Malawi – ‘Vampire’ Attacks Reflect Healthcare Tensions

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Economic woes and unhappiness with healthcare have contributed to the panic in the southern part of the country, says a leading clinical psychologist.

Ten people have been killed and others attacked in October over accusations of blood sucking in Malawi. Police have made some 200 arrests of those allegedly involved in mob justice.

“It’s a reflection of the way the country looks at things and makes sense of tensions and economic pressures,” Dr. Chiwoza Bandawe, a clinical psychologist and professor at the University of Malawi in Blantyre told RFI.

The first blood sucking accusations in Malawi occurred in 1948 and 1949, according to Catholic University lecturer Sangwani Tembo, who spoke at the university on this issue on October 27th.

While marginalised people, including widows, are typical scapegoats, accusations have been placed on the population at large, including doctors.

“It’s also about trying to make sense of the western-type medical profession vis-à-vis traditional medicines, and of course the western type has the power now, and all this contributes to the tension,” says Dr Bandawe.

“I think at some point also there’s been some dissatisfaction with the health system itself, because it has been under-resourced,” he says, adding that some stories have emerged where healthcare workers abused patients.

Medical practitioners are frequently on the receiving end of abuse, especially in the rural areas, says Dr. Amos Nyaka, the head of the Malawi Society for Medical Doctors in Lilongwe.

Lack of education comes into play as well, says Chitawira-based Centre for Human Rights Education Advice and Assistance (CHREAA) Director Vincent Hango.

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Schoolchildren in Mulanje – CC 2010

“We have a good number of people who are illiterate. They believe in witchcraft. It’s very difficult to change their beliefs because this is what they have believed since they were born,” he says.

The government has enforced security in affected areas, but many feel that it should have taken a stauncher response, reassuring those who felt threatened by the wave of violence.

“As a country I think we’re very ashamed,” says Dr Nyaka, adding that the Malawi Society of Medical Doctors “will take this as a challenge to communicate to our people and to reassure them that they are not blood suckers.”

Malawi will from November 1st host a three-day high-level meeting on promoting policy coherence on health technology innovation and access for the African Regional Intellectual Property Office (ARIPO), said Malawi News Agency.

The meeting brings together a range of leaders, policymakers and institutions including representatives from Ministries of Trade, Health and Justice, civil society, international experts and academics.

Minister of Health Atupele Muluzi has said Malawi and many of the 18 ARIPO member states have made great strides in improving public health and by consequence, human development outcomes in recent years.

He said that despite significant progress, the burden of infectious diseases, particularly HIV, malaria and Tuberculosis pose a threat to public health.

Minister of Justice and Constitutional Affairs, Samuel Tembenu said the meeting comes at a time when countries around the world are pursuing various means to ensure availability and access to medicines for their citizens.

The meeting aims at providing a forum for ARIPO countries to exchange views and to share experiences on best practices that promote availability and access to affordable health coverage, Tembenu added.

The high-level meeting has been jointly organised by the Malawi government and the United Nations Development Programme (UNDP).

Find out more in the Africa Research Bulletin:

Malawi – Refugee Clashes Deplored
Political, Social and Cultural series
Vol. 54, Issue 6, pp. 21458C

HEALTH: Malaria
Political, Social and Cultural series
Vol. 54, Issue 4, pp. 21416A–21417C

MALAWI: High Future Growth?
Economic, Financial and Technical series
Vol. 54, Issue 5, pp. 21707A–21707C

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Madagascar – Tackling Plague

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The death toll from the plague spreading in Madagascar has risen close to 100, and the Red Cross has warned that growing stigma attached to the disease could undermine efforts to contain the outbreak.

While cases of bubonic plague occur in Madagascar nearly every year, this year’s epidemic is “much more dangerous”, said Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC).

Plague arrived earlier than expected, and has become much more contagious as it is now being transmitted from person to person as well as from animals to humans, reported the Thomson Reuters Foundation.

The infection is also spreading in urban centres and in areas that until now had not been affected, the World Health Organisation (WHO) said in October. IFRC staff on the ground say panic is exacerbating the stigma around the plague.

There is a risk this could “drive people underground and that may result in us losing some of the contacts we are tracing in order to contain the outbreak”, Sy warned.

The Red Cross is using burial practices that avoid contact with corpses and has opened a plague treatment centre to help Madagascar tackle its worst outbreak of the plague this century.

The latest figures from the country’s health ministry show there have been 911 recorded cases of the plague across 17 of the island nation’s regions since August, killing 95 people so far.

Hospitals in Madagascar are on high alert and are implementing preventative measures, medical staff said. International agencies are also providing ambulances to ensure patients with suspected cases do not spread the virus by taking crowded buses and taxis.

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Council workers clear garbage during the clean-up of the market of Anosibe in Antananarivo – CNN

Sy said building partnerships and trust at the community level is critical, as well as reinforcing an existing referral system for suspected cases.

But overcoming the plague will require longer-term assistance, he emphasised – “not just intervening at the peak and then forgetting about it”.

The outbreak has also hit sectors of society outside impoverished communities, who are typically most at risk, London-based The Guardian reported.

“Normally, the people who catch the plague … live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease,” said Dr Manitra Rakotoarivony, Madagascar’s director of health promotion.

Plague is curable if detected in time. “Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save,” said the WHO’s Madagascar representative, Charlotte Ndiaye.

Over the course of less than a decade, the country’s plague problem appears to have intensified, driven by a combination of economic and environmental factors.

Madagascar has a per capita GDP of about $400 (£300), and national programmes to control the disease have been “hampered by operational and management difficulties”, according to a report by the European Centre for Disease Prevention and Control.

Plague was first introduced to the island in 1898, when steamships from India brought rats infected with the disease. Within two decades or so, it virtually disappeared from Madagascar for 60 years, only to re-emerge in recent decades.

Find out more in the Africa Research Bulletin:

VANILLA: Madagascar
Economic, Financial and Technical series
Vol. 54, Issue 8, pp. 21834C–21835C

MADAGASCAR: Tackling Corruption?
Political, Social and Cultural series
Vol. 54, Issue 5, pp. 21423C–21424C

MADAGASCAR: Enduring Poverty
Economic, Financial and Technical series
Vol. 54, Issue 3, pp. 21636A–21636B

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South Sudan – Cholera Epidemic

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The threat of an uncontrollable outbreak looms large as the rainy season progresses. 

The International Organisation for Migration (IOM) has called for rapid action to prevent a cholera epidemic in South Sudan; more than 18,000 cases, including 328 deaths, have been reported in the country since June 2016.

The IOM warned that the number of cases and deaths is likely to increase significantly as the rainy season approaches, which will leave as much as 60% of the country inaccessible by road, hindering the delivery of important services.

IOM spokeswoman Olivia Headon said that a combination of factors including the rainy season, the movement of displaced persons and the ongoing conflict in the country, means that the disease is becoming increasingly difficult to contain.

“If you are maybe infected with cholera or someone in your family, if you come in contact with this and then you move to a different part of the country, you are also bringing the infection with you,” Headon said.

The scale of the problem in South Sudan is said to be unprecedented, with more than 7.5 million people dependent on humanitarian aid. Headon said that IOM and partners are promoting cholera vaccination campaigns, distributing cholera kits, repairing boreholes and conducting hygiene promotion campaigns, reported Voice of America (VOA). 

On July 28th the World Health Organisation (WHO) also launched a vaccination campaign. The WHO received 500,000 doses of oral cholera vaccine and between July 28th and August 3rd carried out a vaccination campaign in four high risk areas: Tonj East, Kapoeta South, Kapoeta North, and Kapoeta East.

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Children collecting water, South Sudan – CC 2014

Since April 2017 around 2,500 new cases have been recorded, a significant increase on previous months. Persistent drought has also led to the drying of water points, leading to populations in some regions relying on contaminated water, reported CISA

Speaking on July 19th, WHO epidemiologist Joseph Wamala said, “South Sudan has suffered from several major cholera outbreaks in the last four years. Following other successful oral cholera vaccine campaigns, WHO and partners can make a real difference in controlling the outbreak.”

However preventative measures are difficult as the country continues to grapple with ongoing conflict which emerged in 2013, pitting President Salvir Kirr against and his former deputy Riek Machar, with the ethnic Dinka, loyal to Kirr, clashing with the Nuer, allied to Machar.

The conflict has killed tens of thousands of people and displaced millions, many of whom have sought refuge in neighbouring countries. The United Nations (UN) children’s charity (UNICEF) estimates that 900,000 children in South Sudan need psychological help, with at least 150,000 living in camps

“South Sudan has a generation of traumatised children, but there aren’t enough therapists – neither in Juba, nor in remote local communities,” explained Duop Dak, one of the country’s few practicing psychologists, reported Reuters.

The German Foreign Minister Sigmar Gabriel issued a statement on August 10th, following a visit to the capital Juba, urging President Kirr to include the opposition and rebels in national dialogue. The conflict, tensions and factional violence is only exacerbating the risk of a deadly epidemic.

Find out more in the Africa Research Bulletin: 

SOUTH SUDAN: Fresh Offensive Against Rebels
Political, Social & Cultural Series
Vol. 54, Issue. 7, Pp. 21517B–21518B

South Sudan – Graft Claims Denied
Political, Social & Cultural Series
Vol. 54, Issue. 6, Pp. 21484B–21484C

SOUTH SUDAN: Humanitarian Relief Impeded
Political, Social & Cultural Series
Vol. 54, Issue. 4, Pp. 21410A–21411A

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Health – Malaria Vaccine Trials

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Three Africa countries are selected for first phase of a Malaria vaccine pilot. 

The World Health Organisation (WHO) has announced that Ghana, Kenya and Malawi a are to be pilot countries for a new Malaria vaccine for young children from 2018. The vaccine has the potential to save tens of thousands of lives.

The vaccine was developed by GlaxoSmithKline and will be tested on children aged five to 17 months; it has taken decades of scientific and medical expertise to produce, and hundreds of millions of US dollars in funding.

The funding of US$49m for the first pilot phase is being funded by the Global Vaccine Alliance (GAVI), UNITAID and the Global Fund to Fight Aids, Tuberculosis, and Malaria.

However, the vaccine only has partial effectiveness, and the challenge is whether countries can deliver the required four doses per child, said WHO Africa Regional Director, Matshidiso Moeti.

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CC Radio Okapi 2006

Malaria infects roughly 200 million people each year, killing roughly half a million people, and Sub-Saharan Africa is hit particularly hard, with 90% of the world’s cases in 2015.

According to the WHO, modelling and data gathering has been so bad that it has been hard to tell if cases have been rising or falling over the last 15 years.

Kenya, Ghana and Malawi already have fairly strong prevention and vaccination programmes, but were chosen as they still have a high number of malaria cases. The vaccine will be delivered through existing health provisioning systems.

The WHO has stated its aim to wipe out the disease by 2040, although so far it has proven stubborn, with resistance problems to both drugs and insecticides.

According to Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases at Imperial College London, writing in a academic paper published in December 2016, “the slow progress in this field is astonishing, given that malaria has been around for millennia and has been a major force for human evolutionary selection…contrast this pace of change with out progress in the treatment of HIV, a disease a little more than three decades old.” (The Independent 24/4)

Find out more in the Africa Research Bulletin:

HEALTH: Malaria
Political, Social & Cultural Series
Vol. 54, Issue. 4, Pp. 21416A–21417C

HEALTH: Wiping Out Polio
Political, Social & Cultural Series
Vol. 54, Issue. 3, Pp. 21381B–21381C

HEALTH: HIV Treatment Soars
Political, Social & Cultural Series
Vol. 53, Issue. 11, Pp. 21236A–21237C

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Nigeria – Lassa Fever Concerns

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New outbreak of haemorrhagic fever burdens an already strained healthcare system.

Concerns have mounted over an increase in cases of Lassa fever in Nigeria with 44 people having died and authorities warning of the difficulties in combating the virus in a region still suffering from the effects of the Ebola outbreak.

Lassa fever is a haemorrhagic virus similar to that of Ebola; the outbreak was announced only in January despite the first case being confirmed in August 2015, with deaths reported across ten states, including in Abuja.

Chikwe Ihekweazu, an infectious disease epidemiologist said, “it is possible we are only seeing the tip of the iceberg”, the disease may have criss-crossed the country during the busy festive season.

Micchael Asuzu, Professor of Public Health at the University of Ibadan, in southwest Nigeria, said the Lassa response took so long because residents in the initial infected village of Foka, in the northwest state of Niger, attributed deaths to supernatural forces. There are also concerns that doctors could be misdiagnosing, facilitating the spread of the disease.

Lassa fever is an acute haemorrhagic illness that belongs to the arenavirus family of viruses, which also includes the Ebola-like Marburg virus. The virus is transmitted by rodents, often through contact with food or household items contaminated with faeces and urine.

The US Centre for Disease Control and Prevention said that Lassa fever infections in West Africa range from between 100,000 to 300,000 each year, with about 5000 deaths. (© AFP 15/1 2016; PANA, Lagos 9/1)

Find out more in the Africa Research Bulletin

HEALTH: Sierra Leone
Political, Social & Cultural Series
Vol.52, Issue.11, Pp.20804A–20804C

HEALTH: Ebola
Political, Social & Cultural Series
Vol.52, Issue.9, Pp.20733A–20733C

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Ethiopia – Mobile Technology for Childbirth

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Mobile app aims to improve the safety of childbirth across the country, particularly in rural areas.

A new mobile app, ‘Safe Delivery App‘, developed by Danish organisation the Maternity Foundation, is hoped to improve the safety of childbirth in the country by providing simplified instructions and films for emergency situations such as haemorrhaging, birth complications and infections, reported Agence France Presse (AFP).

In Ethiopia, where roughly nine out every ten births are at home without medical support, the app intends to provide life saving guidelines when things go wrong. The foundation aims to use the sharp rise in mobile phone users in Africa, which offers “abundant unexplored potential” to quickly reach otherwise hard to access areas, it said.

Maternity Foundation Program Manager for Ethiopia, Mesfin Wondafrash, said that “midwives may have skills and knowledge…but they may not apply the right procedures when complications arise”. Many midwives are ‘traditionally educated’ and may lack training in up-to date procedures, particularly in rural areas.

Described as an “emergency training tool”, the app is available in local languages and in English. Additionally it can be pre-installed on a mobile telephone so it works even without a network connection or Internet access.

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DFID CC – Malawi

For the roughly 85% of babies who are born at home, if a complication arises, hospital is often the only option, which generally means lengthy travel; Mesfin added that issues such as bleeding can have dire consequences and often prove fatal.

A trial run was undertaken in the small town of Gimbie in the Oromo region, around 450km west of the capital Addis-Ababa, and proved to have promising results. Seventy-eight phones containing the app were distributed to midwives and Mesfin explained that “After a year, the capacity of the app users to manage bleeding rose from 20 to 60 percent, and for new born resuscitation, from 30 to 70 percent”.

The Maternity Foundation says the preliminary results “show a remarkable improvement in the skill and knowledge level of the health workers”. Chief of the Foundation, Anna Frellsen, said that “the advantage of the app over a medical book is that it is easy to understand, easy to access and easy to update”.

The app is also being tested in Ghana and will soon be deployed in Tanzania, Guinea and other African countries. The foundation’s stated goal is to equip 10,000 health workers by 2017; “If we achieve that, we will have ensured a safer birth for approximately one million women,” said Frellsen.

Estimates suggest that worldwide around 5 million babies and 289,000 mothers dies from complications related to childbirth worldwide each year, with the majority in developing countries.

Find out more the Africa Research Bulletin

MATERNAL HEALTH: Africa
Political, Social & Cultural Series
Vol.46, Issue.12, Pp.18239A–18241C

HEALTH: Ethiopia, Zambia
Political, Social & Cultural Series
Vol.47, Issue.3, Pp.18346A–18347B

HEALTH: Africa
Political, Social & Cultural Series
Vol.50, Issue.7, Pp.19796B–19797B

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