26-07-2021

MoNDaY, jUlY 26, 2021
5
Covid-19 boosted excess sale
of antibiotics in India
an inmate at the Central Prison in Freetown, Sierra leone. Photo: anne-Sophie Faivre le Cadre
Sierra Leone abolishes
capital punishment
SaeeD KaMalI DehGhaN
Sierra Leone has become the latest
African state to abolish the death
penalty after MPs voted unanimously to
abandon the punishment. On Friday
the west African state became the 23rd
country on the continent to end capital
punishment, which is largely a legacy of
colonial legal codes. In April, Malawi
ruled that the death penalty was
unconstitutional, while Chad abolished
it in 2020. In 2019, the African human
rights court ruled that mandatory
imposition of the death penalty by
Tanzania was "patently unfair".
Of those countries that retain the
death penalty on their statute books, 17
are abolitionist in practice, according to
Amnesty International. A de facto
moratorium on the use of the death
penalty has existed in Sierra Leone
since 1998, after the country
controversially executed 24 soldiers for
their alleged involvement in a coup
attempt the year before.
Under Sierra Leone's 1991
constitution, the death penalty could be
prescribed for murder, aggravated
robbery, mutiny and treason. Last year,
Sierra Leone handed down 39 death
sentences, compared with 21 in 2019,
according to Amnesty, and 94 people
were on death row in the country at the
end of last year.
Rhiannon Davis, director of the
women's rights group AdvocAid, said:
"It's a huge step forward for this
fundamental human right in Sierra
Leone. "This government, and previous
governments, haven't chosen to [put
convicts to death since 1998], but the
next government might have taken a
different view," she said.
"They [prisoners] spend their life on
death row, which in effect is a form of
torture as you have been given a death
sentence that will not be carried out
because of the moratorium, but you
constantly have this threat over you as
there's nothing in law to stop that
sentence being carried out."
Davis said the abolition would be
particularly beneficial to women and
girls accused of murdering an abuser.
"Previously, the death penalty was
mandatory in Sierra Leone, meaning a
judge could not take into account any
mitigating circumstances, such as
gender-based violence," she said.
Umaru Napoleon Koroma, deputy
minister of justice, who has been
involved in the abolition efforts, said
sentencing people on death row to "life
imprisonment with the possibility of
them reforming is the way to go".
Across sub-Saharan Africa last year
Amnesty researchers recorded a 36%
drop in executions compared with 2019
- from 25 to 16. Executions were carried
out in Botswana, Somalia and South
Sudan.
SaNjeet BaGCChI
The first wave of COVID-19 in 2020 in
India saw a substantial increase in the
sale of antibiotic formulations used in
adults and adolescents, especially
azithromycin, says a study. COVID-19
likely contributed to about 216 million
excess doses of non-paediatric
formulations of antibiotics in total and
38 million excess doses of azithromycin
between June and September 2020,
says the study published this month in
PLOS Medicine, which looked at the
private health care sector in India.
Antibiotics are often used in viral
infections, such as viral pneumonia, to
combat possible bacterial co-infections.
This is despite antibiotics being
ineffective against viral infections,
according to the US Centers for Disease
Control and Prevention.
Overall, 16.29 million doses of
antibiotics were sold in India, the
world's largest antibiotic user. The
proportion of non-paediatric
formulations of antibiotics increased
from 72.5 per cent in 2019 to 76.8 per
cent in December 2020, with children
less likely to suffer from symptomatic
and severe COVID-19 infection,
researchers noted.
Sumanth Gandra, study author and
associate professor of the Division of
Infectious Diseases, Washington
University School of Medicine, US, tells
SciDev.Net that the results suggest that
nearly every person diagnosed with
COVID-19 received an antibiotic - most
especially azithromycin - during the
first wave in India.
"Our results indicate that at least 12
million azithromycin treatment
courses were unnecessarily prescribed
between June and December of 2020,"
says Gandra. "This massive use of
azithromycin, a vital drug for treating
typhoid fever and diarrhoea, is highly
concerning as it will lead to resistance
in bacteria that cause these illnesses."
According to Brian Godman, a
visiting professor at the Strathclyde
Institute of Pharmacy and Biomedical
Sciences, UK, it is important to curb
inappropriate use of antibiotics for viral
infections which will increase
resistance rates and result in greater
loss of life in the future.
"This is particularly important in the
community since inappropriate
prescribing and dispensing of
antimicrobials for essentially viral
infections constitutes their greatest
overuse," Godman tells SciDev.Net.
"Trained pharmacists are important as
they can direct patients to more
appropriate treatments that are more
effective in symptomatic relief and
often cheaper. This should be a priority
in India given the rising antimicrobial
resistance rates."
Similar trends are likely to have
occurred in other low- and middleincome
countries where antibiotics are
often overused, the study said. The
medium- and long-term consequences
for bacterial resistance patterns are
"highly concerning", it added,
highlighting the need for urgent
antibiotic stewardship measures such
as avoiding the use of antibiotics if
there is no suspicion of bacterial
infection, and limiting the duration of
antibiotic treatment for co-infections.
India's approach to antibiotic use
during the pandemic was more of a
knee-jerk reaction than a well thoughtout
plan, says Diptendra Sarkar, a
COVID-19 strategist, public health
analyst and professor at the Institute of
Post Graduate Medical Education and
Research, Kolkata, India.
"While evolving evidence did not
favour the use of antibiotics, there was
little governance on the community use
of antibiotics," Sarkar tells SciDev.Net.
"Self-medication also played a major
role in upscaling antibiotic use that are
not evidence-based."
Customers line up in front of a pharmacy in Kolkata.
Photo: Indrajit Das
Violence against Africa's children is rising
experts say that hIV digital toolkits have to be simple, affordable and adaptable, while ensuring
absolute confidentiality.
Photo: Keila trejo
Digital toolkit to fight HIV disease
eStheR NaKKazI
Digital tools widening access to HIV
prevention, treatment and care
services will be a vital weapon in the
fight against the disease during
COVID-19 and beyond - but they
must be affordable and highly
confidential.
So said health experts at the 2021
International AIDS Society
conference held remotely from Berlin
this week. The event looked at the
potential of digital technology in
eradicating HIV and AIDS, which
currently affects around 38 million
people worldwide.
The Industry Liaison Forum (ILF)
of the International AIDS Society
(IAS) identified and prioritised a set
of digital technological innovations,
based on advances made during the
COVID-19 pandemic, which they say
should be adopted for HIV
prevention and care and to shape
digital health more broadly.
Pradeep Kakkattil, director of the
office of innovations at UNAIDS,
said: "The AIDS movement has been
very much about being the
conscience of access to health and
equity. We need to continue to play
that role when it comes to this
transition from where we are in the
shift to digital, as we digitise health
and access to healthcare."
The digital toolkit includes mobile
applications like SMS that simplify
the return of medical results,
telemedicine which enables online
drug ordering for home delivery, and
public data repositories.
The IAS says it will also look beyond
HIV to how emerging health
technologies have the potential to
improve global health equity and
drive progress towards the
Sustainable Development Goals.
In the session led Wednesday by
the IAS-ILF and UNAIDS, which
oversees the Health Innovation
Exchange (HIEx), panellists agreed
that digital tools must be simple,
adaptable, and affordable, and
designed with local engagement to
ensure absolute confidentiality.
"What we have seen with the
COVID-19 response is that it has been
very much top-down, with no
engagement of communities," said
Helen McDowell, head of
government affairs and global public
health in the UK and a recently
elected ILF industry representative.
"We have also seen the exploitation in
terms of when it comes to profit -
profit versus lives.
"We really need to have this
bottom-up approach which is
community-led … to ensure that we
have equity in terms of access and
trust which is a basic foundation in
the digitisation process." Rahab
Mwaniki, a public health specialist
based in Kenya, said: "In order for
communities not to be left behind we
need to ensure affordability and
confidentiality because some people
have not disclosed their status. We
also need tools that are cost effective."
For McDowell, the solution is
"partnership and collaboration".
"These have to exist between the
industry, public private partnerships,
government and the community,"
she said.
Meg Davis, a senior researcher on
the digital health and rights project at
the Graduate Institute in Geneva,
said: "We need to know which
platforms people are using, how are
they engaging with them … who
really is pushing these platforms to
ensure that people are accessing
information safely and securely."
People with HIV must be engaged
in the design process from the
beginning, says Mwanika, and
remunerated for their participation.
"There is a tendency to look at
communities as people who can just
give their services for free," she
added. "I think if a product is forprofit,
they also need to facilitate the
process for the community."
Nick Hellmann, managing director
and strategy and science advisor at
the Elizabeth Glaser Pediatric AIDS
Foundation, said: "It really does take
a village to implement all these
things. If the community is engaged
very early on in the development
process, you can start to address not
only the issues of scalability, but also
some of the confidentiality and
privacy issues because then everyone
comes out on the same page."
GRaça MaChel
Of all the unspeakable injustices
suffered by Africa's children - and I've
witnessed many - violence is surely the
worst because it is almost entirely
preventable. Africa's children suffer
many hardships, including poverty,
hunger and disease. Violence against
children is avoidable, yet young people
in Africa, especially girls, continue to
live with sexual violence, child
marriage, female genital mutilation,
forced labour, corporal punishment and
countless other forms of abuse.
After decades spent trying to improve
young people's life chances, I had hoped
to see at the very least a significant
reduction in violence that threatens
children. It is now 31 years since the
adoption of the African Charter on the
Rights and Welfare of the Child and we
have seen some governments putting
into place laws and policies aimed at
ending violence against children. There
have also been efforts, though
insufficient, towards eradicating female
genital mutilation and child marriage,
which cause untold lifelong suffering.
Progress is uneven, fragmented and
slow. Violence against children is once
more on the rise driven partly by online
sexual exploitation and child sexual
abuse tourism and recently by
lockdowns and school closures. These
have pushed violence behind closed
doors where it goes unseen and
unreported. Armed conflicts by groups
such as Boko Haram in Nigeria, al-
Shabaab in Somalia and Amba
separatists in Cameroon, frequently
target children, making them the most
common victims of abductions, rape,
forced marriages and murder.
Regrettably, many African
governments lack the political will to
tackle these gross violations. This week,
in an attempt to galvanise action, the
African Partnership to End Violence
against Children (Apevac) convened a
high-level virtual conference to present
its new research findings confirming
worrying levels of violence and slow
government responses. Thankfully,
there are also some good, African
solutions that can be successfully
applied across the continent.
I have witnessed the worst, as well as
the best, of humanity. Yet the brutality
revealed in these findings plumb new
depths. Children still face unacceptable
levels and forms of physical,
psychological and sexual violence. In
some parts of Africa, four in 10 girls
suffer sexual violence before the age of
15. Even worse is that children in most
need - those in residential care or used
as child labour, with disabilities, living
on the streets, or in armed conflict and
refugee situations - are not protected.
Violence against children is not a
uniquely African phenomenon. The
World Health Organization estimated
last year that globally up to a billion
children aged 2-17 had experienced
physical, sexual or emotional violence
or neglect. Many African children enjoy
peaceful lives, but it is clear the
continent faces an urgent problem,
fuelled by complex social and economic
drivers. Increasing urbanisation, armed
conflict, forced displacement,
humanitarian and climate-related
disasters all play a part.
Children surround a UN soldier patrolling a camp for internally displaced people in Goma, in the
Democratic Republic of the Congo.
Photo: Pascal Guyot