Tropical Health Matters

In the lead up to World Malaria Day 2025, the Johns Hopkins Malaria Research Institute held an Expert Briefing for the Media to discuss  the Global State of Malaria: New Research, Evolving Risks, and Silver Linings. The session was moderated by Ellen Wilson.

The two experts included Jane M. Carlton, PhD, director of the Johns Hopkins Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health and a Bloomberg Distinguished Professor in the Department of Molecular Microbiology and Immunology at the School and George Dimopoulos, PhD, MBA, also a professor in the Department of Molecular Microbiology and Immunology.

The speakers discussed and responded to questions regarding the current state of malaria, the need for global commitment to malaria prevention, control, and research, advancing diagnostics and therapeutics, current mosquito vector control methods and their limitations, and the need for an integrated approach to malaria control. As an overview, attendees were told that malaria is a mosquito-borne disease that in 2023 took nearly 600,000 lives in 83 countries, the majority being children under age 5 years in the WHO African Region.  In the U.S., the risk of contracting malaria remains low; however, continued vigilance is needed to prevent increases in both domestic cases from foreign travel and as occurred in 2023 for the first time in 20 years, locally transmitted cases.

Jane Carlton expressed concern that malaria cases had increased from 2022 to 2023, but was hopeful because of innovations such as vaccines, and genetically modified mosquitoes. One could also draw hope from efforts to establish local manufacturing capabilities in endemic countries, including partnerships for African vaccine development and production. And in fact, she noted, in 2022, “one company in Kenya became the first African-based manufacturer to receive WHO pre-qualification for a malaria drug. There is a second Nigerian manufacturer that is making progress.” There are several research organizations and universities in African countries that are working towards new drug and intervention development. Studies are ongoing perhaps to use some local plants as anti-larval treatments.

Prof. Carlton explained that the burden of malaria in India has reduced dramatically. “There’s been about a 70% reduction in cases from just over 6 million in 2017 to 2 million in 2023,” although two million cases is still quite a large number.

Prof. Carlton was also asked about the effect climate change on malaria transmission and the potentially expanding the geographic range of malaria. How are researchers adapting? She observed that, “Yes, that’s a very interesting question. In fact, it goes against intuition in a way but increasing the temperature doesn’t always increase the number of malaria cases. The malaria parasite and the mosquito that carries operate within quite a tight temperature range.

In reality, it can get too hot, but as some areas get wetter and formerly cool areas become warmer due to climate change, malaria transmission can move to new locations. “So, there is an increasing shift and an increasing understanding that surveillance of this particular issue is important,” especially needing to monitor climate contexts. For example, scientists have looking at the invasive Anopheles stephensi, which is severely disrupting activities of National Malaria control programs.

There’s been an analysis from the Oxford Malaria Atlas Project, or MAP, and they have projected that with a freeze for one year of PMI activities, this would result in up to 18 million additional malaria cases and up to 107,000 additional malaria deaths. This represents an increase in morbidity of 13%. This would occur in PMI’s focus geographies across 27 African countries. This analysis doesn’t account for the additional impact of PMI supported diagnostics.

Prof. Carlton observed that “globally, total investments in malaria control reached an estimated $4 billion in 2023, but this already fell short of the $8 billion funding target” of the World Health Organization Roll Back Malaria Partnership.

George Dimopoulos stressed e importance of community engagement in vector control activities. He explained that malaria is one of the diseases of poverty where the poor are disproportionately at risk and impacted. He then responded to a question about gene-drive technology based on the

CRISPR-Cas9 system that can spread mosquito genes in natural populations. “This has advanced very significantly in mosquitoes over the past roughly 10 years.”

Prof. Dimopoulos explained that gene-drive “can also work in all malaria vector species. In this way it becomes a malaria control strategy that could work in all malaria endemic areas.” Prof. Dimopoulos’ team has also done research on the effects of sugars and micro-organisms on the mosquito gut and malaria transmission. “We have shown through our research that the health of the mosquito gut depends on a protein quality control system. With appropriate control interventions, “The mosquitoes become very sick and a large proportion of them will actually die.”

In conclusion, the “Silver Linings” mentioned in the session’s title include advances in both parasite and vector control. Deployment of two malaria vaccines offers one ray of hope. New vector control technologies such as gene-drive, offer another. The speakers encouraged people to attend the upcoming JHU-MRI Malaria Day conference to learn more.

The RBM Partnership to End Malaria has developed a communication kit to help plan for the upcoming World Malaria Day on April 25th. Below are some of the highlights and links they have shared.
To mark World Malaria Day 2025,  the RBM Partnership to End Malaria in collaboration with World Health Organization (WHO) have developed a Messaging Framework and Social Media Toolkit to support partners and individuals in raising awareness and advocating for a malaria-free world.

Objectives for this year include…

• Re-energize efforts at all levels, from global policy to community action, to accelerate progress towards malaria elimination
• Advocate for increased investment in malaria control and elimination programs, including through stepped-up domestic financing and successful replenishments for the Global Fund and Gavi in 2025.
• Promote innovative strategies and approaches to tackle evolving challenges in malaria
• Prioritize country ownership, actively engage communities, and implement data-driven strategies

The emphasis is on three pillars. First in REINVEST, which recognized that “Malaria control and elimination programs don’t just save lives – they’re also a smart economic investment for malaria-endemic countries and their international partners.”

The second pillar calls on us to REIMAGINE. We must Accelerate innovation by investing in the research and development of new and more effective antimalarial drugs, diagnostics, insecticides, vaccines and vector control methods” and turning that research into action.

The third pillar is a call to REIGNITE based on “a renewed sense of urgency and commitment is needed to accelerate the fight against malaria.” This is called the “Big Push against malaria (and) is a multistakeholder effort to drive progress.”

Follow the links to learn more and plan action.

As part of the work for the Johns Hopkins University course on Social and Behavioral Foundations of Primary Health Care, Jenny Truong posted in the class blog about the challenges of Antibiotic Resistance as shared below. Unregulated sale of antibiotics over-the-counter (OTC): In some areas of Vietnam, nearly 91% of antibiotics are sold without a medical prescription. A prescription is required by a 2005 pharmacy law, updated in 2016 and 2024, but in practice, there is little legal enforcement. The 2024 amendment expands health insurance coverage and prohibits operating without a Pharmacy practice certificate but does not specifically address OTC sales, retaining the same fine for selling antibiotics without prescription. Expanded insurance alone won’t stop unregulated sales: 48.6% of study participants said they would still buy antibiotics without prescription even when told they were breaking the law.

We ask that the Ministry of Health and Ministry of Industry and Trade raise the fine on drug sellers from 25 USD to at least 50 USD to curb unlawful sale. There should be consequences as heavy as shutting down the business after multiple infractions. With strong penalties for operating outside of “Good Distribution Practice (GDP) requirements,” there may be a chance to slow the spread of antibiotic resistance (AR). Only when the unregulated drug supply is gone will consumers be pushed to actually use their expanded insurance to see doctors and buy antibiotics with prescription.

Three key stakeholders support regulation. The World Health Organization (WHO) recognizes the irrational use of antibiotics in Vietnam. We must involve them in planning and advocating for funding to support efforts to educate and enforce fines on unlawful sellers. The Food and Agriculture Organization (FAO) supports Vietnam’s National AMR (antimicrobial resistance) Strategy to address antibiotic resistance. We must also involve them in planning efforts and align all sectors for comprehensive education. Corporations may support antibiotic stewardship efforts, like GlaskoSmithKline (GSK). We can collaborate with them to ensure they don’t distribute antibiotics to unlicensed sellers.

Two groups are not supportive. Corporations like Hau Giang Pharmaceutical may benefit from unlawful sale and may try to prevent lost revenue. We must defend our position and prevent efforts to blockade our enforcement.Local pharmacies like Pharmacity continue to break the law and sell antibiotics to those who have no prescription. We must defend our position and notify them that there will be increased penalties for breaking the law. Local unions like Giao Tien Women’s Union and Farmers’ Union have varying stances yet can sway local opinions. We can convince them not to misuse antibiotics and to buy only with prescriptions. Then we can collaborate with them to educate their communities.  

As part of the work for the Johns Hopkins University course on Social and Behavioral Foundations of Primary Health Care, Daniel Gomez Ramos posted in the class blog about the challenges of Bird Flu as shared below.

The Avian Influenza (H5N1) is increasingly becoming a significant concern in the kingdom of Cambodia with developing news revealing that a recent novel variant has the potential to increase the risk of a new pandemic in which human transmission could occur if no measures are taken to identify individual via screening/testing.

Given the limited quantity and quality of testing instrumentation, viable standard protocols, low personnel for both operating equipment and investigating areas of high incidence in humans and wildlife, and training programs, it is imperative that a standardized approach is created and implemented. A mandate for integrating real time-Polymerase Chain Reaction (RT-PCR) for individuals (i.e. workers who are in contact with livestock such as cattle and poultry) aged 12-65 years of age would be appropriate while focusing on the southern and central regions of Cambodia.

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.