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Preeclampsia: The “Silent Killer” Stalking Expectant Mothers

Ten million women develop preeclampsia each year around the world. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. And, the number of babies who die from these disorders is thought to be on the order of 500,000 per annum, according to the World Health Organisation.

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Preeclampsia: The “Silent Killer” Stalking Expectant Mothers
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A recent study has revealed that expectant mothers in African countries, especially Uganda are more likely to die with preeclampsia condition compared to their counterparts in other East African countries.

Preeclampsia is a pregnancy disorder characterised by hypertension especially after 20 weeks of pregnancy. It can be dangerous to both the mother and the unborn baby. Gestational pregnancy may increase the risk of premature birth of the baby, increased birth weight of the baby, cesarean delivery, and preeclampsia.

Bulk of government health facilities in the country are struggling to manage the condition since most of the critical drugs needed to manage the condition are not stocked, simply because the government has not prioritised the condition.

The condition is the second cause of maternal deaths worldwide.

Preeclampsia: The “Silent Killer” Stalking Expectant Mothers

The study done by the Health Action on the situation on reproductive health commodities revealed that only 25 per cent of health facilities in Uganda stock Magnesium Sulphate as compared to 71 per cent in Kenya.

Magnesium sulphate is a mineral that reduces seizure risks in women with preeclampsia. A healthcare provider will give the medication intravenously.

The study conducted in four countries (Kenya, Uganda, Tanzania and Zambia) revealed that facilities in Tanzania and Zambia were not any better as far as the stocking of the commodity is concerned with 45 and 40 per cent respectively.

During the commemoration of world Preeclampsia Day on May 22 in Uganda, health facilities in Lira – a city in the Northern Region of Uganda – called for support from the government to enable them to handle mothers with the condition.

About 10 million pregnant women around the world develop preeclampsia each year. Out of the total 76,000 women die from preeclampsia and related hypertensive disorders. Additionally, the World Health Organisation (WHO) estimates the number of babies who die from these disorders every year to be on the order of 500,000.

In developing countries, a woman is seven times as likely to develop preeclampsia than a woman in a developed country. From 10-25 per cent of these cases will result in maternal death.

Preeclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications.

Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.

In developed countries like the US, pregnant women are commonly followed by a healthcare specialist (doctor, midwife or nurse) with frequent prenatal evaluations. In other areas of the world with little access to care and lower social status of women for instance in Africa, traditional health practices are usually inadequate to detect preeclampsia early.

Hypertensive disorders of pregnancy commonly advance to more complicated stages of the disease, and many births and deaths occur at home unreported.

Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia.

Although levels of prenatal care have increased in many parts of the world during the past decade, the WHO reports that only 46 per cent of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse.

But why are women in Africa dying of this condition yet it can be prevented?

Dr Annettee Nakimuli, an obstetrician-gynecologist at Mulago Hospital in Kampala and lecturer at Makerere University did research to answer that question.

She says although the condition affects women worldwide, in African women, it is more common and particularly severe. It also occurs earlier in pregnancy and can recur in subsequent pregnancies.

Dr Nakimuli reported that at Mulago Hospital where she works, 15 per cent of pregnancies develop life-threatening complications such as preeclampsia, hemorrhage, obstructed labour and sepsis.

She describes herself and her colleagues as being “on the front line” in the battle against death in pregnancy and childbirth. She did a study in 2017 in collaboration with Cambridge’s Department of Pathology and Centre for Trophoblast Research to unravel why a complex disease is so much worse in Africa.

But why would women of African descent suffer so much more from preeclampsia than other women? “There was an assumption in Africa that there was a socioeconomic reason, like poverty,” says Nakimuli. “I was convinced that there was something biological.”

She recruited 750 mothers at Mulago Hospital to what is the largest genetic study of pre-eclampsia conducted in Africa. She collected blood and umbilical cord samples and, in Cambridge, ‘typed’ the DNA to look at all the genetic variation.

“It was kind of a high-risk project, but my determination kept my hope alive. I wanted to find big things.” She says

The findings of the study revealed that killer-cell immunoglobulin receptors (KIRs), genes that protect African women against pre-eclampsia are different from those that protect European women.

KIRs recognises proteins called MHC on the invading fetal cells. Certain combinations of maternal KIR genes and fetal MHC genes are associated with pre-eclampsia, whereas other KIR genes appear to protect against the disease.

Moreover, the risky combination of maternal KIR and fetal MHC proteins occurs at a much higher frequency in sub-Saharan Africa than anywhere else in the world.

From the study, Dr Nakimuli together with other researchers will be researching to understand the biology of preeclampsia.

“We think that women of African ancestry may have these risk genes because of certain beneficial selective pressures, otherwise why would genes that kill mothers and babies be so common in the population? People with the gene that causes sickle-cell anaemia can fend off malaria – perhaps something similar is happening for KIR genes? And so now we are starting work to see whether the genes are protecting against infections such as measles, HIV and malaria.” She says

She also pointed out a lack of awareness and understanding of the condition as a barrier to treatment.

“There’s a general lack of awareness and understanding,” explains Nakimuli. “There isn’t even a Ugandan word for preeclampsia. The closest people get to describing the condition is ‘having hypertension which is different from other hypertension when you’re not pregnant’. It becomes a mouthful.”

Together with other researchers, they developed a format of awareness messages in which a radio presenter would play a real-life testimonial – such as a woman relaying the complications of her pregnancy – and then invite listeners to reply to a related question by sending a text to a toll-free number. Each respondent would subsequently receive an SMS socio demographic survey to complete.

“What makes preeclampsia such a challenge is that it has been impossible to predict or prevent,” explains Professor Ashley Moffett, from Cambridge’s Department of Pathology and Centre for Trophoblast Research, who is an expert on the disease.

“It’s been called the ‘silent killer’ because many women cannot feel the danger signs that their blood pressure is rising until it’s too late. Even when it is detected the only course of action is constant monitoring, and ultimately the only cure is delivery sometimes at too early a stage for the baby to survive,” adds Moffett.

However, during the release of the research study in the four countries in Zambia, Mr Denis Kibira, Executive Director, Coalition for Health Promotion and Social Development (HEPS) who conducted the study cited lack of enough blood pressure (BP) machines, designated preeclampsia ward, a postnatal ward, and inexperienced health workers to handle women with the condition as some of the challenges.

For instance, Lira Regional Referral Hospital in Uganda which receives about 100 expectant mothers daily for antenatal care, has only one blood pressure machine yet it serves nine districts in the region.

Mr Jino Okot, the in-charge of Ogur Health Centre IV, most health workers do not have the necessary skills to administer magnesium Sulphate and the government should do something to improve the situation of the mothers.

“Most of the health workers do not have the skills to diagnose preeclampsia. Some of them do not even know how to mix and administer. The Ministry of Health should understand that health workers need training if we are to ably manage the condition,” Mr Okot said.

Mr Edmond Acaka, Lira District assistant health officer-in-charge of maternal and child health, appealed to the Ministry of Health to come to the rescue of the district by increasing its budget to accommodate more of the commodities.

While Ms Beatrice Nyangoma, communications officer for HEPS-Uganda, asked the Ugandan government to consider regulating prices for magnesium sulphate to improve affordability and availability.

Mr Kibira while releasing the data to health journalists in Zambia in September said different levels of facilities were picked in each country. The methodology used consisted of a questionnaire and a qualitative survey component. Data collectors were trained in June 2018 (Tanzania), July 2018 (Kenya and Uganda), and August 2018 (Zambia).

The levels of health facilities visited in Kenya were level 3 and 5, in Tanzania: ‘Dispensary’ and above (country level 1-3), in Uganda: ‘Health Centre III’ and above (country level 3-7), and in Zambia: ‘Health post’ and above (country level 1-4).

The study conducted across sectors (public, private and mission) hospitals in urban and rural areas in 169 facilities in Kenya, 126 in Tanzania, 145 in Uganda and 237 in Zambia also revealed there was a large variability of supplements per type and country.

The mean availability of these commodities was 36 per cent in Kenyan health facilities, 29 per cent in Tanzanian, 37 per cent in Ugandan and 34 per cent in Zambian health facilities.

The data collection tool assessed the availability of 55 SRH commodities at the moment of data collection in each of the 677 study facilities.

Only in Zambia were all these supplements such as calcium gluconate, ferrous salt, folic acid, zinc, and oral rehydration salts commonly available (70-84 per cent overall) except calcium gluconate, which had an overall availability of just six per cent.

Calcium gluconate was also poorly stocked in other countries, with availabilities of 28 per cent in Kenya, 17 per cent (Uganda) and two per cent (Tanzania).

Oxytocin, used to induce labour and for the prevention and treatment of postpartum hemorrhage, was stocked relatively commonly (47-91 per cent), except the private sector in Kenya (27 per cent) and Zambia (20 per cent).

Zambia was leading with oxytocin stocks in facilities at 94 per cent followed by Kenya at 84 per cent. Tanzania third at 78 per cent while Uganda was the least with 64 per cent.

Gentamicin, used to treat pneumonia and neonatal and maternal sepsis,was moderately available in all countries (overall, 60-81 per cent), except for in Tanzania (23 per cent).

While the availability of dexamethasone, used in the management of pre-term labour to improve foetal lung maturity, was considerably lower, ranging from 11 per cent (overall, Tanzania) to 50 per cent in Uganda.

According to the World Health Organisation, the full intravenous magnesium sulphate regimens are recommended for the prevention and treatment of eclampsia.

“Magnesium sulfate is a lifesaving drug and should be available in all health-care facilities throughout the health system. The guideline development group believed that capacity for clinical surveillance of women and administration of calcium gluconate were essential components of the package of services for the delivery of magnesium sulfate,” says the WHO.

The international health agency states that in settings where there are resource constraints to manage the administration of magnesium sulfate safely in all women with pre-eclampsia, there may be a need to accord greater priority to the more severe cases.

The availability of medical devices from the study was inconsistent across the countries.

Speculums (metal or plastic device that is used to open the vagina enough to see inside were available at 85 per cent of the public facilities of Kenya, 84 per cent of Tanzania’s, 89 per cent of Uganda’s and 64 per cent of Zambia’s public facilities.

The private sector showed lower availabilities at 45 per cent of Tanzanian, 82 per cent of Uganda, 72 per cent of Kenya and 15 per cent of Zambian facilities.

Ultrasound scans had availability levels below 50 per cent in all sectors (public and private hospitals) of all countries, except the mission sector of Uganda (57 per cent).

Foetal scopes were commonly available in the public sector of Tanzania (97 per cent), Uganda (96 per cent) and Zambia (80 per cent), but not in Kenya (35 per cent).

Availability in the private and mission sectors showed a more mixed picture, with availabilities ranging from 16 per cent (private, Zambia) to 96 per cent (mission, Uganda).

Safe delivery kits were not at all available in Kenya and Uganda, and only 16 per cent of Zambian facilities. Tanzania had a much more elaborate availability at 82 per cent of public, 32 per cent of private and 33 per cent of mission facilities.

The availability of antiseptic was similar in Tanzania (65 per cent), Uganda (61 per cent) and Zambia (63 per cent), but lower in Kenya (24 per cent).

Vasectomy and tubal ligation kits were mostly unavailable in the four countries, with all overall availabilities below 10 per cent

Mr Kibira said most of the sexual reproductive health commodities were unavailable in most facilities because the governments were not budgeting enough for them.

“These are essentials that each country should have in place but most countries are not considering them as a priority hence the stock-outs,” he said

In the recommendation, Kenya was asked to adopt a multi-sectoral approach in the

provision of health services and commodities, especially in the rural and hard to reach areas, by integrating and bringing services closer to the population.

“County governments should include all the drugs as essential medicines by making budget available for their purchase,” recommends the study.

For Uganda, the government has been asked to actively seek out strategies to reduce the cost of high-cost SRHC such as magnesium sulphate, for instance through offering subsidies.

“Strategies to improve the SRHC supply chain must be actively sought to ensure that commodities are delivered on time and in the quantities ordered. Healthcare providers to receive additional training on SRHCs, especially in the private and mission sector facilities,” states the study.

The Zambian government has been urged to increase the number of trained staff, and improve the knowledge of existing staff and also improve the supply chain of the commodities.

For Tanzania, inadequate availability of SRH commodities, frequent stock-outs, poor logistic management, and limited community knowledge constituted major factors contributing to the problems experienced with accessing SRH commodities in the country

The government was, therefore, asked to ensure all the commodities on the international Essential Medicines Lists (EMLs) are also included in the Tanzania EML and sensitise communities about SRH services and commodities.

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Angela is a prolific and award-winning health writer who has written for the Daily Nation and is currently in a US-sponsored exchange program in Washington DC.

Data Stories

Revealed: Majority of US Voters Support Patent Waiver on COVID-19 Vaccines

Shock poll reveals majority support for Joe Biden to suspend TRIPS and support global vaccination.

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Photo: Hakan Nural on Unsplash
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A new poll finds that 60% of US voters want President Joe Biden to endorse the motion by more than 100 lower- and middle-income countries to temporarily waive patent protections on Covid-19 vaccines at the World Trade Organization. Only 28% disagreed.

The survey, carried out by Data for Progress and the Progressive International, shows a super majority of 72% registered Democrats want Biden to temporarily waive patent barriers to speed vaccine roll out and reduce costs for developing nations. Even registered Republicans support the action by margin of 50% in favor to 36% opposed.

The new polling shows that “there is a popular mandate from the US American people to put human life and economic recovery ahead of corporate profits and a broken intellectual property system,” said David Adler, the general coordinator of the Progressive International. Burcu Kilic, research director of the access to medicines program at Public Citizen and member of Progressive International’s Council, called on Biden to “listen to Americans who put him in power” and “do the right thing.”

Revealed: Majority of US Voters Support Patent Waiver on COVID-19 VaccinesDue to WTO intellectual property rules, countries are barred from producing the current leading approved vaccines, including US-produced Moderna, Pfizer and Johnson & Johnson. In October of 2020, South Africa and India presented the WTO with a proposal to temporarily waive these rules for the duration of the pandemic so that vaccines can be manufactured across different countries, increasing their availability, reducing their cost and ensuring that they are delivered to everyone on earth as quickly as possible.

In the absence of the waiver, the current manufacturing and distribution rates are unlikely to stem the pandemic’s momentum, especially as new variants, which are more infectious and seem to evade the acquired immunity from prior infection or from the current vaccines, continue to emerge. The US under President Trump joined other richer nations to block them.

The shock poll reveals a level of public support for intellectual property waivers that will likely add to growing congressional pressure on Biden to join those pushing to save lives through a global vaccination drive. Congresswoman Jan Schakowsky is working on a letter to the president to which Schakowsky says more than 60 lawmakers have added their signature, including House Speaker Nancy Pelosi.

Senator Bernie Sanders, Chair of the Senate Budget Committee, responded to the poll saying the US should be “leading the global effort to end the coronavirus pandemic.” According to Sanders, “a temporary WTO waiver, which would enable the transfer of vaccine technologies to poorer countries, is a good way to do that.”

Responding to the new poll, Representative Ilhan Omar called on Biden to “support a waiver to boost the production of vaccines, treatment and tests worldwide,” arguing that it was “not just an issue of basic morality, but of public health.”

Adler argues, “US Americans know rigged rules to prop up big pharma’s profits are not in their interest. The longer the virus has to spread, the more it can mutate and become vaccine-resistant. Covid-19 anywhere is a threat to public health and economic wellbeing everywhere. If intellectual property restrictions are not lifted, the pandemic will go on for longer, killing more people and damaging more livelihoods.”

The threat to the Global South from vaccine apartheid is a “death sentence for millions around the world—and it is because giant pharmaceutical corporations would rather maximize profit than provide vaccines to people who need it,” according to Omar.

Sanders agrees, saying “the bottom line is, the faster we help vaccinate the global population, the safer we will all be. That should be our number one priority, not maximizing the profits of pharmaceutical companies and their shareholders.”

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Erosion of Civil and Political Rights in Africa: Ibrahim Index (IIAG) 2020 Report

The IIAG report concludes that 2020 was a terrible year for democracy in Sub-Saharan Africa where political freedoms have deteriorated over the last decade, with citizens having less freedom to assemble in 2019 than they did in 2010.

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Erosion of Civil and Political Rights in Africa: Ibrahim Index (IIAG) 2020 Report
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Is there a link between democratic liberties and human rights on one hand, and good governance and economic progress on the other? Ever since the fall of the Berlin wall, a thirty-year orthodoxy has argued that the former are indispensable to the latter. However, a report by the Mo Ibrahim Foundation raises questions about this.

2020 Ibrahim Index of African Governance (IIAG)According to the 2020 Ibrahim Index of African Governance (IIAG), political freedoms across the African continent have continued to deteriorate over the last decade, with citizens having less freedom to assemble in 2019 than they did in 2010, and the trend has accelerated since 2015. On the other hand, countries’ scores in the Human Development and Foundations for Economic Opportunity categories have improved, with the biggest strides being made in infrastructure and health.

And although African countries made progress in overall governance during the last decade, the rate of improvement has slowed down over the last five years which explains the below average score in 2019.

Does this mean that the Chinese model of development—which views human and political rights as a barrier to economic progress—is supplanting the Western model, which proposes that they should go hand-in-hand on the continent?

Andrea Ngombet, a human rights activist and former presidential candidate in the Republic of Congo, says that there is more to it than that.

“To be completely honest, the combination of Chinese money, Western companies’ corruption and African autocrats’ lust for power are the causes of the retreat of democracy. All of them have no interest in a democratic Africa with tax to pay, protected workers and protected environment,” he said.

When asked why democracy is in retreat in African countries, Ngombet explained, “China [reinforces] African autocrats with cheap loans which they use for clientelism and populist projects. As the loans are without any democratic conditions, it allows the autocrats to resist the civil society pressure for democracy and accountability.”

Ngombet also explains that, “When looking at the quality of economic growth, it comes with bad loans over authoritarian regimes and those loans finance unprogressive infrastructure.”

The IIAG report shows that Gambia—the most improved of the 54 African countries—experienced the most changes after 2016 when Yahya Jammeh’s repressive 22-year-reign ended, although the current regime still faces challenges in enforcing environmental policies and in the areas of quality of education, law enforcement and compliance with international health regulations.

Source: 2020 Ibrahim’s Index

Source: 2020 Ibrahim’s Index

 

 

The study, whose goal was to help further the conversation on governance in the continent and assess current and emerging trends, analysed 237 variables from 40 different sources. It revealed that African countries are performing the worst in the Participation, Rights & Inclusion category (with an overall average score of 46.2 in 2019). This decline is caused by a deteriorating security situation and an increasingly “precarious environment for human rights and civic participation”.

Source: 2020 Ibrahim’s Index

Source: 2020 Ibrahim’s Index

Nearly half the countries on the continent had less freedom to associate and assemble and a shrinking space for political pluralism and civil society at the close of the 2010s than they had at the beginning of the decade. This was the continuation of a diminution of civil liberties in the second half of the 2000s following improvements in the first half of that decade.

In particular, compared to the country’s scores in 2010, Kenya’s scores for freedom of association and assembly as well as media freedom fell by over 20 per cent from 2015 while the indicators for transparency and accountability, as well as anti-corruption mechanisms also fell during the same period.

However, the Ibrahim report does indicate that the indicators for digital access, energy access, infrastructure and human resources in the education sector have shown a marked improvement under the current Kenyan regime. This is despite a huge debt burden and numerous unresolved corruption cases.

Increased restrictions have been placed on the establishment and operations of civil society and non-governmental organisations which have also experienced higher cases of repression and persecution in most African countries. Political parties have experienced reduced access to state-owned media and public financing for their campaigns which has curtailed their operations.

Democratic elections, the only indicator that had shown a steady improvement since 2010, took a downward spiral in 2015. Election results in countries such as Uganda, Kenya, Côte d’Ivoire, Central Africa Republic, Gabon and the Democratic Republic of Congo have been consistently disputed as the integrity of the electoral process and the independent functioning of election-monitoring bodies have been compromised.

“You can not have democratic elections in the absence of strong institutions such as Independent judiciary, a parliament that is not completely corrupted, independent press, civil societies to monitor and people to engage citizens ahead of elections and inform them by helping them understand democracy rest on their shoulders, governance rests on their shoulder, and not the person that they’ll vote in for,” Tutu Alicante, executive director at EG Justice in  Equatorial Guinea explains.

“It is us that [create] democracy. It is us that [create] governance and all the security, rule of law and human development and not the person [who] as soon as elected will focus on their pockets and family.”

Countries such as Equatorial Guinea, Eritrea, Chad, DRC, Rwanda and Cameroon that have scored dismally in the participation, rights and inclusion category, have all been under the rule of African leaders who have clung on to power.

These findings resonate with those of the 2020 Economist Intelligence Unit Democracy Index which placed Chad, Central African Republic and Democratic Republic of Congo at the bottom of the rankings in democracy in Africa, measured by electoral process and pluralism, functioning of government, political participation, political culture and civil liberties.

It may be encouraging for citizens of Djibouti, Somalia and Eswatini that although their countries are among those with the least scores in terms of participation, they have registered improvements over the decade.

“Full democratic participation is essential for the development in our society. In Africa if we are thinking about Ubuntu as a basic principle of our society, then clearly democracy is needed in a way in which we all participate in order for us as a society to rise up,” Tutu adds.

Egypt has performed exceedingly well in the score for infrastructure (80/100), and health development indicators (all above 60/100) yet, surprisingly, the country is the third least performing country in Africa, after Burundi and Eritrea—with a score of 7.9/100—when it comes to participation as a principal of good governance.

Egypt has been under dictatorship since the Arab Spring overthrew Hosni Mubarak in 2011. The government has authorised the blocking of close to 500 websites belonging to news outlets, blogs and human rights organisations, and in 2017 blocked the use of internet tools such as VPNs.

Other countries that have experienced drastic internet shutdowns, legal digital restrictions and surveillance include Ethiopia, Zimbabwe, Morocco, Benin, Rwanda, Morocco, DRC and Uganda. This often happens during electioneering periods or citizen protests despite “freedom of expression being a fundamental human right enshrined in Article 19 of the Universal Declaration of Human Rights and the cornerstone of democracy”, according to UNESCO, an organisation to which most of these countries belong.

Countries that have managed to transition from dictatorships or civil wars, such as Sierra Leone, Gambia, Togo, Angola and Sudan manifest increasing improvement in their citizens’ access to the fundamental civil rights.

African governments are slowly becoming more inclusive and equal in the provision of public services and the creation of socioeconomic opportunities.

Kenya and Somalia have seen the most improvements under the Gender indicator. Although Kenya has faced difficulties in passing the two-thirds gender rule (leading former Chief Justice Maraga to direct that the president dissolve parliament), it has made impressive strides in providing social-economic opportunities for women and in the representation of women in the executive even though gender equality in civil rights has declined substantially.

In contrast, women in South Africa, Ghana and Equatorial Guinea are enjoying less protection against gender violence.

Is it a question of striking a delicate balance between good overall governance and maintaining the economic growth and security of a country? Or might too much freedom lead to coups and mutiny?

The EUI Democracy report ranked Mali and Burkina Faso—both of which do not have full control over their territories and experience rampant insecurity precipitated by jihadist insurgents—as the worst performing countries in West Africa in terms of democracy. They were downgraded from “hybrid regime” to “authoritarian regime”. The report concludes that overall it was a terrible year for democracy in Sub-Saharan Africa, where 31 countries were downgraded, eight stagnated and only five improved their scores.

It is an interesting phenomenon that, despite low scores in civil and political rights, the best scores are to be found in the Foundations for Economic Opportunity and Human Development categories with 20 countries having improved their governance score in these two areas, albeit at a slowed rate in the last five years. The biggest strides have been made in the Infrastructure and Health indicators, complemented by improvements in Environmental Sustainability.

More often than not, infrastructure and health projects are marred by allegations of corruption and lack of transparency. Yet, a correlation model run by the Mo Ibrahim Foundation shows that there is a strong and positive correlation between the overall governance score and specific indicators such as rule of law and justice, inclusion and equality, anti-corruption, transparency and accountability and business environment. Even though statisticians agree that “correlation does not imply causation”, this model indicates that countries with higher scores in those indicators also have higher overall governance scores.

Yuen Ang argues that “the idea that economic growth needs good governance and good governance needs economic growth takes us to a perennial chicken-and-egg debate” whereas Meles Zenawi has claimed “There is no direct relationship between economic growth and democracy historically or theoretically. Democracy is a good thing in and of itself irrespective of its impact on economic growth and my view is that in Africa most of our countries are extremely diverse that maybe the only option of keeping relationships within nations sane. Democracy may be the only viable option of keeping these diverse nations together, we need to democratise but not in order to grow, we need to democratise in order to survive as a united same nation.”

The 2020 IIAG report paints a picture of a continent that had long embarked on the road to decline in rights, civil society space and participation before it was hit by COVID-19. Even though Africa accounts for 3.5 per cent of the global reported COVID-19 deaths, the pandemic is now threatening hard-won gains in areas such as foundations for economic opportunity and human development.

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The Music of the Nyayo Era

Perhaps, we argue, that if we listen to the popular music of his twenty four year rule can we observe the fingerprint and maybe get a glimpse of the Man and his legacy.

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The Music of the Moi Years
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This week marks the first anniversary since the death of the second president of Kenya, Daniel Torotich Arap Moi. Indeed, much has been written and said about Daniel arap Moi, and his death uncorked a litany of previously hidden details and insights into the Shakespearian drama he presided over while in office.

But how do we evaluate the legacy of Moi’s agency during his time in office?

Is it through the memoirs that will and have been written, the popular slogans that were created by his regime and sang by his supporters or is it the “official” narrative peddled by the state? Or is it, perhaps, the pain his detractors and critics faced or the scars of the victims who suffered his heavy hand?

Popular music reflects the culture of our day. Through it, we can observe the blueprint of an age in the lyrics and sound of that time.

Perhaps, we argue, that if we listen to the popular music of Moi’s twenty four year rule can we observe the fingerprint and maybe get a glimpse of the Man and his legacy.

The following is a chronological account of the sounds and hits that defined the twenty four year rule of Daniel Torotich Arap Moi.

1978: The Kenya scene is just coming off of Daudi Kabaka’s African Twist. But we must start with that style Msichana wa Elimu, a song that advises about marriage. Daudi Kabaka was born in 1939 and died in 2001, was a popular Kenyan vocalist, known by his fans as the undisputed King of twist. Jomo Kenyatta died on August 27th of 1978 and President Daniel Torotich took over as the second president of Kenya.

 

1979: Nico Mbarga has taken over Africa with Sweet Mother. Locally Slim Ali and The Hodi Boys Band are all the rave, playing in hotel lounges and clubs across the Middle East and North Africa and ended up in Kenya Slim Ali is from Mombasa. Here, President Moi is still loved and respected by many people. He enjoys popular support from the people. A pull-out from the Nation describes him as a humble and accessible president.

1980: Fadhili Williams re-releases Malaika. The song was first recorded by a Tanzanian musician Adam Salim in 1945. Fadhili was born in Taita Taveta in 1938 and died in 2001.

1981:  Maroon Commandos and Habel Kifoto produce Charonyi Ni Wasi.

1982: The August 1st coup, a failed attempt to overthrow President Daniel Arap Moi’s government so musicians are under pressure to release unity and praise songs. The biggest hits come from Jambo Bwana by Them Mushrooms which was featured in Cheetah, a Disney film that had the phrase Hakuna Matata which became very popular when Disney released The Lion King later.

1983: Safari Sounds Band releases are recorded That’s Certified Gold. Among the biggest hits were Mama lea mtoto wangu.

1984: Moi has banned Congolese music. But he changes his mind after the release of Mbilia Bel – Nakei Naïrobi (“El Alambre”).

1985:  By now the Nairobi live scene has suffered because of the effects of  the 1982 coup and Moi’s informal censorship. The dark days of the Nyayo era at a crescendo. Detention without trial of many political prisoners and others flee the country at risk of facing the heavy hand of the regime. Still, a rebirth happens in the music scene led by Sal Davis and The Establishment The music isn’t politically conscious however.

1986:  The many detentions of the Nyayo era has also killed the vernacular live scene. State operatives at the time saw these spaces as points of political mobilisation, but Joseph Kamaru leads a little uprising popularising Kikuyu vernacular hits.

1987:  D.O Misiani and Orch come to the scene. And Shirati Band releases some seditious tracks among them Safari Ya Musoma.

1988:  Mombasa Roots Band arrived on the scene with Disco Chakacha – originally released in 1986.

1989: Ten years after it was founded Muungano Choir finally created a pop smash hit Safari Ya Bamba. The following year they released Missa Luba recorded in Germany after the Berlin wall came down, ending the cold war era and the triumphant of liberal democracy.

1990: Les Wanyika released an earthshaking album. One of the biggest hits was Sina Makosa

1991: Albert Gacheru makes his way through Kikuyu Pop music. His biggest hit Mariru – Kikuyu Mugithi Songs

1992: JB Maina releases Mwanake. And Japheth Kassanga, Mary Wambui, Helen Akoth and Mary Atieno are redefining gospel music with the shows Joy Bringers and Sing and Shine.

1993:  Diversification happens in Kenya’s music industry. Many acts like Sheila Tett, Musically Speaking – later Zanaziki and a boy band called 5 Alive change the music scene. Among the many tracks released by Zanaziki is a popular hit. Also, Okatch Biggy and not to forget Princess Julie who create the soundtrack to the Moi government response to HIV in Kenya Dunia Mbaya.

Mid-90s: Urban Music is now bigger than was ever expected. Another boy band Swahili Nation Mpenzi makes their way into the music scene. The opening up of Kenya’s democratic space after the repeal of section 2a in 1991, the import of American culture and growth of local media outlets drastically shifted Kenya’s music scene.

Ted Josiah brings out a  guy called Hardstone – Uhiki who is loved by the growing young urban population.

Jimmi Gathu and others organise for a musician called Eric Wainaina to do the first version of a new national anthem dubbed Kenya Only

Shadez O Black are challenging Hardstone for the artiste of the year award with this smash hit: Serengeti Groove.

Still in the mid 90s there’s a cultural earthquake that changed the music scene in Kenya. Kalamashaka’s hit –Tafsiri Hii. A culmination of  poor governance by the Nyayo era, the structural adjustment programs of the 80’s and 90’s and new young urban generation raised by a staple of America’s hip hop culture and Nairobi’s budding urban culture produces a socially and politically conscious movement of artists who go by the moniker Ukoo fulani.

Eric Wainaina later drops Nchi ya Kitu kidogo. The song that Moi’s government truly hated.

2000s: The music scene expands dramatically and is ungovernable A growing sign that the years of Moi were coming to an end and that he could not hold on any longer to power. Ogopa Deejays arrive in the music scene. The biggest song of those first two years, the soundtrack to the Exit if Moi. All the way from Okok Primary school Gidigidi Majimaji – Unbwogable. This song was used as a slogan by the coalition government that removed Moi from power.

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