3-D Printing of Prostheses to Be Trialled in Uganda

Malugimi Musoma

Researchers are to 3-D print cheap, custom-made prosthetics for child amputees in the developing world after winning CAD$112,000 (US$90,000) from the Canadian government.

The money is coming through the Grand Challenges Canada fund, which supports health-related innovation in developing countries.

“There are more than ten million people in the world with amputations, most of whom live in developing countries,” says Mitch Wilkie, director of international programmes at Christian Blind Mission Canada (CBM), the NGO leading the project. “Around 300,000 of them are landmine survivors and this number is growing by about 26,000 people annually.”

Conventional prosthetic sockets for the remaining part of patients’ injured limbs are made using plaster-of-Paris moulds, but these take up to a week to dry in the sun. Children also require at least two fittings a year – equivalent to around 25 prostheses over a lifetime – to adjust for body growth, making the process expensive for their families.

“We are confident that we can expedite this whole process with 3-D scanning and printing,” says Wilkie. The team hopes to produce prostheses in developing countries for around US$250. At present, they cost up to US$5,000 in developed countries.

The first step is to measure a patient’s residual limb using a handheld US$500 infrared laser scanner. This produces a digital, 3-D image in less than a minute through a freely available software called Socketmixer, which is used to design a matching prosthetic socket. The software is automatic, but once users have gained more experience in designing prostheses they can override its features to amend the resulting socket models, according to cbm Canada.

The digital model is then sent to a US$4,000 3-D printer that takes between six and 12 hours – depending on complexity and size – to print a socket using cornstarch-based plastic. The socket connects to a patient’s residual limb and a standard artificial limb provided by aid agencies.

But Martin Twiste, a prosthetics researcher at the University of Salford, United Kingdom, warns that the suggested materials need to be tested for durability before being used more widely.

He adds that the team could consider sending the digital socket image to a 3-D printer elsewhere in the world to avoid the high cost associated with buying one – in cases where the system would be used infrequently.

The CBM Canada team is currently teaching staff from the Comprehensive Rehabilitation Services for Uganda hospital to use the technology. It is also creating and testing sockets for four hospital patients, who already use traditionally made sockets, to gather their feedback.

Over the next six months, the team plans to conduct clinical field trials with 35 patients at the hospital to compare its technology with current methods.

“We want the technology to benefit as many amputees as quickly as possible,” says Wilkie. Should the trials prove successful, the team envisions offering a package comprising a scanner, software, computer, 3-D printer and training for US$10,000 to US$15,000.

[Courtesy AllAfrica News]

Ebola – the search for a vaccine

LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

[Courtesy of IRIN]

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

Liberia: Ebola Hits Family – Personal Stories

International news reports about Liberia leave the impression of overwhelming irrationality in response to the Ebola crisis. It’s true that fear has provoked unfortunate incidents. But many Liberians are working hard and courageously – despite the lack of an international response that would supply the equipment and medical help to stem the virus.

Ebola hit close to home – hard – this month. Two members of my church – one a nun and the other a social worker who had been under 21-day quarantine and observation – both died.

My cousin Enid, an emergency nurse with the health ministry, was under surveillance as well, after coming into contact with an Ebola patient. She was assigned to Kakata, a densely populated trading town in Margibi County, where several health workers had already died and health facilities didn’t have enough personal protective supplies. Our family was worried about her.

Now, she, too, has died. On her Facebook page a few weeks ago, she posted, “Ebola has hit Margibi again. More health workers are being affected this round 2 and some are even dying. Oh God have mercy.” Our family and friends will remember that she caught the virus trying to save others. Rest In Peace, Enid.

But personal losses aren’t stopping Liberians from trying to help ourselves and each other. Whatever you hear about the situation, you should know that people may be frightened, but most of us are working hard to stop the virus.

Ebola has become a household word. When the first case was reported in the northern Lofa area in late March, the chief medical officer, Dr. Bernice Dahn, warned that “the disease is reported to be spreading along the border” Liberia shares with Guinea and Sierra Leone.

Almost every Liberian citizen now knows what Ebola is. Many believe that the virus is real and are taking preventive measures, while others are in denial. But these people who are denying the existence of the Ebola virus in the country still follow the preventive measures, which baffles me.

“I don’t understand some Liberians”, said one of my friends, Derek Berlic. When I asked him why, he said, “Some people go around saying that the virus isn’t real, but yet still they join us and wash their hands and use sanitizers as frequently as those of us that believe that the virus is real.” He said it pleases him when he sees these individuals taking preventive measures, because it signals that somewhere in these people minds, they believe the virus is real, even if they don’t want to admit it.

Most churches have joined the fight against Ebola by carrying on awareness campaigns, talking about it during sermons and placing buckets of water at entrances of the church buildings for members to wash their hands before entering for service. Both Christian and Muslim religious leaders have called on all Liberians to pray for the country – and, at the same time, to take their own preventive measures.

Supermarkets, shops and other business centers are following suit. The three mobile phone companies in Liberia have been using SMS to sensitive their subscribers by sending daily text messages about the virus. Across cities and towns, Liberians have organized themselves in various communities and are promoting awareness.

It seems that almost every Liberian has now become his or her ‘brother’s keeper’ by carrying on sensitization in taxis, clubs, and market places – wherever they find themselves. On Facebook, many Liberians have made their profile pictures Ebola related and their statuses feature awareness messages on a daily basis. Liberian groups on Facebook discuss the situation.

Liberians in the diaspora have organized themselves into mini-groups to send aid, such as gloves and other personal protective equipment, back home to fight this deadly disease. The Liberian ambassador in Washington DC, Jeremiah Sulunteh, announced that the embassy had established an account for those who want to donate.

The alarmingly high death rate from the Ebola virus among health workers has left citizens wondering how they will get medical care for many common illnesses, which can be deadly also, such as malaria. Bodies of suspected Ebola victims being left in the streets or in houses adds to the anxiety.

In this situation, it’s hard to prevent suspicion and misinformation. There were stories of some individuals going around putting dangerous chemicals such as formaldehyde in wells in various communities. The result is that Liberians had to worry about poisonous chemicals being put into water sources as well as about the Ebola virus; but Police Director Col. Chris Massaqoui has since denounced the rumor. He said the police found no evidence that the stories were true.

The president of Liberia, Madam Ellen Johnson Sirleaf, has addressed the nation multiple times, including announcing a three-month state of emergency. She said, “Under the State of Emergency, the Government will institute extraordinary measures, including, if need be, the suspension of certain rights and privileges.”

The government has passed a regulation for only three persons to sit in the back of a taxi to avoid close contact, but even at that, one can’t possibly avoid touching or rubbing against other passengers. On a daily basis, securing transport is a rush-and-fighting thing, which involves considerable contact with other people who are also trying to get a taxi or bus. In my case, the trip to work usually takes two different commercial vehicles. So movement from place to place has become worrisome. Still, people have no choice but to do it.

And there are positive things every Liberian can do. So this is how I spent my weekend. With the organization Girls As Partners, I managed to reach out to ten different churches in the Gardnersville area of Monrovia, giving them buckets, chlorine and soap so their members could adhere to one of the Ebola preventive measures – washing hands. We also gave out leaflets containing facts about Ebola and its prevention.

We’re in the rainy season now, and we had to walk through small rivers to get to some churches, but it was really fun reaching out to others. Would you believe someone was brave enough to ask me whether I had a political motive for doing this? Nevertheless, I say let’s all be our brothers’ and sisters’ keepers and kick Ebola out of Liberia!

[Courtesy AllAfrica News]

Pakistan: Unsafe drinking water causes disability among children worldwide

9 April 2014 KARACHI:

Toxically germ-infested unsafe drinking water is causing different form of disability among children globally, mainly caused by teratogens. 

The excessive use of medication and consuming polluted water results in the development of abnormal cell tissue in unborn as well as newly born babies particularly during foetal growth, yielding a multiplex of physiochemical defects in the foetus. Improper and untreated disposal of sanitary water and untreated industrial waste is resulting in contamination of sub soil water threatening the nature. 

Principal Investigators of South Asian Association for Regional Cooperation (SAARC) Sector’s Academic Alliance for Subsoil Water Toxicity Research Initiative Prof Qadhi Aurangzeb Al Hafi and Pro-Vice Chancellor of Dow University of Health Sciences (DUHS) Prof M Umar Farooq were of the view this was the first time Pakistani researchers’ study has been recognised at United Nations (UN) and Pakistan takes the historic edge of launching the first ever model of Terato-kinetc Research in the recorded history of medical sciences.The groundbreaking research document has been primed for over 1,700 international esteemed universities of the globe, in accordance with the UN mandates and conventions on the subject. 

The first categorical research model was demonstrated at Higher Education Commission (HEC) Pakistan in continuum of the multi academia polygonal scientific colloquia the UN ‘International Observance Day for Disability’, at Dow University of Health Sciences Karachi followed by its academic sessions and scientific symposia at Punjab University and Higher Education Commission of Pakistan. The multi-academic colloquia consist of 9 scientific orientations, 17 confluences, 10 symposia and 19 demonstrations worldwide. 

[Courtesy of Daily Time]

YAOUNDÉ, 26 March 2014 (IRIN) – Three new polio cases have been confirmed in Cameroon over the past two weeks, making it the country’s first outbreak since 2011 and causing alarm among health officials who link the virus’s spread to weak vaccine campaign coverage and displacement following violence in neighbouring northeastern Nigeria and the Central African Republic (CAR).
Cameroon has confirmed seven polio cases since 2013. Just one case is enough to instigate emergency country-wide vaccination measures under the national health policy. It last experienced a polio outbreak in 2009, the strain also identified in Nigeria and Chad.

The World Health Organization (WHO) has said the virus is at a “very high risk” of crossing borders, and one polio case of the same strain as in Cameroon has just been confirmed in Equatorial Guinea, which saw its last case in 1999.

Cameroon has put in place emergency measures to try to contain the virus, but weak or non-existent monitoring in the cross-border areas with Nigeria and CAR is seriously hampering any national efforts, said Paul Onambelle, a doctor at the Cité Vert district hospital in Yaoundé.

The estimated 100,000 refugees in Cameroon who have fled violence in Nigeriaand CAR make control efforts even harder, said Elisse Clarisse Onambany of the National Expanded Program on Immunization (EPI), who insists refugee children must be included in any immunization campaign, “which means the supply and resources needed must increase”, she said. Half of the refugee population is made up of children aged 11 or under, according to the health authorities.

Immunization in the Far North Region has been extended to include some of the children in the Nigerian refugee population, but thousands of children are still not being accessed because of insecurity in the border area with Nigeria, families being continually on the move, and difficult terrain, said Maria Enjema, a nurse at Far North district hospital of Maroua. “Despite continuous effort by the government to reduce the risk of polio in the north, it is very difficult for health workers to reach all the children, particularly those living along the borders with Nigeria because of the high risk [of Boko Haram-related violence] involved,” she told IRIN.

Meanwhile, ongoing polio campaigns have not always successfully reached the 90 percent of children (aged 0-5 years) needed to eliminate the disease. Some 43 percent of children in Cameroon have not received the three doses required for immunity, and 30 percent have never been vaccinated, said health officials.

The government and partners issue regular polio campaigns for children aged 0-5 in the three northern regions: Far North, North and Adamawa, where the risk of infection is high, but cultural resistance in these areas has limited campaign efforts, said Onambany. “People have different beliefs when it comes to maternal care. Some communities with various religious standpoints on the vaccine say the body is sacred and does not need any chemical to feel better, while some Cameroonians see it as some sort of a public plot.”

Onambany said lack of resources also limited ongoing polio campaign coverage.

Many parents do not understand or believe that three oral vaccinations are required and so they drop out after the first or second round.

Loveline Penda, a mother of five in Yaoundé, told IRIN: “The numbers of vaccines keep increasing and I doubt sometimes what the difference will be if my child does not take a vaccine. Sometimes I miss out but I don’t have to worry because I just believe that my child will be fine.”

The government must take cultural resistance and lack of understanding more seriously and “work to change people’s opinions and knowledge [on polio],” said Idris Haman, a researcher at the University of Yaoundé.


Cameroon health officials are expanding the region-specific immunization campaign nationwide in April, May and June 2014, with the help of partners, said Onambany.

The National EPI will also soon launch an intensive awareness-raising campaign about the vaccination.

“The upcoming campaigns will ensure that the quality of campaign is improved by reaching children three times. We will also intensify communication and sensitization effort so that no family is left untold of the dangers of missing out vaccinations,” Onambany told IRIN.

Over recent years the government has stepped up its surveillance and response to polio, working through networks of trained staff in district hospitals, as well as with community-based monitoring networks and NGO partners. Without support from development partners like WHO and the UN Children’s Fund (UNICEF), containment issues would be lagging far behind, said the EPI.

But unless surveillance steps up across borders, the risk that the polio virus could continue to spread remains a top concern, said Onambelle.

[Courtesy of IRIN Africa]