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Tuesday, June 6, 2017

Pre-eclampsia; African Women’s Neglected Disease

By Esther Nakkazi

Twenty-two year old Lorriane Akampurira thought she had minor problems with her pregnancy. Her feet were swollen. Later her whole body too. It was her first pregnancy.

“People started saying that it was because I was carrying twins. Others said the baby was big,” said Akampurira. When she started feeling real sick she went to hospital. At that point her whole body was swollen like ‘there was water in it and it could burst anytime.’

Lorraine's husband was deeply affected.  They are a young couple, newly married and with no experience. “My wife could not sleep at night but people kept on saying the swelling was normal. She was in pain all night. I kept on asking myself about this normal swelling?,” said Mr. Akampurira.

When Lorraine arrived at the hospital, one look at her from the doctor was enough. The baby had to be removed immediately in order to save the life of mother and baby. Akampurira was diagnosed with Pre-eclampsia.

Pre-eclampsia and eclampsia remain ‘neglected diseases’ among African women.

On 22nd May, Akampulira and her husband joined the rest of the world to commemorate the inaugural world Pre-eclampsia day. In Uganda, the event was organised by the Health Systems Advocacy Partnership (HSAP) project under the theme; ‘Take the Pre-eclampsia Pledge; know the symptoms. Spread the word.’

Pre-eclampsia is a common pregnancy complication that is characterised by new-onset of hypertension. Studies show that women in the developing world are 300 times more at risk of dying from pre-eclampsia.

In Uganda, 368 women die from pregnancy and childbirth-related causes per 100,000 live births and hypertensive disorder, or pre-eclampsia and eclampsia is the second most common cause of maternal death after postpartum haemorrhage.

The cause of pre-eclampsia is unclear but it has been observed to run in families suggesting that there is a genetic predisposition to it. It is still an unknown disease, with no local language equivalent and no clinically useful screening test. Health workers can detect pre-eclampsia by persistent hypertension and presence of protein in urine.

Dr Annettee Nakimuli, the head of the gynaecology and obstetrics department at Mulago referral hospital said at least 4 women die per day at Mulago due to pre-eclampsia and it is responsible for 8% of admissions of pregnant women at this hospital.

Nakimuli said the condition presents with signs like swelling of the body but generally there is no pain. Because of this many women suffer ignorantly. On top of this, pre-eclampsia is surrounded by myths; some say it is witchcraft, a pregnancy of twins, a baby girl as well it is labelled as ‘a disease of cheating women.’

Nakimuli said all women are at risk but more so those in the extreme age bracket; below 19 or over 40 years of age as well as those who get pregnant through IVF.

When Akampurira’s baby girl was delivered at six months she was assured that the body swelling would stop but it did not. Even as she attended this world pre-eclampsia day, her legs were still swollen. She also suffered from kidney disease and was on her way to hospital for another check up of her heart which could have been damaged.

Akampurira’s baby lived for only nine days and died. She had breathing problems.

In Uganda, pre-eclampsia is the leading cause of pre-marital birth. The babies are usually born pre-term, they are small for age and their survival is limited.

“Death is the worst. Women with pre-eclampsia get complications and remain sick forever,” said Nakimuli. Complications include stroke, breathing problems, kidney failure, cardiovascular disease and others.

At Mulago, the gynaecology and obstetrics Unit remits the biggest number of patients to the dialysis. “The urologists are always complaining to us because we send them the most patients,” said Nakimuli. 

Efforts to end pre-eclampsia in Uganda;

On 22nd May, the Health Systems Advocacy Partnership (HSAP), a project seeking to bring stronger health systems so people in Sub-Saharan Africa, particularly Uganda gain better access to sexual and reproductive health services joined the world to bring attention to pre-eclampsia and other hypertensive disorders.

“Hypertensive disorders are not rare complications of pregnancy,” said Denis Kibira the executive director of HEPS-Uganda. Kibira said the government needs to expand access to proven under utilised interventions and commodities for prevention as well as avail early detection and treatment of pre-eclampsia and eclampsia.

Luckily, Uganda knows what to do with pre-eclampsia but there are still some hurdles along the way.

Dr. Jessica Nsungwa Sabiiti, the commissioner in charge of Reproductive Health at the Ministry of Health said Uganda has a policy that recommends the use of Magnesium Sulphate, for use for women suffering from pre-eclampsia.

Magnesium Sulphate, a cheap drug, is one of the 13 UN Lifesaving Commodities for women and children on the Uganda national essential medicine list. Its overall availability in Uganda health facilities is 77 percent.

Unfortunately, health workers especially nurses and midwives, who are the first contact for mothers with pre-eclampsia are not prescribing the drug, said Nsungwa. “They fear the toxicity so their lack of confidence prevents them from prescribing it.”

As a result of fear to prescribe, the nurses wait for the doctors at the detriment of the mother’s health and yet there are just a few of these in primary health care.

But with the awareness growing and government committed to train health workers there is some light at the end of the tunnel. Let alone the condition getting world recognition.

“I was so excited that there is at last world pre-eclampsia day. It will create awareness. We are on our way to success,” said Nakimuli.

After the event, Akampurira and her husband said they were on their way to pick the ‘heart-health’ results from the hospital. Hopefully, the young couple will have the next baby survive.

ends.

Wednesday, May 17, 2017

40 years after the first Ebola outbreak are we able to handle the next epidemic?


By Esther Nakkazi

(An edited version of this piece was published in The EastAfrican newspaper (no link) in September 2016. I wrote it when I was a resident Journalist at the Institute of Tropical Medicine. Just uploaded it in light of the recent Ebola outbreak in DRC)

Driven by discoveries over the last 40 years since the first Ebola outbreak, scientists are optimistic that the new tools and data at hand will limit the damage for the next epidemic.

Since September, 1976, in Yambuku, Zaire - now the Democratic Republic of Congo, when the first outbreak of the disease was reported, 25 Ebola outbreaks have happened but the 2014 West African outbreak was unprecedented.

In nearly two years in three countries there were 11,000 deaths. Over Ebola’s existence of 40 years, 30,900 cumulative cases have occurred with12,800 deaths at an annual average death of 322. 

At the 8th International Symposium on Filoviruses in Antwerp, Belgium, hosted by the Antwerp Institute of Tropical Medicine, on 12-15 September 2016, which reviewed global progress against Ebola, scientists said they have enough Ebola arsenal; vaccines, diagnostics, clinical data and therapeutics ready for the next epidemic.

For the academia and researchers, so much has been discovered over the past 40 years. As Micheal Kurilla, the director biodefence research at the National Institute of Allergy and Infectious Diseases said at the symposium, ‘the once one pager on hemorrhagic fever in text books is now being constantly rewritten and updated.’

“The silver lining of the epidemic is that there has been some solid research from epidemiological, social, anthropological, therapeutic and vaccine research,” said Peter Piot the director of the London School of Hygiene and Tropical Medicine, UK.

Three microbiologists, Professors Peter Piot, Guido van der Groen and Jean-Jacques Muyembe are no strangers to Ebola. The two Belgians received the first ‘unknown’ virus at the Antwerp Institute of Tropical Medicine from the former who sent it from Kisansha and they discovered Ebola.

Top insights on research:

Ebola is not all the time killing it can also save some lives. ITM spearheaded the use of blood and plasma from recovered patients to cure victims although it was not very successful and has since developed diagnostics.

“We have moved relatively quickly, gained a lot of time and learned a lot of things on how to do things better,” said Prof. Dr. Johan Van Griensven who heads the HIV and Neglected Tropical Diseases Unit at ITM.

There is also a general desire to progress Ebola R&D faster through initiatives like the coalition for epidemic preparedness innovations which is creating partnerships and giving incentives to develop vaccines, therapeutics and diagnostics where there is no market to contain outbreaks of emerging infectious diseases. This is at the back drop of limited epidemic R&D market incentives.

There are also efforts to share data and not duplicate funding. What happened in the West African outbreak was terrible. Chinese came in just to pick samples, institutions owned data and refused to share it.

Now efforts have been made to share data and to encourage players to play into each other’s comparative advantage, said Dr. Barbara Kerstiens, the deputy Head Fighting Infectious Diseases and Advancing Public Health Unit, DG for Research and Innovation at the European Commission.

Overall, the WHO has also made harmonised clinical trials a blue print plan for action.

Various pharmaceutical companies have also gone ahead to develop vaccines. On 12 September, Johnson & Johnson, announced that its subsidiary Janssen Vaccines & Prevention B.V had submitted its investigational preventive Ebola prime-boost vaccine regimen to the World Health Organisation (WHO) to be used in emergencies.

“If listed for emergency use, the investigational Janssen vaccine regimen could be a vital prevention tool for rapid outbreak response,” said Johan Van Hoof, Global Therapeutic Area Head, Infectious Diseases and Vaccines, Janssen Pharmaceutical Companies.

It would particularly be available for health workers and vulnerable communities on the front-lines who suffer the most in Ebola outbreaks. It has already been tested and passed in animal models and for safety.

Many other vaccines have passed the test for animal models - which do not necessarily represent the pathogenesis - that occurs in humans. For many Ebola vaccines and treatments when scientists caused disease in rodent species they would be mildly affected although it was deadly in humans. Scientists therefore did not know which animal models would be predictive and this limited advancing.

When the outbreak happened in West Africa everything changed. It was a windfall. The unexpected opportunity to test the animal models under real life conditions was presented.

“It gave us an opportunity to advance and focus on the most appropriate animal models so that the future counter measures will have a much higher probability of success in the next outbreak” said Kurilla. “We got a lot of ‘proof of concept’ for interventions although at some point it was less than ideal to move forward.”

Furthermore, there are new lessons to learn from long studies. For instance, 40 years ago it was unknown that the Ebola virus is spread sexually and that it survives in survivors bodies for a long time 

And a lot to learn from research that did not work like the ITM convalescent plasma treatment that had held a lot of hope. “Data should not be undervalued because showing that something does not work is equally as important and has enormous value,” said Kurilla.

It is also new research that age and viral load where key determinants for the survival against Ebola, not necessarily solely supportive care as many thought.

The WestAfrican Ebola outbreak flipped to the usual; a humanitarian emergency having outbreaks to an outbreak becoming a humanitarian emergency. There were also unnecessary delays and a reluctance both government and international community levels to consider it a humanitarian crisis and not just another health problem until gears shifted.

Thus, institutions like World Health Organisation have made reforms. With no historical formal mechanism in countries for managing outbreaks but a clear architecture in the way humanitarian crisis are managed for conflict and natural disasters changes are underway.

“Previously, the humanitarian and outbreak departments were separate but they are now merged,” said Dr. Rick Brennan the Director, Emergency Risk Management and Humanitarian Response at WHO.

WHO is also working to create a system with standard procedures to support a more predictable mechanism with better leadership and coordination especially working to leverage that capacity to manage large scale outbreaks, said Brennan.

“We need more experience of the humanitarian sector, which is dominated by logistics, organisation, coordination that could be more boring and bureaucratic but I believe we need more of that in the first place,” said Piot.

WHO has also linked up with the World Bank for a ‘unified framework for preparedness’ . This will strengthen preparedness at the country level not just for outbreaks but for emergencies.

The reasoning is that every country is prone to emergencies and its capacity to respond to them needs a baseline study to understand the average patterns faced and how they can prepare.

“We have done this because regardless of the event there are some basics that you always need,” said Brennan. These include good medicine management, information capacity, communication capacities, strong logistic.

WHO has also put in place a special procedure to fast track R&D the WHO Emergency Use Assessment and Listing (EUAL) that can be implemented when there is an outbreak with high rates of morbidity and mortality and a lack of treatment or prevention options.

Janssen Vaccines & Prevention B.V has submitted its investigational preventive Ebola prime-boost vaccine regimen for it.

“If the WHO grants an emergency use listing, this will accelerate the availability of Janssen’s investigational vaccine regimen to the international community in the event another Ebola crisis occurs,” said Paul Stoffels, the Chief Scientific Officer, Johnson & Johnson.

The DRC which has recorded seven outbreaks, the highest ever in a single country, also has lessons. At the epic of the West Africa outbreak it had its own.

“The first thing is to detect, report and test. We now have a good surveillance system and we have trained some health workers,” said Prof Muyembe.

Muyembe who leads the national coordinating committee on Ebola in the country and is the director general of the National Institute of Biomedical Research (INRB) said these are key ingredients to control the virus.

In addition, there is strong community engagement and ownership to implement, control and prevent Ebola. For them dialogue is important and only negotiated solutions are implemented. Ebola survivors are used to disseminate information.

“Many people can now identify Ebola. If the outbreak happened right now they would know exactly what to do,” said Muyembe.

“I think that indirectly DRC demonstrates that you can control this epidemic in the absence of a fantastic health system. A strong leadership, experience and an equipped laboratory were able to bring the epidemic under control,” said Piot.

But the environment was also very different. Currently, the urgency has waned. Unless something is done it is back to business as usual.

In 1977, Piot a young doctor, attended his first WHO meeting after visiting Yambuku. At the WHO meeting strong statements were made like ‘we shall invest in epidemic preparedness, support to build health systems and primary health care’ and believed it.

In 2015 Piot travelled with Muyembe back to Yambuku to see what had come of all the promises.

“We arrived at the mission and what we saw was very sad. A nurse survivor who had survived Ebola in 1976 was there. He runs the hospital laboratory of the hospital. He has a decent microscope and some reagents and that is it. No one pays him.”

Except for tonnes of plumpy’nut which is not required in this region that hardly suffers from malnutrition, there were no anti-HIV and malaria drugs.

“We owe it to the people who died in this epidemics to do much better. When the headlines have gone we should continue with the work,” said Piot.

ends

(An edited version of this piece was published in The EastAfrican newspaper in September 2016. I wrote it when I was a resident Journalist at the Institute of Tropical Medicine. Just uploaded it in light of the recent Ebola outbreak in DRC

Monday, May 8, 2017

Building Capacity for REDD+ among Academia in East Africa

By Esther Nakkazi

Reducing Emissions from Deforestation and forest Degradation (REDD) is a complex subject and so is having academia research about it.

But a project to build capacity for higher education and research on climate change for improved ecosystem health through reduced greenhouse gas emissions and sustainable livelihoods has managed to do just that in East Africa.

The REDD-EA project is a five year project (2014 - 2018) that supports masters, PhD and post graduate studies at Makerere University in Uganda and the University of Dar-es-Salaam (UDS) in Tanzania with short stays at Norwegian University of Life Sciences.

Funded to the tune of $3m by the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED), the project has largely remained on track- meaning they have so far achieved their target.

Prof John Tabuti at the department of Environment Management Makerere University said the first batch of fellowships is on track at both universities. In total, Uganda will build capacity for 34 and Tanzania 15 students.

But like all REDD+ projects, which remains a complex subject, implementers still think that like any other such to have an impact even the academia need to focus on one issue - community engagement.

Officials say that without doubt, community understanding is at the heart of REDD+ projects to be successful. Why? Most of the projects work with communities. Since REDD+ is defined as a multilateral policy that is meant to reward actions that conserve forests, communities are at the core of their success.

The REDD+EA project overall aims to strengthen scientific and institutional capacity of academic institutions to deliver quality research on REDD+ and to generate evidence based results for policy, said Tabuti also the principal investigator of the REDD-EA project.

So far Uganda has trained 7 PhDs and 24 masters, while the University of Dar-es-Salaam is training 6 PhDs and 6 masters. More students will be recruited this academic year said Tabuti.

In Tanzania, ‘Students are already at various stages of their research and dissertation writing. They are expected to translate their theses into scientific papers as a way of wider dissemination of their findings,’ said Dr Edmund Mabhuye a faculty member center for climate change studies at the University of Dar-es-Salaam.

The trained students will also ensure that functional and specialized training programs on REDD+ are created within universities, according to the REDD-EA project aims.

Kellen Aganyira a PhD student at Makerere university on the REDD-EA project fellowship said the opportunity for research and capacity building in higher education for REDD+ can only be got from such projects.

“Building our capacity as researchers is important. If we go down there and find out what is happening on the ground we inform policy makers,” said Aganyira.

“Training researchers is one way of reaching many practitioners since one researcher can disseminate knowledge to stakeholders across scales and levels,” said Mabhuye by email.

Doing it differently;

REDD+ is defined as a multilateral policy meant to reward actions that conserve forests. It involves payment through carbon credits. Since it is communities that should conserve forests, their participation and understanding is key for them to consent and protect forests if the projects have to succeed.

But it is a difficult concept to understand. For instance researchers report farmers asking them how they should pack carbon in order to sell it. Aganyira whose PhD is focussed on community participation in carbon projects agrees that it is a difficult sell.

“Communities do not seem to understand how they arrive at the amounts paid to them,” she said.
And that is not all. The carbon money delays so much that communities loose interest and land policies do not make it any easier. While payments require legal documents of ownership of land most forest land is communally owned.

It was therefore imperative for the REDD-EA project to focus on a deeper understanding of one topic - community engagement. Instead most REDD-EA fellowships students focussed on a wide rage of topics ranging from land tenure, community understanding, carbon in wetlands, carbon credits, REDD+ law, economics and a wide range of other topics.

“The challenge was that we went into many directions. I am a bit unhappy because we have not gone so deep,” said Tabuti. “It should have been narrowed down so that all PhDs focus on one theme to deepen our understanding.”

At Makerere University the next intake promises to be focused. “If I had to do this again I would go for community engagement. At the community you want them to understand and make informed choices,” said Tabuti.

ends

Tuesday, April 25, 2017

From Russia With Love; Uganda Nuclear Power Plant

By Esther Nakkazi

On April 19th, the leading Uganda daily newspaper, The New Vision carried on its front page a story ‘Russia to build Nuclear plant for Uganda’. The story went ahead to state that talks about the project are in the final stages.

When I read the story I did not react much but an expat in energy and infrastructure from Holland hung onto the story and was perplexed. He asked me about the Chernobyl disaster and I knew nothing about it but later found time to read about it.

The Chernobyl disaster occurred in April 1986 and is recorded as the most disastrous nuclear plant accident in history. It spilled over the whole of Europe and was costly in terms of cash and casualties. And its still consuming money and causing damage to humans and wildlife.

We could say that the Russians learnt a lot since then and they are the best country to teach us on how to avoid a similar scenario, read- ‘everlasting disaster’ but there are some issues that are so ‘Ugandan’ I do not know that my country can handle nuclear technology, which requires the highest level of safety.

If you travel on Ugandan roads you would be sorry with the level of careless accidents, safety does not exist! If you watch our construction industry you will be alarmed at how buildings collapse half way and kill workers. So you clearly understand that safety is not an issue in Uganda. For the Chernobyl disaster to happen there was among other things an overlap in safety.

If Uganda has to go ahead with this project there some key questions; who will own the nuclear plant? Is it Uganda or Russia?. If it is Uganda do we have the money to sustain it for hundreds of years after the Russians leave? We must be aware that it continues to eat money even when it is generating no money at all. 

The plant will generate radio active waste, which is harmful to people and the environment. Do we have the capacity to handle such waste which causes cancer if it is not well managed?

Where will the it be built? It has to be built near water because it operates with pressurised water, generates steam and needs water for cooling. So I suppose it will be on Lake Victoria or River Nile, all water bodies shared with partner States. The politics of that will be interesting to watch.

Nuclear energy is good so don’t get me wrong. It is the cheapest form of energy and is carbon-dioxide free during production. You can also use its radiation to treat cancer.

But it is also high end technology, requires discipline and I repeat 'maximum level of safety', which at this point I am afraid to say Uganda does not have. So hopefully the Uganda Ministry of Energy officials who are okaying this project have the capacity to question some of these issues and others that I may not mention here before the project takes off.

Wednesday, April 19, 2017

Stellenbosch University Software Donation troubles Makerere

By Esther Nakkazi

Makerere University will upgrade or all togather overhaul its system responsible for storage of administration, finance and student data, officials said.

The International Tertiary System (ITS) that integrates finance, human resource and academic data was brought in to Makerere from Stellenbosch University about ten years ago. It was a donation costing about $700,000.

However, Makerere University officials say their staff in the academic Registrar’s department who have already been arrested, allegedly tampered with the system which, caused a delay in issuance of transcripts to students who graduated in February this year. But some sources say this is not the case.
The staff also allegedly altered students’s marks and listed some 58 students into the 67th graduation booklet. Makerere administration has been apologising to the affected students and promised quick action.

Now the University wants to upgrade the ITS, which is unique and was tailor-made for Stellenbosch university, and has also since become obsolete.

“We have been operating a system purchased from South Africa but it is now obsolete that is why some unscrupulous staff managed to beat it. So we shall either upgrade it in the medium term or buy a new system,” said Prof Barnabas Nawangwe, the deputy vice chancellor in charge of finance.

Prof Nawangwe explained that either decision would rely on the cost but only if they failed to agree on upgrading the ITS with a new version would they buy a new system.

When Makerere administration realised that there were anomalies on the 67th graduation list, they halted the issuance of transcripts which affected over 14,895 students.

Prof John Ssentamu Ddumba, Makerere University vice chancellor, instructed the IT team to clean up the system and ensure that it is not tampered with again.

In mid March, Mr. Alfred Masikye, the academic registrar wrote to all university stakeholders alerting them on a temporary shut down in processing transcripts which alarmed the recently graduated students who wanted their transcripts for either further studies or to apply for jobs.

According to Masikye’s communication the university management had discovered that names of 58 students had their marks altered and henceforth withdrew them pending further investigations.

Press reports show that as early as 2015, Makerere withheld about 14,000 students’ transcripts until they verified their results. Prior to that incident, in 2008 a meeting had noted that the ITS was insecure and ill functioning.

A source who did not want to be named told this reporter that since inception, the ITS has always had major flaws and was incompatible with Makerere University.

One of the reasons is that the ITS was never configured to Makerere’s requirements but implemented the way it was working at Stellenbosch University, the source said. “It was like do it here as you did it there. It was also a donation and the administrators could not refuse it.”

Stellenbosch University and Makerere University have major variables. As a software that was tailor-made to Stellenbosch, its failures or repairs meant calling someone from South Africa, which was costly, the source said.

She said the two universities with major differences could not be aligned to fit the ITS at Makerere. For instance while the ITS was using the calendar year in Stellenbosch, Makerere uses an academic year so data inout and storage was a challenge.

Makerere university, as its legacy, has always registered students using registration numbers but the ITS system uses a ten-digit student number. When this anomaly was realised the Makerere administration started issuing student numbers on top of the registration numbers to fit the system.

Users at the administration level complained and they requested that one of numbers be dropped but Makerere had to keep its legacy of registration number so both of them were maintained causing more chaos.

The other issue is that the ITS would allow students to register online only after paying at least 60 percent of the tuition fees. The way the ITS was modelled is that it would automate registration with that data input from finance and enable the student to register.

Since Stellenbosch University is a state-subsided most of its students would have no problem with that requirement but Makerere has been in running battles with students to pay their school fees on time. 

However, another source who also preferred anonymity says the students results management system responsible for input, storage and administration of student marks and production of transcripts was locally designed.

He said Makerere is just not saying the truth about the problem and not effectively managing issuing of transcripts to graduated students on time.

Makerere University officials, however said the two were aligned so the locally made system, which was tampered with by its staff was aligned to the ITS and students records would be imported into it. But the matter would soon be resolved.

Ends.  

Monday, April 3, 2017

Ebola Vaccine induced longest reported immune response

By Esther Nakkazi

An investigational “prime-boost” Ebola vaccine regimen, induced a durable immune response in 100% of healthy volunteers over one year, the longest duration follow-up reported researchers said.

The data was reported in The Journal of the American Medical Association (JAMA) on 14th March. The Phase 1 study is the longest duration follow-up reported for any heterologous prime-boost Ebola vaccine regimen.

This follows recent evidence of the persistence of Ebola virus in bodily fluids and the potential for sexual transmission among Ebola survivors, which reinforce the urgent need for a robust and durable vaccine for the disease.

“The world needs a vaccine to help prevent or mitigate future Ebola outbreaks, and ideally it should provide sustained protection for at-risk populations,” said Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson in a press release.

Janssen’s investigational Ebola vaccine regimen was developed in collaboration with the National Institutes of Health (NIH). The regimen is based on Janssen’s AdVac® technology and MVA-BN®technology from Bavarian Nordic A/S. Johnson & Johnson’s partners in the Ebola program also include Europe’s Innovative Medicines Initiative, the London School of Hygiene & Tropical Medicine, Inserm, and BARDA.

In the Phase 1 study, led by the Oxford Vaccine Group at the University of Oxford, UK, healthy volunteers were given one vaccine dose to prime their immune system and the alternative vaccine to boost their immune response.

The Phase 1 study enrolled healthy participants aged 18 to 50 years. Of 75 active vaccine recipients, 64 attended follow-up at day 360, the latest time point analyzed. No vaccine-associated serious adverse events were observed from day 240 to day 360. All of the active vaccine recipients maintained Ebola virus-specific antibody (immunoglobulin G) responses from the first post-vaccination analysis conducted through to day 360. 

Dr Matthew Snape, Chief Investigator of the study reported that this is the longest duration follow-up for any heterologous prime-boost Ebola vaccine regimen yet published. 

Phase 1, 2 and 3 studies are ongoing to confirm these findings.

A total of 10 clinical studies are being conducted on a parallel track across the U.S., Europe and Africa in support of potential eventual registration for the Ebola vaccine regimen. The first study of the vaccine regimen in a West African country affected by the recent Ebola outbreak began in Sierra Leone in October 2015.

In September 2016, Janssen completed a submission to the World Health Organization (WHO) for Emergency Use Assessment and Listing (EUAL) for the investigational preventive Ebola prime-boost vaccine regimen. 

Janssen in partnership with Bavarian Nordic rapidly scaled up production of the vaccine regimen and now has approximately 1,800,000 regimens available, with the capacity to produce several million regimens if needed.
ends

EU funding to combat illegal fishing on Lake Victoria

Fisheries Managers from Uganda, Kenya and Tanzania



















By Esther Nakkazi
The European Union (EU) will contribute 100,000 Euros to improve monitoring, control and surveillance of Lake Victoria to combat illegal, unreported and unregulated fishing. More funds are expected from partner states.

The EU funds to be available for eight months from April to November 2017, will be managed by the Lake Victoria Fisheries Organisation (LFVO) and given to SmartFish one of the largest regional Programmes for fisheries in Africa.

At a regional consultative meeting held in Entebbe (28-29th March), fisheries managers from three partner states that share Lake Victoria of Uganda, Kenya and Tanzania agreed on a joint action plan.

The fisheries managers agreed to carry out joint patrol activities, registration of fishers, enforcement and support to comply with licensing, marking licensed fishing boats as well as to create awareness and encourage voluntary surrender of illegal fishing gears.

“Pooling of assets, information and knowledge between different countries enables countries to share surveillance and control of fishing,” said Fanjanirina Jérômine, IOC-SmartFish monitoring, control and surveillance (MCS) Assistant.

Patrick Kimani the Kenya regional representative IOC-SmartFish said there is need to sustain MCS activities being undertaken although inspite of these illegal fishing on Lake Victoria persists.

Paul Okware the acting assistant commissioner in charge of regulation and control at the Uganda Ministry of Agriculture, Animal industry and Fisheries commented on how illegal users are increasingly using strange illegal methods and gears.

And while these have also increased catching and trading in immature fish,  harmonising all agencies in enforcement for all partner states has become a nightmare, he said.

Fisheries situation in Uganda:

Lake Victoria partner states currently have different standards. This is true especially after Uganda in November 2015, suspended all operations of Fisheries Officers, Beach Management Units (BMUs) and police - these are pending reforms.

But prior to this there was harmony as fisheries management in Uganda, Kenya and Tanzania was on a single spine command as by 2004, co-management, BMUs and other institutions were in place and harmonised.

However, in Uganda, with time these did not function well as parallel and uncoordinated enforcement systems and officers emerged who pushed the technical officers and BMUs to the side lines thus causing a gap for fisheries illegalities to escalate.

In 2015, Uganda's suspension of BMUs was announced by President Yoweri Museveni who also issued a directive requiring fisheries to form a Fish Protection Unit (FPU) led by an officer from the Presidents office. To that effect a Memorandum of Understanding (MoU) was prepared and in the long run the Fish Bill incorporating reforms will be passed.

BMUs helped to; improve sanitation to meet Fish Quality Assurance and safety requirements, maintain and update registers of BMUs and vet fishers to be licensed, provide fisheries catch and marketing data, implement fisheries regulations and management measures at landing sites as well as develop local fisheries management plans.

Museveni also directed that special courts for fisheries be introduced. He abolished importation of fishing gears and announced imprisonment of 7 years for fisheries offenders. According to Okware, after Museveni's announcement over 300 illegal gears were impounded in 2015/2016.

In the meantime, only 0.3% vessels are licensed in Uganda waters, however, if all vessels were licensed and a formidable enforcement was in place, Uganda would collect Ushs 5 billion annually.

Godfrey Monor, the executive secretary LVFO said it was awkward that only 0.3 vessels are licensed by Uganda because it creates a situation of ‘free for all’ which is not healthy for an ecosystem.

But the meeting heard that licensing in Uganda is also used as a management tool, more like, the less the licensing the more the fish stocks will grow.

Uganda has also introduced a mobile licensing system and TradeMark East Africa will soon train fisheries people on e-licensing system.

Kenya and Tanzania Monitoring, Control and Surveillance status report;

In the Kenya waters, according to the 2016 frame survey, gill-nets increased by 2% from 188,984 in 2014 to 192,987 in 2016 of these about 40% are undersize or illegal; monofilaments increased from 58 in 2004 to 20,842 in 2016; beach seines increased by 24% from 724 in 2014 to 901 in 2016.

The number of fishers increased by 9% from 40,133 in 2014 to 43,799 in 2016; boats increased by 7% from 13,402 in 2014 to 14365 in 2016. Over 300 illegal gears were impounded in 2015/2016 and Kenya fisheries are in the process of boat registration to give specific identities to crafts for licensing to commence.

This comes at the backdrop that Kenya since the inception of the devolved system of governance no meaningful MCS has been done as well there is little information exchange between counties and national governments.

Meanwhile, Tanzania has the highest MCS activities compared to Uganda and Kenya on Lake Victoria. For instance for the period January 2016 to March 2017, Tanzania patrols resulted into confiscation of 19,250 beach seines, 3,171 undersize gill-nets, 9,459 monofilaments, 44 dagaa nets, 84,140 kgs of immature fish and apprehension of 777 culprits.

In Tanzania, fishing vessel licensing is done by a competent authority in collaboration with BMUs. According to the frame survey report 2016, the total number of fishing crafts operating in Tanzanian waters were 31,773.

A total of 18,452 or 58.07% of the total Fishing Crafts are registered and licensed, the highest number on Lake Victoria.

Way forward for MCS on Lake Victoria;


The meeting heard that inspite of all activities including joint regional patrols by partners states on Lake Victoria there is increased illegal fishing as well as catching and trading in immature fish.

Susan Imende deputy Director at Ministry of Fisheries Development Kenya said fisheries managers have to think ‘outside the box’ as illegal users are ahead of them, which is pushing down fish stocks and while joint regional patrols could be effective and are a normal procedure the arrested fishers say they are being harassed.

Samson Abura the LVFO Communication Director said this time it should be ‘ business unusual’ and suggested a data base for MCS operations and IUUs to be set up as well as a good plan to show partner governments what is being done.

However, Monor from LVFO was skeptical about sustainability and if suggested activities would create any change. “We have done many activities but get the same results. We shall first increase the appetite of illegal fisheries but what happens after November?,” he asked after the EU funds are used up.

“This is like a ‘knee jack reaction’ because the funds are available. Will it be sustainable and have effective outcomes?” wondered Monor.

ends

Tuesday, March 21, 2017

Government can cheaply realise girls pads pledge

By Esther Nakkazi

When he was campaigning for re-election of Uganda’s top job in 2015, candidate Yoweri Museveni promised free sanitary pads for all school girls under the Universal Primary and Secondary Education (UPE/USE) programs that were started by his party, the National Resistance Movement (NRM).

It was an election pledge he made while on his forth leg of the campaign trail in northern Uganda. “Girls should not have to run away from school because they are embarrassed. We will get them what to use,” said Museveni. But he has not made good on this campaign promise.

He was re-elected in 2016 and he named his wife Janet Kataaha Museveni on the new cabinet as the minister of education and sports who in her capacity is supposed to make this happen.

But now a year later, Mrs. Museveni stunned the nation while speaking to the parliament education committee when she honestly said there are no funds to provide free sanitary pads.

I think the incident would have largely passed as any parliament news item until Dr. Stella Nyanzi  put out a provocative post that rocketed around the internet.

Nyanzi said her own mother provided her with ‘Lilia’ pads to protect her dignity and hygiene meanwhile of Mrs. Museveni who asked parliamentarians to understand that there is no funding, she   dismissed as ‘no mother to the nation’.

“I should visit her without protection during my next menstruation period, sit in her spotless sofas and arise after staining her soul with my menstrual blood! That will be my peaceful demonstration in solidarity with Uganda’s poor adolescent girls,” Stella wrote.

Her demonstration continued with setting up a ‘gofundme’ and an online campaign for free pads. In the schools were she has been girls received free pads while singing and dancing to Stella’s self composed ‘pad lyrics’ which goes like “I have a pad.… I put it here.. I pepeya.”

The Ministry of education has since put out a circular not to allow Nyanzi and activists into government aided schools. Private schools are also monitored.

In my opinion, Nyanzi has given menstrual hygiene visibility. Many people may not like her choice of words but at least the message was sent home and hopefully government will full-fill its pledge.

It is true that candidates may make promises to the public to win over votes but in his case, Museveni was an incumbent and knew that forking out Ush16bn annually to provide free pads was unsustainable but a promise is a promise so let him manoeuvre.

Well, menstrual hygiene management was our topic of discussion at the 18th science café organised by the Health Journalists Network in Uganda (HEJNU) in partnership with Reach A Hand and supported by UNFPA Uganda.

In our discussion at the café we talked about the need to emphasise hygiene while talking about menstruation. I like what Nyanzi wrote; “My mother provided pads in order to protect my dignity and hygiene. I excelled at school although I was a menstruating girl.”

To emphasise it further, Dr Edson Muhwezi, the country Assistant Representative UNFPA said it should not only be the aspect of the pad but also the soap, availability of water and education.

A typical girl without access to modern pads lives in a rural setting, sleeps on the floor, for her it is a taboo to talk about pads in public, she uses a cloth which she washes and cannot even dry in direct sunlight. So it dries but not thoroughly and thus has moulds which cause candida and itching. That is unhygienic.

She is also afraid to go to school and will be absent. Studies have shown that early pregnancy and menstrual hygiene are leading causes of school dropout for girls. A study conducted by IRC and SNV in 2012 estimated that close to 4 million Ugandan girls live without proper sanitary care. As a result, 1 out of 10 girls skips school or drops out entirely due to a lack of menstrual hygiene.

Godfrey Walakira from the youth organisation, Straight Talk Foundation told journalists at the café that it was important to make boys and fathers part of the menstrual hygiene conversation. For isn’t it boys who tease the girls and also make it impossible for them to go to school? While fathers buy pads for their daughters.

Another idea Walakira proposed was to include pads as a mandatory on school items for all girls. After all they ask for all sorts of things; cement, brooms, razor blades, beds, basins.. This should be in the short term as Museveni manoeuvres to fullfill his pledge.

When girls have sanitary wear they are empowered psychologically and they gain self confidence said Sophia Grinvalds, the Founder and Director, AFRIpads (U) Ltd.

They also create equal opportunities for the girls. Let us do the maths. A school term has three months, for each month a girl experiences menstruation for one week. Without pads the girl will miss school for 3 weeks in a term totalling a month of the school term. How then do you expect her to compete with boys?

Even if the government does not offer expensive pads there are cheap alternatives like the Ugandan-made Makapads and AFRIpads which are also reusable and their deluxe kit of 4 pads which costs Ushs 16,000 can be used for a year and the test kit of two pads costs 6,500.

The Afripads are thus durable, cost effective, logistically easy to distribute, ultra absorbent and made of fabric so no burning or itching effect, eco-friendly since they do not require regular disposal and a perfect solution for menstrual hygiene, explained Grinvalds. Many girls are using these in refugee settlements.

So since there are cheaper alternatives which are sustainable surely government can full fill its pledge. It is a good gesture that translates to democracy too. Dr. Muhwezi said non profits shall continue to do their part because at the moment UNFPA has partnered with AFRIpads and Straight Talk Foundation to distribute free pads but it is a concerted effort.

With government as a player in menstrual hygiene, better, broader and faster outcomes for the girl child will be realised. Menstrual hygiene management will be a priority and institutionalised in Uganda. That is not so difficult come on!

Thursday, March 9, 2017

African Media Can Move Beyond Risk in Biotech Reporting

By Esther Nakkazi

An image of an injection into a juicy tomato 'tomato syringe' or a huge cabbage with an elephant body are the most common illustrations used by the media on biotechnology stories.

Its dramatic, catchy, appealing and all about ‘hey-stop-pay-attention’ but can also be the opposite.

So the cabbage can have an elephant gene, yes it can because basically biotechnology involves movement of genes of interest.

These illustrations depicting biotechnology were first published in 2000 and have persisted much to the frustration of scientists, science communicators and not-for-profit organisations like ISAAA or the International Service for the Acquisition of Agri-Biotech Application which continuously tracks such stories and images.

“It gives the impression that scientists are injecting things into crops which creates fear, anxiety, outage and mistrust,” said Dr. Margaret Karembu an environmental scientists from ISAAA who said they have even written to the media houses that continue to use these illustrations to no avail.

She was speaking to media practitioners at a COMESA/ACTESA communication training on biotechnology and biosafety held in Addis Ababa, Ethiopia from 7th to 9th March 2017.

I can best describe it as the media wanting to keep biotech dramatic pictures, illustrations and stories while scientists want facts only. The India suicide story of BT cotton still continues to make rounds alarming people in African and not much is done to explain that these happened due to borrowers failing to pay their debts and it was thoroughly investigated.

The groups on either side of the debate are not very helpful as each feed exaggerated messages to the media that is not well trained. But Dr. Karembu maintains that even those pulling these technologies downward or disagree should argue from an informed point of view.

For the African media, of course minus South Africa, which is ahead of the pack in biotechnology, this reporting might be inevitable. After all, uptake of the technology is at snail-speed. The media can only move in tandem with upcoming laws and research as well skeptics seem to override the contest with the limited public knowledge.

But Dr. Karembu is still unhappy that the African media still depicts biotech as a foreign technology, that those illustrations show monsters trying to dump things in Africa yet more and more African scientists have been trained on biotechnology.

With this pool of trained African scientists, however, a few try to preach the biotech gospel some get disappointed after spending long hours with reporters only to get foot notes in controversial stories.

Biotech stories have to compete and if not relegated to science pages or publications are used as fillers in daily media. Writing them as ‘she-said-he-said’ without much analysis and investigation does not make them popular either.

ISAAA has noted that the African media continues to hype the risk factor alarming publics and not explaining the technology enough. I must say going beyond portraying biotech as a myth, mystery, superstition will take a while for the African media just as interchanging the terms GMOs and biotechnology continues.

Dr. Getachew Belay a plant breeder from COMESA/ACTESA says the word ‘hazard’ makes him uncomfortable in African biotech stories but how risk is overplayed and perpetually communicated remains bizarre to him. All technologies have risks and benefits - the balancing of the two sides alludes the media.

Biotechnology may be used in various industries including pharmaceuticals, but it is particularly controversial in agriculture because it is what we eat. That not withstanding it is a highly regulated technology with rigorous safety assessment.

It does not help that biotech terminologies have no local language translations yet community radios keep mushrooming everywhere in Africa and the farmers tune. But ISAAA has scientists who have been trying to define and find local dialect meaning for biotech terms.

But this it is not as fast as how science is developing and whose work is it anyway? “ You need a strategic approach,” said Dr. Karembu who links these stories to the African victim mentality, which delays grabbing of opportunity and fails to separate politics from technical issues.

“Encourage more of dialogue than debate. Shed off that mentality so you are not victims of the technology,” she said but it easier said than done and especially with writing biotech.

Nixon Ngang’a a science editor at Citizen Television and biotech media trainer said he would still use the illustrations to catch the attention of a six year old and his grandmother. Isn’t that what communication is all about anyway - visual attraction.

But he is quick to defend using these images. ‘It is not malicious. We want to catch attention of the audience,” he said.

I must also say that the narrative is changing albeit gradually. The African media has come a long way in reporting biotech. It is improving as some journalists exclusively becoming science journalists like me but the biotech trainings remain are far in between and some scientists remain media shy.

But we shall get there as the pool of more African journalists and trained on biotech and better pictures and illustrations are made available.
ends

Thursday, February 23, 2017

From Village to Community Health Workers Uganda hopes to achieve health SDGs

By Esther Nakkazi

Uganda had an outbreak of Ebola Hemorrhagic Fever in 2000, there were deaths but it was also largely contained. At the time the Director General at the Ministry of Health was Prof Francis Omaswa.

Using this example at the first international symposium on community health workers ongoing in Kampala, Omaswa said what helped to not turn the outbreak into a catastrophic event like what happened in west Africa was among others village health workers.

Communities listened to village health workers who helped to disseminate information but the most important ingredient here was trust.

For 16 years now, Uganda has engaged Village Health Teams (VHTs) but it will this financial year 2016/ ending June 2017 switch to Community Health Extension Workers or the CHEW strategy.

The symposium is convened by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda. Dr. David Musoke is the symposium chair and its theme is community health workers and  their contribution towards Sustainable Development Goals (SDGs).

Switch from VHT to CHEW strategy;

There is no doubt as to the positive contribution towards promotion of health, community mobilisation and helping to contain disease outbreaks made by VHTs in Uganda. But 16 years after their existence, 75% of the disease burden in Uganda, which is preventable persists and the top 10 killers are still the same.

So could it be that the VHTs strategy is wrong, was it a 'cut and paste' or it just needs an overhaul? Well, the government is now moving to the CHEW strategy. This does not mean that VHTs will disappear, no they won’t.

VHTs will remain with their role of community mobilisation and some will be absorbed into the CHEW system said Dr. Christopher Oleke at the health workers symposium.

Currently, Uganda has 180,000 VHTs working as volunteers but only 60,000 have been trained. With lack of monitoring, supervision and accountability these have been engaged in an unharmonised and uncoordinated structure.

One of the challenges with VHTs has been the supporting partners who have been messy as each trains their own VHT. Imagine this scenario; in one parish a partner trains a VHT to distribute bednets and check for malaria, another one is trained to preach nutritious feeding, one looks out for pregnancy problems, another is trained to encourage delivery in health centres etc.

So the interventions are not bad and by the way they have produced some visible results as in the case of Kanungu district in south Western Uganda where they have improved maternal and new born health outcomes but the governance and lack of leadership among supporting partners has created chaos rather than progress.

You cannot blame partners entirely, the voluntary role can carry only so much responsibilities. But some VHTs are working 7 days a week for long hours and are untrained.

So Uganda wants to fix it. The CHEW strategy will engage only 15,000 health workers. They have to be between 18-35 years and with a minimum education to qualify. They will be paid a salary by the government and get regular training. Their roles will be defined among them conducting baseline and other important surveys.

As Prof Francis Omaswa put it, ‘they should not be the big doctors in the villages’, anymore so they will be monitored, supervised and supported through a proper governance structure. “They should not be left in isolation,” he cautioned.

But most importantly, the CHEWs will 'reorient' the minds of Ugandans towards healthy living. How? According to Dr. Oleke many Ugandans think that having medicines in health facilities and doctors equals to good health.

The CHEWs will focus on the household as a totality promoting good hygiene, standard health practices like immunisation and most of all promote the use of less alcohol which is causing Ugandans numerous health issues said Dr. Oleke.

They will also play an important role of registering all pregnant women and new borns electronically who will be followed through the system - that way Uganda hopes to improve the mother and new- born well being.

The CHEW strategy will have a strong monitoring, supervisory, accountability and will be under a harmonised structure said Dr. Oleke.

Innovative financing for health workers;

But there are cautionary voices and suggestions before the roll out begins this financial year. Dr. Elizabeth Ekirapa from the School of Public Health warned this should not create a parallel administrative structure instead they should be integrated within the national health care system.

Ekirapa also said the CHEW strategy should be sustainable and be home grown or customised to Uganda. It copies a lot from Ghana and Ethiopia CHEWs.

Dr. Patrick Kadama from ACHEST was concerned about the financing structure, which if not well thought out might distort equity. It comes amidst Uganda trying to create a national social health care insurance scheme and other tax based systems.

Dr. Kadama also thinks the CHEW strategy implementers should ensure good returns on the investment thus a specific investment case should be done before roll out. They should also ensure that the CHEWs boost primary health care.

Concurring with everyone else he said the CHEWs should work in tandem and in sync within a defined national health care system - read - ‘not in isolation’ and the roll out should be gradual. Talk about the best of the best but let us wait for implementation. 

ends

Tuesday, February 21, 2017

Who should try accused health workers?

By Esther Nakkazi

Ugandan health workers are fighting back. As cases of what the public view as health workers negligence build up, most of them end up detained in police cells and tried by public courts.

Today the Executive Director for African Centre for Global Health and Social Transformation (ACHEST) Prof. Francis Omaswa said enough of the police officers interference and trials in public courts for Uganda health workers.

“It is wrong to arrest health workers and detain them at police stations,” Omaswa said to which we got a loud applause at the first International symposium on community health workers held in Kampala, Uganda.

The theme is contribution of community health workers in attainment of the Sustainable Development Goals (SDGs) convened by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda.

He said doctors and nurses who commit offences should be tried by their respective professional governing bodies.

In this case the Uganda Medical and Dental Practitioners Council (UMDPC) responsible for licensing, monitoring and regulating the practice of medicine and dentistry for doctors and the Uganda Nurses and Midwives Council (UNMC).

Omaswa has a point after all armed forces accused of offences are court-martialled. Justice is dispensed by their own.

The reasoning could be that people who have no knowledge of the challenges and proceedings in an operation theatre have no business questioning and detaining an accused doctor whose patient has died on the table.

These cases now have a trend in Uganda. Usually, a patient whose case will be viewed as ‘non fatal’ by the concerned parties, such as a pregnancy will report to a health facility. The health workers will demand a fee, a pricey drug not available at the facility or even tell the patients to wait for a senior doctor.

Time is of the essence here. While demands are being made, the patient needs attention and by the time whatever is demanded is availed and the patient is taken to theatre or given treatment, it is the apex of an emergency. A life or two are lost.

With the health system clearly lacking some health workers find themselves in a tight corner inspite of every effort they put in to save lives. So the larger thinking would be to blame the system.

“The best way to manage a system is not to blame an individual,” said Omaswa. Quoting the law, Omaswa who is celebrated as the most efficient Director General at Uganda's Ministry of Health and is remembered for the phrase 'health is made at home and repaired in hospitals' said the Ministry should be led by a technical person and it should not have both a director general and a permanent secretary because it duplicates roles and wastes resources.

While Prof. Omaswa clearly makes a valid point, the larger public has no knowledge of the authorities in charge of accused health workers nor the governing bodies, UMDPC and UNMC, so their immediate action is to go to police.

It also does not help if in some cases the health workers put money ahead of saving lives to which they swear the hippocratic oath. To show that justice is attainable, the health workers governing bodies need to create awareness and show that they can indeed punish those found guilty.

There is a proverb in Uganda which says a person does not just die. The translation is that there is always someone to be blamed for a death.

The public will never understand the system nor medicine but if they for sure suspect that a life could have been saved their only option will be to turn to police for justice!

Tuesday, February 14, 2017

Abortions decline in Uganda; it could cut maternal deaths

By Esther Nakkazi

Uganda is gaining positive results in saving the mother with a decline in the rate of abortions a new  study by U.S based Guttmacher Institute and Makerere University indicates.

Over a decade, the number of women aged 15–49 years who carried out abortions in Uganda declined to 39 abortions per 1,000 women in 2013 from 51 in 2003. This in tandem reduced the annual hospitalisation rate for complications in the same age group to 12 per 1,000 women from 15 over the same period.

Naturally, less abortions would translate to less maternal deaths in Uganda, which are caused by four major preventable factors; unsafe abortions, haemorrhage, hypertension and sepsis.

According to a press release from the Institute, the study also found that 93,300 women were treated across the country for complications from unsafe procedures. Abortion is illegal in Uganda but the law allows it to save a woman’s life.

The 2012 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights permit abortion under additional circumstances—including in cases of fetal anomaly, rape and incest, or if the woman is HIV positive—in practice, legal abortion is both difficult to obtain and to provide.

The country’s abortion laws and policies are inconsistently interpreted by law enforcement officials and the judicial system, and many providers and women remain unaware of the circumstances under which abortion is legal. As a result, most abortions in Uganda are clandestine procedures, which are often unsafe.

“Close to one third of Ugandan women who have abortions each year are treated in health facilities for complications resulting from unsafe procedures, and many other women who experience complications do not get the care they need,” says Elena Prada, consultant with the Guttmacher Institute and the study’s lead author.

“Notwithstanding the Ugandan government’s efforts to improve postabortion care services, stigma and fear of mistreatment are significant barriers for many women in need of these services.”

Over 50% Ugandan women still have unintended pregnancies:

The study also produced new pregnancy estimates, finding that 52% of all pregnancies in Uganda in 2013 were unintended and about a quarter of these unintended pregnancies nationally ended in abortion.

Given that most abortions result from unintended pregnancies, improving family planning services is critical to reducing the incidence of unsafe abortion.

The high proportion of unintended pregnancies reflects the finding that among women of reproductive age, 38% of married women and 45% of unmarried sexually active women had an unmet need for modern contraception in 2011.

“Despite some gains in modern contraceptive use over the past decade, unmet need for contraception in Uganda remains high and must be addressed by improved family planning services,” says Professor Christopher Garimoi Orach, head of the department of community health at Makerere University’s School of Public Health and a study coauthor.

“For example, integrating comprehensive contraceptive counseling into all postabortion care visits can be a powerful intervention to help women avoid future unintended pregnancies.”

The study’s authors recommend efforts to expand existing postabortion care services to ensure that all women with abortion complications are able to get the care they need, particularly in rural areas.

In particular, contraceptive counseling should be strengthened to address high rates of method discontinuation and women’s concerns about side effects. The authors emphasize that counseling must acknowledge the challenges women experience and provide accurate information on the side effects of different methods.

Further, they recommend that family planning services provide a full range of modern contraceptive methods, including long-acting reversible methods such as IUDs and implants, so women can choose whichever method works best for them.

Finally, the researchers suggest clarifying and raising awareness of existing laws and policies on abortion in Uganda among the medical community, the judicial system and women.

Every woman who meets the criteria for a legal abortion should be able to obtain a safe procedure at an affordable cost from a trained health care provider.

Wednesday, January 11, 2017

Zika re-enters Africa as encroachers take over its forest habitat in Uganda

By Esther Nakkazi

The Zika virus has re-surfaced in Africa through Angola. As we all know, Zika was first discovered in Uganda in 1947.

Unfortunately, as it resurfaces in Africa, the Zika forest where it was first identified in Africa is just a few decimals, most of it destroyed by encroachers who feel high rise buildings are much more important than a habitat for mosquitoes species and wildlife.

According to Angolan health officials the country's first two cases of the Zika virus, a French tourist and a resident in the capital Luanda, says AFP.

Since 2015, when the outbreak started more than 1.5 million people have been infected with Zika, mainly in Brazil, and more than 1,600 babies have been born with microcephaly, according to the World Health Organisation.

But in Uganda, the Zika virus, which takes its name from ‘Ziika' - the name has always been misspelt - a forest on the shores of one of Africa’s biggest fresh water lakes, Lake Victoria, where researchers caught the mosquito, isolated the disease and have since kept surveillance, the forest is almost gone.

We can say the researchers at the Uganda Virus Research Institute (UVRI) did a good job and continue to do so. They continue to do research, experiments and monitor the mosquito species in the Zika forest and the whole country.

Continuous monitoring and surveillance means Uganda, which is a biodiversity hotspot with some of the world's most virulent pathogenesis on top of its game of controlling diseases.  

Only to be let down by environmentalists who are oblivious of its importance and thus do not advocate for its conservation and the Wakiso land board who continue to sell part of the zika forest land to big shots with no care at all.

UVRI as a research entity was given a piece of the forest (30 acres) for research but from it 10 acres has been allocated to ‘developers’ by the Wakiso Land board, which of course is under the larger Uganda Ministry of Lands, Housing and Urban development.

The researchers efforts to keep the land for its rightful use has fallen on deaf ears.

Recently, Madame Stephanie Rivoal, the French Ambassador to Uganda visited the Ziika forest and almost cried. She thought Ugandans have not heard of the term ‘conservation’ as she saw hundreds of cut trees, numerous construction sites and encroachers.

By the end of her walk thorough the forest reserve accompanied by Erik Orsenna, -also the ambassador of the Pasteur Research Institute in France-a politician, novelist and Nobel Peace Prize contender their energy and enthusiasm was deflated by the depletion.

The Zika forest still houses wildlife especially monkeys and a number of mosquito species like the Aedes Aegypti and Africanus in the forest.

Dr. Julius Lutwama, who heads emerging and re-emerging infections at UVRI warned that if this wildlife habitat is destroyed the mosquitoes could also have capacity to mutate and adapt. What would we expect anyway if there usual prey is eliminated?