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Hero Rats

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Written by Matt Jalink, Community Health & Epidemiology student at Dalhousie University
September 29th 2016

Rats don’t always have to be pests. An innovative NGO called Apopo, has recruited these rodents for humanitarian purposes. Giant African pouched rats (Cricetomys Gambianus), seen below, have been put through vigorous training to detect explosives such as landmines in addition to aiding in tuberculosis (TB) diagnosis using their keen sense of smell.

 

HeroRat sniffing out a landmine

HeroRat sniffing out a landmine

 

Founded in 1998, by Belgian Bart Weetjenss, Apopo operates as a non-profit organization responsible for training detection rats in one of two programs: Mine Action and Tuberculosis Detection. Mine Action focuses on landmine and explosive removal while Tuberculosis Detection offers a second line option for TB diagnosis. Both programs have yielded impressive results thus far.

This particular breed of rat, the Giant African Pouched Rat, was selected for Apopo’s programs because of their immunity to many tropical disease infections and is endemic to sub-Saharan Africa. The rats are bred in captivity, and the first stage of their training involves being handled by trainers at 5-6 weeks of age to become familiar with human interaction. The rat pups are trained through operant conditioning using a combination of click sounds and food rewards. Click training typically starts at 6 weeks of age so the rats associate the clicking sound with a food reward (usually banana or peanut). Once the rats have grasped the association of clicks with food, they are trained onto their target sent, TNT or TB depending which program they are allocated to. Their tasks become increasingly more difficult, finalizing in a blind accreditation test in order to graduate from their academy. Fortunately, very few of the rats fail to complete their training. If the rat is falling behind in their training schedule, it is not economically efficient to allocate additional training time. The unsuccessful rats are granted an early retirement, and are continually cared for on the Apopo sites.

Currently, Apopo has 31 working rats in the TB Headquarters in Morogoro, Tanzania and 9 at the Maputo clinic in Mozambique. Angola has 42 operational landmine detection rats, and Mozambique has 20 respectively. With 47 rats still in various stages of training, we can expect to see the HeroRat workforce increase over the next few years.

 

Apopo TB detection rat sniffing sputum samples for TB

Apopo TB detection rat sniffing sputum samples for TB

Despite being immune to most tropical diseases, the rats receive weekly veterinary checkups and regular preventative treatments for parasites. To date, no rats have been lost due to their detection work in either TB or mine detection, and the majority live to the end of their expected life span of 8 years. When it is noticed that the rats are not their typical enthusiastic selves about going to work anymore, they are awarded with retirement where they continue to receive weekly health checks and exercise.

Apopo’s headquarters can be found in Morogoro Tanzania where the breeding and training facilities and primary TB detection clinic are located. Mine action centres are located in Mozambique Angola and the Southeast Asian nations Vietnam, Thailand, Cambodia and Laos DPR. They hope to expand to other nations, but the issue lies with funding. With the cost of training one rat at €6000.00, it is not an easy endeavor. Further logistics involve having to register as an NGO through the country’s government and once achieved, import necessary equipment, machines, trained rats and recruit local individuals to become staff.

Stay tuned for more posts about the Mine Action and Tuberculosis Detection Programs!

Below is a link of the founder Bart Weetjenss giving a TED talk about Apopo!

https://www.ted.com/talks/bart_weetjens_how_i_taught_rats_to_sniff_out_land_mines?language=en

World Tuberculosis Day Part III – Treatment & Drug Resistance

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The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Last week we talked about diagnosing TB, and the importance of determining an appropriate treatment course along with that diagnosis. But how is TB treated, and why is drug resistance an issue with TB in particular?

Although those with latent TB infection do not present symptoms, and cannot spread TB bacteria to others, treatment can still be provided to stop them from developing TB disease. This step is important in eliminating and controlling TB around the world, but should only be initiated once the possibility of TB disease has been excluded. In the United States, four treatment regimens are approved, using combinations of isoniazid, rifampicin and rifapentine. Treatment for latent TB can last anywhere from 3 months to 9 months, necessitating between 12 and 270 doses (minimum) of anti-TB drugs [2].

Treating those with active TB disease is a much more pressing matter, as they have the potential to spread the disease to others. Treatment regimens for active TB disease can last between 6 and 30 months depending on resistance, a process which burdens patients and treatment providers alike [3]. With a treatment course this long, some patients inevitably fail to complete the full regimen, for many reasons including finances, social pressures and inadequate access to proper treatment. To provide a glimpse at the financial burden of TB, each case in Canada cost the healthcare system $47,290 [4]. This can lead to acquired drug resistance, which can then be passed on to others when the infected person, coughs, sneezes or spits, releasing TB bacteria into the air [5].

There are two types of drug-resistant TB: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB bacteria does not respond to (at least) the two most widely used and powerful first line TB drugs: isoniazid and rifampicin [6]. XDR-TB involves resistance to isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones (ofloxacin, etc.), and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin) [7]. Both MDR-TB and XDR-TB take longer than regular TB to treat (at least 18 months) and have lower treatment success rates. Furthermore, patients often experience more harsh side effects from treatment, leading to increased hospitalization [8]. In order to maximize the potential for positive treatment outcomes, it is important that further tests are undertaken after initial diagnosis to determine whether bacteria is drug-resistant, and provide appropriate treatment [7].

According to the WHO Global TB Report, in 2014 an estimated 3.3% of new TB cases and 20% of previously treated cases had MDR-TB. More than half of these cases occur in India, China and the Russian Federation. Additionally, an estimated 190,000 people died of MDR-TB in 2014. As of 2015, XDR-TB had been reported in 105 countries. The map below shows the number of patients in these countries with laboratory-confirmed XDR-TB who started treatment in 2014 [9].

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

In response to treatment non-adherence, and to combat the spread of drug-resistant TB, the directly observed therapy, short-course (DOTS) strategy was developed by WHO in 1994. Health workers meet with patients regularly to help with treatment, adherence, and to provide support and education. This strategy also advocates for increased allocation of domestic and international funding and resources to combat TB [10]. Tuberculosis is also highlighted in two recent worldwide strategies, the WHO End TB Strategy, and the UN Sustainable Development Goals (SDGs), which will be discussed in our next post.

When One Door Closes, Another Door Opens: From the MDGs to the SDGs Part 2

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By: Maria Wilson
Global Health Office Outreach Assistant
 
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As a follow-up to the MDGs, the UN has developed 17 Sustainable Development Goals (SDGs), which will come into effect on January 1 2016. As with the MDGs, each SDG has specific targets, which can be found on the UN website, and a set of indicators to measure progress, which will be finalized by March 2016. This ambitious agenda has been proposed to shape the policies and actions of UN member states through to 2030:

  1. End poverty in all its forms everywhere
  2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture
  3. Ensure healthy lives and promote well-being for all
  4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
  5. Achieve gender equality and empower all women and girls
  6. Ensure access to water and sanitation for all
  7. Ensure access to affordable, reliable, sustainable and modern energy for all
  8. Promote inclusive and sustainable economic growth, employment and decent work for all
  9. Build resilient infrastructure, promote sustainable industrialization and foster innovation
  10. Reduce inequality within and among countries
  11. Make cities inclusive, safe, resilient and sustainable
  12. Ensure sustainable consumption and production patterns
  13. Take urgent action to combat climate change and its impacts
  14. Conserve and sustainably use the oceans, seas and marine resources
  15. Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss
  16. Promote just, peaceful and inclusive societies
  17. Revitalize the global partnership for sustainable development

What makes the SDGs different from the MDGs? The most obvious answer is that there are more than double the number of SDGs than there are MDGs, but there are more differences than just that! More SDGs translates to the UN being able to tackle a more broad range of issues related to development. The MDGs were grounded in anti-poverty, however, they often failed to address the root causes of poverty, opting instead to treat the symptoms. The SDGs aim to address the systemic issues that allow poverty to persist, including human rights, governance, peace and stability. The SDG targets also move beyond poverty, examining issues such as climate change and sustainable consumption, which will impact everyone, regardless of their socioeconomic status.

The MDGs were primarily developed by member countries of the Organization for Economic Co-operation and Development and donor agencies focusing their efforts on low and middle-income countries. The process for determining the MDGs barely involved those who were most affected by their targets. The SDGs, however, have come out of international negotiations where low and middle-income countries were granted input. Furthermore, the SDGs are regarded as universal, applying to all countries and actors, rather than creating a divide between “rich donors” and “poor recipients.”

More opportunities for partnership will (hopefully) be a product of, and a driver of, the SDGs. These include public-private partnerships, trade partnerships, global partnerships, local partnerships, and most importantly equitable partnerships. In order to meet the ambitious targets set out in the SDGs, a multidisciplinary and multi-stakeholder approach will be vital.

The MDGs are about to expire, and though there has been considerable progress made on many of the targets, there is still much work to be done. About 1 billion people still live on less than $1.25 per day worldwide, gender inequality persists as women worldwide continue to face discrimination in their everyday lives and over 800 million people still suffer from hunger. The SDGs hope to finish the job of the MDGs, and ensure that this time around, no one is left behind. Over the next 15 years, we are excited to see how the SDGs will impact global health, as health is a key outcome of development.

 

 

 

When One Door Closes, Another Door Opens: From the MDGs to the SDGs (Part 1)

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By: Maria Wilson
Global Health Office Outreach Assistant
 
mdgs2

The United Nations (UN) established a set of eight Millennium Development Goals (MDGs) in 2000. The goals are as follows:

  1. To eradicate extreme poverty and hunger
  2. To achieve universal primary education
  3. To promote gender equality
  4. To reduce child mortality
  5. To improve maternal health
  6. To combat HIV/AIDS malaria and other diseases
  7. To ensure environmental sustainability
  8. To develop a global partnership for development

Each goal has a specific set of targets and technical indicators to measure progress, which can be found here if you are interested. While some targets had earlier end dates, the goals were part of a 15-year plan, set to end in 2015. Despite a commitment from all UN member states at the time, as well as multiple international organizations, the targets have not all met.

However, significant progress was made on the MDGs, and that progress should be celebrated! Below, we have highlighted one achievement under each goal contained in The 2015 Millennium Development Goals Report. The full report can be accessed here.

Goal 1: The proportion of the population in the developing world living on less than $1.25 a day has dropped from 50% in 1990 to 14% in 2015.

Goal 2: Literacy rates among youth aged 15 to 24 have increased globally from 83% in 1990 to 91% in 2015. Furthermore, the literacy gap between women and men has narrowed.

Goal 3: In Southern Asia, there are now 103 girls enrolled in primary school for every 100 boys. This is compared to 74 girls enrolled for every 100 boys in 1990.

Goal 4: The worldwide under-five mortality rate has declined by over half, from 90 deaths per 1,000 births in 1990, to 43 deaths per 1,000 births in 2015.

Goal 5: Over 71% of births globally were assisted by skilled health personnel in 2014, an increase from 59% in 1990.

Goal 6: Over 6.2 million malaria deaths were averted between 2000 and 2015, primarily in children under the age of five living in sub-Saharan Africa. Globally, the incidence rate of malaria has fallen by approximately 37%, and the mortality rate by 58%.

Goal 7: 2.6 billion people have gained access to improved drinking water since 1990. In 2015, this equated to 91% of the global population have access to an improved drinking water source.

Goal 8: Official development assistance from developed countries increased from $81 billion to $135 billion between 2000 and 2014. In real terms, this represents a 66% increase.

There is still much progress to be made on these goals, as well as in other areas. Gender inequality still persists, large gaps in health outcomes still exist between the poorest and the richest, conflict continues to threaten human development, and the health and environmental effects of climate change still need to be addressed. More importantly, we need long-term and universal solutions.

As a follow-up to the MDGs, the UN has developed 17 new Sustainable Development Goals (SDGs), which will come into effect on January 1 2016. Part 2 of this post, coming next week, will review the SDGs, and the ambitious targets they aim to meet by 2030.