More Nurses Needed to Prescribe Morphine

By Esther Nakkazi

Twenty-nine students graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa (IHPCA) at Hospice Africa Uganda on Friday 20th May. The graduates who are either registered nurses or clinical officers can legally prescribe oral liquid morphine for pain relief. 

To date the IHPCA has trained 160 palliative care practitioners in prescribing liquid morphine. Whilst palliative care exists in 80% of the districts in Uganda this is “a drop in the ocean” compared with the demand for palliative care in the country.

Uganda is the first country in the world to make legislation that allows trained nurses and clinical officers to prescribe oral liquid morphine, a cornerstone medication used in Palliative Care. This supplements the few number of doctors, who in most countries are the only registered prescribers of such medications.

Dr. Elioda Tumwesigye the Minister of Health said there is an ''urgent need' to scale up and pledged to support the scaling up of palliative care training in Uganda.

“Despite major achievements, especially the work of Hospice Africa Uganda over the last 23 years, a lot more needs to be done to meet all of the palliative care needs in the country,” Dr. Tumwesigye said at the graduation and spoke of his own personal experience with cancer, having lost both parents to the disease. He revealed his mother was on the Hospice Africa Uganda programme in Mbarara.

Dr Eddie Mwebesa, the acting Chief Executive Director of HAU reiterated the huge need for Palliative care in Africa and in Uganda.

Dr. Tumwesigye said he will support to widen the reach of palliative care and to see if the Government, through the Ministry of Health, will consider stepping in to offer scholarships for palliative care courses, or at least to subsidize student fees at Public training Institutions.

He also said he would work to ensure that all the three academic programmes run at the IHPCA - the Bachelor of Science Degree, the Diploma in Palliative Care and the Diploma in Clinical Palliative Care - are included in the Ministry of Public Service scheme of service.

This has been the most serious challenge faced by graduates from these courses because it means they have no channel for promotion or career progression in public service.

Prof. Stanley Acuda Wilson the Institute principal said the IHPCA is playing a vital role in training and educating doctors, nurses and healthcare workers in palliative care in Uganda and Sub Saharan Africa.

The Institute was recognized by the National Council for Higher Education as a tertiary institution in 2009 and granted a provisional license to confer degrees and diplomas in affiliation with Makerere University. It was also granted the degree awarding Institution status in 2014 with a provisional license to award its own degrees and diplomas.

HAU founder Professor Anne Merriman said “despite the achievements by Hospice Africa Uganda in provision of palliative care services with meagre resources, there are a number of challenges which require government help in order to increase accessibility of palliative care in Uganda and fulfill HAU’s vision of palliative care reaching all in need in Uganda and Africa”.

All over the world, including Uganda, the need for palliative care is significant and growing because of the high prevalence of cancer, HIV/AIDS and increasing prevalence of non-communicable diseases.

Hospice Africa Uganda is the country’s pioneer Hospice founded by Prof. Anne Merriman in 1993. According to Worldwide Hospice and Palliative care Alliance in 2016, 40 million people worldwide need palliative care.

18 million die each year in severe pain and distress due to lack of access to palliative care and pain relieving medications. 78% of these live in middle and low income countries and 6% are children. 42% of countries in the world do not have any palliative care services.

Since its inception HAU has cared for over 26 000 people at its three sites in Uganda, (Kampala, Mbarara and Hoima), and it currently cares for over 4,600 patients annually.

Mobile App to Ease Diagnosis of Neglected Diseases in Africa

By Esther Nakkazi

They could be labelled 'Neglected' but are certainly not forgotten in the technology space. A mobile phone App has been developed to boost the diagnosis of neglected diseases at point of care in Africa.

It will also by-pass the use of sophisticated and expensive laboratory instruments which are difficult to use in resource poor settings.

The App will be implemented by ANDI the African Network for Drugs and Diagnostics Innovation in collaboration with EASE-Medtrend Biotech based in China.

The project uses an Integrated Mobile Diagnostics Readout called the EASE App Technology, to attain state-of-the-art results for multiple diseases in less time and less cost, a press release from ANDI says. EASE stands for Equal Access to Scientific Excellence.

 The Application is now being optimized to perform different Point of Care and Rapid Diagnostics Tests (RDTs) for diseases that are prevalent in Africa. Field evaluation is scheduled to start in Ghana, Ethiopia and Nigeria within the next two months.

“We are not re-inventing RDTs basic principles--- we are making them more user friendly, manageable and affordable with all that "Big Data" and “Cloud Computing” can do for it,” said Dr Peter Chun the CEO of EASE-Medtrend Biotech.

“This leap-frogging approach to innovation in Africa is very promising. The mobile platform can be a game - changer for neglected diseases and other routine disease diagnosis in Africa....it can also support disease surveillance and drug resistance monitoring,” Dr Solomon Nwaka, the Executive Director of ANDI.

Although most Mobile Applications in the medical field provide a platform for information exchange and consultation they do not replace hardware. The EASE App aims to replace bulky and sophisticated instruments, which have limited utility in rural communities of Africa.

It can also be scaled or expanded to incorporate multiple tests, including routine laboratory diagnoses such as blood and urine analyses as well as tests for a number of communicable and non- communicable diseases that are now common in Africa.

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$52 Billion could be saved by Africa by ending Neglected Tropical Diseases

Press Release (edited)
Sub-saharan Africa could save $52 billion (purchasing power parity) by 2030 if the region meets the WHO 2020 control and elimination targets for the five most common neglected tropical diseases (NTDs).

These were statistics released  at the World Economic Forum on Africa (WEF Africa) in Kigali, Rwanda, on 13th  May by Erasmus University.

These statistics, developed with support from the Gates Foundation, were released at a WEF Africa-sanctioned side event, convened by the END Fund to make the case for increased investments in NTD control in sub-Saharan Africa. 

Meeting these goals could also help the region gain the equivalent of 100 million life-years that would otherwise be lost to ill health, disability and early death arising from these diseases.

"NTD control efforts offer a return on investment unparalleled in global health,” said Ellen Agler, Chief Executive Officer of the END Fund, a private philanthropic initiative dedicated to ending the five most common NTDs. “Ending these debilitating diseases will help reduce poverty at all levels, from families and communities to whole nations.”

NTDs are a diverse group of parasitic and bacterial infectious diseases that are particularly prevalent in areas with limited access to safe water, proper sanitation and adequate medical services.

Sub-Saharan Africa bears over 40% of the global burden of NTDs. The five most common NTDs – lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis (bilharzia), soil-transmitted helminths (intestinal worms) and trachoma – account for 90% of the region’s NTD burden. At least one of these diseases is present in all 47 countries of the WHO’s African Region.

The impact of NTDs on both health and economic development in sub-Saharan Africa is massive. Each year, these diseases cause disabilities and disfigurements for millions of African citizens. They also increase absenteeism in schools and dramatically reduce labor productivity, ultimately perpetuating cycles of poverty.

“I have seen the devastating effects of NTDs first hand in my community,” said HRH Queen Sylvia of Buganda, a kingdom in Uganda, who delivered remarks at the side event today. “We cannot continue to let people across Africa suffer from these diseases of poverty when simple solutions exist. It is holding our people and our countries back. We can and we must do more.”

The five most common NTDs in sub-Saharan Africa can effectively be prevented and treated using low-cost, easy-to-administer interventions, such as preventive chemotherapy (PC) treatments through mass drug administration (MDA) in affected communities. 

Such interventions are extremely cost effective due to a number of factors, including drug donations (valued at $4 billion annually); the scale of national programs; the integration of drug delivery with other health initiatives; the use of volunteers and teachers for distribution; and the massive impact of NTD control on economic productivity and educational outcomes. Pharmaceutical interventions work alongside other prevention strategies, including the promotion of safe water, sanitation and hygiene.

In recent years, countries across sub-Saharan Africa have made tremendous progress toward ending NTDs. Donors, development partners and national governments have made unprecedented commitments to these diseases, including through the landmark London Declaration on NTDs, launched by a coalition of partners in January 2012, and the Addis Ababa NTD Commitment, signed by 24 African health ministers in December 2014 declaring increased leadership and budgetary contributions. 

The Sustainable Development Goals (SDGs), adopted by the United Nations General Assembly in September 2015, specifically reference putting an end to NTDs by 2030.

Despite this progress, a funding gap remains to distribute medicines to the millions of people across sub-Saharan Africa who still lack access. Additional resources are urgently needed from all sectors – public, private and philanthropic – to reach the WHO’s 2020 targets for NTDs and reap the resulting health, education and economic benefits.

Notably, Rwanda, the host country for today’s event, has made tremendous progress on NTDs. Thanks to the leadership of the government and the support of partners such as the END Fund, the prevalence of soil-transmitted helminths (intestinal worms) has been reduced by 32% over the last 5 years. However, much remains to be done for the country to eliminate NTDs.

“Now is the time for leaders across Africa to prioritize NTD control and put an end to these terrible diseases in order to improve the lives of our people,” said Rwandan Minister of Health Dr. Agnes Binagwaho, who also spoke at the event. “In Rwanda, we have invested in our people, and we have seen progress as a result of this commitment. With human lives at stake, we simply cannot afford to wait.”

For more information, please contact:

 Sarah Marchal Murray, END Fund

smmurray@end.org; + 1 917 597 7317

Jessica Freifeld, Global Health Strategies       

jfreifeld@globalhealthstrategies.com; +254 714 291 222; +250 729 003 622

Rwanda to use drones to deliver blood supplies in remote areas

By Esther Nakkazi

Rwanda has been awarded $800,000 by the UPS Foundation to support the initial launch of using drones to deliver life-saving medicines like blood and vaccines.

The UPS Foundation has partnered with Zipline a California­-based robotics company and GAVI the vaccine Alliance to make this happen.

Starting later this year, the Rwandan government will begin using Zipline drones, which can make up to 150 deliveries per day of life-saving blood to 21 transfusing facilities located in the western half of the country.

This public-private partnership combines a century of global logistics expertise, cold chain and healthcare delivery from UPS with Zipline’s national drone delivery network and Gavi’s experience in developing countries focused on saving lives and protecting health in the most remote places of the world.

In a press statement issued on 09/May Eduardo Martinez, president of The UPS Foundation and chief diversity and inclusion officer at UPS said the public-private partnerships are the key to solving many of the world’s challenges, with each partner contributing its unique expertise.

While Rwanda’s national drone network is initially focused on the delivery of blood supplies, the plan is to expand the initiative to include vaccines, treatments for HIV/AIDS, malaria, tuberculosis, and many other essential and lifesaving medicines. Rwanda’s drone delivery operation is expected to save thousands of lives over the next three years and could serve as a model for other countries.

“UPS is always exploring innovative ways to enhance humanitarian logistics to help save lives, and we’re proud to partner with Gavi and Zipline as we explore ways to extend the Rwandan government’s innovations at a global scale.”

According to the WHO¹, Africa has the highest rate in the world of maternal death due to postpartum hemorrhaging, which makes access to lifesaving blood transfusions critically important for women across the continent.

“Our partnership with UPS and Zipline is an exciting step into a new territory for the delivery of medical supplies,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “It is a totally different way of delivering vaccines to remote communities and we are extremely interested to learn if UAVs can provide a safe, effective way to make vaccines available for some of the hardest-to-reach children.”

“The inability to deliver life-saving medicines to the people who need them the most causes millions of preventable deaths each year. The work of this partnership will help solve that problem once and for all,” said Zipline CEO Keller Rinaudo.

“With the expertise and vision of UPS, Gavi and Zipline, instant drone delivery will allow us to save thousands of lives in a way that was never before possible.”

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GAVI Alliance funds Uganda yellow fever vaccination as outbreak rages on

By Esther Nakkazi

Uganda has received 714,579 doses of yellow fever vaccine, from the GAVI Alliance, worth 643,765 US dollars (over shs 2 billion), for an emergency reactive mass vaccination campaign in two districts.

Masaka and Rukungiri districts have been hit by a yellow fever outbreak recording 30 suspected cases and 11 deaths. Uganda started experiencing a yellow fever outbreak in January 2016 prior to this it reported a yellow fever outbreak in 2010 that affected five districts in the northern part of the country.

The  International Coordination Group on vaccines comprising of UNICEF, WHO, MSF, and the IFRC okayed for GAVI to pay for the vaccines. 

Immunisation of 698,850 people, aged six months and above will be done in the two districts and a campaign is scheduled to begin in the second week of May.

“The importance of carrying out a massive vaccination campaign is to interrupt the transmission. With this exercise, the affected population will be able to achieve immunity against yellow fever,” said Ms Aida Girma, UNICEF representative in Uganda.

Currently, the Government of Uganda, through the Ministry of Health and its partners, UNICEF, WHO, MSF and CDC, is supporting social mobilization activities, facilitation of health workers, and capacity building of health teams in the affected districts. 

Social mobilization activities include engaging local leaders and village health teams to conduct interpersonal and door-to-door communication with communities in small groups. Utilization of the local media using radio messages is also on-going.

Dr Jane Ruth Acheng, the Director General of Health Services at the Ministry of Health is the overall coordination of the response being done by the National Task Force and she says the general objective of the response plan is to reduce avoidable morbidity and mortality due to the outbreak.

According to WHO, there is no specific treatment for yellow fever but the international organisation recommends that patients should be provided with supportive treatment which includes rehydration therapy for dehydration, analgesics for fever, diazepam for restlessness, and bed nets for preventing the spread of infection.

“Vaccination is the major preventive measure against the disease because it is highly effective,” added Dr Wondimagegnehu Alemu, WHO country representative in Uganda. 

The WHO situation report released on 5th May shows that countries in Africa have suffered from a yellow fever outbreak. One was detected in Angola late in December 2015 and confirmed by the Institut Pasteur Dakar (IP-D) on 20 January 2016. Subsequently, a rapid increase in the number of cases has been observed.

It reported that as of 4 May 2016, Angola has reported 2,149 suspected cases of yellow fever with 277 deaths. Among those cases, 661 have been laboratory confirmed. Despite vaccination campaigns in Luanda, there is still circulation of the virus in most districts of Luanda and in five additional provinces.

Three countries have reported confirmed yellow fever cases exported from Angola: Democratic Republic of The Congo (DRC) (37 cases), Kenya (two cases) and People’s Republic of China (11 cases). Namibia has also reported a suspect yellow fever case exported from Angola. This highlights the risk of international spread through non-immunised travellers.

On 22 March 2016, the Ministry of Health of DRC notified human cases of yellow fever in connection with Angola. The Government officially declared the yellow fever outbreak on 23 April. As of 4 May, DRC has reported 5 probable cases and 39 laboratory confirmed cases: 37 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and Matadi, Kongo central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo central provinces.

The virus in Angola and DRC is largely concentrated in main cities and is likely to have been introduced to the cities following increased yellow fever viral circulation among monkeys in the forest.

What is yellow fever?

Yellow fever is a viral infection that is transmitted to humans through a bite from a mosquito carrying the yellow fever virus. It causes fever, yellowing of the eyes, and bleeding from any part of the body. The "yellow" in the name refers to the jaundice (Nkaka) that affects some patients.

What are the signs and symptoms of yellow fever?

After three to six days of infection with the yellow fever virus, the following signs and symptoms usually appear:

• Rapid onset fever
• Abdominal pain
• Diarrhoea
• Vomiting
• General body weakness
• Yellowing of the eyes
• Loss of appetite
• Bleeding from any part of the body

Some patients may develop yellow eyes, abdominal pain, bleeding from the mouth, nose, eyes and stomach. Most patients fight the infection and the signs and symptoms disappear after three to four days. However, those unable to fight the infection worsen (toxic phase) and many of these eventually die within 10 to 14 days.

How is yellow fever spread?

The yellow fever virus is spread by mosquitoes, which transmit the virus to humans through a bite, leading to the spread of the disease in communities. The infected mosquitoes that spread the disease usually bite people during the day. They breed in open containers around homes, as well as pools of stagnant water and bushes.

Who is at risk of getting yellow fever?

Anyone who is bitten by an infected mosquito can get the disease. However, it is important to note that some members of the community may be more at risk of catching the disease than others, for example: 

• Anyone who is not immunized against yellow fever;
• People who work or live in forests

How is yellow fever treated?

There is no specific treatment for yellow fever. Health workers can only offer supportive care to treat dehydration and fever. Bacterial infections linked to the diseases can be treated with antibiotics. It is important to seek early treatment when symptoms show.

How can yellow fever be prevented?

• Vaccination
• Mosquito control
• Personal protection: wear long sleeve shirts or blouses, trousers, long dresses and long skirts