Wednesday, July 11, 2018

Listening into a Healthy Life

By Esther Nakkazi 
How radio links up with village health clubs to educate communicates on healthy living.

Haruna Amooti is a radio presenter at Life FM, a community radio station that broadcasts mainly in the local languages of Runyoro and Rutooro. 

Once every week, for an hour, from 7.15 to 8.15 pm, Amooti at the Life FM studios in Fort Portal, presents a programme to listeners in seven districts of Kyegegwa, Kyenjojo, Kasese, Ntoroko, Kamwenge, and Kabarole, the estimated reach of the radio.

The young man speaks fluent Rutooro and Lunyoro although his programme is broadcast in Rutooro.
For the content that is broadcast on his programme, Amooti attends a village health club meeting every month. In there, he records live voices of the proceedings of the meeting. Sometimes, Amooti visits the various projects that the clubs have put up.

Some clubs have formed circles where each member makes a monthly contribution and on a rotational basis one member borrows the money. Others have established development projects like piggery and poultry or started drama groups that perform songs and skits with health promotional messages.

“I listen to Amooti’s programme every Wednesday. I never miss it. It teaches us about diseases and how to improve our incomes,” said Teopista Namalembeko, a member of the Kitalesa health club that has a piggery project with twelve pigs. It was after hearing Amooti’s programme that she joined her village health club. 

Amooti’s most memorable meetings wherein clubs in which members have united to form a circle and had financial independence or projects like Teopista’s Kitalesa Club.

“Some members have been able to construct permanent houses and move out of grass thatched ones. While others have used this money from circles to buy land or add to their businesses, which has improved their families’ finances and health,” said Amooti.

He said he was also impressed with the way some clubs use enforcement techniques to improve health. For instance, a village club head and the local community leaders after a meeting, chased away the tenants from rental houses until the landlord constructed a befitting toilet. !

In some instances, Amooti has hosted some of the village health club facilitators to his programme. He asks them what they have done as individuals, or collectively as a club, how effective they have been, what more health interventions they need from government, Malaria Consortium Uganda, the implementing agent and from the community.

“When the community leaders and members hear their own speaking on the radio they get very excited. I think with good mobilization and partnership with district leaders this village health club concept can be very successful and be well replicated,” said Dr. Julius Bahinda, the Kyegegwa District Health Officer.

Lawrence Businge, the Kyegegwa District health educator has been hosted on the show a dozen times. He as well thinks this concept can be rolled out in every district in Uganda because it is ‘workable’.

In his appearances, he has come with designed health messages, which highlight the achievements of some of the clubs and further educates the communities about the three target diseases; malaria, diarrhea, and pneumonia. Sometimes they also discuss and promote government health programmes.

“The radio talk shows amplify our messages because not all members can attend the club meetings,” said Businge. He says the clubs have created a positive impact, mostly they have united communities which can now work togather to take care and control communicable diseases.

Sometimes, during the radio programme, they select a certain disease like malaria and discuss it, how to control it, what are the danger signs that come with it and at the end of every programme, 15 minutes are reserved for in-callers.

“For the fifteen minutes, callers from the districts that do not have village health clubs always request that they want to start them too,” said Amooti. Directly they call and ask him ‘Can you ask that Malaria Consortium group start village health clubs here because we also face the same health problems?’

Other callers request that Amooti alerts Malaria Consortium to include more than the three diseases of malaria, pneumonia, and diarrhea that are currently being handled by the village health clubs. The matter may be considered. 

But for now, to further motivate the village health club members, Life FM in partnership with Malaria Consortium Uganda is going to hold competitions later this month to get the club that has practiced the village health clubs concept best and the best performing village health facilitator.

“That will be the model that we hope shall be replicated all over the country,” said Amooti thoughtfully. But for all he knows now, his radio programme has improved listenership and people are always eager to stay tuned because the information broadcast touches their everyday health issues and economic life.

This article was done for Malaria Consortium Uganda in 2015

Friday, July 6, 2018

A fifth of adolescents are overweight or obese due to the double burden of malnutrition in Africa

A new study from the University of Warwick blames macro-level factors for the double burden of malnutrition among adolescents in developing countries. The study lists war, lack of democracy and urbanization among factors to blame.

The double burden of malnutrition refers to the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases such as type 2 diabetes.
The authors have examined studies of almost 130,000 adolescents and also found that a fifth are overweight or obese and more than 10 percent had stunted growth due to double malnutrition and two percent were classed as both stunted and overweight.

A total of 57 counties were examined including Algeria, Benin, Ghana, Mauritania, Republic of Mauritius, Sudan, Swaziland, and Uganda.

The study entitled The double burden of malnutrition among adolescents: analysis of data from the Global SchoolBased Student Health and Health Behaviour in SchoolAged Children Surveys in 57 lowincome and middleincome countries suggests that factors including war, lack of democracy, food insecurity, urbanisation and economic growth are to blame.

The study was published in the American Journal of Clinical Nutrition (AJCN) and was led by Dr. Rishi Caleyachetty, Assistant Professor, Warwick Medical School.

His team found that the burden of double malnutrition is shockingly common and the researchers are now calling on governments and NGOs to identify context-specific issues and design and implement policies and interventions to reduce adolescent malnutrition accordingly.

The study set out to quantify the magnitude of the double burden of malnutrition among adolescents and explain the varying burden of adolescent malnutrition across low- and middle-income countries (LMICs).

Adolescence is a period for growth and development, with higher nutritional demands placing adolescents at greater risk of malnutrition.

They used data from the Centers for Disease Control and Prevention/World Health Organisation (WHO) Global School-Based Student Health Survey and WHO Health Behaviour in School-Aged Children surveys done in 57 LMICs between 2003-2013, comprising 129,276 adolescents aged 12-15 years.

They examined the burden of stunting, thinness, overweight or obesity, and concurrent stunting and overweight or obesity. They then linked nutritional data to international databases including the World Bank, the Center for Systemic Peace, Uppsala Conflict Data Program, and the Food and Agriculture Organization (FAO).

They found that across the 57 LMICs, 10.2% of the adolescents were stunted and 5.5% were thin. The prevalence of overweight or obesity was much higher at more than a fifth of the adolescents (21.4%). The prevalence of concurrent stunting and overweight or obesity was 2.0%. Between 38.4%-58.7% of the variance in adolescent malnutrition was explained by macro-level contextual factors.

Dr Caleyachetty said: “The majority of adolescents live in LMICs but the global health community has largely neglected the health needs of this population. At the population level, macro-level contextual factors such as war, lack of democracy, food insecurity, urbanisation and economic growth partly explain the variation in the double burden of malnutrition among adolescents across LMICs.

“The global health community will have to adapt their traditional response to the double burden of malnutrition in order to provide optimal interventions for adolescents.”

Thursday, June 28, 2018

Funding for new drugs endemic to Africa available

New funding that will be given through a call for proposals for the discovery of new drugs for diseases endemic to Africa over the next two years is now available.

The Drug Discovery funds is up to $100,000 per project to researchers in Africa to identify new drug candidates, particularly for malaria, tuberculosis and neglected tropical diseases.

The funding will also be used to create a network of drug discovery as well for development scientists that will initiate, develop, share, evaluate and disseminate best approaches and practices within the research community in Africa.

The African Academy of Sciences (AAS), University of Cape Town (UCT) Drug Discovery and Development Centre (H3D), Medicines for Malaria Venture (MMV) and the Bill & Melinda Gates Foundation have committed funding for the discovery of new drugs for diseases endemic to Africa over the next two years.

This is the third call for proposals administered by the AAS’ Grand Challenges Africa (GC Africa), a scheme implemented through the AAS and the NEPAD Agency’s Alliance for Accelerating Excellence in Science in Africa (AESA).

"This partnership will benefit Africa by developing the capacity and augmenting efforts to discover and develop drugs for diseases that are prevalent on the continent and are otherwise being affected by a market bias that has seen drug discovery efforts on the continent hampered," said the AESA / Director of Programmes Prof Tom Kariuki.

Africa represents 17% of the world’s population but bears a disproportionate 25% of the global disease burden with sub-Saharan Africa carrying 90% of the global cases of malaria while 2.5 million who fell ill with TB in Africa in 2016 represented a quarter of new TB cases in the world.
Drug resistance is also compounding the disease burden requiring for Africa to build capacity and step up drug discovery activities.

The new funding will be given to projects that identify new chemical entities with potential for drug development in diseases of local relevance for Africa and to expand institutions' drug discovery research capacity. 

Selected applicants will also benefit from a network of drug discovery scientists in Africa and across the globe, linking them to peers, mentors and providing them with access to resources and technologies

Prof Kelly Chibale - Founder and Director of Drug Discovery and Development Centre, H3D at the University of Cape Town, said: “The attractive aspect of this programme is that it focusses on highlighting and investing in those who are present on the continent. The partners involved are proactively seeking to identify and fund talented African-based scientists to succeed and not to merely survive.

This will result in an effective increase in the numbers of productive and contributing African drug discovery scientists as well as an increase in the quality and impact of drug discovery science generated in Africa by Africans.”

“Medicines for Malaria Venture (MMV) is proud to support the effort to identify new drug candidates for the big three diseases of malaria, tuberculosis and Neglected Tropical Diseases via this call for proposals,” said Dr. Timothy Wells, MMV’s Chief Scientific Officer.

“At MMV, our focus is on bringing forward the next-generation of medicines to help defeat malaria. Through these grants, together with our partners, we aim to support the next-generation of African scientists to get involved in this endeavor for malaria as well as other diseases.”

Tuesday, June 26, 2018

Uganda introduces rotavirus into routine vaccination

Uganda has today launched a new rotavirus vaccine to protect under five-year-old children from diarrhea.

An estimated 10,637 children under five years of age die in Uganda each year due to rotavirus diarrhea. Diarrhea is among the top ten causes of morbidity in Uganda, with rotavirus being responsible for about 40% of all diarrheal cases.

The vaccine, which will be available for free in health facilities throughout the country, is the 11th vaccine to be added into the national schedule of the expanded programme on immunization in Uganda.

Rotavirus vaccine is safe and can be administered simultaneously with other routine infant vaccines. It is given orally and requires two doses at 6 and 10 weeks of age, with an interval of at least 4 weeks between doses.

“This vaccine will help save the lives of thousands of children in Uganda by combating severe diarrhea,” said Gavi Deputy CEO Anuradha Gupta.

“The introduction of rotavirus vaccine marks a key milestone in the country’s commitment to improving the health of all children and I’d like to commend the Government for its efforts to provide a bright future for Uganda’s next generation.”

Speaking at the launch of the vaccine in Buikwe, the Minister of Health, Honorable Dr. Jane Ruth Aceng, announced that Rotavirus vaccine is now available in Uganda. She appealed to Ugandans to take their children at 6 weeks and 10 weeks of age for rotavirus immunization to the nearest health facility.

“WHO emphasizes the use of Rotavirus vaccines to be part of a comprehensive strategy to control diarrhea diseases with the scaling up of both prevention and treatment packages,” said WHO Representative Dr. Yonas Tegegn Woldermariam.

The UNICEF Representative in Uganda, Dr. Doreen Mulenga, congratulated the Ministry of Health for making further progress in securing children’s health by introducing a rotavirus vaccine into its national immunization programme and said that vaccination is one of the best ways to protect children from serious childhood diseases.

The introduction of the rotavirus vaccine into the routine immunization schedule has been financed by Gavi, the Vaccine Alliance, with technical support from WHO and UNICEF.

Rotavirus infection is the leading cause of diarrhea in children under five and it is highly contagious. It poses an exception to typical diarrheal disease management rules.

While improved access to clean water and better sanitation and hygiene practices are vital to preventing most diarrheal diseases, they have done little to disrupt rotavirus infection. The virus may cause severe, dehydrating diarrhea in young children and, in untreated cases, lead to death.

Globally, according to the World Health Organization, an estimated 450,000 children under five years of age die each year from vaccine-preventable rotavirus infections.

Tuesday, June 19, 2018

Another sickle cell treatment option now available to Ugandans

By Esther Nakkazi

Today, 19th June is world sickle cell day and from this year hydroxyurea, arguably the most significant breakthrough in sickle cell treatment ever is now on the list of essential drugs in Uganda.

That means it is now more available in drug shops and that brings the price down to a third of the original price, to Ushs 3,000 per tablet from Ushs 10,000 although this does not necessarily mean its affordable and it is not yet available in public health facilities.

As well it does not mean that it will be prescribed to everybody who’s eligible as Ugandan doctors like elsewhere in the world may not necessarily want to prescribe hydroxyurea because it is given in the most maximum tolerated doses and requires continuous blood tests.

Hydroxyurea was approved for sickle cell treatment in 1998 by the FDA and was originally and it still is a cancer drug which increases healthy forms of oxygen-carrying hemoglobin, resulting in less organ damage and fewer pain crises, transfusions, and emergencies for sickle cell patients.

Specialists doctors who are supposed to treat sickle cell disease, hematologists, are hard to come by so most patients are seen by clinicians except for a few dedicated doctors like Prof. Christopher Ndugwa, a paediatrician now known to many as the ‘Uganda grandfather of sickle cell disease’. He has trained about 80 percent of the doctors who treat sickle cell disease in Uganda.

Sickle cell is a multi-organ disease. When patients get an attack they go through a vaso-occlusive crisis in which sickle-shaped red blood cells clog the vessels and cut off oxygen to joints and organs. The inadequate blood supply triggers excruciating pain, damages vital organs and causes a stroke.

Sickle cell disease has been declared a major public health problem for sub-Saharan Africa by the World Health Organization.

The intensity of the disease was unknown until a study was done which prompted action and institution of policy. Now after 20 years since its approval, the now called wonder drug to Ugandans is no longer scarce and here are some efforts that led to policy, treatment changes and action.

In 2014, the Ministry of Health carried out a survey to profile the sickle cell trait and sickle cell disease across Uganda. To date, Uganda is the only African country with current national prevalence data, which was also been published in a leading medical journal, the Lancet.

The survey found scary statistics; at 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. It further documented a high sickle cell burden with a national trait average of 13.3 percent and a disease burden of 0.73 percent.

The research earned Uganda a reward. It was nominated to host the 6th International Symposium on Sickle Cell Disease (REDAC 2016). Mass screening, patient management, early testing, pre-marital counseling and sensitization campaigns were created.

On 16th March 2017, the Minister of Health, Dr. Jane Aceng presented a Ministerial Statement to parliament about the situation of sickle cell in Uganda. The shocked parliamentarians pledged to support it in terms of allocations of funds to the budget, creating awareness and policy.

They requested that equipment be available to screen at birth for sickle cells in all regional hospitals and a budget be allocated so that funding for sickle cell treatment is not left to donors as was the practice.

Aceng informed them that the Ministry of Health had in fact already set up a national programme to screen newborn babies and children below two years in high prevalence districts and a National Sickle Cell reference laboratory with the capacity to run 8,000 samples at ago was operational.

Aceng also appealed to the Buganda kingdom to collaborate with the Ministry and create awareness. The study showed that Buganda was one of the high burden regions with a prevalence of 20 percent and disease burden above 1.5 percent.

The Kingdom of Buganda agreed to provide support to which they accepted to use Sickle Cell Anaemia treatment drives as a theme in the Kabaka Birthday Run for the next three years.

As such the 2017 edition of the Kabaka’s birthday run launched by the Katikkiro of Buganda Charles Peter Mayiga, he equated the lack of awareness to the early HIV days. He said people referred to sicklers as 'offsprings of parents with bad blood or those that are cursed'. That year the funds from the birthday run went to support sickle cell.

More efforts continued like lobbying from civil society organizations like HEPS Uganda and now finally hydroxyurea is on the table in Uganda. However, elsewhere more treatment options are becoming available.

Endari, a nutritional supplement which has been shown to relax the stiff, sickle-shaped red blood cells of people with the disease is now the newest drug on the market. Another treatment option that still needs to go through clinical trials is CRISPR or gene editing therapy. This can be used to edit the sickle mutation in blood stem cells so they produce more fetal hemoglobin, which can reduce the severity of the disease.

It would be interesting to know if Ugandans would participate in the CRISPR sickle cell clinical trials if they got here. But all we know there is hope after all more treatment options are on the way.

Friday, May 18, 2018

Recombinants harsh to HIV vaccine development

By Esther Nakkazi

Today is World HIV vaccine day. As we celebrate the day, we have a lot of hope this time around more than ever.

For the first time in many years, four efficacy vaccine concepts are in phase III and could give us an HIV vaccine. But even if they do not it is a still a great leap forward.

“If they do not give us a vaccine they will at least give us information about how it works,” said Dr. Francis Kiweewa, the head of research and scientific affairs at Makerere University Walter Reeds Project (MUWRP).

Kiweewa said we shall get to know this important information just two to three years from today in either 2020 and 2021 and that is not far off. He was speaking to journalists at their monthly science cafe organized by Health Journalists Network in Uganda, HEJNU.

But that withstanding you could ask do we still need an HIV vaccine anyway? In some circles, the debate is could HIV be the first epidemic to be eliminated without a vaccine.

I guess you have heard of all the interventions these days, the condom, the antiretroviral therapy for both treatment and prevention, the vaginal ring that showed promising results and more to it scientists are busy in their laboratories cooking up new HIV prevention and therapeutic tools every day.

Dr. Kiweewa says despite these efforts we still need an HIV vaccine. "The numbers of new infections remain incredibly high," he says. For instance in Uganda 500 youth get infected with HIV every week. In South Africa, 5000 young women are infected with HIV every week.

Also, the high cost of treatment is unsustainable and ultimately a vaccine would be cheaper, reach many more people and let us not forget that ‘prevention is better than cure’.

Even if we get the HIV vaccine in the next two to three years, there is a possibility that it might not be suitable for us. And here is why an HIV vaccine might work elsewhere and not for Uganda or East Africans.

HIV has many sub-types, the East African region has two predominant subtypes A and D while southern Africa mostly has subtype C. The Uganda Virus Research Institute (UVRI) scientists did a research, sequencing the virus and found that 50% of the HIV virus in Uganda are recombinants of subtype A and D.

This means 50% of the estimated 1.3 million people who are infected with HIV in Uganda have a combination of subtype A and D or AD/DA. While it may not necessarily be more virulent scientists say it progresses faster.

“A vaccine has that challenge,” says Prof Pontiano Kaleebu, the director of MRC/UVRI and the London School of Tropical Medicine (LSHTM). It is for that reason and many others that the renowned professor thinks we are a forgotten lot. 

“They are forgetting us here where we have recombinants in east Africa,” said Kaleebu. In other words, the spread of recombinant forms of HIV could have implications for vaccines developed to guard against only certain sub-types and not others.

Not enough research is being done in the region, your governments are not investing enough money so that the scientists develop that vaccine that is suitable for you.  So keep the optimism but also be mindful of the future that we could walk away empty handed here where the HIV burden is highest.

Thursday, May 3, 2018

WhatsApp groups with journalists and their sources should stop

By Esther Nakkazi

As we celebrate this years' World Press Freedom day, I say WhatsApp groups with journalists and their sources should stop.

In the current era, WhatsApp groups are formed pretty much after every engagement and for any cause to exchange information, debate issues, network or even fundraise.

Some are just timely, they run for a short while and for a worthy cause. I particularly like the baby shower WhatsApp groups. We discuss everything from the sex of the baby to its gifts. On the D-day, we ‘surprise’ the mother.

After the baby shower is over, happy moments in pictures are shared, the group is deleted and we move on. It is interesting that some people forget about the whole issue and probably check on mother and born baby a year later!

While the exchange of ideas and debating issues via WhatsApp is very good and has changed the way audiences consume news, giving feedback and wider visibility through more eyeballs, I am afraid that WhatsApps groups with journalists and especially the people supposed to give them information is outright wrong.

Ethically it has never been a good idea for journalists to cozy up to the people they cover. I thought journalists are supposed to keep some professional distance? But now the opportunist and savvy public relations officers have mastered their WhatsApp game. Don't also forget that journalists can be lazy.

They set up their own groups, send minute to minute updates - these can even be a voice WhatsApp and by the end of the day all radio stations will be singing their story with the same voice quote like a song.

If the groups only kept the conversations to news discussions maybe it would make sense but the reality is that they move beyond that and engage in ‘lugambo’ and getting daily compliments or updating each on a minute by minute basis, because that is what WhatsApp almost does to us!

The defenders of these groups were journalists are bedding with their sources say these keep the journalists and the people who give them information in constant touch in this era of fast news and they are so much alike press conferences but only in virtual space.

I have been on WhatsApp groups where posts deepen not only to family issues but also to uncomfortable topics where the public relations or communications person will blame the journalist for bad publicity - however truthful the story may be and even pressurise the journalists to apologise or retract because their ‘bosses are angry’ and job security has been threatened. 

I guess it is okay to send a personal WhatsApp to the source but manipulation of a whole group to cover what they want and the way they want it is demeaning good journalism.

Until we understand that the two groups have completely different roles, only then will journalists stop bedding with public relations or communication officers in the same WhatsApp group.