Mental health in Sierra LeoneSierra Leone is a West African country bordered by the North Atlantic Ocean. It is an impoverished country with almost half of the working-age population involved in subsistence agriculture. Between 1991 and 2002, Sierra Leone was subject to a civil war that resulted in more than 50,000 deaths. Sierra Leone also experienced a harsh Ebola outbreak in 2014 that outclassed all others. Its citizens are still recovering from these events, which have resulted in years of physical and emotional pain. This has left hundreds of thousands of people plagued with mental health issues in Sierra Leone.

Mental Health in Sierra Leone

The World Health Organization approximates that 10 percent of Sierra Leone citizens are facing mental health problems. This number may be even higher when taking into account cases that have not been officially reported. “[D]aily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems” as a result of living in extreme poverty. For a long time, there was a lack of political support for mental health in Sierra Leone.

Resources are a big problem when tackling the issue of mental health in Sierra Leone. There are only “two psychiatrists, two Clinical Psychologists and 19 Mental Health Nurses” in a country of seven million people. Furthermore, only four nurses are trained to work with children with mental health issues. Due to the absence of support, many citizens seek out help from the traditional healers available.

Many individuals and organizations are working together with the goal of improving mental health in Sierra Leone. Two organizations that have made significant efforts and progress in raising awareness or providing direct aid to mental health services are the Ministry of Health and Sanitation (MOHS) and the World Health Organization (WHO). Both WHO and MOHS have worked together on projects that have greatly improved support for mental health in Sierra Leone.

The Ministry of Health and Sanitation

Most of those infected or family to those infected during the Ebola virus disease (EVD) outbreak experienced trauma. Patients were often isolated from loved ones and surrounded by strangers. People had to cope with the death of family members and friends. Survivors of EVD beat the virus, but they still experienced toxic stress, depression, insomnia and anxiety. MOHS developed a plan for providing mental health services by improving community awareness, building demand for services and improving access to specialized healthcare workers at all levels of care.

The MOHS worked with the Advancing Partners program on a two-year project funded and managed by USAID’s Office of Population and Reproductive Health and implemented by JSI. In Sierra Leone specifically, MOHS’s framework is being used to aid Sierra Leone’s government with the implementation of health service in post-Ebola recovery. The program is improving mental health awareness in the community, training healthcare workers with the skills to provide high-quality care and reinforcing mental health governance.

So far, MOHS and Advancing Partners have created community healing dialogue (CHD) groups. The groups help communities by providing coping mechanisms, finding resources and offering support for those with psychosocial issues. These groups are placed in areas with a large amount of EVD survivors and trained mental health staff. The CHD groups have “reached almost 700 people in 40 communities across the six districts most affected by the Ebola outbreak (Bombali, Port Loko, Kailahun, Kenema, and Western Areas Rural and Urban).”

The World Health Organization

The World Health Organization is focused on training healthcare workers in Psychological First Aid and the identification of distress. WHO developed the mental health gap action programme (mhGAP) to train community health workers and medical doctors in Sierra Leone. This way, healthcare workers will be able to more easily identify mental disorders and discover treatment options. WHO wanted to create an approach that aims to support mid-level and higher level healthcare workers to provide better tailored services.

Sierra Leone was previously a country where mental health needs were not addressed. The country continues to be impoverished since a large part of its population is unemployed. It experienced devastating losses in its 11-year-long civil war and was further distressed by the severe Ebola outbreak in 2014. The country has a large amount of people still suffering from past issues. That suffering went untreated for a long time. However, organizations like the WHO and MOHS have made considerable progress in addressing the mental health in Sierra Leone.

Jade Thompson
Photo: Flickr

Humanitarian Response Plan for LibyaIn Libya, approximately 823,000 people are in need of humanitarian assistance. This prompted the World Health Organization to create a Humanitarian Response Plan for Libya (HRP). Through this plan, WHO targets 552,000 individuals suffering from the Libyan Crisis, which stems from the Arab uprisings and revolts in 2011.

WHO, as well as partner organizations, plans to provide humanitarian assistance that focuses on key needs such as protection, access to healthcare, education, safe drinking water and sanitation and access to household goods such as essential food and non-food items (NFIs). Here is a look inside WHO’s 2019 Humanitarian Response Plan for Libya.

Humanitarian Response Plan for Libya

WHO’s Humanitarian Response Plan for Libya targets seven sectors: education; health; protection; water, sanitation and hygiene (WASH); food security; shelter and non-food items and multipurpose cash. The health sector has the largest portion of people in need, with approximately 554,000 individuals. The two main objectives of the Humanitarian Response Plan for Libya are to

  • “provide and improve safe and dignified access to essential goods and critical public services in synergy with sustainable development assistance,” and
  • “enhance protection and promote adherence to International Humanitarian Law, International Human Rights Law and International Refugee Law.”

This plan requires $202 million in funding. Therefore, each sector has designated funding based on the goals it plans to implement. The main sectors and their goals are as follows.

  1. Protection: The protection sector is geographically focused. The prioritized areas have the most severe conditions. The 2019 plan intends to bridge the gaps in data regarding protection from past years. The HRP also plans to expand protection monitoring, protection assessments and quality of services as well as reinforce community-based responses.
  2. Health: Several healthcare facilities were destroyed and damaged during the crisis. Non-communicable diseases have started to spread throughout Libya as well. The plan provides access to health services at primary and secondary levels. It also aims to monitor diseases. In addition, the plan prioritizes WASH programs, mental health and psychosocial support.
  3. WASH: Another key focus of the Humanitarian Response Plan for Libya is WASH. The plan hopes to focus its attention on newly displaced persons. Thus, the goals of the WASH sector aim to improve WASH facilities in detention centers, respond to urgent needs and technical support. In doing so, the plan hopes to ensure children have access to safe WASH facilities. It also advocates for the repair of the Man-Made River Project. Moreover, this sector will collaborate with the education sector.
  4. Education: The education sector plans to target 71,000 individuals. Children in high conflict areas are being mentally affected by trauma and distress. These can further affect school attendance and performance. The HRP wants to improve formal education by means of teacher training and provide more supplies for educators. As such, this sector will also prioritize mental health in grades 1-12.
  5. Shelter/NFIs: Shelter and NFI sector focuses on the population displacement as well as damages to infrastructure and homes caused by the uprisings. This sector seeks to secure safe housing for those who are displaced. This sector targets about 195,000 individuals to receive shelter aid.

Overall, the Humanitarian Response Plan for Libya is making strides. As of June 2019, WHO has provided trauma kits and emergency medical supplies to 35 healthcare facilities. This is an increase from the first provision in March. Similarly, medicines for chronic and infectious diseases have been given as well as insulin. In terms of mental health, in January, WHO trained 22 participants in mental health through primary health facilities. The sector also provided training for maternal and reproductive health as well. With this momentum, in time, WHO will continue to meet the goals and targets of the 2019 Humanitarian Response Plan for Libya.

Logan Derbes
Photo: Flickr

Epilepsy Treatment in Developing CountriesAround 50 million people experience recurrent and unprovoked seizures globally. People living with this condition have many triggers for these seizures such as psychological stress, missed medication and dehydration. Half of those living with the disease also have additional physical or psychiatric conditions.

While the physical toll of epilepsy is difficult to manage, the emotional toll is equivalently burdensome. In many countries, a large stigma surrounds patients as people perceive those with the disease as insane, untreatable and contagious. As a result, epilepsy affects people’s education, marriage and employment opportunities. The exclusion of epilepsy patients from society can even lead to increased mental health issues and delay access to proper healthcare treatments.

Epilepsy is a treatable condition if people have access to anti-seizure medication. However, roughly 80 percent of all cases are found in low or middle-income countries. Three-quarters of epilepsy patients living in low-income countries do not have access to life-saving treatment. This fact has sparked a movement in global organizations to raise more awareness about the issue of epilepsy treatment in developing countries.

Three Organizations Raising Awareness about Epilepsy Globally:

World Health Organization (WHO)

Up to 70 percent of people living with epilepsy could become seizure-free with access to treatment that costs 5 dollars per person. In order to address this treatment gap, epilepsy awareness must be prioritized in many countries. The WHO suggests that by labeling epilepsy as a public health priority the stigma surrounding the disease can be reduced. The organization believes that preventing acquired forms of epilepsy and investing in better health and social care systems can truly make a difference in alleviating millions.

Since 2012, the WHO has led a program centered around reducing the epilepsy treatment gap. The projects were implemented in Ghana, Mozambique, Myanmar and Vietnam, and utilized a community-based model to bring early detection and treatment closer to patients. Over time, the program yielded some major results in each of the countries it assisted.

Within four years, coverage for epilepsy increased from 15 to 38 percent in Ghana. The treatment gap for 460,000 people living with epilepsy in Vietnam decreased by 38 percent in certain regions. In Myanmar, over 2,000 health care providers were trained to diagnose and treat epilepsy, and around 5,000 community stigma awareness sessions were held. Continued efforts like the ones found in these countries can help spread treatment to regions of the world that need it most.

 

International League Against Epilepsy (ILAE)

The ILAE is another organization raising awareness around epilepsy treatment. The organization consists of health care professionals and scientists who help fund global research for treatment and potential cures to epilepsy. The major goals of the League are to spread knowledge about epilepsy, promote research, and improve services for patients globally.

With six different regions, the ILAE finds various ways to reach its goals of promoting epilepsy awareness, research and access to care globally. For example, the African region will conduct the 4th African Epilepsy Congress in Uganda to share new developments in epilepsy research in August 2019. These types of Congresses are held once a year in certain regions to continue spreading new information effectively.

The ILAE regularly publishes journals to show research findings and breakthroughs in epilepsy treatments and cures. The organization also provides information to patients themselves on topics such as psychological treatments, diet therapies and information for caretakers. With so many resources available, the ILAE has done a major service by spreading information about epilepsy treatment in developing countries.

 

International Bureau for Epilepsy (IBE)

The IBE focuses primarily on improving the social conditions and quality of life for people living with epilepsy. By addressing issues such as education, employment and driver’s license restrictions, this organization helps create environments free of detrimental stigmas. The IBE’s social improvement programs, designed for people with epilepsy and their families, are some of the main ways this organization impacts epilepsy awareness.

International Epilepsy Day is an example of an initiative created by this organization to promote awareness in over 120 countries. On that day, many global events are held to increase public understanding of epilepsy and new research developments that are available. In addition, the Promising Strategies program also funds initiatives improving the quality of life for people living with epilepsy. The program supports 81 projects in 37 countries and provides $300,000 in support of the projects. For example, Mongolia: Quality of Life was a program designed to improve public knowledge and reduce stigma in Mongolia after the number of epilepsy cases increased by 10 percent in 2004. Soon after the program started in 2008, the quality of life in Mongolia for people with epilepsy increased and better services were given to those in need.

These three organizations often collaborate to create new programs to spread information about epilepsy treatment in developing countries. By raising awareness of the condition and providing better healthcare services, the efforts of these organizations have created a more inclusive and helpful environment for those living with epilepsy in countries around the world.

– Sydney Blakeney
Photo: Flickr

Socioeconomic implications of air pollutionAir pollution is commonly understood as an environmental issue. In the U.S., pollution is most commonly tested using the Air Quality Index. The AQI measures air pollution based upon ground-level ozone, particle pollution, carbon monoxide, sulfur dioxide, and nitrogen dioxide levels. Air pollution causes a number of health risks such as cancer and respiratory infections. In 2016, an estimated 4.2 million people died prematurely due to air pollution. Often, the effects of environmental issues have more consequences for the poor. Thus, concerns stemming from air pollution are not just environmental but also socioeconomic.

Who is affected?

About 90 percent of premature deaths by air pollution occur in low-middle income areas. This issue disproportionately affects lower-income households for many reasons. For one, impoverished homes are often dependent upon energy sources such as coal and wood. The burning of these fossil fuels contaminates the air with carbon dioxide emissions and creates indoor pollution. A lack of finances can also result in the absence of healthcare. Without early treatment, people dealing with infections related to air pollution are more likely to suffer fatal consequences.

Research shows that this disparity supports social discrimination. A study in 2016 reports: “The risk of dying early from long-term exposure to particle pollution was higher in communities with larger African-American populations, lower home values, and lower median income”. Minority groups often face prejudice in places such as employment. On average, a black woman makes 61 cents per dollar earned by a white male counterpart. In sum, minority groups ordinarily earn lower wages. This prohibits them from buying more expensive renewable resources.

The largest effects of air pollution take place in the World Health Organization’s South-East Asia and Western-Pacific regions. These regions are primarily occupied by developing nations. With a lack of financial resources, these countries resort to cheap and environmentally unsustainable practices. For example, the slash-and-burn technique is a method used by farmers and large corporations. This technique involves clearing land with intentional fires, which raises carbon dioxide levels.

What are the implications?

When considering the socioeconomic implications of air pollution, it is important to note all of the key facts. Here are a few things to consider:

  • The WHO has declared air pollution as the number one health hazard caused by environmental degradation. Air pollution can cause ischaemic heart disease, strokes, chronic obstructive pulmonary disease, and lung cancer.
  • Worldwide, 1 in 8 people dies due to the effects of air pollution. In 2018, 7 million people passed away because of infections relating to air quality.

Who is helping?

Air pollution should not be overlooked as a serious issue. Fortunately, in recent years there has been a significant movement to combat poor air quality. For example, China has a reputation for being heavily polluted. However, in 2015, the Chinese government was the world’s lead investor in renewable energy. The government invested $26.7 billion in renewable resources, which was twice the amount that the U.S. invested that same year. Furthermore, between the years 2010 and 2015, particle pollution levels in China decreased by 17 percent.

Organizations such as Greenpeace have advocated for better policies surrounding environmental degradation. In 2013, the Chinese government released the Clean Air Action Plan which set forth the initial progress in combating air pollution. Nevertheless, in 2017, Greenpeace recorded that while particle pollution levels continued to decrease, progress had significantly declined. Greenpeace is now urging the government to produce a new plan to further challenge air pollutants.

Air pollution is harmful to the global ecosystem but it also has a profound impact on society. In order to fully understand the consequences of this issue, one must consider the ways in which environmental degradation targets specific groups. The contamination of the environment, or more specifically the air, often affects minorities and the poorest people. Thus, air pollution should be a top priority not only for environmentalists but also for social activists. Luckily, governments are already seeking plans to prevent the outcome of air pollution. By contributing to organizations such as Greenpeace, everyone can advocate for better policies and regulations against the socioeconomic implications of air pollution.

– Anna Melnik
Photo: Flickr

op Seven Facts About Poverty and Oral Health in Latin AmericaIndividuals living in poverty face disparities. Picture-perfect smiles are often out of reach for those living in impoverished conditions. This is due to various socio-economic factors like food insecurity or lack of dental coverage. The Pan American Health Organization found Latin Americans suffer from twice as many cavities as U.S. citizens. The top seven facts about poverty and oral health in Latin America are discussed here.

Top 7 Facts About Poverty and Oral Health in Latin America

  1. Oral health literacy is a neglected topic of research in the Latin American region. A correlation between the levels of oral health literacy in parents and a child’s oral health is present. This demonstrates the importance of furthering research. The Journal of Oral Research states the lack of oral health research is worrisome for the region. Oral health status is unique to each country and region.
  2. A 2016 report found Brazil’s dental market ranks third behind the United States and China. As a nation with one of the fastest-growing beauty markets, Brazil’s oral hygiene market is amongst the world’s leaders. Products such as toothpaste and mouthwash have seen an increase in recent years. A rising population, an emerging middle class, changes in consumer preferences and investment in promotions are causes of the growing market.
  3. In Latin America, there is a shortage of oral health personnel. Most of the dental systems are limited to pain relief or emergency services. In developing countries, such as those in Latin America, individuals are insufficiently covered for oral health care. This is a result of deregulation or privatization of care. A World Health Organization report indicates Chile has a 1.6 dentist-population ratio (one dentistry personnel per 10,000 people). On the other hand, Brazil sits at 12.3 density. The top seven facts about poverty and oral health in Latin America are revealing Brazil to be a dominating country in dental hygiene.
  4. However, the lack of government funding is a barrier for sufficient oral health care in Latin America. Often, government agencies are more likely to provide adequate funding to health care programs aiming at more serious diseases. Recent health surveys in Mexico investigated heart disease, addictions, immunization, chronic disease as well as violence against women. However, these surveys did not investigate oral diseases. Mexico spends approximately 6.2 percent of its budget on healthcare, a statistic below the 9.6 global average. Mexico’s healthcare system reform is projected to focus on prevention. It will reduce healthcare inequality through social factors and impose a new sales tax on sugared foods and beverages.
  5. In 2015, two dental students from Columbia University’s College of Dental Medicine partnered with the U.S. International Health Alliance, a non-profit organization working to advance global health, to bring dental care to children in Guatemala. Nearly 1,000 children received toothbrushes and lessons on oral health care and prevention of disease. The two dental students mentioned the local diet and lack of access to medical or dental care as two causes for the severe dental decay they witnessed.
  6. The Latin American Oral Health Association held a regional symposium to address the periodontal disease and its effect on general health in Latin America in January of 2019. Eighteen countries were represented as the aim of the symposium was to develop a regional plan to address gingival health issues. The symposium focused on the global burden of periodontal diseases on health, problems associated with diagnostic of the condition, problems associated with the treatment of the condition and possible solutions within Latin America.
  7. The University of West Florida’s College of Health studied the impact of social determinants of health, availability of oral health services, drug use and oral hygiene practices in Ecuador. The surveys conducted found participants had a low level of education, high levels of carbohydrates in their diet, poor feeding and prevention practices. The researchers reported their findings to the local authorities and community officials. They also plan to work closely with the Center for Disease Control and Prevention to develop a device to reduce fluoride levels in the community water system.

Though many countries struggle with oral health, these top seven facts about poverty and oral health in Latin America reveal the strides taken in minimizing the problem. Oral health is at the focus of various organizations both within and outside of Latin America. Researchers aim to look into oral health and increase education in the region. While certain countries like Ecuador and Guatemala struggle with oral health, Brazil acts as a model of what those nations can strive to become.

– Gwendolin Schemm
Photo: Flickr

Dementia in AfricaDementia is universally feared and stigmatized because it is mistakenly viewed as a gradual part of aging. There has been no research found to treat these symptoms, but there are ways to care for and uplift those in need to reduce the risk of dementia around the globe — including Africa.

5 Facts to Raise Awareness About Dementia in Africa

  1. Dementia is an umbrella term under which Alzheimer’s disease can fall. Dementia is categorized as a syndrome and does not have a definitive diagnosis. It is a group of symptoms that affect mental cognitive tasks such as memory and reasoning, Health Line reported. According to Health Line, as dementia progresses with age, it can have an impact on the ability to function independently, placing an emotional and financial burden on families.
  2. Dementia currently affects more than 47 million people worldwide. More than 75 million people are expected to be living with dementia by 2030. Dementia in Africa will rise over the next decades due to an aging population, an increase in noncommunicable diseases and the effects of the HIV pandemic. Even though there has been a reduction in HIV contractions, the disease still leaves its mark as a conduit for dementia. According to The Conversation, South Africa accounts for 17 percent of the global burden of HIV infection. HIV is linked with cognitive decline and leads to HIV-associated dementia (HAD). The Conversation stresses that health care and social care systems are a crucial step toward getting society involved and aware. The World Health Organization (WHO) had a conference in 2015 to discuss global action against dementia. The committee stated that raising generational awareness was essential for encouraging action from younger generations. There is a need to search for disease-modifying therapy, improve care and quality of life and reduce the risk of dementia in Africa.
  3. The WHO emphasized that people must embed a rights-based approach in all interventions. Specifically, the WHO’s committee illustrated the importance that people living with dementia deserve empowerment. The goal is to provide support to exercise their rights and have access to enhanced autonomy to reduce the risk of dementia in Africa. Margaret Chan, director-general at the WHO, offered her view on the conference and its goals.“I can think of no other disease where innovation, including breakthrough discoveries to develop a cure, is so badly needed,” Chan said.
  4. The First WHO Ministerial Conference on Global Action Against Dementia sought to promote a better understanding of dementia, raise public awareness and engagement, demand respect for the human rights of people living with dementia, reduce stigma and discrimination, and foster greater participation, social inclusion and integration. The approval of the WHO Global Action Plan on Dementia in May 2017 allowed Alzheimer’s Disease International to put greater pressure on governments to take the issue with urgency and reduce the risk of dementia in Africa. In the African continent, there is a need for new studies to evaluate dementia prevalence, incidence, mortality and to monitor changes over time. According to WYLD Network, these studies are crucial to emphasize to governments, local and international organizations the necessity to target health policies for older people and the development of strategies for dementia care in sub-Saharan Africa.
  5. As the WHO progresses toward awareness to reduce the risk of dementia in Africa, it instilled an international surveillance platform, the Global Dementia Observatory. The WHO established this for policy-makers and researchers to facilitate monitoring and sharing of information on dementia policies, service delivery, epidemiology and research.

While there is no cure for dementia, several plans like the Global Action Plan on Dementia pave the way for successful care of those developing dementia. Updated research to reduce the risk of dementia in Africa is essential to inform officials of the development and empowerment for the most vulnerable.

Carolina Chaves
Photo: Creative Commons

Vaccines in Egypt
For the past 20 years, the Centers for Disease Control and Prevention (CDC) of the United States has assisted the Egyptian government by providing aid to fight vaccine-preventable diseases. Efforts such as strengthening immunization services, responding to public health emergencies and conducting surveillance studies and surveys have contributed to the reduction of these fatal diseases. The CDC has provided financial support for diseases that can be prevented by vaccines in Egypt through the World Health Organization (WHO), which focuses on polio, measles and rubella elimination.

Impeding Access to Vaccines

In 2006, vaccinations in Egypt eradicated wild poliovirus transmissions. The government continues to monitor the environment for wild polioviruses in a program involving the CDC and other organizations. However, despite the efforts of these organizations, many of those living in poverty in Egypt still do not have access to the vaccination. This presents a problem in the eradication of vaccine-preventable diseases since disease such as the wild poliovirus could return.

According to WHO, full immunization coverage for the poorest to the wealthiest populations showed national levels in Egypt to be under 20 percent. Studies show that the high rates of unemployment and low literacy rates contribute to the increase in the population living in poverty. This results in many individuals being unaware of the healthcare and medical aid they are entitled to and leads to the low proportions of immunization within the population.

Many children are also part of the child labor industry. Working interferes with their school attendance and education, resulting in low literacy rates, which perpetuate the ongoing poverty cycle. Without awareness of health and safety maintenance, those who live under the poverty line may not have the necessary knowledge to access vaccinations in Egypt.

Improvements Made in Vaccinations

The Expanded Program of Immunization (EPI) in Egypt focuses on saving lives by controlling vaccine-preventable diseases such as measles, diphtheria, tetanus, polio and whooping cough through constant surveillance and an increase in vaccine coverage. Despite the extreme decline of cases of vaccine-preventable diseases in the past decades, outbreaks of measles in 2013 and 2014 suggests that full immunization coverage is not yet supported for all populations of Egypt.

However, despite 60 percent of the population living under the poverty line and a large number of people not receiving immunizations, resources and efforts towards improving access to vaccinations in Egypt have increased. WHO claims that only 24 cases of measles, 5.9 cases of mumps and 34 cases of rubella were reported in 2017. A drastic decrease compared to decades of consistent outbreaks in the thousands. Part of the progress could be a result of the fact that 94 percent of children aged 12-23 had received measles vaccinations in 2017. Furthermore, in 2008-2009, there was a significant increase in vaccines in Egypt for measles, mumps and rubella, with 95 percent of children having been vaccinated, an increase of 53 percent from 2007.

The Future of Disease Control

The Ministry of Health and Population (MoHP) works to promote the funding of the Haemophilus influenza vaccine as a part of the PENTA vaccine, a type of vaccine designed to protect the receiver from multiple diseases. The PENTA vaccine will help fight bacterial pneumonia, a communicable disease that contributes to high mortality rates. With WHO supporting the MoHP, the push for programs that fight viral hepatitis is stronger as more resources are being devoted to procuring equipment, allocating funding and the constant surveillance of vaccine-preventable disease outbreaks.

Efforts to control vaccine-preventable diseases are allocating funding to provide coverage for those who may not be able to afford it. Now, increased focus on spreading awareness to the population about the importance and availability of vaccines in Egypt is needed in order to increase coverage and finally eradicate some of the vaccine-preventable diseases in the country.

– Aria Ma
Photo: Flickr

African Programme for Onchocerciasis Control’s Tremendous Success in Eliminating River Blindness in Senegal
Onchocerciasis, more commonly known as river blindness, is a skin and eye disease transmitted to people by infected blackflies. The infection is classified as a Neglected Tropical Disease (NTD) due to its prevalence and intensity. The World Health Organization reports that river blindness is the “world’s second leading infectious cause of blindness.” This process prevents adults and children from participating fully in everyday life, thus perpetuating the cycle of poverty. Fortunately, the African Programme for Onchocerciasis Control has shown tremendous success in eliminating river blindness in Senegal.

Of all the people infected, 90 percent live in African Regions, particularly around fertile river valleys. In these areas around 50 percent of men over the age of 40 have been blinded because of the disease. There have been around 37 million people affected by onchocerciasis. Although the numbers remain high, they illustrate a tremendous improvement in reducing river blindness. Some countries have even been able to eliminate the disease.

Senegal

World Food Programme reports Senegal as having “persistently high poverty rates” typically around 75 percent of people living in chronic poverty. Additionally, 17 percent of people living in rural areas are food insecure. With high poverty rates often comes vulnerability to disease often due to a lack of resources and access to healthcare facilities.

In 2009, the World Health Organization (WHO) reported that river blindness in Senegal showed a drastic disappearance after just 15-17 years of annual treatments. By 2016, 7.2 million people had received treatment for various NTDs. For river blindness alone, the overall treatment coverage had increased from 51 percent to 69 percent that year. This means around 629,000 people received treatment in 2016 while 915,000 were pending treatment in Senegal.

African Programme for Onchocerciasis Control (APOC)

Much of the success in eliminating river blindness in Senegal is accredited to the African Programme for Onchocerciasis Control. In 1995, the African Programme for Onchocerciasis Control (APOC) was launched to control onchocerciasis outbreaks throughout endemic countries in Africa. With funding from the World Bank’s Trust Fund mechanism, APOC was able to allocate money in accordance with each country’s unique needs. As of 2007, APOC had spent $112 million over 12 years of operations, which is relatively low.

In 2010, a total of 75.8 million people of APOC participating countries had received treatment. Projections show that by 2020, APOC will have eliminated river blindness in 12 countries. The program is unique in that it establishes a platform for community involvement. Rural communities feel a sense of empowerment at being able to take control of the situations and help the people in their community.

Community-Directed Treatment of Invermectin (CDTI)

The African Programme for Onchocerciasis Control uses resources readily available in the participating communities, particularly citizen volunteers who conduct most of the local healthcare. Getting to rural areas is incredibly difficult due to terrain, so the implementation of mobile units was found to be ineffective. Often higher risk communities needed a response quicker than what the mobile units could execute, which is where having local volunteers is so vital.

Volunteers are locally elected and trained by professionals in APOC. Their main goals are to collect and administer the ivermectin tablets, the main medicine for treating river blindness. WHO advises a yearly dose for around 10-15 years.  Within their communities, they track and detect signs of infections. In cases were treatments require more care, volunteers are expected to help their patients get to the nearest health facility. In this process, the communities gain a sense of empowerment and engagement by being involved in solving their own health and development.

Successes

By 2006, 11 years after the program’s initial launch, APOC was able to treat 46.2 million people. By 2015, the number more than doubled to 114 million people. World Health Organization reports that in 2014, more than 112 million people were treated for onchocerciasis within 22 countries in Africa- representing 65 percent of global coverage.

World Health Organization has made plans to model the efforts of APOC. The involvement of the community in the process of medicinal distribution proved revolutionary in eliminating the presence of river blindness in Senegal. Additionally, to meet the Millennium Development Goal number one, poverty alleviation, WHO’s Strategic and Technical Advisory Group for Neglected Tropical Diseases has created a guide for further eliminating river blindness throughout Africa. Most of these goals will be reviewed in 2020.

Progress is happening. APOC was able to accomplish the seemingly impossible task of almost eliminating the presence of river blindness in Senegal. Projects will continue to be successful if they use techniques like monthly treatments and the incorporation of the people in local communities to continue in the fight against neglected tropical diseases.

Taylor Jennings
Photo: Flickr

ending child deaths
Each year pneumonia and diarrhoea kill 1.4 million children under the age of five, which is an amount greater than the deaths from all other child illnesses combined. Children in poorer nations are more likely to be victims of these illnesses, hindering long-term growth and development in these countries.

UNICEF and WHO Are Trying to Save Children’s Lives

Created by UNICEF and The World Health Organization (WHO) in 2009, The Global Action Plan for Pneumonia and Diarrhoea (GAPPD) seeks to reduce the number of children affected and, ultimately, end preventable child deaths from pneumonia and diarrhoea. Progress has been slow, but over the past few years, UNICEF and WHO have increased their commitment to focus on these illnesses, hoping to significantly reduce deaths from pneumonia and diarrhoea by 2025.

Pneumonia is a respiratory infection that primarily affects the lungs and can be caused by bacteria, viruses or fungi. For those who have pneumonia, the alveoli in their lungs fill with fluid, making breathing both difficult and painful. Infants with HIV have an increased likelihood of dying after contracting pneumonia.

Diarrhoea, often caused by Rotavirus or Escherichia coli (e-coli) bacteria, is a symptom of an infection of the intestinal tract caused by viruses, bacteria or other parasitic organisms. This bacteria spreads easily through water, food or from person to person. According to UNICEF and WHO, diarrhoea causes extreme dehydration, which can lead to death. Poor sanitation and hygiene increase the risk of becoming infected.

Younger children are the most likely to die from pneumonia and diarrhoea, with 80 percent of deaths from pneumonia and 70 percent of deaths from diarrhoea occurring during the first two years of life. Additionally, over 90 percent of child deaths from pneumonia and diarrhoea occur in low income countries.

Progress Made So Far

Overall, between 2000 and 2015, significant global progress was made with diarrhoea deaths decreasing by 57 percent and pneumonia deaths decreasing by 47 percent. In spite of this progress, there is still much more that needs to be done.

South Asia and Sub-Saharan Africa are disproportionately affected, as child deaths from pneumonia and diarrhoea in these regions have been increasing. In 2000, 20 percent of pneumonia deaths and 24 percent of diarrhoea deaths occurred West and Central Africa. In 2015, however, these regions accounted for 32 percent of pneumonia deaths and 34 percent of diarrhoea deaths.

By 2025, UNICEF and WHO would like to reduce mortality from pneumonia to fewer than three per 1000 births, reduce mortality from diarrhoea to fewer than one per 1000 births and reduce the incidence of severe pneumonia and diarrhoea by 75 percent, compared to 2010 levels. Additionally, they are working towards 90 percent full-dose coverage of all relevant vaccines and at least a 50 percent increase of exclusive breastfeeding during the first six months of life.

What Steps the GAPPD Are Taking to Reach its Goals

To help meet these goals, the GAPPD uses a Protect, Prevent and Treat framework in their efforts to decrease the incidence of these infections. Protection initiatives focus on ensuring that all infants are exclusively breastfed for six months, that all children under the age of five are well nourished and that they receive vitamin A supplementation.

Prevention tactics include improving the quality of drinking water and overall sanitation, encouraging everyone to wash their hands with soap, providing vaccines (specifically for pertussis, measles, hib, PCV and rotavirus), reducing household air pollution and preventing the spread as well as treating HIV-infected and exposed children.

In order to treat children, the number of families who seek medical attention after their child has become ill due to pneumonia or diarrhoea needs to increase. Globally, only three out of every five children are seeking care for pneumonia symptoms. GAPPD hopes to provide medical centers supplies they need to be better equipped, including ORS (oral rehydration salt solution), which prevents the dehydration that occurs with diarrhoea, and oxygen, which is needed for oxygen therapy for children with severe pneumonia.

Technology to Aid in the Efforts

New innovations from the past few years have contributed to efforts to prevent child deaths from pneumonia and diarrhoea. Gravity-fed water supply schemes, which transport river water through pipes using gravity, help reduce the labor required to carry water long distances and, thereby, increase access to water. UNICEF helps communities in Afghanistan, Madagascar, Timor-Leste and Lao People’s Democratic Republic operate and maintain these systems.

In order to ensure infants and young children have access to breast milk, a small feeding cup has been developed by PATH to help infants with breastfeeding difficulties get the breast milk that they need. There has also been a push for breast milk to be donated to hospitals for premature and sick babies. Brazil now has over 200 milk banks and more than 150,000 Brazilian mothers have arranged to donate their breast milk.

In 2016, the GAPPD developed a Monitoring Visualization Tool that allows them to monitor progress toward 2025 goals both globally and for specific nations. With the knowledge gained from this tool, UNICEF and WHO can more strategically coordinate their efforts

It remains to be seen whether UNICEF and WHO will achieve their 2025 goals. However, with new innovations and continuing progress, the elimination of preventable child deaths from pneumonia and diarrhoea can be achieved, hopefully in the near future.

– Sara Olk
Photo: Flickr

Bloodless Malaria Test Sets Bright Future for Sub-Saharan Africa
Brian Gitta is the first and youngest Ugandan inventor to win the African prize for releasing his highly innovative bloodless malaria test. A device called Matibabu tests for malaria by shining a beam of light onto the patient’s finger and can be downloaded on mobile devices.

Matibabu

This bloodless malaria test is low cost and reusable and doesn’t require a physician’s presence. Gitta, in an interview with United Press International, said: “We are incredibly honored to win the Africa Prize — it’s such a big achievement for us because it means that we can better manage production in order to scale clinical trials and prove ourselves to regulators.” These clinical trials will open up new partnership opportunities for Matibabu and vastly expand its entrepreneurial ability.

Many scholars say that Matibabu is “a game changer” for the thousands of people affected by malaria. Clinical trials show that Matibabu has an 80 percent effectiveness rate in identifying malaria, and with constant technology adjustments, Gitta hopes to bring that number up to 90 percent in the coming months.

Gitta’s team continues to perform research on the device as it awaits examination from global regulators. Until the app’s official approval, support from the academic community continues to surface, offering financial and supportive aid to Matibabu.

Malaria in Uganda

Malaria, as defined by the CDC, is a mosquito-borne disease caused by a parasite. People who become infected often experience flu-like symptoms, such as fever, chills, abdominal pain, vomiting or nausea.

In 2016, there were 216 million cases of malaria and over 400 thousand deaths linked to the disease. Uganda specifically bears a large burden by carrying the highest prevalence of malaria, with a rate of 478 cases per 1000 people on yearly basis.

Major challenges of malaria include high transmission intensity, inadequate healthcare resources and inadequate preparedness and response. Since 2014, the disease has decreased by almost 20 percent, but the prevalence is still striking. Inadequate resources include the inability to correctly diagnose the disease due to unqualified staff and inadequate training.

Several attempts have been made in the past to eliminate malaria. Some examples include insecticides and other chemically stronger indoor residual spraying of insecticides. Another example is the utilization of artemisinin-based therapy, which involves the prescription of two separate drugs used to eliminate the parasite located in the bloodstream.

However, these remedies have not proven to be one hundred percent effective. Data from the last decade shows no convincing evidence that malaria has decreased in Uganda in recent years. Gitta’s bloodless malaria test, however, is giving hope to many Ugandan residents who still face the struggle of diagnosis.

Benefits to the New Test

There are several long-term benefits of tests like Matibabu. The accessibility for the general public is arguably the most beneficial, as rural communities now have access to technology and can easily download the app.

Another benefit is that testing is more beneficial and cost-effective than presumption diagnosing. By affirming that a patient does, in fact, have malaria, available resources for malaria treatment can be distributed in the right way.

Furthermore, the World Health Organization states that: “Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria before treatment is started. Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible.” By confirming a diagnosis, planning and treatments can be better financed through a more efficient allocation of money. For example, money being saved for testing could now be financed toward the research of other diseases in Uganda.

Matibabu plans to continue research in the upcoming months. By studying local transmission rates and local treatment costs, Matibabu is better suited to help the welfare of not only Uganda but many sub-Saharan African countries struggling to fight malaria.

– Logan Moore
Photo: Flickr