Malaria –World Malaria Report 2010 (15.12.10)
By Esther Nakkazi
In many countries, the total number of malaria deaths and hospital admissions have been more than halved in a decade as a result of increased control interventions particularly the provision of insecticide-treated mosquito nets.
According to the World Malaria Report 2010, released by the World Health Organisation (WHO) last week, malaria-related deaths have fallen from 985,000 in 2000 to 781,000 in 2009 the largest absolute decreases observed in Africa.
Ban Ki-moon, the UN Secretary General, said it is possible that when a broad range of partners join forces malaria deaths could be eliminated by 2015.
The affiliation between committed African leaders, financial support from donor countries providing more than $5 billion in new money since 2008 and the Roll Back Malaria partnership has already brought success.
“If we heed to the lessons highlighted in this report we can achieve our goal of ending malaria deaths by 2015, accelerate progress toward the MDGs and usher in a better future for all,” said Ban Ki-Moon.
According to the World Malaria report, in eleven African countries including Rwanda in east Africa, the malaria burden dropped by more than 50 percent in 2000 to 2009.
For Kenya, Tanzania and Uganda there was a wide scale implementation of malaria control activities to more than 50 percent of the populations at high risk over this same time period. Most of these populations where able to access Insecticide Treated mosquito Nets (ITNs).
Already, enough nets have been delivered to sub-Saharan Africa to protect nearly 580 million and more than 75 million people have received protection from Indoor Residual Spraying (IRS).
Now the World Health Organisation has promised an additional 54 million nets to be delivered to sub-Saharan by early 2011, totaling 350 million, bringing the goal of universal coverage declared by UN Secretary-General Ban Ki-moon in 2008 within reach.
This achievement represents the largest scale-up of a malaria control intervention in Africa ’s history.
The WHO Director-General, Dr Margaret Chan, said the results set out in the report are the best seen in decades after so many years of deterioration and stagnation in the malaria situation.
"The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates. By maintaining these essential gains, we can end malaria deaths by 2015," said Ray Chambers, the UN Secretary-General's Special Envoy for Malaria.
In the east African region, other countries could emulate Zanzibar and Rwanda’s persistence and maintenance of successful malaria control campaigns and programmes.
According to the report, Rwanda has significantly scaled up malaria control interventions including distribution of 6.4 million mosquito nets over the last three years.
Most of these Long Lasting Insecticide-treated mosquito nets (LLINs) were distributed during a measles vaccination campaign to children below 5 years, and each of them were given as well as all households to avoid further malaria cases and deaths.
Inpatient malaria cases and deaths in Rwanda have now fallen by more than 50 percent from 2000 to 2009 says the report.
However, Rwanda noted an upsurge in cases of malaria beginning in 2009 but a new mosquito net campaign was launched in April 2010 to replace older nets, which then reduced malaria cases and deaths.
By 2009, the number of malaria admissions and deaths in Zanzibar were 81 percent lower than those recorded in 2000, says the report.
Zanzibar’s malaria success is largely attributed to free for all anti-malarial drugs (ACTs) in all public health facilities since September 2003 and universal coverage of nets to the 1.3 million islanders.
Annually, indoor residual spraying is carried out to cover nearly all households and there is improved diagnosis of malaria cases as Rapid Diagnostic Tests (RDTs) began to be more widely used from 2005.
In the rest of Africa, by 2009 more than a third of suspected malaria cases were confirmed with a diagnostic test, an increase from less than 5 percent by 2000.
Now the WHO recommends that all suspected malaria cases undergo diagnostic confirmation prior to treatment. Already, a number of African countries including Uganda have been able to scale up malaria diagnostic testing at a national level.
“Not only has this resulted in saving the unnecessary use of hundreds of thousands of courses of ACTs annually, but has also allowed for the implementation of timely and accurate surveillance for malaria,” said Dr Chan.
Research shows that using RDTs improves the quality of care for individual patients, cuts down the overuse of drugs, protects their therapeutic life, and allows for timely and accurate malaria surveillance.
However, the report cautions that these gains are fragile and all supporting partners should keep in the loop or the opportunity could be lost.
For instance insecticide-treated bed nets remain effective for three years and their supply must be replenished while the development of parasite resistance to antimalarial drugs and mosquito resistance to insecticides are perennial threats.
Ends-
Monday, December 20, 2010
Wednesday, December 1, 2010
Use of herbal remedies in HIV treatment still causes stigma
By Esther Nakkazi
When the cock crows and birds fly out of their nests early morning, the African herbalists rise with the sun to go to the forests.
There, they pick fresh leaves, peel the new bark off trees and dig plant roots from the soft ground before the sun hardens it. They then apply the knowledge most of them acquired from their ancestors.
Traditional herbalists are custodians of knowledge on herbal concoctions that are used by millions of Africans to survive. In Uganda, they are big contributors to HIV treatment as high costs and shortages of modern drugs remains imminent.
The World Health Organization estimates that up to 80 percent of people in the developing world still rely on herbal remedies for their health care. It has thus adopted a deliberate policy of encouraging the development and utilization of traditional medicine in HIV treatment and care.
In Uganda, it is estimated that 70 percent of Ugandans infected with HIV go back to nature and consult traditional herbalists for treatment as various symptoms present. But herbalists feel there is still a lot of stigma with the use of herbs in HIV/Aids although it remains a sustainable way in HIV treatment.
“When a client goes for HIV treatment they do not mention their use of traditional medicine. Yet the drug interaction between herbs and anti-retroviral drugs could be dangerous,” said Ms. Primrose Kyeyune, a technical advisor, Traditional and Modern Health Practitioners Together Against AIDS (THETA)
Experts say the attitude towards traditional medicine use is bad because people do not want to be associated with it.
Stigma Still High Among Users of Herbal Remedies for HIV
“People stigmatize herbal medicine but they buy it every day and prefer herbal products to modern medicines,” said Kyeyune.
According to THETA officials stigma can only be reduced through training and counseling of both the herbalists and the HIV patients. Started in 1992, THETA is a Uganda non-government organization that has been working with traditional healers in Uganda especially in HIV/AIDS prevention and care.
With THETA trainings most herbalists have changed their ways of administering herbs in HIV treatment and care. Many now can identify the dangerous HIV symptoms and refer patients to health facilities to test for HIV. They have also been trained to do record keeping, maintain minimum standards of hygiene and offer counseling.
“Originally herbalists used to claim that they heal HIV but with our training, they now have knowledge that it is not curable,” said Grace Nanyonga, the information officer at THETA.
THETA has trained the herbalists to understand the HIV cycle, which has ensured that most of them know that they can only treat symptoms but cannot heal HIV.
Working as a team the herbalists have now come up with herbs for HIV that can boost the immune system, relieve Herpes Zoster, diarrhea, skin diseases and oral thrush, all opportunistic infections of Aids.
Some of the herbs have been investigated at the research Laboratory in Wandegeya, a Kampala suburb and found to have active substances that are therapeutically useful.
Training for Herbalists
Ssenga Bernadette Nabatanzi a herbalist says since she joined THETA and trained under the Regional Aids Training Network (RATN) her way of treating patients has changed.
“I am now able to keep records of my clients- like the date, age, physical and telephone contacts, next of kin, type of disease or symptoms, and the medicine, which I have administered.”
“In practice, I cannot cut patients with the same razor blade anymore and the patients do not accept because they know their rights. They no more can take herbs which we spit on,” said Nabatanzi a reproductive health specialist.
Nabatanzi says with limited time and long lines of patients, most doctors using modern medicines do not have the time to counsel patients and gain their trust. However, herbalists who are usually permanent residents of the community, are always available and have a lot of time to administer in-depth counseling.
THETA has integrated HIV/Aids information into counseling relating HIV to culture, which enables the patients to feel better. In counseling HIV patients, the herbalists are encouraged to prepare, persuade, and request those who have symptoms to go and check for HIV.
“Usually when they test and find that they are HIV positive they come back and consult me. They confide in me because most herbalists become their confidants and counselors,” said Nabatanzi who also advises on a good diet.
For their services, the herbalists or counselors accept cash payments in installments or in-kind - beans, goats, chicken. The herbalists have also been taught about minimum standards of hygiene- toilets, clean drinking water, well lit and ventilated clinics to not get infected with tuberculosis.
“I am well respected in the society, and the community prefers coming to my clinic,” said Suleiman Nkuutu a herbalist.
But as the communities continue to seek herbalists’ services and trust them, these continue to charge exorbitant fees and with no law to regulate them some administer fake herbs.
THETA also has a problem with those that get so rich as most of them eventually become untrainable, rigid, secretive- they fear that their concoctions will be stolen- so they work at night.
Still, medical practitioners medics treat herbalists with a lot of suspicion and disregard. However, THETA official says that with continued training the gap is getting closed as they start appreciating each other’s role. THETA officials say they can work with all those that fall in the WHO definition of traditional herbalists including those who sacrifice children.
“We would wish to have the witches who sacrifice children on board so that we educate them to stop the practice. If the government can support us we can come together and train all of them,” said Ms. Kyeyune.
Ends-
When the cock crows and birds fly out of their nests early morning, the African herbalists rise with the sun to go to the forests.
There, they pick fresh leaves, peel the new bark off trees and dig plant roots from the soft ground before the sun hardens it. They then apply the knowledge most of them acquired from their ancestors.
Traditional herbalists are custodians of knowledge on herbal concoctions that are used by millions of Africans to survive. In Uganda, they are big contributors to HIV treatment as high costs and shortages of modern drugs remains imminent.
The World Health Organization estimates that up to 80 percent of people in the developing world still rely on herbal remedies for their health care. It has thus adopted a deliberate policy of encouraging the development and utilization of traditional medicine in HIV treatment and care.
In Uganda, it is estimated that 70 percent of Ugandans infected with HIV go back to nature and consult traditional herbalists for treatment as various symptoms present. But herbalists feel there is still a lot of stigma with the use of herbs in HIV/Aids although it remains a sustainable way in HIV treatment.
“When a client goes for HIV treatment they do not mention their use of traditional medicine. Yet the drug interaction between herbs and anti-retroviral drugs could be dangerous,” said Ms. Primrose Kyeyune, a technical advisor, Traditional and Modern Health Practitioners Together Against AIDS (THETA)
Experts say the attitude towards traditional medicine use is bad because people do not want to be associated with it.
Stigma Still High Among Users of Herbal Remedies for HIV
“People stigmatize herbal medicine but they buy it every day and prefer herbal products to modern medicines,” said Kyeyune.
According to THETA officials stigma can only be reduced through training and counseling of both the herbalists and the HIV patients. Started in 1992, THETA is a Uganda non-government organization that has been working with traditional healers in Uganda especially in HIV/AIDS prevention and care.
With THETA trainings most herbalists have changed their ways of administering herbs in HIV treatment and care. Many now can identify the dangerous HIV symptoms and refer patients to health facilities to test for HIV. They have also been trained to do record keeping, maintain minimum standards of hygiene and offer counseling.
“Originally herbalists used to claim that they heal HIV but with our training, they now have knowledge that it is not curable,” said Grace Nanyonga, the information officer at THETA.
THETA has trained the herbalists to understand the HIV cycle, which has ensured that most of them know that they can only treat symptoms but cannot heal HIV.
Working as a team the herbalists have now come up with herbs for HIV that can boost the immune system, relieve Herpes Zoster, diarrhea, skin diseases and oral thrush, all opportunistic infections of Aids.
Some of the herbs have been investigated at the research Laboratory in Wandegeya, a Kampala suburb and found to have active substances that are therapeutically useful.
Training for Herbalists
Ssenga Bernadette Nabatanzi a herbalist says since she joined THETA and trained under the Regional Aids Training Network (RATN) her way of treating patients has changed.
“I am now able to keep records of my clients- like the date, age, physical and telephone contacts, next of kin, type of disease or symptoms, and the medicine, which I have administered.”
“In practice, I cannot cut patients with the same razor blade anymore and the patients do not accept because they know their rights. They no more can take herbs which we spit on,” said Nabatanzi a reproductive health specialist.
Nabatanzi says with limited time and long lines of patients, most doctors using modern medicines do not have the time to counsel patients and gain their trust. However, herbalists who are usually permanent residents of the community, are always available and have a lot of time to administer in-depth counseling.
THETA has integrated HIV/Aids information into counseling relating HIV to culture, which enables the patients to feel better. In counseling HIV patients, the herbalists are encouraged to prepare, persuade, and request those who have symptoms to go and check for HIV.
“Usually when they test and find that they are HIV positive they come back and consult me. They confide in me because most herbalists become their confidants and counselors,” said Nabatanzi who also advises on a good diet.
For their services, the herbalists or counselors accept cash payments in installments or in-kind - beans, goats, chicken. The herbalists have also been taught about minimum standards of hygiene- toilets, clean drinking water, well lit and ventilated clinics to not get infected with tuberculosis.
“I am well respected in the society, and the community prefers coming to my clinic,” said Suleiman Nkuutu a herbalist.
But as the communities continue to seek herbalists’ services and trust them, these continue to charge exorbitant fees and with no law to regulate them some administer fake herbs.
THETA also has a problem with those that get so rich as most of them eventually become untrainable, rigid, secretive- they fear that their concoctions will be stolen- so they work at night.
Still, medical practitioners medics treat herbalists with a lot of suspicion and disregard. However, THETA official says that with continued training the gap is getting closed as they start appreciating each other’s role. THETA officials say they can work with all those that fall in the WHO definition of traditional herbalists including those who sacrifice children.
“We would wish to have the witches who sacrifice children on board so that we educate them to stop the practice. If the government can support us we can come together and train all of them,” said Ms. Kyeyune.
Ends-
Tuesday, November 30, 2010
Makerere University College of Health Sciences Releases Report On Uganda Media Coverage Of Health Research Issues
By Esther Nakkazi
The Uganda media could be saturated with heath system issues but their content minimally refers to research, keeping researchers’ findings on the shelves.
A study titled; ‘From Paper to Mike: An analysis of Health Systems Reporting In Uganda’s Print and Radio Media’, revealed that health systems researchers’ voices and their findings were missing in the articles.
“There seems to be limited interaction between researchers and the media. I am aware that so much research is done but very little is reported in the media and this suggests for a closer working relationship between the media and heath researchers,” said Dr. Anne Katahoire, the principal investigator of the research study.
“Researchers do not trust many journalists for fear that they (journalists) will misrepresent the research findings. That this is partly because journalists do not take adequate time to study and understand carefully the messages being conveyed by the study findings. Also sometimes journalist just wish to sensationalize the findings,” said Nelson Sewankambo the Principal, Makerere University College of Health Sciences.
The study was conducted in the months of March-June 2010 by a multidisciplinary team, from the media and academia led by Makerere University and funded by Research Matters, a collaboration between the Swiss Agency for Development and Cooperation (SDC) and the International Development Research Centre (IDRC).
Nasreen Jessani, IDRC’s Health Program Officer for East and Southern Africa highlighted that “With increasing attention being paid to evidence informed decision-making, it is critical to recognize the role of the media as a ‘broker’ between researchers and decision-makers as well as between researchers and the general public.”
“In Uganda, we need to better understand the context within which researchers, decision-makers and media are interacting so as to better plan for enhanced use of new knowledge in policy and practice.”
The team analyzed over 100 newspaper articles from four local newspapers and 72 radio programmes covering the four regions of Uganda. In-depth interviews with health researchers, reporters, editors, and radio health program presenters and producers were also done.
Through these they explored the coverage of health issues in the media paying attention to the extent to which, journalists used research based evidence and the processes through which research gets or does not get into published articles in the newspapers and health programmes on radio.
The study, like no other done in this area, paid particular attention to the reporters behind the stories in terms of their background training and orientation.
All the newspapers reviewed had health magazines pull outs and the radio stations aired health related programs at least 2-3 times a week, a fact that showed a healthy coverage of health.
The researchers adopted the WHO health systems definition, as “consisting of all the people and actions whose primary purpose is to promote, restore or maintain health”.
This included formal health services including the professional delivery of personal medical attention, actions by traditional healers, all use of medication- prescribed by a provider or not.
It also had home care of the sick; traditional public health activities like health promotion and disease prevention, and other health enhancing interventions like road and environmental safety improvement. The articles identified in each of the newspapers were classified under these categories.
The study found that the majority of health system articles were on disease prevention and health promotion while the articles on the formal health services were more of critics of what was happening in the formal health services in the country but the majority was not informed by health systems research
Of all the published articles reviewed, almost none were based on health systems research in Uganda, for those that referred to some research reports; the research was most likely not conducted in Uganda.
In broadcasting media, it was found that radio programs on health were largely driven and sustained by sponsors (commercial or institutional) who determined the topics, the program running flow and were largely skewed toward disease prevention of the well funded diseases like HIV/AIDS and malaria.
Ideally, health programs on radio would be driven by communities’ health needs or the professional choices of the producers or presenters. But most of the program presenters were also not trained, noted the study.
Newspaper articles were however, largely driven by community questions and were reporters and editors featured a particular health topic, they were driven by what they had either experienced in their own interaction with health system or that of someone they knew.
Indeed, the newspaper articles covered a larger spectrum of health issues relative to radio.
The study was premised on the assumption that the media, an important stakeholder in health systems research could potentially influence policy and public attitudes through its role of sensitization and publicity.
“Reporting should stimulate interest among the readers and debate on important findings that may affect policy development, change in health practices and the behavior of people that impacts on their health,” commented Prof Sewankambo.
Recommendations
“Both the media and the health researchers need to work on their attitudes towards each other. The media portrays researchers as exploitative and as using people as guinea pigs while health researchers have a dismissive attitude towards the media,” said the study.
“Our team found that there are different efforts towards this cause but more needs done. Researchers need to recognize that the media is an important stakeholder in research,” said Dr. Katahoire.
This entails a need for communication budgets in research, engagement of the media in the research process and more face-to-face interactions between the journalists and health researchers.
But also, health research funders need to devote funds for communicating the research findings to the public. If this were done it would improve the links between the media and researchers as well as media reporting of health research, according to the research team.
“This is a strategy that has been recognized and supported by many funders but requires buy-in and mutual trust from a number of players” asserted Ms. Jessani.
“In addition in requires a new cadre of professionals – one that straddles the worlds of research and the worlds of communication. Funding communication is necessary but not entirely sufficient. Adequate skills are required that allow for the distillation and repackaging of research results into different forms for different audiences.”
The research team included Dr. Anne. Ruhweza Katahoire the director, Child Health and Development Centre, School of Medicine College of Health Sciences, Makerere University; Doris Kwesiga a researcher with Makerere University; Esther Nakkazi a freelance science journalist; and Hannington Muyenje the outgoing Country Project Director, BBC world Service Trust in Uganda.
The Uganda media could be saturated with heath system issues but their content minimally refers to research, keeping researchers’ findings on the shelves.
A study titled; ‘From Paper to Mike: An analysis of Health Systems Reporting In Uganda’s Print and Radio Media’, revealed that health systems researchers’ voices and their findings were missing in the articles.
“There seems to be limited interaction between researchers and the media. I am aware that so much research is done but very little is reported in the media and this suggests for a closer working relationship between the media and heath researchers,” said Dr. Anne Katahoire, the principal investigator of the research study.
“Researchers do not trust many journalists for fear that they (journalists) will misrepresent the research findings. That this is partly because journalists do not take adequate time to study and understand carefully the messages being conveyed by the study findings. Also sometimes journalist just wish to sensationalize the findings,” said Nelson Sewankambo the Principal, Makerere University College of Health Sciences.
The study was conducted in the months of March-June 2010 by a multidisciplinary team, from the media and academia led by Makerere University and funded by Research Matters, a collaboration between the Swiss Agency for Development and Cooperation (SDC) and the International Development Research Centre (IDRC).
Nasreen Jessani, IDRC’s Health Program Officer for East and Southern Africa highlighted that “With increasing attention being paid to evidence informed decision-making, it is critical to recognize the role of the media as a ‘broker’ between researchers and decision-makers as well as between researchers and the general public.”
“In Uganda, we need to better understand the context within which researchers, decision-makers and media are interacting so as to better plan for enhanced use of new knowledge in policy and practice.”
The team analyzed over 100 newspaper articles from four local newspapers and 72 radio programmes covering the four regions of Uganda. In-depth interviews with health researchers, reporters, editors, and radio health program presenters and producers were also done.
Through these they explored the coverage of health issues in the media paying attention to the extent to which, journalists used research based evidence and the processes through which research gets or does not get into published articles in the newspapers and health programmes on radio.
The study, like no other done in this area, paid particular attention to the reporters behind the stories in terms of their background training and orientation.
All the newspapers reviewed had health magazines pull outs and the radio stations aired health related programs at least 2-3 times a week, a fact that showed a healthy coverage of health.
The researchers adopted the WHO health systems definition, as “consisting of all the people and actions whose primary purpose is to promote, restore or maintain health”.
This included formal health services including the professional delivery of personal medical attention, actions by traditional healers, all use of medication- prescribed by a provider or not.
It also had home care of the sick; traditional public health activities like health promotion and disease prevention, and other health enhancing interventions like road and environmental safety improvement. The articles identified in each of the newspapers were classified under these categories.
The study found that the majority of health system articles were on disease prevention and health promotion while the articles on the formal health services were more of critics of what was happening in the formal health services in the country but the majority was not informed by health systems research
Of all the published articles reviewed, almost none were based on health systems research in Uganda, for those that referred to some research reports; the research was most likely not conducted in Uganda.
In broadcasting media, it was found that radio programs on health were largely driven and sustained by sponsors (commercial or institutional) who determined the topics, the program running flow and were largely skewed toward disease prevention of the well funded diseases like HIV/AIDS and malaria.
Ideally, health programs on radio would be driven by communities’ health needs or the professional choices of the producers or presenters. But most of the program presenters were also not trained, noted the study.
Newspaper articles were however, largely driven by community questions and were reporters and editors featured a particular health topic, they were driven by what they had either experienced in their own interaction with health system or that of someone they knew.
Indeed, the newspaper articles covered a larger spectrum of health issues relative to radio.
The study was premised on the assumption that the media, an important stakeholder in health systems research could potentially influence policy and public attitudes through its role of sensitization and publicity.
“Reporting should stimulate interest among the readers and debate on important findings that may affect policy development, change in health practices and the behavior of people that impacts on their health,” commented Prof Sewankambo.
Recommendations
“Both the media and the health researchers need to work on their attitudes towards each other. The media portrays researchers as exploitative and as using people as guinea pigs while health researchers have a dismissive attitude towards the media,” said the study.
“Our team found that there are different efforts towards this cause but more needs done. Researchers need to recognize that the media is an important stakeholder in research,” said Dr. Katahoire.
This entails a need for communication budgets in research, engagement of the media in the research process and more face-to-face interactions between the journalists and health researchers.
But also, health research funders need to devote funds for communicating the research findings to the public. If this were done it would improve the links between the media and researchers as well as media reporting of health research, according to the research team.
“This is a strategy that has been recognized and supported by many funders but requires buy-in and mutual trust from a number of players” asserted Ms. Jessani.
“In addition in requires a new cadre of professionals – one that straddles the worlds of research and the worlds of communication. Funding communication is necessary but not entirely sufficient. Adequate skills are required that allow for the distillation and repackaging of research results into different forms for different audiences.”
The research team included Dr. Anne. Ruhweza Katahoire the director, Child Health and Development Centre, School of Medicine College of Health Sciences, Makerere University; Doris Kwesiga a researcher with Makerere University; Esther Nakkazi a freelance science journalist; and Hannington Muyenje the outgoing Country Project Director, BBC world Service Trust in Uganda.
Friday, October 8, 2010
Uganda introduces kits to cut malaria treatment costs
By Esther Nakkazi
Uganda will reintroduce malaria test kits in health facilities nationwide to facilitate malaria diagnosis that could improve the management of the disease.
From next month, National Medical Stores (NMS), the Uganda government’s supplier of pharmaceuticals products, will distribute Rapid Diagnostic Tests (RDTs) that could save thousands of doses of anti-malarials.
The RDTs will enable health workers to detect the presence of malaria within a few seconds cutting down on over diagnosis, time and over prescription of malaria, health experts say.
Research has established that for every 20,000 doses supplied per month to a district, up to 16,000 doses of anti-malarials are saved when health workers use RDTs.
Some of the $90 million from the Global Fund and government resources will be used to buy RDTs that will not only stop presumptive diagnosis, a common practice among most health workers but also avert a tendency of stocking medicines in houses that has cropped up.
Presumptive treatment identifies the likely condition a patient has; it is widely practiced where microscopy or RDTS are not readily available.
Most health workers use presumptive diagnosis, giving all patients anti-malarials after they present with headaches, fever and loss of appetite. In most cases the health workers are ‘playing safe’ especially with children who progress rapidly to severe malaria and death.
But also recently after the switch from the user driven for drug selection and quantification-pull system to the ‘modified’ push system where government estimates pharmaceutical supplies required, the public has adopted a tendency to pick drugs even when they are not sick.
“People line up pretending to have all sorts of illnesses especially malaria and keep the medicines for a rainy day while others sell them off,” said Moses Kamabare the General Manager, National Medical Stores.
Typically when NMS delivers medicines to health facilities, which is once every two months, in just about 2 weeks the Coartem would be finished. “RDTs would ensure that they pick medicines especially Coartem, which is very expensive only when required.”
There is no doubt that using RDTs is a cost effective venture in the treatment of malaria as has been tested in Zanzibar and Ghana. In Uganda, Government supplies free ACTs to all government health facilities but on the open market a dose costs Ushs 15,000 ($7).
Indeed, when an RDT test is administered that turns out negative, Ushs 10,000 ($4) would be saved for every patient. This would save lots of money as few people who claim to have malaria actually have it, but would also ensure reduction of over exposure of the population to drug toxicity.
A study by Malaria Consortium Uganda, found that use of RDTs resulted in a 2-fold reduction in anti-malarial drug prescription at Low Level Health Care Facilities (LLHCFs). The study entitled the ‘Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda’ was published in July 2010.
Research shows that 90 percent of the times when the RDT test is positive, the patients have malaria, but the test also picks past infection in the last 2 weeks.
“It is important that those who come in and the test is negative are not given anti-malarials because the test would be 98 percent negative,” said Dr. Kyabayinze.
With the study results government is working on a policy that will ensure that all people who are treated with anti-malarials first get a malaria test.
Ends-
Uganda will reintroduce malaria test kits in health facilities nationwide to facilitate malaria diagnosis that could improve the management of the disease.
From next month, National Medical Stores (NMS), the Uganda government’s supplier of pharmaceuticals products, will distribute Rapid Diagnostic Tests (RDTs) that could save thousands of doses of anti-malarials.
The RDTs will enable health workers to detect the presence of malaria within a few seconds cutting down on over diagnosis, time and over prescription of malaria, health experts say.
Research has established that for every 20,000 doses supplied per month to a district, up to 16,000 doses of anti-malarials are saved when health workers use RDTs.
Some of the $90 million from the Global Fund and government resources will be used to buy RDTs that will not only stop presumptive diagnosis, a common practice among most health workers but also avert a tendency of stocking medicines in houses that has cropped up.
Presumptive treatment identifies the likely condition a patient has; it is widely practiced where microscopy or RDTS are not readily available.
Most health workers use presumptive diagnosis, giving all patients anti-malarials after they present with headaches, fever and loss of appetite. In most cases the health workers are ‘playing safe’ especially with children who progress rapidly to severe malaria and death.
But also recently after the switch from the user driven for drug selection and quantification-pull system to the ‘modified’ push system where government estimates pharmaceutical supplies required, the public has adopted a tendency to pick drugs even when they are not sick.
“People line up pretending to have all sorts of illnesses especially malaria and keep the medicines for a rainy day while others sell them off,” said Moses Kamabare the General Manager, National Medical Stores.
Typically when NMS delivers medicines to health facilities, which is once every two months, in just about 2 weeks the Coartem would be finished. “RDTs would ensure that they pick medicines especially Coartem, which is very expensive only when required.”
There is no doubt that using RDTs is a cost effective venture in the treatment of malaria as has been tested in Zanzibar and Ghana. In Uganda, Government supplies free ACTs to all government health facilities but on the open market a dose costs Ushs 15,000 ($7).
Indeed, when an RDT test is administered that turns out negative, Ushs 10,000 ($4) would be saved for every patient. This would save lots of money as few people who claim to have malaria actually have it, but would also ensure reduction of over exposure of the population to drug toxicity.
A study by Malaria Consortium Uganda, found that use of RDTs resulted in a 2-fold reduction in anti-malarial drug prescription at Low Level Health Care Facilities (LLHCFs). The study entitled the ‘Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda’ was published in July 2010.
Dr. Daniel Kyabayinze the principal investigator of the study said they found that when RDTs are administered only 20-40 percent of patients who claim to have malaria would have it, so it is very cost effective.
The study says that nationwide deployment of RDTs in a systematic manner should be prioritized to improve fever case management but cautions that there is need to further educate health workers about use of RDTs in order to maximize acceptance.
The study says that nationwide deployment of RDTs in a systematic manner should be prioritized to improve fever case management but cautions that there is need to further educate health workers about use of RDTs in order to maximize acceptance.
“The study found that 1/3 times a person will have a negative test but the health worker will give them anti-malarials anyway,” says Dr. Kyabayinze from Malaria Consortium Uganda.
In the study, health workers said they treat RDT-negative patients because they are afraid of challenges of severe malaria given the long distances to the referral hospitals in case need arises.
Also, among negative patients with RDT results, children under five years were nearly 3 times with more likely to receive anti-malarials relative to older patients, a practice that is in line with the national malaria treatment policy.
The policy encourages presumptive treatment of malaria to reduce malaria-associated morbidity among the under-five age group who contribute a third of the anti-malarial prescriptions for RDT negative results.
In the study, health workers said they treat RDT-negative patients because they are afraid of challenges of severe malaria given the long distances to the referral hospitals in case need arises.
Also, among negative patients with RDT results, children under five years were nearly 3 times with more likely to receive anti-malarials relative to older patients, a practice that is in line with the national malaria treatment policy.
The policy encourages presumptive treatment of malaria to reduce malaria-associated morbidity among the under-five age group who contribute a third of the anti-malarial prescriptions for RDT negative results.
“It is likely that health workers found it socially acceptable to offer anti-malarials to RDT negative patients but also that they appreciate the medical care provided,” says the study. But there are also questions of the accuracy of RDTs in diagnosis.
Research shows that 90 percent of the times when the RDT test is positive, the patients have malaria, but the test also picks past infection in the last 2 weeks.
“It is important that those who come in and the test is negative are not given anti-malarials because the test would be 98 percent negative,” said Dr. Kyabayinze.
With the study results government is working on a policy that will ensure that all people who are treated with anti-malarials first get a malaria test.
Ends-
Wednesday, October 6, 2010
Uganda: What causes Jiggers?
By Esther Nakkazi
In the eastern part of Uganda, live the Basoga, a Bantu group who speak Lusoga. Lately, the media have been awash with the Basoga being infected with jiggers. Recently, a three months baby died of jiggers according to the local press.
The mystery of the cause of jiggers has been politicised and even exaggerated. While the medics attribute jiggers to poor hygiene especially for people sharing accommodation with animals, economists say it is due to chronic poverty - after all research shows that the highest poverty density in Uganda is in Busoga.
The politicians have blamed jiggers on political discrimination in the area by the ruling government. The religious people have said God is angry with the Basoga so the jiggers are a punishment while traditionists are convinced that wizards are active in that area. Some myths have suggested that the jiggers attack mentally retarded people.
Now the environmentalists headed by (Dr. Afunaduula) say we need an environmental approach to eradicate them. However, in the old times, even today the herbalists recommend that after extraction, they put red chilies (pepper) in the wound.
In an effort to eradicate them many volunteers have been to the jigger infested areas and their approach is to help extract them from feet, hands, and bodies of course with cameras recording their good works. But nothing has worked.
Although floods of people showed up to be treated, some schools refused their pupils to go saying it would bring shame to the school!
At the campaign led by the deputy speaker of Parliament, Rebecca Kadaga, a Musoga who comes from eastern Uganda, villagers were treated and taught good hygiene practices like smearing cow dung on the walls and floor of their mud houses.
Cleary something needs to be done about these jiggers killing people in this century! But it is a question of good hygiene and that does not need much debate and unfounded myths.
In the eastern part of Uganda, live the Basoga, a Bantu group who speak Lusoga. Lately, the media have been awash with the Basoga being infected with jiggers. Recently, a three months baby died of jiggers according to the local press.
The mystery of the cause of jiggers has been politicised and even exaggerated. While the medics attribute jiggers to poor hygiene especially for people sharing accommodation with animals, economists say it is due to chronic poverty - after all research shows that the highest poverty density in Uganda is in Busoga.
The politicians have blamed jiggers on political discrimination in the area by the ruling government. The religious people have said God is angry with the Basoga so the jiggers are a punishment while traditionists are convinced that wizards are active in that area. Some myths have suggested that the jiggers attack mentally retarded people.
Now the environmentalists headed by (Dr. Afunaduula) say we need an environmental approach to eradicate them. However, in the old times, even today the herbalists recommend that after extraction, they put red chilies (pepper) in the wound.
In an effort to eradicate them many volunteers have been to the jigger infested areas and their approach is to help extract them from feet, hands, and bodies of course with cameras recording their good works. But nothing has worked.
Although floods of people showed up to be treated, some schools refused their pupils to go saying it would bring shame to the school!
At the campaign led by the deputy speaker of Parliament, Rebecca Kadaga, a Musoga who comes from eastern Uganda, villagers were treated and taught good hygiene practices like smearing cow dung on the walls and floor of their mud houses.
Cleary something needs to be done about these jiggers killing people in this century! But it is a question of good hygiene and that does not need much debate and unfounded myths.
Tuesday, September 7, 2010
Everyone has a role to achieve Millennium Development Goals
By Esther Nakkazi
Africa could be on track to achieve most of the Millennium Development Goals (MDGs) but some of its gains have been eroded by climate change, armed conflicts and unmet commitments for resources by the international community.
But this year, which marks five years to 2015, the target year for MDGs, shows that the goals are attainable though the pace of progress needs to be increased.
Recently, UN Secretary-General Ban Ki-moon announced the development of a Joint Action Plan to be launched this month at the MDG review Summit to intensify the global effort to meet the goals.
So this September, world leaders will meet to agree on strategies and actions to meet the Goals, which represents human needs and basic rights that every individual around should enjoy.
“The world posses the resources and knowledge to ensure that even the poorest countries, and others held back by disease, geographic isolation or civil strife, can be empowered to achieve the MDGs,” said Ban Ki-Moon.
Ban Ki-Moon says meeting the goals is everyone’s business as falling short would multiply the dangers of the world.
In Africa, there are improvements made to attain the MDGs but they are slow while the hard won gains are eroded by food and economic crises as well as climate change.
Experts say Africa could have a chance to reach the target for access to clean water and it is still on track to achieve the MDG target of cutting the rate of extreme poverty in half by 2015, says the UN 2010 report.
Robust growth in the first half of the decade reduced the number of people in Africa living on less than $1.25 a day from 1.8 billion in 1990 to 1.4 billion, while the poverty rate dropped from 46 to 27 percent.
“Many countries are moving forward, including some of the poorest, demonstrating that setting bold, collective goals in the fight against poverty yields results,” says the report.
At the global level, the poverty rate is expected to fall to 15 percent by 2015, just about 920 million people living under the international poverty line, half the number in 1990.
Africa has also made strides in getting children into primary schools with enrollment reaching 89 percent. The 2010 UN report shows that the total number of children out of school decreased from 106 to 69 million in 1999-2008, almost half of the number of these in sub-Saharan Africa.
According to experts from UNESCO, this is encouraging because education is the single one intervention that is likely to have a multiplier effect on progress across all the MDGs.
One year of schooling can increase a person’s earnings by 10 percent and lift their average annual GDP by 0.37 percent, according to a UNESCO report. The girl child- has benefited from this more, as overall more girls are now in school today in Africa with at least three million more children enrolled in school in Ethiopia and more than double in Benin compared with the number in 2000.
Increase in school enrollment has been aided by the abolition of school fees for instance in Burundi, a threefold increase to 99 percent in primary school enrollment was realized in 2008. Tanzania doubled its enrollment ratio over the same period.
Strong interventions have also been made in addressing HIV/AIDS, malaria and child health for instance increasing the number of people receiving anti-retroviral drugs.
According to the 2010 MDGs report, comprehensive and correct knowledge of HIV increased by 10 percentage points or more among women aged 15-24 years.
Between 2000-2008 Rwanda reported 50 percent and more in knowledge about HIV prevention among women and similar progress was made by Namibia.
But there are two MDGs that seem to be unattainable although commitment with resources to address them has been made.
MDGs 4 and 5 which call for reductions in the number of deaths among children under 5 by two thirds, and reducing maternal deaths by three-quarters by 2015. Africa will need $32 million for interventions to attain them.
Although under five-year-old mortality rates in sub-Saharan Africa declined by 22 percent since 1990, this rate is still insufficient to meet the target.
Studies show that all the countries with under five mortality rates exceeding100 per 1,000 live births in 2008 are in sub-Saharan Africa except Afghanistan.
Less than half the women giving birth in Africa get skilled health care when giving birth, but disparities also exists in rich and poor households, says Sha Zukang, the UN under secretary General for economic and social affairs.
According to the UN 2010 report women in rich households are 1.7 times more likely to visit a skilled health worker at least once before birth than the poorest women. Also contraceptive use among educated women is four times higher than those with no education as access is a big problem.
In Africa for every woman who dies, at least 20 other suffer injuries, infections and disabilities, like obstetric fistula but Countdown to 2015 report emphasizes that almost all maternal deaths are preventable.
This is because complications during pregnancy and childbirth are the leading cause of death for women of childbearing age, which can all be dealt with. Countdown to 2015, a global scientific and advocacy movement in its 2010 report, found that 49 out of the 68 high burden countries are not on track to meet MDG 4 on child health. While Botswana, Egypt, Eritrea, Malawi and Morocco are on track to achieving improved maternal health.
The Millennium Declaration represents the most important promise ever made to the world’s most vulnerable people, says Zukang. Accelerated action needs to be done. But it is for each one of us to play a role to attain the MDGs.
Ends-
Africa could be on track to achieve most of the Millennium Development Goals (MDGs) but some of its gains have been eroded by climate change, armed conflicts and unmet commitments for resources by the international community.
But this year, which marks five years to 2015, the target year for MDGs, shows that the goals are attainable though the pace of progress needs to be increased.
Recently, UN Secretary-General Ban Ki-moon announced the development of a Joint Action Plan to be launched this month at the MDG review Summit to intensify the global effort to meet the goals.
So this September, world leaders will meet to agree on strategies and actions to meet the Goals, which represents human needs and basic rights that every individual around should enjoy.
“The world posses the resources and knowledge to ensure that even the poorest countries, and others held back by disease, geographic isolation or civil strife, can be empowered to achieve the MDGs,” said Ban Ki-Moon.
Ban Ki-Moon says meeting the goals is everyone’s business as falling short would multiply the dangers of the world.
In Africa, there are improvements made to attain the MDGs but they are slow while the hard won gains are eroded by food and economic crises as well as climate change.
Experts say Africa could have a chance to reach the target for access to clean water and it is still on track to achieve the MDG target of cutting the rate of extreme poverty in half by 2015, says the UN 2010 report.
Robust growth in the first half of the decade reduced the number of people in Africa living on less than $1.25 a day from 1.8 billion in 1990 to 1.4 billion, while the poverty rate dropped from 46 to 27 percent.
“Many countries are moving forward, including some of the poorest, demonstrating that setting bold, collective goals in the fight against poverty yields results,” says the report.
At the global level, the poverty rate is expected to fall to 15 percent by 2015, just about 920 million people living under the international poverty line, half the number in 1990.
Africa has also made strides in getting children into primary schools with enrollment reaching 89 percent. The 2010 UN report shows that the total number of children out of school decreased from 106 to 69 million in 1999-2008, almost half of the number of these in sub-Saharan Africa.
According to experts from UNESCO, this is encouraging because education is the single one intervention that is likely to have a multiplier effect on progress across all the MDGs.
One year of schooling can increase a person’s earnings by 10 percent and lift their average annual GDP by 0.37 percent, according to a UNESCO report. The girl child- has benefited from this more, as overall more girls are now in school today in Africa with at least three million more children enrolled in school in Ethiopia and more than double in Benin compared with the number in 2000.
Increase in school enrollment has been aided by the abolition of school fees for instance in Burundi, a threefold increase to 99 percent in primary school enrollment was realized in 2008. Tanzania doubled its enrollment ratio over the same period.
Strong interventions have also been made in addressing HIV/AIDS, malaria and child health for instance increasing the number of people receiving anti-retroviral drugs.
According to the 2010 MDGs report, comprehensive and correct knowledge of HIV increased by 10 percentage points or more among women aged 15-24 years.
Between 2000-2008 Rwanda reported 50 percent and more in knowledge about HIV prevention among women and similar progress was made by Namibia.
But there are two MDGs that seem to be unattainable although commitment with resources to address them has been made.
MDGs 4 and 5 which call for reductions in the number of deaths among children under 5 by two thirds, and reducing maternal deaths by three-quarters by 2015. Africa will need $32 million for interventions to attain them.
Although under five-year-old mortality rates in sub-Saharan Africa declined by 22 percent since 1990, this rate is still insufficient to meet the target.
Studies show that all the countries with under five mortality rates exceeding100 per 1,000 live births in 2008 are in sub-Saharan Africa except Afghanistan.
Less than half the women giving birth in Africa get skilled health care when giving birth, but disparities also exists in rich and poor households, says Sha Zukang, the UN under secretary General for economic and social affairs.
According to the UN 2010 report women in rich households are 1.7 times more likely to visit a skilled health worker at least once before birth than the poorest women. Also contraceptive use among educated women is four times higher than those with no education as access is a big problem.
In Africa for every woman who dies, at least 20 other suffer injuries, infections and disabilities, like obstetric fistula but Countdown to 2015 report emphasizes that almost all maternal deaths are preventable.
This is because complications during pregnancy and childbirth are the leading cause of death for women of childbearing age, which can all be dealt with. Countdown to 2015, a global scientific and advocacy movement in its 2010 report, found that 49 out of the 68 high burden countries are not on track to meet MDG 4 on child health. While Botswana, Egypt, Eritrea, Malawi and Morocco are on track to achieving improved maternal health.
The Millennium Declaration represents the most important promise ever made to the world’s most vulnerable people, says Zukang. Accelerated action needs to be done. But it is for each one of us to play a role to attain the MDGs.
Ends-
Friday, August 20, 2010
Tweeter pays money in Africa
Last week was a break through, as user of social media in East Africa, Uganda to be able to earn from a new tool Twitter. I keep a twitter account @Nakkazi, but had not thought much about mastering the skill of tweeting until last week.
The East African Internet Governance Forum (EAIGF) 11th to 13th held a meeting in Kampala, Uganda and Maureen Agena a citizen journalist and I, were invited to tweet and blog.
On the tweeter account @#EA_IGF and the blog name http://eaigf-uganda.blogspot.com (check out the stories and tweets) we tweeted away for three days.
The pay was not bad at all, but what is interesting to note in my opinion is, was it because it was an Internet gurus gathering? Almost all the 100 or so participants knew about twitter and were following on the screen in the conference room or on their laptops.
It would also be interesting to have a business model to offer the client a full package with twitter, blog stories with pictures, pod casts and video clips. Let us see if the market can respond to the offer and what prices they would be able to afford so we get in business.
The East African Internet Governance Forum (EAIGF) 11th to 13th held a meeting in Kampala, Uganda and Maureen Agena a citizen journalist and I, were invited to tweet and blog.
On the tweeter account @#EA_IGF and the blog name http://eaigf-uganda.blogspot.com (check out the stories and tweets) we tweeted away for three days.
The pay was not bad at all, but what is interesting to note in my opinion is, was it because it was an Internet gurus gathering? Almost all the 100 or so participants knew about twitter and were following on the screen in the conference room or on their laptops.
It would also be interesting to have a business model to offer the client a full package with twitter, blog stories with pictures, pod casts and video clips. Let us see if the market can respond to the offer and what prices they would be able to afford so we get in business.
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