Friday, 30 April 2010

MALARIA: GSK Vaccine Mosquitrix

As researchers pioneer the testing of a new vaccine that could protect against malaria, health workers and development practitioners working in Africa are optimistic that the illness will soon meet the same demise as polio. The vaccine, a project twenty years in the making, has been developed by British pharmaceutical corporations GlaxoSmithKline. It is called Mosquitrix, and if tests are successful, it could become available in only two short years.
Malaria kills one child every thirty seconds, making it one of the world’s most dangerous child killers. The majority of all cases occur in Africa and most of the children infected are under five years old. While both treatment and prevention are possible, too many people do not have the resources—both financial and medical—to access either.

Thursday, 29 April 2010

TUBERCULOSIS: XDR-TB in Health Care Workers in South Africa

Healthcare workers in South Africa are at a significantly increased risk of developing drug-resistant tuberculosis, or XDR-TB, in a trend which threatens to further exacerbate the already beleaguered healthcare systems in sub-Saharan countries, according to results of a new study. Researchers say the results underscore the urgent need for stringent TB screening policies among healthcare workers in these areas.
XDR-TB is a potentially untreatable strain of tuberculosis that is resistant to all major primary and secondary anti-tuberculosis drugs. This retrospective study is the first to focus on healthcare workers who have contracted XDR-TB in a non-outbreak setting.

"The purpose of this study was to describe a series of healthcare workers in South Africa with extensively drug-resistant tuberculosis and to determine whether XDR-TB was prevalent among them."
The study was based on a chart review of 270 patients in South Africa with passively detected XDR-TB, including 11 healthcare workers. Of those 11, eight were working in district hospitals, 10 had been treated for TB at least once previously and eight were negative for HIV. At the time these workers were diagnosed with XDR-TB, there were no standard infection control measures in place at the facilities where they were employed.

Dr. Dheda noted that although tuberculosis is a well-recognized occupational risk for healthcare workers in both low- and high-income countries, the prevalence and natural history of XDR-TB in these workers is unknown.
"The emergence and progression of XDR-TB is threatening to destabilize global tuberculosis control," he said. "The negative impact of XDR-TB is further exacerbated by a global shortage of healthcare workers, a shortage which has reached crisis levels in most of sub-Saharan Africa."
"XDR-TB is an important risk for healthcare workers globally, particularly for those who work or travel to high-burden areas, regardless of HIV status," Dr. Dheda added. "Implementation of infection control measures and rapid diagnostic testing for all healthcare workers suspected of TB needs to be undertaken urgently to minimize the risk of drug-resistant TB."

TUBERCULOSIS: MDR & XDR-TB, South Africa mortality stats

In a retrospective study of 174 tuberculosis patients treated at National Jewish Health (formerly National Jewish Medical and Research Center), patients with extensively-drug-resistant tuberculosis (XDR-TB) were almost eight times as likely to die as patients with multi-drug resistant tuberculosis (MDR-TB).
National Jewish Health is a national referral center for the treatment of drug-resistant tuberculosis, and its physicians are recognized worldwide for their expertise in the treatment of drug-resistant tuberculosis.
The study, published in the August 17, 2008, issue of The New England Journal of Medicine, highlights the need for optimal management of multi-drug resistant cases to prevent the progression to XDR-TB, associated with poorer outcomes, including greater risk of death from tuberculosis.
"Over the years, we have become quite proficient at treating multi-drug resistant tuberculosis with initial treatment success rates greater than 90 percent in recent years," said lead author Michael Iseman, MD, Professor of Medicine at National Jewish. "Extensively drug-resistant cases, however, are much more difficult to treat and we still lose more of these patients than we save.
Drug-resistance has become a major problem in the treatment of tuberculosis, making the most effective and best tolerated medications ineffective for millions of patients around the world. Drug resistance arises when inadequate treatment kills most, but not all, of the tuberculosis organisms in a patient; the remaining organisms have often mutated to become resistant to various medications. While multi-drug resistance has been known for many years, XDR-TB was first recognized in March 2006.

TUBERCULOSIS: MDR & XDR, South Africa stats

New forms of highly drug-resistant tuberculosis are emerging and action must be taken soon before they become widespread globally.
Urgent action is needed to implement effective tuberculosis control strategies, especially in countries where tuberculosis control practices have been inadequate.
Research is also needed to assess the extent of the spread of these highly drug resistant strains of tuberculosis worldwide and improved means of diagnosis of tuberculosis and early detection of drug resistance are urgently required, they add.
Among 536 cases of tuberculosis confirmed at a rural hospital in South Africa earlier this year, 41% were multi-drug resistant and of those, 24% met the exact definition of being extensively drug resistant tuberculosis (also referred to as XDR tuberculosis). Such tuberculosis is almost untreatable.
All patients in this outbreak who were tested were HIV positive and 52 of the 53 died after an average of 25 days.
Strains of extensively drug resistant tuberculosis have also been noted in Europe, Asia and North and South America. It appears that there are several strains of this tuberculosis.

TUBERCULOSIS: MDR, XDR, and beta lactams

Tuberculosis (TB) continues to be a global health problem, in part due to the exceptional drug resistance displayed by the TB-causing agent, Mycobacterium tuberculosis. Beyond even acquired drug resistance, these bacteria are also inherently resistant to many other common antibiotics, which limits the available options in finding alternative treatments to resistant TB strains.
However, in a presentation at the American Society for Biochemistry and Molecular Biology's annual meeting, titled "Drug resistance in tuberculosis," John Blanchard of the Albert Einstein College of Medicine discussed his group's work at eliminating this inherent drug resistance, which may help in the battle against the emerging extensively-drug resistant TB strains.
"These XDR strains are even more resilient than multi-drug resistant (MDR) strains," notes Blanchard. They are resistant to almost everything we currently have in the kitchen."
Blanchard, a professor at Albert Einstein's department of biochemistry, and his team have specifically targeted an enzyme called beta-lactamase, which can break down and disable beta-lactams, a large family of antibiotics that includes penicillin and its relatives.
"When the M. tuberculosis genome was sequenced a few years ago, the presence of this beta-lactamase enzyme was discovered," Blanchard says, "which was surprising since beta-lactams have never been systematically used to treat TB."
Perhaps just as surprising was that most scientists didn't pay much attention to the M. tuberculosis beta-lactamase discovery, but Blanchard thought it would be an attractive therapeutic target, considering several beta-lactamase inhibitors had been developed for other bacteria.
"If we could inactivate this inactivator enzyme, it would expose TB bacteria to a whole new range of antibiotics," he says.
While M. tuberculosis was resistant to most beta-lactamase inhibitors, Blanchard's group found that the drug clavulanate was effective in shutting down the TB enzyme. The combination of clavulanate with the beta-lactam meropenem could effectively sterilize laboratory cultures of TB within two weeks, including several XDR-strains.

Tuberculosis: XDR-TB in Burkina Faso

Because data from countries in Africa are limited, we measured the proportion of extensively drug-resistant (XDR) tuberculosis (TB) cases among TB patients in Burkina Faso for whom retreatment was failing. Of 34 patients with multidrug-resistant TB, 2 had an XDR TB strain. Second-line TB drugs should be strictly controlled to prevent further XDR TB increase.

TUBERCULOSIS: Wellcome Library

Two new sources for the study of tuberculosis are now available in the Library's Archives and Manuscripts department.The Library has recently acquired the records of the British Thoracic Society: they have now been catalogued and made available for research. The Society was founded in 1982 as an amalgamation of the British Thoracic Association and the Thoracic Society but it can trace its family tree back to 1910. The Society’s archive thus contains records of predecessor organisations dating back to the 1920s including the Society of Superintendents of Tuberculosis Institutions; The Tuberculosis Association and later known as the British Tuberculosis Association, the British Thoracic and Tuberculosis Association and the British Thoracic Association; the Joint Tuberculosis Council and the Thoracic Society . Over the years, and in its various incarnations, the Society has brought together respiratory physicians, surgeons, anaesthetists, radiologists, pathologists and others working in the field. Its records provide a wide-ranging professional perspective on tuberculosis and lung disease which complements the story told in other collections already held by the Library, such as the records of the lay body the National Association for the Prevention of Consumption and other forms of Tuberculosis.

TUBERCULOSIS: Ethiopia MDR-TB statistics

At St Peter TB Specialized Hospital, high in the mountains of Entoto, north of the Ethiopian capital, Addis Ababa, a masked Johannes is suffering from multi-drug resistant tuberculosis (MDR-TB) and has spent the last month at the hospital.
While the doctors are glad he is receiving treatment, they are also worried – Johannes is a bus conductor in heavily populated Addis Ababa, so there is no telling how many people he could have infected before seeking treatment. Many are unlikely to be diagnosed and treated in time to prevent further infections.
"Diagnosis and treatment of MDR-TB remains a challenge; so far we have only two centres in Addis Ababa that can do the culture and drug sensitivity testing required," Diriba Agegnehu, TB/HIV programme officer for the UN World Health Organization (WHO) in Ethiopia, told IRIN/PlusNews.
"Breaking the transmission cycle is key to ending MDR-TB, so we need to move fast," he added.
Ethiopia, which ranks seventh on WHO's list of 22 high burden TB countries globally, is one of three countries in Africa with more than 5,000 estimated new MDR-TB infections annually. Of these, 1.6 percent of new cases and 11.8 percent of re-treatment cases are MDR-TB.
So far, St Peter is the only facility able to treat MDR-TB in the country.
"We are treating 89 patients, but we have a waiting list of 170 patients," said Abdusamed Adem, director of medical services at the TB hospital. "We urgently need to open new centres."
More than 100 diagnosed MDR-TB patients have died while on the treatment waiting list. Having diagnosed 390 cases of the disease outside the capital, the Ethiopian government is now racing to build testing and treatment centres in several of administrative regions.

MALNUTRITION: India, scheduled tribes

that too many children have died?
I adapt this from
Dylan’s famous 1962 lyrics, but it is nowhere more true than for Adivasis or tribal peoples (called Scheduled Tribes) in India.
Come monsoon, the Indian media is rife with stories of child deaths in tribal areas, frequently reported as “malnutrition deaths”. Kalahandi district in Orissa for instance, had been a metaphor for starvation due to press reports dating back to the 1980s. Melghat area in Maharashtra has similarly surfaced in the press especially during the monsoon when migrant Adivasis return to their villages and to empty food stocks in the home. This is followed by public outrage, sometimes by public interest litigation and often a haggling over numbers.
We recently published a working paper that looks at child mortality among India’s adivasis – the starkest manifestation of their deprivation. We find that an average Indian child has a 25 percent lower likelihood of dying under the age of five compared to an adivasi child. In rural areas, where the majority of adivasi children live, they made up about 11 percent of all births but 23 percent of all deaths in the five years preceding the National Family Heath Survey 2005. While there has been progress in child survival over the years, and much greater vigilance, which often leads to these stories surfacing in the media at all, the fact remains that children in tribal areas are at much greater risk of dying than those in other areas.


WFP has received less than 30% of the funding it requires in order to maintain vital food and nutrition activities to displaced families and can no longer maintain its assistance. In order to make the increasingly limited quantities of food last longer, WFP will be required to reduce rations to 50% of the planned May basket. This means that rather than receiving 2,100 kcal per person per day – which is the minimum amount of food required for a healthy life – families will receive only some 1,050 kcal per person per day. Before September, WFP will have to suspend activities entirely, including nutrition support to 50,000 children under 5 years of age.

Thus far, the regular and far-reaching assistance provided by the Government and people of Yemen and WFP has contributed to stabilizing the levels of acute malnutrition and mortality among the IDP population, particularly in the camps. However, the required ration cuts will reverse this progress and lead to a humanitarian catastrophe. As families are no longer able to meet their basic food requirements, cases of malnutrition and rates of mortality will increase. Moreover, when families will be deprived of the food support they require to survive, they will be forced to move once more in search of assistance.

MALNUTRITION: Somalia conditions worsened by fighting

The International Committee of the Red Cross (ICRC) is warning that malnutrition among children in Somalia has significantly risen.

The agency says the humanitarian situation in the country remains precarious as a result of fighting between government forces and insurgents and because of drought in Central Somalia.
ICRC spokesperson Nicole Engelbrecht says the cases of severe malnutrition have more than doubled in some regions, especially in Southern and Central Somalia.
"In some areas of central Somalia it's up to 30 per cent. In the clinics we support in central and southern Somalia, the Somali Red Crescent identified 115 cases in February and in April the number of cases was up to 350. So it's quite alarming. It's a recurrent phenomenon at this time of the year at the peak of the dry season. But it seems that it is going beyond what we've seen before."

POVERTY: malnutrition not resolved by micronutrients

An article in entitled Don't Medicalize Micronutrient Deficiency argues that biofortifying foods or handing out food supplements is not a sustainable solution to malnutrition problems. Countries that have high levels of malnutrition have food and agriculture problems that pills or fortified foods will not solve.This is a timely reminder, when so many 'solutions' come in the form of technical fixes that are often expensive, short term, inappropriate, unsustainable and often don't even work. I recently mentioned Bill Gates efforts to eradicate water borne diseases like polio, malaria and cholera by developing vaccines when the best strategy would be to improve water and sanitation. Water borne diseases can not be eradicated in areas where people don't have access to clean water and adequate sanitation.


Most NGOs and UN agencies in Niger agree that in 2010 humanitarian actors are better geared to respond to the food security crisis than they were in 2005, but some say there is a risk of repeating mistakes in information-sharing, planning appropriate responses, and raising funds more quickly.
"There are similarities to 2005 that donors and the aid community must heed in order to avert a disaster in 2010," warned CARE, an NGO focusing on poverty eradication, in a communiqué on 26 April.
A government declaration of critical food insecurity on 11 March, with an appeal for international assistance, helped mobilize agencies and donors, said Clare Sayce of CARE International. IRIN spoke to several UN agencies, international NGOs and donors in Niamey, Niger's capital, about responding to the crisis.
Things have changed since 2005: more humanitarian actors are already on the ground; early warning and information-sharing systems are in use; long-term programmes to help communities recover have been running since 2005; the government is more engaged and open to accepting outside help; coordination systems work better now.
"In February 2005, when MSF [Médecins Sans Frontières, the global medical charity] raised concerns of an emerging crisis, few agencies had sufficient teams in place on the ground to pick up the call, and no significant mobilization took place until June and July," said Stephane Heymans, head of MSF in Niger.


On a visit to the West African country, Mr Holmes said aid agencies had identified - and were dealing with - the problem early enough to make a difference.
"We have sounded the alarm much earlier," he told the BBC's Network Africa programme
"And we are tackling it much earlier so I hope that we can avoid the worst, and avoid the kind of scenes we've seen before in Niger or in Ethiopia in the 1980s."
The UN emergency relief co-ordinator was visiting the Zinder area of southern Niger, where he said rates of malnutrition in children had increased because of the lack of food.
People in Zinder told the BBC about how the food shortages were affecting their lives.
"I don't have any food because this year has been very hard," said Nana Mariama.
"I seldom have one meal a day: my breakfast. I have a daughter who attends school; she can't eat every day. My husband has gone to Nigeria to fetch food."
Another man said he had lost more than 80 cattle.


28 April 2010 – The United Nations has joined forces with authorities in Niger to fight malnutrition among children under the age of two – often the most vulnerable to food shortages – in the West African nation, where a food crisis has affected more than half of its 14 million-strong population.
Some 800 children received their first of four supplementary food rations in the village of Koléram, in southern Niger, today, as part of a UN-backed blanket feeding operation to reach 500,000 children with food in areas where acute malnutrition rates are critical.
A monthly ration comprises more than eight kilograms of corn soy blend with sugar and nearly 1 kilogram of oil-enriched vitamin A.
For its part, UN World Food Programme (
WFP) is providing nearly 18 megatons of food to feed 500,000 children as part of the scheme, launched in response to a Government appeal issued in March.

MALARIA: President's Malaria Initiative, Malawi

The U.S. government through the President's Malaria Initiative (PMI) which is implemented by the Agency for International Development has pledged $26 million of additional funds for fighting malaria in Malawi for the 2010-11 fiscal year.
PMI is a collaborative U.S. government effort which aims to reduce malaria deaths by 50% in 15 targeted African countries by achieving 85% coverage of vulnerable people with quality malaria interventions that work. This includes distributing insecticide-treated mosquito nets (ITN), conducting indoor residual spraying campaigns against malaria mosquitoes, providing life-saving anti-malarial drugs and preventing malaria in pregnancy.PMI activities began in Malawi in 2007 and the U.S. government has committed a total of $107 million for addressing malaria over the five year period of 2007-2012. "With six million cases of malaria per year in Malawi, the fight against malaria is far from over but through close collaborations between the governments of the United States and Malawi and other partners, we are making progress," said Curt Reintsma, USAID Mission Director.In 2009, data showed that use of ITNs by vulnerable children improved to 61% from 37% in 2005.

MALARIA: pyronaridine-artesunate

The new anti-malarial combination therapy pyronaridine-artesunate is as effective as the gold standard treatment, and the new regimen is inexpensive and only needs to be taken once daily.
Artemether-lumefantrine has long been regarded as the gold standard for treatment of malaria, with good safety and generally more than 90 percent efficacy. It must be taken twice a day, however, requires a fatty diet for optimum absorption, and the fairly short time taken to metabolize the treatment exposes patients to the risk of early re-infection. Scientists are trying to develop new artemisinin-based combination therapies that are equally convenient, effective and safe, such as pyronaridine-artesunate, to allow health policy makers and care givers in malaria endemic countries greater choice of effective treatment for their patients.
The phase 3 randomized trial was undertaken in seven sites in Africa and three sites in southeast Asia. Patients aged three years with uncomplicated Plasmodium falciparum malaria (the most common form) were randomly assigned either to receive pyronaridine-artesunate once a day or artemether-lumefantrine twice a day, orally for three days, plus respective placebo. Both treatments were given according to bodyweight. The primary efficacy was judged at day 28 by analysis of patients' blood for presence of malaria parasites.The final efficacy analysis consisted of 784 patients in the pyronaridine-artesunate group and 386 patients in the artemether-lumefantrine group. Treatment response occurred in 99.5 percent in the pyronaridine-artesunate group and 99.2 percent in the artemether-lumefantrine group.
There was a lower rate of re-infection and a longer time to re-infection in the pyronaridine-artesunate group than in the artemether-lumefantrine group. The percentage of adverse events was similar in the two groups and most of the adverse events were related to malaria itself. Mild and transient increases in liver enzymes were experienced in the pyronaridine-artesunate group but not in the artemether-lumefantrine group.
The authors were quoted as saying, "Fixed-dose pyronaridine-artesunate, given once a day for 3 days, showed high clinical and parasitological response rates and rapid parasite clearance, and was well tolerated in the treatment of uncomplicated P falciparum malaria. The efficacy of pyronaridine-artesunate still has to be assessed in a real-life setting across the wider population of patients who need anti-malarial treatment, including those who are malnourished or have anemia. However, in view of the results of this study and with a purchase price for pyronaridine-artesunate in the range of less than $1 for adults and less than $0.50 for children, this drug combination should be considered for inclusion in malaria treatment programs."


At least 35 million dollars is the amount made available annually by the United States government to support programmes of fight against malaria in Angola, on Monday in Central Huambo Province, said the US ambassador to this African country, Dan Mozena.
Speaking at the end of a two-day working visit to Huambo, Dan Mozena said that measures in the fight against malaria comprise indoor residual spraying, distribution of mosquito nets and medicines.
According to the diplomat, due to this fund, mortality rate by malaria has reduced in Angolaover the last five years.,09c9cdb8-52fa-4f7f-acab-ddd837418bb0.html

MALARIA: Vaccine

The third phase of testing for the world's most clinically advanced malaria vaccine candidate began last year and researchers at the Kenya Medical Research Institutes and Centers of Disease Control believe it could lead to the nation's first malaria vaccine by 2015.The vaccine works by targeting two groups of children - one group from the age of six to 12 weeks and the other from five to 17 months - in different transmission settings across a wide geographic region.“If the vaccine is proved to be effective in the prevention of malaria, it will be introduced as part of the routine child vaccination series in Kenya by 2015,” said Dr Simon Kariuki, the principal researcher at the Kemri/CDC, told vaccine, known as Mall55 Study, began trials in 2009 with mandatory preliminary duties preceding the actual study.Eight hundred children have now been enrolled int he Mall 55 Malaria Vaccine Study for the five to 17 month age group, and the second phase of enrollment for the six to 12 week age group has already begun. The testing will continue for approximately one year and take place at 11 sites.“There is hope to have a first indication of how well the vaccine works in the older age group of children in approximately a year and a half," Kariuki said.Malaria kills more than 800,000 people annually in Africa, with the majority of those killed under the age of five.

MALARIA: African statistics

ANY disease that each year incapacitates 220 million Africans – or more than 30 per cent of the population – and kills 1 million is a global emergency.
Malaria bleeds the continent to the tune of $12 billion in direct costs every year, resulting in an annual loss of an alarming 1.3 per cent of gross domestic product growth.Our fragile health systems are groaning under the strain – up to 50 per cent of patients are those suffering from the disease during the malaria season and it places great demands on already limited resources, both financial and manpower.In some countries, 40 per cent of the public health spending is swallowed by this scourge.Because of lost man hours, many families are not able to earn, plant, or harvest enough to survive on their own. The disease sends productivity levels plunging in critical sectors, such as farming, mining, and manufacturing, and causes children to miss school.Five of Africa’s most populous countries – Nigeria, Democratic Republic of Congo, Ethiopia, Tanzania and Kenya – with immense agricultural, mining, manufacturing and service potential have the most malaria cases in the world. This alone is a huge blow to the continent.

TUBERCULOSIS: Mass.. Harvard

A Harvard undergraduate was diagnosed with tuberculosis by University Health Services several weeks ago, and roughly forty students at risk for exposure have been asked to submit to a TB skin test, according to information provided by UHS and the Cambridge Public Health Department.
The student, whose identity has not been made public, was released earlier this week after public health officials determined he or she was no longer infectious, according to an e-mail from Jennifer B. Anderson, a UHS Communications Officer.
Anderson also said that no other students have presented signs of an active TB infection.
“We know of no other confirmed cases of TB at Harvard,” she wrote.
But among those students who have been asked to submit to a Mantoux Test, which determines whether an individual has produced antibodies to the tuberculosis bacterium, some have tested positive, according to Kate Matthews, a nurse in the Cambridge Public Health Department.
Matthews stressed that a positive skin test does not mean an individual is actively sick with TB.
“What it means to have a positive skin test is that you’ve had the TB germ in your body at one point. It doesn’t mean you’re sick or contagious,” she said, noting that roughly one in three individuals worldwide have been exposed to TB at some point in their lives.
According to Eric Rubin, a professor of immunology and infectious diseases at Harvard Medical School, those students who test positive for TB without showing signs of illness will be recommended to start a nine month regimen of daily antibiotics.
Rubin also said that there was another case of tuberculosis at a Harvard graduate school within the past two years.
But Matthews, who noted that there are roughly eight to twelve cases of tuberculosis in Cambridge each year, said that this was the first case among undergraduates in “a long time.”


Many DOTS experiences in developing countries have been reported. However, experience in a rural hospital and information on the differences between children and adults are limited.We described the epidemiology and treatment outcome of adult and childhood tuberculosis (TB) cases, and identified risk factors associated with defaulting and dying during TB treatment in a rural hospital over a 10-year period (1998 to 2007).
Methods: Retrospective data collection using TB registers and treatment cards in a rural private mission hospital. Information was collected on number of cases, type of TB and treatment outcomes using standardised definitions.
Results: 2225 patients were registered, 46.3% of whom were children.A total of 646 patients had smear-positive pulmonary TB (PTB), [132(20.4%) children]; 816 had smear-negative PTB [556 (68.2%)children], and 763 extra-PTB (EPTB) [341 (44.8%) children]. The percentage of treatment defaulters was higher in paediatric (13.9%) than in adult patients (9.3%) (p=0.001).The default rate declined from 16.8% to 3.5%, and was independently positively associated with smear-negative TB meningitis (AOR: 2.8; 95% CI: 1.2-6.6) and negatively associated with smear-positive PTB (AOR: 0.6; 95% CI: 0.4-0.8). The mortality rate was 5.3% and the greatest mortality was associated with adult TB (AOR: 1.7; 95% CI : 1.1-2.5), TB meningitis (AOR: 3.6; 95% CI:1.2-10.9), and HIV infection (AOR: 4.3; 95% CI: 1.9-9.4).Decreased mortality was associated with TB lymphadenitis (AOR: 0.24; 95% CI: 0.11-0.57).
Conclusion: (1) The registration of TB cases can be useful to understand the epidemiology of TB in local health facilities. (2) The defaulter and mortality rate of childhood TB is different to that of adult TB.(3) The rate of defaulting from treatment has declined over time.

TUBERCULOSIS: Zambia prisons

HIV and tuberculosis are spreading in Zambia's prisons because of poor conditions and a lack of medical care, according to a report by three human rights groups. The report says prisoners in Zambia suffer from malnutrition and poor medical care, and are at risk of being raped and tortured.It says one of the main problems is overcrowding - a result in large part of slow trials and appeals. Some prisoners, it says, can spend years in prison waiting to be tried. Health and Human Rights Division Director Joseph Amon, of Human Rights Watch, one of the groups that worked on the report, says inmates with HIV and tuberculosis are worst affected. "Again and again people were saying, 'I have been sick for months, I have been unable to get access to treatment'. 'We have seen people die in our cells and we have called out that they needed to get help, they needed to get treatment,' and the prison officials have said, 'This is a prisoner who might escape, we cannot take them,' or 'This is a prisoner who is faking it, he is not really ill.' And what happens is that, in fact, people are dying," Amon said.

TUBERCULOSIS: World statistics

The two most deadly infectious diseases worldwide, HIV and TB, claim the lives of nearly 10,000 people every day. Despite major advances in the treatment of HIV, the AIDS epidemic remains an unprecedented public health challenge, with an estimated 33 million people currently living with the virus and 2.7 million new HIV infections a year. And although scientists discovered a cure for TB more than five decades ago, there is more tuberculosis in the world today than ever before. Today, one-third of the world’s population is infected with M. tuberculosis, and there were an estimated 9.4 million new TB cases in 2008. In tandem, HIV infection and TB create a deadly synergy. TB is the number one cause of death among people with HIV. HIV/AIDS has reignited the TB epidemic across the developing world, fueling increases in MDR-TB and XDR-TB as well.

TUBERCULOSIS: Overview of presentation (Canadian)

The clinical manifestations of pulmonary Tb are protean, but there are a few characteristic syndromes with which patients may present.
i) Primary Tb – The response to the first exposure to Tb, this is usually a subclinical process, though about 5% of immunocompetent patients will develop symtoms. Fever is the most common symptom, as relatively few patients actually have symptoms referable to the lungs (cough is the most common). Rarely, pleuritis or erythema nodosum may be seen. The most common CXR finding is hilar adenopathy, with or without infiltrates.
ii) Latent Tb – Most host’s will be able to control the initial exposure to Tb, rendering the organism dormant/latent. These patients are asymptomatic, and are diagnosed on the basis of a Tb skin test. Approximately 90% of these patients will remain latent; however, 5-10% will develop…iii) Reactivation Tb – If 10% of patients infected with Tb reactivate, 5% will do so within two years of initial infection, and 5% will do so beyond 2 years. Clinically, this is often a subacute or chronic process, with cough, fever, malaise and weight loss. Dyspnea and chest pain may develop, and the cough tends to become more productive over time. Other complications that are seen as the condition progresses include hemoptysis, effusions, bronchiectasis, and hematogenous dissemination (“miliary Tb”).CXR will typically reveal upper lobe infiltrates (reactivation Tb is most commonly found in the posterior apices). Cavitation and volume loss may also occur.
Note that 5% of patients with active Tb have a normal CXR.The gold standard for diagnosis of Tb is a positive culture for Mycobacterium tuberculosis.
Specimens for culture can be obtained via:- sputum (sensitivity approaches 90% with 3 acceptable samples)- induced sputum (sensitivity 90% when done correctly)- bronchoscopy (sensitivity 77%)- early morning gastric aspiration (sensitivity approx. 70%; uncomfortable and cumbersome)Prior to definitive culture results, public health will report the results of the acid-fast smear, and often results of nucleic acid amplification, ie. the (A)MTD test. The MTD is usually reserved for smear positive Tb, where it has high specificity, but sensitivity around 80%.


The T-SPOT.TB test is an in vitro T cell measurement assay used for diagnosing TB disease and latent TB infection and is the first product from Oxford Immunotec using T-SPOT technology. The product offers unrivalled sensitivity with results unaffected by a patient’s immune status. The T-SPOT.TB test is approved for sale in Europe, USA, Canada and over 40 other countries worldwide and is designed to replace the 115 year old tuberculin skin test. It offers a substantially more accurate and effective tool for controlling the spread of TB, addressing a market exceeding $1bn.

Tuberculosis: India tribal communities

Despite numerous special schemes and financial allocations, tribal communities in Hunsur taluk lead a life of poverty, marked by severe malnutrition.
In Bettada haadi in the taluk, tribal residents grapple with appalling health conditions. Eight people in 28 families have tuberculosis, five have died in the past six years, and many others are malnourished and anaemic. They live in dilapidated houses that lack sanitation. Defunct borewells, broken pipes and non-functional streetlights are common sights.
Despite substantial allocations by the Centre under the Integrated Tribal Development Project (ITDP), nothing has changed here.
Community head Sannaiah (60) said, “In our haadi, the anganwadi doors have not opened for a while, 20 families are landless, and 10 do not have below the poverty line (BPL) cards. Only a few of us have received job cards under the Mahatma Gandhi National Rural Employment Guarantee Act and even the few do not have jobs.”
Hunsur Taluk Panchayat executive officer Basavaraj admitted that there are eight tuberculosis cases in the settlement, of which the condition of three women is precarious. “They will be shifted to the district hospital” he told The Hindu, blaming the “apathy of the authorities in implementing the ITDP effectively”.

MALARIA: Problems in practical therapy

Despite the widespread availability of effective new drugs and diagnostic tools, malaria still poses a risk to half the world’s population, and each year about a million people die of the disease, heard a seminar held at the London School of Hygiene and Tropical Medicine to mark world malaria day on 25 April.
The United Nations has called for universal provision of insecticide treated bed nets and prompt treatment for all people at risk of malaria by the end of this year, to achieve the goal of near zero deaths by 2015.
Yet major problems remain. Issues such as misdiagnosis and overprescription of treatments, counterfeit drugs, problems in supply and delivery, and emerging resistance to drugs "all hamper effective treatment." A lack of awareness among donors and the public of some these basic problems "threaten the success of global malaria control efforts."
Brian Greenwood, professor of clinical tropical medicine at the London School of Hygiene and Tropical Medicine, pointed out that treating malaria 40 years ago was much easier, as virtually every child in rural Africa had parasites in their blood, and treatments were cheap and effective. Nowadays prevalence was down to 5-10%, making it necessary to pick out those who needed treatment. Doctors had also failed to appreciate the danger of reliance on monotherapy, which had led to widespread resistance to chloroquine, making it essential to find effective new combination treatments.
Chris Whitty, head of research at the UK Department for International Development, said that these days "almost every death from malaria is an avoidable tragedy." The roll-out of effective new artemisinin based combination therapies meant that the disease was easily treatable, yet for various complex reasons people aren’t getting the drugs they need. Many people fail to seek care, many receive treatment in the informal sector, and many don’t get effective antimalarials.
Most people with malaria are poor, he said, and unable to afford the indirect costs of formal health care, meaning that many people still bought cheaper, less effective drugs from the private sector. Existing drugs are cheap but ineffective, while effective drugs are not cheap.
David Bell of the World Health Organization said that the development of rapid diagnostic tests showed that only about a quarter of cases of fever were actually malaria and that more than 50% of those treated for symptoms of malaria did not actually have the disease.
In Africa over half of cases of malaria were diagnosed on symptoms, not tests
. Mr Bell emphasised that without parasite based diagnosis most recipients of artemisinin based combination therapies would not have malaria, which meant not just a waste of scarce resources but also that non-malarial febrile illness went undiagnosed and untreated. The roll-out of new diagnostics has left a problem of how to treat non-malarial fevers. It was essential to build effective programmes, not just to fund procurement, he said.
Shunmay Yeung, senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine, described the alarming development of resistance to artemisinin in Cambodia. She said that the resistance was only to artemisinin, not to combination therapies that include artemisinin derivatives, which underlined the need for combination rather than monotherapies.
The problem of counterfeit and substandard drugs was discussed by Paul Newton, reader in tropical medicine at Oxford University, who emphasised the need to differentiate between the two as they had different causes and solutions. Although substandard drugs were an issue of quality assurance, counterfeits were the work of criminal gangs which required a concerted effort by Interpol. Counterfeit drugs were already "an under-appreciated public health disaster" in Asia and now posed a tremendous threat in Africa, he said.

MALARIA: Nigeria statistics

Experts say that every 30 minutes, a child dies of malaria.
In Africa, the disease causes about one in six childhood deaths, taking the lives of more than 750,000 children a year and placing an unacceptable burden on health and economic development.Mrs. Taiwo Olarinde, an assistant Manager, Global Fund Malaria Programmes, Society for Family Health (SFH), Ibadan, stated that statistics show that about 63 per cent of hospital attendance in Nigerian health facilities is as a result of malaria. According to her, “this disease also accounts for three out of every 10 childhood deaths, and 705 of illnesses in children under the age of five. More precisely, a child in Nigeria dies of malaria every 30 minutes! Malaria also accounts for one-tenth of maternal deaths in Nigeria! The climatic condition that obtains in the tropics, where Nigeria is geographically located, further favours the breeding of ‘culprit’ mosquitoes that act as vectors for the disease.”She stated, “it is rather ironical and unfortunate that an average citizen still seems to be unaware of the severity of this recognised ‘common disease’. In fact, it is a general believe now that once you have not had Malaria, you are yet to be a Nigerian! The disease has been so trivialised among the rank and file so much that parents now resolve to have malaria in their children treated at home first as compared with some other less severe diseases that are referred to health centres. This disturbing phenomenon of having malaria (in children especially) treated at home, she declared, could lead to the disease progressing to the severe or cerebral stage, which will doubtlessly necessitate urgent and advanced medical attention.Sadly, pregnant women constitute another vulnerable group to malaria, because pregnancy reduces a woman’s immunity to malaria, making her more susceptible to malaria infection and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight - a leading cause of death in children.About two thirds of pregnant women in sub-Saharan Africa attend antenatal clinics at least once during pregnancy, presenting a major opportunity to prevent and treat malaria through ‘intermittent preventative treatment’. Pregnant women, as part of their routine antenatal care, are provided at least two doses of a safe and effective antimalarial (currently, sulphadoxine-pyrimethamine) during the second and third trimesters of pregnancy.The World Health Organisation (WHO) recommended a three-pronged approach to the prevention and management of malaria during pregnancy based on scientific studies. These included the use of insecticide-treated nets (ITNs), intermittent preventive treatment and effective case management of malarial illness.However, boosting access to malaria in pregnancy services was central to making pregnancy safer as evidenced by the situations in Akwa Ibom State, where community service delivery of malaria in pregnancy interventions caused more pregnant women seek antenatal care from the registered government clinics.When Jhpiego, an affiliate of John Hopkins University, USA, made an assessment visit to Akwa Ibom State in 2006, they found that health staff were unfamiliar with intermittent preventive treatment of malaria for pregnant women (IPTp). They also did not have stocks of insecticide treated bed nets (ITNs) to give pregnant women and children.Attendance at local government area (LGA) antenatal care (ANC) clinics, where IPTp and ITNs should have been available, was less than 20 per cent of pregnant women in the area. Community members complained of poor quality ANC services. Finally, the antenatal care staff had not been trained in malaria in pregnancy (MIP) control as part of antenatal care services.It was on this basis that an intervention to address these gaps in MIP services in four LGAs and 15 primary care health facilities (PHCs) and their surrounding communities was started by Jhpiego in partnership with ExxonMobil Foundation, USA and Akwa Ibom State Ministry of Health, Uyo. It involved training of staff, provision of sulfadoxine-pyrimethamine (SP) for IPTp and basic MIP training, including Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT) and Health Management Information System (HMIS). In the intervention LGAs Staff were also trained in community mobilisation including how to implement the community directed interventions (CDI) approach that had been found so successful by the African Programme for Onchocerciasis Control.The CDI ensured an extension of the provision of MIP services through community directed distributors (CDDs) who were selected by their kin groups and trained and supervised by the PHC staff. They were given kits containing SP for IPTp, record books and health education materials as well as ITNs for distribution to pregnant women. They referred pregnant women to ANC to receive all the other basic ANC services such as additional doses of IPTp, blood pressure monitoring and tetanus toxoid immunisation.Indeed, the Akwa Ibom project led by Jhpiego’s country director in Nigeria, Professor Emmanuel Otolorin, marks an important demonstration that NGOs, private corporations, communities, state and local governments can work together to provide malaria services to people who need them. Certainly, the CDI approach that links communities and clinics apart from improving ANC attendance, can now add MIP control to its successes in efforts to eliminate other tropical diseases.At the onset of the interventions, the number of women that had received the required two doses of IPTp increased from 28 per cent in two years interval to 77 per cent in the intervention areas compared to 50 per cent in the control group. ITN use by these recently pregnant women increased from 44 per cent and 46 per cent in the intervention and control areas at beginning of the study to 73 per cent and 58 per cent respectively. Dr. Martins Ogundeji, Executive Director of Primary Health Care & Health Management Centre, Yemetu, Ibadan, Oyo State, corroborated the need for interventions at the community level that would ensure early detection and appropriate treatment of malaria.According to him, a recent trial of the Ward Health system that was carried out in two local government areas in Oyo state, which ensured trained community members can identify dangers in malaria in pregnant women and ensure that appropriate steps corroborate the importance of interventions that link communities and clinics apart from improving ANC attendance.
Written by Sade Oguntola

Wednesday, 28 April 2010


India has been in the news for its robust economic performance and for growth despite the recent global recession. The recent Indian Premier League suggests unbelievable investor confidence and provides great advertising opportunities, fantastic revenue, world-class sport, extraordinary entertainment, phenomenal television ratings and immense customer satisfaction. Yet, the incredible indices of development in India mask the inequity in the country and the human cost of the nation's progress. For millions of Indians hunger is routine, malnutrition rife, employment insecure, social security non-existent, health care expensive, and livelihoods under threat. The vibrant economy, “the shining India,” is restricted to the upper classes, while the majority in Bharat eke out a meagre existence on the margins.
Indices of wealth and development: The gross domestic product (GDP), the indicator of economic growth, is employed to assess the wealth of nations and the well-being of societies. However, its adequacy to evaluate the human condition or the welfare of nations has been questioned. An increase in GDP reflects economic growth but does not take into consideration its sustainability, life expectancy, health and education of people nor its impact on the environment. An example of its biased assessment is that misfortunes for some, due to natural disasters and wars, also mean economic opportunity and wealth for construction, pharmaceutical and defence industries and an increase in the index.
The Human Development Index (HDI) was conceptualised to focus on people-centred measures and policies, rather than on national incomes. The HDI employs life expectancy at birth, adult literacy and enrolment ratios and a measure of the GDP per capita to evaluate human health and longevity, knowledge and education and standards of living. While the HDI does provide a bigger picture when compared to the GDP, it has also been criticised for not capturing the complexity of the human situation.

BIOTERRORISM: Cryptosporidium

In the fight against Cryptosporidium, a waterborne protozoan parasite that commonly causes diarrhea and malnutrition and is a potential bioterrorism agent, researchers from Brandeis University identified a key enzyme that plays a role in the pathogen's RNA and DNA synthesis, along with more than 50 compounds so far that can inhibit the enzyme. They reported their findings yesterday at the American Society for Biochemistry and Molecular Biology's annual meeting in Anaheim, Calif. A number of the compounds showed antiparasitic activity. The research group is working on the first step in the drug development process, which is improving the compounds' potency, bioavailability, and metabolic stability. Cryptosporidum outbreaks have been linked to contaminated water supplies, and infections can be fatal in people who have weakened immune systems. Oocysts remain stable outside the host for long periods and resist the usual water treatments such as chlorine disinfection. In 1993 in the nation's largest waterborne disease outbreak, Cryptosporidium contaminated Milwaukee's water supply, killing more than 100 people and sickening about 400,000 more.

Malnutrition: G8 meeting

This week, G8 development ministers are meeting in Halifax to decide on development priorities for the upcoming leaders summit in June. A key issue being discussed is the health of mothers and young children, and it is easy to understand why: Each year, more than 3.5 million children die as a result of poor nutrition. This is nearly 10,000 lives lost each day.
No issue is more urgent, or more foundational to other development goals, than getting maternal and child nutrition right. Canada is providing critical leadership on this issue as it hosts the G8 Summit.
The science is now clear on what’s at stake. We know that children never recover from the mental and physical stunting that occurs if undernourished in their first two years of life. By allowing under-twos to remain malnourished, we are robbing an entire generation of their very future. That’s why the focus on under-twos is critical — this is the window of opportunity where a global investment can pay dividends for decades to come.
Globally, malnutrition affects almost 200 million children (UNICEF). This means that 200 million children right now are being dealt lasting damage to their young minds and bodies. These are children affected by the earthquake in Haiti, the drought in Kenya, violence in Somalia, and high prices in the Central Asian republics.
Malnutrition is an economic issue as well. Studies show that the cost of malnutrition to developing countries is as high as 11 per cent of GDP, and children who receive adequate nutrition earn wages that are nearly 50 per cent higher as adults.

MALARIA: nets, pyrethroid resistance

Due to the spread of pyrethroid-resistance in malaria vectors in Africa, new strategies and tools are urgently needed to better control malaria transmission. The aim of this study was to evaluate the performances of a new mosaic long-lasting insecticidal net (LLIN), i.e. PermaNet 3.0, against wild pyrethroid-resistant Anopheles gambiae s.l. in West and Central Africa.
A multi centre experimental hut trial was conducted in Malanville (Benin), Vallee du Kou (Burkina Faso) and Pitoa (Cameroon) to investigate the exophily, blood feeding inhibition and mortality induced by PermaNet 3.0 (i.e. a mosaic net containing piperonyl butoxide and deltamethrin on the roof) comparatively to the WHO recommended PermaNet 2.0 (unwashed and washed 20-times) and a conventionally deltamethrin-treated net (CTN).
The personal protection and insecticidal activity of PermaNet 3.0 and PermaNet 2.0 were excellent (>80%) in the "pyrethroid-tolerant" area of Malanville. In the pyrethroid-resistance areas of Pitoa (metabolic resistance) and Vallee du Kou (presence of the L104F kdr mutation), PermaNet 3.0 showed equal or better performances than PermaNet 2.0. It should be noted however that the deltamethrin content on PermaNet 3.0 was up to twice higher than that of PermaNet 2.0. Significant reduction of efficacy of both LLIN was noted after 20 washes although PermaNet 3.0 still fulfilled the WHO requirement for LLIN.
The use of combination nets for malaria control offers promising prospects. However, further investigations are needed to demonstrate the benefits of using PermaNet 3.0. for the control of pyrethroid resistant mosquito populations in Africa.

Niger: drought & hunger

The UN's food agency doubled its aid Monday to Niger as thousands join a desperate exodus from parched farmland in western Africa's Sahel region, where 10 million people are facing hunger.
The search for food has sent thousands flocking into Maradi, the main city in south central Niger, a vast arid country on the southern rim of the Sahara desert that has become the epicentre of the crisis.
As the UN's humanitarian chief John Holmes arrived in the country on Monday, aid agencies said nearly eight million people — more than half the population — were facing food shortages.
"I had to leave Chadakori, my village, where the younwa (hunger) is spreading desolation," said Balkissou, a young woman begging in Maradi's dusty streets.
Her wire-thin body lost in her dress, Balkissou said her village north of the city is "almost empty", save for those too old or too young to leave. She carried plastic bags of food scraps she had collected to send home to her six children.
For months, the city's bus station has become a magnet for refugees from across the entire central-southern region of Niger, where severe water shortages laid waste to crops last year.
"We know that this crisis is only just beginning," Holmes warned after holding crisis talks with the leaders of Niger's transitional government.
Holmes said his agency still faced a shortfall of 130 million dollars for an emergency appeal issued for Niger by the United Nations, which is seeking 200 million dollars (150 million euros).
Echoing his concerns, the UN World Food Program announced it was doubling the number of hungry people it feeds in Niger to 2.3 million people.

Tuesday, 27 April 2010

POVERTY: MDG target will be met

The World Bank says that at least one of the Millennium Development Goals will be met. The Bank's latest Global Monitoring Report was released today. In the annual report, the Bank says the MGD to halve poverty by 2015 will be met. Meanwhile, the goals of halting the spread of AIDS, improving access to education and water, improving child and mother survival and gender equality goals will not be met by 2015 and the progress was slowed by the global recession.
"Poverty rates were falling in all regions, even in Africa the rate was falling about one percent a year," he noted.Portugal said progress made in the 1990s had reduced inflation, strengthened government finances and gave them better access to private capital markets."All those efforts prior to the crisis paid off," he told the press briefing. "It meant that countries were in a stronger position to respond to the crisis."As a result, the estimated 920 million people who will likely be extremely poor in 2015 should represent a cut nearly of nearly 50 percent from the 1.8 billion in such conditions in 1990, the World Bank noted."Based on these estimates, the developing world as a whole is still on track to achieve the first MDG of halving extreme income poverty from its 1990 level of 42 percent by 2015," it said.Asia has done a particularly good job of reducing extreme poverty, and has already seen the rate of extreme poverty plunge from nearly 55 percent of its population in 1990 to just under 17 percent in 2005.That level is expected to fall to 5.9 percent in 2015.

Generic drugs: the threat

India is the source of 80 percent of the AIDS medicines used in MSF projects. Without quality affordable medicines from Indian sources, it would have been impossible to scale up treatment to the levels seen today and millions of lives would not have been saved.Through their governments’ contributions to the Global Fund and other international health agencies, European taxpayers pay for programs that can treat far more people, thanks to affordable medicines from India. But MSF and other groups are concerned that the EC is now trading this away. The draft agreement contains several alarming provisions on intellectual property and enforcement—much stricter than anything required under the international trade rules—that threaten the supply of essential medicines from India.“The right to life and health of people in developing countries is being sacrificed in this deal,” said Loon Gangte, president of the Delhi Network of Positive People (DNP+). “Do not put profits before patients. This trade agreement must not undermine India’s ability to provide people living with HIV/AIDS here and outside India with life-saving medicines in the name of open markets.”One of the harmful provisions in the FTA is something known as ‘data exclusivity’. If introduced by India, data exclusivity will obligate generic companies wishing to register a medicine to repeat clinical studies. This not only creates huge financial barriers that act as disincentives to generic companies, but also violates medical ethics, as people would be subjected to the risks of clinical studies for something that is already known. Data exclusivity therefore creates a new patent-like barrier to access to medicines and vaccines, even when these products are not protected by a patent.“The impact of this proposed agreement is truly global, as treatment will become considerably more expensive, and countries and funders may have to ration the numbers of people they can put on treatment,” said Ariane Bauernfeind, HIV/AIDS program manager for MSF projects in South Africa, Malawi, Lesotho and Zimbabwe. “We are already concerned that newer medicines have been patented in India. The FTA threatens to make an already bad situation worse.”Also in the draft FTA is a provision that extends the duration of a patent term beyond 20 years. In addition, after multiple incidents of Indian generic medicines being detained while in transit to other developing countries in Latin America, Asia, and Africa, the EU is now seeking to legitimize such measures.Formal talks between European and Indian negotiators are opening in Brussels this week. The EU has indicated that it wants to conclude the FTA negotiations ahead of the EU-India summit in October.

Developmet aid less than promises

DAKAR, 27 April 2010 (IRIN) - Members of the Organisation for Economic Coooperation and Development's (OECD) Development Assistance Committee (DAC) gave US$121.5 billion in bilateral aid in 2009, reaching a historic high, but the gap between commitments and promises made in 2005 is widening, says the UK's Overseas Development Institute (ODI). In 2005 DAC donors collectively promised to commit 0.56 percent of gross national income to aid by 2010, but reached just 0.31 percent in 2009, according to OECD's 2010 aid report issued on 23 April. "Though aid commitments have continued to increase, the rate of increase has dropped off in the past few years.making donors increasingly off-track," ODI research fellow Alison Evans told IRIN. DAC donors gave $27 billion to Africa in 2009, an increase of 3 percent on 2008, but this is still less than half of the extra aid they promised at Gleneagles in 2005, said Evans. Norway, France, the UK, Korea, Finland, Belgium and Switzerland all increased their aid commitments, while Japan, Greece, Ireland, Spain and Portugal, among others, reduced theirs. "For EU [European Union] members these DAC figures are particularly sobering," Evans told IRIN. Recognizing many donors have had difficult years amid financial recession, she continued, "were these commitments made just for good times? That isn't the case. They were made because of a commitment to reduce poverty globally and boost international development. for those receiving this aid; they are clearly going to be worried." The largest donors by volume were the USA, France, Germany, the UK and Japan, according to the OECD, but just five countries met or exceeded the UN overseas development aid target of 0.7 percent of national income: Denmark, Luxembourg, the Netherlands, Norway and Sweden. Donors pledged to increase aid to US$130 billion by 2010; but the OECD predicts they will fall short by $78 billion (both figures in 2004 US dollars).

MALARIA: statistics improve

What controlling malaria will do for African economies is multiple — the effect on GDP, the effect on health spending, lost school days, lost work days.
The high birth rate in Africa, which is on track to have two billion people by 2050, may even fall as fewer infant deaths cause families to have fewer children.
Eight African countries besides Zambia have halved their infection rates in the last decade: Eritrea, Rwanda, Botswana, Namibia, South Africa, Swaziland, Cape Verde and Sao Tome.
However, the success does not necessarily translate into lower malaria spending, on average 40 percent of Africa's public health budget, since the gains can be reversed.
"If we make a one-time push and pull resources back, it's going to be a disaster. You can't give someone a bednet, have it wear out in a few years and then expect everything is going to be OK.
Nigeria, DRC, Uganda, Sudan and Tanzania, in that order, have the highest number of cases and together account for more than half of all malaria deaths worldwide.

MALARIA: World Cup personalities help campaign

Sims explains, “It's all about the World Cup. It's using celebrities and soccer players and advocates and politicians — anybody who has a voice to say that malaria can be completely preventable and controllable. You can imagine how many people that will help. A child dies every 30 seconds. So in the length it takes to play a soccer match — 180 people are dead in an hour and a half." Or as she later put it, "three jumbo-jets worth of people die everyday." Horrific, considering these are completely avoidable statistics.
It may be noted that Malaria kills a child in Africa every 30 seconds and nearly one million people each year and around 91% of malaria deaths occur in Africa and of these 85 percent of these are children are under 5 years of age. Half of the World population that is around 3.3 billion people are at risk of malaria worldwide. Sims also added, “$10 will buy a net for a family for five years — $5 for the behavior change, and $5 for the net. You can get an amazing return on your investment because you can end it. If people get treated, they can live. It's a pretty good investment to bet on." We couldn't agree more”.

MALARIA: Kenya will subsidise drug cost

The government will subsidize recommended malaria drugs by June this year.
The initiative, which is the result of a grant agreement between the government and the Global Fund will see a dramatic drop in the price of the drugs from a high of Ksh 600 million to an average cost of Ksh 20 million.
Public Health and Sanitation Minister Beth Mugo was quick to reassure the public that all malaria drugs bought by the government for public health facilities through the initiative were of the highest quality.

MALARIA: Nigeria

Abuja — MALARIA has been identified as the leading cause of high infant mortality rate in Nigeria.
UNICEF Country Representative, Suomi Sakai, disclosed this On Sunday while speaking on the World Malaria Day.
April 25th is World Malaria Day. The theme for this year's celebration is "Counting Malaria Out" with the slogan "Count Me In".

The UNICEF representative, however, expressed hope that the distribution of Long Lasting Insecticide Treated Nets (LLITN), followed by sustained social mobilisation across the country to make sure that families actually use the nets every night will go a long way to protect children from malaria.
"The distribution of so many nets to so many households will be a monumental achievement. The next challenge will be to convince families to use those nets, otherwise the effort will not translate in the reduction of childhood and maternal deaths due to malaria," she said.
Nigeria has deployed its National Malaria Control Programme and the resources of its Roll Back Malaria partners, including UNICEF to reduce the malaria burden by half by the end of 2010.
One of its strategies is to distribute 63 million long-lasting insecticide treated mosquito nets to 32 million households in all 36 states and the Federal Capital Territory.
Eleven states have already received 19 million nets in the first phase and about 46 million more nets will be distributed by the end of this year.
UNICEF is expected to distribute a total of 6.5 million nets.

MALARIA: Tanzania

Beside a large pool of stagnant water from a recent downpour stands a house at Kigamboni, a Dar es Salaam suburb.A woman sweeps her house and as several children play nearby. Although her house has a single door which is not covered with mosquito gauze, its two windows are well covered with gauze to protect her family from mosquitoes that spread malaria.“Is this your child?” I inquired.“Yes she is.”“How do you protect her from malaria? Is there any residual indoor spraying done in your house to protect you from malaria?”“No, I have never seen any residual spraying in my neighbourhood. It’s just God who’s protecting us from malaria,” explains Khadija Juma, a mother of one.She also says it is a bit difficult to protect her child from mosquitoes, especially early in the evening between eight and nine o’clock when she has to prepare food and ensure that her child has eaten. That leaves her child exposed to mosquitoes taking into account that Dar es Salaam is hot and she can’t afford mosquito repellents.According to the Ifakara Health Institute (IHI), in 2007/8 nearly 20 per cent of Tanzanians under the age of five contracted malaria. This is equivalent to an average of 1,700 infections per day in that group. Prevalence in rural areas is more than double of that in urban areas due to, among other factors, low usage of mosquito nets. However, studies indicate that malaria prevalence has roughly halved over the past decade.On top of those efforts to combat malaria, President Jakaya Kikwete recently launched ‘Zinduka’, a campaign to halt malaria through the use of insecticide treated nets.

MALARIA: Australia

In Australia there hasn’t been a major outbreak of malaria since World War II when servicemen returned from Papua New Guinea, and Australia has been officially malaria-free since 1981. While some cases do exist, they are brought in by travellers returning from sub-tropical locations and are often treated and harmless.
This is not the case around the world. Today malaria kills almost 1 million people each year, most of them in sub-Saharan Africa. It accounts for 16 per cent of all under-five deaths in Africa, third only to neonatal causes and pneumonia.

MALARIA: Global Fund

25 April 2010


GENEVA – The global community faces a pivotal year in 2010 in a campaign to eliminate malaria as a major health challenge by 2015 in most of the countries where the disease is endemic. Financial resources needed to meet this internationally agreed goal must be secured this year for this target to be met.

The Global Fund provides two-thirds of international funding in the global effort to control the disease and by the end of 2009 programs supported by the Global Fund had distributed 104 million insecticide-treated nets to prevent malaria. A further 100 million nets are scheduled to be distributed in 2010.

World Malaria Day on April 25th is an opportunity to reflect on what still needs to be done to conquer this disease which kills more than 880,000 people a year, most of them children under the age of five. More than 90 percent of global malaria deaths are in Africa.

The fight against malaria has forged one of the most effective initiatives in global public health, under the leadership of the Roll Back Malaria Partnership, which has been highly successful in coordinating efforts and directing resources to where the need is greatest.

The launch of the RBM Partnership in 1998, the creation of the Global Fund in 2001 and of the President’s Malaria Initiative in 2005 and the introduction of new medical techniques have helped to galvanize efforts to fight a disease which had become neglected.

Today at least 10 of the most endemic countries in Africa have reported declines in new malaria cases and steep falls in child mortality of 50 to 80 percent.

Despite remarkable progress in the past few years, any reduction in the flow of funding to fight the disease could put recent achievements at risk.

“Investments in malaria prevention and control have been among the best investments in global health, resulting in a dramatic decrease in malaria deaths and illness. If adequate financial resources are secured, we could further scale up our efforts and malaria could be eliminated as a public health problem in most malaria-endemic countries by 2015. It can be done. It must be done,” said the Global Fund’s Executive Director, Michel Kazatchkine.

Donors will decide in 2010 how much they will pledge in new financing for the Global Fund over the three years running from 2011-2013.

In so doing they will help decide if the health-related Millennium Development Goals (MDGs) can be met. The health MDGs call for reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other diseases.

In sub-Saharan Africa, Global Fund grants have enabled provision of 72 million long-lasting insecticidal nets and 90 million courses of malaria treatment.

The Global Fund is now helping to fund the largest distribution campaign for long-lasting nets in the history of malaria control. The effort is concentrated in Nigeria and the Democratic Republic of Congo, which together bear 36 percent of the malaria burden in Africa.

Global Fund investments have also played a key role in expanding coverage of innovative and highly effective malaria treatments in many countries where older treatments have encountered drug resistance and, as a result, are no longer working.

The Global Fund has presented three resource scenarios for consideration by its donors. Each scenario is accompanied by an estimate of the results that could be expected at the end of the three-year period for which new funding is being sought.

For example, under the three resource scenarios for 2011-2013 of $13 billion, $17 billion and $20 billion, respectively, Global Fund investments would meet 72 percent of global need in 2015 for insecticide-treated nets for malaria and 94 percent of that need in sub-Saharan Africa if the highest resource scenario applied.

The international target for malaria is to ensure that insecticide-treated nets are provided to 80 percent of the populations most at risk of contracting malaria by 2010. The contribution of programs supported by the Global Fund toward reaching this target in sub-Saharan Africa has increased dramatically in recent years, from 5 percent in 2005 to 58 percent at the end of 2009.

The Global Fund is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases.

Since its creation in 2002, the Global Fund has become the dominant financier of programs to fight AIDS, tuberculosis and malaria, with approved funding of US$ 19.2 billion for more than 600 programs in 144 countries. To date, programs supported by the Global Fund have saved 4.9 million lives through providing AIDS treatment for 2.5 million people, anti-tuberculosis treatment for 6 million people and the distribution of 104 million insecticide-treated bed nets for the prevention of malaria.

MALARIA: US Presidential Statement

Today, I am proud to release the U.S. Government six-year strategy to combat malaria (pdf) globally. By 2014, our goal is to halve malaria illnesses and deaths in 70 percent of at-risk populations, by accelerating and intensifying malaria control efforts in the high burden countries of sub-Saharan Africa. The release of the President’s Malaria Initiative whole-of-government global strategy also outlines contributions to stop the spread of multi-drug resistance in Southeast Asia and the Americas; increase emphasis on strategic integration of malaria prevention and treatment activities with programs for maternal and child health, HIV/AIDS, neglected tropical diseases, and tuberculosis, through multilateral collaboration to achieve internationally-accepted goals; and intensify efforts to strengthen health systems.

Mali: new aircraft for President

The finance ministry today announced that the H.E. President Bingu wa Mutharika's new jet is being paid for with a loan from an un-named foreign bank. With a 25 million USD price tag, it runs equivalent to more than 2/3 of Malawi's direct budget support from the UK. Finance Minister Ken Kanondo explained that the new jet will actually save money in the long run by reducing the cost of chartering planes for presidential trips.
This is would be fine and well if Mr. Kanondo had not prefaced that statement by saying they had just sold the old presidential jet. This begs the question of why Bingu would have been chartering planes in the first place if there was already a presidential jet.

MALARIA: CAMBODIA: Incidence rises

BANGKOK, 27 April 2010 (IRIN) - The number of malaria cases recorded in Cambodia has increased significantly, say health officials, citing several reasons, including better detection and reporting.According to the National Center for Parasitology, Entomology and Malaria Control, there was a 41 percent increase in cases last year. The country - which has become an epicentre for malaria - recorded 83,217 malaria-infected persons in 2009, from 58,887 the previous year, after a steep drop in the number of cases over the past several years. The mosquito-borne disease killed 279 people in 2009 from 209 in 2008, Chea Nguon, the centre’s deputy director, told IRIN from Phnom Penh.
Multiple factors
Nguon cited several factors for the spike, including an earlier-than-usual rainy season, a late distribution of insecticide-impregnated bed nets, and internal migration to malaria-affected areas. He said there was also a natural cyclical rise in the number of cases every two to three years. In addition, the increase reflected a rise in the number of people with access to healthcare, he said.Since 2004, the government has trained malaria workers in 1,300 villages to detect and treat malaria, so a greater number of patients are being properly diagnosed and recorded than in previous years.
“Cambodia is establishing more and more village malaria workers, who are detecting more malaria that wasn’t detected previously,” said Steven Bjorge, technical officer for the World Health Organization (WHO) in Cambodia.“The populations most affected are people who work in the forest,” Bjorge said. Those include soldiers and their families, plantation workers, and even workers at a hydroelectric plant in the west of the country. Villagers hunting and gathering in the forests were also at risk, he said.Many malaria patients in areas with poor access to public health facilities attend private clinics, which do not report cases to the government.Nguon said the number of cases still might be higher than recorded, and as the government trained more village malaria workers, the figures may rise because of better reporting.
Drug resistanceCambodia in recent years has become one of the world’s malaria focal points after authorities detected along the country’s western border with Thailand a strain of the disease resistant to Artemisinin, one of the most effective drugs used to treat malaria.WHO has set up a special Artemisinin-resistant malaria containment project in the area.“As in the past, the Thai-Cambodian border is home to the emerging drug resistance.
The two countries and several partners, donors, as well as WHO, are working relentlessly to eliminate this dreadful parasite from this hot spot,” said Jai P. Narain, director of communicable diseases for the WHO Southeast Asia regional office.Nguon noted that the number of cases in 2009 was still dramatically lower than 12 years ago, when there were 170,387 infected persons and 865 deaths. “Compared to Vietnam or Thailand, the [numbers of] cases are still high,” he said. “We hope to eliminate malaria by 2025, and we are committed to that goal, but it’s still in the process.”

Monday, 26 April 2010

TB: Dubai, compulsory deportation of infected expatriates

ABU DHABI // The law that requires compulsory deportation of expatriates with tuberculosis is counterproductive and should be changed, a senior health official said yesterday. Dr Ali al Marzooqi, the director of public health and safety at the Dubai Health Authority (DHA), said fear of deportation causes most expatriates with the disease to “disappear” once they are diagnosed.
Speaking at InnovHealth 2010, a two-day health conference in Abu Dhabi, Dr al Marzooqi also said the private sector should be allowed to treat patients with TB.Currently, only public hospitals and clinics are allowed to treat the disease. They are required to notify the concerned health authority of each diagnosis and refer it to public safety officials, who are required to follow up.Last year in Dubai alone, the DHA received 242 TB notifications mostly from the private sector. Nearly 60 per cent of those – 142 cases – were lost and could not be followed up.
“We don’t know what happened to those cases, maybe they left the country and went back to their homes for two months or three or four to take their medication there, then come back,” Dr al Marzooqi said. He added that patients tended to provide fake names or contact details to avoid deportation.

Poverty: MDG's success and failings

Ten years ago, world leaders agreed at the UN on the Millennium Development Goals (MDGs), 8 Goals to significantly reduce extreme poverty, disease and illiteracy by 2015. World leaders met to take stock of progress at the mid-point. The first nine years have seen some important successes at the aggregate level, 40 million more children are in school, hundreds of millions of people have come out of extreme poverty, some deadly diseases like tuberculosis and measles have been contained, and fewer people are dying from HIV/AIDS. But the UN Secretary-General warned that if the world has to meet the MDGs by 2015, the speed of implementation needs to be substantially accelerated. Paradoxically, foreign aid levels have actually fallen in the last four years and some of the richest countries are cutting back even further.It is no surprise then that virtually every leader from a developing country spoke during the summit about rich countries breaking their aid promises to the poor with the consequence being schools and health centres left without staff and equipment.But turn our attention to the street conversation from Dhaka to Dakar, from Manila to Mexico City and we shall hear a different discourse on why the MDGs are not being met. For the poorest people living in rural Africa or Asia or the sprawling slums of Latin American cities, their daily experience is of being powerless in the face of being denied basic public services. The economic boom that many countries in the developing world are yet to translate into MDGs for the poor. Whether it is privatization of basic services, social exclusion, or plain inefficiency and corruption, the net effect is the same - more poverty, unemployment and deprivation for those at the bottom of the pile.

TB: Sillitoe obituary

Novelist and poet Alan Sillitoe, one of the "Angry Young Men" of British fiction who emerged in the 1950s, has died aged 82, media reports said on Sunday.
Sillitoe was best known for his gritty novels which vividly portrayed the lives of working class men in post-war Britain.
His works included Saturday Night And Sunday Morning and The Loneliness Of The Long-Distance Runner, both of which were later made into films.
Sillitoe left school at the age of 14 and worked in factories in his home city of Nottingham, central England, before he joined the Royal Air Force as a wireless operator in Malaya.
However, he fell ill with tuberculosis and was hospitalised for 18 months during which time he began to write.