Fun mobile app to dispel sexual and reproductive health myths

By Esther Nakkazi

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

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

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

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

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

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

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

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

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

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

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

At a time when young people are always looking for data and they want to seek for sexual and reproductive health in comfort and privacy, a mobile health solution is one way to do it. It was a fruitful event and to me all the teams were winners at least in the area of rapid innovations.
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Is Sickle-Cell disorder killing more Uganda infants than HIV annually

By Esther Nakkazi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Esther Nakkazi

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

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

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

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

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

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

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

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

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

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

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

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

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Using Technology to Increase Family Planning Uptake

By Esther Nakkazi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More Nurses Needed to Prescribe Morphine

By Esther Nakkazi

Twenty-nine students graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa (IHPCA) at Hospice Africa Uganda on Friday 20th May. The graduates who are either registered nurses or clinical officers can legally prescribe oral liquid morphine for pain relief. 

To date the IHPCA has trained 160 palliative care practitioners in prescribing liquid morphine. Whilst palliative care exists in 80% of the districts in Uganda this is “a drop in the ocean” compared with the demand for palliative care in the country.

Uganda is the first country in the world to make legislation that allows trained nurses and clinical officers to prescribe oral liquid morphine, a cornerstone medication used in Palliative Care. This supplements the few number of doctors, who in most countries are the only registered prescribers of such medications.

Dr. Elioda Tumwesigye the Minister of Health said there is an ''urgent need' to scale up and pledged to support the scaling up of palliative care training in Uganda.

“Despite major achievements, especially the work of Hospice Africa Uganda over the last 23 years, a lot more needs to be done to meet all of the palliative care needs in the country,” Dr. Tumwesigye said at the graduation and spoke of his own personal experience with cancer, having lost both parents to the disease. He revealed his mother was on the Hospice Africa Uganda programme in Mbarara.

Dr Eddie Mwebesa, the acting Chief Executive Director of HAU reiterated the huge need for Palliative care in Africa and in Uganda.

Dr. Tumwesigye said he will support to widen the reach of palliative care and to see if the Government, through the Ministry of Health, will consider stepping in to offer scholarships for palliative care courses, or at least to subsidize student fees at Public training Institutions.

He also said he would work to ensure that all the three academic programmes run at the IHPCA - the Bachelor of Science Degree, the Diploma in Palliative Care and the Diploma in Clinical Palliative Care - are included in the Ministry of Public Service scheme of service.

This has been the most serious challenge faced by graduates from these courses because it means they have no channel for promotion or career progression in public service.

Prof. Stanley Acuda Wilson the Institute principal said the IHPCA is playing a vital role in training and educating doctors, nurses and healthcare workers in palliative care in Uganda and Sub Saharan Africa.

The Institute was recognized by the National Council for Higher Education as a tertiary institution in 2009 and granted a provisional license to confer degrees and diplomas in affiliation with Makerere University. It was also granted the degree awarding Institution status in 2014 with a provisional license to award its own degrees and diplomas.

HAU founder Professor Anne Merriman said “despite the achievements by Hospice Africa Uganda in provision of palliative care services with meagre resources, there are a number of challenges which require government help in order to increase accessibility of palliative care in Uganda and fulfill HAU’s vision of palliative care reaching all in need in Uganda and Africa”.

All over the world, including Uganda, the need for palliative care is significant and growing because of the high prevalence of cancer, HIV/AIDS and increasing prevalence of non-communicable diseases.

Hospice Africa Uganda is the country’s pioneer Hospice founded by Prof. Anne Merriman in 1993. According to Worldwide Hospice and Palliative care Alliance in 2016, 40 million people worldwide need palliative care.

18 million die each year in severe pain and distress due to lack of access to palliative care and pain relieving medications. 78% of these live in middle and low income countries and 6% are children. 42% of countries in the world do not have any palliative care services.

Since its inception HAU has cared for over 26 000 people at its three sites in Uganda, (Kampala, Mbarara and Hoima), and it currently cares for over 4,600 patients annually.

Mobile App to Ease Diagnosis of Neglected Diseases in Africa

By Esther Nakkazi

They could be labelled 'Neglected' but are certainly not forgotten in the technology space. A mobile phone App has been developed to boost the diagnosis of neglected diseases at point of care in Africa.

It will also by-pass the use of sophisticated and expensive laboratory instruments which are difficult to use in resource poor settings.

The App will be implemented by ANDI the African Network for Drugs and Diagnostics Innovation in collaboration with EASE-Medtrend Biotech based in China.

The project uses an Integrated Mobile Diagnostics Readout called the EASE App Technology, to attain state-of-the-art results for multiple diseases in less time and less cost, a press release from ANDI says. EASE stands for Equal Access to Scientific Excellence.

 The Application is now being optimized to perform different Point of Care and Rapid Diagnostics Tests (RDTs) for diseases that are prevalent in Africa. Field evaluation is scheduled to start in Ghana, Ethiopia and Nigeria within the next two months.

“We are not re-inventing RDTs basic principles--- we are making them more user friendly, manageable and affordable with all that "Big Data" and “Cloud Computing” can do for it,” said Dr Peter Chun the CEO of EASE-Medtrend Biotech.

“This leap-frogging approach to innovation in Africa is very promising. The mobile platform can be a game - changer for neglected diseases and other routine disease diagnosis in Africa....it can also support disease surveillance and drug resistance monitoring,” Dr Solomon Nwaka, the Executive Director of ANDI.

Although most Mobile Applications in the medical field provide a platform for information exchange and consultation they do not replace hardware. The EASE App aims to replace bulky and sophisticated instruments, which have limited utility in rural communities of Africa.

It can also be scaled or expanded to incorporate multiple tests, including routine laboratory diagnoses such as blood and urine analyses as well as tests for a number of communicable and non- communicable diseases that are now common in Africa.

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$52 Billion could be saved by Africa by ending Neglected Tropical Diseases

Press Release (edited)
Sub-saharan Africa could save $52 billion (purchasing power parity) by 2030 if the region meets the WHO 2020 control and elimination targets for the five most common neglected tropical diseases (NTDs).

These were statistics released  at the World Economic Forum on Africa (WEF Africa) in Kigali, Rwanda, on 13th  May by Erasmus University.

These statistics, developed with support from the Gates Foundation, were released at a WEF Africa-sanctioned side event, convened by the END Fund to make the case for increased investments in NTD control in sub-Saharan Africa. 

Meeting these goals could also help the region gain the equivalent of 100 million life-years that would otherwise be lost to ill health, disability and early death arising from these diseases.

"NTD control efforts offer a return on investment unparalleled in global health,” said Ellen Agler, Chief Executive Officer of the END Fund, a private philanthropic initiative dedicated to ending the five most common NTDs. “Ending these debilitating diseases will help reduce poverty at all levels, from families and communities to whole nations.”

NTDs are a diverse group of parasitic and bacterial infectious diseases that are particularly prevalent in areas with limited access to safe water, proper sanitation and adequate medical services.

Sub-Saharan Africa bears over 40% of the global burden of NTDs. The five most common NTDs – lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis (bilharzia), soil-transmitted helminths (intestinal worms) and trachoma – account for 90% of the region’s NTD burden. At least one of these diseases is present in all 47 countries of the WHO’s African Region.

The impact of NTDs on both health and economic development in sub-Saharan Africa is massive. Each year, these diseases cause disabilities and disfigurements for millions of African citizens. They also increase absenteeism in schools and dramatically reduce labor productivity, ultimately perpetuating cycles of poverty.

“I have seen the devastating effects of NTDs first hand in my community,” said HRH Queen Sylvia of Buganda, a kingdom in Uganda, who delivered remarks at the side event today. “We cannot continue to let people across Africa suffer from these diseases of poverty when simple solutions exist. It is holding our people and our countries back. We can and we must do more.”

The five most common NTDs in sub-Saharan Africa can effectively be prevented and treated using low-cost, easy-to-administer interventions, such as preventive chemotherapy (PC) treatments through mass drug administration (MDA) in affected communities. 

Such interventions are extremely cost effective due to a number of factors, including drug donations (valued at $4 billion annually); the scale of national programs; the integration of drug delivery with other health initiatives; the use of volunteers and teachers for distribution; and the massive impact of NTD control on economic productivity and educational outcomes. Pharmaceutical interventions work alongside other prevention strategies, including the promotion of safe water, sanitation and hygiene.

In recent years, countries across sub-Saharan Africa have made tremendous progress toward ending NTDs. Donors, development partners and national governments have made unprecedented commitments to these diseases, including through the landmark London Declaration on NTDs, launched by a coalition of partners in January 2012, and the Addis Ababa NTD Commitment, signed by 24 African health ministers in December 2014 declaring increased leadership and budgetary contributions. 

The Sustainable Development Goals (SDGs), adopted by the United Nations General Assembly in September 2015, specifically reference putting an end to NTDs by 2030.

Despite this progress, a funding gap remains to distribute medicines to the millions of people across sub-Saharan Africa who still lack access. Additional resources are urgently needed from all sectors – public, private and philanthropic – to reach the WHO’s 2020 targets for NTDs and reap the resulting health, education and economic benefits.

Notably, Rwanda, the host country for today’s event, has made tremendous progress on NTDs. Thanks to the leadership of the government and the support of partners such as the END Fund, the prevalence of soil-transmitted helminths (intestinal worms) has been reduced by 32% over the last 5 years. However, much remains to be done for the country to eliminate NTDs.

“Now is the time for leaders across Africa to prioritize NTD control and put an end to these terrible diseases in order to improve the lives of our people,” said Rwandan Minister of Health Dr. Agnes Binagwaho, who also spoke at the event. “In Rwanda, we have invested in our people, and we have seen progress as a result of this commitment. With human lives at stake, we simply cannot afford to wait.”

For more information, please contact:

 Sarah Marchal Murray, END Fund

smmurray@end.org; + 1 917 597 7317

Jessica Freifeld, Global Health Strategies       

jfreifeld@globalhealthstrategies.com; +254 714 291 222; +250 729 003 622