Tag: Africa

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Healthcare Innovation in Sub-Saharan Africa

On By ModernMedia
Photo by Usman Yousaf on Unsplash

By Kelly Widdop, Consumer Health Cluster Division Head for Bayer Sub-Saharan Africa   

Healthcare innovation in Sub-Saharan Africa is rapidly evolving, driven by the need to address critical healthcare challenges such as limited access to healthcare services, high rates of infectious diseases, and growing non-communicable diseases (NCDs). With a population of over 1.1 billion people, many of whom live in rural and underserved areas, innovations are crucial to improving healthcare delivery, accessibility, and affordability.

What innovation in healthcare looks like

Healthcare innovation means more than introducing new medicines or medical devices; it involves creating integrated solutions that address both immediate health needs and systemic barriers to care. Globally, healthcare innovation is being driven by advances in digital technologies, personalised medicine, and artificial intelligence (AI) diagnostic tools. In developed regions, this includes the development of digital health, which provides remote consultation, diagnostic services, and treatment monitoring, helping to overcome geographical barriers for patients in underserved areas. In Sub-Saharan Africa, healthcare innovation is focused on overcoming infrastructure challenges and expanding access to self-care and wellness education. Both globally and locally, and in Sub-Saharan Africa, innovation is reshaping healthcare systems, making them more resilient, accessible, and responsive to the evolving needs of populations.

A decade of transformation – where we are as Sub-Saharan Africa

Sub-Saharan Africa presents a unique set of healthcare challenges, including limited infrastructure, a shortage of resources, and barriers related to affordability and access. Although not showing all at once, many changes are being achieved within the healthcare sector.

Kelly Widdop, Consumer Health Cluster Division Head for Bayer Sub-Saharan Africa

Over the past decade, the consumer health sector has undergone transformative growth, driven by a shift towards personalised wellness and a global demand for accessible and preventative care. Innovations in digital tools such as telemedicine and health-tracking apps, have empowered individuals to take charge of their health in real time, fostering a proactive approach to wellness. Alongside this, there has been a surge in personalised health products from targeted vitamins and mineral supplements, dry-to-sensitive skincare solutions, eco-friendly packaging and natural-based ingredients, which is gaining importance as consumers increasingly seek brands that align with their values. These changes have reshaped consumer health, making it more responsive, inclusive and environmentally conscious.

In the realm of nutritional vitamins and minerals, due to the rise in health awareness and lifestyle health management, many consumer health companies have tailored supplements to address common nutrient deficiencies such as bleeding gums, fatigue, joint pain, and delayed wound healing which are usually linked to, for example, a lack of calcium, vitamin b, vitamin c, vitamin d, and zinc. Consumer healthcare products, particularly vitamins and supplements, have empowered individuals to manage everyday health needs independently. With the availability of essential nutrients that support immunity, energy, mental clarity, and general well-being, consumers can now address minor ailments and manage everyday minor issues without needing to visit a doctor all the time, which can get expensive, especially for the low-income consumer. Instead of relying on medical help from a doctor for minor problems, consumers can now find over-the-counter solutions, saving both time and money.

The past decade has brought many changes in the dermatology space within the Sub-Saharan African market. With a focus on unique skin issues in the region, like sun damage and risks from unregulated skin-lightening products, there have been several public campaigns promoting safer skincare. Plus,  with the expansion of telemedicine and digital health platforms, more and more people have access to dermatological consultations than ever before, without worrying about distance. The growing popularity of the use of natural ingredients has become super popular as consumers prefer these safer skincare options. In addition to the easily accessible dermatological products, there has been a significant increase in dermatological education and training across the region to build dermatological expertise in the region. Overall, these investments in both new product innovation and community engagement continuously empower consumers to manage their skin health.

In Sub-Saharan Africa, there have been some great advancements in allergy care, making it easier for people to find over-the-counter solutions for their allergy issues. With more people living in cities and changes in lifestyle and the environment, allergies like rhinitis, food allergies, and seasonal allergies are on the rise. To help with this, healthcare providers and companies have made antihistamines more accessible, allowing people to manage their symptoms without always needing to see a specialist. Plus, there is now a lot of useful information available on how to recognize, prevent, and treat allergic reactions, which helps consumers handle their allergies more effectively without frequent medical visits.

Capacity building – a crucial aspect of the transformation

Capacity building has been a crucial aspect of this transformation. Investments in healthcare infrastructure, training programs, and community health initiatives have strengthened the overall healthcare system. For instance, healthcare providers have been trained to use digital health tools effectively, ensuring that they can offer remote consultations and monitor patients’ health from a distance. Community health workers have been equipped with the knowledge and resources to educate people about self-care practices, preventive measures, and the importance of regular health check-ups. These efforts have not only improved healthcare delivery but also empowered individuals to take control of their health.

Access to self-care has also expanded significantly. With the availability of over-the-counter products, individuals can now manage minor health issues on their own and educational campaigns have raised awareness about the importance of self-care, encouraging people to adopt healthier lifestyles and seek medical advice when necessary. This shift towards self-care has reduced the burden on healthcare facilities and allowed individuals to take a more active role in managing their health, and these changes have reshaped consumer health in Sub-Saharan Africa, making it more responsive, inclusive, and environmentally conscious.

What Sub-Saharan Africa can continuously adopt to succeed

Global relations and intercontinental trade have uniquely provided Sub-Saharan Africa an advantage in bringing successful healthcare innovations to the region.

The adoption of digital health platforms has the potential to change healthcare delivery in rural and underserved areas. Remote monitoring systems can help close the gap in access to health services, making it easier and more convenient for people to get care—just like what has been done successfully in places such as India and Latin America. Personalised health solutions, such as vitamin supplements and skincare products, can cater to local needs and encourage people to take charge of their health and health education initiatives delivered through social media and schools can empower individuals with health literacy, creating a culture of preventive self-care and informed consumer choices.

Additionally, telemedicine and remote care technologies can also be expanded across Africa to keep track of consumers’ health, ensuring they get continuous care even when healthcare facilities are hard to reach. Healthcare in Sub-Saharan Africa should go beyond just offering new products; it should be about creating lasting solutions that truly empower people, patients, and communities. Innovations that fit local needs can make a real difference and improve lives across the continent.

References

Categories : Diseases, Syndromes and ConditionsTags :

Interventions to Eliminate Vertical Transmission of Hepatitis B in Africa

On By ModernMedia
Photo by William Fortunato on Pexels

Researchers at the University of Liverpool have conducted a large-scale analysis that sheds light on the critical steps needed to combat the vertical transmission of chronic hepatitis B virus (HBV) in Africa.

Almost two thirds of all new hepatitis B infections globally occur in Africa. The newly published paper in The Lancet Global Health shows the importance of giving the hepatitis B birth dose vaccine (HepB-BD) within 24 hours of birth, and the potential impact of providing antiviral therapy (antiviral prophylaxis) to mothers during pregnancy. The study estimates for the first time that hepatitis B vertical transmission (passed from mother to baby) could be eliminated in Africa, with increased coverage of these two key interventions.

Chronic hepatitis B is the leading cause of liver cancer and liver cirrhosis in Africa and deaths are rising. Most cases of liver cancer are diagnosed late and are associated with a very poor prognosis in the region. Vertical transmission is one of the commonest routes of infection and is associated with an increased lifetime risk of severe liver disease.

Dr Alexander Stockdale, Senior Clinical Lecturer at the University’s Department of Clinical Infection, Microbiology and Immunology, based at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme, together with Dr Nicholas Riches at Liverpool School of Tropical Medicine, led the comprehensive analysis of more than 113 individual studies which reported on the prevalence of hepatitis B in more than 190 000 women and investigated rates of vertical transmission.

The World Health Organization (WHO) African region faces a significant burden, accounting for 63% of the global total of new infections. This amounted to 771 000 new infections and 272 000 deaths in 2022. Among children under 5 years, the prevalence of HBV stands at 2.5% in the WHO African region – the highest globally.

Dr Alexander Stockdale said: “This study makes the case for investment in birth dose vaccination and maternal antiviral prophylaxis, in view of the exciting potential for elimination of vertical transmission in the WHO African region in our lifetime. Vertical transmission is a key route of new hepatitis B infections. Due to limited implementation of interventions, elimination targets are not currently being met. We project that expanding HepB-BD vaccination coverage to 90% could reduce transmission events by 44%, and adding maternal antiviral prophylaxis for 90% of eligible women could further reduce transmission by 86% and achieve the WHO targets for elimination.”

Dr Stockdale and colleagues have also recently been awarded £3million funding from the National Institute of Health and Care Research to conduct implementation research in Malawi and The Gambia. The NIHR Global Health Research Grant will allow researchers in Malawi, led by Dr Stockdale and in The Gambia, led by Professor Maud Lemoine and Dr Gibril Ndow, to evaluate the effectiveness, safety, feasibility and cost-effectiveness of giving antiviral treatment (tenofovir) to all pregnant women living with chronic hepatitis B to prevent transmission. This study will provide vital evidence on the potential impact of this strategy to guide public health policy in Africa, which has been recognised as a key knowledge gap by the WHO in the 2024 hepatitis B guidelines.

Source: University of Liverpool

Categories : HospitalsTags :

New Study Reveals the Burden of Critical Illness in African Hospitals

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Image from Rawpixel

One in eight patients in hospitals in Africa is critically ill, and one in five of the critically ill die within a week, according to a new study in The Lancet. The researchers behind the largest study of critical illness in Africa to date conclude that many of these lives could have been saved with access to cheap life-saving treatments.

The study is the first large-scale mapping of critically ill patients in Africa. Nearly 20 000 patients in 180 hospitals in 22 African countries were surveyed in the study.

Being critically ill means having severely affected vital functions, such as extremely low blood pressure or low levels of oxygen in the blood. In the new study, researchers show that one in eight patients in African hospitals, 12.5%, is in this condition. Of these, one in five, 21%, die within a week, compared to 2.7% of those who are not critically ill.

A large proportion of critically ill patients, 69%, are treated in general wards rather than intensive care units. More than half of critically ill patients, 56%, do not receive even the basic critical care they need, such as oxygen therapy, intravenous fluids or simple airway management.

“Our study shows that there is a large and often neglected group of patients with critical illness in Africa,” says first author Tim Baker, Associate Professor at the Department of Global Public Health at Karolinska Institutet.

The researchers behind the study emphasise that these are basic but crucial health interventions that can make a big difference.

“If all patients had access to essential emergency and critical care, we could significantly reduce mortality. Moreover, these interventions are inexpensive and can be provided in general wards,” says Carl Otto Schell, researcher at the Department of Global Public Health at Karolinska Institutet and one of the initiators of the study.

Source: EurekAlert!

Categories : Medical IndustryTags :

Merck Foundation Wins Most Influential NGO of 2024 for Efforts Shaping Africa’s Future

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Photo by Hush Naidoo on Unsplash

Merck Foundation, the philanthropic arm of Merck KGaA Germany has been awarded as the “NGO of the Year 2024”, the Most Influential NGO Shaping Africa’s Future and Leading Community Empowerment, by Avance Media, a leading rating and voting firm in Africa.

On receiving the accolade, Senator, Dr. Rasha Kelej, CEO of Merck Foundation and One of 100 Most Influential Africans for five consecutive years – from 2019 till 2023 expressed, “I am thrilled and proud to share that Merck Foundation has been voted as the “NGO OF THE YEAR 2024”, out of the list of 10 NGOs Leading Community Empowerment in Africa, shortlisted by Avance Media, big thanks for everyone who voted for us, we would not have been able to make it without your support and trust in Merck Foundation’s significant role in shaping the future of African communities.”

Winning the “NGO of the Year 2024 ” as per people’s votes acknowledged their collective efforts in shaping Africa’s future through key sectors such as health, education, and economic empowerment.

“This recognition inspires me and my team to continue our mission to transform the patient care landscape, drive cultural change, support girls’ education, empower women, and break the stigma around infertility in Africa and beyond. We are committed to contributing to improving lives of the people.” Dr. Rasha Kelej added.

Merck Foundation was initially announced as one of 10 Most Influential NGOs Shaping Africa’s Future, along with other leading NGOs working in Africa like Save the Children, Plan International, Doctors without Borders, Africa Women’s Development Fun, African Medical & Research Foundation, and others. Merck Foundation was then voted for as the NGO of the Year 2024, out of the 10 NGOs listed.

Since 2012, Merck Foundation, together with their Ambassadors, the First Ladies of Africa, and Partners like Ministries of Health, Gender, Education, and Communication, continues to transform patient care across Africa and bring cultural shift with regards to a wide range of social and health issues, including breaking the stigma around infertility, supporting girls’ education, ending child marriage and FGM, stopping gender-based violence, and raising awareness about diabetes and hypertension.

“I am happy to share that we have provided more than 2080 scholarships to young doctors from 52 countries, in 44 underserved medical specialties. Many of our Merck Foundation Alumni are becoming the first specialists in their countries. Together, we continue to make history,” Dr. Kelej added.

The scholarships of one year, two year and three year fellowship, diploma and master course have been provided in 44 underserved medical specialties like Oncology, Diabetes, Cardiology, Endocrinology, Respiratory, Acute Medicine, Sexual and Reproductive medicine, Embryology, Respiratory, Critical care, Psychiatry, General Surgery, Dermatology, Emergency and Resuscitation Medicine, Gastroenterology, Neuroimaging for Research, Pain Management, Neonatal Medicine, Clinical Microbiology & Infectious Diseases, Advanced Surgical Practice and more.

Through their “More Than a Mother” campaign which is a strong movement that aims to empower infertile and childless women through access to information, education and change of mindset, Merck Foundation has been building quality and equitable reproductive and fertility care capacity, breaking infertility stigma and raising awareness about Infertility Prevention and Male Infertility.

“I am happy that we are contributing to building and advancing fertility care capacity in Africa and improving better access to women’s health. I am very proud to share that we have provided till today more than 650 scholarships of Embryology, Fertility and Reproductive care to young doctors from 39 different countries. Moreover, we also support childless women by helping them start their own small businesses. It is all about giving every woman the respect and support she deserves to lead a fulfilling life, with or without a child”, Senator, Rasha Kelej explained.

Moreover, Merck Foundation strongly believe that Education is one of the most critical areas of women empowerment. Therefore, through their “Educating Linda”, Merck Foundation contributes to the future of young African girls who are brilliant but underprivileged, by providing more than 700 scholarships, to cover their school  fees till they graduate, and thousands of school items to schoolgirls in many African countries including Botswana, Burundi, Malawi, Ghana, The Gambia, Nigeria, Zambia, Zimbabwe, Ghana, Namibia, Democratic Republic of the Congo, Niger and more.

I am happy that we are contributing to building and advancing fertility care capacity in Africa and improving better access to women’s health

Dr. Rasha Kelej

Additionally, Merck Foundation has been raising awareness about many critical social issues including breaking infertility stigma, supporting girl education, women empowerment, ending FGM & child marriage, stopping GBV and important health issues like Diabetes & Hypertension prevention, early detection & Management; promoting healthy lifestyle; infertility awareness & management and more. Merck Foundation has introduced many unique and innovative ways like Songs, Animation Films, Children Storybooks, Health Media Trainings, “Our Africa” TV Program, Awards for Media, Filmmakers, Fashion Designers and Musicians and more.

Source: Merck Foundation

Categories : Diseases, Syndromes and Conditions PaediatricsTags :

Hydroxyurea for Children with Sickle Cell Anaemia Significantly Reduces Infections

On By ModernMedia
Sickle cell disease. Credit: National Institutes of Health

A clinical trial in Uganda has revealed that hydroxyurea significantly reduces infections in children with sickle cell anaemia. Their latest findings enhance strong evidence of hydroxyurea’s effectiveness and could ultimately reduce death in children in Africa, the continent most burdened by the disease.

The group’s research, appearing in the journal Blood, revealed that hydroxyurea treatment resulted in a remarkable 60% reduction in severe or invasive infections, including malaria, bacteraemia, respiratory tract infections and gastroenteritis, among Ugandan children with sickle cell anaemia.

“Our investigation provides powerful justifications for hydroxyurea’s use in children with sickle cell anaemia in Africa,” said Dr Chandy John, paediatrics professor at IU School of Medicine and co-lead investigator of the latest study.

“Given the high rates of infection in this region, we hope our evidence will encourage ministries of health to continue supporting and expanding access to hydroxyurea for young patients who can greatly benefit from the treatment.”

Sickle cell anaemia is a genetic blood disorder that alters the structure of red blood cells and affects oxygen distribution throughout the body, increasing susceptibility to serious health complications and life-threatening infections.

According to the World Health Organization, more than 300 000 children worldwide are born with sickle cell disease each year, with a high prevalence found in African countries.

While hydroxyurea has had U.S. Food and Drug Administration approval as a sickle cell disease treatment for children since 2017, its accessibility and acceptance in Africa have been comparatively limited.

As hydroxyurea has become more recognised in African countries for its effectiveness in treating sickle-cell-related complications, John and his colleagues noticed a knowledge gap about the treatment’s effect on infections.

This led the research group to incorporate hydroxyurea treatment and analysis into their established clinical trial, Zinc for Infection Prevention in Sickle Cell Anemia, led by Indiana University School of Medicine and collaborators in Uganda.

During the study, the researchers examined the effects of hydroxyurea on 117 children in Uganda and focused on a range of infections. After hydroxyurea treatment, results showed a substantial decrease in the incidence of these infections.

Additionally, eight of the nine deaths that occurred in the trial were children whose parents declined hydroxyurea treatment. The only death in a child on hydroxyurea treatment occurred four days after starting treatment, providing insufficient time for hydroxyurea to have an effect.

Of the five children for whom a cause of death was known, all five died of infectious causes.

The high death rate in the study, despite expert clinical care by study personnel, provides further evidence of the urgent need for additional interventions to decrease mortality in children with sickle cell disease in Africa.

“Infections commonly precede other complications related to sickle cell anaemia and often result in hospitalizations that can lead to death,” said Dr Ruth Namazzi, site principal investigator, first author and a lecturer in the Department of Pediatrics and Child Health at Makerere University in Uganda.

“We believe incorporating hydroxyurea treatment as the standard of care for sickle cell anaemia across Africa will not only reduce infections but will more importantly save countless lives.”

Source: Indiana University

Categories : Healthcare Politics and RegulationsTags :

With Funding and Partnerships, Africa’s Healthcare Sector can Become More Capable

On By ModernMedia
Photo by Sora Shimazaki

By Robert Appelbaum & Prelisha Singh, Partners at Webber Wentzel

In Africa, dysfunctional governments are often unable to allocate sufficient funds for essential aspects of healthcare. This results in a shortage of new primary and specialised hospitals, little local pharmaceutical and medical device manufacture and the inability to train doctors beyond undergraduate level, creating a shortage of medical specialists.

In a recent seminar hosted by Invest Africa and moderated by Webber Wentzel, panelists Silven Chikengezha, Liza Eustace, Jen Pedersen, Jasen Smallbone and Dr Sue Tager, shared their insights on how to tackle the problems of financing healthcare in Africa, and building a pipeline of medical professionals who remain in Africa.

Funding

From the perspective of the IFC, the obvious need for greenfield hospitals in Africa is not sufficient to attract funding. To be attractive, projects need to meet certain criteria.

The first is that it must have a sponsor with experience in construction and operations. The second is that it has to have the potential to grow. It takes at least three years for a hospital to start making returns. Primary care is an identified area of potential growth on the continent, but it offers low margins so it needs to build up volumes. If the hospital is a primary healthcare facility that addresses an identified need in the local community, it is more likely to attract reliable footfall. But there is very little revenue in basic services like treating TB, AIDS and giving vaccination, so the facility should offer a range of affordable treatments.

The third criterion for any hospital project seeking funding is that it should have, or will be able to attract suitably qualified staff. Doctors like to work in complementary practice groups, so the hospital should be able to offer an attractive environment for medical professionals.

The next important issue is the certainty of cash flow. Although government-sourced revenue for the hospital can provide a steady income stream, governments can be slow payers. It is important to look at each government’s history of making timely payments. Commercial banks will also consider the affordability of the hospital’s services, given that a very small proportion of Africa’s population has medical insurance. In some countries, governments require employers to pay their employees’ medical bills, which provides a level of comfort to the banks. Technology can help to improve affordability, for example, innovations such as monitors that track the temperature of heat-sensitive medicines in transit, which reduces wastage.

A fifth critical issue for funders is the way the funding is structured. If a large hospital project is structured with 60-70% debt from its initial stages, it is likely to struggle to meet interest payments. It is better to start with a smaller facility that is scaleable, and structure the funding so that there is more equity than debt in the early years.

ABSA noted that they would seek strong equity holders before considering debt, and they will look carefully at who the main equity funders are. This is an area where the IFC and other Development Finance Institutions (DFIs) can play a role because they are usually willing to take the “first loss” risk, which encourages commercial banks to extend debt. Commercial banks take comfort from developers with strong balance sheets.

An emerging source of funding for healthcare projects in Africa (as well as other projects, such as in energy, water and education) are social impact bonds, in which an institutional funder will lend money to an implementer that can correctly manage a project that meets a need – often a need identified by the government. Corporates should be pooling their available funds to create scaleable projects that will make an impact.

If healthcare financing is intended to support existing service providers in Africa, it has to adapt to the capacity of what are often very small- to medium-sized businesses. These businesses, which may be anything from manufacturers of medical devices to providers of digi-health services, need far less than USD 20 million, so they tend to be ignored. But funding is essential to help established businesses build scale. This is another area where DFIs and commercial banks working together can help, as the DFI can provide the first loss facility which allows commercial banks to take risk on smaller clients.

Public-private partnerships

The pandemic made it clear that perceived obstacles between public and private entities in providing healthcare together could be overcome if there was the right will and people in the room.

Speakers discussed the Wits Donald Gordon Medical Centre as an example of a successful PPP, which could be replicated elsewhere. The Donald Gordon offers treatment to the private sector, and the derived profits are used to train medical students from Wits University, which is the public partner. The centre also performs liver transplants for all patients, both public and private. Mediclinic has a share in Donald Gordon but does not receive dividends. All profits are recycled back into the hospital.

A PPP model for the provision of healthcare needs partners who have similar levels of sophistication and can work together. Governments have to appreciate that the role of the private sector is not merely to bring money so that the government can continue running things the way they have always done. Private sector partners should be allowed to introduce the levels of efficiency in delivery that are typically found in the private sector.

Categories : COVIDTags :

African Scientists Show How COVID Variants Spread across Africa

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Source: Fusion Medical Animation on Unsplash

A major scientific report from Africa is featured in the journal Science today. This scientific report shows how the rapid expansion of genomics surveillance in Africa allowed the continent to describe the introduction and spread of the SARS-CoV-2 variants in African countries in real time during the COVID pandemic.

The scientific report includes over 300 authors from Africa and abroad who worked together to describe and analyse over 100 000 genomes and characterise SARS-CoV-2 variants in real time. This was the largest consortium of African scientists and public health institutions ever to work together to support data-driven COVID response in Africa.

This report shows how the large investment, collaboration and capacity building in genomic surveillance on the African continent enabled real-time public health response. Particularly it describes the setting up of the Africa Centres for Disease Control (CDC) – Africa Pathogen Genomics Initiative (Africa PGI) and the continental network by the Africa CDC and World Health Organisation (WHO) Regional Office for Africa (WHO AFRO) to expand access to sequencing and cover surveillance blind spots, in parallel with the growth of the number of countries that are able to sequence SARS-CoV-2 within their own country.

“The publication highlights that sustained investment for diagnostics and genomic surveillance in Africa was needed to not only combat SARS-CoV-2 on the continent, but establish a platform to address the emerging, re-emerging, endemic infectious disease threats, such as Ebola, HIV/AIDS, TB and Malaria. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century,” said Dr. Yenew Kebede, Head Division of Laboratory Systems and Acting Head: Surveillance and Disease Intelligence at the Africa CDC.

African Scientists receiving training in genomics surveillance at the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), South Africa.

This study was led by two labs that setup the network for genomics surveillance in South Africa – the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University and the KwaZulu Natal Research and Innovation Sequencing Platform (KRISP) at the University of KwaZulu-Natal, in close coordination with the Africa CDC, WHO AFRO and 300 other institutions across the continent.
 
“The enormous leap Africa made in genomic surveillance during the past two years is the silver lining in the COVID pandemic,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “The continent is now better prepared to face down both old and emerging pathogens. This is a model of how when Africans are in the driving seat we can come up with lasting change and stay a step ahead of dangerous diseases.”
 
“It has been an inspiring experience to continuously share knowledge, support and learn from colleagues all over the continent during the pandemic. We witnessed small countries with no previous genomics experience become empowered in sequencing and bioinformatics methods, and how they started to actively participate in regular pathogen genomic surveillance for SARS-CoV-2. I think it will be a real model of how scientists and public health officials across countries can form a unified front against infectious diseases in the future,” says Houriiyah Tegally, Bioinformatician at KRISP and CERI and first author on this report.
 
The results also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most relevant being the detection of the Beta and various Omicron subvariants. The report highlights that most SARS-CoV-2 variants, which caused  an epidemic in Africa, were introduced from abroad.

The scientists proceeded carefully in analysing genomic and epidemiological data collected in over 50 countries that experienced quite heterogenous epidemics in order to reconstruct transmission dynamics of the virus in the most accurate way. “The phylogeographic methods that we employ to investigate the movement of the SARS-CoV-2 virus and its variants into, out of, and within the African continent account for uneven testing and sampling proportions across countries, arising from the realities of doing genomic sequencing in the middle of a pandemic, often in low resourced settings,” explains Dr Eduan Wilkinson, head of bioinformatics at CERI at Stellenbosch University and senior author on this report.
 
The initial waves of infections in Africa were primarily seeded by multiple introductions of viral lineages from abroad (mainly Europe). The Alpha variant that emerged in Europe at the end of 2020, was responsible for infections in 43 countries with evidence of community transmission in Ghana, Nigeria, Kenya, Gabon and Angola. For the Delta variant, the bulk of introductions were attributed to India (~72%), mainland Europe (~8%), the UK (~5%), and the US (~2.5%). Viral introductions of Delta also occurred between African countries in 7% of inferred introduction. For Omicron, the scientific results indicate more reintroductions of the variant back into Africa, with at least 69 (95% CI: 60 – 78) from Europe and 102 (95% CI: 92 – 112) from North America than from other African countries. This was amplified for Omicron BA.2; the results suggest at least 99 separate introduction or reintroduction events of BA.2 into African countries, ~65% of which are from Europe and ~30% from Asia.
 
“The ironical part of these results is that most of the introductions of variants in Africa were from abroad, but Africa was the most discriminated and penalized continent in the world with travel bans imposed. Instead of unscientific and inappropriate reactions, we should be building on the infrastructure established in Africa so that the continent can rapidly pivot to other epidemics without the fear of being punished,” says Prof Tulio de Oliveira, director of CERI and KRISP, which lead the consortium analysis with the Africa CDC and WHO AFRO.
 
“This study is a testament of the Africa CDC – Africa PGI efforts to expand access to sequencing to member states and create a platform of coordination and collaboration among institutions within and outside of the continent,” said Dr. Ahmed Ogwell, Acting Director of the Africa CDC.

Provided by Stellenbosch University

Categories : COVID Healthcare Politics and RegulationsTags :

Debunking the Myth that Africa Responded Well to COVID

On By ModernMedia
COVID heat map. Photo by Giacomo Carra on Unsplash

By Nathan Geffen and Francois Venter

There is a view being promoted that COVID didn’t hit Africa as badly as the rest of the world. The reason for this, as recently expressed in an article by Boniface Oyugi in The Conversation, was the effective and well-coordinated response of African governments.

We understand the desire to find good news on the continent. But, on balance, the very little evidence available shows that COVID has hit Africa hard. The continent is highly diverse with over 50 states, so broad generalisations should be treated cautiously but, with an exception or two, there is little evidence of an effective response to the COVID pandemic. For one thing, Africa has the lowest vaccination rate of any continent.

Oyugi uses the WHO’s official COVID infection and death statistics to claim that the continent fared better than elsewhere. These state that as of late July, less than 2% of global cases and less than 3% of global deaths occurred in Africa, which has about 17% of the world’s population. (Oyugi also cites a study which pretty much says the same thing.)

COVID test statistics and confirmed COVID deaths don’t paint an accurate picture of how seriously the pandemic has hit a country (see here). If you don’t measure something properly, you can’t conclude that it’s a small problem. COVID tests are typically only administered with any regularity to a small, predominantly better off, part of a country’s population, and countries that test more tend to find more cases. Official COVID death tolls typically count people who have died in hospital with a confirmed positive test result. But it often doesn’t happen this way, especially on a continent with large rural populations and under-resourced hospitals.

Excess deaths: a vital measure

This is why the most important measure of how hard COVID has hit a country is the excess death toll. By excess deaths, we mean the number of deaths that occurred above what you’d expect given recent historical mortality. In sub-Saharan Africa, the only country that has a system capable of reliably estimating this is South Africa. Every week since the beginning of the epidemic, the Medical Research Council (MRC), using death certificate data provided by Home Affairs, has diligently analysed excess deaths. (Many countries wealthier than South Africa do not have as good a system, so it’s something to be proud of.)

The MRC researchers calculate that there have been over 320 000 excess deaths in South Africa since May 2020 (as of July 2022). As they’ve explained, conservatively 85% of these are COVID deaths. It may be as high as 95%. We can conclude that close to 300 000 people have died of COVID in South Africa. Over the past two years about 1 in 200 people in the country have died of this new infection.

The Economist has been reporting excess deaths by country. It states: “Among developing countries that do produce regular mortality statistics, South Africa shows the grimmest picture, after recording three large spikes of fatalities.”

Official deaths are much lower than excess deaths

But if you look at South Africa’s official, and much less accurate, COVID death toll you get a very different picture: Then we’re only 65th worst in the world (source: Worldometer deaths per million people). Lesotho is in 167th place, suggesting it has had a very small epidemic. Is it plausible that an area with a porous border entirely surrounded by South Africa has a completely different epidemic? (See this set of tweets – by one of the authors of South Africa’s weekly mortality report – that explains how the little mortality data we have from Lesotho suggests it had a serious pandemic.)

What about Namibia at position 74 in the Worldometer list, Botswana at 89, Zimbabwe at position 143 and Mozambique at position 190? Is it plausible that this ordering, almost in reverse order of industrial development, accurately reflects how these countries were affected by COVID?

Depending on your bias, you can approach these statistics in two ways. You can be very optimistic and see this as evidence of a smaller epidemic in sub-Saharan Africa. Or you can be realistic and acknowledge that the official numbers are likely very badly undercounted.

We can’t know for sure though because nearly all African governments did not have the systems in place to count excess deaths.

Most African countries need much better death registration systems

Attempts to estimate excess mortality in most African countries are based on almost no data. To the extent that there is data, it supports the view that the numbers have been badly undercounted. For example, a study published in the British Medical Journal, albeit with many caveats, found death rates in developing countries were twice those of rich countries.

During the height of the AIDS pandemic in the 2000s there was much optimism that the massive influx of foreign aid in response could be used to build better health systems. Bits and pieces of evidence do suggest health on the continent has improved. But it’s very disappointing that most countries on the continent still do not have the vital registration systems in place to measure mortality with decent accuracy. This is one of the most important measures of how a population is doing.

By claiming that African governments have responded well to COVID, when there’s no proper evidence to support this, we fail to hold politicians accountable. We also create the impression that institutions like the World Health Organisation and the African Union’s African Centre for Disease Control are more successful than they’ve actually been. This is a disservice to the vast majority of people living in Africa.

Geffen is GroundUp’s editor. Professor Venter is an infectious diseases clinician and head of Ezintsha at Wits University.

This article is republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Healthcare Politics and RegulationsTags :

Renewed Political Will Needed for the Complexities of African Healthcare

On By ModernMedia
Delegates at the 21st Annual Board of Healthcare Funders (BHF) Conference currently being held in Cape Town.

19 May 2022: Healthcare – Cape Town, South Africa: The healthcare system in South Africa and on the continent is beset with structural challenges and skewed political priorities that hamper the attainment of universal healthcare coverage, therefore a fundamental overhaul of the healthcare system and renewed political will is required to improve citizen’s access to quality healthcare services.

These sentiments kicked off the first day of the 21st Annual Board of Healthcare Funders (BHF) Conference currently being held in Cape Town under the theme: Leading change in strengthening our healthcare ecosystem.

Connected virtually, South Africa’s Minister of Health, Dr Joe Phaahla invited the private sector to submit recommended solutions to strengthen the country’s healthcare systems, emphasising the need for a collaborative approach to transform healthcare.

Dr Phaahla conceded that the health system in the country was already weak before the outbreak of COVID and inequality in access to reliable health services is inextricably linked to the economic and social inequality that our country is facing.

The Minister added, “The country’s healthcare system should be restructured to focus more on preventative services rather than the current curative approach.”

“The socio-economic inequality is perpetuated further by our own health services, which are highly heavily commodified. Our two-tiered healthcare system with one being driven by the private sector for a few who can afford it and the other by the public sector being provided for the majority of the population does not bode well for the future prospects of the country. This system is unsustainable and if we are going to talk about a change in strengthening the health system, we cannot avoid talking about the need to accelerate the creation of a more equitable health system.” 

He acknowledged that the passing of the NHI Bill will not in itself be a silver bullet in the transformation of our health system, however, will lay a good foundation for the country to timely start to fundamentally transform our health system towards equity.

Speaking about the relationship between politics and healthcare, Professor Patrick Lumumba, former Director of the Kenya Anti-Corruption Commission, said, “Politics is at the very heart of the provision of sound healthcare systems.”

He challenged some of the perceptions around the delivery of national healthcare insurance across Africa, asking governments and the private sector to closely examine suitable healthcare solutions that will consider the continent’s current different types of conflicts.

He highlighted that considerations should be made in the best interest of the continent’s populations when making the decision on an approach to be taken for the continent’s healthcare needs, bearing in mind what is affordable to the different countries across the continent, especially given that the continent’s entire GDP is less than that of Italy, which has just under 60 million people.

“The continent is currently under different types of conflict at various intensities, and these conflicts are in turn undermining the provision of healthcare,” said Prof Lumumba.

He noted that in Africa, there is a lack of political will to spend more on healthcare despite the commitments made at Abuja, Nigeria, in 2001 to invest a minimum of 15% of their national budget in healthcare.

“Politicians are rich in making promises. The evidence we have in different countries is that universal health care as promised by politicians and as desired by the population is not easily achievable,” he said.

He cautioned against the temptation to compare the healthcare system in Africa with that of developed countries, citing a lower tax base and GDP in Africa to fund a healthcare system that services a substantially larger population.

“The entire GDP of Africa is slightly over two trillion US dollars, which is smaller than the GDP of Spain, which has a population of no more than 50 million people, it is critical that the private and public sectors; and politicians work together to come up with a system that is going to be beneficial to the majority of Africa’s people,” said Professor Lumumba.

He said the envisaged economic revival of Africa cannot be sustained if the continent’s healthcare needs are not adequately addressed.

“If the continent of Africa is to enjoy the perceived economic growth that is expected, then the population must be healthy. Healthcare is about creating healthcare systems that are also able to retain the skills that are required for Africa’s emerging or growing economies. There is also a clear need for collaboration in the delivery of health services,” said Lumumba.

Dr Millicent Hlatshwayo Chairperson of the Government Employees Medical Scheme (GEMS) reiterated the need for the private healthcare sector to play a meaningful role towards shaping the proposed healthcare funding model to ensure its sustainability.

She acknowledged that the healthcare sector is faced with several systemic challenges, and this is reflected in our international rankings; where South Africa ranks 49th out of 89 countries on the 2022 Global Healthcare Index. Though South Africa is the highest-ranked African country in this index, it has been rated below its peers in BRICS such as China and India, which are rated 40th and 44th respectively.

Dr Hlatshwayo said, “Proposed reforms such as the implementation of the NHI can help to facilitate better cooperation between the public and private sectors. We cannot afford to be passive observers in these deliberations, because our failure to act on these opportunities will be an indictment on the industry.”

Dr Hlatshwayo said from its inception, GEMS has been aligned with the transformation of the healthcare industry and supportive of the principles of universal health coverage.

She said universal health coverage can only be achieved if we get the basics in place, namely qualified staff, equipment and technology, infrastructure and working systems.

Categories : COVID PaediatricsTags :

High COVID Mortality Rate Found in African Children and Adolescents

On By ModernMedia
Photo by Roman Nguyen on Unsplash

African children and adolescents hospitalised with COVID experience much higher mortality rates than Europeans or North Americans of the same age, according to a recent six-country study which included South Africa.

The study, published in JAMA Pediatrics. was conducted by researchers from the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM) and the Institute of Human Virology Nigeria (IHVN). Both organisations are members of the Global Virus Network (GVN).

“This study provides important information about COVID among African children, which was not previously available at this scale. We now have evidence from multiple countries to show that African children also experience severe COVID; they experience multisystem inflammatory syndrome; some require intensive care; some also die, and at much higher rates than outside Africa,” said co-first author Nadia Sam-Agudu, MD, Associate Professor of Pediatrics at the UMSOM’s Institute of Human Virology.

The AFREhealth study collected data from 25 health facilities across Nigeria, Ghana, Democratic Republic of the Congo, Kenya, South Africa, and Uganda. The study included 469 African children and adolescents aged three months to 19 years hospitalised with COVID between March and December 2020. The team reported a high overall mortality rate of 8.3%, compared with 1% or less totaled from Europe and North America. Furthermore, African children less than a year old and with pre-existing, non-communicable diseases were more likely to have poorer outcomes.

Eighteen participants had suspected or confirmed multisystem inflammatory syndrome (also known as MIS-C), and four of these children died.

Dr Sam-Agudu, who led the West Africa team for the study, urged health authorities and policymakers in Nigeria and other African countries to act upon the study findings “to protect children by expanding vaccine approvals and procurements for children specifically, as the variants emerging since our study’s completion have either caused more severe disease and/or more cases overall. We cannot leave children behind in the pandemic response.”

Source: University of Maryland