years, beginning in 2020, to support and strengthen VPD surveillance efforts in the African Region. 

“We hope that this first pledge in support of the VPD surveillance investment case will be catalytic, and will encourage other traditional and non-traditional donors to consider this critical area of work, including how the private sector and governments can work closely together to ensure we successfully bridge funding gaps,” said Elizabeth Ivanovich, Director of Global Health at the UN Foundation.

Dr. Rebecca Martin, Director of the Center for Global Health, CDC, issued a statement of support, adding: "CDC is strongly committed to global health security, helping to strengthen health systems that can prevent avoidable epidemics, detect threats early, and respond rapidly to outbreaks."

At the African Union Summit held in Addis Ababa in January 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledged increased political and financial investments in their immunization programs. 

Commitment 5 of the ADI outlines the need for “attaining and maintaining high-quality surveillance for targeted vaccine-preventable diseases.” Although the Member States have endorsed these commitments and pledged to deliver on universal immunization coverage and high-quality surveillance, challenges remain in achieving immunization and surveillance targets.

Still at the African Union Summit held in Addis Ababa, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledging to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization.

“Our biggest challenge in reducing the horrific toll these diseases still cause is finding the children who are still missing out on vaccines. That’s why improved vaccine-preventable disease surveillance systems are so important, helping health authorities to identify the areas where immunization coverage is weakest and protect those children who are currently being left behind,” said Dr. Berkley.

Vaccine-preventable disease surveillance is a critical component of the integrated disease control strategies and an effective way to detect and respond early to outbreaks – mitigating their impact on national security, the local economy and public health systems. Yet countries in the African Region still face major challenges in both the strategic planning and operation of their surveillance systems.

  

“VPD surveillance is not only a valuable investment that will help countries reach immunization targets,” said Dr. Moeti, “it is a critical component of broader goals such as Universal Health Coverage and the Sustainable Development Goals, and is absolutely essential to protecting all of our health security.”