Gene therapy for ‘bubble baby’ syndrome approved on NHS

The NHS will fund gene therapy for the first time after the UK’s healthcare cost watchdog approved treatment for the so-called “bubble baby” syndrome, despite a price tag of more than £500,000.

The treatment is used against adenosine deaminase deficiency, or ADA-SCID, which disables the immune system and means that children with the illness have to be kept in isolation to avoid infection – hence the “bubble baby” name.

The National Institute for Health and Care Excellence (Nice) said in draft guidance published on Friday that GlaxoSmithKline’s Strimvelis gene therapy for the condition improves overall survival compared with standard stem cell transplant therapy.

Gene therapy is designed to deliver a one-off cure for the patient, and drug-makers are typically asking a hefty price that is comparable to the combined costs of alternative life-long treatment. The Strimvelis therapy is so specialised that it is only offered by one hospital, which is in Italy.

“Strimvelis represents an important development in the treatment of ADA-SCID, offering the potential to cure the immune aspects of the condition and avoid some of the disadvantages of current treatments,” Nice said.

“Costing €594,000 [£530,000], the treatment is usually given once only and the effects are thought to be life-long,” it added. It said that the treatment would give children a better chance of being able to live a more normal life, going to school and mixing with friends without fear of a life-threatening infection.

The draft guidance marks the first time Nice has applied its new cost-effectiveness limits for treatments for very rare conditions.

Look out! Why watching TV on a treadmill is bad for your health

Running: it’s a sport that drives us, literally, to distraction. On one hand, we want the benefits, such as endorphins, mental clarity and sleek legs. On the other, we fight the pain. Because, yes, running hurts. Often, quite a lot.

No wonder many of us prefer to watch something while we run. A gripping news story or a classic episode of Friends could help even the laziest jogger crank out an extra mile on the treadmill. Yet, according to research from Nottingham Trent University and the University of Valencia, runners who look directly ahead – at a screen in the gym, for example – as opposed to towards the floor, adjust their style to lift their body and feet higher during each stride.

Not only is this a surefire way to run slower (all that air time), but it can also lead to injury, since your knees and ankle joints are used to absorb the shock caused by falling from a greater height.

If TV is a bad idea, then, what can you do to keep your mind amused while your legs keep moving? Podcasts and audio books are obvious sources of distraction. Some runners use playlists featuring tracks with a similar number of beats per minute as their expected stride rate (Spotify adjusts to your pace automatically). Varying your incline and speed also keep things interesting.

Downloading a running app can help; most can be set to chime in every few minutes with an update on how fast or far you have run. In really tough moments, or during races that prohibit headphones, I either repeat a mantra (“pain is temporary”) or use mental arithmetic to keep my mind focused yet diverted: chopping up the remaining running time into batches of 10 or five seconds and counting down the segments; picking a random number and counting backwards to zero in awkward chunks, such as sevens.

For visual types, using your imagination helps: you can cultivate a detailed scenario of the ticker-tape finish when you reach a short- or long-term goal or conjure an image of your post-run reward, be it a bath, a drink in the pub or simply a pervasive sense of smugness.

Supreme court to hear challenge to Northern Ireland abortion law

The supreme court will this week hear a case to overturn the restrictions on abortions in Northern Ireland on the grounds that the laws breach human rights.

The Northern Ireland Human Rights Commission (NIHRC) failed at the court of appeal in June to convince judges that the rights of victims of sexual assault and women with fatal foetal abnormalities are violated because they cannot terminate their pregnancies in the country.

Abortion is illegal in almost all circumstances in Northern Ireland, except when there is a direct threat to the life of the mother if the pregnancy continues.

The supreme court will hear evidence from the UN human rights committee when the case begins on Tuesday. It is the first time an organisation rather than an individual has been granted the right to take a case to the final court of appeal in the UK.

Les Allamby, the chief commissioner of the NIHRC, said: “This case has the opportunity to bring about a real change to the law on termination of pregnancy in Northern Ireland.

“The commission began its legal challenge in 2015 as we want women and girls in Northern Ireland to have the choice of accessing a termination of pregnancy locally in circumstances of serious malformation of the foetus, rape or incest, without getting a criminal record or facing going to prison.”

Recognising how difficult it would be for a woman or girl to challenge the law in the circumstances covered by the case, the NIHRC took the case in its own name, Allamby said.

He added: “This case is of great significance in the UK and internationally, just four months after our appeal, the supreme court has granted an expedited hearing. An independent working group of the United Nations will also provide evidence to the court.

“This is extremely rare. Many others will also share their own experiences through the court hearings. We commend those who have come forward as we know it is not easy to tell such personal stories.”

Among the other organisations intervening in the supreme court case is Amnesty International.

In 2015 the Belfast high court ruled that Northern Ireland abortion law breached women’s rights, but that ruling was overturned in June 2017. Northern Ireland is the only part of the UK where abortion in almost all cases isillegal.

The termination of pregnancy is available in Northern Ireland’s hospitals only if it is necessary to preserve a woman’s life. This includes where there is a risk of a serious and adverse effect on her physical or mental health which is long term or permanent.

Northern Ireland has the harshest criminal penalty for abortion of any country in Europe, with the potential for life imprisonment for anyone who unlawfully procures or performs a termination.

Sarah Ewart, whose first pregnancy was given a fatal foetal diagnosis, had to travel to England to terminate her pregnancy. She is an intervener alongside Amnesty International. Ewart will release a statement on the abortion ban outside the supreme court on Tuesday morning.

Opponents of abortion reform, including he Catholic bishops and a number of pro-life organisations, are also intervening in the case.

Last year more than 700 women from Northern Ireland travelled to clinics in Britain to terminate pregnancies.

A woman is being prosecuted in Northern Ireland for helping her 15-year-old daughter procure abortion pills online after a doctor at a clinic where she had sought advice from her GP reported her to the police.

Last year a woman was prosecuted for taking abortion pills after her flatmates reported her to the police.

Air pollution is killing us. As a GP I welcome this new charge on drivers | Chris Griffiths

A report released last week by international experts shows pollution to have caused more deaths in the UK than in many other countries in western Europe. Air pollution is largely invisible, so it is hard to grasp how much damage it is doing to our health. But studies like the Lancet commission on pollution make it clear that poor air quality increases not only the likelihood of developing a range of respiratory illnesses, but also the frequency and severity of bouts of those illnesses.

Like many GPs, I see this “double hit” in the children and adolescents who come to surgery every day. Preschool children who live near main roads have an increased risk of developing wheeze triggered by viral colds – a condition we call “preschool wheeze”. Exposure to traffic pollution also increases the chance of a child developing asthma. For preschool wheezers and children with asthma, high pollution days can then trigger episodes of severe wheezing, especially when pollution has not been dispersed by the wind.

Worse still, as children grow, air pollution restricts the growth of their lungs. While it’s impossible to see these effects in a child sitting in front of you in the surgery, they have been confirmed in a number of research studies in the US and Europe. In effect we are creating a generation of adolescents with stunted lung growth.

As they become older adults, where lung function and capacity naturally decline, this reduced capacity is a big concern. Recent research shows that children with persistent asthma who enter adulthood with reduced lung growth are especially likely to experience faster decline in lung capacity, to a point where in early middle age (as soon as their fourth decade) they have developed chronic obstructive pulmonary disease (COPD).

I treated a middle-aged woman in my surgery last week in exactly this situation: she has persisting asthma that is not responding to treatment. Almost certainly the lung tests I asked her to do in a few weeks’ time will show irreversible lung damage. Such individuals are at major risk of long-term ill health, with frequent chest infections leading to further deterioration in lung function and probably early death.

Yesterday I watched a man struggling for each breath as though it would be his last, his lungs destroyed by COPD. His family watched helplessly. His chest infection hadn’t responded to antibiotics and strong steroid tablets; hospital admission by ambulance was his only chance.

This is why I welcome the London mayor’s new toxicity charge, which comes into force today and aims to drive down air pollution caused by diesel cars in the capital. Researchers in California recently showed that where pollution levels are driven down, children’s lung growth can at least partially recover.

The illnesses linked to air-pollution exposure in adults span other respiratory and non-respiratory conditions, including pneumonia, angina, heart attacks, strokes and even cognitive decline. Sooty particles and nitrogen dioxide inhaled by pregnant women increase the risk of pre-term birth, and low birth weight at term. Overall, therefore, air pollution adversely affects our health across our entire lifespan. These illnesses can have far-reaching effects on a person’s quality of life, that of their families, their livelihoods, and their finances. One patient I remember well lost her job due to recurrent severe asthma attacks.

Last week’s Lancet report named air pollution from vehicles and factories as the biggest killer, accounting for 6.5m deaths worldwide. We know that in Greater London, road transport generates 45% of toxic nitrogen oxide emissions. Modelling has shown that, alongside other measures, the percentage of diesel cars will need to be reduced from 57% to 5% of the total if London is to become compliant with legal limits.

The new toxicity charge has faced criticism from some car owners. I’m sympathetic to the concerns of people already squeezed by the high cost of living, but there are good reasons for introducing pollution charging. Illegally high levels of air pollution affect all people living and working in the capital, from pedestrians and cyclists to drivers themselves. The aim of this charge is to effect behavioural change. It aims to encourage owners of the most polluting vehicles to make fewer journeys, greater use of other transport options or eventually to change to a less polluting type of vehicle, such as an electric-powered one.


Air pollution in the UK, and especially London, has been described by many experts as a public health emergency

This kind of policy decision only happens when the evidence of harm to public health is overwhelming – as, for example, with banning smoking in public places. We know this approach works: the smoking ban has delivered major improvements in public health, reducing rates of pre-term birth by about 4%, childhood hospital admissions for asthma by 10% and pneumonia by almost 20%.

Air pollution in the UK, and especially London, has been described by many experts as a public health emergency. It’s a problem that cannot be solved without some effort on the part of individuals, policymakers and indeed the car industry. Driver charging alone won’t fix this problem, but it is necessary to help everyone breathe clean air. Nobody should have to suffer the ill effects of traffic pollution: they are entirely preventable.

Professor Chris Griffiths is lead at the Centre for Primary Care and Public Health, St Bartholomew’s (Barts), and the London School of Medicine and Dentistry, and co-director of Asthma UK Centre for Applied Research. He has worked as a GP in east London for over 20 years

London’s £10 T-charge comes into effect in fight against toxic car fumes

Drivers of the most polluting vehicles must from now on pay a daily charge of up to £21.50 to drive in to central London.

From Monday, people driving older, more polluting petrol and diesel vehicles will be liable for the £10 T-charge, on top of the congestion charge of £11.50, which has been in place since 2003.

The charge has been introduced in an effort to improve air quality in the capital, where legal pollution limits are regularly exceeded. The mayor, Sadiq Khan, said he wanted to prepare Londoners for the ultra-low emission zone being introduced in April 2019.

“As mayor, I am determined to take urgent action to help clean up London’s lethal air. The shameful scale of the public health crisis London faces, with thousands of premature deaths caused by air pollution, must be addressed,” he said.

“Today marks a major milestone in this journey with the introduction of the T-charge to encourage motorists to ditch polluting, harmful vehicles.

“London now has the world’s toughest emissions standard with older, more polluting vehicles paying up to £21.50 a day to drive in the centre of the city. This is the time to stand up and join the battle to clear the toxic air we are forced to breathe.”

The charge came into effect at 7am on Monday. It is applicable to pre-Euro 4 vehicles in the zone, which covers all of central London to the south of King’s Cross station, to the east of Hyde Park, west of the Tower of London and north of Elephant and Castle.

Pre-Euro 4 vehicles are typically those registered before 2006, but Transport for London suggests that anyone who has a vehicle registered before 2008 checks if it is liable for the charge. The total daily levy can be reduced by £1 if drivers register to pay the congestion charge automatically. People living within the zone and driving cars covered by the new charge are eligible to pay as little as £11.05 a day in total for the two.

Speaking to Sky News on Monday morning, Khan said the T-charge would cost about £7m a year, which he said was a “price worth paying”. He added that the ultra-low emission zone, once introduced, would make money that would then be ring-fenced for clean air initiatives.

And he defended the plan against claims it would do little to solve the problem because relatively few vehicles are covered by it, saying it was part of series of measures, including the forthcoming introduction of the ultra-low emission zone.

Mike Hawes, the chief executive of the Society of Motor Manufacturers, said: “Industry recognises the air quality challenge and wants to see London and other cities meet their targets.

“Investment made by the industry into new diesel and petrol technologies has resulted in the most recent cars being unaffected by this new charge in London and, indeed, exempt from any other charges across the UK.

“This new T-charge will affect a very small number of older vehicles so the impact on air quality will be marginal whereas bigger improvements could be achieved by policies which incentivise the uptake of the latest, lowest emission vehicles.”

Rules allowing upfront charges for foreign users of NHS come into force

Migrants and visitors to the UK not eligible for free healthcare will from now on be charged upfront for the cost of their treatment, as rules come into force that also extend charging to community health services and charities that receive NHS funding.

The system, designed to counter “health tourism”, requires medical staff to establish whether patients are eligible for state-funded healthcare before providing treatment. If they are not, patients must pay an upfront charge that is currently set at 150% of the cost to providers.

But critics – including a former chief executive of the NHS, a range of civil society groups and hundreds of doctors who recently signed a letter to the health secretary – say the new rules, in force from Monday, will deter ill people from seeking life-saving treatment, and patients with infectious diseases could pass undetected.

There is also confusion over how the rules should be applied, with a survey of NHS professionals showing that eight in 10 were unable to make the crucial distinction between the eligibility of refugees, asylum seekers and those whose application for asylum had been rejected.

There are fears that an identification-checking scheme currently under pilot at 20 NHS trusts will be extended across the country, raising the prospect of a future where patients must attend hospital with their passports and driving licences to guarantee receiving treatment they are entitled to.

While hospitals have had a charging regime in place for some time, patients not covered by the NHS have, until now, been sent a bill for the cost of their care after treatment. The Department of Health says many such bills have gone unpaid after trusts lost touch with patients who had left the country or otherwise disappeared.

According to the rules laid out in the National Health Service (charges to overseas visitors) (amendment) regulations 2017, a piece of secondary legislation that passed parliament with no debate, all organisations receiving NHS funding must now charge ineligible patients before they are treated. The charging regime will also be extended to services such as health visiting, school nursing, community midwifery, community mental health services, termination of pregnancy services, district nursing, support groups, advocacy services, and specialist services for homeless people and asylum seekers, according to Doctors of the World.

The DoH stressed that upfront charges would only apply for planned, elective treatments, and that no one would be denied accident and emergency care or maternity services – although some of these can be charged for retrospectively.

However, campaigners against the change have collected many anecdotal accounts of patients being wrongly charged for care, in one case because a patient had a foreign-sounding name, or charged for treatments that are supposedly exempt from the regime.

A survey of NHS staff by Medact found almost two-thirds (62%) of respondents thought failed asylum seekers were ineligible for free primary care, with another third (30%) believing failed asylum seekers were not entitled to free emergency NHS care.

“It is clear that NHS staff do not have the training and support they need to correctly identify who is and isn’t entitled to healthcare,” Dr Ruth Wiggans, co-chair of Medact, said. “What we’ll see as a result is people who should be receiving NHS care being wrongly turned away or simply being too worried to seek help themselves.”

Health minister James O’Shaughnessy said: “The NHS is a cherished national institution that is paid for by British taxpayers.

“We have no problem with overseas visitors using our NHS as long as they make a fair financial contribution, just as the British taxpayer does. The new regulations simply require NHS bodies to make inquiries about, and then charge, those who aren’t entitled to free NHS care. All the money raised goes back into funding and improving care for NHS patients.”

Lord O’Shaughnessy added: “We are clear that some vulnerable groups are exempt from charging and the NHS will never withhold urgent and immediately necessary treatment.”

London’s £10 T-charge comes into effect in fight against toxic car fumes

Drivers of the most polluting vehicles must from now on pay a daily charge of up to £21.50 to drive in to central London.

From Monday, people driving older, more polluting petrol and diesel vehicles will be liable for the £10 T-charge, on top of the congestion charge of £11.50, which has been in place since 2003.

The charge has been introduced in an effort to improve air quality in the capital, where legal pollution limits are regularly exceeded. The mayor, Sadiq Khan, said he wanted to prepare Londoners for the ultra-low emission zone being introduced in April 2019.

“As mayor, I am determined to take urgent action to help clean up London’s lethal air. The shameful scale of the public health crisis London faces, with thousands of premature deaths caused by air pollution, must be addressed,” he said.

“Today marks a major milestone in this journey with the introduction of the T-charge to encourage motorists to ditch polluting, harmful vehicles.

“London now has the world’s toughest emissions standard with older, more polluting vehicles paying up to £21.50 a day to drive in the centre of the city. This is the time to stand up and join the battle to clear the toxic air we are forced to breathe.”

The charge came into effect at 7am on Monday. It is applicable to Pre-Euro 4 vehicles in the zone, which covers all of central London to the south of King’s Cross station, to the east of Hyde Park, west of the Tower of London and north of Elephant and Castle.

Pre-Euro 4 vehicles are typically those registered before 2006, but Transport for London suggests that anyone who has a vehicle registered before 2008 checks if it is liable for the charge. The total daily levy can be reduced by £1 if drivers register to pay the congestion charge automatically. People living within the zone and driving cars covered by the new charge are eligible to pay as little as £11.05 per day in total for the two.

Speaking to Sky News on Monday morning, Khan said the T-charge would cost about £7m per year, which he said was a “price worth paying”. He added that the ultra-low emission zone, once introduced, would make money that would then be ring-fenced for clean air initiatives.

And he defended the plan against claims it would do little to solve the problem because relatively few vehicles are covered by it, saying it was part of series of measures, including the forthcoming introduction of the ultra-low emission zone.

London’s £10 T-charge comes into effect in fight against toxic car fumes

Drivers of the most polluting vehicles must from now on pay a daily charge of up to £21.50 to drive in to central London.

From Monday, people driving older, more polluting petrol and diesel vehicles will be liable for the £10 T-charge, on top of the congestion charge of £11.50, which has been in place since 2003.

The charge has been introduced in an effort to improve air quality in the capital, where legal pollution limits are regularly exceeded. The mayor, Sadiq Khan, said he wanted to prepare Londoners for the ultra-low emission zone being introduced in April 2019.

“As mayor, I am determined to take urgent action to help clean up London’s lethal air. The shameful scale of the public health crisis London faces, with thousands of premature deaths caused by air pollution, must be addressed,” he said.

“Today marks a major milestone in this journey with the introduction of the T-charge to encourage motorists to ditch polluting, harmful vehicles.

“London now has the world’s toughest emissions standard with older, more polluting vehicles paying up to £21.50 a day to drive in the centre of the city. This is the time to stand up and join the battle to clear the toxic air we are forced to breathe.”

The charge came into effect at 7am on Monday. It is applicable to Pre-Euro 4 vehicles in the zone, which covers all of central London to the south of King’s Cross station, to the east of Hyde Park, west of the Tower of London and north of Elephant and Castle.

Pre-Euro 4 vehicles are typically those registered before 2006, but Transport for London suggests that anyone who has a vehicle registered before 2008 checks if it is liable for the charge.

‘My baby went to sleep and didn’t wake up’: young lives lost to Ghana’s silent killer

There is no war or famine in Ghana, and the economy is growing, yet malnutrition remains a silent killer that accounts for one-third of all child deaths in the country.

Although mortality rates are slowly starting to come down across the west African country, Ghana is struggling with high levels of stunting, a condition caused by chronic lack of nutrition in pregnancy and early childhood that permanently affects a baby’s mental and physical development.

One in five babies born in Ghana are stunted, which has been calculated to cost the economy $ 2.6bn (£2bn) a year, about 6.4% of the country’s GDP.

In Bentum, Apprah and Nyanyano, rural communities in Ghana’s Central region, about an hour from Accra, more than 35% of children under five suffer from severe malnutrition.

Kate Afful, 40, at home with her mother in Nyanyano, telling the story of how one of her daughters died at age two

Kate Afful (above, right), 40, at home with her mother in Nyanyano, tells the story of how one of her daughters died at the age of two. Anotherof her six children died during childbirth. She worked as a fishmonger for her husband up until his death, about 10 years ago. Since then, she’s struggled to find work and take care of her remaining four children. Her children are malnourished and often get sick – they only eat “banku”, a fermented corn and cassava dough. “God took my two-year old daughter,” she says. “She was not feeling well so I put her to bed. Later that evening, there was a bad storm. The sky was loud and angry. I heard an explosion in the clouds. When I went to check on my baby, she was dead. I believe the thunder killed my baby.”

Nana Agya Kwao, chief of the farming community of Bentum in Ghana

Nana Agya Kwao (left), 76, the chief of the farming community of Bentum, has two wives and says he has 35 children. As chief, a position he has held for 35 years, he owns the land and has the right to sell or rent it out. Two years ago, he sold most of the farming land in Bentum to a developer. As a result, the majority of villagers lost their livelihoods and now struggle to feed their families. “I am very proud to be the chief. It’s not easy. No one will take my land. I know my people in Bentum cannot farm anymore. But whatever you do for food, is on you.”

A family outside their home in the fishing village of Nyanyano


Child malnutrition is not only about nutrient intake. No sanitation and no waste management make things worse


Early morning in the fishing village of Nyanyano

Ama, in her 20s, with her two children at home in Nyanyano

  • Top image: A family outside their home in the village of Nyanyano; middle image: Nyanyano has no waste management system; bottom image: Ama with her two children at home in Nyanyano

Ama’s husband is a fisherman, and she sells fried food on the street in Nyanyano. Both her children are malnourished, and her oldest child has had an eye infection for two years without medical treatment. “A lot of children die in this village. People talk about my children being sick and malnourished, but I don’t care what they say. There is nothing I can do because I can’t afford to take my children to the hospital or to give them the food supplements the nurses recommend.”

Nyanyano, Ghana. October 9, 2016 Hannah Abekah, 23, at her home in Nyanyano, surrounded by the yellow buckets of rainwater she collected the night before. Hannah never attended school, and started working at a very early age as a fishmonger. She is married to a fisherman, and they have two young children who suffer from malnutrition. Her husband is often away for weeks. 'I just want my children to become great people'

At her home, Hannah Abekah (left), 23, is surrounded by the yellow buckets of rainwater she collected the night before. She has never attended school, and started working at a very early age as a fishmonger. She is married to a fisherman, and they have two young children. Her husband is often away for weeks. “My kitchen is empty. I have no food,” she says. “My children don’t even eat the little food I give them. I don’t know about malnutrition. I just pray my children become great people.”

In Nyanyano a young girl prepares food for her family using pots and pans covered in flies

  • A young girl in Nyanyano prepares food for her family


Lack of potable water means infections, malaria and diarrhoea, increasing child mortality and exacerbating malnutrition


Rebecca, 17, with her two children in Nyanyano. Her children are malnourished and frequently ill

Rebecca (above) has two children who are regularly ill. They receive medicine from the local store instead of professional healthcare at the hospital. Rebecca, 17, doesn’t receive much support from the children’s father. “He doesn’t take care of us as he should. He says he doesn’t have money, but I know he is not honest.” She feels she has nowhere to turn. “Women don’t support one another here, it’s not something we do.”

Inside a typical home in the fishing village of Nyanyano, where most households spend less than $  10 a week on feeding an entire family


Most households spend less than $ 10 a week to feed an entire family


Exhausted from the heat, an elderly woman seeks shade from the sun in Nyanyano. Collecting rainwater is the only source of water for local villagers, who use it for drinking, bathing, and washing

Rachel Edifile, 18, with her two children at her home in Nyanyano, where she works as a fishmonger. Her youngest child is underweight and malnourished, and she relies on help from her grandmother to pay for medical costs

  • Top: inside a typical home in Nyanyano; middle: an elderly woman is exhausted from the heat; bottom: Rachel Edifile with her children

Rachel Edifile, 18, works as a fishmonger in Nyanyano but struggles to provide food for her children. Her youngest child is underweight, and she relies on the help of her grandmother to pay for medical costs. She cannot send her older child to school. “I am not happy,” she says. “I want to take better care of my children, send them to school and buy good food.”

Nevertheless, more children are attending school in the area as private schools have been springing up. Some of the schools provide feeding programmes, so pupils can expect to get at least one meal a day.

A student sleeps at the only school in the farming community of Apprah. Most students at school are malnourished, and many fall asleep during the day or have problems concentrating in class


Most students at school are malnourished and many fall asleep during the day or have problems concentrating in class


In most circumstances, the only meal children receive for the entire day is at school. Here children take a break from learning to enjoy their lunch

Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at the Kasoa clinic

Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at Kasoa clinic. The clinic, the largest run by the government in the city of Kasoa, serves the people of Bentum, Apprah and Nyanyano, but it can involve a journey of up to three hours to get there. According to Amponfi, only 20% of malnourished children are taken to this clinic, mostly extreme cases. Fifteen nurses work at the clinic, serving a catchment area of about 100,000 people. There is also a nutrition officer in the district who visits the clinic four times a month.

The room where women give birth, at the small health clinic in Nyanyano

A clinic on the outskirts of Kasoa.

“There is a stigma associated with having a malnourished child. So we mostly identify malnutrition cases by talking to neighbours. Besides, mothers of malnourished children are lonely and they don’t feel supported by their husbands. Our most important job is to provide a safe environment to counsel them about their children, so that they don’t feel embarrassed about bringing them here. But our effort is just a drop in the ocean.”

Charity Essel, 29, with her two-year-old daughter Tiffany, at the farm in Bentum where she worked until the land was sold two years ago

Charity Essel, 29, used to work on a farm in Bentum before all the farming land was sold to a developer by the local chief two years ago. The land is now surrounded by a 9ft wall, built by the villagers who have lost their farms, and food is scarce. Since birth, Charity’s daughter Tiffany has struggled with malnutrition but Charity says hospital staff never explained what was wrong with her daughter. The child only started to put on weight and improve once a local non-profit organisation diagnosed malnutrition and provided her with dietary supplements, she says. “My daughter used not take any food. When she lay down, I could see all her ribs. My child would have died without the help of this non-profit.”

Christy Ansah, 32, with her youngest daughter near the farm in Bentum where she used to work before the land was sold

Christy Ansah, 32, has also struggled since the farmland in Bentum was sold. As a result of the village chief selling all the farming land in the community to a local company, “no one here can access their farms”, she says. “I was able to feed my four children before, but there is no food any more and no jobs in this village. I struggle to earn a quarter of what I made before.”

Men relax in the middle of the day in Nyanyano. Most work as fishermen and when they are not working they rarely help with household chores


This is a world of mothers – they struggle alone for their children. Most fathers are not involved in childcare


In Nyanyano, a local fishmonger covered in scales prepares fish caught earlier that morning. Protein is rare in Ghana and usually reserved for consumption by male household heads

Mary Essil, 27, at home in Bentum, holding a bottle of glucose that she fed her malnourished son until he died at two months of age

Mary Essil, 27, at her home in the farming community of Bentum, holds the bottle of glucose that she gave her son when he was sick. She could not breastfeed her newborn, who was small at birth. Her baby died when he was two months old. “My baby went to sleep and did not wake up,” she says. Local tradition mandates that when a baby dies of malnutrition, the baby is taken away. Mary and her husband were not allowed to attend their son’s funeral.

NGOs in the area are supporting women like Charity, Mary and Christy. The Cheerful Hearts Foundation, in Kasoa, runs a nutrition programme in the area, conducting workshops in schools for children, and home visits for mothers, led by volunteers.

Nana, chief of Nyanyano, says he is powerless to solve problems like malnutrition and trafficking in the community

Nana, the chief of Nyanyano, at his palace. As a traditional leader, he is responsible for overseeing political and ethical issues in the fishing community. “Fishermen leave women pregnant and then they run away. Mothers are left to fend for themselves and support their children alone. My people are starving. Mothers are desperate … The government does nothing about it. So many people look to me for answers, but I am only one man. I wish I could help them, but I have no power.”

The land the chief sold to developers two years ago is now lying idle. There is some animosity towards him from the community for selling the land, but most people say they felt powerless to do anything to stop the sale. Since then, some families have moved away in search of new opportunities.

A mother and child at the Princess Marie Louise Children’s Hospital in Accra, which hosts the largest facility in Ghana assisting malnourished children and their mothers

What comes in 66 sizes and vegan latex? The new generation of condoms

In the middle of a long and stressful day in her job in finance, Farah Kabir nipped out of the office in her lunch break and ran to the local Boots to pick up some condoms. She grabbed the first ones she saw, rushed to the till and, just before handing the lurid box of Durex over to the cashier, locked eyes with the person queueing behind her. It was her boss.

Understandably mortified, she shared her horror story with her old schoolfriend, Sarah Welsh. A doctor specialising in gynaecology and sexual health, Welsh tells me that Kabir’s experience got her thinking. “Of course it’s natural to feel embarrassed, but I’ve seen the rise in difficult-to-treat sexually transmitted infections, and condoms are the only safe, non-hormonal method of contraception that is effective in protecting against them. Yet there’s still this strange taboo around women being able to buy them. That’s when we got really excited about what we could do to make a difference.”

This summer, Welsh and Kabir launched Hanx, a new brand of stylishly packaged condoms with a cream and gold colour scheme that is more upmarket Scandi stationery than contraception. They are also vegan (most condoms contain an animal byproduct called casein, which they have replaced with a plant alternative), and have a special “clean” scent, as research revealed that many women were put off using condoms by their smell. They are sold in lingerie shops and yoga centres as well as online, where they cost £6 for a pack of three. Welsh says: “It’s something you’d feel proud to carry. At the moment, buying condoms brings on feelings of shame, and we want to combat that. We want to empower women to take control of their sexual health.”

Will Welsh and Kabir succeed in making women feel happier buying and using condoms? Last year, in a survey of 2,000 people by FPA, the sexual health charity, nearly one in five people said they thought it can be embarrassing to buy condoms, nearly one in 10 said they thought it is still taboo for women to buy and carry them and, crucially, more than one in five said that on at least one occasion they had not used one during sex because they don’t enjoy it as much. “We do need to acknowledge that some people have experiences with condoms that don’t feel good,” says FPA’s Bekki Burbidge. “We need to move beyond just saying ‘use a condom’ and find a way to make using them an enjoyable part of sex.”

Farah Kabir and Sarah Walsh of Hanx


Farah Kabir and Sarah Walsh, founders of the vegan condom range Hanx

The design of the condom has barely changed since the 1950s, and it works pretty well when it comes to preventing pregnancies and the transmission of STIs, without messing around with women’s hormones. But it can’t do any of that, of course, if couples choose not to use them because of how they look or feel. A new wave of entrepreneurs and scientists are trying to change that, and transform the condom – and our sex lives.

The newest of these innovations to hit the market is a condom that comes in 66 different sizes, called MyOne, that launched in the US earlier this month and will land in the UK on Valentine’s Day next year. “Size is a problem,” says Davin Wedel, CEO of Global Protection Corp, MyOne’s manufacturer. “You can add studs and ribs and shapes to condoms, but it doesn’t matter how many bells and whistles you add, or how much thinner you make them, unless you fix the fact that they don’t fit the majority of men.”

The average condom length is about 185mm (7.3in; in the industry, condoms are measured in millimetres). That decision was made by regulators who erred on the side of longer penises, to make sure as many as possible were protected from STIs. But a review of existing penis-size studies from across the world found the average length of an erect penis to be 131.2mm (5.2in) – in fact, a US study found lengths varied from 40mm to 260mm (1.6in to 10.2in), with more than 80% coming in at shorter than your average condom. “If you have a very small penis, or a very large one, you cannot buy a condom to be protected,” says Wedel. Condoms that are too long have to be rolled up, which can feel like an uncomfortably tight rubber band around the base of the penis; condoms that are too baggy can feel humiliating and can slip off; condoms that are too short don’t protect the base of the penis from skin-to-skin contact STDs; condoms that are too tight can feel constricting. Average-sized condoms, says Wedel, only cover around 12% of men. MyOne condoms will come in a range of 10 lengths and 10 circumferences, and customers can calculate their own size by printing a measuring kit off the website.

Wedel has been in the condom game for 30 years, since he was an undergraduate student at Tufts University in Massachusetts. Back then, “saying the word condom out loud was taboo”, he says. When he heard that one out of every 100 college students had Aids, and that condoms were the only thing that could prevent it spreading, he and a friend decided to sell packs with a picture of their university mascot, Jumbo the Elephant, and the slogan, “A safe Jumbo is a happy Jumbo”, for $ 1 a piece. “At that time, the need was to normalise condoms, to make them as socially acceptable as toothpaste,” he says. That is why he went on to invent the glow-in-the-dark condom. Wedel hopes his 66 sizes will help men to find the perfect fit – but acknowledges that this variety of different-sized condoms is already on sale in the UK under the TheyFit brand. And, sure, size matters, but it can only take us so far: the FPA’s survey revealed that 14% of respondents said that on at least one occasion they had not used a condom during sex because they don’t like how it feels.

For Dr Aravind Vijayaraghavan at the University of Manchester, the solution is to create a new material. “There has been very little change in what condoms are made of,” he says. “It’s been latex for as long as modern condoms have existed, but that material has some limitations. One of the most common complaints is that it doesn’t provide a particularly natural feel.” Plus, manufacturers can only confirm that it works about 98% of the time. When, four years ago, the Bill and Melinda Gates Foundation launched its challenge for developers to design the next generation of condoms, Vijayaraghavan had his big idea. He had been working with graphene, a form of carbon that is 200 times stronger than steel but also incredibly flexible, and he realised that, if added to latex, it could help create the stronger, thinner condom that the world was waiting for. His team won the grant, and are now working with a manufacturer. Vijayaraghavan says he could potentially have a condom ready for market within two years.

MyOne condoms


MyOne condoms: choose from 66 different fits

Graphene’s hexagonal molecular structure was also the inspiration for the invention of Hex, a condom launched by Lelo, the Swedish brand best known for its designer sex toys; a 36 pack costs $ 45.90 online. “Our biggest single discovery was that it wasn’t the material or shape that needed to change, it was the structure,” says Steve Thomson, Lelo’s global marketing director. Hex’s USP is its specially produced latex with raised interconnected hexagons on the inside of the condom, meaning the surface holds to the penis without constricting, “like a tread on Formula One tyres when you’re driving in the wet”, says Thomson. This, he says, transforms how the condom feels: “Our clinical studies have proved that more than 73% of users could tell the difference. But because of the laws surrounding condom marketing, you’re not allowed to speak to the pleasure benefits.” Companies are not allowed to promote their condoms as “more pleasurable”, because it is a difficult quality to quantify.

But, of course, pleasure is what this is all about. And that, Charles Powell says, is what makes his invention stand apart from all the others. The Vietnam veteran turned oil rig worker turned film producer turned condom inventor says the other developers have “just rearranged the deckchairs on the Titanic, because they all cover the full penis. They’re not going to increase condom usage, because nobody likes them. I’m the only game in town, the only product that will raise condom usage around the world, because people want to wear the Galactic Cap.”

The Galactic Cap, so called because “the pleasure is out of this world”, is made of polyurethane (used in some condoms) and fits over the top of the penis, securing like a plaster, using a medical-grade adhesive, capturing the semen in an airtight reservoir. Powell says it protects both against pregnancy and, so long as there are no sores or abrasions on the penis, against any STDs that are not transmitted by skin to skin contact. “This is a stop gap between wearing a full condom and not using anything. If you know who you’re with and you feel safe, and your partner doesn’t want to use hormonal birth control, this can be a great thing.”

He tells me how he ended up turning his talents to prophylactics: “I had an editor I worked with for three years who came down with HIV. He was like a brother to me. It so shocked me I thought, there’s got to be something better than a traditional condom.” Five years ago, he took $ 50,000 from an insurance policy to design the product, before launching a video campaign on Indiegogo that raised $ 100,000 and received a million views within three days.

He sells the condoms online for $ 20 or $ 100 for 10 – he issues a disclaimer that “it’s an experimental prototype, not FDA approved, not tested for STDs, HIV or pregnancy, use at your own risk – basically, don’t sue me”. He says the FDA takes two years and $ 2m for testing, so he is currently “flying under their radar, because nobody has ever got regulatory approval for a glans sheath, something that covers the head of the penis for sex. There is a law on the books that says it’s illegal to do.” But he believes this can be done, and in the meantime, he hopes to get a CE mark and start selling in Europe, where clinical trials are faster and cheaper. What makes him so sure he will succeed? The customer feedback includes comments such as, “Holy shit, these things are amazing” and “Charles Powell, you, sir, are a genius”. “It’s hugely exciting,” he says, “because it could change the world – this could revolutionise how people have sex.”

Some developers hope to transform our sex lives by other means, such as the makers of Flex, an alternative to the menstrual cup that sits at the base of the cervix, meaning women can have sex while on their period with “no mess”, as the website puts it. You can sign up for a trial online for $ 15 and receive a 24-pack, which lasts for about three cycles.

All of these condoms also aim to take the awkward messiness out of sex, to remove the obstacles that get in the way of lovers feeling as close as possible. Will they make us happier in bed? The first question has to be, will couples actually put them on? As Burbidge of the FPA puts it: “If something’s uncomfortable when you’re having sex, it’s hard to relax and enjoy yourself. So if these innovations improve on what we’ve got and create condoms that people feel more comfortable buying and carrying, and that are more enjoyable to use, that’s great – as long as they also use them.”