Road Injuries and Heart Disease Killing more Ugandans today

By Esther Nakkazi

Boda Bodas or motor cycles are popular in Uganda. They beat the traffic jam, are fast and take you to your next meeting and you arrive on time. At the same time, Uganda like all other developing countries is coping with increasing deaths from non communicable diseases.

So if you live in Uganda, today and you are not HIV positive, you are more likely to die from road injuries or ischemic heart disease. More-so, you will die of road injuries if you are a man. In Uganda, road injuries took a greater toll on men, killing 9,917 males and 3,100 females in 2013.

If all is well, then, you will live to a ripe age of 58.2 years if you are a man and 61.6 years if you are a woman because average life expectancy has increased to those levels. By contrast, women lived an average of 53.6 years and men had a life expectancy of 49.9 years in 1990.

But you will most likely not die from from African trypanosomiasis and diarrheal diseases in Uganda. Mortality from African trypanosomiasis dropped 95% between 1990 and 2013. In 1990, these diseases killed 46,571 people. Twenty-three years later, they claimed 30,480 fewer lives.

This is according to a new, comprehensive analysis of trend data from 188 countries published in The Lancet on December 18, "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

The research was conducted by an international consortium of researchers coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

According to a press release from Meropa Communications, the study shows that the leading killers in Uganda were HIV/AIDS, malaria, and pneumonia, accounting for 34% of all deaths in 2013.

For young people aged 15 to 49 years old, HIV/AIDS and tuberculosis were the top two causes of death, resulting in 43,815 lives lost in 2013.

For older people, 70 years and older, stroke claimed the most lives last year. But more women 6,209 and 4,363 men’s lives died of stroke. And children under the age of 5 years, it was malaria, killing 22,449 children in total.

Progress in Uganda and Internationally:

But generally there was progress with less mortality from a number of diseases that used to take a large toll on the country.

"We have achieved great progress in reducing mortality from a number of diseases, reflecting our country’s investments in improving health for its citizens," said Mr Opio John Nelson, Assistant District Health Officer for Environmental Health from Lira, Uganda.

"But we are still seeing children dying and deaths from other conditions are rising. These data are critical to understanding where we’ve been – and then where we need to go in order to save more lives in the future."

Globally, people live an average of 6.2 years longer than they did in 1990, with life expectancy rising to just under 72 years in 2013. Women showed a slightly larger average gain (an increase of 6.6 years) than men (a rise of 5.8 years). Improvements in health, reduced fertility, and shifts in the world’s age patterns have driven these global gains in life expectancy.

Out of the 188 countries included in the study Uganda ranked 166th for women and for men for longest life expectancies. In 2013, Andorra had the longest life expectancy for women (86.7 years) and Qatar had the longest for men (81.2 years). Lesotho had the shortest life expectancy for both women (51.2 years) and men (45.6 years).

"The fact that people are living longer in most parts of the world is good news but we must do more to address health disparities," said IHME Director Dr. Christopher Murray.

"Only with the best available evidence can we develop policies to improve health and save lives."

Worldwide, ischemic heart disease, stroke, and chronic obstructive pulmonary disease (COPD) claimed the most lives, accounting for nearly 32% of all deaths. Much global progress has been made in reducing mortality from diseases such as measles and diarrhea, with 83% and 51% declines respectively, from 1990 to 2013.

Globally, a number of diseases that have received less attention relative to others are some of the biggest causes of premature death, particularly drug use disorders, diabetes, chronic kidney disease, and cirrhosis. 

The gender gap in death rates for adults between the ages of 20 to 44 is widening and HIV/AIDS, interpersonal violence, road injuries, and maternal mortality are some of the key conditions responsible. For children under 5, diarrheal diseases, pneumonia, neonatal disorders, and malaria are still among the leading causes of death.

Two diseases, HIV/AIDS and malaria, followed very different mortality trends from other diseases. The global death toll from both diseases peaked around 2005 rather than 1990, with deaths from HIV/AIDS and malaria declining 22% and 30%, respectively, from 2005 to 2013. Malaria mortality in Uganda peaked in 2004, with 52,573 deaths, but then fell 44% by 2013.

Leading causes of death in Uganda, with the number of lives lost

1990 (deaths)                                                  1. Diarrheal diseases (38,336)          2. Pneumonia (24,529)                     3. Malaria (22,872)                           4. HIV/AIDS (19,912)                   5. Tuberculosis (12,319)                 6. Malnutrition (9,616)                     7. Preterm birth complications (8,961)                     8. Meningitis (8,960)                         9. African trypanosomiasis (8,235) 10. Measles (8,067)

2013 (deaths)  1. HIV/AIDS (52,939)  2. Malaria (29,545) 3. Pneumonia (28,046 4. Diarrheal diseases (15,710) 5. Tuberculosis (14,738                    6. Road injuries (13,017) 7. Preterm birth complications (10,838) 8. Neonatal encephalopathy (10,733) 9. Stroke (10,572) 10. Malnutrition (9,549)

Find the paper at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61682-2/abstract

The Global Burden of Disease (GBD) Study 2013 is part of an ongoing effort to produce the most timely and up-to-date understanding of what kills and ails people worldwide.

Thousands of collaborators worldwide work together to generate annual estimates of deaths by cause, years of life lost to disability, and rates of premature mortality and illness. To make these data as useful and relevant to policymakers and country leaders as possible, findings from the GBD study can be used at the global, regional, national, and even subnational levels to track trends in health over time.

Researchers found a widening gap between countries with the lowest and highest death rates from a given disease – a potential sign of increasing inequalities in health. They also emphasize the importance of measuring local disease burdens, as the health challenges found in one corner of a country can widely vary from those experienced a few hours away.

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Dr. Edward Bbaale: Should Many Ugandans be Engaged in Agriculture?

By Esther Nakkazi

Uganda's agriculture sector cannot generate jobs yet it is a leading employer in Uganda, with over 8 million people or over 70 per cent of the entire labor force. In terms of productivity, it also has the lowest output per worker researchers say.

This implies that the majority of workers in Uganda are holders of low paying jobs, with very low prospects of overcoming the problem of poverty says Edward Bbaale, a researcher with Center for Basic Research and School of Economics at Makerere University.

So, is it necessary for so many Ugandans to engage in agriculture? Especially, at this point in time, when the demographic dividend is generating a window of opportunity to raise per capita income and thus reduce poverty?

Even when Uganda records growth in the agricultural and manufacturing sectors, they are jobless while growth in the services and industrial sectors is job generating.

A paper by Bbaale entitled ‘Is Uganda’s growth profile Jobless?’ points out that more people should be engaged in other productive activities and sectors rather than agriculture if Uganda has to reduce on its poverty levels and create jobs for the youth.

The research published in November 2014, was funded by Canada’s International Development Research Centre (IDRC)

This paper set out to establish the link between economic growth and employment in Uganda for the period 2006 to 2011. Data is from World Development Indicators, Uganda National Household Panel Survey (2011) and United Nations Statistical Data Base. Researchers adopted the Job Generation and Decomposition (JoGGs) Tool of the World Bank during the analysis.

Overall, the promising sectors for poverty reduction through productivity and employment generation in Uganda by order of importance are; services sector, industrial sector and manufacturing. "If adults manage to engage in these sectors , the demographic shift will have an important poverty reducing impact," says Bbaale.

The services sector was employing over 2 million Ugandans, that is 19 percent in 2006 and 22 percent in 2011 of the labor force. It had all its contributions positive; contributed 39 percent to output per worker and 14 percent to the growth in employment.

“If East African governments are to cope with the pace at which new young entrants will come into the job market in the next decade, there is an urgent need for new innovative approaches to accommodate this youth bulge,” said Eugenia Kayitesi, Executive Director of the Institute of Policy Analysis and Research (IPAR-Rwanda).

Bbaale, however, cautions that agriculture still remains important because it is a major employer in Uganda.

Policy Question:

Since agriculture generates low income for its workers this puts a policy question on the productivity of jobs held in the agricultural sector.

Apparently, agriculture contributes to a decline in the employment rate by 6.5 percentage points. But there are positive increments noted in the services and industrial sector with 1.73 and 0.5 percentage points, respectively.

Of the -20 US dollars registered in per capita output, agriculture and manufacturing contributed negatively with -29 and -0.8 US dollars, respectively. Services and industry contributed positively 7.7 and 2.1 US dollars, respectively.

These findings combined with high productivity in services and industrial sectors give a great prospect to these sectors in an effort to reduce poverty via employment creation.

Agriculture being the major sector in Uganda, a small contraction in employment led to a very big negative effect on growth such that the positive effect in services and industry could not offset it.

Youth Employment:

IPAR-Rwanda in collaboration with Canada’s International Development Research Centre (IDRC) convened a high level conference on innovative approaches to incorporate youth into labour markets in the East African region in November 2014 in Kigali, Rwanda.

In his presentation at the conference, Bbaale said at least 25 percent youth could not find suitable work and 64 percent were discouraged from looking for work because they thought that a job search would be a futile effort. 9 percent did not know where to seek for work.

For those who managed to get employment, 52 percent did not have a contract with the employer, they had an oral contract with an unlimited duration. Some youth were self employed and most of them raised their own start-up capital for their businesses.

Most youth’s reason for becoming self employed were voluntary because they had a desire to become independent and more flexible hours of work, said Bbaale of his research.

Bbaale says governments in East Africa should be mindful of the influx of the youth to urban centres. And the education systems should orient towards relevancy to the job market.

“Supporting youth to find productive employment is a global priority, the situation in Africa could not be more urgent,” said Arjan de Haan, Program Leader of IDRC’s supporting inclusive growth programme.

He also found out that very few youth have benefited from the government youth fund. The majority of the youth also argued that government programmes were not addressing youth unemployment and were not innovative.

“Research and evidence coupled with experience sharing between countries in the region, and giving the youth a voice are all critical ingredients to providing policy makers and practitioners with the tools that are needed to address this growing challenge,” said Arjan de Haan.

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Merck to Wipe Schistosomiasis off the face of Africa

By Esther Nakkazi

Ethiopia will receive around 13 million praziquantel tablets, treatment for schistosomiasis, in 2015.

Ethiopia is one of the most endemic countries for schistosomiasis in the world, says the World Health Organisation, with around 22 million people, or above 20 per cent of the entire population, needing treatment.

Merck (http://www.merckgroup.com), a leading company for innovative and top-quality, high-tech products in the pharmaceutical, chemical and life science sectors will donate the tablets.

The expanded Merck Praziquantel Donation Program will result in a financial commitment totaling around USD 23 million a year.

Merck is committed to the elimination of schistosomiasis, the parasitic worm disease, in Africa. At the beginning of 2012, it announced that it will fight schistosomiasis until the disease has been eliminated in Africa.

To reach this goal, the company will increase the annual donation of tablets up to 250 million in the medium term. The further scale-up of the program will allow the treatment of about 100 million children a year. Between 2011 and 2014, Merck’s annual donation has grown from 25 to about 75 million tablets.

"We have committed to continuing our efforts in Africa, in cooperation with WHO, until schistosomiasis is eliminated," said Frank Gotthardt, Head of Public Affairs at Merck and responsible for the Merck Praziquantel Donation Program.

According to a press release from APO, Gotthardt said that in order to fulfill this commitment, Merck will donate 100 million praziquantel tablets to African countries in 2015. Ethiopia will be one of the main beneficiaries of this donation.

The first meeting of the Global Schistosomiasis Alliance took place at the UN Conference Centre in Addis Ababa yesterday.

“This alliance will allow the different constituencies to engage in a coordinated approach to better address the challenges of meeting the elimination target”, commented Gotthardt.

The round table discussions and first global schistosomiasis meeting took place during the neglected tropical diseases week being hosted by the Ethiopian government from December 8 to 12.

The Merck Praziquantel Donation Program was launched in 2007. Since then, more than 200 million tablets have been supplied and over 54 million children have been treated.

It is also supporting awareness initiatives at African schools to explain the causes of schistosomiasis to children and teach them how to prevent the disease. Merck is also conducting research on a pediatric formulation of praziquantel for preschool children within the scope of a public-private partnership. So far, praziquantel tablets can only be administered to children over the age of six.

Join in for Universal Health Coverage

On Friday, 12 December, more than 500 organizations from over 100 countries will unite behind the first-ever Universal Health Coverage Day – representing an unprecedented worldwide coalition urging access to quality health care for all.

The Uganda government has already taken recent steps to introduce a national health insurance scheme as early as next year. But there is still much work to be done, to ensure that all Ugandans have access to affordable care.

This date, December 12, will also mark the two-year anniversary of the United Nation’s unanimous resolution endorsing universal health coverage. More than 1 billion people lack access to basic health care, and another 100 million fall into poverty trying to access it each year. 

The ongoing Ebola outbreak is only the most recent reminder of the desperate need to strengthen health systems for everyone, everywhere.

There is clear picture yet that universal health coverage is affordable and attainable. For instance Rwanda our neighbour has achieved it. Other countries as diverse as Brazil, Thailand, Mexico and Ghana are implementing steps toward universal health coverage, reducing the number of families facing catastrophic health care costs. In addition, about 24% of the growth in “full income” between 2000 and 2011 in low- and middle-income countries resulted from health improvements.

A report from the United Nations Secretary-General emphasized that universal health coverage is essential to ending extreme poverty and promoting sustainable growth for all. Once considered a pipe dream, universal health coverage, is an idea whose time has come.

Political talk does not lessen demand for Medical Male Circumcision in Uganda

By Esther Nakkazi

Uganda President Yoweri Museveni's negative talk about voluntary medical male circumcision (VMMC) is loud and clear, but Ugandans are not listening, as they continue to demand for the HIV intervention. 

In 2015, Uganda will carry out one million voluntary medical male circumcisions, if funding is available.  If that momentum is maintained, every year, all Ugandan men will undergo operation Abraham at some point. Then we shall have a circumcised nation, which is non muslim.

Museveni was a guest of honour in Fort portal at the World Aids Day (1st December 2014) and in his speech he undermined the importance of male circumcision as an HIV prevention intervention. He made comparisons between Bakonjo and Bagisu, tribes who have traditionally circumcised their men but still do not have the lowest HIV prevalence rates in the country. 

Museveni also mentioned that 'those who circumcise could die’.

Truth Tellers, who are a unified African voice speaking the truth of VMMC, as an HIV prevention intervention, say they want to win Museveni over, however, his talk has so far not lessened the demand and uptake of voluntary medical male circumcision.

Records from the Ministry of Health, show that in 2011, Uganda performed only 57, 132 safe male circumcisions and in 2013 there were 801, 678 procedures. In 2014 over 900,000 procedures have been done.

Dr. Barbara Marjorie Nanteza the Coordinator, AIDS Control Program, Ministry of Health, Uganda, believes that if funding is made available, Uganda will perform over 1,000,000 million medical male circumcisions in 2015.

Uganda has a population of 36 million people. Over 49 percent of these are male. If at least a million a circumcised, per year, then all Ugandan men will at some point undergo operation Abraham.

“Most Ugandans know the consequences of HIV/AIDS, so they seek for protection through SMC, which is so far the most effective and it is provided as an HIV prevention package,” said Dr. Nanteza. 

Truth Tellers, say they need to win Museveni over, even though some feel they have already talked themselves hoarse to both politicians and the public about its benefits.

Research backs it up too. It has shown that men who circumcise, reduce their risk of becoming infected with HIV heterosexually, by approximately 60 percent.

“We have done our best to provide evidence to all the people including all the top politicians plus our President all these years,” said Dr. Nanteza.

“We really need to do something to win the voice of the President of Uganda to promote VMMC, or at least stop him from campaigning against the service,” said Stephen Mugamba who works with Rakai Health Sciences Program.

Truth Tellers stand for accelerated roll out of VMMC for HIV prevention in Africa.

“It is unfortunate the President of Uganda is speaking against Male circumcision. I wish we had a way of looking at circumcision from a cultural angle,” said an official from Kydesa (Kenya Youth Education and Development support Association) Rainbow community.

“ Changing a community culture might be very challenging. It requires deeper evidence that focuses on benefits of foreskin and circumcision as an option for HIV prevention,” he said.

Truth Tellers, now want to target the First Lady, Janet Museveni to champion voluntary medical male circumcision in Uganda.

“The president may have his misgivings about the strategy, however, it is great that they are not affecting the demand for the service. However, targeted advocacy may help. The first lady may also be targeted as a champion and may get to the president-in the spirit of female involvement. This is if she believes," said Martin a Truth Teller about VMMC.

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World Most Endangered Antelope Population Grows

By Esther Nakkazi

Less than 240 Hirola, a type of antelope, are left in the world living along the Kenya-Somalia border. They are critically endangered and without immediate intervention they could go extinct, the first time a mammal would do so on mainland Africa in modern human history.

Hirolas are the last living representative of an evolutionary lineage that originated over three million years ago. They look like a child born to an impala and hartebeest, and have trademark white "spectacles."

In 2006, the Ishaqbini Hirola Community Conservancy was established by Northern Rangelands Trust (NRT), The Nature Conservancy, the Kenya Wildlife Service (KWS), and partners banded together to establish the Ishaqbini Community Conservancy, to protect critically endangered Hirola.

Its the only Hirola sanctuary on the planet. It has a predator-proof fence.

It is also very much a part of the community, who tell regaling stories of helicopters manoeuvring through bushes and the gentleness of captured Hirola during translocation.

One community member, ‘a magical elder' mimics the hyena with red eyes and holes in his ears and grows the tail of a hyena calling them in order to catch them.

"This is powerful and entrenching and shows that the sanctuary indisputably belongs to the community and the stories are beyond any ‘conservation awareness’ we can do ourselves," said Dr. Juliet King, Science Advisor, Northern Rangelands Trust.

A recent survey showed that in less than three years 34 Hirola have been born, bringing the number of antelope protected from poaching and predators in the sanctuary to 78.

“A lot of people may not view 34 births in three years as significant, but with fewer than 240 Hirola left in the world we’re talking about the difference between survival and extinction,” said Matthew Brown, Africa Deputy Director, The Nature Conservancy.

The predator-proof sanctuary was built and 48 Hirola were successfully trans-located into the sanctuary in August 2012. The trans location effort was deemed an overwhelming success (there were no Hirola deaths during or immediately after the trans location.

The Ishaqbini Hirola Community Conservancy where they live is home to Somali pastoralists who voluntarily established this dedicated area for Hirola, assisted with the trans location, and continue to play a crucial role. The people of Ishaqbini have been quietly conserving this landscape for centuries and regard the Hirola as a blessing says a press release.

Additionally, the other wild animals in the sanctuary like giraffes, zebras, kudu, gazelles, ostrich and many others are significantly multiplying. Elephants for the first time have made their way into the sanctuary, and there is now an elephant family of eight settled in their new secured habitat.

The project’s long-term goal is to release animals bred within the sanctuary back into the free-ranging population, ultimately building a viable population that is equipped to cope with natural levels of predation and competition.

Museveni's World Aids Day Message Missed the Science in HIV?

By Esther Nakkazi

President Yoweri Museveni was a guest of honour in Fort portal yesterday and his speech for the World Aids Day missed the science in HIV.

In his message Museveni, encouraged adolescents and young children to abstain from sexual intercourse until they become of age to make informed decisions. He urged health educators to repackage HIV prevention information for young people. That was fine.

He also saluted the Uganda Aids Commission (UAC) headed by former Health Minister Dr. Christine Ondoa for their work; infection rates are down from 162,000 in 2011 to 137,000 in 2013; people living with HIV on life-long treatment are 680,000 people as of June 2014, out of a total of 1,400,000 Ugandans living with HIV; mother to child transmission new guidelines are now rolled out country wide.

And pointed out that inspite of these achievements, 350 new HIV infection still occur in Uganda daily!

He spoke about the challenges Uganda is facing to fight HIV pointing out that most infections are happening among most at risk populations including: Sex workers, fisher folk, Uniformed Personnel and Truckers.

But Activists say while the messages were appropriate and encouraging he missed the point. And  the science in HIV. According to Alice Kayongo-Mutebi the Regional Policy and Advocacy Manager- East/West Africa Bureau, AIDS Healthcare Foundation (AHF).

His messages strongly undermined the importance of circumcision as an HIV prevention method.

"He made comparisons between Bakonjo and Bagisu who have traditionally circumcised their men but still do not have the lowest prevalence rates in the country," said Kayongo. He mentioned that 'those who circumcise could die'. Yes they could but he needed to back it up with stats.

A study done in African countries including his own country, Uganda, showed that men who are circumcised reduce their risk of becoming infected heterosexually by approximately 60 percent.

Kayongo said Museveni also undermined the use of condoms as a prevention tool when he said 'Condoms should stop! If you do not trust someone, then do not have sexual intercourse with them'.

Many studies have indicated that consistent use of condoms results in 80 per cent reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse.

Kayongo also pointed out that Museveni while talking about most-at-risk population did not mention men who have sex with men (MSM) and transgender Ugandans who at the risk of HIV infections.

Although no study has been done yet to establish the HIV incidence among MSM and commercial sex workers in Uganda, they are known to be among the drivers of the HIV epidemic. The one that was being done got suspended at MUWRP.

Scientists have indicated that Uganda’s HIV incidence-new infections per year, can be reduced by 77 percent if the country targeted prevention in most at risk populations which includes MSM.

Apparently, Men who have sex with Men are a bigger danger because most of them also have sex with women and they could be married, especially in a hostile environment like Uganda.

Uganda’s HIV incidence can be averted if they focused more on most at risk populations for prevention said a researcher from the school of Public Health Makerere University, Joseph Matovu. “If they did at least 2 million infections could be stopped by 2025,” said Matovu.

"Telling from the issues mentioned above, some of the President’s remarks were really unfortunate!
We need to continue to highlight the importance of safe male circumcision and condom use as prevention tools," said Kayongo. 

"The President has probably not been adequately informed about the scientific evidence surrounding these two interventions," said Kayongo.

Flavia Kyomukama, an HIV activist said Museveni had earlier said that any young person who gets infected with HIV is committing 'treason'.

"I think it is unfortunate for a Head of state not to know his epidemic and continue to leave some sections of the society behind. No wonder, Uganda's annual new HIV transmission rate is still as high as 137,000," commented Kyomukama.
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