FY 2015/16 – National & County Governments
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Young, Gifted and…Pregnant
The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal.
One in every five Kenyan girls aged between 15-19 has had a live birth or is pregnant. It’s a mind-blowing statistic that speaks to the teenage pregnancy crisis in the country – the United Nations Population Fund estimates that there were about 380,000 cases in 2019 alone. Eighteen-year-old Patricia* (not her real name) was referred to me for legal advice, as she had one such pregnancy. Orphaned at an early age, her paternal uncle took her in but sexually abused her for several years. Today Patricia is 5 months pregnant and not in school, even though this should have been her final year. And while her uncle should be charged under the Sexual Offences Act – facing not less than 15 years in prison if convicted – Patricia will not testify against him for fear of losing the only financial support she has.
The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal. Patricia is one of thousands of girls in Kenya stuck in a predicament caused by sexual violence, lack of information on, and access to youth-friendly sexual and reproductive health. For these girls, their education will be interrupted and their social and economic choices taken away from them.
But there are also increased health risks associated with teenage pregnancies, including physical health issues like convulsions, uterine infections and obstetric fistula – a hole in the birth canal, resulting in incontinence of urine or faeces that often affects women who give birth too young – and mental health challenges like depression and anxiety. And there are risks to the unborn child including premature birth, low birth weight and other neonatal conditions. Preventing teenage pregnancies is about protecting the holistic health of both the mother and the potential unborn child, and by extension, society as a whole.
The Kenya Demographic Health Survey 2014 reported a 2% drop in teenage pregnancies over a 20-year period. This was caused by major changes in girl’s education programmes and in the sexual and reproductive health and rights landscape in Kenya that made birth control and other services more accessible to teenage girls. Yet in 2014, the Kenyan Parliament shot down the Reproductive Health Care Bill sponsored by Senator Judith Sijeny, which suggested among other things, that adolescents be given unrestricted access to comprehensive sexual education and confidential sexual and reproductive health services. There was uproar around the bill, with Kenyans citing religious and cultural beliefs to reject it. But the facts betray this opposition: the same survey (KDHS) shows that about 11% of teenagers, nationwide are having sex before their 15th birthday. Kenya’s teenagers need better access to sexual and reproductive health services.
It’s not all doom and gloom though. In 2013, Kenya signed the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa. In 2015, the Ministry of Health enacted the National Adolescent Sexual and Reproductive Health Policy that aims to enhance the sexual and reproductive health status of adolescents in Kenya and contribute towards realization of their full potential in national development. Additionally, two months ago in March, Kenya through the National Council on Population Development (NCPD), launched the first-ever government-led multi-stakeholder campaign against teenage pregnancy dubbed ‘Let’s Act to End Teenage Pregnancy’.
But sex education is still not being uniformly delivered across the country. Teachers are not all adequately trained and can often pass misinformation onto the students. An African Population and Health Research Center (APHRC) study found that 1 in 4 secondary school students in Homa Bay, Mombasa and Nairobi counties thinks that using a condom during sexual activity is a sign of mistrust. The content of the curriculum is also heavily focused on content covering abstinence and sexually transmitted infections, ignoring other important topics like contraceptive use and access to safe abortion. Furthermore, a new Reproductive Health Care Bill (2019) threatens to negate the gains made on adolescent sexual and reproductive health and rights as it requires health providers to seek parental consent before providing adolescents with sexual and reproductive health services. Requiring parental consent is likely to result in an increase in unintended teenage pregnancy and unsafe abortions because teenagers may not want their parents to know about their sexual activities.
Ending teenage pregnancies will take a concerted effort of policy mixes. The judiciary must strictly implement the Sexual Offences Act. The legislature must review the issue of bride price, particularly, where teenage girls are concerned to de-incentives teenage marriages. Increased girls educational programs and opportunities created. Teachers must receive adequate training on comprehensive sexuality education. A wide range of sexual and reproductive health topics should be taught in the classroom but also parents and guardians must take the lead in providing their teenagers with correct and age appropriate information on sex. Lastly, the legislature must urgently amend Section 33(a) of the proposed reproductive health care law, to enable teenagers freely access quality, youth friendly sexual and reproductive health services. It’s time to bring down Kenya’s startling teenage pregnancy statistics.
Modelling the COVID-19 Pandemic in East Africa
Using mathematical modelling to track and predict the progress of the coronavirus outbreak.
Mathematical models allow us to extrapolate from information currently available about the state and progress of an outbreak, to predict future cases. In this article, we illustrate how, using mathematical models, the COVID-19 outbreak can be modelled mathematically to help prepare for the worst-case scenario and to develop a vaccination policy.
As can be seen from Figure 1, it is clear that the outbreak of COVID-19 in East Africa is taking a similar shape to that of China, USA and other European countries. The infections in China seem to have flattened by the last week of February 2020. East African countries seem to be at different phases of the disease outbreak. Kenya has the highest number of reported cases so far. This could be attributed to the relatively higher number of tests Kenya is carrying out compared to other East African countries. The United States has over 800,000 confirmed cases so far. The time it will take for the infections to significantly slowdown is of much interest to all the stakeholders.
Daily Confirmed Cases
The daily confirmed cases in East Africa, China, USA and some selected countries in Europe are given in Figure 2. It is clear that the confirmed cases in East Africa are still very low compared to Europe, the US and China. This could be attributed to the relatively fewer tests in East Africa. However, Tanzania has reported the highest daily confirmed cases (84) followed by Kenya (29). Daily confirmed cases in China, UK, Italy, France, and Germany are declining while they are increasing in Russia. The trend is quite unstable in USA.
Daily Confirmed Cases Curve in Europe, USA and China
As can be seen from Figure 3, the infections in China, Italy, France, Germany and Spain are in the decline. On the other hand, the daily infections in the US and Russia are yet to start declining.
Considering that the follow-up in China started on 2 December 2019 while in all other countries in the world it started on 22 January 2020, Figure 4 shows the time it took China, Italy, France, Germany and Spain to experience a downward trend in daily infections.
These countries took 67 days, on average, to experience a downward trend in daily infections. Considering the health facilities in these countries and the time they took to implement a total lockdown, 67 days seems to be the earliest time a country can take to experience a downward trend in COVID–19 infections taking into account the measures taken by these countries such as testing, lockdown, social distancing, surveillance and contact tracing. 140 days (about 5 months) is the minimum time any country will take to return to normalcy in terms of COVID-19.
Daily Confirmed and Recovered Cases
Figure 5 gives the daily confirmed and recovered cases in China and Kenya. It is clear that the number of recovered cases in Kenya is currently lower than the number of daily infections. The daily infections in Kenya seem to be increasing despite the country having experienced a decline around the second week of April 2020. This could be attributed to the increased number of daily tests. The recoveries in China had overshot the infections by the first week of March 2020.
Daily Recovered and Dead Cases in East Africa
Figure 6 gives the percentage of recovered and dead cases in East Africa. Burundi has reported the highest percentage deaths (20 per cent). South Sudan has not recorded any recoveries or deaths so far despite reporting four confirmed cases so far. Uganda and Rwanda have not reported any deaths so far. The percentage of recoveries in the two countries (Uganda and Rwanda) are the highest so far in East Africa. The percentage recovered is a key parameter in modelling of infectious diseases. Every country in the world will have its own recovery rate based on such factors as status of health facilities and mean age at infection.
African Countries with the Highest Number of Confirmed Cases
As can be seen in Figure 7, Egypt, South Africa and Morocco have over 3,000 confirmed cases while Algeria has slightly over 2,500 cases. Ghana and Cameroon have slightly over 1,000 confirmed cases so far.
Recoveries and Deaths in African Countries with the highest number of Confirmed Cases
As can be seen in Figure 8, Algeria has the highest recovery and death rates amongst the six countries. Furthermore, among the six African countries, only Algeria has a death rate higher than 10%. Ghana has the lowest death rate of the six African countries while having the highest number of confirmed cases.
Recoveries and Deaths in some selected countries outside Africa
Figure 9 gives the percentage of recoveries and deaths in China, the US and some selected countries in Europe. Surprisingly, recoveries in the UK are very low compared to other major economies in Europe. Also, the number of deaths in the UK are greater than the recoveries. This could be pointing to a strained National Health System (NHS). The recoveries are highest in China (92.6 per cent), an indication of the expected recovery rate in a well-developed country which took the necessary steps early enough. Similarly, a death rate of 5.5 per cent in China points to the expected long-term death rate in a well-developed country which took the necessary steps early enough.
Prediction of Infection in Kenya
The transmissibility of COVID-19 was assessed through the estimation of the reproduction number R, defined as the number of expected secondary cases per infected case. In the early stages of an outbreak, and assuming no immunity in the population, this quantity is also the basic reproduction number R0, i.e. R in a fully susceptible population.
Figure 10 gives the estimated reproduction number of 1.241. This estimate is derived from the available daily COVID-19 incidences in Kenya so far. A serial interval distribution with a mean of 7.5 days and a standard deviation of 3.4 days was used, similar to the COVID-19 Wuhan characteristics.
Predicted Infections in Kenya for the next 5 days
Figure 11 gives the projected incidences in Kenya for the next five (5) days. For the country to experience a reduction in infections, measures must be taken to reduce the reproduction number by continuing to stress on social distancing, hand washing, etc. Infections can be minimised by implementing targeted total lockdown.
Table 1 shows the projected daily infections from 22/04/2020 to 26/04/2020. The upper limits can be taken as the worst-case scenario for the given transmission rate of 1.2 for about 600 daily tests for COVID-19 in Kenya. A similar analysis can be done for any other country whose daily incidences are available.
Table 1: Projected Infections in Kenya
|95% Confidence Interval|
|Lower Limit||Upper Limit|
Why China? A Look at Viral Outbreaks That, Like COVID-19, Originate From the East
China, officially the Peoples Republic of China (PRC), is a country in East Asia and is the most populous country in the world, with a population of around 1.4 billion people. It is also one of the world’s first civilizations.
With over 34,687 species of animals and plants, China is the third-most biodiverse country in the world after Brazil and Colombia. It is home to at least 551 species of mammals, 1221 species of birds and 424 species of reptiles and 333 species of amphibians; most of which are consumed as food.
On December 31 last year, Chinese authorities alerted the World Health Organization, WHO, of an outbreak of a novel strain of coronavirus causing severe illness. It was subsequently named SARS-CoV-2 and is now known as the causative agent of COVID-19. The origin of the virus was the city of Wuhan in China.
The disease, that has flu-like symptoms, has so far infected over 2 million people and caused over 140,000 deaths across 209 countries around the world. The effects it has left in its trail have caused different countries to take extreme measures in a bid to curb the spread of the virus.
This is, however, not the first time China has been the origin of a viral outbreak.
In February 1957, the Asian flu (H2N2) virus emerged in East Asia, triggering a pandemic. It was later traced back to China with a stop in Singapore. It then spread to Hong Kong and to coastal cities in the United States in the summer of 1957.
According to the Centers for Disease Control and Prevention, CDC, the number of deaths caused by the virus stands at 1.1 million people worldwide including 116,000 in the US. A vaccine was developed and the flu tapered off in 1958.
Though the cause is still not known, some authors believe the virus originated from a mutation in wild bucks combining with a pre-existing human strain. The strain later evolved, causing a milder pandemic between 1968-69.
The Asian flu was characterized by symptoms similar to many other strains of influenza, including fever, body aches, chills, cough, weakness, and loss of appetite. It is a respiratory illness, so a dry cough, sore throat, and difficulty breathing are all widely reported among flu sufferers. Other complications include pneumonia, seizures and heart failure.
Hong Kong Flu
The Hong Kong flu (H3N2) outbreak occurred in Hong Kong, China, between 1968-1969, killing an estimated 1 million people globally. It is said to have evolved from the H2N2 strain of influenza that had caused the Asian Flu.
It occurred in two waves, and in most places, the second wave caused more deaths that the first. A vaccine was later developed against the virus but it became available only after the pandemic had peaked in many countries.
Infection caused upper respiratory symptoms typical of influenza and produced symptoms of chills, fever and muscle pain and weakness. These symptoms usually persisted for between four and six days.
The H3N2 virus is still in circulation today and is considered to be a strain of seasonal influenza. In the 1990s, a closely related virus was isolated from pigs.
In 1997, human infections with Bird flu (H7N9) were first reported in China. It is a zoonotic disease (one that passes from an animal or insect to a human), which infects humans after exposure to infected poultry or contaminated environments. Rare instances of person-to-person spread were been identified in China.
Since then, annual sporadic infections have been reported outside of Mainland China, Hong Kong and Macao, but all the cases have occurred among people who had travelled to China before becoming ill.
The current risk to the general public’s health posed by the virus is low but exposure to infected poultry pauses the risk of it spreading to neighbouring countries. There have been 6 waves of the epidemic over the years with the last one being in 2017.
Early symptoms included fever, headache, coughing that produces sputum, muscle pain breathing problems and general malaise. In later stages, other symptoms include pneumonia, multi-organ dysfunction, septic shock and brain damage.
In 2002, a viral respiratory disease caused by a coronavirus called Severe Acute Respiratory Syndrome (SARS-CoV), was reported in Asia. It is thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats) and first infected humans in the Guangdong province of Southern China.
According to National Foundation for Infectious Diseases, NFID, coronaviruses are a large group of viruses that cause diseases in animals and humans. They often circulate among camels, cats, and bats, and can sometimes evolve and infect people. They are named for the crown-like spikes on their surface.
Human coronaviruses were first identified in the mid-1960s. The CDC states that there are 7 coronaviruses that can infect people.
The SARS epidemic from China affected 26 countries and resulted in over 8000 infections in 2003. Some of the affected areas included Toronto in Canada, Hong Kong Special Administrative Region of China, Chinese Taipei, Singapore and Hanoi in Vietnam.
SARS also had influenza-like symptoms including fever, malaise, muscle pain, headache, diarrhoea, shivering, coughing (initially dry) and shortness of breathe. Severe cases often evolve rapidly, progressing to respiratory distress and requiring intensive care.
So Is China Fertile Ground For Future Pandemics?
Given the history above and the current situation the world is experiencing with the COVID-19 pandemic, what does China hold in terms of future outbreaks?
Dr Eddy Okoth Odari, a senior lecturer and researcher of Medical Virology in the Department of Medical Microbiology at the Jomo Kenyatta University of Agriculture and Technology (JKUAT), points out several factors.
“Potential for a pandemic would depend on various socio-economic and geopolitical factors attributed to a country or region. Most pandemics that have emanated from China have been viral in nature and have occurred as a result of such viruses crossing species from animals to humans. Viruses’ crossing from animals to humans is not a strange phenomenon. However, we have to appreciate that most of these viruses, which eventually end up in pandemics, have been traced to the “Wildlife Markets” (wet markets) in Southern China. The activity of trading in wildlife is unique to that region. China being an economic hub where a lot of businesses take place, many people travel to and out of China and therefore I would imagine that any outbreak occurring in China would easily and quickly spread to other regions compared to if such an outbreak would occur for example in an African country.”
In late January, China imposed a ban on trade and consumption of wildlife meat acquired through illegal trading activities, as cases of COVID-19 surged in Wuhan. The city of Shenzen went a step further to extend the ban on cats and dogs. This new law will be enforced on 1st May.
There have been 81,802 cases, 3,333 deaths and 77,279 recoveries since the outbreak (see our tracker for the most up to date numbers), numbers whose veracity continues to be heavily criticized after Chinese authorities reportedly suppressed the news of the outbreak when it first began.
However, for the first time since January, Wuhan reported no new deaths on April 7, joining the rest of China, which has reportedly seen no deaths since March – even though questions have been raised about the veracity of China’s claims. This sharp decline has been attributed to aggressive testing, quarantines and social distancing. Authorities have begun to ease restrictions on lockdowns though still taking precautions to fully resume normalcy in the country.
As to what the future of pandemics holds, Dr Okoth says it is not that easy to tell.
“It may not be possible to predict where a future pandemic may come from, but it is worth assessing such socio-economic and geopolitical factors when trying to generate a model to predict future pandemics.”
He, however, has a warning for African countries.
“Although so far tropical Africa is not recording very high cases as compared to the temperate regions, seasonal variations may work against us. For example, the cold season starting in June through to the end of July (in the case of Kenya) and other southern African countries may make these regions become the epicentres of infections (if not controlled in time) in the coming months.”
This article was originally published by Africa Uncensored. Graphics by Clement Kumalija.
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