Sunday, 25 July 2010

MALARIA: progressive declining in the burden of malaria in north-eastern Tanzania

23 July 2010
Abstract (provisional)
The planning and assessment of malaria interventions is complicated due to fluctuations in the burden of malaria over time. Recently, it has been reported that the burden of malaria in some parts of Africa has declined. However, community-based longitudinal data are sparse and the reasons for the apparent decline are not well understood.
Malaria prevalence and morbidity have been monitored in two villages in north-eastern Tanzania; a lowland village and a highland village from 2003 to 2008. Trained village health workers treated presumptive malaria with the Tanzanian first-line anti-malarial drug and collected blood smears that were examined later. The prevalence of malaria parasitaemia across years was monitored through cross-sectional surveys.
The prevalence of malaria parasitaemia in the lowland village decreased from 78.4 % in 2003 to 13.0 % in 2008, whereas in the highland village, the prevalence of parasitaemia dropped from 24.7% to 3.1% in the same period. Similarly, the incidence of febrile malaria episodes in the two villages dropped by almost 85% during the same period and there was a marked reduction in the number of young children who suffered from anaemia in the lowland village.
There has been a marked decline in malaria in the study villages during the past few years. This decline is likely to be due to a combination of factors that include improved access to malaria treatment provided by the trained village helpers, protection from mosquitoes by increased availability of insecticide-impregnated bed nets and a reduced vector density. If this decline in malaria morbidity is sustained, it will have a marked effect on the disease burden in this part of Tanzania.

MALARIA: An evaluation of historical and current definitions of malaria elimination

22 July 2010
Abstract (provisional)
Decisions to eliminate malaria from all or part of a country involve a complex set of factors, and this complexity is compounded by ambiguity surrounding some of the key terminology, most notably "control" and "elimination." It is impossible to forecast resource and operational requirements accurately if endpoints have not been defined clearly, yet even during the Global Malaria Eradication Program, debate raged over the precise definition of "eradication." Analogous deliberations regarding the meaning of "elimination" and "control" are basically nonexistent today despite these terms' core importance to programme planning. To advance the contemporary debate about these issues, this paper presents a historical review of commonly used terms, including control, elimination, and eradication, to help contextualize current understanding of these concepts. The review has been supported by analysis of the underlying mathematical concepts on which these definitions are based through simple branching process models that describe the proliferation of malaria cases following importation. Through this analysis, the importance of pragmatic definitions that are useful for providing malaria control and elimination programmes with a practical set of strategic milestones is emphasized, and it is argued that current conceptions of elimination in particular fail to achieve these requirements. To provide all countries with precise targets, new conceptual definitions are suggested to more precisely describe the old goals of "control" - here more exactly named "controlled low-endemic malaria" - and "elimination." Additionally, it is argued that a third state, called "controlled non-endemic malaria," is required to describe the epidemiological condition in which endemic transmission has been interrupted, but malaria resulting from onwards transmission from imported infections continues to occur at a sufficiently high level that elimination has not been achieved. Finally, guidelines are discussed for deriving the separate operational definitions and metrics that will be required to make these concepts relevant, measurable, and achievable for a particular environment.

MALARIA: Buffer substitution in malaria rapid diagnostic tests causes false-positive results

22 July 2010
Abstract (provisional)
Malaria rapid diagnostic tests (RDTs) are kits that generally include 20 to 25 test strips or cassettes, but only a single buffer vial. In field settings, laboratory staff occasionally uses saline, distilled water (liquids for parenteral drugs dilution) or tap water as substitutes for the RDT kit's buffer to compensate for the loss of a diluent bottle. The present study assessed the effect of buffer substitution on the RDT results.
Twenty-seven RDT brands were run with EDTA-blood samples of five malaria-free subjects, who were negative for rheumatoid factor and antinuclear antibodies. Saline, distilled water and tap water were used as substitute liquids. RDTs were also run with distilled water, without adding blood. Results were compared to those obtained with the RDT kit's buffer and Plasmodium positive samples.
Only eight cassettes (in four RDT brands) showed no control line and were considered invalid. Visible test lines occurred for at least one malaria-free sample and one of the substitutes in 20/27 (74%) RDT brands (saline: n = 16; distilled water: n = 17; and tap water: n = 20), and in 15 RDTs which were run with distilled water only. They occurred for all Plasmodium antigens and RDT formats (two-, three- and four-band RDTs). Clearance of the background of the strip was excellent except for saline. The aspects (colour, intensity and crispness) of the control and the false-positive test lines were similar to those obtained with the RDT kits' buffer and Plasmodium positive samples.
Replacement of the RDT kit's dedicated buffer by saline, distilled water and tap water can cause false-positive test results.

MALARIA: 'Needle-Free' Intervention as Natural Vaccine Against Malaria

July 23, 2010 — A study published in the journal Science Translation Medicine proposes that preventative treatment with affordable and safe antibiotics in people living in areas with intense malaria transmission has the potential to act as a 'needle-free' natural vaccine against malaria and may likely provide an additional valuable tool for controlling and/or eliminating malaria in resource-poor settings.
The research, conducted by a multinational team of researchers from the London School of Tropical Medicine and Hygiene (LSHTM), Heidelberg University School of Medicine, the Max Planck Institute for Infection Biology, Germany, and the KEMRI-Wellcome Trust Research Programme, Kenya, found that infection with malaria parasites during administration of preventative antibiotics developed a vaccine-like immunity against re-infection.
Approximately half the world's population is at risk of malaria and about one million people (mainly children living in sub-Saharan Africa) die each year from malaria, a mosquito-borne parasitic disease. Malaria parasites are transmitted to people through the bite of an infected Anopheles mosquito. Only an estimated 10 to 100 parasites per mosquito bite invade the liver where they replicate. About a week after infection, tens of thousands of parasites are released into the bloodstream where they are responsible for malaria's recurring fevers and cause life-threatening complications.
In this study, the researchers showed that the antibiotics caused a cellular defect in malaria parasites during their passage into the liver of the infected host. This action did not prevent parasite replication in the liver but blocked the malaria parasite's fatal conversion to the disease causing blood stage. The very late arrest of parasites in the liver allowed the immune system to mount a robust defence against subsequent infections, akin to experimental whole organism vaccine strategies using attenuated parasites.
As already established, antibiotics, especially in combination with other anti-malarial drugs, are safe and affordable drugs against an acute malaria infection. The novel concept is to take advantage of the immunological benefit of antibiotic prophylaxis in areas of moderate to high malaria transmission. In these settings, humans are continuously exposed to new malaria infections delivered by natural mosquito transmission that can be prevented by antibiotics. In the liver, a surplus of parasites presented to the immune system results in robust induction of memory immune responses that can recognize and destroy future malaria infections in the liver, when antibiotics are no longer taken.
Dr Steffen Borrman co-author on the paper says that 'this proof-of-principle study attempts to bridge a gap between basic malaria research and a rapid translation to a potential application in malaria-endemic countries. An important follow-up of this work is the validation of our experimental approach by clinical trials in humans. If successful, periodic administration of antibiotics, preferably in drug combinations, in high-risk population groups, particularly young, non-immune children, may provide an additional valuable tool for controlling and/or eliminating malaria in resource-poor settings.'

MALNITRITION: MALI: Water has become a "luxury"

BAMAKO, 23 July 2010 (IRIN) - In Mali's northeastern Kidal region water shortages - many say the worst in 10 years - threaten lives and the region's very stability, residents and local officials say. Local and national authorities - backed by international agencies - have sent truckloads of water and thousands of tons of rice and fodder to Kidal, where animals are dying daily and water for drinking and bathing is increasingly rare. While residents say the assistance has been significant, they say it is insufficient and long-term solutions are indispensable. "Catastrophe" is in store if water shortages are not resolved, according to a report the Kidal regional assembly recently submitted to President Amadou Toumani Touré following an evaluation in the region. A continuation of today's conditions "will set in motion a vicious cycle: chaotic displacement of people, tension and conflict and urban overpopulation." "The region's very stability is threatened." The local authorities call for building, reinforcing and maintaining wells and bore holes, but also innovative ways to conserve and manage "the precious little water we have". Kidal, like much of the Sahel, receives little rain every year. But in recent years rains have been particularly erratic, starting late and ending early. Housseini Maïga, president of a government and civil society water organisation in Mali, said a town north of Gao, Mali, "saw not a drop of rain in all of 2009 - nothing". Maïga was among water experts and authorities attending a series of meetings 23 to 27 July in the Senegalese capital Dakar, organised by Global Water Partnership. "Rains are cyclical and for a long time we have had good years and bad," Maïga told IRIN. "But in recent years we see only decline." Kidal needs "colossal investment" in water management in order to avoid the worst," Yaya Dolo, regional governor, told IRIN. Lack of safe drinking water is Kidal's principal problem, said Yacouba Sangaré, head doctor in Kidal. "The water table is getting lower and lower... Having water to drink and bathe has become a luxury."Most children coming for medical care have diarrhoea and dehydration, he told IRIN. He added: "I have been in Kidal since 2004 and this is the first time I have seen hunger to this extent - not only among the people but among the animals." "One loses count of the animals dying," Alhabass Ag Intallah, member of parliament from Kidal told IRIN. "The best we can hope for this year is to save one-tenth of the livestock. And in this region where people live off their animals, losing that much can only mean famine. Already we are seeing undernutrition in the population - particularly children - because of the disappearing livestock." Al Hamdou Amoune, like most people in the region, breeds livestock. "I don't know what will become of my family. I lost half of my herd and I'm frightened for the rest. Yes the government has sent help but it won't be enough." He said the region particularly needs water towers. "Life has never been easy in Kidal but these days it just gets worse and worse," teacher Walet Altanata told IRIN. "Without water, what can we do? The heat, the sun - we are used to that. But we cannot bear a lack of water. This is why we implore the government and its partners to help."

Saturday, 24 July 2010

BIOTERRORISM: Pakistan co-operative programme

U.S. Senator Dick Lugar recently announced that Purdue University will receive a $1.6 million grant from the Nunn-Lugar Threat Reduction program to develop real-time infectious disease surveillance programs in Pakistan.The goal of the five year collaboration between Purdue University and three Pakistani universities is to develop a system for collecting and analyzing infectious disease data in Pakistan.The added bioterrorism threat in Pakistan, officials stressed, adds to the need for such a system. “With the growing security and bioterrorism threats in Pakistan, there is a dire need to develop a robust and reliable health surveillance and rapid-response infrastructure with the capability to collect and analyze massive, time-evolving epidemic data in real-time,” Defense Threat Reduction Agency officials said. “The goal is to mitigate human and financial losses, a challenge exacerbated in highly populous areas where thousands of new cases can occur on a daily basis.”DTRA officials noted that a lack of such systems in Pakistan poses serious threats to both the health and security of the general public.“In fact, monitoring and response to any natural or manmade ID outbreak is nonexistent in the country due to insufficient resources, ineffective screening, poorly trained staff and inadequate health policy implementation,” the DTRA officials concluded. “The absence of security measures for protecting supply of food products and drinking water exposes additional serious health and security vulnerabilities.”

BIOTERRORISM: Emerging and Zoonotic Animal Diseases

The Center of Excellence for Emerging and Zoonotic Animal Diseases held its kickoff in the K-State Alumni Center.
The center's goal is to defend U.S. agricultural systems against bioterrorism and to find solutions to pathogens transferred between humans and animals.
"This is Kansas State University responding to one of the most imminent national threats," said Tom Thornton, President and CEO, Kansas Bioscience Authority. "The Weapons of Mass Destruction Commission, the post 9/11 group that determined imminent terrorist threats, has determined that the most imminent threat to our nation's homeland security is a biological attack."
The center received 12 million dollars from the Department of Homeland Security. Researchers hope the center can provide scientific information in a national emergency.

BIOTERRORISM: smallpox vaccine

Two U.S. universities are studying whether one strong injection of a new smallpox vaccine would offer greater protection than two doses of a weaker treatment provided over a period of four weeks, St. Louis University in Missouri announced this week (see GSN, May 18).
"Because of continuing concern about biowarfare and bioterrorism throughout the world, the United States government is working to improve its ability to protect its citizens in the event of a possible bioterrorist attack with the smallpox virus," chief researcher Sharon Frey, an infectious diseases professor at the Saint Louis University School of Medicine, said in a press release.
"If there is a smallpox outbreak, getting people vaccinated as quickly as possible will be a matter of urgency. Giving a single injection of a much stronger vaccine could allow us to protect people much more quickly, when time is of the essence," she added. "We're comparing two doses of the same vaccine to see if a single injection of the high-dose vaccine stimulates the body's defense system against smallpox as well as giving two injections of the lower dose."
The study is funded by the National Institute of Allergy and Infectious Diseases and would involve 90 volunteers at St. Louis University and the University of Iowa. It would use Imvamune, a developmental vaccine produced by Danish biotechnology firm Bavarian Nordic (St. Louis University
release, June 30).

BIOTERRORISM: spotting plague

U.S. Army scientists have devised a new means of spotting deadly plague bacteria through the use of viruses that depend on the potential bioterrorism agent to replicate, says a report published Monday by the Public Library of Science (see GSN, April 20, 2007).
The detection method, developed at the Walter Reed Institute of Research in Maryland, involves monitoring the rate at which two different viruses propagate, according to the report. The use of separate virus types improves the test's accuracy, the Center for Infectious Disease Research and Policy quotes the article as stating.
The test can determine the presence of live plague bacteria within four hours. Present systems can provide results in a similar time frame, but they involve an additional step and cannot differentiate active plague agent from bacteria that is dormant or dead, the report says (Center for Infectious Disease Research and Policy
release, June 30).

BIOTERRORISM: Beware of animal diseases in Bioterrorism

Written by Dr. Sam Sewagudde
Thursday, 01 July 2010 11:05
The suspected outbreak of anthrax in hippos in Western Uganda in the past weeks has yet again reminded us of some of the ignored facts about animal diseases. I overheard someone on the streets of Kampala inform a colleague ignorantly that anthrax was a disease of those who live with or stay near animals in the villages. This totally shocked me and I felt like going over to him and giving a lecture of a lifetime. I, however, restrained myself and just thought about how they didn’t know that the same disease could be brought right at their footsteps in their so-called city. They were possibly unaware of what we call bioterrorism.It is possible for unscrupulous people to use known lethal animal disease agents as weapons of mass destruction. This is known as bioterrorism. Anthrax is indeed one of the microorganisms that can be used as biological weapons of mass destruction. The other significant animal diseases in that group include; Botulism, Plague, Tularaemia, Ebola and Marburg diseases. These diseases are of great public health importance because:The host animals or carriers that are sources of infection often show little or no sign of disease at all.The disease agents have mechanisms of propagation that allow infection to move from one individual to another.Their effects result in high mortality rates and have the potential for a major impact on the public.They can cause public panic and social disruption.They require special action when they occur and also need public health preparedness in order to limit their progress.Anthrax is clearly documented as one of the diseases whose agents have been used in the past for bioterrorism. This can be alternatively spread through spraying in the air, mailed packages and release in the ventilation systems of public buildings.In the wake of the September 11th, attacks on the USA, some people were reported to have been exposed to anthrax in powder form that had been sent to them as mail in envelopes. This incident, a classic example of how an animal disease can find you in the comfort of your office, sparked off a major public health awareness campaign on bioterrorism that got many US citizens and others around the world to be alert about such diseases.As for Ugandans, even though we are far from the USA, and that we probably have far less enemies, we should not ignore the likelihood of such events happening.

POVERTY: The Population-Poverty Connection

June 29, 2010 - The 21st century began on an inspiring note: the United Nations set a goal of reducing the share of the world's population living in extreme poverty by half by 2015. By early 2007 the world looked to be on track to meet this goal, but as the economic crisis unfolds and the outlook darkens, the world will have to intensify its poverty reduction effort.Among countries, China is the big success story in reducing poverty. The number of Chinese living in extreme poverty dropped from 685 million in 1990 to 213 million in 2007. With little growth in its population, the share of people living in poverty in China dropped from 60 percent to 16 percent, an amazing achievement by any standard.India's progress is mixed. Between 1990 and 2007, the number of Indians living in poverty actually increased slightly from 466 million to 489 million while the share living in poverty dropped from 51 percent to 42 percent. Despite its economic growth, averaging 9 percent a year for the last four years, and Prime Minister Manmohan Singh's support of a grassroots effort to eradicate poverty, India still has a long way to go.Brazil, on the other hand, has succeeded in reducing poverty with its Bolsa Familia program, an effort strongly supported by President Luiz Inácio Lula da Silva. This is a conditional assistance program that offers poor mothers up to $35 a month if they keep their children in school, have them vaccinated, and make sure they get regular physical checkups. Between 1990 and 2007, the share of the population living in extreme poverty dropped from 15 to 5 percent. Serving 11 million families, nearly one fourth of the country's population, it has in the last five years raised incomes among the poor by 22 percent. By comparison, incomes among the rich rose by only 5 percent. Rosani Cunha, the program's former director, observed, "There are very few countries that reduce inequality and poverty at the same time."Several countries in Southeast Asia have made impressive gains as well, including Thailand, Viet Nam, and Indonesia. These gains in Asia seemed to ensure that the U.N. Millennium Development Goal (MDG) of halving poverty by 2015 would be reached. Indeed, in a 2008 assessment of progress in reaching the MDGs, the World Bank reported that all regions of the developing world with the notable exception of sub-Saharan Africa were on track to cut the proportion of people living in extreme poverty in half by 2015.This upbeat assessment was soon modified, however. At the beginning of 2009, the World Bank reported that between 2005 and 2008 the incidence of poverty increased in East Asia, the Middle East, South Asia, and sub-Saharan Africa largely because of higher food prices, which hit the poor hard. This was compounded by the global economic crisis that dramatically expanded the ranks of the unemployed at home and reduced the flow of remittances from family members working abroad. The number the Bank classifies as extremely poor-people living on less than $1.25 a day-increased by at least 130 million. The Bank observed that "higher food prices during 2008 may have increased the number of children suffering permanent cognitive and physical injury caused by malnutrition by 44 million."Sub-Saharan Africa, with 820 million people, is sliding deeper into poverty. Hunger, illiteracy, and disease are on the march, partly offsetting the gains in countries like China and Brazil. The failing states as a group are also backsliding; an interregional tally of the Bank's fragile states is not encouraging since extreme poverty in these countries is over 50 percent-higher than in 1990.In addition to attacking poverty, other MDGs adopted in 2000 include reducing the share of those who are hungry by half, achieving universal primary school education, halving the share of people without access to safe drinking water, and reversing the spread of infectious diseases, especially HIV and malaria. Closely related to these are the goals of reducing maternal mortality by three fourths and under-five child mortality by two thirds.On the food front, the number of hungry is climbing. The long-term decline in the number of hungry and malnourished that characterized the last half of the twentieth century was reversed in the mid-1990s-rising from 825 million to roughly 850 million in 2000 and to over 1 billion in 2009. A number of factors contributed to this, but none more important than the massive diversion of grain to fuel ethanol distilleries in the United States. The U.S. grain used to produce fuel for cars in 2009 would feed 340 million people for one year.The goal of halving the share of hungry by 2015 is not within reach if we continue with business as usual. In contrast, the number of children with a primary school education does appear to be on the rise, but with much of the progress concentrated in a handful of larger countries, including India, Bangladesh, and Brazil.When the United Nations set the MDGs, it unaccountably omitted any population or family planning goals, even though as a January 2007 report from a U.K. All Party Parliamentary Group pointed out, "the MDGs are difficult or impossible to achieve with current levels of population growth in the least developed countries and regions." Although it came belatedly, the United Nations has since approved a new target that calls for universal access to reproductive health care by 2015.Countries everywhere have little choice but to strive for an average of two children per couple. There is no feasible alternative. Any population that increases indefinitely will eventually outgrow its natural life support systems. Any that decreases continually over the long term will eventually disappear.In an increasingly integrated world with a lengthening list of failing states, eradicating poverty and stabilizing population have become national security issues. Slowing population growth helps eradicate poverty and its distressing symptoms, and, conversely, eradicating poverty helps slow population growth. With little time left to arrest the deterioration of the economy's natural support systems, the urgency of moving simultaneously on both fronts is clear.
Note:Adapted from Chapter 7, "Eradicating Poverty and Stabilizing Population" in Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization (New York: W.W. Norton & Company, 2009), available on-line at

POVERTY: In 'Ramallah Bubble,' Gaza and West Bank Poverty Don't Exist

06/30/2010 by Alex Kane
Writing from the confines of what some Palestinians call the "Ramallah bubble" (Ha'aretz,
1/1/09), Thomas Friedman (New York Times, 6/30/10) thinks he knows how to solve the Israeli/Palestinian conflict: "quietly support[ing]" the Palestinian Authority while it builds a "real economy, a professional security force and an effective, transparent government bureaucracy."
Friedman has a curious definition of a Palestinian state, which according to Friedman is “in the West Bank and Arab neighborhoods of East Jerusalem.” Gaza is missing from this equation, and probably not by accident, as Friedman has a history of trying to dismiss Hamas-run Gaza as “undemocratic,” and therefore illegitimate--despite the fact that Hamas was democratically elected and the Fatah-run Palestinian Authority is in power illegally (FAIR Blog,
6/16/10). Friedman seems to be following the “West Bank first” approach (New York Times, 6/19/07), first begun by the Bush administration and now followed by the Obama administration, that seeks to shower economic support on the Palestinian Authority in the West Bank while isolating Gaza. If the Gaza aid flotilla affair taught the world anything, though, those looking to end the violence in Palestine can’t ignore the situation in the besieged Gaza Strip.
The irony of Friedman’s column is that the same day it was published online, Al Jazeera English (
6/29/10) reported that a new Save the Children UK report set to come out today paints picture of life in the West Bank, particularly the Israeli-administered zone known as Area C, that’s almost an exact opposite to Friedman’s cheery view:
"The international community has rightly focused its attention on the suffering of families in Gaza, but the plight of children in Area C must not be overlooked," Salam Kanaan, Save the Children's director in the occupied Palestinian Territories, said."
Palestinians in the West Bank are widely thought to enjoy a higher standard of living but tragically many families, particularly in Bedouin and herder communities, actually suffer significantly higher levels of malnutrition and poverty."
The organization called for Israel to immediately cease home demolitions and land confiscations in the West Bank and said the Palestinian authority should take "urgent action" to develop services and improve food security in Area C.
"Palestinian children cannot wait for the stalled peace talks between the Palestinian Authority, Israel and the United States to find solutions to this crisis," Kanaan said.
Friedman’s chat with an “upbeat” Salam Fayyad, the prime minister for the Palestinian Authority, apparently didn’t touch on what Save the Children calls “grinding poverty” in the West Bank. That discussion would surely put the kibosh on any benign and happy view of life under Israeli occupation.

Friday, 23 July 2010

MALARIA: The President’s Malaria Initiative (PMI)

April 2010
"In Africa, where the disease burden is the greatest, many countries are making dramatic gains in reducing the terrible burden of malaria, particularly for the benefit of those most vulnerable so that malaria is no longer an intractable fact of life. Today, I recommit to work with our partners in this fight."
U.S. President Barack Obama, World Malaria Day celebrations, April 24, 2009
A Dramatic Scale-up of Malaria Control Interventions
The U.S. Government (USG) has contributed to a rapid scale-up of malaria prevention and treatment measures across 15 President’s Malaria Initiative (PMI)-supported countries over the past four years. Many of these countries have reported significant reductions in under-five mortality, and there is strong and growing evidence that malaria prevention and treatment efforts are a major factor in these reductions. This progress is a result of the collective actions of African governments; the USG; international organizations, including The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization, the World Bank; and nongovernmental organizations.
PMI Highlights
• More than 41,000 health workers trained on case management; in addition, 2,800 health workers were trained on malaria laboratory diagnosis, and 14,000 were trained on the prevention and treatment of malaria in pregnant women during 2009;
• Nearly 27 million people protected as a result of PMI-supported indoor residual spraying in 2009;
• More than 27 million insecticide-treated nets procured, and more than 19 million distributed since the Initiative began;
• 57 million life-saving antimalarial treatments procured, and more than 40 million distributed since the Initiative began;
• Support provided to countries to improve the management of antimalarial drugs and other essential medical commodities since the Initiative began has resulted in significant improvements in supply chain systems in all 15 PMI focus countries.

MALARIA: Malaria Entomology Revitalized in Zambia

A successful vector control program needs to do more than just spray houses and distribute mosquito nets. It must also have the ability to monitor mosquito populations and their response to vector control measures. The field of malaria entomology was in decline in Zambia for many years, but it attracted renewed interest owing to increased investment in malaria control efforts and interest in malaria elimination. The Ministry of Health, with support from PMI and others, is building entomologic capability to support vector control measures. "In former times, we had entomology technicians in the district who carried out local surveys," reminisces Dr. Cecilia Shinondo, Senior Entomologist and Malaria Specialist for the PMI-supported Health Systems Strengthening Project. "Today these categories of staff have virtually disappeared, but we are rebuilding capacity in entomology by training university students and district environmental health staff."

The National Malaria Control Center's insectary for rearing mosquitoes was recently refurbished with support from PMI. The insectary's small laboratory is now a center of activity, where students learn to identify and analyze mosquitoes (including dissections) to determine if they carry malaria parasites and changes in population survivorship to monitor the effectiveness of vector control programs. Heaters whirr, and a humidifier emits a steamy vapor. Small mesh cages filled with live adult mosquitoes line the shelves, and water-filled dishes in orderly rows contain larvae and pupae. The goal is to establish a colony of mosquitoes that will be used for training and to monitor the quality and duration of insecticides used in IRS and for ITNs and as a control group for insecticide resistance studies routinely conducted before and after the IRS programs. The painstaking work is paying off, and soon the insectary will have sufficient stock to support training and quality control monitoring for Zambia's vector control programs.

MALARIA: Madagascar, distiribution of bed nets to remote areas

Because of difficult terrain, staff from USAID and the Centers for Disease Control and Prevention (CDC), through the President’s Malaria Initiative, trekked up to 120 miles (200 kilometers), forded rivers on foot or crossed in rickety canoes to reach communities to supervise campaign preparations and ensure distribution of free mosquito nets during the first universal coverage campaign in Madagascar in December and November 2009. With the help, goodwill and hard work of local staff, community members and their leaders, about 1,650,000 nets (1,000,000 provided by PMI) were distributed to over 820,000 households, protecting over 4.1 million people in 19 health districts on the east coast of Madagascar where malaria is endemic. This effort, carried out in collaboration with UNICEF, the World Health Organization (WHO), the Malagasy Red Cross, Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM), Population Services International (PSI), USAIDDELIVER and the National Malaria Control Program, is in support of a three-phase mass distribution campaign to achieve universal coverage (two nets per household) by the end of 2010. Teams drawn from local Roll Back Malaria partners supervised distribution in each of the campaign districts. Team members included staff from PMI (Madagascar and U.S.-based) and its implementing partners. Some teams had to sleep in health centers or villagers’ houses while out in the field. In the more remote zones, some distribution sites were located over 30 kilometers from the district headquarters and accessible only by foot over difficult terrain- often either in the rain or on recently rained upon mud trails

MALARIA: Liberia: community co-operation

EQUIP Liberia, a Malaria Communities Program grantee, played a major role in the implementation of a free long-lasting ITN distribution campaign in Nimba County, Liberia, conducted in May-June 2009. EQUIP worked closely with PMI, the Nimba County Health Team, the Ministry of Health, and the national malaria control program to conduct the campaign. The long-lasting ITNs for the campaign were procured and transported to the county level by PMI, while EQUIP assisted the County Health team to oversee the distribution of nets from the county level down to communities.
Over a period of two weeks, 530 community health volunteers trained by EQUIP Liberia distributed more than 180,000 free ITNs in all six districts of Nimba County, often transporting the bales of nets by foot or even canoe when roads were impassable. Volunteers went from house to house to ensure that each household received three nets and to share information about the importance of using a net to prevent malaria. Because ownership of an ITN does not ensure that it is properly used, the volunteers were equipped with nails and cords to help families hang their nets properly.

MALARIA: Studies of Susceptibility of Mosquitoes to Insecticides Guide Malaria Interventions in Ethiopia

In Ethiopia, indoor residual spraying (IRS) of houses with insecticide has been one of the primary tools to prevent malaria transmission for more than 40 years. Entomological monitoring activities to study mosquito behavior and their susceptibility to insecticides were originally performed decades ago to inform IRS operations, but were discontinued due to insufficient funding and lack of trained manpower. PMI recently reintroduced these entomological monitoring activities as part of its support for IRS operations in Ethiopia.
Throughout 2009, PMI supported entomological monitoring activities at 11 sites in Oromia Regional State in order to determine and characterize the dominant mosquito species in the area, as well as test mosquitoes’ susceptibility to three classes of insecticides.

The findings from the entomological monitoring activities indicate that Anopheles arabiensis is the predominant malaria vector in Ethiopia and that this mosquito displays varying levels of susceptibility to the tested insecticides. Susceptibility to organochlorine insecticides such as DDT was shown to be low in all sites assessed, with only 0 to 35 percent of mosquitoes killed 24 hours after insecticide exposure. Susceptibility to pyrethroid and organophosphate insecticides was more variable (46 to 76 percent and 68 to 100 percent, respectively), however, and susceptibility to carbamate insecticides was shown to be high (96 to100 percent). The susceptibility to tested insecticides largely depended on prior insecticide use, with organochlorines and pyrethroids having been extensively used in previous IRS operations and in the agricultural sector, respectively.
Ethiopia is currently scaling up IRS activities as one of the interventions to eliminate malaria in the country. “The findings are crucial to ensure that future IRS operations will remain effective and will have the desired impact on malaria transmission,” says Alemayehu Getachew, focal person for PMI’s IRS implementing partner.
Along with its support for IRS operations in Oromia Regional State, PMI will continue to support entomological monitoring activities, as well as assist other in-country malaria stakeholders to expand monitoring activity into other regions of Ethiopia.

MALARIA: U.S Army Medical Research Unit: Improving Malaria Diagnosis in Africa, One Lab at a Time

Rick Scavetta US Army Africa
June 21, 2010
Inside Rachuonyo district hospital, Simba Mobagi peers through his laboratory's only microscope at a sick woman's blood sample. The 33-year-old laboratory technologist's goal - rapidly identifying malaria parasites. Dozens more samples await his eyes. Each represents a patient suffering outside on wooden benches. Mogabi takes little time to ponder his workload. He quickly finds malaria parasites, marks his findings on a pink patient record and moves to the next slide. Much to his surprise, a U.S. Army officer arrives, removes his black beret and sets down a large box. Inside Maj. Eric Wagar's box is a new microscope - a small gesture within U.S. Army Medical Research Unit-Kenya's larger efforts to improve malaria diagnostics in Africa. For more than 40 years, USAMRU-K - known locally as the Walter Reed Project - has studied diseases in East Africa through a partnership with the Kenya Medical Research Institute. Wagar heads USAMRU-K's Malaria Diagnostics and Control Center of Excellence in Kisumu, a unique establishment begun in 2004 that's since trained more than 650 laboratory specialist to better their malaria microscopy skills. "Working with the Walter Reed Project is so good for the community, as it benefits the patient," Mobagi said, who is looking forward to attending the center's malaria diagnostics course. "Plus, having a new microscope improves our work environment. Work will be easier and we will have better outcomes." Back in Kisumu, wall maps mark the center's success, with hundreds of trained lab technicians from more than a dozen countries across the African continent. International students have come from Ireland, the U.S. and Thailand.
Many students are sponsored through U.S. government aid programs aimed at reducing disease in Africa or by nongovernmental organizations. Most of the center's $450,000 annual budget comes from the U.S. President's Malaria Initiative. Other funding is from the U.S. Defense Department, NGOs and pharmaceutical companies. For students to practice malaria identification, five Kenyan lab technicians work tirelessly to create a variety of blood specimens. Slides may show one or more of malaria's several species - others are free of parasites. The majority of malaria cases are the falciparum species, but many people are co-infected with other species and it's important for students to recognize that, Wagar said. "At our course, lab students learn skills and habits that increase their ability to accurately detect malaria on blood slides. Yet, when they return to their local laboratories, they face the challenge of changing habits and procedures," Wagar said. "Changing behavior is hard to do." In late-April, Wagar accompanied Jew Ochola, 28, the center's daily operations manager to Oyugis, the district center of Rachuonyo that lies roughly 30 miles south of Kisumu in Kenya's Nyanza province. "First I do an assessment of the hospital's lab, what procedures they have, the number of people on staff and the equipment they use," Ochola said. "By partnering with laboratory managers, we hope to increase standards and improve efficient and effective diagnosis. The goal is to lessen the burden of malaria on the local people." To mark progress, lab staffs must collect 20 slides each month that show properly handled blood samples. Monthly visits will mark performance improvement. Through quality malaria diagnosis, USAMRU-K is part of a larger public health effort to reduce malaria's impacts on Kenyan's lives. Illness means paying for treatment and less wages earned, creating an impact on the economy. "By mitigating a public health burden, people should have more time to grow food and have money for things other than medical care," Wagar said. "We can't expect to see change right away, but hopefully things will be a little bit better every month." Working with the Djibouti-based Combined Joint Task Force - Horn of Africa and other DoD agencies, the center recently offered microscopy courses through U.S. military partnership events in Ghana, Nigeria and Tanzania. The effort supports U.S. Army Africa's strategic engagement goal of increasing capabilities and strengthening capacity with the militaries of African nations, Wagar said. "To date, that includes eight Kenyan military lab techs, 17 from the Tanzania People's Defense Force and 30 Nigerians," Wagar said. Accurate diagnosis is also a key factor for military readiness, Wagar said. For example, a Kenyan soldier stationed in Nairobi - where malaria is less prevalent - is susceptible to the disease if posted elsewhere in the country. "Improving malaria diagnosis within African military laboratories sets conditions for healthier troops," Wagar said. "When forces are healthy, they are more capable to support their government and regional security."

MALNUTRITION: Funding of agricultural development

International agricultural development acquired a significant new player last December when the Bill & Melinda Gates Foundation — the biggest private foundation in the world, with US$37 billion under its control — announced that it was joining the Consultative Group on International Agricultural Research (CGIAR).
When the Gates Foundation launched its own agricultural programmes a few years ago its goal was hugely ambitious, namely to develop and introduce 400 new and improved crop varieties to help eliminate hunger in Sub-Saharan Africa, while also bringing some 15 million people out of poverty.
At the time, Bill Gates said: "No major region around the world has been able to make sustained economic gains without first making significant improvements in agricultural productivity".
The Gates Foundation's arrival on the CGIAR scene has provided a financial boost to the consultative group — an international network of governments and organisations that funds 15 renowned agricultural research centres, together credited with spearheading major improvements in crop productivity, such as those responsible for the Green Revolution of the 1960s and 70s.
The foundation's engagement may also have shored up elaborate and controversial reforms to the way that the CGIAR operates that were agreed at a CGIAR business meeting in December in Washington DC, and might otherwise have been in danger of collapsing (See
Gates Foundation joins global crop research network).
But with money comes clout. Many are now wondering what degree of influence the foundation will have over the way that the CGIAR operates and spends its money, and what the net impact of this will be on strategies for using agricultural research to meet the world's need for food.
Undue influence?
Bill Gates' impact on agricultural research through the foundation set up by him and his wife, which describes its first guiding principle as being "driven by the interests and passions of the Gates family", has had a meteoric rise.
Even before the December announcement, the foundation had channelled around US$260–270 million through the CGIAR system, in particular through grants to centres such as the International Rice Research Institute (IRRI) in the Philippines and the International Maize and Wheat Improvement Centre (CIMMYT) in Mexico. A further US$1.1 billion has gone through separate channels into agriculture in developing countries.

POVERTY: Solar power

Solar power could help alleviate rural poverty. David J. Grimshaw and Sian Lewis shine a light on its progress, potential and pitfalls.
Increasing access to energy is critical to ensuring socioeconomic development in the world's poorest countries.
An estimated 1.5 billion people in developing countries have no access to electricity, with more than 80 per cent of these living in sub-Saharan Africa or South Asia. [1]
The problem is most acute in remote areas: 89 per cent of people in rural sub-Saharan Africa live without electricity, which is more than twice the proportion (46 per cent) in urban areas. [1]
For these people, even access to a small amount of electricity could lead to life-saving improvements in agricultural productivity, health, education, communications and access to clean water.
Options for expanding access to electricity in developing countries tend to focus on increasing centralised energy from fossil fuels such as oil, gas and coal, by expanding grid electricity. But this approach has little benefit for the rural poor. Grid extension in these areas is either impractical or too expensive.
Neither does this strategy help tackle climate change. Power already accounts for 26 per cent of global greenhouse gas emissions and while most of this comes from the developed world, by 2030 developing countries are predicted to use 70 per cent more total annual energy than developed nations.[2]
There is therefore a clear need for pro-poor, low-carbon ways to improve access to electricity in the developing world — solar power could be one such solution.
Place in the sun
The Earth receives more solar energy in one hour than the world population consumes in an entire year.
Almost all developing countries have enormous solar power potential — most of Africa, for example, has around 325 days of strong sunlight a year, delivering, on average, more than 6 kWh energy per square metre a day (see Figure 1).
The Desertec Foundation, a joint German and Jordanian company, estimates that covering just one per cent of global deserts in solar panels could power the whole world.

MALNUTRITION: biofuels, ethical and social implications

New biofuels offer a sustainable source of energy but we must consider the ethical and social implications, say Joyce Tait and Banji Oyelaran-Oyeyinka.
Biofuels were first pioneered in the early days of car manufacturing. Cheap fossil fuels soon overtook them as our fuel of choice, but concerns about climate change have revived interest in them — global biofuel production doubled between 2000 and 2007, and is expected to double again by 2011.
'First generation' biofuels, mainly produced from food crops, were initially regarded as a potential renewable and sustainable source of energy. But hopes faded as researchers found biofuels offer small or even negative greenhouse gas emission savings across their life cycle compared with fossil fuels.
Problems associated with environmental impact have also arisen. In Indonesia, for example, large areas of rainforest have been cleared to plant palm oils for biofuels. The country's total rainforest area will soon be about half of what it was in 1990 if current trends continue.
There have been social and economic effects too.
On the plus side, biofuel production has helped some farmers and workers boost their incomes and develop their businesses. But, as with many other types of agriculture, other workers and farmers have experienced inadequate working conditions and negative health effects from pesticide use, for example.
In Colombia, local communities have reportedly lost control of — or even been evicted from — their land to make way for biofuel production.
There is also an ongoing debate among campaigners and scientists about whether biofuel production diverts land and water away from food production, potentially limiting local food supplies and driving up prices.
A new generation of biofuels
Scientists are developing a new generation of biofuels to help avoid such problems. For example, research is exploring the use of plants' inedible, woody parts for biofuel production that would allow non-food crops such as bushes, trees and agricultural waste to be used. Trials are also underway in the United Stateson using algae to produce biodiesel.
Genetic modification is being used to introduce favourable traits into biofuel crops, such as higher yields or the ability to grow on non-arable land. For example, scientists are developing a genetically-modified poplar tree that is a more accessible source of cellulose for bioethanol production.
And the emerging field of synthetic biology is aiming to develop entirely new means of generating biofuels, for example by building microbes that produce hydrocarbons.
Stumbling blocks
Before we bring these new biofuels into wider use we must consider potential stumbling blocks.
One possible area of concern is intellectual property. Several of the new biotechnology techniques being developed for biofuel production have been, or will be, patented. If researchers or companies want to use these technologies, they will have to apply and pay for a licence.
Although patents protect the commercial interests of the patent holder and encourage investment, they can hinder further research and create barriers to using the technology particularly for poorer populations and countries.
The appropriation of traditional or local knowledge should also be carefully monitored as this has proved to be a problem in the past. In 1994, a US company was awarded a patent for neem oil as a method of controlling fungi yet this tree has been used in Indian agriculture for centuries. The patent was later revoked.
There are also governance issues to consider. Biofuels represent an opportunity to help control greenhouse gas emissions, improve rural employment, and provide new sources of much-needed energy. But the interrelated nature of these benefits can bring complex risks if we do not think carefully about the governance of these new technologies.
Small scale bio-energy production might benefit poor rural communities but if it becomes sufficiently profitable, communities risk losing control of both the production and their land to more powerful commercial interests. Most of Indonesia's palm oil plantations are subject to disputes, mainly because of conflicts between customary and state land ownership laws.
Environmental impacts also need to be considered. Some new biofuels have been specifically developed to address these. For example, higher-yielding biofuel crops that might reduce the need for resources such as water and land. On the other hand, biofuel production from non-food crops could put biodiversity at risk because they can be planted in biodiversity-rich areas previously unsuitable for crops.

POVERTY: The poor want biomass, not biodiversity

LONDON] Preserving biodiversity may be the goal of conservationists and environmental activists, but preserving biomass is a more important priority for the poor, says a literature review.
The finding, which researchers said was unexpected, was the result of one of three reviews presented to a symposium this week (28-29 April).
"People just don't care about biodiversity," Craig Leisher, of the US-based Nature Conservancy, told SciDev.Net at the meeting, 'Linking biodiversity conservation and poverty reduction: what, why and how?' which was held at the UK's Zoological Society of London.
Leisher, who conducted the research with Neil Larsen, also from the Nature Conservancy, gave the example of a poor fisherman, for whom the route out of poverty is to catch more fish — not more kinds of fish.
The findings were presented on the same day as a study was published in Science magazine, showing that the world has failed in its bid to halt the decline in biodiversity by 2010.
The Convention on Biological Diversity was agreed in 2002. Yet almost every species and every ecosystem in the world is in decline, according to the study, led by Stuart Butchart from the UN Environment Programme's World Conservation Monitoring Centre, UK, and BirdLife International.
Leisher told SciDev.Net that his organisation has switched from publicising 'biodiversity' to talking about 'nature' because "biodiversity does not resonate as a term".
It now focuses on regenerating areas that are already degraded rather than conserving pristine ones.
"If you restore degraded lands, you will increase biomass and restore nature," Leisher said, adding that the result was a direct impact on poverty reduction.
Jayant Sarnaik — deputy director of the Applied Environmental Research Foundation, India, said that a problem dogging studies of biodiversity and poverty is that the former is defined in various ways.
"The biggest financial institutes like the World Bank ... say that biodiversity is non-renewable biomass. So how can we expect that communities will not [use up resources]? They need biomass for a number of reasons.
"We are always trying to understand things from our perspective, we are not trying to look at how [local communities] perceive biodiversity."
But Matt Walpole, head of the UN Environment Programme's Ecosystem Assessment Programme, and an author of the Science study, warned that the finding that biomass was more important than biodiversity was context-specific.
"If one thinks in terms of consumptive use then amount is important," he said. But in agriculture, for example, biodiversity is important.
"Variability allows adaptability to variations in the ecosystem ... if you've got variation then you are more resistant to shocks."

MALNUTRITION: AFRICA: Bullish about the agricultural future

LONDON, 23 July 2010 (IRIN) - Suddenly, after 20 years of relative neglect, African agriculture is a hot topic, with a substantial growth in production and a new interest among major donors in funding the sector. That is the message emerging from a series of seminars now taking place in London looking at the constraints and opportunities facing Africa's farmers.The figures being presented are impressive and - according to Steve Wiggins, who leads the agriculture programme at Britain's Overseas Development Institute - confound the pessimists who assume the situation to be much worse than it is."I often hear it said that Africa is running out of food per head," he told the seminar. "Now unless these statistics are complete and utter junk, that just simply isn't true. The index shows 16, 17, 18 percent more food being produced per capita compared to the early 1980s."In particular, he said, two regions - West Africa and North Africa - were surging ahead, although there were signs that production in East Africa too might now be beginning to accelerate."For those of us working on Africa," said Wiggins, "people use Asia as a stick to beat us with. Well, as far as I can see, there are two bits of Africa there which have done every bit as well as Asia has done over the last quarter of a century."Wiggins's fellow speaker at the opening session was Ousman Badiane, the Africa director of the International Food Policy Research Institute (IFPRI) in Washington. He put his finger on the mid nineties as the point when Africa really turned a corner.With no other overall change which could account for this recovery, Badiane attributed it to the structural adjustment programmes which so many countries had been persuaded to follow. "I believe it was the result of those strong and messy reform programmes of the 1980s. I remember the pain of it, but it completely changed the environment for agriculture."Challenges, opportunitiesBoth speakers were agreed that the food price spike in 2008 and the world economic crisis pose both challenges and opportunities for African farmers. They worried about a growing protectionism in Asia - a major potential market for African agricultural produce - and about the fact that the speed of Asian development may have closed a window of opportunity for African's own industrialization. Steve Wiggens made the point that "the single biggest stimulus to most farmers is a thriving local city."Above all they worried that the gains of the last 20 years might be reversed. Ousman Badiane referred to a new law passed in Kenya to restore price controls on agricultural produce. "That's where Kenya was 25 years ago," he said. "The danger is that the generation of leaders that went through the pains of those reforms are no longer active. So those leaders today can make the same mistakes as the leaders of 25 years ago."And he added: "It is just for me unimaginable that a farmer stands up every day, produces the food and someone claims that is a common good - "It's OUR rice, it's OUR maize." It's amazing. Nobody goes to the farm with them, but once they produce the product, everybody claims it as their own. That has to change. It's a private product; it belongs to the farmers. And they have to be able to sell it for the price that the market offers."CAADEPOusmane Badiane sees the African Union's CAADEP (Comprehensive African Agricultural Development Programme) project, in so far as it gives a voice to farmers, as an influence against this kind of reversal of policies. The first two seminars both sparked discussion of CAADEP, which obliges member governments to devote 10 percent of their national budgets to agriculture and encourages them to produce a coherent plan to which donors can subscribe.But there was a considerable level of scepticism about CAADEP. One participant, currently working in Malawi, described the frantic rush to produce a programme to put before donors, and said he had seen no evidence of new money becoming available.This was echoed by Christie Peacock, chief executive officer of the NGO Farm Africa. "There's so little vision," she said. "I'm very sceptical about the CAADEP process. It's supposed to be African led, but it's often a very top-down process."She echoed the reservations expressed by several participants, that even if new money was now being offered for agricultural development, both through CAADEP and from the US government's Feed the Future programme, there was no well-thought-out plan about how it should be used. "I think we are visionless at the moment," Peacock said, "and after 20 years of lack of interest, we are in danger of reinventing the wheel all over again."But the keynote speaker at the second seminar, Professor Sir Gordon Conway, author of The Doubly Green Revolution, was more optimistic about funding: "I do think there will be money - about a billion dollars of USAID [US Agency for International Development] money this year, and a billion plus next. Not perhaps the 3.5 billion that has been talked about, but around 2.7 billion will be there.""Twenty years ago there was a view that African didn't need agricultural development, that the private sector would do it all, and among some donor agencies that view is still there. But as a result of the food price crisis we have things like the Feed the Future programme, which looks for countries' own plans. It recognizes that countries are different, asks what they intend to do, and acts accordingly, and I think that's quite a good approach."The African Seminar Series is organized by the Future Agricultures Consortium and the Overseas Development Institute. Further sessions on markets, land issues and agriculture-led development in an urbanizing world will take place between now and the beginning of September.

MALARIA: Malaria rapid diagnostics tests (RDTs) compared

Malaria rapid diagnostics tests (RDTs) can increase availability of laboratory-based diagnosis and improve the overall management of febrile patients in malaria endemic areas. In preparation to scale-up RDTs in health facilities in Malawi, an evaluation of four RDTs to help guide national-level decision-making was conducted.
A cross sectional study of four histidine rich-protein-type-2- (HRP2) based RDTs at four health centres in Blantyre, Malawi, was undertaken to evaluate the sensitivity and specificity of RDTs, assess prescriber adherence to RDT test results and explore operational issues regarding RDT implementation. Three RDTs were evaluated in only one health centre each and one RDT was evaluated in two health centres. Light microscopy in a reference laboratory was used as the gold standard.
A total of 2,576 patients were included in the analysis. All of the RDTs tested had relatively high sensitivity for detecting any parasitaemia [Bioline SD (97%), First response malaria (92%), Paracheck (91%), ICT diagnostics (90%)], but low specificity [Bioline SD (39%), First response malaria (42%), Paracheck (68%), ICT diagnostics (54%)]. Specificity was significantly lower in patients who self-treated with an anti-malarial in the previous two weeks (odds ratio (OR) 0.5; p-value <0.001),>15 years old (OR 0.4, p-value <0.001) and when the RDT was performed by a community health worker versus a laboratory technician (OR 0.4; p-value <0.001). Health workers correctly prescribed anti-malarials for patients with positive RDT results, but ignored negative RDT results with 58% of patients with a negative RDT result treated with an anti-malarial.
The results of this evaluation, combined with other published data and global recommendations, have been used to select RDTs for national scale-up. In addition, the study identified some key issues that need to be further delineated: the low field specificity of RDTs, variable RDT performance by different cadres of health workers and the need for a robust quality assurance system. Close monitoring of RDT scale-up will be needed to ensure that RDTs truly improve malaria case management

MALARIA: attractive toxic sugar bait (ATSB)

Based on a highly successful demonstrations in Israel that attractive toxic sugar bait (ATSB) methods can decimate local populations of mosquitoes, this study determined the effectiveness of ATSB methods for malaria vector control in the semi-arid Bandiagara District of Mali, West Africa.
Control and treatment sites, selected along a road that connects villages, contained man-made ponds that were the primary larval habitats of Anopheles gambiae and Anopheles arabiensis. Guava and honey melons, two local fruits shown to be attractive to An. gambiae s.l., were used to prepare solutions of Attractive Sugar Bait (ASB) and ATSB that additionally contained boric acid as an oral insecticide. Both included a color dye marker to facilitate determination of mosquitoes feeding on the solutions. The trial was conducted over a 38-day period, using CDC light traps to monitor mosquito populations. On day 8, ASB solution in the control site and ATSB solution in the treatment site were sprayed using a hand-pump on patches of vegetation. Samples of female mosquitoes were age-graded to determine the impact of ATSB treatment on vector longevity.
Immediately after spraying ATSB in the treatment site, the relative abundance of female and male An. gambiae s.l. declined about 90% from pre-treatment levels and remained low. In the treatment site, most females remaining after ATSB treatment had not completed a single gonotrophic cycle, and only 6% had completed three or more gonotrophic cycles compared with 37% pre-treatment. In the control site sprayed with ASB (without toxin), the proportion of females completing three or more gonotrophic cycles increased from 28.5% pre-treatment to 47.5% post-treatment. In the control site, detection of dye marker in over half of the females and males provided direct evidence that the mosquitoes were feeding on the sprayed solutions.
This study in Mali shows that even a single application of ATSB can substantially decrease malaria vector population densities and longevity. It is likely that ATSB methods can be used as a new powerful tool for the control of malaria vectors, particularly since this approach is highly effective for mosquito control, technologically simple, inexpensive, and environmentally safe.

Thursday, 22 July 2010

POVERTY: PHILIPPINES: Government plans to give cash to the hungry

MANILA, 22 July 2010 (IRIN) - The money that Edgar Rigeron, a homeless father of six in Manila, earns has never been enough to buy food or feed his wife and their children, much less send them to school. Rigeron's family is among an estimated four million households who have experienced hunger at least once in the past three months, according to a new study [] released on 21 July. The June 2010 Social Weather Survey (SWS) - conducted from 25-28 June in Manila, Balance Luzon, Visayas, and the conflict-affected island of Mindanao - found that 21.1 percent of 1,200 adult heads of households interviewed had experienced hunger at least once in the second quarter of this year. This makes it the third consecutive quarter that hunger - defined as involuntary suffering due to a lack of anything to eat - was reported to be more than 20 percent, with a record-high of 24 percent in December. Of all respondents, 4.2 percent (780,000 families) reported feeling hunger "often" or "always", up from 2.8 percent (530,000 families) in March. In Manila alone, hunger rose to 22 percent in June from 17.3 percent in March, while in Mindanao [] it climbed two points to 26 percent. In Balance Luzon, hunger declined by almost three points to 18.3 percent, while there has been little change in the Visayas. Government response "It is a pitiful life for the children," Rigeron told IRIN as one of his youngest, swathed in a dirty cloth, slept on the sidewalk, and the rest played in a dark alley nearby. "I always appeal for government help." And help may be on its way: In response to the survey, the government announced plans to give money directly to poor families in need. "We are looking at conditional cash transfers through the Department of Social Welfare," Edwin Lacierda, spokesman of newly-anointed President Benigno Aquino, told reporters. According to Budget Secretary Butch Abad, funds would come from a cancelled US$71 million dollar programme set up earlier in which cash was given to schools to feed students. The programme was flawed in that students who were not poor often received aid, Abad said, while the new programme would allow the government to identify those most in need. Specifics of Aquino's programmes to alleviate poverty and hunger are expected in his first state of the nation address on 26 July. According to UN data, 33 percent of Filipinos live on less than $1 per day, while the number of unemployed increased by 6.7 percent to 2.9 million in 2009 from 2.7 million in 2008.

MALARIA: history of spread

When humans left Africa some 50,000 to 60,000 years ago, some were already infected with the world's most deadly malaria parasites, a new study says. The findings contradict the view, held by some scientists, that malaria only began afflicting us about 10,000 years ago, around the time agriculture was invented.
Transmitted by Anopheles mosquitoes, the Plasmodium falciparum parasite infects hundreds of millions of people every year and may kill more than a million. Researchers are still debating when this scourge first began afflicting us. Some have argued that a predecessor to the parasite must have infected the last common ancestor to humans and chimps, 6 million or 7 million years ago, and then co-evolved when Homo sapiens stepped onto the world stage in a process called cospeciation. In this scenario, a related species, P. reichenowi, co-evolved with chimpanzees.
But others, such as famed evolutionary biologist Francisco Ayala of the University of California, Irvine, argue that P. reichenowi jumped the species barrier from chimps to humans quite recently and then became P. falciparum. Ayala believes that this may have happened as recently as 10,000 years ago, when humans settled down and started farming; at that time, irrigation and huts would have created ideal breeding grounds for mosquitoes to help the parasites spread.
Genetic studies allowing scientists to draw the Plasmodium family tree should be able to settle the issue, but so far, there's no consensus.
The new paper,
published yesterday in Current Biology, doesn't quite solve the question of whether cospeciation occurred, but it claims that malaria couldn't possibly have arisen with the advent of agriculture. The authors, from 13 institutes on four continents, reasoned that if humans were suffering from malaria when they left the African continent, it should be evident in the genetic makeup of parasite populations in different parts of the world; the theory predicts that parasites farther away from Africa should be less diverse, just as is the case in humans.
So the team analyzed hundreds of malaria samples from seven countries, sequencing two genes to determine genetic variability within each local population, all the way from West Africa to Indonesia and Oceania. (The Americas, where malaria is believed to have been introduced just several hundred years ago during the slave trade, were left out of the main analysis.)
The researchers found that genetic diversity did indeed decrease at greater distances from Africa. The correlation is very strong, says lead author Francois Balloux of the MRC Centre for Outbreak Analysis and Modelling in London, and the pattern matches human migration out of Africa, which scientists believe started some 50,000 to 60,000 years ago.
"It makes sense," says Austin Hughes of the University of South Carolina, Columbia, who recently published another analysis showing that malaria has been with humans for a very long time. "It's consistent with everything we have tried to say for a long time."

MALARIA: Uganda: the most malarial town on earth

To reach the most malarial town on earth, head north from Kampala, cross the Victoria Nile and, just before you come to the refugee camps that mark the southern edge of Uganda's 20-year civil war, turn east to Lake Kwania. Africa's other Great Lakes are known for freshwater beaches and cool evenings, but Kwania is more of a giant swamp: shallow, full of crocodiles and choked with lily, papyrus and hyacinth. The malaria parasite loves it here.
Kwania's creeks, looking like a million silver fish bones from the air, are perfect for a deadly subspecies of mosquito, Anopheles funestus, which feeds almost exclusively on humans, with an appetite to shame a vampire. The nearby town of Apac is packed with a living blood bank of people. The average funestus bites human flesh 190 times a night. The average resident is bitten tens of thousands of times a year, including 1,586 bites — four a day — that carry malaria.

Driving into Apac late on an August day last year, I saw a naked man lumbering toward me. Tall and thin, he was gray with dust, and his hair bristled with twigs and grass. He was talking to someone only he could see. Edging past, I was surprised by a second naked figure lurching out of a side street. He had the same cracked skin stretched over the same slender frame. Ahead, a third naked figure sat by the side of the road, his head in his hands. I felt as if I'd arrived in a town of zombies.
Apac's empty streets reinforced that impression. The town seemed to exist only for sickness and death: on one road I counted 12 medical centers, 10 drugstores and a crumbling, windowless nursing school. Soon I found a building that belonged to the Ministry of Health. I pulled in, entered and followed a dark corridor to a door marked "District Health Officer." I knocked. Behind two sets of fly screens and under a ceiling fan, Dr. Matthew Emer sat at his desk. I explained I was following a new campaign to rid the world of malaria and was in Apac to see what it was up against. Who were the naked men? I asked. "Brain damage," Dr. Matthew replied. "Severe malaria can do that to a baby. You never recover."
Dr. Matthew thought I should see some statistics. Apac is home to 515,500 people. Between July 2008 and June 2009, 124,538 of them were treated for malaria. That meant 2,000 to 3,000 patients a week for Dr. Matthew and his three fellow doctors, and the number rose to 5,000 in the rainy season. Of Apac's malaria patients, nearly half were under 5.

Signboards erected by the side of the road announced the presence of two foreign-assistance programs. One was a European-funded child-protection group, which had no malaria component to its program. The other was the National Wetlands Program (NWP), funded by Belgium. Partly because of NWP's influence, the draining of malarial swamps is banned — which amounts to preserving wetlands at the price of human life. Spraying houses with insecticide — which in 2008 cut malaria infections in half — is also forbidden. Why? Because of objections from Uganda's organic-cotton farmers, who supply Nike, H&M and Walmart's Baby George line. Chemical-free farming sounds like a great idea in the West, but the reality is that Baby Omara is dying so Baby George can wear organic.
The Problem with HelpingThis, too often, is how aid goes: good intentions sidetracked by ignorance; a promising idea poorly executed; projects that are wasteful, self-regarding and sometimes corrupt. The people being helped often see things this way, as do the ones doing the helping, who ask why the hundreds of billions of dollars given to Africa since World War II have changed so little. It was in the face of such controversy that in 2007 the aid world unveiled one of its most ambitious goals: eradicating malaria.
The history of malaria is a long one. Originating in West Africa, it spread to half of humankind by the mid–19th century and has killed tens of millions and infected hundreds of millions more, including eight American Presidents. Malaria played a role in stopping Alexander the Great in India. It contributed to the fall of Rome, the relocation of the Vatican and the U.S. defeat in Vietnam. It still rages in the poverty-stricken world: it killed 863,000 people in 2008 — 89% of them African, and 88% of those people children under 5 — and infected 243 million more, says the World Health Organization (WHO). The lobbying group Malaria No More reckons that the disease costs Africa $12 billion a year — 1.3% of its economic growth. Fixing that would be the biggest boost to health and development in history. It would also be a stunning riposte to aid's critics.
It could happen. A previous campaign against malaria in the 1950s and '60s effectively eliminated the disease in Europe and the U.S. but made little progress in Africa and Asia, in part because health officials concluded that those places were simply too tough to fix. This time things are different. Now more than ever, it's unacceptable — indeed, immoral — to see Africa and Asia as beyond help. Today's funding is unprecedented, exceeding $10 billion. So is the leadership, from the U.S. President to the Sultan of Nigeria to soccer star David Beckham. Their goal is threefold: universal protection by the end of 2010 via the distribution of 700 million insecticide-treated bed nets; no more malaria deaths by the end of 2015; no malaria at all a decade or two after that.

The logistics of such a plan are less complex than they seem, because while malaria affects half the world's countries, just seven — the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, southern Sudan, Tanzania and Uganda — account for two-thirds of all cases. So how might this malaria campaign succeed where so many others have come unstuck?
The Unlikely LeaderHigh above the Serengeti, Ray Chambers unclips his safety belt and beckons me to follow him to the back of the plane. At 67, Chambers, the U.N. special envoy for malaria, is graying and a little stiff, but with his square jaw, Clint Eastwood voice and the plane — his own — there is still something of the Master of the Universe about him. The son of a Newark, N.J., warehouse manager, Chambers was in his 20s when he came up with the idea of the leveraged buyout, a concept that made him fabulously rich — but not happy. In 1987 he found himself visiting a project for inner-city teenagers in Newark. He promised to pay the college tuition of 1,000 kids "if they stayed the path." That made him feel great. So in 1989 he closed his investment firm and became a philanthropist, giving away $50 million by 1993.

In 2005, Chambers was looking at a photograph of sleeping Mozambican children taken by his friend the Harvard economist Jeffrey Sachs. "Cute kids," he remarked. "You don't understand," replied Sachs. "They're in malarial comas. They all died." Chambers was mortified. "So I said to Jeff, 'I'd like to kind of come up with business concepts to see if we can't save 1.3 million children a year.'" The next year, he established Malaria No More — a group that raises money, implements programs and stands as a case study of how aid can change.
The ethos of Malaria No More is that aid should be seen not as a noble act of charity but as something that's in everyone's interest. Eradicating disease boosts productivity, creates markets, stabilizes governments — even gives celebrities a point. It's a route to prosperity. Official endorsement of Chambers' approach came in 2008 when U.N. Secretary-General Ban Ki-moon appointed him special envoy. "You could see Ray was the guy to get this done," says WHO head Margaret Chan.
To be fair, he was not alone. Many companies are doing well by doing good, realizing that, say, an HIV program at a South African mine cuts absenteeism. A nuanced vision of a successful company is taking hold, one that elevates social responsibility to a core mission — and was backed with $14.5 billion in the U.S. in 2007, according to the Chronicle of Philanthropy.
Partly as a result of Chambers' prodding, that new way of giving aid has encouraged Western governments to open their wallets too. Funding for malaria has exploded from $50 million in 1997 to $6.6 billion for the Global Fund to Fight AIDS, TB and Malaria and $5.5 billion for the President's Malaria Initiative, a U.S. program launched in 2005. A good example of how aid is creeping into our lives in subtler ways is Unitaid. Founded in 2006 to raise money for AIDS, TB and malaria through small taxes on air tickets and check boxes on e-tickets, it has so far raised $870 million.

Religion has caught the bug too — as it were. Rick Warren's Saddleback Church in Lake Forest, Calif., is training health workers in western Rwanda. The heads of the Muslim and Christian faiths in Nigeria are training hundreds of thousands of imams and priests in malaria care and net and drug distribution. Help also comes from retired politicians like Bill Clinton and Tony Blair, who have both set up aid foundations. Blair, whose Faith Foundation is assisting the Muslim-Christian collaboration in Nigeria, told Time, "The nature of help is changing. The malaria campaign is about as good an example as you get of rebalancing the respectability of the aid case."
Real ResultsThe payoff can be spectacular. malaria has been at least halved in nine African countries since 2000. Ethiopia and southern Sudan should reach universal protection this year; Chambers predicts global bed-net coverage in the first quarter of 2011, just months past his target. A visit last August by Chambers and Chan to the children's ward of a Zanzibar hospital produced whoops of joy from Chan. It was empty.
That success is hardly universal — or permanent. Zanzibar has eradicated malaria twice before but each time reimported it from mainland Tanzania. Kenya, an early success story, has slipped. Congo has only just got going. What do these failures have in common? Bad government. When Chambers visited Tanzania in August 2009, he found an approved $111 million Global Fund grant lying unclaimed for want of a single signature. In Uganda, Global Fund grants totaling $367 million were suspended over allegations — now before the courts — of corruption involving three health ministers and several aid groups. "The house is on fire," Chambers told a meeting of ministers and aid groups in Kampala last August. Chan was blunter: "We will hold you to account on behalf of the 350 women and children who die every day here." That, too, is a face of aid.
(Read Dr. Mehmet Oz's explanation on why western diseases are spreading around the world.)
In Apac I visited the town hospital the morning after I arrived to find 30 newly admitted babies. When I returned that night, there were another 10. Martin, 27, was the only nurse on duty, and he was equipped only with quinine — long ago phased out in the West when malaria became resistant to it — headache pills and sugar solution. I watched him try to stick an IV needle into a 4-month-old girl, Doris Amang. He tried the backs of both her hands, then both sides of her head. Doris screamed and kicked. After pricking her 12 times, he gave up. Her veins had collapsed from dehydration. The windows were wide open. I watched a mosquito settle on Doris' cheek.
The next day, I returned. There were 50 babies now but no sign of Martin or any other staff member. The mothers were looking to me, but I had nothing to offer. I left the ward, walked quickly to my car and headed for the gates. Nearby was a naked street walker, feeling his way along the fence. As I roared past, I caught a glimpse of his startled expression, his emaciated face. I drove out of town and didn't stop until I reached Kampala.,29239,1995199_1995197_1995176,00.html

MALARIA: Resistant strains - good and bad news

Phnom Penh - A two-year effort to contain and eliminate a drug-resistant strain of falciparum malaria near the Cambodian-Thai border has shown signs of success, the government said on Friday.Dr Duong Socheat, who heads the National Centre for Malaria Control, said an ongoing programme that to date has tested 2 448 villagers near the western town of Pailin revealed only two cases of the strain resistant to artemisinin combination therapy (ACT).ACT, which uses artemisinin and other drugs to attack the parasite, is the world's most important malaria treatment. Experts are worried the resistant strain could spread from western Cambodia and cause a global malaria crisis."The result is very encouraging," said Duong Socheat of the six-week testing programme that took place in six of Cambodia's most malaria-prone villages. "We have got a very good result."ACT resistance means patients take longer to recover from malaria. Scientists say at some point full resistance would emerge.Concerted effortTwo years ago the government, the World Health Organisation (WHO) and several NGOs combined efforts to tackle the resistant falciparum strain that was discovered in 2007.Dr Steven Bjorge, a WHO malaria specialist in Phnom Penh, said it looked like the methods used to combat the strain were working."It's phenomenally low - we feel it's very, very low," he said of the results. "It looks like we're having success. I am cautiously optimistic."Bjorge said most falciparum malaria cases are found in eastern Cambodia rather than in the country's far west. However, none of the falciparum cases in the east have been shown to be resistant to ACT.He said eastern Cambodia would be targeted later this year with money from the Global Fund, which targets HIV/Aids, tuberculosis and malaria, and which has allocated $102m to the country over the next five years.The ongoing process to test villagers follows a concerted effort around Pailin against ACT-resistant malaria, that included providing mosquito nets, combating fake drugs and educating people. Nationwide 1 300 villages now have two health workers trained to test for malaria and provide free treatment.Duong Socheat said he is hopeful the government target of zero malaria deaths by 2020 can be reached, provided funding and expertise remained available. Last year 270 people died from malaria in Cambodia.The news comes a week after the senior US malaria control official told a conference in Hanoi there were indications that ACT-resistant malaria had emerged in Myanmar and Vietnam.

MALARIA: India' Mumbai statistics

Mumbai: The mill land in and around South Mumbai may be expensive in the realty market, but it is also proving to be a dangerous breeding ground for mosquitoes causing malaria. Alarmed by this development, the Brihanmumbai Municipal Corporation (BMC) has now decided to rope in firemen to conduct fogging operations in mill compounds.
According to the civic health department records, 1,418 cases of malaria have been reported in the city’s private and public hospitals since June 1. On Friday alone, 63 patients with malaria were admitted to the city’s hospitals. The disease has also claimed four lives since June 1, said civic health authorities.
The figures also throw up an interesting fact that most patients, who tested positive, were migrants working at construction sites. “Construction sites pose a huge problem as they are breeding spots for mosquitoes. Also, the workers suffering from malaria are from the north and north-eastern states like Orissa, West Bengal, which come under the ‘the malaria belt’,” said an officer from the civic health department.
According to doctors in the city, there are an equal number of cases of both strains of malaria - vivax as well as falciparum. However, what is worrying is that the vivax strain, which hitherto had been milder than falciparum, is showing signs of increasing severity. “Nowadays, we are seeing patients with vivax also getting serious. In the last fortnight, I have seen about 20-odd patients - half of them suffering from vivax - who have required hospitalisation,” said Dr Pradip Shah, consultant physician, Fortis Hospitals at Mulund.
“My advice to patients is to keep their surroundings hygienic and see to it that no water collection occurs near their buildings, as this is where the female anopheles mosquitoes breed.”
According to the civic body, Kurla has been identified as the worst-hit locality. “I am treating about four fresh cases of malaria, mostly vivax strain, every day,” said Dr Sharad Menon, Kurla-based paediatrician. Fortunately, vivax strain is easier to pick up, so the diagnosis is easy, he added.
The BMC has taken several measures to tackle the mosquito-borne menace. “Many times, construction workers don’t allow the BMC staff to enter construction sites for fogging. We are planning to rope in firemen for this task,” said Manisha Mhaiskar, additional municipal commissioner.
“The BMC surveillance officers in every ward office will also go door-to-door and screen patients with high fever for malaria. The surveillance officers will then go back after 15 days and check the patient again for malaria symptoms, as that is how long it takes for the parasite to fully mature and start affecting a person.”
Mhaiskar assured that the BMC is doing everything possible to control the menace. “The civic body has distributed brochures on malaria to private practitioners as these cases reach the clinics first,” she said.

MALARIA: India: controlled and not controlled

PUNE: Pune, as well as Pimpri-Chinchwad, did not report any malaria deaths last year — April 2009 to March 2010 — even as Mumbai accounted for almost 90 per cent casualties in the state, that is 206 of the total 232, due to the mosquito-borne infection during the same period. A report by the state health department has raised concerns as the state witnessed a sharp rise in the deaths due to malaria last year. According to the report, the year 2008-09 saw 166 deaths while 2007-08 reported 176 casualties. Pune escaped the scourge due to consistent efforts by the civic body. “We follow weekly anti-larval programmes to check the breeding sites of malaria causing mosquitoes across the 144 wards in the PMC limits. A total of 300 field workers, 60 supervisors and 27 inspectors are involved in monitoring potential mosquito breeding areas,” Sadashiv Patole, head of the insect control department of the PMC said on Thursday. The plasmodium vivax strain of malaria, which was considered mild and caused no deaths till 2006, itself claimed 12 lives in Mumbai in 2009-10. The strain had claimed two lives each in 2007-08 and 08-09, also in Mumbai. The main killer is the Falciparum strain of malaria. “The possibility of the plasmodium vivax strain becoming deadlier cannot be ruled out,” Kishore Hargoli, assistant health officer of the Brihan-Mumbai Municipal Corporation, told TOI. “We have asked the central and state governments to conduct research to find out if there is any change in its virulence. Besides, co-morbid conditions like diabetes and hypertension can precipitate things,” he said. Former state entomologist Ashok Bhosale said: “It is only in the last two-three years that deaths due to the Plasmodium vivax strain of malaria is being seen in the state. This is definitely a matter of concern.” Bhosale said, “A large number of construction projects in Mumbai is fuelling the rise in malaria case as these mosquitoes breed in stagnant water. High humidity levels also contribute to the increase.” Pune-based microbiologist Siddhartha Dalvi said, “Of the four strains of plasmodium, falciparum and vivax are the two strains most commonly found in India. Falciparum malaria has been typically associated with the complications of malaria like cerebral malaria.” According to Dalvi, occasional complications and deaths due to vivax malaria have also been reported in the last two years. “This could primarily be due to growing resistance of plasmodium vivax to anti-malarial drugs. Studies need to be conducted to find out if the vivax strains in India have undergone a change in virulence.” Mumbai reported 48,341 malaria cases during 2009-10 as against 27,417 a year before that. On the other hand, Pune reported 148 cases that year as against 105 registered a year before that. Pimpri-Chinchwad registered 633 cases during 2009-10 as against 366 recorded a year before that. However, no malaria deaths were reported from Pune city as well as from Pimpri-Chinchwad last year, the report states.