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Want to keep fruits fresh? Try these Malian innovations

The sight of rotting mangoes in a few weeks’ time will be awash in the country. Mangoes, a second fruit crop in Kenya, is a seasonal crop with high and low seasons. In most counties the seasons start from December and peaks in January to February.

Interestingly, this scenario predisposes fruit farmers, especially small-scale farmers from Makueni, Kitui, Kilifi,

Pot-in-pot evaporative cooling
technology

Murang’a and Embu counties in Kenya to exploitation by traders who offer very low prices for their produce.

Post-harvest experts estimate that 40-50 per cent of fruits and vegetables produced in Kenya are lost or wasted along the value chain. In Kenya alone, 80 per cent of the mangoes are eaten while still fresh, hence the need to increase their shelf life. The losses are majorly caused by lack of access to affordable and appropriate technologies for handling and storage of the highly perishable commodities. However, these ugly scenarios will soon be averted through the use of simple technologies that fruit and vegetable farmers can adapt and use in the farm to curb the losses of agricultural produce hence supporting livelihoods and food security.

Adopting low-tech post-harvest innovations for storing fruits and vegetables could save Kenyan farmers unnecessary wastes by prolonging the shelf life of their fresh farm produce, adds the experts.

Evaporative cooling technologies for improved fruit and vegetable storage from Mali would be most effective in helping farmers increase farm produces’ shelf life in Kenya and other countries. The low-cost technology will enable farmers attain the quality, quantity and consistency required by mango traders hence the ability to increase profits by negotiating for better prices.

Unlike Kenya, Mali farmers have explored widespread use of brick, straw and sack evaporative cooling chambers (ECC) and pot-in-pot, round pot-in-dish and cylinder pot-in-dish clay pot coolers. A survey on evaluation of various low-cost vegetable cooling and storage technologies in Mali that looked at the impact of evaporative cooling on vegetables shelf life, painted a promising picture on its benefits to farmers.

Conducted between May and July 2017, the study was led by Dr EricVerploegen of the D-Lab and Dr Ousmane Sanogo and Dr Takemore Chagomoka former World Vegetable Center-Mali scientists among farmer groups in Sikasso and Mopti regions in Mali. The study titled “Evaporative Cooling Technologies for Improved Vegetable Storage in Mali” looked at the seasonal temperatures and humidity profiles of the two regions in Mali and how it affected the shelf life of vegetables including eggplant and tomatoes.

Cylinder pot-indish evaporative cooling chambers suitable for fruits and vegetables

To gain insight into evaporative cooling device use and preferences, the team conducted interviews in Mali with users of the cooling and storage systems and with stakeholders along the vegetable supply chain. They also deployed automatic sensors to monitor product performance parameters.

According to results from 80 respondents involved in the study, the shelf life of eggplants and tomatoes were significantly longer in Sikasso than Mopti for all vegetables. This difference, says the authors, is likely due to the significant variations in climate conditions between the two regions, which affect the storage conditions experienced by the vegetables in the ECCs.

The eggplants and tomatoes in the straw and sack ECCs in Sikasso were stored in conditions that were an average of over 2 °C lower and 20 percent higher humidity than the vegetables in the straw and sack ECCs in Mopti. “Similarly, the average ambient conditions throughout the study period were more favourable for vegetable storage in Sikasso than in Mopti, as Sikasso is situated in the Sudan-Savanna zone while Mopti is part of the hotter and dryer Sahel-Saharan zone in Mali,” reads the study.

Straw evaporative cooling chambers

Just like Mali, intermittent power supplies and lack of proper storage facilities mean that a lot of farm produce often goes to waste before it arrives in the market in Kenya. But the researchers, now think, that by exploring such ecofriendly off-grid innovations farmers can manage without electricity. In potin-pot technology, a small clay pot is inserted into a large one leaving space between the two. The cavity is then filled with sand, which serves as a medium for holding water for the evaporative cooling. The innovation, adds the authors, is also best suited for household use because of the small volume of produce storable.

However, warns Dr Sanogo, one of the authors of the report, evaporative cooling devices are not appropriate for all settings. He adds, “It is best suited to communities where there is access to water and fruits and vegetable storage needed during hot and dry weather.”

Automatic data sensors used in the study revealed that users were more inclined to water the cooling devices in the dry season and reduce the usage of the devices as the rainy season started.

The decrease in the temperature, along with the increased humidity and protection from pests provided by the devices, resulted in significant increases in shelf life for commonly stored vegetables including tomatoes, cucumbers, eggplant, cabbage, and hot peppers.

Low-cost evaporative cooling innovations used in Mali to increase shelf life of fruits and vegetables

As Kenya gears up for another mango fruit glut and other successive vegetable seasons, the Mali experience is quite an eye opener and potential in aiding small-scale farmers address many of the challenges that face rural households and farmers in need of improved post-harvest vegetable storage.

Millions to suffer from drug resistance globally by 2050

About 700,000 people die annually due to drug resistance globally and the number is expected to increase to 10 million people annually by 2050, a health expert has warned.

A Kenya health ministry official in charge of Antimicrobial Resistance (AMR), Dr Evelyn Wesangula said cases of resistance have become more common not just in Kenya but in the sub-Saharan Africa region.

The World Health Organisation (WHO) warns that the prospect of the world entering a ‘post-antibiotic era’, where common infections can no longer be cured, is real.

Speaking during a MESHA conference held on Thursday at Ngong Hills Hotel, Dr Wesangula said increased cases of drug resistance is posing a threat to the significant gains made in the fight against diseases, a health expert has warned.

While there are many causes of antimicrobial resistance, Dr Wesangula singled out both over use and underuse of the antibiotics as some issues which led to this public health concern.

She said the free-for all access of drugs in pharmacies, drugstores and market places, unregulated prescription in health facilities and from animals to humans as among causes for resistance.

Dr Wesangula said apart from long hospitalisation due to drugs resistance many lives are lost– a situation which should compel governments to act.

“It is a problem with a wide range of consequences. Those who have resistance will face long hospitalisation or will have to try different medicines which is costly.

“This also has an implication on their personal economy and development. If you come to think of sub-saharan region, we have a higher disease burden hence resistance to antibiotics must be a serious cause for worry.” she explained.

According to WHO, AMR occurs when micro-organisms (bacteria, fungi and viruses) change when they are exposed to drugs such as antibiotics leading to prolonged untreated illnesses.

Dr. Wesangula, there is need to intensify efforts such as enforcement of the law to have adhered to prescription procedures for antibiotics.

Like, Kenya, Malawi has similar challenges such as free – for – all access to antibiotics due to weak enforcement mechanisms of the law.

But National Coordinator for AMR in the Ministry of Health in Malawi, Dr Watipaso Kasambara said one strategy they have employed is raising public awareness on the gravity of drug resistance as well as equipping medical staff with appropriate knowledge so as to manage prescription of antibiotics in hospitals among other  interventions.

“Creation of a special unit to look at AMR is one effort by the Malawi government which demonstrates commitment in dealing with the problem at hand,” according to Dr Kasambara.

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Cooking gas that comes from human wastes

The increase of informal settlements in Kenya is a stumbling block to achieving universal access to water and proper sanitation by 2030, experts say.

According to the Kenya Water for Health Organization (KWAHO), over 2.5 million Kenyans occupy slum areas. The number is likely to increase going by estimation that by 2030, sixty percent of Kenyans will dwell in urban areas.

According to Mr. Patrick Alubbe, the executive director for KWAHO, sanitation in slums remains an issue which must be addressed for the country to attain the universal access to clean water and sanitation as envisaged in goal number six of the sustainable development goals.

Mr. Alubbe said Kenya loses Ksh27 billion due to sanitation related problems and Ksh 8 billion due to open defecation annually, an amount which can be saved if issues of sanitations are properly handled.

He said poor sanitation at the slums and generally within urban areas are consequences of many factors among them uncontrolled garbage disposal and inadequate land to build better latrines.

Other factors include untreated sewerage system.

He added that out of the 12 percent of national sewerage coverage only 5 percent get treated. To achieve proper sanitation, experts says innovative technology needs to be employed especially in slum areas in the country like Kibera, Korogocho and Kariobangi all in Nairobi and even in other slums like Oruba and Pandpieri in Migori county among others.

Kibera slums in Nairobi was several years back known for flying toilets (people defecating in plastic bags and throwing them away anyhow in any direction and everywhere) because of lack of proper disposal of the faecal matter coupled with poor latrine cover.

The good news is, the whole situation has changed with the construction of nine biocentres within the slum areas.

The centres, built by community groups with the support of Umande Trust have not only made steps in addressing sanitation issues at the slum but have also economically empowered many low income earners.

Mr. George Onyango, a member of Muvit group operating one of the biocentres at Kibera says the construction of the latrines, fitted with bio digesters which enabled them to also produce gas beside offering washrooms to the slum dwellers has saved many from the frequent outbreaks of sanitation related diseases in the slum. He said they averagely receive between 500 to 1000 people per day using their washrooms at a relatively low fee, a number he said used to defecate in the open using the “flying toilets.”

According to Mr. Onyango, individuals who try to construct their own latrines in the slum have found it difficult to do so because of scarcity of land.

Provision of an improved latrine for the slum dwellers is hence a reprieve to many who were defecating in the open.

He added that the use of the excreta to produce biogas which is used for cooking by slum dwellers at a very small fee has also helped them in managing the waste from the latrines. The project has seen 90 similar latrines which are also used in production of biogas constructed across the county.

Top View: A couple stands on a high ground to have a better view of the Kibera slums
Top View: A couple stands on a high ground to have a better view of the Kibera slums

However, an expert has warned that achieving open defecation free status is not an assurance to proper sanitation. Hygiene and sanitation specialist at Unicef, Engineer Sarh Kemoh has said.

Stopping defecating in the bush and using latrines at home, he said brings the problem of poor sanitation closer to them unless improved latrines are constructed and better excreta disposal mechanisms are employed.

He said the number of toilets constructed does not translate to usage adding that complementary behavior and practices which include hand washing with soap and water, proper use of toilets, safely emptied, transported, treated and disposed waste.

His call for improved latrine comes as counties in Kenya struggle to achieve total open defecation free status by March 2019 deadline. Currently only three counties in Kenya – Busia, Siaya and Kitui have achieved the open defecation free status.

Migori county director of public health, Dr. Kennedy Ombogo says the urban total sanitation program has met many challenges including inadequate water in urban areas, lack of waste disposal sites, and poverty.

Dr Ombogo said landlords who are key in the urban total sanitation program especially in slum areas have not been accessible hence getting the right owner of rental houses has remained a big challenge in addressing sound sanitation.

Going forward the director public health said the department is in the process of developing better waste management mechanisms including producing biogas from the excreta and also coming up with punitive regulations on sanitation.

Slum dwellers on their side have blamed poor sanitation on lack of political good will saying that leaders have occasionally stopped the government from improving sanitation in some slum areas to protect their votes.

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Young women’s HIV burden worries experts

As curtains fell on what has been a landmark scientific conference on the prevention, care and treatment of HIV, it was clear that there are many strides made in the right direction.

Notably, the national adult HIV prevalence has been on a steady decline in the last seven years.

According to the National AIDS and STI Control Programme (NASCOP), “annual new infections are less than a third of what they were in 1993” when the epidemic was at its strongest.

There are now better antiretroviral regimens that are accessible and consequently, more people on treatment inspiring experts to declare that the country may well be on its last mile towards achieving the 95-95-95 dream.

This is essentially a fast track plan to halt the spread of HIV by 2020 and to eventually end the epidemic by 2030.

Initially dubbed the 90-90-90 Aids eradication strategy, the goal is to have 90 percent of people living with HIV tested, 90 percent of those diagnosed with HIV put on treatment and 90 percent of those on treatment achieving durable viral suppression.

Based on advances in the treatment and care of HIV, experts are now aiming for 95-95-95.

Nonetheless, experts are alarmed that this success story has been clouded by failure to prevent new infections among young women 15 to 24 years.

“When you talk about new HIV infections, these are people who are negative today and HIV positive tomorrow.

Young people account for about half of these new HIV infections and this is a worrying statistic,” said Anthony Chazara, LVCT Health and Youth Programme.

Dr Lillian Njagi from Kenyatta National Hospital concurs: “More than half of all new HIV infections occurred among adolescents and young people aged 15 to 24 years which is a sharp rise from 29 percent in 2013.”

According to NASCOP’s latest estimates, 1.5 million people were living with HIV with youths accounting for 280,000 of these numbers.

Speaking at the conference, Dr Njagi was particularly concerned that young women continue to be disproportionally affected by HIV.

Across Africa, HIV infections among young women are double or triple those of their male peers. “In Kenya, young women are almost twice as likely to acquire HIV compared to young men,” she emphasized.

Due to their vulnerability to HIV, young women 15 to 24 years account for 33 percent of the total number of new HIV infections. In comparison, NASCOP statistics show that young men account for an estimated 16 percent of the new HIV infections.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, lack of access to education and jobs, and health systems that do not address the needs of young people. During the entire period of the conference, experts belaboured the fact that the face of HIV has significantly changed.

People living with HIV are no longer as sickly as they used to be. It is therefore now possible for a HIV positive individual with a very high viral load and therefore highly infectious to appear healthy.

This has shaped the attitudes that young women have as well as their own perceptions of being at risk of infections.

Surveys have shown that young women are still more fearful of an unplanned pregnancy than HIV. But there are other factors that have served as obstacles to the prevention of HIV among young women. Experts said

that biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus.

Experts were also quick to clarify that besides sex, the age of the male partner is a defining factor. “The trends are showing that HIV prevalence is high among women aged 15 to 24 and among men aged 35 to 45. This is because of the intergenerational relationships,” Chazara expounded.

The age of the young woman herself is also a factor. Women who had their first sexual encounter before the age of 15 years faced twice the risk of getting infected with HIV.

Importantly, experts belabored the point that interventions are in the pipeline to address the needs of young people in the prevention, care and treatment of HIV.

According to Dr Irene Mukui of NASCOP, “There is a lot of discussion and focus on the youth to figure out how to prevent new HIV infections, to ensure those infected are on treatment and that they have good treatment outcomes once they start taking antiretroviral drugs (ARVs).” With experts drumming support on increasing awareness and knowledge of HIV prevention among young people, these efforts are bearing fruits.

Nonetheless, more young men than women have demonstrated adequate knowledge of HIV prevention.

In the Kenya Health and Demographic Survey (KDHS) 2008, an estimated 48 percent of young women and 55 percent of young men “demonstrated adequate knowledge of HIV prevention compared to 73 percent of young women and 82 percent of young men in 2014.”

There is still no consensus on teaching young people about HIV and sexual health. This remains a debatable controversial issue with the most recent KDHS 2014 finding that an estimated 40 percent of adults were “against educating young people about condoms” for fear that it might be taken as encouragement for them to have sex.

Such fears and controversies notwithstanding, the figures have spoken and raised the alarm. Without urgent and young people tailored interventions, the HIV prevalence among young people will become the epidemic.

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15 years and counting: Researcher’s relentless charge against HIV

Despite the difference in opinion about the statistics on HIV/AIDS in Nyanza, the concern of scientists in the region is much focused on how best to treat and reduce new HIV infections.

Mr. Arthur Ogendo, a Senior Research Officer working for Kenya Medical Research Institute Centre (KEMRI/CDC) in Kisumu, Kenya gives an insight on how they are rolling out the fight against HIV/AIDS even as the search for cure continues. Mr Ogendo has for the last 15 years, dedicated his life to researching on how his own people from Nyanza can participate in eliminating HIV from the face of the earth using people based solutions.

Our member, Christine Ochogo of Radio Nam Lolwe, recently met the ever smiling researcher in Kisumu during our eighth media science café and fielded the following questions to him.

Tell us about yourself.

I am Arthur Ogendo, a senior Research Officer at KEMRI/CDC Kisumu, The organization hosts various research on areas of Malaria, TB, HIV and other infectious diseases. I am a public health specialist currently working in the epidemiology and health research.

Kindly tell us more about the researches you have participated in on HIV.

KEMRI and CDC established a HIV Research Branch in 2000. The branch started with two major studies, one conducted in Asembo, Siaya County and another in Kisumu County both in western Kenya.

The research in Asembo was a Baseline cross sectional survey (BCS) that took a look at HIV infection prevalence and the one in Kisumu was known as Kisumu Breast feeding Study (KiBS) that majored on how to prevent transmission of HIV virus through breast feeding amongst women who are lactating before and after delivery.

What are the finding on the two studies?

In Asembo, the research revealed that there was high prevalence of HIV Infection of 15% as at 2003.

However, this has since reduced due to concerted efforts on behavioral and medical methods being initiated in the region.

In Kisumu the research informed Prevention of Mother to Child Transmission (PMTCT) Policy that mothers can be put on triple ARV for PMTCT was safe tolerable and efficacious . ART was administered to mothers before they deliver and continue with the drugs after delivery to protect the child from being infected with HIV virus through breastfeeding.

What other studies have KEMRI/ CDC conducted in relation to HIV?

Between 2010 and 2013, we did a study that looked at whether early initiation of ARVs treatment would reduce the risk of HIV transmission among HIV sero discordant couples. The study was sponsored by US national Institute of Health (NIH).

Participants were placed onto into two groups, one being on survivors whose CD4 cell count was at above 550 per ml and those whose CD4 count was at 250 per ml or below as per the national guidelines on ART initiation at that time (2010).

We found out that those who started Antiretroviral Therapy (ART) early when their CD4 cell count was high, had more health benefits and the risk of cross infecting their partners reduces by 96%. This was considered a scientific breakthrough.

This has now informed the WHO and Government of Kenya’s health ministry to adopt a ‘test and treat’ policy where infected individuals begin ART treatment immediately irrespective of their CD4 count, to reduce the risk of HIV transmission.

What about the study on vaccines and drugs?

We are coming up with a number of interventions to help in prevention and further spread of HIV/AIDS which include Voluntary Male Circumcision, use of vaginal ring, pills (Truvada), a pilot vaccine, implants among others.

Currently we are conducting a study on antibody mediated prevention (AMP) study. Vaccines are intended to induce immune responses (antibodies) in the body system but sometimes this is a slow process and may not be effective againstthe HIV virus. Antibodies are proteins produced by the body to fight germs in the blood. Therefore we are looking whether infusing antibodies directly into attacking the white blood cells. This

study is targeting about 80 participants who we will be followed up for four to five years.

We in CDC/KEMRI are also focusing on long-term pre- exposure prophylaxis (PrEP) for the population of young women. We are looking at superiority between Cabotegravir and Truvada as a PrEP. Carbotegravir drug has been proven to be effective among HIV-negative older women and it was time to investigate its efficacy in young women who are sexually active.

What are some of the challenges you face in the fight against HIV?

Research is very expensive and we as scientists have been relying a lot on donor funding which is now decreasing.

We are now advocating for the County governments to consider allocating more funding to HIV programs to avoid over reliance on donors who are proving to be unreliable due to changing times and priorities.

What role do you think the media can play in the fight against HIV?

The media plays an important role in dissemination of information and we scientist work best in collaboration with them to pass to the masses information on our progress in HIV research.

Why do scientists fear the media?

Scientists are sensitive to misfacts as reported by the media. We are accountable to our partners and collaborators fear being misquoted or misreported on our research be it on HIV or any other subject.

This calls for consistent and responsible journalism to avoid interfering with the progress made so far as well as avoid misrepresentation of scientific facts. We abhor the media to consult with us when not sure as they do articles because fact checking helps readers and listeners to get the correct information.

What is your patting shot?

Everybody is at risk of contracting HIV and the fight against the virus need concerted efforts from all people despite the County or region or country one comes from.

The society needs to be informed more about HIV on prevention and proper management in a bid to have a HIV free generation to come.

Scientists are still searching for a vaccine that may one day prevent infection of HIV/ AIDS infection and they are hopeful that the vaccine will soon be available. In the meantime, everybody has the responsibility to prevent HIV transmission but embracing behavior change and seeking treatment as necessary.

The perception and impression that those who hail from counties or regions where HIV prevalence is low are at less risk of contracting the virus is a misconception.

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Stigma and side-effects slowing PrEP adoption

The idea of providing an antiretroviral (ARV) medication as pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection by persons at high risk is now well established.

However, the full public health impact will be realized only when PrEP is implemented effectively at scale.

The UNAIDS has projected delivery of PrEP to 3 million persons by 2020 while the National AIDS & STI Control Program (NASCOP) projected upto 500,000 persons on PrEP by 2022 according to the national Framework for Implementation of PrEP in Kenya issued in 2017.

By George Juma I jumageorge10@gmail.com

Data from UNAIDS 2013 show that over 7000 young women get new HIV infections contract globally every week.

Despite having oral PrEP and other researches being conducted to get more forms of the vaccine which can satisfy the taste of users ,the oral vaccine has not been utilized maximally because of arrays of factors including peer pressure, inaccessibility of PrEPS to users among others.

Josephine Nyaboke (not real name) a PrEP user champion in Migori County says issues regarding the packaging of Prep, peer pressure among other remains some of the major challenges she is facing when championing for PrEP use among the youths and the adolescent. She said other side effect of PrEP on usersat the early stages of use has also made many of her clients to abandon the pill.

Nyaboke who currently has 47 clients introduce to the vaccine that she monitors every month to ensure that the drugs adherence level is met also said that delay in the issuance of PrEP at the health facilities has discouraged many of her clients.

The perception of many has been that the PrEP is only used by Key population which includes sex workers, discordant, truck drivers and men sleeping with men, however this is not the cases.

Nyaboke said she started using PrEP in 2017 after having felt at risk of contracting HIV due to the long distance relationship she is in adding that her boyfriend and the parents accepted her proposal.

During this year’s AIDS 2018 Conference in Amsterdam four weeks ago, PrEP was arguably the dominant subject with far more sessions devoted to it than any other topic and will probably also dominate the HIV Research for Prevention (HIVR4P) Conference in Madrid from October 21 – 25,This is a global scientific meeting dedicated exclusively to biomedical HIV prevention and research.

Kenya has made significant progress in the reduction of new HIV infections in the past decade through the scale up of comprehensive HIV treatment and prevention programs including PrEP. Despite this progress, over 70,000 Kenyans mostly aged 15-24 get new HIV infections every year. The story is the same across most of sub Saharan Africa where numerous PrEP initiation programs started in the last year. So far, Kenya has initiated PrEP in about 25,000 people at risk – but retention is a big problem.

Scientists suggest there could be several potential barriers to effective PrEP implementation that could derail the program if not addressed urgently. According to Dr. Dismas Oketch from the Kenya Medical Research Institute, there are anecdotal reports about stigma to PrEP use, lack of knowledge of and access to PrEP, skewed expectations from PrEP adopters, side effects as well as shame and hesitation to demand PrEP; which could negatively affect retention and adherence to PrEP.

Speaking to Sayansi in August in Kisumu during a science café organized by MESHA and AVAC, Dr. Oketch further reiterated that there could be some disconnect between what PrEP providers intend for PrEP and what what PrEP users want from PrEP leading to those who were initially enthusiastic about PrEP withdrawing from it. Ideally, PrEP use is not for everyone and should be limited to individuals at risk and during periods of higher risk when other HIV prevention alternatives are not sufficient.

He says the current trend shows that many people are not using PrEP as expected because of various reasons which they scientist continue to investigate. “Side effects and stigma remain the two most important reasons for PrEP discontinuation.” Despite these threats, Dr. Oketch believes “it is far much better individually, principally, socially and economically to prevent HIV than to treat a lifelong infection of HIV/AIDS.” As a result the KEMRI is exploring other alternatives to PrEP delivery than the daily oral pill. This new PrEP pipeline will include long acting injectable PrEP, PrEP implants and PrEP intravaginal rings.

Latest research conducted by non governmental organization, IMPACT Research and Development Organization (IRDO) in Kisumu early this year shows that sixty four percent of potential PrEP users would prefer the injectables.

According to Dr.Kawango Agot is a researcher working with the IRDO, the research which involved commercial sex workers also revealed that 21 percent of potential PrEP users prefer oral tablets while only 15 percent prefer the intravaginal ring.

In the study, Dr.Kawango said the sample group was placed on injectable, pills and ring Preps all placebo for a period of one month each to established the experience and taste of each participant.

Mrs Josephine Odoyo,a researcher with the Kenya Medical Research Institute (KEMRI) at Lumumba centre in Kisumu county, says PrEP users have been giving a lot of feedback regarding the size of the pill, colour and even packaging of the pill.

The feedback they have been receiving from nearly 2000 users of PrEP, have occasioned new researches to see that the drugs is user friendly.

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The Nile: Let’s talk conservation and trade, not war drums

Hardly a week passes without one reading or listening to mass media stories about the pending Nile water wars between Egypt and Ethiopia. The worst disaster that can haunt the African continent is the unacceptable and shortsighted wars between Egypt and Ethiopia.

In this era of climate change, there is need for extra caution in selectively using vague and biased scientific, technical and policy perspectives to beat war drums that fuel the simmering conflict between Egypt and Ethiopia. These two countries are currently most powerful African nations with rich and unique history including entrenched military skills.

To begin with there is need to constantly remind the two nations and others in the Nile Basin that this mighty river should be used sustainably to foster peace, increased trade, conservation of the environment and overall regional socio-economic development driven by credible science, technology and innovation. War should not be an option. Other Nile Basin countries which must pay extra-attention to curbing the simmering conflict include Rwanda, Burundi, DR Congo, Kenya, South Sudan, The Sudan, Tanzania and Uganda.

Even more, all the Nile Basin countries have major roles to play in protecting and conserving their national and transboundary water resources that form the intricate web constituting the River Nile whose ancient roots once extended to Lake Tanganyika but the northwards journey was later blocked when Virunga Volcanoes in Rwanda exploded.

At the centre of the conflict is Africa’s largest hydro-electric plant, The Grand Ethiopian Renaissance Dam, initiated along the Blue Nile near The Sudan border in 2011. Egypt claims the dam will reduce the amount of water reaching its population and that the country’s survival is at stake. Ethiopia vehemently denies this. The simmering conflict has led to what seems like selective and biased use of scientific data and facts.

In Egypt, the minister for water resources and irrigation, Mohamed Abdel Aty, once said that reducing Nile water by two percent would result in about 200,000 acres of land being lost. However, Ethiopia asserts that hydroelectric power stations do not consume water and all depends on how fast Ethiopia fills the huge dam.

A former prime minister of Ethiopia, the late Meles Zenawi always stressed that the dam would never interfere with water availability in Egypt.

Ethiopia explains that it may even take a decade and half to fill the dam meaning that the normal rate of Nile flow will be maintained. In Sudan there are experts who say the dam will help regulate over flooding of irrigation projects by helping create a much needed steady flow.

However, Egypt constantly needs endless practical reassurances that no Nile Basin nation is plotting to use Nile waters to cause death, destruction, starvation and unlimited economic sabotage.

It is notable that the current regime realizes that Egypt as one of the continent’s big brothers should take a more progressive approach emphasizing socio-economic progress and integration driven by home grown science technology and innovation.

This was clearly emphasized in February 2018 when Egypt hosted the Third Africa Science, Technology and Innovation Forum in Cairo. The Minister for Higher Education and Scientific Research, Khaled Abdel Ghaffar, pledged Egypt’s willingness to build a continent driven by knowledge and innovation.

He told delegates that Egypt would continue to support young African researchers and increase scholarship opportunities for students from other African countries. During the Forum, Egyptian Government and the African Development Bank championed a new push for African nations to work together towards building a new Africa driven by innovation, technology and commercialization of research outputs.

 

Technical Aspects

When Egypt completed building Aswan High Dam in 1970 it reduced annual flooding that benefitted some farmers while the availability of the fertile alluvial soil that increased farm yields declined drastically. There were fears that the dam would cause widespread flooding especially in Sudan because it slowed the flow of the Nile.

Still some experts say that much of the Nile water is actually lost in Egypt due to intense evaporation in the hot arid desert environment. Thus some experts in Sudan and Ethiopia say that the dam could directly or indirectly help curb the loss. However, currently there is no effective technological package that can be developed quickly to manage such massive evaporation process that has been going on for thousands or millions of years in Egypt’s sunbaked environment.

However, may be out of fear or distrust, Egypt is raising its claim of “Nile water flow” to 90 percent from the original 66 percent as major precautionary or bargaining measure.

Although in this era of climate change excessive floods in the Nile Basin may briefly meet the demand, there is need to continuously focus more broadly on science and innovation for sustainable solutions.

This includes various practical aspects of environmental conservation and protection. It includes protection and rejuvenation of water towers or water catchment areas and indigenous forests, especially the vanishing Equatorial Forests of the Congo Basin.

Although overlooked, Nile Basin countries face major negative environment impacts linked to the massive destruction of Equatorial Rainforests by some Western and now Asian timber companies. Rainfall in western Kenya, Uganda, Rwanda,

Burundi and western Tanzania depend on winds picking moisture from the once dense Equatorial Rain Forests.

Nile Basin still has abundant water resources and adequate rainfall that seem deficient because of poor distribution and unbelievable unwillingness to conserve excess rainfall causing floods currently haunting most of East African nations.

African experts are needed to deal with various aspects of water conservation, food production, increasing pollution, climate change, forestry and environment conservation, and other related skills.

With conservative and anti-Third World regimes re-emerging in the West, Egypt with a relatively strong technological and business base, should be at the forefront of innovatively promoting trade and tourism along the Nile apart from giving prompt attention to pollution of the river.

It should take hint from Turkey which is aggressively pushing socio-economic aspects actively in Africa.

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Experts: Not all TB infections come with a cough

Beryl Atieno, a middle-aged TB survivor who hails from Rarieda in Siaya County, had no idea that she had contracted the infectious disease when she started ailing in March 2017.

Atieno was not coughing and therefore had no reason to suspect she had tuberculosis even though she had other signs and symptoms like high fever, loss of appetite, loss of weight among others for one week.

To her surprise, she was diagnosed with TB when she went for screening at the local Madiany Hospital and immediately put on treatment for 6 months under close surveillance until she was cured completely.

“As a TB survivor at first I thought it was normal ailment and I had no reason to imagine that I had contracted it. However after my diagnosis I followed my prescriptions to the letter until now that I am well,” Atieno says.

Just like Atieno, there are a number of people who suffer in silence because of ignorance about tuberculosis, an airborne infectious disease.

There are two types of clinical manifestation of tuberculosis, the most common one being the pulmonary TB which affects the lungs and the second type being extra pulmonary TB which affects all the body organs apart from hair and nails.

TB still remains in the top 10 causes of death worldwide according to World Health Organization.

In Siaya County, Western Kenya, the high TB burden has been attributed to poor health seeking habits among residents who are prone to contracting the infectious disease.

According to the county Tuberculosis and Leprosy Coordinator, Mrs. Mary Wambura, the County records about 2,000 to 2,500 TB patients yearly, placing it among top ten most heavily burdened by the disease in Kenya.

She says that Siaya is also ranked position three in the number of TB patients who have developed Multi-Drug Resistant (MDR) TB. She adds that since 2012 the county has recorded 82 of such patients.

“This high incidence of TB related disease is unacceptable and the society need to have a positive behaviour change in curbing the spread of the airborne disease,” the coordinator advised.

Wambura mentioned that it is very costly to treat MDR TB and revealed that the Kenya spends up to Ksh 2.1 million treating one MDR TB patient “Patients who have contracted TB should adhere to normal TB treatment to avoid escalating to other stage which become expensive and difficult to treat,”

she advises. In the fight to end TB, the coordinator announced that the county health facilities are currently administering one anti -TB drug called Isoniazid to children under five years who stay with TB patients as a measure to prevent them from contracting the disease.

However, she regrets that some parents and guardians still fail to bring their young ones to get the drug hence putting them at high risk of infection.

“Once infected, children get subjected to traditional medicine and other nonmedical means and in the long run they end up dying without being treated for TB,” she regretted.

The health department has also innovated a TB active case finding stamp that helps in identifying and screening TB patients who visit health facilities in the county.

According to the Centre for Health Solutions Technical Adviser on TB in Siaya, Mr. Duncan Barkebo, the TB stamp contain four questions that will be used to screen all patients who seek medical attention in the health facilities.

Barkebo mentioned that the TB active case finding stamps have been distributed to all health facilities within the county so that all the patients get to be screened for the disease.

He regretted that Siaya County has been losing 10 per cent of TB patients every year due to late diagnosis and by the time they start treatment, their immune system is usually very low to respond to the treatment being administered to them.

“This stamp innovation is one of its kind in Kenya and this will ensure no patient is left out in TB screening since the stamp contains four crucial question that will guide clinicians in identifying patients who have contracted the disease early enough for treatment,” Barkebo added.

In 2017 the county recorded 1,700 patients with TB, unfortunately 170 people out of the number died due to late diagnosis.

This, Mr. Barkebo says is unacceptable since it is way beyond the National TB program’s acceptable percentage of less than 5 percent mortality on TB.

TB coordinator Wambura further revealed that the county has 155 TB centres spread across the six subcounties where individuals diagnosed with TB can get treatment.

 

Ms Rose Kaberia, a survivor of MDR TB strain, addresses MESHA journalists during a past media training on infectious diseases

There are effective machines to detect TB by use of sputum and they can be found at Siaya County Referral Hospital, Madiany, Bondo, Matibabu in Ukwala, Ambira and Yala sub county hospitals.

Wambura mentions, “With the machines in place in major health facilities within the six sub counties, locals can seek services closer to them unlike in the past where they had to travel long distances.”

Many people still think that patients who have TB are automatically infected with HIV/AIDS, a notion Mrs. Wambura is discarding saying its false and further advised residents to seek TB testing early as a preventive measure to avoid developing MDR TB.

“The stigma on TB is still high since most patients fear going for testing thinking that they are going to be associated with HIV/AIDS and other customary which are faults, “she mentioned.

Kenya is among countries with the highest TB burden in the world with a prevalence rate of 291 cases per 100, 000 people.

This has greatly been contributed by the high poverty levels in the country estimated at 45.2 per cent through poor nutrition, overcrowding, alcohol and substance abuse and poor access to health care services.

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Why we need HIV vaccines like yesterday

More than 20 years ago, just after I had completed my secondary education, I was diagnosed with HIV. At that time, I thought I now had full self responsibility to my life. I had dreams, just like any other young person. This was the worst news I heard at that moment.

My life came to a standstill for awhile. Everything around me was now dictated by my diagnosis. My education, my career and family dreams were shattered and my parents and siblings were affected even more than myself. Ever since then, life has never been normal, It is not normal, It will never be normal for me even if a cure is found.

I have been to hell and back because of HIV on all fronts. Most notable and physical was my onset of treatment. Twice, I have reacted very badly to medication to the point of almost losing my life. At one point, I thought death would be more relieving than the pain and discomfort I was feeling. I am alive today mainly for having had access to competent, quick medical attention and strong family support at that time. In my more than 20 years work in the HIV field, I do not know of any HIV positive individual who has had it easy both socially and medically. I know some that have even died due to drug reactions, stigma and late diagnosis and lack of access to care and support. We musk a lot; because that is what society wants to see or wants us to portray.

 

Why am I saying all this?

I want to repeat, it is not normal. I do not wish this to happen to our children who have dreams and a full life ahead of them. I would not wish HIV infection to happen even to my worst enemy. It is for these reasons I am joining the prevention advocates. I will do whatever it takes within my ability to speak out and support prevention efforts to stop any single HIV infection where I can. I will support the HIV vaccines initiative because if it succeeds, it will be one of the biggest breakthroughs in the fight against HIV.

It is no longer about me People spoke for us; I am alive today because of the many voices that stood up for us – people living positively with HIV (PLWHIV). My immediate family takes the biggest credit. They read anything and everything they could come across that would enable them to help me and understand me.

But it still has never been normal and it will never be for me. As an existential fact, we are alone. Many a times I am alone, pain, drugs swallowing, loss of appetite….I am alone.

This can, and could have been prevented. I am going to spend the remaining part of my life, advocating for all forms of prevention…. but education and vaccines are going to take centre stage of my advocacy work. For we all know, PREVENTION IS BETTER THAN CURE.

The face of HIV today is young people. As a mother, and as a person who got infected at that tender age, the news about new HIV infections among young people churns my stomach.

I look forward to seeing how advocates are going to be engaged in the HIV vaccine initiatives and I am more than happy and willing to take on this assignment very seriously to let communities know and understand the importance of HIV vaccine and prevention.

Inviolata Mwali Mmbwavi is the National Coordinator International Community of Women Living with HIV Kenya Chapter (ICW-K)

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New device to encourage taking of PrEP drugs

A new device is being developed to encourage individuals at risk of contracting HIV to take their daily dosage of Pre-exposure prophylaxis (PrEP).

Wise Pill was developed as an HIV prevention technique to help take control and take charge of new infections. The device is currently being tested.

To increase the uptake of PrEP among the youth, who are the largest consumers of technology, this invention has been incorporated with IT to help them take their drugs daily.

According to Wise Pill adherence study coordinator, Kamolo Kevin, the program is aimed at getting more young ladies to use the gadget but since it is still on study, they are currently testing its efficacy among 175 girls within Kisumu county.

“This is a generation that studies done previously have shown have had difficulties to adhere to the uptake of PrEP,” Kamollo said.

The device is under study by Kenya Medical Research Institute’s Centre for Microbiology Research (KEMRI-CMR) and helps young adult women carry their prep wherever they go. The device has two compartments that carry 15 tablets each and a participant is supposed to take a tablet each day at a specific time of their choice.

Kamolo said participants using the device were trained before one was handed over to them to ensure they do not interfere with the kit.

“We train them how to open inside.

And when she (participant) gets to open it, it sends a signal to our server,” he said.

To certify whether the participant indeed took their tablets, they give a report each time they go back to the facility which is then counter checked by the servers at KEMRI.

“We also conduct tests to confirm the amount of drug in the participant’s blood. This will help confirm whether participant was taking the drug,” Kamollo explained.

To ensure that the participant never misses to take the daily dosage, she can be prompted by an SMS from the server at the specific time she is supposed to take the drug.

“During registration, members request for the kind of sms to be sent to them as a prompt,” Kamollo said.

With the device easy to conceal as a power bank, Kamollo said they hoped  that the results of the study will help the community on HIV prevention and generally the uptake of drugs.

But in a separate interview, Dr. Elizabeth Irungu, KEMRI, stressed that PrEP was not meant for everybody.

“It is for people who are at risk of acquiring HIV and they just need to be identified or identify themselves and visit a facility to take the pill daily. If the risk is gone, stop. If the risk is back, start,” Dr. Irungu said.

She added, “We need to be sure that you’re HIV negative and not positive. HIV positive individuals should take ARVs not PrEP.”

Other than United States of America, the study on the wise pill gadget is taking place in Kisumu and Thika in Kenya.