Report on Training of Health Professionals on Climate and Health

The role of climate in health is currently enjoying a high profile among the international community in terms of demonstrating climate risk management and adaptation to a changing climate. The effect of climate variability and change on heath is a serious issue for most sub-Saharan African countries. Among the diseases that have public health importance in Ethiopia are malaria, meningitis and acute watery diarrhea. Understanding the relationship of climate and health in Ethiopia would be a tremendous help in early containment of these diseases. In Ethiopia, before the establishment of a Climate and Health Working Group (CHWG), which includes the Federal Ministry of Health and the National Meteorological Agency among other partners, the sharing of information among the two key players was minimal. The goal of this working group is to create a climate-informed health sector that routinely requests and uses appropriate climate information to improve the effectiveness of health interventions. In order to meet its goals, the working group, in collaboration with the International Research Institute for Climate and Society (IRI), organized a six-day training course for health professionals on climate and health. In this training, the Summer Institute course "Climate Information for Public Health" (held for the past two years at IRI in New York), was adapted and implemented. The Summer Institute has involved four Ethiopian participants, one from the National Meteorological Agency (NMA), and three from the Ministry of Health. They played a key role in facilitating some of the course lectures themselves and in identifying local professionals who could also contribute to the curriculum. The general goal of the six-day training was to build the national capacity in order to utilize climate information for decision-making in the health sector at national and regional state levels. The training was comprised of three components: core lectures, practical sessions, and short recap presentations by the participants. Sixteen participants were involved in the training. The selection of the participants was done in consultation with the Federal Ministry of Health. Participants came primarily from the Public Health Emergency Management Units of regional and federal health bureaus and were chosen for their roles in the decision-making around the prevention and control of climate-sensitive diseases. Three types of evaluation were carried out, a pre- and post-test, as well as an overall evaluation. The pre- and post-test helped to evaluate the level of knowledge about climate and health before and after the training. The latter helped in evaluating the organization of the overall training. Generally, the evaluations revealed that the training helped to increase the knowledge of the links between climate and health, as well as the use of climate information for decision-making in the public health sector. This training is the first of its kind organized in Ethiopia, especially at a national level. Most of the participants agreed on the suitability of the content, design and delivery of the course and showed their interest in organizing similar training initiatives in their respective home institutions. It is possible to recommend that this training should be extended to the regional health bureau level, with the already trained participants taking the primary responsibility of facilitating these follow-on activities with the close support of the CHWG. The collaboration of the regional branch offices of the National Meteorological Agency, with respect to using climate information, would play a crucial role in this endeavor. The most important point is to sustain this training and update its contents accordingly. The future research agenda and evidence generation efforts of the CHWG and its members should also focus on other climate sensitive diseases. Even though participants did not indicate there were always established ties to local universities in different parts of the country, these potential partnerships should be addressed in sharing the knowledge of the use of climate information for public health decision-making and in prioritizing locally important diseases. The training was held at UNECA, Addis Ababa, Ethiopia, between November 31st and December 5th, 2009. Financial and technical support was provided by IRI with funding from the Google.org sponsored project "Building Capacity to Produce and Use Climate and Environmental Information for Improving Health in East Africa.

Report on Training of Health Professionals on Climate and Health

The role of climate in health is currently enjoying a high profile among the international community in terms of demonstrating climate risk management and adaptation to a changing climate. The effect of climate variability and change on heath is a serious issue for most sub-Saharan African countries. Among the diseases that have public health importance in Ethiopia are malaria, meningitis and acute watery diarrhea. Understanding the relationship of climate and health in Ethiopia would be a tremendous help in early containment of these diseases. In Ethiopia, before the establishment of a Climate and Health Working Group (CHWG), which includes the Federal Ministry of Health and the National Meteorological Agency among other partners, the sharing of information among the two key players was minimal. The goal of this working group is to create a climate-informed health sector that routinely requests and uses appropriate climate information to improve the effectiveness of health interventions. In order to meet its goals, the working group, in collaboration with the International Research Institute for Climate and Society (IRI), organized a six-day training course for health professionals on climate and health. In this training, the Summer Institute course "Climate Information for Public Health" (held for the past two years at IRI in New York), was adapted and implemented. The Summer Institute has involved four Ethiopian participants, one from the National Meteorological Agency (NMA), and three from the Ministry of Health. They played a key role in facilitating some of the course lectures themselves and in identifying local professionals who could also contribute to the curriculum. The general goal of the six-day training was to build the national capacity in order to utilize climate information for decision-making in the health sector at national and regional state levels. The training was comprised of three components: core lectures, practical sessions, and short recap presentations by the participants. Sixteen participants were involved in the training. The selection of the participants was done in consultation with the Federal Ministry of Health. Participants came primarily from the Public Health Emergency Management Units of regional and federal health bureaus and were chosen for their roles in the decision-making around the prevention and control of climate-sensitive diseases. Three types of evaluation were carried out, a pre- and post-test, as well as an overall evaluation. The pre- and post-test helped to evaluate the level of knowledge about climate and health before and after the training. The latter helped in evaluating the organization of the overall training. Generally, the evaluations revealed that the training helped to increase the knowledge of the links between climate and health, as well as the use of climate information for decision-making in the public health sector. This training is the first of its kind organized in Ethiopia, especially at a national level. Most of the participants agreed on the suitability of the content, design and delivery of the course and showed their interest in organizing similar training initiatives in their respective home institutions. It is possible to recommend that this training should be extended to the regional health bureau level, with the already trained participants taking the primary responsibility of facilitating these follow-on activities with the close support of the CHWG. The collaboration of the regional branch offices of the National Meteorological Agency, with respect to using climate information, would play a crucial role in this endeavor. The most important point is to sustain this training and update its contents accordingly. The future research agenda and evidence generation efforts of the CHWG and its members should also focus on other climate sensitive diseases. Even though participants did not indicate there were always established ties to local universities in different parts of the country, these potential partnerships should be addressed in sharing the knowledge of the use of climate information for public health decision-making and in prioritizing locally important diseases. The training was held at UNECA, Addis Ababa, Ethiopia, between November 31st and December 5th, 2009. Financial and technical support was provided by IRI with funding from the Google.org sponsored project "Building Capacity to Produce and Use Climate and Environmental Information for Improving Health in East Africa.

Data mining techniques on satellite images for discovery of risk areas

The high rates of cholera epidemic mortality in less developed countries is a challenge for health fa- cilities to which it is necessary to equip itself with the epidemiological surveillance. To strengthen the capacity of epidemiological surveillance, this paper focuses on remote sensing satellite data processing using data mining methods to discover risk areas of the epidemic disease by connecting the environ- ment, climate and health. These satellite data are combined with field data collected during the same set of periods in order to explain and deduct the causes of the epidemic evolution from one period to another in relation to the environment. The existing technical (algorithms) for processing satellite im- ages are mature and efficient, so the challenge today is to provide the most suitable means allowing the best interpretation of obtained results. For that, we focus on supervised classification algorithm to process a set of satellite images from the same area but on different periods. A novel research method- ology (describing pre-treatment, data mining, and post-treatment) is proposed to ensure suitable means for transforming data, generating information and extracting knowledge. This methodology consists of six phases: (1.A) Acquisition of information from the field about epidemic, (1.B) Satellite data acquisition, (2) Selection and transformation of data (Data derived from images), (3) Remote sensing measurements, (4) Discretization of data, (5) Data treatment, and (6) Interpretation of results. The main contributions of the paper are: to establish the nature of links between the environment and the epidemic, and to highlight those risky environments when the public awareness of the problem and the prevention policies are absolutely necessary for mitigation of the propagation and emergence of the epidemic. This will allow national governments, local authorities and the public health officials to effective management according to risk areas. The case study concerns the knowledge discovery in databases related to risk areas of the cholera epidemic in Mopti region, Mali (West Africa). The results generate from data mining association rules indicate that the level of the Niger River in the wintering periods and some societal factors have an impact on the variation of cholera epidemic rate in Mopti town. More the river level is high, at 66% the rate of contamination is high

The usefulness of the electronic Disease Early Warning System (eDEWS) in the humanitarian crisis of Yemen

Seit 2015 herrscht im Jemen ein Bürgerkrieg, der zu einer humanitären und gesundheitlichen Katastrophe geführt hat. Um drohende Epidemien rechtzeitig zu erkennen, wurde daher mit Unterstützung der Weltgesundheitsorganisation das elektronisches Frühwarnsystem eDEWS (electronic Disease Early Warning System) aufgebaut. Die vorliegende Studie untersucht die Qualität und Wirksamkeit dieses Systems. Weltweit wiederkehrende Epidemien und Pandemien haben deutlich gezeigt, wie wichtig effektive Frühwarnsysteme sind. Jemen früheres nationales Krankheitsüberwachungssystem - ursprünglich auf Papierbasis – war zunehmend damit überfordert, den Anforderungen in humanitärer Notsituationen gerecht zu werden. Um Daten schneller erfassen zu können und ein zügiges Handeln zu gewährleisten, hat Jemen daher ab dem Jahr 2013 mit Unterstützung der Weltgesundheitsorganisation das elektronisches Frühwarnsystem eDEWS aufgebaut. Das eDEWS setzt sich aus einem elektronischen Kontrollzentrum und einer mobilen Benutzeroberfläche (MBI – Mobile-Based Interface) zusammen. Es registriert Meldung über 31 verschiedene Infektionskrankheiten; Fallmeldungen werden dann systematisch überprüft. Beim Erreichen eines Schwellenwerts wird ein Warnhinweis (alert) ausgelöst. Ziel: Diese Studie untersucht die Leistungsfähigkeit von eDEWS hinsichtlich der Aspekte Rechtzeitigkeit, Durchführbarkeit, Akzeptanz, Vorhersagewert und Zielerreichung hinsichtlich des Schutzes der Bevölkerung durch rechtzeitige Warnungen und Gegenmaßnahmen. Die Forschungsergebnisse sollen die lokalen Entscheidungsträger und internationalen Hilfsorganisationen dabei unterstützen, die Gesundheitsversorgung im Jemen aufrecht zu erhalten und zu verbessern. Methodik: Die Studie folgt einem Mixed-Method Design. Der erste Teil basiert auf einer quantitativen Datenanalyse der Frühwarndaten aus der eDEWS Datenbank und den wöchentlichen Bulletins und dem Jahresbericht von 2016. Qualitative Daten sind durch ausführliche Interviews mit Schlüsselinformanten (Gesundheitsarbeitern in Gesundheitszentren, Mitarbeitern im Gesundheitsministerium und Partnern aus dem Gesundheitscluster (internationale Hilfsorganisationen) erhoben worden. Ergebnisse: - Gesundheitsberichterstattung: Ungefähr ein Drittel der Konsultationen in den untersuchten Gesundheitseinrichtungen von 2013, 2014 und 2015 betrafen Infektionskrankheiten (31%, 28% und 31%). Die Zahl der gemeldeten Infektionskrankheiten stieg in den Jahren 2016 und 2017 um jeweils 38% und 44%. Darunter waren Atemwegserkrankungen, andere akute Durchfallerkrankungen, Malaria und blutiger Durchfall am häufigsten. Mit einer Prävalenzrate von 7% war Cholera im Jahr 2017 die dritthäufigste Diagnose. Das eDEWS stellte sich als ein resilientes und verlässliches System heraus, welches trotz andauernder Konfliktsituationen aufrechterhalten und kontinuierlich weiterentwickelt wurde. - Leistungsindikatoren und Nutzen von eDEWS: Probleme mit der Datenqualität und zeitnahen Reaktionsmaßnahmen bleiben jedoch weiterhin bestehen. So sind in 2016 nur 14% aller Frühwarnungen in den ersten 24 Stunden seit der Entdeckung verifiziert worden. Die durchschnittliche Verzögerung der wöchentlichen eDEWS Bulletin Veröffentlichung hat sich über die Zeit erhöht: Waren es 2014 und 2015 nur 2,8 und 0,5 Tage so stiegt die Zahl für 2016 und 2017 auf jeweils 9 Tage an. Dennoch beeinflussen diese Lücken die Rolle des eDEWS, Ausbrüche in der momentanen, fragilen Situation rechtzeitig zu detektieren, nicht. Die Ergebnisse zeigen, dass der eDEWS ein repräsentatives System ist, da es die gesamte Region des Landes abdeckt. Auch wenn es nur 37% aller Gesundheitseinrichtungen umfasst, so erfasst es dennoch 83% aller funktionalen Einrichtungen in allen 23 Regierungsbezirken und allen 333 Distrikten. - Früherkennung und rechtzeitiges Handeln: Die frühzeitige Warnung ist der Hauptzweck des eDEWS, damit sich die zuständigen Behörden vor Ort rechtzeitig auf einen möglichen Ausbruch vorbereiten können. So wurden Cholera und Diphterie-Ausbrüche vorzeitig vom eDEWS erkannt. Damit konnten zwar die Ausbrüche nicht verhindert werden, aber es war für die Gesundheitspartner wichtig, zumindest die Letalität deutlich zu senken, was auch gelang. Diese liegt nun bei 0,2% und damit deutlich niedriger als 5,5% und 1,3% bei den Cholera-Ausbrüchen 2009 und 2010. Schlussfolgerungen: Das eDEWS ist eine essentielle Komponente des fragilen Gesundheitssystems im Jemen, welches sich trotz der schwierigen Sicherheits- und Versorgungslage als generell sehr hilfreich für Kontrolle von Infektionskrankheiten erwiesen hat. Es kann somit auch als Modell für die Erkennung und das Management drohenden Epidemien für weitere Ländern in Konfliktsituationen dienen, die von einer ähnlichen Situation betroffen sind. Eine substantielle Verbesserung der Gesundheitssituation wird aber erst durch eine Beendigung des Krieges im Jemen zu erreichen sein und so sollte auch eDEWS als Teil einer Friedensinitiative gesehen werden

Aedes aegypti density and the risk of dengue-virus transmission

Using genetically modified mosquitoes to control vector-borne diseases will require specific, quantitative targets for the extent to which populations of competent mosquito vectors need to be reduced in order to produce predictable public-health outcomes. Unfortunately, dengue researchers do not have an entomological measure for predicting the risk of human dengue infection and disease that is as effective as they would like. The situation is further complicated by the fact that contemporary dengue control is based on the assumption, which has not been thoroughly tested, that a reduction in adult Aedes aegypti population densities will decrease risk of virus transmission. Ae. aegypti eradication is not considered feasible and there are no commercially available dengue vaccines or clinical cures. Herein we discuss four interrelated questions that need to be addressed for the proper evaluation and implementation of genetically modified mosquitoes for dengue control. In specific terms, what is an acceptable level of dengue risk? What are the mosquito densities necessary to achieve that goal? What is the best way to measure entomological risk? Because most dengue risk factors are likely to exhibit spatial dependence, at what geographic scale are the components of dengue transmission important? We conclude with two recommendations for improving dengue surveillance and control. First, there is an urgent need for field-based prospective longitudinal cohort studies on the relationships among measures of Ae. aegypti density, dengue incidence, and severity of disease. Second, new rapid, inexpensive, and operationally amenable methodologies are needed to evaluate and monitor the impact of vector-control strategies on disease reduction. Unless competent mosquito vectors are eliminated entirely, predicting and evaluating success following release of genetically modified Ae. aegypti will require a more thorough understanding of the relationship between vector density and the risk of human diseas

Incorporating Biometric And Mobile Systems In Social Safety Nets In Sub-Saharan Africa

This paper measured poverty and corruption in Sub-Saharan Africa and modelled a biometric/mobile solution for curbing corrupt practices in social safety programmes. This is against the backdrop that efforts to better the lives of the vulnerable groups - unemployed, rural poor, women and persons with disabilities - are being frustrated by corruption in social security schemes mounted by various government to cater for these groups. The fallout is that planned benefits don't get to the target audience, precipitating conflicts and social tensions. Even more worrisome is that this segment of the society becomes easy recruits for social menace like kidnapping, terrorism, vandalism, prostitution, among others. Using Nigeria as case study, the study applied biometric system for the documentation and authentication of social safety net beneficiaries so that only genuine persons get the social benefits. Equally, mobile applications and devices are integrated for disseminating information about planned and released social packages from government ministries, departments and agencies (MDAs) to the target audience. The research resulted in an integrated Information and Communication Technologies (ICTs) design that substantially mitigates corrupt practices in social safety nets

The development and prudent application of climate-based forecasts of seasonal malaria in the Limpopo province in South Africa

Seasonal Climate Forecasting (SCF) in South Africa has a history spanning several decades. During this period a number of SCF systems have been developed for the prediction of seasonal-to-interannual variability of rainfall and surface temperatures. Areas of highest predictability, albeit relatively modest, have also been identified. The north-eastern parts of South Africa that includes the Limpopo province has been demonstrated to be one of the areas of highest SCF skill in the country. Statistical post-processing techniques applied to global climate model output were part of this forecast system development, and were subsequently successfully used in the construction of forecasts systems for applications in sectors which are associated with ENSO-driven climate variability, such as dry-land crop yields and river flows. Here we follow a similar post-model processing approach to test SCF systems for application to the incidence of seasonal malaria in Limpopo. The malaria forecast system introduced here makes use of the seasonal rainfall output fields of one of the North American Multi-Model Ensemble (NMME) climate models, which is then linked statistically through multiple linear regression to observed malaria incidence. The verification results as calculated over a 20-year hindcast period show that the season of highest malaria incidence forecast skill is during the austral mid-summer time of December to February. Moreover, the hindcasts based on the NMME model outscore those of statistical forecast models that separately use Indian and Pacific Ocean sea-surface temperatures as predictors, thus justifying the use of physical global climate models for this kind of application. Additional results indicate that model skill levels may include quasi-decadal variability, that the periods over which forecast verification is performed strongly influences forecast skill, and that poorly predicted malaria seasons may have serious financial implications on public health operations.The Japan Agency for Medical Research and Development (AMED; Japan International Cooperation Agency (JICA) through Science and Technology Research Partnership for Sustainable Development (SATREPS) project for iDEWS South Africa.http://www.elsevier.com/locate/envdevhj2021Geography, Geoinformatics and Meteorolog

Clinical metagenomics.

Clinical metagenomic next-generation sequencing (mNGS), the comprehensive analysis of microbial and host genetic material (DNA and RNA) in samples from patients, is rapidly moving from research to clinical laboratories. This emerging approach is changing how physicians diagnose and treat infectious disease, with applications spanning a wide range of areas, including antimicrobial resistance, the microbiome, human host gene expression (transcriptomics) and oncology. Here, we focus on the challenges of implementing mNGS in the clinical laboratory and address potential solutions for maximizing its impact on patient care and public health

Myths and Misconceptions of the Orthodox View of AIDS in Africa

This article rebuts conventional claims that AIDS in Africa is a microbial problem to be controlled through sexual abstinence, behavior modification, condoms, and drugs. The orthodox view mistakenly attributes to sexual activities the common symptoms that define an AIDS case in Africa - diarrhea, high fever, weight loss and dry cough. What has really made Africans increasingly sick over the past 25 years are deteriorating political economies, not people’s sexual behavior. The establishment view on AIDS turned poverty into a medical issue and made everyday life an obsession about safe sex. While the vast, selfperpetuating AIDS industry invented such aggressive phrases as “the war on AIDS” and “fighting stigma,” it viciously denounced any physician, scientist, journalist or citizen who exposed the inconsistencies, contradictions and errors in their campaigns. Thus, fighting AIDS in Africa degenerated into an intolerant religious crusade. Poverty and social inequality are the most potent co-factors for an AIDS diagnosis. In South Africa, racial inequalities rooted in apartheid mandated rigid segregation of health facilities and disproportionate spending on the health of whites, compared to blacks. Apartheid policies ignored the diseases that primarily afflicted Africans - malaria, tuberculosis, respiratory infections and protein anemia. Even after the end of apartheid, the absence of basic sanitation and clean water supplies still affects many Africans in the former homelands and townships. The article argues that the billions of dollars squandered on fighting AIDS should be diverted to poverty relief, job creation, the provision of better sanitation, better drinking water, and financial help for drought-stricken farmers. The cure for AIDS in Africa is as near at hand as an alternative explanation for what is making Africans sick in the first place