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 40, a 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 120Under40.org and follow 120 Under 40 on Facebook and Twitter.

Media contact:

Marianne Amoss, Gates Institute

410-502-9067 / mamoss@jhu.edu

Data Sharing Centre in Uganda

By Esther Nakkazi

I first wrote this story for sciedev.net  http://bit.ly/1NJDm8but 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 

http://www.scidev.net/sub-saharan-africa/data/news/centre-launched-aid-medical-data-sharing.html.

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.

ends

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.

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.

ends-

Mbarara University innovations near commercialisation

By Esther Nakkazi

In August, every year, I travel to Mbarara University of Science and Technology (MUST) to attend the annual Medtech Hack-a-thon. This year it was the second time and as always it was impressive.

At a Hack-a-thon there is both physical and virtual space to accommodate robust pipeline technologies. Hack-a-thons are a new way of coming up with innovations which offer healthcare solutions that are commercially viable.

Most of the participants at the MUST Hack-a-thon are usually students from the various Universities in Uganda. This time the Hack-a-thon was attended by over 220 participants from over 30 universities and organisations across Africa, North America and Asia. A total of 47 teams presented novel technologies that addressed critical health care problems.

The 2015 hack-a-thon awarded $3,000 USD (10.5 Million UGX) in prize money to winners. Others sponsored for the event were Uganda Communications Commission (UCC) and Africell.

Events like Hack-a-thons ‘emancipate fear from young people who also become better thinkers,” said Professor Frederick Kayanja, the former Vice Chancellor, MUST.

He also recognised that innovations raise the profile of a University just as they are crucial to solving Africa’s problems because ‘the beneficiaries are all those who will be patients at one time or another’ which is all of us at some point.

Team MOSES or Mechanically Operated Suction and Evacuation System, a low-cost suction device used in medical facilities where electricity and traditional suction pumps are not reliable or readily available, won the first place and took $1,000 USD.

“Our win at the hack-a-thon was very unexpected but came as a direct result of he environment that CAMTech creates at their events,” said Bharadwaj Swarna, a member of the team MOSES.

“We were able to work with two doctors on our team who provided great mentorship and real-world insight. It’s all about the people that Consortium for Affordable Medical Technologies (CAMTech) brings together at each hack-a-thon that really creates value and helps us build great products.”

Team Vein Finder, a low-cost tool that uses infrared light to improve the visibility of veins and assists clinicians with treating infant cannulation was the first Runner-Up with $750 USD.

Team Medicare, an e-system that uses a mobile platform to enable patients needing emergency care to communicate quickly and effectively with nearby hospitals and that also provides health information to the general public was second and won $500 USD.

Team Haem, had an easy to use calibrated patient mat (mama mat) that helps to reduce the occurrence of maternal haemorrhaging and took home $250 USD.

“I am extremely impressed. For me this is the way to go. As a country we should connect innovation to industry to business,” said Julius Ecuru, the Assistant executive secretary at the Uganda National Council for Science and Technology (UNCST).

This is where it all starts at a Hack-a-thon and to the co-creation lab, said Echuru.

At this Hack-a-thon we also learnt about the two innovations near to commercialisation at the in co-creation laboratory at the Mbarara University run by CAMTech Uganda which will improve health in Uganda and globally.

The locally hand sanitiser, the Sani drop and the Augmented Infant Resuscitator (AIR) are near to commercialisation. The AIR’s lead innovator, Dr. Data Santorino, also a lecturer at MUST and the head of CAMTech Uganda said the AIR is a game changer that will show the rate of breathing, situation of the seal, of the airway, not only of new borns but also has secondary uses like it can be used in an ambulance for patients who have breathing problems.

Dr. David Bangsberg, a professor at Harvard University who is also the director, Centre for Global Health at Mass General Hospital (MGH) said the AIR will not only solve a local health problem but has a big market in the US and Europe.

The hand sanitiser offers a solution for the hand washing problem also gives health workers in hospitals cleaner hands to keep them from getting bacteria and transferring them to mothers who have just delivered.

Hospitals could be places of healing but many bacteria enter the women’s body during delivery, the use of non-sterile instruments or unclean hands during dilation introduces bacteria into the body.

This causes postpartum sepsis sometimes referred to as blood poisoning are the sixth-leading cause of death among new mothers, according to the World Health Organization (WHO). It is the second leading cause of maternal mortality in Uganda.

Dr. Data said the Sani drop hand sanitiser will not replace water and soap but for health workers who typically see one patient and have to walk across the room to wash their hands it is very helpful.

The Sani drop has the potential to kill 99 percent of germs and has the potential of keeping away hospital acquired infections, explained Dr. Data.

Different from other hand sanitisers on the Uganda market, its non sticky, does not make the hands dry, colourless and its smell disappears from the users’ hands in just 30 seconds. It does what all the others do kill germs.

Dr. Bangsberg said the team of innovators at Mbarara University and CAMTechMGH are now moving towards production and doing market research to find out the best price for it.

Both of these innovations, the AIR and the Sani drop, were conceived at Hack-a-thons which remains the spark. Here teams come up with solutions to global health problems, they develop a prototype with a business model to scale the products and present to judges.

I hope more higher institutions of learning in Uganda adopt this model.

ends

Museveni Advocates for Non-Communicable Diseases

By Rahimu Jabendo Via Uganda at Heart (UAH) Community (Edited by Esther Nakkazi) 

President Yoweri Museveni's statement at General Aronda Nyakairima's requiem service is a gold mine of advocacy against non-communicable diseases (NCDs). The 56 year old army General died on September 11 aboard a flight from South Korea en route to Dubai in the United Arab Emirates.

Museveni said Aronda was denied emergency treatment because he had no insurance, which the South Korean embassy in Uganda has refuted http://www.koreaherald.com/view.php?ud=20150922000404 and this could cause a diplomatic rift if not clarified. 

A statement from the Media Centre from the Prime Minister's office issued on 16th September said after a postmortem was performed at Mulago referral hospital by professionals it was found that internally, the brain had signs of lack of oxygenated blood supply. 

The heart was also enlarged, with presence of massive bleeding with in the muscle of the left ventricle involving the whole thickness of the heart muscle. There were also small areas of damaged heart muscle which also had an abnormal fat layer surrounding it. The lungs were also remarkably enlarged. 

The conclusion was that there was acute heart failure due to extensive and irreversible blockage of the heart blood vessel. 

Nobody could have stated the humongous challenge we are facing better and at a most appropriate time than Museveni. He said 'I am annoyed....he (the deceased) had a condition which was either not detected early or if detected was not managed properly'. 

Linda Aronda, the widow's statement then creates a very powerful contrast that clearly brings out how society perceives well-being:

“This heart problem you are talking about, OK it may have been there but we [the family] have never seen it', she said. 'My [two] children are my witnesses. Aronda was full of strength...For 19 years he has never failed to get out of bed or fall sick", she added.

How best to animate the insidious nature of cardio-vascular disease than in this statement. 

Of course family cannot 'see a heart problem' because seeing it requires an 'echo-cardiogram' which if you found in someone's home would be enough to scare the day lights out of you! The combination of the two statements (Museveni and Linda Aronda) show the expected vs. the norm regarding NCDs.

The current orientation of our health system is towards acute infectious diseases. Because of this, the anthropology of well-being is that: When you feel the symptoms (the fever, joint pains, etc) then you know you are sick. Unfortunately, cardiovascular diseases and indeed other NCDs present in the reverse. 

For a very long time (an average of 15 years) you feel very well yet some of the most vital organs of your body are ill! Unlike the developed world where cardio-vascular diseases are among the poor, in the developing world it is a mixed picture. 

Therefore, people develop CVD during the years that they feel they are enjoying life the most: Dollars are coming in, pork, unbelievably comfortable gas guzzling SUVs, and p.o.w.e.r! Society loves them big (the adage 'big is beautiful'). Combined with the 'stress to keep up there', this makes an optimum recipe for hypertension and heart disease.

Museveni expounded further in his informative speech: 'That the deceased was found to have had evidence of 'multiple heart attacks' that occurred in the past (as seen from the post-mortem); that he was known to have 'mild hypertension' for many years; that he complained of 'dizziness and abdominal pain in Korea'. 

Many people with heart disease actually get multiple 'silent' heart attacks, some of them going off unnoticed as vague pains in the left upper abdomen (around where the stomach is located) - sometimes the pain 'radiates' to the jaw - because the diaphragm (the tough membrane that separates the chest from the abdomen and is key for breathing), the heart muscle and the top of the lungs are served by the same nerve - so the pain is vaguely 'referred' to other places which further confuses the picture. 

I do not have an immediate off-hand publication but one physician at Mulago, in a conversation we had, chatted about seeing a series of middle-aged men who come to his clinic complaining of 'ulcers' and when he examines their hearts, he finds they are having real-time 'silent' heart attacks. Some of them report to have been on 'ulcer' medication for months or years.

Museveni expounds further: 'I know he is up there and we are all moving there, but he still had a lot to do here'. In this statement, Museveni alludes to the concept of 'early death' and 'life years lost due to early death'. 

A heart attack in the 50s can cut off an average of 20 life years because as we know, life expectancy at 50 years is much higher than life expectancy at birth in Uganda. A person who hits 50 in Uganda expects to live up to 70 at the minimum, on the average. In one of my small studies, I saw diabetes peaking at 45-50 years in Eastern Uganda yet it peaks at 65-70 years in other studies done in developed countries.

Museveni then gives a prescription in form of an order (unfortunately he gave it only to his generals): 'You all should have periodic medical check-ups!' The key point here is that unlike acute conditions like malaria, by the time you develop a 'seemingly simple symptom like 'abdominal pain' as a result of CVD, you are already terribly terribly ill! With much of the damage irreversible!

Unlike acute diseases, for chronic conditions, the signs (the things that health workers can detect) often precede the symptoms (what the patient complains of). So in order to detect the CVD early, you need a check up - at least every 5 years from when you are 40. And of course he talked about 'officers and their body-weight' and the diminishing levels of physical activity with rank. Then Museveni castigated the Medical Officers for writing 'jargon' that cannot be understood by the non-medical person.

The big butt has no problem as such. The problem is a big abdomen. The fats on the bum are relatively healthy - they are meant as a reserve to handle shocks like illness - it is those on the abdomen. Unfortunately, the two tend to go hand in hand but not always. If you can maintain a healthy 'waist-hip ratio' that is a smaller waist than your hip, it is fine. (But the waist in this case should be measured through the umbilicus, not the groin)

Museveni's speech and indeed the alter-ego speech by Linda Aronda are a gold mine for lifestyle education against the budding problem of chronic diseases in Uganda. They should be scrutinized for decades as our dual burden of disease unfolds. 

Because recent surveys show that as many as 20% of Ugandans have high blood pressure - and this is for all ages - when we zoom in on older age-groups, by age 40, at least one third of Ugandans have high blood pressure. Unfortunately the journalists picked the statement 'am annoyed' and will keep spinning this over and over without bringing out the real message of NCDs on the table.

RIP to the 'gentle giant'! General Aronda Nyakairima.
Adopted from the Uganda at Heart (UAH) Community and Edited 

Marathon with award winning athlete Kiprotich to stop Female Genital Mutilation

By Esther Nakkazi

The first-ever marathon in an effort to accelerate the abandonment of Female Genital Mutilation (FGM) will happen tomorrow September 19, 2015 in Kapchorwa district.

It is organised by the Church of Uganda Sebei diocese in conjunction with Kapchorwa Local Government leadership with support from the United Nations Population Fund (UNFPA).

The ‘FGM Marathon' is to support government effort to eliminate FGM in the districts of Kapchorwa, Bukwo and Kween which is home to the Sabiny as well as raise hope and protect the young girls from undergoing the through the harmful cultural practice. 

The archbishop of the church of Uganda Stanley Ntagali will be the chief runner. Other key runners will include UNFPA Country representative and award winning athlete Stephen Kiprotich.

FGM violates the human rights of girls and women and should not be performed under any circumstance, whether by traditional excisors or by medical personnel, says a statement from UNFPA Uganda. 

'The medicalization of FGM is a violation of human rights that raises serious concerns. There is an urgent need to intensify, expand and improve efforts to abandon FGM."

UNFPA supports a culturally sensitive, community-led approach to addressing FGM. However, cultural arguments cannot be used to condone FGM.

Female genital mutilations (FGM) comprise all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical purposes. FGM is widespread in many developing countries, and has spread to some immigrant communities in other parts of the world, such as Europe and North America. 

FGM is usually carried out on girls younger than 15 – sometimes during the first weeks of life. Occasionally, adult and married women are also subjected to the procedure. 

Here is what UNFPA is doing about FGM: 

In 2007, UNFPA and UNICEF worked closely with WHO and other UN agencies and partners to issue the Interagency Statement on eliminating FGM. The Joint Statement was endorsed by 10 UN agencies and launched in 2007 by the Deputy Secretary-General.

As a result, UNFPA and UNICEF now lead a joint programme to end FGM in one generation. The Joint Programme worked in 15 countries during Phase I (2008-2013), and is currently working in 17 priority countries, starting in January 2014, until December 2017.

UNFPA addresses FGM holistically by funding and implementing culturally-sensitive programmes for the abandonment of the practice, advocating for legal and policy reforms and building national capacity to stop all forms of FGM.

UNFPA is leading the work on development of specific legislation with government partners, and on implementation of laws and bills. UNFPA has taken joint action with local human rights groups and governments in several countries to develop legislation to end the practice.

The enforcement of legislation is part of the effort towards accountability by governments towards their human rights obligations internationally and regionally.

UFPA also support the coordination of efforts towards abandonment of FGM by government stakeholders and NGOs.

UNFPA works at the community level, and promotes collective abandonment of the practice – recognizing that FGM is a social norm that is best left behind in a collective manner – and awareness-raising dialogue through social networks.

UNFPA supports treatment and care to women and girls suffering from its immediate or long-term complications, and works with government partners in order to mainstream FGM prevention and care in all aspects of SRH services.

In recent years, UNFPA has drawn public attention to the elimination of FGM, advocating for actions, such as the need to work with communities in order to prevent the practice.

The 6th of February is the International Day of Zero Tolerance to FGM. At country level, UNFPA has formed partnerships with relevant stakeholders, including government ministries. UNFPA has also developed ties to NGOs, safe motherhood projects, community and faith-based organizations, religious leaders and representatives of the media. Multichannel communication and a holistic approach, working on different levels, are key to the strategy followed by the Joint Programme.

Q & A

Why is FGM performed?

Cultural practices, such as FGM, are rooted in a set of beliefs, values, cultural and social behaviour patterns that govern the lives of people in society. There are many reasons given for practicing FGM. Here are a few: FGM is performed to control women’s sexuality. It is seen as part of a girl’s initiation into womanhood and as part of heritage/tradition. In some communities, the external female genitalia are considered dirty and ugly and are removed to promote hygiene and aesthetic appeal. Economic necessity can determine whether women undergo the procedure. FGM sometimes is a prerequisite for women’s right to inherit. FGM may also be a major income source for practitioners.

· Why does FGM persist?

Although FGM has been shown to have many harmful effects, both physical and emotional, the practice is sustained by social perceptions, including that girls will face shame, social exclusion and diminished marriage prospects, if they forego the practice. These perceptions must change.

· Since FGM is part of a cultural tradition, can it still be condemned?

Yes. The function of culture and tradition is to provide a framework for human well-being; cultural arguments can never be used to condone violence against persons, male or female. Moreover, culture is not static, but constantly changing and adapting. Nevertheless, activities for the elimination of FGM should be developed and implemented in a way that is sensitive to the cultural and social background of the communities that practice it. Behaviour can change when people understand the hazards of certain practices and when they realize that it is possible to give up harmful practices without giving up meaningful aspects of their culture.

For more Q&A, please refer to the webpage dedicated to the Joint Programme on Female genital mutilations/Cutting on the global UNFPA website.

REFERENCES

Female genital mutilations/Cutting on UNFPA website

Female genital mutilations/Cutting, FAQs on UNFPA website

Eliminating Female genital mutilations: An Interagency Statement, UNFPA and other UN

A Holistic Approach to the Abandonment of Female genital mutilations/Cutting, UNFPA, 2007

Annual Reports on the UNFPA-UNICEF Joint Programme on Female Genital Mutilations Cutting: 2008, 2009, 2010, 2011, 2012

Summary Report of Phase I (2008-2013).

How African Parliaments Bring Scientists to their Knees

By Esther Nakkazi

When they are not moving abroad in search of better renumeration and they stay put at home, Africa’s scientists are humiliated by people who are clueless about science.

The typical African scientist is characterised with low pay, working in a bad environment with poor research infrastructure and unavailable long-term benefits or opportunities for promotion.

And now increasingly, Parliaments seem to take pleasure in humiliating scientists for stating facts. I was in Ghana recently and was amused by the story of Professor Alex Dodoo.

On 24th July, the Privileges Committee in the Ghana Parliament pardoned and discharged Professor Alex Dodoo, a Pharmacologist and Lecturer at the School of Medicine and Dentistry of the University of Ghana.

Apparently, Doodo made ‘over contemptuous’ comments describing Members of Parliament as ignorant of the Ebola vaccine trial, which has since been suspended. He was accused of compromising the integrity and sanctity of Parliament.

Dodoo also the Chairman of the Global Vaccine Safety Initiative of the World Health Organization (WHO) made two apologies (which I think were not necessary). One was through his lawyer Yoni Kulendi who made an ‘unreserved, unconditional and irrevocable’ apology on his behalf. Then Dodoo himself made a second apology alongside other witnesses saying he will never again disrespect the great institution of Parliament or its members.

The issue began with clinical trials for the Ebola vaccine that were due to take place in the Volta region but there was limited education to the communities or what you can refer to as ‘failure to carry the community along’.

A parliament and public outcry prompted the Minister of Health to suspend the trials indefinitely. At the time Ghanian Parliament debated the issue, MPs asked if the vaccine had first been tried on ‘mice, rabbits or chimpanzees’ and why were the trials not conducted in countries were Ebola was prevalent, namely Liberia, Guinea and Sierra Leone. We all know vaccines have to first be tested in animals, right!

One MP, loudly expressed the fact that God had already protected Ghana from the deadly Ebola, but now scientists wanted to channel it back through a vaccine. Another one described the compensation to study participants of 200 cedis and a mobile phone for volunteers as ‘silly’.

Doodo, a vocal and press friendly scientist took to the airwaves and described the MPs as ‘ignorant’ by the remarks they made about the Ebola Vaccine Trial. He also described the questions the MPs were asking as “elementary” which were embarrassing and lamented that the cancelation of the trials was indeed so sad for science.

Now we all know that vaccines have to first be tried in animals before progressing to humans. We also know that vaccines do not cause disease except (when its weakened form is used) but these do not make people sick. 

Lastly, compensation is not payment. People take part in clinical trials for altruism or for many other personal reasons but voluntarily and the rewards have to be such that they are not just coerced.

For saying the truth the guy had to make two apologies and with such a precedent there probably may never be any vaccine trials happening in Ghana, Umh!
ends-

Uganda Boda Boda Epidemic

By Esther Nakkazi
It is raining and cold. Twenty-eight-year-old Samwiri Kyeyune, a Boda Boda rider in Kampala, Uganda is taking shelter at Crested Towers, seemingly shivering from the cold although he is dressed heavily.

He has rested his sunglasses on the dirtyish, smelly, fading brown jacket that is slightly bigger than his size. It could be a winter jacket from anywhere in the world.

He is also wearing blue jeans and big black rubber-soled shoes. He keeps a pair of gloves in his pockets and his helmet is resting on the bike, which is now parked in the rain.

Kyeyune’s Boda-boda is one of the 200,000 operating in Kampala according to the Boda Boda Association but only 13,773 motorcycles have been licensed by the Transport Licensing Board.

They take the name Boda-boda, after bicycles and motorcycles that ferry passengers at the border towns between Uganda and Kenya. In Kampala, they are purely motorcycles.

To purchase his, four years ago, Kyeyune and his two siblings sold off an acre of their family land in Mukono near Kampala.

“I was tired of being poor and my wife was unhappy. When we sold off some of the family land, I decided to become a boda rider and make money,” says Kyeyune. Most boda-boda riders are school dropouts and young, below 40 years. They are eager to make money and work for long hours.

He moved to Kampala with his wife, Janet, the family is now bigger with a sixth member, a two-year-old son. He assures that his income has also increased by more than 80% to about 20,000 per day.

With a congested city, many Kampalans aiming to get to their appointments on time just jump on  Boda-bodas, which weave through traffic jams easily.

“I usually park my car at my workplace and move around town on a Boda-boda because it is faster and it is a hassle to find car packing,” says Carol Nakku, a marketing agent with a radio station in Kampala.

Passengers like Carol sometimes in an effort to beat time urge the Boda-boda riders to ‘fly’ yet they never wear helmets. Women are more reluctant than men passengers to wear helmets because like Carol says, it ‘spoils’ their neat hairstyles and they are a risk for disease. Hygiene is considered ahead of safety.

Boda Bodas deaths; Who is to blame?

Twenty-six year old, Michael Tebandeke was taking a turn off Jinja road to Namugongo when a vehicle knocked him and his two passengers off a Boda boda. He has now spent half a month at Mulago the National Teaching and Referral Hospital serving as the apex of medical care in Uganda and the teaching hospital for Makerere University.

Dr. Edward Naddumba, a senior consultant Orthopaedic Surgeon, says 80 percent of Boda boda accidents are due to human error followed by defective vehicles, environmental factors, poor roads, undisciplined road users and road designs.

Dr. Naddumba, is just one of the 28 Orthopaedic Surgeons against a population of 36 million. He says Boda bodas are increasingly the cause of trauma in Mulago.

Patients seen at the Accident and Emergency for Trauma centre are evaluated and those found to have major trauma are admitted to the Emergency ward. Boda bodas are responsible for about 75% of all trauma caused by Road Traffic Cases (RTCs) in Uganda.

Dr. Sam Okuonzi, a Member of Parliament says all over the country each referral hospital has a ‘boda boda’ ward. “They are not called trauma centres anymore which makes more meaning.”

Statistics at the Injury Control Center-Uganda based at Mulago shows that the Hospital receives 5-20 Boda boda related cases per day or 7280 cases a year. A 2011 traffic report shows that 570 Boda boda riders died or 15 die per day in Kampala.

The blame is on the narrow roads and a traffic mix with cows, dogs and cars all using them. Kiosks and markets on the roadsides also make it harder. Most roads have no signs to guide users and have potholes, which are dodged by cars and motorists, only to collide after skipping them.

David Muhwezi from the Uganda National Road Authority says they have tried to put up road signs but they are stolen so they are moving to plastic ones. To completely do away with this problem UNRA proposed a ‘shoot to kill on site' of road signs thieves. It has not helped much.

“Big vehicles do not respect boda boda riders,” says Matthias Okwi, a traffic police officer. Although traffic police have tried to educate riders there is too much political interference. “In 2010 we started  arresting defaulters but politicians started complaining saying police are hurting their people yet they could be unemployed,” said Okwi.

Asidri Paskali from the Boda Boda 2010 Association one of the 57 in the country says riders need education, training and enforcement but the biggest problem is the careless motorists who do not care about them.

Accidents due to Boda bodas:
Many of the Boda boda injuries are on the head, neck, face and involve the lower limbs as well they are usually open fractures.

“Both my legs were broken in the accident. There is no hope for me to walk again,” said Tebandeke in pain at Mulago. His wife says she prays for Tebandeke since he is the sole earner.

At the 'Boda boda ward,' many accident victims have what looks like nails in their legs. It’s a move from a conservative form of treatment to the surgical treatment, which has cut on the time the accident victims spend at the congested ward.

“When we switched to the surgical method, patients are admitted for 14 instead of 33 days,” says Titus Bayeza the head of department, Orthopaedics, at Mulago Hospital.

The hospital has been struggling with big numbers and low resources. Space meant for 20 people now accommodates 60 people,” says Bayeza.

There is also a new trend in the accidents, says Dr. Michael Muhumuza, a consultant Neurosurgeon at the Trauma ward Mulago. The passengers (who sometimes are thieves) are killing the riders to steal their boda bodes.

As a result of the growing numbers, Boda boda injuries consume 62.5% or Ushs.1.5 billion of the Ush. 2.4 billion allocated to the directorate of surgery at Mulago per year says Dr. Naddumba who carried out the study ‘The Impact of Boda Boda Motor Crashes on the Budget for Clinical Services, at Mulago’ published in 2010.

Various donors though, most notably the SIGN organization provides intramedullary implants and the Health Volunteers Overseas also provides most of the external fixator implants. Average maintenance costs for a Boda boda accident patient is Ushs. 700,359 (USD 369) monthly, mostly young people aged 20-29 years according to the study.

Survival rate is low most victims become disabled. While most of the accident victims are also self-employed and their families suffer while they are recuperating from their injuries. Boda boda patients also spend 18% longer in hospital than other trauma patients

“A reduction in the number of trauma cases seen at Mulago hospital most of them from Boda boda accidents will free up space for the hospital to attend to other pressing matters,” said Professor Nelson K. Sewankambo - the Principal of Makerere University College of Health Sciences.

He said trauma has overwhelmed the orthopedics department and hence skewed teaching of residents who require exposure in areas of adult and paediatric orthopedics.

There is a mandatory use of helmets under the Helmet Law but compliance is very low. Although there is evidence that helmets can be highly effective in preventing serious head injuries on the road.
Correctly worn helmets reduced risk of death by 42% and risk of severe head injury by 69% but both riders and passengers don’t like them.

“We don’t wear them because they do not protect us…before you know it, it falls and breaks into small, tiny pieces; so what type of helmets are those? Ever since that happened, I don’t wear one anymore,” said a boda boda rider.

The Uganda National Bureau of Standards has gone to great heights to define a standard helmet also imposing stringent measures like pre-shipment inspection before importation. There are also plans to build a helmet laboratory for testing them.

But helmet wearing and public education programs combined with progressive helmet law enforcement are what could change the whole picture. At least Samwiri Kyeyune wears his helmet all the time.

Ends.
I wrote this for Gemini News based in Canada in 2013 but it has since been removed from the Internet. Since I had a raw copy so I upload it here on my blog. Uganda based journalist, Amy Fallon quoted from it on her blog- Bodabodababy http://bodabodababy.blogspot.com/2013_06_01_archive.html

Ugandans live longer but health loss from HIV, Malaria and Lower respiratory infections grows

MEDIA RELEASE, 27 AUGUST 2015

  

Significant gains have been made against diarrheal diseases since 1990

SEATTLE — People in Uganda are living longer, but a complex mix of fatal and nonfatal ailments cause a tremendous amount of health loss, according to a new analysis of 306 diseases and injuries in 188 countries.

Thanks to marked declines in death and illness caused by HIV/AIDS and malaria in the past decade and significant advances made in addressing communicable, maternal, neonatal, and nutritional disorders, health has improved significantly around the world. Global life expectancy at birth for both sexes rose by 6.2 years (from 65.3 in 1990 to 71.5 in 2013), while healthy life expectancy at birth rose by 5.4 years (from 56.9 in 1990 to 62.3 in 2013).

Healthy life expectancy takes into account not just mortality but the impact of nonfatal conditions and summarizes years lived with disability and years lost due to premature mortality. The increase in healthy life expectancy has not been as dramatic as the growth of life expectancy, and as a result, people are living more years with illness and disability.

Contrary to this global trend, gains in healthy life expectancy and life expectancy are nearly equal in Uganda between 1990 and 2013. Life expectancy increased by 8.3 years for men and by 8 years for women. Healthy life expectancy increased by 8.1 years for men and 8.2 years for women. Life expectancy for women in Uganda still outpaces that of men, 61.6 years compared to 58.2 years.

“Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition” is the first study to examine fatal and nonfatal health loss across countries.

Published in The Lancet on August 27, the study was conducted by an international consortium of researchers working on the Global Burden of Disease study and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

For most countries, changes in healthy life expectancy for males and females between 1990 and 2013 were significant and positive, but in dozens of countries, including Botswana, Belize, and Syria, healthy life expectancy in 2013 was not significantly higher than in 1990.

“The fact that healthy life expectancy has increased for people in Uganda is encouraging, as is the decreasing rate of diarrheal diseases,” said Dr. Tom Achoki, Director of African Initiatives and Clinical Assistant Professor at IHME and study co-author. “But ailments like HIV/AIDS and neonatal sepsis are increasingly affecting Ugandans. More effective, targeted interventions are necessary to improve health in this country.”

The study’s researchers use DALYs, or disability-adjusted life years, to compare the health of different populations and health conditions across time. One DALY equals one lost year of healthy life and is measured by the sum of years of life lost and years lived with disability.

In Uganda, the leading causes of health loss, as measured by DALYs, in 2013 were HIV/AIDS, malaria, lower respiratory infections, diarrheal diseases, neonatal preterm birth complications, neonatal encephalopathy, neonatal sepsis, protein-energy malnutrition, tuberculosis, and road injuries. Neonatal encephalopathy, neonatal sepsis, protein-energy malnutrition, and tuberculosis were not among the leading causes of health loss globally.
Causes of health loss differed by gender in Uganda as well. For Ugandan men, the top-five causes of DALYs in 2013 were HIV/AIDS, malaria, lower respiratory infections, diarrheal diseases, and neonatal preterm birth complications. 

For women, the top five were HIV/AIDS, malaria, lower respiratory infections, diarrheal diseases, and neonatal encephalopathy. For Ugandan men, the fastest-growing leading causes of health loss between 1990 and 2013 were road injuries, neonatal sepsis, and HIV/AIDS, which increased at rates of 127.2%, 89.9%, and 83.8%, respectively. 

For women, the largest increases among the leading causes of DALYs occurred for HIV/AIDS (205%), neonatal sepsis (89.1%), and congenital anomalies (64.2%). Of these fast-growing causes of health loss, only HIV/AIDS was among the 10 leading causes of health loss for men and women in 1990.

The study also examines the role that socio-demographic status – a combination of per capita income, population age, fertility rates, and average years of schooling – plays in determining health loss. Researchers’ findings underscore that this accounts for more than half of the differences seen across countries and over time for certain leading causes of DALYs, including maternal and neonatal disorders. But the study notes that socio-demographic status is much less responsible for the variation seen for ailments including cardiovascular disease and diabetes.

“Factors including income and education have an important impact on health but don’t tell the full story,” said IHME Director Dr. Christopher Murray. “Looking at healthy life expectancy and health loss at the country level can help guide policies to ensure that people everywhere can have long and healthy lives no matter where they live.”

Leading causes of health loss or DALYs in Uganda for both sexes, 2013

1	HIV/AIDS
2	Malaria
3	Lower respiratory infections
4	Diarrheal diseases
5	Neonatal preterm birth complications
6	Neonatal encephalopathy
7	Neonatal sepsis
8	Protein-energy malnutrition
9	Tuberculosis
10	Road injuries

Leading causes of health loss or DALYs in Uganda for males, 2013

1	HIV/AIDS
2	Malaria
3	Lower respiratory infections
4	Diarrheal diseases
5	Neonatal preterm birth complications
6	Road injuries
7	Neonatal encephalopathy
8	Neonatal sepsis
9	Tuberculosis
10	Protein-energy malnutrition

Leading causes of health loss or DALYs in Uganda for females, 2013

1	HIV/AIDS
2	Malaria
3	Lower respiratory infections
4	Diarrheal diseases
5	Neonatal encephalopathy
6	Neonatal preterm birth complications
7	Protein-energy malnutrition
8	Tuberculosis
9	Congenital anomalies
10	Neonatal sepsis

Download the study at http://www.healthdata.org/research-article/global-regional-national-dalys-306-diseases-injuries-hale-188-countries-2013.

Media contact:

Maria Djordjevic, Meropa Communications

mariad@meropa.co.za

tel +27-11-506-7300