STARS Project to access a Continuum of Care enables delivery of healthy babies

By Esther Nakkazi

Twenty-three-year-old Edisa Nanteza is heavily pregnant and beyond the 9 months, she is already at term. She has also had some signs like lower back pain, a bloody vaginal discharge to show that the child is about to pop out.

Nanteza delivered her two older children aged 5 and 3 years at the Traditional Birth Attendant (TBA) and without her ever attending antenatal clinics. But for this third delivery, she is willing to change and deliver from a health facility.

She has learned a lot from the village health worker, Jacent Nakasujja, who aggressively monitors her and she evidently sees mothers with healthy babies in her community that have been born in health facilities.

Nakasujja works with the Grand Challenges Canada funded Stars project as a Community Health worker also called Village Health Team (VHT) in Uganda.

The Stars project on Reproductive, Maternal, New-born and Child health is implemented in Kibaale and Hoima district in midwestern Uganda by Malaria Consortium and is funded by Grand Challenges Canada.

“For the first two deliveries, I lost a lot of blood. The TBA put salt on the umbilical cord of the second baby and it developed a nasty infection,” says Nanteza for the reasons she wants to switch and deliver from a health facility.

What has also jerked Nanteza to go and have this child delivered under the watchful eyes of a skilled health worker are the constant SMS reminders she and her husband Ronald Kyeyune receive on their phones.

As a result of these reminders, she has her ‘delivery bag’ ready to go with all the necessities required for giving birth in case of an emergency.

The SMS are sent out reminding community members about different activities and to remind pregnant women and their husbands about attending antenatal visits. They particularly target men because their response is key in decision making for the health of their families.

Some of Nanteza’s profound fears about delivering from a health facility have been allayed by the VHT. She had a conversation with friends who narrated rude health workers and harrowing tales of survival.

The Malaria Consortium Stars project has trained the midwives and other health workers on how to handle clients at health facilities. “These days they are friendly and disciplined,” Nakasujja assures and that puts Nanteza in warm and caring hands.

Nanteza has also heard from another friend, Jackie Kabaseke, that she got all the services at the health facility with no hassle. “My friend told me when she gave birth the baby was immunized the next day and she spent only two days at the health facility and got discharged,” says Nanteza.

Her friend has only been back to the hospital to treat intense backache pains for which she was given painkillers and to have her bouncing baby immunised.

“During my pregnancy the village health worker visited my home and told me that I have to have four check-ups (antenatal) before birth, deliver in a health facility, maintain good hygiene, sleep under a mosquito net and eat a balanced diet and more so eat green vegetables so I planted them around my home,” says Nanteza’s friend.

She was educated about safety steps during pregnancy like attending at least four antenatal visits at 3, 4,6, 8 months and educated about the importance of antenatal, postnatal care, immunization, prevention of malaria during pregnancy and HIV prevention.

Many women suffer life-altering injuries and die during childbirth or their newborns fail to survive because basic issues that are inexpensive are not adhered to, important information is not passed on and there are no constant reminders or someone to check up on them.

Some luckily give birth without incident but for those who get seriously injured or never come home with their babies the situation can be better with an improved continuum of care from the community to the health facility.

Nanteza has heeded to what she has learned from the VHT who has been aggressively monitoring her and her friend’s good advice - to deliver from a health facility - because there are benefits for both mother and newborn. So this third child will be her first.

It was during one of her routine visits that Nakasujja found Nanteza still at home even though she already had all the labor signs at play. She immediately told her the urgency of going to the health facility with not a minute to waste. The two of them in tow picked up her already packed a delivery bag and traveled the long distance to Nyamarwa Health Centre III.

It is certainly with the VHTs intervention that Nanteza has ended up at the health facility and not the TBA to deliver this third child, says Stella Bakeera-Ssali, the project officer Stars project, Malaria Consortium.

The long line winding with pregnant women waiting to be attended to by Sister Jane Namakula, an enrolled midwife at Nyamarwa Health Centre III had to accommodate Nanteza. But she was lucky, Nakasujja was at her side and explained the urgency of the situation which gave her priority access.

“We have to detain her and monitor her because she is already at term,” says Sister Namakula. “We also can't let her go back home because she lives far away from the health facility and that could be another excuse for not delivering her baby from here,” says Namakula.

As the VHT leaves the health facility she is sure to check on a happy mother with a healthy newborn because she is in well-trained hands of the health worker.

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This Story was facilitated by the STARS project of the Malaria Consortium Uganda

Fellowship boosts Pediatric Hematology-Oncology specialists in East Africa

By Esther Nakkazi

The East African Pediatric Hematology and Oncology Fellowship Training Program at Makerere University College of Health Sciences has graduated its first class of graduates building on the critical mass of pediatric hematology-oncology specialists to independently provide effective, evidence-based pediatric cancer and hematology care in the African setting.

The four physicians who graduated are all pediatricians physicians; Ruth Namazzi, MB ChB, MMed, Barnabas Atwiine, MB ChB, MMed., Fadhil Geriga, MB ChB, MMed. and Dr. Philip Kasirye, MB ChB, MMed. 

“By training physicians through the fellowship program, we are increasing the number of pediatric hematology-oncology specialists who will be practicing in East Africa. This will improve the overall survival for children with cancer and blood diseases in the region," said Dr. David G. Poplack, Director of Global Hematology-Oncology Pediatric Excellence or HOPE and Associate Director of Texas Children’s Cancer and Hematology Centers.

The East Africa Pediatric Hematology and Oncology Fellowship Training Program is part of the comprehensive Global HOPE initiative, which launched in February 2017, a two-year fellowship program. 

“This first class of graduates of the fellowship program represents an exponential increase in the number of pediatric oncologists in East Africa and by extension a huge increase in the number of children diagnosed with cancer who may now receive high-quality treatment and the chance of recovery,” said John Damonti, President of the Bristol-Myers Squibb Foundation. 

“We are proud to support the creation of a sustainable, highly qualified team of oncology and hematology healthcare providers in southern and east Africa, to help change the health outcomes for children,” said Damonti.

In sub-Saharan Africa, about 90% of pediatric patients with cancer die while 80 percent of children with cancer survive in the USA. The most common types of childhood cancers in Africa are blood cancers, including leukemia and lymphoma.

Although most childhood cancers are treatable up until this point, the main reason for the staggering death rate across Africa has been due to an inadequate healthcare infrastructure and a significant lack of expert physicians and other healthcare workers trained to treat children with cancer and blood disorders. 

With the ambitious efforts of Global HOPE to build medical capacity to diagnose and treat pediatric blood disorders and cancer in Africa, the impact is already evident in the higher numbers of children receiving care in Uganda, Botswana and Malawi.

The East Africa Pediatric Hematology and Oncology Fellowship Training Program is the result of cooperation and commitment between some of the most eminent institutions in Africa and on the world-stage in cancer care, medical education, health policy, and pediatric hematology and oncology.

Its a partnership between the Ministry of Health of the Republic of Uganda, Makerere University College of Health Sciences, East African Community, Uganda Cancer Institute, Baylor College of Medicine Children’s Foundation- Uganda, Mulago National Referral Hospital, the Bristol-Myers Squibb Foundation and the Texas Children’s Cancer and Hematology Centers and Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI). 

Atwiine, during his Fellowship, led to the development of a new combination chemotherapy approach to treating children with Burkitt lymphoma in Africa; and championed the widespread use of hydroxyurea to control sickle cell disease in children. He will return to Mbarara to head the children’s cancer service and to initiate a pediatric hematology service.

Geriga conducted research that demonstrated the high incidence of muscle cancers of the face that were previously often misdiagnosed as lymph node cancers. He will spearhead the development of a world-class muscle and kidney cancer care and research program at The East Africa Center of Excellence in Oncology at Uganda Cancer Institute, under the mentorship of world experts from Texas Children’s Hospital.

Kasirye, during his Fellowship, oversaw gigantic improvements in the care of children with Sickle Cell Disease at Mulago and formulation of nationwide guidelines of care for which he received an award of excellence from the Ministry of Health. He was requested to lead the Pediatric Cancer and Blood Diseases program of excellence at Kamuzu Central Hospital in Lilongwe, Malawi before returning to Mulago Hospital.

Namazzi led the upgrading of leukemia and kidney cancer treatment protocols that resulted in major improvements in the survival of children with these cancers. She also served as the Chief Fellow for the last two years. She will focus on research in cancerous and non-cancerous blood diseases and will co-direct the East Africa Pediatric Hematology and Oncology Fellowship.

At the graduation ceremony, Dr. Poplack was awarded an Honorary Doctor of Science, DSc. (Honoris Causa) from Makerere University for his academic contribution in the field of science. Under his leadership for the last 25 years, Texas Children’s Cancer and Hematology Centers established itself as an internationally-recognized leader in the treatment and research of pediatric cancer and blood disorders. 

With a desire to expand care to areas of the world with limited resources, Poplack and his team have worked over the last decade to provide care to children in sub-Saharan Africa. With the inception of Global HOPE, access to care will only continue to increase with this training of pediatric hematology-oncology physicians through the fellowship program.

The Global HOPE was developed to create an innovative pediatric hematology-oncology treatment network in southern and East Africa and will build long-term capacity to treat and dramatically improve the prognosis of thousands of children with cancer and blood disorders.

The initiative will train an estimated 4,800 health care professionals from Botswana, Uganda, Malawi and other African countries, including doctors and nurses specializing in pediatric hematology-oncology and social workers. 

The program estimates that over 5,000 children will receive care in the first five years. Modeled on the work of the Bristol-Myers Squibb Foundation, BIPAI and the Governments of Botswana, Uganda, and Malawi, which created the largest pediatric HIV treatment network in the world, leveraging existing experience, infrastructure, and public/private partnerships created through the initiative. 

Since 2003, the Bristol-Myers Squibb Foundation and BIPAI have trained 52,000 healthcare professionals and currently provide care for nearly 300,000 children with HIV and their families in sub-Saharan Africa, lowering the mortality rate for these children to 1.2 percent. 

The Bristol-Myers Squibb Foundation is committing $50 million over five years to fund the training of healthcare providers as well as clinical infrastructure and operations. BIPAI will raise an additional $50 million for the initiative.

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Uganda's Cipla announces share price for IPO

By Esther Nakkazi

Cipla Quality Chemical Industries Limited (CiplaQCIL), a leading pharmaceutical manufacturing company in sub-Saharan Africa have announced their opening of the Initial Public Offer (IPO) starting Tuesday, August through Friday 24 August 2018 as part of their growth strategy.

CiplaQCIL is a joint venture between India-based Cipla and Uganda's Quality Chemicals Ltd (QCL).

"This will encourage and enable Ugandans to share in our success story after being under private ownership for over 13 years," said Emmanuel Katongole the Executive Chairman of CiplaQCIL. 

The company aims to raise $45 million from its issued shares that are going for 256.5 shillings per share on the Uganda Securities Exchange (USE).

"Interested investors can contact the authorised selling agents and members of the (USE) or visit any branch of Standard Chartered Bank to participate in the CiplaQCIL IPO," said Joseph Kibuuka of Crested Capital, the Lead Sponsoring Stockbroker for the IPO.

"Our long-term vision at CiplaQCIL is to become a center of excellence in the manufacturing of quality and newer medicines that improve the quality of life," said Nevin Bradford the CEO of CiplaQCIL.  

Each of the shareholders will be selling a minority of their stakes to enable sufficient free float and liquidity. Cipla Group, represented through a subsidiary, will retain a majority stake.

The listing has received the relevant approvals required, and the Company will provide further details shortly. Renaissance Capital is acting as the lead transaction advisor and book runner and Crested Capital is the lead sponsoring stockbroker to the listing.

CiplaQCIL is a state-of-the-art pharmaceutical plant based in Kampala, Uganda and focused on the production of high-quality, WHO pre-qualified, life-saving medicines for the Sub-Saharan Africa (SSA) region. 

The Company’s products and pipeline target three major diseases that are widespread in Uganda and SSA and comprise anti- malarials, anti-retrovirals and Hepatitis B and C drugs. 

CiplaQCIL’s relevant products have been pre-qualified by the World Health Organization and approved by regulatory authorities in 19 countries, including Uganda, Kenya, Rwanda, Tanzania, Namibia, Ivory Coast, Zambia, Zimbabwe, Malawi, Namibia, Mozambique, Ghana, Ethiopia, Angola and South Sudan.

Rotavirus vaccine cuts infant diarrhoea deaths by a third in Malawi

Rotavirus vaccination reduced infant diarrhoea deaths by 34% in rural Malawi, a region with high levels of child deaths.

Rotavirus is the most common cause of diarrhoeal disease among infants and young children. Despite improvements in sanitation and case management, rotavirus still caused 215,000 child deaths in 2013, with 121,000 of these in Africa. 

In a study, led by scientists at the University of Liverpool, UCL, Johns Hopkins Bloomberg School of Public Health and partners in Malawi the findings revealed that children who received the rotavirus vaccine had a 34% lower risk of dying from diarrhoea, which is a similar impact to that observed in middle-income countries.

The major new study  provides the first population-level evidence from a low-income country that rotavirus vaccination saves lives.

The findings, published in The Lancet Global Health, add considerable weight to the World Health Organisation's (WHO) recommendation for rotavirus vaccine to be included in all national immunisation programmes.

Professor Nigel Cunliffe from the University of Liverpool’s Centre for Global Vaccine Research, one of the study leads, said: “Rotavirus remains a leading cause of severe diarrhoea and death among infants and young children in many countries in Africa and Asia. Our findings strongly advocate for the incorporation of rotavirus vaccine into the childhood immunisation programmes of countries with high rates of diarrhoea deaths, and support continued use in such countries where a vaccine has been introduced.”

With support from Gavi, the Vaccine Alliance, many countries in Africa with high death rates have added rotavirus vaccine to their routine immunisation programme over the past five years.

To determine the vaccine's impact on infant diarrhoea deaths, researchers carried out a large population-based birth cohort study of 48,672 infants in Malawi, which introduced a monovalent rotavirus vaccine in October 2012.

As low-income African countries often lack birth and death registries – a resource used for similar impact studies in middle-income countries - the investigators and their study team of more than 1,100 people visited the homes of infants in 1,832 villages over the course of four years to collect data, including the infants' vaccination status and whether they survived to age one.

“This is encouraging because children from the sub-Saharan African region account for more than half of global diarrhoea deaths, and with over 30 African countries thus far introducing rotavirus vaccine, the absolute impact on mortality is likely to be substantial,” said one of the report’s lead authors Dr Carina King, a senior research associate at UCL’s Institute for Global Health.

Co-lead author Dr Naor Bar-Zeev, Associate Professor of International Health at the International Vaccine Access Center of the Johns Hopkins Bloomberg School of Public Health, added: "We already knew that rotavirus vaccine reduces hospital admissions and is highly cost-effective in low-income countries with a high burden of diarrhoeal disease, and now we've been able to demonstrate that it saves lives.

“However not all countries are vaccinating against rotavirus yet, including some very populous countries. The key message of this paper is that to do the best for all our children and to help them survive, all countries should introduce rotavirus vaccination."

The researchers also found a direct link between the proportion of the population vaccinated and the reduction in mortality that achieved. Malawi had a strong immunisation programme and was very proactive in planning to introduce rotavirus vaccine, which made it possible to scale up coverage rapidly.

“Within about a year from vaccine introduction, we were able to reach up to 90% of the population. It is vitally important that rotavirus vaccines reach all children, especially the most vulnerable living in poorer settings where the impact of vaccination is greatest,” said one of the authors Dr. Charles Mwansambo, Chief of Health Services for Malawi.

The study received funding support from the Wellcome Trust and GlaxoSmithKline Biologicals.

The REDD+ tool hosted by the Center for International Forestry Research

The innovative REDD+ monitoring tool, International Database on REDD+ Projects and Programs Linking Economic, Carbon and Communities Data (ID-RECCO), is now hosted by the Center for International Forestry Research (CIFOR).

Launched in 2013, ID-RECCO highlights 467 subnational REDD+ initiatives from around the world. It includes 110 variables, such as carbon certification, sources of funding, and expected socio-economic and environmental impacts, in a format that can be used for research purposes and analysis.

ID-RECCO was the first tool to gather such a large amount of information on subnational REDD+ initiatives in a comprehensive way, and it continues to evolve.ID-RECCO is the first comprehensive database on REDD+ projects worldwide. It allows international comparison of very diverse types of projects, in various locations.

“CIFOR is very pleased to host the ID-RECCO database given our priority for understanding the progress and performance of REDD+ on the ground. We are committed to keeping the database updated and ensuring that it stays relevant for the broader tropical forests and climate community, ” says Amy Duchelle, senior scientist at CIFOR.

As Duchelle describes, the next big change to ID-RECCO will allow users to easily distinguish between local REDD+ projects and subnational jurisdictional programs. For REDD+ projects, CIFOR will validate the data through a survey with project implementers that will be conducted in upcoming months.

To expand the database to include subnational jurisdictional REDD+ programs, CIFOR will draw on new collaborative research with Earth Innovation Institute (EII) and the Governors’ Climate and Forests (GCF) Task Force.

ID-RECCO was created by Gabriela Simonet when she was based at the French Agricultural Research Centre for International Development (CIRAD) and Climate Economics Chair (CEC) with the founding partner the International Forestry Resources and Institutions (IFRI).

“ID-RECCO was born in the hands of Gabriela in CIRAD, pushed by her motivation to understand if REDD+ was going to fulfill the on-the-ground socio-economic and ecological impacts that stakeholders were advocating for," says Driss Ezzine-de-Blas, Researcher, CIRAD.

In that sense, it is a ground-breaking initiative and a unique dataset to reach such an understanding. It allows, for example, to extract simple statistics, like the number of hectares covered by REDD+, and understand the trends and types of REDD+ projects and initiatives.

Ezzine-de-Blas also notes that while the data can be used by researchers to match their expectations to the reality of REDD+, other stakeholders will also benefit by taking REDD+ more seriously and will have data-based evidence in hand to continue their work.

"Being frequently updated and open access, it then constitutes a unique tool that makes possible monitoring and impact evaluation of those initiatives, which will provide a better understanding of the conditions of success of REDD+ implementation," says Philippe Delacote, Researcher, Climate Economics chair.

ID-RECCO can be accessed at http://www.reddprojectsdatabase.org/