Katwa town now a hot spot leads to spike in DRC Ebola cases and deaths

By Esther Nakkazi

Katwa, a town in North Kivu province is now the main focus and a hotspot of the Ebola Virus Disease epidemic. In the last 21 days, 86 new confirmed cases were reported in the Democratic Republic of Congo (DRC), of which 49 (57%) were reported in Katwa.

North Kivu of DRC, which is affected by the outbreak of EVD, is among the most populated provinces, with eight million inhabitants. The region has been experiencing intense insecurity and worsening humanitarian crisis.

From the DRC Ministry of Health's Ebola updates Katwa surpassed Beni in terms of the number of cases and deaths. To date, Beni has reported 235 cases (226 confirmed and 9 probable) and 127 deaths while Katwa is 239 cases (228 confirmed and 11 probable) and 182 deaths.

The mortality rate is also higher in Katwa. The mortality rate in Beni is 54% while it is 76% in Katwa.

According to the DRC Ministry of Health, the high mortality rate in Katwa can be explained by the fact that contacts of confirmed cases who refused vaccination and follow-up of contacts are not found until after their death in the community.

Thus, the percentage of community deaths in Katwa is much higher than in other health zones. The high number of community deaths remains a concern as they are an important source of spread of the epidemic.

This situation demonstrates the importance of increasing community engagement and active case finding in the community and health facilities in Katwa, officials from the Ministry said.

Ebola Vaccinations

Since the beginning of vaccination on 8 August 2018, 83,118 people have been vaccinated, including 21,230 in Katwa, 20,593 in Beni, 10,091 in Butembo, 6,109 in Mabalako, 2,746 in Kalunguta, 2,551 in Goma, 2,317 in Komanda, 2,084 in Oicha.

1,813 in Mandima, 1,357 in Karisimbi, 1,325 in Kyondo, 1,283 in Kayina, 1,094 in Bunia, 1,064 in Vuhovi, 920 in Masereka, 772 in Mutwanga, 767 in Biena, 700 in Lubero, 590 in Rutshuru, 583 in Musienene, 527 in Nyankunde, 496 in Mangurujipa, 426 in Rwampara (Ituri), 355 in Tchomia, 333 in Lolwa, 280 in Mambasa, 254 in Alimbongo, 207 in Kirotshe, 141 in Nyiragongo, 97 in Watsa (Haut-Uélé), and 13 in Kisangani.

The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

But as of 20th February 2019, the Strategic Advisory Group of Experts (SAGE) on Immunization has reviewed data on all Ebola candidate vaccines currently undergoing clinical evaluation. There are three candidate vaccines other than the rVSV-ZEBOV-GP vaccine, that are in advanced stages of clinical evaluation or have been licensed.

Two of them are licensed in their country of origin (Ad5-EBOV, monovalent Zaire Makona, licensed in China; and GamEvac-Combi, monovalent Zaire Makona, licensed in Russia). A third vaccine candidate (Ad26.ZEBOV & MVA-BN-Filo, based on a prime/boost strategy using a multivalent, Zaire Mayinga, Sudan, Tai Forest and Marburg,) will be submitted for approval under the United States Food and Drug Administration (US FDA) Animal Rule.

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First ever Africa Protected Areas Congress Launched

This year’s Valentine day was marked on Thursday with special African flavour that saw the launch of the first-ever Africa Protected Areas Congress (APAC) (www.APA-Congress.org) at Nairobi National Park’s historic Ivory Burning Site.

Kenya’s Principal Secretary - State Department of Tourism and Wildlife, Dr. Margaret Mwakima accompanied by Dr.John Waithaka the Congress Director and Mr. Luther Anukur Regional Director, International Union for Conservation of Nature (IUCN), East and Southern Africa presided over the launch.

Dubbed for the love of nature, the APAC 2019 launch sought to position Africa’s protected areas within the goals of economic and community well being as well as seek commitment from African governments to integrate protected areas in the African Union’s agenda 2063 strategic framework for the socio-economic transformation of the entire continent.

“Today we launch the Africa Protected Areas Congress (APAC), the first ever continent-wide gathering of African leaders, citizens, and interest groups to discuss the role of protected areas in conserving nature and promoting sustainable development. 

This landmark forum organized by the World Commission on Protected Areas (WCPA) and the International Union for Conservation of Nature (IUCN) provides us with a platform for holding honest discussions on the future we want for our protected areas and seek solutions to the persistent and emerging problems” said Tourism and Wildlife Principal Secretary, Dr. Margaret Mwakima.

According to the International Union for Conservation of Nature, at the start of the 20th century, there were only a handful of protected areas approximately 200,000 which cover around 14.6% of the world’s land and around 2.8% of the oceans. 

As the world continues to develop, pressure is intensified on the ecosystems and natural resources thus the need to protect them.“We need to come to a common understanding that human beings can live with animals and take care of each other to save biodiversity. As a continent, we can offer resilience, adaptability and tackle climate change to protect our biodiversity,” added Dr. Mwakima.

Protected areas safeguard nature and cultural resources, improve livelihoods and drive sustainable development. We must work together to preserve them. The launch steered awareness and visibility of the upcoming conference to be held on 18th to 23rd November this year. 

The inaugural APAC Journalists’ Award was also launched to provide incentives for African journalists and media houses to be champions of conservation and drive more effort toward reporting on biodiversity in Africa, winners of the inaugural award will be announced, awarded during the November conference, applications are already open for Journalists.

The November congress is expected to attract more than 2,000 delegates who will deliberate on homegrown ways to secure a sustainable future for Africa’s protected areas, people and biodiversity while showcasing homegrown examples of practical, innovative, sustainable and replicable solutions that harmonize conservation and sustainable human development.

The collective efforts from the African leaders are expected to contribute to African Union’s Agenda 2063 of “an integrated, prosperous and peaceful Africa, driven by its own citizens and representing a dynamic force in the international arena”.

Distributed by APO Group on behalf of Africa Protected Areas Congress.

Direct-acting antivirals: confirmation of their short-term clinical efficacy in real life

Press Release

A study published in The Lancet on 11 February 2019 shows that direct-acting antivirals have short-term clinical benefits in the treatment of hepatitis C virus infection. 

These results come from ANRS-funded interdisciplinary research conducted by clinicians, hepatologists, and epidemiologists of the Inserm, Sorbonne University and AP-HP and coordinated by Professors Fabrice Carrat and Stanislas Pol, and Dr. Hélène Fontaine,1 in 9895 patients of the ANRS CO 22 HEPATHER national cohort recruited in 32 centers in France.

The most recent treatments of hepatitis C virus (HCV) infection, the direct-acting antivirals (DAAs), are remarkably effective. Indeed, they eliminate the virus in almost all treated patients (95% in general) in 8 to 12 weeks. 

DAAs were first prescribed in France in 2014. Initially, priority was given to patients with advanced HCV infection, but from January 2017 DAA therapy was extended to all patients with chronic HCV infection.
The virologic efficacy of DAAs is well established, but until now prospective data on their clinical efficacy (ie, their impact on the progression of liver disease associated with HCV infection in real life) were scarce and related to highly selected patients or to patients from retrospective surveys.

An ANRS-funded team of researchers has now compared the clinical progression of HCV infection in patients receiving or not receiving DAA therapy. The researchers monitored clinical progression in "real life" in 9895 HCV-infected patients included between 2012 and 2015 in the ANRS CO22 HEPATHER cohort.

In these 9895 patients, who were followed up for a median period of 33 months2, statistical analysis showed in the 7344 patients who received DAAs before the end of the study that this treatment was associated with reductions in mortality and in the occurrence of hepatocellular carcinoma (liver cancer).

After adjustment for individual factors (age, disease staging, the presence of other diseases, etc.), the patients treated with DAAs showed a 52% reduction in mortality risk and a 33% decrease in the risk of liver cancer compared with patients at a similar disease stage but not treated with DAAs.

"We could have expected these results. It seems logical that the elimination of the virus causing the damage is linked to clinical improvement," said Prof Fabrice Carrat. "Our results show that these benefits are obtained soon after virologic control and the patients are no longer highly selected as in early trials. Our analysis reflects real-world efficacy for all patients."

The prolonged collection of data from these patients cured of an HCV infection will allow the definition of the long-term benefit of DAA therapy and of the modalities needed for medical follow-up (How frequent should liver cancer screening be? How long after the cure? At what cost?). 

One of the difficulties sometimes encountered in this sort of study arises when patients who are cured are lost to follow-up. 

The "linking" of medical data from the patients of ANRS CO22 HEPATHER cohort to the national health data system (SNDS), which was validated by the French Data Protection Authority (CNIL) on 19 July 2018, should help researchers obtain exhaustive information on healthcare consumption by these patients over the long term.

Uganda rescinds Community Health Extension Workers policy

By Esther Nakkazi

After 17 years of engaging Village Health Workers or Teams or VHTs, Uganda was to switch to Community Health Extension Workers or the CHEW strategy by June 2017. The policy for CHEWs was passed on January 14, 2019.

About a month later, the Cabinet decided there was no return on the investment, no financial structure, and no sustainability plan and it would distort equity so the policy was rescinded.

The government was supposed to employ 15,000 CHEWs and pay each one of them Ushs 370,000 per month ($100) as well as offer them regular training but none of these seemed feasible. If they were paid $100 per month they would earn more than the lowest paid health worker and primary school teacher who are paid $60-$90.

The CHEWs were also supposed to be between 18-35 years and with a minimum education (senior 4) and their roles were to be defined by the Ministry of Health leadership but among them was conducting baseline and other important surveys.

They were to be supported by a proper governance structure and not left in isolation. There were other great plans for the CHEWs too - who would 'reorient' the minds of Ugandans towards healthy living, they were to focus on the household as a totality promoting good hygiene, standard health practices like immunization and most of all promote the use of less alcohol which is causing Ugandans numerous health issues.

They would also be strongly monitored, supervised and with detailed accountability and would be under a harmonized structure. The deadline for switching from VHTs to CHEWs was June 2017. It came and passed. But by August 2018, the programme started in 13 districts with the highest disease burden in Uganda. All they awaited was Cabinet approval of the policy.

On January 14th this year the CHEWs policy was passed but of course, as usual even the basic funding was not available and sustainability was an issue. It was rescinded a month later.

Experts suggest the government should instead focus on on-job training, effective supervision and non-monetary incentives for the VHTs. Currently, Uganda has 180,000 VHTs working as volunteers but only 60,000 have been trained.

The profile of the VHTs that I have met in the communities- most of them are community-based, elderly or retired, very popular (they call them 'musawo' - meaning health worker), they are cheerful, ready to work, good mobilizers and seem to enjoy their jobs. I support that they should be trained, supported and appreciated. Let Uganda settle for what it can chew certainly NOT CHEWs at this moment if the funds are not available.

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African Based Centre for relocation of Human Rights Defenders Launched

Press Release:

On 6 February 2019, AfricanDefenders (the Pan-African Human Rights Defenders Network) launched the Ubuntu Hub Cities in Johannesburg, Pretoria, and Cape Town – an Africa based relocation programme for human rights defenders (HRDs).

“In designing the concept of Ubuntu Hub Cities, we wanted to challenge the notion that African HRDs cannot be protected within their own continent,” said Hassan Shire, Chairperson of AfricanDefenders.

The Ubuntu Hub Cities initiative enables African HRDs who have been subject to threats, violence, and extreme pressure, as a consequence of their human rights work, to temporarily relocate and continue their work in a safe working environment, while enriching their experience through professional or educational opportunities

The persistent violations against HRDs across the continent require strategic and immediate actions for effective mitigation and prevention of the risks faced by HRDs. Various national protection mechanisms have been set up to provide effective assistance to HRDs at risk. 

However, when these mechanisms are unable to offer the necessary protection, HRDs can be forced to leave their country due to profound risks to their physical security, liberty, and even life. Relocation is thus a last resort protection measure. 

The Ubuntu Hub Cities initiative aims to enable HRDs to retreat, physically and mentally, and continue their human rights work in a safe environment. It also supports HRDs to safely return to their respective country when it is safe.

From lessons learnt and best practices identified by similar city-based relocation programmes across the world, the Ubuntu Hub Cities initiative is tailored to the needs of African HRDs. By allowing HRDs at risk to relocate closer to home, Ubuntu Hub Cities tackle issues of cultural displacement, stigmatisation, language-barriers, and integration, providing a durable option that combines safety, rest and respite, and opportunities for continued activism.

The Ubuntu Hub Cities launch in South Africa brought together HRDs, civil society organisations (CSOs), academic institutions, and human rights experts to share ideas on how to best shape the Ubuntu Hub Cities in the context of South Africa, chosen for its rich history of civic engagement, and the presence of renowned universities and active CSOs.

“Today marks the culmination of what started in earnest when Hassan Shire, Bra Pitso from the Department of International Relations and Cooperation, and I had a brainstorming session in Geneva a few years ago, and recognised that we already had African hubs hosting HRDs who had escaped persecution, but needed a project that structured, recognised and promoted this reality” said Arnold Tsunga, Chairperson of the Southern Africa Human Rights Defenders Network (SAHRDN). 

“Furthermore, we noted that the Ubuntu value, the African principle that makes people in instinctively want to look after each other in challenging times, was what made these hubs safe for HRDs.” In addition, AfricanDefenders has been relocating HRDs on an ad-hoc basis for several years, holding great expertise on the matter. By officially launching the Ubuntu Hub Cities, ad-hoc efforts will become more systematic in order to ease the relocation process for HRDs at risk.

During the launch, HRDs who had been relocated to South Africa shared their experiences, highlighting the importance of the initiative. “I had to ask myself: do I want to go to prison?” said an HRD, remembering the moment he realised he was at risk because of his work. “My answer was that I did not want to stop my activism, so having access to a relocation mechanism allowed me to be safe, but to continue my activism”.

The importance of integrating adequate psychosocial support mechanisms during the relocation period is an integral part of this, as well as ensuring that the initiative reaches grassroots HRDs beyond the most high profile cases.

To mark the launch, AfricanDefenders and SAHRDN signed a Memorandum of Understanding to guide their collaboration in the implementation of the initiative; Mr. Shire symbolically handed over a key to SAHRDN to open the door to at-risk HRDs in the Ubuntu Hub Cities in South Africa.

On 7 February 2019, the AfricanDefenders delegation and SAHRDN introduced the initiative to a series of stakeholders, including the EU delegation to South Africa and diplomatic missions from Austria, Germany, The Netherlands, Denmark, and Ireland. Moreover, the delegation had an opportunity to exchange with the South African Department of Justice and Constitutional Development for further cooperation.

In the coming days, AfricanDefenders will launch the Ubuntu Hub Cities initiative in Abidjan, Côte d’Ivoire, and Tunis, Tunisia.

On 6 February 2019, AfricanDefenders (the Pan-African Human Rights Defenders Network) launched the Ubuntu Hub Cities in Johannesburg, Pretoria, and Cape Town – an Africa based relocation programme for human rights defenders (HRDs). “In designing the concept of Ubuntu Hub Cities, we wanted to challenge the notion that African HRDs cannot be protected within their own continent,” said Hassan Shire, Chairperson of AfricanDefenders. The Ubuntu Hub Cities initiative enables African HRDs who have been subject to threats, violence and extreme pressure, as a consequence of their human rights work, to temporarily relocate and continue their work in a safe working environment, while enriching their experience through professional or educational opportunities. The persistent violations against HRDs across the continent require strategic and immediate actions for effective mitigation and prevention of the risks faced by HRDs. Various national protection mechanisms have been set up to provide effective assistance to HRDs at risk. However, when these mechanisms are unable to offer the necessary protection, HRDs can be forced to leave their country due to profound risks to their physical security, liberty, and even life. Relocation is thus a last resort protection measure. The Ubuntu Hub Cities initiative aims to enable HRDs to retreat, physically and mentally, and continue their human rights work in a safe environment. It also supports HRDs to safely return to their respective country when it is safe. From lessons learnt and best practices identified by similar city-based relocation programmes across the world, the Ubuntu Hub Cities initiative is tailored to the needs of African HRDs. By allowing HRDs at risk to relocate closer to home, Ubuntu Hub Cities tackle issues of cultural displacement, stigmatisation, language-barriers, and integration, providing a durable option that combines safety, rest and respite, and opportunities for continued activism. The Ubuntu Hub Cities launch in South Africa brought together HRDs, civil society organisations (CSOs), academic institutions, and human rights experts to share ideas on how to best shape the Ubuntu Hub Cities in the context of South Africa, chosen for its rich history of civic engagement, and the presence of renowned universities and active CSOs. “Today marks the culmination of what started in earnest when Hassan Shire, Bra Pitso from the Department of International Relations and Cooperation, and I had a brainstorming session in Geneva a few years ago, and recognised that we already had African hubs hosting HRDs who had escaped persecution, but needed a project that structured, recognised and promoted this reality” said Arnold Tsunga, Chairperson of the Southern Africa Human Rights Defenders Network (SAHRDN). “Furthermore, we noted that the Ubuntu value, the African principle that make people in instinctively want to look after each other in challenging times, was what made these hubs safe for HRDs.” In addition, AfricanDefenders has been relocating HRDs on an ad-hoc basis for several years, holding great expertise on the matter. By officially launching the Ubuntu Hub Cities, ad-hoc efforts will become more systematic in order to ease the relocation process for HRDs at risk. During the launch, HRDs who had been relocated to South Africa shared their experiences, highlighting the importance of the initiative. “I had to ask myself: do I want to go to prison?” said an HRD, remembering the moment he realised he was at risk because of his work. “My answer was that I did not want to stop my activism, so having access to a relocation mechanism allowed me to be safe, but to continue my activism”. The importance of integrating adequate psychosocial support mechanisms during the relocation period is an integral part of this, as well as ensuring that that the initiative reaches grassroots HRDs beyond the most high profile cases. To mark the launch, AfricanDefenders and SAHRDN signed a Memorandum of Understanding to guide their collaboration in the implementation of the initiative; Mr. Shire symbolically handed over a key to SAHRDN to open the door to at-risk HRDs in the Ubuntu Hub Cities in South Africa. On 7 February 2019, the AfricanDefenders delegation and SAHRDN introduced the initiative to a series of stakeholders, including the EU delegation to South Africa and diplomatic missions from Austria, Germany, The Netherlands, Denmark, and Ireland. Moreover, the delegation had an opportunity to exchange with the South African Department of Justice and Constitutional Development for further cooperation. In the coming days, AfricanDefenders will launch the Ubuntu Hub Cities initiative in Abidjan, Côte d’Ivoire, and Tunis, Tunisia. For more information about the Hub Cities initiative, please see www.africandefenders.org.

Ugandan study to facilitate long-term studies on risk factors for Non-Communicable Diseases

By Esther Nakkazi

Uganda could host the first Non-Communicable Diseases (NCD) Centre of Excellence in Africa that will close the knowledge gap of the burden of disease.

Although there is a growing burden of NCDs in sub-Saharan African, there is lack of matched knowledge about how the risk for each individual evolves over their lifespan.

An ongoing project, supported through a Makerere University and Sweden bilateral research collaboration that helped establish the Iganga-Mayuge Health Demographic Surveillance Systems (HDSS) is exploring the feasibility of an NCD population cohort to facilitate long-term studies on risk factors for NCDs in Uganda.

The project is a collaborative research effort between Sweden’s Karolinska Institutet, Makerere College of Health Sciences (MakCHS) and the Makerere University Centre for Health and Population research (MUCHAP)

Dr. Roy Mayega the local principal investigator says the cohort at MUCHAP/Iganga-Mayuge HDSS is the first step of a long term population-based research. It provides for a detailed understanding of the phenotypes related to key NCDs, their relationship to key biomarkers and trends in a context where the prevalence of cardiovascular diseases and diabetes is still relatively low.

Mayega says the project will also provide a platform assessing preventive interventions, early identification of undetected disease, the calibration of risk point-of-care screening and diagnostic tools for use in sub-Saharan Africa.

Dr. Dan Kajungu,  MUCHAP Executive Director says the project is important as quality data paucity remains a key development bottleneck in low and middle-income countries (LMICs) like Uganda and the situation is worse regarding longitudinal data to inform policy effectively.

Available longitudinal studies have been conducted in developed countries and only a few in sub-Saharan Africa because of their complex logistics and requirements of a clear understanding of their feasibility and contextual stability amidst resource constraints.

“Continuity of such project is key,” says Kajungu as the project has already provided the local burden of disease data showing that more deaths are occurring in adult population 15 years and above due to NCDs than the communicable and infectious disease in rural Uganda.

The Makerere project is collecting electrocardiogram (ECG) and spirometry data, in addition to biological samples in form of blood, urine and saliva swab from a consenting population and transferring it to the molecular biology and the biorepository laboratories at MakCHS for analysis.

A system is also in place for continuously registering all births and deaths in the HDSS community. Once a birth or death occurs, community-based scouts report it to HDSS and details of how the death occurred are documented. This verbal autopsy is conducted using the World Health Organisation (WHO) tools to establish the cause of death as determined by a trained physician (medical doctor).

More morbidity or disease data are collected electronically where population cohort members’ health facility data are linked to their household and community data using the HDSS unique identifiers.

The HDSS has the capacity to provide accurate information that facilitates proper allocation of health resources and generate data on different health and health-related problems.

Dr. David Muwanguzi, the Iganga District Health Officer says the Iganga Mayuge HDSS has assisted the district particularly the health department in providing demographic statistics vital for evidence-based planning and budgeting for not only health care but also other services such as education, agriculture among others.

As a result of the project high impact research that influenced policy has been done in the Iganga-Mayuge HDSS platform, for example, the Kangaroo mother care (KMC) in the field of maternal, child and newborn care was piloted in this population cohort, as well as the Integrated Community Case Management (iCCM) for home-based malaria and pneumonia management. Research done here has impacted on low-cost hernia surgery in the study that estimated hernia prevalence and unmet need for surgery, management of diabetes in adults, injury and disability surveillance and support for cerebral palsy in children studies.

“The Iganga-Mayuge HDSS has always sensitized community members on health-related issues and has encouraged people to utilize government programmes like immunization says Ismail Kezaala Ismail, a resident of Kabira village, Kabira parish in Nakigo Sub-county, Iganga District.

Kezaala says the HDSS has benefited the community through free hernia surgery, epileptic drugs to children, wheelchairs for children affected by cerebral palsy, and treatment to children with Tuberculosis.

NCD Research and training for students in a rural setting:

The MUCHAP platform further continues to support research training of graduate students (Masters and PhDs) from Makerere University, and collaborators like Karolinska Institutet of Sweden, John Hopkins School of Public Health and New York University in USA, Hasselt University in Belgium through provision of data for secondary analysis and utilizing the population-based cohort for research and provides mentorship and internship placements to students.

The center hosts the Maternal and Newborn research Working Group for the worldwide network of health and demographic surveillance sites and collaborates with researchers to develop research protocols, implementation, and evidence to facilitate evidence-based planning and budgeting.

Dr. Muwanguzi says the organization brings in partners within Uganda and abroad to conduct research studies and many of them have informed policies and benefited the community members like malaria and pneumonia studies, non-communicable disease epidemiology, hernia surgery, cerebral palsy and epilepsy surveillance among others.

The Centre has the capacity and mechanism of monitoring the global Sustainable Development Goals (SDGs) and universal health coverage (UHC) targets at the subnational level. “This is especially done for indicators that are measured at the individual and household levels as well as those that can be measured at the community level,” says Dr. Kajungu.

The platform has measured various indicators about coverage and uptake of national interventions like the coverage and utilization of immunization and vaccines, mosquito nets for malaria vector control, household income improvement, family planning, and other behavior change interventions at community level.

“This has strengthened the evaluation of burden of disease at the subnational level in that community,” says Edward Galiwango, a project official.

Kajungu says that measuring the progress of SDG and UHC indicators is possible at the subnational level and will complement the national estimates to improve population estimates validity.