Bending the Curve on Child Mortality

By Esther Nakkazi

More children in Uganda, Rwanda and Malawi are living to see their fifth birthdays and get a healthy start to life than ever before. These countries are bending the curve on child mortality leading the way with the fastest decreases in under-5 mortality since 2000.

In Uganda, under-5 mortality has reduced by 6.4% from 148 to 46 deaths per 1,000 live births from 2000 to 2018. On child mortality, Uganda has the 3rd fastest rate of reduction among 54 countries in Africa.

Rwanda has reduced under-5 mortality by 9.1% from 183 deaths per 1,000 live births to only 35 and Malawi by 6.9% from 173 deaths per 1,000 live births to only 50 from 2000 to 2018 according to the Africa regional child health Universal Health Coverage (UHC) new scorecard report by the Tunisian Center for Public Health.

Universal Health Coverage (UHC) Day happens every 12 December and brings attention to the global goal to ensure that all people, everywhere, can get the quality health services they need without facing financial hardship. It is a fundamentally political goal, rooted in the right to health. It is also one of the smartest investments any country can make.

The countries have been able to bend the curves through a combination of interventions including increased breastfeeding, a dramatic scale-up of lifesaving vaccines, sanitation, and hygiene measures, to oral rehydration therapy and zinc, as well as new innovations like kangaroo mother care.

As more countries in the region work toward or achieve universal health coverage, this progress in child health will continue, says the report.

However, more than a quarter-million children are still consistently being missed with lifesaving interventions and new challenges like obesity, combined with ongoing poor vaccination coverage, are threatening to overwhelm already fragile health systems. 

Immunization in Uganda: 

Immunization saves 2-3 million lives globally each year from completely preventable diseases, such as measles, tetanus, and polio. Vaccines are safe. Vaccines work. However, nearly one in five infants miss out on the basic vaccines they need to stay healthy and keep their communities safe and over 1.5 million children around the world die each year from vaccine-preventable diseases.

In Uganda, 253,633 children are still missing out on life-saving vaccines. To bridge the gap in vaccination, it is important to target the poorest and most marginalized communities, the report recommends.

Uganda has a multi-year plan for immunization and a standing technical advisory group on immunization as well as a national system to monitor adverse events following immunization.

In 2018, 84% of districts had 80% or more coverage for the DTP3 vaccine. 57% of districts had 80% or more coverage for the MCV1 vaccine.

Uganda has every vaccine recommended by the WHO in its national immunization program, besides the measles second dose vaccine. No case of wild poliovirus has been recorded since 2010 but difficulty reaching marginalized communities and increased vaccine hesitancy have contributed to multiple measles outbreaks in Uganda and make vaccination campaigns challenging.

In October 2019, Uganda launched the measles and rubella vaccination campaign with the goal of immunizing over 18 million children under 15 (approximately 43% of the population). This campaign was a launchpad for introducing the measles-rubella vaccine into the national immunization program.

Uganda has seen multiple measles outbreaks and has taken steps to respond including by organizing the measles and rubella vaccination campaign in 2019.

Uganda launched a nationwide HPV vaccine rollout in 2015 for girls age 10 protecting millions from cervical cancer and other diseases. At present 3.6% of women in Uganda have HPV type 16 or 18, which cause over 70% of cervical cancers and pre-cancerous cervical lesions.

Annually, 54.8 per 100,000 women get cervical cancer, the first leading cause of female cancer in Uganda.

Vaccines Funding: 

Gavi has invested over US$400 million into vaccination in Uganda ensuring funds remain in place to cover the cost of vaccines is key to maintain progress on child survival. 38% of funding for routine immunizations is provided by the government.

For every US$1 spent on immunization, US$21 are saved in healthcare costs, lost wages and lost productivity due to illness. If we take into account the broader benefits of people living longer, healthier lives, the return on investment rises to US$54 per US$1 spent.

However, there are increased vaccine hesitancy, misinformation, and mistrust although progress in how vaccines are stored has helped increase access in the hardest to reach communities.

But countries have a duty to keep vaccines cold and safe until they reach children, countries must invest in their health systems to maintain progress on vaccine coverage and make sure no children fall through the cracks.

Child Obesity in Uganda:

10 percent of school-aged children are overweight and obese, putting them at a lifelong risk of serious health complications. On child obesity, Uganda has the 3rd lowest rate among 54 countries in Africa.

Over 41 million infants and young children are overweight or obese around the world, and in the African region, the number of overweight or obese children has more than doubled since 1990. Childhood obesity is a global epidemic.

Obese children are more likely to continue to be obese through to adulthood, putting them at a lifelong risk of serious health complications and illnesses like diabetes and heart disease.

In addition to immunization, a child’s health and life prospects hinge on nutrition. While nearly half of deaths in children under five are due to poor nutrition, developing countries face a rapidly growing epidemic of childhood obesity. Undernutrition and overnutrition can exist at the same time in the same community.

Breastfeeding in Uganda:

Breastfeeding is crucial for child development and reduces child mortality by protecting against disease. It is the best source of nourishment for infants and young children and has health benefits that extend into adulthood.

In Uganda, 66 percent of infants receive breastmilk within 1 hour of birth, which is crucial to protect against disease. On early initiation of breastfeeding, Uganda has the 10th highest rate among 54 countries in Africa.

However, gobally only 40% of infants under six months of age are exclusively breastfed. Initiation of breastfeeding within the first hour of life, exclusive on-demand breastfeeding for the first six months and then breastfeeding alongside appropriate foods for two years are all crucial for child development.

Health Care professionals:

Uganda has 0.4 health professionals per 1,000 people, compared to WHO’s recommended minimum of 4.45 per 1,000 people to meet the SDGs by 2030. Uganda must fill this gap and invest in its health workforce.

By strengthening its health system and addressing vaccine-preventable diseases, child obesity, breastfeeding, health workforce shortages and more, Uganda can make great strides toward UHC.

Sources and additional data can be found here: http://bit.ly/2D0n0sw

Sources and additional data can be found here: http://bit.ly/34Cyxdz

PrEP Uganda App launched for HIV prevention and management

By Esther Nakkazi

A user-friendly app used to access information about HIV prevention and a daily pill that can prevent HIV has been developed. The Pre Exposure Prophylaxis (PrEP) app called 'PrEP Uganda' assessed on smartphones was initiated by Charles Brown the executive director Preventive Care International (PCI).

PrEP is a daily pill taken by someone who is HIV negative (Uninfected) before they are exposed to HIV. The PrEP Uganda app will be used for adherence and retention and it has a feature that allows the user to get all information about PrEP including - the nearest sites offering PrEP within that location.

It is also mainly targeted for people who are stigmatized, key populations and meant to empower young people to champion the end of new HIV infections through the PrEP Uganda mobile app.

"For any medication to be effective, the person taking it must adhere well. This mobile app enables a person taking PrEP to set reminders for daily swallowing of the pill. A person can also set a reminder to pick drug refills," Brown told journalists attending a media science cafe organized by the Health Journalists Network in Uganda (HEJNU) held on 26th November.

The mobile app that can be assessed for free through the google app store (play store) for all Android users has an interactive session that allows the user to ask questions about PrEP and HIV prevention and get answers from an expert. The version for IOS (iPhone) users is being developed.

Uganda has made great progress towards ending HIV and achieving the 95,95,95 targets but infections among key and priority populations are still high averaging 2 to 4 times the national prevalence.

As high as 570 new infections per week happen among adolescent girls and young women (AGYW) in Uganda. Prompted by the findings from the studies and WHO recommendations, Uganda
adopted PrEP as an additional strategy for HIV prevention.

Roll out of PrEP started in July 2017 and to date over ninety (90) facilities are implementing PrEP across the country. Over 16,000 individuals at substantial risk of acquiring HIV have been enrolled on PrEP including discordant couples, Sex workers, Men who have Sex with Men (MSM) and People who use drugs (PWUD), Transgender, Fisherfolks, adolescent girls and young women (AGYW) among others.

Despite reaching several clients with PrEP, the program has experienced a number of challenges including myths and misconceptions, the stigma associated with the use of ARVs among others. These can be addressed through user-friendly technologies like mobile Apps that someone can use to access information.

"As we celebrate World Aids day, we need to make all options for HIV prevention available to everyone to choose what is preferred. We need to create safe spaces for adolescent girls and young women to freely access HIV prevention and reproductive health services. We need to involve AGYW, Key and Priority populations in planning and delivery of services," said Brown.

"Together with duty bearers we need to focus on eliminating all forms of stigma towards people living with HIV and support them to adhere and achieve viral load suppression. Science has proven that when people living with HIV achieve viral load suppression to an undetectable level they can not pass on the virus to other people (Undetectable = Untransmittable). A combination of these interventions while not living anyone behind will enable us to achieve epidemic control," Brown told HEJNU journalists.

In Uganda, an estimated 1.3 million people are living with HIV and 52,000 people become newly infected with the virus annually. According to the National HIV and AIDS Strategic Plan (NSP), 2015/16 – 2019/20, the prevalence of HIV has a geographical heterogeneity with urban residents being more affected. The prevalence of HIV differs among the different subcategories with key and priority populations being affected more than the general population.

Invest in Vaccine Preventable Diseases Surveillance or endure $22.4 billion economic burden - WHO warns Africa

By Esther Nakkazi

The World Health Organisation (WHO) has launched an Investment Case for Vaccine-Preventable Diseases Surveillance in the African Region 2020-2030.

It encourages countries to invest in disease surveillance efforts – including a US$22.4 billion economic burden over the next decade and sets forth an ambitious vision for Vaccine-preventable disease (VPD) surveillance in the African region by 2030.

The announcement was made at the high-level “Reaching the Last Mile Forum” in Abu Dhabi on 19 November, by Dr. Matshidiso Moeti, WHO Regional Director for Africa. She called on governments to invest in strong disease surveillance systems that will ensure early detection and response to risks and outbreaks.

“Strong surveillance is the backbone of a functioning health information system, empowering health workers with timely, quality evidence to inform decision-making. To curb the spread of life-threatening diseases, governments must invest in strong and functioning surveillance systems,” said Dr. Moeti. 

With the African Region on the brink of polio eradication, VPD surveillance remains an issue yet to be prioritized by many health leaders. The burden of VPDs and associated outbreaks remain a major threat to people across Africa.

“Despite extraordinary progress boosting vaccine coverage around the world in the past two decades, one and a half million people are still dying from vaccine-preventable diseases every year,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.

The Investment Case further indicates that if current disease surveillance efforts are not maintained, there is a risk to reverse progress made, leading to more than 900,000 deaths. 

 More investment in surveillance: 

The WHO Investment Case outlines the need for increased domestic investment for surveillance activities under the overall umbrella of integrated disease surveillance and response, from countries in the African Region as well as mobilization of international resources, in order to ensure strong disease surveillance. 

At least $470 million in operating costs will be needed over the next decade to reach this ambition. WHO predicts that the investment would save over 700,000 lives, prevent 20 million people from falling ill due to vaccine-preventable diseases, and save US$21 billion over 10 years – estimated to be a 44.6-fold return on investment.

It is notable that resources for VPD surveillance have declined markedly over the past two years – and domestic surveillance expenditure in the African Region remains low. 

“The fact that most countries in the African Region continue to rely on external funding for VPD surveillance is a strong indicator of the work that remains to be done,” said Dr. Richard Mihigo, Programme Manager for Immunization and Vaccine Development at the WHO Regional Office for Africa. “Governments have a central role to play to fill upcoming funding gaps and ensure immunization programs and surveillance remain strong and vigilant.”

A private sector firm has already pledged $5 million over the next five years, beginning in 2020, to support and strengthen VPD surveillance efforts in the African Region. 

“We hope that this first pledge in support of the VPD surveillance investment case will be catalytic, and will encourage other traditional and non-traditional donors to consider this critical area of work, including how the private sector and governments can work closely together to ensure we successfully bridge funding gaps,” said Elizabeth Ivanovich, Director of Global Health at the UN Foundation.

Dr. Rebecca Martin, Director of the Center for Global Health, CDC, issued a statement of support, adding: "CDC is strongly committed to global health security, helping to strengthen health systems that can prevent avoidable epidemics, detect threats early, and respond rapidly to outbreaks."

At the African Union Summit held in Addis Ababa in January 2017, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledged increased political and financial investments in their immunization programs. 

Commitment 5 of the ADI outlines the need for “attaining and maintaining high-quality surveillance for targeted vaccine-preventable diseases.” Although the Member States have endorsed these commitments and pledged to deliver on universal immunization coverage and high-quality surveillance, challenges remain in achieving immunization and surveillance targets.

Still at the African Union Summit held in Addis Ababa, African Heads of State endorsed the Addis Declaration on Immunization (ADI), pledging to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization.

“Our biggest challenge in reducing the horrific toll these diseases still cause is finding the children who are still missing out on vaccines. That’s why improved vaccine-preventable disease surveillance systems are so important, helping health authorities to identify the areas where immunization coverage is weakest and protect those children who are currently being left behind,” said Dr. Berkley.

Vaccine-preventable disease surveillance is a critical component of the integrated disease control strategies and an effective way to detect and respond early to outbreaks – mitigating their impact on national security, the local economy and public health systems. Yet countries in the African Region still face major challenges in both the strategic planning and operation of their surveillance systems.

  

“VPD surveillance is not only a valuable investment that will help countries reach immunization targets,” said Dr. Moeti, “it is a critical component of broader goals such as Universal Health Coverage and the Sustainable Development Goals, and is absolutely essential to protecting all of our health security.”

Ethiopia adopts open access policy

By Esther Nakkazi

Ethiopia has adopted a national policy that mandates all universities and research institutes that receive public funding to make open access. This is expected to transform research and education in Ethiopia’s higher institutions of learning.

Open access builds a knowledge community and allows researchers and research institutions that cannot afford subscription fees to access scientific journals.

The Ministry of Science and Higher Education of Ethiopia (MOSHE) adopted the new national open access policy in September this year and it came into effect immediately.

“Our universities and libraries will have to adapt quickly to comply with the new policy. Each university will have to develop an open access policy to suit its own institutional context, and which is also aligned with the national policy,” blogged Dr. Solomon Mekonnen Tekle, a librarian at Addis Ababa University Library, and EIFL Open Access Coordinator in Ethiopia.

Ethiopia an Electronic Information for Libraries (EIFL) partner country also will benefit from the new agreement ( signed 28 October 2019) signed between EIFL with the academic publisher De Gruyter valid until December 2021, which covers open access publishing and free and discounted access to its (De Gruyter) ’s content.

De Gruyter offers authors from EIFL partner countries the option of publishing their articles in open access for free or at discounted Article Processing Charges (APCs) in its over 440 fully open access and hybrid journals.

Other EIFL countries include Cambodia, Congo, Ethiopia, Georgia, Ghana, Ivory Coast, Kenya, Kosovo, Kyrgyzstan, Laos, Lesotho, Malawi, Maldives, Moldova, Myanmar, Nepal, North Macedonia, Palestine, Senegal, Sudan, Tanzania, Uganda, Ukraine, Uzbekistan, Zambia, Zimbabwe.

Ethiopia’s new national open access policy requires that all published articles, theses, dissertations and data from research conducted by staff and students at the 47 universities that are publicly funded through the MOSHE be open access.

Dr. Tekle says the new open access policy will improve the quality of researchers' work as they will easily critique each other work and it will increase the visibility of Ethiopian research, within the national and international research communities - creating equity, minimizing duplication, thereby saving costs, time and effort.

“There is a strong capacity-building component to the project to train repository managers and administrators to manage their new institutional repositories and open access journals,” said Dr. Tekle.

The policy encourages open science practices including ‘openness’ as one of the criteria for assessment and evaluation of research proposals as such researchers who receive public funding must submit their data management plans to research offices and to university libraries for approval and confirm that the data will be handled according to international FAIR data principles. (FAIR data are data that meet standards of Findability, Accessibility, Interoperability, and Reusability.)

However, two months after it came into effect only three universities - Hawassa, Jimma and Arba Minch universities of the 47 universities under MOSHE have adopted the open access policy but more will comply.

Tekle says at some point the academic community was opposed to open access fearing plagiarism. However, now, ‘researchers and students come to my office in the library and ask for their research to be published in open access so that others, like potential employers, for example, can find and read it’.

However, even if Ethiopia universities have made this move there are concerns over Appointments and Promotions Committees in African universities discriminating against Open Access journal articles which are also perceived and rated lower and given fewer scores.

To date, 46 higher education institutions have signed onto the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities which came into effect in 2003 and is regarded as the milestone of open access movement.

The first African higher education institutions to sign onto it was Stellenbosch University in 2010 but more than 400 institutions worldwide have signed it. It was initiated by the Max Planck Society of Germany, promotes unrestricted access to scientific knowledge and cultural heritage.

A study done in all eight Tanzanian health sciences universities that investigated the faculty's awareness, attitudes and use of open access, and the role of information professionals in supporting open access scholarly communication found that most faculty members were aware of OA issues but did not necessarily translate into actual dissemination of faculty's research outputs through OA web avenues.

The study published in 2013 and entitled ‘Open access behaviours and perceptions of health sciences faculty and roles of information professionals’ found that senior faculty with proficient technical skills were more likely to use open access than junior faculty and the major barriers to OA usage were related to ICT infrastructure, awareness, skills, author-pay model, and copyright and plagiarism concerns.

The study leads author Dr. Edda Tandi Lwoga the directorate of Library Services, Muhimbili University of Health and Allied Health Sciences said most academics used open access venues for accessing scientific works that are freely available on the web more than publishing their own research outputs.

Dr. Williams Nwagwu teaches Informetrics and other quantitative applications in Information Science at the Africa Regional Centre for Information Science (ARCIS), University of Ibadan, Nigeria said university administrators may want to increase the status and visibility of their universities through increase of senior scholars, most of whom achieve this status publishing in low-status open access journals.

Dr. Nwagwu says Africa should not look at the number of journals doing open access or quantity of papers available to address open access - which encompasses many other issues, apart from numbers.

“I acknowledge existing efforts, but there is a need for leadership, consensus building, policymaker engagement etc,” he says.

About the perceived link between 'low status' and open access, Neil Pakenham-Walsh the coordinator Healthcare Information For all (HIFA) Project said this can only be said for predatory journals, but the latter can be regarded an aberration and unrepresentative.

Pakenham-Walsh explained that it is fairly straightforward to identify high-quality open-access journals, and there is no logical reason why they should be trusted any less than subscription-based journals because editorial quality does not depend on whether a journal is restricted-access or open-access.

He argued that if academic institutions have the vision of creating and disseminating knowledge, and if the quality of content is not dependent on restricted versus open, then one might expect academic institutions to actively support open access journals rather than discriminate against them.

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Alarming record breaking temperatures observed over four months globally

By Esther Nakkazi

The Global average temperatures for September 2019 was about 0.57°C degrees above average and

at par with September 2016, making it the fourth month in a row to be close to or breaking a temperature record according to the Copernicus Climate Change Service (C3S), a European Commission’s flagship Earth observation program.

The difference in the average temperatures for September 2019 and September 2016 is very small, according to the C3S data, only 0.02°C. It is smaller than the typical difference between the values provided by the global temperature datasets of various institutions, both months share the top spot together.

"September 2019 being on-par with record temperatures now acts as a reminder of the long-term warming trend that can be observed on a global level. With continued greenhouse gas emissions and the resulting impact on global temperatures, records will continue to be broken in the future,” said Jean-Noël Thépaut, Director of Copernicus ECMWF.

This is close to 1.2°C above the pre-industrial level as defined by the Intergovernmental Panel on Climate Change (IPCC) and about as warm as September 2016 (0.02°C warmer), the previous warmest September in this data record, he said.

June 2019, was the warmest on record and July the warmest month ever recorded while August 2019 settling for the second warmest August in a thirty-year climatological reference period of 1981-2010.

Regions with most markedly above-average temperatures include central and eastern USA, the Mongolian plateau and parts of the Arctic. In Europe, temperatures were above average over most of the continent, especially in the south and south-east.

The Copernicus Climate Change Service (C3S) is implemented by the European Centre for Medium-Range Weather Forecasts (ECMWF) on behalf of the European Union. ECMWF also implements the Copernicus Atmosphere Monitoring Service (CAMS). ECMWF is an independent intergovernmental organization, producing and disseminating numerical weather predictions to its 34 Member and the Co-operating States.

The Copernicus Climate Change Service (C3S), Monthly Climate Summaries from the Copernicus Climate Change Service (C3S) routinely publishes monthly climate bulletins reporting on the changes observed on the global surface air temperature, sea ice, and hydrological variables. All the reported findings are based on computer-generated analyses using billions of measurements from satellites, ships, aircraft and weather stations around the world.

More information about climate variables in September and climate updates of previous months as well as high-resolution graphics can be downloaded here: https://climate.copernicus.eu/climate-bulletins

Surface air temperature anomaly for September 2019 relative to the September average for the period 1981-2010. Data source: ERA5. Credit: ECMWF-Copernicus Climate Change Service (C3S)

Technology eliminates cold storage for Chikungunya vaccine

By Esther Nakkazi

Most of the vaccines we use require cold chain storage to preserve them. Now a new type of vaccine technology that does not require this for the mosquito-borne virus Chikungunya vaccine has been developed says a press release from the University of Bristol. 

The vaccine can be stored at warmer temperatures, removing the need for refrigeration, has been developed for mosquito-borne virus Chikungunya. 

The findings, published in Science Advances, reveal exceptionally promising results for the Chikungunya vaccine candidate, which has been engineered using a synthetic protein scaffold that could revolutionize the way vaccines are designed, produced and stored.

Chikungunya, a virus transmitted by the bite of an infected mosquito causes crippling headache, vomiting, swelling of limbs and can lead to death. Even if a fever ends abruptly, chronic symptoms such as intense joint pain, insomnia, and extreme prostration remain. 

Formerly confined to sub-Saharan Africa, Chikungunya has recently spread worldwide as its mosquito host leaves its natural habitat due to deforestation and climate change, with recent outbreaks in the USA and Europe causing alarm.

Researchers from the University of Bristol and the French National Centre for Scientific Research (CNRS) in Grenoble, France, teamed up with computer technology giant Oracle to find a way to make vaccines that are thermostable (able to withstand warm temperatures), can be designed quickly and are easily produced.

“We were working with a protein that forms a multimeric particle resembling a virus but is completely safe because it has no genetic material inside, said Pascal Fender, an expert virologist at CNRS. 

“Completely by chance, we discovered that this particle was incredibly stable even after months, without refrigeration.”

“This particle has a very flexible, exposed surface that can be easily engineered, added Imre Berger, Director of the Max Planck-Bristol Centre for Minimal Biology in Bristol. “We figured that we could insert small, harmless bits of Chikungunya to generate a virus-like mimic we could potentially use as a vaccine.”

To validate their design, the scientists employed cryo-electron microscopy, a powerful new technique recently installed in Bristol’s state-of-the-art microscopy facility headed by Christiane Schaffitzel, co-author of the study. Cryo-EM yields very large data sets from which the structure of a sample can be determined at near-atomic resolution, requiring massive parallel computing.

Enabled by Oracle’s high-performance cloud infrastructure, the team developed a novel computational approach to create an accurate digital model of the synthetic vaccine. University of Bristol IT specialists Christopher Woods and Matt Williams, together with colleagues at Oracle, implemented software packages seamlessly on the cloud in this pioneering effort.

Christopher explained: “We were able to process the large data sets obtained by the microscope on the cloud in a fraction of the time and at a much lower cost than previously thought possible.”

“ Going forward, technologies like machine learning and cloud computing will play a significant part in the scientific world, and we are delighted we could help the researchers with this important discovery,” added Phil Bates, leading cloud architect at Oracle.

The particles the scientists designed yielded exceptionally promising results in animal studies, soundly setting the stage for a future vaccine to combat Chikungunya disease.

“We were thoroughly delighted,” continued Imre Berger. “Viruses are waiting to strike, and we need to have the tools ready to tackle this global threat. Our vaccine candidate is easy to manufacture, extremely stable and elicits a powerful immune response. It can be stored and transported without refrigeration to countries and patients where it is most needed. Intriguingly, we can now rapidly engineer similar vaccines to combat many other infectious diseases just as well.”

“It really ticks a lot of boxes,” concluded Fred Garzoni, founder of Imophoron Ltd, a Bristol biotech start-up developing new vaccines derived from the present work. “Many challenges in the industry require innovative solutions, to bring powerful new vaccines to patients. Matching cutting-edge synthetic biology with cloud computing turned out to be a winner.”

Paper

‘Synthetic self-assembling ADDomer platform for highly efficient vaccination by genetically-encoded multi-epitope display’ byVragniau et al in Science Advances

Traditional healers super-spreaders of Ebola in DR Congo

By Esther Nakkazi

A 39-year-old woman, a traditional healer, who died in the Salama Health Area in the Madidi district is the new validated case for Ebola Virus Disease in the Democratic Republic of Congo (DRC).

The woman’s death would have been treated like any other but she is a traditional healer and the DRC Ministry of Health has observed the role they play in the transmission of Ebola.

“Traditional health practitioners play a key role in the transmission of the Ebola. Their transmission is by nosocomial infection,”observed the Ministry of health, DRC in a statement it issued in December 2018.

Nosocomial infection is an infection that is acquired in a hospital or other healthcare facility and is spread to the susceptible patient in the clinical setting by various means. The DRC ministry of health officials said a parallel consequence of these nosocomial infections is the contamination of a large number of healthcare providers.

Traditional healers are well-known, widely respected and they remain the health providers of choice in their communities. As such, they remain the first point of contact for some Ebola patients before they consider crossing over to a hospital or health care clinic.

Being a traditional healer, this woman had 45 contacts around her, 3 of whom confirmed positive for Ebola - her husband, mother and son, all admitted to Komanda Ebola Treatment Centre or Centres de Traitement d’Ebola (CTE).

But before that even as a confirmed Ebola case this woman and her family refused to go to a CTE and preferred to self-medicate herself until she had advanced symptoms of Ebola. She was later rushed and hospitalised at the Saint-Pierre Medical Center.

At the Saint-Pierre Medical Center, her case was confirmed and referred to a CTE. Health workers tried to persuade her and her family to go to the ETC but her family outrightly refused.

“The patient was brought home by her family on September 6, where she died at around 10 pm. Oral sampling and dignified and secure burial did not occur by refusal of his family,” said a report from the Ministry of Health, DRC.

Since the beginning of the epidemic, the cumulative number of cases is 3,168, of which 3,057 are confirmed and 111 are probable. In total, there were 2.118 deaths (2007 confirmed and 111 probable) and 975 people healed.

Since vaccination began on August 8, 2018, 227,230 people have been vaccinated. On 25th September 2019, an emergency vaccination was launched in Kisansha. During the 9 days 825,000 children from 6 to 59 months in 24 health zones in the provinces of Equator, Mongala, Kwilu, Kwango, Mai-Ndombe and Kasai Oriental would be immunized.

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Kenya starts Malaria vaccine trial

Kenya has launched the world’s first malaria vaccine today in Homa Bay County, western Kenya.

The malaria vaccine pilot programme is now fully underway in Africa, as Kenya joins Ghana and Malawi to introduce the landmark vaccine as a tool against a disease that continues to affect millions of children in Africa, says the World Health Organisation.

The vaccine, known as RTS,S, will be available to children from 6 months of age in selected areas of the country in a phased pilot introduction. It is the first and only vaccine to significantly reduce malaria in children, including life-threatening malaria.

Malaria claims the life of one child every two minutes. The disease is a leading killer of children younger than 5 years in Kenya.

“Africa has witnessed a recent surge in the number of malaria cases and deaths. This threatens the gains in the fight against malaria made in the past two decades,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

“The ongoing pilots will provide the key information and data to inform a WHO policy on the broader use of the vaccine in sub-Saharan Africa. If introduced widely, the vaccine has the potential to save tens of thousands of lives.”

First vaccination: a day to celebrate

Distinguished health officials, community leaders and health advocates gathered in Homa Bay County – one of eight counties in Kenya where the vaccine will be introduced in selected areas – to mark this historic moment with declarations of support for the promising new malaria prevention tool and to demonstrate a ceremonial first vaccination of a 6-month-old child.

“Vaccines are powerful tools that effectively reach and better protect the health of children who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes. This is a day to celebrate as we begin to learn more about what this vaccine can do to change the trajectory of malaria through childhood vaccination,” said Dr. Rudi Eggers the WHO Representative to Kenya.

Thirty years in the making, the vaccine is a complementary malaria control tool – to be added to the core package of WHO-recommended measures for malaria prevention, including the routine use of insecticide-treated bed nets, indoor spraying with insecticides and timely access to malaria testing and treatment.

Malaria vaccine implementation in Kenya

The Ministry of Health, through the National Vaccines and Immunization Programme, is leading the phased vaccine introduction in areas of high malaria transmission, where the vaccine can have the greatest impact.

The aim is to vaccinate about 120 000 children per year in Kenya across the selected introduction areas, including Homa Bay, Kisumu, Migori, Siaya, Busia, Bungoma, Vihiga and Kakamega counties.

Within the eight counties, some sub-counties will introduce the vaccine into immunization schedules while others are expected to introduce the vaccine later.

Study says fetching water increases risk of childhood death

By Esther Nakkazi

Growing up in the city I did not fetch water but for the few times that I visited my lovely grandma (R.I.P Margaret Njakasi) I had to participate in the activity. It was very much for the younger children and maybe one adult who would carry a big (20 litres) jerrycan.

I loved the experience because it was time to play. The water source was downhill. We went in a group of about 6 from my grandma’s house and we would run all the way. We would quickly line up our water containers and run uphill in a queue and slide down sometimes soiling our clothes while some children did it on bare bottoms.

The time we had to spend depended on how enjoyable the ‘sliding’ was and pretty much of the time it was epic - the shouting when you were sliding to the bottom and the cheers plus the climb to go back up and come through again.

Now new research from the University of East Anglia in the UK says water fetching is associated with poor health outcomes for women and children and a higher risk of death.

Adults collecting water is associated with increased risk of childhood death, and children collecting water is associated with increased risk of diarrheal disease, says the study.

The study entitled ‘The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries’ is published in the International Journal of Hygiene and Environmental Health on Tuesday, September 7, 2019.

The study links women collecting water to maternal health saying if a woman has to collect water chances of giving birth in a health care facility are reduced. The study found that women or girls who have to collect water have reduced uptake of antenatal care and increased odds of leaving young children under five alone for an hour or more.

Researchers studied health outcomes including the risk of child deaths, diarrhoea in children under five, low child weight and height, the number of women giving birth in a health care facility, the uptake of antenatal care and whether young children were being left alone for long periods.

Prof Paul Hunter, from UEA’s Norwich Medical School, the Principal Investigator said not much has been known about the health outcomes of fetching water. “We wanted to find out more about the health implications of fetching water, as well as the outcomes of using unsafe water supplies, inadequate access to improved sanitation – particularly in relation to the health of women and children,” he said.

The research, which involved more than 2.7 million people in 41 countries, is the first to analyse the relationships between water carriage, access to clean drinking water, sanitation and maternal and child health using the UNICEF multiple indicator cluster survey data.

Prof Hunter and his co-investigator Dr Jo Geere, from UEA’s School of Health Sciences, studied data from more than 2.7 million people in 41 low to middle-income countries, looking for associations between access to drinking water, sanitation and health.

Besides women who fetch water’s reduced chances of giving birth in a health care facility, they also have a low uptake of antenatal care and because they have to go to the water source they leave their children under five alone at home for over an hour or go with them. If they are left at home alone unsupervised the children get in trouble.

For the time it takes to walk to a water source, queue up, collect the water and return. Unsupervised children are likely to be at more risk of death from accidental injury or simply from reduced parental care when it is needed – for example during illness or when they are very young, said Dr. Jo Geere, a co-investigator to the study.

“Alternatively, if mothers take their young child with them to collect water, the route may be unsafe due to extreme environmental conditions, hazardous traffic, or interpersonal violence.

“Fetching water may also exacerbate under-nutrition which may inturn impact pregnancies and breastfeeding – increasing the risk of child mortality. And many of the studies we looked at reported fatigue and tiredness affecting water carriers,” said Dr. Geere.

The researchers also found that improving access to water and sanitation is associated with better health outcomes for women and children. This is consistent with another study from Ethiopia, which showed that when taps were installed closer to home, the monthly risk of child death was 50 percent lower among children of the women with access to the new taps.

“This really shows the difference that improved access to clean water makes,”” said Prof Hunter. “Living in a household without a flush toilet was associated with a 9-12 percent higher risk of child death than living in a household where members usually used flush toilets.

Having access to water in homes and having good sanitation led to big improvements to the health of women and children. As such children born into communities with improved sanitation were 12 per cent less likely to die than those born into communities with poor sanitation,” said Prof Hunter.

The research does not specify for how long you have to carry the water and in what way either on the head or lifting jerrycans.
ends

USAID offers $35 for training East African Freight Forwarders

The Federation of East African Freight Forwarders Association (FEAFFA), East Africa’s Freight Forwarders body has today received USD 3.5Million from TradeMark East Africa (TMEA) a leading regional trade facilitation body. 

This is in support of a four-year programme that aims at enhancing skills for customs agents, freight forwarders and warehouse providers in East Africa. The programme, implemented by FEAFFA across East Africa, will offer timely training that is in tune with changing technologies and logistical needs, thus enabling customs agents and freight forwarders to provide competitive and high-quality end to end services.

The two institutions made the announcement as they signed a grant agreement at the ongoing Global Logistics Convention in Kigali. TMEA was represented by its member of the Board of Directors, Ms. Patricia Ithau and FEAFFA was represented by its President, Mr. Fred Seka.

The United States Agency for International Development (USAID) provided the funding through TMEA. USAID is one of TMEA’s 10 donors.

Dubbed the EAC Logistics Sector Skills Enhancement Program; this new initiative will meet the need of the identified large skills gap in the EACs logistics sector; which has resulted into high costs to business. 

Either because a freight forwarder is unaware of certain regulations, or a custom agent is not conversant with multiple country regimes. The two partners said that they expect the programme to evolve into self-sustaining training activities through a robust sustainability model that will generate training related revenue.

“The high logistics costs in East Africa are driven not only by the high cost of inputs required for delivery of goods but also the inefficiencies and poor quality of logistics service delivery,” said Ms. Ithau.

Mr. Seka highlighted important components of the programme saying, “One key component is the updating of the East Africa Customs and Freight Forwarding Practicing Certificate (EACFFPC) curriculum and training materials. 

A strong warehousing module will be introduced to address the skills gaps in this critical element of logistics. We have focused on enhancing FEAFFA’s online learning programme as this will ensure that training is available and accessible in many parts of the region. 

With this funding, FEAFFA will introduce a higher - level qualification that will build on the success of the certificate program. The higher-level training program intends to expose practitioners to global practices and position them as global logisticians”.

A market study conducted by TradeMark East Africa in 2016 found that there was a lack of capacity building in the transport and logistics sector throughout the EAC region. The study established that clearing and forwarding agents had little access to changes in regulations and new technologies adopted by relevant government bodies; and this compelled shippers to understand the clearing process, an additional skill outside their core area of business. 

It also established there were limited formal training opportunities in warehousing, resulting in warehouse functionaries learning the basics on the job. Besides, the few existing logistics capacity building programs are provided in large cities; and this locks out operators at far flung regional economic centres and at major border posts to access them.

The programme will: Develop a continuous professional development (CPD) program that will keep practitioners abreast with emerging trends in the industry. Support domestication of the regional model bill on self-regulation for customs agents and freight forwarders in EAC Partner States.

The EAC Logistics Sector Skills Enhancement Program builds on the many years of successful implementation of the East Africa Customs and Freight Forwarding Practicing Certificate (EACFFPC).

EACFFPC is a mandatory training program for customs agents and freight forwarders developed jointly in 2007 by freight forwarders under FEAFFA, East Africa Revenue Authorities and the EAC Directorate of Customs.

“More than 6000 customs agents and freight forwarders have graduated from the EACFFPC program across the East Africa since it was launched in 2007” said Elias Baluku, FEAFFA’s Ag. Executive Director as he expressed optimism that the new programme will enable the institution double this number.

ends

New contraceptive choices for Niger women

By Esther Nakkazi
Niger, a country in central Africa with one of the highest fertility rates in the world has added more contraceptive choices for women in reproductive ages.

The Caya™ diaphragm and Caya™ Gel were launched in Niger in mid-July and mark the first new non-hormonal contraceptive options to become available on the African continent.

They both are non-hormonal, discreet and reusable barrier methods. They were launched in Niger with support from the Expanding Effective Contraceptive Options (EECO) project funded by USAID.

"Women's contraceptive needs change throughout their lives and they need methods that align with their unique circumstances," said Shannon Bledsoe, WCG Executive Director. "The introduction of this on-demand, non-hormonal method gives women in Niger one more contraceptive choice."

The EECO project, led by WCG and implemented in partnership with PSI, was designed to support the introduction of new and improved contraceptive methods that address method-related reasons for non-use of family planning to better meet the reproductive health needs of women and girls worldwide.

The global health nonprofit PATH developed the Caya diaphragm through a human-centered design process to expand women’s access to affordable, nonhormonal contraceptive options in countries across the world.

According to a press statement from WCG, PSI will market and distribute the Caya™ Diaphragm and Caya™ Gel in Niger's capital of Niamey, training community health workers and healthcare providers to offer the method to women alongside other options within the context of informed choice.

It says unlike previous iterations of the diaphragm, the Caya™ Diaphragm is "one size fits most," eliminating the need for a provider fitting in countries like Niger with shortages of trained healthcare providers.

"Our market research shows that women and men desire more contraceptive options that are within their control and have no side effects," said Moumouni Boubacar, EECO Project Manager at PSI Niger. "The Caya™ Diaphragm puts power in the hands of the couple.”

Officials from the project say the diaphragm’s expansion to Niger and planned marketing of the product will lead to greater access within the country and lay the groundwork for expansion to additional countries. The Caya products also recently received regulatory approval in Nigeria.

Since the diaphragm was made available, they have also not reported any cultural or religious issues and women have been particularly drawn to the idea of a method with no side effects that can be used on-demand rather than continuously.

Niger has one of the world's highest fertility rates, with women having more than seven children in their lifetime on average, in part due to extremely low use of contraception.

NON COMMUNICABLE DISEASES IN UGANDA

NON COMMUNICABLE DISEASES IN UGANDA

Lifestyle issues: Diabetes and Hypertension

Summary of the presentation made by Dr. Roy William Mayega a lecturer at Makerere University School of Public Health at the 3rd Uganda Health Communications Network conference held on 26th -28th June 2019. The conference was themed around Non-Communicable Diseases; Communication, Myths, and Realities. Below Esther Nakkazi summarises Dr. Roy William Mayega presentation;

The rising burden of NCDs
Prevalence of key NCD related risk factors

National NCD risk factor survey:

• 25% of the population have hypertension – equal in rural/urban 
• Overweight at 14%, but with a marked difference between males (9%) and females (20%) 
• Obesity at 5% 
• High bad fats in blood; 11% 
• Only 7% of people with hypertension know 

Local studies

• Iganga: Overweight at 18%; 10% in males and 25% in females 
• Wakiso: About 15% of Ugandans have chronic kidney disease (Kalyesubula et al 2016) 
• Study in peri-urban secondary schools: 11% prevalence of hypertension; high rates of obesity; marked school differences (Nakiriba et al, 2017) An increasing prevalence of risk factors in Uganda 

As an indicator disease: 

• Type 2 Diabetes affects 3% of Ugandans 
• The distribution is not uniform – there are pockets of much higher prevalence e.g. 7% prevalence found in people aged 35-60 years in Iganga 
• Only 51% of people with diabetes are diagnosed 
• In the 1960s, diabetes was very low; however, an upturn since 1980
• Currently, NCDs are responsible for 25% of morbidity 
• 4 major conditions: Cardiovascular diseases, Diabetes, Cancer & Chronic Lung Disease 

Society: The social environment

1. In interrelated changes in population-level factors influenced by globalization (de-Graft Aikins et al. 2010) 
2. Urbanization; peri-urbanization of rural behaviors
3. A rapidly changing food environment: refined foods, sugar, adverting of junk, soda/concentrates, globalization of refined rice/maize/oil, peri-urbanization of diets ,’Rolex’, salting, sharp decline in F&V; traditional starches with high fibre off the dinner table, energy dense pastries taking over the breakfast table even 
4. Changing nature of work: At 95% PA rates, Uganda has been named the most physically active country in the world; however, this mostly works and transport related, and is rapidly changing 
5. Culture of wellness checks 

Health system gaps

1. Health systems in LMICs are not yet ready 
2. The PHC package is mainly oriented towards acute conditions 
3. Care: The vast majority undiagnosed; inadequate treatment; inadequate follow-up and adherence 
4. Prevention: Wellness activities lacking 
5. Other sectors: Not yet on-board 
6. Opportunities: 
7. NCD office established in the MoH to coordinate; various civil society actions 
8. NCDs integrated into minimum health care package; National diet and Physical activity guidelines 
9. MoH Technical Working Group 

A focus on behavioral interventions

Awareness exists but knowledge is low
Iganga: Only 34% of people aged 35-60 were moderately knowledgeable
For effective behavioral strategy, the current messages as they are would be ineffective
Contextually relevant messages have not been developed leading to unrealistic, patchy messages subject to distortion
Challenge: How do we shape the message; what do we say and in a way that is realistic?

Perceptions and practices on lifestyles
“Change means sacrificing a good life...”
To those with diabetes, ‘obesity is sickness’ but to those without diabetes, obesity is ‘success’ and weight loss denotes sickness or a financial crash:
“When someone is big, they think that he has money... They call them ‘omugaiga’; if you are a woman, they call you ‘Hajjati’. “Lose weight and you have HIV”
Gender connotations: “Big is beautiful/Big is big”
Diet: “The things they advise us against are also the tastiest”
Balanced diet unaffordable: “When you have the money you can eat chicken, fish, eggs; you cannot buy half a kilo of meat to serve ten people”
Food environment: The ‘Rolex’, an energy-dense informal snack has been peri-urbanized
Formal physical activity is strange: “Apart from sportsmen, I have never seen anyone running! Maybe the children; but for an adult to run…!” (All laugh)
School environments: Drastic reduction in extra-curricular activities as students are pressurized to learn/space
Peer-driven consumption of very refined foods (e.g. the licking of raw sugar-mixtures)

How people perceive current and future well-being
Attitude change: Most non-ill people have a non-holistic view of wellbeing that focuses on ‘absence of pain and access to basic needs now’: ‘Without pain, risk factors are not viewed as a problem’
People with high blood pressure describe symptoms that mean probable severe disease
People with diabetes seem to have serious psychosocial issues: ‘Diabetes is worse than HIV/AIDS’; ‘Thoughts are more powerful than the disease’;
Lifestyle education only offered to people who already have the disease
Message gap leading to confusing messages e.g. blood group-based diets, concoctions, rigorous activities that substantially reduce the quality of life; herbalists, drug distributors, alternative medicine is predominant information givers
For patients: Support for self-care and autonomy support grossly lacking

Implications for behavior change communication strategies in a typical low-income country
Fill the gap: Nationwide health promotion targeting lifestyles integrated into all sectors with simple, contextualized messages and materials
Develop realistic messages: That promotes a holistic view: linking current and future health, disbanding myths, incorporating gender, attitudes, emphasis on solutions within the household environment
Coaching and autonomy support as novel education strategies to a lifestyle change
School health is foundational to build a resilient generation
For affected people, treatment is life-long: Life-conditions NOT always disease
Taxes on unhealthy food (cooking oil for example)

Childhood Cancer at the UCI: Burden and challenges

Summary presentation made by Dr. Joyce Balagadde Kambugu; Consultant paediatric oncologist, Head paediatric oncology, Uganda Cancer Institute at the 3rd Uganda Health Communications Network 26th -28th June 2019. The conference was themed around Non-Communicable Diseases; Communication, Myths, and Realities. Below Esther Nakkazi summarises Dr. Joyce Balagadde Kambugu presentation;

Status of cancer at UCI

• The number of new children has increased from 250 in 2013 to 582 in 2018 
• Acute leukaemia and lymphoma the most common cancers
• The prevalence of HIV is 6% 
• Kaposi's sarcoma (KS) is the most common HIV associated cancer
• Brain tumours are becoming increasingly common (5%)
• Rhabdomyosarcoma and wilms tumor are the most common solid tumours

Challenges of paediatric cancer care at the UCI
Insufficient Human resource
Misdiagnosis
Delayed presentation
Abandoned treatment
Lack of consistent adherence to treatment
Drug shortages
Treatment-related death
Use of reduced intensity treatment regimens to facilitate tolerability also contribute to treatment failure and excess relapse.

Ultimately these impact negatively on cure

A. Large Patient numbers
The service received almost 600 new patients from all parts of Uganda and parts of the neighbouring countries
Human resource and the infrastructure is strained
Increases risk of treatment abandonment
Increases risk of poor treatment adherence

This will partially be addressed by making operational the regional cancer centres: Mbarara,  Arua Mbale, Gulu
Improving psychosocial support
UCCF
Kawempe home care
Bless a child foundation

B. Late presentation
Early diagnosis of cancer is a fundamental goal
Allows an opportunity for timely treatment while disease burden is still in its earliest stages
Then prognosis may improve, and a cure can be attained with minimal side or late effects.
Delayed diagnosis is associated with more refractory disease and excess relapse
Increases the costs and morbidity of treatment and in turn, increases treatment abandonment

C. Drug shortages

1. Insufficient drug budget to purchase requisite quantities of drugs 
2. Stagnant drug budget despite increasing patient numbers 
3. 7B UGX from 2013/14 till 2017/18 when increased to 8.8B 
4. Currently, drug-availability is at 65% 
5. No access to newer more efficacious therapies with fewer side effects like the Mabs and Nibs 
6. Autonomy from NMS has afforded 2 things 
7. Optimizing of the available budget by enabling direct dealing with the manufactures; Norvatis, Sandos, Roche, Pfizer, Medac 
8. The unit cost of drugs came down so drug availability is now 65% from 30% 
9. The Institute is more in control of assurance of drug quality 

D. Treatment-related death (With compliments from Dr. Margaret Lubwama-Microbiology Phd student)

1. Sepsis 
2. Treatment regimens are intense 
3. Insufficient capacity to investigate 
4. Increasing prevalence of drug-resistant microbes 
5. Inadequate access to antimicrobials 

Access to blood products
UCI gets only 1/3 of requisite blood product demand even though UCI gets more blood products than any other Institution
Treatment-related marrow suppression
Sepsis (increases risk of bleeding)

Time period Jan 2018 to April 2019

Of 87 patients with haematologic malignancy with at least one episode of febrile neutropaenia 38 were paediatric
15 of the 38 children (39% ) had documented bacteremia
Of 22 gram-negative bacterial isolates from the 15 children, 16 (73 %) were multidrug resistant (to more than 3 classes) b-lactams, gentamicin, ciprofloxacin, carbapenems
Of the resistant bacteria l isolates (n=16 ) 50% (n=8) displayed the ESBL phenotype (were susceptible to carbapenems)

E. Need to use reduced intensity treatment regimes
To facilitate tolerability
Malnutrition and Sepsis contribute to treatment failure and excess relapse.
BL in HIC has a cure rate of almost 90% but with very high-intensity treatment regimens

The best survival rate in Uganda for BL is 50% at 2 years
This is the rationale for the rituximab clinical trial that is starting at the UCI in paediatrics in 2020/2021

Uganda’s National Sexuality Education Framework Lies Dormant

By Esther Nakkazi

Uganda is experiencing significant sexual and reproductive health challenges like high teenage pregnancy, early marriages, HIV and gender-based violence in schools.

The National Sexuality Education Framework was developed in response to the urgent need for a National Policy Framework on Sexuality Education and Development and dissemination of related materials.

The Health Journalists Network in Uganda (HEJNU) members in partnership with Uganda Cares teamed up at a media science cafe held on 29th May 2019, to understand what is happening to this National Sexuality Education Framework and why it has not yet been implemented. 

Below are the highlights and excerpts from HEJNU media science cafe by Esther Nakkazi:

Speaker 1: Denis Lewis Bukenya, the Deputy director, Naguru Teenage Information and Health Centre

Overview of the Uganda comprehensive sexuality education framework:

There has been a ban on comprehensive sexuality education in Uganda. But comprehensive sexuality education is a global word which is used to mean that we talk about aspects of sexuality from a rights best angle, where everyone is equal, where there is a choice. 

What sparked off the ban were schools that had curriculums looking at comprehensive sexuality education. Parents groups got concerned and petitioned the ministry of Education and Sports.

The ban has been fueled by a lack of information but also because Ugandans don't come from a background of ‘rights-based’ living. When it was banned a secular was circulated to all stakeholders signed by the ministry of Gender, Labour and Social Development.

It said we need to pause comprehensive sexuality education because of the misconception in schools and advised that the Ministry of Education would lead by coming up with a framework which it did and it was launched in May 2018 by the first lady and Minister of Education.

The process of developing the framework was long and tedious. I don’t want to talk on behalf of the technocrats or anyone but I know there is a bit of fatigue because we feel we are not moving as fast as the country needs the sexuality education framework.

The framework was premised on basically two things; The framework is values based. Do you all have values? Are your values the same as your neighbor? If the framework is values based we have religious, cultural and ethical values. 

It also has six principles; God-fearing, parental role in child up-bring, the centrality of the family in child upbringing, age-appropriateness, risk avoidance and lastly preparedness, response and rehabilitation of learners.

The principles and values provide for the basis of whatever we might need to pay attention to it as journalists of HEJNU.

The framework also has four themes; sexuality and human development, sexuality and relationship, sexuality and sexual behavior and sexuality and sexual health all of which have specific topics.

In theme 1 which is sexuality and human development, it includes ‘knowing oneself’. There is male and female reproductive anatomy and physiology; puberty; human reproduction; body image and sexuality.

In the sexuality and relationships theme, there are types of love, dating, and courtship, preparing for long term relationship, good versus bad relationships, marriage and family.

In sexuality and sexual behavior, there is sexual abstinence and faithfulness, gender-based violence (GBV), and deviant sexual behaviors.

And in the last theme of sexuality and sexual health the topics are menstrual health and hygiene; prevention of pregnancy; importance of antenatal and post-natal care; Abortion and risks associated with it; Sexually Transmitted Infections/Diseases; HIV and AIDS; Care and Support of people suffering from STI and STDs including HIV; Non-communicable diseases and Sexuality.

Targets of education are covered in the framework distributed across the age ranges; early childhood (3-5 years) for pre-primary leaners in nursery, lower primary; (6-9 years) from Primary 1 to 4, upper primary (10-12 years) from primary 5 to 7, lower secondary (13-16 years) from senior 1 to 4 and lastly A-level/tertiary institutions 17+ years senior 5 to 6 students , tertiary institutions of learning for example colleges, institutes and universities.

The comprehensive sexuality education package is provided according to that age and that is where we get to age appropriate terms. I want to comment that I am aware that there's been reactions and discussions about this framework and it comes largely from the Catholic faith.

They have questions about the package especially for the early childhood (3-5 years) for pre-primary leaners in the nursery, lower primary. But also of things like marriage and family, mostly how they are packaged.

I know that there are certain things that are within this framework that I don't believe in and I don't agree with and it's because of the lens I have and I believe in. 

We shall wait for whatever step the country decides to take but right now we can only lobby and give a lot of information so that people understand what we are talking about ‘a rights based approach’ other than ‘values based approach’.

Some of the right's best approach aspects are not agreeable because they are not ‘Godly’ and they say are not acceptable. Ladies and gentlemen that's all I can give you as a preamble. Thank you.

Speaker 2: Bridget Jjuko, AVAC Fellow

The schools have been using other documents for example under PIASCY. So does this mean that you know PIASCY is not operational anymore? If it is how is comprehensive sexuality education going to be integrated into what already is happening in schools?

We have issues like different themes. From the civil society point of view, we say we need to equip the teachers. There is no way that we ought to give this information to children without teachers knowing exactly what they are talking about. That is very key.

The comprehensive sexuality education package is meant to guide what information is being given in school and it is true we have our children in school but they don't spend most of their time in school. What happens when they leave school? If there's going to be a document to guide what is happening in schools or information that is being shared in schools there's a lot of information shared out of school regarding sexuality.

We have a lot of partners outside the schools sharing ‘values based’ information so how is this going to either contradict or integrate with the information that is already going on outside our schools.

I know that the Ministry of Gender is working on a sexuality education framework for the ‘out of school’ and again a lot of engagements were done when this document was being developed. It will be very instrumental and important for the in school and out of school and what kind of information they are sharing together.

So for me as an advocate, it doesn't make sense empowering a person that's in school and leaving another when there's going to be that difference in information. There's going to be a clash. There should be many more engagements right now to avoid the big backlash.

We should actually be up to date on what exactly is happening with this document where it is in the system. Is it implemented? What role do you play as a journalist in the implementation of such a document?

As civil society, we are worried about the Catholic fraternity which runs almost 90 percent of our schools. So if they do not agree with this there's going to be a very big backlash. And right now as steps are going forward to make sure this is implemented those are very key aspects. Those are very key people to involve and engage to make sure that they are on board.

Should the comprehensive sexuality education bill be withdrawn, of course not! It is a very good document but we just want to be sure that it does what it was meant to do. The other thing we are going to know is actually is it going to work and we've been having these discussions so let's try and implement this. From implementation, we are going to learn that there are certain things that are not supposed to be the way they are or that they are things that deserve to be changed.

About how long it will take to be reviewed - the budget and things like that? This is like any other policy document or a framework that can actually be reviewed to incorporate those things. But I don't think it can be withdrawn. I think we are not going to use it but before we need to try it and see how exactly this is going to work for us.

Hilary Beinemigisha, Editor, The New Vision Newspaper;

As media, we have a role to play in this framework and I will summarize the roles in five points: Explain the framework, comply with it, support it, appraise it and evaluate it.

Our first role as media is to explain the framework because we have the audiences and have the platforms. The second role is to comply because the framework faults the media so much that we are the ones bringing bad habits among the children. The third one is to support the framework. Support it as you appraise it as we support it.

If you go to the ministry and you ask any question about this framework some of the technocrats say we finished our work and handed it to the minister. She went and changed a few things. We cannot challenge it without losing our jobs. So let the implementers do their job and start implementing but they say don't quote me.

Alice Kayongo, Programme officer, Uganda Cares;

One of the other areas where the ministry of education is at right now is that they want to harmonize with all stakeholders and precisely this means they want to harmonize with the Catholic church who are the ones a bit uncomfortable with the framework.

The ministry now has the Life Skills Summit every year on sexuality education being conducted at a regional level. It replaces the Youth Conference that used to be conducted yearly. What happens is they gather young people in a central place and then talk to them about this thing called sexuality education but they are doing it a little differently as they identify student leaders from different schools because it's hard to gather all the students. One summit has been held in Kampala region already, held at the Kololo air strip with over 2000 student leaders gathered for three days.

The other thing that the ministry of education is doing right now is that they are planning on resource materials with questions like what exactly do learners need? What do teachers need? This is exactly what Bridget alluded to in her talk because the teachers have no guide. 

So we have a comprehensive sexuality education framework but the teachers don't have a specific date on how they should talk to learners but the ministry says it is in the process of drafting materials for learners, materials for teachers and training materials.

Lastly, in the bid to harmonize with all stakeholders a meeting is planned on the 20th of June. The meeting will be between the ministry and key stakeholders I should say I think it's the technical working group meeting as well as the Episcopal Conference or the Catholic Church. We hope that this meeting should be able to give us a tiebreaker on this issue so that we can move on. 

Otherwise, as of now, we know there were several printed copies of the sexuality education framework at the ministry that awaits to be distributed. They would have been distributed immediately after the launch but I think they await the Episcopal conference because the Catholic church said they don't agree.

My opinion is that let us try out what we have and see how exactly that this is going to turn out. This comprehensive sexuality education framework is meant for in school but unfortunately, we have children out of school. From the engagement, we have had all stakeholders are looking at a child who is at the center of all this issue.

If we have two documents for children in school and out of school what does this mean? Should they be able to talk to the other documents they have created. Otherwise, if we have two documents that are totally different. We are bringing up children that have totally different with the same exact mindsets and different information.

We also need to realize that some of the children that are out of school are in unique settings and come from unique backgrounds which gets me to the other question of age appropriateness. If you find that a 6-year-old has gone through certain things in life that makes them a 15-year-old. That information that you're giving them as a 6-year-old is actually not going to help them when we speak from a public health aspect.

I think these documents need to be aligned so they can save a child at whatever level they are at that as parents you'll know that. I mean I'm a parent. I have an eight-year-old and the discussions you are going to have with them may be different from what you give for example Fresh Kid ( kid musician). 

The environments that they go through that as children are different and although we are looking to protect them but there those that don't have that protection that needs this information.

We are then doing an injustice by not talking about certain things because we are worried that our morals are going to be demolished. That is where age-appropriateness comes from, the setting of the child needs to be looked into and with those two documents in school out of school.

For me, it doesn't matter. A child is a child wherever they are. And the mere fact that a child is just vulnerable. Now the other things that make a child vulnerable are there you know. A child is a child they are vulnerable. They need information.

ends

Civil Society actors seek to protect Murchison Falls tourism site

Civil Society actors have written to the Electricity Regulatory Authority (ERA) to reject the application by Bonang Power to conduct a feasibility study and other activities leading up to the development of a dam at Murchison Falls.

In the protest letter dated 17th June 2019, the civil society actors protest against plans by ERA to issue a licence to Bonang Power and Energy Ltd to develop a 360MW power plant at Murchison Falls.

The falls and the entire Murchison landscape are already under threat from oil activities as over 70% of the oil under the Tilenga project is found in Murchison Falls National Park (MFNP).

The actors also call on ERA and government to promote the exploitation of clean energy such as off-grid solar as opposed to hydropower dams and oil in protected areas.

The letter raises concerns that Murchison Falls landscape is already under immense pressure from oil activities; no more pressures should be allowed. This is more so the case because tourism remains one of the biggest sources of government revenue; it earned the country over $1.6 billion in the 2018/2019 financial year.

On the other hand, development of hydropower dams has increased Uganda's debt burden amidst a few returns. The country's debt burden stands at $11.5 billion and dams are responsible for over 30% of this debt yet few returns are being experienced from them. For instance, only over 20% of the population has power. Poverty has also increased and the much-touted industries arising from increased power generation have offered insufficient and mostly poor-paying jobs.

Uganda is also producing excess power which citizens and industries cannot afford; this drives the tariff up. Another dam amidst excess power will further drive up the tariff. Moreover, Uganda is already over-reliant on hydropower yet to ensure sustainable energy supply amidst climate change threats, countries need to diversify their energy mix.

The government also faces legal action and international shame should ERA allow a dam to be developed at Murchison Falls. The dam would lead to more degradation of the Murchison Falls landscape, which is against international agreements that Uganda is a signatory to, the letter reads.

The signatories to this letter from the Acholi and Bunyoro sub-regions where the planned dam will be located also demand that :

(i) ERA should not approve the application to undertake studies for the development of a hydropower dam at the Murchison Falls. The Murchison falls ecosystem is important in the survival of species such as the Nile crocodile, fish, and others. Moreover, the falls and MFNP provide employment, foreign exchange and are a source of national pride. The above services cannot be replaced by electricity moreover which Ugandans cannot afford to consume.

(ii) Explore alternative energy sources. Uganda is richly endowed with alternative energy resources such as solar and wind. However, these resources remain largely unexploited mainly because Uganda is concentrating on hydropower. In line with aspirations under the Sustainable Development Goals (SDGs) and the Sustainable Energy for All (SEA4ALL) initiative, Uganda should invest more in other energy sources especially off-grid solar and avoid over-reliance on grid-based hydropower. In addition, in line with aspirations under the Paris Climate Change Agreement that Uganda is a signatory to, the government should promote investment in clean energy over oil and should avoid oil activities in protected and critical biodiversity areas including in MFNP.

(iii) UWA should not issue a permit for a dam at Murchison falls:

(iv) Citizens should say no to ERA and the government’s proposal to destroy Murchison Falls: It is only the citizens of Uganda who have the power under Article 1 of the Constitution that can save the Murchison Falls. Only the citizens can stop the single biggest challenge facing our country today, the dominance of politics over governance institutions. Key institutions such as the National Environment Management Authority (NEMA), UWA, National Forestry Authority (NFA), ERA and others that are entrusted with the responsibility of conservation and ensuring that developments benefit citizens without destroying the environment have been pushed on the sidelines by selfish and corrupt politicians. The institutions are being used by politicians to destroy the environment. This is why the country is in an environmental mess characterized by loss of forests, wildlife reserves, wetlands, river banks, lake shores, and others. Citizens must campaign against the destruction of Murchison Falls and all critical biodiversity areas of Uganda. We encourage companies like Bonang Power and Energy to desist from being part of the destruction. Instead, they should invest in other clean energy sources such as off-grid solar.

(v) Civil society: Non-governmental organizations(NGOs)and other civil society groups should work with us to mobilize and empower Ugandans to stop environmental abuses in the country. Only strong civic competence will compel government and institutions such as ERA to know that this country belongs to the people of Uganda and our biodiversity must be used in a manner that meets the needs of the present and future generations.

Study exonerates suspect contraceptives from risk of HIV

By Esther Nakkazi

The good news from the long-awaited trial on a link between three contraceptive methods and increase in the risk of HIV acquisition has brought a sigh of relief, will boost confidence for family planning and reassures women who are at the centre stage.

The results are reassuring at many levels and a winner for all women using contraceptives and those intending to use them, the men who support their partners to use them, the providers who now have more confidence in dispensing them, the researchers and the funders who ensure they are forever available on the market.

We now know that there is no increased HIV risk for women using the injectable depot medroxyprogesterone acetate (DMPA), the implant Jadelle and the copper intrauterine device (IUD) according to results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomised clinical trial.

It is NOT contraception that puts women at a risk of HIV.

ECHO adds the most robust data about contraception safety and effectiveness with solid evidence. It is a much better world for women to know that none of these 3 methods increase the risk of acquiring HIV.

DMPA or Depo is an injection given into the muscle. It is given every 3 months there may be a 6-9 month delay in getting pregnant after the last injection. Jadelle has 2 thin, flexible rods filled with progestogen inserted under the skin of a woman’s upper arm. It lasts up to 5 years but can be removed any time with a rapid return to fertility once removed.

The copper IUD has a ‘T’ shape and is made of soft but strong plastic with copper bands and has a ‘tail’ made of 2 strings. The health worker places it in the womb and it can last up to 10 years, although it removed at any time and fertility returns immediately.

In Uganda two of these researched methods, Jadelle and depot are the two highest used contraceptives by women which help them put off unwanted or avoid high-risk pregnancies, space childbirth, prevent maternal and infant deaths every year. The unmet need for family planning in Uganda reduced from 34.4% in 2011 to 28% in 2016.

In the countries where the ECHO randomized clinical trial took place, at the 12 sites in Eswatini, Kenya, South Africa, and Zambia depot is the number one choice. Women love it because it is discrete and in not all but some circumstances the shot is the only long-acting option on the shelf.

It is good to know that the contraceptives under the ECHO study were highly effective and acceptable further endorsing their primary purpose. The study says participants used either of the three methods assigned to them for 92% of the time they were in the study.

However, we should know that over 150 million women worldwide use modern methods of contraception for family planning and some do not necessarily use the three methods in the ECHO trial so these results cannot be generalised to other contraceptive methods that were not included in the study.

Unfortunately, the study had high HIV incidence and high Sexually Transmitted Infections (STIs) recorded among the 7,800 women who participated yet they were given an optimised level of prevention.

Except for condoms, no contraceptive method protects against HIV or other STIs, and thus women at risk of HIV infection who are using contraception should also be advised to use condoms.

Moving forward we know now that Depot, Copper IUDs and Jadelle has nothing to do with the HIV infection it is high time to invest more in programs to protect women against HIV.

Isn’t it logical that HIV prevention services and family planning should be integrated? African governments can also avail more funding for contraceptives and HIV prevention and enforce that the two are provided in one place.

Committee to Protect Journalists demands UCC to rescind media staff suspensions

Press release (World Press Freedom Day)

The Committee to Protect Journalists today called on Uganda's media regulator to immediately rescind an order yesterday suspending staff from 13 radio and television stations in connection to their coverage of opposition politician Robert Kyagulanyi, known as Bobi Wine.

"This order to suspend journalists from working is a transparent retaliation against stations that covered a critical opposition figure. That Ugandan authorities made this move immediately before World Press Freedom Day communicates a casual disregard for the rights of journalists to report freely and the right of citizens to know," said CPJ Sub-Saharan Africa Representative Muthoki Mumo.

"This order should be immediately lifted and the stations should be allowed to operate without interference."

In a statement published on its website, the Uganda Communications Commission directed the six television stations and seven radio stations to suspend their producers and heads of news and programs, alleging they breached standards by airing "extremist or anarchic messages" and inciting and misleading content.

The stations ordered to suspend staff are Akaboozi FM, BBS TV, Beat FM, Bukedde TV, Capital FM, CBS FM, Kingdom TV, NBS TV, NTV, Pearl FM, Salt TV, Sapientia FM, and Simba FM.

The regulator did not cite specific programming, only asking the stations to submit live bulletins aired on April 29, 2018. However, media reports and a statement issued by the Uganda Parliamentary Press Association indicate that the suspension is likely connected to the airing live of Kyagulanyi's arrest on April 29.

Malaria vaccine trial starts

By Esther Nakkazi

Malawi has launched the world’s first malaria vaccine today in a pilot programme. Ghana and Kenya will introduce the vaccine in the coming weeks.

The vaccine RTS,S will be made available to children up to 2 years of age in 3 doses given between 5 and 9 months of age and the fourth dose at the 2nd birthday.

Malawi, Ghana, and Kenya were selected from among 10 African countries following a request by WHO for expressions of interest. These qualified because they had well-functioning malaria and immunization programmes, as well as areas with moderate to high malaria transmission.

“The malaria vaccine has the potential to save tens of thousands of children’s lives,” said Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General.

Dr. Ghebreyesus said while there are many gains from bed nets and other measures to control malaria in the last 15 years progress has stalled and even reversed in some areas.

Thus the vaccine is a complementary malaria control tool – to be added to the WHO-recommended measures for malaria prevention, including the routine use of insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment.

“We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there,” said Dr. Ghebreyesus.

Malaria is one of the world’s leading killers, killing one child every two minutes. Most of these deaths are in Africa, where more than 250,000 children die from malaria every year. Worldwide, malaria kills 435 000 people a year, most of them children.

The RTS,S vaccine has demonstrated that it can significantly reduce malaria in children. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria.

“We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa.

Pilot programme;

“To step up the fight against malaria, we need every available tool. If this pilot shows that RTS,S is a cost-effective tool against malaria, it will help us save more children’s lives,” said Peter Sands, Executive Director of the Global Fund.

The pilot programme is designed to generate evidence and experience to inform WHO policy recommendations on the broader use of the RTS,S malaria vaccine.

“These pilots will be crucial to determine the part this vaccine could play in reducing the burden this disease continues to place on the world’s poorest countries,” Dr. Seth Berkley, CEO of Gavi.

GSK, the vaccine developer and manufacturer is donating up to 10 million vaccine doses for this pilot.

It aims to reach about 360,000 children per year across the three countries and will look at reductions in child deaths; vaccine uptake, including whether parents bring their children on time for the four required doses; and vaccine safety in the context of routine use.

Ministries of health will determine where the vaccine will be given; they will focus on areas with moderate-to-high malaria transmission, where the vaccine can have the greatest impact.

“This novel tool is the result of GSK employees collaborating with their partners, applying the latest in vaccine science to contribute to the fight against malaria,” said Dr. Thomas Breuer, Chief Medical Officer of GSK Vaccines.

He said they look forward to the results of the pilot, and in parallel, working with WHO and PATH to secure the vaccine’s sustained global health impact in the future.

Financing for the pilot programme has been mobilized through collaborations between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and Unitaid. Additionally, WHO, PATH and GSK are providing in-kind contributions.

“The malaria vaccine is a shining example of the kind of inter-agency coordination that we need. We look forward to learning how the vaccine can be integrated for greatest impact into our work,” said Lelio Marmora, Executive Director of Unitaid.