Wednesday, 29 February 2012

POVERTY: MYANMAR: Humanitarian cost of economic development

BANGKOK, 27 February 2012 (IRIN)

 Photo: Courtesy of Frankie Abreu
Construction underway for Dawei port

A development spree in Myanmar following recent political reforms may have hidden costs for rural dwellers, especially ethnic minorities, say analysts.
Speaking at a recent conference in Yangon on inclusive growth, former World Bank president and Nobel laureate Joseph Stiglitz warned that Myanmar risked becoming "a rich country with poor people", as quoted in local media.
In 2011, foreign investment in mining, oil, gas and hydropower in Myanmar totalled US$20 billion, according to the government.
And while a $3.6 billion project to construct a dam on the Irrawaddy River for a hydropower plant was suspended due to protests stemming from environmental and social concerns, including the projected displacement of thousands of villagers from the northern state of Kachin, a deepwater port project is going ahead, despite similar criticisms.
Saw Frankie Abreu, a coordinator with the local NGO Another Development for Burma, believes the multi-billion dollar project in the southeastern city of Dawei in Tanintharyi Region may displace tens of thousands of villagers and boost undocumented migration to Thailand.
The Burmese government has defended the proposed port, whose construction began late 2011, as a boon to the local economy, but community activists say the gains are coming at too high a cost.
While the government is creating four new villages to house the displaced, Saw Frankie Abreu criticized the plan as insufficient.
"We have seen the houses they are building. They are building one house for each family, but it is for... just four or five people. But villagers have more children than that. And also most of the time they are extended families, but the government is counting this as one family. So where will the others go?" Saw Frankie Abreu asked.
The displacement will "severely" affect the livelihoods of the ethnic minorities living in these villages who are unable to adapt to the new locations, said Khin Ohmar, coordinator of the Burma Partnership, a network of NGOs based in northern Thailand.
"The Mon and Karen people are the majority in this area. They depend on the orchards and farming, like growing betel nuts, for their livelihood. Their livelihoods depend entirely on the land they live on," Khin Ohmar told IRIN.
One of the villages under construction for the displaced from Dawei is 60km north in Bawa village.
"Bawa is a fishing community," said Saw Frankie Abreu, "while the Dawei people are farmers. The land in Bawa is not suitable for farming, so people are now thinking of moving, or are already moving to other places."
A number are trying neighbouring Thailand, said Khin Ohmar.
Win Kay Thi, a Burmese migrant worker from Dawei living in the southern Phang Nga Province of Thailand, told IRIN she would bring her mother and sister, who live in Dawei, to join her.
"I have settled in Thailand as a migrant worker for more than five years, so I understand the environment here. In [Myanmar], I don't know the place where my family is going and my family also doesn't know about the new situation [in Bawa], so I will bring them here," Win Kay Thi said.
"Others in the village are also talking about moving to Thailand," she added. "People in the area are very worried about their future. Right now buildings are mushrooming. They are accelerating the building."
The International Organization for Migration recently estimated 1.4 million unregistered Burmese workers and family members already in Thailand.
"When locals first heard about the project, grassroots people were very optimistic," Saw Frankie Abreu said. "They thought they would get job opportunities, maybe transportation would be better, maybe they can start taking local goods to markets in the city better. Then they started realizing the challenges."

POVERTY: PAKISTAN: Abducted and forced into a Muslim marriage

KARACHI, 27 February 2012 (IRIN)

 Photo: Tariq Saeed/IRIN
Hindus marking a ritual occasion feel increasingly threatened in Pakistan

Sixteen-year-old Ameena Ahmed*, now living in the town of Rahim Yar Khan in Pakistan’s Punjab Province, does not always respond when her mother-in-law calls out to her.
“Even after a year of `marriage’ I am not used to my new name. I was called Radha before,” she told IRIN on a rare occasion when she was allowed to go to the corner shop on her own to buy vegetables.
Ameena, or Radha as she still calls herself, was abducted from Karachi about 13 months ago by a group of young men who offered her ice-cream and a ride in their car. Before she knew what was happening, she was dragged into a larger van, and driven to an area she did not know.
She was then pressured into signing forms which she later found meant she was married to Ahmed Salim, 25; she was converted to a Muslim after being asked to recite some verses in front of a cleric. She was obliged to wear a veil. Seven months ago, Ameena, who has not seen her parents or three siblings since then and “misses them a lot”, moved with her new family to southern Punjab.
"The abduction and kidnapping of Hindu girls is becoming more and more common," Amarnath Motumal, a lawyer and leader of Karachi’s Hindu community, told IRIN. “This trend has been growing over the past four or five years, and it is getting worse day by day.”
He said there were at least 15-20 forced abductions and conversions of young girls from Karachi each month, mainly from the multi-ethnic Lyari area. The fact that more and more people were moving to Karachi from the interior of Sindh Province added to the dangers, as there were now more Hindus in Karachi, he said.
“They come to search for better schooling, for work and to escape growing extremism,” said Motumal who believes Muslim religious schools are involved in the conversion business.
“Hindus are non-believers. They believe in many gods, not one, and are heretics. So they should be converted,” said Abdul Mannan, 20, a Muslim student. He said he would be willing to marry a Hindu girl, if asked to by his teachers, “because conversions brought big rewards from Allah [God]. But later I will marry a `real’ Muslim girl as my second wife,” he said.
According to local law, a Muslim man can take more than one wife, but rights activists argue that the law infringes the rights of women and needs to be altered.
Motumal says Hindu organizations are concerned only with the “forced conversion” of girls under 18. “Adult women are of course free to choose,” he said.

“Lured away”
Sunil Sushmt, 40, who lives in a village close to the city of Mirpurkhas in central Sindh Province, said his 14-year-old daughter was “lured away” by an older neighbour and, her parents believe, forcibly converted after marriage to a Muslim. “She was a child. What choice did she have?” her father asked. He said her mother still cries for her “almost daily” a year after the event.
Sushmat is also concerned about how his daughter is being treated. “We know many converts are treated like slaves, not wives,” he said.
According to official figures, Hindus based mainly in Sindh make up 2 percent of Pakistan’s total population of 165 million. “We believe this figure could be higher,” Motumal said.
According to media reports, a growing number of Hindus have been fleeing Pakistan, mainly for neighbouring India. The kidnapping of girls and other forms of persecution is a factor in this, according to those who have decided not to stay in the country any longer.
“My family has lived in Sindh for generations,” Parvati Devi, 70, told IRIN. “But now I worry for the future of my granddaughters and their children. Maybe we too should leave,” she said. “The entire family is seriously considering this.”
*not her real name

POVERTY: NIGER: Malian refugees flee to hunger zone

GAOUDEL/TILLABERI, 27 February 2012 (IRIN)

 Photo: Jaspreet Kindra/IRIN
For each day over the past three weeks at least 187 Malians fleeing fighting in their country have sought refuge in Gaoudel village, Niger

No babies cry and the children are not even curious about the presence of strangers. “It is hunger and they are shy - they are not used to strangers,” explained one of the mothers, who is among a couple of thousand Malians who have crossed into southwestern Niger and sought refuge in the windswept village of Gaoudel, Ayorou District, after fleeing clashes between Malian government troops and Tuareg rebels.
At least 10 children are among those sheltering in silence from the relentless sun under scraps of fabric tied to sticks in the ground. They are 10km from the Malian border.
During their two-day desert journey here they have had little to eat. Many had no time to pack anything and fled with just the clothes they were wearing. Some managed to come with their animals.
The host population - Tuaregs like the refugees - share their scarce food and water, but are stretched: The refugees now outnumber the villagers.
“They are the same people as us - black Tuaregs. Some are relatives, separated only by the border. We are all fighting drought and do not have enough food,” said Gaoudel village chief Echec Ahmad.
Their only water source - an uncovered well - will run dry in two months, he said, adding that repeated droughts had decimated their herds and that they depended on the few green beans they had managed to grow in a dried-up stream.
Some of the Malian men have arrived with animals, hoping to sell them in Ayorou town (30km away) in Niger’s Tillaberi Region, one of the worst-affected by drought in Niger. But the livestock trade in Ayorou is in poor shape. “There are a lot of animals in the market but not enough buyers,” said Biga Beidari with the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Tillaberi.
The closure of Niger’s border with Nigeria, after attempts by militant group Boko Haram to set up a base in the drought-stricken country, has had an impact on the local economy: The absence of Nigerian livestock buyers in local markets seems to have hit pastoralists across the region hard.
“If I sell three goats, I will be able to buy only 100kg of millet - enough for my family [two wives and seven children] to eat for 10 days,” said Mohammed Warimagalis, a Malian refugee and pastoralist who has picked up English on his travels. He arrived in Niger two days ago with 30 goats, which he fears will help his family survive for only about three months.

No jobs, little food
The refugees are our neighbours and they need assistance now
Most towns in the region are awash with people from food-scarce areas looking for work. An assessment by French NGO Agency for Technical Cooperation and Development (ACTED) found 94 percent of the villages in the districts of Tillaberi, Ouallam and Filingue do not have enough food; 89 percent of the population, or more than a million people, are affected.
The Mali clashes come at an unfortunate time, said Oumarou Sadou, prefect of Tillaberi. “But they [the refugees] are our neighbours and they need assistance now.”
Fighting in eastern Mali has spread to areas closer to the northwestern corner of the Tillaberi Region, prompting an influx of Malians into this part of Niger. Some aid workers fear the numbers could rise, as most arriving up to now had taken pre-emptive action. "We left as we heard the clashes were going to begin," said Warimagalis.
Plan Niger, an NGO operating in the area, says the number of refugees has been increasing rapidly and more resources are urgently needed to support them.
Plan Niger spokesperson Maman Farouk said that over the past five days another 932 refugees had been recorded in Gaoudel. The NGO has been registering Malian refugee children in local schools. They need more food, tents, medicine, bed nets, blankets and mats. They also hope to drill wells to support the host community with water.
Based on local authority figures, IRIN estimates at least 187 Malians sought refuge in Gaoudel village every day in the past three weeks.
Thousands of Malian refugees have trekked across the border to small towns and villages like Mangaizé, Chinégodar, Koutoubou and Yassan in Tillaberi, since mid-January, according to the Malian Ministry of Foreign Affairs.
Most of them - more than 9,000 - ended up in Chinégodar, which is usually home to 1,500 people. However, the number arriving here, where the Niger government and aid agencies have been providing support, has levelled off, said Benoit Kayembe, head of Médecins Sans Frontières Swiss in Niger.
Fighting between the Tuareg liberation movement MNLA (Mouvement National de Liberation de l’Azawad) and government forces resumed in Mali in mid-January, after the Tuareg rebellion was officially declared over by the government in 2009.

POVERTY: Measuring women’s empowerment in agriculture

WASHINGTON, 28 February 2012 (IRIN)

 Photo: Kate Holt/IRIN
Sisters doing it for themselves

The global anti-poverty movement has added a new tool to its arsenal with the launch of an index that measures women’s empowerment in agriculture.
“Agriculture is the most effective way to drive inclusive economic growth of the poorest communities”, which too often include women and children, said Sara Immenschuh of the International Food Policy Research Institute (IFPRI), a partner in compiling the index.
The Women’s Empowerment in Agriculture Index is a partnership between the US government’s Feed the Future initiative, US Agency for International Development (USAID), IFPRI and Oxford University’s Oxford Poverty & Human Development Initiative (OPHI). It uses five criteria to measure the empowerment of developing country women in agriculture, and in their own households.
Pilot programmes in Bangladesh, Guatemala and Uganda studied how engaged women were in decision-making about agricultural production, what sort of access they had to resources and how involved they were in resource-related decision-making; the extent to which they controlled how income was used; whether they were able to have a leadership role in the community; and how they used their time.
If a woman scored well on four out of five indices, she was considered empowered. The results differed from country to country, and the reasons for low or high levels of empowerment also varied.
In Bangladesh, just less than a third of women were empowered, with lack of control over resources, weak leadership and influence in the community, as well as lack of control over income the main reasons.
In Guatemala, the number was less than 25 percent. The less educated a woman was and the younger she was, the more likely she was to be lagging behind in empowerment. On the other hand, the more empowered a Guatemalan woman was in agriculture, the greater the influence she had in other key areas of daily life.

Respect and resources
Lack of leadership in the community and control over use of income were the two biggest factors contributing to disempowerment in Guatemala, the report says.
In Uganda, 37 percent of women were empowered in agriculture and more than half enjoyed gender parity at home.
However, many women in Uganda said widowhood empowered them – because they did not have to waste time asking their husband’s permission to do things but just got on with them.
Ugandan women “who are empowered in agriculture also reported significantly greater decision-making and autonomy with respect to almost all domains”, says the report.
Surveys were conducted in 450 households in southern Bangladesh, and 350 each in the western highlands of Guatemala and northern, central and eastern Uganda, between September and November 2011.
One aim of the project is to help US government agencies and anti-poverty organizations to measure just how successful their programmes are at fighting hunger and poverty.
“We want to improve gender parity not by disempowering men but by bringing women up to the level of men,” said IFPRI senior research fellow, Agnes Quisumbing.
Although they make up 43 percent of the agricultural labour force, women in developing countries own less land, are limited in their ability to hire farm workers and have less access to credit, among other issues.
“Without addressing those inequities, women will be unable to effectively contribute to reducing global poverty and hunger,” said Immenschuh.

The Women’s Empowerment in Agriculture Index was launched on 28 February at the UN in New York.

POVERTRY: AFGHANISTAN: Increased pressure on refugees to leave Pakistan

JALALABAD, 27 February 2012 (IRIN)

 Photo: Heba Aly/IRIN
Afghans who recently returned from Pakistan wait for assistance
The Pakistani army and intelligence service are increasingly harassing Afghan migrants and refugees living in Pakistan’s tribal border area, in an attempt to drive them out of the country, Afghans who recently returned to Afghanistan told IRIN.
“The [harassment] has increased,” said Mawlawi Jalaludeen, an elder from Chakdara, an overcrowded refugee camp in Pakistan’s Lower Dir Agency, home to at least 2,500 Afghans. Many of them fled Afghanistan during the Soviet invasion in the 1980s and settled in mud homes in Pakistan, opening businesses and having children.
After decades of relative comfort, Jalaludeen said life in Pakistan became difficult in recent years. And now, “it has become impossible for us to live there. That’s why we left.”
Analysts say the harassment is a sign of waning tolerance on the part of Pakistani authorities, who continue to shelter 1.7 million registered refugees and 1-2 million additional unregistered Afghans.
“The government of Pakistan wants to put a lot of pressure on Afghanis to return, more than they ever had before,” said Ilija Torodovic, head of the UN Refugee Agency (UNHCR) office in Jalalabad, eastern Afghanistan, some 80km from the Pakistani border. “There will be a lot of turning up the heat. It won’t be turned up immediately, but little by little - there will be more and more pressure. And based on what returning refugees are telling us, we’re already seeing it.”
IRIN spoke to more than a dozen recently returned Afghan men who detailed arbitrary arrests and detentions, disappearances, beatings, and disturbing visits by intelligence officers - allegedly either accusing them of supporting Pakistani insurgents or trying to recruit them to fight the Afghan government.
Analysts say the Afghan and Pakistani governments have been waging a proxy war by harbouring and supporting insurgents - and refugees are being caught in the middle.

Accounts of refugees
Qiamat Gul, a taxi driver, said the Pakistani military entered his home in Chakdara camp at night, searched “everything” and threw his belongings outside. They accused him of helping the Pakistani Taliban, which has officially been fighting a guerilla war against the military since 2007. Pakistan accuses Afghanistan of harbouring and supporting the militants.
“This [harassment] was the reason we left our country and went to Pakistan in the first place. Now we’re facing the same situation there,” Gul said.
Another returnee, Abdel Qadir, said he was faced with the opposite challenge, when intelligence agencies asked him to join the Afghan Taliban, allegedly supported by the Pakistani intelligence service, the ISI.
“It is a step by step process. First they come, they talk to you. They ask you for the information … Then gradually they ask you for people they can train and send [to Afghanistan].”
“They say, ‘Either you do what we say, or you leave the country.’”
One returnee, Janat Gul, from Afghanistan’s Kunar Province, told IRIN recruits are taken in covered trucks to a training camp in the desert called Qariyat - which he himself attended during Soviet years - before being sent to Afghanistan to fight.
The tribal area between Afghanistan and Pakistan is a hotbed of insurgency, which has increased in recent years. Afghans in Chakdara have long been accustomed to interrogation or detention when they leave their refugee camp.
“They always discriminate against us,” said Jalaludeen. “They ask ‘What are you doing here? Why aren’t you returning to your country?’ Without doing anything wrong, we are arrested. It’s illegal.”
But the home invasions are new, the returnees said, and have a particularly aggressive flavour. Women who try to resist the arrests of their husbands are beaten, the returnees said, and children are arrested along with their fathers.
Afghans who are forced out of the country are then asked for bribes at checkpoints leading to the border, according to Ghulam Haidar Faqirzai, director of the Afghan department of refugees and repatriation for Nangarhar Province, which borders Pakistan. In one case, he told IRIN, children were held hostage until a ransom was paid.
Jalaluldeen, Qiamat Gul, Abdel Qadir and Janat Gul are among people from 106 families who left Pakistan for Afghanistan about three months ago, according to an assessment by the International Organization for Migration (IOM). Their departure coincided with a military operation in the area, in which “Pakistan was accusing them of being on one side or another,” one aid worker told IRIN.
Faqirzai said the Pakistani government intends to close the refugee camps “by any means”. His ministry is bracing for an influx of returnees.
This [harassment] was the reason we left our country and went to Pakistan in the first place. Now we’re facing the same situation there
He said 5-10 Afghan families are returning from Pakistan per day, unusually high numbers for the harsh winter season. “Security harassment is the main reason.”
IOM said only six of the families had proof that they were registered refugees in Pakistan, but UNHCR says registered refugees have equally been victims of the increased harassment.
Many of the returnees IRIN spoke to fled in the middle of the night without telling their own family, so as not to be noticed by security forces, which arrest, detain and sometimes beat Afghans who leave the camp without authorization, they said, or because their names were on lists of people targeted by security officials.
“I was arrested along with my five sons and jailed for four and a half months,” said Jalaludeen, who had lived in Chakdara for almost 30 years. “There was no specific reason why we were arrested. They are just giving us trouble so that we leave.”
He waved the Proof of Residence cards belonging to members of his community, which permit them to live in Pakistan until the end of 2012, but said they meant nothing to the Pakistani authorities - a view shared by others.
“Even if you go [to Pakistan] legally, you are harassed,” said one aid worker in Jalalabad.
“They don’t care about registered refugees,” Faqirzai added.

The returnees said Pakistani authorities visited homes with lists, seeking Afghans who returned to their country to be soldiers, police officers or civil servants. Their families - still living in Pakistan - are seen to be Afghan government spies, Faqirzai told IRIN.
“I was asked to give a list of all those Afghans whose sons were in the military in Afghanistan. And to inform them when they came to Pakistan,” Abdel Qadir said. “They were asking me for intelligence information.”
Bakhtaly was born in the Pakistani refugee camp but came to Afghanistan when he grew up to serve in the army and make a living. Pakistani intelligence approached his family and asked to see him within 16 days.
“I told my parents if I go [back to Pakistan], we will be arrested or killed.”
Instead, he urged his family to return to an Afghanistan that cannot host them properly.
Some of those who returned are living in tents, or three families to a home, because they no longer own land in Afghanistan and cannot earn enough of a living here to pay rent.

A divided Pakistan
The Pakistani government denied any attempt to pressure refugees to leave.
“We have allowed these Afghan refugees to fully participate in economic activities in Pakistan for over three decades. This is a testimony to our hospitality,” said Abdul Basit, spokesperson of the Pakistani Foreign Ministry in Islamabad. “You cannot harass one family or two families or 400 families - that is not going to resolve this issue. That logically makes no sense.”

 Photo: Heba Aly/IRIN
Ihsanullah Kotal, an Afghan refugee, returned in 2009 after being detained in Pakistan several times

Still, he said he had read reports of such harassment and acknowledged that “there may be individual acts… We are cognisant of the fact and our authorities keep on trying to ensure that such things do not happen.
“Our plans are very clear. We would like these refugees to go back to their countries as quickly as possible. But obviously, we’d like them to return with honour and dignity.”
Warning against an exaggeration of the problem, another Pakistani official said what he called “questioning” was perfectly normal, and the prerogative of every state.
“If three or four million people live somewhere, and 10 or 20 or 30 of them are asked, it’s no big issue,” he told IRIN. “Every week, I hear of Pakistanis being arrested or detained [in Afghanistan]. These are just normal problems. If I’m not offended, why are those Afghans offended?... They shouldn’t forget that they are living in a foreign land where they are supposed to follow the local laws.”
Observers say a schism between the military and civilian branches of the Pakistani government - currently engaged in a power struggle - may be part of the problem.
“[Harassment of Afghan refugees] is not the government policy. But it might be the ISI policy or military policy,” one aid worker said.

Millions of Afghan refugees returned from Pakistan in 2002-4, after the Afghan Taliban was ousted from power, but returns trickled to a mere 50,000 last year, in accordance with a trend of decline in recent years, due to increasing insecurity and lack of services in Afghanistan.
According to interviews and assessments of Afghan refugees living in Pakistan, UNHCR expects the number of returnees to rise to 300,000 this year - double its initial planning figures - due to increased harassment in Pakistan and an unpredictable future for refugees there, among other factors.
Residency cards for Afghans in Pakistan expire at the end of 2012, and observers are skeptical that Pakistan will extend them as it has in past years.
UN High Commissioner for Refugees Antonio Guterres was in Islamabad last month urging the Pakistani government to extend the deadline, but observers say Pakistan is completely unpredictable.
“You think you’re talking the same language, and then they turn around and do something completely different,” said one aid worker.
Refugees who do not want to be stuck in limbo may opt to return to Afghanistan, UNHCR’s Torodovic said. Others say they may have no choice.
“[In the months leading up to the deadline], a lot of Afghans will be deported from Pakistan,” Majroom, a Jalalabad field coordinator with the NGO International Rescue Committee, told IRIN.
UNHCR says Pakistan has historically respected the voluntary nature of returns for registered refugees.
"What is guaranteed is that there won't be any policy of involuntary expulsion of refugees," Guterres told UK newspaper the Daily Telegraph in a recent interview.

But some are not so sure.
“Progressively, the message that Islamabad is sending is that we are done putting up with this burden,” said Candace Rondeaux, a senior analyst with the International Crisis Group in Afghanistan.
Besides, those who returned due to alleged harassment do not see their relocation as “voluntary”: “It was my choice,” said Ihsanullah Kotwal, a refugee who returned in 2009 after several detentions in Pakistan. “But at the same time, I had no choice.”

POVERTY: AFGHANISTAN-PAKISTAN: From pillar to post - the plight of Afghans abroad

KABUL, 27 February 2012 (IRIN) -

 Photo: Mohammad Popal/IRIN
A 15-year-old Afghan boy takes a nap at a transit centre after being deported from Iran

The government of Afghanistan and the UN Refugee Agency (UNHCR) are seeking endorsement of a new strategy which aims to provide sustainable solutions to the largest and most protracted refugee crisis in the world.
Over the last 30 years of war in Afghanistan at least 10 million people fled. Many have since returned but millions of Afghans remain outside their country, including about 2.7 million registered as refugees in Iran and Pakistan, and an estimated 2.4-3.4 million others in the two countries “illegally”.
Even where conflict has subsided in their home country, many Afghans have chosen not to return because of a lack of services and development. The Afghan government admits it does not have the capacity to re-integrate many returning refugees.
Over the years, Pakistan and Iran have used these refugees as a “whipping boy” for their tense relations with the Afghan government, and “these people are caught in between” - used as a pawn to pressure Kabul and Washington, said Candace Rondeaux, senior analyst with the International Crisis Group in Afghanistan.
Host countries don’t like the word ‘integrated’.
In a sign of a new willingness, last year, Afghanistan, Iran, Pakistan and UNHCR started unprecedented quadripartite talks, the last of which wrapped up in Dubai in January.
The result is a regional, multi-year strategy that was approved by the Afghan cabinet on 27 February. The so-called “Solutions Strategy”, which will be presented to the international community at a stakeholders’ conference in Switzerland in May, aims to improve conditions in communities of origin in Afghanistan to encourage returns while supporting communities which host Afghan refugees in Iran and Pakistan.
UNHCR insists the event is not a pledging conference, but rather an invitation for stakeholders to endorse the new approach, which focuses on directing development projects already funded to areas of high returns.
UN High Commissioner for Refugees Antonio Guterres recently told Reuters the strategy would require US$1.5 billion in funds.
But the strategy faces more than funding challenges. While the quadripartite talks indicate an acceptance at the policy level that alternative solutions need to be found, dynamics in Iran and Pakistan at the operational level sometimes tell another story.
Little progress has been made on more progressive steps like naturalization of vulnerable refugees or legal migration mechanisms. “Host countries don’t like the word `integrated’,” as one aid worker put it.
IRIN takes an in-depth look at the realities on the ground that are likely to test the success of this strategy, while at the same time, making it all the more necessary.

TUBERCULOSIS: KENYA: XDR-TB case raises questions

NAIROBI, 28 February 2012 (PlusNews) -
The Kenyan government's recent failure to adequately treat a patient with extensively drug-resistant tuberculosis (XDR-TB) has some civil society organizations questioning whether the country's TB programme is equipped to diagnose and treat such patients.
In October 2011, an HIV-positive Nairobi woman was diagnosed with XDR-TB while receiving her treatment at the Kenyatta National Hospital for multi-drug resistant TB (MDR-TB). Treatment was provided by the hospital; however, she was prescribed three additional medicines that she had to buy herself, to supplement the regimen.
According to Allan Maleche, coordinator of the Kenya Legal and Ethical Issues Network on HIV and AIDS, KELIN, following a public outcry over the handling of the patient's case, the government has stepped in to pay for all her medication. But Maleche warned that more still had to be done.
“The government needs to have a policy that outlines clearly how it will deal with cases of XDR-TB because at the moment that is missing. The government must also invest in the treatment and care of XDR-TB patients in Kenya," he told IRIN/PlusNews.
MDR-TB is resistant to the two most powerful anti-TB drugs, while XDR-TB is resistant to these and at least two others. XDR-TB patients, who pose the greatest public health risk, are also the most difficult to treat. It costs about US$35,700 to treat a single case of XDR-TB per year and the treatment normally runs between 24 and 36 months.
“We have so far received only three cases of XDR-TB. Two have since died and one is on treatment. But it is difficult to say the exact number of such cases out there because no study has been done to ascertain this," said Joseph Sitienei, director of the National Leprosy and TB Control Programme.
There more than 500 known cases of MDR-TB in Kenya, and only 230 of these are on treatment, but activists warn that more cases could be going undetected.
The resources that are available ... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available

The government admits the TB programme in Kenya has not been adequately funded despite the country’s big TB burden. Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
"The resources that are available... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available," Sitienei told IRIN/PlusNews.
“We are looking for resources to enhance our capacity to deal with cases of both MDR-TB and XDR-TB in order to buy medicines and we are currently in the process of setting up a state of the art isolation ward at Kenyatta National Hospital. But as of today, individual health facilities have some sort of isolation wards that can be used from time to time," he added.
Another major challenge is that TB patients either report late to health facilities for diagnosis or default on their treatment, increasing their chances of developing drug-resistant TB.
Sitenei admitted that TB surveillance had to be improved, as the screening of MDR-TB patients for XDR-TB is "lacking".
“The government will also be training health personnel to be able to adequately do the screening... at the moment, we don’t have the capacity to adequately do the screening."
TB is the biggest killer of people living with HIV. The Kenya National AIDS Strategic Plan 2009-2013 notes that despite the fact that 80 percent of TB facilities provide HIV testing, just about 27 percent of HIV-positive TB patients receive antiretroviral treatment.
“The government has a policy to integrate TB and HIV programmes, but a lot still needs to be done to realize success. Health workers must be continuously sensitized on the need for the integration of care and treatment of the two diseases,” said Nelson Otuoma, coordinator of a local lobby group, Network of People living with HIV/AIDS in Kenya.

Sunday, 19 February 2012

MALNUTRITION: Sweden snow: Man 'survives two months trapped in car'

18 February 2012

The car in which a man was discovered who claims he was trapped inside for two months, in woods north of Umea, Sweden
The cold, nutrition-deprived man may have gone into a kind of hibernation, said one doctor A Swedish man has survived being trapped in his snow-covered car for two months without food, police say.

The car was found on Friday at the end of a forest track more than 1 km (0.6 miles) from a main road in northern Sweden.
Police say the temperature in the area had recently dropped to -30C (-22F).
The man, who was too weak to utter more than a few words, said he had been inside since 19 December. He may have survived by drinking melted snow.
Police say they have no reason to doubt his story.

Sleeping bag
The man, who has not been named, is recovering at Umea University Hospital - where staff say he is doing well considering the circumstances.
The 45-year-old was discovered by snowmobilers who initially assumed the car was a wreck until they dug their way to a window and saw movement inside, reported the Vasterbotten Courier newspaper.
The man was huddled in a sleeping bag on the back seat, said policeman Ebbe Nyberg.
"He was in a very poor state. Poor condition. He said he'd been there for a long time and had survived on a little snow.
"He said himself he hadn't eaten anything since December," Mr Nyberg said.
Doctors at the Umea University Hospital said they would normally expect a person to survive without food for around four weeks, said the Vasterbotten Courier.
One doctor told the newspaper that the man might have survived so long by going into a kind of hibernation.

POVERTY: In Sudan, Seeing Echoes of Darfur

NICHOLAS D. KRISTOF: February 18, 2012

A GREAT humanitarian catastrophe and vicious ethnic cleansing is unfolding here in the remote and impoverished region where Sudan and South Sudan come together.
For some in the Nuba Mountains, living in thatch huts far from electricity or paved roads, the sharpest acquaintance they are making with 21st-century technology is to be bombed by Sudanese aircraft.
Bombings, ground attacks and sexual violence — part of Sudan’s scorched-earth counterinsurgency strategy — have driven hundreds of thousands of people from their homes in South Kordofan, the Sudanese state where the Nuba Mountains are located. In some ways, the brutality here feels like an echo of what Sudan did in Darfur, only now it is Nubans who are targets.
“They said that they want to finish off the black people; they said they want to kill them all,” recalled Elizabeth Kafi, a 22-year-old Nuban who said she was kidnapped in December by Sudanese uniformed soldiers. She and others say that the mostly Arab Sudanese soldiers scorn Nubans partly for their darker skin, partly because some are Christian, but mostly because many Nubans back an armed uprising against decades of Sudanese misrule. In 23 days of captivity, she said she saw the soldiers use guns to execute several Nuban men, including her grandfather and brother-in-law. She described watching soldiers gang rape and then cut the throat of a young Nuban woman, and also stab to death the woman’s 3-year-old son.
Kafi said that she also saw 20 to 25 soldiers hold down two Nuban girls, whom she guessed to be about 14 or 15 years old, and gang rape them. The girls died from the rapes and beatings, she said.
It’s impossible to confirm Kafi’s full story, but others verified that she had been kidnapped. And many other Nubans recount similar attacks, or describe similar racial epithets. As in Darfur, the Sudanese soldiers often call their darker-skinned victims their “slaves.” Ahmed Haroun, a Sudanese official wanted by the International Criminal Court for committing crimes against humanity in Darfur, is now the governor of South Kordofan, and he seems to be employing similar tactics here.
While the Sudanese government is trying to suppress an armed rebellion in the Nuba Mountains, it is civilians who bear the brunt of the suffering. In an apparent effort to starve the rebels, Sudan is blocking aid groups and food assistance from reaching the area, and the United Nations Security Council a few days ago expressed “deep and growing alarm” at rising hunger levels there. Some 28,000 Nubans have sneaked out and settled in a new refugee camp here in Yida, South Sudan, just south of the border with Sudan. Scores more straggle in most days, many half-starved.
“I came because I was starving,” said Muhasin Kuwa, a 24-year-old woman who just arrived at the refugee camp. Both her parents had starved to death, along with seven small children in her small village, she said.
The Sudanese military has tried to block access routes, making escape perilous. I spoke to members from a group of 16 who had crowded into a car, paying $45 each for what they hoped would be a flight to safety in the refugee camp. But then, the day before I interviewed them, they came to a checkpoint manned by Sudanese soldiers.
“They called us over,” said the vehicle’s owner, Haroun Suleiman, 42. “Then they shot at us with guns.”
Two male passengers, ages 41 and 25, were shot dead, he said. Two women, one with a month-old baby, are still missing. The others ran frantically into the bush and escaped, eventually making their way to the refugee camp.
The Sudanese government bombed this refugee camp in November, and, just a week ago, it bombed the nearby town of Jau, in South Sudan. Fears are growing of a new all-out war between Sudan and South Sudan, in part because of an oil dispute. South Sudan separated from the rest of the country just in July, and the two sides can’t agree on the oil pipeline fees that the South should pay. The South then shut off oil production, so both countries are now facing an economic crisis. Some experts warn that the North may try to seize oil wells from the South.
Nuban children are already growing up in war. When kids surrounded me in the refugee camp, I asked them how many had lost a brother or sister in the war. About one-third raised their hands.
When the food runs out in the Nuba Mountains, perhaps in two or three months, there will be a risk of mass starvation. I saw one 4-year-old girl at a feeding center run by Samaritan’s Purse, the aid group, who weighed only 22 pounds. Unless outside countries enforce humanitarian access into the Nuba Mountains, we can expect more famished children like her.
The Sudanese armed forces try to keep aid workers and journalists out, so the story of suffering has not received much international attention. I’m going to try to slip into the Nuba Mountains and report back. Stay tuned.

Saturday, 18 February 2012


 JAKARTA, 17 February 2012 (IRIN) - Indonesia’s attempt to wean its population off rice has been hampered by a lack of viable alternative staples and cultural attachment to the grain, experts say. Following record-high food prices in 2008, the government launched a national campaign in 2009 to reduce rice consumption by encouraging citizens to go one day a week without rice; all 33 provinces were called on to boost non-rice crop production.
But experts say the drive has had limited success.
“The government should pay attention to farmers, giving them guarantees that they will benefit from growing crops like cassava. Right now there’s no fertilizer or seed subsidy, no price certainty or guarantee who will buy the [non-rice] products,” Mulyono Makmur, an adviser to Indonesia’s agriculture minister, told IRIN.
The State Logistics Agency guarantees rice prices by paying a “government purchase price” and distributing subsidized rice to the poor.
Rice production still far outstrips other crops, with the country producing 37 million tons in 2011, with palm oil, natural rubber, coconuts and cassava trailing far behind, according to the government.
“If we diversify our diets by including local crops such as sweet potato, corn and cassava, any increase in food prices won’t severely affect food security,” said Makmur.
The Asian Development Bank warned earlier this month that Southeast Asia should be prepared for a possible rise in food prices.
Indonesians on average consume 113kg of mostly white rice annually, according to the Central Bureau of Statistics.
This is a drop from 139kg in 2010 but is still high, said Makmur, citing averages in Malaysia and Japan of 80kg and 60 kg, respectively.

In addition to food security, the move to cut back rice consumption is also to improve people’s health through more balanced diets, say campaign supporters.
A 2010 survey by the US-based Harvard School of Public Health found that of the nearly 200,000 people surveyed, those who ate five or more servings of white rice per week had a 17 percent increased risk of developing Type 2 diabetes.
Almost 6 percent of Indonesia’s population (some 13.3 million people in 2007) were estimated to be diabetic, according to the most recent national health survey.

Rice is real
Indonesia, the world’s largest archipelago with 17,000 islands, is home to 77 crops, according to Makmur.
But as the popular local saying goes, “if you haven’t had rice, then you have not eaten.”
Because of the public’s lacklustre response to cutting back on rice, in 2010 the government changed the message from “one day, no rice” weekly to “one meal, no rice” daily.
But still, residents in a part of the world responsible for farming and consuming 90 percent of the world’s rice have resisted.

Roots of attachment
Tejo Wahyu Jatmiko, coordinator for the Alliance for Prosperous Villages, a local NGO working to provide access to food in rural areas, said there is a mistaken perception among Indonesians that only poor people eat tubers.
The same stigma applies to fruits and vegetables, said Ahsol Hasyim, director of Indonesia's Vegetable Research Institute.
“In Indonesia people eat rice three times a day and if they don't they are considered [to be] having a hard time economically," he said.
“There’s this image that if you eat rice or wheat, you are prosperous,” Jatmiko added. “I think the issue is how we present commodities like sweet potato and cassava to make them more attractive to Indonesians.”
Jatmiko said the previous government of President Suharto promoted rice as a symbol of prosperity in the 1970s and that image has stuck, even though 75 percent of the world’s poorest rely on rice, according to the Manila-based International Rice Research Institute.
President Suharto launched a "green revolution" in 1969 with the aim of achieving rice self-sufficiency. In 1984 for the first time domestic rice production exceeded consumption.
“At that time, Indonesians from Aceh to Papua were forced to eat rice,” Jatmiko said, referring to the country’s two geographic extremities.
But before rice became the main staple nationwide, many Indonesians had relied on corn, yams and sago, a local starch.
“[President] Suharto used rice as a political tool to stop communism because he believed if people were well-fed they wouldn’t be tempted to become communists.”

MALARIA: New malaria method could boost drug production

BERLIN – German scientists have developed a new way to make a key malaria drug that they say could easily quadruple production and drop the price significantly, increasing the availability of treatment for a disease that kills hundreds of thousands every year. Chemists at the Max Planck Institute take the waste product from the creation of the drug artemisinin — artemisinic acid — and convert it into the drug itself.
The entire apparatus is compact, about the size of a carry-on suitcase, and inexpensive. That means it can be easily added to production sites anywhere around the world.
"Four hundred of these would be enough to make a world supply of artemisinin," said unit director Peter Seeberger, pointing to the machine on a table in his lab in Berlin's Dahlem neighborhood. "The beauty of these things is they're very small and very mobile."
A paper on the new technique was published this month in chemistry journal Angewandte Chemie.
Artemisinin is extracted from sweet wormwood, a plant that primarily grows in China and Vietnam and varies in its availability according to the season. In the extraction process, for every part artemisinin produced, there is 10 times the amount of artemisinic acid discarded as waste.
Past attempts to convert the acid using ultraviolet light to trigger the conversion have been unsuccessful because the process took several steps in a large tank of acid, making production inefficient and far too expensive.
So the Max Planck chemists thought small — creating a machine that pumps all of the required ingredients through a thin tube wrapped around a UV lamp in a continuous process that takes 4 1 / 2minutes from start-to-finish to produce the artemisinin.
The technique can convert about 40 percent of the waste acid into artemisinin — producing four times more of the drug from what had in the past been discarded, Seeberger said.
Colin Sutherland, a malaria expert at the London School of Hygiene and Tropical Medicine who was not involved in the Max Planck research, said the development could be significant in boosting production of the key malaria drug. He noted that currently very little artemisinin can be made from a large amount of the sweet wormwood, which is also difficult to grow.
"If it's a simple process, given a certain amount of plant material, you can generate more drugs, that will make things cheaper and faster," he said.
Since the end product is the same molecule, there should be no decrease in effectiveness of the synthetic product, Sutherland said.
Seeberger said a commercial prototype of the Max Planck machine could be ready in about six months and that it could go into production in about a year. He said current price estimates are around €100,000 (US$132,000).
When it's in production, the idea is to make it available for a minimal fee to cover costs, he said.
"The goal is to make sure that the drug is produced and made available to as many people as possible," said Seeberger, a former Massachusetts Institute of Technology professor who now teaches at Berlin's Free University.
Sabine Haubenreisser, a spokeswoman at the European Medicines Agency, said that if the new drug is close enough to the original, its producers could apply for it to be considered as a generic product or use older data proving artemesinin's effectiveness — which could speed the approval process.
Malaria cases and deaths have been dropping since 2004, due largely to campaigns to distribute bednets, spray homes with insecticide and make better drugs available. The World Health Organization estimates that at least 655,000 people die of malaria every year, mostly children under 5 in Africa.
At the moment, artemisinin-based therapies are considered the best treatment, but cost about $10 per dose — far too much for impoverished communities.
Former U.S. President Bill Clinton's Clinton Foundation currently has a program to purchase the treatments, then sell them at a deeply discounted 50 cents to communities where they're most needed.
Cutting the price further while increasing production could "make a big difference," said Sutherland.
"Many times more children will have access to the right drug early in their disease and that's likely to have an impact on mortality."

POVERTY: LIBERIA: Land grab or development opportunity?

MONROVIA, 17 February 2012 (IRIN)

 Photo: Vincent Chounze
Residents viewing the land they say was seized for foreign investors

Hundreds of villagers and town residents of Liberia’s Grand Cape Mount Country have attracted nationwide attention in their bid to recover what they say is land seized from them and turned over to a Malaysian agro-industrial concern.
A petition sent to President Ellen Johnson Sirleaf’s office in January by the aggrieved people’s political representatives demanded the return of their land.
“This is unbearable,” Mary Freeman, 42, of Sinje Town said. “Our government must care for us and don’t allow these people to kill us silently. What have we done to go through all of these sufferings? This land belongs to us. We were born here and we give birth to our children here too. This is the only place we know.”
Malaysian company Sime Darby Plantations was granted a permit on 21 April 2010 to cultivate 10,000 hectares of palm oil in Bomi and Grand Cape Mount counties. Now, the company has applied for an additional 15,000 hectares for palm oil cultivation in Garwular and Gola Konneh districts, in the Grand Cape Mount County, and another 20,000 hectares in Gbarpolu County.
The attorney representing the aggrieved parties of Cape Mount County, Alfred Brownel, has asked the Environmental Protection Agency to reject these additional requests. He vowed his rights group, Green Advocates, would continue to support those who had lost their land.
“These things must stop,” he said. “Our people deserve the right to survive. They shouldn’t be denied their land. We will not stop until their lives are transformed and the situation changed.”
Critics say the concession is a land grab. When unresolved, land disputes could plunge the country into “serious chaos”, said Jerry Lomah, president of Lomah National Law Firm in Monrovia.
“The government must set up an active land commission to keep eyes on these issues,” Lomah added.
Liberia has a history of land conflicts, especially since the end of the civil war in 2003. In the northeastern town of Ganta there is a long-running conflict over land between the Mandingo and Mano people. Lomah said a land commission could speed up resolution of such disputes and the Sime Darby case.

Mistakes made
A seemingly receptive two-term president reacted immediately to the Grand Cape Mount County concerns by visiting the area and meeting residents of Kon Town, Garwula District. She admitted the government should have gone about the negotiations differently.
“Everybody made mistakes on this one,” she told villagers, “but the thing to do is to correct the mistakes. Now, something could have been done better when it comes to Sime Darby. More consultations and more talks with the people should have taken place.”
She told them that before the government signs an agreement, the legislature conducts public hearings so that views and objections can be raised before an agreement is concluded. However, the residents said they were unaware of any such hearings.
Johnson Sirleaf said the government would now correct this oversight and seek the views of county residents.
“I've come to start the process,” she said. “I came with the ministers of justice, internal affairs, labour, and agriculture because all of them have [a] part to play in the process.”
However, she also told residents of Grand Cape Mount County that when government, including legislators, signed documents with foreign companies or countries, these could not be changed. She said the constitution gave government the authority to sign agreements on behalf of the country, and people should not be directing their frustrations at Sime Darby.
“So, if your government made a mistake, that’s your government. You have to come back to it so we can settle it,” she said.
She said the citizens’ concerns, especially those about jobs and land-grabbing, would be addressed. She said government would ensure locals were given preference when it came to employment with Sime Darby in Grand Cape Mount County.

 Photo: Vincent Chounze
Workers on a Sime Darby plantation preparing palm tree nurseries for planting

The president has set up a committee, co-chaired by officials from the Ministry of Internal Affairs and Justice, to look into the citizens’ complaints in an effort to resolve the dispute with Sime Darby.
Most of those who lost their land have relocated to nearby villages and towns unaffected by the concession. Most are unskilled labourers.

Sime Darby responds
Meanwhile, Sime Darby has denied seizing land. It said it paid fairly for the land and that it had not used force to evict anyone, as landholders had earlier contended.
Sime Darby Board Chairman Tun Hitam said the company had been serious about being part of the community in Grand Cape Mount County since it came to Liberia in 2010. The firm said it expected to invest US$3.1 billion in its Liberian estates by 2025.
In addition, so far, it has rebuilt and refurnished 15 primary schools, and paid teachers the government rate. Sime Darby said it had also refurbished three new school buses, bought one ambulance and expanded hospital wards in its estates.
Sime Darby plantation senior vice-president of the agribusiness division, Helmy Basha, said the firm had already established four plots of nurseries that would generate 780,000 oil palm seedlings. These would kick-start the first planting of 5,200 hectares at Grand Cape Mount County. He said that by 2025, the firm would have planted up to 170,000 hectares with oil palms in the counties of Grand Cape Mount, Bomi, Bong and Gbarpolu.
"For the next 15 years, we're scheduled to invest in infrastructure like roads, bridges, electricity and piped water. We'll also put up the mills," he said.
Basha said Sime Darby would undertake social and environmental impact assessments before the start of any development. For example, it would maintain riparian buffer zones between water bodies and planted areas.
By 2015, the group would start to put up 15 mills - one for every 10,000 hectares. They would extract crude palm oil, be fuelled by biomass, and be self-sustaining, he said.
The firm expects its business in Liberia to be fully-operational by 2035; 35,000 jobs would be created.
“There will also be spillover impacts in uplifting the livelihoods of surrounding communities of the estates," Basha said.
Liberians use palm oil to prepare meals. “If Sime Darby supplies some of the oil to the Liberian market, it will reduce the price of palm oil locally,” said Monrovia businesswoman Sarah Sando.

TUBERCULOSIS: Spending your way out of TB infection

LONDON, 17 February 2012 (IRIN)

 Photo: David Gough/IRIN
TB patients waiting in a hospital in Khayelitsha, Cape Town

A hundred years ago there was no way to treat tuberculosis (TB) except with rest, fresh air and nutritious food. Forty years later the discovery of antibiotics transformed treatment and TB has been a curable disease for more than half a century, but the disease still kills nearly 4,000 people a day. The goals set by the World Health Organization (WHO) to halve the incidence of TB by 2015 and eliminate it as a public health problem by 2050 seem far out of reach.
Mario Raviglione, the head of the WHO Stop TB department, told a meeting of TB experts in London on 15 February: “The incidence is coming down at one percent or so a year, which will ensure TB elimination in several millennia, in my perception.”
TB is a disease often associated with poverty because latent infections are more easily activated by malnutrition and lowered immune systems, and more quickly passed on in badly ventilated, overcrowded living conditions. As people in Western Europe got richer, ate better, and housing conditions improved, TB became increasingly rare, even before there were effective drugs to treat it.
Now there is interest in seeing whether a new generation of social protection schemes, aimed at reducing poverty and often using cash transfers to the poorest, can be harnessed to bring down the rate of TB in developing countries.
Brazil has achieved a steady decrease in TB and has halved the death rate since 1990, despite not achieving the conventional benchmarks for a successful control programme.
Draurio Barreira, who coordinates Brazil’s national programme, told the meeting: “To control TB they say we need to detect 70 percent of those infected, treat and cure at least 85 percent of those… and have default rates not bigger than 5 percent. In Brazil we haven’t reached many of these standards, but we have had very good indicators in TB for more than 15 years. So how we can explain that?”
He attributes the achievement to political commitment. “The big news was the transformation of social policy… by a real increase in minimum wage, and cash transfer programmes for the poor - in the last sixteen years poverty in Brazil decreased by 67 percent.” And, just as in Europe in the 1800s, as poverty declined, TB declined as well.

Cash works
A study in Malawi, also presented at the meeting, showed clear health benefits from even very modest cash transfers to the most disadvantaged households. A pilot scheme gave regular monthly payments to around 10 percent of households, ranging from just over $4 for an elderly person living alone, to nearly $13 for larger families. Children grew better and were less likely to be malnourished, there was less illness in these families and they had more choice of health providers, with the possibility of sometimes using private clinics.
Social protection issues are fundamental in TB control, and that is why TB control now has to go beyond working with national TB programmes
An evaluation of the pilot looked at what happened to recipients of cash transfers living with HIV and AIDS, and found the money was being used to pay for the more nourishing food they need to support drug treatment, and for transport to get their antiretroviral (ARV) medication. The effect on TB Patients was not specifically monitored, but the need for a better diet and the cost of travel for tests and to collect drugs also affects TB patients. “The impacts that we are seeing with these people living with AIDS and HIV could absolutely translate over to people living with TB,” says Candace Miller of Boston University, who presented the study.
The close association of TB with HIV infection and the emergence of multidrug-resistant (MDR) strains are modern complications since the days when eliminating poverty was enough to get rid of the disease. “[But] HIV-TB globally is 12 percent or 13 percent of all cases, so nearly 90 percent are not HIV related,” Raviglione told IRIN.
“If you go outside of Africa - and TB is 75 percent outside of Africa - it doesn’t have the same impact… 60 percent of TB is in Asia, and HIV has little to do with those [cases]. MDR-TB is mostly in the former Soviet Union. Multidrug-resistance is a big scare, but we are talking about less than five percent of all cases of TB - 95 percent are not drug resistant.”
Cash payments and incentives specifically aimed at TB patients are more problematic. A trial in South Africa offering shopping vouchers to patients who complied with the protracted drug regime found no clear difference in the success rate of their treatment. However, the trial was partly undermined by clinic staff who felt the vouchers should be given to the poorest, even those randomly selected for the control group.
This highlights another issue in targeting social support: the perceived unfairness of giving cash or food to people living with TB while denying it to those who - in the words of another speaker - were ‘sick and struggling’ with other diseases.
Targeted interventions may also not be very effective from the public health point of view. Peter Godfrey-Faussett of the London School of Hygiene and Tropical Medicine, which hosted the meeting, argued that the problem with TB control was not the patients in treatment, even if they stopped taking their medicine. The people spreading TB were those who hadn’t been diagnosed but had symptoms and were infectious, and money would be better spent finding those cases and treating them.
Rather than targeting known TB sufferers, Brazil will now specifically target some of its anti-poverty programmes at the social groups where the disease is most prevalent to help control TB - the Afro-Brazilian and indigenous communities, those infected with HIV, and especially prisoners, ex-prisoners and the homeless.
In most countries the people designing social protection programmes do not prioritize TB control and the initial meeting this week is being followed by smaller working meetings on shifting the focus. “Social protection issues are fundamental in TB control, and that is why TB control now has to go beyond working with national TB programmes… they are too low in the hierarchical agenda of countries,” Mario Raviglione told IRIN.
“It is those above who set the real policies… we are talking about a quintessential disease of poverty, which is determined by a bunch of factors which go well beyond health.”

Wednesday, 15 February 2012

MALNUTRITION: A Life Free from Hunger: Tackling child malnutrition. SCF report

February, 2012
What are the causes of malnutrition, the solutions, and the politics? This report sets out six steps to tackle the crisis.

Child Malnutrition
The world has enough food for everyone, but millions of children face a life sentence of hunger and malnutrition – the hidden reason so many die.
This report analyses the causes of malnutrition, focusing on chronic malnutrition and stunting in children. It identifies solutions that are proven to be effective:
direct interventions, such as exclusive breastfeeding, micronutrient supplementation and fortification
indirect interventions, such as introducing social protection programmes, and adapting agricultural production to meet the nutritional needs of children.
Crucially, this report then examines the political factors that contribute to the global burden of hunger and malnutrition.
Action must be taken now to prevent the crisis deteriorating and even more children suffering the life-long consequences. This report recommends how governments, multilateral agencies, business and individuals can play their part in tackling the problem – and help give every child a life free from hunger.
This report is accompanied by a series of country briefings on tackling child malnutrition in Afghanistan, Bangladesh, Ethiopia, India, Kenya, Nigeria, Pakistan and Tanzania.
Save the Children also commissioned a poll in five countries experiencing high rates of malnutrition - India, Nigeria, Pakistan, Peru and Bangladesh. It gives a snapshot of the hardship that families are facing.

Saturday, 11 February 2012

POVERTY: Gates Foundation unveils new agricultural policy

Yojana Sharma : 8 November 2011
The Bill & Melinda Gates Foundation, one of the world's largest donors to international agricultural research for development, has announced tighter priorities for its funding for Africa and South Asia, concentrating on key target countries and crops.
In Africa the focus will be on Burkina Faso, Ethiopia, Ghana, Mali, Nigeria, Tanzania and Uganda. These countries will benefit from significant investment "to translate the movement [of research and development (R&D)] from the lab to farmers' fields," said Prabhu Pingali, deputy director of the foundation's Agriculture Development Division.
In India work will focus on the two poorest states, Bihar and Orissa, and there will be a separate programme in Bangladesh.
"This doesn't mean that we don't care about other countries but it certainly means that these are the areas where we would see significant investments from our side and see spill-over benefits to other countries," Pingali told a seminar on the foundation's agricultural policies portfolio at the International Food Policy Research Institute (IFPRI) in the United States, last week (2 November).
Pingali said the country focus was part of a two-pronged approach, with the second prong concentrating on international research, policy and advocacy, and stepping up global funding for improvements in collecting and analysing data on agricultural production and improvements.
Funding for the Consultative Group on International Agricultural Research, the Food and Agriculture Organization and the World Food Programme and some other agencies will also be strengthened.
The Gates Foundation's US$1.7 billion of agriculture research funding until 2010 had been geared towards smallholder agriculture in Sub-Saharan Africa and South Asia. But Pingali said there was a need to be more targeted. In particular, he said, the foundation wants to understand the entire value chain "from molecule to mouth" and work out what are the necessary investments.
Within the selected countries, work on R&D, agriculture policy, and access to markets will be more closely interlinked on a crop by crop basis, he said. Grants made to these countries will be based not just on technological interventions to reduce productivity gaps in certain crops but also the infrastructures, institutional reforms and policy changes required to improve productivity.
"It's a much more proactive, bottom-up approach to grant-making," Pingali said.
Pingali said the foundation would be putting more money into country policy work, particularly in the target countries to improve agricultural productivity; in capacity-building, such as analytical capacity and overall capacity to manage and run large scale agricultural transformation; and in analysis and data, such as better metrics to analyse environmental consequences and the connection between agriculture and nutrition in poor communities and better post-harvest data.
But he stressed that funding would be based on the countries' own priorities and plans.
Pingali said the foundation had needed to 'recalibrate' its funding for agricultural research because of the entry of many new donors and players into the sector in the wake of the world food crisis in 2008.
"We also felt that countries themselves are beginning to have much sharper visions of what they wanted to see in their agriculture sectors and we wanted to make sure that our work complements the visions of the countries and supports their efforts."
But he admitted that many African countries had been excluded "because of governance issues".
"Governance did come into it as a criteria, initially at least, in excluding certain countries," he said. And some middle-income countries had been included as "you could be in middle income country status and still have enormously high levels of poverty".
He added that middle-income countries were important because of "spill-over benefits to other countries, which you would not be able to get if you targeted only the least developed and the low-income countries".

POVERTY: Banana peel can purify water, say scientists

Daniela Hirschfeld : 17 March 2011
Banana peels Flickr/Karl Faktor
The peels can perform even better than conventional purification materials

[ Banana peels can be used to purify drinking water contaminated with toxic heavy metals such as copper and lead, according to a study.
Researchers from the Bioscience Institute at Botucatu, Brazil, said that the skins can outperform even conventional purifiers such as aluminium oxide, cellulose and silica. These have potentially toxic side effects and are expensive.
The team's method follows previous work that showed that plant parts, such as apple and sugar cane wastes, coconut fibres and peanut shells, can remove toxins from water.
These natural materials contain chemicals that have an affinity for metals.
"I was at home eating bananas when I had the idea: 'Why not make something with this?'" Gustavo Rocha de Castro, a researcher at the institute and co-author of this study, told SciDev.Net.
De Castro and colleagues dried the peels in the sun for a week, ground them and added them to river water containing known concentrations of copper and lead. They found that the peels absorbed 97 per cent of the metals after just one hour.
The peels were tested in the lab and worked perfectly. Eventually their efficiency reduces, at which point the metals should be removed from the skins so that they can be disposed of safely.
Castro said that, although the peels were tested only on copper and lead, the material could also work on cadmium, nickel and zinc.
But he warned that this sort of filter is better suited to industrial purposes and cannot be used for water purification at home as the extraction capacity of banana skins depends on the particle size of the heavy metals — and this is difficult to measure.
Dimitris Kalderis, a wastewater treatment expert at the Department of Environmental Engineering in the Technical University of Crete, Greece, said: "The results are very promising, and the banana peel process has proven to be a cost-effective and quick alternative to conventional methods".
"I think that a small automated system to use either at home or at a central point for multiple families could be developed. The knowledge is there, what we need right now is innovation and construction."
The study was published in Industrial & Engineering Chemistry Research last month (16 February).

POVERTY: Yaws treatment study prompts WHO review

BANGKOK, 11 January 2012 (IRIN)

 Photo: World Health Organization
Boy with skin lesions from yaws

Findings that a one-time oral treatment to cure yaws, a neglected tropical disease, is as effective as the currently recommended penicillin injection have prompted the World Health Organization (WHO) to convene a meeting on how the disease may be wiped out.
"We may be closer now than we have been in decades," Kingsley Asiedu, a yaws expert with WHO's Department of Neglected Tropical Disease Control, told IRIN, calling the study on the bacterial skin disease, which leads to chronic disfiguration and disability in 10 percent of untreated cases, the most significant in half a century.
After a UN-led worldwide control programme cut infections from 50 million to 2.5 million in 1964 in 46 countries, the disease re-emerged in the 1970s when control efforts lagged, affecting an estimated 460,000 people - mostly children - in poor, tropical rural areas mainly in Africa and Asia, according to the most recent figures reported to WHO in 1995.
In 2010, the Lihir Medical Centre in Papua New Guinea (PNG), where the disease is still endemic, gave the one-time oral dose of the antibiotic azithromycin to about half of 250 infants and children from six months to 15 years infected with yaws.
Follow-up exams in 2011 showed the treatment was as effective as penicillin injections, which - unlike oral antibiotics - require trained health staff and equipment often scarce in areas most in need of treatment, wrote the researchers.
In a recent index of health workers' outreach by the NGO Save the Children, PNG ranked in the bottom 20 of 161 surveyed countries.
The meeting of yaws experts convened by WHO in Geneva from 5-7 March will "fully define how we are going to embark [on a new yaws treatment regimen] using azithromycin", said Asiedu.
WHO's yaws treatment guidelines date back to the 1960s and there have been no alternatives since, he added.
In Southeast Asia, WHO set the goal for regional eradication by 2012 in two remaining endemic countries - Indonesia and Timor-Leste. PNG, the Solomon Islands and Vanuatu have also reported cases.
Sub-Saharan Africa was the most heavily affected based on earlier estimates, but the "picture is not entirely clear now", said Asiedu. Cameroon, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic of Congo, Ghana, Sierra Leone and Togo have all reported cases.
More studies are needed to ensure resistance to azithromycin treatment does not develop, said David Mabey from the London School of Hygiene and Tropical Medicine.
While penicillin "has stood the test of time" - still as effective fighting the bacteria causing yaws after roughly 60 years - he noted mass azithromycin had only been used in developing countries for about a decade to treat trachoma, another bacterial disease prevalent in poor rural areas.
Discussions at the upcoming WHO meeting will include a measure to monitor antibiotic resistance, said Asiedu. "Antibiotic resistance is a risk in any treatment and we always have to be vigilant."

POVERTY: Nepal’s Monsanto debate spotlights seed sovereignty

KATHMANDU, 10 January 2012 (IRIN)

 Photo: David Longstreath/IRIN
Agriculture drives Nepal's economy, but less so its research agenda

An effort by US donors and multinational agribusiness Monsanto to partner with Nepal to boost local maize production with imported hybrid seeds has met civil society opposition calling - instead - for home-grown solutions.
“If an organization like USAID [US Agency for International Development] wants to help us with a company like Monsanto, we would hope that they would help us to actually develop our own hybrids instead, not to import their foreign seeds,” said Hari Dahal, spokesperson for the Ministry of Agriculture and Cooperatives, at a recent parliamentary hearing on food sovereignty, as reported in local media.
USAID announced last September its intention to set up a pilot training partnership with Monsanto and the Nepali government, which promotes hybrid maize seeds to boost yields in a country where 41 percent of the population is estimated to be undernourished.
Maize is a staple of the local diet, especially in the maize-producing hilly central interior of the country, which suffers from chronic food insecurity.
In addition, Nepal grows only half of the maize demanded by the animal feed industry and imports the shortfall of 135,000 tons annually, according to USAID.
Demand for hybrid maize seeds, used primarily in the animal feed industry, has increased as animal feed has constituted a growing source of income for commercial farmers.
Opponents of the proposed partnership say it would substitute one form of dependence for another - from the currently imported maize to maize seeds from abroad.
According to the government, the country required 22,656 tons of maize seed in 2011* - less than 1 percent of which was supplied by registered imports.
Calling the US-headquartered Monsanto a “biotech Goliath”, local activists have taken to social media to block the company’s expansion in Nepal, citing concerns of loss of local seeds, dependence on seed imports and environmental damage to the land and surrounding communities.
Known for its genetically-engineered products worldwide, Monsanto has been sued - and settled out of court - in the Americas throughout the last decade multiple times for alleged health and environmental damages linked to its practices. It has also sued farmers whom it accused of patent infringement.

Silent entry
While this would be the first time a donor subsidizes the cost of hybrid seeds on such a large scale in Nepal - targeting 20,000 farmers in three commercial maize-producing districts of Kavre, Chitwan and Nawal Parasi along the southern lowland belt in the Terai region bordering India - Monsanto has been exporting hybrid maize seed to Nepal since 2004.

 Photo: Smriti Mallapaty/ IRIN
Hybrid maize varieties are filling more fields like this one in the lowlands of Nepal in Nawal Parasi

Kiran Dahal, Nepal country representative for Monsanto, said almost 100 percent of its seed is used to produce maize for the feed industry, but it is up to the farmers to decide where they sell their maize and for what purpose.
Monsanto’s presence was unheralded, unsubsidized and until recently, largely unnoticed, said Sabin Ninglekhu, an organizer of the Facebook campaign. “To be honest, we didn’t know Monsanto was in the country before the USAID announcement.”
Over the past decade commercial farmers in the lowlands have started using hybrid varieties, drawn by the potential of higher yields.
In hybrid breeding technology, strains are cross-pollinated to create offspring with combined strengths. Agronomists note that although first-generation hybrids produce higher yields, their offspring often may not give the same results, requiring farmers to purchase new seeds every season.
As yet, no comprehensive long-term report on the distribution and yield of hybrid seed application in Nepal has been produced, according to the Agriculture Ministry.
But preliminary findings in the lowland Nawal Parasi and Palpa districts in 2011 suggest almost doubled yields from hybrid seeds over openly-pollinated local varieties - from 0.8 to 1.5 tons per hectare - as reported by the South Asia office of the International Center for Maize and Wheat Improvement (CIMMYT) based in Kathmandu.

Do it ourselves
But blocking seed imports is only the initial goal of local NGOs protesting against Monsanto: The end objective is to boost local seed use and production by investing more in agricultural research and development, said Facebook campaign organizer Ninglekhu.
“We have used this Monsanto movement as an opening to talk about the ministry’s agricultural vision, its understanding of food security and seed sovereignty and what policies are in place to address these. Monsanto is not the only option.”
Nepal’s political climate was still fragile in late 2011, five years after the signing of the Comprehensive Peace Accord to end a decade of civil war, noted the Washington DC-based International Food Policy Research Institute.
Both the agriculture and science ministries “lack the power, capacity, and continuity to set the country’s long-term agricultural R&D [research and development] agenda,” IFPRI concluded.
The principal government agency devoted to such research - the National Agricultural Research Council - has produced only two hybrid corn strains since its establishment in 1991.
One type has not been taken up by private seed producers as it was deemed not commercially viable, and the other is still undergoing approval, said Chitra Bahadur Kunwar, a senior scientist at the council’s National Maize Research Programme.
Meanwhile, the increasingly scant availability of openly-pollinated local seeds, which can be reused from one season to the next, leave farmers vulnerable to the caprice of importation, said Durga Lamichhane, a commercial maize farmer from Gaidakot in Nawal Parasi District.

 Photo: Smriti Mallapaty/IRIN
Commercial farmer, Tilak Prasad Kandel, on his land in Nawal Parasi District in Nepal where he is growing hybrid maize

“Our local seeds are about to disappear. If for some reason these hybrid seeds do not come, we would be in a situation of emergency,” said Lamichhane, referring to a growing trend among commercial farmers not to save local seeds due to a preference to buy hybrids and other improved seed varieties.
But striving for no seed imports is not realistic, noted Andrew McDonald, a CIMMYT cropping agronomist for South Asia.
“Nepal is not alone: the food security of almost every nation is contingent on input supply chains that transcend national boundaries.”

Call for locally developed hybrids
For Tilak Prasad Kandel, a commercial farmer with a hectare of land in Nawal Parasi, the concern is not dependency, but rather lack of government spending to develop local hybrids. “There are alternatives to Monsanto.”
Though promoting maize hybrids is important to boosting maize production and profitability in Nepal, USAID’s decision to partner with Monsanto alone was questionable, said McDonald.
“I don't think USAID should be in the business of choosing `winners’ by working with a single seed company in a market environment where many private companies are active.”
The US ambassador in Nepal, Scott H. DeLilsi, noted on his own Facebook page on 2 December that “the critical discussion is not about the role of a single company but about the future of agricultural development in Nepal,” and in a 5 December statement USAID said project consultations are on-going.
“We have not worked out the details of the pilot as yet and are still consulting with a variety of groups including the private sector, academia, the MOAC [Ministry of Agriculture and Cooperatives] and Nepal Agriculture Research Council (NARC), civil society and farmer groups. We will take their feedback into account as we further discuss the form of partnership that best meets the needs of Nepali farmers.”
About 16 different maize hybrids from multiple companies are registered for sale by the government’s regulatory process.
No matter the source of seeds, the USAID pilot project would help farmers trying to grow hybrid maize, said Kandel. Not only would it subsidize seed costs, but also provide much-needed education on how to use the seeds, which is the biggest problem for farmers, he added.
According to farmers in Nawal Parasi, the subsidy would cover 75 percent of the cost of Monsanto seeds.
But for now the partnership remains a proposition as the government has not joined.
USAID has stated it “will not move forward independently to fund such a programme” and “encourages this dialogue, which underscores the critical need for Nepal to increase its agricultural production through improved seed technologies and cultivation practices”.
The government’s Natural Resources and Means Committee has requested a report addressing concerns about seed sovereignty from the Agriculture Ministry for a hearing expected to be held in January.

*this figure was incorrectly attributed to the animal feed industry in a previous version and has been corrected

POVERTY: New crop varieties can cut poverty, study finds

Bernard Appiah : 3 January 2012 Harvesting groundnut Flickr/SwathiSridharan
The new groundnut varieties are resistant to major pests and diseases

The thorny question of whether improved crop varieties do, in fact, lift peasant farmers out of poverty has been answered positively in a study of groundnut varieties, according to researchers at the International Maize and Wheat Improvement Center (CIMMYT), in Kenya.
Evidence that new technologies improve small farmers' wellbeing is scarce because the impact of adopting technologies depends on many factors such as the existence of infrastructure, policies and institutions that are often not fully functional in developing countries. For example, technology that increases productivity may not reduce poverty if the farmers do not have access to markets to sell their extra crop.
In addition, some studies have claimed that building capacity is more important than technology for improving livelihoods.
Researchers from CIMMYT selected more than 900 households at random from seven major groundnut growing districts in Uganda and, in 2006, surveyed socioeconomic data and information related to the adoption of improved groundnut varieties. Groundnut is an important crop in Uganda.
Farmers who adopted any of four improved varieties resistant to major pests and diseases — developed by national and international organisations, and released in Uganda between 1999 and 2002 — were compared with non-adopters. The results of the study were published in the October 2011 issue of World Development.
"We found that the adoption of [improved] groundnut varieties significantly increased the net value of income by US$130–254 per hectare," said Menale Kassie, one of the authors of the study. "Adoption of groundnut varieties also significantly reduced poverty as measured by headcount index [the proportion of people below the poverty line] by 7–9 per cent."
In a related study, which has been submitted for publication, Kassie and colleagues found that adopting improved maize varieties also significantly improves rural households' food security and decreases the extent of poverty.
Richard Edema, a plant pathologist and senior lecturer in the school of agricultural sciences at Makerere University, Uganda, said: "Studies [such as this one] can serve as feedback for agricultural scientists to assess whether new [crop] varieties are making real impacts on farmers' lives".
Okello David Kalule, head of the Uganda National Groundnut Improvement Programme, said that, although the new groundnut varieties produce superior yields, some farmers are still growing low-yielding varieties. The reasons for this, he said, include poor agricultural extension services and a lack of access to information about the new varieties.
"Local institutions should be strengthened to collectively improve access to seeds, credit, and information to increase both the spread and intensity of adoption," he said.

POVERTY: Neglected tropical diseases: A new handle on old problems

6 Jan, 2012 : Michael Regnier
‘Neglected tropical diseases’ is a new name for old diseases that cause long-term suffering among the world’s poorest people. The Wellcome Trust and others have funded research into these diseases for decades, but the fruits of this research have not always reached the people most in need. Michael Regnier spoke to some of the scientists who coined the new phrase to raise awareness of these diseases, and to Trust-funded researchers whose work is helping to develop better solutions for tackling them.

Neglected tropical diseases - Wellcome News cover artwork

The ‘big three’ infectious diseases in global health are the all too familiar HIV/AIDS, malaria and tuberculosis. Less well known are a host of other infections endemic across the world. Caused by a motley variety of parasites, viruses and bacteria, these diseases are a serious problem in low- and middle-income countries, causing deaths, long-term disability and disadvantage. They are diseases of poverty, mostly affecting the world’s poorest nations and trapping their people in a cycle of economic stagnation, but they do not receive anything like the attention or funding given to work on the big three1.
In the past five years or so, wider attention has begun to fall on these other diseases, thanks largely to a campaign led predominantly by scientists and centred on a new name: “neglected tropical diseases”, or NTDs.
“The phrase was part of a drive to think about these diseases in a fresh light,” says Professor Peter Hotez, President of the Sabin Vaccine Institute in Washington, DC and Editor-in-Chief of the journal PLoS NTDs. “After the launch of the Millennium Development Goals in 2000, a lot of attention fell on HIV, tuberculosis and malaria. Goal 6 called for action on those three ‘and other diseases’.
“It led to a lot going on in HIV, tuberculosis and malaria, but those of us working on the ‘other diseases’ felt we were on the outside looking in. We were driven to think afresh, to ‘rebrand’ these conditions.”
Hotez’s research is on vaccines for human hookworm infection and other parasitic worms. As with many NTDs, they are not lethal in themselves but infections can last for decades, impairing children’s growth, development and physical fitness and causing severe anaemia during pregnancy, which leads to low birth weight and increased infant and maternal mortality.
“The most common neglected tropical diseases have high morbidity and low mortality,” explains Hotez. “They are causes of poverty through their effects on children, pregnant women and workers. From descriptions in ancient texts, we know these diseases have been around for ever. They are the opposite of emerging diseases.”
We are more scared of emerging diseases, Hotez suggests, but NTDs do more harm overall.

Definitions of neglect
‘Neglected tropical diseases’ is not a precisely defined term. Not all NTDs are exclusively tropical, and the nature of ‘neglect’ varies. Sometimes neglect comes from the communities in which these diseases are found: lymphatic filariasis, for example, causes severe disfigurement and massively swollen limbs, which can lead to prejudice and stigma. In other cases, neglect is from richer nations, where diseases such as schistosomiasis and dracunculiasis are unfamiliar and infections such as cholera and leprosy are chapters from history rather than pressing medical problems.
It doesn’t help that the available information about how many people are infected or dying from these diseases is not always reliable. NTDs are more common in regions of extreme poverty or conflict – not situations that lend themselves to effective epidemiological monitoring.
Research into NTDs may have been neglected too. The Wellcome Trust has consistently funded research on tropical diseases and currently spends a significant proportion of its funding on global health research, and the World Health Organization (WHO) established its Special Programme for Research and Training in Tropical Diseases (TDR) in 1975. However, other major health challenges were competing for attention in the latter half of the 20th century – including emerging infections and the rising incidence of cancer and cardiovascular disease. Meanwhile, the pharmaceutical industry cut programmes on parasitic infections, for example, because there wasn’t a profitable market to invest in.
Frustratingly for those scientists who were researching NTDs, effective drugs were already available for a small number of them but were not being widely used. Even when drug companies began donating these drugs or supplying them at very low cost for use in lower-income countries, simple cost-effective programmes to implement mass drug administration often struggled to find sustained funding.

Proof of principle
Professor Alan Fenwick, Director of the Schistosomiasis Control Initiative (SCI) at Imperial College London, worked in Egypt for 15 years. In that time, the prevalence of schistosomiasis there fell from 20 per cent to less than 5 per cent. He knew it was possible to reduce the burden of the disease until it was no longer a public health issue; his problem was in finding the support to apply this knowledge in other countries.
“Many organisations are interested in supporting research; some, like the Wellcome Trust, are mandated to only fund research,” says Fenwick. “But this left schistosomiasis and others in limbo: most of the research had been done. We had the tools which, if implemented properly, could help some 200 million people in sub-Saharan Africa.”
In 2002, he approached the Bill & Melinda Gates Foundation and suggested they buy and distribute praziquantel, an effective schistosomiasis drug treatment, in countries where the disease was endemic.
“They agreed to allow me to test the proof of principle: ‘Will these countries implement control if given access to drugs and funding?’”
Fenwick was awarded $30m to work with African countries to introduce national programmes to control schistosomiasis. The first treatment began in Uganda in 2003 and after one year, the intensity of schistosome infection had fallen by 70 per cent. Disease control is an ongoing challenge, however: “If we stop treating,” he says, “I fear that within five years it will come back again.”
The SCI has supported or is currently working in 12 African countries and is still expanding coverage. More than 100 million people have been treated at least once. Moreover, it treated people for three parasitic worm infections at the same time, effectively tackling four NTDs with one integrated programme.

Drug development for NTDs
Programmes such as the SCI are successful not only because the drugs are donated or provided at low cost, but also because the drugs are safe and effective and can be given orally in a single dose every six or 12 months. The drugs available for many other NTDs are not so practical and there is a desperate need to discover new treatments. Wellcome Trust funding continues to contribute to every step of this process.
Professor Alan Fairlamb, Co-Director of the Wellcome Trust-funded Drug Discovery Unit at the University of Dundee, agrees that only a handful of current NTD drugs are truly fit for purpose: “Many compounds were developed with a different indication in mind, maybe from cancer research or anti-fungal drug discovery programmes. The target product profile for these original indications does not take into account the association with poverty and the rural setting where most NTD drugs are needed.
“One thing frequently missing in the equation from the pharma perspective is low cost of goods,” he adds. “Expensive drugs are good for the odd safari but too costly for the local population. People often can’t afford the treatment, so they don’t complete the course and this drives resistance. The challenge is to develop cheaper and safer drugs.”
The Dundee Unit works on the best potential targets wherever they come from, making concepts viable for further development in animal models. Fairlamb says they are always looking for scientists with a promising target but who don’t have either the know-how or the infrastructure to do drug discovery. “Our vision is to take excellent basic science and turn it into useful medical products,” he says.
Their most successful project to date is based on an enzyme called N-myristoyltransferase (NMT), which was developed as a target at Imperial College London by Professor Deborah Smith, now at the University of York. The enzyme has been found in a number of parasites: the Dundee Unit is working on developing a drug for human African trypanosomiasis (sleeping sickness) while Smith, also with funding from the Wellcome Trust, is leading on developing drugs and vaccines for leishmaniasis. NMT may even be a target for new malaria drugs.
“There’s still a long way to go,” Smith says, but even if the work on NMT does not lead to a viable drug for all these diseases, it will be valuable research. “We’re doing the groundwork for future potential opportunities,” she concludes.

Approaching the problem from all angles
Some NTDs have no effective drugs or vaccines. Dengue virus, for example, causes fluid to leak from blood vessels into surrounding tissues, leading to severe shock in some cases. The only available treatment is to replace the fluid in hospital, which puts a huge burden on health systems during outbreaks.
“Dengue is neglected in the sense that the true scale of the disease burden is poorly understood and certainly underestimated,” says Professor Cameron Simmons, a Wellcome Trust Senior Research Fellow at the University of Oxford, who studies dengue in Vietnam. As well as helping to develop new drugs and vaccines for dengue, he is researching better diagnostic and prognostic tests to help doctors make decisions about dengue, and novel approaches to vector control.
“The important point,” he says, “is that all these approaches can be complementary. We’re not going to eradicate the virus any time soon, so we need a swag of tools to control dengue.”
It’s a point that applies to NTDs as a whole: each presents specific challenges but they all require continuing research across the spectrum from basic to applied, and will need a range of strategies to control, eliminate or even eradicate them.
Grouping these diseases together under a collective name doesn’t necessarily help the research effort but it has succeeded in drawing more attention to the huge problem they continue to present and the need for sustained, coordinated action. Hotez highlights some of the achievements made since 2005, when the first paper to use the term ‘neglected tropical diseases’ was published: they include major initiatives from the US Agency for International Development and the UK Department for International Development; a new Department of Control of Neglected Tropical Diseases at the WHO; and PLoS NTDs, which launched in 2007.
Ultimately, says Fenwick, it will be impossible to achieve any of the Millennium Development Goals without tackling NTDs. “How can you break the poverty cycle?” he demands. “How can you achieve primary education for all if the kids are full of worms? If they have no energy so that even if they go to school they fall asleep?”
It’s a persuasive argument and one that he, Hotez and others will continue to make to anyone who will listen. “I think as scientists we are taught not to be advocates,” says Hotez. “That’s something I’m trying to correct.”
This feature also appears in ‘Wellcome News’ issue 69. A series of complementary posts about neglected tropical diseases and related research funded by the Trust will be published weekly on this blog, starting next week with ‘The campaign trail’: a closer look at the scientists turned advocates who are campaigning to raise awareness of the global burden of NTDs.

1. In December 2011, the fourth G-FINDER report was published, detailing 2010 global investment into research and development in ‘neglected diseases’, including the ‘big three’ and a number of NTDs. Total reported funding for all neglected diseases was US$3.17 billion in 2010, of which US$2.27bn (71.5%) was spent on HIV/AIDS, tuberculosis and malaria.