Tropical Health Matters

Andaratu Wuni has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

(Graphic source: https://www.aafp.org/news/health-of-the-public/20210429vacchesitancy.html)

Covid 19 has unarguably wrecked devastating consequences globally since its emergence and has proven to to be a ubiquitous public health health problem. Vaccination against the virus has been shown to be the most effective way of limiting severe disease and mortality. However the spate of vaccine hesitancy in Ghana has continued to rise in the last year. The World Health Organization defines vaccine hesitancy as the delay in acceptance or refusal of vaccination despite availability of vaccination services. This public health problem has far reaching consequences not only in Ghana but globally. Currently the vaccine hesitancy rate in Ghana is about 30% and counting! with people 25 years and under leading the hesitancy core.

(Graph Source: https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851)

Since Ghana rolled out vaccines to the general public over one year ago, only 25.9% of the population have been fully vaccinated as of August 19,2022.Ghana has a target of vaccinating 22.9million eligible Ghanaians; that is about 60% of the population in order to achieve herd immunity, however only 8.2 million Ghanaians have been fully vaccinated to date.

Many reasons account for the rise in covid 19 vaccine hesitancy in Ghana; from the depletion of rigorous and continuous education and the consequent lack of community engagement, relaxation of covid 19 protocols, to vaccine misinformation and conspiracy theories as well as political influence. It is time for a policy that will mitigate this crucial problem, which the WHO(before the covid pandemic) described as one of the top ten greatest threats to global health.

The truth is, a single policy may not totally solve the problem as the issue of vaccine hesitancy is a complex one. The best approach will be for policymakers to enact policies to make vaccination a condition for other essential services in Ghana.

Intensify mandatory vaccination especially in high risk individuals and high risk locations, eliminate vaccine exemptions based on all but health related reasons, commit to structured community engagements and outreaches using the key stakeholders like the Ghana Medical Association and the Public Health association of Ghana, use stakeholders like UNICEF Ghana and the Ghana Health Service to disseminate accurate and scientifically proven vaccine information and last but not least introduce incentives for citizens who take the vaccine.

Abigail Arthur has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care. Antibiotics are designed after years of research to determine which specific organisms they target, and at which doses they are effective. Hence, they must be used with strict adherence to prescription instructions to ensure maximum effectiveness. Unfortunately, there is a trend here in Lagos showing the gross misuse of antibiotics. Adapted from https://www.downtoearth.org.in/news/health/antibiotic-resistance-nigeria-stares-at-a-major-catastrophe-68915 The factors driving this phenomenon range from the misconceptions and practices of individuals and their contacts to factors associated with the communities and institutions within, same as well as the policies governing both. In Lagos, much of the misuse is fostered by extremely easy access to antibiotic medications aided by poorly implemented drug regulation policies. For instance, in 2005, there were 100 times more basic drug stores (patent and proprietary medicine vendors) than licensed pharmacy shops in Nigeria. ? While the operators of these basic drug stores have very little to no pharmaceutical knowledge, they are the first point of call for medications in the community.

The effect?

The next time you use the red and black tablet(ampicillin) for a skin infection, or an upper respiratory tract infection, it may not work due to the resistance built by microbes to these abused antimicrobials. ? Antimicrobial resistance (AMR) leads make treatments dear as newer generation (and pricier!) medication is then needed. Unfortunately, AMR can also lead to fatalities.

The way forward:

Antimicrobial Stewardship Programs (AMS) instituted by the Ministry of Health was implemented across only 6 health facilities in Lagos state in 2021. ? Our focus of advocacy is to encourage policy makers to consider antimicrobial resistance as an upcoming emergency following the progressive misuse of antimicrobials in the country. We call for proper control on the sale and advertisement of antimicrobials, an improvement in the patient to prescriber ratio and a strengthening of the Antimicrobial Stewardship Program already in place.

Edwin Chng has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

Dengue has been endemic in Singapore for many decades, with all four dengue serotypes (DENV-1-4) in active circulation. It presents a significant impact on the economy, with the financial burden of dengue estimated to be US$1.04 billion from 2010 to 2020. (Mosquito Photo credit: http://bitly.ws/twG2)

Despite aggressive conventional vector control measures such as fogging and breeding site elimination, Singapore continues to have persistent outbreaks annually. The number of cases in recent years have also surged. From January to July 2022, 9 deaths and 22,468 cases have been reported thus far – the latter number is more than 4 times the number of cases reported in the whole of 2021. Dengue cases is likely to continue to increase, as the traditional peak dengue season in the country is from June to October each year. (Dengue Cases Graph Photo credit: NEA)

 

Singapore’s dengue crisis can be attributed to climate change and a recent change in the prevailing serotype. In the past, the dominant strains in Singapore were DENV-1 and DENV-2, hence the Singapore population has lower immunity to the other two strains. As a result, a large proportion of the population remains susceptible to DENV-3, which is emerging as the dominant strain in Singapore.

As such, as per the World Health Organization, dengue vaccination remains an integral part of dengue prevention and control strategy. The vaccine has an efficacy of about 80% against the outcomes of infection, hospitalization and severe infection which is potentially lethal. Unfortunately, the Singapore government has decided not to include it in the national immunization program, hence it is not eligible for government subsidy. As a result, the vaccine which costs a hefty USD450 remains inaccessible to the average Singaporean. (Vaccine Photo credit: http://bitly.ws/twGk).

Various stakeholders including the National Center for Infectious Diseases, primary care physicians and pharmaceutical companies can rally and work together in awareness campaigns and clinical studies. Health economics data from such collaborations can confirm the cost-effectiveness of dengue vaccines and positively influence the government to consider a change in its existing policy to provide subsidies. Increasing its accessibility and affordability to more Singaporeans will definitely contribute significantly to the fight against dengue in Singapore.

 

Sarah McHugh  has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care. Although malaria transmission and infection rates in Senegal have declined in the past two decades from over 300 incidences of malaria infection per 1000 people at risk in 2000 to about 50 in 2020, malaria remains a burden and Senegal is still working with partners and stakeholders to research potential control and elimination strategies. Malaria is endemic in Senegal, where all of its inhabitants are at risk of contracting the disease and the country has a tropical zone of the country, where there is year-round transmission of malaria and a Sahelian zone, where transmission is high during and after the rainy season. (Map: Malaria interventions across transmission zones in Senegal) The WHO currently recommends that children under five years of age who reside in areas that have high seasonal malaria transmission (where most of the annual malaria cases occur during four months of the year) receive SMC during the months of high transmission. Although not currently recommended by the WHO, Senegal is the only SMC country that includes children up to ten years of age in SMC distribution. (SMC District MAP: PMI supported SMC districts in Senegal)

Lisa Marie Clark has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

Cervical cancer is among the leading causes of death for Kenyan women. Every day, 9 women die from cervical cancer alone in Kenya. HPV vaccination reduces the risk dramatically, particularly for HPV types 16 and 18, which may be responsible for up to 70% of cervical cancers.

Optimal vaccination is in early adolescence starting at age 10, before sexual activity begins. In 2020, uptake of the HPV vaccine in Kenya was low, with only 33% of the target population receiving the first dose and only 16% percent receiving a second dose.  Low uptake may be due to a variety of factors including misinformation, lack of access, and low supply of vaccines.

In 2019, the Kenyan Ministry of Health began including the HPV vaccine in the routine vaccination schedule. The vaccine, with support from GAVI, the vaccine alliance, is offered free of charge. However, the Catholic Church and medical professional groups influenced by religious ideology have been a major opponent to vaccine uptake. The Kenya Catholic Doctors’ Association has been vocal about urging parents to promote abstinence over vaccination, equating HPV vaccination with permission to engage in sexual activities. See vaccination from Republic of Kenya’s Ministry of Health in photo.

In the face of such obstacles to vaccine uptake, more funding is needed to strengthen Kenya’s vaccination campaign, with a focus on building trust and strengthening partnerships with faith leaders to improve vaccine uptake. With more funding from GAVI and improved community engagement vaccination rates would improve, HPV infection rates would decrease, and lives would be saved as a result.