Categoria: News

On the other side of care

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It is Theresa’s son, nurse at Chiulo Hospital, one of the first 2025 newborns. In just a few hours, Theresa found herself on the other side of care.

As for the first delivery, she gave birth to her second child in the hospital where qualified personnel could handle any unforeseen complications—a task she usually performs in that same facility, alongside the hospital’s medical team.

In fact, a few hours before her son’s birth, Theresa was still on duty at Chiulo Hospital. As her first contractions began, she and Francesca Rossi, a gynecology resident, were assisting two women who had arrived at the hospital with childbirth complications: one with a retained placenta requiring emergency surgery, and another with a twin pregnancy complicated by eclampsia and cerebral malaria.

«In Angola, women can benefit from maternity leave for only 90 days- Francesca Rossi explains -. Theresa decided to work until full term so she could then spend the first months with her baby. On Friday evening, as her first contractions started, she was still on shift. She spent the night managing emergencies and supporting the team through very challenging moments».

Theresa stopped working just a few hours before labor began. Her baby boy was born on Sunday in good health, weighing 2.78 kg. Both mother and baby are doing well and returned home on Monday. Theresa will care for her newborn over the next three months before returning to Chiulo Hospital to assist other women through the delicate moment of childbirth.

Every year, approximately 280,000 women die during childbirth or from pregnancy-related complications, the majority in sub-Saharan Africa. Hemorrhages, complications, the distance from hospitals, and insufficient or inadequately trained personnel are the primary causes of maternal mortality. In Angola, the maternal mortality rate stands at 222 per 100,000 live births.

10 shots to navigate our 2024

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In many areas, including sub-Saharan Africa, access to healthcare is not a right for many but a privilege of a chosen few. Every day we work with commitment and dedication in 9 countries to promote the universal right to health for all, especially the most vulnerable. From the tireless work of our humanitarian workers on the field to the daily dedication of those in CUAMM’s offices, every achievement is the result of a shared commitment you are also part of. A heartfelt thank you to everyone who has supported CUAMM this year.

Here is a selection of 10 moments from 2024 we have chosen to recall a year of unwavering commitment.

ETHIOPIA

In the northern region of Tigray, devastated by a prolonged internal conflict, we have initiated the reconstruction of Shire Hospital which serves approximately 2 million people, along with five surrounding health centers. Shire Indasilasse is one of the areas most severely affected by the conflict. Widespread looting and destruction have had a profound impact on the delivery of basic services to the population in a region that hosts the highest number of internally displaced persons.

MOZAMBIQUE

The commitment and collaboration with the Catholic University of Mozambique, based in the city of Beira, goes on. This year, several young people made their dream come true and can finally hold a degree in general medicine. For young individuals like Atianete, HercĂ­lia, Muaziza, and Victorino, this milestone was achieved thanks to their commitment and dedication and also, with the support of scholarships provided by CUAMM.

IVORY COAST

The urban health center of Anonkoua Kouté is located in Abobo, the most populous district in the country. At this center, which handles 3,700 deliveries per year, we inaugurated a new maternity ward. This initiative aims to fulfill one of the objectives of the national health strategic plan: ensuring free and semi-free access to healthcare across the country.

ANGOLA

A comprehensive program where health, environment, and community empowerment come together as one. The Clean Cooking initiative, launched in the province of Uige, aims to introduce improved cooking methods to mitigate the harmful effects of traditional practices, such as respiratory diseases, deforestation, and social exclusion, to name a few. This intervention will involve 16 municipalities and approximately 200,000 families.

SIERRA LEONE

New, larger, and more functional premises have been inaugurated at the Princess Christian Maternal Hospital (PCMH) in Freetown. In October, together with the Minister of Health, we opened the doors to a new outpatient department and a renovated pharmacy for this hospital, which serves over 1.3 million people.

CENTRAL AFRICAN REPUBLIC

An area with 200,000 people and a 120-bed hospital eight hours of driving away from the capital, Bangui. Here, with the construction of the new maternity ward at the Bossangoa hospital, CUAMM’s commitment in the country resumes, amid a context of significant internal instability marked by conflict and armed violence.

TANZANIA

The United Nations Inter-Agency Task Force on the Prevention and Control of Non-Communicable Diseases has awarded Doctors with Africa CUAMM the Task Force Awards 2024 for its commitment to improving health outcomes in rural areas of Tanzania.

SOUTH SUDAN

Adior, in Lakes State, about an hour’s drive from Yirol. In the health center of this small town, where only ruined buildings stood three years ago, there is now a maternity ward. We inaugurated it in July, celebrating the event with the Minister of Health and the entire community.

UGANDA

The new neonatal intensive care unit was inaugurated in Matany, Karamoja. This region, the poorest in the country, records an average of 550 perinatal deaths annually, including 160 neonatal deaths, many of which are preventable. The construction of this new unit comes after the interventions already carried out in support of three other hospitals in the region.

ITALY

CUAMM has been awarded the “Antonio Feltrinelli 2024” Prize by the Accademia dei Lincei for an exceptional initiative of high moral and humanitarian value. Also known as the “Italian Nobel,” the prize was presented in the presence of the President of the Italian Republic, Sergio Mattarella, and will support the significant program “Mothers and Children First.”

IDPs conflict and climate change compound the crisis in Ethiopia

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As the internal conflict in the northern region of Tigary ceased with the peace agreement signed in November 2022, the IDPs crisis in Ethiopia remains dire. To date, 4.5 million people have been forced to flee their home due to conflicts, climate-related disasters and economic pressures in search of safety or simply opportunity.The majority of them is recorded in Tigray, Somali and Oromia regions where Doctors with Africa CUAMM is working with the twofold objective of responding to crises and finding sustainable and durable solutions to create a resilient health system.

Tigray region is hosting the highest number of IDPs displaced by conflict nationwide. As of May 2024, an estimated 871,056 individuals or 38.3% of the national conflict caseload were reported in the region. The war significantly disrupted Tigray’s healthcare system severely limiting people’s access to care. In the aftermath of the conflict, about 70% of hospitals and health centres in the region were either partially or fully damaged. Suhul Hospital, in Shire town, was one of them.

«I started working in this hospital before the war and I have experienced firsthand the consequences of the conflict in terms of human resources, medical equipment, and the satisfaction of both patients and health workers». said Gebremedhin Atakilti – Medical Director at Suhul Hospital.

To respond to the urgent needs of the local population, CUAMM stepped into the region with a first intervention aimed at rehabilitating Suhul Hospital, in Shire town, which serves as referral facility for over 2 million people, including IDPs.

Being one of the biggest urban centres in Tigray, Shire hosts some 175,000 IDPs of which 110,000 within host communities and many in the 6 IDPs camps disseminated across the town. 

«Being located beside the camp, we often face cholera outbreaks and have to be ready to respond – said Tsegay Gebre Yesus – Chief of Five Angels Health Centre in Shire. At this little health centre we mainly serve IDPs offering them free care».

The conflict has severely hindered people’s access to healthcare services, affecting mainly women and children. CUAMM is working both at hospital level and within the community to restore key services such as maternal and neonatal care, malnutrition treatment and follow-up, HIV testing and antiretroviral therapy (ART). In addition, support is being provided to women and adolescent girls who have gone through violence.

While the conflict is the leading cause of displacement in the northern region of Tigray, the onset of El Niño has caused climate-induced displacement in the Southern and Southeastern parts of the country. As of May 2024, drought was the primary cause of displacement for an estimated 544,002 IDPs (16.5% of the national IDP caseload), across Somali, Oromia and Afar regions. Other climate induced reasons include flash floods, seasonal floods, landslides and fire. Such events have a severe impact on local populations in terms of food insecurity and risk of watern-born diseases.

Tigray region hosts the highest number of IDPs primarily due to conflict, whereas the Somali region in the east hosts the highest number of climate migrants, an estimated 397,913 individuals or 73.1% of the national drought caseload. Doctors with Africa CUAMM intervention in the area is targeting Fafan and Liben Zone where the weather conditions have limited people’s access to services and deepened their vulnerabilities. In order to facilitate access to care, CUAMM is deploying 2 Mobile Health and Nutrition teams in 11 selected villages across Filtu and Bokolmayo districts where 21,584 individuals have been reached to date. Health services provided include: paediatric immunization, antenatal care to pregnant women, malnutrition and psychological screening, anthelmintic treatment for schistosomiasis and emergency referral. 

Conflicts, violence, prolonged drought combined with disease outbreaks, such as cholera, malaria, and measles, is further exacerbating the vulnerability of affected communities in Ethiopia, including IDPs and returning IDPs.

A shared commitment: the health of mothers and newborns

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“Increasing Access to Specialized Maternal and Neonatal Services in Karamoja and Lango Region 2024-2026”: this is the priority goal of Doctors with Africa CUAMM together with the Ugandan Ministry of Health, particularly through the recently launched two-year project in Uganda, funded by the ELMA Foundation.

Activities are taking place, in synergy with CUAMM’s already active interventions, in four districts of Karamoja (Moroto, Amudat, Kaabong and Abim) and three districts of Lango (Alebtong, Otuke and Oyam), involving 66 health facilities.

Although there have been improvements in the reduction of maternal mortality, there still remain problems related to the management of obstetric emergencies during the perinatal period and the resulting outcomes. Indeed, wide regional disparities exist: according to the Maternal and Perinatal Deaths Surveillance and Response Report (MPDSR) 2023-24, the maternal mortality rate in Karamoja is 73.9 per 100,000 live births compared to 61.1 per 100,000 in Lango.

“The districts involved were chosen because they have limited access to maternal and neonatal services while having a high patient load. This project will therefore seek to address the challenge of neonatal death and increase the survival of children under 5 years old,” said Peter Lochoro, Uganda Country Representative for Cuamm.

The intervention focuses on on-the-job training and mentoring of health workers to implement quality maternal and neonatal services by strengthening leadership, management and accountability skills from district and national authorities.

“The ELMA Foundation has been supporting us for over 6 years to improve human resource skills and capacities by qualifying health workers through scholarships and promoting mentorship,” added Peter Lochoro.

Specifically, the intervention works on multiple levels and aims to: improve access and quality of care for women during pregnancy, including cervical and breast cancer screening; facilitate Village Health Teams, village health workers, and “peer mothers” in implementing community-based care services, including case referrals and patient follow-up; and engage and raise community awareness of maternal and newborn services.

In addition, it is intended to strengthen emergency referral systems by improving the functionality of ambulance services and providing vouchers to transport patients from communities to health facilities and between facilities and the 9 Comprehensive Emergency Obstetric Care sites for the comprehensive care of obstetric and neonatal emergencies. In this regard, efforts are being made to improve access and quality of care during labor and delivery by supporting the continued functionality of 3 CEmONC sites in Amudat and Oyam districts, specifically the operating rooms; ensuring the availability of needed drugs and medical equipment, along with the availability of blood and blood products; fostering better action planning; and ensuring surveillance and response to maternal and perinatal deaths (MPDSR).

Improved care for women is complemented by efforts to improve access and quality of care for newborns by investing in growing the clinical skills of health workers in advanced neonatal resuscitation care with innovative technologies, facilitating the adoption of infection prevention and control (IPC) practices, strengthening neonatal clinical care in 9 CEmONC sites, and facilitating the use of the “Kokono” device, a protective cradle to create a safer environment for newborns.

The launch event, held in Soroti, was attended by district political authorities and technicians from the 7 districts involved. “The impact of collaboration with CUAMM is being felt, the results on the ground are tangible, and the goals of this project are in line with the Ministry of Health’s national sustainable development priorities,” said Rita Akankwasa, ELMA representative.

Every day in Uganda, and in all the countries where CUAMM has a presence, we try to go the extra mile, together, to ensure that mothers and children can have access to the quality health services they are entitled to.

Little if nothing to live with

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«It was too dangerous to live there; we were bombed almost every day, and my brother died during a missile attack while he was working. His only fault? Being in the wrong place at the wrong time»

This is the reality of the war in Ukraine, and these are the words of Maria Boshenko*, a 30-year-old women from Zaporizhzhia. Due to its geographical location, only a few dozen kilometers from the frontline, the town is constantly under missile threat. Unfortunately, Zaporizhzhia has already experienced several attacks, especially at the beginning of the war, when battles took place to control the nuclear power plant south of the town. In one of these missile attacks, Maria’s brother, lost his life.

Hoping to find better security, Maria left for the north with her 9-year-old son, Ostap*. They moved to an Accommodation Centre in Kyiv, to be relocated shortly after to a IDPs camp in Vasylkiv, 30km away. Since February 24, 2022, the conflict in Ukraine has been experiencing continuous escalation, causing an unprecedented humanitarian crisis, with the civilian population being the primary victim. Death, destruction, mass population movements within Ukraine and neighboring countries, and the socio-health system’s inability to meet essential needs have left about 18 million people in need of humanitarian assistance (Ukraine HRP 2023). The highest concentration of IDPs remains in the Kyiv region that hosts about 16.2% of IDPs, with the city of Kyiv itself accounting for more than 7%.

«I work occasionally as a cleaning woman – said Maria. – but we have little money and are struggling in making ends meet. We hardly have a meal per day».

Both in Ukraine and Moldova, the population, particularly the most vulnerable groups, struggles to meet basic needs such as food, essential hygiene supplies, and basic materials to withstand the harsh Ukrainian winter. Vulnerable categories, including women, children aged 0-3, the elderly, and persons with disabilities are those most hardly impacted and still depend on humanitarian aid.

CUAMM response

As part of the Emergency Call to Support, funded by AICS with 46.5 million, CUAMM, in collaboration with the local Organisation Vidchuij, distributes Food and Hygiene Kits to Internally Displaced Persons, refugees, host communities, and returnees in the areas of Chernivtsi and Kyiv. Beneficiaries identified are IDPs with vulnerabilities such as large families with young children, single-parent households, and those with elderly or persons with disabilities as dependents.

Being a single parent and in view of the difficulties she was going through together with her son, Maria was included in the distribution program implemented by CUAMM in Vasylkiv. As of October 2024, 662 single mothers like Maria received nutritional and essential items kits. In addition, 2,200 non-food kit and 2,200 food kit had been delivered benefiting an overall number of 3,711 people in need.

Daily goods can seem extraordinary when the war takes everything away from you. Providing people with essential items can indeed alleviate the suffering caused by the conflict. Our project is part of a 46.5 million euro initiative funded by the Italian Agency for Development Cooperation, reaching 900,000+ people affected by the Ukraine crisis and it is being implemented in collaboration with Caritas Italiana, Caritas Drohobych Sambir and Volonterskiy ruh Bukovyny (VRB).

«I’m deeply grateful to CUAMM; now we have food, and Ostap can eat as an ordinary child» said Maria who then added «Can you believe a child is just happy with toothbrush and toothpaste? That is how it is, we couldn’t afford them».

Doctors with Africa CUAMM has been working in Ukraine since March 2022, providing assistance to the most vulnerable populations. Since the onset of the humanitarian crisis in Ukraine, CUAMM has reached over 40,594 people and supported over 29 healthcare facilities with medicines, consumables, biomedical equipment and logistical support materials to ensure the continuity of life-saving care.

 

 

 

 

Empowering health professionals to save lives

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A 7-days training on neonatal care was offered from November 22-30 to 40 health workers in Abidjan, Ivory Coast as part of the project “Ensuring quality neonatal care in Abobo, Abidjan” implemented by CUAMM in partnership with Chiesi Foundation.

Midwives, nurses and doctors from 3 different facilities, namely Anonkoua-Kouté (FSU-COM), Saints Cœurs de Clouetcha and Abobo regional Hospital participated in the training held by three international neonatologists from CUAMM together with two experts from the National Mother and Child Health Programme.

«We engaged professionals with different backgrounds, some of them had little experience in neonatal stabilization and resuscitation but it is important to reach a wide range of health professionals especially midwives and nurses who are the first to care for newborns» said Dr. Antonia Tomasoni.

Specific objectives of the training included:

  • Update participants’ knowledge of the essential components of neonatal care;
  • Ensure mastery of resuscitation maneuvers;
  • Guarantee intelligent use of oxygen;
  • Ensure the acquisition of newborn stabilization skills;
  • Conduct on-site simulation and training sessions in a delivery room and/or neonatal ward, to make participants more comfortable in using proper equipment available.

The training, designed to foster knowledge, skills and competencies on essential functions of neonatal care among health professionals, provided both theoretical contents and cinical activities on essential care and neonatal resuscitation and stabilization techniques.

«The most interesting part of the course was that on infection management. These topics are essential for improving the quality of newborn care and allowed me to acquire practical and theoretical skills directly applicable to my daily work. I was able to better understand the concept of infection in infants and its main causes, describe the clinical signs of neonatal bacterial infections, and learn how to monitor infected infants and refer them if necessary» said Adoni Anon Marcel nurse at Saints Cœurs de Clouetcha General Hospital.

Knowing the steps of neonatal resuscitation and performing them correctly, in what is known as the golden minute, is key to save a newborn. Yet, neonatal emergencies are often received in peripheral facilities where health professionals are not properly capacitated with the skills and ability to deliver a timely and effective response.

«80 to 90% of neonatal emergencies can be managed by performing simple procedures at the early stage of the emergency without the need for further procedures such as incubation, resuscitation or even drug therapy» said Dr. Antonia Tomasoni

Unfortunately, both lack of knowledge and poor learning opportunities often jeopardize the ability of health professionals to adequately perform such life-saving procedure, with tragic consequences on maternal an dneonatal health indicators. With a population of 28.5 million and a concerning newborn mortality rate of 385 per 100,000 live births (2021), Ivory Coast faces a critical neonatal healthcare challenge.

By collaborating with Chiesi Foundation on the implementation of the Neonatal Essential Survival Technology (NEST Model), we aim to enhance care for premature, low-birth-weight, and medically fragile infants through healthcare professional training and the provision of essential equipment to neonatal wards.

«Some of the topics covered during the training were new to me, especially specific neonatal resuscitation techniques. Although I had some basic knowledge on these topics, I discovered practical tools and new methods such as MRSOPA. On the other hand, the notions on essential newborn care, such as early initiation of breastfeeding or optimal cord clamping, enabled me to reinforce practices that were already known but sometimes underestimated in my daily work» claimed Diomande Bintou, midwife at Regional Hospital of Abobo.

The initiative is being implemented by CUAMM in collaboration with the Coordination Directorate of the National Program for Maternal and Child Health (DC-PNSME) and it is aligned to the Maternal and Perinatal Death Surveillance and Response Strategy and the Mother and Child Health Strategic Plan (2021-2025) set by the government. The overall objective of the intervention is to ensure improved care for newborns therefore reduce the maternal and neonatal mortality rate in Ivory Coast.

 

Reducing the burden of TB in Ethiopia

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Operational research is an essential tool to understand contexts of intervention, identify effective actions and unlock good practices to be integrated into health planning. This was the approach of Fighting TB strengthening the prevention, early diagnosis and treatment project implemented by Doctors with Africa CUAMM in partnership with UniversitĂ  di Bari and Global Fund in collaboration with the Oromia Health Bureau, funded by Aics.

The intervention merged operational research and on-field activities with the aim to improve access to tuberculosis prevention, diagnosis, and treatment services in the South West Shoa Zone and the three districts/woredas of Goro, Wolisso Rural, and Wolisso Town therefore achieve Sustainable Development Goal 3.3 and Strategic Objective 1 of the Global Fund.

«CUAMM is trying its best to improve the work on infectious disease, especially TB, in the South West Shoa Zone, and also to advocate for it.This is a challenge we are committed to take up, together with the support from donors and stakeholders» said Luisa Gatta CUAMM Country Manager in Ethiopia.

On Thursday, November 28, we gathered at St. Luke Hospital in Wolisso, with partners and local authorities to give account of the work done on TB response over the past 2 years, and to disseminate the results of a research led by our partner University of Bari.

«Despite the burden Tb represents on people and health systems, efforts on research are still limited. With this investigation we aimed to detect the impact of Tb in South Shew Zone to improve diagnostic services therefore mitigate the impact of the disease» said Giacomo Guido, researcher of University of Bari. 

Working in collaboration with Ethiopian health authorities in Wolisso Town, Wolisso Rural and Goro districts, CUAMM has implemented interventions on multiple levels. First, it has increased awareness and consequently, the demand for TB services by providing training to a total of 277 Health Extension Workers (HEWs) and community leaders. Additionally, it engaged the community in advocacy activities during 40 events held in several venues including schools, prisons, factories and marketplaces across the target area. These efforts were complemented by screenings conducted for a total of 499,047 individuals.

«The work we have carried out over the last year is something we cannot but appreciate. It was a load on our shoulder, yet by cooperating with CUAMM we managed to overcome difficulties and challenges and gain good results especially in South West Shewa» said Lemma Desu M&E Coordinator at Oromia Health Bureau 

Secondly, CUAMM strengthened the capacity of health personnel in early diagnosis, treatment and management of TB patients within health facilities by training 72 healthcare workers on clinical management of TB. This was achieved through on-the-job training and the provision of essential supplies for diagnostic services and clinical activities in 16 health facilities and at St. Luke Hospital. Finally, the intervention enhanced the ability of zonal and national health authorities to plan, coordinate and monitor services for the diagnosis, treatment and follow-up of TB patients. Key activities included geo-mapping tuberculosis cases, organizing regular meetings at district and zone level and analysing the results of the operational research conducted by the University of Bari.

«When we were doing TB preventive activities there was a shortage of slides and medical equipment. This project identified these gaps and helped filling them both at local and zonal level. I believe that by scaling up the activities to other districts, we can accelerate the response to TB» stated Tesfaye Kitaba – SWSZ Health OfficeTB focal person.

The intervention conducted over the last two years has shown that regular joint supportive supervision and performance review meeting improves the quality and performance of care for TB patients. Moreover, involvement of community leaders on prevention and control of TB and identification of presumptive cases is paramount in reducing TB incidence as it also is the active case search for TB detection. Finally, collaboration with multiple stakeholders throughout the implementation of activities has been key to ensuring their effectiveness and sustainability.

«We are working closely with CUAMM staff as a whole. This tight collaboration between CUAMM, Oromia Health bureau, Oromia bureau of finance, Health minister and all the other stakeholders is key for the sustainability of the project which is something we truly appreciate» said Guteta Degefa – SWZS Health Office Head.

Ethiopia is one of the countries in the Africa region with the highest burden of TB. Despite the evident progress achieved, as for 2020 the incidence of Tuberculosis was 132 per 100.000 people and the mortality rate of 17 per 100.000. Moreover, 51% of households in Ethiopia count a patient facing catastrophic costs due to the disease. 

Generally, TB patients in low- and middle-income countries face medical expenses, costs of seeking and staying in care, and income loss equivalent to more than 50% of annual income. Such factors end up triggering a downward spiral whereby the patient struggle in completing treatment, is more likely to have repeat episodes and more likely to develop drug resistance resulting in more expensive and arduous treatment. Worldwide, TB has probably returned to being the world’s leading cause of death from a single infectious agent, following three years in which it was replaced by coronavirus disease (COVID-19). 

«Worldwide TB continues to be fueled by inequity. Vulnerable groups like IDPs and refugees, as well as people in isolated places are those whose access to diagnostic services is often neglected. Ensuring detection of undiagnosed, untreated or unreported cases is the challenge we have to address together with that of multi-drug resistance. – said Alessia Montanari External Relations and Communications at Global Fund Geneva – in order to achieve the goal, we are scaling up our efforts to develop innovative tools and to decrease the price for diagnostic services».

Steps forward Concrete perspectives

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The project “Humanitarian Support in Response to Pediatric and Nutritional Care Needs for the Population of Bangui and BĂ©goua” is nearing its conclusion. This project, involving CUAMM in collaboration with Action Against Hunger (ACF) at the CHUPB Pediatric Hospital in Bangui, has been supported by the Italian Agency for Development Cooperation (AICS) and in partnership with the Ministry of Health of Central African Republic.

The main objective? To improve the availability, quality, and coverage of paediatric health services by acting on multiple levels: strengthening the capacities of hospital staff and infrastructure in service delivery; improving hygiene conditions and the prevention and control of hospital infections and infectious disease epidemics; enhancing the identification, coverage, and treatment of severe acute malnutrition in children under five in the health districts of Bangui and BĂ©goua.

At the center of this joint effort by CUAMM, ACF, and AICS is training in various areas as a tool for improving and strengthening health services for children. During the project, theoretical and practical training sessions were conducted in collaboration with the Ministry of Health and the World Health Organization to strengthen hospital infection prevention and control, targeting medical and nursing staff and cleaning personnel at the Complexe. Additionally, awareness activities on good hygiene practices were promoted for mothers and other caregivers.

No less significant was the investment in training various hospital executives on best practices for hospital management. In particular, in August 2024, a mission supported the CHUPB administration in the implementation and use of the human resources management software Homère. Furthermore, in October, two specialized technicians were sent to Bangui to install two radiological devices at the hospital, training 10 members of the surgical staff on their use and the maintenance team for technical monitoring of the equipment.

Training efforts were complemented by ensuring the availability and supply of essential drugs and consumables to provide adequate and quality care for the youngest patients. For this purpose, CUAMM supported the rehabilitation of the CHUPB pharmacy and the rehabilitation of the Isolation Unit, which began in August 2024 and was completed in early October 2024. “The goal of the rehabilitation work was to accommodate the neonatal unit beds before the start of the ward’s renovation. Today, we can say that the objective has been achieved on schedule, allowing children and their caregivers to receive appropriate care. Once again, on behalf of CUAMM, I would like to thank all the parties involved in this activity, and in particular the Hospital Director, Professor Gody, for his usual collaboration in implementing activities within the Complex,” stated Armelle Couvreur, CUAMM project manager in Bangui.

Thanks to this intervention, which began in May 2023, there have been definite steps forward in ensuring better paediatric health services, but many challenges remain. The number of human resources at the CHUPB is insufficient to support the workload, and their motivation is often not sustained by adequate compensation. The supply of drugs and reagents is inconsistent, so CUAMM has developed an action plan to strengthen pharmacy management at the hospital. Additionally, it is crucial to continue investing in medical and managerial training for executives and trainees.

In the face of these challenges, CUAMM envisions concrete perspectives: joint efforts with the hospital administration to promote the autonomy and sustainability of the CHUPB in the near future; consolidating and reinforcing improvements in infection prevention and control; enhancing equipment; improving the skills of medical and paramedical staff through expert missions; supporting research work. Furthermore, continuing to support the 9 UNTAs that received assistance as part of the project and implementing a comprehensive maternal and child health and nutrition package at the community level, reducing the overcrowding of secondary hospitals.

The journey continues, as does CUAMM’s commitment to stand by the mothers and children of the Central African Republic.

 

Read the French version of the article

Antimicrobial Resistance A Global Health Challenge

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Less than a century ago, the fortunate discovery of penicillin revolutionized medicine: until 1929, the world had to contend with daily deaths caused by infections without effective treatments. Today, however, millions of lives are at risk due to infections that no longer respond to available therapies: this is the threat of antimicrobial resistance. To raise awareness about this issue, the WHO has been observing the World Antimicrobial Awareness Week every year since 2015, from November 18 to 24.

A Global Health Threat

Numerous studies have highlighted that the danger now lies not only in pathogens themselves but also in the mechanisms these microorganisms adopt to defend against our attacks. This phenomenon, known as antimicrobial resistance (AMR), represents a global health emergency. Bacteria, viruses, fungi, and parasites can develop mechanisms that make them resistant to drugs designed to kill them or inhibit their growth—these drugs being antimicrobials.

Within this broader issue, the international community is particularly concerned about antibiotic resistance: the ability of bacteria to resist the action of antibiotics and pass this adaptation on to future generations. This undermines the effectiveness of standard treatments, severely impacts healthcare quality, and turns even common infections into potentially fatal conditions. The rise of antibiotic resistance is driven by the overuse of antibiotics in humans and in hospital settings. However, it is also closely linked to environmental factors, such as the use of antibiotics in livestock and agriculture and poor hygiene and sanitation systems with improper disposal of wastewater containing partially active antibiotics.

Antibiotic Resistance: A Serious and Growing Global Concern

WHO estimates reveal the severity of the phenomenon: antibiotic resistance is already a significant cause of mortality. Globally, it is estimated that 1.27 million deaths per year (WHO) are due to antibiotic-resistant infections. In the African region alone, around 250,000 deaths annually are directly attributable to antibiotic-resistant bacteria.

The African Continent

In resource-limited settings where infectious, sexually transmitted, and tropical diseases have high incidence rates, antibiotic resistance takes on even greater significance. Africa accounts for 95% of global malaria deaths, 70% of people living with HIV, and 25% of tuberculosis-related deaths (Africa CDC). In 2019 alone, antibiotic resistance was linked to 55,000 deaths from HIV and 30,000 deaths from malaria, underscoring the severity of the crisis in the region. Beyond the misuse and overuse of antimicrobials, additional factors exacerbate the impact in African nations: migration, low vaccination rates, environmental contamination from pharmaceutical and hospital waste, lack of access to clean water and sanitation, inadequate infection prevention measures, and limited knowledge and training. Antimicrobial resistance places additional strain on health systems, as standard treatments become ineffective, hospital stays lengthen, and healthcare costs rise.

CUAMM’s Operational Research on the topic

Antibiotic resistance is a complex and interdisciplinary issue that spans clinical care, epidemiological surveillance, and public health. This holistic perspective has shaped CUAMM’s collaborative research efforts to deepen field knowledge in Uganda.

The Opt-AMR project, led by the Centre for Infectious Disease Control in Zambia (CIDRZ) and involving the Makerere University (Uganda), Malawi-Liverpool Wellcome Trust Centre (MLW), Medici con l’Africa CUAMM, and Liverpool School of Tropical Medicine, focuses on investigating fever management and antibiotic administration in children. The study addresses both the biological dimension of antibiotic resistance—collecting samples to directly examine bacterial populations—and the community dimension, analyzing how care is managed and treatments are administered. In resource-limited settings, healthcare workers, community health providers, traditional healers, and medicine vendors are often the first responders in treating childhood febrile illnesses, offering support to mothers. Understanding the processes of diagnosis, care management, and antibiotic administration is essential to identifying whether and how unnecessary broad-spectrum antibiotics are being used, and how interventions can improve these practices.

Another research initiative, Advancing Antibiotic Resistance Surveillance and Harnessing Antimicrobial Stewardship in the Karamoja Sub-region (ARSK), linked to the ALL IN ONE project in Uganda’s Karamoja region, explores antibiotic use patterns and the knowledge, attitudes, and prescribing practices of healthcare professionals at St. Kizito and Moroto hospitals. These insights will inform updates to clinical guidelines for antibiotic prescribing, hygiene practices, and patient education. Collaborating with Makerere University and the Uganda National Council for Science and Technology, the research also examines samples from hospital surfaces (e.g., floors, workstations) as well as from healthcare workers and the general population to study bacterial population responses to antibiotic use.

Strengthening Global Partnerships

CUAMM’s operational research has recently expanded to include collaboration with the World Health Organization as part of the Infection Prevention and Control (IPC) network. By rigorously analyzing hospital practices to minimize infection risks, identifying gaps, and implementing improvement strategies, CUAMM aims to limit the emergence of resistant bacteria and safeguard public health.

A Global “One Health” Approach

Antimicrobial resistance (AMR) is a challenge that transcends medicine, connecting human, environmental, and animal health within the One Health framework. Addressing this crisis requires integrated actions, including research, training, prevention, and policy development, to mitigate the impact of a growing threat to public health worldwide.

CUAMM’s work in the field

In Uganda, CUAMM works  to prevent and respond to the outbreak of zoonotic diseases in the northern region of Karamoja thanks to All in One project, implemented in collaboration with Africa Mission and with the financial support of  the Italian Cooperation Agency for Cooperation and Development (AICS).

 

The long way towards ending gbv

Posted on by Redazione Cuamm

One in four adolescent girls in Uganda becomes pregnant before the age of 19. In the Oyam district, where Medici con l’Africa Cuamm began operating in 1996, the percentage is even higher, at 28.5% (source: DHIS 2). The consequences of these early pregnancies have long-term effects on the lives of young girls, including forced marriages, school dropouts, lack of financial independence, social marginalization, stigma, and gender-based violence, to name a few.

According to the Gender Index, in Uganda, approximately 35% of girls drop out of school due to early marriages, and 23% due to teenage pregnancies (UBOS and ICF International, 2012). Child marriage violates the fundamental rights of girls and women, denying them many others, such as the right to education, the freedom to choose whom and when to marry, when to have children, and how many children to have, as well as the right to be safe from sexually transmitted infections. Moreover, data on violence against married women by their partners show that violence against adolescent girls aged 15-19 is higher in all forms compared to violence against adult women aged 20 and above. While 16% of women aged 15 to 49 report experiencing sexual violence, the actual figures could be much higher.

«The community always blames women and young girls. If you got pregnant, it’s because you allowed someone to harm you. It’s your fault- says Ejang Irene, 17 years old – we need to do more to raise awareness about gender-based violence, but we can’t give up on seeking justice. By doing so, we also show that it is a violation of human rights».

Irene (a pseudonym) lives with her family in Oyam District, Uganda. At the age of 15, she had to drop out of school because her parents couldn’t afford the cost of education.

«I wanted to help them and become financially independent, so I started a sewing course. That’s where I met the man who harassed me» Irene told the Cuamm team, who supported her from the moment she filed the report to the trial, providing her with medical care and psychological support.

Medici con l’Africa Cuamm is operating in the Oyam district, in the Lango region, with a series of activities aimed at increasing the availability of and access to social and health services for the most vulnerable adolescent girls, with a particular focus on gender-based violence. The intervention, which covers 11 counties in the district, involves local authorities, associations, schools, and community leaders in intensive advocacy efforts.

«The education and awareness component is key to preventing gender-based violence – says Monica Peace Alupu, CUAMM Social Worker -. Through radio messaging and the dedicated work of village teams, we ensure that services are accessible to everyone, even in rural and peri-urban areas where abuse and violence cases are more frequent».

It is precisely fieldwork that gives concrete support to the intervention, aiming to provide women and young girls with tangible help to escape the cycle of violence they too often endure, addressing their most urgent needs: health and legal assistance.

Community mobilization allows field agents to personally receive reports that might otherwise go unheard while simultaneously raising awareness about available services. Since 2022, CUAMM, in close collaboration with district authorities, has established the first call center in Oyam district. This hotline provides an integrated service for reporting cases of violence, offering psychological support, legal assistance, and clinical care.

Two trained CUAMM social workers manage the hotline, working alongside the District Probation and Social Welfare Officer’s office. The first step involves informing the individual about available services, including healthcare, as well as their rights and potential legal avenues. The social workers act as intermediaries, facilitating the reporting of incidents and initiating the clinical process, which, in cases of physical violence, must be completed within 72 hours in order to prevent sexually transmitted infections and unintended pregnancy. At the same time, legal proceedings are pursued—a path that can be both time-consuming and resource-intensive.

«Unfortunately, the greatest challenge remains ensuring that justice is served for these young girls and women. The system is fragile, judges often are absent, and witnesses fail to appear in court on the day of testimony. It’s difficult to make people understand that gender-based violence is an issue that concerns us all, and one that we must work on together, but we continue to push forward, knowing that we are on the right path» conludes Giovanni Dall’Oglio, CUAMM Doctor and Project Manager in Oyam.

Among the primary challenges are limited access to services for young girls and women in rural or peri-urban areas, the persistent fear of stigma associated with the issue, and the extrimely long duration of legal proceedings, which can take up to three years to conclude.

«In the six-month period from April to September alone, we handled 30 cases. We are committed to ensuring that, once reported, the case does get to court for the woman to have justice but this does not always happen. It is in fact quite common that witnesses fail to appear in court, or that judges themselves are absent. However, we managed to secure two convictions for rape, and this is an achievement considering the average duration of legal proceedings» explains Giovanni Dall’Oglio.