Friday, 11 December 2015

Wanted: Permanent cure for drug-resistant malaria

Drug-resistant malaria has become a global issue, resulting in elimination efforts and collaboration among several actors, including the national programmes, donors, researchers and critically, public health providers. Early detection, strong surveillance and patient follow-up are crucial in fighting the spread of the drug-resistant Malaria.

CHIOMA UMEHA (HEALTH EDITOR) who was among   the eight journalists who recently participated in “Covering the Fight to Eradicate Malaria: A Fellowship for U.S. and International Centre for Journalists (ICFJ)” in Thailand and Cambodia under the sponsorship of the International Center for Journalists and Malaria No More programme  writes her experience on efforts in tackling drug-resistant malaria in these countries.

Inside a clinic at Steung Market, Tbong Khmom province, Ponhea Krek District, Cambodia, Cheng Koy, pricks Sourn Morm’s finger and squeezes out five drops of blood.

He checks his temperature and asks about his symptoms. Then he gets out a file and enters Morm’s answers.

“I am very worried about malaria,” said Koy. “If patients with malaria cases report late and we cannot treat them, they will die. Many years ago we used to see that.”

Koy runs his own dispensary and clinic when he’s not running the local health center. Koy’s favourite uncle, a farmer, encouraged him to take up medicine during the 1980s, when if you didn’t have a vocation, you’d be arrested and forced into the Khmer Rouge’s army.

Mr. Cheng Koy with some International Centre for Journalists (ICFJ) Fellows 2015 (Chioma Umeha - third extreme right) during an interview session recently, at his clinic at Tbong Khmom province, Ponhea Krek District, Cambodia.
It is interesting to know that Koy was trained by PSKhmer (PSK) under the Public Provider Mix (PPM) Network Programme which is funded by The Global Fund-trainings, supplies, commodities, medical detailing (suppoartive supervision).

Some select journalists who recently visited Thailand and Cambodia to study on-going malaria research and development, drug resistance, and innovation had an encounter with Koy.

Aged 50, Koy, a Secondary Nurse conducts Rapid Diagnostic Tests (RDT) for community members of Tbong Khmom province to check if they are infected with Plasmodium Vivax (PV) or Plasmodium Falciprum(PF).

The PPM worker who has been into community health work for over a decade however said: “After conducting RDT for patients I administer Artemisinin-based combination therapy (ACT) to treat them, if they test positive of malaria, I also set up IV for administration of injection when necessary.”

According to him, the diagnostic kits are very easy to use, just as he added that it does not require much training to use it.

Koy is just one out of nearly 400 health providers enrolled in the Public Provider Mix (PPM) Network Programme of PSK. The PPM Network Programme health providers guarantee quality control for diagnosing and treating malaria in Cambodia.

Collaborating, the Programme Manager for Technology Integration, PSK, Graham T. Smith, said that PSK has nearly 400 health providers in its PPM Network involved in quality control assurance in malaria diagnosis and treatment in the Asian country.

After their training, PPM workers receive quality-assured anti-malarials which usually increases their business reputation, the Programme Manager said, adding that their data and the data they collected play a large role in decision making.

According to him, PSI and PSK partners easily track malaria cases, identify outbreaks and re-direct resources to where they are most needed through the data collected by PPM health workers.

Population Services International (PSI) is a global network of 65 nationally rooted health organizations dedicated to improving the health of people in the developing world. PSKhmer (PSK) is PSI’s independent, local network member in Cambodia.

Describing malaria transmission in Cambodia, malaria Technical Advisor for PSI Cambodia, Abigail Pratt, said that the disease is a big issue in Cambodia.

Her words: “With over 50,000 cases reported in 2014, malaria remains a concern in Cambodia, both in terms of public health and economic burden. 21 of 25 provinces are considered endemic, putting nearly eight million people at risk of the disease.

According to her, nearly 63 per cent of confirmed cases are Plasmodium falciparum (Pf) and 37 per cent Plasmodium vivax (Pv) malaria.

The World Health Organization (WHO) recommends using malaria rapid diagnostic tests (RDTs) and prescribing anti-malarials only to patients who have a positive test result.

The T3: Test. Treat. Track initiative of the WHO Global Malaria Programme sets targets of universal access to diagnostic testing in the public and private health care sectors as well as at the community level.

 In Nigeria, Malaria is still a major cause of morbidity and mortality among Nigerians. Prompt and accurate diagnosis of malaria is necessary in controlling this high burden and preventing unnecessary use of anti-malarial drugs, according to experts.

Malaria rapid diagnostic test (MRDT) offers the hope of achieving this goal. However, investigations by Newswatch Times show that the performance of these kits among the most vulnerable age group to malaria is inadequate.

Also, findings by Newswatch Times confirmed that majority of suspected malaria episodes are initially treated by private health workers or community health workers who, in most areas, don’t have access to microscopy or RDTs to carry out malaria testing.

Probably the biggest challenge in scaling up and monitoring good quality in RDT programmes will be to provide adequate supplies of rapid diagnostic tests and appropriate training to all health workers in endemic areas, according to one Nkemakolam Okenwa, a dealer on medicals. “Most areas often report stock-outs, therefore it is critical to sustain supply to ensure that tests are used persistently,” Okenwa suggested.

Global strategies to control and eliminate malaria depend on sustained access to Artemisinin-based combination therapy (ACT) – the WHO recommended first line treatment for P. falciparum malaria – in public and private health facilities.

But, the common experience in Nigeria is that health workers frequently do not prescribe treatment according to the result even when tests are available which lead to wastage of expensive ACTs and RDTs, he added.

Obviously, access to quality artemisinin-based combination therapy (ACT) to treat malaria is increasing around the world, but its misuse, together with the use of cheaper, ineffective drugs can lead to dangerous drug resistance. Spread of resistance could jeopardize the efficacy of ACT, the best treatment currently available. This is food for thought.

This story was published in Newswatch Times on December 5, 2015.

Wednesday, 9 December 2015

2.9m HIV positive Nigerians risk death without antiretroviral drugs –Experts

A whooping 2.9 million people living with HIV/AIDS out of 3.4 million Nigerians diagnosed last year are at risk of death from HIV related illnesses following lack of treatment needed to suppress the infection.

Affected persons are mostly those who are currently living in hiding, who are also infecting new people causing a surge of the disease.

HIV experts revealed this at a scientific symposium to mark this year’s World AIDS Day, organized by the Nigerian Institute of Medical Research, NIMR, in collaboration with Nigeria Medical Association, NMA, Lagos branch.

In her presentation, representative of the Population Council Abuja, Dr. Sylvia Adebajo, noted that only 500,000 people are currently on treatment, while the 2.9 million, largely men, serve as reservoir for the spread of HIV.

“Men do not go to hospital as much as women, so they are the most difficult to reach. Those at higher risks include; women, homosexuals, men who engage with drugs and those who have sex with female sex workers.”

L-r Dr Olalekan Aregbesola (NMA) Dr. Dumebi Owa (NMA) Dr. FIsher LASACA Rep. Dr. Olusegun Ogboye, Project Manager, LASACA, Mrs. Amina Ali, Chair, NEHHWAN, Lagos State, Prof. Oni Idigbe (NIMR), Dr. Sylvia Adebayo, Population Council, Abuja and Prof. Sulaimon Akanmu, Consultant Haematologist, LUTH at a seminar on World Aids Day 2015, recently.
Adebajo noted that the attitude of testing people and letting them go without follow up needs to be stopped, and more people particularly men need to be reached with treatment.

Director-General of NIMR, Prof Innocent Ujah, regretted that despite availability of effective tools for diagnosis and clinical management, the AIDS epidemic still claims estimated two million lives each year, of which about 270, 000 are children.

He lamented: “Despite the fact that effective tools have been available for the diagnosis and clinical management, the epidemic still claims an estimated two million lives each year, of which about 270,000 are children.”

He further observed that new cases of the infection are still occurring in some parts of the world leading to intensified global efforts to stem the epidemic.

According to him, this development informed the choice of the multi-year theme of the World AIDS Day since 2012 which has been, “Getting to Zero with the three main sub-themes of Zero new infections, Zero deaths from AlDS-related illnesses and Zero discrimination.”

Ujah who lauded the UNAIDS 90-90-90 initiative said it was designed to have 90 percent of all people diagnosed with HIV infection receive sustained ARV therapy and 90% of all people receiving ARV will have viral suppression.

However, corroborating with the United Nations Agency on AIDS, the DG said that it will be impossible to end the epidemic without bringing HIV treatment to all those who need it.

He said that people with the virus will have to be diagnosed before they are provided treatment. When on treatment, there should be adequate viral suppression achieved in those treated, he added.

His words: “In 2014, the UN AIDS came up with the Global 90-90-90 initiative. This is an ambitious treatment target to help end the AIDS epidemic. Whereas previous AIDS targets sought to achieve incremental progress in the response, the post-2015 era is nothing less than the end of the AIDS epidemic by 2030.

“However, it is the view of the UNAIDS that it will be impossible to end the epidemic without bringing HIV treatment to all who need it. To provide treatment, people with the virus will have to be diagnosed. When on treatment, there should be adequate viral suppression achieved in those treated.

“The multi – year theme since 2012 has been “getting to zero with the three main sub-themes of zero new infections, zero deaths from AIDs – related illnesses and zero discrimination.

“With 90 percent of those on treatment having viral suppression, there will be a drastic break of transmission of new infection and end the HIV/AIDS pandemic by 2030,” he said.

He said NIMR conducted an outreach in Alimosho Local Government area of Lagos state to increase awareness on HIV/AIDS as well as enhance HIV counselling and testing.

Also in her presentation on how to prevent new infection, Dr. Oladipo Fisher, from Lagos State AIDS Control Agency, LASACA, said early initiation of HIV positive people into antiretroviral drugs will decrease rate of new infections as well as reduce HIV-related illnesses and deaths.

Similarly, Consultant Haematologist, Lagos University Teaching Hospital, LUTH, Prof. Sulaimon Akanmu, noted that people who test positive to HIV can possibly eliminate the virus if they commence treatment immediately they are diagnosed. “This will help bring their viral load to an undetectable level where they will likely not infect other people, and this is in line with the World Health Organization, WHO’s new treatment guideline for HIV/AIDS.”
This story was published in Newswatch Times on December 5, 2015.

S/Leone: IMF approves USS46.14m disbursement

The Executive Board of the International Monetary Fund (IMF) has approved US$64.59 million(equivalent of SDR 46.665 million of the local country’s currency) to be distributed in three tranches.

The augmentation of access was approved after the Executive Board completed the third and fourth review of Sierra Leone’s performance under a three-year arrangement by the Extended Credit Facility (ECF).

IMF said: “The completion of the third and fourth review enables the immediate disbursement of US$46.I4 million (SDR 33.335 million). This amount includes the first tranche of the augmentation in an amount of about US$2 l .53 million (SDR 15.555 million).”

The Executive Board also approved the authorities’ request for the re-phasing of the fifth and sixth disbursements under the arrangement.

Christine Lagarde, IMF Chief
In completing the review, the Executive Board additionally approved the authorities’ request for waivers of non-observance of the end December 2014 performance criteria on the ceiling on Net Domestic Bank Credit to Government.

“The ECF arrangement for SDR 62.22 million (about US$95.9 miIIion) was approved in October and was augmented twice,” the Fund said.

Following the Executive Board’s discussion on Sierra Leone, Min Zhu, Deputy Managing Director and Acting Chair, made the following statement: “With the World Health Organization declaring Sierra Leone Ebola free on November 7, the country now faces the difficult challenge of economic recovery.

Complicating that task, the decline in iron ore prices has led to the shutdown of the main iron ore mines, with consequent sharp declines in GDP and exports, and reduced fiscal revenues.”

He said, “As a result, the fiscal challenges in 2016 will be substantial. It will be critical for the authorities to ensure sufficient revenues and financing to priority spending, especially for the post Ebola Economic Recovery Strategy (ERS).”

“This will require strong moves on tax policies and continued efforts on tax administration.

“The Bank of Sierra Leone should continue targeting price stability in support of economic recovery.

With depreciation pressures stemming the lost iron ore exports, BSL should enhance monetary policy instruments and liquidity forecasting to increase its ability to respond to any second round inflationary pressures.

BSL should also enhance supervision of the financial sector, understand and resolve any underlying stress through a timely diagnostic of key troubled bank.

“The updated debt sustainability analysis shows that while Sierra Leone’s risk of debt distress is moderate, the economy is increasingly vulnerable to further shocks. Thus, borrowing policies should remain prudent in view of the narrow export base and fragile fiscal position.

Financing needs, particularly for investment projects should continue to be covered mostly with grant and concessional loans.”

This story was published in Newswatch Times on November 28, 2015.

The poor can also enjoy cosmetic surgery – Experts

The belief that that cosmetic surgery is an exclusive treatment for the rich has been disproved. This is because experts have confirmed that the poor and middle class Nigerians can as well access the treatment and give their body the perfect look of their dream.

The scientists who spoke recently, during a press briefing to flag-off a Body Art Cosmetic Surgery Centre in Lagos, observed that majority of Nigerians want to have that perfect look, and added that many of them do not know how to go about it, while some believes only the wealthy people can access the treatment.

According to them, the cosmetic surgery centre was established to accommodate Nigerians who would love to have the perfect body of their dream, even as the noted that the cost of services of the new centre is within the reach of average Nigerian who will be provided with personalised treatments using state-of-the-arts procedures with highly skilled medical team.

The lead consultant for the centre, Dr. Guillermo Bluggerman, a plastic surgeon and a specialist in reconstruction and aesthetics, said with perfect hands, cosmetic surgeries often does not come with side effects, as against what some people experience when they visit quacks or centres with sub-standard equipments.

Bluggerman, who has made significant contributions in the area of transplant surgery and body hair, said the cosmetic treatment also includes giving people with hair loss the opportunity to have their hairs back.

Explaining the various cosmetic surgeries that are carried out at the centre, he said Nigerians need not worry anymore about how to get their desired body, as the centre was there to offer solutions in that regard.

On breast augmentation, he said: “The procedure is done to enhance the size and improve the appearance of the breast, using implants or excess fat from other parts of the patient’s body.

“Among other procedure is liposuction; this is done to trim and reshape specific parts of the body, by removing unwanted fat deposits,” adding that for those who were involved in exercise and still haven’t been able to remove some particular unwanted fats, they can access liposuction treatment, as this would remove them and sculpt the body into a more desirable shape. Liposuction can be carried out on the thigh, arms, abdomen, knees, buttocks, calves, ankles, the back, among others.” he said.

For butt enlargement, he explained that the procedure involves enhancing the size of the buttocks to improve shape appearance, as well as accentuate feminism. He added that it can be done by inserting artificial implants into the buttocks or fats from other parts of the body, which gives it volume and an appealing shape.

According to him, age, pregnancy, breastfeeding, weight gain and weight loss, are part of the factors responsible for sagging breast, adding that with breast lifting, the breast can return to its previous shape. “During breast lifting, excess skin and fats are removed to make them firmer with youthful shape, which greatly enhances appearance.”

On his part, the Managing Director, Nordica Fertility Centre, Dr. Abayomi Ajayi, collaborating earlier views and said that it wrong to think that cosmetic surgery is an exclusive treatment for the rich, even as she insisted the that poor and middle class Nigerians can equally access the treatment and give their body the perfect look they dream of.

Ajayi said: “Despite the fact that majority of Nigerians want to have that perfect look, most of them do not know how to go about it, while some believes only the wealthy people can access the treatment.”

“Here in Nigeria, cosmetic surgery is still discussed on a hush hush level, as most people do not like to talk about it. But in places like Italy, you see people clamouring for cosmetic surgery, because they want to look good,” he added.

The fertility expert further explained that the cosmetic surgery centre was established to accommodate Nigerians who would love to have the perfect body of their dream, adding that the centre was pocket friendly and gives personalised treatments using state-of-the-arts procedures with highly skilled medical team.

“The centre offers variety of procedures like liposuction, tummy tuck, breast augmentation, breast lift, cheek and chin augmentation, vagina tightening, butt enlargement, botox, among others. Those who have concerns about their body and would want to improve their looks can access treatments at the centre,” he stated.

He also added that with the establishment of the centre, Nigerians would not have to fly abroad for cosmetic surgeries, as this would cut cost of transportation, feeding and accommodation in a foreign land.

This story was published in Newswatch Times on November 28, 2015.

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