Twenty-eight percent of college graduates are jobless, a number likely to rise amid the global economic crisis. There's little in the way of a welfare state, so the educated and the unschooled, the desperate and the adventuresome strike out with hammers, chisels and bowls, slipping beyond hungry children and that distant ceaseless war in Darfur to the south.When a man disappears from home, neighbors nod: "He went for gold."It is estimated that a quarter of the country holds gold deposits. The two places most popular for mining are Southern Kordofan province near the Nuba Mountains in central Sudan and around Almahas in the north, where Sadig and six friends headed after pooling $3,000, most of it borrowed or raised from jewelry sold by sisters and mothers.They leased a metal detector and hired a man reputed to know where to find buried riches. Off they went, hoping for a precious metal that brings about $40 a gram, or $1,230 an ounce, on world markets, but more often than not leaves a man with handfuls of shiny, worthless grit.After exploration showed promise, Sudan's gold mining industry began in earnest in the 1990s, turning the north into a blurry landscape of tens of thousands of prospectors, some working alone, others driving house-sized trucks and earth-moving machines owned by corporations from China, India, Turkey and other countries."I am on vacation," said Tarig Ali, a private school teacher who earns about $160 a month. "I have decided to take a chance with my friend. If I find gold, I will quit my job and start my own business.... Why should I stay at home?"Sadig's body is hard from bricklaying in Khartoum's affluent neighborhoods. They were built with oil money, but that has not seeped down to the poor, and bricklaying is not acceptable for a university graduate in a country where parents push their children to become doctors and engineers.Hopping off the bus, Sadig scanned the dry, cracked land, the bottom of an eons-ago sea, at the terraced pits that gouge a land once ruled by pharaohs and Romans.There are men like him and boys emptying sacks. Their skin claimed by dust, they look like lost amber-colored clouds, laughing. Men crouch over muddy pools, working sieves and sliding drops of silver mercury into pans, watching gold latch on to them as they squiggle through the muck.
http://www.latimes.com/news/nationworld/world/la-fg-sudan-gold-diggers-20100618,0,371387.story
Wednesday, 30 June 2010
MALARIA: Rain forest reduction enhances spread of malaria
A small reduction in tropical rainforest cover can increase malaria incidence by nearly 50 per cent, a study in the Brazilian Amazon has found.
Open spaces and partially sunlit pools of water, typical conditions of deforested landscapes, provide an ideal habitat in which the Anopheles darlingi mosquito— the main vector of the malaria parasite in the Amazon — can live and lay its eggs, according to the study, published online early in Emerging Infectious Diseases.
The authors, from the University of Wisconsin, Madison in the United States, and Santo Antonio Energia in Brazil, an energy consortium, studied high-resolution satellite data of land cover from 54 Brazilian health districts bordering Peru from 1996 to 2006. They also examined health data collected in the same areas in 2006.
They found that a four per cent change in forest cover was associated with a 48 per cent increase in malaria incidence.
Areas with less deforestation had a lower malaria risk, suggesting a link between conservation practices and health.
"We believe that the small change in deforestation is greatly amplifying the number of mosquito vectors, and thereby increasing malaria risk in humans," said Sarah Olson, lead author of the study.
"Local land management and development policies should weigh this human health risk along with the economic benefits of deforestation."
Kevin Lafferty, an ecologist at the University of California Santa Barbara, who questioned the links between climate change and malaria last year, said:
"Certainly, deforestation can create conditions that favour mosquitoes. Also, human populations tend to move into areas that are recently deforested. If these are migrants that bring malaria with them, they can set off epidemics.
"But it is important to formally quantify the link between deforestation and malaria, whatever the causal chain.
However, he added that "economics trumps climate change [and deforestation] when it comes to determining the future of malaria.
"[Economics] is an overlooked aspect of malaria given the current emphasis on climate change, but there is good evidence that endemic malaria is much more likely in poor countries and that malaria makes poor countries even poorer. It is a vicious cycle."
http://www.scidev.net/en/news/small-change-in-forest-cover-can-double-malaria-rate.html
Open spaces and partially sunlit pools of water, typical conditions of deforested landscapes, provide an ideal habitat in which the Anopheles darlingi mosquito— the main vector of the malaria parasite in the Amazon — can live and lay its eggs, according to the study, published online early in Emerging Infectious Diseases.
The authors, from the University of Wisconsin, Madison in the United States, and Santo Antonio Energia in Brazil, an energy consortium, studied high-resolution satellite data of land cover from 54 Brazilian health districts bordering Peru from 1996 to 2006. They also examined health data collected in the same areas in 2006.
They found that a four per cent change in forest cover was associated with a 48 per cent increase in malaria incidence.
Areas with less deforestation had a lower malaria risk, suggesting a link between conservation practices and health.
"We believe that the small change in deforestation is greatly amplifying the number of mosquito vectors, and thereby increasing malaria risk in humans," said Sarah Olson, lead author of the study.
"Local land management and development policies should weigh this human health risk along with the economic benefits of deforestation."
Kevin Lafferty, an ecologist at the University of California Santa Barbara, who questioned the links between climate change and malaria last year, said:
"Certainly, deforestation can create conditions that favour mosquitoes. Also, human populations tend to move into areas that are recently deforested. If these are migrants that bring malaria with them, they can set off epidemics.
"But it is important to formally quantify the link between deforestation and malaria, whatever the causal chain.
However, he added that "economics trumps climate change [and deforestation] when it comes to determining the future of malaria.
"[Economics] is an overlooked aspect of malaria given the current emphasis on climate change, but there is good evidence that endemic malaria is much more likely in poor countries and that malaria makes poor countries even poorer. It is a vicious cycle."
http://www.scidev.net/en/news/small-change-in-forest-cover-can-double-malaria-rate.html
The first study to quantify the effects of human migration on malaria incidence on a global scale has been published — and could lead to more effective strategies for eliminating the disease, say scientists.
Prompted by evidence that eliminating malaria in a single country is not possible if there is a steady influx of infected people from neighbouring countries, researchers mapped rates of migration and malaria transmission within and between global regions. Their work is published in Proceedings of the National Academy of Sciences (PNAS) this week (21 June).
Using migration data, transmission maps for the malaria parasite Plasmodium falciparum and global population databases the researchers identified groups of countries that were more strongly affected than others by high levels of population, and therefore infection, movement.
These groupings include countries in western and north-central Africa; central American countries where P. falciparum malaria is endemic; and countries in West and East Asia.
The researchers found that some countries, such as Ethiopia, Myanmar, China, Iran and Afghanistan, are more isolated. In these cases a nationally focused control or elimination programme stands a better chance of success.
The study also identified which nations are likely to be net exporters and importers of P. falciparum. In Africa, Mali, Burkina Faso and Niger are net migrant exporters, principally to West Africa, whereas low-transmission countries, such as Mauritania and Senegal, are receiving more malaria-infected migrants than they release.
Andrew Tatem, a researcher at the Emerging Pathogens Institute at the US-based University of Florida, and a co-author of the study, said that this is the first attempt to quantify the effects of human migration on malaria infection on a global scale.
Although there have been occasional similar studies "the datasets we used on malaria transmission and migration patterns have only recently been constructed, so it wasn't possible to examine the evidence on such a large scale before," he said.
Carlos Guerra, from the Ecuadorian Biotechnology Corporation and the Malaria Atlas Project of the UK's University of Oxford, said that the study enabled evidence-based guidelines for the design of more effective malaria-control strategies.
Countries that are connected by the flow of population and infection are already starting to work together. Examples include the Asia Pacific Malaria Elimination Network, the E8 group of eight southern African countries and PAMAFRO, a malaria reduction project between Ecuador, Colombia, Peru and Venezuela.
http://www.scidev.net/en/news/human-migration-maps-reveal-global-flow-of-malaria.html
Prompted by evidence that eliminating malaria in a single country is not possible if there is a steady influx of infected people from neighbouring countries, researchers mapped rates of migration and malaria transmission within and between global regions. Their work is published in Proceedings of the National Academy of Sciences (PNAS) this week (21 June).
Using migration data, transmission maps for the malaria parasite Plasmodium falciparum and global population databases the researchers identified groups of countries that were more strongly affected than others by high levels of population, and therefore infection, movement.
These groupings include countries in western and north-central Africa; central American countries where P. falciparum malaria is endemic; and countries in West and East Asia.
The researchers found that some countries, such as Ethiopia, Myanmar, China, Iran and Afghanistan, are more isolated. In these cases a nationally focused control or elimination programme stands a better chance of success.
The study also identified which nations are likely to be net exporters and importers of P. falciparum. In Africa, Mali, Burkina Faso and Niger are net migrant exporters, principally to West Africa, whereas low-transmission countries, such as Mauritania and Senegal, are receiving more malaria-infected migrants than they release.
Andrew Tatem, a researcher at the Emerging Pathogens Institute at the US-based University of Florida, and a co-author of the study, said that this is the first attempt to quantify the effects of human migration on malaria infection on a global scale.
Although there have been occasional similar studies "the datasets we used on malaria transmission and migration patterns have only recently been constructed, so it wasn't possible to examine the evidence on such a large scale before," he said.
Carlos Guerra, from the Ecuadorian Biotechnology Corporation and the Malaria Atlas Project of the UK's University of Oxford, said that the study enabled evidence-based guidelines for the design of more effective malaria-control strategies.
Countries that are connected by the flow of population and infection are already starting to work together. Examples include the Asia Pacific Malaria Elimination Network, the E8 group of eight southern African countries and PAMAFRO, a malaria reduction project between Ecuador, Colombia, Peru and Venezuela.
http://www.scidev.net/en/news/human-migration-maps-reveal-global-flow-of-malaria.html
MALNUTRITION: NIGER: Acute child malnutrition increases by 42%
DAKAR, 28 June 2010 (IRIN) - Nearly 17 percent of Niger's children younger than five suffer acute malnutrition, a 42 percent increase over the same period last year, according to a national survey released by the government. More than 15 percent acute malnutrition is classified as a critical emergency by the UN World Health Organization (WHO). The report links this increase to the poor 2008-2009 harvests. [http://www.irinnews.org/Report.aspx?ReportId=86689]. The government, with UN agency and NGO support, surveyed 8,000 under-fives nationwide from late-May to mid-June. In Agadez region, only urban centres were surveyed due to insecurity. Without immediate intervention, the situation is likely to further deteriorate before the September harvests, according to the government. Below are some of the report's most important findings: . Nationwide acute malnutrition: Nearly half a million children are acutely malnourished, including some 87,000 severely malnourished. The most affected regions are Diffa [http://www.irinnews.org/Report.aspx?ReportId=88425], Maradi [http://www.irinnews.org/Report.aspx?ReportId=89393], Zinder [http://www.irinnews.org/Report.aspx?ReportId=88541] and Tahoua [http://www.irinnews.org/report.aspx?ReportId=89499], where acute malnutrition falls into WHO's critical threshold. Acute severe malnutrition has increased to 3.2 percent from 2.1 percent a year ago. According to WHO, the median fatality rate for severe acute malnutrition ranges from 30 to 50 percent, but can be reduced substantially when properly treated. . Age and gender: Throughout the country, with the exception of Diffa region, children younger than three are twice as affected by acute malnutrition than older children (21.7 percent compared with 9.5 percent). More boys than girls are malnourished. . Mortality: The rate is higher than one death per 10,000 children a day but remains below the humanitarian community's emergency threshold of two deaths per 10,000 children a day, except in Zinder region. The relatively low death rate may not reflect the gravity of the nutritional crisis due to the ongoing depletion of food stocks. . Chronic under-nutrition: Similar to 2009, nearly half of Niger's children are chronically undernourished and lacking life-sustaining nutrients. In Zinder region, six children in 10 do not eat enough on a daily basis to maintain natural physical activity. In Niamey, 17 percent of children suffer from under-nutrition. A fifth of the surveyed children nationwide are severely chronically undernourished.
MALNUTRITION: NIGER: Mixed blessing of first rain
DAKAR, 29 June 2010 (IRIN) - The beginning of the rainy season in the arid Sahel region of West Africa is bringing hopes of renewed grazing land and harvests, but also apprehension in Niger as weakened animals are succumbing to the first rains, according to the government, aid workers and herders. The head of the Niger Association for the Revival of Breeding (AREN), Dodo Boureima, told IRIN the circumstances are "absolutely dramatic". "Our generation has never experienced such a situation and it is well beyond anything we anticipated. Thousands of animals [in Dakoro, southern Niger] have already died because of the first rains and we are expecting more losses," said Boureima. The first heavy rains fell in the southern region on 16 June. Sudden temperature change, the physiological demands on the digestive system of changing from a fodder to a grass diet, and water-borne diseases are always taxing for the cattle. "Since the animals are already extremely weak, many are expected to die with the first rains," said NGO Action Against Hunger's (ACF) West Africa regional representative Patricia Hoorelbeke. Cattle were hit by last year's drought, which left the country with limited grazing land and caused the price of animal feed to soar, making it unaffordable for subsistence farmers. [http://www.irinnews.org/report.aspx?ReportId=89575] Hoorelbeke said the most at-risk animals - cows and sheep - were also the Sahel's most common. Camels and goats are generally more resilient and more likely to survive the first rains. The Ministry of Livestock and Animal Husbandry is currently assessing post-rain fatalities to identify suitable responses. "The current response is inadequate," said ACF's Hoorelbeke. "In the next month of so, there will be grazing land again. It is time to identify those [animals that] have lost too much [weight] to recover and to focus on the future." Hoorelbeke noted that recovery can be a lengthy process. During livestock surveys in 2000, she met breeders who said they had still not mananged to build their herds back to the size they were before the 1984 drought.
POVERTY: Brain development retarded by malnutrition
People who live in countries where disease is rife may have lower IQs because they have to divert energy away from brain development to fight infections, scientists in the US claim.
The controversial idea might help explain why national IQ scores differ around the world, and are lower in some warmer countries where debilitating parasites such as malaria are widespread, they say.
Researchers behind the theory claim the impact of disease on IQ scores has been under-appreciated, and believe it ranks alongside education and wealth as a major factor that influences cognitive ability.
Attempts to measure intelligence around the world are fraught with difficulty and many researchers doubt that IQ tests are a suitable tool for the job. The average intelligence of a nation is likely to be governed by a complex web of interwoven factors.
The latest theory, put forward by Randy Thornhill and others at the University of New Mexico, adds disease to a long list of environmental and other issues that may all play a role in determining intelligence. Thornhill made the news in 2000, when he coauthored a provocative book called A Natural History of Rape in which he argues that sexual coercion emerged as an evolutionary adaptation.
Writing in the journal, Proceedings of the Royal Society, Thornhill and his colleagues explain that children under five devote much of their energy to brain development. When the body has to fight infections, it may have to sacrifice brain development, they say.
To test the idea, Thornhill's group used three published surveys of global IQ scores and compared them with data from the World Health Organisation (WHO) on how badly infectious diseases affect different countries. The list included common infections, such as malaria, tetanus and tuberculosis.
The scientists found that the level of infectious disease in a country was closely linked to the average national IQ. The heavier the burden of disease, the lower the nation's IQ scores. Thornhill believes that nations who have lived with diseases for long periods may have adapted, by developing better immune systems at the expense of brain function.
"The effect of infectious disease on IQ is bigger than any other single factor we looked at," said Chris Eppig, lead author on the paper. "Disease is a major sap on the body's energy, and the brain takes a lot of energy to build. If you don't have enough, you can't do it properly."
"The consequence of this, if we're right, is that the IQ of a nation will be largely unaffected until you can lift the burden of disease," Eppig added.
"It's an interesting and provocative finding," said Geraint Rees, director of the UCL Institute of Cognitive Neuroscience. "It explains about 50 to 60% of the variability in IQ scores and appears to be independent of some other factors such as overall GDP."
"The authors suggest that more infectious disease could lead to lower IQ scores through an impact on brain development. This is an interesting speculation, but the data don't prove it one way or the other," he said. "A bigger problem is that it might be driven by a third factor, that affects both infectious disease prevalence and IQ test scores."
For reasons that are unclear, IQ scores are generally rising around the world. Thornhill suggests monitoring rates of infectious diseases in nations as they develop, to see if they decline and IQ tests scores rise.
Richard Lynn, professor of psychology at Ulster University, and author of the 2002 book, IQ and the Wealth of Nations, said disease and IQ is a two-way relationship, with low national IQs being partly responsible for widespread infectious diseases.
"In recent decades, HIV has been a serious infectious disease, and it has a high infection rate in low IQ countries, especially in southern Africa, where it is present in around 30% of the population … This is attributable to the low IQ of the population who do not understand the way the infection is contracted, and have erroneous beliefs about how to prevent infection."
http://www.guardian.co.uk/science/2010/jun/30/disease-rife-countries-low-iqs
The controversial idea might help explain why national IQ scores differ around the world, and are lower in some warmer countries where debilitating parasites such as malaria are widespread, they say.
Researchers behind the theory claim the impact of disease on IQ scores has been under-appreciated, and believe it ranks alongside education and wealth as a major factor that influences cognitive ability.
Attempts to measure intelligence around the world are fraught with difficulty and many researchers doubt that IQ tests are a suitable tool for the job. The average intelligence of a nation is likely to be governed by a complex web of interwoven factors.
The latest theory, put forward by Randy Thornhill and others at the University of New Mexico, adds disease to a long list of environmental and other issues that may all play a role in determining intelligence. Thornhill made the news in 2000, when he coauthored a provocative book called A Natural History of Rape in which he argues that sexual coercion emerged as an evolutionary adaptation.
Writing in the journal, Proceedings of the Royal Society, Thornhill and his colleagues explain that children under five devote much of their energy to brain development. When the body has to fight infections, it may have to sacrifice brain development, they say.
To test the idea, Thornhill's group used three published surveys of global IQ scores and compared them with data from the World Health Organisation (WHO) on how badly infectious diseases affect different countries. The list included common infections, such as malaria, tetanus and tuberculosis.
The scientists found that the level of infectious disease in a country was closely linked to the average national IQ. The heavier the burden of disease, the lower the nation's IQ scores. Thornhill believes that nations who have lived with diseases for long periods may have adapted, by developing better immune systems at the expense of brain function.
"The effect of infectious disease on IQ is bigger than any other single factor we looked at," said Chris Eppig, lead author on the paper. "Disease is a major sap on the body's energy, and the brain takes a lot of energy to build. If you don't have enough, you can't do it properly."
"The consequence of this, if we're right, is that the IQ of a nation will be largely unaffected until you can lift the burden of disease," Eppig added.
"It's an interesting and provocative finding," said Geraint Rees, director of the UCL Institute of Cognitive Neuroscience. "It explains about 50 to 60% of the variability in IQ scores and appears to be independent of some other factors such as overall GDP."
"The authors suggest that more infectious disease could lead to lower IQ scores through an impact on brain development. This is an interesting speculation, but the data don't prove it one way or the other," he said. "A bigger problem is that it might be driven by a third factor, that affects both infectious disease prevalence and IQ test scores."
For reasons that are unclear, IQ scores are generally rising around the world. Thornhill suggests monitoring rates of infectious diseases in nations as they develop, to see if they decline and IQ tests scores rise.
Richard Lynn, professor of psychology at Ulster University, and author of the 2002 book, IQ and the Wealth of Nations, said disease and IQ is a two-way relationship, with low national IQs being partly responsible for widespread infectious diseases.
"In recent decades, HIV has been a serious infectious disease, and it has a high infection rate in low IQ countries, especially in southern Africa, where it is present in around 30% of the population … This is attributable to the low IQ of the population who do not understand the way the infection is contracted, and have erroneous beliefs about how to prevent infection."
http://www.guardian.co.uk/science/2010/jun/30/disease-rife-countries-low-iqs
POVERTY: KENYA: Short-term gains of price controls outweighed in long term
NAIROBI, 30 June 2010 (IRIN) - If a new bill seeking price controls on maize, wheat and other essential commodities is implemented, it may benefit the poor who have been priced out of food in the short term but is unsustainable in the long term, warn analysts.Kenya's parliament recently passed the Price Controls (Essential Goods) Bill, which is awaiting presidential approval. "The goal of having low stable prices is noble; it benefits the poor and supports growth. However, I do not think that price controls are the best policy option," Dickson Khainga, head of the macroeconomics division at the Kenya Institute for Public Policy Research and Analysis (KIPPRA), told IRIN. "Kenyans have gone through a regime of price controls and it did not help investment and productivity."Price controls in the 1990s were dogged by claims of manipulation, corruption and political interference."Price controls would most likely drive out investment given that in most of these sectors, producers are [also] asking for higher prices," added Khainga. Foreign direct investment in Kenya has been increasing and experts fear price controls will lead to massive job losses as investors shift to neighbouring countries where they can make a profit. The practice by small-holder farmers of hoarding maize harvests to protest against low prices is common. There are also concerns that farmers may switch to more profitable crops, which would reduce supply. Maize prices rose by up to 130 percent in Nairobi in 2009 after several failed harvests [http://www.irinnews.org/Report.aspx?ReportId=84577 ]. In addition to poor weather, poor infrastructure and high input costs have continued to drive up essential commodity prices. According to a World Bank economic update for December 2009 [http://siteresources.worldbank.org/INTKENYA/Resources/Kenya_Economic_Update_Dec_2009-full.pdf ], power outages and transport bottlenecks were blamed for close to a 10 percent reduction in sales in the manufacturing sector. "The final [commodity] price is a factor of many things in the whole chain of production," Betty Maina, chief executive of the Kenya Association of Manufacturers (KAM), said."If you are a miller and the price of maize is high and the cost of electricity is also high and you are not able to sell it [the maize flour] at a decent profit, there is a possibility of shortages," said Maina. "If the input costs are high and the output costs are set too low - there will be a problem." Though price controls hold the promise of protecting groups struggling to meet price increases, economists are sceptical about them due to their distortion of resource allocation. Price controls are often imposed to check inflation; Kenya's overall inflation has, however, been declining from 19.5 percent at the end of 2008 to below 5 percent at end-2009, according to the World Bank update. ConcernsAmong the arguments for the bill is that it seeks to cushion the vulnerable against cartels. ".Maize and wheat millers are a cartel that makes supernormal profits and should not, therefore, be allowed to control the grains trade in its entirety," wrote commentator Kwendo Opanga in the 26 June Daily Nation.However, KAM's Maina said: "If there is suspicion of collusive competitive behaviour there are anti-trust, anti-competitive behaviour laws. Kenya's monopoly and prices [commission] should [prevent] any collusive behaviour."There are also quality concerns as manufacturers cut costs to sell at lower prices. The government can fight quality deterioration through product standard specifications and enforcement - but this would add to expenses. The emergence of black markets due to shortages is also a concern, as are other expected costs from queuing, tie-in sales and subsequent commodity rationing. While some analysts are calling for keener price regulation by the commission as opposed to price controls, others are urging a balance whereby there will be price controls but at levels that do not drive out business while making products available to consumers.Mixed responseA retailer in the Ruaka area of Kiambu, in central Kenya, Lameck Mwalumba, expressed mixed feelings: "It may be beneficial if everybody sells at the same price. Then it will be up to the individual shopkeeper to retain his customers."However, if the price is too low there may be a higher demand than the supply. These should balance. "But how does this relate to things like COMESA [the Common Market for Eastern and Southern Africa]," Mwalumba asked. "We might be excited about something that will harm us later." Cheaper quality imports from neighbouring markets where prices are competitive would further upset local production, for instance. KIPPRA's Khainga said: "[Implementing] price controls is treating the symptoms and not curing the underlying disease; in the long run it is not sustainable and is not consistent with regional integration and globalization."The focus should be on increasing agricultural productivity, encouraging production and consumption of so-called 'orphan' commodities such as millet, sorghum, cassava etc [to diversify consumption patterns] and enhance private sector competition."
Monday, 28 June 2010
POVERTY: MDG stats
Ten African countries have halved their poverty rates over the last two decades, but child mortality rates have increased in six sub-Saharan nations, a report on the U.N.'s Millennium Development Goals released Tuesday found.The countries that halved their poverty rates since 1990 include relatively populous countries such as Ethiopia and Egypt and post-conflict countries such as Angola, the report said. However, in Nigeria and Zimbabwe, the proportion of the population living in extreme poverty has risen.Sub-Saharan Africa is the only region in the world registering an increase in the under age 5 mortality rate, which has risen in Cameroon, Central African Republic, Chad, Congo, Kenya and Zambia. Thirty-four of the world's 36 countries with child mortality rates above 100 per 1,000 births are in sub-Saharan Africa. The others are Afghanistan and Myanmar.The Millennium Development Goals Report Card, which was sponsored in part by the Bill and Melinda Gates Foundation, was released Tuesday to coincide with meetings of G-8 and G-20 countries in Canada beginning Friday.The report said that the key message concerning the millennium goals is that progress is possible.The conditions that help a country make progress include open trade policies, an openness to technology, consistent leadership committed to reducing poverty, and reform aimed at making the public sector accountable, the report said.The Millennium Development Goals, adopted by 189 world leaders in 2000, include cutting extreme poverty by half, ensuring universal primary school education for all children, reducing child and maternal deaths, halting and reversing the HIV/AIDS pandemic, and cutting in half the proportion of people without access to safe water and basic sanitation, all by 2015.Tuesday's report said that progress was mixed on the goal of halving the number of people who suffer from hunger. Just over half of countries have made progress in reducing undernourishment. Progress has varied greatly. In Ghana, hunger levels were cut 75 percent between 1990 and 2004. But in the Democratic Republic of Congo, hunger levels more than doubled to 76 percent during the same period.Ahead of the World Cup earlier this month, the U.N. tried to underscore some of the vast differences between countries by noting that life expectancy in Nigeria is 48 years compared with 75 years in Argentina, and that women in Ivory Coast are eight times more likely to die in child birth than women in Brazil.
http://www.nola38.com/health/sns-ap-af-africa-development-goals,0,1569823.story
http://www.nola38.com/health/sns-ap-af-africa-development-goals,0,1569823.story
MALARIA: Nigeria, bed net distribution
Gombe — Federal Government has concluded plans to distribute a total of 63 million treated mosquito nets across the country by December. This is as the Gombe state Government has ordered security agencies in the state to arrest and prosecute whoever may be found to have diverted the long lasting insecticidal nets into the markets for sale.
Professor Christian Chukwu, Minister of Health unveiled this in Gombe stating that it was the Federal Government's determination to do this among its citizens.
According to the minister, over 19 million of the Long Lasting Insecticidal Nets have been distributed in 11 states between May 2009 and now. The distribution is expected to achieve universal coverage in line with the objective of the national malaria strategic plan
http://allafrica.com/stories/201006170390.html
Professor Christian Chukwu, Minister of Health unveiled this in Gombe stating that it was the Federal Government's determination to do this among its citizens.
According to the minister, over 19 million of the Long Lasting Insecticidal Nets have been distributed in 11 states between May 2009 and now. The distribution is expected to achieve universal coverage in line with the objective of the national malaria strategic plan
http://allafrica.com/stories/201006170390.html
MALARIA: Genome study in Africa
In the ten years since the Human Genome Project was completed genomics has progressed in leaps and bounds, but surprisingly little has been about Africa or by African scientist.
The vast majority of genomic studies have been of American, Asian and European genomes, with just one genome-wide association study (looking at malaria) based on an African population – surprising considering that around one billion people live on the African continent.
That makes today’s announcement all the more exciting. A new partnership from the US National Institutes of Health (NIH) and the Wellcome Trust looks to fund population-based genetic studies in Africa. The $38 million Human Heredity and Health in Africa (H3 Africa) Project will also build capacity for African scientists to do genomic studies in their home countries.
Yesterday, I attended a press briefing for the launch of H3 Africa and heard how African populations are interesting, scientifically, for a number of reasons.
First, we know that African genomes contain more genetic variation than any other on Earth. African genomes are also much ‘older’ than European or Asian genomes. In practical terms, this means that it is easier to focus in on particular gene variants and work out their level of association with particular traits, say risk of high blood pressure, because the signal is clearer. The genetic variants in African genomes are more clearly associated with certain regions of the genome than in Asian and European genomes, which will make it easier to find those ‘ancient’ variants that are associated with disease risk and apply to everyone worldwide
http://wellcometrust.wordpress.com/2010/06/23/putting-africa-on-the-genomic-map/#more-2323
The vast majority of genomic studies have been of American, Asian and European genomes, with just one genome-wide association study (looking at malaria) based on an African population – surprising considering that around one billion people live on the African continent.
That makes today’s announcement all the more exciting. A new partnership from the US National Institutes of Health (NIH) and the Wellcome Trust looks to fund population-based genetic studies in Africa. The $38 million Human Heredity and Health in Africa (H3 Africa) Project will also build capacity for African scientists to do genomic studies in their home countries.
Yesterday, I attended a press briefing for the launch of H3 Africa and heard how African populations are interesting, scientifically, for a number of reasons.
First, we know that African genomes contain more genetic variation than any other on Earth. African genomes are also much ‘older’ than European or Asian genomes. In practical terms, this means that it is easier to focus in on particular gene variants and work out their level of association with particular traits, say risk of high blood pressure, because the signal is clearer. The genetic variants in African genomes are more clearly associated with certain regions of the genome than in Asian and European genomes, which will make it easier to find those ‘ancient’ variants that are associated with disease risk and apply to everyone worldwide
http://wellcometrust.wordpress.com/2010/06/23/putting-africa-on-the-genomic-map/#more-2323
MALARIA: study on incentives to increase bed net use
Background
Insecticide-treated bed nets (ITNs) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa. Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns. To date, behavioural incentives have been studied mostly in developed countries. No study has yet looked at the effect of incentives on the use of ITNs. Reported here are the results of a cluster randomized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar.
Methods
The study took place from July 2007 until February 2008. Twenty-one villages were randomized to either intervention or control clusters. Households in both clusters received a coupon redeemable for one ITN. After one month, intervention households received a bonus for ITN use, determined by visual confirmation of a mounted ITN. Data were collected at baseline, one month and six months. Both unadjusted and adjusted results, using cluster specific methods, are presented.
Results
At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups (99.5% vs. 99.4%), but net use was substantially higher in the intervention group (99% vs. 78%), with an adjusted risk ratio of 1.24 (95% CI: 1.10 to 1.40; p<0.001). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%), with an adjusted risk ratio of 0.97 (p<0.01). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%; p<0.001).
Conclusions
Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term, but, over time, the use of ITNs is similar to households that did not receive incentives. Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.
http://www.malariajournal.com/content/9/1/186
Insecticide-treated bed nets (ITNs) have been shown to reduce morbidity and mortality due to malaria in sub-Saharan Africa. Strategies using incentives to increase ITN use could be more efficient than traditional distribution campaigns. To date, behavioural incentives have been studied mostly in developed countries. No study has yet looked at the effect of incentives on the use of ITNs. Reported here are the results of a cluster randomized controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar.
Methods
The study took place from July 2007 until February 2008. Twenty-one villages were randomized to either intervention or control clusters. Households in both clusters received a coupon redeemable for one ITN. After one month, intervention households received a bonus for ITN use, determined by visual confirmation of a mounted ITN. Data were collected at baseline, one month and six months. Both unadjusted and adjusted results, using cluster specific methods, are presented.
Results
At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups (99.5% vs. 99.4%), but net use was substantially higher in the intervention group (99% vs. 78%), with an adjusted risk ratio of 1.24 (95% CI: 1.10 to 1.40; p<0.001). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%), with an adjusted risk ratio of 0.97 (p<0.01). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%; p<0.001).
Conclusions
Household-level incentives have the potential to significantly increase the use of ITNs in target households in the immediate-term, but, over time, the use of ITNs is similar to households that did not receive incentives. Providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.
http://www.malariajournal.com/content/9/1/186
MALARIA: Customs group to fight $200 bln bogus drug industry
Counterfeit drugs have become a $200-billion-a-year industry and the 176-nation World Customs Organization (WCO) will sign a declaration later this month to fight the scourge, an official said on Thursday.
Fake or substandard versions of medicines are often hidden in cargoes sent on circuitous routes to mask their country of origin.
"We have more fakes than real drugs in the market," said Christophe Zimmermann, the WCO's anti-counterfeiting and piracy coordinator. "In 2007-2008 alone, it rose 596 percent."
Pharmacies and back street merchants in Africa sell fake medicines at rock-bottom prices.
The World Trade Organization says fake anti-malaria drugs kill 100,000 Africans a year and the black market deprives governments of 2.5-5 percent of their revenue.
The Brussels-based WCO represents customs operations globally and has joined with former French president's Jacques Chirac's foundation to raise awareness at upper echelons to curtail the illicit industry.
Spurred by Chirac's foundation, 176 national customs chiefs will sign a declaration on June 24 to ban the making and marketing of counterfeit drugs, Zimmermann told Reuters.
Fake medicines often contain the wrong or toxic ingredients and pose a growing health threat worldwide, especially in poor countries where drugs are sold to treat conditions such as malaria, tuberculosis and HIV.
"If these subjects are not dealt with and strong action not taken, they will be a source of conflict," said Catherine Joubert, director general of the Fondation Chirac, adding that so far 30 groups had signed the declaration.
Getting the WCO's 176 members on board will lend legitimacy to proposals to revamp obsolete legislation and improve coordination between enforcement agencies, Zimmermann said.
Western Europeans spend an estimated 10.5 billion euros ($14.3 billion) a year on illicitly sourced medicines, according to a Pfizer-sponsored survey published in February.
In a sign Europe is taking the issue seriously too, justice ministers on the Council of Europe are set to ratify a convention on counterfeit medicines in Istanbul this November.
http://www.reuters.com/article/idUSTRE65961U20100610
Fake or substandard versions of medicines are often hidden in cargoes sent on circuitous routes to mask their country of origin.
"We have more fakes than real drugs in the market," said Christophe Zimmermann, the WCO's anti-counterfeiting and piracy coordinator. "In 2007-2008 alone, it rose 596 percent."
Pharmacies and back street merchants in Africa sell fake medicines at rock-bottom prices.
The World Trade Organization says fake anti-malaria drugs kill 100,000 Africans a year and the black market deprives governments of 2.5-5 percent of their revenue.
The Brussels-based WCO represents customs operations globally and has joined with former French president's Jacques Chirac's foundation to raise awareness at upper echelons to curtail the illicit industry.
Spurred by Chirac's foundation, 176 national customs chiefs will sign a declaration on June 24 to ban the making and marketing of counterfeit drugs, Zimmermann told Reuters.
Fake medicines often contain the wrong or toxic ingredients and pose a growing health threat worldwide, especially in poor countries where drugs are sold to treat conditions such as malaria, tuberculosis and HIV.
"If these subjects are not dealt with and strong action not taken, they will be a source of conflict," said Catherine Joubert, director general of the Fondation Chirac, adding that so far 30 groups had signed the declaration.
Getting the WCO's 176 members on board will lend legitimacy to proposals to revamp obsolete legislation and improve coordination between enforcement agencies, Zimmermann said.
Western Europeans spend an estimated 10.5 billion euros ($14.3 billion) a year on illicitly sourced medicines, according to a Pfizer-sponsored survey published in February.
In a sign Europe is taking the issue seriously too, justice ministers on the Council of Europe are set to ratify a convention on counterfeit medicines in Istanbul this November.
http://www.reuters.com/article/idUSTRE65961U20100610
MALARIA: progress stata
Major efforts are being made to achieve the goals for malaria control set by the World Health Assembly1 and the Roll Back Malaria partnership,2 including halving the malaria burden by the end of 2010 compared with 2000. Particularly encouraging is the progress in availability of long lasting insecticide treated mosquito nets. In Africa alone, 140 million nets were distributed between 2006 and 2008.3
These efforts, coupled with targeted application of indoor residual spraying and modest increases in access to artemisinin based combination therapy, have begun to produce results. In countries where these malaria control interventions have been scaled up, such as Eritrea, São Tomé and Principe, Rwanda, Zambia, and Zanzibar (Tanzania), rates of malaria cases, hospital admissions, and deaths have dropped by more than 50%.3 In São Tomé and Principe and Zanzibar, these gains have been mirrored by a greater than 50% fall in all-cause hospital admissions
http://www.bmj.com/cgi/content/extract/340/jun11_1/c2714
These efforts, coupled with targeted application of indoor residual spraying and modest increases in access to artemisinin based combination therapy, have begun to produce results. In countries where these malaria control interventions have been scaled up, such as Eritrea, São Tomé and Principe, Rwanda, Zambia, and Zanzibar (Tanzania), rates of malaria cases, hospital admissions, and deaths have dropped by more than 50%.3 In São Tomé and Principe and Zanzibar, these gains have been mirrored by a greater than 50% fall in all-cause hospital admissions
http://www.bmj.com/cgi/content/extract/340/jun11_1/c2714
MALARIA: substandard medication
Background
Two major cities in West Africa, Accra, the capital of Ghana, and Lagos, the largest city of Nigeria, have significant problems with substandard pharmaceuticals. Both have actively combated the problem in recent years, particularly by screening products on the market using the Global Pharma Health Fund e.V. Minilab protocol. Random sampling of medicines from the two cities at least twice over the past 30 months allows a tentative assessment of whether improvements in drug quality have occurred. Since intelligence provided by investigators indicates that some counterfeit producers may be adapting products to pass Minilab tests, the results are compared with those from a Raman spectrometer and discrepancies are discussed.
Methods
Between mid-2007 and early-2010, samples of anti-malarial drugs were bought covertly from pharmacies in Lagos on three different occasions (October 2007, December 2008, February 2010), and from pharmacies in Accra on two different occasions (October 2007, February 2010). All samples were tested using the Minilab protocol, which includes disintegration and active ingredient assays as well as visual inspection, and most samples were also tested by Raman spectrometry.
Results
In Lagos, the failure rate in the 2010 sampling fell to 29% of the 2007 finding using the Minilab protocol, 53% using Raman spectrometry, and 46% using visual inspection. In Accra, the failure rate in the 2010 sampling fell to 54% of the 2007 finding using the Minilab protocol, 72% using Raman spectrometry, and 90% using visual inspection.
Conclusions
The evidence presented shows that drug quality is probably improving in both cities, especially Lagos, since major reductions of failure rates over time occur with all means of assessment. Many more samples failed when examined by Raman spectrometry than by Minilab protocol. The discrepancy is most likely caused by the two techniques measuring different aspects of the medication and hence the discrepancy may be the natural variation in these techniques. But other explanations are possible and are discussed.
http://www.malariajournal.com/content/9/1/157
Two major cities in West Africa, Accra, the capital of Ghana, and Lagos, the largest city of Nigeria, have significant problems with substandard pharmaceuticals. Both have actively combated the problem in recent years, particularly by screening products on the market using the Global Pharma Health Fund e.V. Minilab protocol. Random sampling of medicines from the two cities at least twice over the past 30 months allows a tentative assessment of whether improvements in drug quality have occurred. Since intelligence provided by investigators indicates that some counterfeit producers may be adapting products to pass Minilab tests, the results are compared with those from a Raman spectrometer and discrepancies are discussed.
Methods
Between mid-2007 and early-2010, samples of anti-malarial drugs were bought covertly from pharmacies in Lagos on three different occasions (October 2007, December 2008, February 2010), and from pharmacies in Accra on two different occasions (October 2007, February 2010). All samples were tested using the Minilab protocol, which includes disintegration and active ingredient assays as well as visual inspection, and most samples were also tested by Raman spectrometry.
Results
In Lagos, the failure rate in the 2010 sampling fell to 29% of the 2007 finding using the Minilab protocol, 53% using Raman spectrometry, and 46% using visual inspection. In Accra, the failure rate in the 2010 sampling fell to 54% of the 2007 finding using the Minilab protocol, 72% using Raman spectrometry, and 90% using visual inspection.
Conclusions
The evidence presented shows that drug quality is probably improving in both cities, especially Lagos, since major reductions of failure rates over time occur with all means of assessment. Many more samples failed when examined by Raman spectrometry than by Minilab protocol. The discrepancy is most likely caused by the two techniques measuring different aspects of the medication and hence the discrepancy may be the natural variation in these techniques. But other explanations are possible and are discussed.
http://www.malariajournal.com/content/9/1/157
Background
Although insecticide-treated bed nets are effective tools, use often does not follow ownership. House structure and space arrangements may make the attempt to use bed nets difficult, especially for school age children. The objectives of this study were to explore whether an individual's sleeping arrangements and house structure affect bed net use in villages along Lake Victoria in western Kenya.
Methods
Sleeping arrangements of residents were directly observed for use of a bed net, use of a bed, and location. House size, number and types of rooms, bed availability, and residents' ages were estimated. The family heads and mothers were asked about the reason for not using bed nets. Individual bed net use was examined against age and sleeping arrangement. Net use at the household level was examined against four variables: bed availability, bed net availability, house size, and number of rooms.
Results
Bed net use by children between five and 15 years of age was lower than that among the other age classes. However, age was dropped from the final model, and sleeping arrangement was significantly associated with net use. Net use was significantly associated with bed availability, number of rooms and their interaction.
Conclusion
Net use was affected by sleeping arrangement and availability of suitable locations for hanging nets, in addition to net availability. Most residents had likely not realized that sleeping arrangement was a factor in net use. The ease of hanging a net is particularly important for children.
http://www.malariajournal.com/content/9/1/176
Although insecticide-treated bed nets are effective tools, use often does not follow ownership. House structure and space arrangements may make the attempt to use bed nets difficult, especially for school age children. The objectives of this study were to explore whether an individual's sleeping arrangements and house structure affect bed net use in villages along Lake Victoria in western Kenya.
Methods
Sleeping arrangements of residents were directly observed for use of a bed net, use of a bed, and location. House size, number and types of rooms, bed availability, and residents' ages were estimated. The family heads and mothers were asked about the reason for not using bed nets. Individual bed net use was examined against age and sleeping arrangement. Net use at the household level was examined against four variables: bed availability, bed net availability, house size, and number of rooms.
Results
Bed net use by children between five and 15 years of age was lower than that among the other age classes. However, age was dropped from the final model, and sleeping arrangement was significantly associated with net use. Net use was significantly associated with bed availability, number of rooms and their interaction.
Conclusion
Net use was affected by sleeping arrangement and availability of suitable locations for hanging nets, in addition to net availability. Most residents had likely not realized that sleeping arrangement was a factor in net use. The ease of hanging a net is particularly important for children.
http://www.malariajournal.com/content/9/1/176
MALARIA: Malaria Elimination in Zanzibar: A Feasibility Assessment
Due to the recent success that Zanzibar has achieved in reducing its malaria burden, the Zanzibar Malaria Control Program (ZMCP) is facing an important decision of whether to continue sustaining malaria control or to seek malaria elimination. To reach their decision, the ZMCP conducted an assessment to gauge the feasibility of reaching and sustaining malaria elimination from the operational, technical and financial perspectives. This feasibility assessment resulted in a series of evidence-based recommendations, and is the first robust analysis on the feasibility of elimination, therefore forming a strong foundation from which strategic decisions and programmatic shifts in Zanzibar can be made.
Many local and international experts provided technical advice to the feasibility assessment. This work benefited from the intellectual leadership of the Clinton Health Access Initiative and many members of the Malaria Elimination Group, with financial support provided by the UCSF Global Health Group through a grant from ExxonMobil.
The final report and recommendations on a way forward were recently presented to the senior leadership of the Zanzibar Ministry of Health and Social Welfare. Conclusions on the short- and long-term challenges of achieving and sustaining elimination are outlined as well as strategies that will be critical for elimination to succeed. The ZMCP has already begun implementing several of the recommended strategies, most notably strategies to enhance surveillance capacity, which are paramount for any elimination effort.
More information and resources on malaria elimination can be found at the Malaria Elimination Group website: www.malariaeliminationgroup.org
POVERTY: Microcredit in Guatemala
GUATEMALA CITY, Jun 21, 2010 (IPS) - Rosenda Gómez, a 53-year-old mother of five, knows all about challenges. To overcome them, she started a modest sausage business in Guatemala, and thanks to her leadership skills and training and other support she received, she is now an example of the economic empowerment of women.Sixteen years ago she began to make homemade sausages in her village, Laguna Ocubilá, to sell in the nearby city of Huehuetenango, the capital of the northwestern province of the same name. But her business was a micro-enterprise that allowed her family to just barely scrape by -- until things changed radically three years ago, when the Centros de Servicios para los Emprendimientos de las Mujeres (CSEM) came to her village. CSEM, a network of centres providing technical and financial services for women entrepreneurs, is sponsored by the United Nations Development Fund for Women (UNIFEM) in association with Guatemalan institutions. "We began to receive support, in the form of credit, training to improve our products, and promotion of our chicken and pork sausages in markets and fairs -- none of which we had before," Gómez told IPS. With that boost, Gómez, who only went to school up to third grade, managed to increase production from five to 50 kgs of sausages a week, and demand continues to grow. She also received support to set up a meat processing centre, along with other women backed by the CSEM, which changed the life of her family and her business. Her three youngest children, between the ages of 13 and 15, still live with Gómez and her husband, a truck driver, while the other two have already given them seven grandchildren, she says proudly. Her achievement is even more impressive given the limited economic independence of women in this impoverished Central American country. Men represent 65 percent of the economically active population, and women only 35 percent, according to the government's national survey on employment and income. Social organisations point to the vicious circle of poverty, lack of education and lack of health care suffered by so many in this country of 14.3 million people, where the poverty rate is slightly higher for women (51.5 percent) than for men (48.4 percent), according to the 2006 national survey on living conditions. The CSEM is now supporting 3,273 women in seven services centres that began to be established in 2006 in the country's poorest provinces. Seven others operate in El Salvador, Honduras and Nicaragua. "We learned how to draw up a business plan, market our products and estimate production costs," Sonia Paz, the head of the Asociación de Mujeres Olopenses women's association in the eastern province of Chiquimula, where one of the CSEM centres operates, told IPS. Paz forms part of a group of 36 women who make and sell handicrafts like bags and keychains using fibre from the maguey, or agave, plant. "Thanks to support from the CSEM, we have improved the quality of our products and we have registered with the tax office," said Paz. Rita Cassisi, UNIFEM coordinator in Guatemala, told IPS that the CSEM helps women set up businesses by offering loans, organisational training, assistance in improving products, marketing techniques and other support. "One of the vacuums that we have seen is women's access to financing, which is why the programme is focused on a strategy of economic empowerment at the local, national and regional levels," she explained. At the local level, the CSEM centres work with economic development agencies and public and private lending institutions; at the national level they work with universities, the Economy Ministry, the Presidential Secretariat of Women, and women's groups; and in Central America as a region they work with organisations and agencies that support women. According to Cassisi, the CSEM's beneficiaries "are at the base of the business pyramid; they are women who set up micro-enterprises and micro-businesses, which help move the economy." Like any effort, the CSEM has run into hurdles. Gilda Rivera, head of the CSEM in the western province of San Marcos, told IPS a that although they opened their doors in April 2009, things are moving slowly. "The problem is that we don't have funds to invest, and we have around 80 women waiting for our support," she said. In Rivera's view, too many requisites are set for approval of projects in some cases, which slows down the process, while many women are waiting for training and loans in order to upgrade their businesses and increase production. According to the third regional report on the labour market in Central America and the Dominican Republic produced by the International Labour Organisation (ILO) and the Central American Integration System (SICA), 73 percent of women in the labour force in Guatemala work in the informal economy. Iris Alvarado at the non-governmental Centro de Investigación, Capacitación y Apoyo a la Mujer (CICAM - Centre for Women's Research, Training and Support), told IPS that Guatemala faces serious challenges in terms of gender equity, above and beyond women's economic independence. The country's high levels of gender violence and limited access to education and health, especially in rural areas, must be addressed in the attempt to combat gender inequalities and to provide equal opportunities and living conditions for girls and women, Alvarado said.
http://ipsnews.net/news.asp?idnews=51893
http://ipsnews.net/news.asp?idnews=51893
POVERTY: Microcredit problems in India
Savita Ramesh Rathore stands at the door of her dimly lit workshop in Mumbai's Dharavi slum, filled floor to ceiling with bundles of old clothes, and talks about the cost of her son's wedding last year. "Jewels, clothes, food, the town hall," says Rathore, 50, who makes towels from discarded clothes. She borrowed 30,000 rupees ($647) from moneylenders charging 60 percent interest and took additional loans from friends. Three months ago she got a 10,000-rupee loan from urban lender Hindusthan Microfinance at an interest rate of just over 20 percent to repay some of that debt.
Rathore is one of 25 million Indians who have taken so-called microfinance loans, often without adequate documentation or collateral, according to research firm Micro-Credit Ratings International. As Hyderabad-based SKS Microfinance plans to become the first microlender in the country to go public, an industry credited with helping alleviate poverty is suddenly provoking comparisons to subprime lenders in the U.S.
"Globally, microfinance is showing characteristics of the Western financial markets before the collapse," says Sanjay Sinha, managing director at Micro-Credit Ratings in Gurgaon. "In the U.S., homeowners were given loans at 120 percent of the value of their properties. In rural India, people are being lent to at 150 percent of the value of their enterprises."
Microfinance firms make loans in poor areas largely shut off from traditional banking services. The past two years have been marked by surging defaults in some countries. Microfinance markets in Nicaragua, Morocco, and Pakistan have seen default levels climb to more than 10 percent, the threshold that marks a "serious repayment crisis," according to a February report from policy and research firm Consultative Group to Assist the Poor.
India, where more than 600 million people live on less than $1.50 a day, is the world's largest microfinance market. Most microfinance loans in India range from 5,000 to 20,000 rupees ($108 to $431), with interest rates ranging from 18 percent to 33 percent. Although Indian microfinance firms have reported bad-loan ratios of about 2.5 percent on average, levels may be higher because some lenders roll over loans to struggling borrowers to avoid defaults, says Micro-Credit's Sinha.
Microfinance lending in India may surge by about 40 percent annually over the next few years, says Sinha. SKS, betting the potential for growth will attract investors, is seeking regulatory approval for an initial public offering. Basix Group, which focuses on poor households in rural areas and provides loans averaging about 3,000 rupees, may sell shares in an IPO next year, says Chairman Vijay Mahajan. Others are likely to follow. Until now, microfinance companies have relied on loans and grants from banks, insurers, and foundations for funding, he says.
Micro-Credit's Sinha worries that growth in the microfinance market is masking an erosion of lending standards that may spark rising defaults. India doesn't have a nationwide system for tracking borrowers' credit histories, making it hard for lenders to check whether clients have multiple loans. "There is significant investor interest in microfinance companies' public issues, but it's being driven by irrational exuberance," says Sinha.
Rural lending can be particularly tricky. "If there's a bad monsoon and the farmers lose their crops, our money can go along with it that year," says Amit Kalokhe, a loan officer at Mumbai-based Hindusthan Microfinance. The firm tries to reduce risk by lending to groups of people rather than to individuals, founder Anil Jadhav says. "That way if one person defaults, others can pay the amount," he says. The 10,000-rupee advance to towel maker Rathore in Mumbai was part of a loan to a group of women, according to the company.
Rathore is already mulling how to finance another major outlay: her 19-year-old daughter's wedding. "Once my present loans are paid off, I know there will be more," she says, looking past the open sewage drains near the two-room home she shares with four family members. "The cycle doesn't end."
The bottom line: Rushing to cash in on a growing market, India's microlenders may be handing out money to borrowers who can't afford to repay it.
http://www.businessweek.com/magazine/content/10_26/b4184050319788.htm
Rathore is one of 25 million Indians who have taken so-called microfinance loans, often without adequate documentation or collateral, according to research firm Micro-Credit Ratings International. As Hyderabad-based SKS Microfinance plans to become the first microlender in the country to go public, an industry credited with helping alleviate poverty is suddenly provoking comparisons to subprime lenders in the U.S.
"Globally, microfinance is showing characteristics of the Western financial markets before the collapse," says Sanjay Sinha, managing director at Micro-Credit Ratings in Gurgaon. "In the U.S., homeowners were given loans at 120 percent of the value of their properties. In rural India, people are being lent to at 150 percent of the value of their enterprises."
Microfinance firms make loans in poor areas largely shut off from traditional banking services. The past two years have been marked by surging defaults in some countries. Microfinance markets in Nicaragua, Morocco, and Pakistan have seen default levels climb to more than 10 percent, the threshold that marks a "serious repayment crisis," according to a February report from policy and research firm Consultative Group to Assist the Poor.
India, where more than 600 million people live on less than $1.50 a day, is the world's largest microfinance market. Most microfinance loans in India range from 5,000 to 20,000 rupees ($108 to $431), with interest rates ranging from 18 percent to 33 percent. Although Indian microfinance firms have reported bad-loan ratios of about 2.5 percent on average, levels may be higher because some lenders roll over loans to struggling borrowers to avoid defaults, says Micro-Credit's Sinha.
Microfinance lending in India may surge by about 40 percent annually over the next few years, says Sinha. SKS, betting the potential for growth will attract investors, is seeking regulatory approval for an initial public offering. Basix Group, which focuses on poor households in rural areas and provides loans averaging about 3,000 rupees, may sell shares in an IPO next year, says Chairman Vijay Mahajan. Others are likely to follow. Until now, microfinance companies have relied on loans and grants from banks, insurers, and foundations for funding, he says.
Micro-Credit's Sinha worries that growth in the microfinance market is masking an erosion of lending standards that may spark rising defaults. India doesn't have a nationwide system for tracking borrowers' credit histories, making it hard for lenders to check whether clients have multiple loans. "There is significant investor interest in microfinance companies' public issues, but it's being driven by irrational exuberance," says Sinha.
Rural lending can be particularly tricky. "If there's a bad monsoon and the farmers lose their crops, our money can go along with it that year," says Amit Kalokhe, a loan officer at Mumbai-based Hindusthan Microfinance. The firm tries to reduce risk by lending to groups of people rather than to individuals, founder Anil Jadhav says. "That way if one person defaults, others can pay the amount," he says. The 10,000-rupee advance to towel maker Rathore in Mumbai was part of a loan to a group of women, according to the company.
Rathore is already mulling how to finance another major outlay: her 19-year-old daughter's wedding. "Once my present loans are paid off, I know there will be more," she says, looking past the open sewage drains near the two-room home she shares with four family members. "The cycle doesn't end."
The bottom line: Rushing to cash in on a growing market, India's microlenders may be handing out money to borrowers who can't afford to repay it.
http://www.businessweek.com/magazine/content/10_26/b4184050319788.htm
POVERTY: LESOTHO: Hard times delay MDGs
JOHANNESBURG, 25 June 2010 (IRIN) - Life is mostly hard in the mountainous kingdom of Lesotho, but the chronic droughts that seem signal the unfolding impact of climate change are projected to become more severe, and could squeeze cultivable land from an already slim 10 percent to a mere three percent in 25 years. "While other factors contribute to droughts and the shrinking of cultivable land, climate change exacerbates the situation," said a new UN Development Programme (UNDP) assessment of countries' progress towards achieving the eight UN Millennium Development Goals (MDGs), which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education by 2015. Erratic weather, lack of access to agriculture inputs, soil erosion and high HIV/AIDS prevalence have all contributed to shrinking cereal production. In 1980 Lesotho produced grain enough to meet 80 percent of its requirement; by 2004 it could barely cover 30 percent of its needs, and output has been steadily dropping, according to the UN World Food Programme. The UNDP report noted that adapting to climate change, which will affect food production, was urgently required to ensure all the MDGs are met, but this would take more money. The extra costs will arise from rapid interventions, like beefing up social protection and improving the capacity of any particular programme aimed at achieving the UN goals to adapt to capricious weather patterns. The report cited studies that tried putting a cost on making the MDGs "climate resilient" globally. "Estimates set the cost of 'climate resilient' MDGs to be about a third higher than the conventional cost of meeting the MDGs - around US$100 billion a year for the next decade." The report also looked at how and to what extent the 2006-08 food price crisis, the global recession, and rapid urbanization had affected the ability of countries to achieve the MDGs. There is more bad news for Lesotho. In 2009 the global recession took out more than a million jobs in neighbouring South Africa, especially in the mining sector, a traditional source of work and income. Unemployment in Lesotho shot up from a high 23 percent in 2008 to 29.4 percent in 2009. The report noted that "Progress towards the MDGs is expected to improve, as growth is recovering in many countries, but achievement of the MDG goals will be delayed." Read the report at: http://content.undp.org/go/cms-service/stream/asset/?asset_id=2620072
POVERTY: Inhibits education
ZIMBABWE: No chance to prepare for the future HARARE, 23 June 2010 (IRIN) - Chenai Moyo, 18, is confident she would have passed the examinations at her school in Harare, Zimbabwe's capital, but for two years in a row there was no money; now she has to fend for the family and depends on an older man for support. "I couldn't register for examinations last year [2009] because my father had just passed away, and the little money that was there went towards his burial. My mother is not employed and now that she is ill the situation is worse for me and my brothers," Moyo told IRIN. Her mother tested positive for HIV in 2009. Moyo was a brilliant student but said she would probably never sit her O-Level examinations, a school-leaving certificate. "My mother talked me into marrying this man, who is an elder in our church. He has promised to look after my ill mother and my two brothers, but I have given up hope of ever going to school again," she said. She is not alone: recent education ministry statistics showed that some 100,000 learners (33 percent of those eligible to write O-level exams) and around 10,700 learners (29 percent of those eligible for A-level exams) had failed to register. "This year ... there are a number of students out there who have failed [to register] because of poverty," education minister David Coltart said in a statement. Zimbabwe's ailing education system, once a model for sub-Saharan Africa, has buckled and all but collapsed under the economic and political crises of the past decade, when widespread food shortages, hyperinflation, cholera outbreaks, and an almost year-long strike by teachers in 2008 led to a dramatic decline in the standard of learning. It is not uncommon for 10 pupils to share a textbook, and although the government drastically slashed school fees in February 2009, deepening poverty put even the reduced cost of attending government schools in some areas beyond the reach of thousands of children. The government extended the initial exam registration deadline of 28 May by two weeks, but most people were sceptical that parents and students who had previously been unable to pay the fees - US$10 per O-level subject and US$20 per A-level subject - would be able to raise the money in time. "The extension means nothing at all - the period is too short, and one wonders why the government is in such a hurry to close the door on students," the president of the Progressive Teachers Union of Zimbabwe (PTUZ), Raymond Majongwe, told IRIN. "Besides, late entrants will be fined US$5 per subject and we don't know where the government expects the poor parents that have failed to raise the examination fees to get the extra amount." Majongwe said he thought the ministry's figure for the number of students who had failed to register for examinations was an "understatement" of the gravity of the situation. "According to our own independent surveys, close to 200,000 O- and A-level students have been denied the chance to prepare for their future. There are thousands who have resigned themselves to fate, as they have failed to write in the past and are not part of the current statistics since they are not attending school," he pointed out. A headmaster at a secondary school in Seke rural district, about 40km south of the capital, said only 30 students at his school would write their O-level examinations this year. "I was supposed to have 125 students sitting for their O-level examinations but only a handful managed to register," he noted. "While the examinations fees might not seem too high, it should be remembered that the majority of households in rural areas still have large families to look after, and there is a significant number of child-headed families."
MALNUTRITION: Please manage the food better
JOHANNESBURG, 24 June 2010 (IRIN) - A new global architecture to govern food security is urgently needed to reduce the number of hungry people, and predict and prevent another food price crisis like the one that took the world by surprise in 2006-08. Shenggen Fen, director general of the International Food Policy Research Institute (IFPRI), a US-based think-tank, urged leaders of the G8 industrialised countries and G20 emerging countries, who will be meeting in Canada for two days from 25 June, to focus on this issue."The existing governing systems, and even countries, failed to predict the [food price] crisis in 2007/08," and ever more people have been going hungry since then, he told IRIN.The food price crisis and the recession that followed pushed the number of malnourished men, women and children to more than one billion in 2009, according to UN agencies, and the figure is still growing. "Hunger has been much more pervasive than poverty ... If past trends continue, global food security will deteriorate even further," warned an IFPRI report on meeting the UN Millennium Development Goal to halve hunger, called Business As Unusual, written by Fen and released on 23 June."While food prices have dropped, incomes because of the recession have been reduced by a much higher rate," said Holger Matthey, an economist at the UN Food and Agriculture Organization (FAO).The G8 countries pledged US$22 million to tackle global hunger at their 2009 meeting in L'Aquila, Italy, "But we don't know how much of that money has come through," said Fen, who proposed setting up a tracking system to monitor funds for reducing hunger. IFPRI uses its Regional Strategic Analysis and Knowledge Support System (ReSAKSS) to monitor funding for agriculture in Africa. "We could maybe expand this system to cover global flows," Fen suggested.After the 2006-08 crisis, when staples such as maize, rice and wheat climbed to their highest prices in 30 years, many donor countries, aid agencies and analysts suggested that the existing Committee on World Food Security (CFS) be reformed.The CFS is a technical committee of the FAO, and serves as a forum in the UN system for the review and follow-up of policies on world food security, food production, nutrition, and physical and economic access to food.Jacques Diouf, director-general of FAO, announced last week that the CFS was being reformed to make it a "global platform for policy convergence and the coordination of expertise and action in the fight against hunger and malnutrition in the world".Fen said the UN Secretary-General's High-Level Task Force on the Global Food Security Crisis, set up after the crisis, had done a "good job" in coordinating initiatives to respond to the crisis. "But that task force also needs support - it needs current information from policy institutes such as IFPRI and other academics; there needs to be more information-sharing between governments and organizations to make this work."Another crisis?Uncoordinated policy actions of governments across the world during the 2006-08 food crisis made prices even more volatile and affected access to markets, said a new joint Agricultural Outlook for the next 10 years, produced by the Organization for Economic Cooperation and Development (OECD) and FAO. Food prices have come down, but are still high, according to FAO.The Outlook acknowledged that the 2006-08 food price crisis "was due to the contemporaneous occurrence of a panoply of contributing factors, which are not likely to be repeated in the near term. However, if history is any guide, further episodes of strong price fluctuations in agricultural product prices cannot be ruled out, nor can future short-lived crises". High crude oil and energy prices were major contributors to forcing up food prices in 2006-08. Fossil fuel and energy prices not only affect the cost of agricultural inputs, but expand the quantity of agricultural land being diverted to produce grain for biofuel. "Crude oil and energy prices are assumed to increase over the coming decade as global economic activity is restored," the Outlook commented. Burgeoning demand for milk and meat in emerging economies like China and India also puts pressure on the amount of staple grains diverted to animal feed. Besides higher population growth rates - two percent per year in Africa - high urbanization trends and a large emerging middle class will drive demand for food.The OECD/FAO projected that staples like wheat would cost 15 percent to 40 percent more from 2010 to 2019 than they did from 1997 to 2006.Merritt Cluff, a senior FAO economist who led the Outlook research team, advised food aid agencies to "source food purchases locally where possible ... [so] that local rural communities receive higher payments for their commodities and stimulate production". Numbers of hungry growing The task of halving the number of hungry from 1990 levels by 2015, as required by the MDG, has grown - the world will have to help 73 million people out of hunger every year to reach the MDG target. To help achieve this, Fen suggested that countries scale up investment in agriculture and social protection - a twin-track approach proposed by the UN task force in the wake of the 2006-08 crisis.A study Fen conducted in China showed that for every $1,200 spent on agricultural research in 2000, 11 people were lifted out of poverty; in Uganda, for every additional $920 invested in agricultural research in 1999, 58 people were lifted out of poverty.It paid to concentrate on country-led, bottom-up approaches to making people food secure by involving local governments and seeking broad participation; if countries could not afford agricultural reforms, the private sector should be brought in. Fen urged countries to experiment with new policies and expand successful pilot initiatives, saying: "Scale up the unusual." The IFPRI report noted that in Kenya, where the Business Alliance Against Chronic Hunger launched its first pilot programme in 2009, more than 30 private companies had become members. According to local news reports the initiative had helped more than 2,000 farmers.Worldwide, food markets remain volatile. In 2006-08 prices were "exacerbated by trade policies of exporters, creating higher import prices", said FAO's Cluff. No trading system could ensure that people would get "cheap food, but net importers deserve to have unrestrained access to markets on a predictable and fair basis". Cluff suggested that developing countries put in place well functioning markets, and establish commodity exchanges to make "price discovery more transparent and fair".
MALNUTRITION: WEST AFRICA: Call for more aid as 10 million face hunger
DAKAR, 24 June 2010 (IRIN) - Several UN agencies and NGOs are calling for a greater mobilization of aid workers and funding in the West African Sahel to meet the needs of a population facing one of the worst nutrition crises in recent years. Over 10 million people are at risk of hunger in the Sahel before the September harvests, according to the Food and Agriculture Organization's (FAO). [http://reliefweb.int/rw/rwb.nsf/db900sid/LPAA-84NH9V?OpenDocument&query=sahel%20snapshot] In Niger, about half of the 13.4 million inhabitants are facing hunger. Up to two million Chadians and hundreds of thousands of Mauritanians and Malians also need assistance. There have been early interventions and prepositioning, but more should have been done earlier, say aid workers and the response needs to be urgently scaled up. In late 2009, the Famine Early Warning System Network highlighted signs of the crisis: a drop in cereal production, poor pastoral conditions and a dangerous combination of poverty and high food prices. [http://www.fews.net/docs/Publications/West_Outlook_2009_October_final_en.pdf] "There are always delays in supply pipelines. This means that decisions taken today will have an impact on the ground in late July or August. Food distributions should have started in April or May," said the Swiss operation director of Médecins Sans Frontières (MSF), Bruno Jochum. Support remains crucial, he added, since during the months of August and September, people are typically left with no food while they wait for the next harvest. Only 57 percent of the US$190 million emergency appeal by the UN Office for the Coordination of Humanitarian Affairs (OCHA) for Niger is funded. In Chad, the World Food Programme (WFP) still lacks $23 million of the $65 million required for the food crisis. The head of the European Commission Humanitarian Aid Office (ECHO) for West Africa, Cyprien Fabre, noted, however, that the donor response is timelier than in 2005, when the food crisis caught many unprepared. [http://irinnews.org/Report.aspx?ReportId=88958] This time, he said, early warning and response mechanisms were in place in most affected countries and funds were rapidly allocated. "Operations are well under way in Niger, Burkina Faso and Mali. In Chad, more actors are needed to respond properly. Funding will be available, if necessary." Chad The situation in the Sahelian belt of Chad is especially worrying. "Chad is somehow like Niger in 2005," explained the UN Children's Fund (UNICEF) regional adviser for nutrition, Félicité Tchibindat. "The number of organizations on the ground is limited, so is the political will. On the bright side, humanitarian agencies and donors are now starting to respond." Such mobilization will help, but the imminent start of the rainy season will make the tricky task of bringing assistance to remote villages in a landlocked country even more challenging. WFP indicates that it can take as long as 3-5 months for food to arrive in Chad. In parts of the country, roads will be officially closed as of the end of June because of the rains. "Even if there are cargos and cargos of stocks, if they cannot be delivered, people will not get food. Without prepositioned food, it will become very difficult. Agencies may have to look into air deliveries," said OCHA's public information, advocacy and donor relations officer for West Africa, Yvon A. Edoumou. "Very vulnerable" If there are normal harvests in the autumn, the population is expected to recover at the end of the year. A normal to wet rainy season is forecast by the Permanent Inter-State Committee for Drought Control in the Sahel (CILSS). Precipitation is crucial in a region where most agriculture is rain-fed. "If the rains fail, it will be a catastrophe in the whole region. People's assets are significantly depleted. They have borrowed money to eat and are now waiting for the rains," said ECHO's Fabre. The Sahel countries are among the poorest in the world. A third of the population of Chad and Niger is chronically undernourished. Each year, 300,000 under-five children die of malnutrition, according to UNICEF. "The population is already very vulnerable," said OCHA's Edoumou. "When you live from one day to the next, any shock provokes a crisis. If the rains are poor, if the cattle are affected by a mysterious disease, people are in difficulty."
POVERTY: CHAD: Factors behind the food crisis
N'DJAMENA, 23 June 2010 (IRIN) - The recently finalized multi-agency and governmental vulnerability assessment map (VAM) of Chad, covering more than 4,000 households in 212 villages from April to June 2009, [http://www.reliefweb.int/rw/rwb.nsf/db900sid/MDCS-86EB6R?OpenDocument&rc=1&cc=tcd] analyzed factors contributing to the current food crisis http://www.irinnews.org/Report.aspx?ReportId=88370 triggered by a 2009 drought. The Tibesti, Borkou and Ennedi regions in the north, where 2 percent of the population live according to the 2009 census, were not surveyed [http://www.irinnews.org/Report.aspx?ReportId=89412]. Who heads the households, whether they can read, are married, or their children are in school, a person's profession and where they live all influence how much and what food someone accesses, finances and consumes. Here are some highlights from the report. . 1.6 million: People were "food insecure" and faced physical or financial barriers to getting food. . 50 percent: Children from 7 to 14 years of age enrolled in school in the regions of Kanem, Bahr-El-Gazal, Batha, Ouaddaï, Sila, Chari-Baguirmi, Hadjer Lamis and Salamat. These regions were also the most food insecure. . 16.6 percent: Children younger than five with acute malnutrition nationwide, with 4.4 percent severely malnourished. (Acute malnutrition is measured by the size of the upper arm and a child's weight. The World Health Organization classifies acute malnutrition levels above 15 percent as "critical" emergencies.) . 39.1 percent: Chronically malnourished children, determined by height. . 7.7 percent: Households nationwide that had taken a loan, of which 41 percent had borrowed money to buy food. . 54 percent: Illiterate heads of households. . 12 percent: Households headed by women - 56 percent widowed. . US$56: Monthly food expense in poor households - 70 percent of income. . $202: Monthly food expense in richer families - 58.7 percent of income. . 2 percent: Portion of monthly income spent on, respectively, healthcare, ceremonies, non-alcoholic drinks. . 56 percent: Households having a single source of revenue. . 43 percent: Households in the western, arid Kanem region, from which at least one person had migrated, most often for work (58 percent) versus the national migration average of 18 percent. . 24 percent: Households in the southernmost region of Logone Oriental, from which a woman had migrated. This region also reported one of the lowest rates of exclusive breastfeeding [http://www.irinnews.org/report.aspx?ReportId=85611], with 92.2 percent of newborns receiving something other than breast milk as their first food. . 1 day: Number of times a week families eat vegetables, milk and fruit, respectively. . 78 percent: Families who buy their food at the market even though 83.6 percent reported growing food and 45.7 percent said they raised animals.
POVERTY: Malawi improved by one third
Malawi news report that the nation has managed to reduce poverty by one third since 2003, according to Newby Henry Kumwembe, Permanent Secretary, Ministry of Industry and Trade, Malawi.He was speaking at a side event organized by CUTS Geneva Resource Centre in the World Trade Organisation (WTO) on during the review of Malawi trade policy “Poverty in Malawi has been reduced from 64% of the population to 40% since 2003,” said Kumwembe. According to Kumwembe this impressive reduction in poverty “has been possible due to sustained economic growth and by maintaining an open trade policy regime.”Kumwembe also highlighted the many challenges still faced by Malawi.“The two most important challenges facing Malawi are: very high transport costs as Malawi is a landlocked country; and the lack of supply-side capacities”, he said. He appealed to Malawi development partners for more aid-for-trade to enable Malawi to realize its full developmental potential.
David Luke of the United National Development Programme concurred with the assessment by Kumwembe.According to Luke “Malawi presents a mixed picture in mainstreaming trade into development and inadequate human and financial resources are the main causes for under-performance”. He also mentioned that social sectors had received greater attention from donors than productive sectors. While investment in social sectors is extremely important, productive sectors too should not be ignored. Michael Roberts of the WTO Secretariat in his presentation pointed out the importance of aid for trade in helping countries like Malawi maximizing the contribution of trade to economic development and poverty reduction. He pointed out that “growth should be sustained and broad-based to ensure lasting development impacts”. Among the many constraints mentioned, he also identified the need for better coordination among donors. For example, more than twenty donors are active in Malawi without always coordinating their funding activities.
David Luke of the United National Development Programme concurred with the assessment by Kumwembe.According to Luke “Malawi presents a mixed picture in mainstreaming trade into development and inadequate human and financial resources are the main causes for under-performance”. He also mentioned that social sectors had received greater attention from donors than productive sectors. While investment in social sectors is extremely important, productive sectors too should not be ignored. Michael Roberts of the WTO Secretariat in his presentation pointed out the importance of aid for trade in helping countries like Malawi maximizing the contribution of trade to economic development and poverty reduction. He pointed out that “growth should be sustained and broad-based to ensure lasting development impacts”. Among the many constraints mentioned, he also identified the need for better coordination among donors. For example, more than twenty donors are active in Malawi without always coordinating their funding activities.
TUBERCULOSIS: AFRICA: Straight talk with MSF medical coordinator
JOHANNESBURG, 22 June 2010 (PLUSNEWS) - Dr Eric Goemaere is the medical coordinator of Médecins Sans Frontières (MSF) in South Africa. His career in HIV and AIDS has spanned decades, moving from an era in which antiretroviral (ARV) drugs were beyond the reach of most, to a time where millions are living with HIV and on treatment. IRIN/PlusNews sat down with Goemaere to ask him about the future of funding, drugs and the fight against HIV.
QUESTION: Has MSF experienced cuts in international funding and, if so, how is this affecting its programmes?
ANSWER: Indirectly. In some of our programmes in Uganda and in Kenya we have seen patients coming to us - and sometimes from far away - and saying, 'Where I used to get access to my drugs, I've been told, No'. By default, they come to an MSF programme where there are still treatment slots available. For the moment these numbers are limited, but in the future they might grow to the tens of thousands, and that would definitely put a strain on the programme. MSF is a very small fish in the pond ... we choose to be privately funded and we are extremely restricted in our funding. We are not in a position to absorb the withdrawal of funding, and we do not want in any way to pretend [to do] so. Q. Second- and third-line drugs are out of reach to many living with HIV and TB; as HIV/AIDS becomes increasingly less "exceptional", what is that likely to mean in the development of these drugs? A. MSF are supporting patent pools ... to avoid going back to those battles we had in the beginning of the 2000s against pharmaceutical companies. A patent pool is a sort of win-win agreement where [pharmaceutical companies] give up their patent to a pool; in exchange they get royalties for that, as part of a totally negotiated agreement. In the United States, someone diagnosed HIV-positive at 20 years old has a life expectancy of 69 years. Why so? There are an almost unlimited number of regimens, or different drugs that you can combine, to ensure that once resistance comes up you have an alternative. Here [in Africa], we don't have that luxury - we have two bullets; two regimens - so we estimate that we can offer [someone diagnosed with HIV] 10 years [or so] ... at this stage.
Q. How serious is the threat of drug resistance?
A. Drug resistance is a problem, [but] this is a natural phenomenon and we will have to deal with it, although I would say it has accelerated [because] people are not adherent. Twenty percent, or one-fifth, of our patients have drug resistance after one year, [which] compares very favourably with some European cohorts. So it's not more of a problem, but it is an alarming problem for the good reason that we need to shift to second-line regimens, [which] ... are about five times more expensive than first-line regimens - so [drug resistance] will increase cost.
Q. Why isn't tuberculosis (TB) declining in South Africa?
A. The answer is very simple: the TB epidemic is fuelled by the HIV epidemic. To tackle the TB epidemic, you need to tackle the HIV epidemic ... 70 percent of TB patients are HIV-positive, so they are co-infected. In Khayelitsha township [outside Cape Town], where I work, the TB incidence rate has reached astronomical levels, with more than 6,000 new notifications per year - that is more than the whole of the United Kingdom in one township - and this was fuelled only by the high HIV prevalence. The good news is that when you get a good coverage with the ARVs, you immediately see the TB notification rate going down, and that's what we've been seeing for the last two years.
Q. What is the single biggest obstacle to tackling HIV in southern Africa?
A. It's combined factors, and the importance of these factors changes with time. In the beginning the biggest obstacle was drug prices; we managed to tackle that problem. Then the problem became about healthcare facilities, because HIV was treated mostly at central level [large hospitals in urban centres, which] required lots of doctors, and not many doctors were available. Slowly, surely, by increasing coverage we managed to decentralise care to primary healthcare level [clinics]. Today, unfortunately, the biggest problem might become funding. If not enough funding is available we [will] go back in time ... back to centralised care, with patients [coming for treatment when they are] sicker, and [case management] becoming more complicated.
QUESTION: Has MSF experienced cuts in international funding and, if so, how is this affecting its programmes?
ANSWER: Indirectly. In some of our programmes in Uganda and in Kenya we have seen patients coming to us - and sometimes from far away - and saying, 'Where I used to get access to my drugs, I've been told, No'. By default, they come to an MSF programme where there are still treatment slots available. For the moment these numbers are limited, but in the future they might grow to the tens of thousands, and that would definitely put a strain on the programme. MSF is a very small fish in the pond ... we choose to be privately funded and we are extremely restricted in our funding. We are not in a position to absorb the withdrawal of funding, and we do not want in any way to pretend [to do] so. Q. Second- and third-line drugs are out of reach to many living with HIV and TB; as HIV/AIDS becomes increasingly less "exceptional", what is that likely to mean in the development of these drugs? A. MSF are supporting patent pools ... to avoid going back to those battles we had in the beginning of the 2000s against pharmaceutical companies. A patent pool is a sort of win-win agreement where [pharmaceutical companies] give up their patent to a pool; in exchange they get royalties for that, as part of a totally negotiated agreement. In the United States, someone diagnosed HIV-positive at 20 years old has a life expectancy of 69 years. Why so? There are an almost unlimited number of regimens, or different drugs that you can combine, to ensure that once resistance comes up you have an alternative. Here [in Africa], we don't have that luxury - we have two bullets; two regimens - so we estimate that we can offer [someone diagnosed with HIV] 10 years [or so] ... at this stage.
Q. How serious is the threat of drug resistance?
A. Drug resistance is a problem, [but] this is a natural phenomenon and we will have to deal with it, although I would say it has accelerated [because] people are not adherent. Twenty percent, or one-fifth, of our patients have drug resistance after one year, [which] compares very favourably with some European cohorts. So it's not more of a problem, but it is an alarming problem for the good reason that we need to shift to second-line regimens, [which] ... are about five times more expensive than first-line regimens - so [drug resistance] will increase cost.
Q. Why isn't tuberculosis (TB) declining in South Africa?
A. The answer is very simple: the TB epidemic is fuelled by the HIV epidemic. To tackle the TB epidemic, you need to tackle the HIV epidemic ... 70 percent of TB patients are HIV-positive, so they are co-infected. In Khayelitsha township [outside Cape Town], where I work, the TB incidence rate has reached astronomical levels, with more than 6,000 new notifications per year - that is more than the whole of the United Kingdom in one township - and this was fuelled only by the high HIV prevalence. The good news is that when you get a good coverage with the ARVs, you immediately see the TB notification rate going down, and that's what we've been seeing for the last two years.
Q. What is the single biggest obstacle to tackling HIV in southern Africa?
A. It's combined factors, and the importance of these factors changes with time. In the beginning the biggest obstacle was drug prices; we managed to tackle that problem. Then the problem became about healthcare facilities, because HIV was treated mostly at central level [large hospitals in urban centres, which] required lots of doctors, and not many doctors were available. Slowly, surely, by increasing coverage we managed to decentralise care to primary healthcare level [clinics]. Today, unfortunately, the biggest problem might become funding. If not enough funding is available we [will] go back in time ... back to centralised care, with patients [coming for treatment when they are] sicker, and [case management] becoming more complicated.
POVERTY: EGYPT: Surviving on a crust in Cairo's expanding slums
CAIRO, 23 June 2010 (IRIN) - For seven-year-old Ahmed Yasser, it is normal to have just a crust of bread to munch on throughout the afternoon as he plays with other children in a narrow alley in the sprawling slum of Arab al-Maasarah, 20km south of Cairo. "What else can the children eat?" Yasser Ali, Ahmed's father, told IRIN. "The last time we ate protein was a month ago when a charity sent us a kilo of beef." Bread and other carbohydrate- and calorie-rich meals are common in Cairo's informal settlements. Fruit, vegetables and protein-rich foods are hard to come by given high unemployment and rising food prices. Most slum-dwellers fail to give their children a balanced diet, which adversely affects both their growth and their educational progress, Mona Sadek, a researcher at the state-run National Centre for Educational Research, said. "Most of the children in these slums suffer anaemia. They depend on cheap food, which is scarcely nutritious." Ahmed and his two siblings have stopped going to school because their father, a construction worker, lost his job and could no longer support them. Around 9 percent of Egypt's workforce of 26.2 million is unemployed, according to the Central Agency for Public Mobilization and Statistics (CAPMAS), a government research body. Government and World Bank estimates of poverty levels among Egypt's urban population are misleading and "grossly underestimated", said Sarah Sabry of London University's School of Oriental and African Studies (SOAS) in a brief published in May. [http://www.soas.ac.uk/cdpr/publications/dv/file58993.pdf?filename=Development+Viewpoint+No.+52+May+2010] "The urban poor are much more prevalent than commonly assumed. The populations of informal areas are increasing, both in absolute numbers and relative to the rest of the city's [Cairo] population," she stated, drawing on research for her extensive working study published in May 2009. [http://www.iied.org/pubs/pdfs/10572IIED.pdf] According to estimates by the UN Human Settlements Programme (UN-HABITAT), some 40 million, or 50 percent, of Egypt's population of 80 million were urban dwellers [http://ww2.unhabitat.org/habrdd/conditions/nafrica/egypt.htm] in 2010. It projects that by 2025, the country would have an urbanization rate of 59 percent (57 million people out of a population of 96 million). Controversy over poverty measurements Sabry said there is much controversy surrounding poverty measurement methods globally and in Egypt as they are ever-changing, often subjective and tend to apply one-size-fits-all criteria - such as living on under US$1 a day. She lists three main reasons why urban poverty in Egypt, which is largely concentrated in the capital, has been underestimated: the government's "restrictive definition of urban areas" in the five governorates of Greater Cairo's ever-expanding boundaries; consistent under-counting of the populations of Greater Cairo's informal settlements by CAPMAS because of the logistical and security difficulties of surveying large slums; and the real cost of basic food and non-food items and public services for slum-dwellers being much higher than commonly recognized and "certainly much higher than the costs assumed for poverty lines". The study found that for many of the residents of Greater Cairo's eight informal settlements, education is poor, malnutrition rates are high and health conditions are "often deplorable because of the lack of access to essential services". It said current poverty measurement methods only assess the cost of a certain minimum daily intake of calories and not whether the food is nutritious or not. "The extent of malnutrition in urban areas in Egypt is confirmed by the estimate from a 2005 survey that about 16 percent of children were underweight. It is revealing that the rate of malnutrition among children (16 percent) is much higher than the recorded income poverty rate in urban areas (5 percent)," the study said. "Breakfast is almost non-existent in the life of most slum children," Mohamed el-Esma'ai, a social activist, said. "Even when they have this breakfast, it usually has nothing to do with what they should eat." Wellbeing index? Sabry proposed a poverty measure beyond income alone that encompasses the many dimensions of wellbeing - such as housing quality, access to basic infrastructure and services and the quality of work people are engaged in. In addition, she called for more comprehensive surveys of Cairo's informal settlements in order to truly ascertain the level of poverty within them. The danger of underestimating urban poverty was that policymakers would not appropriately address the issues faced by this fast growing population and direct necessary funding to them, Sabri's study said. Amin Hanafi, a 51-year-old scrap metal dealer from Arab al-Maasarah, provides his three children with food that fulfils their calorific needs but does not qualify as nutritious."We aren't rich enough to give the children special food. They eat whatever others eat," said Hanafi, who earns about 200 Egyptian pounds (US$36) a month.
TUBERCULOSIS: SOUTH AFRICA: Hidden toll from TB
JOHANNESBURG, 23 June 2010 (PLUSNEWS) - Shocking results from a study involving post-mortem examinations at a hospital in KwaZulu-Natal Province have revealed the extent to which tuberculosis (TB) is taking a toll on the lives of young, HIV-positive South Africans. The study, published in the 22 June issue of the PLoS Medicine journal, found that out of 240 inpatients aged between 20 and 45 - who died after being admitted to Edendale Hospital between October 2008 and August 2009 - 94 percent were HIV-positive and half had TB. South Africa is battling devastating dual epidemics of HIV and TB, with 80 percent of TB cases occurring in people who are also HIV-infected. While TB is known to be the country's leading cause of death, the difficulty of diagnosing the disease in HIV-positive people makes it hard to determine the true number of TB-related deaths. KwaZulu-Natal has the country's highest HIV prevalence and greatest TB burden; even so, the results were a surprise. "Young people were coming in and dying, but we didn't know how many cases of TB we were missing," Dr Douglas Wilson, head of medicine at Edendale Hospital and one of the study's co-authors, told IRIN/PlusNews. "We were absolutely staggered by the amount of TB we found." Of the 50 percent of patients in the sample being treated for TB, 58 percent of these were still culture-positive when they died, meaning that active TB was detected by culture testing their tissue samples. The majority (70 percent) did not have drug-resistant strains of TB, so prompt treatment with a six-month course of first-line TB drugs could probably have saved their lives. "They just started [treatment] too late," said Wilson. In the 17 percent of patients who were on antiretroviral (ARV) treatment when they died, the proportion of culture-positive TB was about the same. ARV treatment prevents TB when started early enough, so the finding implies that these patients also started ARV treatment too late. Since the study, the South African government has revised its HIV/AIDS treatment guidelines to recommend that patients co-infected with TB start ARV treatment earlier; Edendale has already implemented the change. Wilson said he would also like to see earlier diagnosis, particularly at primary care clinics, where most TB cases are handled. He said a major public health campaign should encourage people to ask for a sputum test and chest x-ray if they experienced any of the common symptoms of TB. "We need patient activism to increase on this," he said. Hidden burden of MDR-TB Seventeen percent of the patients in the study who had TB were found to have multi-drug resistant (MDR) strains, despite a significant portion being on their first course of TB treatment. The authors surmised that many had probably contracted drug-resistant TB in their community rather than as a result of failing to adhere to treatment. "These findings point to a hidden burden of MDR disease among HIV-coinfected individuals in KZN [KwaZulu-Natal]," they said. Wilson noted that Edendale Hospital was one of four sites in KwaZulu-Natal where state-of-the-art equipment for more rapid diagnosis of MDR-TB had been installed but was not yet operational due to resource constraints. "I'm hoping this study will help focus attention on the problem," he said. The authors suggested that routine TB screening for hospitalized patients, especially those who were HIV-positive, and earlier initiation of TB and ARV treatment could help reduce the TB death toll.
MALNUTRITION: GLOBAL: Ghana tops list of less hungry countries
JOHANNESBURG, 22 June 2010 (IRIN) - Ghana, often hailed as a success story in West African agriculture, tops a global list of 10 countries that have managed to slash their number of hungry people by a huge margin. The list is included in the preliminary findings of a report card on the UN Millennium Development Goals (MDGs) by the Overseas Development Institute (ODI), a UK-based think-tank. The eight MDGs range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education by 2015. MDG 1 aims to eradicate poverty and hunger. The ODI researchers showed progress towards the MDGs in absolute as well as relative terms, said Liesbet Steer, a senior researcher at ODI who worked on the report. The absolute methodology records the progress of countries, while the relative measure records progress towards achieving the MDG. Steer said the rationale behind the use of two measures was illustrated by Ethiopia and Ghana. Ethiopia features in the ODI's list of top 10 countries that have made absolute progress, but not in its list of countries that have made relative progress, which Ghana topped. Ghana cut the number of malnourished people - one of the indicators of MDG 1 - by 75 percent between 1990 and 2004; it more than halved the number of undernourished people from 34 percent to 9 percent in the same period. Ethiopia, which has struggled with food insecurity, also brought down its percentage of hungry people quite significantly, from 71 percent in 1990 to 46 percent in 2004. "Ethiopia has made a significant reduction in the numbers of undernourished, but it has not managed to halve the number as required by the MDGs," said Steer. Overall, the strongest relative progress in reducing the number of hungry was made in Southeast Asia, Latin America, and the Commonwealth of Independent States (CIS), previously the Soviet Union. In September 2010 the ODI will release detailed findings on what the countries have been doing right to bring down their numbers of hungry. The analysis - released ahead of a meeting of the G-8 and G-20 countries, which begins in Canada on 23 June - also focused on progress towards reaching MDG 4 (reducing child mortality) and MDG 5 (improving maternal health), which are on the conference agenda. Read the ODI's preliminary findings at: http://www.odi.org.uk/resources/download/4908.pdf
MALNUTRITION: KENYA: Kakuma camp cuts child malnutrition
NAIROBI, 22 June 2010 (IRIN) - Aid workers in a camp for some 80,000 refugees in northwest Kenya have in six months slashed acute child malnutrition rates by doubling the provision of nutritional supplements, scaling up feeding and adopting community feeding programmes. The number of acutely malnourished children in the camp at Kakuma has fallen from 1,800 in November 2009 to fewer than 1,200 in June 2010, according to John Burton, the UN High Commissioner for Refugees (UNHCR) health coordinator in Kakuma, a decline from 17 percent of the children to 7.9 percent. According to Kakuma Medical Unit, 70 percent of acute malnutrition cases reported in December 2009 were among the 13,100 Somali refugees relocated from Dadaab, in northeast Kenya, at the beginning of the same month. A medical employee told IRIN: "Acute malnutrition tends to happen over short time changes, as opposed to chronic malnutrition which results from year-round lack of life-enriching nutrients. Children, newly arrived, were probably debilitated from all the movement, first from their home country, later from Dadaab to here. "Also, due to the sudden congestion of the camp and consequent lack of safe drinking water and adequate sanitation facilities, waterborne diseases and an outbreak of cholera were recorded inside the camp, highly affecting children and causing sudden weight loss." During the intervention, new growth standards for children were introduced, lowering the threshold, in terms of middle upper arm circumference, for what is considered acute malnourishment. The new standards would thus place more children in the category of "acutely malnourished". "Together with our nutrition partners in Kakuma - IRC [International Rescue Committee] and other NGO partners - we have doubled the distribution of Plumpy'nut from 400 cartons per month to 800 since February," said Burton. Plumpy'nut is a ready-to-use therapeutic food with a peanut paste base that is high in protein and energy. A new approach The intervention also included introducing community feeding programmes (technically known as community therapeutic care), designed to care for malnourished children with greater community involvement and limiting the length of stays in therapeutic stabilization centres. Traditionally, the programme was tailored for moderately and severely malnourished children in stabilization centres where children could be admitted for as long as possible till they improved. The new concept involves limiting their stay so that after about a week, the child is discharged to an out-patient programme. Every morning children are given therapeutic food under the supervision of nutrition nurses. In addition, mothers are trained and supported in how to feed their child and linked to a mother-to-mother support group. After the child has started improving, and the mother is well versed in how to look after it, visits to the treatment centre are reduced to once a week and the mother is given one week's supply of therapeutic food to use at home. UNHCR sources told IRIN that budget cuts in the past two years had cut funding for the camp from US$1,180,018 in 2008 down to $967,679 in 2009 and with the influx of Somali refugees from Dadaab in November, some extra funding allocated to Kakuma was immediately channelled to the cholera and malnutrition outbreak through special programmes and hiring more staff. "That funding allowed us to respond to respond to the emergency, but sustainability is key to success, and our healthcare system inside the camp is far from that," said a Kakuma medical unit employee.
POVERTY: NIGER: Forced to sell cattle for a handful of dollars
DAKAR, 22 June 2010 (IRIN) - Nigeriens are likely to take years to recover from selling their weakened livestock at a fraction of its normal value due to drought in the Sahel region. The drought threatens almost 70 percent of herds, according to rough estimates from the International Committee of the Red Cross (ICRC)."It can take up to 10 years to rebuild a herd with no assistance," head of the Niger Association for the Revival of Breeding (AREN), Dodo Boureima, told IRIN. "Next year, people will not be able to survive off their livestock."With good rains and government and international support, herders are expected to recover from their losses in two to three years, said the emergency programme officer at the Food and Agriculture Organization (FAO), Nourou Tall.In a country where almost three quarters of the estimated 13.4 million inhabitants depend at least partly on livestock, animals represent economic security: providing milk and meat for the family; money for food, education and health care; and a dowry in marriage contracts.Pastoralists experiencing the greatest losses may be forced to change livelihood, to guard others' animals, or to find work in towns and cities, said Boureima. Supporting the stockbreedersThe director of pastoral development in Niger's Ministry of Livestock and Animal Husbandry, Haido Abdul Malik, has been travelling across the country for the last two weeks to evaluate pasture conditions. He is alarmed by what he has seen: hardly any grazing land left; soaring prices of animal feed and weak or sick animals."We just met with a stockbreeder who had 50 animals that could no longer move. We saw several dead ones," Malik told IRIN. "We have seen cattle worth CFA 150,000 (USD$300) sold to butchers for CFA 3,000 (USD$6). That is not even enough to buy one bag of food for the animals." To protect the poorest stockbreeders, organizations such as FAO, Veterinarians Without Borders (VSF) and the ICRC, have been buying some of the weakest cattle at higher than current market prices.In the past two months ICRC purchased and slaughtered nearly 20,000 animals and treated another 60,000 against parasites, in northern Niger, paying the equivalent of two months worth of food, for three animals. The animal meat was redistributed to the most vulnerable community members. Agencies are also selling animal feed at below-market prices, distributing vitamins and vaccinating animals to protect them from disease.Too late?Early response from herders and international agencies has meant that even though animals are weakened, they are not dying in massive numbers, said FAO's Tall. "Herders have learnt from the past crisis and moved with their animals when they were still able to; some sold animals when the market price was good; and bought animal fodder on time."But AREN head Boureima said outside help for animals had still come too late. Sahelian breeders sent a letter to their respective governments in late 2009 calling attention to the crisis. "It took months before they finally reacted. We could have averted this", Boureima told IRIN. VSF's technical adviser, Stéphane Pil, agrees: "Animal fodder could have been provided earlier, diminishing the pressure on grazing land," but he added, the response has been better and quicker than during the 2005 drought. Preventing the next crisisNiger is one of the countries most at-risk of climate-change-related drought, according to the World Bank. (LINK: http://www.irinnews.org/Report.aspx?ReportId=85179)Pastoralists' traditional coping mechanisms will have to shift more drastically, given the environmental threats they face, said Pil. "Traditionally, pastoralists move with seasons. [But] this way of living is threatened by climate change. Animals suffer more and more regularly from a lack of food during the dry season and this has dramatic consequences for the population."Government policies need to be developed to take this into account, said the regional humanitarian adviser, Jan Eijenaar, at the European Commission's Humanitarian Aid Office. "The sector needs to be regulated and stockpiles need to be made during good years."Stockbreeder Abdou Magagi backed up these views when he spoke to IRIN in April. "We don't stock grass because when the situation is normal, we have nothing to do with it. [This year] we should have made stocks, but if the situation gets back to normal, no one will think about stocking any more."
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