The Nation Newspaper

Tag: Pneumonia

  • NGOs seek action against Pneumonia

    The Coalition of Non-Governmental Organisations has called for more domestic financing for Pneumonia vaccines, routine immunization programmes and strengthened health care systems.

    Knowledge Management and Communication Coordinator, Community Health and Research Initiative Asma’u Rufai, made the appeal in a statement jointly signed by Vaccine Network in Abuja.

    She poke at an event to mark, the World Pneumonia Day.

    It was first hosted in 2009 when over 100 organisations formed the Global Coalition against Child Pneumonia.

    Rufai said Nigeria scored 38 per cent coverage in the integrated Global Action for Prevention and Control of Pneumonia and Diarrhea (GAPPD).

    According to her, Nigeria is among the three countries with the lowest score of 38 per cent little above Chad which score 29 per cent and Somalia with 27 per cent in the GAPPD.

    She however noted that the score is against a threshold of 70 per cent for Pneumonia and Diarrhea GAPPD scores for 2017.

    She added that GAPPD also showed Nigeria’s inability to meet the Pneumococcal Conjugate Vaccine (PCV) coverage threshold of 45 per cent by scoring only 26 per cent.

    “We are calling on the Nigerian government to reaffirm its commitments by increasing local financing to immunization, better the policies on immunization and expand the coverage of routine immunization,’’ she said.

    The world pneumonia day was to raise awareness about pneumonia as the world’s leading killer of children under the age of five.

    Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses, or fungi.

  • UN: 15,000 children die each day despite health progress

    UN: 15,000 children die each day despite health progress

    The number of children who die before their fifth birthday globally has more than halved since 1990, but the current death count of 15,000 children daily is far too high, the UN said on Thursday.

    “Despite this progress, large disparities in child survival still exist across regions and countries, especially in sub-Saharan Africa,” Under-Secretary General, Liu Zhenmin, and top UN economic official, said.

    The UN said in a report that was published on Thursday that in countries south of the Sahara desert, one in 13 children die before they reach the age of five.

    In developed countries, the ratio is one in 189, according to the report that was drawn up by several agencies, including the World Health Organisation and the UN Children’s Fund.

    It said that preventable and treatable diseases like pneumonia and diarrhoea, as well as birth complications are the biggest killers of young children around the globe.

    The agency is especially worried about newborn mortality, as 7,000 babies who are less than a month old die each day.

    According to the report, the vast majority of these newborn deaths occur in South Asian or sub-Saharan countries, pointing at high number rates in India, Pakistan, Nigeria, the Democratic Republic of the Congo and Ethiopia.

    The UN agencies urge countries to improve health care for pregnant women, and to promote immunisation, breastfeeding and cheap medicines.

    “Access to clean water and sanitation facilities are also key to keeping small children safe from illness,’’ the UN said.

    NAN

  • Tackling child pneumonia with technology

    Tackling child pneumonia with technology

    Six months of coughing and a debilitating fever was too much for Olivia Koburongo’s 86-year-old grandmother, whose body had been weakened by other age-related conditions. My grandmother, the 26-year old says, died of pneumonia that could not easily be diagnosed because of a lack of proper diagnostic equipment. “For six months she kept taking wrong medicine. Several health workers in different health facilities had diagnosed her with malaria. Pneumonia was discovered after a postmortem was conducted when she died,” Koburongo reveals.

    Killer ailment

    Children and the elderly are especially vulnerable to pneumonia. According to Unicef, pneumonia accounts for almost one million child deaths worldwide every year; 922,000 in 2015 which is 16% of total deaths among children under five years of age. In Uganda, Unicef estimates that the disease kills up to 24,000 children under-five every year, many of whom were misdiagnosed with malaria.

    Uganda, like its neighbouring countries, lacks proper diagnostic equipment for many diseases such as pneumonia, therefore health workers rely on basic clinical examinations. It is in this context that in 2014, Koburongo and four others invented “Mama-Ope” (Mother’s Hope): a biomedical smart jacket that detects and analyses pneumonia symptoms among children, with the aim of providing more accurate diagnosis. Koburongo, a graduate of Telecom Engineering from Makerere University, says the team has developed a prototype that is three times faster than the standard diagnostic process in Uganda.

    According to co-founder Brian Turyabagye, also a telecom engineer: “The jacket diagnoses, measures the extent to which the disease has affected the lungs and also tracks the progress of the disease since diagnostic information is sharable.”

    Milestone

    Mama-Ope won runner-up prize in the Big Ideas Innovation competition run by the University of California Berkeley in 2015. The $6,500 (about Shs 22.7m) prize provided seed money that the team used to develop a prototype.

    The team is currently in the process of getting certification from Uganda’s Ministry of Health.

    According to Dr Flavia Mpanga Kaggwa, a Health Specialist at Unicef Uganda: “The jacket needs to be approved by a regulatory authority to have the possibility of commercial viability. Otherwise I think it would be a great addition to the tools used in diagnosing pneumonia.”

    Once certification is secured, the team intends to do mass production and supply the jacket to countries in East Africa at a cost of about $80 (Shs280,000).

    In the meantime, Mama-Ope has been gaining supporters around the world – in March this year, Brian Turyabagye won the Pitch@Palace Africa event hosted by HRH The Duke of York in London, England.

    “We plan to have the jacket also operate on solar energy which is more reliable for most East African countries,” Turyabage says.

    How it works

    Traditionally, doctors use a stethoscope to check for abnormal crackling sounds in the lungs. However, if medics suspect malaria or tuberculosis which also cause respiratory distress, they may end up misdiagnosing the patient.

    Currently at prototype stage, the Mama-Ope kit is designed to work as follows: health workers slip the jacket onto the child, and its sensors pick up sound patterns from the lungs, temperature and breathing rate. Each sensor is aligned to a particular symptom and in four minutes, data is computed and sent to a mobile phone application which does the diagnosis.

    “The processed information is sent to a mobile phone app (via Bluetooth) which analyses the information in comparison to known data so as to get an estimate of the strength of the disease,” explains Turyabagye.

    According to studies carried out by its inventors, the jacket can diagnose pneumonia up to three times faster than a doctor, and reduces human error.  The Mama-Ope team has also hired private medical researchers from Makerere University’s Infectious Disease Institute to test their prototype, and sought guidance from Unicef. Dr Namwase, a paeditrician at Mulago National Referral Hospital, said the device is “easy to use because there are not so many processes involved but also does not require special training to the health workers.”

    After displaying the result on the app, the technology goes on to advise on the appropriate action, e.g. if the disease is severe, it advises the user to reach out to the nearest referral hospitals. The beauty of this is that the doctor can gauge the severity of the disease from the point it was first diagnosed by using the information stored on the cloud.

     Aim

    Mama-Ope’s founders hope the smart jacket will help in saving diagnosis time and reduce the number of deaths due to pneumonia, which would be a great contribution to the country’s Sustainable Development Goals (SDGs) and save the government on wastage of drugs.

     

     

     

     

     

     

     

     

  • How to prevent pneumonia, meningitis, by experts

    Experts have urged Nigerians to practise good hygiene to avoid contracting pneumococcal and meningococcal diseases.

    The specialists, who consist of the best from West African, spoke  at this year’s West African Vaccine Summit in Lagos.

    It had as theme Ready for life.

    The professionals agreed that though there were vaccines by Pfizer to treat the diseases, if one rested, drank plenty of water and juices to keep the body hydrated, increased the intake of Vitamin A and C, washed hands to prevent germs spread, and covered the mouth while sneezing or coughing, the chances of knocking off the diseases were high.

    According to a Professor of Medicine at the Obafemi Awolowo University (OAU), Ile- Ife, Gregory  Erhabor, the West African region  has a plethora of meningitis and pneumonia.

    Erhabor said: “In 2008, an estimated 177,000 under five children died from pneumonia in Nigeria alone. The African Meningitis Belt—extending from Senegal in the West to Ethiopia in the East—has the highest annual incidence of Invasive Meningococcal Disease (IMD) worldwide, with superimposed frequent epidemics occurring every eight to 12 years. The diseases are a contagious and life-threatening infection. And is the leading cause of bacterial meningitis and septicaemia in many parts of the world like Western Europe and North USA among children aged two months to 12 years, following introduction of universal immunisation against H.influenzae type b and S.pneumoniae.

    ‘’It occurs most frequently in infants, young children, and teenagers. And can be difficult to diagnose. It can progress very quickly and be fatal within a few hours, with up to 20 percent of patients dying despite rapid treatment.  Hence it is good to maintain a clean environment because N. meningitidis is spread by airborne droplet infection or direct contact with respiratory secretions or saliva, e.g., through coughing, kissing or sharing a glass or eating /drinking utensil.  And children’s immunity should not be compromised.”

    Dr Adejumoke Ayede of the Department of Paediatrics, College of Medicine at the University of Ibadan, said the number one risk factor is age due to lack of serum bactericidal antibodies.

    Others are defects in host defence. He explained that patients with deficiency of  components, weak immune system, such as long-term therapy with corticosteroids in patients with nephrotic syndrome, Systemic lupus erythematosus (SLE), a chronic inflammatory disease that has protean, hepatic failure or respiratory tract infections, such as the flu, may suffer from the disease.

    Ayede, a  Consultant Paediatrican/Senior Lecturer, said there were environmental factors, such as crowded living areas – dormitories, barracks, day care; climatic conditions,such as low humidity, smoking, and contact with patients.

    ‘’And the two most common manifestations of IMD are:  Meningitis affecting about 50 percent of patients or Septicaemia, affecting between five percent and 20 percent of patients. Less common manifestations of IMD are pneumonia, occurring in up to 15 percent of patients, respiratory tract infections, otitis media, and focal infections (e.g., conjunctivitis, urethritis, arthritis, or pericarditis).

    “But with the dry season, this region has recently benefited from the Meningitis Vaccine Project, a major alliance of international health bodies that have developed and are deploying an affordable and effective vaccine against serogroup A meningococcus, is the main cause of the disease in this area. The vaccine is meningococcal conjugate vaccine,” Ayede said.

    Director Corporate Affairs Nigeria and East African Region, Pfizer, Mrs Margret Olele, said the firm was passionate about research and development (R and D), and was working to bring the benefits of vaccines into previously unexplored areas where successes could be recorded, help usher in a new era of vaccine innovation, prevent and treat diseases.

    “Pfizer’s world-class vaccines are produced by more than 500 global scientists with deep expertise in investigating and advancing unique vaccine candidates to deliver the next wave of breakthroughs to meet needs and help save lives. It has made investments in developing world-class vaccine manufacturing expertise, sites, and capabilities,’’ she said.

    She said the drug giant was working in areas, such as hospital-acquired infections.

    ‘’At the same time, we’re  building on our leadership in pneumococcal and meningococcal disease prevention. Our unique Investigational Vaccine-Based Immunotherapy Regimen (VBIR) brings the science of vaccine research out.

    ‘’Pfizer is also developing an experimental PCSK9 vaccine, designed to induce the body to produce its own antibodies. It is seeking to develop a cytomegalovirus (CMV) vaccine to prevent diseases that can have a devastating and lifelong impact on young children. And they are accessible and affordable,” Mrs Olele added.

  • ‘GSK won’t hike price of pneumonia vaccines for 10 years’

    Pharmaceutical giant GlaxoSmithKline (GSK) will not increase the price of its pneumonia vaccines for the next 10 years.

    The company said it took the decision to ensure that children do not die of the disease.

    Pneumonia is the number one killer disease among chiodren under five.

    According to the International Vaccines Access Centre’s (IVAC’s) preliminary findings launched in Abuja on the World’s Pneumonia Day, marked on November 12, an estimated 750,000 Nigerian children died largely from diseases last year. About 127,000 died of pneumonia.

    The preventable and treatable disease claimed more lives last year compared to malaria, which used to be the number one child-killer disease in the country, last year.

    GSK Medical Director Dr. Lana Odunuga said his organisation has placed a 10-year price freeze on pneumonia drugs as the country graduates from GAVI funds next year.

    This, Odunuga said, is to ensure pneumonia vaccines are available to the people even after donor support is withdrawn.

    He urged the government to be consistent with policies and programmes, stressing that the country was on the right path and there was need to sustain it.

    He said: “I just want to emphasise that we need consistency in our programmes. We have done very well in our policy making; we have done very well in our coordination. So, it is just consistency and once we  are consistent, we will get there. We need to start from somewhere and we are on a journey, we will get there.

    “We are supporting the immunisation programme, we are providing the vaccines that are used for the prevention of pneumonia in children.  And one of the things I highlighted as part of our own support is actually to make sure that even at a time when Nigeria graduates from GaVI fund, which will eventually happened, Nigeria will still be able to access the vaccines as the same price at which they are getting it now. In addition to that we have also tried to make it possible to reduce the cost a child pays for vaccines in Nigeria by one dollar. ”

    He said GSK  is to set up six centres across the country for the distribution of vaccines next year, blaming BokomHaram for the high incidencevof the disease. He stressed that the disruption of infrastructure led to displacement of people.

    NPHCDA Acting Executive Director, Mr. Emmanuel Odu,  noted that the Federal Government, in addressing  pneumonia among children, introduced pentavalent vaccine.

    He urged stakeholders to vaccinate their children against the disease.

    The Emir of Jiwa, Alhaji Musa Idris, who was chairman on the occasion, assured that the traditional leaders would continue to mobilise their subjects towards eradicating pneumonia in rural.

    He stressed, that as traditional rulers, they were committed to enlightening their people

    International Vaccines Access Centre (IVAC) report stated: “Pneumonia is now the leading cause of child deaths in Nigeria, a position previously held by malaria over the years. In 2015, about 17 percent ( 127, 00 deaths) and 10 per cent (75,000) of all under-five deaths, including neonatal deaths were caused by pneumonia and diarrhea.”

  • World Pneumonia Day: NGO wants increased funding to eradicate childhood pneumonia

    The Partnership for Advocacy in Child and Family Health (PACFaH), a Non-Governmental Organisation (NGO), has urged the Federal Government to allocate more resources toward eradicating pneumonia among children.

    Mr Remi Adeseun, Pharmaceutical Society of Nigeria (PSN)-PACFaH Progamme Director, made the call at the commemoration of World Pneumonia Day on Saturday in Abuja.

    The theme of the event is “Mainstreaming/Prioritising Pneumonia in National Health Planning.’’

    Adeseun said that Nov. 12 every year was set aside to raise awareness on pneumonia the world’s leading infectious and second killer of children under the age of five.

    He explained that a lot of people were ignorant of the death toll caused by the disease hence the number of cases of the scourge was increasing daily.

    Adeseun, however, urged governments at all levels to take the lead in sensitising the public to the preventive and curative measures of the disease, as it was with malaria and HIV and AIDS.

    He decried existing situation where pneumonia had been over-shadowed as a priority on global health due to lack of awareness of its deadly impact, adding that affordable treatment and preventable option were readily available.

    The director, who lauded government’s interventions through various eradication programmes on malaria and HIV/AIDs morbidity and mortality across the country, appealed that more attention should be extended to pneumonia and diarrhea eradication.

    He said such eradication effort could come through “immediate implementation of childhood pneumonia guideline as recommended by World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF).

    He explained that the bodies recommended that Amoxicillin Dispersible Tablet should be used as the first-line drug management of childhood pneumonia.

    According to Adeseun, with adequate funding and attention, there would be drastic reduction in the incidence of this preventable and treatable disease in the country.

    “The PSN-PACFaH project urges Nigerian government to strengthen the coordination of efforts geared toward ending childhood pneumonia in the country.

    “Since a lot of factors contribute to its prevalence in the world and Nigeria particularly, no single intervention can effectively prevent, treat or control its spread.

    “The onus lies on the government to take concrete steps, bring to the table, mainstream and coordinate all donor and government-led efforts in the fight to end preventable and treatable pneumonia death in our great nation.

    “There is urgent need to increase the health sector budget and to allocate more resources toward childhood pneumonia mainstreaming along with the other eradication programmes like Tuberculosis, Polio, HIV/AIDs, among others,’’ Adeseun said. (NAN)

  • Alert on better treatment of pneumonia, diarrhoea

    Mothers have been alerted to better ways of treating pneumonia and diarrhoea. The treatable diseases, account for the death of over 400,000 children under the age of five yearly. They can be treated with Amoxicillin Dispersable tablet (Amoxicillin DT) and Zinc- Lo ORS.

    The Pharmaceutical Society of Ngeria (PSN) said it influenced the  inclusion of Amoxicillin Dispersible tablets and Zinc-Lo ORS in the basic package of health services/Essential Medicine List, to be funded by the one percent Consolidated Revenue of the Government.

    According to its President, Olumide Akintayo, the move is in consonance with the WHO/UNICEF new guidelines on first line treatment for childhood pneumonia and diarrhoea.

    Akintayo said PSN in collaboration with Partnership for Advocacy for Child Health (PACFaH) embarked on a three-year programme on child and family health, funded by the Bill and Melinda Gates Foundation (BMGF), and coordinated by an indigenous firm-Development Research and Project Centre (DRPC) to domesticate this WHO/UNICEF new guidelines.

    He said the flag off of the new guideline is slated for November 12-World Pneumonia Day. “A National Policy Dialogue is being organised, in collaboration with the Federal Ministry of Health on that day, as the new guidelines have been successful both at the pilot states-Kaduna and Kano,” he stated.

    Meanwhile, the 88th Annual National Conference of the Society holds in Abuja from Monday November 9th – Saturday November 14th 2015.

    “We expect a massive turnout as pharmacists all over the States of the federation will witness change of baton of the leadership of PSN which will take place at the AGM holding on Friday, November 13,” said Mr Akintayo.

  • How to stop pneumonia, by expert

    How to stop pneumonia, by expert

    Children under five and those above 75 can easily catch pneumonia, a chest and respiratoty physician has said.

    Dr Cyril Chukwu of the Lagos University Teaching Hospital (LUTH) said the disease is common in the children and the elderly.

    According to him, pneumonia is caused by germs, which grow in the lungs.

    The disease, he said, may also be caused by germs, such as virus, bacteria and fungi.

    He said bacterial pneumonia is the commonest and the most important of all causes of the disease.

    Chukwu said pneumonia is common as a result of dirty environment and poor ventilation in homes.

    He continued: “In Lagos, there is almost no space. There are buildings everywhere, which make ventilation impossible.”

    He advised the people to live in ventilated environment to avoid being infected with pneumonia.

    “For example, there are many people with different health issues, at a bus stop. So, people must be cautious about those around them,” he said.

    He said people often erroneously take pneumonia to be tuberculosis (TB) because they have similar symptoms.

    Chest pain, chronic cough and sneezing as well as running nose are some of the symptoms of the disease, he added.

    He urged the Federal Government to enlighten Nigerians on cleanliness, adding: “The importance of living in well ventilated houses and offices should be articulated.”

    Chukwu said it is not everybody with cough, chest pain or sneezes that have pneumonia.

    Diagnosis, he said, should be left to the doctor who has the necessary qualifications to handle the disease.

    “So, it is the work of a doctor to if a patient is suffering from pneumonia or tuberculosis. The cough of pneumonia, TB or cancer patient can only be differentiated by a doctor,” Chukwu said.

    He called for more awareness on the disease, adding that many people still do not know anything about it.

    “We need our people to live in well ventilated houses. If they are aware that a well-ventilated environment is important to good health status, they would do something about it.

  • 5 children die every minute in Africa – WHO

    5 children die every minute in Africa – WHO

    In 2013, an estimated 6.3 million children under five died, 2.9 million of them in the WHO African region. This is equivalent to five children under 5 years of age dying every minute. Two thirds of these deaths can be attributed to preventable causes. A third of all these deaths are in the neonatal period.

    Pneumonia, diarrhoea, malaria and HIV are the main causes of death in infants and young children. In the African Region, about 473 000 children die from pneumonia, 300 000 from diarrhoea, and a further 443 000 from malaria every year. In 2012, 230 000 new HIV infections were recorded among children under 5 years of age.

    “Although tremendous progress has been made in identifying and treating infants and children with HIV, much remains to be done to scale-up and sustain effective prevention, care and treatment, especially of pneumonia and diarrhoea,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

    Pneumonia is the single biggest killer of children worldwide, accounting for nearly one in seven deaths among young children, with an estimated over 950 000 deaths annually. Most of the deaths occur in resource-constrained countries, with 50% in sub-Saharan Africa.

    Globally, diarrhoeal diseases account for nearly one out of every six deaths in children under 5 years of age, equivalent to over 578 000 deaths per year. Diarrhoeal disease occurs more commonly in HIV-infected people, with worse outcomes than in uninfected children.

    Persistent diarrhoea in particular is associated with a high risk of death in HIV-infected children. Administration of oral rehydration and zinc in combination with antiretroviral therapy (ART) and restoring immune function are critical for the treatment of diarrhoea in children with HIV.

    “Undernutrition is another critical risk factor in most countries in the African Region, and nutrition and food security remains a fundamental challenge to child survival. Breastfeeding is one of the best ways to provide newborns, infants and young children with the nutrients that they need while protecting them against conditions like pneumonia, diarrhea and undernutrition,” Dr Moeti added.

    The World Health Organization (WHO) recommends that exclusive breastfeeding starts within one hour after birth and lasts until a baby is six months old. Continued breastfeeding and appropriate complementary foods should be made available for up to 2 years of age and beyond.

    In mid-2013, WHO issued new guidelines for breastfeeding and the prevention of mother-to-child transmission (PMTCT) of HIV. These recommendations were intended for use in resource-poor settings in low-and middle-income countries.

    One of the recommendations for PMTCT is to promote the use of ART in all pregnant and breastfeeding women. These recommendations also include providing ART – irrespective of one’s CD4 count – to all children under 5 years of age with HIV, all pregnant, and all breastfeeding women with HIV including their infants until they cease to breastfeed.

    Health systems in Africa are often not able to adequately address the severe burden of childhood disease. Low total health expenditure with high out of pocket health costs hamper progress in child survival. Hence just as health can drive economic growth, ill-health can push people into poverty and make it very difficult for them to escape the vicious cycle of poverty and disease.

    WHO said it will continue to work with governments and partners to strengthen health systems to reduce unacceptably high infant and child deaths in the African Region.

  • How to manage pneumonia, by expert

    How to manage pneumonia, by expert

    A naturopath, Dr Solomon Abutoh, has recommended bitter (garcina) kola, honey, allium sativa (garlic) and eucalyptus oil for the management of pneumonia.

    According to him, a mixture made from the combination can ensure relief for people who have the ailment.

    He said during rainy season, many health conditions, such as pneumonia usually occur and as such curative measures must be taken.

    Eucalyptus oil, he said, should be dropped in handkerchief and inhaled deeply at intervals by those suffering from the ailment.

    He also said it is important to wear a dust barrier (covering the nose and mouth) when passing or working in a dusty environment.

    Pneumonia, Abutoh described, is a lung inflammation caused by bacteria or viral infection, in which the air sacs are filled with pus and may become solid.

    The ailment, he said, is often wrongly diagnosed as fever because of its symptoms, which are similar to those of fever.

    He spoke of pneumonia as a respiratory disorder, characterised by inflammation of the lungs, leading to consolidation of one or more lobes (alvioli).

    “The lungs are a pair of organ located on either side of the vertebral column but within the rib cage. They are responsible for the effective intake of oxygen and exhalation of carbondioxide. Like the other organs, the lungs can malfunction when exposed to unfavourable environment.

    “Pneumonia is caused by bacteria known as pneumococcal bacteria. There are four stages of pneumonia. They are congestion, red hepatisation, grey hepatisation and resolution,” he said.

    Congestion, he said, is when the alveoli are filled with red blood cells instead of air. Red hepatisation is when the lungs become solid. Grey hepatisation is when the lungs become greyish in colour (as revealed by X- ray). Resolution means there is a higher rate of white blood cells due to resistance to inflammation, depending of course on the immune system of the person so affected,” he said.

    He identified some of the symptoms as cold, rigour (stiffness) pain in the chest, dyspnea (difficulty in breathing) and heightened pulse rate.

    Others are rusty sputum, herpes around the mouth and skin, and weakness.

    “In addition, there is usually a sort of crepitating (cracking sound) when the patient’s breathing is monitored with a stethoscope. This is different from the wheezing sound in asthma patients,” Abutoh said.

    To treat the ailment, the naturopath said, it is important for patient to be kept warm by wearing thick clothes. Also warm bath and drinks are also recommended.

    “Since Pneumonia is a bacterial infection, appropriate anti-baterials must be introduced to allow for proper and efficient exchange of gases, without which there cannot be proper circulation of blood, and hence transportation of nutrients for optimum well being.

    “A lot of bacterial and even fungi thrive or are very active in cold and damp environment. We must endeavour to keep ourselves and environment warm, as this remains the only way to keep these opportunistic diseases at bay.”