Higher dose of Hydroxyurea benefits Sickle Cell Anemia more, says study

By Esther Nakkazi

A study in Uganda that could revolutionalize the treatment delivery of sickle cell anemia in sub-Saharan Africa has shown that a higher dose of hydroxyurea is more effective for children.

Hydroxyurea, approved for sickle cell treatment in 1998 by FDA and was originally and it still is a cancer drug is the standard treatment for sickle cell disease in the U.S. and Europe but in much of sub-Saharan Africa, which has a high disease burden, it is not standard treatment. Sickle cell disease has been declared a major public health problem for sub-Saharan Africa by the World Health Organization.

The study published in the New England Journal of Medicine on 25th June 2020 shows that among children with sickle cell anemia in sub-Saharan Africa, hydroxyurea with dose escalation had superior clinical efficacy to that of fixed-dose hydroxyurea, with equivalent safety.

Researchers believe the study findings in Uganda will have a worldwide impact since an escalated dose is not currently the standard in some European countries and other regions.

In the randomized, double-blind trial, seeking to uncover the best treatment for sickle cell disease in sub-Saharan Africa, 200 children were divided into two groups with one group given a fixed dose of hydroxyurea, (approximately 20 mg per kilogram of body weight per day) and the other arm an escalating dose of (approximately 30 mg per kilogram per day).

The arm with the higher dose showed more benefit for the patients prompting the data and safety monitoring board to halt the trial early.

It was done by Indiana University School of Medicine (IUSM) in partnership with Robert Opoka, MMed, at Makerere University and Mulago Hospital in Uganda and funded by the Doris Duke Charitable Foundation and the Cincinnati Children’s Research Foundation.

“We hope this will change practice for the overwhelming majority of kids with sickle cell,” says Dr. Chandy John, a physician-scientist at IUSM’s Ryan White Center for Pediatric Infectious Diseases and Global Health and the study’s lead co-investigator.

“You increase the dose and make sure it’s safe at the higher dose because hydroxyurea has some side effects. But people didn’t want to do that in Africa, because it’s more complicated to do.”

The researchers also found that the escalating dose showed similar side effects as the fixed-dose and the financial cost of making the escalated dose standard in sub-Saharan Africa is not significant.

“To see this so unequivocally—to the point that the study’s [monitoring] board stopped the study early because they said the difference was so huge, it was not ethical to continue having two groups. None of us, including our sickle cell experts, expected the differences would be so huge. We were really shocked,” says Dr. Chandy John.

Researchers observed that the higher dose isn’t much more expensive, drug companies are subsidizing the medication, and the Ministry of Health of Uganda could classify it as an essential drug, meaning it would be provided for free.

However, the logistics of moving children in sub-Saharan Africa to the higher dose present challenges as it requires specialized providers - or pediatric hematologists.

“In rural areas, you can’t have a bunch of pediatric hematologists all over the country—that’s not practical, so training is needed for frontline healthcare workers in the basics of what to do with sickle cell,” says Dr. Chandy John.

The researchers' next set of studies is looking at very practical things about implementation where most of the affected children live. The study in Uganda was conducted at Mulago, a national referral hospital in the capital city, Kampala, but most kids with sickle cell are in rural areas with fewer resources.

“One study we’re proposing is…how do we practically implement this in lower-resource settings?,” says Dr. Chandy John. Sickle cell is a genetic disease that is not curable but preventable. In most communities in sub-Saharan Africa, there is a lot of ignorance about sickle cell disease with lots of myths and misconceptions about the disease.

At least 15,000 to 20,000 babies are born with sickle cell disease every year in Uganda, and 80 percent of them die before their 5th birthday. As a single disease, it could be killing more under-fives than any other although the statistics are scanty.

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New technique revolutionizes eye imaging

By Esther Nakkazi

A new study shows it is possible to take magnetic resonance imaging (MRI) pictures of the eye as it moves across a scene, an artwork, or as we read.

Eye motion is a major confound for MRI in neuroscience or ophthalmology and the technique will open new possibilities in fields such as sleep and dream research and more generally for understanding brain activity in disorders of consciousness.

The new MRI technique published in the journal Progress in Neurobiology reveals for the first time simultaneous details about the eye, its musculature, and oculomotor properties and analysis of its anatomy and neurophysiology according to a press release from the centre Hospitalier universitaire Vaudois.

The study conducted by the Radiology Department of the University Hospital Center and University of Lausanne (CHUV-UNIL) as well as Fondation Asile des aveugles (FAA) is based on recent advances in MRI that allow for taking many snapshots of an object that repeatedly moves, such as the beating heart or moving eye.

Researchers can also study eye position even when the eyes are closed which would open new possibilities in fields such as sleep and dream research as well as more generally for understanding brain activity in disorders of consciousness.

“This is the first time scientists are able to image the eye while it moves, establishing a link between behavior and anatomy," says Dr. Benedetta Franceschielo, a post-doctoral fellow and lead author of the study, who works in the team of Professor Micah Murray, principal investigator of this project.

"This will open a new field of ophthalmic MRI, where we will be finally able to combine multiple assessments within a single, fast, session. The applications are infinite. They span from medical diagnosis to eye-brain mechanisms,” explains Dr. Franceschielo.

Eye movements are a major obstacle for imaging the eye, especially in the cases of children, the elderly, or patients with eye disease. The necessity to fixate ordinarily restricts the range of compliant participants; something often challenging for pediatric and aged populations alike.

“We have removed the onus of maintaining central fixation. Because we used standard MRI equipment and eye-tracking hardware, the approach we have developed and validated is readily deployed to the broad scientific community and impacts not only the breadth of participant inclusion but also the extent of naturalistic paradigms that can be investigated," said Professor Murray about the wider impact of this new technological advancement.

“Five years ago, this research would not have been feasible. Only at the confluence of staggering progress in hardware, software, and methodology development in a university setting did this become possible,” says Professor Stuber.

Supported by the Swiss National Science Foundation, the team of researchers is composed of neuroscientists, engineers, mathematicians, and optometrists from laboratories of Professors Micah Murray and Matthias Stuber at the Radiology Department of the CHUV- UNIL, the Center for Biomedical Imaging (CIBM), and FAA.

The team is now refining this technique to optimize it and make it versatile for clinical application in the field of ophthalmology. This invention not only represents a turning point in the way scientists study the eyes but also in cognitive neuroscience.

It has also recently demonstrated its value by allowing the creation of new protocols both in the field of diagnosis in ophthalmology as well as in visual rehabilitation.

Reference: Progress in Neurobiology.
Author: Benedetta Franceschiello, Lorenzo Di Sopra, Astrid Minier, Silvio Ionta, David Zeugin, Michael P.Notter, Jessica A.M.Bastianseen, Joao Jorge, Jérôme Yerly, Mat- thias Stuber, Micah M.Murray.

More agriculture funding in Africa should be devoted to Agroecology

By Esther Nakkazi

The bulk of Africa's agricultural funding should be devoted to agroecology - an agricultural practice that builds sustainable and resilient food systems and will transform food and farming systems, experts advise.

Only 3% of Gates Foundation projects the world’s biggest philanthropic investor in agricultural development in Africa support ‘agroecology’ and 85% of projects funded by the Foundation are limited to developing industrial agriculture. 30% of farms around the world are estimated to have redesigned their production systems around agroecological principles.

Agroecology works with nature combining different plants and animals and uses natural synergies rather than synthetic chemicals to regenerate soils, fertilize crops and fight pests. It also improves farmers’ livelihoods through diverse income streams, resilience to shocks, and short supply chains that retain value in the community meaning it has the potential to reconcile the economic, environmental, and social dimensions of sustainability.

However, despite its benefits most funding to Africa's agriculture goes to industrial agriculture - which has failed to assure food and nutritional security in a positive social and environmental context.

“With the compound challenges of climate change, pressure on land and water, food-induced health problems and pandemics such as COVID, we need change now. And this starts with money flowing into agroecology,” says Biovision president Hans Herren.

“We need to change funding flows and unequal power relations. It’s clear that in Africa as elsewhere, vested interests are propping up agricultural practices based on an obsession with technological fixes that are damaging soils and livelihoods and creating a dependency on the world’s biggest agribusinesses. Agroecology offers a way out of that vicious cycle,” says Olivia Yambi, co-chair of IPES-Food.

A new report finds that support for agroecology is now growing across the agri-development community particularly in light of climate change, but this hasn’t yet translated into a meaningful shift in funding flows.

A new report shows funding for Africa agriculture goes to industrial agriculture

The report by Biovision, IPES-Food, and the UK-based Institute of Development Studies reveals that money flows for agricultural development in Africa are to industrial agriculture which has failed to assure food and nutritional security in a positive social and environmental context.

Industrial agriculture is defined as the large-scale, intensive production of crops and livestock, often involving the use of synthetic chemical fertilizers on crops and pesticides.

“Most governments, both in developing and developed countries still favor ‘green revolution’ approaches, with the belief that industrial agriculture is the only way to produce sufficient food,” says  Herren.

“But these approaches have failed,” warns Herren, winner of the 1995 World Food Prize and 2013 Right Livelihood Award. “They have failed ecosystems, farming communities, and an entire continent,” he said.

 As many as 85% of projects funded by the Gates Foundation, the world’s biggest philanthropic investor in agricultural development, are limited to developing industrial agriculture.

The report says 13% of projects by Kenyan research institutes are agroecological. Another 13% focus on replacing synthetic inputs with organic alternatives. Some 51% of Swiss-funded projects have agroecological components, but only a handful are truly systemic.

The Money Flows report looks at investments in sub-Saharan Africa with a focus on Switzerland, a major bilateral donor, the Bill & Melinda Gates Foundation, the biggest philanthropic investor in agri-development and Kenya, one of Africa’s leading recipients and implementers of agricultural research for development or AgR4D.

More than 60 percent of the population of sub-Saharan Africa is smallholder farmers, and about 23 percent of sub-Saharan Africa’s GDP comes from agriculture, according to the McKinsey & Co. consulting firm.

“What needs to happen is for investments in AgR4D to target agroecology because the industrial agriculture and food model has shown its many weaknesses and failures to assure food and nutritional security in a positive social and environmental context,” says Hans Herren.

Kenya is one of Africa’s leading recipients and implementers of agricultural research for development (AgR4D). The country ranks third in sub-Saharan Africa in spending on agricultural research after Nigeria and South Africa. Around 13% of projects carried out by Kenyan research institutes are ‘agroecological’, with a further 13% of projects focussing on the substitution of synthetic inputs.

To accelerate this shift, the report calls on donors to a shift towards long-term, pooled funding models; require projects to be co-designed with farmers and communities; increase the share of funding going to African organizations; and increase transparency in how their projects are funded, monitored and measured for impact.

The study was carried out by Biovision Foundation for Ecological Development, a not-for-profit organisation involved in ecological and sustainable development projects in Africa, in collaboration with the International Panel of Experts on Sustainable Food Systems (IPES-Food), an independent, expert panel that works towards the transition to sustainable food systems, and the UK’s Institute for Development Studies.

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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