Posts or Comments 12 November 2024

Archive for "water"



Environment &Mental Health &NGOs &WASH &water Bill Brieger | 21 Aug 2024

Haiti: Addressing lead exposure in a low- or middle-income country, a multipronged approach

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 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.

Community &WASH &water Bill Brieger | 19 Aug 2023

WASH and UNICEF in Vietnam: A Tale of New Policies, Successes and Challenges

Kayla Vuong has written about the importance of water and sanitation in the class blog of the JHU course Social and Behavioral Foundations of Primary Health Care. Below are her observations.

“Universal access to clean, safe drinking water and improved sanitation” still remains a challenge in Vietnam, a low-middle income country in Southeast Asia. In order to address this challenge, the Government of Vietnam has asked for support from the United Nation Children’s Fund (UNICEF), who has had 40 years of experience in Water, Sanitation and Hygiene (WASH).

Since its involvement in 2018, UNICEF has helped the Vietnamese government develop national WASH policy and test out policy implementation at four remote provinces of Vietnam (Dien Bien, Gia Lai, Kom Tum and An Giang).

In fact, UNICEF has been collaborating with many Vietnam national partners such as the Ministry of Agriculture and Rural Development (MARD), Ministry of Health (MOH), Ministry of Education (MOE) and Ministry of Construction (MOC) to deploy “communication tools on drinking water safety, household water treatment and storage, community-led total sanitation (CLTS), and school-led total sanitation and WASH in schools under the Integrated Early Childhood Development (IECD) program“.

Additionally, UNICEF has also planned National “Open Defecation Free” (ODF) initiatives which is still pending approval from the Ministry of Construction.

These efforts really paid off as improvement in water safety, sanitation and hygiene has been observed throughout the country. Indeed, thousands of households have benefited from “upgraded WASH facilities and ceramic water filters; 18,000 children now practice healthy WASH behaviors“, as seen in the featured picture of this blog.

However, “disparities in access to hygiene and sanitation remain a social challenge.” Open defecation is still a social norm in the poorest regions of Vietnam such as the Central Highlands and Northern mountainous regions. Only 13% of the population wash their hands with soap after defecating and “the rate is even lower among ethnic minority groups.”

Clearly, there are still more work to be done. Moving forward, in order to sustain WASH, the Government of Vietnam should involve its stakeholders who may be able to support them. For example, key findings in WASH should be shared with all the stakeholders (MAR, MOH, MOE, MOC, community partners, etc.) for program development and policy discussion purposes. The government should also partner up with local ceramic manufacturers to produce low-cost ceramic filters for the public.

Finally, Vietnam should enlist its biggest supporter UNICEF, who has great partnerships and global cooperation networks, to invest more in both direct interventions for improved facilities, local capacities in WASH and policy development to bridge those disparities.

Schistosomiasis &water Bill Brieger | 15 Mar 2023

Effective Strategies to Eliminate Schistosomiasis in School Children in Rural Parts of Ghana

By Lauren Koranteng and originally posted in the Social and Behavioral Foundations of Primary Health Care Blog. “Overcoming poverty is not a task of charity, it is an act of justice. Like Slavery and Apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings. Sometimes it falls on a generation to be great. You can be that great generation. Let your greatness blossom.” – Nelson Mandela According to the World Health Organization, Schistosomiasis is a “disease of poverty that leads to chronic ill-health “. It is caused by a parasitic worm that lives in freshwater snails. The larval forms of the parasite is released by the snails. Humans who make contact with the water during various activities like recreation, agriculture and also for livelihood get infected. The prevalence rate in Ghana is 23.3% , however there are some areas that have localized prevalence levels that are >50% ( Kulinkina et al). A vulnerable population that is often infected are school aged children who access the waters mostly for recreational reasons (Antwi et al). These are usually school aged children who live in hard to reach areas in the country with poor sanitation. It is important for the disease to be controlled because chronic ill health also impacts the cognitive abilities of the children. Praziquantel is a drug used for preventative chemotherapy against Schistosomiasis. It offers a solution to eradication of the disease and could be executed through drug administration of praziquantel through the school system. This kind of mass administration has been done before in the country, but unfortunately, the behavior of children swimming in these infected waters did not change. This behavior of continuous exposure of children to these water bodies presented a limited factor in the eradication of this disease and intervention. Using the national health insurance program in the country, praziquantel can be made available again but through school programs in these rural areas.  Additionally, the school curriculum can include health education that will encourage children to avoid fresh water bodies where possible. Sanitation improvement and reduced human and infected water contact will also be a priority health development goal. So, in working with stakeholders such as the Ghana Health Service and the Ministry of Education, a realistic plan can be developed and executed.  This can include a mass drug administration program, health education and sanitation improvement.  This may be reasonable interventions to use to support children who are in contact with fresh water bodies and at a high risk of contracting Schistosomiasis.

Typhoid &water Bill Brieger | 14 Mar 2023

Typhoid fever in Lagos, Nigeria

By Peace Ige, and originally posted in the Social and Behavioral Foundations of Primary Health Care Blog.

In Nigeria, typhoid fever continues to be a significant disease, and its prevalence is on the rise. The disease is transmitted through the oral consumption of contaminated food or water and can also be spread through personal contact due to unsanitary practices (Enabulele et al., 2016). The increasing incidence of antibiotic-resistant strains of the bacteria makes treating typhoid fever challenging. The lack of proper surveillance, limited laboratory capacity, and inadequate data availability in Nigeria make it difficult to assess the actual prevalence of typhoid fever.

There needs to be more reliable and consistent data on the incidence of typhoid fever in Lagos and Nigeria, making it challenging to assess the disease’s prevalence accurately. This under-reporting is due to several reasons, including using antibiotics before confirmatory laboratory tests and patients’ failure to seek medical attention, as laboratory services are often not affordable (Enabulele et al., 2016).

According to a study published in The American Journal of Tropical Medicine and Hygiene (primary article), the lack of epidemiological data tracking regarding typhoid fever in sub-Saharan Africa prompted the World Health Organization (WHO) to call for a continent-wide approach to generate more accurate disease incidence and antimicrobial susceptibility data in 2008. The study emphasizes the importance of antibiotic resistance as a significant health security issue, as S. Typhi has developed resistance to multiple drugs, making it difficult to treat.

Typhoid fever remains endemic in Lagos, Nigeria, and the larger sub-Saharan Africa region, posing a significant public health challenge. To address this issue, coordinated efforts are needed from all stakeholders. Strengthening surveillance systems to collect accurate data on typhoid fever incidence, prevalence, and antimicrobial susceptibility is critical (Enabulele et al., 2016). This requires government funding to improve laboratory infrastructure and trained personnel. Accessible data can guide policy decisions and interventions. Improving sanitation and hygiene practices is also vital to combating typhoid fever.

The government should invest in improving access to potable water, wastewater management systems, and community education on personal hygiene practices. Public and private sector partnerships can be established to improve water and sanitation infrastructure in vulnerable communities. Increased vaccination campaigns are a cost-effective intervention in reducing the incidence of typhoid fever. The Nigerian government should increase the coverage of the typhoid fever vaccine in Lagos state, especially for vulnerable populations such as children and those in low-income communities.

A robust public health campaign should promote vaccine uptake and raise awareness of typhoid fever and its causes. A multi-sectoral approach is needed to address the root causes of typhoid fever in Lagos. Collaboration between the government, healthcare providers, the private sector, and other stakeholders is necessary to ensure the implementation of effective interventions. Advocacy efforts are necessary to ensure political commitment and support for policies addressing typhoid fever in Lagos. By implementing these strategies, Lagos can reduce the incidence and impact of typhoid fever on its population.

Lagos, Nigeria, must take responsibility for addressing the issue of typhoid fever and external support. The World Health Organization (WHO) has already called for a continental approach to generate accurate disease incidence and antimicrobial susceptibility data, and Nigeria must take advantage of this support. One of the critical areas where external support is essential is strengthening the healthcare system’s capacity for surveillance and diagnosis of typhoid fever. This includes improving laboratory facilities and providing training for healthcare workers.

Support from organizations such as WHO and the Centers for Disease Control and Prevention (CDC) can help develop effective policies and programs to control the spread of typhoid fever. Another area where external support is critical is promoting research into new and effective treatments for typhoid fever. This includes developing new antibiotics and vaccines and studying the disease’s epidemiology and ecology to understand better how it spreads and can be prevented.

External support is essential in helping to raise awareness of the issue of typhoid fever and its impact on public health in Nigeria. By working with local communities and stakeholders, external organizations can help to educate people about the disease, how it is spread, and how it can be prevented. This can create a sense of urgency around the issue and mobilize local communities and governments to take action.

The bluish line in the graph shows the rate of S. Typhi that can resist ampicillin. The orange line shows Chlora6mphenicol-resistant S. Typhi. Co-trimoxazole-resistant Staphylococcus typhi prevalence is shown by the gray line. S. the yellow line shows Typhi tetracycline resistance. The dark blue line shows the proportion of S. Typhi resistant to ciprofloxacin. The green line shows cefuroxime-resistant S. Typhi.

In 2003, cefuroxime entered clinical use. The red line shows the proportion of S. Typhi strains resistant to cefotaxime. In 2008, cefotaxime was made available to the public. In conclusion, typhoid fever remains a significant public health issue in Lagos, Nigeria. The persistence of the disease can be attributed to poor surveillance, inadequate data availability, restricted laboratory capacity, and resource and financial limitations that contribute to poor quality water, sanitation, and hygiene infrastructure.

The adoption of proper measures can significantly reduce the incidence of typhoid fever in Lagos. The Lagos State Government and stakeholders in Nigeria must show more commitment and will to provide the necessary means to combat the endemic disease. The involvement of external forces such as WHO, CDC, and other international organizations in promoting the eradication of the disease is essential. Their support in generating more accurate disease incidence and antimicrobial susceptibility data, improving laboratory capacity, and providing resources for disease surveillance and control is a significant step toward eradicating the disease.”

All stakeholders must work together to ensure the necessary measures are taken to end the endemic disease. With proper measures in place, we can significantly reduce the incidence of typhoid fever in Lagos, Nigeria, and ultimately eradicate the disease.

Ref.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924394/

Schistosomiasis &water Bill Brieger | 20 Aug 2021

Schistosomiasis in Mozambique, the Importance of WASH

As part of the class blog in the Course, Social and Behavioral Foundations in Primary Health Care at the Johns Hopkins Bloomberg School of Public Health, students occasionally write about tropical diseases. Below we are re-posting one such blog by an author going by the username of “kamilinea.”

Photo by mrjn Photography on Unsplash

Schistosomiasis is a parasitic disease, estimated to affect more than 240 million people globally, in which transmission and propagation is dependent upon human exposure to contaminated freshwater. This disease, which has a prevalence of approximately 50% in Mozambique, can cause significant morbidity including blood in the urine or stool, scarring and calcification of the bladder, kidney damage, liver and spleen enlargement, scarring of the liver, genital lesions, vaginal bleeding, infertility, and eventual possible cancer of the bladder along with rare spinal cord damage. Children, who are particularly susceptible to this disease through playing in freshwater, can develop anemia, stunted growth, and intellectual delays.

Exposure typically occurs while bathing, washing clothes, swimming, fishing, or working in contaminated fresh water including lakes, streams, and rivers. Although mass drug administration (MDA) with praziquantel is a main focus of disease control, treatment does not prevent reinfection. Multiple studies have concluded that elimination is currently impossible without infrastructure changes resulting in improvements in water, sanitation, and hygiene (WASH) throughout Mozambique. Providing these changes would allow citizens to avoid exposure to schistosomiasis as well as many other infectious diseases.

Figure 2.

Distribution of Schistosomiasis haematobium in Mozambique, The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg

A policy that implements infrastructure changes throughout Mozambique to increase WASH is necessary to improve control and progress toward elimination. More specifically, a policy that would support development of safe-water wells throughout rural regions of Mozambique would allow for sustainable access to safe water. For this policy to be effective, buy-in and support from many stakeholders is imperative including the communities themselves, the government, and the Ministry of Health and organizations such as the WHO, the Schistosomiasis Control Initiative, and the Water and Sanitation Program. The government would need to provide financial support, however funding could be obtained through the World Bank which already supports some WASH programs throughout the country.

Schistosomiasis is a disease that could be eliminated in Mozambique through various control efforts, however elimination is currently not possible without improvements in WASH. All efforts should be made to encourage the government of Mozambique to prioritize this effort and involve supporting organizations in order to eliminate schistosomiasis.

Agriculture &Counterfeit Drugs &Dengue &Diagnosis &Elimination &Environment &Floods &Irrigation &Mosquitoes &Severe Malaria &Surveillance &water Bill Brieger | 24 Sep 2020

Malaria News Today 2020-09-23/24

Today the issue of water is important for malaria mosquito propagation, both in irrigation and flooding. Artificial skin enables testing of mosquito biting. Fake medicines for malaria and other conditions threaten Africa’s health. Archived RDTs can aid surveillance. Finally there is concern for co-infection with both malaria and dengue leading to severe disease. Follow links below to read details.

Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia

Despite extensive irrigation development in Ethiopia, limited studies assessed the impact of irrigation on malaria vector mosquito composition, abundance and seasonality. This study aimed to evaluate the impact of sugarcane irrigation on species composition, abundance and seasonality of malaria vectors. Adult Anopheles mosquitoes were collected using CDC light traps from three irrigated and three non-irrigated clusters in and around Arjo-Didessa sugarcane irrigation scheme in southwestern Ethiopia.

Overall, 2108 female Anopheles mosquitoes comprising of six species were collected. The ongoing sugarcane irrigation activities in Arjo-Didessa created conditions suitable for malaria transmitting Anopheles species diversity and abundance. This could drive malaria transmission in Arjo-Didessa and its environs in both dry and wet seasons. Currently practiced malaria vector interventions need to be strengthened by including larval source management to reduce vector abundance in the irrigated areas.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection

A systematic review and meta-analysis examined co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection. Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved.

The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.

South Sudan: Flooding deepens a humanitarian crisis in Pibor area

Today, however, the Pibor River has swelled to make parts of the town inaccessible and is threatening the clinic. Many neighborhoods cannot be reached by foot, and a local ferry is too expensive for many who live in the area. A mobile MSF team is providing medical care in hard-to-reach areas. “Our focus is now on malaria, measles and flooding,” said Josh Rosenstein, MSF deputy head of mission. “Today we are reaching out to the community through our daily mobile clinics, treating the most severe illnesses. We’re also implementing our flood contingency plan, which includes building additional flood defenses around the clinic to ensure we can continue to provide medical services, as the water level is rising at an alarming speed.”

Stratifying malaria receptivity in Bangladesh using archived rapid diagnostic tests

Surveillance of low-density infections and of exposure to vectors is crucial to understand where malaria elimination might be feasible, and where the risk of outbreaks is high. Archived rapid diagnostic tests (RDTs), used by national malaria control and elimination programs for clinical diagnosis, present a valuable, yet rarely used resource for in-depth studies on malaria epidemiology. 1022 RDTs from two sub-Districts in Bangladesh (Alikadam and Kamalganj) were screened by qPCR for low-density Plasmodium falciparum and Plasmodium vivax infections, and by ELISA for Anopheles salivary gland antibodies as a marker for exposure to vectors.

Concordance between RDT and qPCR was moderate. qPCR detected 31/1022 infections compared to 36/1022 diagnosed by RDT. Exposure to Anopheles was significantly higher in Kamalganj despite low transmission, which could be explained by low bed net use. Archived RDTs present a valuable source of antibodies for serological studies on exposure to vectors. In contrast, the benefit of screening archived RDTs to obtain a better estimate of clinical case numbers is moderate. Kamalganj could be prone to outbreaks.

New tool mimics human skin to allow detailed study of mosquito biting

eLife: Researchers develop a human skin mimic to study mosquito biting in high resolution without using humans as ‘bait.’ The tool, which uses an artificial blood meal and a surface that mimics human skin, will provide detailed understanding of blood feeding without using human subjects as bait. It can also fit conveniently into a backpack, allowing the study of mosquitoes in laboratory and natural environments.

Blood feeding is essential for mosquitoes to reproduce, but it is during blood feeds on human hosts that they pass on pathogens such as malaria. It consists of a bite ‘substrate’ – a transparent, temperature-controlled surface that mimics body temperature to attract mosquitoes. An artificial meal is applied on top of this and covered with a commonly used membrane that mosquitoes can pierce. The meal resembles blood, allowing mosquitoes to engorge and increase their weight by two to threefold. This bite substrate is then placed in a transparent cage, and an external camera records the mosquitoes’ behaviour. The team tested biteOscope with four medically important species of mosquito.

Counterfeiting of Fake Drugs in Africa: current situation, causes and countermeasures

The more desirable a product is the higher the tendency to replicate it and meet that parcel of consumers that want to join the trend but cannot pay the price. Profit is one of the many reasons that make counterfeit an attractive business for many.  Africa, unfortunately but not surprisingly, is one of the most affected continents, comprehensible since its markets have become a huge target for second generation goods, with a major focus on pharmaceutical drugs.

The World Health Organization (hereinafter, WHO) stated that 42% of all fake medicine reported to them between the years of 2013 and 2017 was linked to the African continent and we expect that these numbers fall short of reality. Africa is seriously affected by it and one clear example is the anti-malarial medication. Anti-malarials and antibiotics are amongst the most commonly reported as fake or substandard medical products.

Case Management &coronavirus &COVID-19 &Research &water Bill Brieger | 31 Mar 2020

COVID19 Challenges for African Researchers

Not surprisingly COVID-19 related travel restrictions and bans now occur throughout the world, and for African researchers, this means inability to travel for research related collaborations, planning meetings and conferences. Thus, it becomes necessary to ask, “What can we do here at home,” especially considering increasing restrictions on local movement and gatherings.

In the very short time since COVID-19 was finally and officially recognized in China, many research articles have been published. Although these obviously focus on China, they raise possible research questions that need to be addressed in Africa, especially those countries still at the early stages of the epidemic.

Obviously, studies on the clinical management are needed, and one group of Chinese researchers are examining “biological products have broadly applied in the prevention and treatment of severe epidemic diseases, they are promising in blocking novel coronavirus infection,” especially based on reports from previous coronavirus experiences like SARS and MERS.[1] Other studies have examined the role of managing blood glucose levels[2], anticoagulant treatment[3] and the potential of antiviral treatment,[4] among others. What aspects of clinical management will become important to African patients’ survival?

In the process of requesting adequate diagnostic, monitoring and treatment supplies and equipment generally for the country, the tertiary and research hospitals need to ensure they have made requests for the equipment and supplies that are needed not just to provide life-saving treatment, but also to test appropriate approaches in the local setting. Each setting is different and must be studied because already there are anecdotal reports of younger age groups being affected by severe disease in the USA compared to earlier reports from China.

Taking a lesson from the Ebola epidemic in West Africa, there is need to study how COVID-19 will affect the delivery of health care, especially malaria services. Patrick Walker and colleagues[5] modeled the effects of health systems disruption on malaria including challenges in receiving based treatment when clinics were overwhelmed, seen as possible sources of disease and finally shut down as health workers themselves died. Outreach services like insecticide-treated net distribution were also stopped, and the efforts of community health workers were curtailed. To what extent is that happening with COVID-19?

Until there are proven drugs and vaccines, it is extremely important to learn about local epidemiology[6] in order to develop appropriate strategies to prevent the spread of COVID-19. This effort should involve researchers from many disciplines such as public health specialists, anthropologists, sociologists, educationists, and psychologists.

While the medical research mentioned above is carried out in hospitals and clinics, people conducting social and epidemiological studies ideally should be in the community where we can observe people washing their hands or not, gathering in groups or not, and finding out why they do these things. We need formative research to help develop health education, and at the same time ensure social and educational scientists can gather information to evaluate whether the health education as appropriate and worked.

Likewise, research is needed on health systems[7] and must involve political scientists, economists, public administrators, and of course public health specialists, also. A great danger exists for people who cannot keep a social distance from themselves such as those incarcerated in prison and living in camps for refugees and internally displaced people,[8] a common problem throughout the continent. They too need to get into the organizations and systems that provide care and learn what the policy makers and decision makers are thinking.

As Bronwyn Bruton has observed,[9] “Some 40 percent of Africans live in water-stressed environments in which obtaining access to clean water—let alone soap—is an insurmountable daily hurdle, and for those populations, even simple measures to prevent the spread of the virus, such as frequent handwashing, will be out of reach.” In addition he asks difficult questions about what happens to children who are home and cannot go to school, the vast numbers of people in the informal economy who cannot rely on a salary, if they stay home, and the many people in conflict zones. These are questions that urgently need to be studied in Africa.

Answers to our COVID-19 research questions are needed urgently, probably much sooner than funding can be found to support such research.  The question for our African research colleagues is what can be done now with resources at hand in an environment where movement is restricted? We will definitely need speedy responses from our Institutional Ethics Review Boards and be creative in our use of research methods.

Roxana Elliott[10] reports that data collection in the diverse African region “is difficult, especially when measuring statistics such as mobile penetration, which require face-to-face data collection in order to include those who cannot be reached via mobile. Language barriers, lack of infrastructure, and the sheer number of people throughout Sub-Saharan Africa make collecting face-to-face data nearly impossible due to cost and time constraints, especially in rural areas.” She, therefore, suggests that mobile-based surveying methodologies can alleviate these issues. She also recommends a country-by-country approach, and hence we see that in 2017 an estimate of 32% of the population had a smartphone 48% a basic phone, and 20% no phone.

How can social and health researchers design studies using this mobile resource to answer vital COVID-19 questions in the nearest future? If our students are now at home, can they, for example, be contacted to observe, at a safe distance, the human health related actions in their communities? Can they interview family members to learn why people practice prevention or not? Can they relate family experiences seeking health services for suspected respiratory illness?  Can they report on the water supply situation in the rural and urban areas where they are staying?

There are the questions which African colleagues can debate at a proper social distance (via phone, zoom, Skype, WhatsApp, and others), and come up with creative ways to find answers to prevent a worsening epidemic in Africa.

References

[1] Yan CX, Li J, Shen X, Luo L, Li Y, Li MY. [Biological Product Development Strategies for Prevention and Treatment of Coronavirus Disease 2019. Article in Chinese] Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):139-145. doi: 10.12182/20200360506. (English abstract in PubMed).

[2] Ma WX, Ran XW. [The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19. Article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):146-150. doi: 10.12182/20200360606.

[3] Tang N, Bai H, Chen X, Gong J, Li D, Sun Z.Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 Mar 27. doi: 10.1111/jth.14817. [Epub ahead of print]

[4] Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, Wang D, Liu C, Meng Y, Cui L, Yu J, Cao H, Li L. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19).J Intern Med. 2020 Mar 27. doi: 10.1111/joim.13063. [Epub ahead of print]

[5] Patrick G T Walker, Michael T White, Jamie T Griffin, Alison Reynolds, Neil M Ferguson, Azra C Ghani. Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis. www.thelancet.com/infection Published online April 24, 2015 http://dx.doi.org/10.1016/S1473-3099(15)70124-6

[6] Luan RS, Wang X, Sun X, Chen XS, Zhou T, Liu QH, Lü X, Wu XP, Gu DQ, Tang MS, Cui HJ, Shan XF, Ouyang J, Zhang B, Zhang W, Sichuan University Covid-ERG.[Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review. Article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):131-138. doi: 10.12182/20200360505.

[7] Philip Obaji, Kim Hjelmgaard and Chris Erasmus Coronavirus infections in Africa are rapidly rising. Its weak health systems may buckle. USA Today. Updated 27 March 2020, Accessed 29 March 2020. https://www.usatoday.com/story/news/world/2020/03/27/coronavirus-africa-preparedness-rising-covid-19-infections/5076620002/

[8] Nick Turse. In West African Coronavirus Hotspot, War Has Left 700,000 Homeless and Exposed. The Intercept. March 26 2020, 5:33 p.m. https://theintercept.com/2020/03/26/burkina-faso-africa-coronavirus/

[9] Bronwyn Bruton. What does the coronavirus mean for Africa?. Atlantic Council. Tue, Mar 24, 2020. https://atlanticcouncil.org/blogs/africasource/what-does-the-coronavirus-mean-for-africa/

[10] Roxana Elliott. Mobile Phone Penetration Throughout Sub-Saharan Africa. GeoPoll (In Market Research, Tech & Innovation). Posted July 8, 2019 https://www.geopoll.com/blog/mobile-phone-penetration-africa/

Cholera &Surveillance &water Bill Brieger | 19 Dec 2017

Comprehensive Cholera Prevention and Control: Lessons Learnt from the United Republic of Tanzania

Dafrossa Lyimo of the Ministry of Health, Tanzania presented Tanzania’s experience in preventing and controlling cholera at the 4th African Regional Immunization Technical Advisory Group (RITAG) meeting in Johannesburg, 5-8 December 2017. Those experiences are summarized below.

Cholera outbreak in Tanzania started with the index case detected in Dar es Salaam Region on 6 August 2015. The World Health Organization was notified by Ministry of Health on 15 August 2015. By 31 December 2015 the outbreak spread to 22 out of 26 regions in Tanzania Mainland. Zanzibar started reporting cholera cases on 20 September 2015 from Urban West District in Unguja Island. By December 2015, the outbreak spread to all 10 districts of Pemba and Unguja.

Cumulative cases on the Tanzania Mainland were 12 619 cases with 199 deaths (CFR 1.57%) in 2015, 11 360 cases with 172 deaths (CFR 1.5%) in 2016, and up through Nov 2017, 3 615 cases with 61 deaths (CFR 1.7%). Likewise the Cumulative cases in Zanzibar were 1 143 cases with 15 deaths (1.31%) in 2015, 3 187 cases with 53 deaths (CFR 1.66%) in 2016 and as of Nov 2017, 358 cases with 4 deaths (CFR 1.12%). The last case reported 11 July 2017

Best practices for controlling cholera in the country fall in four domains. In the area od Coordination Tanzania established a Public Health Emergency Operations Centre (PHEOC) in the Ministry of Health. To support this the Ministry appointed an Incident Manager, Deputy Incident Manager, and a PHEOC Manager for the cholera outbreak response. The National Task force Team was established with a wider composition which meeting every Friday discussing issues and giving way forward. National Rapid Response Teams were trained. these teams worked based on national response guidelines which were developed and distributed to all districts.

In the domain of Surveillance, the Ministry initiated a Daily Situation Report (SITREP) for sharing a daily cholera status in the regions and districts , on going interventions and gaps. This group conducted twice a country wide data validation/verification of the reported cases in 17 regions, which also confirmed under-reporting of cases. A Cholera reporting line list register was designed and printed in booklets and distributed to 26 regions in the Tanzania Mainland, to standardize reporting from districts and regions.

The third domain consisted of Water Sanitation and Hygiene interventions. The country distributed 21,600,000 aqua tablets of water guards in 514,285 households. Also distributed were 50 drums 45kg each of 70% High Test Hypochlorite to 83 district water authorities for bulk chlorination. Twenty hand pump boreholes were installed in hotspot villages of Mara and Mwanza regions, thereby Improving the access to clean and safe water. One hundred HACH chlorine testers were distributed for monitoring free residue chlorine in cholera reporting districts.

Social Mobilization was the fourth domain. Cholera leaflets and fliers were designed and distributed in reporting districts. Cholera messages were developed and aired through community media and mobile phone messaging. Community engagement and owning cholera interventions was undertaken using the community social networks and peer groups who focused on Hand washing, Use of treated water, and Use of toilets behaviors.

Cholera control and prevention efforts addressed various Challenges
in Tanzania. one concern was a weak surveillance system starting at the district level in several districts. Lack of reporting cholera cases, under-reporting and late reporting occurred. In some districts that had laboratory capacity, only positive cases were reported, but generally there was inadequate laboratory capacity to test and confirm Vibrio. This meant that samples had to be transported to regional laboratories (long turn around time)

A second challenge was Weak coordination at the region and District level. A third was Inadequate and poor access to WASH. this included a Limited supply of clean and safe piped water in most of districts. Thus 52% of rural population get water from unimproved sources. (Shallow wells, river, lakes and few deep wells). In urban settings, water utilities can supply water not more than 50% and still chlorination is not regularly done. there was low latrine coverage especially in rural areas. About 73% of rural population use unimproved latrines and 13% with no latrines. A fourth challenge was the Misconceptions about cholera causation and some of the interventions.

In the process of addressing these challenges several Lesson were learnt. First, a well established surveillance system helped to in the early notification of cases and quick response. Strong coordination at all level of response is important to ensure the control of outbreak is done on time. Effective social mobilization and community engagement helped in the behaviour change towards the control of cholera. Finally Adequate and good access to WASH ensured the control of spread of cholera

Tanzania has put together a comprehensive cholera prevention program based on surveillance, coordination, water & sanitation and social mobilization. While cases have reduced, Tanzania is not relenting in implementing these key interventions.

NTDs &Vector Control &water Bill Brieger | 22 Mar 2017

World Water Day: Water and Neglected Tropical Diseases

The United Nations introduces us to the challenges of water. “Water is the essential  building block of life. But it is more than just essential to quench thirst or protect health; water is vital for creating jobs and supporting economic, social, and human development.” Unfortunately, “Today, there are over 663 million people living without a safe water supply close to home, spending countless hours queuing or trekking to distant sources, and coping with the health impacts of using contaminated water.”

Haiti: Importance of Water to prevent STH

Many of the infectious health challenges known as Neglected Tropical Diseases (NTDs) have issues of water associated with their transmission. This may relate to scarcity of water and subsequent hygiene problems. It may relate to water quality and contamination. It may also relate to water in the lifecycle of vectors that carry some of the diseases.

Even though water is crucial to the control of many NTDs, it is not often the feature of large scale interventions. The largest current activity against five NTDs is mass drug administration (MDA) on an annual or more frequent basis to break the transmission cycle.  Known as diseases that respond to preventive chemotherapy (PCT) through MDA, these include lymphatic filariasis (LF), trachoma, onchocerciasis, schistosomiasis and soil transmitted helminths (STH) has been undertaken for over 10 years.

We have recently passed the Fifth Anniversary of the London Declaration on NTDs, which calls for the control of ten of the many these scourges The Declaration calls for “the elimination “by 2020 lymphatic filariasis, leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma.” Another water-borne NTD, guinea worm, should be eradicated soon. Two of the elimination targets are part of MDA efforts, LF and trachoma.

Cameroon: mapping the community to detect NTD transmission sites

Ministries of Health and their donor and NGO partners who deliver MDA against the 5 diseases in endemic countries express interest in coordinating with water and sanitation for health (WASH) programs. People do recognize the value of collaboration between NTD MDA efforts and WASH projects, but these may be located in other ministries and organizations.

The long term implementation of WASH efforts is seen as a way to prevent resurgence of trachoma, for example, and  strongly compliment efforts to control STH and schistosomiasis. Hopefully before the 10th Anniversary of the London Declaration the vision of “ensuring access to clean water and basic sanitation,” can also be achieved.

Finally as a reminder our present tools for the control of Zika and Dengue fevers relies almost entirely on safe and protected household and community sources of water to prevent breeding of disease carrying Aedes aegypti mosquitoes. If we neglect water, we will continue to experience neglected tropical diseases. Hopefully the topic of water and NTDs will feature prominently at next months global partners meeting hosted by the World Health Organization.

 

Monitoring &Mortality &water Bill Brieger | 05 Nov 2015

The quantitative impact assessment of community health projects in selected African countries by using Lives Saved Tool

Park 1Chulwoo (Charles) Park who has been undertaking the Masters of Science in Public Health at the Johns Hopkins Bloomberg School of Public Health is sharing herein his experiences with the LiST tool in African countries.

The Lives Saved Tool (LiST) is a computer-based tool that estimates the impact of scaled up health intervention packages in a quantitative manner. By modeling complex mathematical relationship of coverage difference among interventions for maternal, neonatal and child health (MNCH), LiST shows us quantitative results, such as mortality rates, incidence rates, number of cases averted, percentage of stunting and wasting, number of cause-specific death and lives saved.

Especially, LiST can project and run multiple scenarios for subnational target population in the country not only to evaluate existing MNCH project but also prioritize investments for the future based on the quantitative results. World Vision International (WVI) has implemented LiST analysis to strengthen its evaluation and strategic planning methods for MNCH projects since 2013.

Recently, the mid-term evaluations for Access to Infant and Maternal (AIM)-Health project in Kenya, Mauritania, Sierra Leone, Tanzania, and Uganda were conducted through mixed methods analysis, both qualitative research (in-depth interview and focused group discussion) and quantitative research (LiST) from June to September of 2014.

Park 2Subsequently, LiST was solely utilized to quantify the retrospective impact of Water, Sanitation, and Hygiene (WASH) project in Southern Africa Region (SAR), Malawi, Mozambique and Zambia between 2010 and 2014. The significant impact indicates that the combined effect of all five WVI WASH interventions (improved water source, home water connection, improved sanitation, hand washing with soap, and hygienic disposal of children’s stools) have prevented 989,745 diarrhoeal cases among the under-five target population of 506,019 children.

In other words, every single young child prevented 1.96 cases of diarrhea, and prevention rate for diarrhoea was 13% throughout the implementation period. Another results indicate that WVI’s WASH project contributed a 209% mean increase in percentage of under-five lives saved and 15.5% mean decrease in under-five mortality rates across SAR.

  • Chulwoo (Charles) Park, MSPH ’15
  • Johns Hopkins Bloomberg School of Public Health, Department of International Health, Division of Global Disease Epidemiology and Control
  • For more information write to e-mail: park@jhmi.edu

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