Studies have shown that high blood pressure (BP) among children and adolescents is relatively common, although only a few have been conducted in Africa. Scientists from the Mwanza Intervention Trials Unit (MITU) recently published a report in the journal of Scientific Report – Nature which shows that adolescents with high BP in Tanzania can be identified in school settings and linked to routine health care services. This study was conducted in 2018 among 500 students aged between 11-15 years from three public secondary schools within Mwanza city.The report published was based on the study aimed to describe the procedures which could be used to accurately measure BP among adolescents and to determine the burden of high BP in this population. The study involved taking BP measurements using an automatic digital BP machine at three different occasions spaced at an interval of more than a month. Participants with sustained high BP had their BP status confirmed using a portable BP machine programmed to automatically record BP measurements every 15 minutes over 24 hours.
Dr Mussa Kelvin Nsanya – a researcher at MITU and the study lead author – said that, “Adolescents with high BP in Africa can be identified using multiple BP measurements taken at multiple steps in a span of days to months followed by a 24-hour BP monitoring for confirmation. In addition, schools could save as an effective platform for screening of high BP and raising awareness to cardiovascular diseases”.
Findings from this study showed that 50 out of 500 adolescents (10%) had sustained high BP on repeating BP measurements at three different occasions. Using BP measurements taken over 24 hours, investigators of this study confirmed that 13 (2.6%) adolescents had high BP. MITU scientists are continuing to follow-up participants enrolled in this study in order to identify those with high BP and examine factors related to long-term changes in BP measurements.
MITU in collaboration with the London School of Hygiene and Tropical Medicine and Ludwig Maximilian University of Munich, Germany has received funding from the European Research Council to conduct a study among 1,000 young men aged 18-24 years in Mwanza city, Tanzania. The purpose of this study is to investigate the patterns and factors that cause intimate partner violence in the study population.
Between June and December 2021, young men from 24 streets across the city will be invited to take part in the study and those who agree to participate will be interviewed. A team of 9 researchers is carrying out the survey in the streets located in 6 wards in Nyamagana and Ilemela districts of Mwanza city. The interviews cover a range of topics about the lives of these young men and their views and understanding of the different forms of intimate partner violence, its causes and possible ways for preventing it.
The interviews are carried out using hand held computer tablets – a modern data collection technique. In some parts of the interviews, the young men are given the tablets and head phones to listen to the questions and enter the responses by themselves. This ensures that they are part of the research process and safeguards the confidentiality of their responses.
Dr. Gerry Mshana, a senior researcher at MITU and lead scientist for this study said: “Intimate partner violence is a major problem hindering the health, wellbeing and development of children, young people and adults in Tanzania and other parts of the world. We are very pleased for the opportunity to carry out this important and unique study to generate evidence from young men in Mwanza on the magnitude of the problem and their views about it. The results will increase our understanding of the problem and help in designing appropriate interventions and policies in Tanzania and in other similar low-income countries.”
On 26 May 2021, MITU started conducting a survey to collect data that will help to evaluate a reproductive health programme known as “Adolescent 360” or A360. The A360 programme was implemented by the Population Services International (PSI) in 10 regions in Tanzania mainland, including the Mwanza region, and was targeting girls aged 15 to 19 years.
The survey is being conducted in 15 wards of Ilemela district in Mwanza city. In each ward, two streets will be selected by lottery to participate in the study and later visited by trained female research assistants to identify households with girls aged 15 to 19 years. Once this exercise is completed, female research assistants will visit the homes of identified girls to inform them about the study, obtain their consent to participate in the study, and conduct a detailed interview in a private location. Research assistants will also separately interview a sample of adults who live with the interviewed girls. MITU would like to find out whether the A360 programme helped to improve what girls’ knew about family planning (ways to delay or prevent pregnancy), and whether the programme made it easier for girls’ to use family planning services if they wanted to avoid or delay getting pregnant.
More than 5,000 girls will be involved in this survey which is expected to be completed by the end of September 2021. MITU received funds to conduct this survey from the Bill and Melinda Gates Foundation and the Children’s Fund Foundation.
Joint Statement by the Heads of the World Bank Group, International Monetary Fund, World Health Organization, and World Trade Organization
The Heads of the World Bank Group, International Monetary Fund, World Health Organization, and World Trade Organization today convened for the first meeting of the Task Force on COVID-19 Vaccines, Therapeutics and Diagnostics for Developing Countries. They issued the following joint statement:
“As many countries are struggling with new variants and a third wave of COVID-19 infections, accelerating access to vaccines becomes even more critical to ending the pandemic everywhere and achieving broad-based growth. We are deeply concerned about the limited vaccines, therapeutics, diagnostics, and support for deliveries available to developing countries. Urgent action is needed now to arrest the rising human toll due to the pandemic, and to halt further divergence in the economic recovery between advanced economies and the rest.
We have formed a Task Force, as a “war room” to help track, coordinate and advance delivery of COVID-19 health tools to developing countries and to mobilize relevant stakeholders and national leaders to remove critical roadblocks—in support of the priorities set out by World Bank Group, IMF, WHO, and WTO including in the joint statements of June 1 and June 3, and in the IMF staff’s $50 billion proposal.
At today’s first meeting, we discussed the urgency of increasing supplies of vaccines, therapeutics, and diagnostics for developing countries. We also looked at practical and effective ways to track, coordinate and advance delivery of COVID-19 vaccines to developing countries.
As an urgent first step, we are calling on G20 countries to (1) embrace the target of at least 40 percent in every country by end-2021, and at least 60 percent by the first half of 2022, (2) share more vaccine doses now, including by ensuring at least 1 billion doses are shared with developing countries in 2021 starting immediately, (3) provide financing, including grants and concessional financing, to close the residual gaps, including for the ACT-Accelerator, and (4) remove all barriers to export of inputs and finished vaccines, and other barriers to supply chain operations.
In addition, to enhance transparency we agreed to compile data on dose requests (by type and quantity), contracts, deliveries (including through donations), and deployments of COVID-19 vaccines to low and middle-income countries—and make it available as part of a shared country-level dashboard. We also agreed to take steps to address hesitancy, and to coordinate efforts to address gaps in readiness, so countries are positioned to receive, deploy and administer vaccines.”
Continuing routine immunisations during the pandemic estimated to save more than 700,000 child lives from vaccine-preventable diseases
The health benefits of maintaining routine childhood vaccination programmes in Africa during the COVID-19 pandemic far outweigh the risk of SARS-CoV-2 transmission that might be associated with clinic visits, according to a modelling study published in The Lancet Global Health.
For every additional COVID-19 death that might be associated with additional exposure to the virus during routine clinic visits, the model predicts that 84 deaths in children before five years of age could be prevented by continuing with routine vaccinations. The additional risk of COVID-19 transmission associated with clinic visits is predicted to primarily affect older adults living in the same household as the vaccinated children.
The findings suggest that continuing with usual vaccination schedules could prevent 702,000 child deaths from the point of immunisation until they reach five years of age.
The study looked at all 54 countries of Africa and found that in all countries, the number of child deaths averted through vaccination far exceeded the number of excess COVID-19 deaths that might be associated with clinic visits.
However, the authors acknowledge there are other issues that will affect whether vaccination programmes can continue, such as vaccine supply chain problems or healthcare staff shortages during the pandemic.
Dr Kaja Abbas, joint lead author of the study, from the London School of Hygiene and Tropical Medicine, UK, said: “We found that, even with our most conservative estimates, the benefits of routine childhood immunisation in Africa are likely to far outweigh the risk of additional COVID-19 transmission that might ensue, and these programmes should be prioritised as far as logistically possible.”
National immunisation programmes are at risk of disruption due to the severe health system constraints associated with the ongoing COVID-19 pandemic and physical distancing measures introduced to mitigate transmission of the virus.
Researchers created a mathematical model to assess the risks and benefits of continuing with vaccination programmes during the current pandemic for all 54 countries of Africa. Their model assumes that the spread of COVID-19 in African countries will be similar to other countries that were affected earlier in the pandemic and were unable to control the virus. It estimates around 60% of the population will become infected and that the potential disruption to health services will last for six months.
Exact data on the risk of SARS-CoV-2 infection associated with routine clinic trips for childhood immunisations were not available, so the model was based on assumptions relating to the likely number of people encountered during such a journey, both at the clinic itself as well as during travel there and back again. Risks to the child, accompanying adult and any household members were taken into account. The model also accounted for the household size and age composition in each country, as risk of death from COVID-19 is known to substantially increase with age.
The researchers based their estimates of the number of childhood deaths that could be prevented by routine immunisations on existing health data from each country. They focused on the impact of vaccines for diptheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b and Streptococcus pneumoniae (bacterial causes of pneumonia and meningitis), rotavirus, measles, rubella, meningitis A and yellow fever. Vaccination rates for each country were assumed to be the same as in 2018.
According to the model, continuing with routine immunisation programmes may lead to 8,300 additional deaths across Africa (uncertainty interval 1,300 to 25,000), attributable to SARS-CoV-2 infections associated with children visiting immunisation clinics.
However, suspending such vaccination programmes to avoid excess COVID-19 deaths could lead to 702,000 children across Africa dying from preventable diseases before the age of five (uncertainty interval 635,000 and 782,000), according to the model. The researchers say this scenario assumes no catch-up vaccination campaigns at the end of the COVID-19 risk period and may overestimate the negative impact of suspending vaccination services for a short period of time.
Even in a much more conservative scenario (where suspending vaccination is primarily assumed to increase the chance of a local measles outbreak and children would be protected from other diseases from existing immunity in the population or catch-up immunisation campaigns at the end of the COVID-19 risk period), the number of childhood deaths that could be prevented was still greater than the potential increase in COVID-19 deaths for most countries of Africa.
Dr Tewodaj Mengistu, co-author of the study, from Gavi, the Vaccine Alliance, Switzerland, said: “Routine immunisation programmes are facing enormous disruption across the globe due to this pandemic. Lockdowns make it harder for vaccinators and parents to reach vaccination sessions, health workers are being diverted to COVID-19 response, and misinformation and fear are keeping parents away. This important study shows just how big an impact this could have, risking the resurgence of diseases that vaccines have kept largely at bay.”
Findings were similar for all 54 countries of Africa, ranging from between 4 and 124 preventable child deaths in Morocco to between 28 and 598 in Angola, for each excess COVID-19 death. One third of vaccine-preventable deaths would be in Nigeria, Ethiopia, Democratic Republic of Congo and Tanzania, the study found. Around one third of vaccine-preventable deaths would be caused by measles, and another third would be attributable to pertussis, according to the model.
While the study clearly shows the health benefits of vaccination for children, it revealed that the additional risk of COVID-19 infections acquired during visits to the clinic would primarily affect adults from the same household. According to the model, 11% of excess COVID-19 deaths attributable to clinic visits are expected to affect parents or adult carers and 88% are predicted to affect older adults living in the same household as the vaccinated children. The researchers say this highlights the importance of shielding older adults to lower their risk of acquiring COVID-19, while children in their households can benefit from routine vaccinations.
Dr Stefan Flasche, senior author of the study, from the London School of Hygiene & Tropical Medicine, UK, said: “We found that the biggest factors affecting the benefit of maintaining childhood immunisations during the pandemic are the likelihood of transmission of COVID-19 during clinic visits and the number of people encountered at the clinic. This highlights the need for personal protective equipment for clinic staff, the need to implement physical distancing measures and avoid crowded waiting rooms, and the importance of good hygiene practices to reduce virus transmission.”
The authors acknowledge that other factors must be considered when making decisions on sustaining routine childhood immunisation programmes during the COVID-19 pandemic. These include vaccine supply chain problems, reallocation of doctors and nurses to other prioritised health services, staff shortages resulting from ill-health or COVID-19 infection, and decreased demand for vaccination caused by fear of contracting COVID-19.
Dr Emily Dansereau, co-author and program officer at the Bill & Melinda Gates Foundation, USA, said: “Across the African continent, many essential health services – from immunization to antenatal care to HIV and TB services – are experiencing significant challenges in the face of COVID-19. To address these new challenges and build resilient health systems, countries are exploring how to rethink health service delivery and are embracing innovative approaches to reach women, children and families with high quality support and care.”
Kaja Abbas*, Simon R Procter*, Kevin van Zandvoort, Andrew Clark, Sebastian Funk, Tewodaj Mengistu, Dan Hogan, Emily Dansereau, Mark Jit, Stefan Flasche, LSHTM CMMID COVID-19 Working Group. Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Global Health. DOI:10.1016/ S2214-109X(20)30308-9
We have new exciting news about a low cost drug which has been found to be effective in treating severe COVID-19 cases. See attached PDF file.
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The investigational antiviral remdesivir is superior to the standard of care for the treatment of COVID-19, according to a report published today in the New England Journal of Medicine. The preliminary analysis is based on data from the Adaptive COVID-19 Treatment Trial (ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The randomized, controlled trial enrolled hospitalized adults with COVID-19 with evidence of lower respiratory tract involvement (generally moderate to severe disease). Investigators found that remdesivir was most beneficial for hospitalized patients with severe disease who required supplemental oxygen. Findings about benefits in other patient subgroups were less conclusive in this preliminary analysis.
The study began on Feb. 21, 2020 and enrolled 1,063 participants in 10 countries in 58 days. Patients provided informed consent to participate in the trial and were randomly assigned to receive local standard care and a 10-day course of the antiviral remdesivir intravenously, developed by Gilead Sciences, Inc., or local standard care and a placebo. The trial was double-blind, meaning neither investigators nor participants knew who was receiving remdesivir or placebo.
The trial closed to enrollment on April 19, 2020. On April 27, 2020 (while participant follow-up was still ongoing), an independent data and safety monitoring board overseeing the trial reviewed data and shared their preliminary analysis with NIAID. NIAID quickly made the primary results of the study public due to the implications for both patients currently in the study and for public health. The report published today in the New England Journal of Medicine describes the preliminary results of the trial.
The report notes that patients who received remdesivir had a shorter time to recovery than those who received placebo. The study defined recovery as being discharged from the hospital or being medically stable enough to be discharged from the hospital. The median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. The findings are statistically significant and are based on an analysis of 1059 participants (538 who received remdesivir and 521 who received placebo). Clinicians tracked patients’ clinical status daily using an eight-point ordinal scale ranging from fully recovered to death. Investigators also compared clinical status between the study arms on day 15 and found that the odds of improvement in the ordinal scale were higher in the remdesivir arm than in the placebo arm. Trial results also suggested a survival benefit, with a 14-day mortality rate of 7.1% for the group receiving remdesivir versus 11.9% for the placebo group; however, the difference in mortality was not statistically significant.
Ultimately, the findings support remdesivir as the standard therapy for patients hospitalized with COVID-19 and requiring supplemental oxygen therapy, according to the authors. However, they note that the mortality rate of 7.1% at 14 days in the remdesivir arm indicates the need to evaluate antivirals with other therapeutic agents to continue to improve clinical outcomes for patients with COVID-19. On May 8, 2020, NIAID began a clinical trial (known as ACTT 2) evaluating remdesivir in combination with the anti-inflammatory drug baricitinib compared with remdesivir alone.
J Beigel, et al. Remdesivir for the Treatment of COVID-19 – A Preliminary Report. The New England Journal of Medicine. DOI: 10.1056/NEJMoa2007764 (2020).
NIAID Director Anthony S. Fauci, M.D., is available for comment.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
Full publication : https://www.nejm.org/doi/full/10.1056/NEJMoa2007764
Disproportionate numbers of adults with chronic diseases, such as obesity, hypertension and lung disease, reduced their physical activity levels during the first weeks of the UK COVID-19 lockdown, according to a new study co-led led by the London School of Hygiene & Tropical Medicine (LSHTM),
The research, conducted with UCL and the University of Bath, also found similar reduced levels of activity for people with disabilities and depression.
Published as a pre-print on medRxiv, the study uses data from a UK-wide online survey of more than 5,800 adults aged 20 and over, and reveals that while the majority (60%) of adults have maintained the same intensity of physical activity as they did pre-COVID-19, a quarter (25.4%) adopted lower intensity physical activity. This latter group included a bigger proportion of adults who have health conditions that heighten the risk of suffering from the most severe effects of COVID-19, should they contract the SARS-CoV2 virus.
Lead author of the study, Dr Nina Rogers (UCL Epidemiology & Public Health) said: “Low levels of physical activity put adults at increased risk of chronic diseases like obesity, cardiovascular disease and stroke which are also potential risk factors for more severe complications if someone develops COVID-19.
“It is concerning that in the mid to long term, multiple lockdowns might lead to prolonged periods of low physical activity which could increase the size of the population that is most vulnerable to severe complications from COVID-19.”
The study also found that not only people with medical conditions but also those who perceived themselves or others in their home to be at risk, had more frequently changed towards a more inactive lifestyle.
Senior author Dr Chrissy Roberts, Associate Professor at LSHTM said: “We believe that the trade-off between being protected from COVID-19 and the health detriments of reduced physical activity could place already vulnerable populations in a potential ‘no-win’ situation.
“When we’re talking about vulnerable people, it’s not just those who already have underlying health problems, but those who perceive themselves to be at risk too.
“We could well see seasonal cycles of COVID-19, as we do with flu. If that’s the case then we have to start thinking about protecting people from this COVID-19 epidemic, or the one that could come next year. If a person feels at risk now and reduces their physical activity in response, then this could set them on a course towards developing the same risk factors that would make them vulnerable to severe complications from COVID-19 in subsequent epidemic waves.”
Virologist Peter Piot, director of the London School of Hygiene & Tropical Medicine, fell ill with COVID-19 in mid-March. He spent a week in a hospital and has been recovering at his home in London since. Climbing a flight of stairs still leaves him breathless.
Piot, who grew up in Belgium, was one of the discoverers of the Ebola virus in 1976 and spent his career fighting infectious diseases. He headed the Joint United Nations Programme on HIV/AIDS between 1995 and 2008 and is currently a coronavirus adviser to European Commission President Ursula von der Leyen. But his personal confrontation with the new coronavirus was a life-changing experience, Piot says.
This interview took place on 2 May. Piot’s answers have been edited and translated from Dutch:
“ON 19 MARCH, I SUDDENLY HAD A HIGH FEVER and a stabbing headache. My skull and hair felt very painful, which was bizarre. I didn’t have a cough at the time, but still, my first reflex was: I have it. I kept working—I’m a workaholic—but from home. We put a lot of effort into teleworking at the London School of Hygiene & Tropical Medicine last year, so that we didn’t have to travel as much. That investment, made in the context of the fight against global warming, is now very useful, of course.
I tested positive for COVID-19, as I suspected. I put myself in isolation in the guest room at home. But the fever didn’t go away. I had never been seriously ill and have not taken a day of sick leave the past 10 years. I live a pretty healthy life and walk regularly. The only risk factor for corona is my age—I’m 71. I’m an optimist, so I thought it would pass. But on 1 April, a doctor friend advised me to get a thorough examination because the fever and especially the exhaustion were getting worse and worse.
It turned out I had severe oxygen deficiency, although I still wasn’t short of breath. Lung images showed I had severe pneumonia, typical of COVID-19, as well as bacterial pneumonia. I constantly felt exhausted, while normally I’m always buzzing with energy. It wasn’t just fatigue, but complete exhaustion; I’ll never forget that feeling. I had to be hospitalized, although I tested negative for the virus in the meantime. This is also typical for COVID-19: The virus disappears, but its consequences linger for weeks.
I was concerned I would be put on a ventilator immediately because I had seen publications showing it increases your chance of dying. I was pretty scared, but fortunately, they just gave me an oxygen mask first and that turned out to work. So, I ended up in an isolation room in the antechamber of the intensive care department. You’re tired, so you’re resigned to your fate. You completely surrender to the nursing staff. You live in a routine from syringe to infusion and you hope you make it. I am usually quite proactive in the way I operate, but here I was 100% patient.
I shared a room with a homeless person, a Colombian cleaner, and a man from Bangladesh—all three diabetics, incidentally,which is consistent with the known picture of the disease. The days and nights were lonely because no one had the energy to talk. I could only whisper for weeks; even now, my voice loses power in the evening. But I always had that question going around in my head: How will I be when I get out of this?
After fighting viruses all over the world for more than 40 years, I have become an expert in infections. I’m glad I had corona and not Ebola, although I read a scientific study yesterday that concluded you have a 30% chance of dying if you end up in a British hospital with COVID-19. That’s about the same overall mortality rate as for Ebola in 2014 in West Africa. That makes you lose your scientific level-headedness at times, and you surrender to emotional reflections. They got me, I sometimes thought. I have devoted my life to fighting viruses and finally, they get their revenge. For a week I balanced between heaven and Earth, on the edge of what could have been the end.
I was released from the hospital after a long week. I traveled home by public transport. I wanted to see the city, with its empty streets, its closed pubs, and its surprisingly fresh air. There was nobody on the street—a strange experience. I couldn’t walk properly because my muscles were weakened from lying down and from the lack of movement, which is not a good thing when you’re treating a lung condition. At home, I cried for a long time. I also slept badly for a while. The risk that something could still go seriously wrong keeps going through your head. You’re locked up again, but you’ve got to put things like that into perspective. I now admire Nelson Mandela even more than I used to. He was locked in prison for 27 years but came out as a great reconciler.
I have always had great respect for viruses, and that has not diminished. I have devoted much of my life to the fight against the AIDS virus. It’s such a clever thing; it evades everything we do to block it. Now that I have felt the compelling presence of a virus in my body myself, I look at viruses differently. I realize this one will change my life, despite the confrontational experiences I’ve had with viruses before. I feel more vulnerable.
One week after I was discharged, I became increasingly short of breath. I had to go to the hospital again, but fortunately, I could be treated on an outpatient basis. I turned out to have an organizing pneumonia-induced lung disease, caused by a so-called cytokine storm. It’s a result of your immune defense going into overdrive. Many people do not die from the tissue damage caused by the virus, but from the exaggerated response of their immune system, which doesn’t know what to do with the virus. I’m still under treatment for that, with high doses of corticosteroids that slow down the immune system. If I had had that storm along with the symptoms of the viral outbreak in my body, I wouldn’t have survived. I had atrial fibrillation, with my heart rate going up to 170 beats per minute; that also needs to be controlled with therapy, particularly to prevent blood clotting events, including stroke. This is an underestimated ability of the virus: It can probably affect all the organs in our body.
Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We are learning while we are sailing. That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair.
“My lung images finally look better again. I opened up a good bottle of wine to celebrate, the first in a long time.”–Peter Piot, London School of Hygiene & Tropical Medicine