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Dr. Angeli Achrekar
On January 20, 2021, President Joe Biden appointed Dr. Angeli Achrekar as the new U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, which means she will be leading the President’s Emergency Plan for AIDS Relief (PEPFAR).

Who is Dr. Angeli Achrekar?

Dr. Achrekar is remarkably qualified for her position. She has earned her doctorate from UNC-Chapel Hill, a master’s degree from Yale and her bachelor’s degree from UCLA. In addition to her academic accomplishments, Dr. Achrekar has a career of public service under her belt, involving combating HIV/AIDS around the globe, public health development and women and girls’ health. She originally worked in India and with UNICEF. She then started working with the CDC starting in 2001, where she led the National Initiative to Improve Adolescent Health. This initiative spanned across multiple agencies and consisted of professionals from a variety of disciplines in more than 100 organizations.

Following her leadership of the National Initiative to Improve Adolescent Health, Dr. Achrekar started her work with PEPFAR to fight HIV/AIDS around the world in 2003. In working with PEPFAR, she traveled to South Africa. There, she coordinated with local governments to assess risk patterns that occur through drug use and among sex workers. Dr. Achrekar then became Senior Public Health Manager for the CDC in its Division of Global HIV/AIDS. Lastly, she started in 2011 with the U.S. State Department where she helped come up with and develop the Saving Mothers program, as well as the Giving Life program.

Developments Since Her Appointment

Since her appointment, Dr. Achrekar has already made strides in her position to fight AIDS and other diseases around the world. Notably, under her leadership, PEPFAR has been part of a joint effort with other organizations and agencies including USAID which will bring a new treatment to TB patients in Ghana, Ethiopia, Kenya, Mozambique and Zimbabwe. Rather than patients needing to take a combination of drugs for treatment, the new treatment will combine two drugs so patients will be able to take fewer drugs in total. The new development is a big leap forward and Dr. Achrekar said, “The availability of a shorter, more easily tolerated, and safer regimen for TB prevention that is also affordable is critical for accelerating the fight against TB. The new development is big news as latent tuberculosis is said to affect up to a quarter of the world’s population.”

The Importance of Fighting AIDS in Relation to Global Poverty

PEPFAR’s work to fight AIDS holds much significance to the fight against global poverty because the two interconnect considerably. AIDS disproportionately affects those in poverty. Considering that the prevalence of AIDS has been commonly linked with poverty, a critical component of fighting the disease is fighting poverty. In his article “Is HIV/AIDS Epidemic Outcome of Poverty in Sub-Saharan Africa?” Noel Dzimnenani Mbirimtengerenji wrote, “Unless and until poverty is reduced or alleviated, there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences.”

Sean Kenney
Photo: Wikipedia Commons

Lead Poisoning in Children
For more than a century, the people of Kabwe, Zambia have lived with devastatingly high levels of lead exposure. In 1994, after 90 years, Kabwe’s lead mine shut down. More than 25 years later, the people of Kabwe still suffer the consequences of decades of unstable mining and nearly nonexistent clean-up efforts by mine owners. Environmental health authorities say Kabwe has unprecedented levels of lead contamination leading to lead poisoning in children.

The EPA “defines a soil lead hazard as 400 parts per million (ppm) in play areas and a 1,200 ppm average for bare soil in the rest of the yard.” Black Mountain, a favorite place for Kabwe’s children to play, measures a staggering 30,000-60,000 ppm. The “mountain” is a massive heap of refuse. Adults often crawl through make-shift tunnels mining for lead, copper, manganese and zinc to sell. With more than half of Zambia’s population living below the poverty line, mineral scavenging provides vital income. Many people who venture beyond the “DANGER KEEP AWAY!” warning outside the mine site, say the risk of lead poisoning is a necessity if they want to feed their families.

Children at Risk

Lead poisoning in children is at a disproportionate rate due to children’s developing bodies and brains. Children absorb four to five times more lead than their parents. Lead exposure can result in skin rashes, poor appetite, weight loss, cough, stunted growth, learning disabilities and death. Often, lead poisoning goes undetected until it is too late. Many families will hide their lead-poisoned children because they fear stigma due to their child’s symptoms. In Zambia, 45.5% of children live in extreme poverty. As a result, they do not often have access to proper healthcare to treat lead poisoning.

The World Bank Project

The World Bank is funding a $65 million project, the Zambia Mining and Environment Remediation and Improvement Project (ZMERIP). The project aims to reduce environmental risks in lead hot spots. It also seeks to assist the Zambian government in addressing the dangers of lead exposure and implementing safety protocols, providing health intervention and engaging mining companies in expanding awareness of their environmental and social responsibilities.

In 2020, the ZMERIP began the largest health intervention to address blood lead levels (BLLs) in children in Zambia. More than 10,000 children received lead poison testing. The CDC recommends a BLL in children of no more than 5 µg/dl. Of the children tested, 2,500 had BLLs of 45 µg/dl or more. Chelation therapy, “which binds the lead into a compound that is filtered out through the kidneys”, is the preferred treatment for children who test 45 µg/dl or higher. Children who test lower, receive vitamin supplements, iron and protein as treatment.

The World Bank attempted another project similar to the ZMERIP in 2011 but achieved little progress. With lessons learned, the World Bank is hopeful this new project will be successful. If the project attains the goals it has set out to complete, more than 70,000 people including 30,000 children will benefit from the information. While some Zambians have yet to realize the risks of lead exposure, the World Bank reports mostly positive responses to their health advocacy.

The Future for Zambia

For the children of Kabwe, the ZMERIP offers hope of reducing lead poisoning in children. It offers hope that play is not a risk and a toddler’s appetite for a fistful of dirt is not a life sentence by lead poisoning. The key to the project’s success is continuing prevention practices, education, remediation and the Zambian government’s obligation to enforce safety regulations after the project’s completion expected in 2022. The ZMERIP’s commitment places focus on improving the lives and futures of Kabwe’s most vulnerable and valuable asset, its children, the country’s future.

Rachel Proctor
Photo: Wikipedia Commons

Healthcare in South Africa
With a population of 57.78 million people and with approximately 49.2% of the adult population living below the poverty line, AIDS and healthcare in South Africa are two of the country’s main issues. In particular, the unequal distribution of healthcare resources has worsened the country’s fight against HIV and AIDS. During recent years, South Africa has begun to take steps toward change. Here are five facts about the AIDS and healthcare crisis in South Africa.

5 Facts About AIDS and Healthcare in South Africa

  1. Systems of Healthcare in South Africa: South Africa’s healthcare system is severely divided between the public and private sectors. The public sector (the healthcare provided by government funding) covers about 84% of the population. In South Africa, 70% of doctors work in the private sector, as people who can afford private healthcare tend to pay better, and private doctors have access to better resources. Furthermore, per capita expenditure in the private sector, or the cost per person, was about $1,400 in 2014, while per capita expenditure in the public sector was about $140. For comparison, the United States’ per capita healthcare expenditure is about $11,200.
  2. Rural vs. Urban Communities: As in many countries, there is significant inequality in access to healthcare between rural and urban communities. In South Africa, people living in rural areas tend to rely on public healthcare. Unfortunately, there is an inadequate number of trained healthcare professionals in the public sector. A study conducted in 2002 revealed that urban areas of South Africa were more likely to have higher percentages of HIV infections. However, as a result of the inequality of healthcare, people in rural South Africa were two times less likely to receive testing for HIV or AIDs.
  3. AIDS Epidemic: In South Africa, 7.7 million people live with AIDS, the highest case rate in the world. About 20% of the world’s HIV cases are in South Africa, and within the country, about 60% of women have HIV. Even in areas in which testing is available, many choose not to partake, as they are afraid of receiving a positive result. A lack of resources, including education for young people and proper training for healthcare workers, has created issues surrounding awareness of the disease, proper diagnosis and access to PrEP. This drug reduces the possibility of infection by 99%.
  4. ART Program AID: In 2003, South Africa rolled out the largest Antiretroviral Treatment plan (ART) in the world. Offered through the public sector, ART serves as the primary HIV intervention for both children and adults. An important aspect of its implementation was affordability, as only 13.7% of South Africans have medical insurance. With the help of CDC South Africa, government facilities and mission hospitals, more people were able to access and benefit from the program.
  5. The Good News: ART has proved to be successful, as adult HIV deaths peaked in 2006, with 231,000 deaths, and then decreased dramatically. In 2014 there were 95,000 deaths, which was a reduction of 74.7%. In total, from the very beginning of the program in 2003 to 2014, the ART program reduced HIV adult deaths by an estimated 1.72 million, a clear positive trend. Most recently, in 2018, 71,000 people died from AIDs-related illness, which was a 50% decrease from 2010. Furthermore, 62% of people with HIV had access to treatment. 87% of pregnant women with AIDs also received antiretroviral medication, preventing 53,000 HIV infections in newborn babies. These statistics are all improvements from previous years.

While there is still work to be done to improve AIDS and healthcare in South Africa, much progress has been made. Increased funding and support for new programs and access to antiretroviral medication have had a significant impact. Moving forward, it is essential that these programs expand their efforts to further reduce deaths caused by HIV and AIDS.

Alyssa Hogan
Photo: Flickr

Other Outbreaks During COVID-19
All eyes are constantly on the lookout for surges in COVID-19 cases both in one’s own country and around the world, but other outbreaks during the COVID-19 pandemic are on the rise and getting very little attention or preventative measures. The CDC and WHO are monitoring current outbreaks, which include alerts and warnings about an Ebola outbreak in the Democratic Republic of the Congo, MERS-CoV in Saudi Arabia, Influenza A in Brazil and yellow fever in French Guiana.

“Disruption to immunization programs from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles,” said Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO. The question now, with most hospitals worldwide overflowing with COVID-19 cases, is how can people suffering from any other disease get the aid that they need? Taking a look at individual states around the world and how they each are handling outbreaks within the current pandemic will allow for discussion on keeping more people safe and healthy.

CDC Guidelines for Non-COVID-19 Care

The CDC has created a framework for providing non-COVID-19 care in hospitals and clinics, with a graph depicting what a patient is advised to do depending on the seriousness of their sickness or condition. Potential for patient harm, level of community transmission and symptom lists are all considered.

The CDC also lists a few key considerations for healthcare providers at this time, asking that they are prepared to detect and monitor COVID-19 cases in the community, provide care with safety procedures in mind and consider other services that may require expansion. While in theory, these are positive factors to implement during a health crisis of this magnitude, many countries with high poverty levels do not have adequate resources or staffing to ensure these practices.

Ebola and Measles in the Democratic Republic of the Congo

While the two-year Ebola outbreak was just declared over on June 25, 2020, the DRC is facing a rise in measles cases due to a lack of vaccines while it prioritizes COVID-19 treatments. In 2019, the percentage of vaccinated children increased from 42% to 62% in Kinshasa but the plans for a national immunization program in 2020 experienced delay.

Now, staffing is short, vaccinations are not a priority and those who are receiving vaccinations are doing so in danger of contracting COVID-19 due to lack of resources. Progress toward polio eradication is also suffering, and over 85,000 children have not received immunizations. The DRC is seemingly engaging in a three-front war, fighting numerous other outbreaks during COVID-19. Thabani Maphosa, Gavi managing director, hopes that if the pandemic clears in three months, immunizations will catch up to necessary levels within the next year and a half.

SII Concerned Over Clinical Trial Postponements

The Serum Institute of India is cautioning the public about the concerns for other outbreaks during COVID-19. Clinical preliminaries may be in danger and CEO Adar Poonawalla shared his thoughts about the findings: “The resulting dosing of the enlisted subjects has been postponed, therefore affecting the immunization plan given in the convention. In addition, follow-up visits for inoculation, well-being appraisal just as blood withdrawal are postponed.” He also mentioned the fear of hospitals due to COVID-19 contamination and the flipping of general hospitals to COVID-19-only clinics.

There have been a few other outbreaks during COVID-19 but the world has yet to see the long-term effects. While the whole world scrambles for a vaccine for COVID-19, it is not surprising that other medical and health concerns seem to be on hold, especially when countries are highly recommending or, in some cases, enforcing social distancing and quarantine. These limitations for worldwide immunization trials and vaccines mostly concentrate in low-income and low-resource areas, like the case in the DRC. While funding these areas always desperately need funding, information and discussion about the concerns are also quite valuable at this time.

– Savannah Gardner
Photo: Flickr

The Cost pf Ending PovertySeveral economists estimate that the cost of ending world poverty is around $175 billion. To the average person, this amount can seem like an unachievable goal to reach, therefore making any contribution futile. In other instances, some people prefer not to make direct donations to end poverty, in fear that their money is not being allocated efficiently.

Let’s consider a product that has had immense success despite its price often being called into question.

AirPods, similarly to most Apple products, have become a staple for many technology users. Chances are that you either know someone who owns a pair of AirPods or you own a pair yourself.

On different social media outlets like Twitter and TikTok, AirPods have turned into a meme in which the small product is often mocked for its big price. The first generation AirPods sold for an average of $149 per pair. On October 30, 2019, Apple launched AirPods Pro at a price of $249.

Apple sold over 60 million pairs of AirPods in 2019 and is projected to sell an estimated 90 million pairs in 2020. In 2019, AirPods generated an estimated revenue of $6 billion while the revenue in 2020 is expected to reach $15 billion.

Apple’s sales of AirPods in 2020 alone is eight percent of the yearly estimated cost of ending poverty. On a large scale, this percentage may seem like a small portion of what is needed to minimize this global issue. However, $250 on a smaller scale can go a long way to help.

6 Other Ways to Spend $250 that can Help End Global Poverty

  1. Sponsor a child – Many children from war-torn countries live as refugees in impoverished conditions. With a full $250 donation, UNICEF will be able to sponsor three refugee children for a lifetime. Through this donation, UNICEF can provide these children with access to clean drinking water, immunizations, education, health care and food supply.
  2. Buy a bed net – A bed net can help prevent the spread of malaria by creating a physical barrier between the person inside and the malaria-carrying mosquitos. The CDC Foundation’s net is an insecticide-treated net (ITN) which continues to create a barrier even if there are holes in it. Each net can protect up to three children and 50 nets can be provided with a $250 donation.
  3. Provide a community with bees – Bees pollinate around an average of a third of the food supply. Consequently, providing a community with a batch of bees could help local agriculture flourish. Additionally, these bees are often monitored by community-based youth programs that promote entrepreneurship. Through Plan International, seven different communities could benefit from a $250 donation.
  4. Register a child – By registering a child with a birth certificate, that child then has access to necessary human rights such as health care, education and inheritance. A birth certificate is also an essential part of protecting children from child marriage, human trafficking and forced labor. A $250 donation could register seven children for a record of existence.
  5. Buy a goat, baby chicks and a sheep for a familyGoat’s milk can provide children with protein that is essential for growth. Baby chicks can also produce nutritious eggs and the possibility to generate income. Sheep will yield milk, cheese and wool for a family. All of these animals will offer a family a continuous supply of living necessities. One of each animal can be given to a family through a $250 donation.
  6. Fund a community center – A $250 donation could go towards investing in the lives of youth in poverty by funding a community center. This donation goes towards building or modernizing youth centers in impoverished areas. A community center creates a space for health operations, play spots for children and technological hubs.

These are a few of the many effective ways to make a simple contribution to alleviating this global problem that costs no more than a set of AirPods.

Ending world poverty is not an easy task, nor is it inexpensive upon first glance. However, an individual can make a massive impact once the cost of ending poverty is put into perspective. A personal contribution to ending poverty can be as simple as making a donation for the same price as a pair of AirPods.

Camryn Anthony
Photo: Flickr

Malaria is a leading cause of death in Sub-Saharan Africa. In 2018, among 228 million cases of malaria globally, there were 405,000 deaths, 94% of which were in Sub-Saharan Africa. Although treatment has gotten much better in recent years and deaths due to malaria have begun to decline globally, in the time of the COVID-19 pandemic worries have arisen that those who receive treatment for malaria will be unable to continue to do so. (https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/maintain-essential-services-malaria.html)Recent results from the Global Fund’s biweekly survey of HIV, TB, and malaria treatment programs found that 73% of malaria programs reported disruption to service delivery, with 19% reporting high and very high disruptions. Activities within the programs are being canceled due to lockdowns, restrictions on the size of gatherings, transport stoppages, COVID-related stigma, and clients not seeking health services as usual. With these disruptions to important malaria treatment services, such as insecticide-treated net campaigns and antimalarial medicine administration, the World Health Organization predicts that deaths from malaria in Sub-saharan Africa could double. (https://www.theglobalfight.org/covid-aids-tb-malaria/) These deaths would return countries' malaria mortality levels from the year 2000, regressing on the progress that malaria treatment has reached in the past 18 years. It has never been more vital than now that countries continue to mitigate malaria treatment in their communities and sustain essential services that have helped save so many lives of those affected by malaria. (https://www.who.int/news-room/detail/23-04-2020-who-urges-countries-to-move-quickly-to-save-lives-from-malaria-in-sub-saharan-africa) The Global Fund is a partnership designed to help eradicate HIV, TB, and malaria epidemics. It raises and invests more than $4 billion a year to support local programs for these epidemics. They partner with local experts in countries, as well as governments, faith-based organizations, technical agencies, the private sector, and those affected by these diseases to raise money, invest it, and implement strategies to give aid. (https://www.theglobalfund.org/en/overview/) The Global Fund has created an urgent mitigation plan to curb the effect of COVID-19 on delivering essential health services, such as malaria relief, as well as making $1 billion available to other countries as part of their response. They plan to adapt malaria programs to mitigate the impact of COVID-19, protect frontline workers with protective equipment and training, reinforce supply chains, laboratory networks, and community-led response systems, and fight COVID-19 by supporting testing, tracing, isolation, and treatment. The Global Fund is seeking an additional $5 billion to mitigate the impact of COVID-19 on countries receiving treatment for malaria, TB, and HIV. (https://www.theglobalfund.org/en/covid-19-plan/) Along with the Global Fund and the WHO, the CDC has also created a set of key considerations for continuing essential malaria prevention, while safeguarding against the COVID-19 pandemic. In addition to recommending that a representative from the National Malaria Control Program should be considered for membership on the country’s National COVID-19 Incident Management Team, the CDC recommends continued access to Insecticide-Treated Nets for populations at risk, physical distancing during spray treatments, and the continuance of essential routine entomological monitoring activities while abiding by social distancing and wearing protective gear. The CDC also recommends that countries monitor their supply chain and adapt their malaria treatment programs if needed, due to higher costs or less resources. Countries should continue to collect data on COVID-19 and malaria illness in the population. It is important that countries communicate their continuation of malaria treatment to their citizens and educate them on how to seek treatment while also protecting themselves from COVID. (https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/maintain-essential-services-malaria.html)
The leading cause of death in Sub-Saharan Africa is malaria. There were 228 million cases of malaria globally in 2018. Additionally, there were 405,000 deaths, 94% of which were in Sub-Saharan Africa. The treatment improves in recent years and malaria has begun to decline globally. However, concerns about receiving treatment for malaria occurs during the COVID-19 pandemic. Recent results from the Global Fund’s biweekly survey of HIV, TB and malaria treatment programs found that 73% of malaria programs reported disruption to service delivery. Around 19% reports high and very high disruptions.

Lockdowns canceled activities within the programs. There are restrictions on the size of gatherings, transport stoppages, COVID-related stigma and patients are not seeking health services as usual. The World Health Organization predicts that deaths from malaria in Sub-saharan Africa could double due to disruptions to important malaria treatment services. For example, insecticide-treated net campaigns and antimalarial medicine administration. It is extremely vital that countries continue to mitigate malaria treatment in their communities. Additionally, the countries should sustain essential services that have helped save many lives affected by malaria.

The Global Fund

The Global Fund is a partnership that helps eradicate HIV, TB and malaria epidemics. It raises and invests more than $4 billion a year to support local programs for these epidemics. The organization partner with local experts in countries, governments, organizations, the private sector and those affected by these diseases. The aim of the partnership is to raise and invest money and implement strategies to give aid.

Furthermore, The Global Fund created an urgent mitigation plan to curb the effect of COVID-19 on delivering essential health services. The plan includes making $1 billion malaria relief available to other countries as part of their response. In addition, The Global Fund plans to adapt malaria programs to mitigate the impact of COVID-19 and protect frontline workers with protective equipment and training. It also reinforce supply chains, laboratory networks and community-led response systems. The Global Fund fights COVID-19 by supporting testing, tracing, isolation, and treatment. It seeks an additional $5 billion to mitigate the impact of COVID-19 on countries receiving treatment for malaria, TB and HIV.

Centers for Disease Control and Prevention (CDC)

The CDC created a set of key considerations for continuing essential malaria prevention while safeguarding against the COVID-19 pandemic. The CDC gives four recommendations during the COVID-19 pandemic. First, a representative from the National Malaria Control Program should be considered for membership on the country’s National COVID-19 Incident Management Team. Second, continued access for Insecticide-Treated Nets for populations at risk should be put in place. Third, physical distancing during spray treatments should be imposed. Lastly, the continuance of essential routine entomological monitoring activities while abiding by social distancing and wearing protective gear.

For countries that impacted by malaria, the CDC advises the countries to monitor their supply chain and adapt their malaria treatment programs. Countries should continue to collect data on COVID-19 and malaria illness in the population. It is important that countries communicate their continuation of malaria treatment to their citizens and educate them on how to seek treatment while also protecting themselves from COVID-19.

Giulia Silver
Photo: Flickr

Healthcare in Zambia
Zambia, a landlocked country in Southern-Central Africa, faces several ongoing health challenges. In 2017, Zambia’s public health expenditure was 4.47% of the GDP, one of the lowest rates in southern Africa. Two ministries that provide information about health and deliver health services, administer public healthcare in Zambia. These are the Ministry of Health and the Ministry of Community Development, Mother and Child.

Problems in the Healthcare System

As public healthcare in Zambia remains incredibly underfunded, pharmacies in Zambia are not always well-stocked, and many deem emergency services inadequate. Additionally, inequities in public health care service access and utilization exist in the country. While 99% of households in urban areas are within five kilometers of a health facility, this close access occurs in only 50% of rural areas.

As a result of these deficiencies within the system, UNICEF reports that Zambia’s under-5 mortality rate is 57.8 deaths per 1,000 live births. In 2009, 980,000 people lived with HIV/AIDS in Zambia, and 45,000 of those people died the same year due to the disease.

Lack of clean water has resulted in water- and food-borne diseases and epidemics that have been devastating Zambia for decades, including dysentery and cholera. These issues mainly affect impoverished areas, as overcrowding leads to sanitation issues. In the Kanyama slum in Lusaka, 15 households share one latrine when the weather is good. During the rainy season, Kanyama’s high water table causes the filling of 10,000 latrines with water. Areas like Kanyama require long-term infrastructure measures, such as sanitation, sewage lines and piped water.

The Path to Development

Centers for Disease Control and Prevention (CDC) established an office in Zambia in 2000 to address HIV, tuberculosis, malaria and other diseases. CDC support in Zambia includes expanding academic and clinical training programs with advanced technology at the University of Zambia and the University Teaching Hospital, and the development of a National Public Health Institute to strengthen public health surveillance. Moreover, CDC instituted a Field Epidemiology Training Program (FETP) to train a workforce of field epidemiologists to identify and contain disease outbreaks before they become epidemics. Exactly 42 epidemiologists have graduated from the program since December 2018.

In 2018, Zambia presented to the World Health Assembly in Geneva regarding the cholera outbreak by citing its efforts regarding vaccination, water safety and waste management. Additionally, Gavi, the Vaccine Alliance, worked with Zambia to fund and deliver 667,100 oral cholera vaccine doses to Lusaka slums after an outbreak that affected more than 5,700 people.

Looking Ahead

Most recently, Zambia embarked on the first round of its annual Child Health Week campaign from June 22- 26, 2020 to deliver child survival interventions to protect children and adolescents from deadly diseases. Furthermore, to promote fairness and equality, the campaign aims to improve children’s health by ensuring essential services reach children who do not benefit from routine health services. This campaign accelerates the country’s progress toward attaining the U.N. Sustainable Development Goals (SDGs) for reducing child deaths by two-thirds by 2030, improving healthcare in Zambia overall.

The infrastructure for healthcare in Zambia is overall poor due to a lack of funding, poorly maintained facilities and supply shortages of medications and medical equipment. However, one step to a better healthcare system is to ensure equitable access to health services, especially for those who live in rural areas or slums. To reduce inequities, Zambia must strengthen primary facilities that serve the people who live in these regions and dismantle the existing barriers.

Isabella Thorpe
Photo: Flickr

Tuberculosis in BotswanaBotswana is a southern African country with just over 2 million residents living inside its borders. Every Batswana lives with the threat of tuberculosis, an infectious disease that remains one of the top 10 causes of death on the African continent. Tuberculosis has a 50% global death rate for all confirmed cases. Investing in tuberculosis treatments and prevention programs is essential. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Preventative and community-based treatment shows promise in combating tuberculosis in Botswana.

Treating Tuberculosis in Botswana

Tuberculosis treatment cures patients by eliminating the presence of infectious bacteria in the lungs. The first phase of treatment lasts two months. It requires at least four separate drugs to eliminate the majority of the bacteria. Health workers administer a second, shorter phase of treatment to minimize the possibility of remaining bacteria in the lungs.

Early identification of tuberculosis is a crucial step in the treatment process and significantly reduces the risk of patient death, according to the Ministry of Health. Preventative treatment methods are vital because they inhibit the development of tuberculosis infection. They also reduce the risk of patient death significantly.

Health workers detect tuberculosis with a bacteriological examination in a medical laboratory. The U.S. National Institutes of Health estimate that a single treatment costs $258 in countries like Botswana.

Involving the Community

Botswana’s Ministry of Health established the National Tuberculosis Programme (BNTP) in 1975 to fight tuberculosis transmission. The BNTP is currently carrying out this mission through a community-based care approach that goes beyond the hospital setting. Although 85% of Batswana live within three miles of a health facility, it is increasingly difficult for patients to travel for daily tuberculosis treatment. This is due to the lack of transportation options in much of the country.

Involving the community requires the training and ongoing coordination of volunteers in communities throughout the country to provide tuberculosis treatment support. Community-based care also improves treatment adherence and outcome through affordable and feasible treatment.

The implementation of strategies such as community care combats tuberculosis. For example, it mobilizes members of the community to provide treatment for tuberculosis patients. The participation of community members also provides an unintended but helpful consequence. For example, community participation helps to reduce the stigmas surrounding the disease and reveals the alarming prevalence of tuberculosis in Botswana.

A Second Threat

In addition to the tuberculosis disease, the HIV epidemic in Africa has had a major impact on the Botswana population, with 20.3% of adults currently living with the virus. Patients with HIV are at high risk to develop tuberculosis due to a significant decrease in body cell immunity.

The prevalence of HIV contributes to the high rates of the disease. The level of HIV co-infection with tuberculosis in Botswana is approximately 61%. African Comprehensive HIV/AIDS Partnerships (ACHAP), a nonprofit health development organization, provides TB/HIV care and prevention programs in 16 of the 17 districts across the country in its effort to eradicate the disease.

Fighting Tuberculosis on a Global Scale

The World Health Organization (WHO) hopes to significantly reduce the global percentage of tuberculosis death and incident rates through The End TB Strategy adopted in 2014. The effort focuses on preventative treatment, poverty alleviation and research to tackle tuberculosis in Botswana, aiming to reduce the infection rate by 90% in 2035. The WHO plans to reduce the economic burden of tuberculosis and increase access to health care services. In addition, it plans to combat other health risks associated with poverty. Low-income populations are at greater risk for tuberculosis transmission for several reasons including:

  • Poor ventilation
  • Undernutrition
  • Inadequate working conditions
  • Indoor air pollution
  • Lack of sanitation

The WHO emphasizes the significance of global support in its report on The End TB Strategy stating that, “Global coordination is…essential for mobilizing resources for tuberculosis care and prevention from diverse multilateral, bilateral and domestic sources.”

– Madeline Zuzevich
Photo: Flickr

Countries with CholeraCholera is a disease of inequity that unduly sickens and kills the poorest and most vulnerable people – those without access to clean water and sanitation.” – Carissa F. Etienne, the Director of Pan American Health Organization.

Profuse vomiting, diarrhea and leg cramps, followed by intense dehydration and shock, are all symptoms of cholera. It is a highly contagious waterborne illness that can cause death within hours if left untreated. Cholera is mainly caused by drinking unsafe water, having poor sanitation and inadequate hygiene, all of which allow the toxigenic bacteria Vibrio Cholerae to infect a person’s intestine.

While cholera can be treated successfully through simple methods, such as replacing the lost fluid from excessive diarrhea, there are still many people around the globe struggling with the disease. There are 2.9 million cases and 95,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

The countries that have the greatest risk of a cholera outbreak are the ones that are going through poverty, war and natural disasters. These factors cause poor sanitation and crowded conditions, which help the spread of the disease.

Yemen

Yemen is known for being one of the countries with the most Cholera cases. The number of cholera cases in Yemen has been increasing since January 2018; the cumulative reported cases from January 2018 to January 2020 is 1,262,722, with 1,543 deaths. The number of cases in Yemen marked 1,032,481 as of 2017, which was a sharp increase from the 15,751 cases and 164 deaths in 2016. On a positive note, the numbers showed a decrease by February 19, 2020; 56,220 cases were recorded, with 20 associated deaths.

The Democratic Republic of the Congo (DRC)

The DRC is another country with a high number of Cholera cases. There were 30,304 suspected cases of cholera and 514 deaths in 2019. Although the number of 2019 cases was smaller than that of 2017 (56,190 cases and 1,190 deaths), the 2019 data showed an increase from 2018 (27,269 cases and 472 deaths). As of May 13, 2020, 10,533 cases and 147 deaths were reported; most of these reported cases originated from Lualaba regions, Haut Katanga and North and South Kivu.

Somalia

Somalia also stands as one of the countries with the most Cholera cases. From December 2017 to May 30, 2020, there were 13,528 suspected cholera cases and 67 associated deaths in Somalia. These reported cases are from regions of Hiran, Lower Shabelle, Middle Shabelle and Banadir.

Other than the three countries listed above, there are many others that are also going through Cholera outbreaks. Uganda reported a new Cholera outbreak in the Moroto district in May 2020; a month later, 682 cases and 92 deaths have been reported. Burundi also declared a new cholera outbreak this past March; 70 new cases were reported.

Helping Cholera Outbreaks

Many non-profit organizations like UNICEF are constantly working towards helping these countries and many more. A good example of a country that has shown a great decrease in cholera cases following external aid is Haiti.

Haiti experienced the first large-scale outbreak of cholera with over 665,000 cases and 8,183 deaths. After a decade of efforts to fight against cholera, the country recently reported zero new cases of cholera for an entire year. An example of how UNICEF helped Haiti is by supporting the Government’s Plan for Cholera Elimination and focusing on rapid response to diarrhea cases. However, the country still needs to keep effective surveillance systems and remain as a cholera-free country for two more years to get validation from the World Health Organization (WHO) of the successful elimination of the disease.

Alison Choi
Photo: Flickr


Kenya is a coastal country located in East Africa. The nation is developing significantly in terms of economy and healthcare provision. However, since there is a high prevalence of natural disasters and poverty, there are recognizable problems when it comes to healthcare in Kenya. For instance, there are 8.3 nurses and 1.5 doctors per 10,000 people. These numbers fall drastically short of the WHO recommendation of 25 nurses and 36 doctors per 10,000 people. Here are six of the major issues related to healthcare in Kenya and how the country is addressing them.

6 Facts About Healthcare in Kenya

  1. In 2016, malaria was the leading cause of mortality in Kenya. The CDC reported that there are nearly 3.5 million new clinical cases and 10,700 deaths each year. Nevertheless, treatments are on the rise. Long-lasting insecticide-treated mosquito nets and artemisinin combination therapies (ACTs) have proven to be effective prevention and treatment. ACTs are fast-acting and “artemisinin-based compounds are combined with a drug from a different class” to make the treatment. Since the early 2010s, access to ACTs has increased significantly, though there is still a need for access to them in rural areas. In 2019, the WHO reported that Kenya became the third country to implement the world’s first malaria vaccine. Children receive this vaccine as part of routine immunizations, and experts expect it to lower malaria cases significantly in Kenya.
  2. Kenya has one of the highest rates of HIV-infection in the world. UNAIDS reports that, in 2018, 1.6 million Kenyans were living with HIV. Of this population, Avert, a resource for information on HIV and AIDS, states that more than half are unaware of their HIV status. Fortunately, the Kenyan Ministry of Health has announced that HIV cases are decreasing, with the HIV prevalence standing at 4.9% as of February 2020. To improve HIV status awareness, the Kenyan government has partnered with the EGPAF to invest in door-to-door testing campaigns and self-testing kits. The program has emphasized aiding counties with high or rising HIV prevalence. Additionally, UNAIDS reported that 91% of HIV-positive pregnant women were able to access antiretroviral treatment in 2018.
  3. Kenya is one of the most highly industrialized countries in East Africa, meaning that pollution is prevalent. Air pollution in Kenya causes death both directly and indirectly. The State of Global Air reports that, in 2017, air pollution directly caused 4,710 deaths in Kenya. Indirectly, air pollution has increased cases of pneumonia, tuberculosis, water pollution and diarrheal diseases, which are among the top fatal diseases in the country. The combined direct and indirect deaths from air pollution total approximately 18,000 each year. However, there is hope for improvement. Inventions like air sensors can report data about air quality. Kenyans are using these sensors to report data via social media and pressure leaders into making change.
  4. Cancer cases in Kenya are on the rise. As a noncommunicable disease, cancer is one of the leading causes of death in Kenya. The Union for International Cancer Control (UICC) reports that Kenya has 47,000 new cases every year. The UICC also notes that cancer tends to appear in the younger population, and this trend is attributed to lifestyle and environmental changes. To address this crisis, the country is investing in cancer research and support. Additionally, the Kenyan Parliament passed a law to address proper cancer management.
  5. Infant deaths are one of the greatest challenges facing healthcare in Kenya. UNICEF reports that 74,000 children in Kenya die before the age of five each year. These deaths are often caused by poverty, as many families cannot easily access the resources needed for child healthcare. One such resource is insurance. According to the WHO, in 2018, 80% of the Kenyan population did not have any insurance. As a result, the government set aside $40-45 million to establish Universal Health Coverage to help more people to access appropriate healthcare services.
  6. There is a stigma surrounding mental health in Kenya. As a result, there are limited resources allocated to mental health awareness, and Kenyans resist seeking help for mental health issues. Despite this stigma, there is intensive research being done to engage both informal and formal health practitioners in addressing mental health problems to improve healthcare in Kenya.

 

Kenya is determined to address the most challenging problems related to healthcare in the country. There is an emphasis on research and investing in resources to help more people to access better and more affordable healthcare services. Healthcare in Kenya is expected to see improvement in the coming years.

Renova Uwingabire
Photo: Flickr