Thursday, 30 December 2010

POVERTY: CANADA: Reasons behind poverty on first nations reserves

CHRISTIE BLATCHFORD : Globe and Mail :  Dec. 30, 2010

In the court case of Pikangikum v Nault is a glimpse of an answer to the age-old Canadian question of how so many first nation communities in this country continue to suffer appalling conditions and ruinous poverty even as Ottawa throws millions and millions and millions of dollars at impoverished reserves.
That hint of an answer is found in what happens when intransigent bureaucracy (the federal Indian and Northern Affairs Canada, or INAC) meets stubborn and hypersensitive first nation, in this instance the Pikangikum band.
And what happens, as Ontario Superior Court Judge John dePencier Wright found, is … nothing.
Thus, more than a decade after the remote Pikangikum reserve in Northwestern Ontario first came to national attention (for, among other things, youth suicide rates that are said to be the highest in the world) and their local MP was named Indian Affairs minister and all seemed rosily possible, little has changed for the band’s approximately 2,100 residents.
As Judge Wright said, a much-ballyhooed power grid remains uncompleted, costing Canadian taxpayers an extra $3-million a year to keep prohibitively expensive diesel generators going; effluent from the water treatment plant is still going into Pikangikum Lake, which supplies the community’s drinking water; sewage facilities are inadequate.
A golden opportunity to improve life for some of Canada’s poorest citizens was “missed because of the unfortunate collision between an unstoppable force and an immoveable object,” the judge wrote.
Judge Wright’s 93-page decision, which amounts to a searing indictment of the status quo, was released just before Christmas to almost no attention.
He dismissed the Pikangikum lawsuit against former Indian Affairs minister Robert Nault, which had alleged he acted unlawfully by imposing what’s called “third-party management” – basically, an outside party is appointed to administer band funds – on the reserve.
In fact, Judge Wright found that when INAC arbitrarily moved to impose third-party management on the reserve in November of 2000, it did so “against the wishes” of Mr. Nault.
Calling the strike “breathtaking in its ramifications,” the judge said that either “elements in the Ontario Region of [INAC] were amazingly disloyal to their Minister or were shockingly oblivious to political realities.”
Third-party management is supposed to happen only after lower-level interventions, such as joint management or “co-management,” have failed, and always after a meeting with the band.
Instead, 10 days before the 2000 federal election, INAC abruptly announced it was arriving on the reserve to begin third-party management.
The action was “extraordinary on both the political level and procedurally,” the judge said, taken as it was against the minister’s wishes and on the eve of an election.
“The Minister did not agree with the imposition of third-party management,” Judge Wright said. “He wanted co-management.”
The judge did, however, find there were plenty of legitimate reasons for some sort of government intervention: Pikangikum was reeling from suicides; its only school had been shut because of a fuel spill for almost a year; the new water treatment plant had twice flooded, due to human error, and the community was in crisis.
The fault for all of it, Judge Wright said, is evenly divided between the Pikangikum band and the INAC bureaucracy, which appears to have fought Mr. Nault tooth and nail after he took over the ministry in 1999.
Pikangikum wasn’t just another reserve to him, but as the long-time MP for Kenora-Rainy River, his constituents.
“…to the annoyance of some in his department,” the judge said, Mr. Nault “instructed people at the highest levels” to give him monthly progress reports on the Pikangikum school project (tanks on the school fuel tank farm were to be replaced with more environmentally safer ones).
“To the annoyance of Mr. Nault … the bureaucracy was continuing to follow its accustomed five-year schedule and not treating this project as an ‘expedited’ matter for the Minister’s constituents as he had promised them,” the judge said.
The shine was soon off Mr. Nault’s reputation at the band office, the final straw coming when native leaders believed – wrongly it turned out – that he had personally appointed the third-party agent, which the band saw as another incarnation of the hated old “Indian agent,” to handle band affairs.
But for Mr. Nault, the judge wrote, there were two breaking points – the first when, in reaction to his perceived high-handedness imposing third-party management, the band contested the move at the Federal Court of Canada and personally served him with legal papers at a meeting, the second when a band official threatened to close the school, finally about to re-open after an oil spill had closed it for much of the previous year.
Internally at INAC, meantime, the bureaucracy, stung by Mr. Nault’s special interest in and treatment of Pikangikum, now sent every single piece of paper about the band, even routine funding requests not requiring the minister’s approval, to his desk, where they sometimes languished in a mountain of documents.
As Judge Wright once put it – and he was specifically talking about the fact that the band had missed a chance to receive housing assistance desperately needed, but the line has much broader application, “No one’s hands were clean …”

MALNUTRITION: Vitamin A Doses Keep Child Malnutrition Away

Sujoy Dhar*

Renu Devi of Bagwanpur Rati village in India's Bihar state with her
children who take the Vitamin A doses. / Credit:Sujoy Dhar/IPS Renu Devi of Bagwanpur Rati village in India's Bihar state with her children who take the Vitamin A doses. Credit:Sujoy Dhar/IPS

VAISHALI, India, Dec 30, 2010 (IPS) - With three small children to raise in a dirt-poor village in eastern India’s Bihar state, farm labourer Renu Devi is an unsung rural supermom who shuttles between home and field every day. But the demure 30-year-old mother does not forget to bring her children to the biannual Vitamin A rounds in Bagwanpur Rati, one of the villages in Vaishali district of Bihar. This is because Vitamin A deficiency is a major cause of malnourishment in children. And in India’s rural heartlands, pro-active state governments like the one in Bihar have been teaming up with the United Nations Children’s Fund (UNICEF) to reach out to the nine to 59-month-old children with Vitamin A doses twice every year.
The rounds, given during the routine immunisation, precede an earnest campaign for awareness and information using the rural public announcement systems, which include men going around beating drums and hollering the dates for the rounds.
India’s national policy recommends that all nine to 59- month olds be given Vitamin A Supplementation (VAS) twice yearly to reduce the risk of blindness, infection, under- nutrition and death associated with such deficiency.
"I take my children because it is good for their eyesight," mutters an almost unlettered Renu Devi, clutching her three children together as she reaches her thatched house from the field to take care of the family.
In India, a country of 1.2 billion people, nearly 62 percent of pre-school children are deficient in Vitamin A, according to latest estimates, says UNICEF. There is a high prevalence of wasting (20 percent), stunting (48 percent) and anaemia (70 percent) among children below five years owing to nutritional deprivation.
Research from World Health Organization has found that giving Vitamin A to preschool children twice yearly reduced under-five mortality by 23 percent.
In Bihar, Vitamin A deficiency amongst pre-school children has long been a public health problem. But since 2005, UNICEF has been working with the Bihar government to strengthen the Child Development and Nutrition Programme’s outreach and get to children who would otherwise be left out.
In Bihar, the success of the drive has been achieved by adapting an outreach strategy to include beneficiaries that are nutritionally, economically and socially vulnerable. Vitamin A Supplementation (VAS) to cover children from socially excluded areas through special strategies is designed for this purpose, UNICEF officials say.
According to Dr Vandana Joshi, UNICEF nutrition specialist in Patna, the specialty of the Bihar campaign is the creation of additional sites for the rounds to reach uncovered areas and ensure vitamin supplementation to children from excluded areas.
"Additional sites were created to significantly increase outreach to children, which is reflected in the fact that each additional site, on an average, gave Vitamin A dose to approximately 115 children during the round which were otherwise missed," says Joshi.
Once known for lawlessness and crushing rural poverty, Bihar – now under the aegis of chief minister Nitish Kumar who was returned to power in 2010 for a second five-year term – is witnessing more growth and development.
The outcome is visible in the villages of Vaishali, a district contiguous to state capital Patna but with pockets of poverty despite the overall resurgence in the otherwise backward state.
Elderly village woman Shanti Devi says she does not care to know the exact benefits of Vitamin A. But since it is good for the children, she will take her six-month-old grandchild for the doses when he reaches nine months. "My grandchild is now only six months old. So we have to wait for three more months, but surely I will get him the doses," says Shanti Devi.
Vitamin A is an important micronutrient for maintaining normal growth, and is essential for a well-functioning immune system and visual and reproductive functions.
"The Bihar programme is special for several reasons," explains Joshi. "The additional site approach apart, the campaign and distribution is powered by the use of 80,000 Anganwadis (government-sponsored child and mother care centres of India), and accredited social health activists." "Our efforts are to create new additional sites as per local conditions and reach more to the backward caste and tribal habitations (known as the Schedule Caste and Scheduled Tribes)," she says.
Joshi’s words find meaning in the villages of Vaishali district.
In Bhagwanpur Rati village, Priya Devi is an Anganwadi worker whose easy access to every household helps her spread the word about the Vitamin A rounds.
"We undergo training and then fan out to survey the 9- month to 59-month-old children," says Priya Devi. "We educate the mothers, tell them what to feed their babies to provide nutrition and also ask them to come to the centres for check ups."
The Anganwadi workers in Bihar are supported by a strong contingent of trained nurses and midwives.
At Mansurpur health sub-centre in Vaishali district, nurse Amita Kumari says, "We remove misconceptions among the villagers about the doses and they have all wholeheartedly accepted us."
The latest coverage data indicate that in the first semester of 2009, VAS in Bihar reached 13.4 million nine to 59-month-olds, or 95 percent of children in this age group.
As Mukesh Kumar, district anaemia extender of UNICEF in Vaishali, points out: "The Vitamin A campaign has really caught on in Bihar with the villagers recognising it as the chhamachwali dawa (the medicine in spoon) and accepting it without any inhibition."

MALARIA: Sickle cell disease still feared and deadly

  Photo: IRIN: Some 200,000 babies are born every year in sub-Saharan Africa with sickle cell disease

BANGKOK, 30 December 2010 (IRIN) - A century after the drawing of an anaemic patient’s sickle-shaped red blood cells came out of Chicago in the USA - a sketch that officially placed this still pervasive genetic disorder into medical books - confusion, discrimination and lack of treatment continue to surround sickle cell disease (SCD), especially in Africa where more than 200,000 babies are born every year with the disease. “Sickle cell is a true public health problem with medical, human and social dimensions,” Oumar Ibrahima Touré, Mali’s health minister until earlier this month, told IRIN.
Despite advances in treatment and research over the past century, SCD is still largely undiagnosed in the world's most affected areas where the problem is too complex for any quick-fix solutions, researchers say. And without treatment there is a 50 percent chance a sickle cell patient will die before the age of five, most commonly of a blood infection.
For its impact on lives and livelihoods, SCD has been deemed a “threat to the economic and social development of Africa” by the West Africa-based Federation of Associations Combating Sickle Cell Disorder in Africa (FALDA).

Still misunderstood
“People still don’t know about this sickness and there’s a lot of judgment, forcing sick people to hide,” said Dramane Banao, president of a national initiative to fight SCD and mother of a 19-year-old woman with SCD in the West African country of Burkina Faso.
Sickle cell disease is inherited and present at birth, but can show no symptoms for the first four months of life.
Characterized by irregular haemoglobin (iron-rich, oxygen-transporting protein in red blood cells), the disease causes red blood cells to morph into a sickle-shape (crescent) instead of a disc, which leads to clumping and blocked blood vessels.
This clumping can cause pain, infection and, in some cases, organ damage. When sickle-shaped cells die, sickle cell anaemia, the most common form of SCD, takes hold.
Anti-cancer drugs and bone marrow transplants have extended the life expectancy of sickle cell patients into their 50s.
“Life expectancy has increased, which is a huge accomplishment in the fight against the disease,” Dapa Diallo, director-general of the Centre for Sickle Cell Disease in Mali, said. “Sickle cell cannot be cured, but with proper care [the health of a patient] can be improved.” But life expectancy for a person with SCD in Africa, where a proper diagnosis is scarce, is still less than 20 years on average. “They didn’t know at all what the sickness was and treated me for malaria,” Abdoul Karim Ouedraogo, a 42-year-old sickle cell patient, said. At first, he was thought to be cursed, and now walks with crutches when SCD, prior to his diagnosis, damaged his hip.

An iron-rich protein in red blood cells that carries oxygen from the lungs to the entire body. Sickle cell disease is characterized by irregular haemoglobin. Healthy red blood cells live about 120 days in the bloodstream, but sickle-shaped ones die within 20 days, which creates a shortage of red blood cells and less oxygen movement. This is the most common form of sickle cell disease.

Inherited disease:
When an offspring is born to two parents who carry the sickle cell trait.

Sickle cell crisis
Sudden pain throughout the body when blood clumps and oxygen is not delivered. A crisis can last from hours to weeks.

Sickle cell trait
Carrying one copy of the sickle cell gene does not translate into experiencing symptoms of the disorder; rather, the trait is passed to offspring, which have a 50 percent chance of carrying the disease and a 25 percent chance of having two copies of the trait, and thus having the disease.

Up to one in four adults in sub-Saharan African countries like Nigeria carry the sickle cell trait, according to the World Health Organization (WHO). Though carriers do not necessarily experience symptoms, testing is recommended for genetic counselling. A man and woman, if both are carriers, have a 25 percent chance of having a child with SCD. But the development of genetic testing, which has resulted in improved prenatal diagnosis in some parts of the world, is underutilized in the most heavily affected parts of West Africa, and has even led to discrimination and fear. Finding a marriage partner can prove difficult for carriers of the trait: Carriers can be perceived as being sentenced to having a very sick child. “We see ourselves as burdens on our families,” Moussa Soulale, diagnosed at 13 and now 25, said from Mali where she is a teacher who has learned to live with her illness.
Screening, education, prenatal diagnosis and treatment have proven effective in fighting the disease among smaller populations, such as in the eastern Mediterranean country of Cyprus. But affected countries in Africa - where some populations have up to a 45 percent carrier rate, according to WHO - pose other challenges.
“The level of care and quality of management of the crisis are not well studied in Africa,” said Brahima Soumaoro, a Mali-based medical researcher. There is an urgent need to put in place training for health workers “based on standards of proven efficacy,” he said, in the hope of containing SCD as it has been contained in the USA and Europe.

1910: James Herrick, a doctor in Chicago in the USA notices “peculiar elongated and sickle shaped” blood cells in Walter Clement Noel, a dental student from Grenada suffering from anaemia. Sickle cell disease, though known for years in Africa, was then formally reported in the US medical journal, Archives of Internal Medicine.
1917: The genetic basis for sickle cell is first suggested by Victor Emmel, an American anatomist, in the US medical journal, Archives of Internal Medicine.
1922: Three more cases are reported in the USA and the disease is formally named.
1923: Doctors at the Maryland-based Johns Hopkins University conclude sickle cell disease is an “autosomal recessive characteristic” - two copies of the gene must be present for it to be expressed.
1927: It is discovered that “sickling” happens because of a lack of oxygen.
1940: The connection is made between abnormal haemoglobin and the tendency of red blood cells to sickle.
1949: It is determined that carrying the sickle cell trait can be symptomless.
1954: Anthony Allison hypothesizes that the sickle cell trait offered protection against malaria. As more research was done, it is discovered that those with the sickle cell trait, not the disease, are protected against malaria. But those with sickle cell disease either die from the blood disorder or die after coming into contact with malaria because of a weakened immune system. Subsequent research has called into question the sickle cell trait’s ability to protect against malaria.
1970s: Forced testing for black people proliferates when sickle cell screening programmes began in the USA.
1979: Calculations suggest the sickle cell gene developed 70,000-150,000 years ago.
1994: It is recognized that all of the areas where sickle cell disease originated have been, or are now, endemic locations of malarial infestation.
1995: Hydroxyurea, an anti-cancer drug, is found to be an effective therapy in reducing complications from SCD.
1996: Bone marrow transplants are now used to treat sickle cell disease in children.
1996: The Federation of Associations Combating Sickle Cell Disorder in Africa (FALDA) is formed.
2000: The introduction of pneumococcal vaccine greatly reduces child mortality in the USA as those with SCD were at high risk of developing pneumococcal meningitis.
2003: Hydroxyurea increases life expectancy for sickle cell patients.
2010: Mali President Amadou Toumani Touré opens a research centre to promote SCD research, training and genetic counselling for medical follow-up, with the ambition of creating globally influential advancements. Touré calls the centre part of the fight against poverty.

POVERTY: PAKISTAN: Child domestic workers at risk of violence

  Photo: David Swanson/IRIN:  According to official figures, there are three million child labourers in Pakistan (file photo)

KARACHI, 30 December 2010 (IRIN) - In recent months stories in the Pakistani media of horrendous abuse suffered by some children engaged in domestic work have focused attention on their plight. In Karachi, the capital of the southern province of Sindh, this month, 14-year-old Muhammad Zafar was rescued by police after neighbours reported the boy had been kept shackled at the home of his employers. He had also not been paid wages for some 19 months. “His employers told us he had stolen gold items, and we could not see him or take him away till these had been paid for,” Zafar’s mother, Parveen Bibi, told IRIN. She said the boy had been sent out to work as the family was very poor.
At a busy fast-food outlet in Karachi, several small girls watch over children they are paid to “mind”. Their charges are in many cases barely a few years younger than themselves. In houses across cities, it is common to see children sweeping floors, washing dishes or performing other kinds of work. They are a part of the child labour force, which consists, according to official figures, of three million children under 18. Of these, according to a 2003 survey in six major cities by the government’s Commission for Child Welfare and Development, 8 percent are engaged as domestic workers.
The International Labour Organization (ILO) puts the number of children working in the domestic sector at 264,000, according to a 2004 report.
“The abuse of children who work as domestic labourers is under-reported. These children are often trafficked from rural areas of Sindh and the Punjab, and brought to cities to work. As such they have no one to watch over them and are vulnerable to violence,” Salam Dharejo, national manager at the Child Labour for the Society for the Protection of the Rights of the Child NGO, told IRIN. He said this year they had documented six cases of death among child domestic workers as a result of violence inflicted on them.
It is believed that rising inflation is forcing families to send their children out to work. “Hardship for almost all families is increasing because food is more expensive,” Sikander Lodhi, an economic analyst, told IRIN.
According to the Consumer Price Index of the Federal Bureau of Statistics, annual inflation was running at 15.37 percent in November 2010. Food price inflation is a key factor in this trend.
“Poverty is a huge factor in people sending children out to work, or selling them to those who use them as labour. The recent floods have also brought an increase in child labour, as people who came into cities after being displaced from poverty-stricken districts in Sindh and the southern Punjab saw opportunities to obtain employment for children in urban households,” Dharejo said. “My ten-year-old daughter now works in a big house, looking after a two-year-old and doing some cleaning chores. I worry about her constantly,” Saadia Bibi, 40, told IRIN.
Torture, sexual abuse
She has good reason to worry. Last month, in the southern Punjab city of Multan, a child the same age working as a maid was brutally tortured because her employers believed she was possessed by evil spirits.
There have been other allegations of torture involving child maids although in the high profile case of 12-year-old Shahzia Masih, whose employer was accused of her murder in January this year, a court in November acquitted him of the charges.
Mistreatment of child domestic workers, according to the limited research available, is widespread.
Sexual abuse is not uncommon either. According to the Alliance Against Sexual Harassment (AASHA), comprising a group of organizations working against the harassment of women in the workplace, 91 percent of female domestic workers say they have suffered sexual abuse.

Wednesday, 29 December 2010

POVERTY: Could Ivory Coast turmoil make chocolate more expensive?

By Mark Gregory : BBC News

A Baoule farmer gathers cocoa beans on November 17, 2010 in Zamblekro, a village near the city of Gagnoa  Ivory Coast's cocoa farmers will find a way of getting their beans to market

Chocolate lovers everywhere have reasons to be nervous about the political turmoil in Ivory Coast. The West African nation produces nearly 40% of the world's raw cocoa.
And without cocoa, of course, there would be no chocolate.
Already the wholesale price of this crucial raw ingredient in one of the planet's favourite foods has doubled in the last four years.
And that was before the single largest producer of the commodity began its recent slide towards conflict.
So will Ivory Coast's problems push up the price of a bar of chocolate in the shops?
In some respects they already have.
The current stand-off between incumbent President Laurent Gbagbo and Alassane Ouattara, the man held by the United Nations to have won recent elections, follows years of tensions.

'Sapped confidence'
"The tensions have starved Ivory Coast of investment and sapped the confidence of cocoa growers," Laurent Pipitone, an expert in economic issues at the London-based International Cocoa Organisation, told the BBC.

Cocoa Highs and Lows
Cocoa farmer

Dec 2009: $3,510/ tonne; Nov 2010: $2,666; Dec 2010: $3,000
Cocoa accounts for 6-8% of cost of chocolate bar

"It takes three years for a cocoa bush to become productive after it's been planted," he says.
With the political outlook uncertain, farmers in Ivory Coast have been less willing to take the financial risk and put in the effort required to grow more cocoa, which means the country's productive capacity has gone into gradual decline. This has been one reason why world cocoa prices have risen in recent years. But intriguingly, the general view among analysts seems to be that the latest escalation of political tension will not make matters much worse than they already are. That is partly because of the nature of cocoa production. Ivory Coast's crop is produced by thousands of independent small farmers. The chances are that in the short term they will carry on working, whatever the political environment.
"The farmers need the income," explains Mr Pipitone. "They may stop planting new cocoa plants but they won't stop producing with what they've already got," he says. He also believes the growing political crisis will not stop the farmers getting their products to market.

Disease impact
If the normal channels for selling their products get closed off by unrest in the main city, Abidjan, Ivory Coast's farmers will simply move more of their cocoa in small quantities across borders into neighbouring countries where they can sell it, he believes. However, the international price of cocoa has risen about 12.5% since early November as a direct consequence of the problems in Ivory Coast.

Cocoa is traded in two places: London and New York. The price - currently around $3,000 (£1,900) a tonne in New York - is still actually a lot lower than it was in the early part of 2010.

Protests in Bouake, in central Ivory Coast, 4 December 2010.  The election dispute has sparked protests and violence In New York, the price hit a 30-year high of around $3,510 (£2,350) a tonne in December 2009. In London, the peak came a few months later in July. At those times the world really was facing a real prospect of a cocoa shortage, which made the price shoot up. The key issue then was not so much political uncertainty in Ivory Coast - though that was a factor - but the impact of disease. Ivory Coast is the world's largest cocoa producer but Ghana and Indonesia are also important players. This time last year, Ghana's cocoa industry was battling against "black pod" and "swollen shoot", while Indonesian farmers were up against "VSD" (Vascular Streak Dieback). Chocolate lovers will be relieved to know that all these forms of disease appear to be on the wane. Indeed, this year, after a run of poor harvests, Ghana's cocoa farmers have enjoyed a bumper crop.
Higher exports from Ghana are expected to partly offset any shortfall from Ivory Coast. Ivory Coast has suffered similar disease issues to neighbouring Ghana but not to the same extent. Its problems have been more of a political nature. The net effect is that cocoa prices are higher than they were several years ago, partly due to the ongoing impact of tensions in Ivory Coast. But prices are not as high as they were a few months ago when the main issue was disease in Ghana and Indonesia.

A man stands next on cocoa bags in front of a warehouse at the Abidjan port on December 9, 2010

'Changed recipes'

The international price of cocoa has risen by 12.5% since November So what does all this mean for the cost of a bar of chocolate? It is hard to know exactly. Cocoa is the ingredient that makes chocolate special but industry experts say the raw ingredient only accounts for 6-8% of what the consumer pays for the final product. The rest is partly the cost of other ingredients such as sugar and milk, but more importantly it includes manufacturing, distribution, advertising and the chocolate makers' profit. Nonetheless, analysts say high cocoa prices over the last few years have had an impact on the way chocolate is made and sold. It is reported that some manufacturers have changed their recipes, reducing the amount of raw cocoa they use.
Others have reduced the size of the products they sell while keeping the price the same. The pricing strategies used by the world's major chocolate makers are, it seems, every bit as complicated and hard to unravel as the political intrigues in Ivory Coast.


User-friendly, a mass of information

Feed the Future Icon   Global Health Icon

POVERTY: USAID to have website "Dashboard"

29 December 2010 (IRIN)
USAID intends to give agriculture in Southern Africa a big boost in 2011, according to the new US aid websiteJohannesburg, - In its bid to become more transparent, the US government has launched a new “Dashboard” website to show foreign aid flows.
The US government spends more than US$58 billion a year in foreign assistance through more than 20 agencies. Total government expenditure is over three trillion (thousand billion) dollars annually.
Though the USA is the world’s largest aid donor, it devoted only 0.2 percent of its Gross National Income (GNI) to Official Development Assistance (ODA), according to 2009 figures released by the Organisation for Economic Co-operation and Development - far short of the 0.7 percent of GNI commitment made by rich countries in 1970.
The “Dashboard”, still incomplete, only provides details of aid managed by the state and the US Agency for International Development (USAID) amounting to $37 billion. Peace and security tops the list of sectors which receive foreign assistance - nearly $11 billion. Humanitarian aid gets the fourth highest amount - just over $4 billion.

POVERTY: Microfinance faces hurdles in empowering Afghan women

 December 28, 2010 :  By Michelle Nichols: Additional reporting by Hamid Sayedi; Editing by Paul Tait and Nick Macfie
Safia, an Afghan woman who benefits from a microfinance loan program, works at her beauty salon in K  Picture taken December 21, 2010. REUTERS/Omar Sobhani : Safia (R), an Afghan woman who benefits from a microfinance loan program, works at her beauty salon in Kabul December 21, 2010. More than 1.5 million loans worth $831 million have been given out in the past seven years, said the Microfinance Investment Support Facility for Afghanistan (MISFA), which was set up by the government in 2003 to coordinate the sector.

KABUL (Reuters) - In a dimly lit room at the back of an Afghan house, 21-year-old Zahara is crouched on a plank of wood weaving a large carpet on a loom that she was able to buy using a microfinance loan of $1,100.
Zahara started weaving carpets when she was 10 and did not go to school, but the loan from non-profit development group BRAC allowed her to start her own business about 18 months ago and she has since taken out two more loans of $330 each.
"When I first got the money, the carpets I was making were small and now I can make bigger carpets," said Zahara, who heard about microfinance loans from her neighbor in Kabul. "Before I made carpets for other people and now I make them for myself."
More than 1.5 million loans worth $831 million have been given out in the past seven years, said the Microfinance Investment Support Facility for Afghanistan (MISFA), which was set up by the government in 2003 to coordinate the sector.
Thirty years of conflict have shattered Afghanistan's economy and infrastructure, leaving two-thirds of the roughly 30 million population illiterate and at least a third in dire poverty.
Aside from security fears, microfinance is facing a shortage of skilled people to run programs, as well as challenges in reaching sparsely populated rural areas and religious concerns among conservative Muslims about paying interest.
"If you talk to the real villagers, they need money," said Fazlul Hoque, head of non-profit development group BRAC in Afghanistan, which is responsible for half the country's 430,000 microfinance clients. "We need to establish a credit culture."
Unlike traditional bank loans which require paperwork such as proof of identification and income, many microfinance lenders simply require borrowers to become part of a support group and verify their ability to repay.
The average annual income in Afghanistan is $370, according to the World Bank. But Hoque said the default rate on BRAC loans was low, around 3 or 4 percent.

Microfinance -- developed more than 30 years ago by Bangladeshi economist Muhammad Yunus, who won the Nobel Peace Prize in 2006 for his efforts -- traditionally targets women. MISFA said 60 percent of current Afghan clients are women.
"Women are ignored, so one of our social missions is to bring them out, so that there will be a kind of dignity of women, they can have a better position in the family," said Hoque, adding that more than 80 percent of BRAC's clients were women.
But the independent Afghanistan Research and Evaluation Unit (AREU) said it would take more than access to microfinance to empower women and build their social status.
"Credit can be a means to assist women to achieve more decision-making power and autonomy, but there needs to be a purposeful, culturally attuned strategy in place to support this process," said Paula Kantor, an AREU visiting researcher and former director of the unit.
There are enduring limits on women's rights across Afghanistan more than nine years after the strict Islamist Taliban were ousted after more than five years in power, during which women were made to wear all-covering burqas and were rarely allowed out in public for education or work.
A U.N. report earlier this month found that millions of Afghan women and girls suffer from traditional practices such as child marriage and "honor" killings, and that authorities are failing to enforce laws protecting them.
AREU senior research officer Sogol Zand has been studying microfinance and gender in Afghanistan and said that when a loan helped improve a family's economic situation it reduced domestic violence, but when a family found it difficult to repay their loan, the violence increased.
Microfinance also faces a religious hurdle because Islamic law prohibits the payment or acceptance of interest fees. Some microfinance organizations try to work around this by calling an interest payment an administrative or service charge.
MISFA is working to develop a loan that would be compliant with Islam, while some smaller microfinance groups such as FINCA, which has about 9,000 Afghan clients, already offer such loans.
"There are indeed a number of Afghans who do not participate in mainstream microfinance ... for fear of social pressure," said MISFA Managing Director Katrin Fakiri. "Potential borrowers must have a choice between Islamic or conventional loans."

Fakiri said the Afghan microfinance sector was consolidating to ensure it grows responsibly and to address its challenges, the most obvious of which was poor security limiting expansion.
"What makes this worse is the fact that many government entities at the regional level have no adequate knowledge of microfinance, its social mission and the fact that it is a government-supported national program," Fakiri said. "As a result, support for microfinance on the ground is weak."
But the biggest problem was finding people with the skills to run the programs. Fakiri and Hoque said a lack of educated staff created other issues such as mismanagement, miscommunications and misperceptions.
Fakiri said MISFA was educating local government and microfinance staff about the sector and had teamed up with the Central Bank of Afghanistan, the Afghanistan Banking Association and international donors to create the Afghanistan Institute of Banking and Finance, which offers a basic microfinance course.
Safia, 32, took out a BRAC small business loan for 70,000 Afghanis ($1,555) so she could improve her beauty shop in the Kabul neighborhood of Polisukhta. A large vase with fake pink flowers adorns the window of Stara Beauty Parlor, where Safia and her employee do hair and make-up.
Safia had to ask permission from her husband to get the loan, but said her success had earned her more respect from him.
Posters of heavily made-up women with elaborate hairstyles decorate the shop walls and a thin curtain in the front window hides customers from people passing on the busy street outside.
"When I got the money it helped me to do a lot of work in my shop," said Safia, a mother of two. "I will be able to make an independent future."

POVERTY: AFGHANISTAN: Bleak outlook for food security in 2011

 Photo: Akmal Dawi/IRIN : Over 7 million Afghans need food aid

KABUL, 29 December 2010 (IRIN) - The UN World Food Programme (WFP) plans to assist 7.3 million people in Afghanistan in 2011 but only has enough funding to feed the most vulnerable for a few months, and needs US$400 million to continue its humanitarian activities next year.
WFP appealed to donors for urgent funding through a Consolidated Appeals Process (CAP) launched on 5 December with the aim of making up a food shortfall of 103,600 tons (costing about $157 million) until June.
The UN Secretary-General warned in a December report that the funding shortfall could affect all WFP projects, including school feeding and food-for-work.
“If additional support cannot be obtained, WFP will have to cut planned food distribution activities throughout Afghanistan,” said the report.
Thus far no WFP project has been suspended and the organization said it was utilizing resources so as to avoid cutting food assistance to the most vulnerable.
“We have prioritized our activities to maintain lifesaving food assistance, including support for mothers and children, and for people affected by conflict or natural disaster,” Challiss McDonough, a WFP spokeswoman in Kabul, told IRIN.
Recent funding from the USA and Canada eased wheat shortages faced by WFP following the catastrophic floods in Pakistan in July. But the US-funded Famine Early Warning System Network (FEWS-NET) has predicted that over half of the country would be highly or moderately food-insecure in January-February. It said wheat prices had increased by over 31 percent since July 2010 and further increases were likely in the coming months.
Afghanistan remains among the most food-insecure countries in the world where armed conflict and natural disasters have denied access to adequate food to over eight million people, aid agencies say. They also think the humanitarian situation is likely to deteriorate in 2011.

Fighting, displacement and food
Afghan and foreign forces have been using military helicopters to deliver aid supplies to at least three provinces, the NATO-led International Security Assistance Force said.
Hundreds of families have reportedly been displaced in the southern provinces of Kandahar and Helmand where US-led forces have been locked in battle with the Taliban.
Aid officials in both provinces said they urgently needed food for distribution to conflict-affected internally displaced persons and other vulnerable groups.
“We have requested food aid for 2,500 families but have not heard from WFP and other aid organizations yet,” Ghulam Farouq Noorzai, director of the refugees and returnees department in Helmand, told IRIN, adding that 900 of the families had been displaced from Marjah and Nad Ali districts in Helmand Province.
Meanwhile, winter is also having an impact: In the northeastern province of Badakhshan, officials said roads to 10 districts had been blocked by snow and there were concerns about food shortages.
“Food prices have hiked significantly and we are extremely concerned about the situation of inaccessible vulnerable families,” said Sayed Nasir Hemat, head of the Afghan Red Crescent Society in Badakhshan, adding that his organization did not have adequate resources to respond.


Rice production has increased markedly in the eastern Nangarhar Province, Afghanistan

MALARIA: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka

Lynsey Addario for The New York Times

By DONALD G. McNEIL Jr.: Published: December 27, 2010
 Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts.
Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do.
The country — the former British colony of Ceylon, famous for tea and cinnamon — is an island, so eradication is possible.
That almost happened once. After independence arrived in 1948, Sri Lanka had an estimated one million annual cases. With DDT and chloroquine, it drove that down to 18 cases by 1963. But spraying was cut back as DDT fell into disfavor, and by 1969, there were more than 500,000 cases.
Simultaneously, the country’s ethnic fabric fell apart. The majority Buddhist Sinhalese passed laws discriminating against the Hindu Tamils, who were favored under the British, leading to 30 years of civil war. The majority was also split for decades between pro-Soviet and pro-Western factions.
Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest. Nonetheless, by 2005, the country was below 2,000 cases, though experts said they were undercounted in rebel areas.
Last year, the rebellion was crushed, and malariologists hoped the new national reconciliation policy would lead to eradication. As cases ticked up, a ministry official blamed global warming — a weak argument in a wet tropical country. But he also said more clinics would be opened in former rebel areas.

POVERTY: COTE D'IVOIRE: Political impasse sparks food price hikes

  Photo: Alexis Adélé/IRIN:  Vegetable sellers say many would-be clients walk away when they hear the cost of goods

ABIDJAN, 28 December 2010 (IRIN) - While political rivals in Côte d’Ivoire trade barbs, diplomats make declarations and regional groups issue warnings, many Ivoirians are eating less so they can feed their children, as prices for basics like cooking oil, rice and flour climb, in some cases doubling.
For now the crunch is hitting mostly poor families, Ivoirians in the commercial capital Abidjan told IRIN. This is a growing population group: In 2008 nearly half of Côte d’Ivoire’s then 20 million people were below the poverty threshold of about US$1.25 per day, compared to about one-third in 2000, and 38 percent in 2002, according to the International Monetary Fund (IMF).
“Poverty has increased on a steady trend [in the past 20 years] as a result of the successive socio-political and military crises,” IMF said in a May 2009 country report.
“We’re at the end of our tether,” Françoise Mahan, a midwife in Abidjan’s Abobo District, told IRIN, one month after the presidential run-off election which ended in unprecedented deadlock with two political camps claiming power. Already after the October first round, tensions led to some prices creeping up.
“I can no longer get what I need at the market with 2,000 CFA francs [$4] for my family of three. Now I need about 50 percent more - but at the moment we just can’t afford that.”
Food prices are soaring in Abidjan and other main cities. In the northern city of Odienné and in Gagnoa in central Côte d’Ivoire, before the election crisis a kilogram of sugar cost the equivalent of about $1.25. It now costs $2.40; and the same goes for a litre of cooking oil. A sack of rice now costs around $35 in Odienné and the centre-north city of Korhogo; families could buy the same sack before the political crisis for around $26.
In Abidjan a kilogram of meat cost $2.80 before; now prices range between $4.40 and $5.
As the government of the internationally recognized president, Alassane Ouattara, called for a nationwide strike to begin on 27 December - to try to force incumbent President Laurent Gbagbo to step down - many Ivoirians are simply trying to make ends meet.
“We heard about the strike call,” said a youth in the central town of Gagnoa. “But it’s the holiday season and some people wanted to come out and try to make at least a bit of money.”
Karim Koné, petrol station attendant in Abidjan’s Adjamé District, said he eats less per day to make whatever food the family has go further. “I’ve started depriving myself of food during the day. I prefer to leave whatever I’d eat in the middle of the day for the family’s evening meal.”

Snowball effect
People’s lack of buying power is hitting vendors and this is having a snowball effect. “Before, I could make about 15,000 CFA francs [$30] a day, but since about a week ago that’s impossible,” said meat vendor in Adjamé Ousmane Diallo. “People just aren’t buying.”

  Photo: Monica Mark/IRIN :  "Everyone's having a tough time," said one vendor

In Abidjan’s wealthier neighbourhood of Cocody, Fatim Touré sat waiting for clients. “Many people just turn around when I tell them the prices,” she told IRIN. “But it’s not the vendors’ fault; with this crisis, hauliers are charging more for moving vegetables into Abidjan.” She said a sack of aubergines which used to cost her $20, now cost $26.
For now petrol prices, which fluctuate periodically, have not yet risen significantly during the crisis; but chauffeurs told IRIN given the instability fewer drivers are venturing out and transport prices – for both passengers and goods – are up.
“Some of our colleagues have not come out because of the strike,” Abidjan taxi driver Drissa Fofana told IRIN. “But we’ve got to feed our families. The situation is tense so we take the risk; we’ve doubled our tariffs, even if petrol prices have remained the same.”
Cooking fuel is costing families more: In Abidjan a 12-kg bottle of propane gas that went for about $9, now costs about $13. A market vendor in Gagnoa told IRIN charcoal there used to be $10 a sack; now it’s double that.
“Everyone's having a tough time, so one really can’t blame the vendors,” said the mother of seven who sells juices and other items in a Gagnoa market. The crisis has simply worsened what was already a bad situation for her family; she said her husband is unemployed and they cannot afford to put their children in school.
Higher-income families in Abidjan are able to keep extra food at home just in case of further unrest. Some said the most significant impact for now is that they feel confined to their homes.
“Every week we stock up at the supermarket, just in case,” bank executive Bertrand Comoé said. “I don’t allow the children to be out after 6pm. Everyone is home by that hour; it’s like a prison. It’s stressful, but we have to do what we can to avoid the worst.”
A 5 December joint statement by the African Development Bank and World Bank expressed concern about the political situation’s impact on the average Ivoirian. Having re-engaged in Côte d’Ivoire in 2008 after suspending relations in 2004, the World Bank has closed its office in the country and stopped disbursing funds since the election crisis.
“The sustained crisis in Cote d'Ivoire will drive many more Ivoirians further into poverty and hurt stability and economic prosperity in the West African sub-region,” the statement said.

Tuesday, 28 December 2010

MALARIA: Community response to intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea

Christopher Pell et al. Malaria Journal 2010, 9:369 Published: 22 December 2010
Building on previous acceptability research undertaken in sub-Saharan Africa this article aims to investigate the acceptability of intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea (PNG).

A questionnaire was administered to mothers whose infants participated in the randomized placebo controlled trial of IPTi. Mothers whose infants participated and who refused to participate in the trial, health workers, community reporters and opinion leaders were interviewed. Men and women from the local community also participated in focus group discussions.

Respondents viewed IPTi as acceptable in light of wider concern for infant health and the advantages of trial participation. Mothers reported complying with at-home administration of IPTi due to perceived benefits of IPTi and pressure from health workers. In spite of patchy knowledge, respondents also demonstrated a demand for infant vaccinations and considered non-vaccination to be neglect. There is little evidence that IPTi has negative impacts on attitudes to EPI, EPI adherence or existing malaria prevention practices.

The degree of similarity between findings from the acceptability studies undertaken in sub-Saharan Africa and PNG allows some generalization relating to the implementation of IPTi outside of Africa: IPTi fits well with local health cultures, appears to be accepted easily and has little impact on attitudes towards EPI or malaria prevention. The study adds to the evidence indicating that IPTi could be rolled out in a range of social and cultural contexts.

MALARIA: The reality of using primaquine

Kathy Burgoine et al. Malaria Journal 2010, 9:376  Published: 27 December 2010

Primaquine is currently the only medication used for radical cure of Plasmodium vivax infection. Unfortunately, its use is not without risk. Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency have an increased susceptibility to haemolysis when given primaquine. This potentially fatal clinical syndrome can be avoided if patients are tested for G6PD deficiency and adequately informed before being treated.

Case presentation
A 35-year old male presented to our clinic on the Thai-Burmese border with a history and clinical examination consistent with intravascular haemolysis. The patient had been prescribed primaquine and chloroquine four days earlier for a P. vivax infection. The medication instructions had not been given in a language understood by the patient and he had not been tested for G6PD deficiency. The patient was not only G6PD deficient but misunderstood the instructions and took all his primaquine tablets together. With appropriate treatment the patient recovered and was discharged home a week later.

Whilst primaquine remains the drug of choice to eradicate hypnozoites and control P. vivax transmission, the risks associated with its use must be minimized during its deployment. In areas where P. vivax exists, patients should be tested for G6PD deficiency and adequately informed before administration of primaquine.

POVERTY: SUDAN: Southern returnee deluge leaves aid workers in a quandary

  Photo: Paul Banks/UNMIS :  A Southern Sudanese returnee family residing in a school premises.

 AWEIL, 28 December 2010 (IRIN) - Build camps and run the risk of long-term dependence, or build nothing and watch basic needs grow: this is the dilemma facing aid workers in Southern Sudan amid an unexpectedly large deluge of people leaving the north of the country in the run-up to January’s secession referendum in the south.
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), some 92,000 people of southern origin, many of them displaced during decades of civil war, had crossed from north to south between October and 22 December, and the rate of return was increasing.
The problem is that many are returning by bus, dropped off in major southern towns with no means of completing their journey to their area of origin.
When IRIN visited Aweil, capital of Northern Bahr al Ghazal State, recently, some 5,000 returnees were stuck in limbo there after spending a week on the road.
They were waiting for basic lifesaving assistance, such as water, emergency health services, and latrines, and also waiting for any word from the state government on what was in store for them next.
A week later, a UN official in the area told IRIN these returnees were still camped in the open air in a makeshift settlement that continued to swell with new arrivals.
“Establishing a formal camp means that people become used to the assistance that is given in the camp, [which] creates resistance to the closure and elimination of these camps,” said Giovanni Bosco, head of OCHA in Southern Sudan.
As Southern Sudan looks towards likely independence following its 9 January referendum, the prospect of multiple new camps outside towns in potentially volatile border states like Northern Bahr al Ghazal and Upper Nile is a significant concern, given the already low levels of infrastructure in the south and the imperative of beginning long-term development work after independence.
“It can take years to close a camp and to do a proper resettlement with durable solutions,” added Bosco.

Makeshift arrival settlements
The dire situation in the makeshift arrival settlements, however, is necessitating a response that the aid community admits could have long-term consequences.
“In an emergency environment and if a population is in need, regardless of where they are, we step in and try to provide them with assistance,” said Lise Grande, who coordinates UN humanitarian operations in the south.
“But we’re very clear that the reinsertion package, which is usually about three months worth of food and support to their households… needs to be delivered in points of final destination. The overall policy is not to have the transit sites become returnee camps,” she said. “But if people are in trouble in transit areas, of course we are going to respond.”
A day before the convoy of more than 600 families was expected to arrive in Aweil, Daniel Gar, the Northern Bahr al Ghazal State official in charge of facilitating their arrival through the government’s Relief and Rehabilitation Commission, said the government was expecting more than 87,000 to return before the referendum.

Allocation of land plots
Asked how the government planned to cope with the influx of new arrivals, Gar said his government “did not have much to give aside from plots [of land].”
“We are asking for the support of the UN agencies and aid groups,” he said.
When the Southern Sudanese government announced in August its plan to bring 1.5 million southerners home before the independence referendum, UN agencies including the International Organization for Migration decided that the organized returns programme proposed by the government could not be led by the international community given the time constraints and the likelihood that this particular returns effort could be interpreted as a political process, notably by the Khartoum government.
In the absence of significant international support for the process, the initial funds allocated by the southern government and by state governments have proven insufficient to support the high numbers of returns, particularly the final step of moving people from the urban centres where they arrive by bus to “points of final destination” in villages and rural areas.
According to OCHA in the southern capital, Juba, and to aid groups operating in towns like Aweil, the problems of funds for transport and the government’s lag in allocating plots for new arrivals in some areas is directly contributing to the threat of the creation of camps.

Monday, 27 December 2010

MALARIA: Spain: Historical aspects

Every summer thousands of us travel to exotic climes with mosquito nets, jungle-strength cream and anti-malarial drugs. But how 'foreign' really is Malaria to Spain and Europe ?
Despite all the concern about climate change enabling malaria to spread to the West, the weather is by no means the biggest factor in determining the presence of malarial mosquitoes. Europe was until the last century rife with the disease. In fact, the last country in Western Europe to eradicate malaria was cold, damp Holland in the late nineteen-sixties.
Malaria, or 'paludismo' as it is also known in Castilian, was endemic to Spain until well into the 20th century. Its existence has had a huge effect on the landscape in certain areas. Much of Spain 's wetland surface area has been drained in the fight to eradicate it. On the flip side, some sites like Doñana have to some extent been saved from extensive rice farming by the presence of malarial mosquitoes.
The disease probably took off from its ancestral enclaves with the Neolithic revolution between 8,000 and 10,000 BC. Sedentary life, the formation of the first villages, land clearance and crops irrigation, the increase in human population (thanks notably to the improvement in living conditions and food availability) certainly favoured the spread of malaria. New strands of resistant parasites would have been brought by the waves of invasions that swept across the Peninsula . We know for example that malaria followed Hannibal in his wake.
By the Middle Ages, kings and noblemen had gained control of the best wetlands for themselves, where they could hunt and earn lucrative profits by exploiting their natural resources (everything from rice cultivation to leech farming). However, these advantages were offset by the fear of marshes as breeding grounds of plagues and incurable fevers. As way of illustration, while the common European word comes from the Latin for 'bad airs', 'paludismo' comes from the Latin 'Palus' for lagoon. Such was the dread of these sites that a royal decree was passed in 11th-century Valencia sentencing any farmer to death who planted rice too close to villages and towns. For centuries afterwards, there was conflict between rice growers and the authorities who passed law after law restricting rice fields to wetlands that were unsuitable for other types of crops.
The disease continued to decimate local populations throughout the centuries and was to spread over the centuries with the increase in rice farming. The only areas relatively free of the disease were the colder northern statelets (Asturias, northern Navarra and Leon.). This north-south divide was patent in the organisation of the ventures of the Conquistadors; soldiers from Asturias , Galicia or Vizcaya would often be rejected for their tendency to suffer chapoteadas - marsh fevers. It was believed that people from malarial zones had developed a certain lucky immunity (I am unaware as to whether there is any real immunity among Spaniards as this is say among Sub-Saharan Africans). There is a long list of famous people who have died here from malaria ( Hannibal 's wife and son-see above, Emperor Isabel, Felipe II, Felipe IV, Felipe V, Fernando VI, Carlos II, Santa Teresa de Jesús, Hernán Cortés.).

Distribution of malaria in Spain in 1786.

An outbreak hit Barcelona in the 1880's as the city ran out of money to finish the Eixample, as is described by Robert Hughes in 'Barcelona'. As speculation sent prices sky high, thousands of investors went bust when the bubble burst and hundreds of plots were left bare for a decade. Here stagnant waters built up, a ripe environ for mosquito larva.
At the turn of the 20th century, malaria was considered the biggest single health risk by the Spanish authorities, and an estimated 800,000 people had malaria in Spain , with some 4,000 dying every year. This concern led to the passing of the Cambó Law in 1918, which gave legal backing to the already strong trend of wetland drainage since the mid-19th century. The law was often ineffective as it allowed for wetlands to be converted into rice fields, though it was responsible for the destruction of much of Spain 's wetland surface area until its repeal in the early 1980's.
Along with drainage, one of the most effective controls was the release in 1921 of a fish called 'gambusia' or mosquitofish, incidentally probably now the most widespread freshwater fish in the world. This little fish is a voracious devourer of mosquito larva and rapidly took to Iberian waters. Improvements in housing, public health and sanitation, and a falling rural population all helped to cut back the parasite, though the Civil War meant a temporary halt to its retreat. Four years after it finished, in 1943, a final serious outbreak hit the country with 400,000 people affected and 1,250 deaths, but by the end of the forties it had been effectively controlled and restricted to a few pockets, with the use of DDT from 1947 onwards delivering the coup de grace .
The defeat of malaria
Malaria was declared officially eradicated in 1964, which was just in time for mass tourism, which certainly would not have taken off had it not been for the parasite's prior eradication. It also coincided nicely with the UN no longer classifying Spain as a Third World country. As all development workers know, malaria is eradicated by means of progress, not by a change in the temperature or necessarily draining all wetlands.
Malaria could indeed return to Europe , but the real trigger would be a massive economic meltdown rather than any rise in temperature, which would only make matters worse.

  Spanish first-day cover in support of the UN's world anti-malarial campaign of 1962, just before the disease was delared erradicated from the country.
Malaria update
Nothing to do with Spain, but following on from the 'Malaria in Spain' thing, I've discovered that Holland wasn't the last place in Europe to be declared malaria-free. Thus: It was not until 1975 that the last pocket of indigenous malaria in Greek Macedonia was considered eliminated and the World Health Organization declared the continent free of the disease. []
However, so called 'imported' as opposed to autochthonous malaria is an increasing problem in Spain and the EU. According to the WHO
Throughout Europe, imported malaria is a growing medical and health issue. Since the early 1970s, the reported number of imported cases increased ten-fold, from 1 500 cases in 1972 to more than 15 000 in 2000.

POVERTY: It's time to focus on poor people – not poor countries

Andy Sumner  Andy Sumner 27 December 2010 :

It's time to focus on poor people – not poor countries
A new approach to reducing poverty is needed in 2011 if people are not to be left behind while their countries get steadily richer

india slumA child stands in a lane of a slum settlement in the northern part of New Delhi, India. Photograph: Amit Bhargava/Corbis

One little noticed story of 2010 was that five more developing countries officially lost their "poor" status.
When the World Bank carried out its annual reclassification in July, Senegal, Tuvalu, Uzbekistan, Vietnam and Yemen all graduated to middle-income status – countries that have reached the $1,000 (£644) or so GDP threshold.
Taken by themselves, not big news perhaps, but add to that 22 other countries which, since 2000, are no longer considered officially poor, then a quite profound global change is under way: in short, most of the world's poor no longer live in "poor" countries.
China was upgraded in 2001 (based on 1999 data) and India, Pakistan, Nigeria and Indonesia are among the other states that have become middle-income countries (MICs). Only 39 states are still considered to be low-income countries (LICs).
As we enter 2011, it is likely that more will follow. Ghana, for example, looks set to graduate in 2011, particularly in light of its new GDP figures unveiled last month. The country will join Senegal, Cameroon, Angola and Sudan, which are among the growing number of African MICs.
On the other hand, given the lingering reverberations of the global economic crisis, there is also a risk that some countries might drop back under the threshold, slipping once again into low-income status. Pakistan or the Ivory Coast might have cause for concern in 2011, for example.
On the whole, this is a good news story, but with an underside. Yes, there are fewer poor countries but poverty remains high in terms of absolute numbers in the MICs.
The news raises some pressing and difficult questions for aid and development policy. As developing countries get wealthier and are reclassified, many are still characterised by persistently high levels of poverty. Indeed, roughly three-quarters of the world's poor now live in MICs – 960 million, or a new "bottom billion". And this isn't just about China and India. Even if they are removed from the equation, the share of the world's poor living in MICs has still tripled since 1990.
In light of the above, how should global poverty reduction be done differently in 2011?
First, the LIC/MIC binary: If the focus is poor people not poor countries then the LIC/MIC way of looking at the world needs a rethink. The new UN multidimensional poverty measure might be one alternative tool. But there are many others.
Second, the end of aid and the equity elephant: overseas development assistance (ODA) is becoming less important and equity more important. More equitable countries reduce poverty faster, and stubborn asset, gender or identity inequality (ie caste systems) might begin to explain persistent poverty amid wealth in the new MICs. This entails some thinking on what ODA is for. Any attempt to discuss inequality will be viewed as an infringement on political sovereignty but is domestic inequality solely a domestic issue if it hinders the effectiveness of aid?
And could there be a case for a new multilateralism based on putting resources from donors and new MICs together? Keep an eye out in 2011: the fact that the world's poor are increasingly found in MICs has the power to shake up the entire aid and development industry.

MALARIA: Cerebral malaria, common cause of epilepsy in children

 Sade Oguntola :  27 December 2010
Cerebral malaria, one of the deadliest forms of malaria, is a medical emergency demanding immediate diagnosis and treatment. Experts warn that malaria is best prevented, especially since its severe form is a potential cause of epilepsy in children, reports Sade Oguntola.
What is your impression of malaria? As a mother, do you see it as a deadly disease or one to be handled with levity? Do you belong to that group of mothers that do not bother to treat malaria in your child when you notice its symptoms?
Well, even if you do not bother that malaria could make your child miss some days at school, experts warn that it should concern you that it might turn out to be cerebral malaria, a severe form of the disease, whose aftermath, when not treated promptly, may be epilepsy.
Cerebral malaria is a severe or complicated form of malaria affecting the brain, occurring predominantly in children, with a mortality rate of 15-25 per cent. It affects about one million children every year, primarily in sub-Saharan Africa. Coma, headaches, seizures, and impaired consciousness are frequent manifestations of this infection.
Children less than five years of age are particularly susceptible because of low levels of immunity. It only takes one bite from an infected mosquito to contract the disease that directly affects the brain, causing fever, vomiting, chills, and coma.
In addition, children with cerebral malaria are at risk of developing several adverse neurological outcomes, including epilepsy, disruptive behavior disorders and disabilities characterised by motor, sensory or language deficits. Since most of the neurological effects did not present themselves immediately, they were not evident at the time of the child’s discharge from the hospital after the initial malaria illness.
A new study on cerebral malaria in African children reported that almost a third of cerebral malaria survivors developed epilepsy or other behavioral disorders.
The research, which appeared in journal, The Lancet Neurology, looked at several hundred children during a nearly five-year period in Blantyre, Malawi. The children were evaluated for cognitive function in three major areas: attention, working memory, and tactile learning. Evaluation was done at hospitalisation, six months after the initial malaria episode, and two years after the episode.
They found that at six months, 21 per cent of children with cerebral malaria had cognitive impairment compared with six per cent of their healthy Ugandan peers. At two years, cognitive impairment was present in 26 per cent of the patients, compared with 8 per cent of the community children.
The researchers involved in this first-ever prospective study of cerebral malaria survivors that included a control group suggested that cognitive impairment may begin to manifest itself months after the initial episode. In fact, cognitive function was most dramatically impaired in the area of attention.
The impact of the findings on African society is no doubt immeasurable. By extrapolation, they stated that about 135,000 African children younger than five years might have developed epilepsy due to cerebral malaria-induced brain injury each year, and cerebral malaria may be one of the more common causes of epilepsy in malaria-endemic regions.
Since these are children that had survived the malaria, but their quality of life and what they contribute to society is severely hampered, the experts declared the need to be more aggressive in treating the two major risk factors: seizures and high fever before better treatment for seizure and fever are identified in hopes of minimising the risk of epilepsy in years to come.
Previous studies had linked epilepsy to disruption of brain development during early childhood - roughly between the ages of one and five -because of the fragility of the brain during this period.
Nonetheless, Dr. Ikeoluwa Lagunju, a consultant paediatric neurologist, University College Hospital (UCH), Ibadan, Oyo State, declaring the importance of preventing malaria, stated that cerebral malaria was a severe form of malaria in which you have malaria parasite invading the brain.
Dr. Lagunju stated:“We see cases of cerebral malaria quite often, particularly during the rainy season. Transmission of malaria parasite is quite high during the rainy season and so you tend to have many cases of malaria and its severe forms during this season.”
According to her, “malaria parasite is usually found circulating in the blood stream and that is why you have fever, vomiting, chills and rigours. But in severe cases, these parasites would go through the blood to the brain and when you have a heavy load of malaria parasite in the brain, it is believed that it could block some blood vessels, cause swelling of the brain and some other abnormalities.
“When this happens, the child becomes unconscious, but afterwards, a number of them recover consciousness. But cerebral malaria is highly fatal and can kill rapidly, with poor management, when it is not recognised or involves someone who has not been in a malaria-endemic area.
However, Dr. Lagunju remarked that in those who survived cerebral malaria, the brain had been affected. “It is a form of injury to the brain. The brain is peculiar in the sense that it does not regenerate. You can injure your finger nail and then it grows back. You can have a wound and then you loss the skin and the skin grows back, but the brain is not like that,” she stated.
According to her, ‘If you have a child who has had cerebral malaria, he may recover from the illness, but then he may have problems with vision and hearing and few of them may later continue to have seizures and have what we call epilepsy.
“So, these are the things that we worry about with cerebral malaria and that is why prevention of malaria remains the best option.”
Certainly, nobody can tell which malaria will be severe enough to involve the brain. According to Dr. Lagunju, the best option is to prevent malaria through the use of insecticide-treated nets, ensure clean surroundings, maintain low lawns and clean drains, prevent stagnant waters and ensure a clean environment.
She reiterated the need for mothers to know how to treat malaria. “Gone are the days of: are you a doctor? Why did you then give anti-malarial medicines? We actually expected that mothers should have a pack of rapidly acting anti-malarial drug that they can readily administer as soon as they notice that the child is unwell. This will help to quickly clear the malaria parasite and reduce the risk of the child going on to develop severe forms of malaria.”
Professor Surajudeen Arigbabu, a consultant neurosurgeon at the Lagos University Teaching Hospital, reiterated that once the brain is injured, it cannot recover. According to him,” for any loss of a part of the brain or an injury, the effect is permanent and for that reason, if a person is diagnosed with cerebral malaria and there is a damage to any part of the brains later in life, that part of the brain that is damaged may become an epileptogenic focus and with resultant convulsions from time to time.”

POVERTY: Diamonds in the Central African Republic

Diamonds are feeding cycles of poverty and conflict in the CAR in much the same way as they did in Sierra Leone and Liberia in the 1990s and early 2000s. The scale of the problem is smaller, because the CAR has fewer diamonds, and its armed groups are less organised, but the dynamics are identical and the human suffering just as real. Misguided governance of the mining sector, in part a legacy of decades of misrule and state fragility, rewards the lucky few, leaves thousands of artisanal miners and their families fighting for their livelihoods and encourages smuggling.

Widespread poverty and well-oiled illicit trading networks enable armed groups to profit from diamonds, and weak security forces can do little to stop them. It is high time the government and international partners paid
more attention to these interlinked issues and committed to genuine reform of the mining sector. The first step is to prise control of the sector from the regime’s grip and open it to national and international scrutiny

Global Fund - timely oversight or trigger happy

Bill Brieger : 26 Dec 2010

In the past year the Global Fund to fight AIDS, TB and Malaria (GFATM) has suspended grants in Mauritania, The Philippines, Zambia, and Mali. In fact one grant to Mali was terminated. Efforts to identify high risk grants are underway.
Some are saying that the Office of the Inspector General (OIG) of GFATM is finally showing some teeth, while others worry that actions to suspend and terminate will harm the very persons that the Global Fund was set up to help. At the recent 22nd GFATM Board Meeting the Executive Director provided the following comments based on OIG work:
Based on recent OIG findings in a number of countries, activities involving cash transfers for training events and associated costs, including per diems, travel, meal and expense payments, are in many cases posing a high risk of misuse
The OIG has identified five countries where measures to protect Global Fund-financed drug shipments from theft need to be implemented
The Secretariat and OIG agree that LFAs have not been sufficiently focused on the identification of fraud risks and actual fraud in Global Fund-financed programs, and may not currently have the capacity to address these risks
Prior to the recent Board meeting, one wonders whether the communication between the Secretariat, the Executive Director and the Office of the Inspector General were clear and efficient. A 6th December 2010 memo entitled “Joint communication on Inspector General matters” mentioned that, “The Inspector General and the Executive Director of the Global Fund have initiated sincere effort towards collaboration to follow up on recent findings by the Inspector General as well as to take steps to permanently strengthen grant oversight.”
The memo concluded that, “The Global Fund, by nature of its mandate, sometimes has to work with entities with weak programmatic and financial capacity, and to operate in environments where there may be a paucity of financial controls and lack of oversight systems. The Global Fund’s risk management systems are constantly improving. Recently discovered fraud has made the Secretariat determined to redouble its efforts to improve these systems.”
In some cases of suspended grants the Global Fund is looking for alternative Principal Recipients to manage the funds or find alternatives to ensure services to those in need do not cease to be served. The concern about the Local Fund Agents is valid since the Global Fund, unlike other international agencies, does not have country offices or provide technical assistance.
Several years ago I worked with a team in Nigeria to design and deliver adolescent and youth peer education on reproductive health through community based organizations (CBOs). The initial effort focused on how to organize and train peer educators and the technical aspects of reproductive health. Eventually it became obvious when one CBO leader was using her personal bank account to keep project funds that the local CBOs needed as much technical assistance in establishing and maintaining proper financial and accounting procedures as they did in organizing peer based reproductive health education.
The Global Fund operates in a scale thousands of times larger that our small peer education projects, but the basic principle remains. Don’t condemn local organizations for poor financial performance if you did not try to help them develop better financial and accountability procedures in the first place.
Currently 22% of grants are considered to be poor performers. Too much is at stake in reaching 2015 and beyond to simply say to poor performers, “sorry, your funds are suspended.”

MALARIA: Malaria transmission and vector behaviour in a forested malaria focus in central Vietnam and the implications for vector control

Wim Van Bortel et al. Malaria Journal 2010, 9:373 Published: 23 December 2010
In Vietnam, malaria is becoming progressively restricted to specific foci where human and vector characteristics alter the known malaria epidemiology, urging for alternative or adapted control strategies. Long-lasting insecticidal hammocks (LLIH) were designed and introduced in Ninh Thuan province, south-central Vietnam, to control malaria in the specific context of forest malaria. An entomological study in this specific forested environment was conducted to assess the behavioural patterns of forest and village vectors and to assess the spatio-temporal risk factors of malaria transmission in the province.

Five entomological surveys were conducted in three villages in Ma Noi commune and in five villages in Phuoc Binh commune in Ninh Thuan Province, south-central Vietnam. Collections were made inside the village, at the plot near the slash-and-burn fields in the forest and on the way to the forest. All collected mosquito species were subjected to enzyme-linked immunosorbent assay (ELISA) to detect Plasmodium in the head-thoracic portion of individual mosquitoes after morphological identification. Collection data were analysed by use of correspondence and multivariate analyses.
The mosquito density in the study area was low with on average 3.7 anopheline bites per man-night and 17.4 culicine bites per man-night. Plasmodium-infected mosquitoes were only found in the forest and on the way to the forest. Malaria transmission in the forested malaria foci was spread over the entire night, from dusk to dawn, but was most intense in the early evening as nine of the 13 Plasmodium positive bites occurred before 21H. The annual entomological inoculation rate of Plasmodium falciparum was 2.2 infective bites per person-year to which Anopheles dirus s.s. and Anopheles minimus s.s. contributed. The Plasmodium vivax annual entomological inoculation rate was 2.5 infective bites per person-year with Anopheles sawadwongporni, Anopheles dirus s.s. and Anopheles pampanai as vectors.
The vector behaviour and spatio-temporal patterns of malaria transmission in Southeast Asia impose new challenges when changing objectives from control to elimination of malaria and make it necessary to focus not only on the known main vector species. Moreover, effective tools to prevent malaria transmission in the early evening and in the early morning, when the treated bed net cannot be used, need to be developed.

MALARIA: Protecting the malaria drug arsenal: halting the rise and spread of amodiaquine resistance

Protecting the malaria drug arsenal: halting the rise and spread of amodiaquine resistance by monitoring the PfCRT SVMNT type

Juliana M Sa and Olivia Twu : Malaria Journal 2010, 9:374 :  Published: 23 December 2010

Abstract (provisional)
The loss of chloroquine due to selection and spread of drug resistant Plasmodium falciparum parasites has greatly impacted malaria control, especially in highly endemic areas of Africa. Since chloroquine removal a decade ago, the guidelines to treat falciparum malaria suggest combination therapies, preferentially with an artemisinin derivative. One of the recommended partner drugs is amodiaquine, a pro-drug that relies on its active metabolite monodesethylamodiaquine, and is still effective in areas of Africa, but not in regions of South America. Genetic studies on P. falciparum parasites have shown that different pfcrt mutant haplotypes are linked to distinct levels of chloroquine and amodiaquine responses. The pfcrt haplotype SVMNT (termed after the amino acids from codon positions 72-76) is stably present in several areas where amodiaquine was introduced and widely used. Parasites with this haplotype are highly resistant to monodesethylamodiaquine and also resistant to chloroquine. The presence of this haplotype in Africa was found for the first time in 2004 in Tanzania and a role for amodiaquine in the selection of this haplotype was suggested. This commentary discusses the finding of a second site in Africa with high incidence of this haplotype. The >50% SVMNT haplotype prevalence in Angola represents a threat to the rise and spread of amodiaquine resistance. It is paramount to monitor pfcrt haplotypes in every country currently using amodiaquine and to re-evaluate current combination therapies in areas where SVMNT type parasites are prevalent.

MALARIA: Malaria Treatment Guidelines - are health workers aware?

Bill Brieger : 26 Dec 2010
Malaria Journal published a few days ago an article comparing the costs of treating children and adults for malaria at a Nigerian hospital based on clinical diagnosis versus treating only when microscopy was positive for parasites. Normally we would pass abstracts from such articles on to members of our listserve (see link at right), but comments from a colleague in Nigeria gave pause.
He rightly pointed out that normally any research that helps us consider the factors involved in proper malaria diagnosis and treatment is welcome as we move toward universal coverage and elimination. His concern was that the researchers, who conducted their study in 2009, had not followed national malaria treatment policy and guidelines, which had been promulgated in 2005 based on the alarming growth of resistance of malaria parasites to the common, though cheap, antimalarials such as chloroquine and sulphadoxine-pyrimethamine (SP).
First the cost findings from the team at Bowen University Teaching Hospital (aka Baptist Medical Center, Ogbomosho) -
For children, testing all but treating only Giemsa positives was $6.04/child
Empiric treatment of all children clinically diagnosed was $4.49/child
For adults, treating only Giemsa positives was $4.84/adult for treatment option one and $4.97/adult for option two
Empiric treatment for adults was $4.14/adult for option one and $4.63/adult for option 2
In spite of the cost findings, the researchers did point out the drawbacks of empirical or clinical diagnosis in terms of accuracy and potentials for promoting drug resistance and called for scale up of rapid diagnostic tests (RDTs) to address these concerns.
The treatment regimens in this study included …
Pediatric patients: artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg on days one to two and 5 mg/kg on day three in suspension)
Adult option one: four and one-half 50 mg artesunate tablets on day one and nine additional artesunate tablets over the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets
Adult option two: four and one-half 50 mg artesunate tablets on day one and nine additional artesunate tablets for the next four days plus nine 200 mg tablets of amodiaquine at a dose of 10 mg/kg on day one to two and 5 mg/kg on day three
National treatment guidelines specifically stress use of artemisinin-based combination therapy (ACT) for basic, uncomplicated malaria treatment.These guidelines are undergoing further revision with a stronger emphasis on ACT use based on RDTs and microscopy where available and recognition of the dangers of monotherapy drugs like chloroquine, SP and even artesunate itself.
The researchers from Ogbomosho are rightly concerned about cost issues, and being a private/NGO university and hospital, they do witness the direct effects of medication costs on patients that health staff in the public sector may not see.
This is still no excuse for not following national treatment guidelines when these drugs were available for their procurement in 2009. Now with the advent of the Affordable Medicine Facility malaria (AMFm) in Nigeria all health facilities, especially NGO hospitals like Ogbomosho, have no reason not to buy and dispense the correct medicines.
To re-emphasize this point, a press release from November 2010 clearly states -
“The Federal Government has directed all medical doctors and other health officials in the country to henceforth start using Artemisinin-based Combined Therapy (ACT) for the treatment of malaria disease in the country. Minister of Health, Prof. Onyebuchi Chukwu, gave the directive yesterday in Abuja during the ministerial press briefing on Affordable Medicines Facility (AMF) for malaria programme. According to the minister, the spread of malaria had become so critical that everyone in the country was now involved.”
We hope health workers in all sectors get the word! Hopefully national authorities will step up their efforts to disseminate guidelines to all front line health workers whether in public, private or NGO sectors.

One Response to “Malaria Treatment Guidelines - are health workers aware?”
on 26 Dec 2010 at 11:07 am 1.Bill Brieger said …
Bright Chukwudi Orji commented on FaceBook …
The Challenge is still the availability of the AMfm drugs. We hope that government will make do their promises and make the drugs available. Out in the field, my primary concern is to put these drugs on the hands of those at risk, but when …the drugs are not available, what happens? However, this is no excuse for the Ogbomoso University not to follow the national anti-malarial drug policy. This brings to mind the question on national ethical review board. I learnt it has been constituted but not sure if functioning and how to reach the board?

POVERTY: NEPAL: Discrimination continues against Dalits

  Photo: Naresh Newar/IRIN:  Dalits are still regarded as “untouchables”

KATHMANDU, 24 December 2010 (IRIN) - Dalit communities, the lowest of the 100 caste groups in Nepal, continue to be marginalized, despite the fact that caste-based discrimination was abolished in 1963, activists say.
"Untouchability and discrimination were legitimized by the state over a century ago," said Bhakta Biswakarma, national head of the advocacy group, Nepal National Dalit Social Welfare Organization (NNDSWO).
"Today we see the state doing little to change the situation. Discrimination against the Dalit as the untouchable caste is still practised so rigidly - especially in the remote areas."
The 1854 Civil Code, introduced by the Rana regime, explicitly declared the Dalits untouchable, the lowest status within the Hindu social hierarchical structure.
This imposed strict regulations on where the Dalit were allowed to live (they could not enter temples or use the same tap water as higher castes), forbad them from education and from participating in community festivals.
Those who defied the law of untouchability were punished; the state imposed the practice of discrimination on society, said Suman Poudel, an official with the Dalit NGO Federation (DNF).
Little has changed for the estimated 23 Dalit communities in the country's hill and Terai regions, despite the propagation of legal rights.

Impoverished and neglected
Dalit communities have the lowest human development rankings in the country: 49.2 percent live below the poverty line compared with a national average of 31 percent, according to the World Bank.
The UN Development Programme (UNDP) says discriminatory labour practices persist in the Terai, where the majority of Dalit live. During annual harvest seasons (March-May and September-November), high-caste landlords reportedly continue to use debt bondage to secure unpaid labour from Dalit labourers.
In the Terai, many Dalits are landless and live on less than US$1 a day, Poudel said, while UNDP assessments reveal that their annual per capita income is less than half that of higher castes ($764 to $1,848) across the rest of the country.
With a literacy rate of less than 33.5 percent above grade six (against 67.5 percent among higher-caste Brahmins), and high rates of school dropout, improving the social condition of Dalit communities is a challenge.

Weak implementation
And while caste discrimination was officially abolished in 1963, experts say the government has been weak in enforcing the ban.
"There are a plethora of policies and laws that have been drafted to protect the Dalit," said Oxfam's Robert Sila, a social inclusion and civil society expert. "But there is no seriousness on the government side when it comes to implementing these policies."
One of the pillars of the government's poverty reduction strategy for a long time has been social inclusion, but there is little evidence of that, Sila says.
However, Sudha Neupane, under-secretary for the gender equality and social section of Nepal's Ministry of Local Development, says the government is focusing heavily on combating discrimination.
"The government is very sensitive to the issue of discrimination against the Dalit," Neupane said.
A starting point would be addressing the controversy over population size. Government statistics show that the Dalit make up nearly 13 percent of the 29 million population, although the Dalit put that figure at more than 20 percent.
"A government cannot effectively address the needs of a population if it doesn't have their exact numbers. It should do a fresh census to determine the real numbers," said Sila.
Nepal's last national census was done in 2001 and a new one is expected in 2011.