THE CARDIOPAD
Idea: A computer tablet diagnoses heart disease in rural households with limited access to medical services.

Problem: Cardiovascular diseases kill some 17 million worldwide annually. In many African countries, those at risk often have to spend huge amounts of money and travel hundreds of miles to reach heart specialists concentrated in main urban centres. The Cameroon Heart Foundation has noted a “sharp spike” in heart disease among its 20 million-strong population, which is served by fewer than 40 heart specialists.

Method: A program on the Cardiopad, designed by 24-year-old Cameroonian engineer Arthur Zang, collects signals generated by the rhythmic contraction and expansion of a patient’s heart. Electrodes are fixed near the patient’s heart. Africa’s first fully touch-screen medical tablet then produces a moving graphical depiction of the cardiac cycle, which is wirelessly transmitted over GSM networks to a cardiologist for interpretation and diagnosis. “I designed the Cardiopad to resolve a pressing problem. If a cardiac exam is prescribed for a patient in Garoua in the north of the country, they are obliged to travel a distance of over 900km to Yaoundé or Douala,” Zang says.

Verdict: At the Laquintinie, one of the country’s biggest hospitals, cardiologist Dr Daniel Lemogoum said that, in a recent survey, three in every five persons who uses the Cardiopad has been diagnosed as hypertensive, or at risk of heart diseases. “These are people who would not necessarily have been aware they are hypertensive. It means sudden deaths might be preventable.”

SICKLE CELL DISEASE RESEARCH
Idea: To carry out scientific research on sickle cell disease (SCD) and show that large-scale, cutting-edge genomic studies are possible in Africa.

Problem: Every year, 300,000 children worldwide are born with SCD, a genetic blood disorder that can result in severe anaemia. Seventy percent of these children, or 210,000, are born in Africa. Tanzania has one of the highest annual birth rates of SCD in the world and without treatment up to 90% of these children will die in early childhood. However, many of these deaths could be prevented by early diagnosis and treatment. A better understanding of the genetic and environmental mechanisms of the disease will lead to improved diagnosis and therapies.

Method: Dr Julie Makani from Muhimbili University in Tanzania is working with the Wellcome Trust to conduct a genome-wide association study (GWAS) in order to better understand the genetic and environmental factors affecting SCD. The Muhimbili Wellcome Programme originally aimed to follow 400 children but is now following 2,500, making it one of the largest, biomedical SCD resources in the world. Dr Makani says that the work “provides validation that it is possible to conduct genomic research in Africa”.

Verdict: Professor Lorna Casselton from the Royal Society says: “SCD has a severe toll on Africa, and high-quality research to lessen the burden is much needed. Dr Makani stands as a role model for other young African scientists wishing to make a difference.” Olivia Honigsbaum

THE TUTU VAN
Idea: The brightly coloured “Tutu Tester” van is a mobile clinic that incorporates screening for tuberculosis (TB) and HIV into a general health check-up in order to overcome the stigma associated with these diseases.

Problem: South Africa is at the centre of an epidemic of TB/HIV co-infections. An estimated 5.7 million people are infected with HIV and, fuelled by HIV, the country’s rate of TB has increased over the last 20 years to the point where it now has the third highest TB burden in the world. In the case of HIV, voluntary counselling and testing (VCT) is vital for preventing and treating the disease. However, data from the Desmond Tutu HIV Foundation conducted in communities most affected by HIV shows that VCT is often inaccessible or inadequately performed. This results in missed opportunities for prevention and increased morbidity and mortality – hence the need for new control strategies to keep the epidemic in check.

Method: The Tutu Tester is a mobile clinic that takes sophisticated testing equipment and trained staff (including a nurse, a counsellor and an educator) into areas without adequate health facilities. By framing TB and HIV screening within a battery of other healthy living tests, including pregnancy, diabetes and hypertension, people are encouraged to get tested for the diseases. Dr Linda-Gail Bekker, a leading scientist working with the foundation, says that data from these screens shows that “the increase in TB has quite clearly tracked the increase in HIV rates”. Further, the introduction of Antiretroviral therapy (ART) for HIV has also led to a decline in the incidence of TB. This suggests that ART programs, if sufficiently implemented, may greatly assist in reducing TB mortality.

Verdict: There is still a stigma attached to HIV and TB. But as Liz Thebus, a healthcare worker at the Tutu Tester says: “The outside world does not know whether someone wants to be screened for HIV or diabetes. They are in that respect much more anonymous.”

 

SPEAKING BOOKS

Idea: A range of easy-to-use audio books designed to get potentially life-saving health messages out to millions of isolated people struggling with depression and mental health problems.

Problem: In 2003, Zane Wilson, the founder of the South African Depression & Anxiety Group (Sadag), the country’s largest mental health initiative, was horrified at how suicide rates among young South Africans were spiking. Mental health carries a huge social stigma across Africa and information booklets designed to help people with depression or mental health problems simply weren’t working, especially in remote communities with high illiteracy rates. People weren’t getting the help they needed – a 2009 study showed that only a quarter of the 16.5% of South Africans suffering from mental health problems had received any kind of treatment.

Method: Speaking Books created a range of free books with simple audio buttons talking the user through each page. The first Speaking Book, voiced by South African actress and celebrity Lillian Dube, was called Suicide Shouldn’t Be a Secretand focused on how depression is a real and treatable illness, encouraging people to get help when they need it.

Verdict: Speaking Books have now produced 48 titles in 24 different languages and are now used in 20 African countries across the continent. The books now tackle a number of critical healthcare issues outside of suicide prevention such as HIV and Aids, malaria, maternal health and clinical trials. Speaking Books has also expanded to China, India and South America. “The situation we face in rural South Africa is the same in any other African country – low literacy compounded by lack of access to services and affordable healthcare,” says Wilson. “This means that patients are often not able to get help for many health problems. We believe that this interactive, durable, high-quality, hardcover book engages the user or patient, and allows them to build self-confidence and skills with a simple action plan”.

 

ETHANOL COOKING OIL PLANT
Idea: Refining locally sourced cassava into ethanol fuel to provide cleaner cooking fuel.

Problem: Forests in Africa are being cut down at a rate of 4m hectares a year, more than twice the worldwide average rate. Some of this is fuelled by demand for wood and charcoal, which the UN estimates is still used in almost 80% of African homes as a cheaper option to gas. The smoke from cooking using these solid fuels also triggers respiratory problems that cause nearly 2 million deaths in the developing world each year.

Method: CleanStar Mozambique, a partnership between CleanStar and Danish industrial enzymes producer Novozymes, has opened the world’s first sustainable cooking-fuel plant in Mozambique. CleanStar has steered clear of monoculture crops in favour of sustainable farming methods. One-sixth of the final yield comes from locally harvested cassava, which requires farmers to plant in rotation with other edible crops to keep the soil fertile. A Sofala Province-based plant transforms the products into ethanol, which is sold on the local market along with adapted cooking stoves also produced by the company.

Verdict: “City women are tired of watching charcoal prices rise, carrying dirty fuel, and waiting for the day that they can afford a safe gas stove and a reliable supply of imported cylinders,” CleanStar marketing director Thelma Venichand said. “They are ready to buy a modern cooking device that uses clean, locally made fuel, performs well and saves them time and money.” The plant aims to produce 2m litres of fuel annually, and reach 120,000 households within three years.