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“In Kenya we have reagents to test and detect swine flu but not the one to confirm it," said Muthoka. |
As the possibility of a global swine flu pandemic has become a reality, the preparedness of Africa to deal with an outbreak is plaguing the minds of many.
Africa is in a very precarious situation as very few African countries have the necessary reagents to diagnose the flu and none of them are capable of confirming the diagnosis of the disease that manifests itself in the form of cough, fever/chills, sore throat, headache and fatigue, symptoms that are similar to other diseases such as malaria.
"In Kenya we have reagents to test and detect swine flu but not the one to confirm it, as that can only be done in Atlanta in the US and [in] London," said Dr. Phillip Muthoka, Kenya's assistant Director of Medical Services, to IslamOnline.net (IOL).
He said that both the Kenya Medical Research Institute (KEMRI), which is recognized by the World Health Organization (WHO) as a regional lab, and the Kabete Central Veterinary Laboratory in Nairobi, have the capacity to perform polymerase chain reaction (PCR) tests that are "almost confirmatory or with little error." In other words, they are "ninety-nine percent accurate."
"PCR is fast and will give you preliminary results [on whether] it is influenza A or B," said Muthoka.
Muthoka says the flu is a big challenge to many African countries as it cannot be detected by physical examination. The most important factor in diagnosis is the history of the patient. In other words, whether he/she has traveled to or from a country already affected or whether he/she has been in close contact with a swine flu patient. The only way to confirm it is by a laboratory test.
"If you have a positive history then oro-pharyngeal and nasal swabs are done. It is difficult to distinguish between malaria and other fevers and the swine flu but if a patient does not get better in two days then we think of other differentials," explained Muthoka.
Besides the difficulty facing many countries regarding the detection and confirmation of H1N1 (the technical name for swine flu), Muthoka said that no country, especially in Africa, can have enough Tamiflu.
"[Tamiflu] is expensive and it is difficult to know how many people will be affected in a pandemic. Kenya has only 1000 doses and will rely on the WHO Afro-region's one million doses in case of a pandemic."
Most of Africa may not be prepared because of the existing disease burden the continent is already suffering from. These, he said, include malaria, HIV/AIDS and tuberculosis.
No Vaccine Development
Whereas the Centers for Disease Control and Prevention (CDC) and USAID are helping to build capacity, including the ability to test for H1N1, Muthoka said it is still a long path for most African countries.
Dr. Joseph Aluoch, a chest specialist in Kenya, agreed that Africa is ill-equipped to deal with an H1N1 pandemic. "[According to] political pronouncements we are [well equipped], but from health and scientific perspectives we are not," he told IOL at the launch of the seasonal flu vaccine, Vaxigrip, in Nairobi.
"We do not [have] vaccines [or] anti-virals; we lack Tamiflu, highly specialized isolation facilities and intensive care [units]. We do not have specialized ambulances to take or transfer those affected to hospitals," said Aluoch.
"We do not [have] enough doctors and nurses to deal with a pandemic. We have been surviving by the grace of God as Africa has never been affected by the flu pandemic."
Dr. Mohamed Lumba, a consultant pediatrician, said the situation was compounded by the fact that vaccine developments are often in the global north and will take a long time to reach Africa.
Lumba said the process of research and development of a vaccine is expensive and can only be done in countries having the technological and financial wherewithal as well as the necessary manpower and this is by and large only available in the developed world.
"Obviously they will not release [the vaccine] to us if there is a pandemic affecting their populations. We will only rely on the role of the WHO to ensure some stock is sent to us. But there is a need to build capacity in the developing world for vaccine development. Already, this is taking place in places like China and India but we need more," said Lumba.
As regards to other forms of flu, Lumba says that most people do not take them seriously in spite of the fact that over 5 million people contract avian influenza each year, with an annual death rate of 500 thousand to one millions.
Wallace Bulimo, a virologist at the US Army Medical Research Unit at KEMRI, said there is a need to build on the knowledge gathered from regional surveillance of the avian flu to better understand swine flu. Swine flu is a disease of pigs caused by type A influenza virus and this disease can cross into the human population and can be transmitted from human to human.
Aluoch said that the flu is one of the re-emerging diseases with high morbidity and mortality. "It attacks people and is a major source of economic losses and social disruptions."
During the Vaxigrip launch in Nairobi on April 30, Dr. Evans Amukoye of the Center for Respiratory Disease Research at KEMRI said that washing hands is one of the best ways of dealing with influenza spread as hands are a very important means of spreading the disease.
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