State of the Covid-19 pandemic in East Africa two years on

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Face masks
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What you need to know:

  • In this issue of Healthy Nation, our reporters take a deep dive behind the scenes and the statistics to check the current state of affairs on the ground in the Anglophone EAC countries, reporting on their observations and interviews, providing some insights as to how the pandemic evolved in East Africa.

BY DR AHMED KALEBI

March 2022 marks two years since the coronavirus pandemic was announced in East Africa, with Kenya being the first country in the East African Community (EAC) to confirm a case of the disease. It was discovered in a returning young Kenyan traveller on March 12, 2020. 

dr ahmed kalebi, pathologist, covid-19 in east africa
Dr Ahmed Kalebi, an independent consultant pathologist.
Photo credit: POOL

That was three months after the outbreak was reported in December 2019 in Wuhan, China, and two months after the first case outside China was recorded on January 14  in Taiwan. 

Other EAC countries followed in quick succession to confirm their first cases. Rwanda announced its first case on March 14; Tanzania on March 16; Uganda on March 21, Burundi March 31, and South Sudan on April 5, 2020 — becoming the 51st of Africa’s 54 countries to confirm Covid-19 in its borders.

Currently, the pandemic is at an all-time low in all the EAC countries, with the territories enjoying a long stretch of the lowest test positivity rates of below one per cent, the lowest daily caseload, lowest hospitalisations and lowest daily deaths being recorded since the pandemic struck.

However, all the EAC countries have been ravaged by waves after waves of Covid-19 characterised by surges in new caseloads, hospitalisation and deaths over the past two years. 

The Economist currently has the most comprehensive and rigorous data estimating how mortality has changed during the pandemic at the global level. Globally, the modelling by The Economist estimates that the total number of excess deaths due to Covid-19 is two to four times higher than reported. Excess deaths refer to the number of deaths from all causes during a crisis above and beyond what would have been expected during “normal” times. 

Cumulative deaths

The estimated excess Covid-19 cumulative deaths during the pandemic based on the analysis by The Economist puts Kenya as having the highest death numbers as at end of February 2022 estimated at 96,989 excess deaths versus 5,639 confirmed Covid-19 deaths; Tanzania at 64,931 versus 796; Uganda 63,089 versus 3,588; South Sudan at 32,862 versus 137; Rwanda at 24,938 versus 1,457; and Burundi 18,944 versus 38.

Translated per capita, the excess deaths as analysed and published by The Economist indicate that South Sudan has the highest excess deaths per million over the two years of the pandemic, followed by Rwanda, then Kenya, Burundi, Uganda and Tanzania in that order.

A lot remains unknown and unexplained about Covid-19, but overall it appears that there isn’t much to separate the EAC countries in terms of fatalities and disease burden of Covid-19 during the last two years. The EAC countries also appear to have fared much better than most countries worldwide in terms of mortality as they all recorded relatively low excess mortality from Covid-19 despite low vaccination rates. Scientists speculate that the relatively low mortality may be due to a young population, background immunity from other coronaviruses, environmental factors such as sun exposure, and acquisition of herd immunity through infection exposure. This phenomenon begs for further research and explanation.

What is well documented is that at the onset of the pandemic, all the EAC countries took early and decisive strict measures that were aimed at restricting entry and spread of the virus into their borders, announcing a raft of measures such as social restrictions, school closures, lockdowns or curfews and limiting of inbound travels. Subsequently, the EAC countries took different paths in managing the pandemic. 

Uganda and Rwanda in particular both stood out in having multiple extended lockdowns with restrictions of social gatherings and limitation of people’s movements, whereas Uganda also enforced the longest school closure in the world. The severe imposition of strict measures in these countries might be a reflection of the level of authoritative governance on the population. 

On the other hand, Tanzania discarded various public health measures and declared itself free of coronavirus on the orders of former President John Pombe Magufuli who died in March 2021. After his demise, his successor Samia Suluhu moved swiftly to bring the country back into the global mainstream of public health measures, including advocating for vaccination.

In this issue of Healthy Nation, our reporters take a deep dive behind the scenes and the statistics to check the current state of affairs on the ground in the Anglophone EAC countries, reporting on their observations and interviews, providing some insights as to how the pandemic evolved in East Africa.

The report by Amina Wako specifically highlights the situation that has unfolded in Tanzania and the present challenge of trying to reverse the denialism of coronavirus in the society where the people are shunning vaccination. 

In South Sudan, Leon Lidigu exposes how conspiracy theories have driven vaccine hesitancy leading to low vaccine uptake amid the country’s inadequate health systems. 

In Uganda, we get an in-depth account from Angela Oketch and Irene Abalo on how the longest school closure in the world has impacted a generation of learners missing out on two school years while in Rwanda, Amina Wako and Angela Oketch narrate experiences of efficient testing conducted by the public health laboratories run by the Rwandan government.  

In Kenya, Leon Lidigu and Angela Oketch go behind the scenes to reveal how the situation on the ground differs from what has been reported in terms of official statistics as the number of deaths appears to have far exceeded official records.

As we come to the tail-end of the pandemic — which is where I and many scientists believe we are heading to largely due to community immunity acquired from past infection and vaccination — it is evident that so much remains unknown about the Covid-19 pandemic, and a lot of information is lacking.

Thus, there is a need for in-depth scientific research and social investigations — such as the reporting by the Healthy Nation team — that will unearth relevant information to enable the society to reflect and learn valuable lessons that can be used to strengthen public health systems in seeing through an end to the coronavirus pandemic and to help prepare for future pandemics. 

Dr Ahmed Kalebi is an independent consultant pathologist based in Nairobi and a PhD Researcher at the University of Cape Town. He is the founder, former CEO and retired chief consultant pathologist at the Lancet Group of Laboratories in East Africa. Twitter @DrAhmedKalebi 


Tanzania's daring hunt for herd immunity


BY AMINA WAKO

Walking through the streets of Dar es Salaam as a visitor makes you feel out of place. Not because of how you’re dressed but due to the fact that you’re wearing a mask. That makes you look odd.

Healthy Nation team entered Tanzania through the Julius Nyerere International Airport for a four-day visit to get a clear picture of how a country that initially denied the existence of Covid-19 is fighting the virus.

Dar es Salaam, tanzania, covid-19, Kariakoo market
Tanzanians going about their business at the famous Kariakoo market in Dar es Salaam.
Photo credit: Ericky Boniphace | Mwananchi

Passengers arriving from different countries are asked to take a rapid antigen test on arrival at the airport at their own expense, but Kenya is exempted. 

Travellers must also fill in an online traveller’s health surveillance form within 24 hours before arrival in Tanzania. There are posters all over the airport and officials keep reminding travellers to adhere to Covid-19 protocols. After clearing with the Immigration office, we left the airport to our hotel. 

There is no sign of any awareness of Covid-19 as people go about their normal lives.

No one has a mask on. We discover there is utter ignorance and dopiness to follow Covid-19 protocols when our taxi driver, shouting in an uncovered face, asks, “Barakoa ya nini na hapa hakuna vumbi? (Why wear a mask yet there is no dust here?). 

“We don’t wear masks to prevent dust. We wear them to avoid contracting Covid-19,” we respond. He laughs before replying, “Unaona Tanzania kama kuna Covid? Huu muda wote sijapata Covid na sijakuwa nikivaa barakoa.” (Do you think there’s Covid-19 in Tanzania? I have not contracted the virus all this time yet I have not been wearing a mask)

In the streets, people still show little concern for the virus that has already claimed the lives of over 5.8 million people globally, according to the World Health Organization (WHO). The only place wearing masks was being enforced was at hospital entrances but immediately people walked in, they would remove their masks and roam freely within the facilities.

So why did Magufuli ignore the existence of Covid-19? We asked a former government official who sought anonymity.

“As much as we condemned him for his hard stance, the late president was thinking about his people; we all know how bad it was when people around the world lost their livelihood due to the lockdowns, he feared that,” the official said.

Apart from Covid-19, he told Healthy Nation, there are other illnesses and the president noticed that people stopped going to hospitals for treatment when the lockdown was imposed. They panicked.

“He feared more people would die from other illnesses than even Covid-19.” To him, locking down the country would have also brought the economy to its knees.

“Before making the decision, I am sure he weighed the pros and cons, and to him, the pandemic did not warrant the harsh guidelines that were imposed,” he added.

Initial response

But Tanzania’s initial response to the coronavirus pandemic in March 2020 was swift. The late President John Pombe Magufuli’s government announced a raft of measures to curb the spread of the virus when the first imported case was confirmed on March 16, 2020.He ordered the closure of schools, banned public gatherings, suspended all sports activities, put restrictions in place at the borders with requirement for incoming travellers at the airport to undergo mandatory 14-days quarantine, and urged the public to observe caution.

However, on April 8, 2020, Mr Magufuli changed tune when he asked the citizens to congregate in churches and mosques to pray for protection against the coronavirus. He then proceeded to publicly downplay the threat of the virus until June 2020.

He declared Tanzania ‘Covid-19 free’. Under his leadership, herbal remedies were encouraged, testing for Covid-19 was scrapped and the numbers stopped being reported.

People were urged to pray to defeat the virus at a time when other countries were advising their people to mask up and observe public health measures recommended by WHO.

For over a year, Tanzania stopped reporting on the Covid-19 cases. During that period, however, a spate of deaths attributed to pneumonia struck both members of the public and government officials.

This forced WHO Director-General Tedros Adhanom Ghebreyesus to ask Tanzania to start reporting the Covid-19 numbers.

In a statement issued on February 20, 2021, Tedros noted that Tanzanians traveling to neighbouring countries and beyond tested positive for Covid-19.

Days before the WHO statement, Tanzanian lawmaker Zacharia Issay spoke in parliament and expressed concerns over what he termed as growing deaths from “pneumonia.”

“I am tired of going to funerals in my constituency,” he remarked, and on visiting the hospital for testing, noted that “all the ventilators were in use.”

The increase in pneumonia cases raised concern because it came when the country denied Covid-19.

Activists in the country also claimed the number of deaths was higher than normal.

Even church leaders across the country voiced their concerns and took a different stance from Mr Magufuli by advising their congregates to take precautions to protect themselves from Covid-19; proclaiming that they were witnessing an increased number of deaths due to ‘pneumonia.’

The Evangelical Lutheran Church in Tanzania through its Presiding Bishop Dr Fredrick Shoo issued a statement referencing the Bible in Hosea 4:6 that “In order that they do not perish” thus directing people to observe public health safety measures including handwashing, wearing of masks and physical distancing in the churches. 

It is almost impossible to quantify the numbers of diagnosed pneumonia cases in the country due to lack of access to data.

Modelling results published by the MRC Centre for Global Infectious Disease Analysis at Imperial College London back then suggested that the actual number of infections in Tanzania between April 29 and May 26, 2020 was 24,869, while deaths might have been close to 16,000.

These high numbers in infections and deaths were attributed to the local transmission after the government removed the protocols and guidelines for Covid-19.

If people died in Tanzania, were the deaths evident in the society and where were they being buried?

According to our sources, in Dar es Salaam, many people who died in 2020 and were suspected of having contracted Covid-19 were buried at Kondo cemetery on the outskirts of the Tanzanian capital.

Our sources further revealed that burial sites have since become expensive as many are almost full, including Sinza cemetery, Njiro cemetery and Kindondoni cemetery.

“Many people died in 2020, and talking to family members,  their loved ones had coronavirus-like symptoms even though the hospitals did not indicate Covid-19 as the cause of death. “What made me believe that the government was hiding their deaths is because these graveyards were even guarded by government security personnel, and we were not allowed to get close,” one of the sources said.

Walking through Kondo cemetery, it was evident that many deaths happened in 2020 between April to December.

However, we cannot definitively link them to Covid-19 as no confirmatory testing was ever conducted.  It was also difficult to take pictures as we noticed three men following us. 

During the pandemic, reports of hazmat-suited government officials burying people at night emerged on social media.

Zitto Kabwe, party leader of ACT-Wazalendo, was one of the people on the forefront calling out the government for denying the truth about the spread of coronavirus in Tanzania.

Zitto still insists the government of Magufuli hid Covid-19 deaths, adding that there is work being done to have that data out.

“I stand by that —  the deaths are hidden. There is no data on the number of deaths. There is work being done to search for the truth about the data on Covid-19. It will involve scientific modelling and survey,”  he said.

But two years later, here we are at the airport where the government has enhanced surveillance for international travellers to prevent further importation of the virus.

All travellers, including Tanzanians, returning residents and plane crew must present a pre-departure negative Covid-19 certificate upon arrival. The country only accepts Covid-19 test results done at nationally accredited or approved laboratories using samples tested within 96 hours of departure to Tanzania.

How Covid-19 in Tanzania was managed also brought out the concept of “herd immunity” used by Sweden.

Herd immunity is the indirect protection from an infectious disease that happens when a substantial proportion of the population achieves immunity either through vaccination or immunity developed through the past infection.

If it were that the objective was to attain herd immunity, WHO-Tanzania stated that it was wrong to allow the disease to spread unchecked through the population to achieve it.

WHO said it supports achieving herd immunity through vaccination, not by allowing disease to spread through any segment of the population as this would result in unnecessary cases and deaths. 

“Herd immunity against Covid-19 should be achieved by protecting people through vaccination, not by exposing them to the pathogen that causes the disease.”
 
It was not until July 2021 that the Tanzanian government started the vaccination of its citizens against Covid-19. WHO says the slow uptake of the vaccines in the community is partly because of low-risk perception.

“If someone does not appreciate that they are at risk, then they may not welcome measures being introduced to mitigate that risk,” WHO noted.  During the last Covid-19 situation report released on February 11, 2022, confirmed cases stood at 33,549 with fatalities at 796, while cumulative tests conducted were 447,895. 

Spot checks around government hospitals in Dar es Salaam painted a picture of a country still in denial. The vaccination centres were empty, with only health officials seated and hoping someone would pop in to get a jab.


What stories have the graveyards of Kenya buried? A lot, it appears


BY LEON LIDIGU AND ANGELA OKETCH

Last August, the government admitted that its daily statistics on Covid-19 deaths may be inaccurate due to the lack of pathologists in the counties, casting a doubt on the accuracy of the number of the deaths that the Health ministry has been announcing.

Sheikh Hamza Juma, Amin Mohamed, Kibra Muslim Cemetery , covid kenya
Kibra Muslim Cemetery caretaker Amin Mohamed (left) and Sheikh Hamza Juma clear weeds at a gravesite on February 24
Photo credit: FRANCIS NDERITU | NATION MEDIA GROUP

When Healthy Nation visited a cemetery in Nairobi County, which had registered the highest number of deaths, we established that indeed there were more deaths recorded in 2020 when the virus struck and last year, than in previous years.

It is exactly 11:45 am and Mr ‘Juma’, 38, is busy humming away in the scorching sun while sweating profusely as he digs a shallow grave at Lang’ata Cemetery.

We are worried that the grave is too shallow, which exposes it to mongrels  that can easily dig it up but Mr Juma is quick to remind us that the measurements are dictated by the cemetery management given the overwhelming number of bodies.

“Ever since the pandemic showed up, business has been booming. There’s no more space to bury those who have died as a result of Covid-19,” he says.

He discloses that it costs Sh14,000 to bury a Muslim while Christians have to part with Sh25,000.

Boniface (not his real name) started work at 5.30am and it involves plastering graves, tiling and putting tombstones on them, engraved with beautiful memories of the deceased as per what clients want.

“At the peak of the pandemic, I would wake up as early as 4am to do this but now that coronavirus deaths have reduced, business has been slow,” he says in a disheartened way.

This is the unfortunate reality surrounding Covid-19 deaths in Kenya, that as much as it is a devastating pandemic that has robbed thousands of families around the country of their loved ones, it has presented a source of livelihood and opportunities to some.

The caretaker of the cemetery John Mutiso, 52, has spent the better part of the morning helping a family that had bought a grave last week lay their loved one to rest.

“I have been in charge of the Muslims side of the cemetery for two years. We have buried 280 to 300 people who died of Covid-19 here, there is no more space and that is the biggest challenge at the moment.”

At the Lang’ata cemetery,we sit on four acres of land. Here, thousands of bodies have been buried but fresh soil around graves is a clear indicator that the frequency has been higher in the past two years.

A section has been designated to bury Muslims while the right side over the fence is allocated for ethnicities from predominantly Christian communities.

“The northern part is mainly allocated to Nubians and Somalis, while on the far corner is a place where we have allocated for Muslims of Indian descent,” Mr Mutiso explains.

He reveals that at one point in the middle of the pandemic, people became increasingly scared.

“Those who were sent to bury dead Muslims from predominantly Christian tribes here would sometimes dump the bodies out of fear of contracting coronavirus then take off without doing it properly.”

But Muslim brothers, he adds, who were tasked with burying their people here were kind enough to find a place to bury the dead from predominantly Christian tribes.

“The dead deserve respect. The grave that looks sunken and is unmarked belongs to the first person who was buried here after he died of coronavirus in 2020.”

All is known about him is that he was an Asian street pastor aged 50 who had come to Kenya from Bangladesh to preach. He fell sick then died somewhere in the city after which his body was taken there for burial.

Mr Mutiso clarifies that the 280-300 number combines both the medically suspected and those confirmed through tests to be Covid-19 cases. In the most recent Covid-19 wave, he reveals, they still got two to three Covid-19 bodies a day to bury.

At the Kibra Muslim Cemetery, 52-year-old Hamza Khamis Juma, an Imam in Kibra’s main Jamia Mosque Makina, is busy helping Mr Amin Ismael Mohammed, 47, a volunteer caretaker, to clear weeds that have infested most graves.

“Since 1902, there has been an existing tradition not to plaster any graves here and we abide by it, this is a cemetery dedicated to the Kibra Muslim community alone , we do not take in any dead ‘outsiders’ but usually refer them to Lang’ata,” he says.

Covid-19 exposed a big challenge that cemetery managers had to deal with, and according to him, they did not have a place set aside with the right facilities to wash dead bodies and prepare them for burial.

“Before the pandemic, we used to do it from home but now because the government set new guidelines, we have had to have the bodies prepared elsewhere like Masjid As-Salaam Janaza in South C before they are brought for burial.”

He confesses that without Covid-19, they would still be making endless trips to South C.

Since then, they have resolved to crowdsource for funds to set up a facility where they can wash and prepare bodies.

“We appealed to the locals and they listened, some donated building blocks, sand and other building items,” he says.

Other wellwishers have provided them with incredible labour support and guidance in setting up the project when it was stuck. The project, now nearing completion, has cost Sh2.6 million.

According to the official records kept by Mr Mohammed, who is also a clinical officer at Mbagathi District Hospital and runs a clinic in Kibra, they have buried a total of 29 bodies that were confirmed to have died of Covid-19 at the cemetery in the last two years.

“On November 11, 2020, we buried two confirmed coronavirus cases. In December the same year one case. In February 2021 we had one case, in March two cases though one was a suspected case, in April eight of which seven were confirmed with coronavirus while one was suspected.”

He further highlights that most of the people who died were aged between 60 to 70 years.

They recorded the highest number of deaths in April last year due to the third wave of the Delta variant, and in total, “18 females and 11 males have been laid to rest here after succumbing to coronavirus.”

At Masjid As-Salaam Janaza, Mr Sulaiman Sessanga, 40, whose work is to wash and prepare dead bodies for burial, is busy washing up before prayers.

“When a Covid-19 body is brought in, I first disinfect it while it’s still in the body bag using bleaching agents after which I wash it with the same and also other chemicals using hot water then cold water.”

He’s usually donned in protective gear from head to toe. He has protective equipment, gumboots and gloves but the challenge is that they are too costly even as they handle approximately three Covid-19 dead bodies a day.

He admits that at first he was afraid. “At first I would go home so scared that I could transmit the virus to my family. I test myself regularly just to be sure and I am glad Allah has kept me safe,” Mr Sulaiman tells Healthy Nation.

Across the world, countries have been recording Covid-19 deaths in different ways. At the start of the pandemic and even now, Kenya counted only those individuals who died in hospitals after testing positive for the virus.

This means deaths from the virus happening in the villages, urban slum zones and city estates were not accounted for so long as they did not happen in a hospital.

Health Principal Secretary Susan Mochache told a parliamentary committee that the ministry can only confirm deaths that occur within hospitals and post-mortem exams of a few that happen within urban communities.

“People are dying in numbers but we cannot give evidence that the community death occurs as a result of Covid-19 complications when issues of pathology are absent at counties. We are not able to capture all the deaths,” she said.

She said counties have not invested in autopsy and therefore are not able to ascertain deaths that occur within communities.

“I have seen a rising number of deaths in my own village,” Ms Mochache disclosed.

Working out how many people have died of the virus can be more complex given that other deaths were being recorded at community levels, however, scientists have found that countries were underreporting the numbers, with more than 100 countries not collecting reliable data on the actual death and not releasing them in a timely manner.

At end of February 2022, official records from the Ministry of Health show that cumulatively, Kenya has lost 5, 639 people, but this is not the number those other institutions are recording.

According to the report released by the World Bank, if the 10 per cent figure is applied to the Kenya population, using the United Nations’s estimate of 284,000 deaths in Kenya in 2019, it would suggest that the total excess mortality since the start of the pandemic has been roughly 28,000.


In Uganda, learners reopened with blank memories after the world’s longest school closure


BY ANGELA OKETCH AND IRENE ABALO

All that Blessing Atwijuka could do was express herself using gestures — pointing at things and touching us when she wanted to communicate. She could not communicate using the signs that she was taught in school two years ago.

When we arrived at the Hand in Hand Special Needs Education Centre, a private school off Uganda’s Mukono town, it was difficult to tell that it was a school as most of the pupils were in home clothes. The uniforms were not fitting. The pupils had outgrown them.

Susan Mujjawa, Blessing Atwijuka , Hand in Hand Special Needs Education Centre, uganada
Blessing Atwijuka having a sign chat with Susan Mujjawa, NTV Uganda sign language interpreter, at Hand in Hand Special Needs Education Centre, Uganda
Photo credit: PHOTO | IRENE ABALO

Unfortunately, almost all the pupils in the school — much like Atwhijuka — had forgotten to communicate using the formal sign language they were taught before the schools were closed due to Covid-19.

Schools in Uganda reopened on January 10 after nearly two years of closure, making it the longest school closure in the world since the Covid-19  broke out. Not all students were able to report back to their various schools on reopening.

At this centre in Mukono, there were 26 learners when the institution closed. On reopening, only 20 reported. More tellingly, of those who have reported back, no one is able to communicate formally using the sign language that they had previously learnt.

While announcing the reopening, Education Minister John Muyingo said all students would automatically join classes a year above where they left. However, this directive cannot apply to special school learners. Two years of absence from class has had its toll on the young learners.

The teachers now have to put in extra effort to ensure that the pupils grasp all they are being retaught. Being children with special needs,  learning has to move slowly.

For us to communicate better with the pupils, we were accompanied by an NTV sign language interpreter, Ms Susan Mujjawa, who was able to tell that the pupils could not communicate using signs but only gestures.

When Ms Mujjawa tried to communicate with Atwijuka, she realised that she was not understanding her signs. Since the closure of the schools, Atwijuka was just at home and had not attended any formal learning that teaches sign language.

Atwijuka was in Class One in March 2020 and now she has to stick to that class for some time until she is able to sign in basic communication before she is moved to the next class.

As the rest of the pupils in normal schools were having their online learning materials distributed by the government, learners like Atwijuka and four million others with hearing impairment were disadvantaged. Uganda has more than four million people with hearing impairment, according to the 2016 National Housing and Population Census.

“For such children, it would require that we hire the services of a sign language interpreter to sit through the classes with them since the lessons are designed for the hearing. This was going to be so expensive for the school and even the parents,” the school’s director Taaka Odwori said.

“It would cost between USh50,000 to USh100,000 to have a sign language interpreter sit with her through the learning for a day.”

“They were left behind. They were just idle as there was no way you could conduct home learning for this special group without involving the services of a sign interpreter,” Ms Odwori said.

She noted that the two-year closure of the school was not necessary because the other schools had systems that supported them while for the special learners, the systems were not favourable.

Ms Mutesi Aminah, the Senior Inspector of Schools and the acting Jinja City Education Officer, conceded that children with special needs have since been left behind and that they were never considered during the distribution of learning materials.

This does not just apply to children with special needs. Even some normal pupils are affected as their schools have been turned into restaurants, guest houses, soda depots and other businesses following the prolonged school closure. According to education authorities, most of the schools affected are the private institutions that could not stand on their own. In Kampala alone, more than 40 schools have closed for good. Also, some of the teachers and students went into various businesses and have not reported back to classrooms. The dropout is worrying.

Ms Aminah told Healthy Nation that learners in rural schools have been the most disadvantaged since they were not able to get learning materials. Most of them have not gone back to school.

“In rural areas such as Chisema, fishing has taken up learners’ time and those who would have come back have remained to earn money from the fishing business. Enrolment is very poor. They have tasted money and coming back to the classroom will not be easy,” Ms Aminah said.

She said that in town, some learners have been turned into market vendors, selling masks. Others are mining stones in quarries.

Out of the 1,200 teachers in the city, (700 in primary and 500 in secondary schools) about 15 have not reported back to schools. Also, an estimated 15 private schools have been closed down.

The government’s order on closing schools as a containment measure has been criticised as not being informed by scientific data. However, researchers in Uganda have supported the move, saying it was necessary for the reduction in infections.

Prof Pontiano Kaleebu, a Ugandan physician, clinical immunologist and the executive director of the Uganda Virus Research Institute, told Healthy Nation that the lockdown on schools was inevitable since children were also transmitting the disease to adults at home. “When the pandemic came, we were all scared. The children were not getting severely sick but there was a lockdown that affected everyone including schools,” he said. He added: “Schools could not continue if there was a lockdown. Some schools have day scholars. The teachers and meals (could not be got easily),” Prof Kaleebu explained. 

Experts have since warned that the two-year closure of schools paints a deeply troubling picture to the learners and will have a huge impact on the education sector, which was struggling even before schools were closed.

A World Bank report published in December said that approximately 24 million children are “at risk of never returning to school.”

According to the United Nations Children’s Fund (Unicef), the long closure of schools created a shadow crisis for children.

“Beyond falling behind on their education, many children are missing out on school-based meals and routine vaccinations; experiencing social isolation and increased anxiety; and being exposed to abuse and violence, drop out, child labour and child marriage,” Unicef says.

Dr Mary Goretti Nakabugo, the executive director of Uwezo — a charity promoting access to learning in Uganda — confirmed that the country’s education sector is in a crisis. “We must ensure that when the children come back to school, they are able to stay in school,” said Dr Nakabugo.

A new report by Uwezo Uganda on its latest national learning assessment collected in August 2021, surveying all children aged 6 to 16, revealed that the overall proportion of children who are still in the “non-reader” stage (those who could not read or sound out letters of the alphabet) doubled from 6.2 per cent in 2018 to 12 per cent in 2021. The proportion of children who can’t even recognise letters jumped up by about 10 per percentage points, with the biggest losses for the youngest children. The decline in the proportion of children who can recognise letters appears to be about five percentage points greater among poorer pupils.

In 2018, 80 per cent of 10-year-olds could recognise letters. In 2021, that number had fallen to 69 per cent. This means that out of 10, only seven can recognise letters.


The country, after assessing all the challenges, went for the automatic promotion of learners to the next class. 

The government prepared the bridged curriculum, which was compressed to cover the lost topics and find a way to close the gap.

However, with the challenges where schools are required to download their teaching aids and teachers have to undergo online training, will the system work?

During a visit to Victoria Nile School, one of the best performing schools in Jinja, pupils were overcrowded in their classrooms. The numbers in the school had shot up due to the closure of private schools around.

“The school has a population of about 3,000 pupils. Before, we were 2,035. There has been movement from private schools. More are coming in and now we are failed by structures that are not enough. We are not accommodating more pupils now,” Mr Mbogo Livingstone, the deputy headteacher, told Healthy Nation.

Ms Aminah said despite rural schools being affected, registration in schools within the city has doubled. She gave an example of Masese Secondary School, which had an enrolment of about 500 students, now accommodating 1,000.

“The schools are receiving students from private schools that could not be doing well and the parents are not sure of their future. We now have a challenge of infrastructure in some of the schools.”

The government is now making tents as classrooms to accommodate more learners as it waits for the next budgeting year to allocate money for classrooms. 

Uganda recorded the first case of Covid-19 on a traveller from the United Arab Emirates on March 21, 2020. The cases that later became ascending figures are now accumulated to just over 163,000. But the pandemic appears to have subsided with a positivity rate of less than one per cent at end of February 2022. Despite the pandemic waning in the country, its impact on society will linger on perhaps for a lifetime for the generation of affected learners.


South Sudan’s Covid vaccine hesitancy driven by conspiracy theories


BY LEON LIDIGU 

It is 10.47am and Juba International Airport is a beehive of activity. 

Three men fully donned in personal protective equipment, armed with spray pumps commonly used on cattle, around their backs, show up on the runway to disinfect us. 

We are then shown a little structure about two metres away from the runway and instructed to submit our Covid-19 test result slips for verification before checking in after filling a biodata form. 

uba International Airport , covid south sudan, coronavirus
Passengers are screened at Juba International Airport in Juba, South Sudan on January 31, 2020.
Photo credit: AFP

At Juba Teaching Hospital, which is one of the three main Covid-19 vaccination centres in the country besides Juba Military Hospital and Juba Police Hospital, we are greeted by a disheartened Dr Maker Isaac, a medical director at the facility, as he laments about low vaccine uptake. 

“We have shut just down our vaccination centre as you have seen from the Ministry of Health (MoH) directive. This was the biggest centre in South Sudan, where we used to vaccinate foreign dignitaries who came here in thousands before traveling outside the country. But locals hardly show up because they still don’t believe Covid-19 exists while others believe the jab will make them impotent. Rumours on social media questioning the safety of the vaccine have led to mistrust among the population.” 

“We have faced many challenges trying to keep the centre afloat such as vaccine unavailability, hesitancy even among health workers who are leading the war on coronavirus and now financial constraints have totally crippled us.” 

“That said, the people here are not following Covid-19 protocols, they still think coronavirus is fiction despite losing their loved ones to the virus,” Dr Isaac tells Healthy Nation. 

“We have rolled out strategic plans but people are still not coming to be vaccinated. We do not have resources and we are unable to pay even those administering the jab. Initially, we had 27 workers administering the jab because this country has only received donations of AstraZeneca and Johnson and Johnson (J&J) doses. We reduced the number to five and now we are on our knees completely due to lack of resources,” observes Dr Maker.

The expert notes that with the high vaccine hesitancy in the west as circulated on social media, many locals are keeping off vaccination centres “because they do not understand why westerners are refusing to take the doses they themselves have manufactured while expecting Africans to be vaccinated”. 

“Recently there were protests in Canada against the Covid-19 vaccines and many people here have been asking why the country is donating the vaccines to South Sudan."

Outside the hospital, Okej Paul, 29, a boda boda rider, is waiting to ferry us to our next destination. He is not wearing a face mask. 

“I will not take any Covid-19 vaccine because I heard that if you have a weak immune system it will damage your body. I have heard such stories from friends here in South Sudan and this is why I have refused get vaccinated despite the World Health Organization saying the doses are safe,” he says. 

At Juba Police Hospital vaccination centre, 16 people are waiting to get their dose. 

Second Lieutenant Louis Taban, 36, is next in line. 

“I have come here for the Covid-19 vaccine. I heard they brought J&J, which I have been waiting for because I heard it is very good. There is a lot of misinformation and scepticism around here but I choose to listen to health experts, who also say we have to keep washing our hands with soap and water,” the officer says. 

Stella Juak, 26, says she has come for the vaccine because she is preparing to travel outside the country for business. 

“I was scared at first because there have been a lot of rumours that the vaccine is not good especially when you are planning to get pregnant.” 

Thirty seven minutes after our arrival, Rt. Reverend James Choul, the moderator of the Presbyterian Church of South Sudan and Sudan, walks into the facility to heartbreaking news. “I was told there is J&J here, which is why I came over, but the administrators tell me they have run out of the doses.” 

The cleric blames social media for the low vaccine uptake in the country. 

“I know people in my congregation and even family members who have refused to take the jab. I try to urge them to get vaccinated but as you know everyone has their freedom of choice. However, t I hope they remember that protection is better than cure.” 

Dr James Tong, the vaccine manager and supervisor at the centre, confirms that they have run out of J&J doses. 

He notes that the consignment of AstraZeneca doses that the country received in December last year expired on January 31 this year and that South Sudan’s Health ministry instructed they be sent back. 

“We do encourage people to get vaccinated but the numbers are much lower than what we were recording in the beginning. The challenges we face keep piling up day by day and there is also a policy by the Health ministry that is now reducing the number of staff in this hospital.” 

“According to an official letter that I received from the ministry, they said we reduce the number of staff from 19 to five. They did not give a reason but I suspect it’s because the number of those coming for the jab has really gone down.” 

“We used to receive 300 people per day but now we get at most 20 to 30 people per day,” the manager tells Healthy Nation. 

Dr George Legge, the director of Expanded Programme on Immunisation in the country, says: “Last year we could not roll-out the vaccine because we did not have a vaccine roll-out plan and so we decided to donate the 75,000 doses of AstraZeneca to Kenya before they went bad. It would be unfair for the doses to go bad under our watch at a time when the world is in dire need of the vaccines and also when our neighbours were in a better position to utilise them. This tells you the kind of people we are in South Sudan.” 

The director confirms that their second batch of AstraZeneca, which was donated in December last year, has expired.

South Sudan received her first batch of AstraZeneca from the COVAX facility on March 25, 2021, which it donated to Kenya. 

“We started with three main vaccination centres —  Juba Teaching Hospital, Juba Military Hospital and Juba Police Hospital. With time we expanded to include other 12 smaller vaccination sites within Juba and so far we have reached 10 states, which is 74 counties. In total we have vaccination sites in 391 health facilities in the country.” Dr Legge highlights. 

According to WHO, only a total of 372, 634 doses have been administered as of February 4, 2021 since the roll-out on March 3, 2020. 

Sacha Bootsma, the WHO Covid-19 incident manager in South Sudan, explains that the health system in the country is 99 per cent dependent on donor funding. 

“The government does not have a big budget for health programmes. For South Sudan, fighting Covid-19 is not a priority,” she says. 

Ms Bootsma, however, admits that they cannot explain why they haven’t seen many deaths and hospital admissions in light of the non-adherence to WHO recommendations by the public and low vaccine uptake. She cites the possibility of ‘herd immunity’ in the past Covid-19 wave. 

“We haven’t seen what we see in other countries like spikes in coronavirus cases, many people falling severely sick or unexplained deaths but the country’s surveillance systems are weak and are thus not able to detect the majority of Covid-19 cases. We honestly cannot explain this but we are in the process of preparing for a mortality survey to look at that ‘excess deaths’ among  communities.””

Dr Maker Isaac shares the same view, citing a ‘miracle’ in how the country has been navigating the last two years of Covid-19 considering the fact that in a population of around 11 million people with very low vaccination rate, only a few coronavirus cases and deaths have been reported as per official government data, which he attributes to herd immunity. However, he cannot explain the low number of deaths. 

WHO defines herd immunity, also known as population immunity as the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. 

The number of Covid-19 cases reported in South Sudan stands at 19,955 and cumulative deaths at 137 by the end of February 2022.


Rwanda: The land of public health efficiency
 

BY AMINA WAKO AND ANGELA OKETCH

For the last two years since countries started recording cases of coronavirus,  Mr Johnson Omwando’s nature of work has seen him make frequent trips across East African countries.

One thing that has stood out for him in all the countries is how Rwanda has managed to conduct Covid-19 tests in an efficient and faster way.

 King Faisal Hospital, paul kagame, kigali, rwanda, covid
Rwanda’s President Paul Kagame receiving the first injection of the Covid-19 vaccine at King Faisal Hospital in Kigali on March 11, 2021.
Photo credit: AFP

Unlike other countries, Mr Omwando observed, Rwanda has the faster turnaround time for results, particularly for travellers.

“It takes only two hours for the PCR test results to be back and three minutes for the rapid test unlike other countries where it can even take days before getting back your results,” he said.

Rwanda’s response to Covid-19 was quick and decisive. It has also been effective.

Early response and rigorous containment measures following the first Covid-19 case on March 14, 2020 as well as previous experience in handling the Ebola outbreak in 2019 are some of the contributing factors to Rwanda’s success. The country’s response and implementation of initiatives like scaling up preventive measures to mitigate exposure to virus, installing hand-washing stations in public facilities and temperature checks using thermo-scan prior to the first confirmed case have also gone ahead to cement the country’s efficient management of the disease.

Only public hospitals are allowed to test for Covid-19 in Rwanda, with a standardised price charged across all the facilities. Rwanda government, observed Mr Omwando, invested appropriately in technology to facilitate the flow of information from a facility to a traveller.
 
To date, Rwanda has confirmed 129,468 cases of Covid-19 with 1,457 deaths reported to World Health Organization . 

At the airports, preventive measures have been put in place, including equipping the facilities with protective plexiglass at check-in and immigration counters and social distancing markers. Further, there is thermal and temperature screening as well as increased sanitisation levels.

Also, arrivals must have tested negative for Covid-19 within 72 hours before departure and conduct a second test upon entry into the country. Exiting travellers are required to book and pay for their tests at least two days before departure through Rwanda’s online platform.  “Even with the restrictions being eased, Rwandese have a culture of following rules, you will still see people wearing masks and sanitising and I think their discipline is one of the things that has helped the country to managed the pandemic, “added Mr Omwando, who explained that according to his experience with Covid-19 testing as a frequent traveller, he ranks Rwanda as the clear best, followed by Kenya then Uganda, while Tanzania ranks the worst in terms of efficiency, integrity and confidence.

For the two years the world has been fighting Covid-19, Rwanda has used different technologies and innovative approaches to handle the pandemic. In May 2020, Rwanda deployed five high-tech robots to help fight against Covid-19 by reducing contact between medics and patients. 

The robots have been helping in the distribution of drugs, food, disinfection of patient stations, and assessing vital signs in patients.

Other tech-based solutions initiated to fight the pandemic included the deployment of drones to create awareness among citizens as far as Covid-19 preventive measures are concerned.  Smartphones were also used to follow-up on Covid-19 patients undergoing home-based care and identify contacts of Covid-19 confirmed cases. 

In addition, a Geographic Information System is being used to visualise data and monitor Covid-19 cases at the household level and assess the need for implementing the guideline if need be.

Rwanda has enhanced testing capacity, and coverage using antigen-based testing provided at various health facilities across the country. To curb Covid-19, the country prioritised testing, isolation, and contact tracing.  

Rwanda introduced home-based care for asymptomatic patients by the use of community health workers to manage the cases at home and refer when appropriate. Each village has a team of elected community health workers who understand the specific needs of their constituencies. The country rolled out the first Covid-19 vaccination campaign on March 5, 2021;  with Pfizer-BioNTech and AstraZeneca vaccines received through the international vaccine cooperative, COVAX Facility. 

As of February 25, 2022, a total of 18,193,932 vaccine doses have been administered, with over seven million people fully vaccinated. In January, Rwanda launched a countrywide vaccination campaign and narrowed it down to the village and family levels to help vulnerable people who cannot reach vaccination sites and educate those who are hesitant to take the vaccine. 

Teams of youth volunteers, local leaders, and health professionals have been going door to door in all districts administering the Covid-19 vaccine.


Zanzibar adopts new non-invasive tech for testing travellers 


BY MARY WANGARI

As the world resumes normalcy in a slow but steady pace, things have never been the same for travellers globally since they have had to endure invasive, lengthy and hectic Covid-19 testing procedures, which has drastically affected the tourism sector.

However, this is now history in Zanzibar, which has become the first country in Africa to adopt a new non-invasive Covid-19 testing technology.

In spirited efforts to boost the tourism sector in the island, the government of Zanzibar has signed a partnership with Alfa Care, a firm based in Dubai, to access the first ever non-invasive Covid testing technology. The exponential deep examination (EDE) screening technology, which targets tourists visiting the island, was launched last month. 

While addressing the press at the State House during the launch of Complete Testing Protocol in Zanzibar,  President Hussein Mwinyi said his government will do everything possible to revive the tourism sector in the island —  a popular tourist destination.

“Tourism is the backbone of Zanzibar’s economy. It accounts for 30 per cent of the country’s GDP. Based on this, it is crucial for the government to facilitate travel for tourists while at the same time keeping people safe,” 

“One way to do this is using EDE scanners. We will still conduct PCR testing for tourists entering and exiting the island. Passengers who do not manage to get a PCR test within 24 hours before departure can get an EDE test two hours before the flight,” stated President Mwinyi.

Abeid Amani Karume International Airport , President Hussein Mwinyi, zanzibar, covid
Airport staff waiting to welcome arriving visitors at the Abeid Amani Karume International Airport in Zanzibar.
Photo credit: MARY WANGARI |NATION MEDIA GROUP

He disclosed that the tourism sector in Zanzibar was immensely affected in the wake of the global pandemic due to disharmony in testing protocols. “In 2020, the number of tourists plummeted to 1,380,700 from 2,798,600 in 2019; an equivalent of 50.67 per cent decrease. Dubai had halted its flights to Zanzibar because it was disagreeing with our testing protocols,”

“With the entry of the state-of-the-art testing protocols, people can now come from all over the world to visit us and even to be tested for Covid-19.”

The president observed that they are also expecting more tourists from the United Arab Emirates (UAE). “Fly Dubai has already resumed operations and soon Etihad will commence its flights,” he affirmed, adding: “The EDE testing, whose results are known within seconds, will be integrated so that once you take it in Zanzibar, you do not need to do it again in the UAE.”

On the issue of East Africa integration, President Mwinyi appealed to the other governments to adopt the modern testing technology, saying it will not only enhance trade but also boost tourism among the East Africa nations. “We are proud to be the first country in East Africa to start using this technology. It is our hope that the rest of the East Africa will learn from us and embrace the new technology,” he said.

EDE scanners deploy electro-magnetic waves that detect coronavirus and provide test results within minutes, explained Dr Mohamed Gurlez, a biologist.

The technology is said to be highly effective with a 93.5 per cent sensitivity rate and 83 per cent specificity rate. The technology was first launched in Abu Dhabi during the peak of Covid-19 pandemic in 2020. It has since been widely used in the UAE.

To test for Covid, medics have been conducting World Health Organization’s approved polymerase chain reaction (PCR) diagnostic tests. During the testing, a health practitioner collects nasal swabs from the uppermost part or the back of the patient’s nostrils in a procedure known as a nasal mid-turbinate swab. Some people find the procedure extremely invasive and uncomfortable, avoiding it at all costs.


 

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