Injectable anti-HIV drugs could be available in 2017

By Esther Nakkazi

Science is moving HIV treatment and prevention forward from oral to injections. Instead of taking a daily pill for antiretroviral therapy it will switch to an injection lasting three months at most.

Scientists believe, especially women, who are also the most affected by HIV will easily adapt to the use of these long-lasting injectables because of their familiarity with injections through contraception.

Almost one in four new HIV infections in sub-Saharan Africa are in young people aged 15-24 years, and two-thirds of these are among girls who are also users of contraceptives and injectables are favourites.

“When you think about young women, in particular, being very adapted to getting injections for contraception this could be a very nice natural next step,” said Jeanne Marrazzo, the director of the University of Alabama at Birmingham School of Medicine Division of Infectious Diseases.

Scientists also believe the injectables will reduce stigma and daily adherence, which is still a challenge to people taking anti-HIV drugs daily and they will also give users a choice.

“Young people sometimes forget to take the pill so if we give them formulations where they do not have to worry it will probably work better,” Thomas Hope, a Professor of Cell and Molecular Biology at the Northwestern University, Evanston at the biennial HIV Research For Prevention conference (HIVR4P 2016) held 17-21 October in Chicago, USA.

The injectables under development will be used for therapy and for Post Exposure Prophylaxis (PrEP). Two different drugs, Rilpivirine by Janssen Pharmaceutical Companies of Johnson & Johnson and Cabotegravir by ViiV Healthcare, a global specialist HIV company with GSK, Pfizer Inc. and Shionogi Limited as shareholders are collaborating.

For treatment, two injections of Cabotegravir and Rilpivirine will be given in the butt at the same time. While for PrEP, only one injection of Cabotegravir - a new drug to users - will be administered.

“The treatment work is well advanced but prevention is still early,” said Joe Romano, President of NWJ Group, LLC.

Although treatment may be an easy sell to users it will be a challenge for PrEP which communities are less aware of.

“PrEP is more like a contraceptive. It is a product you give to healthy people. Overall, individuals are aware of pregnancy risk all the time and less about HIV risk, which comes on and off,” said Nelly R. Mugo, a gynaecologist and a principal research scientist at the Kenya Medical Research Institute (KEMRI).

But although injections for ARVs may be acceptable there are many technical issues yet to be addressed. Men are still naive in this field and most importantly how long can someone go between the injections, explained Romano.

Scientists are looking at injectables with drugs 3-4 millilitres and for it to last for 1-3 months.

“Men have no experience. Healthy men typically do not get an injection normally every three months,” said Romano.

Then variations in the human body around metabolism, drug absorption are also key as well as being cautious that when an injection goes in it cannot come out!

However, the most pressing issue for injectables for ARVs is the so-called ‘tail’, which basically means if the drug is injected in an individual at what point does its concentration go down so that they are not at risk before the next dose. If the drug levels are down what happens if infections with a bit of drug in the background?

“I think 3 months is good but if it starts to get less than that and you have to go every month to the clinic that is still a hustle,” said Lynn Morris the head of the HIV Virology laboratories at the National Institute for Communicable Diseases (NICD) in South Africa.

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Scientists caution public expectations on 2016 HIV cure breakthrough research

By Esther Nakkazi

In the year 2016, there was so much excitement about cure research opportunities from the ‘functional cure’ for HIV. However, scientists cautioned the public about high expectations.

Scientists at the National Institutes of Health (NIH) and Emory University in an experiment induced sustained remission of SIV in animals, which if translated to humans could mean that there is a possibility of having people on anti-HIV drugs sustain suppression of the virus and get off of the drugs. 

This is called sustained HIV remission or a ‘functional cure’ which is not a cure but an outcome of a treatment that induces prolonged, undetectable levels of HIV viremia without the daily anti retroviral treatment (ART).

I attended the biennial HIV Research For Prevention conference (HIVR4P 2016) held 17-21 October in Chicago, USA and Anthony Fauci, an immunologist who heads the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and had carried out a landmark research about it explained that some people call it a cure others sustained remission.

Fauci with his team carried out an experiment, which involved infecting monkeys with SIV, the simian form of HIV. The research was published in the Oct. 14 issue of the journal Science.

According to a press release from the National Institutes of Health (NIH), the investigational treatment regimen consisted of 90 days of ART combined with 23 weeks of treatment with a laboratory-derived monkey antibody against a cellular receptor called alpha-4-beta-7 (a4b7) integrin. 

This antibody is similar to the human drug vedolizumab, which is approved by the U.S. Food and Drug Administration (FDA) for treating ulcerative colitis and Crohn’s disease.

The animals’ immune systems suppressed the virus to undetectable levels for as long as 23 months and the regimen led to the near-complete replenishment of key immune cells that SIV had destroyed, something unachievable with antiretroviral therapy (ART) alone.

Way Forward: 

While speaking to the press at the HIVR4P 2016, Fauci said there was so much that they (scientists) do not know, especially the mechanism, but what was loud and clear was the effect. So they decided to start a study in humans. 

The NIAID team will start an FDA approved study with 15-25 people with this profile; HIV infected, 18-65 years old, stable with controlled viremia, CD4 count of 450+, not pregnant and generally with a relatively healthy immune system.

They will get treatment interruptions of combined short-term vedolizumab treatment and ART for 30 weeks. Thereafter, both will be stopped and they will be followed for at least seven months.

The study investigators hope that what happened in the monkeys suppressing SIV replication will be repeated in humans - basically control the virus levels in the absence of ART and the antibody - so the immune system controls the virus in the absence of ART. Preliminary results are expected by the end of 2017 or beginning 2018.

“If we discontinue therapy in the 15 and 4 of them do not rebound that is the best anybody has ever seen,” said Fauci. Most patients immediately rebound after discontinuing therapy.

He also cautioned on public expectations. “Even if it is dramatic in animals we do not want to take a human who is infected and do more harm than good that is why we are starting off with a small phase I study whose primary goal is safety.”

African scientists comments about the 'functional cure' research; 

I interviewed some leading African scientists who attended the HIVR4P 2016 about the 'functional cure' research. Here is what some of said about it.   

'Cautious hopeful'. “It is exciting that we are beginning to get signals. However, these are monkey studies but bring hope. Over the years, we have learnt that people and animals are different so I would say -cautious hopeful, said Nelly R. Mugo, a gynaecologist and a principal research scientist at the Kenya Medical Research Institute (KEMRI).

'Surprising result.' “It is a very surprising result and I think everybody recognises that. I can say we do not really know how it is working, obviously we have some idea but we do not really know the mechanism,” said Lynn Morris the head of the HIV Virology laboratories at the National Institute for Communicable Diseases (NICD) in South Africa.

'It is too early.' “It is exciting because it offers another opportunity. If it is confirmed by other studies it will be quite exciting because people might be able to come off ART. But I think It is very early,” said Thumbi Ndung’u an immunologist and Scientific Director of the HIV Pathogenesis Programme at the University of KwaZulu Natal in South Africa.

Studies in Africa

Many HIV studies are done in Africa and Morris hopes that if a study is done in the US as Fauci promised there will be interest in doing it in South Africa.

In her opinion, from a cure perspective it is going to be a simple study do to. "The point is it is a licensed product so let us not waste time figuring out the mechanism let us just try it. If it works we can figure out if it really prevents rebounding then we can try and figure out how we can do this,” said Morris.

“It is exciting because integrins unlike the virus are the same. The big issue is going to be cost,” said Morris referring to monoclonal antibody therapies which are extremely expensive.

“But cost should never ever be used as a barrier to doing things because if there is a need the cost is a flexible controlled by demand. People should not come with negative things like cost I think the studies have got to be done and if they work people will find a way around the obstacle,” she said.

If the drugs work they will be re-licensed for HIV and it is envisaged that there will be a different pricing structure and there will be mass production. 

Over 37 million people according to UNAIDS need ART. Currently, they are only produced for the niche market for people suffering from inflammatory bowel disease. 

“It is yet another piece of evidence that we are moving closer to a situation where HIV is like cancer where it can be treated and does not come back in a long time,” Thumbi Ndung’u said.

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Ban on sex education in Uganda schools to be lifted

By Esther Nakkazi

By early next year, the ban on sexuality education in Uganda schools will be lifted after a policy to guide the curriculum on what will be taught has been developed.

We all had concerns that the sex education ban was unjustified but recently we talked about it at a Science Café and shockingly authorities in the know said it was a blessing in disguise.

The Science Café was the 14th held by the Health Journalists Network in Uganda at their home in Ntinda and the second one sponsored by United Nations Population Fund (UNFPA) Uganda Its theme was ‘teenage pregnancy’ held on November 30th with oversight from Reach A Hand.

Penninah Kyoyagala Tomusange the national programme officer, Adolescent and youth sexual and Reproductive Health and Rights at UNFPA-Uganda said although we all thought that the ban on sexuality education was a bad thing it was actually a good move by the government. Why?

Apparently, the previous content and packaging was terrible. So right now all stakeholders are meeting to create a package that will have relevant and accurate information for sex education in Ugandan schools.

“Sexuality education is about accurate information,” emphasised Kyoyagala. “No teenager wants to be a dad or Mum.”

Sexuality education is also a life long thing since environments keep changing, sometimes its verbal other times non verbal.

One misinformation that was in the old package was on condom use. So the new curriculum talks about proper condom use but condoms will not be distributed in schools. The students will be informed on where to find them in health facilities.

This is a good move but will it work given the disconnect between health facilities and education centres. The two government entities do not seem to speak to each other at all! Look at the way youth are always begging for youth friendly services in health facilities.

It is only a song well sang but only practiced by a few facilities like the Naguru Teenage Information Health Centre.

We also had Denis Lewis Bukenya the deputy director, Naguru Teenage Information and Health Centre (NTIHC) talk to us at the science Café. He too emphasised the need for accurate information and to regularly sensitize and empower teenagers to make better-informed decisions.

“Provide accurate information so that the decisions teenagers make are accurate,” said Bukenya.

He said the youth need to have ready access to youth friendly sexuality education services so they can get their needs and questions attended to. Bukenya also stressed a need to educate boys who are not only active participants in creating teen pregnancies but are also custodians of the decision making process.

Godfrey Walakira the training and development manager, Straight talk foundation Uganda, was also a speaker at the science cafés and gave astounding statistics. He said research shows 43% of all Uganda teenagers are forced into the first sexual encounter. The early sex debut is also at the young age of 12/13 years in Uganda.

Pregnancy usually leaves stigma around the girl yet many times it is not their fault entirely. Many are defiled and according to the Police crime report 2011, defilement was the most prevalent crime.

Meanwhile, teenage pregnancy is still a big problem in Uganda. Walakira noted that the national average prevalence of teenage pregnancy currently stands at 24% according to the Uganda Demographic Health Survey (UDHS 2011).

Regionally, the rate of teenage pregnancy is highest at 30.6% for Central Uganda, 30.3% for Eastern, 29.7% for Karamoja, 26.4% for West Nile and 25.6% for the North Uganda, Western Uganda is at 22.6 while south western is at 15%.

Walakira stressed the need to handle a number of issues that lead to teenage pregnancies including child marriages whose prevalence stands at 59% for Northern Uganda, 58% for Western region, 52% for Eastern region, 50% West Nile, 41.9% for central region, 37% for southWestern and 21% for Kampala according to the 2011 UDHS.

One way that Uganda can reverse these stats is increase in teenagers’ access to age appropriate sexual reproductive health information, which, can effectively be done through provision of appropriate information to the schools or directly through the communities.

The conclusion therefore at the Science Café was that Uganda should popularise sexuality education in schools. It will delay their sexual debut, probably reduce teen pregnancy but most importantly when the teenagers get accurate sex information they are empowered.

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Dissemination of new innovations for utilisation of Roots, Tubers and Bananas

By Esther Nakkazi

After three years of intensive research, the RTB-ENDURE project will present research findings on expanding the utilisation of Roots, Tubers and Bananas (RTB) in a workshop on Tuesday 6th and Wednesday 7th December 2016 at Crane Hall, Imperial Golf View Hotel, Entebbe.

An exhibition of RTB Technologies and Innovations will also be held alongside the workshop at the Botanical Gardens, which are located close to the hotel.

The project from 2014 to 2016 has added value to the fresh products of roots, tubers, and bananas, expanded their utilisation and reduced on their post-harvest losses among communities in the East African region, said Diego Naziri, a Post-harvest Specialist at International Potato Center (CIP).

Uganda has hosted the $4 million European Union (EU) funded project.

Realising RTB’s full potential as crops and as products in Africa is important as they are food security crops, important sources of income, are less susceptible to price fluctuations in the world food market as compared to grains and legumes.

CGIAR Research Program on Roots, Tubers and Bananas data entails that these are consumed as a staple food and they contribute over 20 percent of caloric requirements and constitute nearly two-thirds of per-capita food production in sub-Saharan Africa.

CGAIR-RTB project also confirms that Post-harvest losses are much higher with this group of crops than with grains, as inherent bulkiness and perishability have traditionally limited them to on-farm and local markets.

However, they are bulky, perishable, with a limiting shelf life and short direct marketing. Africa lacks handling and storage technologies of RTBs and with an underdeveloped potential for value addition.

Naziri says the RTB-ENDURE project has been a research-for-development that has placed research in the context of value chains and the demands and needs of its actors in the production, postharvest handling, processing, marketing, and business organization to make the chain function more efficiently.”

For more about the new innovations on this RTB-ENDURE project please follow #RTB on twitter and more will be highlighted on this blog. 

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Mombasa Tea Auction to go Digital

By Esther Nakkazi

After years of refusing to go digital, East Africa tea traders and growers have accepted to replace the current manual open outcry system, with the computerized electronic auction.

Today, East Africa Tea Trade Association (EATTA) signed a financing agreement with TradeMark East Africa (TMEA) to provide financing provide of US$ 1.5 million that will enable automation of the tea auction in Mombasa.

A statement from TMEA says the automation is expected to reduce the tea trading cycle by about 65% from the current 45 - 60 days to less than one month. Reduced delays will also ensure that farmers receive timely payments negating need to take loans to finance their producer operations.

The Mombasa tea auction is the world’s largest black tea auction and handles about 75% of tea exported through the port of Mombasa covering shipments from the EATTA member countries of Burundi, Kenya, Rwanda, Uganda, DRC, Tanzania, Ethiopia, Malawi, Madagascar and Mozambique.

In 2015, the auction handled more than 350 million kilos of tea, providing a platform through which more than one million farmers in Africa could sell their tea, before shipping it across the world.

The proposed integrated Tea Trading System (iTTS) will encompass the entire tea export processes including pre-auction, auction, post-auction and a Business to Business marketing network says a statement from TMEA.

“This portal will simplify the tea auction with the added benefit of increasing transparency and thus gaining stakeholder confidence in the auction,” said Mr. Nicholas Munyi, EATTA chairperson, at the signing ceremony.

“TMEA is committed to boosting intra- Africa trade and also East Africa’s trade with the world by reducing the barriers to trade. Automation of key trade systems is one way that has enabled us move closer to achieving this vision,” said Frank Matsaert TMEA CEO.

“I am excited to see that tea, a major forex earner for the region, will reach the breakfast tables across the world in an efficient and cost effective way and that the farmers working hard on their farms will regain confidence in the trading process as a result of the transparency and accountability the system will give,” explained Matsaert.

Once fully implemented, the platform, will ensure that, stakeholders of the tea auction including farmers, buyers and sellers, receive real time information on what is happening on the auction bourse.

Further, the automation will reduce delays and paper work, which is synonymous with the manual systems. The tea brokers will benefit from an automated and streamlined trading platform that reduces complex and bureaucratic trading processes and physical movement of documents to various players.

The tea producers both in Kenya and other countries in the region will have real time access to information on the tea sales as well as have lower logistics costs as they will be able to access the information online eliminating the need for travel to Mombasa.

Automation for the Mombsa auction was supposed to be implemented by 2013 using the Indian tea e-auction model, the only country in the world using it. A team from EATTA left for India on a fact-finding mission but found that despite it operating for eight years, the Indians still preferred the manual open outcry system.

The report presented by the team to EATTA said the Indian government imposed the e-auction on them in order to collect more taxes from tea but they were unhappy with it because it was not interactive and it was too commercialized without meeting in the auction room.

So EATTA stakeholders, overwhelmingly, voted against it in a meeting saying the auction, which basically, is a ‘public sales’, would lose its transparency, competition and risk technology failure without a guaranteed power supply at Mombasa.

The traders and growers said using the e-auction would be a health hazard if buyers were to sit uninterrupted through the 8 hours looking at computer screens and the auction would lose its gusto.

It is interesting that these now don’t see it as a health hazard and are willing to move with the times embracing technology.

New research establishes storage temperature for East African highland bananas

By Esther Nakkazi

Margaret Nalujja a trader at Bugolobi market a suburb in Kampala can now earn about 80 percent more from selling East African highland cooking bananas locally known as matooke in Uganda.

“From a cluster of peeled matooke I earn Ush 5,000 while the unpeeled sells for Ush 3,000,” said Nalujja.

Unlike the older generation that has for centuries been preparing matooke through long hours of peeling and steaming in banana leaves most of Nalujja’s clientele who are hotels, bachelors and the young generation want already peeled matooke that they just boil. Supermarkets also prefer it.

Market research under the RTB-ENDURE project has established that Uganda consumers prefer peeled matooke even when it has been under cold storage, said Dr. Enoch Kikulwe, an associate scientist at Biodiversity International of Uganda.

One of the questions that Ugandan farmers also wanted to know under the project was the temperature under which the matooke could be stored without getting spoilt, said Dr. Kikulwe also the team leader of the banana sub-project of RTB-Endure.

“This research has answered this fundamental question for East African highland cooking bananas.”

Scientists have found that both the peeled and unpeeled East African highland cooking bananas can stay for 12 days with no taste or color changes under cold storage of 12-18 degrees centigrade. Most standard fridges offer cold storage of 5-8 degrees centigrade.

Without cold storage the matooke can only stay for 3 days without ripening or rotting.

Bananas occupy 1.3 million hectares nationwide and are grown mainly by subsistence and semi-commercial farmers and it is a staple food for the rural communities. The matooke is a key source of livelihood for over 13 million farmers and a major staple food in Uganda.

A lot of research has been done on increasing the shelf life of other banana varieties like the Cavendish but we did not know what to do with the matooke said Dr. Kephas Nowakunda, the head of the food biosciences and agribusiness research program at the National Agricultural Research Organisation (NARO)

Dr. Nowakunda explained the other benefits of peeled bananas including leaving the waste on the farm to make manure and reducing rubbish.

The RTB-ENDURE research project has focused on innovations for improved postharvest management and expanded use of the cooking banana, cassava, potato and sweetpotato with an aim to improve food availability and income generation for roots, tubers and bananas producing communities.

RTB crops are essential staple foods in developing countries. They have high nutritional value, they generate income, and they contribute to the sustainability of cropping and production systems.

The RTB-ENDURE project is implemented in Uganda by the CGIAR Research Program on Roots, Tubers and Bananas (RTB), led by the International Potato Center (CIP), as part of a larger three year project funded by the European Union with technical support of IFAD.

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A forty-year walk with Ebola – it hasn’t been a 'walk in the park'

By Esther Nakkazi

40 Years ago, around September, the first Ebola blood samples were carried by a Congolese woman in her handbag from Zaire to Belgium on Sabena airlines. Yes, you read that correctly.

Currently, with an Ebola outbreak anywhere, travelers not even remotely near the source have to fill in forms, temperatures have to be taken, suspects quizzed and isolated or even denied access to places. It is the drill.

The fascinating 40-year history of Ebola since the first outbreak in Yambuku, a small village in the DRC, was told at the 8th international symposium on filoviruses in Antwerp, Belgium.

Nothing is the same anymore. Zaire is now the Democratic Republic of Congo, Sabena airlines - then the national carrier for Belgium - closed in 2001, its succeeded by Brussels Airlines.

As you know, this last Ebola outbreak was vastly different from all the ones before. Ebola has become a household name now, 40 years after Yambuku.

Forty years ago, though, Ebola was unknown.

In 1976, in Yambuku, a small village in Mongala Province in northern DR Congo, a young doctor Jean-Jacques Muyembe was ordered by the minister of health to make investigations about a disease that had killed some people.

Muyembe arrived with a medical assistant. The health workers suspected typhoid or yellow fever. Muyembe examined some sick people and collected blood samples without gloves. His hands and fingers were stained with blood but he just washed it off with water and soap. In addition, he collected liver samples from 3 nurses who had died.

When a nurse who he knew was vaccinated from typhoid and yellow fever said she had a fever the alarm bells started to ring. The trio (Muyembe, the medical assistant, and nurse) flew to Kisansha to further investigate the samples.

The disease was nothing they knew. Sadly, the nurse and medical assistant died in the next few days but Muyembe was saved - not by the ‘moon suit’ but by washing his hands with water and soap.

A Congolese woman who was traveling to Belgium on Sabena airlines was asked to drop the samples off at the Institute of Tropical Medicine (ITM) in Antwerp, where Muyembe’s friend was working.

The Ebola samples arrived in Belgium in September 1976. Dr. Guido van der Groen picked them up on his bicycle. They were packed in used containers. He took them for proper storage at ITM.

Here the team tried to identify the virus and found that it was close to the Marburg virus isolated from monkeys in Uganda by the Germans, but clearly, it was not the same. Muyembe was informed about it and warned that it concerned a very dangerous new virus. They then tried to give the new virus a name.

At first, they opted for Yambuku where the index case was discovered but they soon realized that if you use the name of a town it will cause too much stigma. Then they looked for any landmark near Yambuku and found the Ebola river which is why Ebola is now named after a river near Yambuku.

The Ebola forty-year journey has seen 25 outbreaks by now, 30,900 cumulative cases and 12,800 deaths. A new book ‘on the trail of Ebola’ by Dr. Guido van der Groen details this history.

Frontline health workers have been most affected by Ebola over the years, but right now it is a serious public health threat. Many ongoing efforts in terms of policy, diagnostics, and research are being discussed at this symposium.

Clearly, the Ebola journey hasn’t been a ‘walk in the park’.

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Uganda off WHO list of yellow fever risk countries

By Esther Nakkazi

After a month of no evidence of active transmission, Uganda has now been declared yellow fever free.

The ministry of Health says between the 1st to the 30th of June 2016 there were no cases of active transmission in the country. A vaccination coverage of 94 percent, which is above the World Health Organisation (WHO) recommended coverage of 90 percent was achieved in the three affected districts of Masaka, Rukungiri and Kalangala.

Following the successful yellow fever vaccination campaign in the affected districts, no new cases have been confirmed, said Professor Anthony Mbonye, the acting director of general health services, Ministry of Health.

A total of 627,706 residents (aged six months and above) were vaccinated including 273,447 in Masaka district and 304,605, 49,654 in Rukungiri and Kalangala districts respectively.

Thereafter, the Public Health Emergencies Operations Centre Network (PHEOC) coordinated a one month enhanced Yellow Fever surveillance in 17 districts surrounding the three districts with no confirmed cases.

However, disease surveillance to detect any other possible outbreak and heightened efforts to prevent the risk of transmission through international travel is still ongoing, said Prof. Mbonye.

It is mandatory that individuals travelling from yellow fever high risk countries into Uganda are fully vaccinated against it before entry into Uganda. Unvaccinated travellers from Uganda are also advised to access the yellow fever vaccine from accredited centres.

On 7th April 2016, yellow fever was confirmed by Uganda Virus Research Institute (UVRI) on 3 samples from Masaka by serology. This diagnosis was re-confirmed on 21st April 2016 by CDC Fort Collins (WHO Collaborative Centre for Yellow Fever)

Intensification of yellow fever Surveillance activities also confirmed yellow fever in Rukungiri and Kalangala districts on 13th April 2016 and 4th May 2016 respectively.

From 24th March to 4th May 2016, a total of 65 suspected yellow fever cases were reported from districts in the greater Masaka region and 7 cases were confirmed from Masaka (5), Rukungiri (1) and Kalangala (1). Three of confirmed cases died.

With support from World Health Organization (WHO), the CDC, ICG, GAVI, UNICEF and other partners, the Ministry of Health conducted a reactive yellow fever vaccination in the three districts that had confirmed outbreaks.

The vaccination campaign was implemented from 19th May 2016 to 22nd May 2016 in Masaka and Rukungiri districts and from 4th June 2016 to 7th June 2016 in Kalangala district.

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Sex education in Uganda schools was a bad move?

By Esther Nakkazi

It was at the celebrations of the 2016 World population day held in Isingiro district that I first heard President Yoweri Museveni talk about the unessential need for Uganda to have sex education in schools.

The theme was ‘invest in teen girls’ and in his speech, Museveni juxtaposed high teenage pregnancy with teaching sex education in schools.

“I want to discuss with all stakeholders about sex education in schools. There is a time for everything,” he said meaning he actually wanted to fix what he started.

Sex education started being taught in primary and secondary schools in 2001 when Uganda was preaching abstinence-only. It was an official program of President Museveni under the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY).

PIASCY was launched by President Museveni in 2002 to promote abstinence and life skills education among school children. It was funded by the US lead government agency USAID and the Centres for Disease Control and Prevention (CDC). It was later bounced to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). 

The main aim of PIASCY was to empower young people to delay their sexual relations until marriage through abstinence. Thus, materials of instruction were made and distributed in primary and secondary schools and at youth rallies.

For kids aged 5-12 years the message was mainly abstinence and its benefits and as they grew older the subsequent message was correct condom application and uses. For kids 13-18 years it was upgraded to also include age sensitive subjects like masturbation, abortion, homosexuality but there was also some misleading and inaccurate information on condoms and HIV prevention.

Fifteen years down the line, after pumping kids with comprehensive sex education in schools, this is the scenario.

Uganda teen pregnancy incidence rates are sky high compared to its neighbors, HIV rates among adolescents are growing, teens spend happy moments exchanging porn and according to Parliamentarians the God-fearing Nation- read Uganda- is getting ‘more gay’.

Of course, there are positive contributions that sex education has made to Uganda's teens but the policymakers are adamant about them. All that is cited are these bad stats.

Latest stats from United Nations Population Fund (UNFPA) say 140 per 1,000 teenage girls get pregnant annually in Uganda compared to 41, 101 and 128 in Rwanda, Kenya, and Tanzania respectively.

The Ministry of Health reports that 25 percent of Uganda teenagers become pregnant by 19 years and face four times the risk of maternal death compared to women older than 20 years plus their rates of neonatal death are about 50% higher.

According to the 2011 Uganda Demographic Health Survey (UDHS), many of the pregnancies in female adolescents aged 15-19 years are neither desired nor planned and those who had a child five years prior to the survey did not want to have it at that time.

Abortion is illegal in Uganda except under exceptional circumstances that include saving the life of the woman or preserving her physical and mental health. Studies show unplanned pregnancies in adolescents coupled with high teen pregnancy rates contribute to the high incidence of abortion and its related deaths.

A study done at the national referral hospital, Mulago, showed that almost 50% of the women who died from abortion complications were adolescents. But these also tend to seek an abortion later than others and are more likely to use unskilled providers.

In mid-August, a month after President Museveni who signed onto this program complained, the Uganda parliament debated the motion to withdraw sex education in schools.

Lucy Akello, a Member of Parliament, Amuru district moved a motion, which appreciated that ‘comprehensive sexuality education lacks defined approaches to guide children at their tender age and to uphold Uganda with its morals, virtues of an Africa setting and a God fearing Nation.

It was agreed that the ministry of education halts dissemination of comprehensive sexuality education training materials and conduct of such programs in any schools in Uganda until a policy has been laid out in Parliament. 

Also, the National Curriculum Development Center in conjunction with relevant stakeholders would develop a comprehensive sexuality education curriculum in line with Uganda’s cultural values and practices.

During the debate, every member who spoke supported the motion. They blamed sex education in schools for the widespread 'immorality' inclusive but not limited to early sex, abortions, homosexuality and teen disobedience.

Of course, there should be other things to blame like the increasing exposure to porn and ‘raw and uncensored material’ on the Internet but in the meantime according to our legislators adopting this motion will fix everything.

Here is another scenario from a highly educated Ugandan.

So last year, I was attending the Makerere University Walter Reed Project (MUWRP) stakeholders meeting in Kampala thematized ‘Mitigating disease threats of Public Health Importance: 13 years of MUWRP in Uganda’.

Prof Vinand Nantulya, the Chairman of the Uganda Aids Commission (UAC) was the key speaker. He juxtaposed Uganda’s HIV new infections increase to the vulnerability of young women who are increasingly getting lured into sexual activities. He said it is worse.

UNAIDS estimates that 380 new HIV infections occur in Uganda making it the third leading contributor to new HIV infections in Africa after Nigeria and South Africa.

Prof Nantulya said one of the ways this would be fixed was to have more education about HIV in schools, which is also part of the comprehensive sexuality education package. He said more funds needed to be provided for PIASCY.

“PIASCY, which was good and helpful to educate the youth is not as good as it used to be. I want PIASCY back,” he said.

So its either that Uganda children and adolescents do not need sex education at all or that the PIASCY project got it wrong. Whatever it is we are not going back to the era when Uganda’s children got sex education from their grandparents, parents or relatives as Museveni suggested. No one has that time anymore. It is easier done in schools with the right messages and at an appropriate age. So since it cannot just be blown away, fix it.

Is a malaria free Africa by 2030 possible?

By Esther Nakkazi
Is a malaria free Africa by 2030 possible? The glass is half full.

Forty-seven World Health Organisation member states in the African Region unanimously adopted a new malaria framework with specific actions to reach ‘an African Region free of malaria’ by 2030.

In a meeting held in Addis Ababa on 21st August, they came up with a framework to guide member countries towards attaining targets of the Global Technical Strategy (GTS) for malaria (2016-2030) within a given time frame.

The GTS was founded in May 2015 at the 68th World Health Assembly on the vision of a world free of malaria and consists of four goals and related targets to be achieved by 2020, 2025 and ultimately by 2030.

It for instance aims to reduce malaria mortality rates and case incidence by at least 90% by 2030 as well to eliminate malaria from at least 20 malaria endemic countries. It also aims to prevent re-establishment of malaria in all Member States that are malaria-free.

A press release from WHO AFRO says this framework's priority interventions and actions have been organized according to programme epidemiological strata in order to engender evidence-based targeted interventions.

The GTS has guiding principles like country ownership and leadership with involvement and participation of communities within a multisectoral context. It also encourages mobilizing and working with other sectors in malaria control and elimination.

To an extent some of these goals are achievable.  Some projects have demonstrated it. Six countries; Algeria, Botswana, Cape Verde, Comoros, South Africa, Swaziland have the potential according to the WHO to eliminate local transmission of malaria by 2020.

Meanwhile, two countries, the Democratic Republic of the Congo (DRC) and Nigeria alone account for more than 35% of the global estimated malaria deaths so if efforts are concentrated here that would give a lot of mileage I suppose.

But how possible is it that the Africa region can be malaria free by 2030?

Well, there is some impressive progress so far in controlling it. Since 2000, malaria death rates have plunged by 66%, translating into 6.2 million lives saved, most of them children. Between 2000 and 2015, the number of malaria cases and deaths within the African Region declined by 42% and 66%, respectively says the WHO.

In addition, more people with suspected malaria get tested before treatment and many more are sleeping under insecticide-treated mosquito nets. In 2014, 65% of the suspected malaria cases got tested before treatment compared to only 41% in 2010. In 2015, two in three households in Africa had their own insecticide-treated mosquito net, compared to only 2% back in 2000.

And like Dr Matshidiso Moeti, the WHO Regional Director for Africa said, “Malaria is no longer the leading cause of death among children in sub-Saharan Africa. More and more children get to sleep under a net.”

Malaria is also still on top of the global and regional agenda and so it remains a priority, identified in target 3.3 of the Sustainable Development Goals (SDGs) which commits to end it by 2030. The WHO also reaffirms to end it by then.

However, despite the significant progress made, malaria continues to be a major health and development problem in the Africa Region as it still bears the biggest malaria burden with about 190 million cases (89% of the global total) and 400 000 deaths (91% of the global total) in 2015 alone.

We cannot talk about a malaria free Africa without talking funding which the World Malaria report 2005 says increased substantially by 410% between 2005 and 2013 for programme financing. Overall, international financing for malaria control increased from US$ 100 million to US$ 1,640 million in 2013.

But the report also shows that even with these increases the annual investment per person at risk remained low at US$ 2 in the year 2013 and this funding situation is further threatened by low domestic financing.

So in the period 2005-2013, the proportion of total malaria funding contributed by national governments in Africa stagnated at less than 10% and these rely on external funding.

Meanwhile, based on GTS cost estimates and at a fixed 2013 population at risk of malaria in Africa of about 830 million, the total cost of malaria elimination in Africa by 2030 is US$ 66 billion.

There is thus a funding gap which is not new because most health projects are suffering from low aid.

Furthermore, implementation of the GTS will necessitate addressing some key challenges like weak health systems (which were tested during the Ebola outbreak).

As well there is the threat of resistance to the medicines combined to a lack of a vaccine and the adverse effects of climate variability and change.

One of the reasons for reversing the malaria deaths as mentioned earlier was as said by Dr Moeti; ‘more children slept under a net but there is need to continue to invest in changing people’s behaviours.’ She also said more people with suspected malaria got tested before treatment.

It is only if people in the region change their behaviour and sleep under treated nets and also seek treatment within 24 hours after testing. These are some of the sustainable ways to keep the gains achieved and also move forward.

Otherwise, the glass really remains half full as the balance for the gains and the challenges for implementing the GTS remains glaringly odd.

ends

Anne Merriman Hospice Africa Foundation launched

By Esther Nakkazi

The 2014 Nobel Peace Prize nominee Professor Dr. Anne Merriman's efforts to improve palliative care for Africans are starting to pay off. She is also an advocate of a good death, which is a basic human right.

While in 1993 only three African countries had palliative care now 35 have support care and 20 have affordable oral morphine based on Merriman’s formula which she developed in 1980. Hospice Africa Uganda (HAU) the model she founded for Africa is also producing enough oral liquid morphine for all in need in Uganda, with the support of the Ugandan government.

Since its founding, Hospice Africa Uganda has cared for more than 27,000 patients. It currently provides family centred care for up to 2,000 patients across its three centres in Kampala, Mbarara and Hoima. 

 “An Africa where Palliative Care reaches whoever needs it is a very big vision. This vision can only be achieved if impeccable clinical services, like the ones offered at Hospice Africa Uganda, are spread all over the continent and are integrated into the health service delivery system of every country, said Dr. Eddie Mwebesa, the Chief Executive Director of HAU.

Also recognising the shortage of morphine prescribing doctors,  Merriman’s work has changed the law in Uganda to allow specially trained nurses to also prescribe morphine. 

So Uganda is the only country in the world where nurses can prescribe morphine, hence it was in 2015 ranked by the Economist, Quality of death Index as the second country in Africa (35th worldwide) for the highest quality of death.

It is estimated that 50 percent of people in Africa will not access a health worker in their lifetime, and less than 5 percent reach chemotherapy or radiotherapy.

On Wednesday, 17 August the Anne Merriman Hospice Africa Foundation was launched in Kampala by Dr. Jane Aceng,  the Uganda minister of health during the 5th International African Palliative Care Association Conference. 

“Every human being on the planet no matter their colour, creed or social background should expect a pain free, peaceful, end of life. Unfortunately in Africa this is not the case for most," said Merriman.

"I have worked with dedicated teams for the last 23 years to change this and now that I am 81-years-of age, our loyal supporters and I, want to ensure that this work continues, until the vision is a reality. Together we have achieved a lot - but so much more needs to be done.”

She appealed to world leaders and policy makers to take note and to do all in their power to ensure that people in Africa experience a good death. “We need strong and powerful advocates to support this cause.”

“We are here because we want to move the ethos of care: compassionate, team oriented, and patient centred, forward together. It's for this purpose that the Anne Merriman Hospice Africa Foundation will thrive in its vision," said Mrs Shelley Enarson, a founding advisor to the Foundation, at the launch.

"The AMHA Foundation will promote the spirit of keeping the patient at the center of our care, and ensuring that the ethos of organisational partnerships are encouraged” said Dr. Mwebesa.

ends.

Refugees a Blessing to Uganda says Museveni

By Esther Nakkazi

Since 17th July 2016, the total number of South Sudanese refugees that have arrived in Uganda is 37,890 according to UNHCR. 73 percent of all refugee new arrivals are children.

Two days ago at the joint political leadership of the NRM that included the central executive committee, cabinet and permanent secretaries President Museveni said Uganda caring for African refugees brought by adversity, is not just charity. It is also good strategy.

He elaborated how the Banyarwanda comrades were supported when they stayed in Uganda as refugees for 34 years (1960-1994). When they gained ascendance in Rwanda, they opened it up for interaction, including trade, with East Africa. Today Uganda exports US$263 million worth of goods and services to Rwanda. Rwanda, in turn, is exporting US$78 million worth of goods to Uganda.

And through Rwanda Airlines, Uganda is currently contributing about US$ 24.1 million to the prosperity of the people of Rwanda. South Sudan, before the outbreak of the conflict in 2013, was contributing US$ 700 million per annum (exports and remittances) to the prosperity of the people of Uganda.

Recently, about 40,000 Ugandans came back from South Sudan on account of the present conflict there. They were there apparently looking for prosperity.

Therefore, Ugandans should know that unity within Uganda and Pan-Africanism in the whole of Africa are not mere acts of solidarity but are also investments to create a better framework for the prosperity of all Africans said Museveni.

“I, therefore, salute Ugandans for welcoming our brothers and sisters, the African refugees as well as other African business persons. It is the cumulative, Pan-Africanist efforts of as many Africans as are enlightened on this point that will guarantee the prosperity of the African people,” he concluded.

Uganda rural based doctors play God

By Esther Nakkazi

Only two years into medical practise, the youthful doctor Gamukama Tuhaise is the in-charge of Rwekubo health centre IV, where a new born baby dies almost every day. With limited resources and a small workforce tough choices make him play God.

On the eve of Uganda's 2016 World Population day celebrations, commemorated world over on the 11th of July, I travelled to Isingiro the land of highland bananas (Matooke) and the venue for Uganda’s big event celebrated and attended by President Museveni and non profits like UNFPA-Uganda.

As the road snaked into the hilly, ridged terrain of Isingiro, you would think all the Matooke eaten in east Africa is grown here as almost the entire vegetation was of Matooke and the many lorries on the road from this Uganda-Tanzania border district were all loaded with them with just a few carrying milk cans.

At least 20 lorries of Matooke leave Isingiro for Kampala everyday and 700,000 litres of milk are produced per month. For the thousands of guests who attended the World Population day  celebrations in Isingiro, refreshments served to us were between a choice of water or milk. I am certain if lunch was served too, it would be a mountain of Matooke on our plates.

The 2016 theme, ‘investing in teenage girls’ was timely and relevant to especially Uganda, which tops the East African region in teenage pregnancy. Everyday over 20, 000 girls under age 18 give birth in developing countries according to UNFPA.

In Uganda, 140 per 1,000 teenage girls get pregnant annually compared to 41, 101 and 128 in Rwanda, Kenya and Tanzania respectively according to UNFPA.

Stillbirths and death in the first week of life are 50 percent higher among babies born to mothers younger than 20 years than among babies born to mothers 20–29 years old, says the WHO.

Furthermore, deaths during the first month of life are 50–100 percent more frequent if the mother is an adolescent versus older, and the younger the mother, the higher the risk.

The rates of preterm birth, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death and of future health problems for the baby.

The statistics for Isingironian pregnant teens are not available but when I interviewed some of them most were impregnated by fellow teen boys and I am not sure I got an explanation to pin this to. Later when I visited Rwekubo health centre IV and also talked to some teen mothers and their youthful mothers ( now grandmothers) my heart sunk.

A teenage mother with her son Austin in Isingiro district

Seventeen year old Rosemary Kukiriza lay on the bed staring blankly at the ceiling her face showing no particular emotion, not exactly sad, eyes darting from her mother who was standing by her bedside to other teen mothers like her holding their new borns.

She was only 3 hours out of theatre and had lost her first born baby, another statistic at Rwekubo health centre IV where at least a new born dies everyday.

Isingiro has about half a million people. Its located in western Uganda, on the Uganda-Tanzania border, a newly established young district with no referral hospital with Rwekubo health centre IV as one of two biggest and busiest health providers.

Kukiriza’s 36 year old mother was making all the noise, seemingly restless and talking in undertones with an elderly woman attending to a patient on the left bed next to Kukiriza’s. It was her first grandchild afterall who had passed on and she told me she had given birth to Kukiriza at 14 years so why did fate have to follow her daughter and not any other?

She narrated ‘the story’ from when they had arrived at Rwekubo health centre in the night at about 4pm to when they got her daughter in theatre at 10am in the morning, occasionally opening her eyes wide or clasping her hands or slapping one finger into the palm of her left hand to emphasise a point - the whole system was full of delays- she said.

“Why didn’t they take Kukiriza to be operated upon as soon as we arrived? That nurse really delayed. They only took her to the theatre this morning at about 10 o’clock,” she said with near anger or regret in her voice.

Doctor Gamukama dressed in a faded, dark green, cotton health workers uniform and half listening to our conversation explained the circumstances under which Kukiriza had been admitted.

She was in distress, pain and before taking her to theatre certain practical things had to be done; blood type established, vitals taken, the theatre cleaned and prepared, fuel for the generator bought and the lone anaesthetist called in.

The health centre has one oxygen point; no running water - every week a water truck delivers water; it has a few health workers - this happens everywhere as few health workers want to be based in rural areas like Rwekubo health centre IV,  it is powered by a generator-sometimes this jams; and Rwekubo almost serves an entire district of half a million people.

“We have only one anaesthetist will he stay here day and night without doing anything else? Preparation of theatre takes about 40 minutes. The generator has to be fuelled and the theatre powered,” if an operation is to happen said Gamukama.

Kukiriza’s baby was born alive but died a few hours afterwards. It was tired. Efforts to resuscitate it did not help something partly blamed on herbs. “Many women take herbs which thicken the fluids so it becomes difficult when you try to resuscitate the baby,” said Gamukama. Asked which particular herb was responsible for this outcome he said he did not know.

His advise is for women to stop taking herbs when pregnant although in Africa, herbal knowledge for pregnancy is passed on across generations and herbs are preferred to antenatal visits. So outlawed traditional birth attendants still remain women’s preferred choice when giving birth and for nursing pregnancy sickness.

“If you resuscitate a baby for an hour and there is no response you take a decision,” said Gamukama. The oxygen has to be turned off. It is only rational.  It could also be playing God?

He explains; if only there was another doctor-led team in the theatre to handle the baby it would be easier but he has to handle both mother and baby concurrently. Usually, the preference is to save the mother.

Understanding doctor Gamukama’s perspective of the theme in terms of teen mums and saving new borns was real important afterall he is the star of the Isingironian film.

Of the 70 maternal related operations that take place in a month at Rwekubo health centre IV, most of them done by him, 20 percent are of teenage mothers aged 16-19 years and their babies often die. Looking at the centre’s records from 1st July almost a baby had died a day most of them born to teen mums.

“It does not affect them much. After one year they will be back here. They are usually pregnant within the next three months after losing a baby,” said Gamukama with certainty.

Some want to fill the void immediately while others want to stop the scorn and stigma by village communities ‘as the daughter of so and so who has failed to bear a child for our son’.

But there is also prestige in switching names to ‘mama boy’ or whatever name the first born child bears and merely just to prove themselves.

Seventeen year old Ainembabazi Brenda is also camped at the Rwekubo health centre for the last one month and 2 weeks. She has no complications yet in her third trimester of the pregnancy but being a teen and at the advise of the health worker she has stayed.

“When the teen mothers stay here it reduces the risk of losing the baby and it keeps us health workers updated on every step,” said Gamukama. However, its expensive on both the health centre which has limited space and resources and on the family that has to ferry daily meals to the otherwise not sick pregnant woman. Not forgetting the overall confounding factor- poverty.

But its worth it. For instance, in doctor Gamukama’s opinion if Kukiriza had come in at least 24 hours before the onset of her symptoms her baby would be alive. For all those reasons, ‘you cannot stop babies from dying,’ he says. As well, poverty cannot let teen pregnancies stop, he concludes.

As we drive out of Rwekubo health centre's gates, Kukiriza's mother is holding a box wrapped in Africa fabric cloth bearing the body of her grandchild. She waves back to us limply and we wish her well.

Hopefully, her next grandchild born born by teenage Kukiriza will live to see another day and drink of Isingiro's thousands of litres of milk and eat of its mountains of matooke.
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This trip was facilitated by UNFPA-Uganda 

Fun mobile app to dispel sexual and reproductive health myths

By Esther Nakkazi

(Written on July/22nd/2015 and first published here https://www.the-newshub.com/technology/fun-mobile-app-to-dispel-sexual-and-reproductive-health-myths)

A mobile application to dispel sexual and reproductive health myths won the ‘#HackForYouth’ Hackathon organised by the United Nations Population Fund (UNFPA) in Uganda.

The 3G Tree@viQ is an incentive based mobile application, which will provide young people with information about Sexual and Reproductive Health and Rights (SRHR).

It is simple, basic, interactive and fun said Natalie Cojohari, who works with UNFPA in Moldova and was the head of the winning team at the three day Hackathon (22-23 July) held at the Sheraton in Kampala.

The hackathon followed principles of “user-centred design”, actively engaging young people in the development of solutions that are based on their real needs and experiences. It was graced by the Mr. Ahmad Alhendawi, the UN secretary General’s Envoy on youth and Chris Baryomunsi, the Uganda State Minister of Health. It attracted young people from 13 countries.

Although the winning team developed the app for especially the youth in eastern Europe, it can also be adapted elsewhere. The region is burdened by increasing rates of HIV and STIs but is also has a high mobile phone penetration with no sexuality education in school and what is available is not accurate.

Ms. Cojohari explained that there are many sexual and reproductive health myths in her region like; you cannot get pregnant if you have sex for the first time, it is safer to use two condoms, if you wash your genitals with Coca Cola after sex you will not get pregnant.

So the app will basically be a quiz based on myths and if the player wins they will be incentivised with free data, airtime or meal. Ms. Cojohari said it will increase the users self esteem and improve their knowledge on sexual and reproductive health.

At the pitching session, teams came up with innovative solutions which were interactive, informative and educative to youthful users in their privacy customised with appropriate content for particular regions that offer unconventional solutions to promote young people’s knowledge on sexual and reproductive health.

These ranged from apps that could aggregate data, offer vouchers to young pregnant girls to get SRH services, or give youth friendly messages and the ability to chat in privacy with a certified e-volunteer and an app that gives access to information to empower them against sexual harassment.

The judges said the 3G Tree@viQ was well packaged, the quiz gives the youth a challenge and since at that age, everyone wants to beat the system, it will keep them engaged and rewarded at the same time improving their knowledge on sexual and reproductive health and rights in their privacy.

At a time when young people are always looking for data and they want to seek for sexual and reproductive health in comfort and privacy, a mobile health solution is one way to do it. It was a fruitful event and to me all the teams were winners at least in the area of rapid innovations.
ends

Is Sickle-Cell disorder killing more Uganda infants than HIV annually

By Esther Nakkazi

After Evelyn and her boyfriend had dated for four years they decided to get married. They were young and so in love. The only medical check-up they bothered to take was HIV as was advised by friends and family.

Soon she was pregnant with a baby boy and another one came a year later. Evelyn’s hope was to have two and maybe another set of children later after securing a place in her career as a lawyer.

Henry the second child was sickly and not as strong as his big brother. They blamed it on the diet, the maid, low appetite, everything, whatever. The frequent visits to the hospitals and long nights of the child crying with unexplained pain sent the young parents panicking.

After many misdiagnoses by various physicians, one of them casually suggested a sickle cell disease test. The confirmatory test turned the young family into misery and eventually the husband left to remarry someone ‘normal’ which still leaves tears in Evelyn’s eyes.

Something else still hurts so bad. While seeking treatment for her little boy she was shocked when a doctor said to her “for those who succumb…it is nature’s way of cleansing the human race.” It meant her child would die anyway and it's then that she got determined to fight for him.

About 12,000 to 16,000 children below five years die of sickle cell disease annually in Uganda. Sickle cell disease has been declared a major public health problem for sub-Saharan Africa by the World Health Organization. However, its funding remains very low.

According to Evelyn, ignorance among health professionals and the public is the biggest challenge. “The few doctors who treat sickle cell in children are just passionate about it.”

So while cardiologists are heart specialists and oncologists in cancer, sickle cell disease has no specialty.

Prof. Christopher Ndugwa, a pediatrician is referred to as ‘Uganda's grandfather of sickle cell disease’. He has trained about 80 percent of the doctors who treat sickle cell disease in Uganda.
“I became passionate about sickle cell disease because it was neglected and children were suffering,” said Prof. Ndugwa.

Besides the few medical professionals, the statistics too tell a story of laxity.

At least 15,000 to 20,000 babies are born with sickle cell disease every year in Uganda and 80 percent of them die before their 5th birthday. As a single disease, it could be killing more under-fives than any other although the comparable statistics are scanty.

These figures are from 2014, the Ministry of Health survey carried out to establish the prevalence of sickle cell trait and sickle cell disease across Uganda.

Charles Kiyaga the national sickle cell coordinator at the ministry of health says the survey documented a high sickle cell burden with a national trait average of 13.3 percent and a disease burden of 0.73 percent.

But the distribution is not uniform across the country with some high burden districts; Gulu, Lira, Kitgum, Dokolo, Oyam, Tororo, Jinja, and Kampala have a prevalence of 20 percent and disease burden above 1.5 percent.

With these alarming figures, the ministry of health started newborn screening in the high burden districts covering a total of 274 health facilities and also equipping them with prophylactic drugs like penicillin, antimalarials, folic acid and training health workers in sickle cell management.

So far over 50,000 newborn babies have been tested.

One high burden district though remains an enigma. Bundibugyo situated at the border of Uganda and the Democratic Republic of Congo. It is one of the highest-burden districts with a prevalence of 21.7 percent of trait and 1.9 percent of disease and these figures have been constantly high since 1949.

A 1949 study put the prevalence of trait among people in Bundibugyo at 45 percent. Why its still a mystery is that except for its neighbor Ntoroko district with a trait prevalence of 15 percent all districts around Bundibugyo have a prevalence trait of less than 10 percent.

Scientists believe there is a need to investigate further the factors that predispose the Bamba tribe who predominantly live in Bundibugyo to more sickle cell disease as opposed to the districts around it. Of course intermarriages among carriers without knowledge promotes increased spread amongst communities.

Data from the 2014 survey has been useful as Uganda is now the only African country with current national prevalence data, which has also been published in a leading medical journal, the Lancet.

The research earned Uganda a reward. It was nominated to host the 6th International Symposium on Sickle Cell Disease (REDAC 2016) which happened last month and raised the profile of the disease among Ugandans.

Mass screening, patient management, early testing, counseling, and sensitization campaigns have been created. Pre-marital counseling and testing are being promoted in collaboration with religious leaders.

“We want it to become policy for every couple to test for sickle cell disease before they get married,” says Evelyn.

Dr. Jane Ruth Aceng the Minister of Health says there are plans to scale up newborn screening services in high burden districts and introduce hydroxyurea, which is a disease transforming drug.

She says the Ministry of Health also plans to implement a policy to administer the pneumococcal vaccine to children with sickle cell disease above 2 years to protect them from recurrent infections.

In an effort to increase advocacy and support groups, Evelyn says they have a Whatsapp group and self-help messages.

“We send each other messages if there is a child who is sick or one of our members. We also teach the families to have home remedies,” she says. These could be as simple as using hot water bottles for pain, drinking at least 3-4 liters of water per day, eating nutritious foods.

“If a child eats one egg, a sickle cell child will eat two eats every day. They’ve got to have enough proteins.” In her opinion and considering the pain she concludes, “it is easier to give birth to a child with HIV than one with sickle cell disease.”

NB: Lynn Najjemba a journalist by training has a dear son very ill, a sickle cell sickler who needs to have a bone marrow transplant. For any contributions you can make towards this cause please contact Najjemba directly on  +256704 026 888/ lynn.najjemba@panosea.org or follow the tweet #savekacie

What turns the mighty elephant away? Chilli, Condom, Firecracker

By Esther Nakkazi

A low cost and ingenious innovation made of chilli, a firecracker and a condom can drive a huge elephant away and protect communities' food.

A ‘chili cloud’ made of chili powder mixed with sand and a lit firecracker inside of a condom can be thrown near a grazimg elephant to make it uncomfortable enough to turn around.

This four-step elephant alarm system does not harm the elephant. It just makes the elephant uncomfortable enough to turn around.

Honeyguide Foundation with support from The Nature Conservancy is working with local communities in northern Tanzania to use fireworks, chili powder, and flashlights to safely redirect elephants off farmland.

“The elephant alarm system is an ingenious and inexpensive way to reduce conflicts by safely redirecting the animals off farmland,” said Matthew Brown Africa Region Conservation Director, The Nature Conservancy in a press release.

Before this innovation villagers used to throw a spear at those stubborn elephants and they would go off and die somewhere else but now they use a torch and a chili cloud to chase away them.

Human-wildlife conflict has become a growing challenge as more people turn to farming in corridors where elephants range, conflicts between the two cause huge problems.

When an elephant wanders onto a villager’s farm, it can have a devastating effect: A single elephant can destroy someone’s food supply for the entire year in one night, trample property, and threaten a family’s safety.

“The fact that people on the ground are participating, and we’re saving elephants while protecting livelihoods is amazing. Honeyguide wants to make sure that farmers and communities continue to be conservationists, and in order to achieve this, elephants need to be seen as a friend rather than foe,” said Damian Bell, Executive Director, Honeyguide.

The elephant alarm system does more than protect one wandering elephant and one family’s crops each night: It’s part of a holistic strategy to protect landscapes, natural resources, and wildlife for the long term. Ensuring that local communities benefit from wildlife, and are engaged in their conservation, is a key element to save them.

“Elephants are enormous animals to try and keep out of your vegetable patch and also extremely dangerous animals,” said Bell.

“Since we have developed the human elephant conflict toolkit, we have seen an attitude change with in these communities whereby they are much more confident that they can keep elephants out of their fields without harming the elephants.”

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Using Technology to Increase Family Planning Uptake

By Esther Nakkazi

Often times, leaders and the international community attend global conferences and make commitments towards causes they never honour because there is no mechanisms to make them accountable.

Now Samasha Medical Foundation, a Uganda non profit dedicated to advocating for improved health, has developed an innovation that can monitor if commitments are honoured and translated into implementable activities.

The Motion Tracker is an online monitoring tool that can track mechanisms made towards achievement of commitments made by governments and their leaders.

It is an evidence based tool based on the WHO health systems Framework monitoring service delivery, health workforce, information, medicines, financing and governance.

“This was a proof of concept project translating reproductive health global commitments into action at a country level,” said Moses Muwonge the director Samasha.

“It is an evidence based tool that has been very good for us to know how our resources are expended and has helped us to coordinate with all the stakeholders working on reproductive health issues,” said Dinah Nakiganda, the assistant commissioner reproductive health at the Ministry of Health.

The Government of Uganda made reproductive health related commitments at various global fora; in 2011 at Every Woman Every Child (EWEC), 2012 at the London Family Planning Conference –FP 2020 and in 2013 at the UN Commission on Life Saving Commodities (UNCoLSC).

Samasha working with Reproductive Health Supplies Coalition (RHSC) developed a Commitments Compendium, which has a compilation of explicit and implicit statements from the Commitments made by Uganda, which were deconstructed into implementable activities that can be monitored, said Dr. Muwonge.

In the project methodology, selected individuals from organisations that contribute to reproductive health related commitments were selected basing on a stakeholder mapping matrix.

Primary data was collected using a partner contribution questionnaire and secondary data was collected through review of various documents like policy statements, newspaper articles. Data was also collected from key informant interviews, desk reviews, email correspondences, meetings one-on-one meetings and phone calls.

The methodology and tools have now been adapted by Burkina Faso and Zambia, said Muwonge.

Cornelia Asiimwe the program officer at Samasha says partner reporting on contribution to commitments increased from 23 in September 2015 when the project was launched to 64 in April 2016.

“The percentage of returning users has also grown. At first they were spending just about a minute now they take 3 minutes and more, which shows that they like the tool,” said Asiimwe.

After about a year now, the Motion Tracker has shown that the different commitments are either on track or have been or not achieved in regards to reproductive health commitments in the areas of finance, policy, service delivery, supply chain and technology said Asiimwe.

It also tracks the money and helps policy makers devote money to areas where it is needed most, said Nakiganda.

Espilidon Tumukurate an adviser for Jhpiego, said this is one of the success stories and now the innovation is an export. He however said that Samasha needs to get more funding and take the tool to the lower level- district- and also track how the money is helping deliver services.

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.

ends

  

$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