The Secret Behind Rwanda’s Successful Vaccination Scores: When Poverty Can’t Stop You

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THE best medical treatment option in the world can’t save a single patient unless it is delivered at the proper time, with the proper plans and processes in place.
Thats why implementation science for health matters. It can best be described as a collection of principles that, if applied, will ensure the best possible health care is delivered to a specific community. It involves using evidence-based research to identify the obstacles to delivering health services, and the best ways to overcome them. The research must take into account things like geographical limitations, the social and economic make up of a community as well as cultural practices. Once established for one community, the methodology can be reused in others.
Through my own experience as an academic and as former health minister of Rwanda I am convinced that unless we adopt this approach we won’t be able to achieve universal health coverage and other United Nations Sustainable Development Goals. This is particularly true for Africa where health services are stretched because of a lack of resources.
If we incorporate efficient, evidence-based practices into our service delivery models in Africa well save millions of lives, as well as millions of dollars.
A vaccination programme rolled out in Rwanda illustrates what I mean.

THE RWANDAN EXAMPLE
In 2011 Rwanda began a vaccination programme for human papillomavirus (HPV) the most common sexually transmitted disease in the world. 33 countries had rolled out vaccination programmes, but few of them were in developing countries and none were in Africa.
In 2010, when we were preparing our first campaign, Rwanda seemed an improbable candidate for achieving near-universal HPV vaccination coverage. After all, we were ranked the 15th poorest nation in the world. International skeptics argued that developing countries couldn’t manage because of their weak scientific base, poor infrastructure, economic difficulties and overemphasis on curative, rather than preventative, medicine.
At the time even the developed world had achieved only moderate coverage of HPV vaccinations. The US had less than 35% of its adolescent female population fully vaccinated, and France also had a low coverage. If countries like this couldn’t realize HPV universal vaccination roll-outs, how could low and medium income countries manage?
But we weren’t deterred. We convinced HPV vaccine producers to ignore the global disapproval by presenting our evidence-based strategy of how we would roll-out a programme across the country. They listened, and then signed a public private partnership agreement, which funded the programme.
Despite the seemingly impossible odds, Rwanda achieved 93% HPV vaccination coverage within a year of initiating the campaign. The coverage level has been maintained ever since.
What is the secret to Rwandas success? The answer is simple. We put our trust in implementation science.
IMPLEMENTATION SCIENCE IN ACTION
For the rollout we collected evidence, adapted distribution methods to our setting and set clear targets and outcomes.
Every step of HPV distribution was evidence-based. To analyse the cultural implications of our programme, the Ministry of Health conducted a series of interviews and discussions with community members. We set up a task force which included all stakeholders – religious, educational, political, parliamentary, and community leaders – and designed a strategy of nationwide community education to spread awareness of cervical cancer, the benefits of the vaccine, and the proper time to receive it. Since almost all types of cervical cancer are caused by the human papillomavirus, it was important first to explain the link with cancer.
Using the same focus groups, we developed a method of defining and reaching the target population. Since HPV is a sexually transmitted disease, we wanted to vaccinate girls before they became sexually active. The task force researched the proper age bracket for this. Its conclusion was that a school-based vaccination scheme of 12-year-old girls would be most effective. Over 97% of female Rwandan pre-teens are enrolled in primary school and few have sexual intercourse at that age.
Another research component was on the cold chain management. We needed to know how much vaccine to procure, how much storage space and money this would require, how many transport vehicles we would have to mobilise and where to send them. We also drew from our experience in rolling out other vaccination programs to create a rotating decentralized storage system.
Once all the evidence had been evaluated, we put a detailed delivery plan in place. We organised a distribution system to transport the vaccine from the cargo plane, to Kanombe International Airport, to the national warehouse, to the 30 district hospitals, to the 436 health centres at that time, to the primary schools.
We also collaborated with Rwanda’s 45,000 community health workers and all the teachers concerned. They identified girls who were absent from school on the day of vaccination to make sure they were covered too. And teachers were taught how to monitor students in the days after the vaccination so that they could report any adverse side-effects and be a key pillar of the HPV vaccine pharmacovigilance system.
The principles of implementation sciences applied for the success of the HPV vaccination roll-out have been used in other vaccination campaigns. Today in Rwanda we have more than 90% of all children fully vaccinated for 11 vaccines, with an additional HPV vaccine for all girls.

NEED FOR RESEARCH AND EDUCATION

As Vice Chancellor of the University of Global Health Equity in Rwanda we are introducing researchers to implementation science.
Like any science, it requires research. At the moment, the global focus (and therefore global funding) is on clinical research and fundamental sciences. Last year less than 2% of all research grants offered by the National Institute of Health, the largest funder of health research in the world, have been dedicated to implementation science.
But to improve health care we must also invest in implementation research to improve service delivery. Sure, we need basic science to create cheaper, more effective technology. But we also need implementation science to provide cost-effective ways of delivering and promoting universal health coverage.

-This article was originally published on The Conversation.

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Early HIV vaccine results lead to major trial: researchers

WAAF Team member testing a community member to know status

Durban (South Africa) (AFP) – Promising results from an early safety trial with a potential HIV vaccine have paved the way for a major new study, researchers announced at the International AIDS Conference in Durban on Tuesday.

An 18-month trial with a candidate vaccine dubbed HVTN100 drew on 252 participants at six sites in South Africa, one of the countries hardest-hit by an epidemic that has claimed more than 30 million lives worldwide since the 1980s.

The participants fell within a low-risk category for contracting the sexually-transmitted virus, the researchers said.

The trial cleared a key hurdle in the long, three-phase process to test new drugs. In this early phase, the main point is to assess safety, not efficacy.

“We wanted to see if this vaccine candidate is safe in a South African population and if it is tolerable,” Kathy Mngadi, principal investigator at one of the research sites, explained to AFP.

The team also looked for antibodies signalling that the body’s immune system was responding to the vaccine.

The trial built on the foundations laid by a groundbreaking trial conducted in Thailand in 2009, which yielded the world’s first partially effective vaccine, dubbed RV144.

While hailed as a breakthrough, the effect of the Thai course decreased with time, dropping from 60 percent after one year to 31.2 percent after three-and-a-half years.

“RV144 set us on this journey of hope, but also showed us what we still need to learn and accomplish in this field,” said Fatima Laher, co-chair of the HVTN100 trial.

– Next step –

All the study criteria “were met unequivocally and, in many instances, the HVTN100 outcomes exceeded both our own criteria,” added trial protocol chair Linda-Gail Bekker.

The next phase of the trial, dubbed HVTN702, will kick off in November with the recruitment of 5,400 South African men and women aged between 18 to 25 at high risk of contracting HIV.

People are divided into risk categories through criteria that includes their sexual activity.

“We hope to have results in five years, and it is going to be a very exciting five years for all of us because it is the result of many, many years of hard work,” said Glenda Gray, HVTN Africa programme director.

A fully effective vaccine is still a long way off, she cautioned.

But recent studies have shown that even a partially effective blocker could have a huge impact if rolled out on a large scale.

Some two-and-a-half million people are still becoming infected with HIV every year, according to a new study published on Tuesday, even as drugs have slashed the death rate and virus-carriers live ever longer on anti-retroviral treatment.

While the quest for a cure continues, many view a vaccine as the best hope for stemming new infections.

Larry Corey, principal investigator for the HIV Vaccine Trials Network, a publicly-funded international project, said vaccines were barely mentioned the last time the conference was held in Durban some 16 years ago.

“It’s really gratifying now to see how far we’ve come scientifically,” he said.

Last year, billionaire and philanthropist Bill Gates, who spends millions of dollars on AIDS drug development, said he hoped for an HIV vaccine within a decade, as a cure seems less likely.

Malaria vaccine loses effectiveness over several years: study

WAAF Team member testing a community member to know status

An experimental vaccine against malaria known as Mosquirix — or RTS,S — weakens over time and is only about four percent effective over a seven-year span, researchers said Wednesday.

The findings, published in the New England Journal of Medicine, are based on a phase II clinical trial involving more than 400 young children in Kenya.

There is currently no vaccine against malaria on the world market and Mosquirix — developed by the British pharmaceutical giant GlaxoSmithKline — is the experimental vaccine in the most advanced stage of development.

It has also been tested in a vast clinical trial that spanned seven African nations, and last year the European Medicines Agency gave it a “positive scientific opinion” regarding its use outside the European Union.

But the current study, involving 447 children from five to 17 months of age, suggested otherwise.

Some of the infants were given three doses of the malaria vaccine, while others received a vaccine against rabies for comparison.

In the first year, the protection against malaria among Mosquirix-vaccinated children was 35.9 percent.

But after four years this protection fell to 2.5 percent.

Researchers said that on average, over the course of seven years, the vaccine would be considered just 4.4 percent effective against malaria.

This rate “was substantially lower than that seen over short-term follow up,” said the study.

Furthermore, among children who were more frequently exposed to mosquito-borne malaria, cases of infection with the parasite P. falciparum in the fifth year were higher than in the control group.

Researchers said this phenomenon may be occurring because the vaccine protects against the earliest form of malaria’s life cycle, known as sporozoites, and reduces exposure to a later form, known as the blood-stage parasite, which causes the clinical symptoms of malaria such as fever, nausea, vomiting and diarrhea.

“The reduced exposure to blood-stage parasites among persons who have received the RTS,S/AS01 vaccine may lead to a slower acquisition of immunity to blood-stage parasites, leading to an increase in episodes of clinical malaria in later life,” said the study.

The results of a larger, phase III clinical trial with the same vaccine, published last year, showed that three doses could reduce the risk of malaria by 28 percent over a period of four years.

The rate of protection rose to 36 percent when children received a fourth dose of the vaccine, suggesting that this additional dose was significant.

Malaria killed more than 400,000 people worldwide in 2015, with most of the deaths occurring in sub-Saharan Africa and most among children under age five.

The research was funded by the PATH Malaria Vaccine Initiative and the Bill and Melinda Gates Foundation.

AFP

Angola’s yellow fever death toll tops 300: WHO

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Angola’s yellow fever outbreak has killed more than 300 people since December, with cases of the deadly disease spreading to the Democratic Republic of Congo, Kenya and even China, the World Health Organization has said.

The outbreak was first detected in the capital Luanda at the end of last year, and has now been confirmed in most coastal and central regions of the west African country.

“Angola has reported 2,536 suspected cases of yellow fever with 301 deaths,” WHO said in an update released Thursday.

“Despite vaccination campaigns in Luanda, Huambo and Benguela provinces, circulation of the virus persists in some districts.”

WHO warned of unimmunised travellers spreading the virus after neighbouring DR Congo reported 41 cases imported from Angola, with two cases in Kenya and 11 in China.

“The outbreak in Angola remains of high concern due to persistent local transmission in Luanda despite the fact that more than seven million people have been vaccinated,” WHO said.

There is no specific treatment for yellow fever, a viral hemorrhagic disease transmitted by infected mosquitoes and found in tropical regions of Africa and Latin America’s Amazon region.

Yellow fever vaccinations are routinely recommended for travellers to Angola, though the country had not previously seen a significant outbreak since 1986.

Aid groups have warned of poor health facilities and vaccine shortages limiting Angola’s ability to cope with the outbreak.

AFP

Eating Healthy: Nutrition tit-bits

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Food is the basic need for nourishment of our physical bodies which is scripturally proven (1Kings 19:8). Right from the womb a baby is developed by the food stored by the mother as well as what is being consumed.

Food is made up of nutrients which perform important functions in the body. Without food life cannot continue.

The body requires energy for its activities such as respiration, movement, reproduction etc. foods that provide energy are those that contain the nutrients Carbohydrate, Protein and Fat. We will take a critical look at Carbohydrate for now.

The main function of Carbohydrate is to provide energy while protein and Fat provide energy when there is no carbohydrate in the body. Carbohydrate is completely broken down to glucose which is the fuel that gives the body energy. Also glucose is the only food required by the brain to function.

The energy needed by the body in a day is around 2000 calories (unit for measuring energy) however your body might need more or less depending on your gender, age, weight, height and most importantly your level of activity.

Carbohydrates are found in the following foods;
Fruits, Vegetables, Bread, Cereals and grains (rice, maize, wheat, millet etc.), cereals and grains food product like Banku, Koko (fermented corn dough porridge), Tuo zaafi etc., Milk and milk products (yoghurt, ice cream etc ) and Foods containing added Sugars (cakes, cookies, sugar sweetened drinks/beverages).

Carbohydrates are basically broken down to sugars and it is important not to consume more than the body needs. Excess carbohydrate can be converted to Fat in the body and increase the amount of fat in the body than required.

It is therefore necessary to feed the body with the right amount of carbohydrate mainly from healthier foods and not from foods with added sugars like Sweetened drinks.

Healthy foods high in carbohydrates include ones that provide
Dietary Fiber eg. Beans, Oatmeal, Fruits, Vegetables, Wheat bread, Brown rice
Whole grains eg. Corn, Rice, Millet, Sorghum

It is recommended that 45% – 65% of the body’s energy should come from carbohydrate meaning that about 50% of your meals should be carbohydrate not more, not less. Most people especially in Africa consume more carbohydrate and very little of the other food nutrients.

Assuming your body needs 2000calories of energy in a day,

About 1000calories should come from carbohydrate.

1 calorie=4g carbohydrate

Thus you need about 250g of carbohydrate in a day. 250g carbohydrate in a day can be obtained from eating

A bowl of breakfast cereal, 3 slices of bread and a plate of rice or 1 cup size Banku or a plate of pasta

By: Frema Addy

Feature/Opinion: Climate Change; A Sustainability Issue That Needs To Be Addressed Now

Even though the term “climate” is a very familiar term known worldwide, it cannot be guaranteed that everybody knows what climate really is. Gladly, this article delves more into what climate actually is, as well as the many effects climate can have on living things and the natural environment at large.

Climate can be defined as the general weather conditions at a specific area or region over a long period of time. Such weather conditions that are studied over time in order to determine the climate of a region include temperature, air pressure, humidity, precipitation, sunshine, cloudiness and winds.

Changes in the climate of a certain region come with their effects on living things, as well as the society and the ecosystems in a broad variety of ways. These effects can never be tackled unless the real causes are identified.

It is sometimes amusing how some activities of man, turn round to affect them in a negative way. One example is the greenhouse effect, which is caused by the release of fossil fuels such as coal, oil and natural gas into the atmosphere in the form of carbon dioxide. The result of this is the condensing of the layer of the greenhouse gas, which in turn increases the warmth of the earth (usually referred to as global warming).

Additionally, effects of global warming include the rising of the sea level and the swamping of coastal areas. The thermal expansion caused by the warming of the oceans (since water expands as it warms) and the loss of land-based ice (such as glaciers and polar ice caps) due to increased melting are the main causes of this rise. Subsequently, the rise is sea level also causes the increase in the events of flooding, which leads to loss of lives and properties.

Apart from flooding, there are other effects of the rise in the sea level which are usually overlooked. Such effects include contamination of water bodies, including sources of drinking water. This comes from the overflow of sea water into these drinking water bodies. And of course, salty water is not safe for drinking.

Another effect of the rise in sea level is the threatening of wildlife populations. Many forms of wildlife make their home on the beach. As the rising ocean erodes the shoreline and floods the areas in which coastal animals live, animals like shorebirds and sea turtles will suffer. Their delicate nests may be swept away by flooding, an especially big problem for endangered animals like sea turtles that can’t afford to lose any offspring. Their habitats may be so damaged by flooding or changes in the surrounding plant life that they can no longer survive in the environment.

In order to prevent all these effects from happening, there must be some measures put in place. First, there is the need to limit global warming pollution. Political governments need to enact new laws that cap carbon emissions and require polluters pay for the global warming gases that they produce. This message must be well publicized to the people, letting them know that the government will hold them accountable for what they do — or fail to do — about global warming.

Secondly, we can help reduce global warming through our transportation systems. We must choose alternatives to driving such as public transit, biking, walking and carpooling, and bundle your errands to make fewer trips. Choosing to live in a walkable “smart growth” community near a transportation hub will mean less time driving, less money spent on gas and less pollution in the air.

We can also help reduce global warming by personally practicing recycling in order to reduce waste. Do your part to reduce waste by choosing reusable products instead of disposables. Buying products with minimal packaging (including the economy size when that makes sense for you) will help to reduce waste. And whenever you can, recycle paper , plastic , newspaper, glass and aluminum cans . If there isn’t a recycling program at your workplace, school, or in your community, ask about starting one. By recycling half of your household waste, you can save 2,400 pounds of carbon dioxide annually.

One might ask that how this ever persistent global warming issue can be solved and how long this journey is actually going to take. Nevertheless, we must make efforts in trying to make the world a sustainable place to live, for both present and future generations. And remember, a journey of a 1000 miles begins with just a step. Good luck in our quest for a sustainable earth!

Written By: Owusu Siaw Nana Yaw

Sierra Leone revises safe burial policy amid countdown to zero Ebola case

Ebola

Sierra Leone’s National Ebola Response Center (NERC) announced Wednesday a revised update in the “safe and dignified” burial policy in the Western Area including the capital Freetown.

From now on families in the Western Area can now negotiate for which cemetry to bury their dead ones.

The NERC chief executive officer Pallo Conteh made the disclosure in his weekly press conference Wednesday but noted that for now all burials “will be carried out by the burial team together with staff of the funeral homes within 24 hours.”

Pallo announced that “all funeral homes must clear and close all storage of corpses from now on but will be open for the sale of coffins only.”

“All suspicious burials should be reported to 117 or the police,” he warned.

Conteh informed the media that the overall Ebola situation in the country remains encouraging with the country recording no case of the Ebola virus for 12 days now and that there are only 2 patients currently admitted for Ebola.

Of the two, one of them has tested negative and has been discharged Wednesday, whilst the other patient is said to be recovering and is expected to be discharged this week.

He said when Sierra Leone begins the countdown and reaches 42 days, NERC will add another three months to make sure that what happened in Liberia is not repeated in Sierra Leone.

He was optimistic that the countdown will start very soon.

Source: Xinhua