Nigeria: Akwa Ibom Ranks Highest in HIV Prevalence Rate in Nigeria

The Nigerian HIV/AIDs Indicator and Impact Survey (NAIIS) has shown that Akwa Ibom has the highest prevalence rate of HIV in the country.

The result indicates that about 5.5 per cent of the people living with HIV in Nigeria are in Akwa Ibom State, followed by Benue State, which has about 5.3 per cent prevalence rate.

It also states that while the North-West has the lowest prevalence rate at 0.6 per cent, the South-South geopolitical zone has the highest with 3.1 per cent.

Speaking during the announcement of the NAIIS result on Thursday, the Director General of the National Agency for the Control of AIDs (NACA), Sani Aliyu, said about 1.9 million Nigerians are currently living with HIV.

The event was held at the Banquet Hall of the State House in Abuja.

He said the percentage of People Living with HIV (PLHIV) in Nigeria, among the age group of 15-49 years, is 1.4 per cent (1.9 per cent among females and 0.9 per cent among males.)

In his response to the prevalence rate in the state, the minister of Health, Isaac Adewole, said this is not the time to start blaming states.

“For the south-south, (it) is Akwa-Ibom that has the highest prevalence, and, for the North Central, it is still Benue State.

“But then we should also look at the quality of interventions we have had. Benue has one of the largest interventions programme in the country, so that is also expected to yield results.

“It would have been frustrating if with those interventions, we now have 10 per cent in Benue.” he said.

He noted that he was quite happy about the downward trend in Benue State.

In his goodwill message, David Young, Charge de Affairs, Embassy of the United States of America, said “Beyond the data, the survey has proved the capacity of Nigerians working together in solidarity with one another to rise and resolve challenges regarding the health and well being of their brothers and sisters.

“The US government is proud to support Nigeria in conducting the NAIIS survey,” he said.

The Country Director, Center for Disease Control Nigeria (CDC), Mahesh Swaminathan said the results will help the government improve it efforts in the fight against the virus.

“The encouraging results presented today, along with ongoing monitoring and evaluation data will help the Government of Nigeria to intensify efforts in the fight against HIV/AIDs to achieve epidemic control.

“CDC will continue to work alongside our Nigerian brothers and sisters in this fight.” he said.

Africa: ‘Exciting’ News in Fight Against Drug-Resistant TB

Cape Town — In an important step in the fight against strains of tuberculosis which resist conventional treatments, the U.S. Food and Drug Administration (FDA) has agreed to review urgently a new drug for approval.

The introduction of the drug, called pretomanid, has shown promise in clinical trials for cutting the length of treatment for various kinds of drug-resistant TB down to six months. It can also be taken orally instead of by injection.

Drug-resistant TB is difficult and costly to treat. Until recently, treatment for multidrug-resistant (MDR) TB has often taken nine to 18 months or more, and that for extensively drug-resistant (XDR) TB up to two years or longer.

When the trials were launched, Dr Francesca Conradie of Sizwe Hospital in Johannesburg noted that XDR-TB in particular is “an absolute devastation to patients, their families, and communities”.

The announcement of the FDA’s decision was made this month by the TB Alliance, a non-profit group based in New York and Pretoria which is dedicated to finding and making available better drugs to fight TB. FDA approval is an important step towards manufacturing and marketing drugs.

The alliance said the FDA has accepted for review an application to use the novel drug as part of a three-drug regimen which also includes bedaquiline and linezolid. The FDA granted the drug “priority review” status, meaning that it aims to make a decision within six months instead of taking 10 months.

The alliance expects a decision in the third quarter of this year and says if pretomanid is approved it will work with manufacturers to ensure that it will be accessible to everyone who needs it.

The alliance said the three-drug regimen has been studied in 20 clinical trials, either alone or in combination with other anti-TB drugs. It was announced last October that nine of every 10 participants in trials at three South African sites had been cured of drug-resistant TB after six months of treatment and six months of post-treatment follow-up through a simplified and shortened treatment regimen.

The FDA’s acceptance of the drug for review is “exciting”, says the Treatment Action Group, a New York-based activist think tank. “Pretomanid represents only the fourth new TB drug to go through stringent regulatory review in the past half a century, and the first developed by a not-for-profit organization.”

Malawi: Dedza Shocks Stakeholders With Increased Cases of Kidney Failure

Out of at least 12 patients with kidney failure that Kamuzu Central Hospital (KCH) recruits every month, six come from Dedza alone, a development which has worried stakeholders in the district.

KCH, situated in Malawi’s Capital Lilongwe, is a referral hospital serving districts in the country’s Central Region.

The bad news from Dedza was revealed during the commemoration of World Kidney Day held Thursday at Umbwi Secondary School by KCH and its cooperating partners.

In fact, the commemoration was held in Dedza because of those scaring statistics from the district and stakeholders took advantage of the event to raise more awareness among residents about how they can prevent kidney failure.

According to health experts, the disease is, among others, caused by the damage inflicted to the kidneys by sicknesses such as high blood pressure, diabetes and severe malaria.

However, stakeholders gave mixed views on what may be leading to increased cases of kidney failure in Dedza with Senior Chief Kachere saying it is due to excessive consumption of alcohol and smocking.

“Please, reduce uptake of alcohol and stop smoking,” he pleaded with the gathering during the ceremony.

On the other hand, District Medical Officer, Dr Misha Stande, alleged that it is because people drink an influx of traditional medicine from neighbouring Mozambique.

According to her, the unregulated dosage of traditional medicine in the human body releases alot of toxic matter that overworks the kidneys and eventually leading to kidney failure.

“However, we are civic educating people through our Out Patient Department and Non Communicable Diseases sections on how they can stay healthy. We conduct regular tests for NCDs which also enables us to detect early enough if there is any kidney injury,” explained Stande.

Taking his turn, Dr Charles Munthali from KCH, acknowledged the problem of Kidney failure in Malawi, describing it as severe.

“The 12 referral cases we receive in a month are a few the district hospitals can manage to diagnise using the limited equipment and resources they have. So many people remain undiagnised and continue to suffer ignorantly,” observed Munthali.

He added, “Even at KCH we do not have enough Dialysis Machines that we use for treating patients with kidney failure. Of late, we have been prioritising those that are critically ill”.

Munthali thinks there should be mass sensitisation about kidney failure in the country to prevent the disease and emphasized that if the disease reaches chronic level in a person, it is very expensive to treat.

“Actually, k4 million is required for a patient with kidney failure to undergo kidney dialysis treatment for one year,” he said.

And Mayamiko Khomba, a Renal Nurse at KCH, concurred with the other speakers on prevention of kidney failure, adding that people need to eat healthy.

“A balanced diet panctuated with a lot of vegetables and fruits is very important. People must also consider drinking at least two litres of water per day and reduce salt uptake,” she said.

This was the 13th year Malawi was joining the rest of the World in commemorating World Kidney Day which falls on 14 March and the theme was; Kidney Health for everyone, everywhere.

Nigeria: Undetected Cases of TB Aiding Transmission, Says NTBLCP

Abuja, Lagos and Ibadan — The tuberculosis cases that are still undetected are constituting a pool for continuous transmission of the disease in Nigeria, the National Tuberculosis, Burulli Ulcer and Leprosy Control Programme (NTBLCP) Department has said.

National Co-ordinator of NTBLCP, Dr. Adebola Lawanson, who disclosed this yesterday in Abuja ahead of the 2019 World TB Day, represented by Dr. Emperor Ubochioma, said Nigeria had been classified among the countries with high burden of TB and currently ranked sixth globally and first in Africa.

She noted that an estimated 418,000 new TB cases occur in Nigeria in 2018 and the country notified 104,904 (25 per cent) and 106,533 cases in 2017 and 2018 respectively, giving a gap of 314,712 and 319,599 cases yet to be notified respectively.

“The increasing pool of drug resistant to TB in the country continues to be a major threat to the control of the disease,” she said.

Lawanson said the missing TB cases in the country could be found among men, women and children with different forms of TB, adding however that the proportion of missing TB cases among children is more worrisome, as Nigeria was only able to notify seven per cent of the estimated childhood TB cases in 2017.

She said that as part of efforts in finding the missing TB cases in the country, the Federal Government, with the support of partners, is rapidly expanding TB diagnostics and treatment services to more sites across the country.

On his part, Dr. Bassey Nsa, Country Director (Challenge TB program) of KNCV, called on active involvement of the private sector in finding the undetected cases of TB.

He urged government to come up with policies that will aid the smooth intervention of private players.

In another development, the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed that the Nigerian HIV/AIDS burden has dropped from 3.2 million to 1.9 million.

President Muhammadu Buhari has urged stakeholders not to relent in the fight against HIV/AIDS but to increase the momentum in a concerted effort to end the epidemic ahead of 2030.

Buhari, who announced the NAIIS result at the Banquet Hall of the State House yesterday in Abuja, expressed delight that fewer Nigerians are now affected by HIV.

He said we could not celebrate yet, as almost a million Nigerians living with HIV are currently not on treatment.

The President, who stated that to achieve epidemic control and end AIDS in Nigeria, we need a more co-ordinated and funded national response, directed NACA and the Federal Ministry of Health to undertake detailed consultations and consensus building with key sectoral ministries, the legislature, governors of high prevalence states, our development partners and civil society to chart a new strategic path and building on the results of this survey.

The Director-General of NACA, Sani Aliyu, said Nigeria had made good progress in scaling up HIV treatment and prevention services in recent years.

However, dentists have said that the rising cases of oral diseases in Nigeria may increase the risk of Acquired Immune Deficiency Syndrome (AIDS), heart attack, diabetes, cancer, stroke and other health problems, if not addressed urgently.

This was disclosed yesterday by the body of dentists at the Federal Medical Centre (FMC), Ebute Metta, Lagos State, ahead of the World Oral Health Day on March 20.

President of Nigerian Dental Association (NDA), Dr. Evelyn Eshikena. said “the problem facing oral health in the country is enormous, as it contributes a major public health challenge.”

She said poor oral health, especially an unhealthy mouth with gum disease, might increase the risk of serious health problems such as heart attack, stroke, diabetes, pre-term labour and AIDS.

Head of Department, Dental Services, FMC, Ebute Metta, Dr. Obiora Chinwuba, said that most people rather use different medications, which propagate disease conditions than present their oral health challenges to registered dental facilities.

Meanwhile, newly-inducted medical doctors and dentists from the University of Ibadan (UI) medical school have been charged to imbibe positive healthcare attitude as a major tool of operation.

Vice chancellor of the university, Prof. Idowu Olayinka, spoke yesterday at the Batch B induction ceremony of the 2016/2017 set, which ushered in 32 new medical practitioners and 11 dental professionals into the field of healthcare.

He urged the incoming doctors to be ready at all times to discharge the good mandate that had been passed to them by the institution.

“The height you attain in life is not just a function of your capability, but most importantly, your attitude,” he said.

Represented by the Deputy Vice Chancellor (Administration), Kayode Adebowale, the VC encouraged the inductees to know their limitations and seek help from their senior colleagues when a patient’s condition seems challenging.

He also reminded them of the sanctity of a patient’s personal and medical information, even till death and beyond, as dictated by the core ethics of the medical profession.

The Registrar, Medical and Dental Council of Nigeria (MDCN), Tajudeen Sanusi, called for diligence and dedication, as those could be survival tools for the patient-doctor relationships.

The inductees were warned against any form of sexual misconduct with patients, and to respect the patient’s autonomy and dignity, disregarding social differences, political affiliation, gender and race.

Madagascar: In Madagascar, 1,100 Measles Deaths Are More About Money Than ‘Vaccine Hesitancy’

Antananarivo — In a healthcare centre in the Madagascan capital of Antananarivo nine-year-old Faneva inches his arm forward. The nurse disinfects his skin before inserting the needle. A few seconds later, it’s all over. The young boy smiles in relief.

This is the front line of efforts to combat Madagascar’s deadliest measles outbreak in living memory. The virus has killed more than 1,100 people – mostly children – since September, and infected nearly 100,000 more all across this large island nation.

The outbreak is raging, at least in part, due to low immunisation rates. But unlike in more developed countries where parents refuse to vaccinate their children because of so-called “vaccine hesitancy”, the challenge in Madagascar is one of affordability and accessibility.

Despite measures put in place to tackle the spread of measles, the response in Madagascar has been complicated by the high cost and logistical challenge of transporting the vaccine to health centres in remote districts, and storing it long enough at the required low temperature.

Madagascar is among Africa’s poorest countries; 75 percent of its population of 26 million live on less than $2 per day. It faces a host of humanitarian challenges, including El Niño-induced droughts that fuel food insecurity; cyclones that displace tens of thousands annually; and severe health problems such as seasonal plague, chronic malnutrition, and now measles.

Faneva received his first dose of the measles vaccine when he was just nine months old, his father, Fanilo Andrianarivony, told IRIN. But his school now requires everyone who is nine years old or younger to be vaccinated with a second dose. In Faneva’s class at school, 15 pupils caught the virus between November and December, despite medical reports indicating they had been vaccinated as babies, their teacher said.

Although a double dose of the vaccine – one at six to eight months, and a booster at least a month later – is recommended by international health bodies, the second dose is not yet part of the routine immunisation schedule recommended by Madagascar’s health ministry. As a result, very few parents take their children to receive a booster dose.

“A single dose is only half effective,” said Jean-Benoît Manhes, the deputy representative for UNICEF in Madagascar. “To become 85 percent effective, a second dose is needed.”

Even with the double dose, there is still a 15 percent risk of contagion, Manhes said, explaining that “for individual coverage to work, you need mass immunity, up to 95 percent”.

Reaching the required level of immunity is a huge challenge in Madagascar, where measles vaccination coverage – children who have received at least one dose of the vaccine – is barely 60 percent, according to the World Health Organisation. This low coverage rate has been one of the main drivers of the current outbreak, the WHO said.

Poor health infrastructure and low levels of awareness are factors that have led to an increase in measles cases globally, not just in Madagascar, according to UNICEF. At the same time, complacency and vaccine hesitancy have caused the virus to re-emerge and spread in more developed countries that had been declared measles-free.

“Global cases of measles are surging to alarmingly high levels,” UNICEF warned this month, with 10 countries accounting for over 74 percent of the total increase in 2018.

“Almost all of these cases are preventable,” UNICEF executive director Henrietta Fore said in a statement. “Measles may be the disease, but, all too often, the real infection is misinformation, mistrust, and complacency. We must do more to accurately inform every parent, to help us safely vaccinate every child.”

In Madagascar, UNICEF, the WHO, and the health ministry launched an immunisation campaign to target all 114 districts in the first quarter of this year.

More than two million children, including Faneva, were immunised in January, and 1.4 million children were vaccinated in February. But the campaigns only reached 25 and 22 districts respectively, meaning another 67 districts still have to wait until the end of March or the beginning of April.

“We are asking the authorities to send vaccines as quickly as possible to our region,” a nurse working in a health centre in one of the yet-to-be-reached southern districts told IRIN, preferring her name not be used.

The nurse said that in districts like hers the lack of vaccines means they can only vaccinate children under nine months old with the first routine dose. “It’s heartbreaking to see the desperation of parents, but we can’t do anything until [more] vaccines arrive,” she said.

To immunise all the nearly eight million children from nine months to nine years old, Madagascar needed $7 million; however, all the necessary funds were only collected this month. And even now, financial and logistical obstacles remain.

“Ideally, a single national campaign at the same time for all the districts would have been perfect to interrupt the outbreak,” UNICEF’s Manhes said.

Sourcing the number of vaccines needed was a major challenge, and getting eight million doses at one time was “very complicated”, Manhes said.

“Very few laboratories are producing the measles vaccine, and orders are still planned five years in advance,” he explained. UNICEF had to negotiate with countries like the Democratic Republic of Congo, Uganda, and Yemen to get all the vaccines it needed.

Even when stocks are available, disseminating the vaccines and syringes across Madagascar is no easy task due to the vast size of the island – roughly the same size as France or Spain but with notoriously tricky terrain and poor roads, especially in the more remote regions.

In mid-February, the WHO said there was a gap of $3 million in the budget for the third and final vaccination campaign. But at the beginning of March, the Malagasy authorities, with the support of their technical and financial partners, said it would now be possible.

On 5 March, UNICEF and the government signed an agreement to supply 500 health centres in remote parts of the country with $4.5 million worth of solar refrigerators, allowing them to store the vaccines and cut back on shortages in areas where there is no electricity.

“Health centres will be able to offer daily immunisation services when they are equipped with solar refrigerators,” said Julio Rakotonirina, a professor of epidemiology who is Madagascar’s minister of public health.

Manhes explained how difficult it is in remote, rural regions far from the capital. “It can happen that parents come to the [health] centre with their children and there is no vaccine,” he said. “When they come back a week later, the centre is closed because the staff went to get their pay. A week later, they come back but the vaccine is out of date or no longer effective because the cold chain has broken down. Do you think they will come back a fourth time, especially if their village is a few hours walk from this centre?”

For Manhes, these broader failings are driving the upsurge in epidemics like the current one. “It is important that Madagascar adopts a sustainable and strengthened health system,” he said.

Other health and humanitarian concerns in Madagascar also risk worsening the effects of the epidemic. With 47 percent of Malagasy children under age five facing chronic malnutrition, there are risks of serious complications and death if they contract measles, the UN’s emergency aid coordination body, OCHA, said.

“Malnutrition that strikes one child in two, also makes the measles bed in Madagascar,” said the WHO representative in Madagascar, Dr. Charlotte Faty Ndiaye.

While families with children unprotected from the virus live in fear, others, like the parents of four-year-old Rado, mourn the outbreak’s latest victims.

“He had coughed a lot and had a very high fever,” Rado’s mother, Haingo Nomenjanahary, recalled of the days when her son first became ill.

She took him to the health centre only when rashes developed on his face and body. “We were rushed to the hospital, but the doctors did not save my son,” she said.

Rado had never been vaccinated against measles. “He had another [different] vaccine at six months, but when he was nine months old, I had no time to take him to the basic health centre,” Nomenjanahary said. “I did not expect that not being vaccinated could kill him.”

Rado’s one-year-old sister, Ravaka, is luckier than her brother. Nomenjanahary now knows that to protect her youngest daughter she has to take her to be vaccinated, and a few weeks after her son died, she did just that.

Ravaka received her first dose of the measles vaccine at 11 months. “I hope that now she is immune to this danger,” her mother said. “And if God still gives me children, I’ll take them to the basic health centre to be vaccinated,” she promised.

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South Africa: Quack Claims About Oxygen Treatment Are Dangerous

If you go scuba-diving and come up to the surface too fast, you might need Hyperbaric Oxygen Therapy. But, experts warn, it can’t treat cancer, stroke, Alzheimer’s disease, autism, or arthritis, as some quack outfits are claiming.

Hyperbaric Oxygen Therapy (HBOT) is generally known as the treatment to cure “the bends” (decompression sickness) in underwater divers.

The therapy uses high concentrations of oxygen at high pressure, and has been approved for use in 14 conditions including decompression sickness, gas gangrene (caused by a bacterial infection and accompanied by an odorous gas), necrotising soft tissue wounds (as with diabetic foot wounds caused by severe bacterial infection) and thermal burns amongst others.

But practitioners of so-called mild hyperbaric oxygen therapy (mHBOT) are fraudulently cashing in on the science that supports medically-approved HBOT.

Dr Cecilia Roberts, President of the Southern African Underwater and Hyperbaric Medical Association (SAUHMA), says the association is “very concerned with the false hope, claims and marketing of mHBOT as well as the threat to the scientific field of Hyperbaric Medicine.”

Treatment is administered in a special chamber where patients inhale 100% percent medical oxygen at high pressure – twice the average atmospheric pressure exerted at sea level. This increases the amount of oxygen in the blood, which “has direct and indirect therapeutic medical effects which promote the healing process,” says Roberts. But this applies only to the conditions for which it is indicated.

Dr Jack Meintjes, Programme Coordinator for Underwater and Hyperbaric Medicine programmes at Stellenbosch University, says misinformation is being fed to the public by mHBOT opportunists: “If you administer low pressure HBOT, it is like moving someone from Johannesburg down to Cape Town and then claiming you are treating them. We know this is not true. You have to have a certain level of the medicine, so to speak, to have an effect and that will only be possible if the pressure is high enough to dissolve more oxygen in the plasma. But the quacks quote the evidence for proven HBOT for their mHBOT saying, ‘Look, here is the evidence for HBOT, come to us and we will treat you.'”

mHBOT is usually administered in an inflatable soft chamber with air or air mixed with added oxygen.

These chambers – prohibited by the American Food and Drug Administration for use other than in acute mountain sickness – often do not comply with South African safety regulations.

Fabric chambers are not designed to be used with 100% oxygen. Oxygen in high concentrations increases the risk of fire. Cosmetics such as deodorant, hairspray and makeup could easily combust under high oxygen content. “Our team specifically investigates all these things, and we know exactly what the safety rules and regulations are according to international standards. Some mHBOT practitioners and marketers do not even have a fire extinguisher on site, so how can they advise on the correct fire extinguishing systems when they sell these chambers to the public as home devices?” says Meintjes.

The increased atmospheric pressure in the hyperbaric chamber is another safety concern and a serious risk. If the soft chamber inadvertently deflates, as in the event of an unexpected power shortage, this could cause serious injury to a patient’s eardrums or lungs.

But in spite of warnings and recommendations from HBOT experts and bodies such as SAUHMA, the use of mHBOT devices is on the rise.

The South African company O2xygenate claims mHBOT can be used for a string of indications including cancer, stroke, Parkinson’s disease, Alzheimer’s disease, autism, arthritis, multiple sclerosis and cerebral palsy amongst others – none of which is approved for treatment with HBOT or mHBOT. O2xygenate also advertises its services for diabetic ulcers and burns – conditions indicated as treatable with HBOT only. Treatment costs range from R500 an hour to R8,000 for 20 treatments. The company also sells soft hyperbaric chambers for home use.

The company SpecialKids advertises mild hyperbaric treatment through O2xygenate for off-label conditions in children. Its website provides a direct link to the O2xygenate website.

Former chiropractor Malcolm Hooper, who owned the hyperbaric treatment clinic Oxymed Australia, is to stand trial for unsafe practice following the death of a former client who was undergoing treatment for multiple sclerosis at Hooper’s facility.

“The problem is,” says Dr Meintjes, “Our colleagues associate us with all this quackery and they won’t refer patients to us here at the Tygerberg HBOT Department. Instead, despite the evidence for the successful treatment of soft tissue and bone damage following radiation, or certain diabetic foot wounds with HBOT, two or three amputations are done each day at Tygerberg Hospital; we do not get a single referral. And it costs the state patients nothing to be treated here.”

Pretoria-based vascular surgeon and former president of SAUHMA, Dr Gregory Weir, says, “Modern hyperbaric oxygen therapy is part of mainstream evidence based medicine. The hyperbaric physician and his team is an under-utilised resource.”

Weir has lodged a complaint with the South African Health Products Regulatory Authority (SAHPRA) about the misuse of mHBOT. The matter has been referred to the Deputy Director of Medical Devices at SAHPRA, Andrea Julsing. “SAHPRA should be made aware of the false claims made by the charlatans who exploit patients for financial gain,” says Weir.

Useful organisations

Southern African Underwater and Hyperbaric Medical Association: www.sauhma.org

South Pacific Underwater Medicine Society: www.spums.org.au

European Underwater and Baromedical Society: www.eubs.org

Undersea and Hyperbaric Medical Society: www.uhms.org

Canadian Undersea and Hyperbaric Medical Association: www.cuhma.org

Tanzania: 62 Kidney Dialysis Machines for Delivery Tomorrow

IN what certainly represents a major breakthrough for people suffering from kidney complications, the government is expected to receive, tomorrow, 62 new kidney dialysis machines from the government of Saudi Arabia that will be distributed to zonal and regional hospitals countrywide.

Currently, the country has 42 machines, according to the Deputy Minister for Health, Community Development, Gender, Elderly and Children, Dr Faustine Ndugulile. This means, that, in all, the country will have 104 machines at the various health facilities.

Dialysis machines are used to filter a patient’s blood to remove excess water and waste products when the kidneys are damaged, dysfunctional, or missing. The dialysis machine represents an artificial kidney.

Speaking at a news conference yesterday, Dr Ndugulile said the government was putting all measures in place for reducing the cost of treating people suffering from kidney complications.

He was speaking to remind Tanzanians on the importance of frequent health check-ups as the country joined the rest of the world to commemorate World Kidney Day (WKD), which is marked on March 14 every year. This year’s theme is ‘Kidney Health for Everyone Everywhere’.

Despite the growing burden of kidney diseases worldwide, kidney health disparity and inequity are still widespread. Globally, chronic kidney diseases (CKD) cause at least 2.4 million deaths per year and are now the sixth fastest growing cause of death.

According to Dr Onesmo Kisanga, a kidney specialist at the Muhimbili National Hospital (MNH), a team of experts is currently conducting a study to establish the number of people suffering from kidney complications in the country.

Transplantation is considered the most cost-effective treatment of CKD. However, it has high set up costs with regards to infrastructure and requires highly specialised teams, availability of organ donors and cannot be done without dialysis backup.

According to Dr Ndugulile, a single dialysis in Tanzania costs 250,000/-, meaning that a patient can spend up to 1m/- per week. However, he explained that the country had so far reduced referrals for India to treat kidney complications.

Initially, a person who was referred to India for kidney transplantation spent between 80m/- and 100m/-, but now a patient who receives the same treatment at MNH or Benjamin Mkapa Hospital (BMH) which are currently offering kidney transplantation surgery, spends only 21m/-.

“Until now, 42 patients have been successfully operated, out of which 38 were treated at MNH and four others were operated at BMH; if they were to be referred to India, 4.2bn/- would have been spent but the total cost in Tanzania was only 800m/-,” he said.

This means that, by carrying out transplantation at local medical facilities, the government saved over 3bn/-. According to Dr Kisanga, the country has only 14 kidney specialists and that five others are expected to be deployed in the country after accomplishing their studies.

Nigeria: Over 2 Million Nigerian Children Receive Treatment Against Parasitic Worms

“My son had blood in his urine for almost a year and I didn’t know what to do,” says Rahab Haruna, a 45-year-old mother from Adamawa State.

“I went to several pharmacies and explained the symptoms, to no avail. When we went to hospital, he was diagnosed with Schistosomiasis. We were also told the drugs to treat the disease is scarce and we were given alternatives that did not work. I can’t wait to take this drug home to give to my son and his friends,” she exclaimed when given Praziquantel, the WHO recommended treatment against all forms of schistosomiasis.

Like Rahab, very few parents know Schistosomiasis and that it can be treated despite the fact that the disease is rampant in their communities. In Nigeria 44 million children are at risk of being infected with Schistosomiasis – an acute and chronic disease caused by parasitic worms. Symptoms of schistosomiasis are caused by the body’s reaction to the eggs from the worm. Intestinal schistosomiasis can cause abdominal pain, diarrhoea, and blood in the stool. Liver enlargement is also common in advanced cases of Schistosomiasis. The main symptom of genital schistosomiasis is haematuria (blood in the urine).

Over the past three months, the World Health Organization’s (WHO) Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN) has supported Nigeria to reach over 2 million children who have never had Schistosomiasis treatment before.

Conducted across 27 LGAs in Borno, 18 LGAs in Adamawa and 3 LGAs in Bauchi state, ESPEN contributed in bringing the geographic coverage of treatment to 100% in Adamawa, Borno and Bauchi states.

People can get infected with Schistosomiasis during routine agricultural, domestic, occupational and recreational activities, which expose them to infested water. In addition, lack of hygiene and certain play habits of school-aged children such as swimming or fishing in infested water can make them vulnerable to infection. The economic and health effects of schistosomiasis are considerable and the disease disables more than it kills. In children, schistosomiasis can cause anaemia, stunting and a reduced ability to learn, although the effects are usually reversible with treatment. Chronic schistosomiasis may affect people’s ability to work and in some cases can result in death.

The Schistosomiasis treatment, ‘Praziquantel’, is effective, and safe; even though re-infection may occur after treatment. With this treatment, the risk of developing severe complication from the infection is diminished and mostly reversed when treatment is timely.

The World Health Organization has helped the country to have a complete mapping of where Schistosomiasis is endemic in the country. The mapping has shown that 583 of the 774 LGAs in the country have schistosomiasis. In addition to mapping, WHO provides Praziquantel drugs for mass drug administration (MDA). As of the beginning of this year, 449 of the 583 endemic LGAs had conducted at least one MDA including 190 that carried out MDAs in 2018 alone. All children at risk are reached and provided a dose of praziquantel during MDA campaigns. Capacities of health workers are built for the campaign as well as continued routine treatment.

“These MDAs are indeed what is what is needed. They are truly impactful and do touch on lives of many children,” stated Dr Anyaike Chukwuma, the National NTD coordinator. “So far, I am glad to report that at least 2 million children have so far been reached this year and I looking forward to reaching even more by the end of the year.”

Dr Rex Mpazanje, speaking on behalf of the WHO Representative to Nigeria, indicated that “as with other NTDs, WHO is continuing to work with the Government and other development partners to advocate for and facilitate increased availability and access to treatment to end the scourge of Schistosomiasis.”

He further reveals, “Since the beginning of 2018, WHO has expanded its support to include actual conducting of MDA campaigns alongside implementing partner NGOs.” WHO’s work on schistosomiasis is part of an integrated approach to the control of neglected tropical diseases (NTDs). Although medically diverse, neglected tropical diseases share features that allow them to persist in conditions of poverty, where they cluster and frequently overlap.

WHO continued local support is being made possible by the continued global support of the Arab Bank for Economic Development in Africa, Bill &Melinda Gates Foundation, Christoffel-blindenmission, Department for International Development (DFID) United Kingdom, Glaxosmith Kline, Johnson & Johnson, Kuwait Fund for Arab Economic Development, Mectizan Donation Program, Merc Sharp & Dohme Chibret, Sightsavers, The END Fund, Merck Group, United States Agency for International Development (USAID) and The World Bank.

Africa: Shorter, Safe Treatment of TB in People With HIV Found

Co-administering a drug for treating HIV called dolutegravir with two common TB medicines can safely shorten TB treatment, a study says.

The WHO estimates that those living with HIV are 20 to 30 times more likely to develop active TB, with a third of all HIV deaths every year being attributed to TB. According to WHO guidelines, longer treatment of drug-resistant TB requires drugs to be administered for about 20 months whereas shorter treatment has a duration of nine to 12 months.

But a study conducted in South Africa from January 2018 to February 2019 by the Aurum Institute and partners shows that administering dolutegravir for eight weeks and subsequently adding three-month of two first-line TB medicines – rifapentine and isoniazid (3HP) – can safely be used to treat TB in people with HIV.

“We wished to show that 3HP with dolutegravir in people living with HIV was safe. The 3HP will be very useful for preventing TB in people living with HIV,” Gavin Churchyard tells SciDev.Net.

Churchyard, group CEO of South Africa-based Aurum Institute and co-principal investigator of the study, adds that the research finding paves the way for scaling up the 3HP regimen in 12 high-burden TB countries: Brazil, Cambodia, Ethiopia, Ghana, India, Indonesia, Kenya, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe.

Researchers presented the findings of the study – which involved 60 HIV-positive adults in South Africa and has not yet been published in a journal – at the Conference on Retroviruses and Opportunistic Infections in Seattle, United States last week (6 March).

According to the researchers, after completing treatment, the participants were followed for four more weeks. Co-administration of dolutegravir, rifapentine and isoniazid was well-tolerated, with no serious adverse drug reactions, the researchers add.

“The plan is to scale up 3HP for people living with HIV and all household contacts, particularly children under five years, in all high burden countries.” Churchyard explains, adding that his team is seeking funding to help make the drugs accessible to poor people living with HIV and with TB.

Kizito Lubano, a clinical researcher at the Kenya Medical Research Institute and an honorary lecturer at Kenya-based University of Nairobi School of Medicine, agrees with the study’s findings but says that the small sample size of 60 is not enough for making recommendations for large-scale use. “There is a need for comprehensive multi-centre phases three and four trials with larger sample sizes to have sufficient confidence to recommend for routine use,” he tells SciDev.Net.

He adds that any simplification of treatment options leading to shorter duration and low number of medicines is a desirable goal of any disease treatment and control programme.

“The current treatments are the best based on scientific advancement and knowledge of HIV/AIDS and TB,” says Lubano. “However, there is a need for continuous improvement as knowledge increases.”

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

Africa: UN Warns of Millions of Premature Deaths By 2050 Due to Environmental Damage

Nairobi — Environmental damage caused by man-made activities is having a devastating toll on human health, the United Nations said on Wednesday, warning of millions of premature deaths due to air and water pollution by 2050 if action was not taken.

Seen as the most comprehensive and rigorous assessment on the state of the environment, the U.N.’s Global Environment Outlook said human health – was in “dire straits” due to unsustainable development and poor environmental protection.

Air pollution from vehicles and industry as well as burning fuels such as wood, coal and kerosene for cooking, heating and lighting was resulting in around 7 million deaths annually, said the report – costing around $5 trillion in welfare losses.

Water quality has worsened due to increased organic and chemical pollutants such as plastic, pathogens, heavy metals and pesticides. Almost 1.5 million people die annually due to diseases related to drinking pathogen-polluted water, it said.

“Our key message is that a healthy planet enables healthy human life – and that the planet is becoming increasingly unhealthy and this is impacting our health,” said Joyeeta Gupta, one of the leading scientists who worked on the report.

“The causes of an unhealthy planet need to be addressed.”

The 740-page report – compiled over six years by 250 scientists from 70 nations – said human activities could endanger the “ecological foundations of society” and called for unprecedented action.

It was released at the U.N. Environment Assembly, a five-day summit where environment ministers plan to commit to creating a more sustainable planet, from reducing food waste and plastic pollution to developing technologies to combat climate change.

TRANSFORMING FOOD, ENERGY, WASTE

U.N. officials said the health and prosperity of humanity was directly tied to the state of the environment and there was a need to transform to more sustainable models of development.

“The Global Environment Outlook has a very clear message: we cannot transform the world by tweaking around the edges,” said Joyce Msuya, acting executive director of U.N. Environment.

“We need to look at transforming how we produce and consume in the areas of food, energy and waste to ensure a healthy future for all.”

The agriculture sector, for example, is not only a significant contributor of greenhouse gas emissions, she said – one-third of food produced globally was being wasted, yet demand for food was rising due to population growth.

While production of renewable sources of energy was at an all-time high, two-thirds of the world’s electricity still came from fossil fuels, said Msuya.

“It’s time to value waste and discard our current model of economic growth and the mountains of waste that have come to characterise our urban spaces and waterways,” she said.

The report provided a slew of suggestions to help policymakers tackle challenges from reducing carbon emissions and curbing plastic pollution to tackling food waste.

Adopting less meat-intensive diets and reducing food waste, for example, would reduce the need to increase food production by 50 percent to feed an estimated 10 billion people on the planet in 2050, said the report.

Experts said it was time to end the “grow now, clean up after” model of economic development – and there were growing signs that people are asking for such a transformation. It was now time for their governments to listen, they added.

“We know what the problematic human behaviours are that are affecting our environment – it’s the way we eat, it’s the way we get around, it’s the energy we use to power our homes and it’s how we build our homes and all the infrastructure that goes with that,” said Paul Ekins, who also worked on the report.

“There are signs that all those behaviours are under question – from movements towards eating less meat to movements towards switching to electric vehicles. We now need to universalise these habits and behaviours.”

(Reporting by Nita Bhalla @nitabhalla, Editing by Claire Cozens. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s and LGBT+ rights, human trafficking, property rights and climate change. Visit http://news.trust.org)

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