Tag Archives: Disability

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 Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.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]

Africa: Diabetes – Ticking Time Bomb

It is estimated that more than 500 million people worldwide will have diabetes in 20 years’ time. As World Diabetes day was commemorated last week, people have been warned to take better care of their health by reducing their risk of getting diabetes.

About six million people in South Africa have diabetes and most of these people are unaware that they have this condition. Internationally, it is estimated that about 347 million people in the world have diabetes, up from 153 million 30 years ago. Experts in the medical field warn that the numbers will double in 20 years’ time if people do not actively take responsibility for their health.

“If things continue as they are the numbers of people with diabetes will go up by 50%. The current projection is about 550 million people in the world will have diabetes, but we think that things are probably going to change. By informing patients about decreasing diabetes, the chances of diabetes and the consequence of diabetes through better control, exercise and diet, hopefully those numbers will change significantly”, says Professor Gerald Brock from the University of Western Ontario, Canada.

Professor Block says unhealthy lifestyle is a major contributing factor to diabetes.

“This has become a trend. We are seeing increasing rates of diabetes and obesity in South Africa. It probably relies largely on decreasing exercise, higher rates of food consumption. Lack of physical exercise and diet are the two main drivers for the increasing rates of both adult and childhood obesity”, she says.

Diabetes is a chronic illness where the body cannot control its blood glucose levels properly. About 85% of the population with diabetes in the country has what is called Type 2 diabetes, meaning it is more of an acquired condition and it’s reversible.

“The Type 2 diabetic patient is typically over-weight, lacks physical exercise and the important message there is that it is something they can change by changing their diets and begin to exercise. Those people will no longer be diabetic. The insulin resistance or lack of the insulin doing its job in that individual is because they are not exercising, hence, they have obesity problems”, says Professor Block

Courtesy AllAfrica News

SOUTH SUDAN: Highest Global Maternal Mortality Rate

 

 

South Sudan has the worst reported maternal mortality rate in the world.

“More women die in child birth, per capita, in South Sudan, than in any country in the world,” says Caroline Delany, a health specialist with the Canadian International Development Agency (CIDA) in South Sudan which is funding a raft of maternal health programmes.

A 2012 report entitled Women’s Security in South Sudan: Threats in the Home by Geneva-based think-tank Small Arms Survey (SAS) says a national survey carried out in 2006 indicating 2,054 deaths per 100,000 live births may have been an underestimation.

“Many deaths are not reported, in part because 90 percent of women give birth away from formal medical facilities and without the help of professionally trained assistants,” it said.

Childbirth and pregnancy, rather than conflict, are the nation’s biggest killers of girls and women.

“One in seven South Sudanese women will die in pregnancy or childbirth, often because of infections (from puerperal fever and retained placenta), haemorrhaging, or obstructed births, with a lack of access to healthcare facilities playing a large role in their deaths,” SAS found.

“When we talk about security in South Sudan there is a tendency to focus on issues such as guns and militia groups. But real human security means protection from anything that threatens health and wellbeing. In South Sudan there is nothing that poses greater threat to a woman’s life than getting pregnant,” says SAS researcher Lydia Stone.

Lack of midwives

“Midwives can prevent up to 90 percent of maternal deaths where they are authorized to practice their competencies and play a full role during pregnancy, childbirth and after birth,” the UN Population Fund (UNFPA) in South Sudan said in a May report on maternal mortality.

At the maternity ward in Juba Teaching Hospital, staff members say there are not enough (or the right) drugs, and never enough trained staff.

Midwife Julia Amatoko is one of three registered midwives at the country’s ramshackle and constantly overcrowded hospital in the capital.

“We are just a few and a lot of mothers are coming. And beds are not enough for the mothers. We have just eight beds for the first stage of labour and for the post-natal mother,” she said.

According to UNFPA, South Sudan has just eight registered midwives and 150 community midwives.

Amatoko said the lack of professional midwives working alongside traditional birth attendants (TBA) and community midwives caused needless death. “Those who are TBA’s are not able to cope with the serious cases, like when the mothers have post-partum haemorrhage.”
Giving birth even at the country’s leading hospital is a lottery, especially at night. “I’ve been here for three months, and two mothers died, in the night,” she said, due to a lack of human resources.

“Midwives are the backbone for reduction of maternal mortality… but here, with all the midwives and birth attendants put together, there are only around 20,” said consultant obstetrician and gynaecologist Mergani Abdalla.

“If you have professional midwives that can provide basic obstetric care – once South Sudan can deploy those, they can expect progress, but it will happen slowly,” said midwifery specialist for UNFPA Gillian Garnett.

UNFPA is looking forward to the graduation of around 200 midwives next year.

Treatment delays

Many women come to the hospital late, when they are already in the throes of a difficult labour, said Abdalla.

“There are delays at the community level, with a lot of cultural and other kind of issues; there are delays in getting to the hospital because of the transport infrastructure, the lack of ambulances, the roads; and then there are delays in the hospital as well,” said Garnett.

Mariam Kone, a medical coordinator for a Médecins Sans Frontières (MSF) hospital in Aweil, Northern Bahr-el-Ghazal, echoed the problem. “We are receiving ladies at a really late stage… They’re usually in a septic condition or they’re anaemic, and many have malaria,” she said.

MSF admits around 6,000 people a year to the maternity ward and had 18 deaths last year, mainly due to postpartum haemorrhage, septicemia and eclampsia.

Blood, scissors and gauze

At Juba hospital, UNFPA is supplying kits for mothers, surgical instruments and life-saving drugs such as oxytocin to stop bleeding, but Amatoko bemoans the lack of basics: “We need scissors for delivery, and browns for packing. We don’t have even cottons in the ward; gauze-we don’t have.”

The nation’s first blood bank has been built but not filled at the hospital, which only has a family-size fridge full of blood (mostly allocated by relatives for patients due for surgery).

“The biggest need is blood transfusion, because most of the [maternal mortality] cases are due to post-partum haemorrhage”, said Abdalla.

Garnett says that if these were normally healthy women, blood loss would not be so tragic, but a combination of poor health and the delays at community and hospital level to seek health care puts most women at risk even before they go into labour.

In a country where girls are often married off in their early teens, the number of children they have is often not up to them.

“A married woman of childbearing age is expected to become pregnant at least once every three years, and to continue until menopause,” the SAS report found.

[Courtesy of IRIN]

Diabetes Myths:- Liberia

Lucy Dollokieh, a mother of four from Liberia’s Nimba County, developed severe pains when urinating and thought she had been cursed by a witch, but when a volunteer came to her village describing diabetes symptoms she recognized them, went to a nearby hospital and was diagnosed with diabetes. She now injects herself daily with insulin.

With low awareness of the disease’s symptoms and only one hospital in the country that can diagnose it  – Ganta Methodist Hospital in Nimba County – the vast majority of the estimated 50,000 cases in Liberia go undiagnosed, according to the World Diabetes Foundation (WDF). Many sufferers who seek treatment do so when the disease is well developed and they are already losing their eyesight or limbs, staff at Ganta Methodist Hospital, where Lucy was diagnosed, told IRIN.

John Dowee, a diabetes victim, 45, told IRIN he had no idea he was suffering from diabetes until he was told by a doctor at the hospital. “I suffered a lot. Whenever I urinate I go through severe pain. It hurt me a lot, but I never knew I was infected.”

Many diabetes sufferers think they have been cursed by a witch, said Viktor Tayror, an administrator at the hospital. They visit witch doctors, offering them kola nuts to decipher the curse, he said. Many are instructed to sacrifice animals to get better. One patient recently treated at Ganta hospital went into a diabetes coma that she thought had been inflicted by witches.

Misdiagnosis in clinics compounded these beliefs, said Tayror. “If they come to a clinic they may get treatment for different things – for a UTI [urinary tract infection] or something else. So people don’t get better and they consider it to be a witch,” he told IRIN. “They don’t know what to do.”

Diabetes, which the UN World Health Organization says causes about 6 percent of deaths worldwide every year, is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. (See WDF’s diabetes facts).

While infectious diseases are the biggest killers in the developing world, non-communicable diseases, including diabetes, will become the biggest killers in the next 25 years, according to the World Health Organization.

To raise awareness of diabetes, WDF-trained practitioners run regular radio shows on local radio stations on what they call the “sugar sickness”, said Nora Keah, a nurse and diabetes supervisor at the hospital.

Health staff keep the message simple: “We tell them,` this is what happens, and we can help you’,” added Tayror.

WDF also trains nurses and midwives at Ganta Hospital in proper diabetes care, including running regular screenings at the hospital and around the county to teach them how to manage the disease, including injecting themselves with insulin, and taking their own blood tests. Taking a train-the-trainers approach, practitioners teach community volunteers to encourage people to get tested.

All testing is free, but patients must pay for treatment: US$3 for a vial of insulin, to be injected daily, versus the $20 market rate. Most patients use one vial a day.

Some 200 people have been diagnosed and treated in the two months since the programme began, far higher than previous numbers, said nurse Keah.

While WDF covers training it does not finance staff salaries or drug supply, to try to encourage the project to be sustainable, according to Hanne Strandgaard, programme coordinator at WDF. The Ganta Hospital runs a revolving fund for drug purchase – “people have to get used to buying,” said Tayror – “but $3 per day is still a lot for many Liberians.” Some 83 percent of Liberians earn less than $1.25 a day according to the World Bank’s most recent statistics.

To move forward, the government needs to subsidize diabetes treatment – it currently gives the disease no support because it is low on the health agenda, said Strandgaard. All diabetes care is currently funded by two donors: the WDF and Insulin for Life though Ganta Hospital staff are trying to encourage the US Agency for International Development to come on board.

It is now up to the hospital to persuade the government to adopt the project’s model and to show that it is working, to try to elicit some longer-term funding, Strandgaard told IRIN.

Tayror said hospital staff plan to extend the project further into communities, even into schools, if they can secure more funding, which officially runs out at the end of the year.

While many patients were grateful to finally receive relief from their suffering, some are not optimistic they will be able to keep up treatment. “My condition is very critical,” said patient Zokeh Suah. “I would prefer to die and stop suffering from this disease. I sometimes wonder how my life will turn out.”

[Courtesy IRIN News]

Cholera, Measles Kill Hundreds:DRC

Outbreaks of measles and cholera in parts of the Democratic Republic of Congo have killed hundreds of people, with thousands more infected, says an official of the UN World Health Organization (WHO).
“Since September 2010, 115,484 measles cases and 1,145 related deaths have been reported in South Kivu, Katanga, Maniema, Kasaï Occidental, Equateur, Bas Congo and Kasaï Oriental provinces,” Tarik Jasarevic, a WHO media and advocacy officer, told IRIN.

According to Jasarevic, a lack of government funding halted follow-up mass immunization activities in the regions, leading to the measles outbreak.

Close to six million children were vaccinated in the most affected areas in April and May, but the epidemic spread to other provinces not covered in the immunization campaign.

Mass immunization campaigns are planned. At least 915,000 children in nine provinces are targeted for vaccination in the first two campaigns scheduled for July.

WHO and the UN Children’s Fund (UNICEF) are seeking an additional US$9 million to carry out these two campaigns in September and the first semester of 2012.

Measles is a highly contagious viral disease, preventable by immunization. It can cause complications such as blindness, encephalitis (inflammation of the brain), severe diarrhoea, ear infections and pneumonia.

Cholera 

Some 1,449 cholera cases and 74 deaths have also been recorded since March in Kisangani, Orientale, with the outbreak spreading along the Congo River to Bandundu and Equateur provinces and to Kinshasa, the capital, Jasarevic said. As of 8 July, 3,245 cholera cases had been reported with 192 deaths.

The International Federation of the Red Cross (IFRC) is supporting the DRC Red Cross in hygiene promotion activities in the affected provinces, according to a 13 July report by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

The health ministry and partners are also setting up water chlorination points and providing free cholera treatment to contain the outbreak, said Jasarevic.

Cholera is an acute intestinal infection caused by the consumption of food or water contaminated with the bacterium Vibrio cholerae. Associated diarrhoea and vomiting can lead to severe dehydration and death without prompt treatment.

The DRC is also grappling with new cases of the wild polio virus, with a total of 62 cases recorded by 7 July, according to Victor Makwenge Kaput, the Minister of Public Health.

[Courtesy of IRIN]

‘One Billion People with Disabilities Worldwide’ – UN

 

More than one billion people worldwide experience some form of disability, the United Nations and the World Bank said in a report that calls for the elimination of barriers that often force the people with disabilities to “the margins of society.”

The World Report on Disability, developed by the World Health Organization (WHO) and the World Bank, with contributions from over 380 experts, urges governments to “to step up efforts to enable access to mainstream services and to invest in specialized programmes to unlock the vast potential of people with disabilities.”

“Disability is part of the human condition,” said WHO Director-General Margaret Chan at a ceremony in UN headquarters to launch the report. “Almost every one of us will be permanently or temporarily disabled at some point in life.”

“We must do more to break the barriers which segregate people with disabilities, in many cases forcing them to the margins of society,” Dr. Chan said.

Etienne Krug, a WHO disability specialist, suggested that the barriers themselves are a cause of disability.

“Disability results a lot from the barriers that society erects for people with disabilities,” he said, “barriers such as stigma and discrimination; such as lack of access to health services and rehabilitation services or problems of access to transportation and buildings and information services.”

Speaking to UN Radio, Dr. Krug called for the “mainstreaming of all services. That means to make everything accessible. Children with disabilities shouldn’t go to school to a segregated school, but rather be integrated in a normal school as much as possible.

“Employment should be accessible to people with disability so that they don’t have to live in poverty or from charity. Health services should be designed so that they also respond to the needs of people with disabilities. So basically all services should be accessible to people with disabilities.”

 

The famed British theoretical physicist Stephen Hawking, who suffers from amyotrophic lateral sclerosis (ALS), told the launch via video: “We have a moral duty to remove the barriers to participation for people with disabilities, and to invest sufficient funding and expertise to unlock their vast potential. It is my hope this century will mark a turning point for inclusion of people with disabilities in the lives of their societies.”

The barriers mentioned in the report include: stigma and discrimination; a lack of adequate health care and rehabilitation services; and inaccessible transport, buildings and information and communication technologies.

“As a result, people with disabilities experience poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities,” WHO said.

The report recommended that governments and their development partners provide people with disabilities access to all mainstream services, invest in specific programmes and services for those people with disabilities who are in need, and adopt a national disability strategy and plan of action.

In addition, governments “should work to increase public awareness and understanding of disability, and support further research and training in the area. Importantly, people with disabilities should be consulted and involved in the design and implementation of these efforts.”

Nearly 150 countries and regional organizations have signed the Convention on the Rights of Persons with Disabilities (CRPD), and 100 have ratified it, committing them to removing barriers so that people with disabilities may participate fully in their societies, WHO said.

[Courtesy of UN News service]

ZIMBABWE: $45 million fund for HIV/Aid Maternal Health

About 13 percent of pregnant women in Zimbabwe are HIV positive, one of the highest rates of infection in Africa, according to EGPAF.

Marc Rubin, deputy country representative for the UN Children’s Fund (UNICEF), said eliminating paediatric HIV in Zimbabwe would require a massive scale-up of the PMTCT programme.

“New HIV infections are still occurring at alarmingly high rates, particularly amongst young women, and AIDS-defining conditions are the leading contributing factor to both maternal and child mortality,”

Read More Here