Tuesday, 30 November 2010

MALARIA: KENYA: Health system "needs overhaul"

  Photo: Julius Mwelu/IRIN

Drug shortages in Kenya are frequently reported by the media, with major hospitals reporting sometimes lengthy stock-outs of drugs to treat malaria, tuberculosis and HIV (file photo)NAIROBI, 30 November 2010 (IRIN) - Every year thousands of Kenyans go without essential medicines because of poor supply chain management, corruption and insufficient funding of the health service, say civil society members.
"The health system lacks the capacity to run effectively - many health workers are not skilled enough, for example, to request for drugs before they run out," said Christa Cepuch, programmes director for Health Action International (HAI) Africa.
She noted that according to a 2008 government survey, 42 percent of people administering drugs in the public health system are untrained.
Under Kenya's drug supply system, health centres receive standard kits containing essential drugs from the Kenya Medical Supplies Agency, but this system has been criticized as too rigid and unable to cope with health facilities' varied needs. The country is piloting a new “pull” system where drug supply is based on orders from health centres, in the hope that this will improve the ability to provide essential drugs in the quantities required.
“Facilities will only receive drugs based on utilization and need so that we avoid situations where drugs are stolen or wasted because they were supplied to a facility that doesn’t need them,” Francis Kimani, Kenya's director of medical services, told IRIN.
But activists say merely changing the drug supply system may not be enough to address the supply problems. "There is a need to overhaul the system from the ground up, to clean up the whole system," said Patricia Asero of the East Africa Treatment Access Movement.

Frequent stock-outs
Drug shortages are frequently reported by the country's media, with major hospitals reporting sometimes lengthy stock-outs of drugs to treat malaria, tuberculosis and HIV, among others.
A 2009 Kenyan study published in the American Journal of Tropical Medicine and Hygiene found that two years after Artemisinin combination therapy (ACT) was introduced as the first-line treatment for malaria, one in four surveyed facilities had none of the four recommended weight-specific ACT treatment packs in stock while three in four were out of stock of at least one of the packs. The shortages sometimes lasted several weeks.
This, according to the authors, caused health workers to prescribe a range of inappropriate alternatives. Some of the main reasons for the stock-outs were delays in procurement, poor management of stock flows and a lack of funds to purchase new drugs.

  Photo: IRIN: Demanding access to drugs: Kenya spends an average of US$14 per person per year on health, less than half the World Health Organization's recommended $34 (file photo)

According to Kimani, the government was working to improve the efficiency of the national drug supply system. “The government has recently allowed the Kenya Medical Supplies Agency to purchase drugs directly from local suppliers in a bid to stem shortages, and we hope this will help in reducing stock-outs of essential drugs,” he said.

Asero noted that corruption was a major problem, with drugs frequently “disappearing” from health facility stores. "Where I come from in Migori [Nyanza Province], a shipment of drugs might arrive one day and within a week you go to see the doctor and he tells you they are out of stock. In one week? I don't think so," she said.
According to HAI's Redemtor Atieno, many government pharmacists set up private pharmacies to sell stolen government medicines.
The government can ill afford to lose medicines; as it is, the budget for drugs is inadequate to cover national needs and has diminished over the past few years.

Funding gap
Kenya now spends 8.87 percent of the national health budget on medicines, down from 10 percent in 2009-2010 and 12 percent in 2008-2009. The country spends an average of US$14 per person per year on health, less than half the World Health Organization's recommended $34.
"That budget works out to roughly 56 Kenya shillings per person - enough to buy you maybe four Paracetamol," said HAI's Cepuch.
The Ministry of Medical Services has, according to Kimani, requested additional funds from the Treasury to purchase essential drugs to prevent further shortages.
However, Atieno noted that more money would not solve the problem of erratic drug supplies until the system was completely overhauled.
"We need to know exactly how to fix the supply chain, we need to address corruption and we need to train health workers - otherwise it's like we are throwing money away," she said.

POVERTY: KENYA: Humanitarian situation likely to worsen in 2011

  Photo: Siegfried Modola/IRIN

La Niña conditions will not only lead to water scarcity but also food insecurity, heightened conflict and disease
NAIROBI, 30 November 2010 (IRIN) - Kenya is likely to witness worsening food security, significant disease outbreaks, and further pockets of conflict in 2011, as well as a continuing flow of refugees from Somalia, say aid officials.
"There is a fear of La Niña compromising the [food security] gains made," said Aeneas Chuma, the UN Resident and Humanitarian Coordinator at the 30 November launch of Kenya’s 2011 Emergency Humanitarian Response Plan (EHRP) appeal. Most of the US$525 million funding requested is expected to meet food security and refugee needs.
At present, the number of food aid beneficiaries has dropped to 1.2 million from a peak of 3.8 million during the 2009 drought due to favourable October-December 2009 short rains and March-May 2010 long rains. But numbers are expected to rise, with poor rains in eastern and northeastern regions, as well as lower levels in western areas.
According to the assistant minister in the Ministry of State for Special Programmes, Mahmoud Ali, an estimated 250,000 and 40,000 children younger than five, respectively, are affected by moderate and severe acute malnutrition nationally.
"With the La Niña, the drought, and the shortfall of water... cholera outbreaks are also likely," said Patrick Lavand’homme, deputy head for Kenya of the UN Office for the Coordination of Humanitarian Affairs (OCHA).
Kenya has been struggling with repeat cholera outbreaks since 2006 – reported cases have declined over the January to October period to 3,000 compared with 8,000 in 2009.
Conflict over water and pasture during the dry spell is also projected to continue in arid parts, with “an estimated 10,000 people… expected to be displaced due to resource-based conflicts, fuelled by proliferation of small arms into the country from the neighbouring countries”, according to the EHRP.

Planning for influx
Contingency planning for a likely surge in Southern Sudanese asylum-seekers, as a possible impact of the 9 January referendum, is also necessary, said officials. “We are talking about probably 20,000 Sudanese asylum-seekers in the first half of 2011 and about 80,000 more in the second half,” said Lavand’homme.
A continued influx of Somali refugees, now estimated at about 4,000 a month, is expected to continue into 2011. Kenya hosts 412,193 refugees and asylum-seekers and the numbers are projected to rise to 455,000 by the end of 2011, according to the government.
“Given the escalation of fighting in Somalia, a weakened central government, and the proliferation of armed groups, it is envisaged that there will be an increase in the refugee population in Dadaab [refugee camp] of between 60,000 and 100,000 in 2011,” stated the EHRP.
While Kenya's political situation is expected to remain stable in 2011, aid agencies will be assessing the impact of the recently passed constitution, such as new county boundaries, and preparations for the 2012 general elections.
The EHRP, dubbed 2011+, will be characterized by longer-term humanitarian projects incorporating disaster risk reduction into 2012-2013. "We are hoping this will encourage donors to deal with crises on a continuum basis to build on the year-on-year capacity," said Anne O'Mahony, Kenya director for Concern Worldwide.
Continued humanitarian assistance is vital as Kenya deals with multiple challenges, including a growing population and a lack of infrastructure, said O'Mahony, adding that recurrent drought and flooding had brought about a chronic poverty cycle in the arid areas.
“Chronic poverty also is not very far from our doorsteps as seen in urban slums in Nairobi and Mombasa," she said.

Monday, 29 November 2010

TUBERCULOSIS: Expanding tuberculosis control in China: Combining domestic and foreign investment

China had an estimated 1.3 million new cases of tuberculosis (TB) in 2008, of which 112,000 were multi-drug resistant (MDR-TB). Over the period 2001, TB was the second largest cause of death among China's 39 notifiable communicable diseases. In a Policy Forum, published in this week's PLoS Medicine, Zhong-wei Jia (Peking University) and colleagues from Beijing, China, report on how a combination of increased domestic funding, supplemented by foreign loans and donations, led to a dramatic increase in TB case finding. The authors also highlight the way in which changes in TB control policy (carried out in the wider context of health system reforms) generate challenges for TB monitoring and evaluation. The authors conclude "As China becomes more reliant on domestic rather than foreign investment; there is a premium on evaluating the links between financing for health in general and for TB control in particular. Studies of this kind are rare, and yet they are vital in setting future policy for the control of diseases like tuberculosis."

TUBERCULOSIS: Housed in history: Alameda once site of tuberculosis sanitarium

By Christopher Schurtz For the Sun-News: 11/27/2010
Freelance writer Christopher Schurtz can be reached at cschurtz@zianet.com.

LAS CRUCES - A century ago, people came to the New Mexico Territory, drawn by its agricultural possibilities, mineral wealth, and rugged beauty.
But some came to save their own lives.
From the 1880s through the 1930s, thousands of people suffering from tuberculosis came to New Mexico and the Mesilla Valley. New Mexico's dry air and altitude offered one of the only treatments available for the disease, which was then one of the leading causes of death in America.
Tuberculosis sanitariums were established around the territory, and in Las Cruces, the most prominent was the Alameda Ranch Resort, located on a large farm near what is now the corner of Hoagland Road and North Alameda Boulevard.
Though suburban housing now covers the original grounds, a sprawling, 120-year-old house remains at the west end of Townsend Terrace, preserved by owners with a unique link to the home's past.
A 'lungers' resort
The first mention of the Alameda came in the early 1890s, when J.K. Livingston opened a resort for "health seekers" on a large farm a mile north of Las Cruces.
The annual 1892 report to the Territorial Governor reported Livingston had "recently erected a model home hotel, bowered in trees, surrounded by a small but beautiful ranch. For people who are sick, or even desiring a rest, it is a most delightful location."
The resort included an 11-room, Territorial-style adobe main house with a large dining room, kitchen, bedrooms, staff offices and reading rooms. Livingston also built a two-story, 20-room dormitory to the northeast of the main house.
Livingston operated the Alameda at least until the late 1890s, when the property was sold, possibly as a result of legal issues Livingston was having with business partner Col. Eugene Van Patten, who ran his own health resort in Dripping Springs.
In June 1904, local widow Edith Bowyer sold the Alameda and the surrounding acreage to Dr. Robert E. McBride, a physician from Louisiana.
McBride's own wife reportedly suffered from tuberculosis, and he bought the Alameda with the intent of transforming the health resort into a proper medical sanitarium.
McBride, with significant help from manager R.W. Favrot, improved the buildings and set up tents outside the dormitory. He advertised in national papers and published an informational pamphlet written by Favrot that promotes the Mesilla Valley's dry, sunny climate, which "is so mild, so salubrious, that it offers the greatest attraction to the stricken."
Inside the Alameda Ranch Resort, the furniture was "simple and convenient" but carpets and rugs were "studiously avoided."
"Every attempt is made to provide air - the wholesome dry air that is the life-giving blessing of this valley," the pamphlet states.
Patients were provided chairs to sit long hours outside, and were encouraged to eat as much as possible. A windmill provided fresh groundwater.
The Alameda also offered croquet and lawn tennis, and, for a cost of 50 cents a ride, field trips to Las Cruces, Van Patten's Resort or the Shalem Colony eight miles north of town.
Bedding was cleaned frequently, and sanitation was "the highest priority."
Topping the list of rules at the Alameda was a ban on spitting, one of the unfortunate side effects of the lung disease.
"Expectoration about the premises is one of the gravest infractions of our rules," the pamphlet states. "Cupsidors are placed about the grounds and on the porches. Sputum cups are furnished to those who require them. Guests are requested not to cough in the dining room."
The cost to stay at a sanitarium wasn't cheap, even at modest locations like the Alameda, which charged $12 a week for room and board. Most treatments required at least a six-month stay, if not much longer, meaning only the well-to-do could afford the treatment.
Sanitarium decline
It is unclear how long McBride operated the sanitarium. Most sanitariums closed by the early 1930s, largely due to the Depression and changing opinions of the effectiveness of a dry climate in treatment.
As one of the only doctors in the area, McBride more and more found himself practicing general medicine for the local population.
By 1908, the McBrides were selling off parcels in what the Rio Grande Republican called the "McBride subdivision on the Alameda Boulevard." At the same time, McBride began to get involved in local politics and civic issues.
In 1919, county records indicate McBride sold the Alameda to S.E. Shull, a Christian minister who briefly worked for the local Y.M.C.A.
Shull later sold the property, according to county land records, in 1925 to Vincent and Mirian May, old friends of Dr. McBride.
Vincent May, a prominent political and business leader, had served with McBride on the Board of Regents of New Mexico College of Agriculture and Mechanical Arts. In 1912, the two were among other partners in developing the Fort Selden Hot Springs Resort and National Spa, according to the Rio Grande Republican.
In 1935, McBride established the first clinic in Las Cruces, in a house on Water Street, which became known as McBride Hospital.
Preserving the Alameda
The Mays remained in the old Alameda house, installing a metal roof that's still there. The old two-story dormitory, deemed structurally unsafe, was torn down.
After Vincent died, Mirian rented out rooms during World War II, and stored piles of goods from the May family's old dry goods store.
The house fell into disrepair over the years, as modern housing development began to fill in around the Hoagland neighborhood by the 1960s.
In 1977, the Do a Ana Historical Society honored the May House as a building worthy of preservation. And Mirian's great-niece Victoria and her husband, Alan Holmes, who moved into the house after her death, seemed up for that task.
The Holmeses cleaned out rooms full of old dry goods, wood trunks and papers, and only replaced things that could not be saved.
The house still has its original wood floors, 10-foot-high doors, various fixtures, and even a rose bush planted by Mirian, as well as most of the century-old glass windows.
"We've tried our best not to change anything," said Al Holmes, a historian who just published a book about Fort Selden through Sunstone Press.
"Also, you just don't want to make (the ghost of) Aunt Mirian mad. The house is fine the way it is," added Vicki Holmes.
The Holmeses say the house still draws curious passers-by, and even some who remember it from their childhood, before it was fixed up, as a somewhat creepy - and perhaps haunted - house, at the end of a semi-cul-de-sac.
"There are older parents who come up with kids trick-or-treating who ask us "Does that old witch still live here?" One guy in his 40s told us 'that house used to scare the hell out of us.'" Al Holmes said.
The Holmeses hired local carver Richard Gonzales to transform an old thick mulberry tree in front of the house, which neighborhood kids used to call "the murder tree," into a statue of Saint Francis.
They said they'd like to try to get the house placed on New Mexico listing of historical properties.

TUBERCULOSIS: Mortality Among Patients with Tuberculosis and Associations with HIV Status --- United States, 1993--2008

November 26, 2010
Worldwide, tuberculosis (TB) incidence increased from 125 cases per 100,000 population in 1990 to 142 cases per 100,000 population in 2004, primarily because of the human immunodeficiency virus (HIV) epidemic (1). Persons with HIV are at increased risk for TB disease, and those with TB have a high risk for death. This is documented most clearly in resource-limited settings, where limited access to antiretroviral therapy (ART) and other health-care services contribute to the elevated mortality (1). The impact of HIV on patients with TB is less clear in resource-rich nations such as the United States. To understand the impact of HIV on the risk for death during TB treatment in the United States, data were analyzed for all culture-positive patients with TB from 1993 to 2008, and the proportion that died was determined and stratified by HIV test result. Mortality data were restricted to patients reported before 2007. The proportion of all patients with TB who died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006. Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 131 of 663 (20%) in 2006. The proportion of patients with TB and HIV who received their TB diagnosis postmortem dropped from 191 of 2,927 (7%) in 1993 to 32 of 768 (4%) in 2006; 624 of 10,468 (6%) persons with TB and unknown HIV status received their TB diagnosis postmortem in 1993, and this proportion did not decline. Further reductions in mortality can be achieved by enhanced TB/HIV program collaboration and service integration.

Since 1993, all cases of TB diagnosed in the United States have been reported to CDC and entered into the National TB Surveillance System (NTSS), a comprehensive database that contains demographic, clinical, and outcome data. All culture-confirmed cases of TB were reviewed by CDC to determine 1) the proportion of cases diagnosed postmortem and 2) the proportion of cases in persons who were alive at diagnosis and who died during TB treatment; results then were stratified by HIV status (i.e., HIV infected, HIV uninfected, or HIV status unknown). The HIV-unknown category included patients with indeterminate or unknown results as well as patients who were not offered or refused testing. Rates of HIV test reporting during 2007--2008 were stratified by selected demographic characteristics. Mortality analyses were restricted to patients reported before 2007 (to allow 2 years for treatment outcomes to be reported) and to those whose outcomes were known (excluding patients who moved, were lost to follow-up, were uncooperative with treatment, or whose outcome was missing or listed as other). Because California reports HIV test results only for patients who receive diagnoses of acquired immunodeficiency syndrome (AIDS), and does not report the HIV status of those who test negative, all data from California were excluded.

The proportion of patients with TB who had documented HIV test results increased substantially, from 6,015 of 16,507 (36%) in 1993 to 6,234 of 7,872 (79%) in 2008 (Figure 1). The proportion of patients with TB who had a known outcome and were alive at diagnosis but died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006 (Figure 2). Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 299 of 1,393 (21%) in 1997 and later to 131 of 663 (20%) in 2006 (Figure 2). By contrast, the proportion of TB patients without HIV who died during treatment decreased from 213 of 2,705 (8%) in 1993 to 281 of 5,315 (5%) in 2006. For patients with unknown HIV status, 1,282 of 8,587 (15%) died in 1993, with no decrease in proportion observed over the study period (Figure 2). Among patients with HIV who received diagnoses of TB, 191 of 2,927 (7%) received their TB diagnosis postmortem in 1993, which decreased to 32 of 768 (4%) in 2006. Among culture-confirmed cases of TB that occurred in persons who were HIV uninfected, 53 of 3,080 (2%) received their TB diagnosis postmortem in 1993, a proportion that decreased to 31 of 5,762 (1%) in 2006. Of those with unknown HIV status, 624 of 10,468 (6%) received their TB diagnosis postmortem; that proportion did not decline.

Among those with known HIV status, 2,932 of 6,015 (49%) patients with TB had HIV infection in 1993 and accounted for 950 of 1,163 (82%) deaths during treatment and 191 of 244 (78%) patients who received a TB diagnosis postmortem. In 2006, 769 of 6,533 (12%) patients with reported status had HIV, but accounted for 131 of 412 (32%) and 32 of 63 (51%) of those who died during treatment and those who received a TB diagnosis postmortem, respectively.

HIV testing during 2007--2008 was lower in certain demographic groups than the overall sample, notably, 102 of 201 (51%) patients aged ≤4 years, 95 of 144 (66%) patients aged 5--14 years, 1,824 of 3,253 (56%) patients aged ≥65 years, and 2,154 of 3,056 (70%) non-Hispanic white patients had HIV test results reported (Table).

Editorial Note
This analysis demonstrates a substantial reduction in case-fatality rate among patients with TB in the United States from 1993 to 2006, a decline that occurred almost exclusively in persons with HIV and corresponded to an increase in reported HIV test results and broader availability of highly active ART. In 2008, however, 21% of patients with TB still had unknown HIV status, and this proportion was even higher in certain demographic groups. This is unacceptable given that knowledge of HIV status is essential for appropriate treatment and that current guidelines recommend HIV testing for all patients with TB in the United States (2). A larger proportion of patients with TB were tested for HIV in some countries with a much higher burden of HIV and TB than the United States and far fewer resources, such as Kenya.*
In resource-limited settings, studies have demonstrated that without concurrent treatment of HIV, up to 50% of persons with HIV who develop TB will die during the 6- to 8-month course of TB treatment, many of them in the first 2 to 3 months (3,4). When patients with TB and HIV are treated with ART and prophylactic therapy for opportunistic infections as recommended (5), the proportion of patients who die during TB treatment can be reduced to less than 10% (4).
Recent research from New York City showed acceptable TB treatment success in patients with TB and HIV only when they received ART and directly observed therapy (6), underscoring the critical importance of these two treatment modalities. In this analysis, mortality declined steeply among patients with TB and HIV after highly active ART became widely available during 1995--1996. Data such as ART use, CD4 count, and specific cause of death are not reported to NTSS, and the impact of each of these could not be directly assessed; however, highly active ART use likely was an important factor in reducing mortality and, of course, can only be provided to those whose HIV infection is known.
A substantial proportion of culture-confirmed TB diagnoses among persons with either documented HIV infection or unknown HIV status were made postmortem. Research has demonstrated that when patients with TB and HIV die from TB, it is often because diagnosis is delayed (7), and these deaths might have been prevented if TB disease had been diagnosed and treated earlier. Screening persons with HIV for TB at regular intervals in accordance with current recommendations (8) allows for earlier diagnosis and treatment of TB and has been shown to lower mortality (9).
Treatment of latent TB infection and use of ART have been shown to substantially reduce the risk for TB disease in persons with HIV (10). Increasing HIV testing of the general population will help identify those for whom early ART initiation and treatment of latent TB infection might prevent TB before it develops (10).
The findings in this report are subject to at least two limitations. First, California accounts for approximately 20% of the patients with TB in the United States, and excluding those data might affect generalizability if those patients differed from other patients with TB in key ways. Second, outcome data were missing for 10% of all patients included in this analysis, and NTSS does not document cause of death for those who died; knowledge of mortality concerning these patients is limited.
Much progress has been made in reducing mortality among patients with TB and HIV in the United States since 1993. Further reductions in mortality can be achieved by enhanced TB and HIV program collaboration and service integration, including 1) providing HIV testing to all patients with TB; 2) screening all persons with HIV for TB disease and infection regularly; and 3) providing early and appropriate TB and HIV treatment to all patients with TB and HIV.† States and local health-care organizations should analyze their own data to determine how to best target interventions aimed at increasing HIV testing. In addition, studying the specific causes of death in patients with TB and HIV would facilitate development of additional measures to decrease the risk for death.

MALNUTRITION: UNICEF supports efforts to fight malnutrition in Pakistan's flood-affected Sindh Province

Carly Sheehan, UNICEF
THATTA DISTRICT, Pakistan (November 26, 2010) — The devastating monsoon floods that recently affected more than 20 million people in Pakistan—including 2.8 million children under the age of five—have brought many underlying problems to the surface. In a country that already had alarmingly high rates of malnutrition, the floods have made the situation worse.
Even before this crisis, about a third of Pakistan's children were born with low birthweight. The challenge now is not just to scale up nutrition interventions but, in some areas, to establish them for the first time.
Children in Sindh province, for example, are particularly vulnerable to malnutrition. Even before the floods, stunting rates in Sindh were higher than the national average. To combat the problems of malnutrition and stunting, UNICEF and its partners screen children through outpatient therapeutic feeding programs, where their weight, height and mid-upper arm circumference (a key indicator of growth and development) are measured.
Mobile units and stabilization centers
As part of this effort, mobile therapeutic feeding units reach communities that have no access to fixed health-care centers. The vast majority of children in such communities can be effectively treated by the mobile units, but severe cases need to be treated at a stabilization center.

A child holds his ration of high-energy biscuits  © UNICEF Pakistan/2010/Sheehan
A child holds his ration of high-energy biscuits, provided as part of a UNICEF-supported therapeutic feeding program in Thatta district, Sindh Province, Pakistan.

In Thatta district, UNICEF has established the first stabilization center in a district civil hospital to treat malnourished children with serious medical complications. The center was set up with support from Engro Chemicals, through UNICEF, as a public-private partnership. With beds for six children and their caregivers, the center receives nutrition supplies and medicines from UNICEF. The National Institute of Child Health trains staff at the facility.
Hameed, 2, was recently admitted to the Thatta center, suffering from high fever and diarrhea. "We had no idea what was wrong with him. The village doctor gave him drips, which caused swelling all over his body," says his grandmother. Today, Hameed's condition is beginning to show marked improvement as a result of therapeutic feeding and medical treatment.
The five other children currently being treated at the center are suffering from a range of complications, including respiratory illnesses and severe dermatitis.
Demand exceeds capacity
The stabilization center in Thatta is the first of its kind, and the demand for its services exceeds capacity. "At the moment, we have six children admitted here, and until now we have treated 51 patients in two months," says Shagufta Samoo, a staff nurse at the center. "We have had to refer children to other hospitals because we had no space."
Women and children listen to a health education session in Pakistan UNICEF Pakistan/2010/Shuja
Women and children listen to a health education session delivered by a 'Lady Health Worker' in Thatta district, located in Pakistan's flood-affected Sindh Province.

Thatta's Deputy District Health Officer, Dr. Khaled Navaz, explains that much more work is needed to improve the nutritional status of children—especially girls—and women. "In our society, males are given higher priority than females, so we see many more malnourished girls than boys," he says. "More health education sessions are needed as mothers are also malnourished, and we should provide nutrition support in schools."
Through the government's extensive ‘Lady Health Worker' program, local women deliver maternal and child health and nutrition messages to pregnant women and lactating mothers. "We are telling the lactating mothers that for six months they must breastfeed and nothing else, after which semi-solid and solid food should be given," says health worker Maqbool Ahmed.
Life-saving supplies
UNICEF has provided extensive support to this program, particularly since thousands of Lady Health Workers were themselves affected by the flooding. Meanwhile, UNICEF continues to work closely with the government, and non-governmental and community-based organizations, to deliver life-saving and sustaining nutrition supplies to children affected by the flooding.
More than three months after the monsoon rains began, however, serious underfunding of UNICEF's emergency operations is jeopardizing its flood response. So far, only about half of the organization's $251 million Pakistan flood appeal has been received.

MALNUTRITION: Cycle of floods, droughts aggravate malnutrition in Africa - WHO

Luanda – The cycle of floods and droughts that have become commonplace in various African countries are contributing to the aggravation of malnutrition in the region, due to the lack of food associated with poor harvest and production breakdown.
This was said Thursday in Luanda by the regional director of the World Health Organisation (WHO), Luís Gomes Sambo.
Luís Gomes Sambo was speaking at the official opening of the 2nd Interministerial Conference on Health and Environment in Africa, whose ceremony was presided over by Angolan vice-president, Fernando da Piedade Dias dos Santos.
The vice-president on the occasion stated that the recent floods in southern African countries, particularly in the border between Angola and Namibia, are examples of the phenomenon.
“The nutritional effects, the recurrent cycle of floods and drought go even farther and affect school performance of hit children,” he added.
According to him, many African countries are still unprepared to lessen the challenges of public health associated with climatic alterations for various reasons.
To him, these reasons are associated with the poor capacity to predict and face the natural phenomena, poor perception of the consequences of climatic alterations to the public health, inadequate articulation of the health and aid systems that are mostly fragile and incapable of responding to disasters and public health emergencies.
In view of the poor budgets allocated to the health and environment sectors, the World Health Organisation and the UN Environment Programme (UNEP), with support from the Governments of France, Spain and other UN agencies, formulated technical instruments that facilitated the analysis of the situation and evaluation of the needs in 17 countries of the continent, it was said.
This process, according to the official, shall lead to the formulation of national joint plans of action and be financed in order to produce desired results.
The official also spoke of the urgent need for a speedier implementation of the Libreville Declaration on Health and Environment in Africa.
The analysis of the situation and evaluation of the needs conducted in the 17 countries show that it is possible to overcome the deficit of knowledge and mobilise the interest of governments and partners for the definition of pertinent policies in health and environment, Gomes Sambo also said.
According to him, the poor and marginalised populations are more exposed to environment and their effects on health.
Luís Gomes Sambo expressed the hope that the Luanda final commitment becomes a turn in the definition of policies and concrete actions, aimed at a sound environment and better climate for the African populations of the present and future.

BIOTERRORISM: Journal of Bioterorism

Journal of Bioterrorism & Biodefense (JBTBD), a broad-based journal was founded on two key tenets: To publish the most exciting researches with respect to the subjects of Bioterrorism & Biodefense. Secondly, to provide a rapid turn-around time possible for reviewing and publishing, and to disseminate the articles freely for research, teaching and reference purposes.

BIOTERRORISM: how to deal with animal disease outbreak

John G. White Nov 25, 2010  While she held court Thursday last week during an all day Food and Agricultural Emergency Response Planning workshop, Amber Wilson told a quick story of an area veterinarian in charge (AVIC) who responded to a suspected foreign animal disease (FAD) at a central Kansas sale barn.
“Of course, by protocol he had to pull on his white outerwear and special boots, everything including the face mask, before he entered the holding area,” she explained of the district veterinarian.
Although it was a false symptom, which he recognized almost immediately, rumors had already spread quicker than a prairie wildfire.
“That shows you how quickly things can get out of hand,” she said, which isn’t uncommon. Wilson used the Tylenol scare that involved just two tainted bottles, or salmonella-infested tomatoes that cost millions before it was found the culprit was a bad batch of peppers instead, as examples.
All of which isn’t a deterrent to the seriousness of an actual breakout. A case of foot and mouth disease completely ruined the Taiwan pork industry, which until the case broke was the principal supplier of pork to Japan.
Or in England, where the same disease totally crippled the beef industry.
Planning for the real or the hypothetical was key for this workshop held at the Montevideo American Legion and attended by about two dozen including federal, state and local agency personnel, two veterinarians (Dr. Jim Koew­ler, of Clara City, and Dr. Arnold Jostock, district veterinarian), two county commissioners, mem­bers of the Chippewa County Emergency Re­sponse team, including Marve Garbe and Clara City’s Roger Knapper, plus one livestock producer.
“They were invited,” said Garbe of the livestock producers, then added that he was surprised and disappointed that the ag community was so poorly represented.
Wilson, a consultant with the USDA, said later that the makeup of those attending the workshop was rather typical of her past experiences, which she and other staff of SES Inc. are conducting in every county of the country.
While a couple of scenarios were played out in focus groups in the afternoon sessions, the plan was not to develop an actual plan. Garbe said a structure is already in place for a county-wide disaster response, and if need be, the “players” can be inserted into the “model.”
None of which lessens the serious potential impact of such a disaster, which as Wilson pointed out numerous times, can happen anywhere at any time whether it happens by happenstance or by terroristic design.
“It doesn’t have to happen at a major turkey facility,” she cautioned at one point. “It might start with a pet parakeet.”
The results of a biotic disaster can be, as Taiwan and Great Britain learned, devastating on all levels. Using the turkey industry as an example, which she said is part of a $6.1 billion livestock industry in Minnesota alone, and involves an average of 68,000 semi loads of birds a year, a disease outbreak could affect the industry itself, a dependent feed grains industry as well as a work force that stretches from the barns themselves to a grocery store hundreds of miles distant. She reminded that at least 20 plus percent of all Minnesotans are employed in some way by the agricultural industry.
“The impact is enormous,” said Wilson.
And a disease can spread quickly before being diagnosed by wind, truck, human hair and a multitude of other carriers — depending on the pathogen.
She added that it doesn’t have to be a product of bioterrorism, noting that most of the bioterrorism in the U.S. has been the result of internal groups with no known ties to Al-Qaeda. “It might be spread by someone discarding a pop can,” said Wilson.
She used a simulated foot and mouth disease scenario that began on a farm in northeast Iowa near the South Dakota border, one that took 11 days between exposure and diagnosis.
Using her PowerPoint, she went through the pre-diagnosis steps through the post diagnosis steps, such as the disaster declaration (done by the governor and at secretarial levels of the USDA), the movement control orders, the quarantine zones that continually had to be expanded, an epidemiological investigation, the appraisal, depopulation and disposal of the infected livestock, and the sur­veliance of the entire state and states nearby.
With very little effort and in little time, there were 5,844 affected farms, plus the costs to appraise each one, the euthansizing of animals — each step along the way adding incremental costs that eventually added up to $471.32 million. This did not include export losses.
“Despite the hardship and the costs, it’s the depopulating of the animal herd that is so difficult,” she said.
Garbe agreed, noting that in Chippewa County with the high water table it would be difficult to find a place to bury large numbers of animals. “We just aren’t prepared for something like that,” he said, before adding, “plus, nobody wants that in their back yard.”
While there are rules for USDA indemnification for such disasters, it can hardly make up for the overall economic impact, said Wilson.
There is in place an overall concept of disaster plans, in which a control area surrounds the infested zone and premises. Beyond that is a surveillance zone, and beyond even that is what is hoped to be a disease-free zone.
Coordinating the logistics, though, was the essence of the afternoon workshops. Everyone, said Wilson, plays a role from the emergency management levels through the veterinarians, ag trade associations and groups, county health officials, law en­forcement, livestock producers and the media.
“County planning is critical,” she concluded. “A FAD such as foot and mouth impacts our entire economy, and it is a situation that starts with livestock producers. They must be able to recognize the symptoms and to react accordingly. Once diagnosed, stopping animal movement is critical in preventing the spread of the disease from the area. Depopulation, as difficult as it is, of affected and exposed animals is essential to stopping the disease. Biosecurity is the only weapon we have to fight a FAD.”
As if the point hadn’t been made, she added: “A FAD can happen. Any­where. At any time.”

BIOTERRORISM: U.S. Will Expand Biosecurity Work to Africa,

Nov. 23, 2010 Martin Matishak

WASHINGTON -- The U.S. Cooperative Threat Reduction initiative will work to secure deadly pathogens in Africa to prevent their use as tools of bioterrorism, a key Defense Department official said yesterday.

  U.S. Senator Richard Lugar (R-Ind.), shown in 2008, recently led a U.S. delegation to study biosecurity measures at laboratories in several African nations. The United States intends to focus on preventing terrorist acquisition of disease agents from Africa, a Pentagon official said yesterday (Vano Shlamov/Getty Images).

The Nunn-Lugar program has effectively safeguarded biological weapons facilities in the former Soviet Union but deadly disease materials, such as Ebola and anthrax, remain for the most part unprotected at research institutions in East Africa, Andrew Weber, assistant to the Defense secretary on nuclear, chemical and biological programs, said yesterday.
"I've been to a lot of the former bioweapons laboratories in the Soviet Union territory and if you look at the diseases that they weaponized, the pathogen samples originated in Africa," he said during a global health and security conference organized by the University of Pittsburgh's Center for Biosecurity.
"We don't want terrorist groups to do the same thing that the Soviet weapons program did," according to Weber, who earlier this month accompanied Senator Richard Lugar (R-Ind.), one of the CTR program's creators, on a tour of biological research facilities in Kenya, Burundi and Uganda designed to highlight the potential threat.
The region has experienced terrorist attacks in the past from al-Qaeda linked groups such as the Shabab, an Islamic extremist organization that claimed responsibility for recent suicide attacks in Uganda, he said.
"Terrorism in that part of the world is not a hypothetical situation," Weber told the audience.
Lawmakers in 2004 expanded the U.S. threat reduction effort's mandate to include securing weapons of mass destruction and related materials outside the Soviet bloc.
The program is on track to receive roughly $523 million in fiscal year 2011, once the annual spending bills are approved by both houses of Congress and sewn together in conference.
More than $209 million of the proposed funds would go toward biological threat reduction in the former Soviet Union. That works includes safeguarding pathogens, developing laboratories that conduct research on disease countermeasures and some border security operations.
The CTR program has not previously addressed biological risks in Africa, according to Lugar spokesman Mark Helmke. The effort would eventually install new physical security measures and train more medical personnel, he told Global Security Newswire today.
The effort is currently making preparations to begin work on the continent and the "stage is set to move quickly," a Defense Department spokesman said today by e-mail.
Weber said recently the program was likely to provide several million dollars to African states to improve security at laboratories that store dangerous pathogens. He added yesterday that "big thrust and focus" of the initiative's biological engagement work in Africa would be to improve biosafety and biosecurity at research institutions.
Biosafety is often defined as measures intended to prevent the release of infectious agents within a laboratory or the outside environment. Biosecurity involves active methods to avert biological terrorism or other disease breakouts.
During their visit to the Kenya Medical Research Institute, which maintains dangerous pathogens including anthrax and Ebola, in the capital city of Nairobi, the U.S. delegation noticed that several orange bags filled with biohazard waste "were just sort of sitting around" on the ground because the facility's small incinerator had "pretty limited capacity," according to Weber.
"While we were there a stray cat went into one of the bags, had lunch, and then hopped over the wall into the largest slum in Africa," he added. "That's just an example of why we need to focus a little bit more on biosafety."
Weber said that while there has been "tremendous progress" in standing up "administrative" and human health laboratories in the region, veterinary facilities have been largely neglected by the international donor community.
For example, the Uganda Virus Research Institute, which once housed Ebola and Marburg samples, lacked the resources to deal with anthrax outbreaks that killed hundreds of hippopotamuses in recent years.
"They just didn't have the diagnostic tools to deal with that very effectively, so we're trying to help them out" by providing them with modern equipment that could lead to quicker diagnoses, Weber said. "I think that's an important gap that the Nunn-Lugar program can help fill is this lack of attention to the animal health laboratories."
After his speech, the senior DOD official predicted that the threat reduction effort would have a long-term presence in Africa.
"I think it's going to be, just because of the nature of endemic disease, it's going to be absolutely a continuation of the long-term strategic partnership in the region," he told GSN.
The decision to expand the threat reduction program into Africa rather than other regions was based on several priorities, including: the prevalence of endemic disease, the presence of terrorist groups with intent to use biological agents; and the level of existing infrastructure and capacity and the impact the effort could have on improving that, according to Weber.
"Unfortunately, there's terrorism in East Africa, as well as the South Asia region. So yes, we need to work in both; we need to prioritize. A lot of what I described should be a global effort but we can't start everywhere at the same time," he told GSN.
He noted that the U.S. Centers for Disease Control and Prevention has been engaged in the region for decades, with offices in both Kenya and Uganda.
Weber also predicted the Cooperative Threat Reduction biological engagement work would eventually make up half of the program's budget, noting that the disease effort began with $2 million in the late 1990s and has grown to more than $200 million in the pending budget cycle.

MALARIA: malaria parasite Plasmodium falciparum in gorillas

Plasmodium falciparum is the most prevalent and lethal of the malaria parasites infecting humans, yet the origin and evolutionary history of this important pathogen remain controversial. Here we develop a single-genome amplification strategy to identify and characterize Plasmodium spp. DNA sequences in faecal samples from wild-living apes. Among nearly 3,000 specimens collected from field sites throughout central Africa, we found Plasmodium infection in chimpanzees (Pan troglodytes) and western gorillas (Gorilla gorilla), but not in eastern gorillas (Gorilla beringei) or bonobos (Pan paniscus). Ape plasmodial infections were highly prevalent, widely distributed and almost always made up of mixed parasite species. Analysis of more than 1,100 mitochondrial, apicoplast and nuclear gene sequences from chimpanzees and gorillas revealed that 99% grouped within one of six host-specific lineages representing distinct Plasmodium species within the subgenus Laverania. One of these from western gorillas comprised parasites that were nearly identical to P. falciparum. In phylogenetic analyses of full-length mitochondrial sequences, human P. falciparum formed a monophyletic lineage within the gorilla parasite radiation. These findings indicate that P. falciparum is of gorilla origin and not of chimpanzee, bonobo or ancient human origin.


MALARIA: Wild Chimpanzees Infected with 5 Plasmodium Species

Data are missing on the diversity of Plasmodium spp. infecting apes that live in their natural habitat, with limited possibility of human-mosquito-ape exchange. We surveyed Plasmodium spp. diversity in wild chimpanzees living in an undisturbed tropical rainforest habitat and found 5 species: P. malariae, P. vivax, P. ovale, P. reichenowi, and P. gaboni.

Despite ongoing and, in some regions, escalating morbidity and mortality rates associated with malaria-causing parasites, the evolutionary epidemiology of Plasmodium spp. is not well characterized. Classical studies of the blood pathogens of primates have found protozoa resembling human malaria parasites in chimpanzees and gorillas; however, these studies were limited to microscopy, negating conclusions regarding evolutionary relationships between human and ape parasites. Recent studies that used molecular approaches showed that captive and wild chimpanzees (Pan troglodytes) and lowland gorillas (Gorilla gorilla), as well as captive bonobos (Pan paniscus), harbor parasites broadly related to P. falciparum; wild and captive gorillas and captive bonobos and chimpanzees are sometimes infected with P. falciparum itself. Further, captive chimpanzees and bonobos have been shown to have malaria parasites related to human P. ovale and P. malariae; P. vivax has been identified in various monkeys and 1 semiwild chimpanzee. Recently, P. knowlesi, a simian malaria species, became the fifth human-infecting species, highlighting the possibility of transmission of new Plasmodium spp. from wild primates to humans.


POVERTY: Africa Needs Aid, Not Flawed Theories

Bill Gates NOVEMBER 27, 2010 The science writer Matt Ridley made his reputation with books like "The Red Queen: Sex and the Evolution of Human Nature" and "Genome: The Autobiography of a Species in 23 Chapters." His latest book, "The Rational Optimist: How Prosperity Evolves" is much broader, as its title suggests. Its subject is the history of humanity, focusing on why our species has succeeded and how we should think about the future.
Although I strongly disagree with what Mr. Ridley says in these pages about some of the critical issues facing the world today, his wider narrative is based on two ideas that are very important and powerful.
The first is that the key to rising prosperity over the course of human history has been the exchange of goods. This may not seem like a very original point, but Mr. Ridley takes the concept much further than previous writers. He argues that our success as a species, as opposed to earlier hominids, resulted from innate characteristics that allowed us to trade. Not long after Homo sapiens emerged, we were using rare objects, like obsidian blades, far away from the source materials needed to produce them. This suggests that large numbers of commercial links were established even at the hunter-gatherer stage of our development.
Africa Needs Growth, Not Pity and Big Plans Mr. Ridley gives many examples of how exchange allowed groups to thrive, by enabling them, for example, to acquire fish hooks or sewing needles. He also points out that even the most primitive human groups today are open to exchange. I've always thought this openness was surprising, considering the risks involved, but Mr. Ridley convincingly describes its adaptive value.
Exchange has improved the human condition through the movement not only of goods but also of ideas. Unsurprisingly, given his background in genetics, Mr. Ridley compares this intermingling of ideas with the intermingling of genes in reproduction. In both cases, he sees the process as leading, ultimately, to the selection and development of the best offspring.
The second key idea in the book is, of course, "rational optimism." As Mr. Ridley shows, there have been constant predictions of a bleak future throughout human history, but they haven't come true. Our lives have improved dramatically—in terms of lifespan, nutrition, literacy, wealth and other measures—and he believes that the trend will continue. Too often this overwhelming success has been ignored in favor of dire predictions about threats like overpopulation or cancer, and Mr. Ridley deserves credit for confronting this pessimistic outlook.
Having shown that many past fears were ultimately unjustified, Mr. Ridley finally turns his "rational optimism" to two current problems whose seriousness, in his view, is greatly overblown: development in Africa and climate change. Here, in discussing complex matters where his expertise is not very deep, he gets into trouble.
Mr. Ridley spends 14 pages saying that everything will be just fine in Africa without our worrying about negative possibilities. This is unfortunate and misguided. Is his optimism justified because things always just happen to work out? Or do good results depend partly on our caring and taking action to prevent and solve problems? These are important questions, and he doesn't answer them.

In discussing Africa, Mr. Ridley relies on critics who say, essentially, "Aid doesn't work, hasn't worked and won't work." He cites studies, for instance, that show a lack of short-term economic benefit from aid, but he ignores the fact that health improvements, driven by aid, have been a major factor in slowing population growth, which has proven, in turn, to be critical to long-term economic growth. I may be biased toward aid because I spend my money on it and meet with lots of people who are alive because of it, but even if that were not the case, I would not be persuaded by such incomplete analysis.

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Olivier Cirendini/Lonely Planet Images
The Jemaa El Fna market in Marrakesh, Morocco, at dusk:

Matt Ridley argues that the key to rising prosperity over the course of human history has been the exchange of goods.
Development in Africa is difficult to achieve, but I am optimistic that it will accelerate. Science will come up with vaccines for AIDS and malaria, and the "top-down" approach to aid criticized by Mr. Ridley (and by the economist William Easterly) will fund the delivery of these life-saving drugs. What Mr. Ridley fails to see is that worrying about the worst case—being pessimistic, to a degree—can actually help to drive a solution.
Mr. Ridley dismisses concern about climate change as another instance of unfounded pessimism. His discussion in this chapter is provocative, but he fails to prove that we shouldn't invest in reducing greenhouse gases. I asked Ken Caldeira, a scientist who studies global ecology at the Carnegie Institution for Science, to look over this part of the book. He pointed out that Mr. Ridley celebrates declining air-pollution emissions in the U.S. but does not acknowledge that this has come about because of government regulations based on publicly funded science, which Mr. Ridley opposes. As Mr. Caldeira rightly observes, "It is a wonder of development that our economy can grow as air pollution diminishes." What is true of the U.S. case, I'd suggest, can be true of the world as a whole as we deal with the challenges posed by climate change.

"The Rational Optimist" would be a great book if Mr. Ridley had wrapped things up before these hokey policy discussions and his venting against those he considers to be pessimists. I agree with him that some people are overly concerned with potential problems, and I hadn't realized that this pessimism was so common in rich countries over the last several centuries. As John Stuart Mill said in 1828, in a quote from the book that I especially enjoyed: "I have observed that not the man who hopes when others despair, but the man who despairs when others hope, is admired by a large class of persons as a sage."
The most obvious instance of excessive pessimism in Mill's era was the "Communist Manifesto." In one of history's great ironies, Karl Marx used the profits from the German textile mills of Friedrich Engels's father to support the writing and distribution of a political philosophy based on pessimism about capitalism.
Pessimism is often wrong because people assume a world where there is no change or innovation. They simply extrapolate from what is going on today, failing to recognize the new developments and insights that might alter current trends. For too long, for instance, population forecasts have ignored the possibility that population growth would ease as the world became better off, because people who are wealthier and healthier do not feel the need to have so many children. (For more on this issue, see the excellent presentations on the "Gapminder" website of the development expert Hans Rosling.)
A lot of the rhetoric about sustainability implicitly assumes that we will exhaust our natural resources, as though there will never be any substitution of one commodity for another in the future. But there has always been such substitution. The late economist Julian Simon made a famous wager with the biologist Paul Ehrlich, author of "The Population Bomb." In response to Mr. Ehrlich's prediction that population growth would lead to resource scarcity and mass starvation, Simon bet him that the cost of a basket of commodities, including copper, chromium and nickel, would actually decrease between 1980 and 1990. Mr. Simon won the bet because he believed that, despite increased demand, increased supply would win out. And in fact, to take one example, fiber optics soon took the place of copper wire in many communications technologies.
There are other potential problems in the future that Mr. Ridley could have addressed but did not. Some would put super-intelligent computers on that list. My own list would include large-scale bioterrorism or a pandemic. (Mr. Ridley briefly dismisses the pandemic threat, citing last year's false alarm over the H1N1 virus.) But bioterrorism and pandemics are the only threats I can foresee that could kill over a billion people. (Natural catastrophes might seem like good candidates for concern, but I've been persuaded by Vaclav Smil, in "Global Catastrophes and Trends," that the odds are very low of a large meteor strike or a massive volcanic eruption at Yellowstone.)
Even though we can't compute the odds for threats like bioterrorism or a pandemic, it's important to have the right people worrying about them and taking steps to minimize their likelihood and potential impact. On these issues, I am not impressed right now with the work being done by the U.S. and other governments.
The key question that Mr. Ridley fails to address is: What's wrong with worrying about and guarding against threats that might become real, large problems? Parents worry a great deal about their children's safety. Some of that worry leads to constructive steps to keep children safe, and some is just negative emotion that doesn't help anyone. If we all agree to join Mr. Ridley as rational optimists, does that mean that we should stop worrying about trends that might cause problems and not take action to anticipate them?
Mr. Ridley devotes his attention to just two present-day problems, development in Africa and climate change, and seems to conclude, "Don't worry, be happy." My prescription would be, "Worry about fewer things while understanding the lessons of the past, including lessons about the importance of innovation." This might qualify me as a rational optimist, depending on how stringent the criteria are. But there can be no doubt that excessive pessimism may cause problems with how society plans for the future. Mr. Ridley's book should trigger in-depth discussions on this important subject.
Like many other authors who write about innovation, Mr. Ridley suggests that all innovation comes from new companies, with no contribution from established companies. As you might expect, I disagree with this view. He also seems to think that innovation involves simply coming up with a new idea, when in fact the execution of the idea is critical. He quotes the early venture capitalist Georges Doriot as saying that as soon as a company succeeds, it stops innovating. A great counterexample is Intel, which developed over 99% of its breakthroughs after its first success.
Mr. Ridley describes the economy of the future as "post-corporatist and post-capitalist," a silly throwaway phrase. He never explains what will replace all the companies that figure out how to make microchips or fertilizer or engines or drugs. Of course, many companies will come and go—that is a key element of capitalism—but corporations will continue to drive most innovation. It is a dangerous and widespread problem to underestimate the ongoing innovation that takes place within mature corporations.
In his quest to highlight exchange as the key mechanism in the success of our species, Mr. Ridley underplays the role of other institutions, including education, government, patents and science, all of which, especially since the 19th century, have played a central role in the improvements that humanity has experienced. Too often, when Mr. Ridley finds an example that minimizes the contributions of these institutions, he seems to think that he has validated the idea that exchange deserves all of the credit.
I am always amazed by scientific possibilities. Electricity, steel, microprocessors, vaccines and other products are possible only because of our efforts to understand the world and how it works. The scientists and tinkerers who investigate these mechanisms are engaged in a profound process of discovery. Without their curiosity and creativity, no amount of exchange would have produced the world in which we now live.

—Bill Gates is co-chairman of the Bill & Melinda Gates Foundation and serves as chairman of Microsoft.

POVERTY: The number of very poor countries has doubled in the last 30 to 40 years,

Agence France-Presse:  November 25th, 2010
GENEVA — The number of very poor countries has doubled in the last 30 to 40 years, while the number of people living in extreme poverty has also grown two-fold, a UN think-tank warned Thursday.
In its annual report on the 49 least developed countries (LDCs) in the world, the UN Conference on Trade and Development (UNCTAD) said that the model of development that has prevailed to date for these countries has failed and should be re-assessed.
"The traditional models that have been applied to LDCs that tend to move the LDCs in the direction of trade-related growth seem not to have done very well," said Supachai Panitchpakdi, secretary general of UNCTAD.
"What happened is that in the past 30-40 years, the number of LDCs have doubled so it has actually deteriorated, the number of people living under the poverty line has doubled from the 1980s."
The report indicated that the situation has sharply deteriorated in the past few years.
The number of individuals living in extreme poverty "increased by three million per year during the boom years of 2002 and 2007," reaching 421 million people in 2007.
While these countries proved somewhat resilient during the crisis, they are nevertheless very fragile, notably due to their dependence on imports.
"The import dependence has become quite devastating, the expenditure for LDCs on food imports rose from 9 billion dollars in 2002 to 23 billion in 2008," noted Supachai.
In addition, the economies in these countries are little diversified, with very weak improvements in domestic savings, a strong reliance on external savings and a faster depletion of natural resources, said UNCTAD.
"All these shortcomings are now hindering the nations' post-recession development prospects," it warned, calling on the countries to adopt a new structure of development.

Fighting Poverty Can Save Energy, Nicaragua Project Shows

Marianne Lavelle: National Geographic News: November 25, 2010
In two small villages on Nicaragua’s Mosquito Coast, a project to improve electricity service had a remarkable side benefit—household energy use actually dropped nearly 30 percent. When efficient compact-fluorescent (CFL) lightbulbs were added to the mix, energy savings surpassed 40 percent.
The effort cut costs and brought longer hours of daily electricity service to the people of Orinoco and Punta Marshall, while demonstrating how improving energy access to poor people around the world can go hand-in-hand with reducing fossil fuel emissions, say the authors of a new study.
It shows that you can meet development objectives for the poor and climate objectives for all of us at the same time,” said Daniel Kammen, chief technical specialist for renewable energy and energy efficiency at the World Bank, and co-author of an analysis published Thursday in the weekly journal Science.
The Energy Poverty Challenge
The study set out to demonstrate a method for measuring both the climate and financial benefits of making investments that improve delivery of reliable, affordable energy for poor communities. Mobilizing such investment is crucial, with 1.5 billion people around the world living without electricity. Another 1 billion people have unreliable electricity, and nearly half the global population relies on unhealthy and polluting wood, charcoal, and dung stoves for cooking.
The United Nations said in a report co-written with the International Energy Agency earlier this fall that its goals for fighting extreme poverty will fall short unless nations also work to bring electricity and modern, safe cooking technology to the “energy-poor” people around the world.

The Sandy Bay village on Nicaragua's Miskito Coast.  The village of Sandy Bay, about 30 miles (48 kilometers) away from Orinoco, is on the Mosquito Coast, where many homes have no electricity or rely on costly diesel generation. Photograph by M. Timothy O'Keefe, Alamy

But short-term costs often trump potential long-term benefits when governments and institutions consider energy improvement investments. For example, because of the low up-front capital costs and the ease of obtaining fuel supply, diesel generation is often the technology of choice in poor rural areas in the developing world. The study authors say that makers of energy policy who choose diesel don’t give sufficient consideration to the volatility of oil prices, and the resulting expensive generation costs.
That was certainly the case in the villages of Orinoco and Punta Marshall near the Caribbean Sea, where 172 homes, six churches, two health clinics, two schools, and a carpentry shop relied on a government-run diesel “microgrid.” The researchers don’t know how much the Nicaraguan government was paying for diesel, but they estimated the “marginal” cost of electricity on the system, the cost to provide each additional kilowatt-hour, based on average diesel prices at that time in Managua, was 54 cents per kilowatt-hour, more than five times the estimated cost for electricity on Nicaragua’s national grid.
Households did not have meters to measure how much power they used, but paid flat tariffs that differed house-to-house—the price reckoned by the government electric company based on assessments of how many appliances seemed to be in each home. This approach is “quite common” in the developing world, said Christian Casillas, of the Renewable and Appropriate Energy Laboratory at the University of California, Berkeley, co-author of the analysis in Science. “Rural electricity providers are often more concerned about the additional capital cost of installing meters, and are not aware of, or are indifferent to, the long-term savings that can result from consumer response to more accurate price signals, which we quantify in the study,” he said.
The energy improvements in Orinoco and Punta Marshall were made beginning in the summer of 2009, in a partnership between the Nicaraguan government and the nonprofit group, blueEnergy. Soon after the simple installation of conventional electricity meters in the homes, at a cost the study authors estimated at about $4,350, household energy use dropped about 28 percent. The pattern that the researchers observed—the greatest savings occurred in daylight hours—suggested that residents had taken steps such as turning off lights during the day. The resulting savings of an estimated 5,625 gallons (21,291 liters) of diesel fuel annually translated to a more than $22,000 reduction in fuel costs over the course of a year (based on $1.06 per liter diesel fuel). And, the study authors calculated, carbon emissions were reduced by 57 tons, with cost savings of $386 per ton.
A second step was to distribute 330 high-efficiency compact-fluorescent (CFL) lightbulbs to the communities, with each household given the opportunity to exchange up to two of their incandescent bulbs for CFLs. Representatives of the government energy agency and blueEnergy visited each household to explain that CFLs consume 25 percent of the electricity of incandescents while providing the same level of lighting and lasting much longer. They also explained that the bulbs need to be disposed of by returning them to the government agency, due to the small amount of mercury in each CFL. The cost of the program, including labor, was estimated by the researchers to be about $1,030. The energy load on the system fell by 50 kilowatt-hours per day, or a 17 percent drop on top of the savings due to the meter installations. That reduced diesel fuel needs by about 2,460 gallons (9,310 liters) per year, translating to a 25-ton reduction in carbon emissions, at a cost savings of $374 per ton.
Nicaraguan energy authorities used the fuel savings to extend the hours of electricity service to the communities by two hours each day, for a total of 12 hours. And 37 percent of the households saw lower electricity bills; for the poorest households, costs did not fall with their drop in energy use because the regressive tariff structure required that the smallest consumers pay a fixed rate, the researchers noted.
Renewable Energy Opportunity
The researchers underscored the even greater potential to reduce carbon emissions in the community, now that the electricity load has been slashed. They calculated that downsizing the diesel fuel electricity generator could save a further $5,760 per year (or $147 per ton of carbon reduced). And adding renewable energy to the system would also be a net benefit: Replacing a portion of diesel fuel generation with biogas, produced locally through anaerobic digestion of animal dung and agricultural residues, could save $4,012 per year ($271 per ton of carbon reduced), and installation of a 10-kilowatt wind turbine could save about $7,767 per year ($34 per ton of carbon reduction.)
The only emissions-reducing improvement the researchers considered that would actually cost money was adding a 10-kilowatt solar photovoltaic installation to the system; the cost would be $9,501 annualized, or $322 per ton of carbon reduced. But with savings of more than $1,600 per ton possible for all of the other energy improvement measures the researchers catalogued, as well as likelihood that diesel fuel will cost more in the future, a solar system for further cutting carbon emissions could begin to look affordable to authorities managing the system.
It’s an important finding for countries such as Nicaragua, Central America's largest nation, and and among its poorest. A 2007 World Bank report said that although Nicaragua has great potential for renewable energy at a competitive price, the majority of its electricity generation is from petroleum.
“This is really a prescription to think about energy systems holistically,” said Kammen. “It was hard to do that in the past. It does require data, which can lead you to some really important observations.”
The analytical method outlined in the paper is “very helpful for certain contexts, particularly for looking at how increasing energy efficiency can help support energy access," says Richenda Van Leeuwen, senior director on energy and climate for the the United Nations Foundation, a nonprofit that supports the work of the UN. She said she especially sees potential for the approach to be adapted for addressing the global problem of primitive cookstoves. Inefficient wood and waste stoves, used by 3 billion people around the world, create black carbon particulate emissions, a large contributor to climate change, and have a devastating impact on health—especially for women and children.
“There is really room for more research in this area for both traditional cooking and kerosene-based lighting, which both emit smoke,” Van Leeuwen said. “You could begin to monetize the savings of fewer trips to clinics, and fewer treatments for acute pneumonia and other respiratory illnesses that are common among people breathing in cookstove smoke day in and day out.”
Van Leeuwen said the approach is among those being weighed by the new public-private partnership, the Global Alliance for Clean Cookstoves, launched earlier this fall by the UN Foundation in conjunction with the governments of the United States, Germany, Norway and Peru; the United Nations; global energy company Shell* and its Shell Foundation; investment bank Morgan Stanley; and the nonprofit SNV-Netherlands Development Organization.
The type of analysis that Casillas and Kammen did, called a “marginal cost abatement curve,” has been done before to show the benefits of energy efficiency for the developed world—with the most notable example in climate change literature a 2007 study by the consulting firm McKinsey and Company. But Kammen said his new study underscores the importance of doing a similar analysis for the world’s poor, who can spend more than 30 percent of their income on energy services. In wealthy countries, only 2 to 3 percent of Gross Domestic Product is spent on energy. “Because energy services are often expensive,” said Kammen, “finding ways to provide them more efficiently benefits the poor more than the rich.”

* This report is produced as part of National Geographic’s Great Energy Challenge initiative, sponsored by Shell. National Geographic maintains autonomy over content.

POVERTY: World Banks Lends Uganda $100 Million in Budget Support to Reduce Poverty

By Fred Ojambo - Nov 24, 2010
The World Bank will lend $100 million to Uganda to finance projects aimed at reducing poverty in the East African nation, Finance Minister Syda Bbumba said.
The Washington-based lender will provide the loan through its International Development Agency to improve “service delivery” and “infrastructure development,” Bbumba told reporters today in the capital, Kampala.
The 40-year concessional loan, with a grace period of 10 years, will carry an interest rate of less than 1 percent, the minister said. The World Bank is expected to release the entire loan as early as next week and it will be spent in the 12 months through June, she said.
The loan is the eighth credit line the World Bank has given Uganda to support its budget, with earlier loans worth a total of $760 million, Bbumba said. About 23.3 percent of Uganda’s population live below the poverty line, compared with 31.1 percent in 2005-06, the minister said, without giving details.
The country’s population is rising by 3.2 percent a year, one of the fastest growth rates in the world, with more than half the population under the age of 15, Bbumba said.

POVERTY: Want to slash poverty? Look to Latin America.

By David R. Francis / November 22, 2010
While poverty has grown in the United States, it's been shrinking in Central and South America.
Brazilian children use new computers in their classroom. A development program in Brazil offered small amounts of cash to poor families if they sent their children to school, contributing to a swift rise in literacy and decline in poverty.

  Agilix Labs, Inc. / AP / File

One in 10 South Americans – about 38 million people – escaped poverty during the past decade. That's remarkable progress by any measure.
Contrast that with the United States, where poverty has been growing due to a decade-long stagnation of income for the middle class and the Great Recession. In 2009, the US had more poor people than in any of the 51 years since poverty levels have been estimated.
Of course, America's poor are far better off than South America's poor. And the US still has a much lower poverty rate (14.2 percent versus around 70 percent). South America remains infamous for huge income gaps between a tiny elite and masses of people making, often, just $1 or $2 a day.
Still, 10 years of growing prosperity has shrunk that gap. The credit goes to democratic leftist governments that have vastly boosted social spending to help the poor, maintains Mark Weisbrot, a left-of-center economist at the Center for Economic and Policy Research in Washington.
Half of that improvement comes from Brazil. Under outgoing President Luiz Inácio Lula da Silva, the nation pushed up the minimum wage a real 65 percent in eight years, helping to raise the wages of tens of millions of workers, including many receiving more than minimum wage. A program offered small cash grants to poor families if they sent their children to school.
The results? Real income per person is up some 24 percent since 2000. Illiteracy is down. Poverty has been halved since 2002; extreme poverty is down by 70 percent, says Mr. Weisbrot, pulling more than 19 million people into the middle class.
And the economy hasn't suffered. Unemployment under Mr. da Silva's presidency dropped from more than 11 percent to 6.7 percent. Income inequality has fallen considerably.
Other nations with "progressive" governments have made much social progress, notes Weisbrot. He lists Bolivia, Ecuador, Argentina, and Venezuela. Under President Hugo Chávez, attacked by the right in the US, oil-rich Venezuela has tripled social spending per person since 2003. Attendance at universities has doubled. Most of the poor now get health care under a government program.
The continent weathered the financial crisis relatively well. Social spending rose. So there was no big rise in poverty, says Norbert Schady, an economic adviser to the Inter-American Development Bank, speaking from Quito, Ecuador.
Moreover, prospects for continued economic progress are strong. The Institute of International Finance (IIF), set up by the world's biggest banks, forecasts 6 percent growth in gross domestic product in Latin America this year, which includes Mex­ico and Central America as well as South Am­er­ica. That growth should shrink poverty further.
By contrast, the IIF forecasts a 2.5 percent growth rate this year for the US. At that slow pace the US could see a further rise in poverty.
South America's new economic vigor is also causing a geopolitical shift. The US has long considered Latin America part of its political and economic sphere of influence. Officials running South America's left-of-center governments often charge the US with imperial ambitions.
But as US growth slows, South America's businesses have reached out to other markets. While 15 percent of South America's trade is still with the US, a greater share is tied to Europe. Also, trade within the continent is growing with a free-trade deal. So South American governments no longer feel so much under the thumb of the US.

POVERTY: WHO: Spiraling Health Costs Push 100 Million People Into Poverty

Geneva 22 November 2010

Photo: WHO UN HABITAT / Anna Kari Share This

The World Health Organization says spiraling health costs push 100 million people into poverty every year. Now, a WHO report provides practical guidelines on how governments can strengthen their health financing systems, and make services available to more people.
Rich and poor governments alike are struggling to pay for health care. Some people have good health plans that cover most of their expenses. But, they are in the minority.
The World Health Organization reports about one billion people in the world do not get the health services they need, because they are not available or are not affordable.
WHO Health Systems Financing director, David Evans, says these people have a difficult choice to make. Either they pay directly for health services they cannot afford, or delay care and run the risk of getting a more serious disease.
"Probably 100 million people make the choice to use their services each year, pay for them, and they suffer the financial consequences. They are pushed down the poverty line simply because they pay for health services," Evans said.
He adds that although this is unacceptable, there is an alternative.
"But, what the report says, it is not just acceptable, but it is not necessary. Something could be done about it, and something can be done about it now," Evans stressed.
The report highlights three key areas of change.
It says governments can raise and allocate more money for health. For example, WHO notes, in 2000, African heads of state committed to spend 15 percent of government funds on health. So far, three countries, Liberia, Rwanda and Tanzania have achieved this.
The report says governments also could raise money more fairly and spend it more efficiently. Evans says a number of countries are adopting these options with some success.
"Gabon is a low income country. It has introduced a tax on financial transactions, and that is going to help. If Gabon can do something like that, other countries can do it," Evans said. "In terms of financial risk protection, Thailand has introduced health insurance for everyone, and that health insurance is tax-funded, particularly for the poor. So, that what happens is, the insurance now pays the cost that the people would have paid previously out of their own pockets."
The report says smarter spending could increase global health coverage between 20 and 40 percent. It identifies 10 areas where greater efficiencies are possible.
One is in the purchase of medicines.
France is an example of this. It uses generic drugs wherever possible, a policy that saved the country almost $2 billion in 2008. The report says more efficient spending on hospitals could boost productivity by 15 percent.
WHO acknowledges impoverishment and financial catastrophe are more prevalent in low-income countries because people there rely more on out of pocket payments for health care. Therefore, it says, poor countries will need more help from the international community.

POVERTY: Ghana: Poverty reduction strategies must empower girls

Nov. 25, GNA - Mr Samuel Ofosu-Ampofo, Eastern Regional Minister, on Thursday said all strategies involved in poverty reduction must aim at empowering girls and women for a sustainable livelihood.
He said there were many girls and women who had no skills let alone means of livelihood and all those factors contributed to the high poverty levels in the country.
He therefore called for a concerted effort in addressing that issue which was paramount if poverty reduction was to be achieved.
According to the Regional Minister, the continuous neglect of girls and women through systematic training programmes posed a big threat to all strategies adopted for national poverty reduction programmes.
Mr Ofosu-Ampofo was speaking at a meeting with the Minister for Local Government and Rural Development, Mr Joseph Yieleh Chireh, New Juaben Municipal Chief Executive, Mr Alex Asamoah and executive members of the Social Investment Fund (SIF), prior to inspection and inauguration of SIF projects in Koforidua.
He therefore urged the SIF urban poverty reduction programme to channel its resources into the empowerment of disadvantaged girls who for some reasons could not make it through formal education since focus on formal education alone could not achieve any significant reduction in poverty.
Mr Ofosu-Ampofo urged the SIF to re-direct its attention to the institutionalization of sponsorship packages to disadvantaged girls through vocational training since the developmental projects alone without a significant empowerment of girls would not impact on poverty reduction.
Dr Jones Quartey Papafio, Board Chairman of SIF, corroborated the views of the minister saying that the rate at which many young girls were selling phone cards on the streets was alarming and raised the point for support.
He said the SIF would therefore put in a comprehensive programme to ensure that the laudable idea of the minister was adopted so that women empowerment would be a part of the urban poverty reduction strategy of the SIF.
Mr Justice Akuffo Henaku, Zonal Coordinator for Eastern and Volta Regions, said apart from the construction of projects selected by the people themselves, there were micro-finance loans being disbursed to women to enhance their businesses.
He said SIF had realized that accessing of the loans from the banks were cumbersome to small business enterprises such as food sellers and therefore looked as if there was no support for them.
Mr Henaku indicated that SIF was taking steps to ensure that all traders no matter how small their businesses had access to the loan facility.

POVERTY: Study: Poorest Countries Must Diversify to Break Out of Poverty Cycle

Lisa Schlein: Geneva 25 November 2010

A woman shops in a well-stocked food shop in Bujumbura, Burundi (File) Photo: AP
A woman shops in a well-stocked food shop in Bujumbura, Burundi (File)

A new United Nations study argues the Least Developed Countries must diversify and modernize their economies to achieve development and break out of their poverty trap. The UN Conference on Trade and Development's 2010 Least Developed Countries report says LDC's are stuck in old ways of doing things and this is preventing them from moving their economies forward.
The report says the world's 49 poorest countries have done a fair job of weathering the global downturn. But, it says they are still trapped in the so-called boom-bust cycles, which have long plagued their economies.
The report says the Least Developed Countries must develop their abilities to produce an increasing range of higher value-added goods and services through expanding investment and innovation.
Otherwise, it warns they will have difficulty achieving substantial and lasting poverty reduction. UNCTAD Secretary-General, Supachai Panitchpakdi, says LDCs are too heavily dependent on exports of primary commodities and low-value-added manufactures.
"LDC's have shown positive trends in the trade activities. But, it is mainly driven by commodities and mainly oil and gas and all these primary commodities. They have not been able to benefit from any global trends to wean themselves away from increasing dependence on commodities," said Panitchpakdi.
Supachai says there has been very little diversification into manufacturing activities. He says only the LDCs in Asia have been relatively successful in diversifying their economies.
New poverty figures estimate the number of people in extreme poverty has increased by three million per year during the boom years of 2002 and 2007. In 2007, the figures show more than 420 million people were living in poverty, that is twice as many as in 1980.
UNCTAD economists note the focus of support for LDCs is mainly in the area of trade. They say this must change and greater emphasis must be put on helping the poor countries expand other areas of economic interest.
The report argues the need for more and new forms of financial assistance to support the LDCs domestic activities. It says technology and commodities, as well as climate change adaptation and mitigation also should be given priority.
The main author of the report, Zeljko Kozul-Wright, says globalization has not treated everyone well or equally. She says the LDC's have been on the losers' side.
Kozul-Wright says the LDC's must break free of their dependence on trade in exports because business as usual will not deliver growth.
"We also believe that South-South linkages offer significant growth opportunities for all developing countries, including LDCs through free trade and investment flows. And, indeed, one of the reasons for the resilience of LDCs to the shock owes something to the growth of these linkages in recent years, and it is particularly strong in Asia," she said.
The report says LDCs face a difficult medium-term outlook. It says low investment levels and weak financial development continue to pose serious concerns.
Therefore, it says the world's poorest countries will depend largely on the speed of economic recovery in the rest of the world and on increased support from international donors.

TUBERCULOSIS: South Africa uses nanotech against TB

Munyaradzi Makoni (Munyaradzi Makoni is a freelance science journalist based in Cape Town, South Africa.)    24 November 2010   Patients struggle to stick to the routine of taking daily tuberculosis medication for months on end: Andy Crump/ WHO/TDR

South Africa is using nanotechnology to improve existing tuberculosis drugs. Munyaradzi Makoni looks at a developing country's experience.
Treating tuberculosis (TB) in developing countries is a problem. Patients struggle to stick to the routine of taking daily tuberculosis medication for months on end — particularly when they must travel long distances for a nurse to ensure they take the drugs. This and the side effects mean many give up before completing the course.
Lack of adherence means the 50-year-old drug regimen is failing as multidrug-resistant strains emerge. Chances are remote that it will be replaced anytime soon with new antibiotics.
But the days of clockwatching for TB patients may soon be over. Researchers in South Africa are working on a way to deliver that half-century old treatment in a new guise — incorporating the drugs into nanoparticles so they are released slowly into a patient's bloodstream, raising the possibility that daily pills could be replaced with a single weekly dose.
Nanotechnology research is not cheap but researchers are hopeful that money spent on expensive research and development will be worthwhile when pitched against savings in treatment costs and substantial gains in health.
And those gains are there to be made. TB is one of the leading causes of adult death in South Africa with approximately 460,000 new TB cases in 2007, according to the WHO. South Africa is ranked fifth on the list of 22 high-burden TB countries in the world.
Old drugs repackaged
First-line treatment for TB consists of a pill of each of four antibiotics — isoniazid, rifampicin, pyrazinamide and ethambutol — taken every day.
South African scientists from the Council for Scientific and Industrial Research (CSIR) have incorporated these drugs into nanoparticles that are invisible to the human eye.
White blood cells take up nanoparticles because they look like foreign objects and, effectively, transport them throughout the body while releasing their cargo, says Hulda Swai, senior scientist at CSIR's Centre for Polymer Technology. "These nanoparticles have superior properties for absorption in the small intestine to improve bioavailability and uptake into the circulation," says Swai.
The safety and uptake of the nanoparticles is being tested in TB-infected mice and the effectiveness of the nanodrug is being compared to conventional therapy to see whether a weekly nano dose is as effective as the standard daily treatment regime.
Human trials for the antibiotic, called Rifanano, are scheduled for 2012.
Affordability rules
But the trials are not spared problems that affect clinical trials in many developing countries.
"Manpower and animal models are not always available, and where available, the expertise specific for nanomedicine is scarce," Swai told SciDev.Net.
But the potential advantages of the technology make its pursuit worthwhile. If TB treatment is reduced to a once-a-week dose, the overall costs, both of the drugs and of employing healthcare staff, could be significantly reduced.
"Given savings as a result of lower dose and higher efficacy, the consequence of targeted delivery — releasing drugs only after reaching the position required in the body — treatments might actually become cheaper," says Bernard Fourie, chief scientific officer of Medicine in Need, a non-profit research organisation with a base in South Africa that aims to develop treatments and vaccines suited to the developing world.
  Nanodrugs, tailored for delivery to the lungs or other sites of infected tissues have the potential to stop cancer cell growth, better protect against infection and more effectively attack and kill viruses and bacteria without affecting healthy cells around them.
"Remarkable benefits to healthcare" could be expected over the next decade with the development of drugs, vaccines and other pharmaceuticals that will specifically target diseased cells, Fourie says. But the major question, is whether such new technologies would also benefit poor populations, such as those in Sub-Saharan Africa where TB, HIV/AIDS and malaria continue to affect millions.
But Fourie believes South Africa's pharmaceutical industry is capable of adopting nanotechnology, and that availability and access to such nanomedicines shouldn't be a problem.
Swai agrees, saying: "Only a small fraction of treatment costs is actually related to the drug itself. The nanodrugs are designed to make use of cost-effective materials that are easily accessible and relatively cheap to manufacture."
And because the technology is home grown it will be less expensive to manufacture nanodrugs than to buy imported mainstream drugs, adds Swai.
Not just TB
CSIR researchers are also working on nanoencapsulating antiretrovirals and antimalarials, as well as second-line TB drugs used for resistant cases where the first-line drugs don't work.
For instance, nanoencapsulation can involve coating the anti-malaria drug chloroquine with nanomaterials that include liposomes which can deliver the drug by penetrating cell membranes, making their action on diseased cells more targeted and efficient.
CSIR is collaborating on this research with the African Institute for Biomedical Research in Zimbabwe, and the Kenya Medical Research Institute as well as institutes on other continents including the University of Brasilia and Federal University of Rio Grande du Sul in Brazil; India's Post Graduate Medical Research Institute and Life Care; and the University of Buenos Aires in Argentina.
Not without risk
Many researchers warn that the growing number of developing countries interested in nanomedicine need to be aware of the potential risks associated with nanotechnology.
Janice Limson, head of the Biotechnology Department at South Africa's Rhodes University, says: "The potential applications for nanomaterials are phenomenal, but researchers do agree that any developments in this regard must be partnered with research into understanding toxicity."
Materials have different properties at the nanoscale. For example, gold is nonreactive but at the nanoscale it becomes a catalyst for reactions.
While these properties are what make nanotechnologies so useful, they may also have unforeseen adverse effects. Globally, researchers are only just beginning to understand the toxicity of nanostructures and it is the subject of extensive work by a number of groups in South Africa.
  First-line TB treatment consists of four antibiotics — isoniazid, rifampicin, pyrazinamide and ethambutol — taken every day: Andy Crump/ WHO/TDR

Andre Nel, chief scientist of the division of nanomedicine at the University of California in Los Angeles' NanoSystems Institute, says that there is a lot of interest in assessing whether the 'nanocarriers' that transport drugs have "hazardous effects that are different and independent from the drugs being delivered".
The former Stellenbosch University student says that so far the only studies on the effects of nanotechnology in animals have focused on industrial nanomaterials rather than those used in nanomedicine. He adds that the same screening methods will be used to look at the safety of nanodrugs.
Though unaware of any specific regulations to monitor the risk of nanodrugs in South Africa, Nel says most countries would like to have specific independent evaluation criteria for nanotherapeutics. But no set of risk factors specifically for nanotherapeutics has been indentified yet.
"Most agencies worldwide are basing their assessments on traditional methods of drug safety assessment in which the nanomaterial is regarded as an integral component of the therapeutic substance as there has been no special risk that evolved as a result of nanodrugs," he says.
But these hurdles do not prevent research teams in South Africa from forging ahead. The new TB drug delivery method has been slated for availability in government clinics in 2016.
And Swai and her team are already planning for the future. "We hope to undertake the nanoencapuslation of traditional actives - ingredients granted authorisation used in treating other diseases of poverty around Africa such as sleeping sickness, ascariasis, leishmaniasis, chagas disease, onchocercariasis ," she says.
And for those like the blog's owner who don't know about nanotechnology, here is a typically valuable Wikipedia entry: http://en.wikipedia.org/wiki/Nanotechnology