Translating Africa’s tech enthusiasm into an enterprise ecosystem

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Technology is disseminating across Africa and technology consumer markets have grown rapidly as a result. But so far, only a few local technology entrepreneurs have seized the economic opportunities that ensue. In contrast to consumer markets, entrepreneurship ecosystems may take more time and resources to grow than enthusiasts of Africa’s technology boom anticipated.

Various media stories regularly celebrate the surges in mobile phone penetration, the distribution of laptops in rural schools and the steadily growing base of internet users, particularly in sub-Saharan Africa. For example, 10 years ago, less than 20 per cent of Africans owned a mobile phone; today, roughly 80 per cent do. The initial hype around Africa’s rapidly emerging technology markets was significant. Development and economic experts alike predicted that technology would allow local people to solve local problems and therefore drive innovation: rural farmers might access market information through feature phones and individuals in remote places could benefit from mobile healthcare and virtual education services. With technology consumer figures in East Africa growing at double digit rates every year, it seemed likely that the next big technology start-up would come out of Africa.

Multinationals profiting from tech boom

But now, a few years in, patience is starting to wane. Although technology is helping address local problems, the major start-up boom that angel investors and venture capitalists hoped for has not yet happened. Instead, the big economic opportunities of Africa’s technology catch-up are largely being seized by traditional multinationals. For instance, Kenya’s mobile service provider Safaricom, owned by Britain’s Vodafone, offers the mobile money service MPESA, which is returning million dollar profits across seven African nations. South Korea’s Samsung has a 50 per cent share in Africa’s overall smartphone market.

The reason is that, just like anywhere in the world, suddenly owning a mobile phone does not automatically make people relentless tinkerers and innovators. Instead, skilled developers, graphic designers and other technology experts tend to prefer stable employment to the start-up world. Given that unemployment rates are as high as 40 per cent in some African nations, this is not surprising. Add to that the risks associated with starting a business. Globally, an average nine out of 10 technology start-ups fail. Locally, starting a business tends to be even riskier: in the absence of personal savings and alternative employment options to fall back on, entrepreneurial success often becomes a matter of livelihood.

Forging a technology entrepreneurship ecosystem

One example of how to encourage entrepreneurs to seize the opportunities of Africa’s technology boom is through business incubation and acceleration. Across Africa, roughly 40 such organisations provide co-working and networking spaces, intensive business development programmes and sometimes seed funding. Although the basic parameters of African business incubators and accelerators are similar to those of their counterparts in Silicon Valley or London, their role couldn’t be more different. Instead of selectively fostering individual start-ups, Africa’s innovation hubs are driving the much more fundamental emergence of a technology entrepreneurship ecosystem.

For instance, innovation hubs are helping build technology skills by offering a space for collaboration. Before their existence, technology enthusiasts met irregularly in coffee shops or at universities. Now, there are dedicated spaces brimming with developers, graphic designers, hackers and bloggers every day. Business accelerators and incubators are also legitimising technology entrepreneurship as a profession, particularly in the eyes of parent generations. “Now you can actually say, I’m going to the hub. Before, it was like: I’m at the coffee house. It looked kind of like idleness,” a young technology entrepreneur explained to me. Finally, hubs’ seed funding for technology start-ups significantly reduces the financial risks associated with business creation or makes starting a business possible in the first place.

The question of how many vastly successful technology start-ups have come out of Africa might therefore not yet be one to ask. Instead, entrepreneurship takes more than the availability of technology. Although technology entrepreneurship ecosystems are emerging across Africa, often with the support of business incubators and accelerators, they are one example of how not everything can be leapfrogged.

*Marlen de la Chaux [2013] is doing a PhD in Management Studies.

On faith and secularism

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I recently accepted an invitation to visit a church in Kalinga Linga, one of the many shantytowns in Lusaka, known locally as compounds. The service was held in a dilapidated classroom where the floor was worn out and had big ruts, the furniture was small, old and not very comfortable and there was an uninspiring zinc roof with some bright florescent tubes attached to it. There were no musical instruments or equipment, but there was plenty of music from the human voice and an African choir can transform the voice like no other. The choice master conducted the range of male and female voices methodically, showing skill, depth and a superb understanding of harmony. The singers sung with a passion for God you can only find on this continent.

Zambia is a very religious country and in 1991 President Chiluba declared that the country was a Christian nation. Gay rights became a political football which rival political parties play to try and discredit each other in the eyes of the most important institution after the state, the Church.

People in Kalinga Linga face many hardships and being able to eat two meals a day is a luxury for many families, yet their faith is deep and unwavering. I have often wondered how those in precarious circumstances maintain their faith, but perhaps the answer lies in the deacon’s opening statement. He said: “Let us thank God that we are alive and energetic.” How strange that those struggling with survival should appreciate and honour the gift of life which those living in comfort take for granted so easily, as they yearn for what they do not have.

Thankfulness

The deacon said that January is the month of thankfulness and I thought how hollow this might sound to a cynic reading about the terrible events in France. Secularism is the privilege of the comfortable while those languishing in the compounds or the banlieux cling to their faith for in faith there is hope and with no faith there is hopelessness.

In the compounds people identify with Jesus because he was poor, he suffered and he was redeemed. Perhaps they need to believe that there is more than this life and the harsh hand it has dealt them. Of course, many well off people are religious. Wealth does not insulate us from illness, accidents, crimes, loss and other vagaries of life or existential crisis. Likewise, there are poor people who have given up waiting for a God who does not heed their prayers. Life is too complex to conform to simple bivariate explanations.

Yet the multitude of faithful poor, downtrodden people in the world is still astounding. In Africa they look to Jesus or Mohamed to find the courage to face another day hustling in the markets, begging in the streets or doing what it takes to put food in mouths. In religion there is community and in community there is help when the load becomes unbearable. There is the discipline of the choir and the literacy of religious studies. And when confronted with the humiliations of poverty the churchgoers in the compound can reclaim some of their dignity.

Perhaps the poor do have more to gain from faith then the middle classes, and religion for all its good and bad will not give way to secularism in Africa.

*Zenobia Ismail [2013] is doing a PhD in Politics and International Studies. Picture credit: ‘Hands’ by africa and http://www.freedigitalphotos.net. 

Obesity in Africa

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Obesity is rapidly becoming a growing problem across low- and middle-income countries, including those in sub-Saharan Africa. In many African countries, the prevalence of overweight is even estimated to be higher than the prevalence of underweight. With on-going changes in diet, urbanisation, and an increasingly sedentary lifestyle, the prevalence of obesity is predicted to continue to grow.

But what does it mean to be obese? You may have heard from your doctor or from public health campaigns that if your BMI is over 25 then you are overweight, if it’s over 30 then you are obese, and if your waist circumference is more than 94 cm as a man or 80 cm as a women then you have central obesity.

These numbers were chosen because, above these thresholds, you are considered to be at substantially increased risk of diseases like diabetes and cardiovascular diseases. Globally, 44% of the burden of diabetes and 23% of ischaemic heart disease are attributable to overweight and obesity. However, this risk of developing disease at certain levels of body fat and size has been shown to differ between ethnic groups and population.

Although such ethnic variation exists, most of what we know about obesity is based on studies conducted in populations of European descent. By contrast, the relationship between obesity and disease in sub-Saharan African populations is poorly understood.

Redefining obesity 
In collaboration with colleagues at the Medical Research Council/Uganda Virus Research Institute, Uganda, we conducted a study of approximately 6,000 rural Ugandan adults in 2011. In this population, we found that waist circumference and BMI may be useful tools for identifying people who had diabetes, hypertension or dyslipidaemia.
However, the currently recommended cut-offs or waist circumference and BMI may not be appropriate for African populations.

Instead, we suggest that a substantially lower cut-off for waist circumference (≥78 cm) should be considered for men. A slightly higher cut-off (≥82 cm) should be considered for women. We also recommend that, for screening purposes, a BMI cut-off lower than the current recommendation of 25 kg/m2 should be considered.

This was the first study of BMI cut-offs and the largest study of waist circumference cut-offs in sub-Saharan Africa. Much more work still needs to be done to decide on what the best cut-offs should be for African populations. This work is now, therefore, being expanded by the African Partnership for Chronic Disease Research (APCDR) into a large-scale collaborative project across sub-Saharan Africa. We have, so far, collated data on 56,000 individuals from 11 countries across the region.

Public health importance
A clearer understanding of the relationship between anthropometric measures (body size and shape) and risk of disease may be particularly important for sub-Saharan African populations for a number of reasons.

Firstly, the prevalence of obesity and cardiometabolic disease (such as diabetes and heart disease) is increasing across sub-Saharan Africa. Thus, the need for clinical guidelines and prevention programmes related to adiposity (body fat) is growing.

Secondly, resource-limited settings may benefit greatly from low-cost, easy-to-implement indicators of cardiometabolic risk, such as anthropometric measures.

Lastly, sub-Saharan Africa is struggling under a double burden of under- and over-nutrition. It is, therefore, important that clinical guidelines and public health messages are designed to communicate an optimal healthy, rather than simply reduced, body size.

Overall, a better understanding of obesity within sub-Saharan populations will be important for the design and implementation of public healthcare policy and population prevention programmes in an effort to address the growing burden of cardiometabolic diseases.

*Georgina Murphy [2009] did a PhD in Public Health and Primary Healthcare. This work was done as part of a collaboration between the University of Cambridge, Wellcome Trust Sanger Institute, and Medical Research Council/Uganda Virus Research Institute, Uganda. Georgina has now moved to the University of Oxford, Nuffield Department of Medicine (georgina.murphy@ndm.ox.ac.uk). Picture credit: zirconicusso and http://www.freedigitalphotos.net.

A looming epidemic: tackling non-infectious disease in sub-Saharan Africa

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When we think of health problems in Africa, we generally focus on infectious diseases (such as HIV and malaria), malnutrition, and maternal and childhood mortality. By contrast, non-communicable diseases (NCDs) such as obesity, heart disease and cancer are frequently referred to as ‘diseases of affluence’, and thus thought only as a problem of rich, developed countries.

However, did you know that 80% of all deaths due to NCDs actually occur in developing countries, including those in sub-Saharan Africa? Although infectious diseases are still a major problem in Africa, these countries are also battling with a substantial and rapidly growing burden of NCDs. In South Africa, for example, cardiovascular disease is the second leading cause of death after HIV, accounting for up to 40% of deaths among adults. By 2030, NCDs are projected to overtake infectious disease as the most common cause of death in Africa.

So what can be done to tackle this looming epidemic of non-infectious diseases in sub-Saharan Africa? One of the major obstacles we face in developing appropriate preventative strategies at a national level in Africa is a lack of reliable, high quality health information on NCDs. Since treatment and management for long-lasting or recurrent diseases is very expensive and requires strong and stable healthcare systems, prevention programmes may be a more cost-effective strategy for resource-poor countries. However, in order for governments to plan and implement prevention and control strategies, they need good quality data on disease burden and risk.

Uganda

In 2010, I set off to rural Uganda to work with a Ugandan project leader and team to set up and coordinate an epidemiological study on NCDs. The purpose of the study was to address this need for more information about the magnitude, distribution and determinants of these diseases in sub-Saharan Africa. The study was a collaboration between the University of Cambridge, Wellcome Trust Sanger Institute, and Medical Research Council Uganda/Uganda Virus Research Institute (MRC/UVRI). I joined as a PhD student to help coordinate the design and delivery of the project. I thus had the unique opportunity to work and live from the study field station in rural Uganda for a year, observing the project first-hand.

Piggybacking on the already well-established MRC/UVRI long-running study of HIV, we surveyed 8,000 rural Ugandans on their lifestyle (such as smoking, physical activity, and diet), physical measurements (such as obesity, blood pressure and cholesterol), and took blood samples (for tests such as for cholesterol and genetic analysis).

This was not an easy feat. Imagine trying to measure someone’s height and weight on uneven, unpaved ground, or explain to participants what you plan to do when there isn’t a local word for blood pressure. How do you ensure that adequate follow-up medical care is given to those identified with health problems in a setting where no national guidelines exist on how to treat high cholesterol and the only suitable healthcare facilities for some conditions are far away and expensive? There may be challenges to doing high quality large-scale NCD research in a low-resource setting, but it is possible! During my time in Uganda I learnt the importance of working together with collaborators, local staff, local leaders, and the community, in order to overcome such challenges together. All collaborators put a lot of emphasis on ensuring that everyone was well informed, enthusiastic, and engaged in what we were trying to achieve.

Disease risk

We successfully finished the study in 2011 and I then settled back into a slightly chillier life in Cambridge. I have since been seeing what the data has to tell us. I’m focusing on social determinants of risk factors such as smoking, obesity, blood pressure, and cholesterol, as well as evaluating how we define disease ‘risk’ for African populations. Are the tools we use to identify those at increased risk of diabetes or cardiovascular disease really internationally applicable? For example, what does it mean to be obese for Africans? Will they have the same level of risk of disease for a given amount of body fat as those of European descent? We continue to have a strong working relationship with our collaborators in Uganda (and indeed others across Africa) and research on a wide-range of topics is on-going.

I am very excited by the opportunity to work in such a new and growing area of research. This global health work has allowed me to merge my academic background in molecular medicine with my experience in international development. Ultimately I hope that this work can help to inform healthcare policy and prevention programmes, allowing Africa to achieve healthy and prosperous social and economic development.

*Georgina Murphy [2009] is a PhD student in the Genetic Epidemiology group at the Wellcome Trust Sanger Institute and the International Health Research Group at the University of Cambridge. A research paper on the project she has been working on is published in the International Journal of Epidemiology. This blog was first published on the Sanger Institute blog.

Putting an end to meningitis season

In the region of Africa stretching west to Senegal and east to Ethiopia, the scorching dry season is known by another name: meningitis season. For more than a century, large-scale outbreaks of meningitis primarily caused by the bacteria Neisseria meningitidis have led to significant suffering.  As a result, meningococcal disease is a particularly feared disease in the countries of the meningitis belt. Patients experience a sudden onset of symptoms such as headache, fever, and a stiff neck and can die within 48 hours or sustain permanent cognitive and hearing impairment. Hundreds of thousands of cases and thousands of deaths occurred during the largest epidemic recorded, in 1996.

Meningococcal vaccines were first developed in the 1970s and have been used extensively to control epidemics in Africa. Unfortunately, these polysaccharide vaccines have a limited impact on preventing future outbreaks since they do not protect very young children and provide protection to older children and adults for only a few years.

When I first began collaborating with the Centre pour le Développement des VaccinsMali (CVD-Mali) in Bamako and the African Meningococcal Carriage Consortium (MenAfriCar) as a graduate student in 2009, a new opportunity to prevent meningitis outbreaks was on the horizon.

The Meningitis Vaccine Project (MVP) was formed through a partnership between the World Health Organization and the nonprofit health organisation PATH with funding from the Bill and Melinda Gates Foundation. MVP’s goal was to develop an affordable vaccine designed specifically for use in the meningitis belt, where Neisseria meningitidis serogroup A was the most common cause of meningitis at that time, using new conjugate technology to join the polysaccharides in the older vaccines to a protein, eliciting a stronger immune response.

Evidence from the UK, US, and other resource-rich nations where conjugate meningococcal vaccines were already in use indicated that these types of vaccines could protect very young children, induce a long-lasting immune response, and result in widespread protection in the population. Even though the technology already existed to produce this vaccine and similar vaccines were being used elsewhere with great success, the vaccines had not yet reached the resource-poor countries of the meningitis belt, the region of the world that needed them most. Not surprisingly, one of the largest barriers was cost. Conjugate meningococcal vaccines are available in the US for approximately $100-150 a dose.

The challenge for MVP was to create a new model for vaccine development that would overcome this barrier in countries like Mali where the per capita income in 2010 was less than $700 a year. After significant effort to secure a producer, conduct clinical trials, and acquire the necessary approvals, MVP marked an historic moment in December 2010 when the newly developed vaccine MenAfriVacTM was introduced in Burkina Faso, Mali, and Niger in the first-ever preventative campaign against meningococcal disease in Africa. Through a coordinated effort between partners across several countries and continents, nearly 20 million individuals aged 1 to 29 years were vaccinated during a four-week period. And the price of the vaccine? Forty cents a dose.

That no cases of meningococcal disease caused by serogroup A bacteria have been identified among the millions of vaccine recipients since then is an incredible step forward for public health. This is an encouraging sign, but only time will tell if this vaccine will completely eliminate serogroup A meningococcal disease from the meningitis belt. MVP continues to work to roll out the vaccine in other high-risk countries.

Photo: Nicole Basta (standing second from left) with CVD-Mali director Dr. Samba Sow (standing far left), members of the CVD-Mali field research team, and representatives from the MenAfriCar Consortium. Bamako, Mali, May 2010.

As an infectious disease epidemiologist, I am interested in understanding the transmission dynamics of infectious diseases, assessing the direct and indirect effects of vaccines and vaccination programmes, and determining optimal strategies for disease prevention and control. This December, I will launch a field study to address the number one question following the introduction of the MenAfriVac vaccine: how long will protection last? Through the “MenAfriVac Antibody Persistence” (MAP) study, we will enrol thousands of residents of Bamako, Mali, over the next five years to investigate the magnitude and duration of the immune response to this vaccine, identify risk factors that may lead to poor vaccine response, and determine whether protective immunity is maintained in the entire population over time or if booster doses or catch-up campaigns are needed. This research is supported by the US National Institutes of Health Director’s Early Independence Award and will allow me to continue to collaborate with colleagues at the CVD-Mali to address a significant and timely public health problem.

The history of the field of public health is full of stories of significant triumphs over diseases such as smallpox and health hazards that once dominated everyday life but are now nearly forgotten. While the introduction of MenAfriVac and its early success is incredibly promising, researchers and public health officials now have the challenging task of monitoring the impact of the vaccine and evaluating its effects on the population. My hope is that the NIH-funded MAP Study will contribute to our knowledge about the immune response following vaccination, and help determine the best strategy for utilising this groundbreaking vaccine to protect those at highest risk in the future.

*Nicole Basta (Gates-Cambridge 2003-2004 – MPhil Epidemiology) is an Associate Research Scholar at Princeton University in the Department of Ecology and Evolutionary Biology. She is the Principal Investigator for the upcoming NIH-MAP study. Additional details of her research can be found at: http://www.princeton.edu/~nbasta