Livelihood and Disease- Ebola outbreak and Challenges for Bush meat

www.ctvnews.ca/mobile/health/congo-s-ebola-outbreak-poses-challenges-for-bush-meat-1.3977007

#Livelihood vs Disease

#Live bush meat source of Ebola and other disease causing agents

#Butchers and handlers of live bush meat at risk

of contracting disease

#Smoked or cooked meat low risk of disease spread

#Challenges of Bush meat trade and Ebola outbreaks

The Black Pellets that Smell Trouble

I woke up to find two pellets on my cooker, I immediately recognized what they were. But because I had not found the culprits, I still had about a 10% doubt that my line of thought could be wrong. A few days later I heard the noise, rattling and running in the ceiling, that was the confirmation, there were rodents in the house. Whether they were rats or mice it did not matter, the problem was that there were rodents in the house. My mind wondered where they had been, how many they were, where were they hiding, what they had been eating and what is attracting them in the house.

Rodents as source of disease

Now the man and mouse chase started, I had to catch these rodents and get them out of the house. But why was I so concerned?

Apart from rodents being a nuisance and a nightmare in the house, they also carry infectious diseases in their urine and feaces. If the are infested with ticks or fleas, these also carry dangerous human infectious diseases, some of which are fatal.

These diseases can be spread through;

  1. A bite from a rodent
  2. A scratch
  3. Fleas or ticks carried by the rodents

The table below lists some of the infectious diseases spread by rodents and their modes of transmission.

So next time you see these four legged creatures, think twice before you pet them or entertain them in the house.

Why you should Iron your clothes inside out

In warm climates, it is common to air dry clothes. Apart from saving energy, air drying is simple and cheap. If you have ever travelled in the tropics or gone on vacations or holidays in tropical areas of the world, the simplicity of life is striking. While others may use a line to hang their clothes, many place their clothes on any surface as long as they get dry. Clothes can be dried on bushes, on fences, on the grass and many places.

Despite all these advantages of air drying there are times that one gets unwanted hitch hikers on their clothes. These hitchhikers are so small that they are difficult to spot with the naked eye. They are meticulously placed in hidden places within the clothes, be it a shirt, t-shirt, pair of trousers, shirts or under garments. The eggs laid by a fly Cordylobia anthropophaga will hatch within the seams and the larvae will burrow into the skin of the person wearing the clothes.

Cordylobia anthropophaga, tumbu fly

Cordylobia anthropophaga, tumbu fly

Ironing clothes, destroys the eggs of the fly and paying particular attention when ironing the seams can be helpful.

Remember that these fly larvae do not only burrow into human skin but in animal skin as well including dogs and cats.

How do you know if you are infected?

So what happens when one is infected by the fly? A small pimple like growth appears, it is sometimes itchy but painful. The swelling grows by the day and so does the pain. Fever follows and in a few days, the larvae can be seen wiggling within the skin on the swelling as it comes to the surface to breathe. By covering the pimple with a plaster, adhesive tape or Vaseline blocks the air and this forces the larvae to come to the surface as it struggles to breathe.

At this point the larvae can be carefully squeezed out, just like when squeezing out a pimple. Careful attention should be taken so as not to burst the larvae to avoid infection. A successful squeeze results in a hairy wiggling larvae and a hole in the skin where the larvae was staying.

Larvae of Cordylobia anthropophaga, tumbu fly

larvae of Cordylobia anthropophaga, tumbu fly

The wound should be carefully disinfected and dressed. If fever persists one should seek medical attention.

So next time you are out in the tropics remember to iron your clothes and beddings, so you don’t become a habitat for the hairy fly larvae.
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Experienced but no Opportunities- Capacity Building Without Infrastructure

The notion of capacity building is something that is repeatedly emphasized when addressing various challenges in low income countries. It is an idea that resonates not only with the developing world sharing information and knowledge with the resource poor countries in sub-Saharan Africa and other parts of the world but also within resource poor countries.

Capacity building is an idea that is accepted and has helped train personnel from various resource poor countries in essential techniques and methods . These techniques and methods are expected to improve knowledge, service provision and way of life for many.

Capacity building works on the notion that “the more we know the more we can achieve” but is this always the case?


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Why is capacity building important?

  1. There is always need for new ideas and capacity building is one way to achieve this.
  2. Capacity building fulfills the need for new experiences; this involves people traveling from one place to another in search for and to learn new ideas from others
  3. Capacity building also works on the notion that after attaining these new ideas and experiences the knowledge gained can be transferred and used at home (place of origin of the trained individuals)

With public health, infectious and non-communicable diseases, capacity building may involve new diagnostic methods and tools, disease prevention and management tools and skill sets needed for the various diagnostic tools.

One advantage of capacity building is that people are able to acquire training from various state of the art research institutes around the world. But there are many challenges that the trained individuals may face upon returning to their home countries.


These challenges include:

  1. Lack of infrastructure
  2. Lack of resources (reagents, equipment, finances/ funding) to sustain their newly acquired knowledge
  3. Skilled personnel move to new locations where they will be able to utilize their skills which most often involves abandoning their home base
  4. some of the skilled personnel opt to find new areas of work and sometimes completely changing careers due to lack of infrastructure/ tools.

With plenty attaining tertiary education and research skills (especially those from resource poor countries), scores are excited to retain home to utilize their skills. The challenge arises when they arrive at their home base and realize that their institutions do not have or completely lack up to date infrastructure to support their knowledge and skills. Soon the enthusiasm to work and help people in their home country boils down to frustration, leading to countless returning to the countries where they were trained and or other countries where they can get jobs matching their skill set.

The question remains “is capacity building without proper infrastructure in the intended countries/ populations, of benefit , or is it encouraging skilled personnel to move away from resource poor countries in search of greener pastures”?


In most resource poor countries, where the health systems are struggling, conducting research in life sciences including infectious diseases is a big challenge. Even if infrastructure such as research laboratories maybe available, finding/ obtaining reagents can be a logistical nightmare. Most often reagents have to be sourced from other countries, most often than not from Europe and USA. Importing these reagents incurs charges on top of the price for the reagents. This has resulted in abandoning such line of research and opting for affordable approaches where resources can be easily sourced locally.

Running a molecular biology and or a microbiology laboratory in resource poor countries not only requires the right equipment and skill set but also a reliable power supply. A reliable power supply is needed to keep the equipment running including storage facilities for reagents and samples. Samples and reagents that are not stored at optimum temperatures, are more likely not to work effectively and may result in poor outcomes.

Most often emerging, re-emerging and Neglected tropical diseases occur in rural areas most of which have poorly equipped health centers that are understaffed and can not run microbiology or molecular biology tests for diagnosis of these diseases. As such there is need for samples to be transferred to research laboratories in nearby towns and cities where laboratories are available. For some preparing the samples for transportation and the transportation itself can be a big challenge.

There is need to improve capacity in form of well equipped laboratories that can be able to carry out diagnostic tests such as those requiring PCR and other diagnostic techniques. To attain this not only are skilled personnel required but also steady power supply, equipment, funding and reagents. Lack of funding could result in abandoning such approaches.

It is essential to build capacity at all levels but also there is need to improve infrastructure so that people are able to use their skills to their maximum potential.

Infectious Disease Management Strategies- Cholera

Did you know that;

  • 2 billion people worldwide drink water from sources contaminated with feaces

  • Each year approximately 2.9 million people contract cholera worldwide

  • Approximately 80 million people live in cholera hotspots in Africa

  • Approximately 95 000 people die from cholera each year

Today’s entry looks at cholera and why this infectious disease is still a problem in many developing countries.

The story of Abdu- Al Nehmi is full of the challenges faced in this region and I quote;

“Despite having severe diarrhoea, 53-year-old Abdu al-Nehmi travelled for 3 hours from his village to Sana’a City, Yemen, for treatment. He was vomiting and the car broke down, but he had no other choice but to make the difficult journey, “There is no health centre in our area,” says Abdu. Since Yemen’s conflict escalated in 2015, more than half of all health facilities have closed or are only partially functional, leaving 14.8 million people without basic healthcare.”

This is one of the many stories of cholera not only in Yemen, but South Sudan, the Democratic Republic of Congo (DRC) and many other countries where cholera is endemic or suffer seasonal outbreaks of cholera.

As of April 2018, cases of cholera outbreaks were reported in Liberia, Congo, DRC, and Nigeria in central and west Africa ; Malawi and Zimbabwe in Southern Africa and Somalia and Uganda in East Africa

From Abdu- Al Nehmi’s story,

five challenges already stand out;

  1. People have to travel long distance and often facing many obstacles to get medical treatment
  2. Poor transportation
  3. Lack of health facilities in his local area
  4. Conflict which has led closure of most health facilities
  5. Lack of basic healthcare

Cholera is a preventable disease and can be controlled by a multi-sectoral approach, including;

a. Basic Water, Sanitation and Hygiene (WASH)

b. Oral Cholera Vaccines (OCV)

With a well functioning health system, proper infrastructure, adequate health personnel, sufficient knowledge and training capabilities, ample financial resources and good governance; it is possible to implement various intervention strategies to tackle cholera in rural communities as well as low income countries.

In as much as countries are part of declaration/s to combat cholera, implementing the agreed measures could be a challenge. This results in continued cholera outbreaks in the affected regions. Despite identification of cholera hotspots, most countries still struggle to control the disease due to various challenges. Implementation can be hampered by ongoing conflicts which further weaken existing health systems. This in turn increases the likelihood of diseases such as cholera, measles, malaria and diarrhoea which are preventable but spread rapidly within communities.

Shortage or lack of safe drinking water, proper sanitation and waste management are some of the main causes of cholera outbreaks. Overcrowding perpetuates the spread of cholera in peri-urban slums and refugee camps where sanitation and availability of safe drinking water could be a challenge.

Rural populations living along rivers and lake shores are also prone to cholera.

To prevent stories like that of Abdu al-Nehmi from happening again and save lives, Countries should take it upon themselves to improve the lives of their communities not only by signing declarations but by further implementing these agreements for the benefit of their populations. Improving governance, transportation, primary healthcare and providing safe drinking water will go along way in reducing diseases such as cholera and other infectious diseases affecting rural populations.

For further reading on infectious diseases and rural populations in developing countries; visit https://www.springer.com/us/book/9789811004261


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http://www.who.int/en/news-room/feature-stories/detail/prevention-for-a-cholera-free-world
https://reliefweb.int/report/democratic-republic-congo/cholera-outbreaks-central-and-west-africa-2018-regional-update-3
https://m.nasdaq.com/article/malawi-cholera-death-toll-rises-
to-30-after-heavy-rainfall-hits-capital-20180411-00924
http://nehandaradio.com/2018/04/14/cholera-outbreak-hits-chitungwiza/

Did You Know…

Did you know that ;

•approximately 15 million people die every year from infectious diseases?

•Most of the people dying from infectious diseases live in developing countries?

•over 300 emerging infectious diseases have been reported between 1940-2004

Infectious Diseases and Rural Livelihood is a book which looks at the effects of rural livelihood and the impact of infectious diseases on health and poverty. It explores cultures and traditions in developing countries and their role in infectious-disease management and prevention. It highlights the associated healthcare systems and how these have contributed to some of the challenges faced, and goes on to elaborate on the significance of community involvement in infectious-disease prevention, management and control. It also emphasizes the importance of surveillance and setting up strategies on infectious-disease management that are favourable for poor communities and developing countries. The book allows students, researchers, healthcare workers, stakeholders and governments to better understand the vicious cycle of health, poverty and livelihoods in developing countries and to develop strategies that can work better in these regions. Read more at https://www.springer.com/us/book/9789811004261

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Planning A Trip to the Tropics, Four Things You need to Know

Traveling to new places is exciting and sometimes adventurous but there is always the lingering fear when the destination are tropical countries.

Tropical countries are located between the Tropic of Cancer to the north approximately 23°26′ (23.5°) N and the Tropic of Capricorn to the south 23°26′ (23.5°) S.

Tropical countries are host to various infectious diseases some of which are fatal. People living in these regions struggle with these diseases making them one of the major public health problems. But what does this mean for the traveler?

A few items to have on your checklist before traveling to the tropics should include:

  1. Check what infectious diseases are prevalent in the country you plan to visit and take the necessary precautions
  2. Check what vaccinations are required in the countries you are interested to visit
  3. What is the healthcare system like in the country you are planning to visit
  4. Is there a possibility of medical evacuation

After arriving in your destination country it is important to know what are the recommended precautions for the various infectious diseases available locally. Sometimes it is the simplest of actions that can save your life.




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Cholera, Small-Scale Businesses and Livelihood

Sporadic cholera outbreaks are not unusual in most developing countries. The current outbreaks in Zambia and Malawi are a reminder of some of the challenges posed by infectious diseases in urban and semi-urban areas as well as rural communities. So, how does cholera come about?

Cholera is an infectious disease caused by bacteria, vibrio cholerae. The bacteria are introduced into the body through consumption of contaminated food or water. The bacteria are usually found in food and water contaminated with feaces. Hence in areas where there is poor sanitation, there is a high likelihood that water used for human consumption and cleaning food could be contaminated by human faecal matter. In areas where there is open defecation and water is collected from unprotected wells, rivers or lakes, the surface runoff (especially during the rainy season) collects faecal matter and deposits it in these water bodies. If this water is consumed without treatment with chlorine or boiling to kill the responsible bacteria, people are likely to contract cholera. For people living close to rivers and or lakes, defecating in water is one habit that perpetuates the spread of cholera. If the contaminated water source is not identified more people will be infected resulting into an outbreak.

The scenario described above is mostly common in rural areas where the availability of treated piped water is limited. But why are cholera outbreaks still occurring in urban and semi-urban areas for example in Lilongwe, Malawi, Lusaka, Zambia and Kinshasa, the Democratic Republic of Congo?

There had been a number of cholera outbreaks in London most of which had claimed a lot of lives. It is the outbreak in 1854 near Broad Street in London that brought up something unique and still applicable today. The outbreak killed over 600 people and it took the work of a physician John Snow to discover that contaminated water was the source of the outbreak. The district of Soho in London where the outbreak occurred was experiencing similar problems that we are experiencing today in most large cities in developing countries; influx of people into cities, with poor or lack of sanitary services to support the ever increasing population.

John Snow studied clusters of cholera cases to identify the source of the outbreak. Is it possible to apply the same theory that John Snow used to identify the sources of cholera in the affected areas? Apart from improving sanitation, are there efforts to find out what is the source of the cholera outbreaks?

Back to our towns and cities in developing countries, overcrowding in the cities has resulted in poorly designed settlements with poor sanitation facilities. These sanitation facilities include, waste disposal units, toilets, and sometimes safe water. Poor waste disposal, lack of clean toilets/latrines and safe drinking water have contributed to the spread of cholera. Flies from filthy toilets/latrines carry germs including bacteria responsible for cholera and contaminate fruits, and food that is not covered. If this contaminated food is consumed, that individual may contract cholera.

Take for example, in most informal settlements the food business is rampant. As people rush to work early in the morning they grab all sorts of food on the way. These include mangoes (in season in Malawi), boiled cassava, boiled maize, home-made traditional drinks (such as thobwa) that are re-packaged in bottles that have been used before, rinsed by the vendor and the drinks are then poured in these bottles. The challenge is what sort of water was used to clean the utensils holding the food, or the water used to clean the fruits, or the hands of the person serving/selling the food?

The food vending business in not only common in the informal settlements but also in the city markets, where food vendors prepare and sell food to the masses on the streets. The challenge with the markets in towns of most developing countries, is the waste that is lying around everywhere and flies that swarm these places. Poor sanitation in these market places could be a source of cholera.

Identifying the actual source of the disease is a huge task this could explain why Zambia, decided to ban gatherings and food vending in the city of Lusaka.  While reducing the risk of spread of cholera this ban has affected the livelihoods of many who survive on selling various food products.

Food vending is a source of income for many families. It is a business that does not require huge capital investment to start hence can be carried out by any household as long as they have the food. Whether it is selling ready-made food, or fruits of all kinds, the food business brings the required needs for the household on a daily basis. The little money they make from selling the food, the family is able to put a meal on the table. Unless it is carried out on a large scale, this is a hand to mouth business and any shock could affect financial situation of the family.  As such a ban like the one imposed in Lusaka Zambia, does not only prevent people from getting their daily snack or treat from the street/market but also deprives the food vendors of the needed income to sustain their households. To the food vendors, this is a hard blow as their lives depend on the money they make from their small scale businesses. To the government on the other hand, it is trying to fulfil its duty to reduce the risk of spread of cholera within the population.

The cost of the outbreak to the government and the population as a whole can never be underestimated. Cholera management, prevention and control requires a lot of resources both human and monetary. These hidden costs may never be visible to the public and the affected communities but they are there. For the cholera camp to run, the medicine and all necessary chemicals required to treat and disinfect all contaminated areas, the equipment used by the medical personnel, fuel and other transportation costs to transfer cholera patients to the camp, the list is endless.

On the community level, the loss of lives to cholera affects the family equilibrium. This could result in loss of livelihood, through death of the bread winner; loss of human capital, where the skills of the deceased are lost and loss of labour, where people are unable to tend to their farms and other businesses in order to take care of their sick family members.

Balancing the need to control and prevent the spread of cholera and how this affects livelihoods for small scale business owners and communities is no simple matter. The cost of prevention is cheaper than the cost of curing a disease. As the old saying goes “Prevention is Better than Cure”.

Let us work hard to prevent the spread of cholera in our communities. It begins with every individual, observing proper hygiene in our households, drinking and using safe water, keeping our surroundings clean, and making sure there is a toilet that is well kept and used will help reduce the spread of cholera and other diarrhoeal diseases.

For small scale business owners and food vendors, let us do our best to prepare and store the food we sell in clean  environments, the lives of your customers depend on you, keep your food safe so that you have a healthy customer. A dead customer will not come to buy from you. Cholera prevention begins with you.

For governments, ensure that populations are provided with safe drinking water and are taught the right methods to keep their water safe from contamination.

When Does an Outbreak Become a Threat?

Since August various outbreaks have made headlines, including the plague outbreak in Madagascar, the monkeypox outbreak in Nigeria, and the Marburg virus outbreak in Uganda. During the same period there have been several outbreaks of cholera, dysentery, malaria and diarrhoea some of which have gone unnoticed but are affecting children, and families in many regions of the world.

Why are some outbreaks given priority while others seemingly go unnoticed?

Some of the reasons some outbreaks make headlines could be due the virulent nature of the disease, how fast they can spread within a community, and the fatality or survival rate. A closer view on the diseases that were making headlines the past months can shed some light in this regard.

Marburg virus:

Marburg virus or Marburg haemorrhagic fever is a severe disease that is in the same family as Ebola

The disease which is passed on from non-human primates e.g. bats to humans and later from human to human is a cause for concern. With a case fatality rate varying between 24% – 88%; this a disease that cannot be taken lightly. Just like Ebola, Marburg virus disease can spread through contact with body fluids from the infected individual. There is currently no treatment for the disease.

Plague:

Plague is a dangerous disease that wiped entire villages in the middle ages (The Black death from 1347-1350 in Europe)

Even though currently the disease has a cure and is endemic only in a few countries with Democratic Republic of Congo, Madagascar and Peru being the most endemic, it is extremely dangerous if it gets out of control. Bubonic plague is the most common form and can be treated if detected early but pneumonic plague is the most virulent and can spread very rapidly through the population.  Plague is transmitted from animals to humans through a bite from an infected flea and can spread from human to human through direct contact with infected tissues and inhalation of infected respiratory droplets.

Monkeypox virus

Although similar to the eradicated smallpox virus

Monkeypox virus is milder with a case fatality rate between 1% and 10%. The disease is transmitted from wild animals to humans with limited spread from human to human. Even though the case fatality is low, the disease has no cure although the smallpox vaccine was highly effective in preventing monkeypox.

Of the three diseases outlined, one common factoris the affected population. These three disease outbreaks started in rural villages in Uganda, Madagascar and Nigeria respectively.

Rural populations carry most of the infectious disease burden in developing countries

The outbreak in Uganda started with a male game hunter who lived near caves with a heavy presence of bats. The man got sick and was nursed by his family and died. No samples were collected. A few days later the sister who nursed him died and so did another brother. Both the sister and the brother nursed the game hunter. After the death of the game hunter and after the sister got sick, the brother refused to be hospitalized and went back to the community.  This was after the infection was confirmed to be Marburg virus. The question arises, how could be allowed to go home when we had been in contact with two people who died from such a dangerous disease?

In the case of the plague outbreak in Madagascar, a man visited a rural plague endemic area and traveled by public taxi where his symptoms developed. The taxi ride took the man through two major cities, and was treated without following safety procedures for plague cases. The people who shared the taxi with the symptomatic man, and those who treated him without safety procedures, were also exposed to the disease.

Monkeypox virus is transmitted from animals to humans hence contact with infected wild animals or their carcass could lead to exposure to the virus. Rural communities living in close proximity to forests and nature reserves where wild animals are still available, exploit the forests and the wild animals as source of livelihood.

The role livelihood plays in infectious disease acquisition and spread should not be disregarded

Most of the affected communities have faced these outbreaks before, while in others, they are an annual occurrence. The question arises what is the missing link? Apart from rare outbreak, some of the outbreaks such as cholera, diarrhoea and skin infections, for example scabies and ringworm (taeniasis), are a common occurrence that at times they don’t even make global headlines. In as much as these diseases are almost always linked to poverty, could the livelihoods in the affected communities be contributing to these seasonal outbreaks? Apart from the presence of the disease causing agents, what are the human factors that perpetuate diseases within these communities?

It is time to think outside the box of poverty and cast the net wider

Simplifying that diseases are due to poverty could blind stakeholders other underlying factors perpetuating disease in poor rural communities.

Monkeypox in Nigeria; Effects on Health and Livelihood

Monkeypox a viral disease similar to human smallpox is currently affecting populations in parts of Nigeria.

The illness which has no specific cure, is a zoonotic disease, passed on from wild animals to human.

The socioeconomic challenges presented by this outbreak are an example of how infectious diseases affect not only health but also the livelihood of affected families and communities.

Businesses associated with bushmeat in the affected regions have seen a drop in patronage as people refrain from consumption of wild meat to avoid contracting the disease. This has affected sources of income and livelihood for many within the affected communities. Socially, it has affected how people interact with each other for example communities in the affected areas have been urged to avoid hand shakes, which are a form of greeting, as this could allow spread of the virus.

The article presented on this link http://cerebrallemon.com/monkeypox-endemic-worsens-disease-reaches-rivers-akwa-ibom

shows a conserted effort between health personnel and the communities as they try to contain and prevent the spread of the disease.

Surveillance, awareness campaigns and willingness of communities to work together with health personnel will ensure success in fighting this outbreak.

For more information on Monkeypox virus http://www.who.int/mediacentre/factsheets/fs161/en/