Experts caution against stagnation of immunization coverage in Africa

Press Release – Global immunization experts attending the biannual Regional Immunization Technical Advisory Group (RITAG) meeting urged African countries to strengthen their routine immunization. Over the past five years, immunization coverage in sub-Saharan Africa has stagnated at 72%, exposing populations to vaccine-preventable diseases and outbreaks.

The immunization experts also emphasized the importance of increased domestic investment in disease surveillance and the need for community engagement to drive vaccine deployment during outbreaks.

“The regional experts’ meeting presented a unique opportunity to assess current and future immunization needs in Africa,” said RITAG Chair, Professor Helen Rees. “We have mapped out what can and must be done to secure the future of millions of children on this continent.”

In sub-Saharan Africa, nearly 31 million children younger than 5 years suffer from vaccine-preventable diseases every year. More than a half million of them die due to lack of access to the vaccines they needed.

In 2017, Heads of State from across Africa endorsed the Addis Declaration on Immunization, a historic pledge that envisions an Africa in which every child, no matter their economic circumstances, has access to vaccines.

This year, the World Health Organization’s (WHO) Regional Office for Africa, in partnership with the African Union Commission, will launch a progress report on the implementation status of the 10 commitments outlined in the Addis Declaration. The report will take stock of progress made over the past two years, highlight gaps and issue recommendations to guide progress towards stronger immunization systems.

“By vaccinating children, we are doing more than preventing diseases and saving lives. We are also ensuring that children get the education they deserve and returning valuable time to their families because they no longer need to make long hospital visits. Vaccinations also release scarce government funds,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

According to WHO data, illness and deaths due to vaccine-preventable diseases cost sub-Saharan Africa US$13 billion each year – funding that could be channeled towards strengthening health systems and building economies.

The immunization experts gathered in Brazzaville also discussed a range of pressing issues, including the ongoing Ebola outbreak, polio eradication, and progress against the Regional Strategic Plan for Immunization.

The Democratic Republic of the Congo is grappling with the second-largest Ebola outbreak in history, with more than 650 confirmed cases so far. Despite challenges in reaching areas marred by long-term conflict, nearly 60 000 people have been vaccinated, including approximately 20 000 health workers and front-line workers. The country’s Ministry of Health has launched its first randomized control trial for experimental Ebola treatments. However, continued efforts are necessary to ensure the outbreak is contained.

In contrast, other diseases, such as polio, are on the brink of eradication. The last case of wild poliovirus in Africa was reported in August 2016 in the north-eastern state of Borno, Nigeria. If no new cases of wild poliovirus are detected in Nigeria by August 2019, Africa will attain the wild poliovirus eradication goal.

As the world nears polio eradication, funds for fighting the disease are declining. Between 2016 and 2019, the Global Polio Eradication Initiative budget more than halved, from US$ 322 million to US$ 153 million. 

That initiative provides more than 90% of all funding for disease surveillance in sub-Saharan Africa, including 16 polio-funded laboratories that process clinical and environmental samples for acute flaccid paralysis surveillance (used for detecting poliomyelitis) and other vaccine-preventable diseases, such as yellow fever and measles.

The Regional Immunization Technical Advisory Group emphasized the need for greater government ownership of disease surveillance programmes to ensure that the progress made in curbing vaccine-preventable diseases is not reversed.

“The fact that most sub-Saharan African countries continue to rely on external funding for immunization financing 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 programmes remain strong and vigilant.”

Creative messaging and sensitisation to kick Ebola out of Congo

By Esther Nakkazi

Officials in the Ministry of Health in the Democratic Republic of Congo have turned to sports to sensitize the public especially the youth about Ebola. This was after it was observed that young people were often the source of reluctance in the community and the first perpetrators of the destruction of sanitary materials.

The aim of the football tournament was to appease this youth, raise awareness about Ebola and invite them to take ownership of the Ebola response to end the epidemic, a statement from the Ministry of Health says.

To sensitize the public and particularly the youth, the coordination of the Ebola response organized a football tournament in Beni and Butembo in order to build trust with the youth of both cities. The last phases of the football tournament 'Ebola Pas Chez Moi' started on Monday, December 17, 2018, with the final and the small final of Butembo. 

After two weeks of strong emotions, it was the 'Racing Club of Kivu' (RCK) team that won the title of tournament champion in Butembo after having imposed on penalties against the team 'Jeunesse Sportive de Butembo '(JSB). The RCK will face Beni's championship team in the Grand Final of the tournament and attempt to win the Cup of Hope this Thursday, December 20, 2018.

Throughout the tournament, many awareness activities were organized including community animators who animated the games with messages and awareness songs. After being trained on the disease and the means of prevention, the young players themselves became involved in raising public awareness by recording prevention messages that were also broadcast by local radio stations. 

A special prize was awarded to the player of the tournament voted the best sensitizer of the competition. Handwashing and temperature sensing devices were installed at the entrance to all stadiums. 

In addition, on the sidelines of the Butembo final, experts from the different pillars of the Ebola response were set up in stands and answered all the public's questions about the epidemic.
Meanwhile, vaccination has continued wide-belt vaccination (or ring plus) in Otomaber (in Komanda Health Zone) and Aloya (in Mabalako Health Zone). Continued immunization of primary care providers in the Goma Health Zone.

The ministry records show that since vaccination began on 8 August 2018, 48,048 people have been vaccinated, including 19,017 in Beni, 8,619 in Katwa, 5,077 in Mabalako, 4,974 in Butembo, 2,208 in Kalunguta, 1,663 in Mandima, 824 in Komanda, 791 in Vuhovi, 750 to Masereka, 700 to Lubero, 670 to Oicha, 607 to Kyondo, 599 to Mutwanga, 434 to Bunia, 355 to Tchomia, 344 to Musienene, 257 to Goma, 70 to Biena, 63 to Alimbongo, 13 to Karisimbi and 13 to Kisangani.

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Research says nine of ten Africans are unqualified for the Jobs they apply for

Research conducted by the ROAM or Ringier One Africa Media (www.ROAM.Africa) Group shows that many Africans who apply for a job are not qualified in the first place

Close to 90% of applicants that apply to a job position are objectively not a match to the role advertised. This is caused less by a shortage of jobs, but a fundamental misunderstanding of job requirements, both from employers and candidates.

This has been uncovered by research conducted by ROAM, who is encompassing the market-leading job portals in West Africa (Jobberman) and East Africa (Brightermonday), as well as Executive Recruitment and HR Solutions firm The African Talent Company. The company has analysed data sets from more than 12 million users, as well as from more than 100,000 employers, across Nigeria and Kenya active in the last two years.

Matthew Page, ROAM Head of Jobs, on the background of the research: “We have recently conducted a data review and were shocked by this huge gap. Our initial hypothesis was that this is due to a shortage of jobs, gaps in the labour markets, and desperation."

"However digging deeper into our database, our analysis found that many candidates were indeed qualified for other available jobs, but did not necessarily apply for these. African employers and our clients indeed face a challenge in hiring the right people,” he said.

The company’s research further brought to light that an average job listing receives about 140 - 160 applications. This showcases that there are huge hiring efforts involved in the application and recruitment process, even before the interview. 

This is both on the candidate side, to launch this large number of wrong applications, as well as from the employer, to identify the 10% of right candidates, amidst a large number of unqualified requests.

“Hiring the right competency upfront typically returns 3x productivity for the employer. It also minimises the onboarding time required to get an employee up to speed. That is why we have launched smart employer products in the last months. These facilitate a smooth hiring experience for employers, through tech-enabled shortlisting and matching products that identify the best candidate for the best position”, adds Matthew Page.

Clemens Weitz, CEO of ROAM elaborates on the potential for economic growth: “Our research clearly shows that the education of the African job market has a long way to go - both on the seeker and employer side. Solving this challenge will unlock tremendous latent economic potential."

"Imagine an efficient economy, where all employees sit in the job that is a perfect, natural fit for their individual nature. Productivity and satisfaction would skyrocket. AI and machine learning have tremendous potential, and we plan to fundamentally solve this challenge in 2019,” he said

Press Release APO

Ebola Update

By Esther Nakkazi

According to the World Health Organisation concerns have been raised regarding the disproportionate number of women and children infected during this outbreak. 

To date, females accounted for 62% (280/450) of overall cases where sex was reported. Of all female cases, 83% (230/277) were aged ≥15 years. Of these women, at least 18 were pregnant, and an additional seven were breastfeeding or recently delivered at the time of infection. 

There have been 27 cases among infants less than one year of age, with 70% (19) of these being boys, and 21 fatalities (age-specific case fatality of 78%). There were also nine cases in infants aged less than one month. Children, less than 15 years of age accounted for 24% (106/447) of cases.

There are likely a multitude of factors contributing towards this disproportionate disease burden observed in women and children. These include exposure within formal and informal health facilities, involvement in traditional burial practices, transmission within family groups (including transmission between mothers caring for children), differences in health-seeking behavior, as well as the impact of ongoing conflict on the underlying population structure in affected areas. 

Among those with available information, commonly identified risk factors reported by cases include: having contact to a known case (224/320, 70%), having attended funerals (121/299, 40%) and having visited/admitted to a health facility before the onset of EVD (46/139, 33%). Of note, 46% of female cases (84/181) reported having attended funerals, in contrast to 31% of male cases (37/118).

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Traditional Healers fuelling Ebola spread

By Esther Nakkazi

In the past three weeks, a significant increase in Ebola cases has been observed in Butembo and Katwa with the main challenges in these areas related to the high density and mobility of the population in this major trading city of North Kivu, said Dr. Oly Ilunga Kalenga, the Minister of Health, Democratic Republic of Congo.

Another observed an unusual aspect of this epidemic is the role played by centers of traditional health practitioners in the transmission of the virus that a key factor in nosocomial infections. Nosocomial infection is an infection that is acquired in a hospital or other health care facility and is spread to the susceptible patient in the clinical setting by various means.

DRC ministry of health officials says a parallel consequence of these nosocomial infections is the contamination of a large number of healthcare providers. To date, 44 health workers have been infected (9% of the total number of cases), of whom 12 have died.

"Strengthening infection prevention and control measures in public, private and traditional health facilities is one of the priorities of the teams today," said Dr. Ilunga at a press conference in Kinshasa held Thursday, December 6, 2018.

Dr. IIunga also observed a reluctance by the community which is more violent than the reluctance usually observed during previous Ebola outbreaks.

"A minority of the population in these areas express their reluctance through the regular destruction of medical equipment and health centers as well as the physical attacks of health workers," he said.

Meanwhile, vaccination is still ongoing with more than 40,000 vaccinated people, and vaccination teams have averted more than 10,000 Ebola cases in 4 months or nearly half of the balance sheet of the epidemic in West Africa that lasted 2 years.

Since the beginning of vaccination on August 8, 2018, 41,226 people have been vaccinated, including 18,270 in Beni, 6,272 in Katwa, 4,578 in Mabalako, 3,556 in Butembo, 2,092 in Kalunguta, 1,663 in Mandima, 769 in Vuhovi, 750 in Masereka, 599 in Mutwanga, 521 in Oicha, 434 in Bunia, 409 in Komanda, 392 in Lubero, 355 in Tchomia, 274 in Musienene, 241 in Kyondo, and 51 in Alimbongo.

Continuation of vaccination of front-line providers in Lubero as a preventive measure in the context of the preparation of the health zone also continues.

Dr. Ilunga cautioned that the epidemic will last for several months and that the risk of spread will remain high until the epidemic is completely extinguished.

£28 million from UK government to support nutrition in Uganda

By Esther Nakkazi

The UK government has launched the Karamoja Nutrition Programme worth £28 million pounds which will improve the delivery of quality nutrition services across Karamoja.

84 percent of people in Karamoja are unable to afford a nutritious daily diet, 45 percent of households have limited access to food, and over half of all households do not have much diversity in their diet. 

Malnutrition, therefore, remains a major impediment to Karamoja’s development, undermining the health and economic prospects of the population. More than 1 in 3 children in Karamoja experience stunted development due to malnutrition.

The Karamoja Nutrition Programme, funded by UK aid and implemented by the United Nations Children’s Fund (UNICEF) and the United Nations World Food Programme, will strengthen the Government’s health system to ensure children and mothers across the region receive high-quality health and nutrition services and are better nourished.

The programme supports all District Local Governments in Karamoja to develop the skills of nutritionists and health workers; improve the treatment of severe acute malnutrition in hospitals and health centres; generate evidence to improve the design of nutrition services; procure and manage quality nutrition supplies; and provide more effective nutrition leadership and coordination across all Government departments and partners.

“Working to strengthen the Government’s health system, with strong district leadership and engagement, presents an opportunity for Karamoja to address its malnutrition challenge,” said Francesca Stidston, the Head of Office for the Department for International Development (DFID) in Uganda.
 

"This programme is timely in that it will help to ensure that children access higher quality nutrition services, which are essential to their survival and healthy development,” said Dr. Doreen Mulenga, UNICEF’s Representative in Uganda.

The programme will support: over 100,000 malnourished children under the age of 5 with a community based supplementary feeding programme; nearly 15,000 severely malnourished children with specialized treatment in hospitals and health centres; 140,000 children to receive Vitamin A supplements and deworming medication twice a year; and around 70,000 pregnant or breastfeeding women with iron folic acid supplements to treat anemia.

At the launch, the leadership from Karamoja’s eight districts - Abim, Amudat, Kaabong, Kotido, Moroto, Napak, Nakapiripirit and Nabilatuk - as well as leaders from the Ministry of Karamoja Affairs, committed to ensure that all pillars of the programme are fully integrated within the health sector and are effectively planned and budgeted for after the programme ends in three years.

“The Karamoja Nutrition Programme is a continuation of the Government of Uganda and development partners’ march to end child stunting in Uganda,” said WFP’s Country Director El-Khidir Daloum.

“We are outraged by the level of stunting in Karamoja, which remains unacceptably high. Ending stunting is mission possible,” Daloum said.

While child stunting has reduced by roughly one percent every year in Karamoja since 2006, 35 percent of all children under the age of 5 in Karamoja are still stunted.

The Karamoja Nutrition Programme compliments other programmes in Karamoja, such as the Karamoja Resilience Support Unit supported by USAID, Irish Aid, and UK aid and GIZ’s programme to improve the reliability of water supply and sanitation in selected health centers, which collectively contribute to a comprehensive multi-sectoral nutrition response to all people across Karamoja.

Urgent Research for Development Action Plan required to Combat ArmyWorm

By Esther Nakkazi

A more coordinated research-for-development (R4D) action plan is urgently needed to ensure that effective and affordable solutions reach smallholder farmers in sub-Saharan Africa so they can sustainably combat the voracious fall armyworm an international conference heard.

The international conference held from Oct. 29 to 31 at the African Union Commission in Addis Ababa, Ethiopia was also aimed at drawing a science-based roadmap to combat the fall armyworm.

“We must look at the big picture to design safer, accessible, effective and sustainable solutions against fall armyworm,” said Martin Kropff, director general of the International Maize and Wheat Improvement Center (CIMMYT).

“Fall armyworm has been the fastest pest to expand across the continent,” said Eyasu Abraha, Ethiopia’s State Minister for agriculture development.

African leaders consider the invasive fall armyworm “a big threat for African food security,” said Amira Elfadil, African Union Commissioner for Social Affairs, at the opening of the conference.

Since the initial shock in 2016, various stakeholders - farmers, researchers, extension officers, agribusinesses, governments, and donors have reacted quickly to fight the invasive pest in various ways.

They have used pesticides, agroecological approaches and new seeds but still the situation is far from under control. African farmers have as well lost millions of dollars in earnings due to the loss of crops to the fall armyworm.

The rapid increase of the pesticide market in Africa has led to the circulation of plenty of banned or counterfeit products, some very toxic, said Steven Haggblade, a professor in the Department of Agricultural, Food, and Resource Economics at Michigan State University, USA. Besides, most farmers are also often not well trained in the use of such chemicals and do not protect themselves during application, he said.

On the other hand, pesticide use also has many negative trade-offs, said Paul Jepson, a professor of environmental and molecular toxicology in the College of Agricultural Sciences at Oregon State University.

Natural enemies like parasitic wasps are also often far more vulnerable to pesticides than fall armyworm larvae, which are hard to reach and hide in the maize whorls for instance.

Since it was first detected in Nigeria and São Tomé, the moth has spread across more than 40 African countries where it has found an ideal environment, with diverse agro-ecologies and a warmer climate all year round amplifying its persistent threat. It has also been seen in India since July 2018.

Entomologists are trying to fill a knowledge gap in how the fall armyworm behaves and migrates throughout Africa. What is known is that it has a host range of more than 80 plant species, including maize, can cause total crop losses, and at advanced larval development, stages can be difficult to control even with synthetic pesticides.

The female fall armyworm can lay up to a thousand eggs at a time and produce multiple generations very quickly without pause in tropical environments. The moth can fly 100 km (62 miles) a night, and some moth populations have even been reported to fly distances of up to 1,600 kilometers in 30 hours, according to experts.

During the conference, experts debated intensely on the technical gaps and the best ways to combat the pest through an integrated pest management strategy, including how to scout the caterpillar in the crop field, establish monitoring and surveillance systems, pest control innovations and appropriate policy support to accelerate the introduction of relevant innovations.

They also heard the many collaborative initiatives, including national task forces and expert working groups, which have informed the current state of knowledge but were cautioned about the many still existing knowledge and technology gaps.

“The cost of not collaborating is pretty severe,” said Regina Eddy, who leads the Fall Armyworm Task Force at the USAID Bureau for Food Security. “The real gamechanger will be that all experts agree on a common and concrete research-for-development agenda and how to organize ourselves to implement it effectively.”

The conference was jointly coordinated by CIMMY and hosted by the Fall Armyworm R4D International Consortium which recommended that common methodologies and research protocols be developed to ensure data from various studies across the continent are better used and compared. For instance, this would look at how best could the true impacts of the fall armyworm on food and seed security, public health and environment be measured?

Conference participants also agreed to work on defining economic and action thresholds for fall armyworm interventions, to ensure better recommendations to the farming communities and that advice must include the use of environmentally safer pesticides, low-cost agronomic practices and landscape management and fall armyworm-resistant varieties, among other integrated pest management tools.
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