Tuesday, February 24, 2015

Agriculture Expansion in Tanzania May Greatly Increase Risks of Plague in Humans

Press Release
Maize cultivation sparks surge in plague-carrying rodents; experts fear acceleration of agriculture production across Africa may carry same risks beyond Tanzania

Deerfield, Ill. (February 23, 2015) —The push to boost food production in East Africa that is accelerating the conversion of natural lands into croplands may be significantly increasing the risk of plague according to a new study published online today in the American Journal of Tropical Medicine and Hygiene (AJTMH).

Researchers studied rodents in northern Tanzania, where over the last few decades croplands have expanded by 70 percent. They found that in areas where maize production has been introduced, the number of rodents infested with plague-carrying fleas that can cause human infections nearly doubled compared to numbers in neighboring wilderness areas.

Scientists also linked the maize fields to a 20-fold increase in the population of the African rat (Mastomys natalensis) that is a major conduit for plague and a number of other diseases, including deadly Lassa fever—an affliction often mistaken for Ebola—that has become a growing concern in West Africa.

“We found that introducing maize production in natural areas appears to create a perfect storm for plague transmission,” said Hillary Young, PhD, a community ecologist at the University of California, Santa Barbara, and one of the lead authors of the study. “The presence of the crop as a food source caused a surge in the population of a rat species known to carry plague. Local farmers often then store this harvested corn next to or inside their homes—baiting in the hungry field rats and increasing opportunities for human infection.”

“These kinds of conditions are what breed outbreaks,” Young said.

Plague is an ancient disease caused by the bacterium Yersinia pestis that continues to sicken and kill people even in the 21st century. Since 2000, most of the outbreaks of plague have occurred in Africa, particularly the Democratic Republic of Congo and Madagascar, an island nation off the coast of Mozambique [In 2013, ASTMH published a series of infographics about plague in the first decade of the 21stcentury.] Just since last September, an outbreak in Madagascar led to 263 infections and 71 deaths. Plague also occurs in the USA, with a small number of cases reported annually in western states.

Plague has long been a threat in Tanzania and continues to emerge in sporadic outbreaks. From 1980 to 2011, for example, there were about 8490 cases and 675 deaths reported in the country.

According to the World Health Organization (WHO), plague is treatable with antibiotics and supportive therapy but, left untreated, it is fatal 30 to 60 percent of the time.

Rats and Expansion of Agriculture
In June and July of 2011, shortly after the typical annual peak in human plague cases, investigators studied three areas in northern Tanzania. In these areas, plague outbreaks have been documented in the past, and maize production has expanded and now abuts the boundaries of protected lands.

Young said the area of Tanzania where the study was conducted is a historic hotspot for plague, though so far there has not been an uptick in infections documented in the farming communities studied.

But the researchers, which included investigators from Stanford University, Colorado State University, the Smithsonian Institution, and Tanzania’s Sokoine University of Agriculture, believe all of the factors that could cause an outbreak are now in place: a population surge in rodents carrying plague and fleas capable of transmitting plague to humans, coupled with crop storage practices and rat behaviors that could increase contact with humans.

“People in these communities tend to store their maize in their houses, to protect it, but that also has the effect of attracting these rats,” Young said. “The rats that persist in human areas are also particularly competent hosts for plague, as well as likely to interact with humans. Together, these changes increase the opportunities for humans to be bitten by plague-infected fleas.”

Curious Findings
One curious finding from the study was that the African rats living in the agriculture areas played host to a larger number of plague-carrying fleas than their relatives in the forest and even carried a species of plague-infected flea that is completely absent in forest rats.

The researchers also noted that the African rat, with its capacity to support large litters—the female of the species can nurse up to 14 pups at a time—is well suited to take advantage of a crop production cycle that offers opportunities for rodent populations to surge as crops mature.

“Lessons learned from this case are also broadly important for understanding the dynamics of other zoonotic diseases in this era of rapid landscape change,” the authors state.

Indeed, across sub-Saharan Africa, which possesses 60 percent of the world’s arable and significant food security challenges, efforts are underway to rapidly and widely increase agriculture production as a way to address both economic and food security concerns. Among the more ambitious projects is one underway in Kenya that aims to convert one million acres (about 400,000 hectares) into irrigated farmlands.

“This result gives us another example—as if we need another example after Ebola—of the connected world we live in. Although it’s not as infectious as the Ebola virus, plague can be transmitted through human contact as well as flea bites, and we had this kind of transmission in the United States in the last century.

Researching the impact of land use on both animals and humans is important for preventing and dealing with outbreaks of transmissible diseases like plague,” said ASTMH President Christopher Plowe, MD, MPH, FASTMH. “In Africa in particular, food production is a critical issue. This is an opportunity for agriculture and tropical medicine to work together with local communities to benefit us all.”

Monday, February 9, 2015


Press Release
January 29th, 2015
A Uganda-Dutch company that uses mobile technology, to rapidly exchange information with specific target audiences has received an impact investment of Euros 1million from the Netherlands - ABN AMRO Social Impact Fund.

The ABN AMRO Social Impact Fund invests via direct participation in social enterprises that aim to achieve both social/sustainable and financial results. The fund is particularly interested in enterprises whose innovative business model can help revolutionise the market. Development of the fund fits in with the bank’s aim to strengthen its position as a leading socially responsible company

The TTC Mobile CEO and co-founder, Bas Hoefman says ; “The funds will be used to expand the company's activities, hire more local and international staff and spread our projects all over the world, effectively turning the company into a leading global social enterprise.”

Eunice Namirembe, the TTC Mobile Uganda country director, has said that this investment will facilitate more social projects and possible expansion of some of the existing ones.

This funding comes at a time when according to research statistics; Africa is experiencing the highest growth rates in mobile phones uptake. Hoefman further says, “For the predominant part of our projects in the developing world we use SMS because internet connectivity is still low.

However this is improving and has resulted in a massive increase of broadband subscriptions and according to TTC Mobile founder Bas Hoefman it is expected that by 2017, 40% of people in Africa will own a smart phone. This opens an opportunity to a whole range of new business models customized to Africa.

TTC Mobile currently reaches millions of people across Africa, Asia and Latin America through several projects in the areas of healthcare, agriculture and education. The company is now active in 23 countries of which 18 are from Africa, partnering with organizations such as UNICEF, The World Bank and the World Health Organization (WHO) in addition to government institutions, NGOs and businesses.

TTC Mobile was registered in 2007 in Uganda and in the Netherlands originally as Text to Change (TTC) and according to Hoefman it all began in Uganda when TTC launched an interactive Short Messaging (SMS) large-scale mHealth campaign that reached 15,000 people aimed at creating awareness around HIV/AIDS and to stimulate people to get tested for the deadly disease. We owe a lot to this country. This program was the first large scale interactive mHealth campaign in Africa.

With the success of its original mHealth campaign in Uganda, TTC Mobile has now expanded its projects to include a global mobile messaging platform with a private sector focus in emerging
markets, market research and social marketing.

According to Eric Buckens, the Manager of ABN AMRO Social Impact Fund, “TTC mobile reaches diverse groups of people at a large scale in developing countries. The goal is to support them in their daily lives and truly bring about improvements in matters that directly concern them, such as healthcare. The enterprise fits the aims of the ABN AMRO Social Impact Fund completely.”

Among the most successful projects currently being run by the company is one in Tanzania where TTC Mobile's unique partnerships have enabled them to use their mobile services to reach over 500,000 pregnant women, mothers and communities with valuable information on healthy pregnancy and safe motherhood, in addition to reminders to regularly seek care at a clinic.

TTC is also actively involved in the fight against Ebola in western Africa. "We have managed to reach people in hard-to-reach places with vital messages. And this has later impacted behavioral change. It is TTC’s mission to enable organizations engage and interact with people that are in emerging markets. The fastest and most efficient way to do this is through mobile “Bas Hoefman notes.

TTC Mobile's social marketing business is conducted by the use of mobile technology tools through the use of text messaging (SMS), Interactive Voice Response (IVR), a Call centre, and face-to-face surveys using tablets and smart phones and online surveys.

Monday, February 2, 2015

Will Rwanda be a Circumcised Nation by 2015?

By Esther Nakkazi
Rwanda faces a daunting task of hitting a target of 700,000 Voluntary Medical Male Circumcision (VMMC) procedures by mid 2015.

Rwanda, plus twelve other developing countries, in which prevalence of HIV is high and circumcision is low, were identified as a priority, where innovative approaches to scale-up are currently being explored.

The 13 priority countries, were identified by the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to scale up in an action plan that aims to reach 80 percent coverage of VMMC by 2015. 

If these procedures are carried out by the end of this year, the target of reaching 20 million adult VMMC will be achieved plus 3.36 million new infections will be averted at a cost of $16.5 billion.

As of 2010, only 2.7 percent of the total number of the VMMC procedures needed to reach the anticipated target had been performed. Many countries still have challenges of lack of infrastructure, a limited number of health workers, and funding.

The biggest question now is how many countries among the 13 WHO recommended countries will be able to achieve the given target by the end of this year?

By 2010, Kenya, was on track to achieve the 80 percent coverage by 2010 and Uganda if not for a lack of funding would also hit this target, because the Ministry of Health says if they have the money one million men will be circumcised this year.

To hit this set target, the Ministry of Health in Rwanda, factoring in limited resources and skilled health workers, is using PrePex (Circ MedTech Ltd, Israel), a non surgical device, for all adult men seeking VMMC.

Ministry of health officials think the device will accelerate the pace of service delivery, scale up programs and maximize the impact of the intervention.

Voluntary medical male circumcision has been conclusively demonstrated to reduce the lifetime risk of male acquisition of HIV by about 60 percent and a component of a comprehensive strategy towards achieving an AIDS-free generation.

The PrePex device is an FDA-approved and WHO pre-qualified non-surgical device. It works by compressing the foreskin and cutting off blood circulation, after which the distal foreskin becomes necrotic, permitting easy and bloodless removal after 1 week.

In the PrePex procedure, injected anaesthetic or sutures are not necessary, and skilled health workers who are trained and certified can perform the procedure in a clean, non-sterile setting. Procedure time with the PrePex device is five times faster than with the surgical technique, and the procedure is also safer.

In Rwanda, surgical male circumcision will only be reserved for men who are not eligible for PrePex or for males under the age of 18 years.

But the country, made a target of having its entire male population, eligible for circumcision by 2015, circumcised, which requires a bold strategy that focuses on the efficiency of task-shifting, judicious use of resources, and the leadership of civil society.