Ghana

Ghana halts Ebola vaccine trial due to community protests.

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Ghana has halted a plan to test two Ebola vaccines in an eastern town after legislators backed local protests against the trials sparked by fears of contamination, officials said on Wednesday.

The country’s Food and Drugs Authority said it had begun enlisting volunteers in Hohoe in the Volta region to be injected with drugs made by Johnson & Johnson and Bavarian Nordic as part of a global Ebola vaccine drive.

Youth leaders threatened to boycott the program. “We don’t want to be guinea pigs,” one local leader told Reuters.

Ebola has killed more than 11,000 people in Guinea, Sierra Leone and Liberia since it began more than a year ago but new cases have declined sharply. Ghana has yet to record a case.

“The (health) minister has suspended the trials indefinitely because the people said they don’t want it,” Health Ministry spokesman Tony Goodman said. The worst-hit countries have completed first trials of an experimental vaccine.

On Wednesday, parliament ordered the trials suspended and summoned the health minister to appear next week on the matter, senior parliamentary official Ebenezer Dzietror told Reuters.

Learning from Rwanda.

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How is it that Rwanda, among the world’s poorest countries – and still recovering from a brutal civil war – is able to protect its teenage girls against cancer more effectively than the G-8 countries? After just one year, Rwanda reported vaccinating more than 93% of its adolescent girls against the human papillomavirus (HPV) – by far the largest cause of cervical cancer. Vaccine coverage in the world’s richest countries varies, but in some places it is less than 30%.

In fact, poor coverage in the world’s richest countries should come as no great surprise, especially when one considers the demographics of those missing out. Where available, evidence suggests that they are mainly girls at the lower end of the socioeconomic spectrum – often members of ethnic minorities with no health-care coverage. This implies that those who are at greatest risk are not being protected.

CommentsView/Create comment on this paragraphIt is a familiar story, one that is consistent with the global pattern of this terrible disease, which claims a life every two minutes: those most in need of protection have the least access to it. Of the 275,000 women and girls who die of cervical cancer every year, 88% live in developing countries, where mortality rates can be more than 20 times higher than in France, Italy, and the United States. That is not just because vaccines are not readily available; it is also because women in these countries have limited access to screening and treatment. Without prevention, they have no options if they get sick.

CommentsView/Create comment on this paragraphAlarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate. If it turns out that girls at risk of not receiving all three doses of the HPV vaccine are also those with an elevated risk of being infected and missing cervical screenings as adults, they may be slipping through not one but two nets.

CommentsView/Create comment on this paragraphIt is still not clear why this is happening. What we do know is that HPV is a highly infectious sexually transmitted virus, which is responsible for almost all forms of cervical cancer. HPV vaccines can prevent 70% of these cases by targeting the two most common types of the virus, but only if girls have not yet been exposed to the virus, which means vaccinating them before they become sexually active. Yet efforts to communicate this to the public have been met with skepticism from some critics, who argue that the vaccine gives young girls tacit consent to engage in sexual activity, ultimately leading to an increase in promiscuity.

CommentsView/Create comment on this paragraphHowever, quite apart from the evidence to the contrary, intuitively this makes no sense. To suggest that giving girls aged 9-13 three injections over six months gives them a green light to engage in sex and sets them on a path to promiscuity is utter nonsense. It is like saying that people are more likely to drive dangerously if they wear a seat belt; in fact, the opposite is more often the case.

CommentsView/Create comment on this paragraphWhether such attitudes and misinformation account for poor vaccine coverage in places like France and the US is still not known. It may simply be that some parents or girls mistakenly believe that one shot of the HPV vaccine is enough to provide protection, or that some socially disadvantaged girls lack sufficient access to in-school vaccination services. Or perhaps the cost of the vaccine is a barrier in some of these countries. Whatever the reason, unless coverage for all three doses increases, cervical cancer and pre-cancer rates will increase.

CommentsView/Create comment on this paragraphIn countries like Rwanda, people know this only too well, which is why they have been so eager to tighten the net on HPV. They have seen the horrors of cervical cancer, with women in the prime of their lives presenting with late-stage disease and suffering slow and painful deaths. Without changes in prevention and control, deaths from cervical cancer worldwide are projected to rise almost two-fold by 2030, to more than 430,000 per year.

CommentsView/Create comment on this paragraphAnd now, with help from my organization, the GAVI Alliance, a public-private partnership created to improve access to new vaccines for the world’s poorest children, other low-income countries are following Rwanda’s lead. As of this year, Ghana, Kenya, Laos, Madagascar, Malawi, Mozambique, Niger, Sierra Leone, Tanzania, and Zimbabwe have all taken steps to introduce HPV vaccines, with more countries expected to follow.

CommentsView/Create comment on this paragraphG-8 countries’ generous contributions to organizations like mine show that they understand the importance of childhood immunization. But, while HPV infection rates may be falling in some of these countries, are they falling fast enough? In the US, for example, the G-8 country for which we currently have the most data, infection rates have halved in the six years since the vaccine was first introduced. Yet failure to reach the 80% coverage mark means that 50,000 American girls alive today will develop cervical cancer, as will another 4,400 girls with each year of delay.

CommentsView/Create comment on this paragraphSo it is worth remembering that even in wealthy countries, there is an urgent need to overcome challenges in protecting the hardest-to-reach girls, who often are at high risk of HPV infection. Overcoming these challenges is essential to reducing cervical cancer and pre-cancer rates in the coming years. Rwanda’s success should be the norm, not the exception.

Read more at http://www.project-syndicate.org/commentary/on-how-rwanda-is-beating-cervical-cancer-by-seth-berkley#By3XogWXL7Bj4SZs.99

In fact, poor coverage in the world’s richest countries should come as no great surprise, especially when one considers the demographics of those missing out. Where available, evidence suggests that they are mainly girls at the lower end of the socioeconomic spectrum – often members of ethnic minorities with no health-care coverage. This implies that those who are at greatest risk are not being protected.

It is a familiar story, one that is consistent with the global pattern of this terrible disease, which claims a life every two minutes: those most in need of protection have the least access to it. Of the 275,000 women and girls who die of cervical cancer every year, 88% live in developing countries, where mortality rates can be more than 20 times higher than in France, Italy, and the United States. That is not just because vaccines are not readily available; it is also because women in these countries have limited access to screening and treatment. Without prevention, they have no options if they get sick.

Alarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate. If it turns out that girls at risk of not receiving all three doses of the HPV vaccine are also those with an elevated risk of being infected and missing cervical screenings as adults, they may be slipping through not one but two nets.

It is still not clear why this is happening. What we do know is that HPV is a highly infectious sexually transmitted virus, which is responsible for almost all forms of cervical cancer. HPV vaccines can prevent 70% of these cases by targeting the two most common types of the virus, but only if girls have not yet been exposed to the virus, which means vaccinating them before they become sexually active. Yet efforts to communicate this to the public have been met with skepticism from some critics, who argue that the vaccine gives young girls tacit consent to engage in sexual activity, ultimately leading to an increase in promiscuity.

However, quite apart from the evidence to the contrary, intuitively this makes no sense. To suggest that giving girls aged 9-13 three injections over six months gives them a green light to engage in sex and sets them on a path to promiscuity is utter nonsense. It is like saying that people are more likely to drive dangerously if they wear a seat belt; in fact, the opposite is more often the case.

Whether such attitudes and misinformation account for poor vaccine coverage in places like France and the US is still not known. It may simply be that some parents or girls mistakenly believe that one shot of the HPV vaccine is enough to provide protection, or that some socially disadvantaged girls lack sufficient access to in-school vaccination services. Or perhaps the cost of the vaccine is a barrier in some of these countries. Whatever the reason, unless coverage for all three doses increases, cervical cancer and pre-cancer rates will increase.

In countries like Rwanda, people know this only too well, which is why they have been so eager to tighten the net on HPV. They have seen the horrors of cervical cancer, with women in the prime of their lives presenting with late-stage disease and suffering slow and painful deaths. Without changes in prevention and control, deaths from cervical cancer worldwide are projected to rise almost two-fold by 2030, to more than 430,000 per year.

And now, with help from my organization, the GAVI Alliance, a public-private partnership created to improve access to new vaccines for the world’s poorest children, other low-income countries are following Rwanda’s lead. As of this year, Ghana, Kenya, Laos, Madagascar, Malawi, Mozambique, Niger, Sierra Leone, Tanzania, and Zimbabwe have all taken steps to introduce HPV vaccines, with more countries expected to follow.

G-8 countries’ generous contributions to organizations like mine show that they understand the importance of childhood immunization. But, while HPV infection rates may be falling in some of these countries, are they falling fast enough? In the US, for example, the G-8 country for which we currently have the most data, infection rates have halved in the six years since the vaccine was first introduced. Yet failure to reach the 80% coverage mark means that 50,000 American girls alive today will develop cervical cancer, as will another 4,400 girls with each year of delay.

So it is worth remembering that even in wealthy countries, there is an urgent need to overcome challenges in protecting the hardest-to-reach girls, who often are at high risk of HPV infection. Overcoming these challenges is essential to reducing cervical cancer and pre-cancer rates in the coming years. Rwanda’s success should be the norm, not the exception.

Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster-Randomized Trial.

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Background

Oxytocin (10 IU) is the drug of choice for prevention of postpartum hemorrhage (PPH). Its use has generally been restricted to medically trained staff in health facilities. We assessed the effectiveness, safety, and feasibility of PPH prevention using oxytocin injected by peripheral health care providers without midwifery skills at home births.

Methods and Findings

This community-based, cluster-randomized trial was conducted in four rural districts in Ghana. We randomly allocated 54 community health officers (stratified on district and catchment area distance to a health facility: ≥10 km versus <10 km) to intervention (one injection of oxytocin [10 IU] one minute after birth) and control (no provision of prophylactic oxytocin) arms. Births attended by a community health officer constituted a cluster. Our primary outcome was PPH, using multiple definitions; (PPH-1) blood loss ≥500 mL; (PPH-2) PPH-1 plus women who received early treatment for PPH; and (PPH-3) PPH-2 plus any other women referred to hospital for postpartum bleeding. Unsafe practice is defined as oxytocin use before delivery of the baby. We enrolled 689 and 897 women, respectively, into oxytocin and control arms of the trial from April 2011 to November 2012. In oxytocin and control arms, respectively, PPH-1 rates were 2.6% versus 5.5% (RR: 0.49; 95% CI: 0.27–0.88); PPH-2 rates were 3.8% versus 10.8% (RR: 0.35; 95% CI: 0.18–0.63), and PPH-3 rates were similar to those of PPH-2. Compared to women in control clusters, those in the intervention clusters lost 45.1 mL (17.7–72.6) less blood. There were no cases of oxytocin use before delivery of the baby and no major adverse events requiring notification of the institutional review boards. Limitations include an unblinded trial and imbalanced numbers of participants, favoring controls.

Conclusion

Maternal health care planners can consider adapting this model to extend the use of oxytocin into peripheral settings including, in some contexts, home births.

Discussion

This community-based, cluster-randomized trial of prophylactic oxytocin (10 IU) administered via Uniject by peripheral health care providers without midwifery skills showed statistically significant reductions of 51% in the risk of PPH for blood loss ≥500 mL and 66% for blood loss ≥500 mL or with gushing and large blood clots. Results for severe PPH (≥1,000 mL) were not statistically significant. All secondary outcomes suggested the intervention was safe.

The magnitude of protective effect for blood loss ≥500 mL in this trial is similar to results shown for community-based prophylactic misoprostol (600 mcg) versus placebo in rural India (47% reduction in PPH) [10] and to a meta-analysis of health facility–based prophylactic use of intramuscular and intravenous oxytocin versus no uterotonics in high-income countries (50% reduction in PPH defined as ≥500 mL blood loss; 95% CI: 0·43–0·59) [9]. PPH reduction in this study was greater than trial results shown for prophylactic misoprostol (600 mcg) versus placebo in rural Pakistan (24% reduction in PPH) and in Guinea Bissau (11% non-significant reduction in PPH) . Mean blood loss among both oxytocin and control women in this trial was lower than that reported in these community-based misoprostol trials. Our results show mean blood loss of 185.5 mL and 229.2 mL among oxytocin and control deliveries, respectively, as compared to results from India (214.3 mL versus 262.3 mL), Pakistan (337 mL versus 366 mL), and Guinea Bissau (443 mL versus 496 mL) . Lower blood loss in this trial is expected, as early treatment of PPH with an additional injection of oxytocin (10 IU) in both our trial arms likely reduced ultimate blood loss among all PPH cases.

Several limitations of this study warrant discussion. The ratios of numbers of women in oxytocin and control arms of the trial range from 0.68 at the identification of eligible pregnancies to 0.77 at enrollment. Prior to randomization, CHO catchment areas were stratified by distance to emergency obstetric care, but not by population size, as these data were only available for Kintampo North and South. In these two districts, the ratio of population in the oxytocin versus control catchment areas is 0.88, explaining some, but not all, of the imbalance. As shown inTable 2, fertility between study arms is similar. There was no evidence that field workers in the oxytocin arm systematically missed identifying more pregnant women than in the control arm. However, if they did, it is unlikely that these women would have substantially different characteristics than the homogenous group that provided initial consent for the study (and which represented 99% of all identified pregnancies in both groups).

Two CHO behaviors differed by arm of the trial. First, control CHOs initiated blood-loss measurement (i.e., unfolded the drape) on average one minute later than oxytocin CHOs following delivery, possibly leading to an underestimate of blood loss in the control group. However, if delayed unfolding of the drape by control CHOs reduced blood loss measures, it would underestimate impact of oxytocin on outcomes. Second, CHOs in the oxytocin group referred women prior to delivery more frequently (17.3%) than control CHOs (12.5%), possibly indicating that the analyzable sample in the oxytocin group excluded a larger pool of women having a difficult delivery and thus potentially at higher risk of PPH. Data extracted from hospital records for referred women did not, however, indicate a higher risk (6 PPH cases among 198 referred women in the oxytocin group = 3.0%).

In an un-blinded study, differential measurement errors across arms of the trial are possible and thus, lack of blinding constitutes a study limitation. However, in this study the intervention was provided by CHOs who were not birth attendants. They were not responsible for managing the births nor were they responsible for the birth outcome, two issues which we believe would decrease the chances that they influenced the study outcome. The CHO’s job was to respond to the call, to give (or not give) the injection and measure blood. They had no previous experience with birth, or visual blood loss estimation and possible associations with bad maternal outcomes.

This trial provides evidence that administration of intramuscular prophylactic oxytocin in Uniject by peripheral health care providers without midwifery skills can effectively decrease the risk of PPH at home births under research conditions. Furthermore, none of the secondary outcomes reflecting safety suggested that this intervention was unsafe. Across trial arms, service was successfully provided to three-quarters of all calls requesting CHO assistance. However, CHO compliance varied widely, and was likely due to CHOs working alone in their catchment area per trial protocol; that is, they were on call 24 hours per day for 19 months. In a scaled-up program, additional staffing or the ability to refer calls to a neighboring CHO would be required to increase and sustain CHO compliance. There is no evidence that the intervention decreased health facility–based births. However, 17% of pregnant women (n = 5919) chose to deliver at home without a CHO and research is needed to understand the barriers to reaching these women. Another concern was the frequent lack of compliance with free referral to hospital for PPH cases. Refusal of referrals was unexpected and underscores the importance of providing community-based early treatment to women reluctant to seek care outside the home.

Cost is an important component of intervention feasibility. Oxytocin in Uniject is currently commercially available only in a few Latin American countries and thus its eventual market-driven cost is unknown. The United Nations Commission on Life-Saving Commodities for Women and Children includes oxytocin among 13 medicines unavailable to women due to issues such as cost or supply because they are not subsidized by global bulk purchase agreements or advance market commitments. The Commission has developed specific recommendations to address these issues as well as to promote oxytocin in a Uniject-type device [24]. It is anticipated that oxytocin in Uniject will cost US$1.00 or less, and potentially substantially less once sustained demand is established. The oxytocin in Unijects used in this study, were purchased on a non-commercial basis at a cost of $1.40 per dose. A commercial price for the product, should sustainable demand emerge, could be lower as economies of scale play a significant role in the cost of producing pharmaceutical products.

These results also raise additional questions. For example, if oxytocin in Uniject is not an option, could providers entrusted to vaccinate children and provide other injections use a traditional syringe and ampoule for oxytocin administration? The skills required are the same as are issues regarding needle disposal. As a cost-saving measure, could a time/temperature indicator be placed on a flat of oxytocin ampoules (versus individual ampoules), since ampoules within a flat are generally exposed to the same environmental conditions? This issue is mentioned in the UN Commission on Life-Saving Commodities for Women and Children and will likely be determined by the willingness of pharmaceutical companies to allow it. Regarding the duration that oxytocin can remain out of the cold chain in hot climates, additional analyses from this trial are currently underway to assess the number of days that oxytocin can remain out of the cold chain under field conditions in central Ghana prior to indication by the time/temperature indicator that the device should be discarded. Such information will serve health care planners in determining the required resupply schedule and the feasibility of this schedule locally. Could a lay provider safely and effectively use oxytocin in Uniject? (A randomized trial assessing use of oxytocin in Uniject by traditional birth attendants to prevent PPH is underway in Senegal now; clinicaltrials.gov: NCT01713153.) Is the BRASSS-V calibrated plastic drape used here necessary or could a simplified drape that indicates only when treatment and referral are needed (versus a quantitative blood loss measure), or other PPH detection pads suffice? This choice will be determined by the objectives of local health planners and the ability to easily obtain or import supplies. In Ghana, local manufacture of the blood loss measurement drape is considered a priority for scaled-up use.

While the move towards use of skilled birth attendants is gathering global momentum, poverty and inequity—particularly in selected areas in countries—will remain issues for the foreseeable future. Prophylactic use of uterotonics to prevent PPH, the biggest killer of women during childbirth, is a key intervention and use of oxytocin as the drug of choice should be considered where its use is feasible. It is unhelpful to pose this issue as oxytocin versus misoprostol. The more appropriate question is: Where and under what circumstances can each of these proven effective drugs be used? Ultimately, decisions regarding the balance of advantages and disadvantages of using oxytocin or misoprostol for PPH prevention at home births will depend on local conditions, human resources, infrastructure, and national policies.

Source:PLOS

Ten years in: taking stock of the biosafety protocol.

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Speed read

·         The Cartagena protocol covers the safe transfer and use of GM organisms

·         But most of its 164 signatories have still not fully implemented it

·         Industry has been making efforts to work with governments within the protocol

Many challenges lie ahead for the Cartagena protocol to be effective, Maria Elena Hurtado reports.


  Ten years after the Cartagena Protocol on Biosafety entered into force to detail the safe handling, transfer and use of living genetically modified organisms, vast majority of its 164 signatories have not fully implemented it.  

Yet in recent years, researchers have started producing genetically modified fish in Panama for human consumption, and releasing genetically modified mosquitoes into the wild in Brazil and elsewhere to try and prevent dengue fever, sometimes with unclear safety and regulatory oversight.

The protocol commits signatory countries to appoint a national authority to administer the protocol, to create national biosafety frameworks and regulations, and to build capacity for risk assessment and the safe handling and transport of living modified organisms (LMOs).

HNE00022PHI

Fifty-two countries have domestic regulations fully in place, 75 have one or more biosafety laws and almost all of them have national authorities for administrating it, reports an article published in the anniversary edition of the protocol’s newsletter.

“But still there is a long way to go to make sure the national biosafety rules and regulations in place are workable and countries have the necessary capacity to enforce them,” Braulio Ferreira de Souza Dias, executive secretary to the Secretariat of the Convention on Biological Diversity, tellsSciDev.Net.

“For example, the effectiveness of biosafety regulations will be minimal unless countries have the necessary tools to detect and identify LMOs.”


Challenges ahead


And for the protocol to be fully effective, “we need to work towards achieving its universal membership”, said de Souza Dias, in a press release published earlier this month (10 September). “I call upon all countries that have not yet done so to fast track their national processes to ratify or accede to the Cartagena protocol … as soon as possible.”

“The absence of legal certainty in many countries has been commonly regarded as one of the most serious stumbling blocks in the path of biodiscovery.”

Braulio Ferreira de Souza Dia, Convention on Biological Diversity

Also, the speed of implementation has decreased over the last three years, Stefan Jungcurt of the Canada-based International Institute on Sustainable Development, tells SciDev.Net.

“As more and more countries approve LMOs for cultivation and import, the political priority given to biosafety is diminishing, which translates into a lack of financial and other support to implement the protocol on a national level,” he says.

In his view, a key pending issue is approving UN guidelines for risk assessment and risk management. Claudio Chiarolla, director of biodiversity governance at the Institute for Sustainable Development and International Relations, a non-profit policy research institute based in France, agrees.  

Both Jungcurt and Chiarolla tell SciDev.Net that one of the most important issues will be to determine  the protocol’s scope regarding the potential socioeconomic impact that LMOs pose for the sustainable use and conservation of biodiversity, and what appropriate action can be taken.

“The protocol will also have to deal with other types of LMOs such as genetically modified mosquitoes, aquatic species, microorganisms orproducts of synthetic biology, which are different to LMO crops,” Jungcurt adds.

A new international treaty was adopted at a 2010 meeting in Japan, called the Nagoya – Kuala Lumpur Supplementary Protocol on Liability and Redress to the Cartagena Protocol on Biosafety.
This treaty deals with potential damages resulting from the export and import of LMOs.

Jungcurt says: “The most immediate challenge here is achieving its coming into force and its national implementation, as well as establishing rules and procedures on who is liable if damage occurs during transboundary movements”.


A fair share


De Souza Dias told a meeting in Denmark this month (4 September) that the Nagoya protocol “put an end to the mistrust among industry, indigenous and local communities over the equitable sharing of benefits”.

“The absence of legal certainty in many countries has been commonly regarded as one of the most serious stumbling blocks in the path of biodiscovery,” he adds. “The Nagoya protocol seeks to address this concern.”

He recognises the high stakes involved for different groups. “Over the last two decades, the issue of free trade in LMOs on the one hand, and biosafety on the other, have led to heated debates and, at times, to tense legal disputes.”

But he believes industry has been making efforts to work with governments within the process of the biosafety protocol.

“The participation of representatives of industry and civil society in the Cartagena protocol process has been helpful to maintain transparency and balance in taking decisions,” he says.

Smart lenses make spectacles accessible to millions.

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Spectacles with variable lenses that can be adjusted by a wearer with no access to specialist eye care are being mass produced.

The first 30,000 pairs will be shipped to Afghanistan, Ghana and Tanzania by the end of the month.

Focusspec is the first self-adjustable lens to be produced in large quantities, though other similar glasses have been designed. The technology is expected to improve the lives of millions of adults in the developing world living with poor eyesight.

The spectacles were developed by Dutch industrial designer Frederik Van Asbeck, based on a discovery in 1964 by Nobel Prize-winning physicist Luis Alvarez. Alvarez designed a lens that was convex on one side and concave on the other. He found that by placing two such lenses on top of each other, and moving one relative to the other, the focus could be changed.

“The technology to produce those lenses with the needed high precision — an aberration of a micrometre will cause a headache — was developed only a few years ago,” Van Asbeck told SciDev.Net.

Anyone can adjust the strength of the lenses themselves, by turning wheels located on the side of the spectacles, eliminating the need for an eye expert.

Van Asbeck says Focus on Vision, serving the WHO’s VISION 2020 programme, will produce one million pairs of glasses a year in the Netherlands.

The glasses have been tested in Afghanistan, Cambodia, Ghana, India, Nepal and Tanzania.

“I see people’s faces light up when they adjust their spectacles and discover they can read again, take care of themselves, work, get an education,” says Jan in ‘t Veld, a board member for Focus on Vision, which undertook a large part of the fieldwork.

In ‘t Veld says the lenses are scratch-, UV-, water- and dust-resistant — and optically almost as good as the far pricier lenses used in Western countries.

Ben van Noort, co-board member and ophthalmologist, points out that Focusspec lenses can only be adjusted between +0.5 to +4.5 dioptre or -1 to -5 dioptre (most people wear between -6 and +6) and they are unsuitable for astigmatism. “Still, they work for 80–90 per cent of adults,” he says.

Lillian Mujemula, optometrist and main distributor of the glasses in Tanzania agrees: “Most of our clients live in remote areas, where there are no optometrists. People are very happy with the glasses because they are of good quality and easy to use. I believe people can wear them for many years.”

Brien Holden, professor of optometry in Sydney and chairman of the International Centre for Eyecare Education (ICEE) told SciDev.Net: “The FocusSpec has an important place as a stop-gap solution. But they cannot replace the long-term strategy of educating eye care personnel and creating optical workshops and distribution channels in each community in need”.

Holden also points out there is a need for proper scientific field studies, which ICEE is now in the process of designing.

The spectacles are expected to be sold at local shops, schools and health centres for US$3–5 a pair.

Source: www.scidev.net

Fragile newborns survive against the odds.

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TAMALE, Ghana, 7 August 2012 – Awintirim Atubisa spent the first two months of his life tied to his mother’s chest in a cloth ‘pouch’, just like a baby kangaroo.  When he was born, six weeks premature, he weighed 1.3kg and was at risk of hospital-acquired infection, severe illness and respiratory tract disease.

But he survived, thanks to the UNICEF-supported Kangaroo Mother Care program.  The program encourages mothers to wrap their premature and underweight newborns to their chests using a ‘pouch.’  Snuggled against their mother’s skin, the babies’ body temperatures stabilise, their heart rates steady and they begin to breathe more easily.

Kangaroo Mother Care has been particularly successful in the Upper East and Central regions of Ghana, where babies who might have once died for want of an expensive incubator are now surviving.

Skin-to-skin care

Awintirim’s mother, Lydia Atubisa, says skin-to-skin contact, which is the cornerstone of Kangaroo Mother Care, calmed her baby son.

“When he was alone, he would start to shake and cry. But he becomes still as soon as I tie him to me and hold him. The heat of my body makes him feel like he is still in the womb,” she said.

Margaret Kugre, the nurse in charge of the program at the Upper East Regional Hospital, said that constant skin contact between mother and baby saves the lives of fragile babies in a region where incubators are scarce and unreliable. Before Kangaroo Mother Care was introduced in 2008, up to four tiny babies would have to share the maternity ward’s only incubator, which was often broken for months at a time.

Exclusive breast feeding is another key aspect of the program.  Babies are fed nothing but breast milk for the first six months of life, avoiding illnesses from contaminated water or breast milk substitutes.

The program encourages mother and baby to go home as soon as possible, to reduce the risk of hospital-acquired infection.  Lydia and her son were in the hospital for one month after the birth, but as soon as he was stable and gaining weight and she could confidently tie her cloth pouch and breastfeed, they moved back home to Sandema.  Awintirim and Lydia only return to the hospital for monthly weigh-ins.  At his latest check-up, six weeks after delivery, he weighed nearly 2kg.

In the first six months of 2011, 99 underweight babies were born in the Bolgatanga Municipal area in Ghana’s Upper East Region.  All were introduced to the Kangaroo Mother Care program and all survived.

Lydia is confident her son will become strong and she has big dreams for his future: “I want him to be a doctor so he can save lives, like the doctor who saved him.”

Culture adapts to new approach

The kangaroo program has been quickly adapted into Ghanaian culture. Ms. Kugre said mothers were happy to carry their newborns on their chests but nurses also involve a woman’s husband and mother-in-law.  “Carrying the baby on the back is preferred in Africa,” she said. “We work with the whole family so it is not so strange to them. In the ward, we wrap the babies onto the mother-in-law so she can feel what it’s like.”

Derek Bonsu, the Medical Superintendent at Saltpond Hospital in Central Region, said Kangaroo Mother Care empowers mothers. “They get to play an active role in the saving of their child. And no one monitors a vulnerable baby better than a desperate mother.”

Central Region also enjoys success

The program has saved hundreds of lives since it was introduced to the Central Region in 2008. Mr. Bonsu said premature and underweight babies were common and often died before Kangaroo Mother Care was introduced.

“We are in the middle of an area with social and economic problems. There is a lot of illiteracy and poverty, an early age of sexual initiation, a tradition of harmful practices, malnutrition… Mothers have had anaemia, malaria and other parasites and infections, all having an effect on the pregnancy, delivery, and health of the unborn baby. Many of the babies are born preterm or with too low a birth weight.  This should not be deadly, but we did not have a functioning incubator in the hospital and were losing the babies.”

The success of the program is clear. Before June 2008, 9 out of the 16 underweight babies born at the hospital died.  After the program started in June, all 12 babies born underweight lived.

Source: UNICEF