Girl, 10, Dies After Genital Cutting in Sierra Leone


A 10-year-old girl has died after undergoing  female genital mutilation (FGM) during an initiation into a secret women’s society in Sierra Leone, police said on Wednesday, sparking renewed calls for the practice to be banned.

Authorities have arrested the woman in charge of initiations as investigations continue, said Amadu Turay, unit commander of the Mile 91 police division, in Sierra Leone’s northern Tonkolili district about 240 km (145 miles) east of Freetown.

“She died of blood loss,” Turay told the Thomson Reuters Foundation, adding that it was assumed FGM was the cause.

A local activist said 67 other girls were reported to have been initiated and were awaiting medical examination.

Female genital cutting is widely practiced in the West African nation as part of girls’ initiation into secret societies which wield significant political clout.

Nine in 10 women have been cut in Sierra Leone which has one of the highest rates of FGM in Africa, according to United Nations data. It is one of only a handful of African countries which has not outlawed the internationally condemned practice.

The ritual typically involves the partial or total removal of the female genitalia and can cause serious health problems. The last reported death in Sierra Leone was two years ago, and the victim was 19.

Activists have helped develop a national strategy for FGM reduction but are waiting for the government to adopt it, said campaigner Rugiatu Turay, formerly the deputy minister of social welfare, gender and children’s affairs.

Just last week discussions on the strategy were held with religious leaders, doctors and chiefs in the district where the girl died, she said. One of the things they were told was to warn parents of the risk of death.

“Now that we have this situation, we want to just set the law,” said Turay, founder of Amazonian Initiative Movement, a grassroots anti-FGM group in Sierra Leone.

“FGM is killing our women and girls. We need to get enough publicity on this incident to draw the attention of government.”

A government spokesman could not immediately be reached for comment.

President Julius Maada Bio this month launched a campaign led by the First Lady called “Hands Off Our Girls,” focused on ending rape and child marriage, according to a statement.

Though it aims to eliminate “all forms of abuses against woman and girls,” the campaign does not mention FGM.

Sierra Leone starts new countdown to Ebola-free status


Sierra Leone has released its last two known Ebola patients and begun a new 42-day countdown to a declaration that it is officially free of the virus, officials said on Monday.

More than 11,300 people have died of Ebola in Guinea, Sierra Leone and Liberia in an outbreak that was declared in March 2014 and is rated the world’s worst.

The two women just released from hospital were treated in Kambia district on the Guinea border after being infected by a 67-year-old woman who posthumously tested positive for Ebola.

Her death lead to almost 1,000 people being put in isolation and stopped the previous countdown a week after it began in August. One community is still under quarantine but that should be lifted this week barring any new cases, officials said.

There were only two new cases in Guinea in the week of Sept. 20 and none in either Sierra Leone or Liberia, according to figures from the U.N.’s World Health Organisation (WHO).

A country must record zero new infections in 42 days to be declared Ebola-free, said WHO, which began the count in Sierra Leone on Sunday.

“It’s good news for Sierra Leone and the sub-region. I am hoping that this time we won’t fall off,” Pallo Conteh, who heads the national Ebola Response Centre, said.

“It is difficult to say you are confident because you know with Ebola one mistake might just lead to a spike again,” he said.

Ebola cases in W Africa reach 20,000


The World Health Organisation on Wednesday said that the number of people infected by the Ebola outbreak in the three west African countries has passed 20,000, even as the death toll from the deadly-disease reached 7,842.

Cumulative Ebola cases in the three west African countries — Sierra Leone,Liberia and Guinea — stood at 20,081, the WHO said in a statement.

Despite various missions launched by the UN, after it declared the outbreak a “public health emergency of international concern” in August, the disease has continued to spread and experts warn the epidemic will last a full second year.

Meanwhile, the UN Population Fund (UNFPA) today announced that the so—called “CommCare” technology has been chosen to support the Guinean Government Response Plan against Ebola in order to obtain timely and reliable information on patients as well as facilitate contact tracing.

UNFPA said the innovative and time—saving application will be used to locate the contacts and to transfer, in real time, the data collected by the community workers.

Nearly, 158 community workers have already been using these phones to retrieve the data collected in the field.

The UNFPA office in Guinea has been organising training sessions for community workers and supervisors throughout the territory.

 

 

Learning from Rwanda.


How is it that Rwanda, among the world’s poorest countries – and still recovering from a brutal civil war – is able to protect its teenage girls against cancer more effectively than the G-8 countries? After just one year, Rwanda reported vaccinating more than 93% of its adolescent girls against the human papillomavirus (HPV) – by far the largest cause of cervical cancer. Vaccine coverage in the world’s richest countries varies, but in some places it is less than 30%.

In fact, poor coverage in the world’s richest countries should come as no great surprise, especially when one considers the demographics of those missing out. Where available, evidence suggests that they are mainly girls at the lower end of the socioeconomic spectrum – often members of ethnic minorities with no health-care coverage. This implies that those who are at greatest risk are not being protected.

CommentsView/Create comment on this paragraphIt is a familiar story, one that is consistent with the global pattern of this terrible disease, which claims a life every two minutes: those most in need of protection have the least access to it. Of the 275,000 women and girls who die of cervical cancer every year, 88% live in developing countries, where mortality rates can be more than 20 times higher than in France, Italy, and the United States. That is not just because vaccines are not readily available; it is also because women in these countries have limited access to screening and treatment. Without prevention, they have no options if they get sick.

CommentsView/Create comment on this paragraphAlarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate. If it turns out that girls at risk of not receiving all three doses of the HPV vaccine are also those with an elevated risk of being infected and missing cervical screenings as adults, they may be slipping through not one but two nets.

CommentsView/Create comment on this paragraphIt is still not clear why this is happening. What we do know is that HPV is a highly infectious sexually transmitted virus, which is responsible for almost all forms of cervical cancer. HPV vaccines can prevent 70% of these cases by targeting the two most common types of the virus, but only if girls have not yet been exposed to the virus, which means vaccinating them before they become sexually active. Yet efforts to communicate this to the public have been met with skepticism from some critics, who argue that the vaccine gives young girls tacit consent to engage in sexual activity, ultimately leading to an increase in promiscuity.

CommentsView/Create comment on this paragraphHowever, quite apart from the evidence to the contrary, intuitively this makes no sense. To suggest that giving girls aged 9-13 three injections over six months gives them a green light to engage in sex and sets them on a path to promiscuity is utter nonsense. It is like saying that people are more likely to drive dangerously if they wear a seat belt; in fact, the opposite is more often the case.

CommentsView/Create comment on this paragraphWhether such attitudes and misinformation account for poor vaccine coverage in places like France and the US is still not known. It may simply be that some parents or girls mistakenly believe that one shot of the HPV vaccine is enough to provide protection, or that some socially disadvantaged girls lack sufficient access to in-school vaccination services. Or perhaps the cost of the vaccine is a barrier in some of these countries. Whatever the reason, unless coverage for all three doses increases, cervical cancer and pre-cancer rates will increase.

CommentsView/Create comment on this paragraphIn countries like Rwanda, people know this only too well, which is why they have been so eager to tighten the net on HPV. They have seen the horrors of cervical cancer, with women in the prime of their lives presenting with late-stage disease and suffering slow and painful deaths. Without changes in prevention and control, deaths from cervical cancer worldwide are projected to rise almost two-fold by 2030, to more than 430,000 per year.

CommentsView/Create comment on this paragraphAnd now, with help from my organization, the GAVI Alliance, a public-private partnership created to improve access to new vaccines for the world’s poorest children, other low-income countries are following Rwanda’s lead. As of this year, Ghana, Kenya, Laos, Madagascar, Malawi, Mozambique, Niger, Sierra Leone, Tanzania, and Zimbabwe have all taken steps to introduce HPV vaccines, with more countries expected to follow.

CommentsView/Create comment on this paragraphG-8 countries’ generous contributions to organizations like mine show that they understand the importance of childhood immunization. But, while HPV infection rates may be falling in some of these countries, are they falling fast enough? In the US, for example, the G-8 country for which we currently have the most data, infection rates have halved in the six years since the vaccine was first introduced. Yet failure to reach the 80% coverage mark means that 50,000 American girls alive today will develop cervical cancer, as will another 4,400 girls with each year of delay.

CommentsView/Create comment on this paragraphSo it is worth remembering that even in wealthy countries, there is an urgent need to overcome challenges in protecting the hardest-to-reach girls, who often are at high risk of HPV infection. Overcoming these challenges is essential to reducing cervical cancer and pre-cancer rates in the coming years. Rwanda’s success should be the norm, not the exception.

Read more at http://www.project-syndicate.org/commentary/on-how-rwanda-is-beating-cervical-cancer-by-seth-berkley#By3XogWXL7Bj4SZs.99

In fact, poor coverage in the world’s richest countries should come as no great surprise, especially when one considers the demographics of those missing out. Where available, evidence suggests that they are mainly girls at the lower end of the socioeconomic spectrum – often members of ethnic minorities with no health-care coverage. This implies that those who are at greatest risk are not being protected.

It is a familiar story, one that is consistent with the global pattern of this terrible disease, which claims a life every two minutes: those most in need of protection have the least access to it. Of the 275,000 women and girls who die of cervical cancer every year, 88% live in developing countries, where mortality rates can be more than 20 times higher than in France, Italy, and the United States. That is not just because vaccines are not readily available; it is also because women in these countries have limited access to screening and treatment. Without prevention, they have no options if they get sick.

Alarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate. If it turns out that girls at risk of not receiving all three doses of the HPV vaccine are also those with an elevated risk of being infected and missing cervical screenings as adults, they may be slipping through not one but two nets.

It is still not clear why this is happening. What we do know is that HPV is a highly infectious sexually transmitted virus, which is responsible for almost all forms of cervical cancer. HPV vaccines can prevent 70% of these cases by targeting the two most common types of the virus, but only if girls have not yet been exposed to the virus, which means vaccinating them before they become sexually active. Yet efforts to communicate this to the public have been met with skepticism from some critics, who argue that the vaccine gives young girls tacit consent to engage in sexual activity, ultimately leading to an increase in promiscuity.

However, quite apart from the evidence to the contrary, intuitively this makes no sense. To suggest that giving girls aged 9-13 three injections over six months gives them a green light to engage in sex and sets them on a path to promiscuity is utter nonsense. It is like saying that people are more likely to drive dangerously if they wear a seat belt; in fact, the opposite is more often the case.

Whether such attitudes and misinformation account for poor vaccine coverage in places like France and the US is still not known. It may simply be that some parents or girls mistakenly believe that one shot of the HPV vaccine is enough to provide protection, or that some socially disadvantaged girls lack sufficient access to in-school vaccination services. Or perhaps the cost of the vaccine is a barrier in some of these countries. Whatever the reason, unless coverage for all three doses increases, cervical cancer and pre-cancer rates will increase.

In countries like Rwanda, people know this only too well, which is why they have been so eager to tighten the net on HPV. They have seen the horrors of cervical cancer, with women in the prime of their lives presenting with late-stage disease and suffering slow and painful deaths. Without changes in prevention and control, deaths from cervical cancer worldwide are projected to rise almost two-fold by 2030, to more than 430,000 per year.

And now, with help from my organization, the GAVI Alliance, a public-private partnership created to improve access to new vaccines for the world’s poorest children, other low-income countries are following Rwanda’s lead. As of this year, Ghana, Kenya, Laos, Madagascar, Malawi, Mozambique, Niger, Sierra Leone, Tanzania, and Zimbabwe have all taken steps to introduce HPV vaccines, with more countries expected to follow.

G-8 countries’ generous contributions to organizations like mine show that they understand the importance of childhood immunization. But, while HPV infection rates may be falling in some of these countries, are they falling fast enough? In the US, for example, the G-8 country for which we currently have the most data, infection rates have halved in the six years since the vaccine was first introduced. Yet failure to reach the 80% coverage mark means that 50,000 American girls alive today will develop cervical cancer, as will another 4,400 girls with each year of delay.

So it is worth remembering that even in wealthy countries, there is an urgent need to overcome challenges in protecting the hardest-to-reach girls, who often are at high risk of HPV infection. Overcoming these challenges is essential to reducing cervical cancer and pre-cancer rates in the coming years. Rwanda’s success should be the norm, not the exception.

Anti-cancer vaccine for Laos.


Khonekham with health card with health card
Khonekham holds her health card showing she has received her first dose of the HPV vaccine

A programme to vaccinate girls against the virus that causes cervical cancer has begun in Laos, South East Asia.

It’s one of nearly a dozen developing nations where the HPV vaccine is being introduced in the coming year as part of a scheme to enable poorer countries to benefit from the newest vaccines.

It is five years since the jab was first offered to girls in the UK.

The project is being organised with the support of the Global Alliance for Vaccines and Immunisation (Gavi).

“Start Quote

The HPV vaccine represents a very significant commitment to women’s health in the coming decades.”

Helen Evans GAVI Alliance

The vaccine protects against the sexually transmitted human papillomavirus – preventing the infections that cause 70% of cases of cervical cancer.

‘Proud’ to be immunised

Khonekham Sirivong, 13, stood patiently in the queue of girls waiting for the HPV vaccine.

This was a poignant moment for her and Somsouk, her aunt, one of the nurses, under the shelter of trees in the school grounds.

Somsouk’s mother – Khonekham’s grandmother – died from cervical cancer. The two helped nurse her through years of illness.

“I remember she was in a lot of pain,” said Khonekham. “The family did everything it could, but she died. I am very proud to be immunised – and to have the HPV vaccine free of charge.”

Vaccine ‘crucial’

Cervical cancer is a far bigger cancer killer in developing countries because most lack a national screening programme, which can detect pre-cancerous changes in the cervix, enabling timely early treatment.

In Laos, most cases are discovered too late. Cancer treatment in the world’s poorest nations is also limited. Laos has no radiotherapy. Patients who can afford it are sent to Thailand.

“Approximately 275,000 women die every year from cervical cancer and over 85% of those deaths are in the developing world,” said Helen Evans, Gavi deputy chief executive.

“The number of deaths is projected to rise dramatically, so that’s why it is absolutely crucial that this vaccine is introduced.

“The HPV vaccine represents a very significant commitment to women’s health in the coming decades.”

survivor of cervical cancer
“I feel lucky to be alive,” said Sommay Khamkeomany

I have visited a lot of hospitals, in many of the world’s poorest countries – from Sierra Leone to Malawi and Bangladesh. But they have rarely been as crowded at Setthathirath hospital in Vientiane.

A senior oncologist, Dr Keokedthong Phongsavan, showed me round one of the wards, where the beds had spilled out into the corridor and were squeezed next to each other to accommodate more patients.

Sent home to die

However, it was not the overcrowding, but the limited treatment options that presented the biggest problem.

“I feel helpless,” said Dr Phongsavan. “Patients are often diagnosed very late, and then there is often very little I can do to help them. I have to send them home to die.”

The mortality rate for cervical cancer in Laos is six times that of the UK. But there are some success stories. Sommay Khamkeomany was diagnosed with cervical cancer last year when she was just 32.

She had surgery and has now been told she has a 95% chance that her cancer will not recur.

“I have two girls aged five and three,” said Mrs Khamkeomany. “When they are old enough I will ensure they have the HPV vaccine – and fortunately I should still be here to see that happen. I feel lucky to be alive.”

Milestone

The HPV jab is the most expensive of all childhood vaccines. A course of three injections can cost more than £200 privately in the UK and other wealthy countries. It was well beyond the reach of most developing nations until Gavi negotiated a price of less than £10.

Like other Gavi-supported countries, Laos has to make a token financial contribution, but also has to supply the nurses and organise distribution of the vaccine.

The two-year pilot project in Laos involves about 20,000 girls being immunised. If successful, it will lead to a national roll-out of the jab.

By 2020, Gavi hopes to have supported HPV immunisation of more 30 million girls in over 40 countries.

The benefits, in terms of lives saved, won’t be felt for decades, but it represents a milestone in the promotion of women’s health.

Yield Trends Are Insufficient to Double Global Crop Production by 2050.


Abstract

Several studies have shown that global crop production needs to double by 2050 to meet the projected demands from rising population, diet shifts, and increasing biofuels consumption. Boosting crop yields to meet these rising demands, rather than clearing more land for agriculture has been highlighted as a preferred solution to meet this goal. However, we first need to understand how crop yields are changing globally, and whether we are on track to double production by 2050. Using ~2.5 million agricultural statistics, collected for ~13,500 political units across the world, we track four key global crops—maize, rice, wheat, and soybean—that currently produce nearly two-thirds of global agricultural calories. We find that yields in these top four crops are increasing at 1.6%, 1.0%, 0.9%, and 1.3% per year, non-compounding rates, respectively, which is less than the 2.4% per year rate required to double global production by 2050. At these rates global production in these crops would increase by ~67%, ~42%, ~38%, and ~55%, respectively, which is far below what is needed to meet projected demands in 2050. We present detailed maps to identify where rates must be increased to boost crop production and meet rising demands.

Discussion and Conclusions

Numerous studies have shown that feeding a more populated and more prosperous world will roughly require a doubling of agricultural production by 2050 [1][7], translating to a ~2.4% rate of crop production growth per year. We find that the top four global crops – maize, rice, wheat, and soybean – are currently witnessing average yield improvements only between 0.9 to 1.6 percent per year, far slower than the required rates to double their production by 2050 solely from yield gains. This is because yield improvements are below ~2.4% per year in many areas of our most important agricultural lands. At these rates maize, rice, wheat and soybean production may increase by ~67%, ~42%, ~38%, and ~55% respectively, by 2050 globally. There is a 90% chance that the total global production increase from yields alone would be between 34–101% for maize, 21–59% for rice, 4–76% for wheat, and 13–84% for soybean by ~2050. Thus, if these yield change rates do not increase, land clearing possibly would be needed [3] if global food security is to increase or even maintained (Table 1).

We found that the top three rice and wheat producing nations are witnessing very low yield growth rates. China, India and Indonesia are witnessing rice yield increases of only 0.7%, 1.0%, and 0.4% improvement per year. China, India, and the U. S., the top three wheat producers similarly were witnessing yield increases of only 1.7%, 1.1%, and 0.8% per year, respectively. At these rates we found that yield driven production growth in India and China could result in nearly unchanged per capita rice harvests, but decline steeply in Indonesia.

In many of the smaller crop producing nations, maize, rice, or wheat yield improvement rates are below the 2.4% doubling rate. Unfortunately, a high percentage of total calories consumed in these countries are from these four crops. This is particularly true for maize throughout much of Africa (e.g., Kenya, Zambia, Zimbabwe), Central America (e.g., Guatemala, Nicaragua, Panama), and parts of Asia (e.g., Nepal, Georgia).

Rice provides ~19% of dietary energy globally. Rice provides a higher percentage of total calories consumed in countries such as Dominican Republic, Costa Rica, Haiti, Sierra Leone, Nigeria, and North Korea, yet yields are declining, −0.1% to −3.2% per year. Elsewhere rice yields are increasing too slowly to overcome the impact of their population growth. In some of the world’s top rice producers, e.g. India and China, the per capita production may remain nearly unchanged. In numerous smaller rice producers across the world where rice is an important significant provider of daily dietary energy such as in Peru, Ecuador, Bolivia, Benin, Togo, Myanmar, Philippines, Malaysia, South Korea, Nepal, and in Sri Lanka, the per capita production may also remain unchanged.

Wheat provides ~19% of global dietary energy. Wheat comprises an even larger portion of the diet in some countries where yields are declining, particularly Eastern European countries of Bulgaria, Hungary, Czech Republic, Moldova, Romania, Slovakia, and Ukraine. In many countries, such as Bolivia, Peru, Paraguay, Afghanistan, and Iraq, wheat yield increases are too low to maintain their current per capita harvests.

Our analysis identifies where yield improvements are on track to double production and where investments should be targeted to increase yields. The observed rates of yield change result from several location-specific, socio-economic, and biophysical factors that are described elsewhere [23]. Many studies illustrate that intensification can be unsustainable [32][36], but several notable projects in Africa [37] and elsewhere [38] have shown that sustainable intensification is possible and necessary to boost global crop production.

Clearly, the world faces a looming and growing agricultural crisis. Yields are not improving fast enough to keep up with projected demands in 2050. However, opportunities do exist to increase production through more efficient use of current arable lands [4] and increasing yield growth rates by spreading best management practices and closing yield gaps under different management regimes [38][42] across the globe. A portion of the production shortfall could also be met by expanding croplands, but at a high environmental cost to biodiversity and carbon emissions [4][43][45]. Alternatively, additional strategies, particularly changing to more plant-based diets and reducing food waste [4][46][48] can reduce the large expected demand growth in food [3][4].

Source: PLOS

Niger’s achievement in child survival.


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