Thursday, December 31, 2015

Uganda Celebrates 10 years of Community Research

In November, we (I am a volunteer of the Community Advisory Board at the Makerere University Walter Reed Project) celebrated ten years of cross CAB at the 10th annual Cross-CAB network Forum. The cross CAB is when all the CABs of the different institutions meet togather. Thsi was the tenth anniversary, a milestone achievement really.

Dr. Emmanuel Mugisha outlined the why the Cross CAB annual meetings were started, saying it was because the community was inquisitive about research. At the time that they were started the concept was not understood by the high level researchers but there was a common ground which was the community and that is how all the stakeholders started talking.

It was hard to get people to buy into the concept. In Nov 2005, the first Cross CAB meeting was held, ten years later in the same month, November, we held a Cross CAB meeting, thus its sustainable.

He emphasised that research should empower the communities to have power over their health. Research findings should also move to influence public health policies and implementation.

The CAB is an important platform in making people understand that they have to participate in research. He emphasised that participation in research is voluntary.

Dr. Francis Kiweewa: Highlights of his talk: “Stop being consumers of the science but be part of the science.”
  • Many studies fail to take place in Africa because people do not want to participate in research maybe because they are not aware, are ignorant or they are confused.
  • Taking part in clinical trials is very important.
  • Africans need to stop being consumers of science but also contribute to the making of science. He said “many times people ask me has this vaccine been tested on Americans yet?” Dr. Kiweewa said Africans should know that the virus is less in those areas.
Dr. Joseph Ochieng; Highlights of his talk-

A: The first IRB in Uganda was established in 1986. But research ethics has been active for the last 13 years.
  • The last revision of research ethics guidelines was last year by Uganda National Council for Science and Technology (UNCST).
  • The ethical review guidelines keep changing and being updated. The world over research ethics is new and we are trying to make it a discipline.
B: Role of community representatives; they should be drawn from the community to help the IRB appreciate the proposed research.
They are expected to represent the cultural and moral values of a community.

C: Consent forms; In our community many people do not want to read so consent forms should be short.
  • The Uganda culture is a listening culture. The community representatives should advise the IRB to have few pages.
  • People should be able to understand the risks in a consent form. Are the risks clearly stated? Adequate informed consent is key. The benefits can come in later.
  • The community representatives should be able to bring out the salient aspects of the research to volunteers.
  • You cannot eliminate all risks but the best way is put on the table all the harms that the volunteers would be going through when they undergo the research.
  • If you do research that does not go to theIRB, there are few journals that will accept it. If the science is bad then the research is bad.
  • In research accountability is having a publication.
Adeodata Kekitiinwa: Highlights of her talk:
  • Adolescents have the highest mortality rate for HIV in Uganda. Majority do not fear HIV they fear pregnancy most.
  • There is a lot of sexual exploitation of adolescents by adults.
  • There is a lot of exploitation by the adults because even if you are giving transport refund you are closing one eye for the adolescents.
  • The global trend in HIV is declining but among the adolescents it is increasing and they need to be included in research. There is an urgent need to research about HIV in adolescents.
  • There is a lot of alcohol and substance abuse among them. It is not because they have HIV that abuse these but because they are adolescents.
A: Informed Consent for adolescents in research;
  • Informed consent must be given and should be taken home so that they do not make a rush decision. (24 hours) those with low mental capacity should be given a chance to take longer to consent.
  • As we talk about research we have to tell adolescents about the benefits, -tell them about any intervention without mincing words.
B: Rights of Adolescents in research;
  • Some adolescents head households but they will decide about which family member will be able to involved in that process. Health workers go wrong when they make their decisions on which family member to participate with adoloscents in the research.
  • An adult judgement cannot override the decision of an adolescents- that does not sound African.
  • There are some adolescents that head households but legally they are not allowed to consent on their own.
  • Research should not be done among adolescents with a low mental state- if they had nutrition issues when young.
  • Many adolescents would participate in research just to have the transport refund. In the process the researchers are jeopardising the rights of the adolescents.
  • We have issues of adolescents being abused by family members.
  • Adolescents even if they head households are not legally acceptable to make that decision to participate in research.
C: Ambience for research venue;
  • Institutions doing research among adolescents must be able to have the sensitivity and privacy. The venues were they do research should have the ambience.
  • Long waiting time - not conducive for adolescents
  • We have started study visits on phone so that they may be able to miss school.
  • Mandatory parental escorts in research for adolescents.
  • Who deals with them in research must be taken care of, shared confidentiality is shared with the care taker.
  • If the adolescent says NO you stop there - do not force them concluded Dr. Kenkiinwa.

Thursday, December 10, 2015





3.0 Purpose: To Leverage additional Domestic Finances to support Procurement of HIV and AIDS drugs for the National Response

3.1 Objectives of the Memo

This cabinet information paper is intended to;

Provide information to Cabinet on the current funding gaps for HIV and AIDS drugs for the Public Health response to HIV/AIDS in Uganda.

Provide Information to Cabinet on the progress in the implementation of the Public Health Response to HIV/AIDS Epidemic in Uganda.

Seek for support from Cabinet for mobilization of additional domestic resources to support the funding gap for HIV and AIDS drugs for the implementation of priority interventions for the HIV and AIDS response in Uganda.

4.0 Epidemiology (Burden) of the HIV/AIDS Epidemic in Uganda

Uganda has been grappling with a severe generalized HIV/AIDS epidemic for over three decades. The 2011 AIDS Indicator Survey (AIS) revealed an increase in HIV prevalence among adults aged 15-49 years, from 6.4% in 2004/05 to 7.3% in 2011. This increase is attributed to incident HIV infections and improved survival due to increased access to HIV care and treatment services including antiretroviral therapy (ART).

The increase in prevalence was noted in several regions with doubling of prevalence in some regions such as West Nile. The HIV burden (number of people in the country living with HIV was estimated at 1,486,642 (Adults 1,339, 248 and pediatric 143, 312) in 2014 and will be 1,544,315 (1,406,789 adults and 137,526 children) at the end of 2015.

The data for Uganda indicate geographic and socio-demographic heterogeneities. Women are disproportionately more affected than men with an overall HIV prevalence of 8.3% among women compared with 6.1% among men. 

By geography, HIV prevalence ranges from 4.1% in Mid-Eastern region to 10.6% in Central 1 region. Mid-Eastern Uganda, with the highest population coverage of circumcision (53%) had the lowest HIV prevalence at 4.1% and registered a modest decline from 5.3% in 2004/05 . HIV prevalence was higher among uncircumcised men (6.7%) compared to circumcised men (4.5%).

Urban residents are more likely to be infected (8.7%) than their rural counterparts (7%); this picture is prominent among women with HIV prevalence among urban women estimated at 10.7% compared to 7.7% among rural women while the rates for urban and rural men are the same (6.1%). In the younger age groups 15-24 years, HIV prevalence is estimated at 3.7%; the female HIV prevalence for the age groups 20-24 is two to three fold that of males within the same age category.

The country continues to experience a high rate of new HIV infections. The number of new HIV infections was consistently higher than that of individuals initiated on treatment until 2013 when the tipping point was reached (ratio of new HIV infections to the net increase in ART was <1). It is estimated that approximately 99,000 new HIV infections occurred in 2014 - falling from 137,000 in 2013, 140,000 in 2012 and 147,000 in 2011. (MoH- Estimates and Projections, 2014).

Data from the MoH also indicates that high-risk behaviors remain prevalent in Uganda. Reported condom use in high-risk encounters is low. Comprehensive knowledge combining several knowledge measures remains low. In 2011, only 36% of women and 43% of men aged 15-49 had comprehensive knowledge about HIV/AIDS, with very modest increases from 2004/05 (less than 10% for both men and women). 

Overall, 25% of the men reported having two or more sexual partners in the previous year, compared with 3% of the women. Condom use among those engaging in higher risk sex declined from 47% in 2004/05 to 29% in 2011 among women and from 53% to 38% among men.

5.0 The Public Health Response to HIV/AIDS in Uganda

The Government of Uganda has been addressing the HIV/AIDS epidemic through the implementation of the National Prevention Strategy, the National Strategic plan and the Health Sector Strategic and Investment Plan. In July 2014, these documents were re-inforced with the development of the HIV Investment Case which identified National core HIV/AIDS priorities. The response is premised on structural, behavioral and bio-medical interventions.

The priority interventions in the Feasible Maximum HIV Investment Case Scenario for Uganda will be scaled up over the first three years between 2015 and 2018 and thereafter maintained at the targeted levels through 2025. 

These priorities include the rapid scale up of ART coverage to 80%, with test and treat for MARPS, eMTCT coverage to 95%, annual HCT coverage of 50% of 15-49 years population, coverage of condoms use to 80%, coverage of SMC to 80% and expansion of BCC services to achieve a reduction in the number of sexual partners by 25%. The National Strategic Plan and Health Sector Strategic and Investment plan will also focus on the identified priorities in the HIV Investment Case.

It is envisaged that with the implementation of the priorities in the Investment Case, the country could avert 2,160,000 new HIV infections and 570,000 AIDS-related deaths between 2015 and 2025. Other integrated adjunctive interventions such as isoniazid preventive therapy, early detection of TB in HIV infected persons, and expanding ART coverage to all co-infected persons will be implemented because of their implications for the incidence, prevalence and mortality from the related TB epidemic.

6.0 Progress in the Public Health Response

The Ministry of health has a Health Sector HIV Strategic Plan (HSHASP 2010/11-2014/15) to guide the Public Health response to the HIV and AIDS epidemic. The health sector public health response focuses mainly on behavioral and bio-medical interventions. 

These include; BCC, Condom programming, HCT, STI management, Safe Male Circumcision, eMTCT, Care & Treatment and Strategic Information. The implementation of these interventions is tailored to focus on geographic and socio-demographic groups that are disproportionately affected by the epidemic. For the core programs that have been prioritized in the public health response, the following progress has been made;

6.1 Behavior change communication

Data from the NSP Mid Term Review indicate that many achievements have been registered in behavior interventions. These include the development of a BCC message book which was distributed to all districts; a pastoral letter distributed by the Inter-Religious Council of Uganda (IRCU); and interventions targeting cultural leaders. 

UAC also established a message clearing committee and launched a new campaign ‘Zip-up 256’. However, it is estimated that only 1,639,649 individuals were reached with BCC, representing 7.9% of the targeted number. Also, HIV risk behaviors persisted.

The Knowledge Management Communication- BCC review of 2013 indicates that consistent, targeted messages that are grounded in the realities of the communities, promoted by multiple sectors and multiple channels such as mass media and telecommunications are valuable but should be used strategically and targeted to communities. 

The review notes that the ABC campaign was previously successful but overlooked the influence of gender, coercion and socioeconomics of decision-making dynamics and did not target MARPs such as sex workers and fishermen as well as the risk compensation due to new technologies like SMC and ART . 

Inconsistencies in messages were also cited as a challenge (e.g. mixed messages around use and non-use of condoms). The current BCC models and messages are being adjusted to align with the current environment.

6.2 Condom Programs

The MoH is implementing a Comprehensive Condom Programming Strategy (CCPS) that is aimed at increasing demand for male and female condoms, improving access to and utilization of condoms, strengthening the condom supply chain management, and monitoring and evaluation. Both male and female condoms (FC2) are procured and distributed. 

The country has recently strengthened capacity for the Condom Post-shipment testing policy, and this has greatly improved the condom throughput. The number of condoms procured annually are significantly below the projected national need. 

 The Comprehensive Condom Programming strategy has been reviewed and a report is available. The review is the basis for the design of the next strategy that is being designed to refocus demand creation and condom distribution. 

With support from partners, a total of 172, 201,292 (56% of estimated national need) condoms were procured and distributed in the country in the last year. The capacity for post shipment testing at National Drug Authority (NDA) has continued to improve from 13 million in 2013 to 18 million per month in 2014. There is however a continued challenge of the lack of a budget line for this in the Ministry of Health budget.

6.3 HIV counseling and testing (HCT)

HIV Counseling and Testing is a critical entry point for HIV prevention and Care Programs. The number of people who tested for HIV in the last year was 10,273,927 out of a target of 7,421,024 people. Most of these tests were conducted in health facilities based on the Provider Initiated Testing and Counseling (PITC) approach. 

The population level proportion who know their HIV status were last determined in the 2011 AIS and was 45% for men and 66 % for women. The higher coverage among females is attributed to HCT opportunities during MCH and PMTCT services. 

HCT has expanded over the last three years with expansion of Provider Initiated Testing and Counseling (PITC), community models, and couples HIV counseling and testing. access to testing by some population groups (e.g. men) is still low. Couple testing is also low; only 5% of testers received couple HCT in 2014. A Population HIV Impact Assessment Survey will be conducted early next year and will help us determine the trend in this indicator.

6.4 Male circumcision

Data from UAIS 2011 indicate that the SMC prevalence was 26%. The annual target for the national SMC program is 1,001,875 circumcisions, to contribute to the NSP target of 4.2 million circumcisions by 2015. SMC scale-up was initially slow but has significantly increased due to improved capacity. 

The circumcision program has expanded and cumulatively a total of 2.4 million men have been circumcised since the program was initiated. In the last financial year, 688,313 men were circumcised. The program has developed a policy for tetanus immunization in response to the tetanus adverse events. In the new policy, there are proposals for booster immunization doses for target eligible males.

6.5 PMTCT and Early Infant Diagnosis (EID)

The implementation of the eMTCT program in Uganda is based on four prongs including:- 
a) Primary HIV prevention 
b) meeting the unmet need for family planning
c) lifelong ART-Option B+ and 
d) family centered treatment for children and adults infected with HIV. 

The new guidelines for Option B+ have been fully rolled out in the country and coverage of ART treatment to mothers receiving PMTCT in 2014-2015 was 112,909 (92%) against a need of 122,581 HIV infected pregnant women. The number of facilities implementing these new guidelines in the country has continued to increase and was 4,200 sites countrywide.

The PMTCT facility coverage has increased significantly over the past year; from 2,138 in 2013 to 3,248 facilities providing PMTCT services by June 2014. The proportion of pregnant women tested for HIV increased from 30% in 2008 to 95% in 2014. In 2013, EID facility coverage was 1,696 (76% of the facilities) including 100% of referral hospitals, 100% of district hospitals and 100% of HCIVs, 84% of HCIIIs, and 5.6% of HCIIs. 

Coverage of EID testing among infants (first DNA PCR) in 2013 was 60,437 (51%), a steady increase from 7% in 2007. However, the percentage of exposed infants who received the first PCR at two months has increased from 45.6% in 2011 to 59.8% by June 2014, against the NSP target of 50% by 2015. Prevalence of HIV among those tested was 9% in 2012 and 4.6% in 2013, a significant decline from 19% in 2007. Furthermore, data from MoH indicate that new pediatric infections reduced from 28,000 in 2009 to 15,000 in 2013 and were 9,500 in 2014

6.6 Care and Treatment

The objective of the Care and Treatment Program is to expand coverage so as to maximize individual patient benefit as well as the community prevention benefit. The Ministry of Health through the AIDS Control Program is implementing new guidelines for prevention and treatment that are focusing on enrolment of CD4<500 and test and treat for 
i) All TB/HIV and Hepatitis B/HIV co-infected individuals,
 ii) HIV infected children under 15 years, 
iii) HIV infected pregnant and lactating mothers, 
iv) All MARPS. This also includes a phased introduction of viral load monitoring of treatment in addition to the clinical and immunological markers.

The active ART enrollments grew by 28% during the 2014. The proportion of people who are on ARVs increased from 53% in 2009 to 750,896 (56%) by December 2014 of those in need (adults 694,627(58%) and children 56,269 (38%). 

ART enrollment increased to 823,050 (761,771 adults and 61,279 children) by September 2015. This coverage is based on the new HIV prevention and Treatment guidelines in which the number of people in need has gone up and is currently estimated at 1,345,872 (1,196,556 adults and 149,216 children) at the end of 2014 and is estimated to be 1,406,702 (1,269,176 adults and 137,526 children) by December 2015.

The total number of facilities providing ART in Uganda has increased from 1,552 at the end of 2013 to 1,658, of which 1,204 were concurrently providing ART to children by the end of 2014. These facilities include two national referral, 13 regional referral and 112 of 140 general/district hospitals (80%), 186 of 206 (90%) HCIVs, and 1084 out of 1309 (83%) HCIIIs, and 200 out of 2777 HCII as well as 31 specialized HIV clinics. The number of facilities providing pediatric ART increased from 869 in December 2013 to 1,204 sites (December 2014).

The Ministry of Health has introduced viral load monitoring through a centralized viral load laboratory at CPHL supported by the sample transport network. Since August 2014 to August 2015, a total of 132,000 viral load tests have been conducted. The Early Infant Diagnosis (EID) has continued to scale up services and last year over 98,000 tests were conducted and over 70,000 babies from 2239 health facilities.

7.0 Fundamental problem to be addressed in the Memo

In order to address the big challenge of the HIV/AIDS epidemic indicated in (4.0) and to sustain the achievements in (6.0) above, the MoH and Partners are implementing interventions that include the scaling up of priority behavioral and biomedical interventions in the National Strategic Plan, National Prevention Strategy, the Health Sector Strategic and Investment Plan and the HIV Investment Case. Other sectors are implementing Structural interventions and some behavioral interventions.

The Goal of the MoH and partners supporting the implementation of these interventions is to contribute to the following goals: (a) aversion of 2,160,000 new infections between 2015 and 2025- 77% reduction in new infections, (b) reduction of new infections in children from 14,200 to 4,040 between 2014 and 2025 (c) aversion of 570,000 deaths by 2025 and (d) saving lives of 42,620 children from AIDS related death by 2025.

The Care and Treatment program is an essential component of the interventions to achieve these targets. The Specific request in this Cabinet Memo therefore is for additional domestic financing to procure emergency drugs to fill out a critical public sector gap for the period November 2015 - June 206 and to request for the inclusion of additional resources in the budget for July 2015 - June 2016 to bridge a public Sector Funding gap. The ministry of Health aims to achieve the UNAIDS triple 90 targets in the scale up of the Care and Treatment program towards an AIDS Free generation.

8.0 Issues for Consideration by Cabinet

This Cabinet memorandum seeks to update Cabinet on the Status of the HIV and AIDS epidemic and to mobilize for funds to fill the gap for essential life saving ARVs. There are two major funding mechanisms in place for drugs: 
1) The Government of Uganda (GOU) budget support to the Health sector through the Ministry of Finance Planning and economic development; 
2) Support from AIDS Development partners; mainly PEPFAR and the Global Fund. The United States Government through PEPFAR supports the private sector ARV needs through the Joint Medical Stores and Medical Access Uganda Limited warehouses. The GOU and the Global Fund support the public Sector drug needs through the National Medical Stores (NMS).

The Government of Uganda has been increasing its contribution for public sector ARVS through NMS. There however remains a gap because the funds were insufficient for the patients currently enrolled on treatment, a situation which has been compounded by the depreciation of the shilling in recent months. 

There is therefore a stock out at the NMS and at the public health facilities. As a result of that, the Ministry of Health has asked the Global Fund to carry forward funds which were in their second year budget to fill the gap in the current first year. This therefore has a ripple effect in the second year which will also require to be offset to prevent a similar situation from recurring.

The focus for the resource mobilization in this memo therefore is to mobilize for funds for the procurement of anti-retroviral drugs to support the Care and Treatment Program in two categories namely; a) a subvention from the Ministry of Finance to the tune of USD 10,071, 638 for an emergency order for ARVs for November 2015 - June 2016 and b) funds to the tune of USD 92,281,641(excluding previous allocations to NMS budgets) for the July 2015 - June 2016 budget period.

9.0 Timing

This Cabinet Memorandum needs urgent action by Cabinet to bridge the Funding gap for essential drugs to ensure patients that are currently on treatment continue to receive essential life saving treatments. The Ministry of Health has notified AIDS Development partners including the Global Fund and the United States Government of Government of Uganda's intentions to increase domestic financing for the HIV and AIDS response and the processes it will take to mobilize them that includes the development of this Memorandum for Cabinet.

10.0 Policy analysis

The Ministry of Health concurs with the proposed procurement of essential life saving drugs to contribute to a reduction in new HIV infections and avert AIDS related deaths in a quest for an AIDS free generation. 

This will in turn save costs and contribute to socio-economic development. These interventions are in line with the Global UNAIDS triple 90 targets, the goal of the National Development Plan, the HIV Investment Case, the National HIV Prevention Strategy, the National Strategic Plan and the Health Sector Strategic and Investment Plan.

11.0 Implications of the Cabinet Memorandum

The Ministry of Health has conducted a Financial Gap analysis to determine the funds currently available from GoU and from AIDS Development Partners in order to determine the existing Funding Gap for essential drugs for the HIV and AIDS response. The focus for this Cabinet Memo will be on the procurement of essential life saving drugs for the Care and Treatment Program. 

Because of the current stock outs for ARVs in the Public Sector, the Ministry of health has requested the Global Fund to carry forward the funds in the 2nd year period of the HIV Grant that is currently being implemented to ameliorate the current deficit in drugs. The Global Fund have agreed to that request; that however will bridge but not completely close the first year gap. More importantly however, this front load will now result in a bigger public Sector Gap for the second year of the Global Fund Grant.

The request in this Memo is therefore for additional domestic funding for a) bridging the emergency requirements for ARVs for the period November 2015 - June 2016 for patients currently on treatment and b) bridging the gap for ARVs for the period July2016 - June 2017 Based on the programmatic and Financial gap analysis for the Care and Treatment Program for the public sector, the funding requirements for essential life saving drugs for the Emergency order for November 2015 - June 2016 and for the intermediate period July 2016 - June 2017 are summarized in table 1 and table 2 below.

This Cabinet Memo aims to mobilize for funds for the procurement of anti-retroviral drugs to support the Care and Treatment Program in two categories namely a) a subvention from Ministry of Finance to the tune of USD 10,071, 638 for an emergency order for ARVs for November 2015 - June 2016 and b) funds to the tune of USD 92,281,641(excluding what was previously in the NMS budget) for July 2015 - June 2016 budget period.

12.0 Recommendations

The Ministry of Health and Partners have proposed a plan to scale up the HIV and AIDS response that aims at an AIDS free generation by 2030. To implement that plan, there are significant resource gaps. The Ministry of Health proposes to Cabinet that GOU leverages for a subvention from Ministry of Finance for USD 10,071, 638 for an emergency order to support the procurement of essential life saving ARVs to support the current public sector gap at NMS. The Memo also seeks for USD 92,281,641 in the budget period July 2016- June 2017.

13.0 Conclusion

The implementation of the proposed priority interventions in the HIV Investment Case, the National HIV Strategic Plan, National Prevention Strategy and Health Sector Strategic and Investment Plan has the potential to significantly reduce the number of new HIV infections and AIDS related death in Uganda. Care and Treatment is an essential component in these plans. It is essential that Government prioritizes HIV and AIDS commodities particularly ARVs that will have impacts on the AIDS epidemic by cutting AIDS related deaths and contributing to a reduction in new infections. In the long term, this will also save costs of care and contribute to enhanced socio-economic development.

14.0 Attachments and References

This Memorandum needs a Certificate of Financial implication from Ministry of Finance Planning and Economic Development

15. Address of Author and Date of Initiation




16th November, 2015.

Wednesday, December 2, 2015

Every Day is a Diabetes Day

By Esther Nakkazi

Next year, Merck, a leading science and technology company, in partnership with Uganda Ministry of Health aims to reach 30,000 Ugandans with free diabetes screening and education through its “Merck Uganda Diabetes Day” campaign which is dubbed “Every Day is a Diabetes Day”.

The move follows a Combined Diabetes and Cancer Campaign in Uganda as part of the Merck Cancer Control Program. The program is one of the initiatives of the Merck Capacity Advancement Program (CAP).

The CAP was launched by Merck in 2012 to expand healthcare capacity in the areas of research and development, supply-chain integrity and efficiency, pharmacovigilance, medical education, and community awareness in Africa and developing countries.

Through the combined community campaign, Merck aims to provide more than 2,000 Ugandans with free cancer education and diabetes screening and advice on how to lead healthier lives to enable them prevent the diseases.

According to World Health Organisation (WHO), by 2020 there are expected to be 16 million new cases of cancer every year, 70% of which will be in developing countries where governments are least prepared to address the growing cancer burden and where survival rates are often less than half those of more developed countries.

“Supporting healthy families, healthy communities, healthy economies - this is our over-all target we want to achieve”, said Kai Beckmann, Member of the Executive Board of Merck.

“We are convinced, that this initiative will make a great contribution to advance cancer and diabetes healthcare in Uganda. The close partnership with ministries of health and universities in Africa is a key for the success of the diabetes and cancer awareness campaign.”

At the campaign, Uganda’s Minister of State of Health, Sarah Opendi stated that most patients report to the health facility when the cancer is at an advanced stage which poses a challenge because nothing much can be done to save the patient’s life. “This is partly due to the nature of the cancers since they have no symptoms during the early stages but also due to our poor health seeking behaviours”

“According to the World Health Organization (WHO), over one third of cancer deaths are due to preventable causes such as a viral infection, poor nutrition and widespread tobacco use,” said Sarah Opendi.

“It is important to note that once diagnosed early cancer can be treated and cured. Uganda just like other developing countries faces a wide range of health system challenges and cancer is often not a priority in limited resource settings. Therefore the Ministry of Health appreciates private public partnerships with reputable companies like Merck to promote key health guidelines and raise awareness about cancer so that people learn how to detect and prevent it,” Opendi added.

Successful awareness campaigns on Diabetes in Uganda

“Merck previously partnered with the Ministry of Health, Makerere University and Uganda Diabetes Association to carry out medical camps and nationwide diabetes awareness through text messages via mobile phones (SMS) to healthcare providers and community members.” Rasha Kelej, Chief Social Officer for Merck Healthcare

“Today Merck addresses Cancer and Diabetes at the same campaign, which will help to target the common risk factors for non-communicable diseases (NCDs) such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity.” Kelej added.

Sarah Opendi emphasized: “Cancer awareness is very low in Africa, regardless of whether the patient is educated or not. For example even doctors, teachers and bank managers are late in responding to the disease, therefore our partnership with Merck to implement their Cancer Control Program is very important for Uganda since educating the public and healthcare providers about the signs and symptoms of cancer will help promote early detection and better survival outcomes.”

Merck has delivered healthcare services in Africa since 1897. With a population rising faster than in any other global market and a growing middle class, the company is increasingly tapping into the continent’s innovative spirit to create health awareness and help respond to unmet medical needs.

The Group’s Executive Board is visiting 10 African countries this week to underscore its commitment and rising importance of the continent. Among others, Merck seeks to start local production diabetes treatment Glucophage in Algeria, inaugurate an office in Nigeria and start the sale of its Muse® Auto CD4/CD4% System to detect HIV.

Tuesday, December 1, 2015

Uganda cannot eliminate Malaria like the Comoros

By Esther Nakkazi

Uganda launched the Uganda 2014-15 Uganda Malaria Indicator Survey (UMIS) officially on Friday, 6th November at Hotel Africana. Dr. Elioda Tumwesigye was the guest of honour at the launch and he was elated about the results.

Finally, Uganda made progress reducing malaria prevalence from 43% five years ago to now 19% . Treated insecticide bed net coverage now stands at 90% and net use over 70% thanks to non profit organisations like Malaria Consortium.

Dr Tumwesigye told us that he had been to South Africa for a conference recently and listened to a presentation from Comoros Island, where the presenter eloquently elaborated how they eliminated malaria. His wish now is that Uganda should emulate the Comoros and eliminate malaria.

Is the malaria parasite more intelligent than the people working on it, he asked the Ugandan scientists.

But before we have a delegation of Ugandan scientists jumping onto the plane headed for the Comoros to ‘study’ and emulate its example, here are the facts about why the Comoros malaria success story cannot happen to Uganda.

The Comoros is an island and in 2010 they gave almost an entire population anti-malarials in a three year programme to eliminate the parasite that causes malaria thereby preventing transmission of the disease.

In order to spread malaria, a mosquito has to feed off a human who is infected and then when it bites it injects the infectious sporozoites into another human.

So on an island where population movements can be controlled, if about 90 percent of the population swallows the anti-malarial drugs the mosquitoes can bite people who are not infected and hence not transmit malaria. With time if the infected are few the vector cannot spread the disease.

But in Uganda how can you limit people’s movements? Someone with malaria will come from Apac to visit a relative in Kampala and a mosquito will bite him and pass on malaria to the Kampala host. In other wards, you cannot restrict people’s movements even if we are land locked.

Secondly, if we grant Dr. Tumwesigye the benefit of doubt and Uganda eliminates malaria, that means an entire population’s immunity will be lost. In this scenario if someone visited from a neighbouring country and a Ugandan got infected they would die very fast because it would be a ‘new’ disease in the body. Uganda would also be prone to a malaria epidemic.

Also the 2012 Comoros Demographic Survey (DHS) showed that 6 in 10 households owned at least 1 mosquito treated net. The data from the Malaria Indicator Survey (MIS) conducted in 2011 showed that 8.9% of children under 5 tested positive for malaria. Compared to Uganda in 2009, malaria prevalence was 42% and in 2014-15 it is now 19%. Comoros is a low prevalence country in comparison to Uganda.

Finally, there is no magic bullet for the control of malaria just as there is no single example from a country that Uganda can emulate. Only let us continue to combine all the prevention methods, sleeping under a mosquito net, treatment, indoor residue spraying and a vaccine when it comes along.

Friday, November 20, 2015

Are Kala Azar cases increasing in Uganda?

By Esther Nakkazi

This week, on 19th and 20th November, representatives from the Ugandan Ministry of Health, key stakeholders in the field of the Drugs for Neglected Diseases initiative (DNDi) and the World Health Organisation (WHO) met in Kampala to discuss current treatments for Visceral Leishmaniasis, commonly known as kala azar.

I was invited to the meeting and just understood why not many people are interested in kala azar.

First of all, the disease affects mainly the world’s poorest populations who live in arid or semi-arid regions of the world. In Africa, Eastern Africa is the most affected region with an estimated annual incidence rate of 29,000 to 56,000 cases.

Although Uganda’s national diagnosis and treatment Visceral Leishmaniasis or kala azar guidelines were drafted in 2007, they are yet to be revised. Other countries, which have the disease prevalent like Kenya, Ethiopia and Sudan have already done so.

Guidelines are important as new drugs come to the market, because policies will change and access to treatment will be improved.

No one knows the burden of disease in Uganda for Kala azar. All the scientists know is that it is endemic to Amudat district in Uganda and increasingly people from other districts like Kotido, Moroto, Katakwi, Napak and Nakapiripirit all in the Karamajong region are presenting with it.

So maybe there are increasing cases but no one knows or they are not concerned! Indeed Kala azar is a neglected disease.

“We have not mapped so we do not know the extent of the disease in the country but more people from other districts are presenting with it,” said Dr. Thomson Lakwo, assistant commissioner, the national Entomologist for Onchocerciasis Control programme, NTD progarmme, Ministry of Health.

Scientists working on neglected tropical diseases at the ministry of health in Uganda said the increased cases could be de to increased awareness because many cases were not reported previously.

At Amudat Hospital, the only place where kala azar is treated in Uganda, they register 12-15 cases per month. Kala azar patients present with symptoms of irregular bouts of high fever, weight loss, swelling of the spleen and liver, a swollen abdomen and anaemia.

Prof Joseph Olobo a lecturer at the Immunology Department, College of Health Sciences, Makerere University, said they are training more health workers to treat the disease. He said kala azar is treatable but fatal if left untreated. Amudat has first class facilities.

70 percent of patients sick of kala azar are children and it affects more men than women because they spend more time outside looking after animals.

It is spread by the female sand flies that bite an infected person and spread the disease. So it can be easily eliminated with treatment if all the affected population is treated because the female sand flies will not be able to spread it. The vector will remain but with nothing to inject to its hosts around.

Unlike malaria, which cannot be eliminated with drug prophylaxis, because the vector has many species and the malaria parasite survives in many conditions, scientists think because the sand fly is confined to arid and semi arid areas, the people in that region can be given treatment and it can be eliminated. They also think a vaccine can be developed.

But alas, private pharmaceutical companies lack interest in producing new drugs for patients suffering from neglected diseases since they cannot recuperate their investments in drug development.

Costs of treating an adult patient is about 60 Euros and half of that for children and fortunately, patients once treated do not relapse. The drugs provided for free by the International Dispensing Association (IDA) and through the Drugs for Neglected Diseases initiative (DNDi).

Being a neglected disease there is hardly research for new treatments or they are not prioritized, so they are unavailable, inaccessible, and unaffordable. Currently, the treatment is only by injections and toxic.

But Dr. Monique Wasunna, the director, Drugs for Neglected Diseases initiative (DNDi) Africa regional office says they are hoping for less invasive tests for kala azar and the use of oral medication.

Action has been taken and in 2013, Ethiopia, Kenya, Sudan and Uganda partnered to create the Leishmaniasis East Africa Platform (LEAP), with a mandate to research new treatment options for kala azar and support their access.

In 2010, in its first landmark study, LEAP together with DNDi delivered sodium stibogluconate and paromomycin combination therapy for Eastern Africa, which was over 91 percent effective in treating the disease.

The therapy is recommended by the WHO as a first-line treatment for kala azar in Eastern Africa.

“The most significant achievement from the study is that the therapy is cheaper and has nearly halved the length of treatment from the previous 30 days to 17 days,” said Dr. Wasunna.

She said the development of the new therapy was a milestone since it came after 70 years of little or no improvement and change in kala azar treatment in Africa.

I hope the Uganda national guidelines for kala azar are developed after this meeting.

Thursday, November 12, 2015

Philips introduces new diagnostic device to help prevent childhood pneumonia deaths in low-resource countries

Press Release
Automated breathing rate monitor aims to better diagnose main cause of death among children under the age of five (1)

NAIROBI, Kenya, November 12, 2015/ -- On the occasion of World Pneumonia Day, Royal Philips  ( today announced the upcoming release of a Children’s Automated Respiration Monitor, aimed to help improve the diagnosis and treatment of pneumonia in low-resource countries, potentially preventing many of the 935,000 childhood deaths caused by pneumonia each year(2). 

The Children’s Automated Respiration Monitor has the potential to assist community health workers in establishing a more accurate measurement of a sick child’s breathing rate to help improve the diagnosis of pneumonia.

Each year, pneumonia kills more children than AIDS, malaria and tuberculosis combined, and remains the leading infectious cause of death among children under-five, killing nearly 2,500(3) children a day, with most victims under two years of age. 

Every 35 seconds a child dies of pneumonia, with 99 percent of deaths occurring in low-resource settings in developing countries, which are typically rural with poor healthcare facilities, and where treatment is not available for many children(4).

One important aspect in diagnosing pneumonia is monitoring a child’s breathing rate. In many emerging markets, community health workers manually count through visual inspection, how many breaths a child takes in the span of one minute. But achieving an accurate count can be difficult, as shallow breaths are hard to detect, children often move around and there may be distractions and other checks to perform.

The Philips Children’s Automated Respiration Monitor converts chest movements detected by accelerometers into an accurate breathing count, using specially developed algorithms. The monitor not only provides quantitative feedback, but also qualitative feedback to the healthcare provider based on the World Health Organization’s IMCI(5) (Integrated Management of Childhood Illness) guidelines to diagnose fast breathing rates, which is one of the key vital signs to diagnosing pneumonia.

Accurate diagnosis of breathing counts would support health workers in administering the antibiotics that children with pneumonia need, potentially preventing many of the deaths caused by pneumonia each year. Additionally, accurate diagnosis could help rationalize the use of antibiotics, by potentially reducing unnecessary costs and antibiotics overuse rates, which contributes to the rise of drug-resistant diseases.

“The Philips Children’s Automated Respiration Monitor will be a game changer in diagnosing and treating pneumonia,” said Salim Sadruddin, Senior Child Health Advisor at NGO, Save the Children ( “If we can remove the subjectivity associated with health workers counting breaths, we can improve the quality of treatment and help improve patient outcomes.”

Global child health organizations like UNICEF have made pneumonia a key area of focus in their effort to reduce child mortality in underdeveloped countries throughout the world. UNICEF’s Supply Chain division’s product innovation project called ARIDA(6), launched a call for technology to industry in 2011, with the aim to achieve innovation in this space, followed by the publication of a Target Product Profile (TPP)(7) for automated respiration monitoring in November of 2014.

“As a leading health technology company, Philips’ vision is to improve people’s lives through meaningful innovation”, said JJ van Dongen, CEO Philips Africa. “Today, the population growth is highest in emerging markets like Africa and South East Asia, and innovation can help drive sustainable solutions that bridge the divide between the privileged and lesser privileged sections of society to improve the quality of life at all levels.“

The development of the Philips Children’s Automated Respiration Monitor has been a result of collaboration between the Philips Africa Innovation Hub located in Nairobi, Kenya, the Philips Research team in Eindhoven, The Netherlands and the Philips Innovation Campus in Bangalore, India. Field testing on the Children’s Automated Respiration Monitor was conducted in East Africa and India and improvements in design and technology incorporated on the basis of feedback from local community health workers and clinical officers in these low-resource settings.

The Philips Children’s Automated Respiration Monitor is pending CE-marking and is expected to become commercially available from the second quarter of 2016.

Reduced funding for Sex Education in Schools led to increased new HIV infections says AIDS Commission Boss

By Esther Nakkazi

We have heard from Prof Vinand Nantulya, the Chairman of the Uganda Aids Commission (UAC) as one of the key presenters that Uganda’s HIV new infections have been going up, nothing new, but one of the reasons is due to the vulnerability of young women, which he says is getting worse.

Makerere University Walter Reed Project (MUWRP) is holding its stakeholders meeting in Kampala with a theme; ‘Mitigating disease threats of Public Health Importance: 13 years of MUWRP in Uganda’.

UAC estimates that 380 new HIV infections occur in Uganda daily or 138,700 annually, added to the already 1.6 million people living with HIV making Uganda the third leading contributor of new HIV infections in Africa after Nigeria and South Africa.

UNAIDS estimates that 48% of all new infections worldwide are from Uganda, South Africa and Nigeria and 10 percent of these are from Uganda.

What UAC has done is to try and have messages targeted to this age group improved and monitored. All AIDS/HIV public messages to the Ugandan media have to go through the UAC clearing house to ensure that they are consistent and accurate.

Another issue that Prof Nantulya would like to see restored is education about HIV in schools that would help this particular group, the young people vulnerability is getting worse as they get lured into sexual activities.

But then the PIASCY project which stands for Presidential Initiative on AIDS Strategy for Communication to Youth that was funded by USAID and was helpful to this age group was stopped. Funding is almost no more for this PIASCY project.

Over 50 percent of Uganda’s population, which is below18 years and are in school would benefit from this education. But they are not anymore.

At the MUWRP stakeholders meeting today Prof Nantulya has said “the PIASCY programme, which was good and helpful to educate the youth is not as good as it used to be. I want the PIASCY programme back.”

I am not sure why USAID stopped or reduced funding for this component of educating the youth about HIV but for sure it is one of the reasons, maybe that, new infections are going up among the youth in Uganda. More on this topic will be investigated.

Dr. Anthony Mbonye, the commissioner for community health services at Uganda's Health Ministry gave the key note address emphasising that an HIV vaccine is still needed to fight HIV and hailed MUWRP’s contribution to these efforts.

Dr. Hannah Kibuuka, executive Director, MUWRP also the research site Principal Investigator has given us an overview of their activities and taken us through their contribution towards a safe and effective HIV vaccine.

Chris Baryomunsi, the state minister for health and Dr. Francis Kiweewa a researcher at MUWRP decried the low use of condoms among the public.


Wednesday, October 21, 2015

Rwanda Minister of Health wins $100,000 Roux Prize

Please participate in this Survey link

Dr. Agnes Binagwaho, a trained pediatrician and Minister of Health of Rwanda has won the Roux Prize, for turning evidence into health impact, rebuilding her country's war-torn health system and creating initiatives to improve indoor air quality and combat neonatal deaths.

She is the second winner of the Roux Prize, worth a US$100,000 which is given by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and is named for founding board member David Roux and his wife, Barbara.

It was launched in November 2013 and it is the world’s largest award for evidence-based public health achievement. She will be presented with the Roux Prize at a ceremony in Washington, DC, today on October 21.

Dr. Binagwaho has been using Global Burden of Disease (GBD) data and evidence from the Ministry’s own data-gathering efforts to ensure the country’s limited resources are saving the most lives and reducing suffering.

Dr. Binagwaho was working as a pediatrician in France when the Rwandan genocide occurred in 1994. When she returned to her country in 1996, most of the health system infrastructure had been destroyed and many health workers had been killed or fled the country.

“There was no trust in the health system, no medications, and no tools to provide health care,” said Dr. Binagwaho. “I remember coming back with kilos of meds in my bag, just to be able to provide care.”

Dr. Binagwaho’s work was part of a wider effort led by the government of Rwanda to rebuild the country from the ground up and ensure that even the poorest citizens could receive health care.

After directly caring for patients as a physician, Dr. Binagwaho served as Executive Secretary of the National AIDS Control Commission and Permanent Secretary of the Ministry of Health. In 2011, she was appointed Minister of Health.

Dr. Binagwaho has been an active user of GBD data since 2012 and eventually joined the GBD enterprise as part of the international collaborative network, which now totals more than 1,400 contributors from 115 countries. GBD is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. Along with Dr. Bingawaho, more than 20 Rwandans now collaborate on the GBD study.

“The Global Burden of Disease, by creating and generating data, helps us understand where we need to invest the next dollar, the next effort, the next education initiative,” said Dr. Binagwaho.

Dr. Binagwaho has overseen a remarkable improvement in the health of Rwandans. GBD data revealed that between 1990 and 2013, Rwandan life expectancy increased by about 15 years for both men and women, one of the strongest increases of any country in the world.

Healthy life expectancy has also risen dramatically, by roughly 12 years for both sexes since 1990. Much of this improvement can be mapped directly to policies and investments that Dr. Binagwaho has instituted.

For example, after looking at GBD estimates and finding that household air pollution was the leading risk factor for premature death and disability in the country, Rwanda started a program to distribute 1 million clean cookstoves to the most vulnerable households. 

On a recent fact-finding trip, IHME interviewed families who have received these cookstoves and found that not only is the air they breathe much cleaner, but they are also spending less money on cooking fuel, allowing them to devote more of their household budget to healthier foods.

Dr. Binagwaho and her staff also analyzed GBD data to see where and how they could improve the country’s health and found a large percentage of Rwandans were dying during the first months of their lives. 

They decided to embark on a campaign to decrease neonatal deaths. After investing money in education, equipment, and training in neonatology at hospitals throughout the country, the neonatal mortality rate has started to decrease.

“Whether you are in the capital of Kigali or out in a rural hospital, health policy decisions are being made based on data in Rwanda,” said Tom Achoki, IHME Director of African Initiatives. “The Honorable Minister has made it a priority not only to educate the Ministry in how to produce and analyze quality data, but how to use data to effectively and efficiently overcome Rwanda’s health challenges.”

“In the course of her work leading Rwanda’s health policy and planning, Honorable Minister Binagwaho has come to embody what Dave and Barbara Roux had in mind when they conceptualized the Roux Prize: using rigorously derived evidence to improve health in her community,” said Dr. Christopher Murray, Director of IHME and co-founder of GBD. “Dr. Binagwaho is not just using disease burden data to improve health – she and her staff at the Ministry of Health are committed to making the Global Burden of Disease study stronger and more useful by vetting its results and addressing data gaps.”

Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 1,400 researchers in 120 countries, led by IHME. Results are regularly published in peer-reviewed journals for more than 300 diseases, injuries, and risk factors, by age, gender, and country. Results from the latest updates through 2013 are available in a series of online data visualization tools at

The Roux Prize is intended for anyone who has applied health data and evidence in innovative ways to improve population health. Nominees may come from anywhere in the world and could include, but are not limited to, staff in government agencies, researchers at academic institutions, volunteers in charitable organizations, or health providers working in the community.

Tuesday, October 20, 2015

Dear Blog Reader. Help us do Science!

Dear blog reader, thank you for reading my blog. I have partnered with Paige Brown Jarreau of Manship School of Mass Communication, LSU, Ph.D. Mass Communication, Louisiana State University to carry out a survey of my blog’s readership.

My blog, was selected from a wide sample of science bloggers around the world to participate in an unprecedented study of science blog readers. By participating, you’ll be helping me improve Uganda sciegirl and contributing to novel academic research on the readers of science blogs. It should only take 10-15 minutes to complete.

For completing the survey, you will be entered into a drawing sponsored by! for a $50.00 Amazon gift card (100 available, or guaranteed 2 per specific blog included in this survey), as well as for other prizes (t-shirts). Every single participant will also receive an art perk from Paige Brown Jarreau

Survey link:

Thanks!! Esther

Tuesday, October 13, 2015

Publics Rights To Information in Uganda Day commemorated

By Esther Nakkazi

On September 28, 2015, Uganda commemorated International Right to Know Day (RTK) with celebrations marking the 10th Anniversary of the Access to Information Act (ATIA), which promotes the right of access to public information held by the State.

During the celebrations held alongside the 2015 Forum on Internet Freedom in East Africa, experiences, lessons and challenges relating to ATIA, which was passed back in 2005, were discussed. The event also served as the launch of the 2015 report on the State of the Right to Information in Africa.

Uganda was the first country in East Africa to adopt an access to information law. It was followed by Rwanda in 2013, making the two land locked nations the only ones out of the five countries that constitute the East African Community (EAC) with existing Access to Information laws. However, regulations to actualise the implementation of ATIA in Uganda were only passed six years later in 2011.

10 years on, the country has made significant strides. The Uganda Debt Network reports that at least 62 percent of Ugandans can access budget information. Hilda Namagembe said Uganda ranks among the 19 countries able to provide substantial budget information, the challenge, however, is if they cannot tell if the citizens are using the information for action.

Teacher transfers to fill gaps in schools, better budget allocations and improved public health service delivery to grassroots communities including the availability of medicine in health facilities are some of the other reported ways the right to information has successfully improved livelihoods.

Meanwhile, in order to encourage more citizens to exercise their right, in August last year, the Office of the Prime Minister (OPM) through the Ministry of Information and National Guidance in partnership with the Collaboration on International ICT Policy for East and Southern Africa (CIPESA) and the Africa Freedom OF Information Centre (AFIC) launched the online portal - Ask Your Government ( to enable citizens to directly query Ministries, Departments and Agencies of the Government of Uganda for information.

Proactive release of information however is low, while the culture of secrecy and fear of reprisal remains prevalent. According to Gilbert Sendugwa the Executive Director, AFIC, “many Ugandans still do not understand what it means to have the Access to Information Act”. Sendugwa added that building awareness, demand and creating responsiveness was required in order to improve the ATIA knowledge among citizens.

Silvia Birahwa from the Directorate of Information and National Guidance noted that as a result of the delay in passing ATIA’s regulations, they have had different levels of compliance within government ministries, departments and agencies (MDAs), with some government officials compliant and others making little or no responses to requests for information.

Kenneth Lubogo, a Member of Parliament for Bulamogi County in Kaliro district said it was imperative to make the whole system mandatory, so that government information officers have a reason to do it.

Birahwa said that Information officers within various MDAs reported a lack of capacity including limited access to internet and a lack of interest as barriers to the release of information.

Accordingly, the recently updated government communication strategy is aimed to better equip Chief Information Officers within the MDAs to better respond to information requests and to aid the progress of the ATIA.

In recognition of some MDAs who have adopted the right to information and exercise this by promptly and adequately responding to information requests, the Ministry of Lands, Housing and Urban Development (MLHUD) received an award for their commitment to the consistent and prompt release of information using the website. Dennis Obbo the Principal Information Scientist at MLHUD received the award on behalf of the Ministry.

The celebrations to mark a decade of ATIA were hosted by AFIC and the Collaboration on International ICT Policy for East and Southern Africa (CIPESA) together with the Office of the Prime Minister.

Dear blog reader, thank you for reading my blog. I have partnered with Paige Brown Jarreau of Manship School of Mass Communication, LSU, Ph.D. Mass Communication, Louisiana State University to carry out a survey of my blog’s readership. 

My blog, was selected from a wide sample of science bloggers around the world to participate in an unprecedented study of science blog readers. By participating, you’ll be helping me improve Uganda sciegirl and contributing to novel academic research on the readers of science blogs. It should only take 10-15 minutes to complete.

For completing the survey, you will be entered into a drawing sponsored by! for a $50.00 Amazon gift card (100 available, or guaranteed 2 per specific blog included in this survey), as well as for other prizes (t-shirts). Every single participant will also receive an art perk from Paige Brown Jarreau

Survey link:

Thanks!! Esther

Internet Freedom Forum calls for Safety

By Esther Nakkazi

The second Forum on Internet Freedom in East Africa kicked off in Uganda with a call for Internet safety in the face of Internet freedom.

The Collaboration on International ICT Policy for East and Southern Africa (CIPESA) hosted the Forum bringing togather human rights defenders, journalists, government officials, academia, bloggers, developers, the arts community, law enforcement agencies and communication regulators.

The two-day event 28 and 29 September 2015, in Kampala, Uganda at the Golf Course Hotel and coincided with the International Right to Know Day.

The Forum serves as a platform to discuss how the current state of internet freedoms in Africa said Wairagala Wakabi the CEO CIPESA. He said the main work of CIPESA is to use research to improve ICT policy in Africa.

Jaco du Toit, the Adviser for Communication and Information, UNESCO regional office for Eastern Africa said there is growing concern about monitoring mechanisms on the Internet.

“Authorities have tended to resort to more direct forms of internet censorship, such as the harassment or arrest of bloggers and online journalists, rather than sophisticated URL blocking or systematic filtering because they did not yet have the technical capability to do so,” said Jaco.

He said the new media has brought new possibilities of interaction between the media and public and said the Forum should consider discussions on a range of issues including data surveillance, self regulation and hate speech.

Crystal Simeoni from Hivos East Africa said Internet Freedom should not be for techies and human rights defenders only but should spark conversations among even the local people and create connections for the public to participate.

She said as Hivos they are considering exploring the issues of privacy and access to information because from the consultations they have done these have very few voices and there is huge gap.

In Africa, Government Ministries, Departments and Agencies (MDAs), Civil Society Organisations (CSOs), the private sector, academia and ordinary citizens are increasingly utilizing online tools for social and economic engagement, online debate, advocacy and business development.

A panel on ‘electioneering and extremism in the digital age’ with Gbenga Sesan from Paradigm Initiative (PIN) Nigeria, James Marenga from NOLA Tanzania , Nanjira Sambuli from Umati/IHub Research Kenya and Emma Belinda Were from Uganda Media Centre discussed among other things if the Internet needs to be controlled.

They all agreed that Internet users should be responsible for whatever they post on social media. They also discussed how government should regulate online space but cautioned that government ‘control’ of the online space is out of the question.

It is true that as more people join the Internet, control of what they say online is not easy. However, governments are increasingly aware of the potential influence of online publications and bloggers.

Marenga said all governments across the world want to see information that favors them but there should be no control of the Internet. Sesan explained how Nigeria has moved from not being able to say anything to being able to say just anything online.

So many Nigerians who cannot face someone and say something have taken to the Internet to say whatever they want online but in so doing the users have matured.

Although Emma Were had at first said it would be necessary for Governments to control the Internet in the face of the misinformation that users send out, citing the many government officials that Ugandans have been killed by social media she later back tracked on it.

Citing the same issues that happen in Kenya, Nanjira Sambuli said people 'die' all the time on Kenyan social media but increasingly online users have learnt to ask questions to verify the information.

“When you are online there are some people you look for authenticity,” said Sambuli. “We should not control what people say online, but always encourage them to ask for evidence.”

“If you 'control' the Internet you create a black market of information said Gbenga Sesan.


Tuesday, October 6, 2015

Jail time for killing others on Social Media

By Esther Nakkazi

For the moment it is wise to cross check death announcements that come through social media in eastern Africa. In the region 'social media deaths' are becoming a common notice. Somehow, a tweet will do the rounds of someone who has died before you know it main stream media has picked it up.

Undoing that requires the officials to appear in public to dispel it. But not anymore for Ugandans who do it.  The government of Uganda is working on a new law to control the use of social media according to the State Minister for Internal Affairs, James Baba.

Minister Baba was quoted by Unwanted Witness,, which had an exclusive interview with him and he said the government is working on a new social media law. 

Concerns have been made by government officials who had been 'killed' by social media but had no law to even summon the offenders. The Parliament committee on ICT was alerted and its the one spearheading this initiative. But is is said that offenders might get big penalties or jail time.  

Pamela Ankunda, ministry of internal affairs spokesperson revealed that the process of having the regulation in place is on course. “The minister hinted on the bill and it should be on cabinet’s order paper now,” Ankunda told Unwanted Witness.

Once endorsed, the social media regulation bill will be added to a list of already existing cyber laws such as the computer misuse act, the anti-pornographic law and the regulations of interception of communications act which all focus on narrowing the online expression space.

Friday, October 2, 2015

What will Uganda get out of the Innovation Africa 2015 Forum?

By Esther Nakkazi

Nothing seems to work out right in Uganda, except for a few things that are hard to come by and you have probably heard that phrase many times. So its nothing new you say to yourself.

So I am attending this Innovation Africa 2015 Summit with the theme ‘Developing Skills for the 21st Century Africa’ organized by Africa Brains. The host, Hon Maj Dr. Jessica Alupo Rose Epel – Minister of Education, Science Technology & Sports, opening speech started as usual with Uganda is open for business.

She said ‘there is no better gathering than Innovations Africa for government and industry partnerships’ and yes it was such a well-organized conference but it made me curious to know if Uganda has clinched any deals during such forums.

We got talking after listening to Rwanda. Of course, it has to be Rwanda. On the sidelines of the Innovation for Africa conference held in Kigali in 2014, Rwanda signed an agreement with Positivo BGH, a Latin American multinational, which manufactures laptops, computers, tablets, and other electronic gadgets, to put up a production plant in Kigali.

What my source- a government official by the way- told me is that Positivo BGH had first approached the Uganda government officials before going to Rwanda. Everyone they talked to in Uganda was happy with them and they have a real profile, the firm has an annual turnover in excess of $2.5 billion annually and with over 40 years of experience.

When I say happy, all the Ugandan officials including the Ministers in charge and the Uganda Investment Authority who the Positivo BGH company approached agreed that indeed it was a good investment but no one could take the decision to approve it.

That is the problem they say no one takes the initiative and there are no clear guidelines as to how approval should be done. So while Ugandans were going round in circles, which took forever, the Rwanda government was approached.

In three days, the deal was done and approved. 20,000 hectares of land were immediately allocated to them. Right now, the assembly factory is in place and operational. It produces 12,000 laptops per month with the capacity of increasing production as we have heard at the Innovation Africa 2015 Summit happening now in Uganda.

They have given thousands of Rwandans jobs who do not have to import computers or phones anymore and they are thinking of supplying the whole of East Africa said Dr. Celestin Ntivuguruzwa – Permanent Secretary for Education, Rwanda.

So I do not know how to end this blog without envy for Rwanda but I think Uganda should style up. I am waiting for the deals Uganda will clinch at this Innovation Africa 2015 conference. I am sure as usual there will be none but we will be happy that we hosted the Summit.

And I see it happening for other 26 countries in attendance like Angola, Botswana, Burundi, Congo Brazzaville, DRCongo, Equatorial Guinea, Ethiopia, Gabon, Ghana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Nigeria, Rwanda, Senegal, South Africa, Swaziland, Tanzania, Cameroon, Tunisia, Zambia. They will all unlike Uganda take something tangible out of it.


Wednesday, September 30, 2015

Gates 120 under 40 campaign to highlight young leaders in family planning

Press Release;

This week, the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health launched 120 Under 40a new project that will recognize and highlight the achievements of the next generation of family planning leaders worldwide.

The project launched on September 26 — World Contraception Day, an annual event that puts international attention on enabling young people to make informed decisions about family planning and reproductive health.

“120 Under 40 shines a light on the ‘positive disruptions’ made by young leaders in family planning, enabling others to model their behaviors and build on their success,” says Jose “Oying” Rimon, director of the Gates Institute. 

“The project’s international profile will increase awareness of family planning as critical to young people’s health and wellbeing and essential to sustainable global development.”

Over the next five years, 120 Under 40 will recognize and galvanize the accomplished and inspiring young people who are making a difference in family planning and reproductive health worldwide. The nomination period opens January 1, 2016.

Nominees must be 40 years or younger by December 31, 2016, and must have made significant contributions to family planning at the local or national level in one or more of the following categories: advocacy, programming/program implementation, research, service delivery, demand generation, policy/government or media.

Nominees and nominators will hail from all over the world. To demonstrate the depth and breadth of the young leaders’ involvement in the family planning movement, all nominees will be posted on the 120 Under 40 website.

From this pool of nominees, an expert review board and the public will choose 40 winners who will be announced on World Contraception Day 2016. The process will repeat in 2018 and 2020, so that a roster of 120 outstanding young leaders will be assembled by 2020 — the year by which the Family Planning 2020 (FP2020) partnership aims to enable 120 million additional women and girls to access life-saving contraceptives and other reproductive health supplies.

Please visit and follow 120 Under 40 on Facebook and Twitter.

Media contact:
Marianne Amoss, Gates Institute

Data Sharing Centre in Uganda

By Esther Nakkazi
I first wrote this story for it had some misinformation which has been corrected here on my blog.

A medical informatics centre was commissioned in Uganda to enable the country’s scientists share big data with the rest of the world.

The state-of-the-art Ugandan Medical Informatics Centre (UMIC) will collect, store and analyse data to advance genomic research.

The five-year project was presented to a scientific audience during the 2015 Science Symposium Programme at the Uganda Virus Research Institute (UVRI) held on 13 August 2015.

The centre, which is a partnership between the MRC Uganda, the Wellcome Trust Sanger Institute and the University of Cambridge, is funded by the UK Medical Research Council. The UMIC is located at the UVRI campus in Entebbe.

“We produce a lot of data but we cannot handle them. The centre will be able to share sequenced data with similar ones around the world,”said Pontiano Kaleebu, director of the MRC/UVRI Uganda Research Unit on AIDS. The integrated data centre cost £3 million (about US$4.7 million), according to Kaleebu.

Genetic and genomic data have implications for individuals, families and society. They can be used to identify how families and communities are susceptible or resistant to diseases.

Jenny Thornton, the programme manager of the African Partnership for Chronic Disease Research (APCDR) at the UK-based University of Cambridge, said the centre will analyse medical data for use worldwide.

APCDR provides opportunities to assess the burden of non-communicable diseases and their risk factors by developing strategies for data harmonisation, shared resources, and by bringing together epidemiological studies, research expertise and infrastructure across Sub-Saharan Africa.

The UMIC will be a crucial resource in helping to develop preventive and control strategies for non-communicable diseases, said Thornton. But the data must be turned into practical use, she cautioned.

Kaleebu said the UMIC will also be used to build capacity in bioinformatics in Africa. Bioinformatics can be used in hospitals to find disease trends among specific age groups, and to aid policymaking.

The centre has been established at a time when there is increasing genomic research in Africa, but genomic data are sent abroad because analysing them is limited, according to Kaleebu.

“Our African colleagues are interested in using these data,” said Kaleebu. “The data will be owned by the countries, scientists or institutions that send them to us, but we shall have partnerships.”

He said a fee for the services offered would be worked out to help sustain the centre.

These centres are very good for sharing information and they make research for big sample sizes cheaper, but they pose some ethical dilemmas, says Erisa Sabakaki Mwaka, a bioethics expert at the School of Biomedical Sciences, Makerere University College of Health Sciences.

Mwaka asks: “For instance, if you find out from these data that a certain population is predisposed to a particular disease, do you go back and tell the communities if it is [doing] something bad?”

And accessing the data could pose a challenge for ownership and biopiracy because Uganda has no specific legislation on genomic research, Mwaka adds.

This article was produced by SciDev.Net's Sub-Saharan Africa desk

Friday, September 25, 2015

Tanzania's Sharp decline in Child Stunting

By Esther Nakkazi
Tanzania's average annual rate of reduction in stunting from 2010 to 2014 is approximately 5 percent—faster than the nearly 4 percent annual rate required to meet the World Health Assembly target says the Global Nutrition Report 2015 which is a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.

In this chapter written by Lawrence Haddad exploring what is behind Tanzania'a sharp decline in child stunting he attributes it to no definitive, in-depth analysis of the factors behind the improvement in child growth, but offers several clues.

The report shows that the rates of child stunting in Tanzania, though still high, have fallen sharply in the past few years. Three national surveys in 2004, 2009, and 2010 showed a static rate of stunting at 44–43 percent, whereas two later national surveys—in 2011 and 2014—show rates of 35 percent (IFPRI 2014).

Stunting in Tanzania fell as shown in the 2006 study from the Kagera region using four rounds of survey data from 1991–1994, which showed that a combination of income gains and health program interventions was most effective at accelerating stunting rate declines in that part of Tanzania at that time (Alderman et al. 2006).

From 2010 to 2014, thinness in women of reproductive age declined from 11 to 6 percent, vitamin A supplementation rates increased from 61 to 72 percent, and iron-folate supplementation during pregnancy increased from 3.5 to 8.3 percent. 

On the other hand, exclusive breastfeeding rates declined from 50 to 41 percent, rates of infants and young children with minimum acceptable diets are flat at 20 percent, and the percentage of house- holds using iodized salt declined from 82 to 64 percent.

Undernourishment rates declined modestly, from 41 percent in 2000 to 35 percent in 2014. Access to improved water and sanitation in 2012 remained low at 53 percent and 22 percent, respectively—not much changed from their rates in 2000 (54 percent and 15 percent, respectively) (IFPRI 2014).

Rates of $1.25-a-day poverty almost halved—from 85 to 43percent—between 2000 and 2012 (World Bank 2015).

The Tanzanian government’s spending on health increased substantially between 2008 (US$383 million) and 2014 (US$622 million) (West-Slevin and Dutta 2015).

In conclusion, the Global Nutrition report says strong reductions in poverty, allied to modest changes in underlying determinants and program coverage, backed with strong commitments by government and external partners—manifest in increased funding—are potential explanations for the declines in stunting. Lawrence Haddad says more research is needed for a more definitive answer.

Global Nutrition Report 2015: Stunting, Obesity, Diabetes trends

By Esther Nakkazi

New information on the global nutrition status has been released in the Global Nutrition Report 2015 which is a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.

The Global Nutrition Report is an annual report that assesses progress in improving nutrition outcomes and identifies actions to accelerate progress and strengthen accountability in nutrition. It was called for at the Nutrition for Growth (N4G) Summit, held in London in 2013 and hosted by the Governments of Brazil and the United Kingdom.

The call came on the basis that strong accountability enhances the enabling political environment for nutrition action by giving all stakeholders—existing and new—more confidence that their actions will have an impact, that bottlenecks to progress will be identified and overcome, and that suc- cesses will spread inspiration. The Global Nutrition Report series is thus designed to be an intervention in the ongoing discourses in and governance of global nutrition.

The 2015 report shows countries' progress in improving the nutrition status of their populations and assesses their progress in meeting the targets for reducing undernutrition by 2025, set by the World Health Assembly (WHA) in 2012.

For the first time, the report takes a closer look at how countries are faring in combating overweight, obesity, and noncommunicable diseases. In 2013 the WHA adopted the Non-Communicable Disease (NCD) Monitoring Framework, which monitors nine voluntary global targets for 2025. 

One of these targets is “Halt the rise in diabetes and obesity,” and this year the report uses global and national World Health Organization (WHO) data on adult overweight, obesity, and diabetes to track progress in attaining this target.

For the World Health Assembly nutrition indicators of stunting, wasting, and overweight in children under age 5, the trends in the number of countries meeting global targets are positive, especially for stunting.
  • For stunting, 39 of 114 countries with data are on course to meet the global target, compared with 24 in 2014. In 2015, 60 countries are off course but making some progress. The number of countries making no progress on stunting in 2015 is 15, compared with 19 in 2014. 
  • For wasting, 67 of 130 countries with data are on course (defined as < 5 percent prev- alence). For countries in both the 2014 and 2015 datasets, the number of countries on course has increased from 59 to 63 and the number off course has declined from 64 to 60. 
  • Only 1 country—Kenya—is on course for all five WHA undernutrition targets. Four coun- tries (Colombia, Ghana, Vanuatu, and Viet Nam) are on course for four targets. But only 4 countries are not on course for any target. Seventy-four countries have the required data to make an assessment on their progress on five WHA undernutrition indicators. 
  • Less than half of children under age 5 avoid stunting or wasting in five large low-income countries: Bangladesh, Democratic Republic of the Congo, Ethiopia, Nigeria, and Pakistan. 
  • Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines. Changes in wasting rates are more variable across states. 
  • For under-5 overweight rates, 24 of 109 countries with data are off course and making no progress toward meeting the WHA target. Thirty-nine are on course and making good progress (compared with 31 in 2014), 24 are on course but at risk of losing that status, and 22 are off course but making some progress. 
  • For exclusive breastfeeding, 32 of 78 countries with data are on course, 10 are off course but making some progress, 30 are off course and making no progress, while 6 are off course and show large reversals in rates (Cuba, Egypt, Kyrgyzstan, Mongolia, Nepal, and Turkey). New data from India show that exclusive breastfeeding rates have nearly dou- bled in the past eight years. 
  • In 2015, 151 new data points were added to the database on the five undernutrition WHA indicators. The percentage of data points for the 193 countries on the four WHA nutrition indicators (stunting, wasting, overweight, and anemia) increased from 71 percent in 2014 to 74 percent in 2015. Only 9 of these 151 were from OECD countries (Australia, Chile, and Japan). 
  • For adult overweight, obesity, and diabetes, very few countries are on course to meet global targets. 
  • All 193 countries are off course for the WHA target of no increase in adult overweight and obesity (body mass index ≥ 25); in fact, rates increased in every country between 2010 and 2014. Countries’ rates of increase range from 0.2 to 4.3 percent and average 2.3 percent globally. Country progress varies across regions. 
  • Only 1 country out of 193—Nauru—achieved even a small decline in adult obesity (BMI ≥ 30) between 2010 and 2014; prevalence for men there fell from 39.9 to 39.7 percent. The mean population-weighted age-standardized global prevalence of obesity is 15 per- cent among women and 10 percent among men. 
  • Only 5 of 193 countries (Djibouti, Iceland, Malta, Nauru, and Venezuela) have halted the rise of the diabetes indicator (raised blood glucose). 
  • One hundred and eighty-five countries are off course on all three adult indicators: over- weight and obesity, obesity only, and diabetes. 
  • The proposed 2030 WHA nutrition targets from WHO represent a useful basis on which to establish a broader consensus on these targets.

Wednesday, September 23, 2015

Health Journalists link up with Scientists at Science Cafés

By HEJNU reporter

Once every month, health journalists in Uganda attend a Science Café. It is usually held on a Wednesday from 3-5 pm, a day and time largely selected by them.

The Health Journalists Network in Uganda (HEJNU), an independent, non-profit organization dedicated to increasing understanding of health care issues and improving health literacy among Africans organises the Science Cafés in partnership with AVAC, a global non-profit organisation that works to accelerate the ethical development and global delivery of HIV prevention options.

Generally, Science Cafés present a platform for unique public engagement on issues that may be rather isolated from the general public including journalists.

“This is a very impressive innovation and it is good to know that journalists are interested in what is going on in research,” said Francis Kiweewa, the head of research and scientific affairs, Makerere University Walter Reed Project (MUWRP).

Kiweewa was the scientist featured at the fifth Science Café that discussed HIV ‘Cure’ at the HEJNU home in Ntinda alongside journalist Hilary Bainemigisha, the editor at the leading daily newspaper ‘The New Vision’.

“The science cafe concept is spot on in the way it mobilises science writers, keeps us in touch with each other as we share updates for our improvement of skills in writing science,” said Bainemigisha.

We hold them in an informal setting and keep the numbers small ranging from 20 to 25 people, which allows for more in-depth interaction and absorption of the topics discussed, said freelance science journalist and the head of HEJNU, Esther Nakkazi.

“I was very free wearing sneakers. I liked the free environment, any body can shoot any question any time,” said Dr. Salim Wakabi a senior researcher at MUWRP who was featured at the fourth Science Café that discussed vaccines.

“Chances of impact are greater when people see their opinions and participation being valued during the sessions. We believe the speakers divulge more in-depth information and thorough explanations because of the small groups and in such a setting,” said Nakkazi.

On a typical day, at the monthly HEJNU Science Cafés, two young journalists employed at media houses elsewhere come over and clean the chairs, set up tents and make sure drinks and stationery are available. They are also responsible for mobilising the journalists.

That makes the Cafés extremely cheap since there is no money spent on the venue in a posh hotel or building. But that also means that the rain can stop a Café from happening but so far that has not happened, said Nakkazi.
Dr. Barbra Marjorie Nanteza and Marion Natukunda at a Café

Wilfred Ssenyange, working with the national broadcaster, Uganda Broadcasting Service (UBC) makes sure genuine journalists are invited and they have to confirm attendance with him.

He said he knows that the numbers have to be kept small and so warns them not to come along with friends who have not been invited, a practice that is so common among Ugandan journalists.

Jael Namiganda, a journalist with Metro FM, ensures that the journalists register and that they are comfortable. But also follows up on the stories produced.

She says its good training for her and hopes to become a prominent science journalist. The two only graduated in 2014 and they are referred as ‘HEJNU interns’ which they protest.

“To measure the impact, we provide a detailed report to our sponsors from the sessions,” said Evelyn Lirri, a journalist and the deputy at HEJNU who writes out the reports. These entail the discussions and the stories that are published out of the Science Cafés.

“We love that the journalists can write stories from the Science Café but we do emphasise that we are more interested in them learning. So actually, when you observe, most of them are listening to the speakers instead of the rush mood when they have to produce a story,” said Lirri.

At the Science Café there are usually two speakers either a researcher or scientist, and someone from civil society. Discussions are fluid and interactive through how the speaker engages with the audience in a casual manner.

Angelo Kaggwa-Katumba, a program manager at the AVAC office based in New York helps with choosing the topics and invitations for speakers.

“It has been excellent,” said Kenneth Mwehonge from HEPS Uganda, civil society organisation. “Sharing information on on-going biomedical HIV prevention research with journalists is integral in having a successful role out of new prevention technologies.”

Nakkazi explained that so far, the Science Cafés are only about HIV prevention but they will soon expand to other areas and cover a bigger geographical area beyond Kampala so that other journalists benefit.

She said these offer journalists an opportunity where many would never otherwise interact with some of the guest speakers on such an informal yet personal level as well as generate story ideas, critique work and engage in thought provoking debate.

“The informal setting of the Science Cafés works well because it reduces the distance between the speakers and the journalists. This particular setting makes it easier to freely ask questions and have a discussion,” said Rosanne Anholt a research intern at Athena Institute and HEJNU for a Masters in International Public Health, VU University Amsterdam, the Netherlands.

When Dr. Barbara Marjorie Nanteza the National Safe Male Circumcision (SMC) Coordinator at the AIDS Control Program, Ministry of Health, Uganda was invited to speak to journalists at the 3rd Science Café on Safe Male Circumcision, she first expressed how she was not happy about the media reporting on the topic.

But after the Science Café and the media coverage that followed from it, she sent the HEJNU secretariat a message saying she had heard on radio what the journalists had aired and it was good.

“I would like to thank you for the chance you offered me to talk to the journalists about SMC programme in Uganda. I am really happy about the media awareness by the respective journalists…. and if they ever want to hear from me again, just let me know in advance, said Dr. Nanteza.

“Over time, the quality of questions at the Science Café, the sharing of story ideas, peer criticism and final output in the different media houses is improving,” Bainemigisha who edits the Saturday New Vision paper observed. “Writers now have easier access to sources they have met at cafes which eases work.”

Although it is a good innovation it still needs some improvement. For instance, Anholt thought that for two Science Cafés she attended (on male circumcision and HIV vaccine research), the way the topics were discussed remained very (bio) medical without adding a social aspect.

“By social aspects I mean, what are the social issues around male circumcision? Are there any cultural practices or beliefs that interfere with circumcision campaigns? Are there any misconceptions that need addressing?,” said Anholt.

She said that adding the political, economic and cultural context, which could be achieved by the same speaker or having an additional speaker would be valuable and add to journalists’ in-depth understanding of HIV.

Nakkazi said the Science Cafés are also meant to promote a culture of scientists sharing their findings outside of the scientific community in a relaxed setting and prepare the media for research studies results.

At one of the Cafés they have featured Dr. Clemensia Nakabiito a lead researcher in the ASPIRE study who talked about the vaginal ring as an HIV prevention tool for women. Although journalists did not produce any stories they were prepared for the upcoming results, which could be announced by early 2016, said Nakkazi.

There is enthusiasm from the journalists to be part of the monthly Science Cafés as evidenced from the consistency of the turn up, which also means that they are gaining knowledge and want to continuously improve their understanding and skills of reporting about health care issues.

Most of them record the speakers, get their contacts, take pictures and they usually ask a lot of questions creating lively debates, which indicates a genuine interest. Dr. Wakabi commented that it is what is said ‘off cuff’ that sinks in best.

“We have regular journalists attending and we hope they will learn the science and create a solid Network even beyond this,” said Nakkazi after the Science Café was concluded and journalists rushed to get sound bites.