Wednesday, April 25, 2018

Suddenly, why am I among the generation to not end malaria?

By Esther Nakkazi

The world over, on this day, April 25, 2018, it is World Malaria Day. Today is also the tenth World Malaria day ever after a decade when it started being celebrated and maybe the saddest ever because malaria is on the rise again.

With not much time to waste we should know that the gains we sang about and thumped our chests over about conquering malaria for the past decade have reversed. In 2016, malaria cases rose for the first time in a decade and there were 216 million cases of malaria, 5 million more than the previous year.

There were also 445,000 deaths in 2016 as well human migration is continually importing the disease from high burden areas to lower burden areas. In some high burden countries, the annual number of deaths from malaria has increased. Those with the greatest burden of disease and death are those caught up in a humanitarian crisis where conflict remains the greatest challenge like Burundi, Chad, DR Congo and South Sudan.

Sadly, this treatable disease, malaria, still kills a child every two minutes.

I have not suffered from malaria in about five years and I think it is because I try to prevent it. I often spray my inside and outside my house twice a year. I sleep under a mosquito treated bed net and when I stay out of Uganda for long, I take my medication days before I return.

But it is not only me who has achieved some feat, some countries have even bigger gains. Egypt and Morocco have been malaria-free since 2000, and Algeria since 2016. Others are following suit, Botswana, Cape Verde, Comoros, South Africa and Swaziland, will most likely eliminate malaria by 2020.

Algeria, Comoros, Madagascar, the Gambia, Senegal, and Zimbabwe have also been honored this year by the African Leaders Malaria Alliance for leadership in scaling down malaria cases. In total forty-four countries are reporting less than 10,000 cases.

But even with my own prevention success and for the countries mentioned, malaria is back and with a vengeance. Suddenly, the target of reducing malaria cases by at least 90% by 2030 looks bleak.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO says the malaria fight is at crossroads. But he is hopeful this generation could be it but wants urgency.
“We could be the generation to end the disease for good. If we don’t seize the moment now, our hard-won gains will be lost,” says Dr. Ghebreyesus and cautions, "if we continue along this path, we will lose the gains for which we have fought so hard."

Anti-malaria campaigners say we have become complacent in dealing with malaria. Funding has also flatlined. However, if ONE of the actions to revitalize the fight against malaria is funding then we have hope after the London Malaria Summit.

The UK Prime Minister Theresa May and other Commonwealth leaders made a commitment to halve malaria burden across 53 member countries by 2023 in response to the London Malaria Summit.
There was renewed leadership and energy in the fight to end malaria or “Ready to Beat Malaria” and resource commitments - worth over £2.9bn ($4bn) - to catalyse progress towards beating malaria at a time when efforts to end the preventable disease have stalled.

In addition, the Multilateral Initiative on Malaria (MIM) conference in Dakar brought together scientists and researchers from across Africa to share the latest innovations in the fight against the disease.
Specifically, over the next five years, the Wellcome Trust committed more than £100 million to understand the parasite genome, designing more effective vaccines, developing new treatments, insecticides, and diagnostic tests, and tackling the emergence of a "super strain" of resistant malaria in Southeast Asia before it spreads to Africa. 

Zenysis Technologies has a software platform to help governments identify potential malaria outbreaks ahead of time and they committed in-kind technical support worth $6 million to other malaria-endemic countries in Africa and elsewhere.

Also, five crop protection companies, BASF, Bayer, Mitsui Chemicals, Sumitomo Chemical Company & Syngenta, launched ZERO by 40, a joint initiative supported by IVCC and the Bill & Melinda Gates Foundation, to accelerate development of innovative vector control tools and extend their commitments to help eradicate malaria by 2040.

Australia announced an investment of AUS $56.25 million from their Health Security Initiative to support the development of new resistance beating malaria prevention, diagnosis, and treatment tools 2018-22. They also committed up to AUS $700,000 to support the July 2018 Malaria World Congress in Melbourne and finance new Health Security Fellowships for professionals working in the Greater Mekong Sub-Region.

The Kingdom of Eswatini pledged to get rid of malaria by 2020 and to double domestic financing for indoor residual spraying and also committed to mobilize more domestic resources from the private sector.

Ghana agreed to be one of three countries to pilot the new malaria vaccine, RTS, S, and one of the first to introduce next-generation resistance beating insecticides for indoor residual spraying. RTS, S, the first approved malaria vaccine, will be used in the field starting later this year. The Gate Foundation is working with GSK and other partners to find ways to make RTS, S more durable.

Guyana committed to a targeted response, technology transfer and the need to introduce new tools to accelerate their efforts to defeat malaria. Kenya said it would ensure at least 80% of people living in malaria risk areas are using appropriate malaria preventive interventions and that all malaria cases are treated in accordance with the National Malaria Treatment Guidelines. 

While Malawi committed to reduce malaria incidence and deaths by at least 50% by 2022 and to eliminate malaria entirely from the country by 2028.

With all this renewed commitment and my own success am hoping that this generation does end malaria. 

MTN has largely complied with license obligations but some areas lacking

By Esther Nakkazi

The Uganda Communications Commission or UCC has published an evaluation report showing MTN Uganda Ltd’s regulatory compliance since it gained a National Telecommunications Operators license in 1998.

However, the report covers only the past ten years of UCC monitoring the operations of MTN evaluation focused on three broad categories of obligations; the financial, legal and technical.

Whereas MTN has to a large extent complied with most of its license and regulatory obligations, there are a number of outstanding areas of non-compliance which must be addressed before UCC processes its application for renewal of a license, says Godfrey Mutabazi, the UCC executive director in the report.

The report says MTN has largely provided uninterrupted telecommunications services during the course of its license in accordance with the laws of the Republic of Uganda. MTN got its license on April 15, 1998, from the Government of Uganda acting through the Minister of Works, Transport and Communications and UCC granted it an NTO license.

But it is due to expire in October 2018 and in accordance with the provisions of its National Telecommunications Operators (NTO) license, has formally submitted its application for a single term renewal of the license for another ten years.

The report says the evaluation will enable UCC to consider the application for renewal of MTN’s license. The evaluation reveals that MTN has largely been compliant, providing uninterrupted telecommunications services to Ugandans for over 20 years as an NTO.

As at 31st December 2017, MTN Uganda recorded growth in its subscriber base with 239,047 fixed lines and 11,587,207 mobile subscriptions. The client base is serviced by a national radio network of more than 1,637 base stations and it is fibre network that spans 4500 kilometers and a national mobile agency network of 77,144 among others.

Its revenues have also grown to more than UG Shs 1.3 trillion and have been recognized as one of the top taxpayers as well it has participated in various corporate social responsibility drives.

The report says MTN has pretty much complied with its financial obligations, for instance, its payment of the Levy on the Gross Annual Revenue, the initial Bid fee and Initial fee and maintains accounting records with acceptable accounting principles in accordance with the license agreement.

But points out that it has failed to comply with payment of assessed spectrum fees with an outstanding balance of Ushs 27,979,938 and has also failed to pay authorized fees for two invoices amounting to $295 and $3,540.

Throughout the monitoring period, it was observed that MTN which is obliged to interconnect with other licensees, so that users of one operator can communicate and access services with users of another operator, has indeed interconnection agreements with a number of licences like UTL, Airtel, Sure telecom, Simbanet, Afrimax, Africel/Orange and Smile Communications .

However, MTN has failed to meet statutory timelines for interconnections with One solutions Ltd, MTN-Simbanet, Roke Telecom. MTN has submitted that for these ones the obligation is not exclusive to them but UCC says the dual responsibility does not absolve MTN of its interconnection duties with the interconnection seekers.

Furthermore, it is also faulted for charging Ush 3 higher domestic interconnection fees. UCC requires MTN to charge domestic interconnection fees of Shs 112, a fee set in 2012, but MTN unilaterally levies Ushs 115. To this MTN argues that UCC did not have the powers to set interconnection rates by 2012.

UCC also says MTN has failed to report material information about the integrity of billing platforms. Over 360,000 incidents of erroneous billing were reported between June and Oct 2014, by MTN data customers.

However, even if MTN is obliged to report these matters to the regulator, it did not until its integrity questioned. Adamantly, MTN says it was under no obligation to report such incidents to the Regulator and only admitted to ‘multiple bundle loading and system logic failure and reimbursed some affected customers. But UCC maintains that the delay in communication of billing system malfunctions to its client base and to the regulator was negligent of MTN. 

UCC also observed that MTN delays in resolving consumer complaints, citing the last 2 years when it failed to resolve consumer 90% of complaints in 24 hours as the agreed threshold. It only managed to resolve 76.5% of complaints within the stipulated timelines.

It also noted that MTN is non-compliant with regulatory directives and continues to send out unsolicited messages without ‘opt out’ information contrary to UCC directive requiring all operators to stop such messages.

MTN in response argues that it instructed its content provider to ensure that all messages have ‘opt out’ messages. But UCC says MTN only applied this directive to 3rd party content providers and not MTN’s own unsolicited messages.

UCC is still receiving input from the public about the performance of MTN Uganda ahead of its license renewal. A public hearing was held on 26th March 2018 and UCC heard from MTN’s clients.

Ultimately, the regulator says if the decision is made to renew the license, the terms and conditions under which MTN Uganda’s new license will be granted will be different.

One in four blood transfusions transmit malaria in some parts of Africa

By Esther Nakkazi

At least one in four blood bank supplies in some areas of sub-Saharan Africa contain malaria parasites putting a high risk of transfusion-transmitted malaria especially to children with anemia.

Researchers suggest that for malaria to be eliminated, all sources of disease transmission, including the region’s blood banks, need to be addressed.

“Our findings clearly reinforce World Health Organization or WHO recommendations that all transfusion recipients receive preventive malarial treatments,” said Dr. Claudia Daubenberger based at the Swiss Tropical and Public Health Institute.

According to the WHO, 90 percent of all malaria cases are located in sub-Saharan Africa. Transfusion-transmitted malaria (TTM) in this region is estimated at 28%.

The findings were from two research studies presented at the 7th Multilateral Initiative on Malaria (MIM) Pan African Malaria Conference in Dakar, Senegal on 16 April 2018.

The first study, a systematic review, and meta-analysis gathered results from 24 studies including more than 10 studies from Nigeria, Africa’s most populous country to assess malaria prevalence among 22,508 blood donors.

Also, articles from databases and clinical trial registries reporting prevalence studies of malaria parasitemia amongst blood donors in sub-Saharan Africa published between 2000 and 2017 were used.

As well grey literature sources such as the WHO website and published reports of ministries of health websites of countries and reference lists of papers were also screened. Risk of Bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool.

The pooled prevalence of malaria parasitemia found was 23.46 percent. The study showed that without better vigilance, children receiving transfusions to address malaria’s impacts like anemia risk exposure to more malaria-causing parasites.

“Our research is only the first line of inquiry needed to address this risk. Pregnant women and children receive the majority of transfusions in this region,” said Dr. Selali Fiamanya and colleagues from the Worldwide Antimalarial Resistance Network (WWARN).

The technical challenges of diagnosing and removing the Plasmodium parasites from the blood banks require further analysis, but we know already that these findings threaten the next generation—our future, said Dr. Fiamanya.

The second study, focusing on the blood supply of Equatorial Guinea’s capital, Malabo, found much higher levels of latent malaria infection, most of it—more than 89 percent—at a level that commonly used diagnostic technology cannot detect.

Typically, rapid diagnostic tests (RDTs) and thick blood smear microscopy are used to diagnose malaria, but these cannot detect latent malaria infection so low-level or asymptomatic infections can hide reservoirs of parasites that fuel future malaria outbreaks.

The study used a more sensitive diagnostic test—quantitative polymerase chain reaction (qPCR) assays, which are currently too expensive and unsuitable for most field conditions—to examine.

29.5 percent of the 200 blood samples collected in Malabo were contaminated according to the study conducted by Dr. Daubenberger and colleagues at the Swiss Tropical and Public Health Institute, and Dr. Tamy Robaina at the Malabo Blood Bank.

All of the samples thought to be free of the malaria parasite held very low concentrations of the parasites—under 100 parasites per microliter of blood said Dr. Daubenberger.

“With better screening technology and practices in place, blood banks in sub-Saharan Africa can be well placed to serve as a surveillance system, helping to monitor malaria and other transfusion-transmitted infectious diseases,” said Dr. Daubenberger.