African leaders on Monday, January 29, 2018 made a landmark commitment to remove nutrition-related barriers that prevent children and societies from realising their full potential.

The leaders made the commitments at the launch of African Leaders for Nutrition (ALN) − an initiative championed by the African Development Bank (AfDB) and the African Union Commission (AUC) – in Addis Ababa, where they agreed to jointly overcome malnutrition and elevate nutrition as driver for economic growth and sustainable development.

According to the President of the AfDB, Akinwumi Adesina, stunted children today will lead to stunted economies tomorrow. The impact of stunting is irreversible, but preventable.

Poor nutrition is responsible for stunting children’s growth, harming children’s educational development and future economic prospects. In 2016, 59 million African children suffered from stunting and 14 million suffered from wasting. Combined together, this is more than the population of France, more than the population of South Africa and seven times the population of Switzerland, Adesina warned.

“There’s every reason to care: poor nutrition is the main cause of death for millions of children under five. Indeed, three million children die every year in Africa from malnutrition. If current trends continue to 2030, Africa will have lost a mind boggling 36 million children because they didn’t have enough to eat or to eat well enough.”

The African Union has endorsed the African Leaders for Nutrition initiative and encouraged its champions to continue to dialogue and strengthen advocacy efforts in support of improved nutrition.

The Prime Minister of Lesotho, Motsoahae Thomas Thabane, read the resolution of African leaders on the ALN initiative, where they agreed that food security without improved nutrition will not deliver the desired inclusive socio-economic outcomes − especially as the number of those affected by hunger and malnutrition has not decreased over the past few years.

The declaration commended Member States who have made progress in ending child stunting and addressing underweight children and encouraged others to do the same.

“Nutrition is at the heart of our continental agenda and is a developmental issue. Nutrition security remains critical to all ongoing programmes and has a positive impact on development. Working together, we can make a difference,” said the Chair of the African Union Commission, Moussa Faki Mahamat, in a statement at the event.

President Adesina described Africa as the only region where the number of stunted children has increased, from 47 million in 1990 to 59 million in 2016.

“There is both a moral and economic obligation on us to resolve this utterly preventable African disaster. Africa can defeat stunting and malnutrition if its leaders align and leverage their combined will,” he told African leaders.

“So, today, I speak for the victims of the silent killer of life: malnutrition. God did not create kids’ stomachs to be empty. Nothing breaks our hearts more than a mother unable to calm the rumbling, hollow stomach of her hungry baby. A proverb in my Yoruba language says, ‘Elders cannot be in the marketplace and watch the heads of babies hang lose when strapped to the mothers back’.”

To the leaders, he said: “You are the elders. You cannot watch as three million babies die from malnutrition on the backs of equally malnourished mothers. We all need to hear the voices of these mothers and children and act without delay!”

He described ‘grey matter infrastructure’ as Africa’s most important infrastructure and stressed the determination of the African Development Bank to help Africa feed itself and become self-sufficient in food: nutritious food.

“The African Leaders for Nutrition initiative will keep a report card, an Africa Nutrition Accountability Score Card, which will rate countries scientifically on their progress in addressing malnutrition and building grey matter infrastructure. This policy innovation will build incentive to complement and strengthen the commitment. To achieve greater impacts on nutrition, governments should prioritise nutritional investments, through Nutrition-Sensitive Budgeting.”

The President of Madagascar, Hery Rajaonarimampianina, who presented an African Union Commission’s study on the Cost of Hunger in Africa (COHA), described malnutrition as one of the main barriers that prevent children and societies from realising their full potential.

“Stunted children fall ill more frequently – generating high health costs to families and the economy equivalent to between 1-30% of the total public budget allocated to health, or 3% of GDP. If we reduce current stunting rates by 50% by 2025, we can expect a saving of $21.7 billion; if we achieve the AU Malabo goal of reducing stunting to 10% and underweight children to 5% by 2025, we can expect a saving of up to $39.3 billion,” he said.

The first release of surveillance data on antibiotic resistance by the World Health Organisation (WHO) reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.

WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterial infections across 22 countries.

The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the “Global tuberculosis” report.

Among patients with suspected bloodstream infection, the proportion that had bacteria resistant to at least one of the most commonly used antibiotics ranged tremendously between different countries – from zero to 82%. Resistance to penicillin – the medicine used for decades worldwide to treat pneumonia – ranged from zero to 51% among reporting countries. And between 8% to 65% of E. coli associated with urinary tract infections presented resistance to ciprofloxacin, an antibiotic commonly used to treat this condition.

“The report confirms the serious situation of antibiotic resistance worldwide,” says Dr Marc Sprenger, director of WHO’s Antimicrobial Resistance Secretariat.

“Some of the world’s most common – and potentially most dangerous – infections are proving drug-resistant,” adds Sprenger. “And most worrying of all, pathogens don’t respect national borders. That’s why WHO is encouraging all countries to set up good surveillance systems for detecting drug resistance that can provide data to this global system.”

To date, 52 countries (25 high-income, 20 middle-income and seven low-income countries) are enrolled in WHO’s Global Antimicrobial Surveillance System. For the first report, 40 countries provided information about their national surveillance systems and 22 countries also provided data on levels of antibiotic resistance.

“The report is a vital first step towards improving our understanding of the extent of antimicrobial resistance. Surveillance is in its infancy, but it is vital to develop it if we are to anticipate and tackle one of the biggest threats to global public health,” says Dr Carmem Pessoa-Silva, who coordinates the new surveillance system at WHO.

Data presented in this first GLASS report vary widely in quality and completeness. Some countries face major challenges in building their national surveillance systems, including a lack of personnel, funds and infrastructure.

However, WHO is supporting more countries to set up national antimicrobial resistance surveillance systems that can produce reliable, meaningful data. GLASS is helping to standardise the way that countries collect data and enable a more complete picture about antimicrobial resistance patterns and trends.

Solid drug resistance surveillance programmes in TB, HIV and malaria have been functioning for many years and have helped estimate disease burden, plan diagnostic and treatment services, monitor the effectiveness of control interventions, and design effective treatment regimens to address and prevent future resistance. GLASS is expected to perform a similar function for common bacterial pathogens.

The rollout of GLASS is already making a difference in many countries. For example, Kenya has enhanced the development of its national antimicrobial resistance system; Tunisia started to aggregate data on antimicrobial resistance at national level; the Republic of Korea completely revised its national surveillance system to align with the GLASS methodology, providing data of very high quality and completeness; and countries such as Afghanistan or Cambodia that face major structural challenges have enrolled in the system and are using the GLASS framework as an opportunity for strengthening their AMR surveillance capacities. In general, national participation in GLASS is seen as a sign of growing political commitment to support global efforts to control antimicrobial resistance.

The need for a global surveillance system was highlighted by WHO in 2014 in the “Antimicrobial resistance global report on surveillance”.

In October 2015, WHO launched the Global Antimicrobial Surveillance System (GLASS) working closely with WHO Collaborating Centres and existing antimicrobial resistance surveillance networks and based on the experience of other WHO surveillance programmes. For example, TB drug resistance surveillance has been implemented in 188 countries over the past 24 years. HIV drug resistance surveillance started in 2005 and by 2017, over 50 countries had reported data on pretreatment and acquired resistance using standardised survey methods.

Any country, at any stage of the development of its national antimicrobial resistance surveillance system, can enrol in GLASS. Countries are encouraged to implement the surveillance standards and indicators gradually, based on their national priorities and available resources.

GLASS will eventually incorporate information from other surveillance systems related to antimicrobial resistance in humans, such as in the food chain, monitoring of antimicrobial consumption, targeted surveillance projects, and other related data.

The Catholic Bishop of Awka Diocese, Most Rev. Paulinus Ezeokafor, has called for an end to stigmatisation and discrimination against victims of leprosy.

Ezeokafor made the call while presenting some items to victims of leprosy as part of activities to mark the 2018 World Leprosy Day at the Leprosy Settlement, Oji-River in Enugu State on Sunday, January 28, 2018.

Some of the items donated include bags of rice, mattresses, mats, cartons of noodles, tubers of yam and crutches.

The cleric, who described stigmatisation and discrimination against leprosy victims as “unfortunate” also urged the Enugu State Government to resettle victims cured of the disease with their families.

“It is unfortunate that in spite of recent developments in medicine and health education about leprosy, people still do not understand that they can be cured of the disease permanently and be integrated into the society.

“They see the external signs and think it is not over. Leprosy can be cured and once cured, it is cured.

“This question of their continuous stay here as a result of stigmatisation makes no meaning of life,” the bishop said.

Ezeokafor, who noted that the children of the leprosy victims were free from the disease called for more support to fund their education.

In his remark, Mr Emmanuel Omeke of the Tuberculosis, Buruli Ulcer and Leprosy Unit of General Hospital, Oji-River said the settlement was still faced with challenges of routine drugs.

“It is true that German Leprosy and Tuberculosis Relief Association supply free leprosy drugs, but other routine drugs for treatment of malaria and other ailments are lacking for treatment of the victims,” he said.

Responding, the Chairman of the Leprosy Settlement, Mr Benjamin Udenze, commended the Catholic Bishop for the gesture, noting that the centre currently had over 140 members.

Udenze also commended the bishop for sustaining a scholarship scheme for 22 children of the settlement for15 years.

The chairman said the donations from the cleric as well as from other donors would go a long way to relieve them of their sufferings.

The News Agency of Nigeria (NAN) reports that other donors were Obijackson Foundation, Omex Global, the Anglican Church, Enugu Diocese and other individuals also made separate presentations to the victims.

By Peter Okolie

The World Health Organisation (WHO) says national programmes should boost active case-finding, strengthen surveillance, improve contact-tracing and focus more on early detection of leprosy cases among children to ensure achievement of the global target of zero child infection by 2020.

The call comes as the world observes World Leprosy Day on Sunday, January 28, 2018 to mark the suffering of people affected by this preventable and curable disease that appears to have eluded defeat.

Leprosy was globally declared to have been “eliminated as a public health problem” 18 years ago. However, pockets of endemicity have continued in many countries. India and Brazil report the highest number of cases annually.

Some of the children who have recently been diagnosed already showed signs of disability. This strongly calls for early case detection and surveillance, says the WHO.

Leprosy is caused by infection with the bacillus Mycobacterium leprae, which multiplies very slowly in the human body. The bacterium has a long incubation period (on average five years or longer). The disease affects nerve endings and destroys the body’s ability to feel pain and injury.

Data published by WHO in 2017 show that although the overall number of cases is slowly declining, that of new cases does not align with global efforts and resources deployed to interrupt transmission.

Reports from 145 countries of WHO’s six regions show that, of the total of 216,108 newly diagnosed cases of leprosy during 2016, 18,472 involved children, representing almost 9% of all new cases reported annually.

Leprosy is curable and treatment provided in the early stages averts disability.

Multidrug therapy is made available free of charge through WHO and has been donated to all patients wordwide by Novartis since 2000 (and earlier by The Nippon Foundation since 1995). It provides a simple yet highly effective cure for all types of leprosy.

Discrimination

Despite global efforts to repeal laws that discriminate against those affected by leprosy, adults still face crippling social barriers and children are deprived of education or subject to bullying and rejection due to stigma associated with the disease.

Besides elimination, WHO’s new global strategy focuses on working with governments and partners to end the discrimination and stigma associated with the disease and ensure that all legislation that allows for discrimination on the basis of leprosy is overturned.

Continued discrimination against people affected by leprosy has deterred people from coming forward for diagnosis and treatment and encouraged cases to remain hidden, indirectly contributing to transmission.

Social stigma also facilitates transmission among vulnerable groups, including migrant populations, displaced communities, and the ultra-poor and hard-to-reach populations. Combating stigma and ensuring early diagnosis through active case-finding, which the new strategy emphasises, is critical to making progress.