Malaria could be eliminated by 2015

Malaria –World Malaria Report 2010 (15.12.10)
By Esther Nakkazi
In many countries, the total number of malaria deaths and hospital admissions have been more than halved in a decade as a result of increased control interventions particularly the provision of insecticide-treated mosquito nets.
According to the World Malaria Report 2010, released by the World Health Organisation (WHO) last week, malaria-related deaths have fallen from 985,000 in 2000 to 781,000 in 2009 the largest absolute decreases observed in Africa.
Ban Ki-moon, the UN Secretary General, said it is possible that when a broad range of partners join forces malaria deaths could be eliminated by 2015.
The affiliation between committed African leaders, financial support from donor countries providing more than $5 billion in new money since 2008 and the Roll Back Malaria partnership has already brought success.
“If we heed to the lessons highlighted in this report we can achieve our goal of ending malaria deaths by 2015, accelerate progress toward the MDGs and usher in a better future for all,” said Ban Ki-Moon.
According to the World Malaria report, in eleven African countries including Rwanda in east Africa, the malaria burden dropped by more than 50 percent in 2000 to 2009.
For Kenya, Tanzania and Uganda there was a wide scale implementation of malaria control activities to more than 50 percent of the populations at high risk over this same time period. Most of these populations where able to access Insecticide Treated mosquito Nets (ITNs).
Already, enough nets have been delivered to sub-Saharan Africa to protect nearly 580 million and more than 75 million people have received protection from Indoor Residual Spraying (IRS).
Now the World Health Organisation has promised an additional 54 million nets to be delivered to sub-Saharan by early 2011, totaling 350 million, bringing the goal of universal coverage declared by UN Secretary-General Ban Ki-moon in 2008 within reach.
This achievement represents the largest scale-up of a malaria control intervention in Africa ’s history.
The WHO Director-General, Dr Margaret Chan, said the results set out in the report are the best seen in decades after so many years of deterioration and stagnation in the malaria situation.
"The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates. By maintaining these essential gains, we can end malaria deaths by 2015," said Ray Chambers, the UN Secretary-General's Special Envoy for Malaria.
In the east African region, other countries could emulate Zanzibar and Rwanda’s persistence and maintenance of successful malaria control campaigns and programmes.
According to the report, Rwanda has significantly scaled up malaria control interventions including distribution of 6.4 million mosquito nets over the last three years.
Most of these Long Lasting Insecticide-treated mosquito nets (LLINs) were distributed during a measles vaccination campaign to children below 5 years, and each of them were given as well as all households to avoid further malaria cases and deaths.
Inpatient malaria cases and deaths in Rwanda have now fallen by more than 50 percent from 2000 to 2009 says the report.

However, Rwanda noted an upsurge in cases of malaria beginning in 2009 but a new mosquito net campaign was launched in April 2010 to replace older nets, which then reduced malaria cases and deaths.
By 2009, the number of malaria admissions and deaths in Zanzibar were 81 percent lower than those recorded in 2000, says the report.
Zanzibar’s malaria success is largely attributed to free for all anti-malarial drugs (ACTs) in all public health facilities since September 2003 and universal coverage of nets to the 1.3 million islanders.
Annually, indoor residual spraying is carried out to cover nearly all households and there is improved diagnosis of malaria cases as Rapid Diagnostic Tests (RDTs) began to be more widely used from 2005.
In the rest of Africa, by 2009 more than a third of suspected malaria cases were confirmed with a diagnostic test, an increase from less than 5 percent by 2000.
Now the WHO recommends that all suspected malaria cases undergo diagnostic confirmation prior to treatment. Already, a number of African countries including Uganda have been able to scale up malaria diagnostic testing at a national level.
“Not only has this resulted in saving the unnecessary use of hundreds of thousands of courses of ACTs annually, but has also allowed for the implementation of timely and accurate surveillance for malaria,” said Dr Chan.
Research shows that using RDTs improves the quality of care for individual patients, cuts down the overuse of drugs, protects their therapeutic life, and allows for timely and accurate malaria surveillance.
However, the report cautions that these gains are fragile and all supporting partners should keep in the loop or the opportunity could be lost.
For instance insecticide-treated bed nets remain effective for three years and their supply must be replenished while the development of parasite resistance to antimalarial drugs and mosquito resistance to insecticides are perennial threats.

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Use of herbal remedies in HIV treatment still causes stigma

By Esther Nakkazi

When the cock crows and birds fly out of their nests early morning, the African herbalists rise with the sun to go to the forests.

There, they pick fresh leaves, peel the new bark off trees and dig plant roots from the soft ground before the sun hardens it. They then apply the knowledge most of them acquired from their ancestors.

Traditional herbalists are custodians of knowledge on herbal concoctions that are used by millions of Africans to survive. In Uganda, they are big contributors to HIV treatment as high costs and shortages of modern drugs remains imminent.

The World Health Organization estimates that up to 80 percent of people in the developing world still rely on herbal remedies for their health care.  It has thus adopted a deliberate policy of encouraging the development and utilization of traditional medicine in HIV treatment and care.

In Uganda, it is estimated that 70 percent of Ugandans infected with HIV go back to nature and consult traditional herbalists for treatment as various symptoms present. But herbalists feel there is still a lot of stigma with the use of herbs in HIV/Aids although it remains a sustainable way in HIV treatment.

“When a client goes for HIV treatment they do not mention their use of traditional medicine. Yet the drug interaction between herbs and anti-retroviral drugs could be dangerous,” said Ms. Primrose Kyeyune, a technical advisor, Traditional and Modern Health Practitioners Together Against AIDS (THETA)

Experts say the attitude towards traditional medicine use is bad because people do not want to be associated with it.

Stigma Still High Among Users of  Herbal Remedies for HIV

“People stigmatize herbal medicine but they buy it every day and prefer herbal products to modern medicines,” said Kyeyune.

According to THETA officials stigma can only be reduced through training and counseling of both the herbalists and the HIV patients. Started in 1992, THETA is a Uganda non-government organization that has been working with traditional healers in Uganda especially in HIV/AIDS prevention and care.

With THETA trainings most herbalists have changed their ways of administering herbs in HIV treatment and care. Many now can identify the dangerous HIV symptoms and refer patients to health facilities to test for HIV. They have also been trained to do record keeping, maintain minimum standards of hygiene and offer counseling.

“Originally herbalists used to claim that they heal HIV but with our training, they now have knowledge that it is not curable,” said Grace Nanyonga, the information officer at THETA.

THETA has trained the herbalists to understand the HIV cycle, which has ensured that most of them know that they can only treat symptoms but cannot heal HIV.

Working as a team the herbalists have now come up with herbs for HIV that can boost the immune system, relieve Herpes Zoster, diarrhea, skin diseases and oral thrush, all opportunistic infections of Aids.

Some of the herbs have been investigated at the research Laboratory in Wandegeya, a Kampala suburb and found to have active substances that are therapeutically useful.

Training for Herbalists

Ssenga Bernadette Nabatanzi a herbalist says since she joined THETA and trained under the Regional Aids Training Network (RATN) her way of treating patients has changed.

“I am now able to keep records of my clients- like the date, age, physical and telephone contacts, next of kin, type of disease or symptoms, and the medicine, which I have administered.”

“In practice, I cannot cut patients with the same razor blade anymore and the patients do not accept because they know their rights. They no more can take herbs which we spit on,” said Nabatanzi a reproductive health specialist.

Nabatanzi says with limited time and long lines of patients, most doctors using modern medicines do not have the time to counsel patients and gain their trust. However, herbalists who are usually permanent residents of the community, are always available and have a lot of time to administer in-depth counseling.

THETA has integrated HIV/Aids information into counseling relating HIV to culture, which enables the patients to feel better. In counseling HIV patients, the herbalists are encouraged to prepare, persuade, and request those who have symptoms to go and check for HIV.

“Usually when they test and find that they are HIV positive they come back and consult me. They confide in me because most herbalists become their confidants and counselors,” said Nabatanzi who also advises on a good diet.

For their services, the herbalists or counselors accept cash payments in installments or in-kind - beans, goats, chicken. The herbalists have also been taught about minimum standards of hygiene- toilets, clean drinking water, well lit and ventilated clinics to not get infected with tuberculosis.

“I am well respected in the society, and the community prefers coming to my clinic,” said Suleiman Nkuutu a herbalist.

But as the communities continue to seek herbalists’ services and trust them, these continue to charge exorbitant fees and with no law to regulate them some administer fake herbs.

THETA also has a problem with those that get so rich as most of them eventually become untrainable, rigid, secretive- they fear that their concoctions will be stolen- so they work at night.

Still, medical practitioners medics treat herbalists with a lot of suspicion and disregard. However, THETA official says that with continued training the gap is getting closed as they start appreciating each other’s role. THETA officials say they can work with all those that fall in the WHO definition of traditional herbalists including those who sacrifice children.

“We would wish to have the witches who sacrifice children on board so that we educate them to stop the practice. If the government can support us we can come together and train all of them,” said Ms. Kyeyune.

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Makerere University College of Health Sciences Releases Report On Uganda Media Coverage Of Health Research Issues

By Esther Nakkazi

The Uganda media could be saturated with heath system issues but their content minimally refers to research, keeping researchers’ findings on the shelves.

A study titled; ‘From Paper to Mike: An analysis of Health Systems Reporting In Uganda’s Print and Radio Media’, revealed that health systems researchers’ voices and their findings were missing in the articles.

“There seems to be limited interaction between researchers and the media. I am aware that so much research is done but very little is reported in the media and this suggests for a closer working relationship between the media and heath researchers,” said Dr. Anne Katahoire, the principal investigator of the research study.

“Researchers do not trust many journalists for fear that they (journalists) will misrepresent the research findings. That this is partly because journalists do not take adequate time to study and understand carefully the messages being conveyed by the study findings. Also sometimes journalist just wish to sensationalize the findings,” said Nelson Sewankambo the Principal, Makerere University College of Health Sciences.

The study was conducted in the months of March-June 2010 by a multidisciplinary team, from the media and academia led by Makerere University and funded by Research Matters, a collaboration between the Swiss Agency for Development and Cooperation (SDC) and the International Development Research Centre (IDRC).

Nasreen Jessani, IDRC’s Health Program Officer for East and Southern Africa highlighted that “With increasing attention being paid to evidence informed decision-making, it is critical to recognize the role of the media as a ‘broker’ between researchers and decision-makers as well as between researchers and the general public.”

“In Uganda, we need to better understand the context within which researchers, decision-makers and media are interacting so as to better plan for enhanced use of new knowledge in policy and practice.”

The team analyzed over 100 newspaper articles from four local newspapers and 72 radio programmes covering the four regions of Uganda. In-depth interviews with health researchers, reporters, editors, and radio health program presenters and producers were also done.

Through these they explored the coverage of health issues in the media paying attention to the extent to which, journalists used research based evidence and the processes through which research gets or does not get into published articles in the newspapers and health programmes on radio.

The study, like no other done in this area, paid particular attention to the reporters behind the stories in terms of their background training and orientation.

All the newspapers reviewed had health magazines pull outs and the radio stations aired health related programs at least 2-3 times a week, a fact that showed a healthy coverage of health.

The researchers adopted the WHO health systems definition, as “consisting of all the people and actions whose primary purpose is to promote, restore or maintain health”.

This included formal health services including the professional delivery of personal medical attention, actions by traditional healers, all use of medication- prescribed by a provider or not.

It also had home care of the sick; traditional public health activities like health promotion and disease prevention, and other health enhancing interventions like road and environmental safety improvement. The articles identified in each of the newspapers were classified under these categories.

The study found that the majority of health system articles were on disease prevention and health promotion while the articles on the formal health services were more of critics of what was happening in the formal health services in the country but the majority was not informed by health systems research

Of all the published articles reviewed, almost none were based on health systems research in Uganda, for those that referred to some research reports; the research was most likely not conducted in Uganda.

In broadcasting media, it was found that radio programs on health were largely driven and sustained by sponsors (commercial or institutional) who determined the topics, the program running flow and were largely skewed toward disease prevention of the well funded diseases like HIV/AIDS and malaria.

Ideally, health programs on radio would be driven by communities’ health needs or the professional choices of the producers or presenters. But most of the program presenters were also not trained, noted the study.

Newspaper articles were however, largely driven by community questions and were reporters and editors featured a particular health topic, they were driven by what they had either experienced in their own interaction with health system or that of someone they knew.

Indeed, the newspaper articles covered a larger spectrum of health issues relative to radio.

The study was premised on the assumption that the media, an important stakeholder in health systems research could potentially influence policy and public attitudes through its role of sensitization and publicity.

“Reporting should stimulate interest among the readers and debate on important findings that may affect policy development, change in health practices and the behavior of people that impacts on their health,” commented Prof Sewankambo.


Recommendations

“Both the media and the health researchers need to work on their attitudes towards each other. The media portrays researchers as exploitative and as using people as guinea pigs while health researchers have a dismissive attitude towards the media,” said the study.

“Our team found that there are different efforts towards this cause but more needs done. Researchers need to recognize that the media is an important stakeholder in research,” said Dr. Katahoire.

This entails a need for communication budgets in research, engagement of the media in the research process and more face-to-face interactions between the journalists and health researchers.

But also, health research funders need to devote funds for communicating the research findings to the public. If this were done it would improve the links between the media and researchers as well as media reporting of health research, according to the research team.

“This is a strategy that has been recognized and supported by many funders but requires buy-in and mutual trust from a number of players” asserted Ms. Jessani.

“In addition in requires a new cadre of professionals – one that straddles the worlds of research and the worlds of communication. Funding communication is necessary but not entirely sufficient. Adequate skills are required that allow for the distillation and repackaging of research results into different forms for different audiences.”


The research team included Dr. Anne. Ruhweza Katahoire the director, Child Health and Development Centre, School of Medicine College of Health Sciences, Makerere University; Doris Kwesiga a researcher with Makerere University; Esther Nakkazi a freelance science journalist; and Hannington Muyenje the outgoing Country Project Director, BBC world Service Trust in Uganda.

Uganda introduces kits to cut malaria treatment costs

By Esther Nakkazi

Uganda will reintroduce malaria test kits in health facilities nationwide to facilitate malaria diagnosis that could improve the management of the disease.

From next month, National Medical Stores (NMS), the Uganda government’s supplier of pharmaceuticals products, will distribute Rapid Diagnostic Tests (RDTs) that could save thousands of doses of anti-malarials.

The RDTs will enable health workers to detect the presence of malaria within a few seconds cutting down on over diagnosis, time and over prescription of malaria, health experts say.

Research has established that for every 20,000 doses supplied per month to a district, up to 16,000 doses of anti-malarials are saved when health workers use RDTs.

Some of the $90 million from the Global Fund and government resources will be used to buy RDTs that will not only stop presumptive diagnosis, a common practice among most health workers but also avert a tendency of stocking medicines in houses that has cropped up.

Presumptive treatment identifies the likely condition a patient has; it is widely practiced where microscopy or RDTS are not readily available.

Most health workers use presumptive diagnosis, giving all patients anti-malarials after they present with headaches, fever and loss of appetite. In most cases the health workers are ‘playing safe’ especially with children who progress rapidly to severe malaria and death.

But also recently after the switch from the user driven for drug selection and quantification-pull system to the ‘modified’ push system where government estimates pharmaceutical supplies required, the public has adopted a tendency to pick drugs even when they are not sick.

“People line up pretending to have all sorts of illnesses especially malaria and keep the medicines for a rainy day while others sell them off,” said Moses Kamabare the General Manager, National Medical Stores.

Typically when NMS delivers medicines to health facilities, which is once every two months, in just about 2 weeks the Coartem would be finished. “RDTs would ensure that they pick medicines especially Coartem, which is very expensive only when required.”

There is no doubt that using RDTs is a cost effective venture in the treatment of malaria as has been tested in Zanzibar and Ghana. In Uganda, Government supplies free ACTs to all government health facilities but on the open market a dose costs Ushs 15,000 ($7).

Indeed, when an RDT test is administered that turns out negative, Ushs 10,000 ($4) would be saved for every patient. This would save lots of money as few people who claim to have malaria actually have it, but would also ensure reduction of over exposure of the population to drug toxicity.

A study by Malaria Consortium Uganda, found that use of RDTs resulted in a 2-fold reduction in anti-malarial drug prescription at Low Level Health Care Facilities (LLHCFs). The study entitled the ‘Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda’ was published in July 2010. 

Dr. Daniel Kyabayinze the principal investigator of the study said they found that when RDTs are administered only 20-40 percent of patients who claim to have malaria would have it, so it is very cost effective.

The study says that nationwide deployment of RDTs in a systematic manner should be prioritized to improve fever case management but cautions that there is need to further educate health workers about use of RDTs in order to maximize acceptance.

“The study found that 1/3 times a person will have a negative test but the health worker will give them anti-malarials anyway,” says Dr. Kyabayinze from Malaria Consortium Uganda.

In the study, health workers said they treat RDT-negative patients because they are afraid of challenges of severe malaria given the long distances to the referral hospitals in case need arises.

Also, among negative patients with RDT results, children under five years were nearly 3 times with more likely to receive anti-malarials relative to older patients, a practice that is in line with the national malaria treatment policy.

The policy encourages presumptive treatment of malaria to reduce malaria-associated morbidity among the under-five age group who contribute a third of the anti-malarial prescriptions for RDT negative results.

“It is likely that health workers found it socially acceptable to offer anti-malarials to RDT negative patients but also that they appreciate the medical care provided,” says the study. But there are also questions of the accuracy of RDTs in diagnosis. 

 
Research shows that 90 percent of the times when the RDT test is positive, the patients have malaria, but the test also picks past infection in the last 2 weeks.

“It is important that those who come in and the test is negative are not given anti-malarials because the test would be 98 percent negative,” said Dr. Kyabayinze.

With the study results government is working on a policy that will ensure that all people who are treated with anti-malarials first get a malaria test.

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Uganda: What causes Jiggers?

By Esther Nakkazi

In the eastern part of Uganda, live the Basoga, a Bantu group who speak Lusoga. Lately, the media have been awash with the Basoga being infected with jiggers. Recently, a three months baby died of jiggers according to the local press.

The mystery of the cause of jiggers has been politicised and even exaggerated. While the medics attribute jiggers to poor hygiene especially for people sharing accommodation with animals, economists say it is due to chronic poverty - after all research shows that the highest poverty density in Uganda is in Busoga.

The politicians have blamed jiggers on political discrimination in the area by the ruling government. The religious people have said God is angry with the Basoga so the jiggers are a punishment while traditionists are convinced that wizards are active in that area. Some myths have suggested that the jiggers attack mentally retarded people.

Now the environmentalists headed by (Dr. Afunaduula) say we need an environmental approach to eradicate them. However, in the old times, even today the herbalists recommend that after extraction, they put red chilies (pepper) in the wound.

In an effort to eradicate them many volunteers have been to the jigger infested areas and their approach is to help extract them from feet, hands, and bodies of course with cameras recording their good works. But nothing has worked.

Although floods of people showed up to be treated, some schools refused their pupils to go saying it would bring shame to the school!

At the campaign led by the deputy speaker of Parliament, Rebecca Kadaga, a Musoga who comes from eastern Uganda, villagers were treated and taught good hygiene practices like smearing cow dung on the walls and floor of their mud houses.

Cleary something needs to be done about these jiggers killing people in this century! But it is a question of good hygiene and that does not need much debate and unfounded myths. 

Everyone has a role to achieve Millennium Development Goals

By Esther Nakkazi

Africa could be on track to achieve most of the Millennium Development Goals (MDGs) but some of its gains have been eroded by climate change, armed conflicts and unmet commitments for resources by the international community.

But this year, which marks five years to 2015, the target year for MDGs, shows that the goals are attainable though the pace of progress needs to be increased.
Recently, UN Secretary-General Ban Ki-moon announced the development of a Joint Action Plan to be launched this month at the MDG review Summit to intensify the global effort to meet the goals.

So this September, world leaders will meet to agree on strategies and actions to meet the Goals, which represents human needs and basic rights that every individual around should enjoy.
“The world posses the resources and knowledge to ensure that even the poorest countries, and others held back by disease, geographic isolation or civil strife, can be empowered to achieve the MDGs,” said Ban Ki-Moon.

Ban Ki-Moon says meeting the goals is everyone’s business as falling short would multiply the dangers of the world.

In Africa, there are improvements made to attain the MDGs but they are slow while the hard won gains are eroded by food and economic crises as well as climate change.
Experts say Africa could have a chance to reach the target for access to clean water and it is still on track to achieve the MDG target of cutting the rate of extreme poverty in half by 2015, says the UN 2010 report.

Robust growth in the first half of the decade reduced the number of people in Africa living on less than $1.25 a day from 1.8 billion in 1990 to 1.4 billion, while the poverty rate dropped from 46 to 27 percent.

“Many countries are moving forward, including some of the poorest, demonstrating that setting bold, collective goals in the fight against poverty yields results,” says the report.
At the global level, the poverty rate is expected to fall to 15 percent by 2015, just about 920 million people living under the international poverty line, half the number in 1990.

Africa has also made strides in getting children into primary schools with enrollment reaching 89 percent. The 2010 UN report shows that the total number of children out of school decreased from 106 to 69 million in 1999-2008, almost half of the number of these in sub-Saharan Africa.

According to experts from UNESCO, this is encouraging because education is the single one intervention that is likely to have a multiplier effect on progress across all the MDGs.

One year of schooling can increase a person’s earnings by 10 percent and lift their average annual GDP by 0.37 percent, according to a UNESCO report. The girl child- has benefited from this more, as overall more girls are now in school today in Africa with at least three million more children enrolled in school in Ethiopia and more than double in Benin compared with the number in 2000.

Increase in school enrollment has been aided by the abolition of school fees for instance in Burundi, a threefold increase to 99 percent in primary school enrollment was realized in 2008. Tanzania doubled its enrollment ratio over the same period.

Strong interventions have also been made in addressing HIV/AIDS, malaria and child health for instance increasing the number of people receiving anti-retroviral drugs.
According to the 2010 MDGs report, comprehensive and correct knowledge of HIV increased by 10 percentage points or more among women aged 15-24 years.

Between 2000-2008 Rwanda reported 50 percent and more in knowledge about HIV prevention among women and similar progress was made by Namibia.

But there are two MDGs that seem to be unattainable although commitment with resources to address them has been made.

MDGs 4 and 5 which call for reductions in the number of deaths among children under 5 by two thirds, and reducing maternal deaths by three-quarters by 2015. Africa will need $32 million for interventions to attain them.

Although under five-year-old mortality rates in sub-Saharan Africa declined by 22 percent since 1990, this rate is still insufficient to meet the target.
Studies show that all the countries with under five mortality rates exceeding100 per 1,000 live births in 2008 are in sub-Saharan Africa except Afghanistan.

Less than half the women giving birth in Africa get skilled health care when giving birth, but disparities also exists in rich and poor households, says Sha Zukang, the UN under secretary General for economic and social affairs.

According to the UN 2010 report women in rich households are 1.7 times more likely to visit a skilled health worker at least once before birth than the poorest women. Also contraceptive use among educated women is four times higher than those with no education as access is a big problem.

In Africa for every woman who dies, at least 20 other suffer injuries, infections and disabilities, like obstetric fistula but Countdown to 2015 report emphasizes that almost all maternal deaths are preventable.

This is because complications during pregnancy and childbirth are the leading cause of death for women of childbearing age, which can all be dealt with. Countdown to 2015, a global scientific and advocacy movement in its 2010 report, found that 49 out of the 68 high burden countries are not on track to meet MDG 4 on child health. While Botswana, Egypt, Eritrea, Malawi and Morocco are on track to achieving improved maternal health.

The Millennium Declaration represents the most important promise ever made to the world’s most vulnerable people, says Zukang. Accelerated action needs to be done. But it is for each one of us to play a role to attain the MDGs.

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Tweeter pays money in Africa

Last week was a break through, as user of social media in East Africa, Uganda to be able to earn from a new tool Twitter. I keep a twitter account @Nakkazi, but had not thought much about mastering the skill of tweeting until last week.

The East African Internet Governance Forum (EAIGF) 11th to 13th held a meeting in Kampala, Uganda and Maureen Agena a citizen journalist and I, were invited to tweet and blog.
On the tweeter account @#EA_IGF and the blog name http://eaigf-uganda.blogspot.com (check out the stories and tweets) we tweeted away for three days.

The pay was not bad at all, but what is interesting to note in my opinion is, was it because it was an Internet gurus gathering? Almost all the 100 or so participants knew about twitter and were following on the screen in the conference room or on their laptops.

It would also be interesting to have a business model to offer the client a full package with twitter, blog stories with pictures, pod casts and video clips. Let us see if the market can respond to the offer and what prices they would be able to afford so we get in business.

British Barristers urge African states to stand together to defeat ICC

By Esther Nakkazi

During the Kampala African Union summit, i saw many colleagues hurrying to some place. Naturally, i decided to follow the train and there, a press conference on Sudan President Al-Bashir addressed by two London based Barristers and a Sudanese Human Rights official. Here are the excerpts of the press conference

Plans to lodge a complaint to the International Criminal Court (ICC) on the indictment of President Omar Hassan Al-Bashir by British lawyers are under way. The barristers with Temple Gardens Chambers said they are representing over 8 million people from the Sudanese Workers Union in this case.

They want to challenge the international court over Al-Bashir’s immunity as a serving head of state and if it is lawful for the UN Security Council to refer to the ICC a non-member state like Sudan.

“ We think that these issues which now seem to concern only Sudan may have wider consequences for Africa,” said Geoffrey Nice a barrister with Temple Gardens Chambers, London at the sidelines of the AU summit

The lawyers advised that if other African states behaved like Chad they could stand together and say ‘NO’ to the ICC on the arrest of a serving head of state.

The lawyers were attending the AU Summit in Kampala drumming up support for the AU leaders to say ‘No’ to the ICC even if they emphasized they were not against the ICC and justice. 'Justice should not be selective.'

“If there are countries that think like Chad, they could gather together and say we regard Bashir to be having immunity until his presidential term ends,” said Rodney Nixon, another barrister with Temple Gardens Chambers, London.

They advised that a grouping by African States could carry more weight and the case could be lodged with the International Centre for Justice (ICJ).

The ICC should have a provision so that States should observe other head’s of States immunity and take a clear position whether they are signed up or not.

They warned that unless this is made clear, it would affect relations between states in Africa.

The lawyers said they are collecting sufficient evidence, which they have already worked through to challenge the prosecutor, Luis Moreno-Ocampo.

They also have details of the victims of the genocide and have presented them with legal options and they are challenging the ICC on allegations of Al-Bashir committing genocide.

“We are coming up with steps to challenge the sufficiency of the genocide evidence. We have recognized the crimes, it is not the ICC to deal with it,” said Nice.

But they want the case to be tried under the Ocampo regime so that they test the system and also because they anticipate that the next prosecutor will come from Africa, which will be an even bigger challenge.

The African prosecutor will be under pressure to try all these leaders that Ocampo fails to prosecute, said Nice.

Mohamed Ansari, the president of the African Crisis Relief Centre, a Sudanese non-governmental organization argued that there could be no definitive ruling on the case before there is sufficient evidence.

“There should be a desire to get to the bottom of this – these things are not be looked at critically? If nothing were done, then it would get greater strength,” said Ansari.

African Union Summit

It has been a long week of tight security, many interviews and press conferences at the African Union summit in Munyonyo. As a science writer, it has been an interesting time to see that at least some attention is being devoted to health- maternal health and children development.

For this week, I have been going to Munyonyo, it could have been at least 10 security checks per day. That makes it 70 in a week! If there are any health effects these machines cause I could become a victim.

Well brother leader jetted in on Saturday, causing a traffic jam of about 2 hours in the small city of Kampala. I saw some boda boda riders wearing t-shirts with Gaddaffi’s picture. The extra long convoy, big bill boards welcoming him and the fight between his detailed security with Ugandan security is not new but typical of his visits to African countries.

Agenda setting: many international organizations, civil society and African musicians are in Kampala to persuade African leaders to devote at least 15% of national budgets to health. It is expected that this will not be businesses as usual of pegging their signatures onto documents and forgetting them.

This time, with the impressive turn up of African leaders for the Kampala summit and the many voices involved we only hope that the matter is taken seriously.

But of course, everyone is aware that African leaders are the least interested in health. If the agenda were to be set by them, the summit would just be discussing Somalia, Al-Shabaab and Sudan’s Bashir.

Precisely, that is where the hot discussion are except that big brother donor is watching and there is prompting. It is interesting to see how tempers rise when the issue is discussed!

Electricity could control Uganda's high birth rates?

I once sat in a workshop and one official from the Ministry of Finance, Planning and Economic Development told us that finally they are ready to tackle Uganda’s high fertility/birth rates (6.7 per woman) not by using family planning security but by providing electricity to rural areas.

It has been a debate,  no one has ever proven it scientifically but it is said that boredom is one of the reasons that the rural folk engage in birth giving activities. With all the myths about using family planning it is envisaged that if they were kept busy say with the youth provided with Internet then they would be engaged and birth rates would go down.

Now, it is official that by the end of FY 2008/09, rural electrification coverage increased to 6%, up from 1% in 2001. The overall access to electricity in Uganda also increased from 5% in 2001 to 15% in 2008.

It would be interesting if there were any such research done to see the impact of electricity on rural births. Unfortunately, we don’t have the data for places that now have electricity. The study would control for other factors including family planning security and then see the impact of electricity on births. I would love to read such research.

Water Quality needs Africa's attention

Esther Nakkazi

In Africa maybe we should listen more and utilise our scientists. African scientists under the umbrella of the Pan Africa Chemistry Network (PACN) released a report on water quality, which is even more important than water quantity. http://www.theeastafrican.co.ke/news/-/2558/910540/-/pf99xoz/-/index.html

Water quality is important but not much attention is given. Below is the story and the link above of the published story.

Water quality in sub-Saharan Africa is declining, presenting a worrying picture of toxicity, yet it is failing to raise the same profile as water quantity in Africa.

In sub-Saharan Africa, most water resources are showing unacceptable levels of toxic substances, heavy metals, persistent organic pollutants (POPs) and biological contaminants.

These are originating from especially domestic wastewater and local industries but the amounts of the pollutants although high are only estimated due to lacking of water quality monitoring.

“Water quality is deteriorating, adaptation and planning of water resources is difficult, as many African countries don’t have water quality monitoring programmes,” says a report by the Pan Africa Chemistry Network (PACN) released last month.

This makes water pollution statistics hard to come by due to scarce analytical laboratories, while there is substantial under-investment as well as absence of a structured framework for water governance.

However, scientists working within Africa have the knowledge, expertise and potential to help formulate and implement sustainable water strategies to maintain quality.

This can be done through increasing Africa’s capacity in analytical chemistry, to support chemical monitoring and water management activities to collect data through centers of excellence.

The PACN through its report ‘Africa’s Water Quality: A chemical Science perspective’ of March 2010 alerts African governments to implement preventive policies based on scientific evidence and to raise the profile of water quality in policy agenda, so that it is considered alongside water quantity.

The PACN was set up by the Royal Society of Chemistry, with a focus on MDGs aimed at advancing the chemical sciences across Africa. It represents an innovative approach to working with universities, schools, scientists and teachers. It is also engaging with chemical societies throughout Africa and the Federation of African Chemical Societies.

The PACN suggests increased establishment of ‘Centres of Excellence’ in analytical chemistry staffed with African scientists, which will play a role in the evaluation and monitoring of water quality. With the support of Syngenta, regional hubs in Ethiopia and Kenya have been set up.

“The centres should play a role in facilitating networking activities between African and non-African scientists in water research and management and ensuring that water quality data is shared,” notes the report.

“In the light of climate change and massive population expansion, Africa’s scientists must play a vital role in meeting water quality challenges.”

In 2009, Africa’s population exceeded one billion and increases at a rate of 2.4 percent annually. Overall, 341 million people lack access to clean drinking water, and 589 million have no access to adequate sanitation, which means it will be unlikely that the 2015 MDGs will be met.

Public Health experts say access to clean drinking water and basic sanitation, including toilets, wastewater treatment and recycling affects a country’s developmental progress in terms of human health, education and gender equality.

Records show that about a half of all patients occupying African hospital beds suffer from water-borne illnesses due to lack of access to clean water and sanitation, which costs sub-Saharan 5 percent of GDP per year.

Water-borne diseases like typhoid, cholera, and dysentery are among the major causes of mortality and morbidity in Africa, spread by microbiological pollutants. After all, 75 percent of Africa’s drinking water comes from groundwater and is often used with little or no purification.

“A detailed knowledge of water quality is essential so that drinking water can be adequately treated and the contamination of its sources can be prevented,” says the report.

Chemical contaminants can also cause disease, developmental problems and can adversely affect agricultural yields and industrial processes.

But in comparison to quality, Africa has quantity, abundant water resources although not evenly distributed across the continent, and rainfall patterns are increasingly unpredictable due to climate change.

Africa has an abundance of water; it has 17 rivers, each with catchments over 100,000 km2, more than 160 lakes larger than 27 km2. Rainfall too is plentiful, with Africa’s annual average precipitation level comparable to that of Europe and North America.

But there are disparities in water availability, for instance about 50 percent of Africa’s total water resources are concentrated within the River Congo basin.

DR Congo therefore has the highest available freshwater per capita at 250,000 m3 per capita per year. In contrast, Burundi and Kenya have only around 840 and 950 m3 freshwater per capita per year, respectively.

The report points out that the disparity in water resources across Africa means that a quarter of all people are experiencing water stress, measured between 1000 and 1500 m3 per capita per year. And with populations increasing, water scarcity is emerging as a major development challenge for many African countries.

Projections show the situation will worsen by 2025, that many countries will suffer water scarcity and stress. Furthermore, almost all sub-Saharan African countries will be below the
level at which water supply is enough for all.

The report is from a 2009 Sustainable Water Conference held by the PACN, hosted by the University of Nairobi, Kenya, and sponsored by the RSC and Syngenta.

The findings and recommendations contained within this report represent the views of the 180 scientists and practitioners that attended this conference from 14 different countries in Africa, as well as the UK, Switzerland, Colombia and Uruguay.

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IT experts say on the Uganda fibre optic cable

By Esther Nakkazi

The Uganda National Backbone Initiative project (NBI) for the past months has been facing so much criticism for its sloppy and shoddy work.

I have been speaking to experts and following the debate on i-network www.i-network.or.ug mailing list. Here are some issues that have come up:

Some experts are calling to uproot the already laid cable, something experts are talking about with mixed feelings after the time and funds invested in the $110 million Chinese funded project.

In the meantime, NITA has asked the Chinese-Huawei Technologies, to stop work on the project and to undertake a forensic audit and fix mistakes at the firms cost.

But Huawei officials said the dig-ups in the city by utility companies are responsible for the damages on the cable. They insisted that each party comes up with a team to investigate works on the cable.

Huawei officials like some experts in the IT sector and on I-Network mailing list insist that the G652 is a standard widely used cable.

Dr. Ham Mulira pioneer ICT minister and also an IT expert says he does not understand why they say the cable can not work. It is a standard cable the most widely used, it is sad when people make wild statements.

“The cost of the project is not only the fibre, there are civil works, compensation for the right of way, you just do not divide cost by distance,” said Mulira of the cost of the Ugandan cable that is said to be more expensive than Rwanda.

As a showcase and reference for a cable laid in Africa, Huawei would never do shoddy work. Many African countries were in Uganda to study the project including Malawi, ICT ministry official said.

But Samuel Besweli on the I-Network mailing list says the G652 cable limits capacity to 2.5Gbps-10 Gbps and it will require additional repeaters or DCF/SEQs to compensate for the long haul applications, which could simply become more expensive than initially laying the G655 cable.

Experts say the technology to solve these problems is in place and at advanced stages so it may not necessarily be costly after 15 years when the cable needs upgrading. Although the question would then be why not set up one that does not need upgrading initially.

Here are some excerpts from Mark Tinka, the chief Network Architect, Global Transmit Communications, Malaysia and others on the I-Network Mailing list about the cable: the average life span of a terrestrial or submarine cable system (other external factors notwithstanding) is between 15 - 20 years.

G652 is capable of pumping 10Gbps, and if the cable is fairly new with minimal to no splicing or fibre cuts, it could manage 40Gbps within 10 years of its useful lifecycle so the capacity issue is a non-issue.

Fibre is cheap, and with the ducting already in place, sending G655 through will be, easy, moreover, upgrading the whole network can be in phases. While those running 40Gbps or less are still on G652 you can install the G652.

This is an operational issue, not a technical one even if the fibre was G652, G653 or G655. We cannot predict that the next revision of G655 or G656 or whatever future cable will be much better.

Stakeholders in the Industry are also worried that the cable was not laid deep enough, which will create cuts and down time.

Safety in terms of depth remains to be seen when it is in operation, the trade off is between cost, security and timelines. Pulling out fibre and replacing it for no major technical or commercial reason is counter-intuitive.

The significance of being able to pump 880Gbps up to 1.6Tbps or 160 wavelengths @ 10Gbps each, worth of bandwidth over a single core of newer, low attenuation G652 fibre should not be underestimated.

I would suggest going ahead to light what has been laid, continue to lay the remaining G652 until it runs out, and then purchase and lay G655 for the remainder of the
project. However, all current purchases of G652 must halt!, advised Tinka.

Grandma: Lover of Pets

Over the Easter holiday, I was off to the village (now a small town) to visit my maternal grandmother Mrs. Margaret Njakasi. She has had a heart problem over the last few months and as her granddaughter, I feel obliged to care for her. Not that she has no children, she has three of them but my mother R.I.P, her firstborn was her best friend and naturally I feel that in her absence I should be her caretaker.

Both my maternal grandparents are alive and so is my paternal grandmother from whom I get my first name, Esther. My estimates put grandma’s age (Mrs. Njakasi) at about 80 years but her children give me different figures 76-79. Whatever.

I consider her a hero; she, for instance, brought up my 3 cousins whose father my uncle Eddie (my mum’s brother) died of HIV in the early 90’s. One of the girls, Susan was brought to grandma’s house only 2 years old. She later told me she thought grandma was her mum. Susan is now a woman in her early 20’s.

But grandma is almost the only poor person I know (there are others of course) who keep pets. Every time I visit there is a dog or a cat on her heels. I remember visiting grandma when I was young and she had a dog-called Pido. Naturally, as a kid I was afraid of Pido, whenever Pido came near me I would scream and my mum, irritated, would tell her mother to keep 'her' dog away from me.

Grandma keeps a cow, whose name 'Alinyikira' is loosely translated -'she who works hard'- but grandma talks and sings for the cow as though she was a human being. My cousins claim the cow cries when grandma is leaving say for church or a visit. Strange!

On this Easter day, there was a new cat. Really happy to see me, grandma invited me to go sit in the living room, as opposed to the mats we usually sit on outside the house on the verandah.

Mr or Ms. Cat spotted me with tea and bread and the mewing started. Grandma first put a pillow and called for the cat to sit near her. The cat was more interested in what I was eating. She climbed really close to my chair and mewed louder. Oh dear!

Grandma encouraged me to give the cat some bread. Then my cousin, Banga, angrily narrated how grandma treats the cat as though it was her child. She even allows it to eat from her plate, he said really disgusted. Another cousin chipped in, she gives them (pets) milk (from the cow) not considering us.

Banga kicked the cat away, saying it is a spoilt, lazy cat that can’t even catch mice. I sensed that the cat really detests Banga, after eating a fair share of my bread she went and coiled on the pillow near grandma. Unfortunately, she has no name; grandma has run out of names I guess.

But being poor and a lover of pets, she either has to share her food with them or collect leftovers both of which she does diligently. I prefer dogs to cats, maybe I should keep one. But it is too expensive! I am sure I never inherited grandma’s love for pets or I would not think the way I do, and none of the grandchildren I know keep them either. It is different from Grandma and pets!

Kenyan Matutu driver outsmarts Nigerian journalist on World Water Day 2010:

So it was the World Water Day 2010 celebrations in Nairobi. The theme for this year was water quality; makes a lot of sense since there are so many efforts focused on water availability.

So I was in town for the day. After the celebrations at UNEP in Nairobi, I and a group of journalists decided to take a Matatu back to town. The ride would have gone without incidence save for the continuous jokes by one of the Nigerian journalists, Fidelis, in the heavy traffic jam.

And an abrupt turn by the lady driver ahead of our Matatu that almost caused an accident. There was no bang, if anything it could have been just a scratch because the Matatu driver stopped so suddenly, my tall neighbor banged his head on the Matatu roof.

Immediately the driver (Kenyan of Indian origin) jumped out of her car and angrily scolded the taxi man. Somehow the driver was not arguing back, he was only trying to explain that she had turned so abruptly and the scratch was insignificant.

Meanwhile, we were holding up a lot of cars in the heavy jam, the cue seemed endless to the eye. Back inside the Matatu, Fidelis was making all sorts of comments. At one point he stood up to go and ‘help’ the Matatu driver, who according to him was doing nothing to assure the lady driver that she was the one in the wrong.

If anything he was making more noise than the Matatu driver but while inside the Matatu. Other passengers were smiling just enjoying the drama of the day, some were anxiously peeping out of the windows impatient to go.
I was listening to Fidelis and his talk of what he would do if only this had occurred in Lagos.

Suddenly, the Matatu conductor came and opened the boot and because I was in the back seat, I took it that he wanted to put in their some luggage. The driver of the Matatu also slowly got in his seat and within seconds we were racing up the street.

With all the cars out of the way by now we could have flown. On taking off I saw the confused lady driver trying to take a run a bit and then taking the photograph of the back of the Matatu but it was too late and too smooth.

So there was no case for the Matatu driver because the boot was open and there were no number plates to record on the mobile phone picture taken by the lady. Fidelis acknowledged that Yes the taxi conductor was smarter than him. And that is what I call smart. Happy World Water Day 2010! Be a smart water consumer get rid of water waste the only way to have quality water for consumption.

Homosexuality- what Ugandans say.

By Esther Nakkazi

Last week I went to cover a meeting ‘Coalition of human rights and the Constitutional law’ at Imperial Royale hotel in Kampala. Tempers flared, people spoke emotionally as they debated the anti-homosexuality bill.

The guest speaker was Professor, Makau Mutua, a scholar in law, gender and sexuality from Kenya. He spoke about human rights, why people are homophobic and tried to explain that there is no normal sexual orientation because whatever one has is normal to that individual.

Before I discuss this let me back up a bit on my neighbor from Spain, Anna Maria, who came to Uganda for a journalism fellowship under the International Federation Journalism (IFJ). She is a politics writer and is attached to one of the Ugandan daily newspaper, The Monitor.

Anna-Maria and her husband Ernesto (who speaks very little English) came to Uganda just about two months ago and they live on the apartment just above mine in Kiwatule.

One Tuesday morning, as is the normal practice with Anna-Maria we left home for work. We boarded a taxi (matutu -14 passenger seater) to go to work and as usual started talking about the yesterday activities. She had gone for one of the political party, Forum for Democracy Congress (FDC) press conferences and was making an assessment of the two party candidates Dr. Kizza Besigye and Maj Gen. Mugisha Muntu.

But at the press conference she said, she had missed an opportunity to ask a good question. Why was the opposition silent about the anti-homosexuality bill when these parties like FDC talk about promoting democracy, and human rights? Fair enough question but time was up by the time she raised her hand.

So we engaged in a talk about homosexuality in Spain. Deducing from her talk it was basically human rights respect. We were so deep into talk that I did not notice the silence that had engulfed the taxi, everyone in the 14 seater-commuter taxi listening in on our conversation.

In the front row in the matatu was a fat man who attentively listened to our conversation and he was irritated all the while because he suddenly turned and almost angrily asked Anna-Maria if she really thought it was proper to practise homosexuality.

In Uganda, we shall never accept it because ‘we have to protect the traditional family’, he said. His thoughts were not any different from the usual in Uganda. Africans are generally homophobic, Ugandans are not any different, the very few who are not have been either exposed, are open-minded or are both.

So Mr. X (the fat man)‘s next question to Anna-Maria was what would she do if her son married a man. At this time he really sounded irritated or angry and had now turned starring at her. Of course all the while she labored to explain about human rights to which he answered that in ‘countries’ like where Anna-Maria comes from they encourage people to become gay which made her raise her voice a little bit.

She tried to explain that if her son were gay that would be his choice she would never interfere but she definitely would not have encouraged him into it. His take on this was that if his son ever engaged in homosexuality, he would kill him. What! She was stunned. Okay at this point I thought we should just switch topics.

Why, there is mob-justice in Uganda, which she has no idea about and the last time an American reporter had an assignment about homosexuality at the same newspaper, she was almost deported. Fortunately we got to the stage where she alighted and immediately Mr. X turned to me and emphasized that in Africa we shall never allow homosexuality.

He also expressed a fear (common among many people) that if Uganda did not accept a bill that outlaws homosexuality, the greater part of the population would become gay. At the time I was alighting off the taxi to yet another day of hard work. First forward to last week’s meeting where Prof Mutua gave a brilliant talk explaining why homosexuality is a right, why being gay is termed ‘un African’ and giving reasons why Africans are homophobic.


During the discussions Odonga Otto a member of parliament made it very clear that, he was thinking and speaking like 90 percent of his colleagues in parliament, ‘MPs do not consider homosexuality a right and it will never be a right in their lifetime’ in Uganda. The author of the Bill, Bahati, is also of this position that homosexuality is not a right. Period. As the discussion progressed there was one basic issue, in this seminar mostly attended by lawyers and human rights activists, that Ugandans would not accept homosexuality as a human right.

During the workshop, there was a demand for a scientific explanation for homosexuality. Some participants in the meeting (MPs) let Prof Mutua know that if there was scientific evidence as to why people become homosexuals, then the debate would be different and they were convinced that it was a health problem.

Of course if there is scientific evidence, it is hard to come by, and if this will be the basis for MPs to pass the bill then they probably will, but there are hardly any studies that justify it as a health problem.

Also even if research was carried out it is unlikely that it would be done in Africa. But many people in Uganda think it is a habit, which is learnt, and as some Pastor alleged is motivated by money, ‘we can treat them psychologically and talk them out of the habit’ he concluded. Now here are some thoughts and observations on this issue: its true that homosexuality could have been practised among some African societies, and even in Uganda, who knows? But prior to this Bill no one seemed to mind it.

The community now feels that they are being oppressed and coarsed into knowing and debating homosexuality. Some lady who travels frequently for international meetings recently told me ‘it is not our agenda at all. We have more serious problems and I feel oppressed when I am exposed to homosexuality talk’. Many have echoed this, for a poor country like Uganda is it its agenda?

Secondly, the way different people debate and look at issues depends on a number of factors. The ability to just listen and allow debate on an issue without necessarily attacking or getting emotional is a preserve of very few human beings and neither does it follow the intellectual level of an individual.

Most of the fear expressed in Uganda is that when is not outlawed, half of Ugandans will become homosexuals! One explanation given for this is, in a country like Uganda, I guess just like in most of Africa, communities still thrive and someone is everyone’s business. The communalism and culture means society has established standards, if it does not fit it is judged wrong.

Which brings me to another point that was talked about by Prof Mutua, that homosexuality is considered ‘un African’. Mr. X asked Anna-Maria why do you people bring homosexuality here. Of course his idea was that she represents a whole race.

For the mere reason that apart from a few human rights activists, the people on one side telling Ugandans that the anti-homosexuality Bill is terrible are not Ugandans, so it comes off as forcefully imposing a position on a community, which has gained independence and thinks they can run their own affairs.

The threats and prominent presidents’ condemnations with all African presidents silent does not help matters. The Bill being a private members Bill, whose owner, an accountant, by far and large has failed to authoritatively defend it passionately is another matter. On one TV programme it was a total mess. This could help if there were Ugandans interested in not having it pass through but the ‘push’ factor. Bahati is not really audible about the anti-homosexuality bill.

I will say this again, the homophobia is intense but so is the push factor from outside. My feeling is that the Bill could never ever be passed, how many people would end up in prison, from churches, medical practioneers? But when the forces out of Uganda make it their point to crush it the insiders feel alienated from it and probably will have the more reason to not let outsiders dictate on how they conduct business.

Just like Anna Maria explained the more she lives in Uganda, the more she understands Mr. X’s reaction. There are so many factors that make society tolerate each other, but the key to all this is dialogue, which is still limited. In one of the traditional proverbs in Uganda they say people from the underground can never tell people living on earth how hot the temperatures are or how bright the sun is shining. They are from the underground!

The people on earth can figure out that actually hot temperatures are bad and decide to plant trees to cool it off, or they are good, when the people from underground insist they automatically become stubborn mules!

(This is what I have heard, seen, observed and also partly my opinions. It is interesting that a friend does not even want me to write about this topic, it is demonic she says! I am a Christian but enjoy debate and knowing what people think)
Ends-

Look beyond treatment-Uganda scientists on US antimalarial drug quality study

By Esther Nakkazi

This week the US published a report from a study on the quality of anti-malarial drugs in Uganda and other African countries.

But Uganda scientists have different opinions saying although the study was good and relevant, there are more pressing problems with malaria, which kills at least 300 people, per day, mostly children under five years and pregnant women in Uganda.

Some Uganda scientists think the study was a 'commercial ploy’ by the malaria industry but all agree there is a bigger problem than impure drugs. They pointed out that the resistance problem for malaria drugs is more of a bad consumer behaviour problem rather than purity of drugs.

In Uganda, drug resistance is manifested because many people misuse drugs properly rather than taking low quality anti-malarials. Dr. Myers Lugemwa, officer in charge of malaria research at the ministry of Health said even if it sounds like common sense but the fastidious behavior of patients  probably caused by ignorance and cultural beliefs brings about drug resistance.

He said many patients seeking treatment have cheeky behaviors like ceasing to take medicines when they feel better and sharing medicines with neighbors and friends.

So for Uganda and many other countries the issue of quality of drugs is not a primary concern but accessibility.

“We are only taking what is available, we can not just have people die because the drugs are not good quality. We have tested them and found them effective,” said Dr. Lugemwa.

National Drug Authority (NDA), the Uganda regulatory body officials said they test all the drugs that come to the market and they are dealing with counterfeits on the market but the laboratories are registering a downward trend in quality testing failure over the past decade.

“There has been a drop in drug failure rate in our laboratories over the last 10 years. But there are problems with consumers due to self medication, incomplete doses and as a result drugs become ineffective,” said Fredrick Ssekyana, the spokesperson for Uganda National Drug Authority (NDA).

The reactions follow the release of a report that said that the most effective type of malaria-fighting drugs sold in three African countries including Uganda are often of poor quality, raising fears of increased drug resistance.

Between 16 per cent and 40 per cent of artemisinin-based drugs sold in Senegal, Madagascar and Uganda failed quality testing, for reasons including impurities or not containing enough active ingredient, the survey found.

'I am alarmed by these results because it means there are many cases of malaria that are being only partially treated, and that just guarantees acceleration of artemisinin drug resistance.'— Rachel Nugent, Centre for Global Development

The study was the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization.

Artemisinin-based drugs are the only affordable treatment for malaria left in the global medicine cabinet. Other drugs have already lost effectiveness due to resistance, which builds when not enough medicine is taken to kill all of the mosquito-transmitted parasites.

If artemisinin-based drugs stop working, there is no good replacement and experts worry many people could die.

"It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active [ingredients] or the presence of impurities in the product," said Patrick Lukulay, director of a nongovernmental U.S. Pharmacopeia program funded by the U.S. government, which conducted the survey. "This is a disturbing trend that came to light."

NDA officials said they also have a problem with increasing drug counterfeits on the market, which is a global evil, but it is working with Interpol to curb the vice.

“We have people who change expiry dates, drug labels and even make pills using cassava flour,” said Ssekyana.

The three-country report also found bad drugs in both the public and private health sectors, meaning governments — some buying medicines with donor funds — are not doing enough to keep poor-quality pills out.

All of the drugs tested from the public sector in Uganda, however, passed the quality tests. But 40 per cent of the artemisinin-based drugs in Senegal failed.

"There are countries where donated medicines are not subjected to quality controls, they're just accepted," said Lukulay. "There are countries in Africa where Chinese products have been donated and found to be unacceptable later in the public sector."

Donations come in during epidemics or seasonal disease outbreaks, simultaneously and generously, and they are accepted by non-governmental and faith-based organizations unconditionally, according to NDA officials.

“We urge that the donations are subject to the same tests but we usually re-export or destroy them and the costs are borne by those who donate them,” said Victoria Birungi Kwesiga, inspector of drugs at NDA.

Nearly 200 samples underwent full quality control testing in a U.S. laboratory to examine the amount of active ingredient present and drug purity. For both drugs, 44 per cent from Senegal failed the full quality testing, followed by 30 per cent from Madagascar and 26 per cent from Uganda.

“I think this is a commercial ploy to discredit other drug companies super ceding others,” said a pharmacist in Wandegeya a suburb in Uganda.

“They should look beyond treatment to prevention. Recently I heard in the media that Uganda mosquitoes are resistant to DDT, they should focus on the parasite,” said Rhona Nankya a nurse in Kampala.

In all three countries, the antimalarial brands collected from various areas and sectors tended to either do well across the board or poorly, which could prove helpful for governments working to ban low-grade drugs.

Results from the other countries surveyed — Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania — have not yet been publicly released by the WHO.

Ends-

Research to Policy -MRC/UVRI 20 years celebrations

By Esther Nakkazi
On 2nd February we celebrated the Medical Research Council/ Uganda Virus Research Institute (MRC/UVRI) 20-year marriage anniversary on HIV research at Entebbe.
Medical research is not a sexy topic to cover by all means but it such an important topic especially when it translates into policy.

The search for government policy formulations from science research was not something I used to pay attention to, even as a science journalist, but as a freelancer you get privileges of tuning your pen and mind to whatever publication you are contributing to.

So in 06/07 while writing stories for a UK based editor, Robert Walgate, for a health magazine RealHeathNews the stories he was interested in were policies that accrue from research. There was one outstanding one, at the time, male circumcision as a result of the research done in Uganda, Kenya and South Africa. It is yet to become policy in Uganda.

Successfully the MRC/UVRI, a multi disciplinary, research unit on HIV has managed to lead to HIV policies, guidelines and treatment protocols in Uganda and beyond. For instance research conducted at the unit has produced such ground breaking results that is has helped change international guidelines for treating HIV.

A major trial conducted by the unit in the 1990’s showed that an antibiotic drug, cotrimoxazole (septrin) was able to cost effectively prevent many of the debilitating secondary infections that plague HIV patients because of the damage to their immune systems caused by the virus.

As a result, provision of these drugs for HIV has been introduced not only in Uganda, but also almost everywhere in Africa.
Dr. Paula Munduri manager HIV research programme at the Unit is currently planning a new study of cotrimoxazole in combination with ART to see if cotrimoxazole treatment is necessary once patients’ immune systems have sufficiently recovered.

If the results show that continued cotrimoxazole treatment is unnecessary then this could save money on giving people extra pills they do not need. But also importantly it will reduce on the number of pills that patients need to take when they are already on four to eight pills per day with ART, so this could improve patient compliance with treatment.

If funding is secured to go ahead, the trial will start in mid-2010. The funding has been secured, hopefully enough to carry more important research, as one of the speakers at the Entebbe celebrations announced. Mr. Martin Shearman, the British High Commissioner, announced 40 million pounds in support of the unit for the next ten years.

Some of the research underway as part of the unit’s basic science programme is to develop an HIV vaccine and exploring issues around the appearance of viral resistance to anti-retroviral drugs. The major focus is to pinpoint which host factors and which viral factors are actually responsible for providing protection against HIV.

One of the puzzles of HIV today is why a small group of individuals in this world have natural protection, that is even when exposed to the virus they do not seem to get the infection easily. It important to understand the special attributes of their immune systems, to design a vaccine, which could create such an immune response in other people.
Dr. Pietro Pala is leading this study a part the International Centre for HIV Vaccine Immunology (CHAVI) which is a large group of collaborating universities in the US and the UK linked up with samples from a very large cohort of sero-discordant couples in Kampala.

Samples have been collected since 2007; and enrollment of the patients in the study was recently completed.
MRC boasts of the most advanced basic research infrastructure, understanding the immune responses, people progression to HIV. It transcends all institutions because of the collaborations.

On 2nd Feb at the anniversary celebrations a regional reference laboratory at MRC/UVRI to monitor HIV drug resistance was commissioned by Dr. Gilbert Bukenya, the Vice president.
Hopefully we shall have more policies formulated from research at MRC/UVRI and I will have so much to write about the next time Walgate calls!


The lab commissioned at the MRC/UVRI 20th anniversary
Ends.

BEANS AND WOMEN IN RWANDA

Esther Nakkazi in Rwanda

The journey to Kigali started off on the Rwanda Air twin-engine propeller Dash-100, a small 37-seater plane. It was on short notice by Centre for International Tropical Agriculture (CIAT), but it was worth the journey on the earsplitting, rickety plane and heavy rains as we landed at the airport in Kigali.

The good news was that on January 15, 2010, Rwanda scientists at the Institut de Sciences Agronomiques du Rwanda (ISAR) released 15 new bean varieties that are going to benefit thousands of farmers in the central and east African region.

Rwanda and Beans:
For this beans field-learning trip, I think I have learned so much about climbing beans, I am contemplating becoming a bean farmer or changing my name to Ms. Esther Bean.

But seriously, here are some facts about Rwanda and beans, particularly climbing beans, which fascinated me so much, and interestingly, I had never seen them grow in the field.

Rwanda is one of Africa’s most densely populated nations. It relies on beans as the main staple food, source of protein and calories as such beans are consumed on a daily basis by almost everybody. The very poor can eat them alone. 

Luckily, beans described as a ‘poor mans’ meat’ and a second-class protein can be the sole source of protein with very little or no first class protein (animal) supplement. 

That is why Rwandans, who reportedly are the highest consumers of beans in the world at 50-60kgs kgs per capita (per person per year), grow strong and healthy by eating only beans as a source of protein.

They eat the leaf, as a vegetable, the grain at major meal times- lunch, dinner, and kids eat beans for breakfast with tea before going to school. In other countries when one eats a meal like Irish or sweet potatoes than beans, the other food is the bigger portion but in Rwanda, the beans per meal are more than the other food.

Rwanda has one of the highest diversity of beans in Africa. It has so much variety in terms of color, types-bush beans and climbing beans as well as Rwanda farmers have immense knowledge on beans.

The new bean varieties released by ISAR on 15th January. 

For instance according to Augustine Musoni, a bean breeder with ISAR, since the year 2000-2010, Rwanda in partnership with CIAT has developed 35 beans varieties. They have thus, managed to get high yielding, disease resistant and climate change tolerant beans that can easily grow elsewhere in the region.

Rwanda also has the mandate to breed for climbing beans in the region under CIAT. In Rwanda, beans are grown in especially the northern region. 

For our tour, we visited Ruhengere, a 2 hours ride from Kigali, and also Kirambo and Musanze in Bulera district. I must say that Rwanda is a beautiful country with many hills. I can describe it as a high rising brown cake, decorated with green icing sugar with thick chocolate (brown dirty water) flowing along its hills.

With its high population and declining land size, climbing beans allow maximum use of limited land and are comparable to having skyscrapers in cities in terms of space utilization.

Women and Beans:
Beans are described as a woman’s crop. Women in Rwanda plant, cultivate, harvest, store, sell, cook the beans and they are very much involved in the selection of bean varieties developed by plant breeders. 

The farmers’ experience in growing beans is excellent, actually, Rwandan women could be the most experienced about growing beans in the world, with a lot of knowledge the ladies are said to know their beans very well.

They can tell which beans can grow in a particular type of soil and season. Hence, Rwanda bean breeders, have a deep connection with Rwandan women via beans. The breeders cannot release a variety until they get confirmation from women who touch, cook and taste them in the participatory variety bean selection.

“When we are breeding we get women to select the varieties. They have the traditional expertise, they will look at the seed in their hands and just say this variety cannot be grown here or it will not do well,” said Musoni.

A woman farmer in Rwanda tending to her climbing beans.

Women also give beans names in Rwanda. The beans bear scientific names but are also given local names.

One of the varieties released on January 15th was CAB 2 – scientific name, Gasirida, local name after a woman farmer Cansilde Gasirinda.

The women also name some beans after what they look like in terms of colors, shape- ‘red kidney’, or other characteristics like weight, ‘coltan’ because they are heavy and fetch more money just as the mineral coltan.

Jacqueline Mujawamariya, 31 years old has spent many years growing, tending, eating and selling beans. She eats beans with Irish potatoes and posho and does not remember that many days when she had a meal with no beans.

As a bean farmer and trader, she has bought a calf from her beans proceeds. She described the climbing beans –as ‘sweet’ compared to bush beans. But also the climbing beans technology –is comparable to the 'Jack and the Beanstalk', which is extremely useful where land pressure is soaring and the need for higher yields is very intense.

CIAT and Beans:

The partnership between the Centre for International Tropical Agriculture (CIAT), the Pan-Africa Bean Research Alliance (PABRA) and Rwanda’s ISAR has developed improved climbing beans that slink up stakes two meters high- tripling, and even quadrupling yields.

These beans require stakes and relatively more labor, but they give back assisting in soil nitrogen fixing, as well as reduction of soil erosion in sloping areas that experience heavy rain. 

In Rwanda, the immediate pay off from the high yields of climbing types has catalyzed farmers’ adoption of soil fertility improvements, such as organic amendments and the use of agroforestry. This has led to better soil conservation and more sustainable agro-ecosystems for areas.

According to Dr. Robin Buruchara, Africa regional Coordinator CIAT, the national programmes like ISAR in Rwanda, or Kawanda Agricultural Research Institute (KARI) in Uganda, are given lines for breeding that they make adaptable to the needs of the country.

For instance, the ‘marker assistance selection’, which is basically conventional technology is used to breed varieties that are selected by farmers. CIAT, the custodian of beans varieties, however, does not allow the varieties to be sold after being bred even after the country program adds value because they are a ‘public good’.

That hopefully, is knowledge enough for you to become Mr/Ms. Bean like I would like to become  a bean farmer like the Rwandan women.
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