Tropical Health Matters

Bright C. Orji, Charity I. Anoke, William Robert Brieger presented a poster at ASTMH 2024 in New Orleans that analyzed the ability of national surveys to detect health program outcomes.

Intermittent preventive treatment of malaria in pregnant women (IPTp) promotes health of the mother and unborn child. One noteworthy benefit is reduction of low birth weight (LBW, less than 2.5kg). Large survey data sets aid learning about such benefits on a national scale.

We analyzed data from the 2018 Nigeria Demographic and Health Survey (DHS) to document the impact of IPTp on birth weight. Key variables included IPTp which based on national guidelines is given monthly at antenatal clinics from the 13th week, aiming to provide a minimum of 3 doses. DHS obtained this information from women giving birth in the previous two years.

Birth weight included women giving birth in the previous five years. A quarter had a record of newborn weight reported from a health facility.

Since many did not, women were also asked to estimate the size of the baby at birth: very small, smaller than average, average, larger than average, and very large. We combined the latter three categories into “average or larger”.

Of those giving birth in the past 2 years, 23% took only one dose, 24% took 2 doses, while 17% had 3 or more doses. In the broader sample of those giving birth in the previous 5 years 2.8% estimated that their baby was very small.

Among those women with a record of birth weight, 7% were LBW. Preliminary analysis comparing perceived size and IPTp doses found 3% receiving only one dose thought their baby was “very small” at birth, as did 3% of those taking 2 doses and 4% receiving 3 or more.

Among the subset with a recorded birth weight, 9% who took only one dose of IPTp had LBW baby, as did 7% who received 2 doses, and 6% who got 3 or more doses. It appears possible to compare outcomes (LBW) with interventions (IPTp), but data type and availability may limit conclusions.

Even though a smaller subset of women had access to a recorded birth weight (most women delivered outside a health facility), birth weight appears to provide a better indication of IPTp effectiveness than subjective perceptions of child’s size at birth.

The findings even with limitations show the value of national surveys to justify policies protecting pregnant women from malaria.

The World Health Organization has prepared an important document entitled “Health is the Argument for Climate Action: COP29Health is the Argument for Climate Action: COP29 Special Report on Climate Change and Health”. Malaria and other vector borne diseases are highlighted.

The report addresses diseases carried by mosquitoes by stating that, “Climate change increases the transmission of deadly infectious diseases such as dengue, malaria, West Nile virus” and others which are temperature and rainfall dependent. In particular, malaria transmission is intricately connected with temperature and rainfall patterns, and extreme weather events have been shown to cause rapid spikes in cases.”

Climate change not only effects environmentsClimate change not only effects environments where these diseases thrive, but impacts the livelihoods of populations, reducing their ability to pay for prevention and treatment. Migration and displacement also may result increasing vulnerability to disease.

Two of the report’s recommendations have special bearing on malaria. One is the need to “develop and implement innovative financing mechanisms, such as a global health insurance scheme for climate-vulnerable nations” and communities. A second is the importance of “Strengthen(ing) health surveillance systems, particularly in low-income countries, to better track and respond to climate-related health impacts.”

Recognizing the climate dependence of malaria will be a crucial step in eliminating the disease.

This study was presented by Stalin Edegba Ewoigbokhan of Emerald Public Health Consulting Services Ltd., Abuja, Nigeria, at the second annual conference and scientific meeting of the Health Promotion and Education Alumni Association, College of Medicine, University of Ibadan on 27 September 2024.

This study investigates the perspectives of community members and key informants on the roles of informal community-based health workers (CBHWs) in achieving the global 95-95-95 HIV/AIDS targets across four Local Government Areas (LGAs): Akpabuyo and Calabar Municipal in Cross River and Essien Udin and Ikot Ekpene in Akwa Ibom State, Nigeria. The research focuses on understanding the contributions, challenges, and community perceptions of CBHWs in HIV prevention, treatment, and care, which are crucial for meeting the World Health Organization’s 2030 goals for halting HIV Transmission.

The study involved eight focus group discussions (FGDs) with a mix of male and female participants across the four LGAs, 27 in-depth interviews with key informants, including community leaders, health officials, program managers, and CBHWs. The data was analyzed to identify recurring themes related to the roles and effectiveness of CBHWs in HIV prevention and treatment within the communities.

Community members identified major health issues, such as tuberculosis, HIV, and hypertension. Key drivers of the HIV/AIDS epidemic cited by participants included unprotected sex, sex work, sharing of infected sharp objects, men having sex with men, blood transfusions, and breastfeeding by HIV-positive mothers. CBHWs were acknowledged for their roles in HIV counseling, condom distribution, first aid, and drug administration. However, they face significant challenges, including insufficient supplies, poor funding, and inadequate training. Despite these challenges, both community members and key informants view CBHWs as essential in reducing HIV-related stigma, promoting treatment adherence, and contributing to HIV prevention.

While CBHWs play a critical role in HIV prevention and care, their effectiveness is often limited by systemic issues such as inadequate resources and poor infrastructure. The study recommends enhancing CBHWs’ impact through increased government support, adequate incentives, continuous training, and better integration into the formal health system. These measures are essential for optimizing the contributions of CBHWs toward achieving global HIV/AIDS targets.

Keywords: Community-Based Health Workers (CBHWs),HIV Prevention, 95-95-95 Targets, Challenges in HIV Care

Press Release: Artificial Intelligence and Innovations in Public Health Promotion Practice to Take Center Stage in Ibadan

The growing role of Artificial Intelligence in public health will take centre stage in Ibadan, the capital of Oyo State, as the Health Promotion and Education Alumni Association, College of Medicine, University of Ibadan (HPEAAICM), kicks off her 2024 Annual General Meeting and Scientific Conference, between September 24 to 26, 2024, from 9 am daily, at the Koltol Hotel, Ikolaba, Ibadan.

The hybrid event brings together public health practitioners, program managers, researchers, policymakers, and students from across Nigeria and internationally. The conference will focus on an increasingly critical topic: Artificial Intelligence (AI) and its innovative applications in public health promotion.

Bright Orji, HPEAAICM president says “this year’s theme, “Artificial Intelligence and Innovations in Public Health Promotion Practice,” reflects the growing role AI plays in transforming healthcare systems globally. AI-driven innovations are not only revolutionizing disease detection, diagnosis, and treatment but are also enhancing the ability of public health practitioners to design, implement, and evaluate health promotion programs”.

AI and Public Health

Artificial Intelligence, often referred to as the driving force behind the “Fourth Industrial Revolution,” is revolutionizing every sector, including healthcare. In public health, AI’s ability to process large amounts of data rapidly and with remarkable accuracy makes it a game-changer. Its applications span across:

• Disease Surveillance and Prevention: AI systems can analyze vast quantities of data to predict disease outbreaks, track epidemic patterns, and monitor real-time public health issues. This capacity for early detection is particularly relevant in the global fight against pandemics, as seen during the COVID-19 crisis.
• Personalized Health Promotion: AI-powered tools can tailor public health interventions to individual or community needs, improving health outcomes by promoting behaviors that are most effective for specific populations. These tools can analyze data from various sources such as social media, wearable health devices, and electronic health records, providing public health professionals with actionable insights.
• Health Communication and Education: AI chatbots and virtual health assistants are enhancing patient engagement and communication. These tools help in delivering health education to people, addressing misconceptions, and providing reliable health information in real-time. They are proving especially useful in low-resource settings, where healthcare personnel are often overstretched.
• Predictive Analytics in Health Promotion: AI algorithms can help anticipate health risks based on behavioral patterns, enabling health professionals to implement targeted preventive interventions. These predictive models can guide public health strategies for addressing lifestyle-related diseases like diabetes, hypertension, and obesity.

Dr. Orji emphasizes that the use of AI in these capacities promises to strengthen health systems, improve efficiency, and ensure that public health interventions are data-driven and evidence-based. However, “these technologies also raise important questions regarding equity, privacy, and ethical use, which will be key points of discussion during the conference”, he adds.

The event will feature keynote presentations, panel discussions, and breakout sessions that explore cutting-edge AI innovations and their real-world applications in public health. Eminent scholars from Nigeria and abroad will lead conversations on various aspects of AI in health promotion, shedding light on the opportunities and challenges these technologies present.

Why You Should Attend

This year’s Conference will bring key thematic opportunities to attendees including:

1. Networking Opportunities: Engage with a diverse group of public health practitioners, technology innovators, policymakers, and academics to discuss collaborative solutions to global health challenges.
2. Knowledge Exchange: Gain insights into how AI is being integrated into public health strategies, from improving surveillance and health promotion to transforming patient care and health education.
3. Influencing Policy: Participate in discussions that can help shape the future of health policy, especially concerning the ethical use of AI in public health promotion.
4. Capacity Building: Discover AI-driven tools and technologies that can enhance the effectiveness of public health programs, especially in resource-constrained settings like sub-Saharan Africa.
5. Global Perspective with Local Impact: The event will contextualize AI advancements within the Nigerian and broader African public health systems, ensuring that discussions remain relevant to local needs and priorities.

AI in Nigerian Public Health

In Nigeria, where public health systems face significant challenges, AI offers tremendous potential to strengthen health promotion efforts. The country continues to battle high maternal and child mortality rates, infectious disease outbreaks, and the rise of non-communicable diseases. However, AI innovations can improve data management and health service delivery in these areas, allowing health officials to track outbreaks, assess health risks, and intervene promptly, says Dr. Orji.

AI-powered telemedicine is already transforming healthcare delivery in remote regions of Nigeria, where access to physical health facilities is limited. During the COVID-19 pandemic, AI-assisted health surveillance tools helped track and predict outbreaks, leading to more effective responses.

The 2024 HPEAAICM Scientific Conference will delve into these success stories, highlighting the lessons learned and offering a roadmap for future AI integration in public health, Dr. Orji added.

Signed

Dr. Bright Orji, MPH, Ph.D
President, HPEAAICM

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Registration and Contact Information:

Registration for the event is now open. Participants can register for either in-person or virtual attendance via the HPEAAICM website (https://hpeaaicm.org/2024-agm/registration/).

For further inquiries and to confirm your participation, please contact:

Dr. Bright Orji, MPH, Ph.D
President, HPEAAICM
Phone: +234 803 709 6014
Email: OrjiBright.Clement@jhpiego.org

About HPEAAICM:

The Health Promotion and Education Alumni Association of the University of Ibadan College of Medicine (HPEAAICM) is dedicated to advancing the field of public health through education, innovation, and collaboration. The association brings together alumni who are leading public health professionals, researchers, and educators from across Nigeria and beyond.  Join us as we explore the intersection of AI and public health promotion—an exciting journey towards a healthier future driven by technology and innovation!

The Health Promotion and Education Alumni Association of the University of Ibadan College of Medicine (HPEAAICM) is hosting its Second Annual General Meeting & Scientific Conference from September 24 to 26, 2024. The association represents graduates of the first African graduate level professional and academic Master of Public Health program, which started at the University of Ibadan in 1975 as the African Regional Health Education Center (ARHEC) within the Department of Preventive and Social Medicine. At the beginning of this century ARHEC became the Department of Health Promotion and Education within the first ever Faculty of Public Health in Nigeria.

The association aims to keep members up to date on new knowledge and practices that have arisen since they obtained their MPH. In addition, the association arranges seminars, conferences, and symposia on issues of public health concerns and provides a link between the health promotion specialists and the public.

The main theme of this year’s Conference is “Artificial Intelligence and Innovations In Public Health Promotion Practice.” Sub-Themes include the following:

• Digital Health Technologies: Implication for Health Promotion Strategies in community Engagement.
• Artificial Intelligence application in Disease Surveillance, Outbreak, Prediction and prevention
• Use of Artificial Intelligence in addressing Health Equity and Social Determinants of Health
• Enhancing the implementation of Health Promotion Policy through digital Health Technologies
• Health Promotion: A Key Strategy for Reproductive, maternal, Newborn, Child, Adolescent Elderly Health plus Nutrition (RMNCAEH+N) intervention.
• Current trends in the use of health promotion principle for climate change environmental health promotion
• Addressing Global Health challenges of Communicable and Non-communicable diseases through Health Promotion Initiatives.

For more information and inquiries send a mail to: abstract@hpeaaicm.org

On August 20, 2024, esaayman posted this blog about Hepatitis C in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health.

Hepatitis C remains a significant public health burden in South Africa, disproportionately affecting people who inject drugs, with the highest prevalences, monitored by the South African Community Epidemiological Network on Drug Use and the National Institute for Communicable Diseases, ranging from 68% to 94% in Tshwane. Despite national guidelines and an action plan for viral hepatitis recommending direct acting antiviral therapy and point-of-care technology use for hepatitis c management in people who inject drugs since 2019, with treatment registration by SAHPRA since 2020, access remains limited. The essential medicines list restricts treatment to tertiary level liver clinics. These clinics are often inaccessible to people who inject drugs due stigma, and stringent abstinence-based criteria for treatment.

_{Community hepatitis C screening at Sediba Hope Medical Centre (Source: SHMC, 2024)}

While community-based HIV-focused harm reduction services, such as opioid agonist therapy, exist, they are primarily managed by donor-funded civil society organizations, with limited integration into public healthcare systems. The City of Tshwane’s health department in partnership with the University of Pretoria initiated opioid agonist therapy services at primary care level in 2016, however with limited resources allocated, hepatitis c screening and treatment remains sporadic. A local pilot study, offered by Sediba Hope Medical Centre, a public-private partnership-based clinic for marginalized communities, has demonstrated successful community-based hepatitis c treatment integration, signalling for sustained access to care at the appropriate level.

_{HIV and viral hepatitis prevalence in South Africa (Source: INHSU, 2021)}

Improved access to treatment within the city would require purposeful implementation of hepatitis c treatment guidelines alongside best practices from harm reduction guidelines and national action plans. This includes training of primary care providers to manage uncomplicated cases, further supported by specialist through existing mentoring platforms. To strengthen clear referral pathways, collaboration between liver clinics and community-based harm reduction and primary care facilities is required, building on the use of existing inter-facility referral applications and decentralized medication delivery options. Additionally, dedicated funds for adequate diagnostic tools, care coordination staff, and medication procurement should be considered on a national level, with the same urgency as with the HIV response. By implementing these strategies, Tshwane can expand access to hepatitis c treatment for people who inject drugs, thereby aiming to become the first South African city to achieve micro-elimination, averting adverse health outcomes for people who inject drugs. Implementation strategies and outcomes should be documented to inform increased treatment coverage nationally, further advocating for the consideration of direct acting antivirals for inclusion in the primary care essential medicines list.

According to MinahHAli, polio is still with us as seen in this posting about polio challenges in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health

Image Source: UNHCR

After a much-desired decrease of polio cases in Pakistan, the recent increase in cases reported has been alarming. This latest surge coincided with the Afghan Refugee Crisis in Pakistan, showcasing the impact of government policies in the success of polio eradication.

What is Polio? Polio, also known as poliomyelitis, is a viral disease which affects nerves in the spinal cord or brain stem leading to paralysis and death in some cases. Poliovirus rapidly spreads either via feces or droplets from coughing/sneezing. Polio mainly affects unvaccinated children.

Why are Polio vaccination initiatives focused on Pakistan and Afghanistan? Are all polio cases the same? Pakistan and Afghanistan are the last two countries in the world which consistently report polio cases. Despite spending $9.3 billion over the course of 10 years (2013-2023) polio cases remain present in Pakistan.  According to WHO, Polio cases in Afghanistan can be traced back to one variant: YB3A. However, recently polio cases in Pakistan are now also from YB3A variant.

Image Source: CNN

What is the Afghan Refugee Crisis and how is it fueling the spread of polio? Pakistan is the largest host country for Afghan refugees since 1979 post-Soviet invasion. In 2019, Ministry of National Health Services, Regulation and Coordination in Pakistan, along with UNHCR, promised healthcare which included polio vaccination to Afghan refugees. However, due to increased security threats recently near the Pak-Afghan border these efforts have stopped.

Due to attacks on Pakistani soil which have been linked to Afghan terrorist groups, the Federal Government of Pakistan is currently forcibly relocated Afghan refugees back to Afghanistan. Due to this, many Afghans refugees refuse to seek healthcare in the fear of being reported and deported.

Why are the polio eradication programs failing? The political climate in Pakistan, especially in the Khyber Pakhtunkhwa province which borders Afghanistan, is tense; heightened insecurity, fueled with tribal conflicts amongst Pakistanis and Afghanis residing in the area is making polio vaccination programs “almost impossible”, according to polio eradication lead at Bill and Melinda Gates foundation.

By neglecting the on-going polio spread amongst Afghan refugees, Poliovirus is making its way into Pakistani citizens/communities.  It is imperative that the Ministry of National Health Services, Regulation and Coordination, as well as the provincial Khyber Pakhtunkhwa Government increase their efforts for polio vaccination- regardless of immigration status.

On August 20, 2024, Yasir Ahmed Posted this blog about polio challenges in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health

Pakistan and Afghanistan are the only countries in the world reporting wild type polio virus cases. Polio is a crippling disease that does not have any cure but it is preventable through immunization. The detection of wild-type virus in wastewater suggests 2024 target of ending all wild virus transmission will be missed. 6 cases were reported in 2023 and 14 have been reported this year so far.  According to a report by IMB, an estimated 300,000 children have been consistently missed in vaccination activities in Pakistan and in the East region of Afghanistan. Disinformation, false beliefs and mistrust on the government and administration, refusal, not understanding the importance of vaccines, and low general literacy and health literacy etc. are among the important factors contributing to these missed opportunities.

In addition to the above-mentioned factors, insecurity, movement across the porous 2400 kilometers long Pakistan-Afghan border, and poor water and sanitation and waste management are the contributing factors. I believe that the missed opportunities to reach and vaccinate these children has a major role in the spread of poliovirus along with poor water and sanitation in these areas.

The program uses four distinct risk tiers to classify areas according to the risk they present and to devise risk appropriate strategies. Core reservoir districts (or Tier 1 districts), high-risk districts (or Tier 2 districts), vulnerable districts (or Tier 3 districts), and low-risk districts (or Tier 4 districts). Most of the tier 1 and tier 2 areas are located on the western border aka Pakistan-Afghan border (upper parts on the map).

Pakistan Polio Eradication Program is an initiative that is driven by the largest surveillance network in the world (up to 339,521 trained and dedicated polio workers), quality data collection and analysis, behavioral change communication, laboratories, and epidemiologists and public health experts in Pakistan, working with experts and local and international stakeholders. The government started National Emergency Action Plan for Polio Eradication in 2010, which runs supplemental immunization activities on regular basis to reach every child in Pakistan. As a result, a huge decline in the number of polio cases is seen since the 90’s. The World Health Organization (WHO) and UNICEF along with other key partners of the Global Polio Eradication Initiative, has been a very supportive to the Government of Pakistan in polio eradication. Gavi the vaccine alliance, the Center of Disease Control (CDC), Rotary International, and Bill and Melinda Gates Foundation are important stakeholders that provides major financial, technical and field support.

A Polio-worker is pictured giving an oral polio vaccine during an immunization campaign.

Innovative approaches are required to reach the children missing vaccinations including:

• Expanding the network and improving data collection and surveillance, targeting the areas of high density with polio cases e.g., the tribal areas along the porous Pak-Afghan border.
• Mandatory vaccination at border crossing.
• Increased security for the polio workers.
• Taking local religious and community leaders and scholars on-board to counter disinformation and false beliefs.
• Continuation and strengthening of National Emergency Action Plan for Polio Eradication by the government of Pakistan.

Continued efforts and support from the local and international stakeholders as we are getting very close global polio eradication.

The challenges of maternal and child health is the theme of a posting by Dr Ashraf in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health.

Rural areas in Bangladesh, like Zakiganj, a subdistrict located in northeastern border region of Sylhet district, continue to face significant health challenges despite the nation’s overall progress in healthcare. With a population of approximately 250,000, Zakiganj is served by only one 50-beded government health center. The inadequate infrastructure, shortage of trained healthcare providers and low healthcare services contributes to the higher maternal and infant mortality rates compared to surrounding regions.

The photo shoes a community health worker of PRF visiting a household during surveillance, Zakiganj. According to UNICEF, in 2014, Sylhet had the lowest disparities in key maternal and newborn health interventions compared to most districts in Bangladesh. This is of great concern and requires policy level discussions with key stakeholders and intervention to improve maternal and child health.

The statistics are provided from Maternal and Newborn Health Disparities, Bangladesh, UNICEF.To address these issues, we advocate for enhanced policy measures focusing on increasing healthcare funding, expanding the number of healthcare facilities, improving infrastructure, and implementing comprehensive training programs for healthcare workers. Such measures can ensure that mothers and children in Zakiganj receive the quality care they need. Even newborn health care is possible in rural areas like Zakiganj.

Key stakeholders in this advocacy would include the Ministry of Health and Family Welfare, UNICEF Bangladesh, Projahnmo Research Foundation, PRF, World Health Organization (https://www.who.int/bangladesh ), BRAC, and Save the Children Bangladesh. Each organization brings unique strengths to the table, starting from policy implementation to providing technical support, quality training to health care workers and on ground services. Their collaboration and support is essential for a holistic approach to improving health outcomes in this region.

Call for Action:

We urge the Ministry of Health and Family Welfare to prioritize maternal and child health in Zakiganj by increasing funding and resources. Collaborating with organizations like PRF and BRAC will provide the necessary evidence including their years of research in this region, and pilot programs to support these policy changes. Immediate action is very important to reduce mortality rates and improve the overall health of mothers and children in rural Zakiganj.

Mickelder Kercy (mkercy1) posted this entry on lead exposure in Haiti in the class blog of the course, Social and Behavioral Foundations of Primary Health Care at the Johns Hopkins Bloomberg School of Public Health

Graph Data Source: American Heart Association

Recent studies conducted in Haiti revealed that lead exposure increases the risk of hypertension, a major cardiovascular or non-communicable disease. Among children, lead is responsible for several mental and behavioral disorders. Sources of lead exposure includes contaminated drinking water, paint, and batteries.

Laws have been enacted to regulate the prevention and management of exposure to environmental toxicants. These laws mandate institutions to supply safe water, ministry of health to provide adequate care, and companies to sell and safely dispose of their products without harm to population members. Currently, these overarching laws are not being implemented due to political instability, poor governance at the national and municipality levels, and deteriorating socio-economic conditions nationwide.

Several initiatives have been taken that could address lead exposure in Haiti:

• The Ministry of the Environment (MdE) sought the financial assistance of the Global Environment Facility (GEF) to improve the drinking water system.
• The Global Environment Facility (GEF) has allocated $4.5 million from the Least Developed Countries Fund (LDCF) to the Ministry of the Environment project to help strengthen policies, regulatory bodies, and organizations in support of the management, supply, and access to clean drinking water (SDG 6) in Haiti starting 2023.
• The Presidential Transitional Council (CPT) plans to budget $7,590,221 for waste management in the capital of Haiti.

Current initiatives are promising stirring up among population members the optimistic view that they could signal a departure from decades of inefficiency and ineffectiveness in government affairs. As recommended,

• The Ministry of the Environment (MdE) and Presidential Transitional Council (CPT) should demonstrate accountability, transparency, and proficiency in current projects.
• The Presidential Transitional Council (CPT) should prioritize waste management according to international standards in the triage and disposal of hazardous wastes such as lead-based batteries.
• The Ministry of Public Health and Population (MSPP) should promote lead exposure prevention in businesses and at the population level, and management across all primary health care facilities.
• Sustainable lead exposure mitigation is a necessity. Based on current human capital and financial resources, the MdE and MSPP could potentially seek out-of-country technical assistance from
  • The Lead Exposure Elimination Project to inventory lead-based paints and reformulate them into safer products nationwide, and

The Pure Earth to train employees in the Initial Site Screening (ISS) protocol application to update current maps of lead contaminated sites across all 10 departments in Haiti.