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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