Sierra Leone inaugurates insectary to study malaria-carrying mosquitos
By Kemo Cham
The first ever Vector-borne Disease Insectary and Laboratory (VDIL) designed as part of efforts to control the spread of malaria has been inaugurated in Sierra Leone.
The VDIL, located in the northern district of Makeni, was developed with the support of the United States Government through its President’s Malaria Initiative (PMI) program. It will provide a platform for scientists to study and understand the habits of mosquitoes, their malaria transmission dynamics and the particular type of insecticides that kill mosquitoes that carry the malaria parasite. Officials hope this will provide the Ministry of Health and Sanitation (MOHS) vital information to make informed decision on suitable mosquito control interventions.
This information will then be used for developing effective strategies in vector control management and the protection of the population against vector borne diseases.
Malaria is a disease caused by parasites that invade and destroy red blood cells in humans. The parasites are transmitted to persons through the bites of infected Anopheles mosquitoes.
Malaria remains one of the biggest health threats to particularly developing countries like Sierra Leone, which has a prevalence rate of 40 percent, according to the 2016 Malaria Indicator Survey (MIS). The country’s entire population of over seven million is thought to be vulnerable to the disease. The Ministry of Health records more than 2 million outpatient visits due to malaria annually, of which half are said to be children under-five years of age.
According to the MIS, the northern region of the country has the highest prevalence rate of the disease by microscopy, with 52 percent. The southeast has a prevalence rate of 40 percent, while the western area is 6 percent.
In 2017, there were an estimated 219 million cases of malaria in 87 countries. The estimated number of malaria deaths stood at 435 000 the same year.
From a global perspective, the WHO African Region carries highest share of the malaria burden, which was estimated at 92% of cases and 93% of deaths in 2017.
The global antimalarial crusade targets reducing cases by 40 percent by 2020, under the 2015 [MDGs] baseline; and the new UN SDGs seek to reduce it by 90 percent by 2030.
The PMI is a U.S. Government initiative which is meant to control and eliminate Malaria, which is considered as one of the leading global causes of premature death and disability. The initiative was originally launched by former U.S. president George W. Bush in 2005, and has been continued by each successive U.S. president. It was notably expanded under Bush’s immediate successor, President Barack Obama, who doubled annual funding which is currently at US$723million as of the 2017.
Sierra Leone was first announced as a new PMI country in 2017, as a result of the Obama Administration’s expansion scheme, making the West African country recipient of a 15 million U.S. dollars annual grant for malaria control activities.
The PMI program is implemented through USAID and the CDC, together with partners such as Vectorlink, which is implementing the VDIL project.
When it was first launched, the goal of the PMI was to reduce malaria-related mortality by 50 percent across 15 high-burden countries in sub-Saharan Africa through a rapid scale-up of four proven and highly effective malaria prevention and treatment measures: Insecticide-treated mosquito nets; Indoor residual spraying; and accurate diagnosis and prompt treatment with artemisinin-based combination therapies; and intermittent preventive treatment of pregnant women.
The program has evolved to expand to more countries and introduce more preventive measures. The program currently works in 24 focus countries in sub-Saharan Africa and supports two country programs and one regional program in the Greater Mekong Subregion in Asia.
The establishment of the VDIL is in line with Sierra Leone’s National Malaria Control Strategy, which emphasizes on prevention and control through vector control, case management, and malaria in pregnancy.
U.S. Ambassador Maria Brewer presided over the inauguration of the insectary in Makeni on April 12, and in a statement she commended the good partnership and continued collaboration between the U.S. and Sierra Leone governments, noting that this latest investment will save the lives of Sierra Leoneans through a more effective means of prevention of malaria.
Postgraduate college of health specialists gets new board chair
Prof. Sahr Moses Gevao is the new chairman of the Sierra Leone Council for Post-Graduate Colleges of Health Specialties.
Prof. Gevao, who was among 11 presidential appointees approved by parliament on Thursday, 11 April, replaces Prof. Radcliffe Lisk, the pioneering chairman of the Council which was established as a response to the need for specialist training in the medical field.
The Sierra Leone Council for Post-Graduate Colleges of Health Specialties was established in 2016 following the enactment of an Act in parliament. The idea was to provide local training in specialized areas in medicine. The Council is meant to supervise and coordinate the training of postgraduate health specialists.
With its establishment, government hoped to cut down on huge monies spent to send Sierra Leoneans for such training abroad.
Faced with a serious shortage of doctors, Sierra Leone particularly suffers from a lack of specialist practitioners in areas such as medicine, dentistry, midwifery and pharmacology.
Besides the drain in the country’s coffers, sending people abroad meant that many of the trainee doctors end up staying abroad, rather than returning home. Scholarship opportunity is a major hurdle, and this has been a source of frustration particularly for the younger generation of practitioners.
The Council is tasked with formulating policies for the promotion of continuous professional development in medicine, dentistry and the supervision and coordination of research in medicine.
Prof. Gevao has the task of realizing these objectives, working on the foundation laid down by his predecessor.
Gevao has served at various levels in the health sector, including as head of the National Blood Services Programme, Vice Chancellor of the University of Sierra Leone and head of the College of Medicine and Allied Health Sciences (COMAHS).
Focus 1000, partners validate KAP Immunization study
The first Knowledge, Attitudes and Practices (KAP) study on immunization services in Sierra Leone has been validated following a thorough scrutiny by stakeholders in the immunization sector.
The GAVI (Global Alliance for Vaccine and Immunization) funded study was conducted by the health NGO, Focus 1000, in partnership with UNICEF, the Ministry of Health and Sanitation, WHO and the United States Centers for Disease Control and Prevention (CDC). Officials said the goal is to identify factors limiting uptake of immunization services in the low performing parts of the country and inform policy decisions and particularly the planned national immunization communication strategy.
Mr Paul Sengeh, Director of Research and Evaluation at Focus 1000, said at the validation workshop held at the Charm’s Hotel in Aberdeen, Freetown on Wednesday that the study assessed perceptions and attitudes of parents and caregivers of children qualified for vaccine services.
The KAP study, which involved a household survey and a multi-stage cluster sampling design, was conducted in Kono, Kambia, Moyamba and the Western Area Rural districts, each district representing every one of the four regions (under the previous geographical arrangement of the country). These districts, according to the study authors, have the lowest uptake of immunization services.
Out of 720 respondents targeted, 684 responded to the survey questionnaires. Some of the findings were that even though attitude towards vaccines were generally high, factors such as proximity to health facilities, delay in health centers, and fear of side effects of the vaccines were discouraging many caregivers from taking their children for immunization. Educational levels of the parents, as well as trust in both the healthcare provider and the facility influence acceptance of vaccines. There were also concerns around monetary demands from healthcare workers.
Sierra Leone ranks poorly in many global health indices, particularly maternal and infant mortality. The country is ranked as having the highest rates of maternal mortality [1, 195/100, 000], according to figures from the Ministry of Health. It also ranks in the top 10 countries with the highest rate of infant mortality [157/1000].
And many of the diseases fueling infant mortality are vaccine preventable.
According to the EPI, average national vaccination coverage, that’s children who are fully immunized, is 79 percent. Therefore, said Pa Ousman Manneh, Communications for Development Specialist at Unicef, it means that the country needed to try hard to reach the missing 30 percent of unvaccinated children.
Mr Manneh, who is the UNICEF focal person involved with the KAP study, said while Sierra Leone appears to be doing well in national vaccination coverage, it needs to do more to close the gap.
“If every child is vaccinated, that will seriously reduce the under-five mortality,” he said.
Dr Tom Sesay, Program Manager, Expanded Program on Immunization (EPI), hailed the study, noting that the findings will help in crafting and packaging the government’s responses to health issues of children.
Dr Sesay also revealed that the KAP study was one of a series of studies currently being undertaking relating to immunization in the country, among them the Equity Assessment Study which seeks to identify reasons why children are not immunized, where the unimmunized children are and how to reach them. There is also the Urban Slum study which looks at coverage of immunization in the urban areas. It follows concern over low uptake of immunization services in the urban centers.
“I am very interested in the Western Area because immunization coverage in the urban areas is slow and that’s not what is expected,” said Sesay.
Following Wednesday’s validation, Focus 1000 and its partners are expected to finalize the report for subsequent public dissemination.
Mohamed Bailor Jalloh, CEO of Focus 1000, said despite the revelations of low vaccines uptake, the study also showed that a lot was currently being done to change the situation. He said the next move is to ensure the results are used to draw the strategy and make a difference.
Makeni midwifery school gets new skills lab
The School of Midwifery Makeni (SOMM) has received a major boost towards skills based education and training, with the inauguration of a new skills lab, library and computer lab.
The state of the earth facility was constructed with the support of the United States government, through its Health Resources & Services Administration (HRSA) and the U.S. President’s Emergency Plan (PEPFAR). The project, funded under HRSA’s Resilient and Responsive Health Systems (RRHS) initiative, entailed renovations, procurement and installation of equipment, training, policy development, and integration of skills-based learning into the midwifery curriculum.
Midwives, otherwise known as Skilled-Birth Attendants, are professionally trained to assist women in childbirth. They are trained to recognize the variations of normal progress of labor, and understand how to deal with deviations from normal.
Sierra Leone has the highest rates of maternal mortality globally, at 1, 195/100, 000, according to figures from the Ministry of Health. It also ranks among countries with the highest rates of infant mortality at 157/1000. Health ministry officials and experts say this is largely as a result of a range of implementation challenges including the critical shortage of health workers and the skills required to manage obstetric and newborn care.
According to the 2013 Demographic Health Survey, 3000 midwives were needed to ensure adequate care during pregnancy and birth in the country. Before the 2014 Ebola epidemic, the country had less than 100 trained midwives. The epidemic claimed many lives of healthcare providers, among them midwives.
The School of Midwifery Makeni (SOMM) was established in 2010 as part of efforts to increase the chances of access to midwifery education, amidst much demand for the services.
SOMM, accredited by the Sierra Leone Nurses and Midwives Board, was the second national midwifery school, after the School of Midwifery in Freetown, which has been in existence since 1945, and had been unable to meet the increasing demand for midwives in the country. In 2017, the third national school of midwifery was opened in the southern Bo district.
Since its inception in 2010, SOMM has enrolled 712 Students and graduated 467 midwives who were deployed by MoHS to various districts. Currently 97 students are awaiting graduation by May 2019.
The School trains State Certified Midwives (SCM), which is a two (2) year upgrading program of State Enrolled Community Health Nurses (SECHN) to SCM. It also trains obstetric nurses (SRNs and SECHNs) from St. John of God-Faith based nursing training school for a period of 3 to 5 months, on basic obstetrics and Midwifery, which are critical component of their curriculum.
In addition to the basic theoretical instruction received in the classroom, students receive clinical instructions in the clinical lab and practice settings in maternity units.
The new skills lab was designed to provide simulation-based education and training to complement other, more traditional forms of training. The US Mission’s Public Affairs Department said the facility will provide the advantage of teaching and assessing competence in management of rare yet life threatening events such as post-partum hemorrhage, pre-eclampsia, and birth asphyxia.
“Through simulation, students are able to become adept at clinical service delivery in a safe and supportive environment,” the statement says.
Health is one of the top priorities in the US Government’s engagement in Sierra Leone. HRSA in 2017 became the seventh U.S. government agency to join the U.S. Mission in the country.
The other agencies include the Centers for Disease Control and Prevention (CDC) which, like the HRSA is part of the U.S. Department of Health & Human Services, and USAID. Majority of the programs they are involved in are health related.
USAID is notably funding efforts to capacitate the country to detect, prevent and respond to infectious disease outbreaks under the global One Health initiative.
The RRHS is a 5-year, US$ 9.5 million grant which includes a heavy emphasis on achieving improved maternal health and HIV outcomes through strengthened midwifery education. The prime recipient of the RRHS grant is ICAP at Columbia University.
U.S. Ambassador Maria E. Brewer inaugurated the new facilities in Makeni in the second week of April. She was accompanied to Makeni by Minister of Health and Sanitation, Dr. Alpha T. Wurie. Also in Makeni to witness the inauguration ceremony were George Tidwell, Country Office Director for HRSA, and Dr. Susan Michaels-Strasser, Principal Investigator, ICAP at Columbia University.
In May 2018, a similar facility was commissioned by Ms Brewer at the National School of Midwifery (NSM) in Freetown. Politico understands that another facility is expected to be established at the Faculty of Nursing in the College of Medicine and Allied Health Sciences.
Sierra Leone to clamp down on illegal packaged water producers
The Ministry of Health and Sanitation has warned producers of packaged water of an impending crackdown over failure to follow laid down procedures.
Officials said last week a proliferation of illegally produced packaged water has posed a serious health risk to the population, hence the need for proper monitoring and appropriate action.
The latest warning comes after the Ministry said it had acquired technical and financial boost from the world Health Organization (WHO) and the World Bank that will enable it test water quality and embark on rigorous monitoring of the activities of packaged water producers.
A deficiency in the government’s ability to provide portable water for the population has opened a business opportunity for the private sector, with packaged water businesses sprouting all over the place over the last decade. There are over 100 such water brands sold across the country, mostly in the capital, Freetown. Very few of these have the right facilities to produce quality products, raising issues of health concern.
The recent MICS 2017 conducted by Statistics Sierra Leone revealed that all water sources, both household and at source, were found to contain 95 percent E.coli contamination. This means that they have either human or animal feces. E. coli [Escherichia coli] is a bacteria that normally live in the intestines of healthy people and animals. Most varieties of the microorganism are harmless or cause relatively brief diarrhea. But a few particularly nasty strains can cause severe abdominal cramps, bloody diarrhea and vomiting.
Doris Bah, Program Manager at the Water, Sanitation and Hygiene (WASH) department in the Ministry of Health and Sanitation (MoHS), attributed this situation to the lack of appropriate treatment facilities by most producers. She said their findings revealed that some producers use only ordinary sponge to filter the water.
“The Ministry is going to be very rigid this time round,” Ms Bah said at a recent engagement with stakeholders involved in the packaged water sector.
Previous findings have also revealed that some packaged water producers packaged the water directly from water wells without treatment.
World Malaria Day Commemorated
Sierra Leone last week joined the rest of the world to commemorated World Malaria Day amidst calls for proactive measures to prevent infection with the parasitic disease.
Officials at the Ministry of Health and Sanitation (MoHS) also urged citizens to ensure timely check whenever symptoms of Malaria set in.
Malaria is a disease caused by a parasite called Plasmodium. It is transmitted with the bite of a mosquito. It is one of the leading causes of death globally, with World Health Organization (WHO) statistics showing that over 219 million people are infected annually and 435, 000 dying.
The developing world, particularly Africa, records the highest burden of Malaria infections in the world, accounting for 200 million in 2018. In Sierra Leone, 1, 869 people died in 2018 from Malaria.
The Ministry says Malaria is responsible for 2million cases reported in the outpatients department, accounting for over 35 percent of all hospital consultations. It also says 17 percent of all those who are admitted for the disease die. Children and pregnant women are the most affected by Malaria everywhere.
But Malaria is preventable and treatable. Public health authorities say the best way to prevent it is through sleeping under mosquito treated bed nets. People are also urged to clean their environment to deprive mosquitoes a breeding ground.
People should also strive to report to the nearest hospital as soon as they show signs of malaria infection, said Dr Juana Smith, Director of Disease Prevention and Control.
“Every two minutes a child dies of malaria. This is why health personnel always emphasize that when there is suspected fever, go to the nearest health facility,” Dr Smith said at a press conference on the eve of the commemoration on April 25.
Sierra Leone has made Malaria treatment free in all government hospitals, as part of accelerated efforts in the response to the disease. Pregnant women and children are encouraged to take anti-Malarial drugs.
But very often patients complain of poor treatment in the hands of healthcare workers, including illegal monetary demands. This has forced people to take to self-treatment and consumption of cheap over-the-counter drugs.
World Malaria Day 2019 was commemorated on the theme: ‘Zero Malaria Starts with Me.’
First Malaria vaccine goes for test
After more than three decades in development the world’s most promising vaccine against Malaria went into test last week.
The World Health Organization (WHO) said the vaccine, named RTS,S, is the first ever vaccine that has been shown to provide partial protection against malaria in young children.
“RTS,S is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children,” the WHO said in a statement on the eve of the launching.
Malaria is caused by a parasite which is spread by mosquitos. It is one of the world’s leading causes of deaths, especially among children and pregnant women.
RTS,S, say experts, trains the immune system to attack the malaria parasite.
Malawi became the first of three countries approved to conduct the test. Kenya and Ghana were also set to commence the test this week.
Children between 5 months and 2-years-old will be given doses of the vaccine, with 360, 000 children targeted every year in the three countries, up to the end of 2022.
Nine countries, among them Sierra Leone, had applied for the opportunity to host the trials.
WHO said the three countries were selected due to the high number of malaria cases they record.
The development of the vaccine cost nearly $1bn.
RTS,S, which is a protein-based vaccine and manufactured by GSK in collaboration with PATH’s Malaria Vaccine Initiative (PATH/MVI) and a network of African research centres, went through five years of clinical trials on 15 000 people in seven countries.
In one clinical trial, it was discovered that children who received doses of the vaccine had a lower chance of developing malaria, according to WHO. It said the children who received the vaccine also had lower chances of developing severe malaria.
The study showed that the vaccine prevented about four in 10 malaria cases among children.
"Overall, there were 29% fewer cases of severe malaria in children who received the vaccine," a report by the researchers states.
WHO officials, while warning that this vaccine may not be a perfect solution, said it is expected to have considerable impact.
The landmark trial of the Malaria vaccine comes at a time when the world health agency said progress in the global response to the malaria pandemic has stalled.
Malaria remains one of the world’s leading killers, claiming one child’s life every two minutes. Most of these deaths are in Africa, where more than 250 000 children die from the disease every year. Children under 5 are at greatest risk of malaria’s life-threatening complications. Worldwide, the disease kills 435 000 people a year, two-third of them children.
African Vaccine Week celebrated
African countries must step up efforts and be vigilant in the fight against vaccine preventable diseases, the World Health Organization (WHO) said last week as the region celebrate the 2019 Africa Vaccine Week.
The Africa Vaccine Week, an extension of the World Vaccine Week, provides a platform for reflection of efforts towards strengthening vaccine delivery across the African region. It is also used to recognize vaccine heroes committed to saving lives. Some countries use the period to provide critical vaccines and screenings for millions of people.
The week also serves as a rallying moment for immunization advocates to encourage governments to keep immunization high on their national and regional agendas.
This year’s commemoration comes amidst concerns over a resurgence of Measles, the viral disease that affects children but which is vaccine preventable. WHO listed nine countries that are currently battling the outbreak, including Sierra Leone’s two neighbors – Liberia and Guinea.
WHO in a statement signed by its spokesman for Africa, Collins Boakye-Agyemang, listed other countries to include Chad, Cameroon, DR Congo, Madagascar, Mali and Uganda.
Sierra Leone has itself battled about two measles outbreaks in the last two years. The last outbreak of the viral disease in the country was in December 2018, six months after the first outbreak. In response to the December outbreak, the MoHS rolled out of a mass vaccination campaign in the three affected districts of Pujehun, Kambia and Koinadugu.
The Island nation of Madagascar has had the largest outbreak in this latest wave of the epidemic, with 122,000 cases recorded between October 2018 and April 2019.
Measles is a highly contagious disease that accounts for 13% of all vaccine-preventable deaths in children younger than 5 years in Africa; it infects nine in ten people who are not vaccinated.
But measles is just one of many vaccine preventable illnesses that afflict the region.
“Everyone has a role to play in ensuring that children and communities get the immunization services they need – from politicians and community advocates to health practitioners and parents themselves,” Evaristo do Espirito Santo Carvalho, President of São Tomé and Príncipe, said at the launch of the ninth African Vaccination Week early this week in São Tomé and Príncipe capital, São Tomé.
The theme for this year’s African Vaccination Week is “Protected Together: Vaccines Work!”, emphasizing the power of vaccines in saving lives and keeping everyone healthy, from infants to elders.
The week which ran from 22 to 28 April, also celebrated the vaccination heroes who help expand the coverage of immunization services across the African region – from parents and community leaders to health workers and innovators.
“We need to work together to improve immunization delivery so that all children are protected from preventable diseases. Recent disease outbreaks on the continent remind us of the urgency of this goal,” said Dr Matshidiso Moeti, World Health Organization Regional Director for Africa.
She added: “Outbreaks of measles in Madagascar and Ebola in the Democratic Republic of the Congo underscore the need for increased investments in immunization as a fundamental part of strengthening primary health care systems.”
Vaccines are one of the most effective and cost-effective public health interventions available. Yet, one in five children in Africa still does not have access to all the necessary and basic vaccines a child should receive.
Every year, more than 30 million children younger than 5 years in Africa fall sick due to vaccine-preventable diseases. Of these, more than half a million die – representing 56% of the global deaths related to vaccine-preventable diseases, according to WHO.
© 2019 Politico Online
