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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.

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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.

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Photo: Unsplash/Michael Anfang
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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.

Teen Pregancy Infographic.png

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.

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Modelling the COVID-19 Pandemic in East Africa

Using mathematical modelling to track and predict the progress of the coronavirus outbreak.

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Modelling the COVID-19 Pandemic in East Africa
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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.

Figure 1: COVID-19 Cumulative confirmed cases in East Africa, Europe, USA and China between 22/01/2020 and 21/04/2020. Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 2: COVID-19 Daily confirmed cases in East Africa, Europe, USA and China between 22/01/2020 and 21/04/2020. Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 3: Daily confirmed cases in China and some selected countries in Europe
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 4: Time taken to experience a downward trend in the Infections in Chinam Italy, France, Germany and Spain
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 5: Daily Confirmed and Recovered Cases in Kenya and China
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 6: Percentage Recovered and Dead Cases in East Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 7: African Countries with the highest confirmed cases
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 8: Cumulative Recovered and Dead cases in some selected countries in Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 9: Percentage recoveries and deaths in some selected countries outside Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 10: Reproduction Number
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

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.

Figure 11: Predicted Infections in Kenya for the next 5 days
Source: Author

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

 

       Date

 

Prediction

               95% Confidence Interval
Lower Limit Upper Limit
22/04/2020 12 5 20
23/04/2020 12 6 20
24/04/2020 13 6 21
25/04/2020 13 7 22
26/04/2020 14 7 23

 

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Why China? A Look at Viral Outbreaks That, Like COVID-19, Originate From the East

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Why China? A Look at Viral Outbreaks That, Like COVID-19, Originate From the East
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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.

Infographic: AFP

Asian Flu

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.

Bird Flu

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.

SARS

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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