Trypanosomiasis in the Central African Republic
Trypanosomiasis, a parasitic infection that is transmittable to humans through bites from the tsetse fly, is an illness common only among those living in sub-Saharan Africa. People living in rural areas and those who depend on agriculture, hunting or fishing for their food are most exposed to the infection. Poverty, war and failed healthcare systems can contribute to the spread of trypanosomiasis. Proper diagnosis requires a skilled staff and early treatment can help prevent the infection from worsening. The Central African Republic (CAR) has the highest number of cases of the disease in the world. Trypanosomiasis in the Central African Republic is a pressing health issue, which demands sustained funding for treatment and medical training.

About the Infection

Also known as human African sleeping sickness, trypanosomiasis is most prevalent in the 36 sub-Saharan African countries, including the CAR. There are two types of trypanosomiasis. Depending on which parasite causes the disease, an infected individual could have Trypanosoma brucei rhodesiense or Trypanosoma brucei gambiense (the more common of the two). If an individual becomes sick with the latter, symptoms can go unnoticed for months or years before the infection begins to affect their central nervous system. Symptoms include fever, headaches, confusion, poor coordination and irregular sleep patterns. Transmission of trypanosomiasis can occur from mother to child, a tsetse fly bite or sexual contact with an infected person.

If trypanosomiasis goes untreated, an individual can experience worsening symptoms and can eventually enter a coma — hence the infection’s nickname (sleeping sickness). People in the CAR are especially susceptible to contracting the disease from doing agricultural work. Much of the population of the CAR lives in rural areas, depending heavily on subsistence farming to survive. More than 55% of the nation’s GDP stems from agriculture and 80% of the workforce is in the farming industry. Since citizens are dependent on farming and hunting for their food, they are at a higher risk of exposure to the tsetse fly and thus, have an increased rate of contracting trypanosomiasis.

Treating Trypanosomiasis

Infected individuals’ symptoms often go unnoticed or untreated. The CAR’s political climate, high poverty rate and lack of proper healthcare centers all facilitate the spreading and worsening of the infection. As of 2018, more than 71% of the population lived below the world’s poverty level, meaning that medical staff and treatment were inaccessible to most citizens living with trypanosomiasis in the Central African Republic. The country is also recovering from the violence of late 2013, which left many hospitals and offices ransacked or closed. Due to these various factors, citizens suffering from trypanosomiasis in the Central African Republic have few options for testing and medication.

There is one well-known medication that can treat the disease, called nifurtimox-eflornithine combination therapy (NECT). Though NECT can significantly help patients with trypanosomiasis, the treatment includes multiple injections and close monitoring of the symptoms — both of which are usually unavailable or difficult to follow through to completion.

The Good News

However, with combined efforts from the government and other organizations, more patients suffering from the illness are receiving treatment. With help from the World Health Organization (WHO), CAR’s government is monitoring the cases and number of deaths from trypanosomiasis and working to provide more clinics, healthcare professionals and medication. The WHO and CAR’s health sectors aim to eliminate transmission of the disease by 2030. With only 997 cases and 164 deaths reported in 2018 (the lowest number in the 80-year battle with the disease), the CAR is on track to reach this goal partially due to consistent outside aid.

One notable international organization, Médecins San Frontières, mobilizes doctors and nurses throughout the CAR to provide free diagnoses and medication for those who have trypanosomiasis. Citizens are made aware of the free medical care and the organization can screen thousands of patients.

Over the next few years, help from organizations like the WHO and Médecins San Frontières can lead to adequate testing and medication for citizens with trypanosomiasis in the Central African Republic. It is imperative that organizations and countries in a position to help — contribute trained medical staff, funding and medicine to aid in the CAR’s fight against trypanosomiasis.

Danielle Kuzel
Photo: Flickr

Infection Prevention and Control in Sierra Leone
Sierra Leone did not have an existing infection prevention and control program before its 2014-2016 Ebola epidemic. However, infection prevention and control is an essential element aiding in eradicating and preventing cross-infection among the community, patients, health care providers and hospital visitors.

The Current Course of Action

The Ministry of Health and Sanitation, with the help of the Centers for Disease Control and Prevention (CDC), has made significant strides in an attempt to get Sierra Leone’s health sector back on the right track. This partnership involves the implementation of the National Infection Prevention and Control Action Plan (IPC) to prevent future infection and disease. The IPC will enable the equipping of health facilities and open up conditions for the resources required for standard and transmission-based precautions. Further, the goal of the IPC aims to prevent and contain health care-associated infections.

The CDC’s Involvement

Disease threats are spreading faster than ever before but the CDC’s efforts in Sierra Leone have helped improve the country’s prevention, detection and ability to respond to infectious disease outbreaks. These abilities remain especially key before outbreaks become epidemics with the potential to affect global populations.

The CDC has played an important role in infection control in Sierra Leone, even establishing a country office in 2015 to focus on global health security. The CDC has been diligently working with Sierra Leone on surveillance, emergency management, strengthening laboratory and the workforce capacity to respond to disease outbreaks.

More than 700 CDC staff members served on over 1,000 deployments to Sierra Leone after the Ebola outbreak. Further, this makes it the CDC’s largest outbreak response ever in a single country. Sierra Leone, as of November 2015, is Ebola-free.

Keeping Infection and Disease Under Control in Sierra Leone

Sierra Leone has taken a different approach to sustain the infection prevention and control. The country has invested in ongoing training for its health care workers. These efforts have helped ensure a safe working environment for all, with lower health care-associated infection risks. Health care workers and hospitals have improved their disposal of waste practices, hiring individuals to clean, along with disposing of the waste.

In addition, Sierra Leone has heightened awareness of infection prevention and control with the aid of supported sanitation and hand hygiene campaigns. These campaigns aid in the creation of a culture of hand-washing and have drastically reduced cross-infection among patients, thus eradicating Ebola.

As Dr. Keiji Fukuda, the WHO Assistant-Director General, states, “When health workers are infected at work, this puts other health care workers at risk. Understanding where the breach in these measures is occurring and taking the steps needed to fully implement infection prevention and control measures can put an end to these infections.”

Na’Keevia Brown
Photo: Flickr

Project Healthy Children

Global hunger is one of the most pressing and visible poverty-related issues in our world today. People can easily recognize the defined ribs, sunken eyes and bone-thin limbs of starvation. However, there is another side to hunger that is not as obvious: micronutrient deficiency.

Micronutrients are vitamins and minerals such as zinc, iron, iodine, vitamin A and folic acid. In developed nations like the United States, most people get these critical nutrients from maintaining a well-rounded diet or taking a daily supplement. But it isn’t always that simple in some other parts of the world. In fact, micronutrient deficiency remains a big problem in Eastern and Southern Africa but often does not get the attention it deserves because the effects are not immediately visible. For this reason, micronutrient deficiency has been nicknamed “hidden hunger.”

Hidden hunger has real and long-lasting consequences. Insufficient amounts of vitamins and minerals can result in learning disabilities, mental retardation, low work capacity, blindness and premature birth. These deficiencies lower overall health and weaken the immune system, thus making it much harder to survive infections like HIV and measles. They can cause extreme birth defects in children and are the leading cause of maternal death during childbirth.

Background

Clearly, micronutrient deficiency is a pressing issue that deserves the attention necessary to mitigate it. An organization called Sanku’s Project Healthy Children (PHC) is doing just that through a process known as food fortification: essentially, they add critical micronutrients to the flour people already consume.

PHC is based in Tanzania and currently supplies almost 2 million people with fortified flour to help them get the vitamins and minerals they need. Flour is a staple food that many people consume regularly; according to the PHC website, “over 50 million Tanzanians eat maize flour every day,” but more than 95 percent of it is produced without added nutrients in small, rural mills. Countries like Tanzania are in desperate need of better access to micronutrients—here, about 35 percent of children under 5 years old have stunted growth due to under-nutrition. Project Healthy Children uses the mills and distribution systems already in place to simply add essential micronutrients to the flour with no additional cost for the consumer. This way, people can get the nutrition they need without changing their eating or purchasing habits.

Why Food Fortification?

  1.  It is cheap: Food fortification is very inexpensive, typically costing no more than $0.25 per person annually. In other words, one quarter donated is enough to supply someone with adequate nutrients for an entire year.
  2. It is effective: Improving nutrition can be highly beneficial to overall health, work capacity and productivity. Women who sustain good nutrition before getting pregnant greatly reduce the risk of maternal death and birth defects.
  3. It has a huge payback: The economic rewards of food fortification are astounding. The WHO estimates that the consequences of micronutrient deficiency (birth defects, learning disabilities, premature death, etc.) can cost a country about 5 percent of its GDP per year. Supplying people with critical vitamins and minerals puts less pressure on a country’s health care system and allows for a more productive workforce. In addition, the Copenhagen Consensus estimated that for every dollar spent on nutrition in young children, a country will save an average of $45 and sometimes as much as $166.

The Future of Project Healthy Children

In the past few years, Project Healthy Children has become even more streamlined in its approach to food fortification. A partnership with Vodafone, a mobile network based in the United Kingdom, allows PHC staff to remotely monitor flour mills so that they instantly know when a machine is down or a mill is low on nutrients. The partnership saves money, time and manpower, allowing PHC to run more smoothly.

Project Healthy Children currently helps nourish about 1.7 million people in sub-Saharan Africa but hopes to reach 100 million people by 2025, an ambitious goal that would be instrumental in lifting communities in Southern and Eastern Africa out of extreme poverty.

– Morgan Johnson
Photo: Flickr

Drug Resistant Infections
Antibiotics have long been considered one of the greatest marvels of modern medicine. Since their discovery in the early 1900s, antibiotics have promoted a previously unprecedented large-scale fight against disease. Their effectiveness, however, is starting to show its limits.

CDC Analysis

According to the Center for Disease Control (CDC), antibiotic resistance—also known as antimicrobial resistance or general drug resistance—is becoming more and more prevalent, with over 23,000 people dying from a drug-resistant infection or disease in the United States alone. Studies have shown that over 700,000 people die annually worldwide from drug-resistant infections. Diseases once thought to be treatable, such as tuberculosis and common bacterial infections, are slowly becoming harder to cure with standard antibiotics and antimicrobial drugs.

A Mounting Crisis

The sheer overuse of antimicrobial drugs, such as antibiotics, antimicrobials, or antifungals, is often cited as a factor in the rise of drug resistance. Numerous studies show that these medications are grossly overprescribed, specifically drugs in the antibiotic category. The overexposure of antimicrobial drugs to different bacteria drastically reduces the drug’s ability to fight infections and diseases, leading to a resistance that is almost impossible to treat. This phenomenon is only growing, with the United Nations estimating that resistant infection could kill up to 10 million people annually by the year 2050.

The Developing World at Risk

Developed nations like the United States and Western Europe have far greater chances of eliminating the problem by fighting diseases from the backend, with access to clean water, food and sanitary living conditions. But for underdeveloped countries where over half of the population lives below the poverty line, drug-resistant infections pose even more serious risks. These countries rely on antimicrobial drugs and vaccines to stave off epidemics and diseases and cannot afford to develop drug resistance of any kind. The United Nation’s (UN) latest findings point towards economic hazards of drug resistance as well, showing that if resistance continues to develop, healthcare costs and lack of resources could potentially send the economy into a decline similar to that of the 2008-2009 era.

Innovative Solutions

Finding innovative ways to combat drug resistance is the most urgent goal. The UN is among several groups looking to solve the resistance crisis, calling upon major pharmaceutical companies, research groups and investors to accelerate funding and assistance. Emphasizing the need for a worldwide plan, Dr. Margaret Chan, Director General for the World Health Organization, has stressed the need for a timely response, “Antimicrobial resistance is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”

As a part of the much-needed urgent response plan, the WHO proposed a new strategy to the World Health Assembly in 2015 that highlights five main goals to fight drug resistance:

  1. Raise awareness
  2. Gain knowledge
  3. Reduce risk of infections overall
  4. Optimize the current use of antimicrobial drugs
  5. Increase investment in research and technology for new antimicrobial drugs

Hope for the Future

The CDC has also constructed what is known as the National Action Plan, a five-year goal with similar objectives working under their Antibiotic Resistance Solutions Initiative. Despite the imminent threat of drug resistance, the crisis is being taken seriously with appropriate responses in progress and clear plans of action to follow.

Olivia Bendle
Photo: Pixabay