GINGIVITIS: A DENTAL MENACE

What is Gingivitis?

Gingivitis is a medical condition characterized by inflammation of the gums (gingiva) due to certain causes such as microbial infection (mainly), but may be mechanical (gum injury) in some cases. It is considered a periodontal condition, meaning that it does not affect the teeth, but only occurs in areas around the base of the teeth. Due to its mildness in most cases, it is usually ignored or the symptoms are managed at first, until the damage to the gums get worse and it eventually progresses into a severe disease that can result in tooth loss. 

What causes Gingivitis?

The most common cause of gingivitis is poor oral hygiene, leading to the growth and accumulation of harmful bacteria around the teeth to form a plaque. Naturally, dental plaques occur on the teeth from time to time when colonizing bacteria try to adhere to the surface of a tooth. The presence of this bacterial plaque may not be harmful at first, but will eventually cause dental problems when the plaque accumulates. As the plaque builds up, it hardens over time and remains strongly attached to the surface of the tooth (along with the bacteria).

The accumulation of such bacteria around the teeth can trigger the immune response, causing immune cells to infiltrate that area of the gums and elicit inflammation, which may be further worsened by the metabolic products from the bacteria that are capable of slowing digesting the substance of the gum and causing destruction of gum tissue. If left untreated for long periods, the inflammation will eventually progress into a more severe form that can cause loosening and loss of teeth.

What are the Signs and Symptoms of Gingivitis?

In mild cases, there may be little or no symptoms. The condition may progress painlessly and without any immediate warning signs, but eventually, certain manifestations gradually occur that point toward gum inflammation. Some of such symptoms include bleeding of gums spontaneously or after brushing, signs of red, tender or swollen gums, persistent bad breath, feelings of pain while chewing or when the gums are touched, formation of deep pockets between the teeth and gums, loose teeth, noticeable changes in the way the teeth fit when biting, etc. When adequate dental care is not administered, the inflammation may eventually progress to a full-blown gum disease (periodontal disease).

The inner layers of the gums gradually start to pull away from the teeth, forming small pockets of exposure that can be infected by the bacteria, causing further worsening of inflammation. The resultant gum destruction gives rise to loosening of teeth and eventual tooth loss.

How can Gingivitis be diagnosed?

A Dentist through a dental examination can diagnose gingivitis. The Dentist inspects the teeth and gums for signs of gum bleeding, swelling, softness, pocket depth between the gums and teeth, tooth sensitivity, signs of a shaky tooth, and signs of improper teeth alignment.

How can Gingivitis be treated?

The major aim of gum disease treatment is to reduce swelling, depth of pockets, risk of infection, and to stop disease progression. The type of treatment mainly depends on the stage of the disease and the overall health of the individual.

Nonsurgical treatment methods include professional dental cleaning to remove the plaque and tartar from around the teeth and below the gum line, as well as smoothening any rough spots on each tooth (planing) to remove bacteria and ensure a smooth, clean surface for the reattachment of gums to the teeth. In addition to these, there are a number of surgical treatments for gum disease, which include pocket reduction surgery to reduce the space between the gums and teeth so as to limit bacterial growth beneath the gums, bone grafting to replace any aspect of the jaw bone that has been destroyed by gum disease, soft tissue grafts to reinforce thin or receding gums, and guided tissue regeneration to stimulate the growth of bone and gum tissues in order to fill up any pocket areas naturally.

Note that nonsurgical treatment of gingivitis is usually the main treatment method needed to treat gum disease. However, surgical methods become necessary when the gum and bone tissues around the teeth are significantly damaged and cannot be repaired by nonsurgical methods. Antibiotics can also be used in the treatment of gingivitis to eliminate the bacteria associated with gum disease.

Source: Healthline. https://bit.ly/3yaqGC5

How can Gingivitis be prevented?

Gum disease can be primarily prevented by daily brushing of teeth (twice a day) using a fluoride-containing toothpaste and a toothbrush with soft bristles. Brushing removes plaques on the surface of the teeth and limits harmful bacterial growth. Flossing should also be done daily to remove food particles and plaque from in between the teeth and under the gum line, which are places your toothbrush cannot reach. Antibacterial mouthwashes can also be used to rinse out one’s mouth in order to limit harmful bacterial growth, plaque formation and prevent bad breath. Other supplementary preventive measures include avoidance of smoking, reducing stress levels, maintaining a balanced diet, and avoiding any activities that require frequently grinding or clenching your teeth, as this puts excessive pressure on the supporting tissues of the teeth.

Reference

ANTIMICROBIAL RESISTANCE: A GLOBAL THREAT

What is Antimicrobial Resistance (AMR)?

In order to fully understand the concept of antimicrobial resistance, it is important to first understand the term ‘antimicrobials’ and their use in the medical sector. Antimicrobials are drugs or substances that are capable of destroying or preventing the growth of microorganisms that could be potential pathogens. They encompass various drug categories such as antibiotics, antifungals, antivirals and antiparasitics, which are drugs that kill or halt the growth of pathogenic bacteria, fungi, viruses and parasites respectively. Antimicrobial resistance is the term used to describe a scenario where pathogenic microorganisms develop the ability to counter the effects of these drugs and continue thriving.

Different classes of microorganisms have different ways of developing resistance to drugs, such as antiparasitic resistance observed in human parasites like the Malaria parasite (Plasmodium falciparum), antifungal resistance in parasitic fungi like Candida albicans, and antibiotic resistance observed in various bacteria. Among all the forms of drug resistance, the most prevalent and most disturbing is the problem of antibiotic resistance, which will be the main focus in this article.

Source: Center for Infectious Disease Research and Policy. https://bit.ly/3wVVlTk.

What are Antibiotics and what causes Antibiotic Resistance?

Antibiotics are drugs that destroy or inhibit the growth of bacteria, and are widely used to cure numerous infectious diseases like tuberculosis, meningitis, typhoid fever, etc. They are actually chemicals produced naturally by various bacteria and fungi in the environment when competition for nutrients is very high, and are used as weapons to destroy other microorganisms in order to get enough nutrients for themselves. Though most antibiotics are natural, some are produced artificially by man or by chemical modification of the natural antibiotics.

Just as we humans make use of antibiotics to fight bacteria, these bacteria are also learning ways to fight back. Naturally, when bacteria are exposed to antibiotics for long periods, they begin to adapt by developing various cellular mechanisms to resist the effects of the drugs. There are many factors that facilitate the occurrence of antibiotic resistance, such as when we overuse antibiotics for minor infections or take them wrongly for non-bacterial infections like common cold and flu, which are generally caused by viruses. Another cause of antibiotic resistance is self-medication, or not completing one’s dosage of prescribed drugs. Also, the use of antibiotics in agriculture for improving livestock growth is a major factor, as drug resistant microbes can quickly develop in these animals and get transmitted to humans through the faeco-oral route or by consumption of these livestock as food. 

Why is Antibiotic Resistance dangerous?

Antibiotic/Antimicrobial resistance is actually rated by the World Health Organization (WHO) as one of the top ten global public health threats facing humanity. According to global statistics, an estimated 700,000 people die yearly from antibiotic-resistant infections and at the rate which antibiotic resistance is rising, WHO estimates that by 2050, about 10 million people could die yearly, which is equivalent to a death rate of one person every three seconds. The emergence of antibiotic resistance means that simple bacterial infections could become fatal and the current medical treatments we take for granted might soon be ineffective. A plethora of infectious diseases caused by bacteria will become untreatable, and implementation of surgical procedures will be hazardous due to the risk of infection by drug-resistant bacteria.

In addition, a more worrisome trend is the emergence of bacteria nicknamed ‘superbugs’, which exhibit resistance to many types of antibiotics (multidrug resistance). An example is the bacteria that causes gonorrhoea, called Neisseria gonorrhoeae, which has developed resistance to almost every type of antibiotic used for treating gonorrhoea. This poses a major problem, as the possibility of gonorrhoea becoming untreatable is quite glaring, and infected individuals run the risk of extensive damage to their reproductive system, which can cause infertility and could possibly become fatal if the infection spreads to other parts of the body.

Another alarming fact to note is the persistent drop in the research and development of new antibiotics since the 1980s due to a number of barriers in scientific discovery, pharmaceutical production and international drug policy. Another contributing factor to delayed drug development is the logic that as more antibiotics are produced and used, more cases of antibiotic resistance keep emerging worldwide. 

What can be done to prevent or limit the spread of Antibiotic Resistance?

The major impediment to curbing antibiotic resistance is the fact that many people are not aware about the threat it poses to public health on a global scale. Therefore, the first step to controlling antibiotic resistance is raising massive public awareness about how dangerous it is, and what can be done by individuals, non-governmental organisations, civil societies, healthcare providers and the government especially to effectively curb this menace. Healthcare providers play a major role in the awareness drive by educating patients and the general public on the various steps to ensuring appropriate use of antibiotics, such as the avoidance of self-medication, strict adherence to drug prescription from a certified medical professional, and reducing the excessive use of antibiotics for minor infections. Antibiotics should never be taken for cold or flu symptoms, as these are mainly caused by viruses.

The government and national policymakers also have a major role to play in a number of areas so as to ensure effective antibiotic resistance control. There is a need for country leaders and health-allied organizations to channel more funds into the research and development of new drugs that will be effective against already resistant bacteria, and also develop novel rapid diagnostic methods that can quickly determine the specific cause of an infection and how best it can be treated. This will help reduce the use of and subsequent resistance to antibiotics. Also, regulatory policies need to be implemented by national policymakers to reduce the use of antibiotics in agriculture for animal growth enhancement. It is also important for healthcare sectors worldwide to start developing alternative treatments aside antibiotics that will be effective in destroying bacteria and treating infections without the risk of drug resistance emerging. Examples of such alternatives include the use of Phage therapy, Lysin treatment, Bacteriocins and the exploitation of Predatory Bacteria in killing infectious pathogens. Vaccines also play an important role, as they offer protection against infectious diseases, thus, reducing the need for antibiotics and preventing the emergence of antibiotic resistance. 


Reference

DEMYSTIFYING YELLOW FEVER AND ITS VACCINE

What is Yellow Fever?

Yellow fever is a severe, flu-like, haemorrhagic disease caused by a specific type of virus called the Yellow Fever Virus, which is transmitted among humans through the bite of an infected Aedes mosquito. The disease is specifically endemic to the tropical areas of Africa, Central America and South America where epidemics regularly occur due to the high density of infected Aedes mosquitoes and prevalence of unvaccinated individuals with low immunity to the viral disease. According to statistics from the World Health Organization, there are over 200,000 cases of Yellow fever worldwide each year, with a global mortality rate of about 30,000 deaths, which mostly occurs in low-resource settings with high mosquito burden and inadequate access to the Yellow fever vaccine.

What causes Yellow Fever?

The disease is caused by a specific type of virus transmitted through the bite of infected mosquitoes called Aedes aegypti, which is also known to transmit the Dengue and Zika Viruses among humans. Aedes mosquitoes bear certain physiological similarities but a number of morphological differences from the Anopheles mosquito known to cause Malaria. The mosquitoes breed in humid and semi-humid environments, especially tropical rainforests with prevalence of pockets of still water surfaces. The incidence of the disease is much more common among populations that have not been vaccinated against Yellow fever, which leads to regular small-scale epidemic outbreaks in such regions. The virus, upon entry into the human body, causes extensive damage to the Liver, which leads to the accumulation of unconjugated bilirubin in various parts of the body, especially in the eyes and skin where it is most noticeable. This is known as ‘Jaundice’ and is responsible for the characteristic yellow appearance of the skin and eyes of infected persons, hence, the name of the disease.

What are the Signs and Symptoms of Yellow Fever?

Yellow fever starts out with non-specific symptoms in infected persons, although some individuals do not experience any symptoms initially. The Yellow fever disease typically has three phases, each with its noticeable features. The first phase of symptoms tends to appear about three to six days after exposure to the bite of an infected mosquito, and is usually non-specific as it appears similar to the flu and cannot be easily distinguished from other illnesses. The symptoms include fever and chills, nausea and vomiting, headache, and muscle aches, which lasts about three to four days on average before proceeding to the remission phase in most people, where all the symptoms gradually resolve and the patient improves within two days. Unfortunately, about 15% to 25% of patients proceed to a more severe stage called the toxic phase, where viral haemorrhagic fever occurs, which is characterized by high fever, internal bleeding, extensive liver damage resulting in hepatomegaly (swelling of the liver) and jaundice (yellowing of eyes and skin), vomiting with blood, as well as damage to the kidneys and circulatory system. About half of the patients that proceed to this phase die within seven to ten days if left untreated.

Source: VeryWell Health.  https://bit.ly/3iwNCWC.

How can Yellow fever be diagnosed?

Empirical diagnosis of Yellow fever is usually based on the individual’s symptoms, travel activity and prevalence of Aedes mosquitoes in their residence areas. However, the initial symptoms of the disease are quite similar to a number of other diseases and can not be used as a definitive diagnosis for Yellow fever, except when in the advanced (toxic) phase. The disease can be confirmed through specific blood tests that serve to detect the antigens or antibodies that are peculiar to the virus, and the presence of such antigens or antibodies confirms the positivity of the patient for Yellow fever. It is important to note, however, that antibody tests can only detect the virus about five days after infection, as it takes the body three to five days to produce sufficient antibodies specific to the virus. Polymerase Chain Reaction (in early stages) and ELISA (in later stages) are tests that can be used to detect the antigens and antibodies of the Yellow fever virus respectively.

How is Yellow Fever treated?

So far, no antiviral medication has been approved for the complete treatment of Yellow fever, thus, no cure for the disease exists. Treatment of infected persons requires management of the symptoms with supportive healthcare and the administration of medications that assist the body’s immune system in fighting off the Yellow fever infection. Certain treatment actions that can be taken include ensuring proper hydration and oxygenation of the patient, consumption of a healthy diet, maintaining a healthy blood pressure, and administration of drugs that ease the fever, muscle aches, headaches and vomiting. Any other infections associated with that of the Yellow fever infection can be treated with the appropriate medications as well. These will serve to speed up the recovery of the patient.

Source: Ayushman Hospital.  https://bit.ly/3BqJGzq.

How can Yellow fever be prevented?

The most important means of preventing the Yellow fever infection is vaccination. The Yellow fever vaccine has been long approved by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) as it safe and affordable for most individuals worldwide. A single dose of the vaccine offers life-long protection from Yellow fever and does not require a booster shot. In areas where the disease is highly endemic and vaccination coverage is low, it is necessary to carry out mass immunization campaigns to vaccinate at least 80% of the population in that region in order to achieve herd immunity. This will serve to greatly reduce the rate of transmission of the disease in such regions. Also, individuals travelling to areas where Yellow fever is endemic are also required to get vaccinated for protection against the disease.

Another means of preventing the Yellow fever disease is through vector control in urban and rural areas by eliminating the habitats and breeding sites of Aedes mosquitoes (especially pockets of standing water), and minimizing skin exposure to the mosquito by wearing adequate clothing and making use of topical insect repellants. Insecticide-treated bed nets can also be used to reduce exposure to the vector, but this is limited by the fact that Aedes mosquitoes only bite in the daytime, not at night. Consistent surveillance for Yellow fever cases, especially in unvaccinated communities, is very necessary, and epidemic preparedness strategies should be put in place to ensure swift response to any reports of Yellow fever cases in such communities. 

Reference

TUBERCULOSIS: A MAJOR PUBLIC HEALTH THREAT

Overview of Tuberculosis

Tuberculosis is a highly infectious disease of the respiratory system in humans. It is one of the oldest diseases ever known to man, and has been associated with a high mortality rate in the absence of adequate treatment and in immunologically weakened persons. It is generally regarded as a disease of poverty due to its prevalence in low-resourced regions with inadequate medical treatment. Over the ages, tuberculosis has remained a major public health threat, with over 1.7 billion people infected globally, and is still one of the leading causes of deaths worldwide, with over one million deaths every year. The major factors that make tuberculosis difficult to eradicate is its prevalence in poverty burdened regions, association with HIV-positive individuals, and the trend of antibiotic resistance in drug treatment.

What causes Tuberculosis?

The disease is mainly caused by the bacterium Mycobacterium tuberculosis, which is also called the ‘tubercle bacilli’. It usually infects the lungs and causes damage (pulmonary tuberculosis), but can spread to other parts of the body as well (extrapulmonary tuberculosis). It is transmitted through the air (airborne) and can infect a healthy person who inhales droplets containing the tubercle bacilli from the cough or sneeze of an infected individual. Once inside the body, the bacteria invade the respiratory tract, where the immune system responds and numerous white blood cells gather at the site of infection to form a restrictive barrier around the bacteria called a ‘granuloma’. If the barrier formed by the immune cells is able to keep the tubercle bacilli under control, the infection will not spread and the bacteria will be trapped within the granuloma. This results in a ‘Latent Tuberculosis Infection’ (LTBI), hence, the individual is not infectious and there will be no damage or symptoms.

However, if the bacteria escape from the granuloma, the infection will spread to other parts of the Lungs, as well as other organs of the body through the bloodstream, resulting in a full-blown tuberculosis disease. At this point, symptoms begin to manifest and the individual becomes infectious. Note that persons with latent tuberculosis infection can still develop active tuberculosis later on, especially in HIV patients (weakened immune system), and children below 5 years of age (developing immune system).

What are the Signs and Symptoms of Tuberculosis?

In individuals with latent tuberculosis infection, there are no symptoms observed as the bacteria are trapped by the immune system and are not capable of causing damage. In cases of active tuberculosis, the damage caused by the bacteria in the lungs gives rise to symptoms such as persistent coughs with thick phlegm or blood (haemoptysis) lasting three weeks or more, chest pain, fever, weakness, night sweats, loss of appetite and rapid weight loss. If untreated, the bacterial infection can spread to other organs in the body (extrapulmonary tuberculosis), resulting in the development of swollen lymph nodes in the neck, along with other symptoms that depend on the site of infection. For example, if the Brain and Spinal cord are infected, the condition is called ‘Tuberculous meningitis’, and the individual will experience additional symptoms such as dizziness, headaches and neck stiffness.

Source: VeryWell Health. https://bit.ly/3etZEPk.

How is Tuberculosis diagnosed?

There are various methods for the diagnosis of tuberculosis disease. Certain tests such as the Tuberculin skin test (Mantoux test) and a Blood test are commonly used for tuberculosis diagnosis, however, these tests cannot differentiate between a latent tuberculosis infection (LTBI) and an active tuberculosis disease, and may also yield false positives if the individual had earlier received a tuberculosis vaccine. For actual confirmation, the specific tests used are Chest X-Ray or CT scans, and laboratory culturing of sputum samples (phlegm from deep within the throat) for direct bacterial identification.

What is the burden of Tuberculosis in Africa?

Research studies have shown that a great percentage of global tuberculosis cases occur in developing countries and resource-limited regions, especially in Africa, where it is highly endemic due to the limited resources, poor medical attention and inadequate treatment of cases. As of 2016, the World Health Organization African region (WHO Afro) accounted for about 25% of the estimated number of tuberculosis cases worldwide. African countries such as Nigeria, Liberia and Sierra-Leone are among the top 30 countries with the highest burden of tuberculosis globally. In fact, in Nigeria alone, the incidence of tuberculosis in 2019 was estimated at 220 cases per 100,000 population, and every year, about 590,000 new cases occur in the country, leading to the death of over 245,000 Nigerians. The country alone accounts for about 4% of the tuberculosis incidence worldwide. The tuberculosis incidence rate in Liberia and Sierra Leone was about 308 and 304 cases per 100,000 population respectively, however, Nigeria still ranks as the country with the highest tuberculosis burden in Africa. Other African countries like Ghana, Guinea Bissau and Mali also have very high rates of tuberculosis incidence in the global index.

The major challenges that impede the reduction and eradication of tuberculosis in Africa include poverty, undernutrition, poor infection prevention and control (IPC) measures, high financial burden of tuberculosis treatment, late diagnosis and diagnostic errors, increased HIV burden, ineffective disease surveillance systems, poor political will to eradicate the disease, and the trend of antibiotic resistance in the region. 

How can Tuberculosis be treated?

Tuberculosis is quite curable if treatment commences early enough. It can be treated by the use of specifically prescribed antibiotics, but the treatment has some disadvantages, such as the fact that the drugs are expensive, require months of consistent consumption, and could produce a few unpleasant side effects with time. The treatment regimen usually lasts about 6-12 months for either latent or active tuberculosis, depending on the severity of the disease, and involves the use of antibiotics like rifampin, isoniazid, pyrazinamide, etc.

Source: The Myanmar Times. https://bit.ly/3et7KaG. 

How best can Tuberculosis be prevented?

The most effective way of preventing the disease is by vaccination with a special vaccine called ‘BCG Vaccine’ (Bacillus Calmette-Gurein), which will help protect the individual from future infections. As the disease is airborne, it is difficult to effectively prevent people from getting infected. Thus, it is important that people are aware of the symptoms of the disease, and individuals suspected of having the disease should be isolated, tested and treatment must be commenced immediately if positive to avoid spreading the infection to others. Tuberculosis patients on antibiotic treatment should ensure they strictly adhere to the prescriptions in order to ensure effective resolution of the disease and prevent the bacteria from developing drug resistance.

Reference

  • World Health Organization (2020). Tuberculosis. https://bit.ly/3hLcdI5.
  • Web MD (2020). Tuberculosis – Symptoms, Causes, Treatment and Prevention. https://wb.md/3esevKb.
  • Adebisi YA, Agumage I, Sylvanus TD, Nawaila IJ, Ekwere WA, Nasiru M, et al. Burden of Tuberculosis and Challenges Facing Its Eradication in West Africa. Int J Infect. 2019;6(3):e92250.

CHOLERA: A BURDEN IN AFRICA

Overview of Cholera

Cholera is an infectious disease among humans, characterized by acute diarrheal symptoms and is regarded as an infectious disease of poverty due to its prevalence in regions that are low-resourced with poor sanitary conditions. Every year, over 2.9 million cases occur around the world, causing around 95,000 deaths annually. Although the disease is cosmopolitan, it is highly endemic in Africa, a continent that is home to numerous underdeveloped countries where resources are limited and the infection prevention and control measures are inadequate.

Globally, cholera is considered as one of the most rapidly fatal illnesses ever known, as it causes severe diarrhea and vomiting, leading to rapid dehydration, shock and possible death.

What causes Cholera?

The disease is caused by a specific bacterium called Vibrio cholerae, which invades the human intestine and produces a powerful toxin that causes excessive loss of water and electrolytes from the body, leading to the production of massive, loose diarrheal stools popularly referred to as ‘rice-water stool’. It may be accompanied by repeated bouts of vomiting. This causes severe dehydration and if left untreated, can be fatal to the patient in a matter of hours. The causative bacterium is found in food and water sources that have been contaminated by the feces of an infected person, hence, transmission of the disease is high in places with poor water supply and improper sanitary conditions. Water sources like ponds, rivers, streams, lakes and tap water are known to harbor the bacteria and can be transmitted to various persons through food and drinks gotten from these water sources, vegetables grown with infected human waste as fertilizer, as well as the consumption of raw or undercooked fish and other marine foods gotten from polluted water bodies.

Source: UN Water. https://bit.ly/3gxxjsR

What are the Signs and Symptoms of Cholera?

Upon entry of the bacteria into the intestines, the symptoms of cholera can begin within a few hours to about 5 days after infection. Sometimes, infected persons may experience mild or no symptoms, but they are capable of spreading the infection to others through improper disposal of their fecal matter. However, when the infectious dose of bacteria cells is high, infected persons will experience severe symptoms within a few hours or days, some of which include sudden, massive diarrhea characterized by frequent production of very loose stools every hour or so.

This is accompanied by nausea and vomiting, which further compounds the severity of dehydration, as a lot of body fluids and electrolytes are lost in the process. The possible fatality of cholera depends on the level of dehydration, as it leads to dryness of skin, extreme thirst, sunken eyes and dry mucous membranes, low blood pressure, and electrolyte imbalance, which gives rise to tachycardia (rapid heart rate), muscle cramps and shock. If left untreated, such severe dehydration can lead to death in a matter of hours.

Source: Smithsonian Magazine. https://bit.ly/3q2onyy.


How is Cholera diagnosed?

Due to the sudden onset of symptoms in severe cases of cholera infection, diagnosis is usually based on the characteristic signs and symptoms of the disease. However, in individuals where the infection is mild, diagnosis is made by taking a stool sample from the infected patient’s excreta or taking a rectal swab and carrying out a laboratory analysis to detect the Vibrio cholerae bacteria. 

What is the level of Cholera burden in Africa?

Cholera is an infectious disease with worldwide geographical distribution, however, it has a much higher prevalence of cases and mortality rates in the African continent. This is due to the fact that many African countries lack access to clean water supply and practice poor sanitary measures, which is a common situation in most rural, underdeveloped areas. As of 2017, about 34 countries worldwide experienced cholera outbreaks, of which the majority were African countries like Somalia, Ethiopia, Democratic Republic of Congo, Nigeria, Zambia and South Sudan. A total of about 1,227,391 cholera cases were recorded worldwide, of which 179,835 of the cases were from Africa. In terms of mortality, about 57% of the worldwide deaths from cholera occurred in African countries.

Reservoirs of the cholera bacteria, mainly contaminated marine environments like shallow springs, streams, river brooks, lagoons, heavily polluted water surfaces, wetlands, groundwater systems and sewage disposal systems, are quite prevalent in these areas because of the poor sanitary practices. Although the cholera outbreaks occur in all seasons, most of the cases in these regions are reported during the onset of the rainy and dry seasons. These findings highlight the fact that in order to tackle cholera outbreaks effectively, more infection prevention and control measures need to be channeled to regions of higher prevalence, especially in the African continent.

How can Cholera be treated?

Upon infection, the most important thing to do is to ensure immediate replacement of the body fluids and electrolytes lost through repeated diarrhea. Cholera patients are treated with Oral Rehydration Solution (ORS), along with intravenous fluid replacement therapy in more severe cases. With proper rehydration of the patient, the symptoms start to abate and treatment with antibiotics becomes secondary as it only serves to shorten the course of diarrhea and further lessen the severity of the disease by eliminating most of the bacteria. Persons infected with cholera are advised to seek medical attention immediately and the replacement of lost fluids must be made a priority.

How best can Cholera be prevented?

When travelling to or residing in areas endemic to cholera, you can successfully prevent infection by frequently washing your hands with soap and water after making use of the toilet and before handling food, or at least using an alcohol-based hand sanitizer when soap and water are not available. Never drink water from unsafe sources such as taps, boreholes, streams, etc. Only make use of boiled or disinfected water, or when affordable, make use of bottled water for drinking, cooking and even brushing teeth. Avoid food vendors along the street and only eat food that is properly cooked. Avoid raw foods such as uncooked fish or seafood, and only take fruits or vegetables that have been properly washed in pure, boiled water.

Certain oral cholera vaccines such as Vaxchora, ShanChol, Euvichol and Dukoral have been approved worldwide for individuals travelling to regions of active cholera transmission. However, no particular cholera vaccine offers 100% protection against the disease, and are not regarded as a standard preventive measure against cholera. The major preventive measures include adequate handwashing, consumption of only pure food and water sources, and avoidance of raw or uncooked food and impure sources of water.

References

  • Centers for Disease Control and Prevention (2020). Cholera – Vibrio cholerae infection. https://bit.ly/35rud31.
  • Mayo Clinic (2020). Cholera. https://mayocl.in/3xs46oF.
  • Ebob TJ. An Overview of Cholera Epidemiology: A Focus on Africa; with a Keen Interest on Nigeria. International Journal of Tropical Disease and Health. 2019;40(3):1-17. 

TETANUS: THE PUNCTURE WOUND DISEASE

What is Tetanus?

Tetanus is a serious disease that affects the nervous system and is caused by bacterial infection of deep wounds, characterized by repeated bouts of painful muscle spasms. The disease is also called “Lockjaw” because it causes stiffness of the neck and jaw muscles in an infected person, making it too difficult to open the mouth or swallow, and causes breathing difficulties. The disease has been known to man for ages and still remains a public health threat in various parts of the world, especially in resource-limited settings where immunization coverage is low and unclean birth practices are common. Individuals of all ages are susceptible to contracting tetanus, but the disease is particularly common and severe in infants and their mothers due to infection from the use of unclean surgical equipment during child delivery and lack of vaccination. 

What causes Tetanus?

The disease is caused by the bacteria Clostridium tetani, which produces dormant spores that can survive in soil, dust and human faces for years, and can gain entry into the body through deep cuts and puncture wounds from contaminated objects like nails or pieces of glass. The bacteria thrive in anaerobic conditions (low oxygen), thus, puncture wounds are a good site for their growth. Upon entry into the wound, the bacterial spores germinate to give rise to active bacteria, which actively grow and divide due to the anaerobic condition in the wound, simultaneously releasing a potent toxin called “Tetanospasmin” that affects the nervous system. Tetanospasmin is one of the most potent microbial toxins ever known to man, and acts by inhibiting the nerve cells that regulate muscle contractions in the body. As a result, the muscles begin to contract more forcefully and more frequently, causing the excessive muscle spasms characteristic of tetanus. Risk factors that make an individual susceptible to contracting tetanus include deep wounds caused by nails or splinters and exposed to soil or manure, an infected umbilical cord during birth delivery of an unvaccinated mother, use of unsterilized surgical equipment, shared use of contaminated needles among drug abusers, and infected skin lesions in people living with diabetes.

What are the Signs and Symptoms of Tetanus?

The total incubation period of the bacteria ranges from 3 to 21 days, but the average time from infection to manifestation of symptoms is about 10 days. There are four forms of tetanus, which are generalized, localized, cephalic and neonatal tetanus. Generalized tetanus is the most common and is mainly characterized by stiffness and painful muscle spasms starting from the jaw and neck, and then progressing to other parts of the body. The patient experiences difficulty swallowing, fever, diarrhea, intense headaches, rapid heartbeat, sweating and muscle rigidity. There is uncontrolled tension in the muscles around the mouth, resulting in a characteristic persistent grin called “risus sardonicus”. During intense muscle contractions involving the whole body, the arms are folded against the sides, the legs are fully extended, and the neck and abdomen are arched with the head thrown backwards, giving a peculiar, tensed posture called “opisthotonos”, which is a definitive sign of generalized tetanus (see illustration). At times, the muscle contractions can be so powerful that bone fractures and tendon dislocations may occur, which further worsens the state of the patient.

These muscle contractions can be induced by stimuli such as noise, bright light and physical touch, thus, such patients are kept in very quiet isolation to minimize the presence of such stimuli. Without adequate medical attention, severe cases of generalized tetanus usually result in death due to breathing difficulties caused by muscle rigidity of the neck and abdomen, or damage to nerves that regulate vital functions such as breathing and heart rate.

Localized tetanus is characterized by persistent contractions involving only the muscles around the infected wound, but this can eventually become generalized if left untreated. Cephalic tetanus involves the muscles of the face and is caused by head injuries that got infected or ear infections that spread to the nerves of head. Damage of the facial nerves results in facial palsies characterized by a drooping appearance on one side of the face. It can progress to generalized tetanus if left untreated, and can be fatal. Neonatal tetanus occurs in infants, mostly as a result of using unsterile surgical equipment to operate on the umbilical cord during childbirth. As a result, the infant becomes infected and develops contractile symptoms similar to that of generalized tetanus within 28 days of birth. Neonatal tetanus is a major cause of infant mortality in underdeveloped countries worldwide. 

How can Tetanus be diagnosed?

The symptoms of tetanus are very peculiar and cannot easily be mistaken for other diseases; hence, presence of the symptoms demands immediate commencement of treatment. However, for the sake of confirmation, a blood test and laboratory culture can be carried out to confirm the presence of the causative bacteria. Anyone with signs of muscle stiffness and spasms is advised to seek expert medical attention immediately. The earlier the diagnosis, the more effective the treatment will be.

How can Tetanus be treated?

There is no specific medication for treating the disease. Treatment is usually by management of symptoms. The muscle spasms and stiffness can be treated with anticonvulsants (like Diazepam), muscle relaxants (like Baclofen), and neuromuscular blockers (like Pancuronium). Antibiotics like Penicillin, Metronidazole and Tetracycline can be administered to the patient to limit bacterial multiplication and toxin production. Tetanus patients must be given adequate nourishment, as they require a high daily calorie intake due to increased muscle activity. Ventilators can be used to support patients that have difficulty breathing if their respiratory muscles are affected.

Source: iStock. https://bit.ly/3fWS5Br

How best can Tetanus be prevented?

Persons with any deep cuts, wounds or burns should seek immediate medical attention to have their injury cleaned thoroughly to prevent infection. Such injuries must be properly dressed to prevent contact with soil and other sources of infection. The individual should be given a shot of Tetanus Immunoglobulin (TIG) quickly, as it contains antibodies that kill the causative bacteria and provide short-term protection against tetanus. However, vaccination remains the most effective method of preventing tetanus infection. The tetanus vaccine is usually administered as part of the DTaP vaccine against Diphtheria, Tetanus and Pertussis (whooping cough). The vaccine is routinely given in five shots with monthly intervals. At the age of 11 to 18 years, a booster shot is necessary to maintain immunity against the disease, and such booster shots should be continually given every 10 years, especially in regions where tetanus is common. 

Reference

COVID-19 Vaccination Hesitancies

Studies have shown that COVID-19 disproportionately impacts the Black community and other minorities in the United States. These trends have roots in the country’s systematic racism and discrimination towards Black people. Today, as the widespread dissemination of the COVID-19 vaccine begins, many individuals have valid concerns and hesitancies. We cannot address the current issues with vaccine uptake without acknowledging the horrors of the past.

The History of Racism

In a recent survey made by the National Association for the Advancement of Colored People (NAACP), only 18% of Black respondents indicated they would be getting the vaccine. The racial gap in vaccination attitudes is in-part a result of the past historical atrocities of experimentation (Tuskegee, Henrietta Lacks, and James Marion Sims) that instilled distrust amongst the Black community towards the health care systems.

There has never been any period in American history where the health of                                                            Blacks was equal to that of whites. [The] disparity is built into the system 

  Evelynn Hammonds, New York Times

Racism Today

While understanding past traumas help to interpret various attitudes and behaviours, focusing solely on these events ignores the everyday racism Black people still face today. Highlighting only the atrocities in history provide a false narrative that racism is a concept of the past — when in fact, Black Americans experience discrimination to this day.

Research indicates that Black patients will go out of their way to be seen by a Black physician because their resulting health outcomes are often better (Bajaj & Stanford, 2021). Physician-patient racial concordance significantly impacts care delivery, and such concordant messaging was proven to be immensely valuable during the COVID-19 pandemic. Alsan and colleagues (2020) reveal that watching videos delivered by a Black physician increased information-seeking behaviours among Black patients. The NAACP also supports this finding by noting Black Americans are twice as likely to trust messages delivered by someone of their own racial/ethnic group. Hence, the identity of the health professional translates into the trust and attitudes of the recipient, which is a meaningful relationship to keep in mind during vaccine-rollout.

Misinformation

The internet creates a space for misinformation, and it becomes difficult for individuals to differentiate between facts and myths — a phenomenon termed infodemic. Many individuals do not have a clear understanding of how vaccines work (McLernon, 2021) and this lack of knowledge makes them prime targets for conspiracies and myths. To combat the spread of misinformation, public health professionals must shift their strategies and meet people where they are. Social networking sites such as Facebook, Twitter and Instagram are prime locations to engage with the public and tackle misinformation. Many health institutions (e.g. The World Health Organization) have active social media accounts with millions of followers. Social media has proven to be an effective health education tool and is where the future of health promotion lies. Local and national campaigns need to incorporate the use of digital spaces into their strategic plans.

Some physicians are already embracing the power of social media to help spread awareness surrounding the COVID-19 vaccines. For example, Dr. Kristamarie Collman has been actively battling misinformation using the increasingly popular app, TikTok. One video alone received over half a million views.

For some people, it means a lot when it comes from someone who looks like them, when it comes from someone who speaks like them.
                       Dr. Kristamarie Collman 

View Dr. Kristamarie Collman’s video here: 
www.tiktok.com/@drkristamarie/video/6904348408841063686?sender_device=pc&sender_web_id=6895549672766916102&is_from_webapp=v3&is_copy_url=0

It is important to recognize that while these popular platforms are helpful for education, not everyone is engaging online. As Allison Matthew (Huang, 2021) notes, health promotion efforts need to meet people at a level of communication that is the most convenient for them. For some individuals, this may be through social media, but for others, it could be through television, mail or telephone.

Building Trust

Increasing Black representation in public health is important; however, the reality is only 5% of physicians in the United States are Black (Bajaj & Stanford, 2021). Hence there is a need for efforts to be directed at the community level. Beyond Black doctors, health promotion strategies should seek support from community leaders in churches, sororities, and local organizations. The challenge is not only in education and overcoming vaccine hesitancies, but in building trust for the health care system as a whole.

Strategies of Action

There is a need for Black physicians and healthcare professionals to be at the forefront of current COVID-19 vaccination efforts. Highlighting the involvements of Black health leaders is critical in establishing trust. Dr. Kizzmekia Corbett was part of the Moderna vaccine development team and a lead scientist for COVID-19 vaccine research at the National Institute of Health (Scripps National, 2020). She notes that people have the right to be hesitant and that rebuilding trust in medical institutions will take time (Scripps National, 2020).  

In addition to ensuring Black representation in public health and the scientific community, there also needs to be focus directed towards effective communication strategies. Utilizing different channels and providing information that is accessible and understandable is crucial to increasing vaccination rates.

References

THE RELATIONSHIP BETWEEN OBESITY, DIABETES AND COVID-19

What is Obesity?

Generally, the term ‘obesity’ is attributed to individuals that appear to be overweight in an unhealthy way. However, obesity is actually defined as having a body mass index of 30kg/m2 or higher. The Body mass index (BMI) is a measure of one’s body weight in relation to height, in order to determine the body size. There are certain BMI ranges used to classify the weight of individuals in terms of health, as can be seen in the diagram below:

Source: Obesity Action Coalition.  https://bit.ly/39AtuiQ.

What causes Obesity?

There are a number of contributing factors that can lead to an individual becoming obese. Some of them include:

 Overconsumption of calories in one’s diet – When you consume more calories than you burn in a day through overeating for long periods, this can result in accumulation of the extra calories and can lead to unhealthy weight gain.

 Not exercising enough – Living a sedentary lifestyle that does not involve regular exercise and locomotory activities can also cause quick weight gain due to minimal burning of calories.

 Aging – Elderly individuals usually have a slower metabolic rate, less muscle mass and carry out fewer activities, thus, they tend to gain weight more easily than younger persons. This is the reason why elderly persons are advised to exercise regularly so as to reduce the chances of unhealthy weight gain.

 Pregnancy – Due to the higher metabolic rate observed in pregnancy, expectant mothers are usually likely to develop a high appetite and consume more calories than they burn off, which increases their risk of becoming obese.

 Not getting enough sleep – When you do not get enough sleep, certain hormonal changes tend to occur, which can make you get hungry more quickly and consume more high-calorie meals.

 Depression – Individuals battling with depression may sometimes develop unhealthy eating habits as an emotional coping mechanism, which can cause quick weight gain.

 Genetic causes – Certain genetic factors can affect the way one’s body processes food for energy use, and can also affect fat storage functions, making it easier for the individual to gain weight quickly.

Some other factors that can increase one’s risk of weight gain and obesity include specific disease conditions like Hypothyroidism, Cushing syndrome and Osteoarthritis.

Source: Wasatch Peak Family Practice.   https://bit.ly/3cssWxI.

What is Diabetes?

More accurately put, Diabetes mellitus (DM) is a metabolic disease characterized by high levels of glucose in the bloodstream, usually as a result of insufficient levels of insulin. A fasting blood glucose level higher than 125mg/dl is diagnosed as diabetes mellitus. This condition is more common among individuals that consume unhealthy levels of calories and sugar containing foods, however, there are a number of other causes. There are different types of diabetes, which include:

 Type 1 Diabetes Mellitus (T1DM): This is an autoimmune metabolic disease that occurs when the body’s immune system starts attacking and destroying cells in the Pancreas, which is the organ that produces insulin. The reason for this is not exactly known, but it is usually genetic-related or may possibly be caused by a viral infection of the Pancreas. Though it is less common than type 2 diabetes, it is more likely in children and young individuals.

 Type 2 Diabetes Mellitus (T2DM): This type of diabetes occurs when the body cells develop resistance to insulin due to a number of reasons, of which abdominal fat and obesity are notorious factors. As a result, the body cells do not take up glucose and it accumulates in the bloodstream.

• Gestational Diabetes: This type of diabetes occurs during pregnancy due to certain hormones produced by the placenta that block the effects of insulin on the body’s cells, causing reduced glucose uptake and subsequent accumulation.

• Prediabetes: This occurs when one’s blood glucose level is higher than the normal range (75-120mg/dl), but is not high enough to be diagnosed as diabetes.

• Diabetes Insipidus: Though this condition shares a similar name with Diabetes mellitus, it is actually not related to high blood glucose levels, but rather, is caused by removal of excessive amounts of fluid (in urine) from the body by the kidney. The condition was given a similar name to diabetes mellitus as it bears a resemblance to one of the symptoms of DM, which is excessive urine production and fluid loss.

Source: News Medical Life Sciences.   https://bit.ly/3pAEPFs.

What causes Diabetes?

Diabetes occurs as a result of the body’s inability to effectively take up glucose from the bloodstream, which results in accumulation and high blood glucose levels. Insulin is a hormone produced by the pancreas that stimulates body cells to take up glucose, thus, when insulin is not produced in sufficient amounts (T1DM) or the body cells do not respond to the insulin produced (T2DM), glucose is not absorbed by the body, and it builds up in the bloodstream, causing damage to various organs like the eyes, kidneys, nerves, etc., and a number of other negative health effects. There is a direct correlation between obesity and diabetes, and there is also proof of genetic factors that increase the likelihood of diabetic occurrence in certain individuals.

What is the relationship between Obesity and Diabetes?

Many research studies so far have established the fact that obesity is a high-risk factor for diabetes, and recent research shows that obese individuals with a BMI of 30kg/m2 and above are about 80 times more likely to develop type 2 diabetes than those with a BMI below 22kg/m2. Though the exact reason why obesity leads to diabetes is not yet fully understood, it has been confirmed that excessive abdominal fat in obese persons greatly decreases the sensitivity of the body’s cells to insulin. This occurs because fat cells (adipocytes) spontaneously release certain substances called ‘pro-inflammatory mediators’, which are generally involved in an inflammatory response, but are also known to decrease insulin responsiveness because they interfere with the ability of the cells to chemically bind to the insulin circulating in the blood. Another scientific explanation is that obesity may cause certain chemical changes to some components of the antibodies circulating in the blood, and these changes cause the antibodies to bind to and inhibit a particular enzyme that is responsible for the transfer of insulin from the bloodstream to the body tissues.

Obesity is also known to trigger metabolic changes in the body by the release of fat molecules into the blood, which also reduce insulin sensitivity. In all research studies carried out so far, the bottom line is that obesity greatly increases one’s risk of developing type 2 diabetes mellitus (T2DM).

Source: Springer Link.  https://bit.ly/36uszyF.

What is the relationship between Diabetes and COVID-19?

Several clinical studies have shown that COVID-19 patients with underlying medical conditions like diabetes, cardiovascular diseases and respiratory conditions have higher rates of morbidity and mortality, especially resulting in their admission to hospital Intensive Care Units (ICUs). The typical disease complications observed in diabetes mellitus like hypertension, heart failure and chronic kidney disease are factors that aggravate the severity of the COVID-19 infection. Elevated blood glucose levels (hyperglycemia) have been observed to facilitate viral entry into the body’s cells and also indirectly increase the viral replication of SARS-CoV-2, thus, increasing the viral load in the COVID-19 patient and worsening the associated disease complications.

Also, research shows that the inflammatory response caused by the coronavirus has ways of increasing insulin resistance by interfering with the normal functions of the skeletal muscles and liver, which are the major insulin-responsive organs in the body. Once these organs lose their insulin sensitivity, they become unable to effectively take up insulin, and the blood glucose level keeps rising.

Diabetic patients usually experience a reduction in the efficacy of certain immune cells such as the Helper T-Cells and Natural Killer (NK) Cells. As a result, the immune systems of such patients are unable to fully fight the COVID-19 infection, thus, making the individual more susceptible to the disease. Also, certain drugs used for the clinical management of COVID-19 patients, like Corticosteroids and Antiviral agents, are known to increase blood glucose levels and might worsen the diabetic symptoms/signs in such patients.

How can the complications of Obesity, Diabetes and COVID-19 be avoided?

The major step necessary to prevent diabetes and its complications is weight control, by cultivating regular exercise habits and diet regulation of calories to reduce the risk of developing obesity and excessive abdominal fat. Methods like having a ‘weight loss accountability schedule’ can be set up between the individual and their medical adviser to ensure strict commitment to the weight control measures. Losing a fair amount of body weight can greatly improve the insulin sensitivity of the body cells and lower one’s risk of developing obesity and subsequent type 2 diabetes. The prescriptions of medications for managing diabetes should be strictly adhered to in order to avoid the emergence of complications in the long run. Diabetic COVID-19 patients need to be given special medical attention to prevent case worsening and increased mortality.

References

Mental Health Conditions: The African Perspective

Overview of Mental Health in Africa

The African continent is a large one consisting of many nations, of which, most are low and middle-income countries (LMICs), especially in the Sub-Saharan region. Most parts of the continent are characterized by high mortality rates from malnutrition, infectious and non-infectious diseases, and a lack of basic healthcare amenities. Healthcare is one economic aspect that is poorly funded in many African countries, which is highlighted by the inability of these nations to implement the Abuja Declaration of 2001. This declaration, which was made by member countries of the African Union, involved a pledge by each country to allocate at least 15% of their national budget to the healthcare sector. Two decades after this declaration, healthcare budgetary allocation in many African countries still lags below 15%, and mental health happens to be the least considered aspect of the health sector.

Much earlier on in 1988 and 1990, the member states of the World Health Organization (WHO) African Region had developed and adopted two public health resolutions to improve the quality of mental health services by formulating suitable mental health policies, programmes and action plans. Series of surveys since then have shown that despite some level of improvements, a lot is yet to be done about the state of mental health services in most African countries. Various misconceptions about mental health conditions are prevalent among the general public, and people’s attitudes towards mental illness are strongly influenced by traditional beliefs in the supernatural. Stigmatization against mentally challenged individuals is very common, and little is done to support such persons physically or emotionally.

Source: Rand Corporation.  https://bit.ly/3cKGCSV.

Problems Associated with Mental Health in Africa

With the development of newer and more effective medications for the treatment of mental illnesses, it is expected that the management outcomes of mental cases should greatly improve, however, this is not the case in most African countries. Access to such medications is limited in these countries, mostly due to their poor purchasing power, logistical problems, and difficulties in establishing local production. A shortage of mental health workers is quite common in most African countries, as statistics show that the African region has just 1.4 mental health workers per 100,000 people, compared with the global average of about 9 mental health workers per 100,000 individuals. There is a glaring deficit of Psychiatrists in the region due to minimal professional training and low rate of specialization among doctors as a result of the associated stigma. In addition, the state of mental rehabilitation facilities is quite appalling, as the number of hospital beds for mentally ill patients is far less than the global average, which is one of the reasons why low rates of visits to mental health facilities are recorded in the region.

Though some efforts have been made to establish policies to improve the quality of mental health services, little success has been recorded with implementation, and a number of African countries outrightly lack any standalone mental health policies or programmes. This is further compounded by the deficit of substantial research into mental health problems, making it difficult to monitor the frequency of mental cases and the level of treatment inadequacies. With the absence of definitive research, there is no statistical basis for governments and policy markers to work with in order to enact and implement effective policies that suit the mental health challenges peculiar to each country. One of the consequences of the weak policy system is the nonchalant use of crude treatment methods for the management of mentally ill patients, such as beating, chaining and forceful administration of medications to patients in mental rehabilitation centers. As a result of the distressing experiences faced by these patients, it is quite common for individuals with mental health conditions to refrain from seeking medical attention, for fear of being ‘taken away’ to rehabilitation centers to receive such treatment methods.

The emergence of the COVID-19 pandemic has further worsened mental health states, not just in Africa, but on a global scale. The lockdown measures implemented by most countries served as a trigger for various mental conditions like depression, loneliness and anxiety, and also exacerbated the already existing mental disorders of indoor and outdoor patients. This has resulted in an increased demand for mental health services, which unfortunately cannot be met by many health facilities, as most healthcare efforts are currently channeled towards the COVID-19 response. As the pandemic gradually resolves, most hospitals and health facilities have been reopened, but social distancing measures are still being implemented, making it difficult to have regular physical appointments with mental healthcare givers.

Solutions to the Mental Health Security Challenges in Africa

Collective efforts must be made by all African leaders to increase the national budgetary allocation to mental healthcare in their individual countries, and also work towards setting up more rehabilitation centers that are well-equipped to adequately handle mental health cases. Public-private partnerships should be established in order to create intensified training programmes for psychiatrists and other mental health professionals, and efforts should also be made to introduce incentives into their payment scheme to encourage them in their job of caring for mentally challenged individuals. National health-related bodies and non-profit organizations (NGOs) can encourage policy making by awarding grants to African researchers for carrying out quantitative and qualitative research studies that assess the prevalence of mental disorders, the associated risk factors, the effectiveness and cost of treatment interventions, and the type of policies most suitable for responding to mental health challenges. Such research studies will enable governments and policy makers to enact and implement effective policies that will improve the quality of mental health services, and also ensure the eradication of all abusive treatment methods, while preserving the fundamental human rights of mentally ill patients in rehabilitation centers.

In a bid to improve public awareness about mental health conditions, individual African countries can make efforts to set up awareness campaigns at the local and national levels through physical means like awareness rallies and educational programmes in rural and urban communities, as well as the use of virtual means like circulation of infographics and myth busters about mental health on social media platforms and hosting television or radio programmes that educate citizens on the complexities of mental disorders and the need to preserve the dignity of mentally challenged persons. Through such physical and virtual means, people can also get access to expert medical advice on the right practices necessary to maintain their mental wellbeing, and mentally ill persons can be encouraged to seek medical help without delay.

With the advent of the COVID-19 pandemic, health systems in most developed countries have adopted the use of telemedicine in the administration of healthcare services, including those related to mental health. As the rate of telecommunication use has greatly improved in most African countries recently, similar telehealth approaches can be adopted as well. A number of mental health-focused NGOs are currently being set up across Africa such as MANI and PsyndUp in Nigeria, the MEGA project in Zambia and South Africa, Wazi in Kenya and MindIT in Ghana. These mental health tech startups have been working closely with local and national psychiatry associations to provide free virtual consultations for mentally challenged persons, thus, ensuring quicker and easier access to mental healthcare services. National and international health bodies, together with African governments, can support these initiatives with the necessary funds and equipment to encourage their efforts in ensuring that the goal of adequate mental health security is achieved.

References

COVID-19 Vaccine Skepticism among Racial Minorities

COVID-19 has unjustly impacted communities of color, especially African Americans and Hispanics – these communities see disproportionate infection and death rates from the coronavirus than other racial groups. Further, small businesses run by individuals of color have seen greater losses than those run by white Americans. To reduce the long-term burden of the virus upon racial minorities, it is vital that opportunities for vaccination are equitable and accessible for all, regardless of one’s location or income level.

However, it is understandable why some people of color may be skeptical about trusting the COVID-19 vaccine. There is a troublesome history of non-consensual medical practices towards patients of color. For instance, biological property has been stolen and exploited without credit or compensation, as was the case with Henrietta Lacks’s cancer cells. As well, during the Tuskegee Study of 1932, black males were injected with syphilis without their consent and were not given any available treatment. This study went on for 40 years and lead to 157 preventable deaths. Unfortunately, racism is still pervasive both explicitly and implicitly within society, and the medical field is not immune to this. Further, undocumented immigrants may avoid accessing health care services in fear of their status being discovered or reported, as well as these locations being targeted by immigration services. As well, both African Americans and Hispanics have been routinely underrepresented in clinical trials for many different treatments and conditions

We are not highlighting these upsetting events to further drive mistrust between patients of color and the medical community. We are bringing them to light to bring awareness to these serious systemic issues and to instead build trust by contrasting these experiences to the truth about receiving the COVID-19 vaccine: 

→ The vaccine has been approved for use among most Americans
  o Currently, the only groups that are cautioned against receiving the vaccine are pregnant                              women and those who have allergies to any of its ingredients

→ The vaccine will NOT infect you with the coronavirus
     o The currently approved vaccines do not include a deactivated or weakened version of COVID-19
     o The vaccine contains mRNA, a molecule naturally produced within your body
i. It prompts our cells to create a protein that our immune system will learn how to identify and target, subsequently developing an immune response to kill the virus before it infects us and symptoms develop
ii. It DOES NOT influence or change one’s DNA or genetic makeup
iii. Once mRNA has done its job, it is rapidly disposed of in the body 

→ African American and Hispanic populations are receiving the COVID-19 vaccine at a slower rate than  other racial groups in America
 o However, these groups are dying of COVID-19 at disproportionate rates
 o There is no indication of any differences in the type of vaccine being distributed between different racial groups – in fact, race and ethnicity of vaccinated individuals is only reported about half of the time

→ Undocumented immigrants have the right to receive the COVID-19 vaccine
of U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection has       been specifically instructed to not carry out enforcement operations at or near vaccination sites or health care facilities

→ COVID-19 vaccine developers actively worked to include more racial and ethnic minorities in their       clinical trials
  o The efficacy results of the vaccine for these groups were very similar between the different developers

i. This means there were no significant differences in how well the different vaccines work to prevent COVID-19 infection among racial groups  


Hopefully, this information will provide some reassurance for people of color who are debating whether to receive the COVID-19 vaccine. It is important that everyone plays their part in keeping our communities safe. America needs as many people to get the COVID-19 vaccine as possible in order to slow and eventually stop the devastating effects of the virus upon the lives of citizens. Higher vaccination rates not only benefit our physical health but also will improve mental health and economic activity. With fewer social distancing guidelines, we will be able to safely access our social support systems and help out businesses that have seen significantly reduced revenue within the past year. The more people who receive the vaccine, the better off Americans will be in the long run.  

References: