disease in Sub-Saharan Africa
The threat of disease transmission plays a significant role in the life of sub-Saharan Africans. Diseases such as malaria, HIV/AIDS, tuberculosis, heart disease and diarrheal diseases remain leading causes of death for African citizens. Of particular worry is HIV/AIDS, the fourth leading cause of death on the continent. Furthermore, urbanization has direct links with reducing disease in sub-Saharan Africa. The United Nations Programme on HIV/AIDS estimates that 25.5 million people currently live with HIV/AIDs in sub-Saharan Africa, representing approximately 64% of the world’s cases. The transmission rate is particularly high in sub-Saharan Africa due to high rates of poverty, with over 60% of the population spending less than $1 a day.

Fortunately, in recent years, sub-Saharan Africa has witnessed a downturn in disease trends. For example, in the last six years, Africa has reduced AIDS deaths by over 30%. One can partly explain the successes in stopping the transmission of disease in sub-Saharan Africa by the process of urbanization that sub-Saharan Africa has undergone in recent years. Physician’s Medical Center Labs explains this relationship, highlighting factors such as sex work, migration, polygamy and teenage marriages, all of which increase with higher poverty levels.

What is Urbanization?

Urbanization is the process of making an area more urban. Characteristics defining urban areas include higher population density, greater infrastructure and non-agricultural opportunities for specialization. Urbanization has been ongoing since the 1950s in sub-Saharan Africa – however, its pace has increased in the past few decades. The rate of urbanization in sub-Saharan Africa is the highest globally, with an average annual growth rate of 4.1%. Urban growth results from a multitude of factors, including migration and the reclassification of cities. Migration from rural areas to urban centers is predominantly based on educational and financial concerns.  However, seasonal and forced migration can also play a role in the growth of urban centers. This fast-paced urbanization is not without its challenges, including income loss, weak investment and less productivity. Nevertheless, urban areas can create circumstances that can reduce the transmission of disease in sub-Saharan Africa.

Improving Sanitation

Improved sanitation follows urbanization. Even in the most impoverished urban areas, sanitation conditions are still better than those in rural communities. The key factors contributing to sanitation levels are clean water and flush toilets. Poor urban areas remain two times more likely to have clean, piped water. They are also four times more likely to have flush toilets than rural areas. This is vital to disease prevention as poor sanitation in human waste is a key driver of disease transmission, specifically diarrheal diseases. Piped water can also reduce the threat of mosquito growth. Large amounts of stagnant water provide breeding grounds for dangerous mosquitos, which transmit viruses such as malaria. Piped water decreases the need for stagnant storage sites, diminishing this problem.

Empowering Women

Urban areas provide greater educational opportunities. While schools in rural areas remain understaffed, urban schools can cater to more students with a higher quality of education. This access to education is essential for females as women are 20% more likely to attend school in urban areas. Education for women is key to increasing awareness of sexual health needs and reproductive control. Along with education, the increase in infrastructure that results from urbanization can also increase access to resources for women. They can access the clinics and facilities necessary to control their fertility and protect themselves during sex. This is especially important for female sex workers in the region. In urban areas, the infrastructure of clinics, reproductive health resources and educational opportunities provide women with solutions that can decrease the prevalence of sexually transmitted diseases and infections.

Tracing Diseases

Urbanized areas have the infrastructure necessary to support cell towers and the internet. Because of this infrastructure growth, urban settings allow for high rates of cell phone usage. Meanwhile, rural areas tend to lack access to personal technology devices. In South Africa, around 50% of the rural population do not have access to a personal cellular device. The increased prevalence of mobile phones in urbanizing areas could play a consequential role in combating disease transmission in sub-Saharan Africa. The success of mobile phone contact tracing apps that some utilized during the COVID-19 pandemic highlights this. A Massachusetts Institute of Technology study has found that these apps can decrease the infection rate and break transmission chains even with limited use. People could utilize these tools, thanks to urbanization, to decrease the transmission of disease in sub-Saharan Africa.

US Foreign Assistance is Vital

When looking at the benefits of urbanization throughout the world, it is important to focus on the dangers it can present. While urbanization can foster gender equality, education and quality healthcare, poorly managed urbanization can worsen inequality and destabilize governments. The work of U.S. Foreign Assistance plays a consequential role in the lives of Africa’s urban population. However, U.S. assistance remains disproportionately focused on rural settings, leaving these urbanizing areas in danger. Thus, the continued role of the U.S. in supporting poverty reduction initiatives throughout sub-Saharan Africa is vital to support and foster long-term, stable urbanized growth. One cannot discount the role of urbanization to impede the transmission of disease in sub-Saharan Africa.

Haylee Ann Ramsey-Code
Photo: Unsplash

Kenyan mobile money system M-Pesa Reduces Poverty in Kenya
Experts argue that expanding access to financial systems and services are an indispensable component of reducing poverty. However, Kenya offers only limited access to banking services outside of central cities. Fixed-line telephones are largely unavailable, and minimum fees for banking services pose an impediment to the rural poor and can deter use. Due to these facts, many rural and poor Kenyan households traditionally lacked access to proper finance-management resources. However, mobile money transfer service, M-Pesa, now provides Kenyans with an alternative to traditional banking. Mobile money reduces poverty in Kenya by creating a simple and accessible resource for individuals and families to manage their finances. In under a decade, the expansion of M-Pesa’s simple SMS-based system changed household finance so drastically that nearly 200,000 Kenyans—around 2% of the population—were able to break out of poverty.

Establishing Financial Resilience

M-Pesa allows individuals to send and receive payments via text, as well as deposit and withdraw cash from M-Pesa agents stationed in villages. With 110,000 agents located throughout the country, M-Pesa helps Keynan households overcome the country’s lack of accessible financial services. Now, there are 40 times more M-Pesa agents stationed throughout Kenya than ATMs. Users can easily and inexpensively store savings by depositing cash into their mobile phones via M-Pesa agents. Increased access to savings helps Kenyan households weather unexpected economic hurdles. One study found that following a financial shock, the per-capita spending of households using M-Pesa was 12% higher than households that didn’t use M-Pesa. The discrepancy is likely due to the increased saving capabilities of M-Pesa users.

Long-Term Implications for Poverty in Kenya

An MIT study in 2016 examined the long-term effects of using M-Pesa’s service. They found that between the years 2008-2016, per capita consumption of goods increased by approximately 18.5%. The mean of the households in the study spent $2.50 per day, which is well above the $1.25 or even the $2.00 per day that constitutes extreme and general poverty. According to the study, M-Pesa directly helped as many as 194,000 Kenyan households escape poverty between 2008 and 2016.

Financial Independence for Women

Additionally, the MIT study found that M-Pesa helps Kenyan households run by women in particular. Between 2008 and 2016, the savings of women-headed households using M-Pesa grew by 22% compared to those who did not. Furthermore, nearly 185,000 Kenyan women using M-Pesa could switch from subsistence farming to more economically productive activities, such as sales or business. This economic freedom came regardless of whether their home had a female or male head. For households with two incomes, M-Pesa gives women the ability to store savings, allowing Kenyan women to gain newfound financial independence and opportunity for their own economic pursuits.

More Resources from M-Pesa

Since MIT’s 2016 study, M-Pesa has increased the number of Kenyans with access to formal financial services from 75% to 83% in 2019. Along with personal banking, M-Pesa helps Kenyan households with a wide array of financial services. These include taking out loans, actively managing savings and collaborating with local banks. With the introduction of M-Pesa, the number of bank accounts held by Kenyans grew from 14% in 2007 to 41% by 2019. Largely due to this mobile money service, Kenya is now ranked third in the continent in citizen access to financial service, behind only South Africa and Seychelles. Researchers hope that M-Pesa’s success in Kenya will encourage further study of how mobile money reduces poverty in other countries.

 – Alexandra Black
Photo: Flickr

Under Skin Vaccination
Bioengineering researchers at M.I.T. have developed a method to store and maintain immunization records for people in developing countries, primarily children, who have little or no access to paper records. The M.I.T. researchers have applied an invisible dye technology to detect patterns of quantum dots; one can place this dye under the skin during vaccinations. Once administered, a computer similar to a smartphone interprets the near-infrared marks to access medical records. If further improved, this technology could save lives by helping to maintain an accurate medical history for vulnerable populations. Here are 10 facts about under skin vaccination.

10 Facts About Under Skin Vaccination

  1. Immunization records can be challenging to maintain in developing countries. Keeping track of a child’s vaccination history, for example, may rely on an underserved hospital or community to maintain paper files. People can lose such files in areas of poverty and political discontentment or they can suffer damage, thereby erasing the child’s medical history. Further, parents may forget their child’s medical history, and especially as the result of no centralized database for record-keeping. Under skin vaccination is a promising initiative to reduce these issues.
  2. Verifying immunization history is a cumbersome process. For example, in 2015, the Ministry of Health in Ethiopia invited Dr. Wilbur Chen of the Center for Vaccine Development and Global Health at the University of Maryland to verify immunity coverage for children in rural areas. The process involves taking blood samples and testing immunization in labs, a lengthy and expensive process. Dr. Chen and his team found a big difference in the reported versus actual vaccination rates. Researchers, such as Dr. Chen, find under skin vaccination methods an innovative way to reduce this consumptive process.
  3. Record-keeping problems contribute to 1.5 million vaccine-preventable deaths per year. According to global health experts, the majority of these deaths come from developing countries where resources for maintaining records are lacking. Holes in medical record-keeping may constitute an incorrect vaccine type, brand or lot number for vaccine recipients. A lack of accurate training for maintaining complete records may lend to the problem, depending on the country.
  4. Researchers at M.I.T. are developing trials of a new record-keeping solution by embedding records under the skin. So far the trials have successfully embedded records on pig, rat and cadaver skin. The purpose of the study was to decentralize medical records since centralized databases only exist in wealthier, developed nations that have resources to maintain records. One of the bioengineers, Ana Jaklenec, admits that she was inspired by Star Trek’s “tricorder” device that scans a body for its vital signs and medical history, eliminating the need for maintaining medical records.
  5. New research combines vaccines with an invisible dye that administers concurrently. The invisible dye is naked to the eye but one could interpret it easily with a cell-phone filter that detects near-infrared light to see the coded marks. It is likely the dye is visible for up to 5 years, a crucial period of time for vaccinating children. During this period of time, children typically receive immunizations in several doses, such as in measles, mumps and rubella (MMR). Medical professionals could pair typical vaccines with the invisible dye to incorporate decentralized records.
  6. The new dye in the vaccines includes nanocrystals. Researchers call these nanocrystals quantum dots, which can project near-infrared light for detection by specialized phone technology. The quantum dots are copper-based, measuring four nanometers in diameter and encapsulated in spherical microparticles of 20-micron diameters. The encapsulations permit the dye to remain under the patient’s skin after they receive an injection.
  7. Instead of traditional syringes, the new vaccination type that scientists developed uses microneedles. Medical professionals can administer both the vaccine and the patterned die easier by using a patch that resembles a band-aid to on the skin. In addition to improvement in record-tracking, the new delivery method would not require a skilled medical professional or expensive storage costs. The dye patterns can also be customizable in order to correspond to the vaccine type, brand or lot number.
  8. Jaklenec and her M.I.T. colleagues found no difference compared to traditional injection methods. The team tested the microneedle patch method on lab rats with a polio vaccine. The team found no difference in antibodies when it compared it to traditional syringe methods of vaccine administration. Compared to the scar that smallpox vaccines caused (now eradicated worldwide) the microneedle-patch method leaves no visible trace.
  9. The invisible dye vaccine can create a discreet record-keeping method for families. According to bioengineer Mark Prausnitz of Georgia Institute of Technology, the invisible “tattoo” would provide patient confidentiality in the absence of adequate record-keeping and medical information while also providing improved record accessibility. The microneedle-patch method also avoids more controversial recognition technology such as iris scans.
  10. The M.I.T. team is working towards a feasible international immunization method, specifically aimed at poorer countries. For future applications of under skin vaccination development, the M.I.T. researchers are surveying health care providers in African countries to assess the best way of implementing this method of immunization tracking. They are also working to increase the amount of data they can store in the embedded code with information such as administration date and lot number of the vaccine batch.

These 10 facts about under skin vaccination development illustrate advancements in record-keeping. Utilizing these technologies, developing countries would have advanced strategies for tracking immunizations, ultimately increasing vaccination efficacy. This new method could potentially reduce the number of unnecessary deaths due to lost or forgotten medical information with a noninvasive, safe technology during critical years of childhood development. It could also be the start of a new system of storing data through biosensing that could significantly improve health care like that seen in futuristic science fiction.

Caleb Cummings
Photo: Flickr