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Monday, August 21, 2017

Uganda trains coffee stakeholders ahead of first ever auction

By Esther Nakkazi

Ahead of the annual coffee 'Taste of Harvest' competition and Uganda's first ever coffee auction to be held 22 to 26 January 2018, the Uganda Coffee Development Authority, (UCDA) in partnership with the African Fine Coffees Association (AFCA) will provide specialty coffee training.

A three-day training for 20  coffee producers, exporters, processors and roasters in Uganda at Hotel Africana beginning tomorrow, August 22, and will be conducted by UCDA’s highly skilled quality and promotions staff in collaboration with AFCA. 

The training will provide participants with the skills to prepare and process high quality specialty coffee beans and enable them to prepare to participate in the Taste of Harvest (TOH) competition, said Mr. Edmund Kananura, Director Quality and Regulatory Services.

The training will highlight the benefits of the 'Taste of Harvest' competition and Auction as well as provide skills on how to prepare and process high quality specialty coffee beans. As well it will include improved coffee processing practices and proper use and handling of coffee equipment and drying materials, as well as quality management to ensure efficiency and consistency of coffee, said a statement from UCDA.

The training will be conducted with grant support from the American people through the USAID/East Africa Trade and Investment Hub. The USAID East Africa Trade and Investment Hub works to boost trade and investment with and within East Africa.

The 'Taste of Harvest' annual competition will be held alongside the first ever coffee Auction Uganda, at the Uganda Coffee Development Authority Quality Lab in Lugogo, Kampala, under the theme, “Accessing specialty coffee markets through the new Taste of Harvest Coffee Auction System” from 22nd to 26th January 2018.

At the competition, interested farmers submit their best coffee samples for grading. The grading of coffee is determined by specialists known as Q and R graders.

Coffee that scores above 80 is considered to be a specialty coffee and automatically attract good market and even better prices. The competition therefore serves to show that good practices can benefit farmers, said a UCDA statement.

As part of its mandate, UCDA regularly trains farmers across the country to produce quality coffee through good handling practices. As a result there are areas which do produce high quality coffees such as in Kanungu, Sipi, Iganga and Luwero.

Ugandan coffee in general has great taste. It is just a matter of handling it the right way. Farmers must work hard to get more and better quality coffee across the board.

UCDA is excited about the opportunities that the auction and competition will bring to Uganda’s coffee industry, said a statement from UCDA. "Through these two events, producers of high quality coffees, including smallholder coffee farmers, will access new markets and create an international brand for their coffees. UCDA is pleased to be working with AFCA to achieve this reality for Ugandan farmers."

Uganda Coffee Development Authority is mandated to promote and oversee the coffee industry through supporting research, promoting production, controlling coffee quality and improving the marketing of coffee in order to optimize foreign exchange earnings for the country and payments to the farmers.

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Increased male circumcision does not mean Uganda will meet its target

By Esther Nakkazi

The latest 2016 Uganda Population HIV Impact Assessment (UPHIA) survey includes much to celebrate. The proportion of men aged 15-49 years that are circumcised increased from 26% in 2011 to 43% in this survey.

"This is good progress which must be lauded," said Angelo Kaggwa Katumba program officer at AVAC. "Question is, is this pace fast enough for Uganda to achieve its Voluntary Medical Male Circumcision (VMMC) targets?"

It has been documented that between 2010 to 2016, the total number of VMMCs performed in Uganda increased from 9,052 to more than 3.4 million. However, an estimated 4.2 million men and boys between the age of 10-49 years remain uncircumcised.

In terms of funding, U.S President's Emergency Plan for AIDS Relief (PEPFAR) continues to be the principal donor for VMMC – supporting about 85% of all circumcisions during this period.

"If it has taken us 6 years to circumcise 3.4 million men then definitely its going to be tricky reaching the 4.2 million uncircumcised men by 2020 and given that Uganda's targets are used to meet the global targets this is going to impact on the global performance," said Kenneth Mwehonge -Program Officer- Advocacy & Networking Coalition for Health Promotion and Social Development (HEPS Uganda).

The report shows that the proportion of men circumcised ranges from 14% in Mid Northern region to 69% in Mid-Eastern region. The prevalence of male circumcision was highest among young people l5-29 years at over 45%.

It also shows that about 6% of of Uganda's adult population aged 15-49 years in Uganda are living with HIV. Among children under five and 5- 14 years, HIV prevalence is 0.5%. Based on the survey results, the total number of adults and children of all ages living with HIV in Uganda is estimated to be approximately 1.3million.

The 2016 UPHIA, is a nationwide survey that was conducted to provide estimates of HIV incidence, HIV prevalence, viral load suppression, syphilis, hepatitisB infection, and other important HIV/AIDS programme indicators. 

Data were collected in all districts of the country from a sample of households that are representative of the Ugandan population. The survey was conducted from August 2016 to March 2017 from 12,483 households and achieved very high participation rates of over 95% for both interviews and blood draws.

A total of 16,670 women and 12,354 men aged 15-64 years were interviewed and tested for HIV, syphilis and hepatitisB. In addition, 10,345 children aged 0-14years were tested, including 6,527 aged, 0-4years and 3,818 aged 5-14 years. 

The 2016 UPHIA was led by the Government of Uganda and conducted by the Ministry of Health in collaboration with ICAP at the Columbia University. Funding for the survey was provided by the U.S President's Emergency Plan for AIDS Relief . 

Technical assistance was by the U. S Center for Disease Control and Prevention (CDC) other collaborating partners included Uganda Virus Research Institute, Uganda Bureau of Statistics, WHO and UNAIDS. 

In the survey results released on 17th August, adult HIV prevalence was found higher among women at 7.5% compared to 4.3% among men. The HIV prevalence among young people 15-24 years was 2.1% (0.8% in men and, 3.3% among women). 

Among adults, HIV prevalence is lowest in those 15-19 years and highest among men aged 45 to 49 years at 14%. Among women, HIV prevalence is highest in the age groups of 35 to 39 years and 45 to 49 years at 12.9% and 12.8% respectively. 

"Let us first first salute everyone involved in the fight against HIV as there is something to celebrate in terms of the general HIV prevalence in Uganda, however when we dis-aggregate data, we realize that there is a significant increase of prevalence among certain categories of people like adolescents, young girls and women," said Mwehonge.

It was also higher among residents of urban areas at 7.1% compared to 5.5% in rural areas.  There was also differing magnitude depending on the geographical region from 2.8% in West Nile, 3.4% in North East region, 4.4% in East Central(or Busoga region); 4.8% in Mid-East region; 5.5% in Mid-West region. 

The survey found HIV prevalence was higher in urban areas at 6.6% in Kampala; 7.4% in Central 2 (Greater Mubende, Luwero and Mukono); 7.6% in central region (greater Masaka) to 7.7% in south Western region. This is similar to the findings of the 2011 Uganda AIDS Indicator Survey (UAIS) when Mid-Eastern showed the lowest and Central the highest estimated HIV prevalence, a press statement from the Ministry of Health said.

The 2011 UgandaAIDS Indicator Survey estimated national HIV prevalence among adults at 7.3% compared to 6.0% in the 2016 UPHIA. Among women and men, HIV prevalence declined from 8.3% and 6.1% in 2011 to 7.5% and 4.3% in 2016 respectively.

In urban areas, it declined from 8.7% to 7.1%, while in rural areas it fell from 7.0% to 5.5%. These declines in HIV prevalence may be due to a decreasing number of new infections in recent years due to the impact of the intensified HIV prevention and treatment services in the country.
 
The 2016 UPHIA also established the rates undetectable virus or suppressed HIV viral load(VLS). UPHIA showed that adults age 15-49 years had a VLS of 57.4%. This finding shows that with support from development partners such as PEPFAR, the Global Fund and other programs, the Government of Uganda's HfV programme is having an impact and making great progress toward the UNAIDS and national goal of having population level VLS of at least 73% by 2020.

Data from UPHIA identified existing gaps in HIV programmes and specific populations that need special focus. For instance, HIV prevalence the 15-19 year olds was 1.1% (1.8%in girls and 0.5% in boys) there was an increase to 3.3% among those aged 20-24 years (5.1% in young women and 1.3% in young men) which suggests that new infections remain an issue in these age groups said the Ministry of Health statement.

"This continuing infection risk necessitates innovative interventions to prevent new infections in young people beginning around age 20."

Furthermore, women 15-24 and men under 35 years of age who are living with HIV have rates of VLS <500h. 'These lower rates of VLS are driven by younger people being unaware of their HIV status and not accessing available services. Interventions are needed to ensure young people know their statusand if HIV positive are linked to care.

UPHIA also established the magnitude of syphilis and hepatitisB infection in the general population. The prevalence of active syphilis among adults aged 15- 49 years was l.9% (2% among women and 1.8% among men).This was similar to the findings in 2011, in which the prevalence of syphilis was l.8%. 

The prevalence of active hepatitisB infection among adults was 4.3% (5.6% among men and 3.l% among women). HepatitisB prevalence was highest in the Northern Region, Mid North(4.6%), followed by North East(4.4%), and WestNile (3.S%).

HepatitisB infectionwaslower in the rest of the country with a range of 0.8% in the South West region to 2.7% in East Central Region. The preliminary results of 2016 UPHIA demonstrate that Uganda has made significant progress in the national HIV as HIV prevalence has declined across socio-demographic subgroups and across the country.

"This decline may be a result of falling new HIV infections. Furthermore, almost 60%of people living with HIV (PLHIV) have undetectable HIV, which means that treatment programs are successfully reaching the majority of the population with HIV," said the MoH statement. But there needs to be more  prevention awareness creation and treatment is needed for those 15-29 years.

"Moving forward, the PHIA results demonstrate the urgent need to prioritize and fast track the roll-out of high impact interventions if we are to meet the global set targets and achieve epidemic control," said Mwehonge.

"There is need for innovative approaches to reach the 4.2m men by 2020 especially the men between 45-49 years whose HIV prevelance was reported at 14%," Sylvia Nakasi, Policy and Advocacy Officer, Uganda Network of AIDS Service Organisations (UNASO).

"With the launch of the Presidential Fast Track Intiative to end HIV by 2030 in June 2017 by the President,  I hope there is an opportunity to increase investment in prevention and care interventions among vulnerable populations. With this pronouncement its an opportunity to advocacte and hold our leadership accountable," concluded Nakasi.

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Friday, August 11, 2017

Media Role in Africa Research

The New Vision Letter's page reaction to sperm count article 
The New Vision cartoon on the sperm count article








































By Esther Nakkazi 

On July 31st we published a news release from a paper published in the African Health sciences journal.

I and a team from the journal as well as Bernard Appiah based at Texas A&M now volunteer to do this for some of the exciting papers published in this journal. It helps that is is open access. 

I help further do the dissemination because of my contacts most of whom I got from my work with the World Federation of Science journalists. 

And I immediately put it out on my blog this one - it has a few eyeballs, 56 today, compared to my other posts, which make it to over 100+ instantly. 

We went into this mode after I met most of these people at a 'building the bridges' 26-28th April, workshop in Kampala that was sponsored by the US National Library of Medicine with partners like Association of Health Care Journalists, Partnerships in Health Information (Phi) and the Alfred Friendly Press Partners.

We are all volunteers in this so we help each other out without really meeting physically. All of us are busy! But what we really aim to achieve is to help Africans appreciate research,  so I think the letter and the cartoon ↑- I didn't add the article written by the New Vision yet -but I will- its offline,  are just a good start to have this conversation. 

We also want African researchers and scientists to be seen not only in 'peer reviewed journals'  but also by their own African media. Maybe, that will improve the way Africans view research and ultimately African governments will fund research more. What they put in now is just peanuts. Africans will do research with their own agenda we hope. That will be super. I am just thinking aloud!

So here below I highlight the author and co-author's reaction and some people just called me to express themselves about the article. 

Uchenna I Nwagha, Professor of Obstetric Biology and Reproductive Medicine, Department of Obstetrics and Gynecology/Physiology College of Medicine, University of Nigeria, Enugu Campus (co-author of the paper). This is reaction to the letter published in The New Vision by Patrck Odongo

I am happy with the controversy generated by this topic. We performed a systematic review of the studies available at our disposal since we did not get any RCT on the subject matter in the African population.

We are aware that our conclusions do not provide a grade A evidence but at least, it provided some epidemiological evidence. It is thus not right for Paul Odongo to dismiss our findings just like that considering the peculiar socio-economic characteristics of the study population.

We are very much aware that it is only a systematic review and meta-analysis with RCT, which give the highest degree of evidence. However, we did not find any RCT but used epidemiological studies to raise the alarm

Even case reports or expert opinions are not dismissed in scientific circles as they too provide some degree of evidence for a new situation or escalation of an existing problem. I know that most people have encountered this situation in their day to day clinical practice but have been unable to put them down due to the lack of writing culture. We worked with what was available, followed strict guidelines, and came up with some evidence, which is a cause for worry.

One researcher called me to ask why the paper did not talk about sperm quality. He said it is not the the count but the quality that matters. Here is Dr Pallav Sengupta, the head of Physiology Unit, Faculty of Medicine, Lincoln University College, Malaysia reaction. He was the principal investigator and I sent that concern to him.

Our report is on sperm count only, not semen quality. Semen quality includes four parameters: semen volume, sperm count, sperm morphology and sperm motility. Our report is not describing changes in other parameters, it is entirely concerned on sperm count changes.

This newspaper report is describing some weaknesses of this study. We appreciate it. It will definitely help us to improve the quality of our future articles.

We are patting ourselves on the back as we await more comments and as we think of writing another press release from another paper from the African Health Sciences journal!



Tuesday, August 8, 2017

Funding Cancer; Today’s research is treatment tomorrow

By Esther Nakkazi

On 8th August 1967, the lymphoma treatment research centre was born in Uganda. The Irish surgeon, Denis Burkitt who was treating tropical diseases was interested in Burkitt’s Lymphoma - a highly curable paediatric lymphoma.

This disease, which was later named after the Irish surgeon, was a strikingly disfiguring tumour, with malaria and viruses as causative factors and was commonly manifested among the young male population.

In 1972, when Uganda’s president Idi Amin threw out all foreigners from the country, the expatriates left the lymphoma treatment centre in the able hands of Prof Charles Olweny. Olweny and his staff kept the UCI alive and thriving, they followed up almost all their patients.

Dr. Tom Tomusange (RIP) and his team navigated through thickets and roadless places during these patient safaris to follow up on patients. As a result, for a patient cohort of over 200 patients only about 6 were lost to follow up. That was just one of the successes.

At a press conference to mark 50 years, today, Dr. Marissa Mika, a historian and anthropologist who has been studying the history of cancer in Uganda since 2010, took us through the 1950s, 1960s and 1970s, when UCI conducted cutting edge chemotherapy clinical research trials on Burkitt’s lymphoma.

According to Dr. Mika, the data from these clinical trials continues to inform treatment protocols across the globe. Also for its excellent work at that time, the UCI won the Lasker award for research on Burkitt’s lymphoma in 1972.

It was no easy feat for UCI to be bestowed upon the Lasker award, about the equivalent of today’s noble prize, but they had done profound research against Burkitt's lymphoma, which could be put into remission and eventually healed and with very limited funding.

As the lymphoma treatment centre now the Uganda Cancer Institute (UCI), turns half a Century old, it is also celebrated as the oldest cancer research and public oncology facility in Africa. Recently, it was designated as a centre for excellence in oncology by the East African Development Bank.

“UCI is making an impact in East Africa and it is on its way to becoming an example in Africa,” said Jackson Orem the executive director of UCI.

But what can it take for UCI to win the Lasker award again? And does it mean Uganda Burkitt’s lymphoma was wiped out and is no more? Unfortunately not. Burkitt’s lymphoma continues to be a major paediatric problem in Uganda.

The problem according to Dr. Orem is that the gains that were made at the time Burkitt’s lymphoma was healed were never followed up. The other problem is limited funding for cancer.

“When investment in an area is made it should be followed up. In 1967 they were emphasising generation of new knowledge. We are trying to put that back at UCI,” said Dr. Orem at the half Century mark.

The man at the helm of UCI says unlike other African countries that may be waiting for ready made solutions, his Institute is putting research at the forefront of fighting cancer.

But we all know that research is impossible without funding. And to this he says; research must be funded. It should not be considered a luxury. For today’s research is tomorrow’s treatment.

Ultimately, at the UCI, the research that was done 50 years ago is treatment today.

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Monday, August 7, 2017

Uganda to set Sweetpotato Seed Standards

By Esther Nakkazi

Uganda is creating a sweetpotato seed system with standards for inspection and certification.

Under the seed system farmers will buy clean, high quality planting materials from certified suppliers, which will ensure high yields and reduce the spread of pests and diseases.

Sweetpotato is vegetatively propagated where each cropping cycle is started by planting vine cuttings or root sprouts most of them sourced from farmers own fields or their neighbors.

This way there is no check on the quality of vines planted and increases the risk of spreading diseases despite farmers’ efforts to select healthy-looking vines. This also facilitates accumulation of pests and diseases leading to significant decline in yield. But this will change.

“We have developed and piloted seed standards and inspection procedures for sweetpotato so that farmers can access quality planting material of the right varieties and at the right time,” said Dr. Godfrey Asea, the director, National Crops Research Resource Institute (NaCRRI)

The sweetpotato standards have been developed with leadership from Prof Settumba B Mukasa, a plant genetic and lecturer at the school of Agricultural Science Makerere University who is working with the Phytosanitary and Quarantine Services of the Ministry of Agriculture and Fisheries (MAAIF), HarvestPlus, International Potato Center (CIP) and other seed system stakeholders.

“The standards are currently in form of technical guidelines for field inspection primarily based on tolerance levels for visual disease readings, pest incidence varietal mixtures in the seed crop, land use history, source of planting material for the seed crop and laboratory testing,” said Prof Settumba.

As well, the team is also developing inspection instructional materials for sensitizing, training and technically empowering the plant inspectors, seed producers, laboratory operators, and net protected nursery multipliers, said Prof Settumba.

For Uganda and the other sub-Saharan countries that are members of the Sweetpotato for Profit and Health Initiative (SPHI) it is key to have policies that would ensure sustainability of a model of production for delivery of quality planting material.

The SPHI with 11 participating countries ̶ Burkina Faso, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Burundi, Uganda̶̶ and Zambia have a target of reaching 10 million households in sub-Saharan Africa by 2020.

To reach this goal, the provision of quality sweetpotato seed or planting material is critical and it requires strong seed systems, said Margaret McEwan, senior project manager for sweetpotato seed systems at International Potato Center.

Participants from SPHI participating countries meeting in Uganda last month under the annual ‘Community of Practise’ get togather exchanged information on how to create and sustain sweetpotato seed systems.

“Scaling up sweetpotato seed systems is not only about the technologies, but also the factors which create an enabling policy environment, the social and behavioural change and new organizational arrangements which are needed, so that farmers can access quality sweetpotato planting material of the right varieties, at the right time,” said Asea.

Prof Settumba emphasised the same issue saying although there are a number of seed classification systems, whatever system is used, standards and guidelines are set by the government.

As well, to maintain sweetpotato seed systems, there is need to identify policy issues that would ensure sustainability of a model of production and delivery of quality planting material,” said Settumba.

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Tuesday, August 1, 2017

72% decline in sperm count in African men over 50 years

By Esther Nakkazi

A press release from the African Health Sciences says sperm count for African men has declined by 72% over the past 50 years. The data is from a paper published in the African Health Sciences journal of June 2017.

“This is a threat to the procreation of the future generations,” said Dr Pallav Sengupta, the head of Physiology Unit, Faculty of Medicine, Lincoln University College, Malaysia.

“I was amazed at the magnitude of the problem. 72% decline over time is a dangerous downward trend.This situation is indeed scary,” said Uchenna I Nwagha, Professor of Obstetric Biology and Reproductive Medicine, Department of Obstetrics and Gynecology/Physiology College of Medicine, University of Nigeria, Enugu Campus.

The current concentration is also very near to the World Health Organisation (WHO) cut-off value of 2010 of 15×106/ml, which is a major issue of concern.

The data is also in line with other studies of other men worldwide.

After a systematic review and meta-analysis that retrieved data following MOOSE guidelines and PRISMA checklist, they found that the major possible causes are poorly treated sexually transmitted infections (STIs) and hormonal abnormalities, consumption of excessive alcohol and tobacco smoking.

Other published articles cited exposure to pesticides and heavy metals as principal triggers of decreased sperm count among African men.

"We have put forth the evidences of the decline and discussed various causative factors over the past 50 years like lifestyle, food habits, disease prevalence and others,” said Dr Sengupta also the lead author.

“More than one factor is involved in this decreasing trend, correlation with a single factor is difficult to establish. But we are also working on their correlations for our upcoming reports,” said Dr Sengupta.

In the meta-analysis conducted, the researchers retrieved data from fourteen studies that have been conducted during 1965 and 2015 on altering sperm concentration in the African male. The studies were done in Nigeria, Tunisia, Tanzania, Libya and Egypt among males aged 19 to 55 years.

After analysis of this data, a time-dependent decline of sperm concentration (r = -0.597, p = 0.02) and an overall 72.6% decrease in mean sperm concentration was noted in the past 50 years.

In 1991, WHO estimated that almost 20-35 million couples were infertile in Africa. Nigeria was suggested to have been suffering from highest infertility problems among the other African countries, the male infertility factor accounting for 40-50%.

“In recent times, in the course of managing infertility in Nigeria, I have observed the apparent decline in sperm count in men and a decrease in ovarian reserve over time in women,” said Prof Nwagha.

Said Prof Nwagha, “Apart from life style and others, one situation in Nigeria is the effect of environmental toxins from generators. Most Nigerians rely on generator sets for electricity as public power is grossly inadequate, unreliable and epileptic, in the face of enormous urbanization and deforestation. The resultant effect of the environmental toxins from generator fumes on the germ cells over time may be a significant contributor to what we are experiencing today.”

“We, therefore, advocate for more epidemiological studies to identify the possible etiological factors to enable us to halt this dangerous trend, and to avoid natural reproductive extinction,” added Prof Nwagha

Other studies have shown a significant decrease in sperm concentration worldwide in men in North America, Europe and New Zealand. Overall studies show a 57% decline in sperm count worldwide from 1980.

Other researchers in the study included Dr. Emmanuel Izuka from the College of Medicine, University of Nigeria, Enugu Campus, Nigeria and Dr. Sulagna Dutta of Lincoln University College, Malaysia.
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