MALARIA: Emergence of artemisinin-resistant malaria on the western border of Thailand:

Aung Pyae Phyo MD a b, Standwell Nkhoma PhD c, Kasia Stepniewska PhD a d e, Elizabeth A Ashley MD a b d, Shalini Nair MSc c, Rose McGready MD a b d, Carit ler Moo b, Salma Al-Saai MSc c, Arjen M Dondorp MD a d, Khin Maung Lwin MD b, Pratap Singhasivanon MD a, Nicholas PJ Day FRCP a d, Nicholas J White FRS a d, Tim JC Anderson PhD c, Prof François Nosten MD a b d

Summary

Background

Artemisinin-resistant falciparum malaria has arisen in western Cambodia. A concerted international effort is underway to contain artemisinin-resistant Plasmodium falciparum, but containment strategies are dependent on whether resistance has emerged elsewhere. We aimed to establish whether artemisinin resistance has spread or emerged on the Thailand—Myanmar (Burma) border.

Methods

In malaria clinics located along the northwestern border of Thailand, we measured six hourly parasite counts in patients with uncomplicated hyperparasitaemic falciparum malaria (≥4% infected red blood cells) who had been given various oral artesunate-containing regimens since 2001. Parasite clearance half-lives were estimated and parasites were genotyped for 93 single nucleotide polymorphisms.

Findings

3202 patients were studied between 2001 and 2010. Parasite clearance half-lives lengthened from a geometric mean of 2·6 h (95% CI 2·5—2·7) in 2001, to 3·7 h (3·6—3·8) in 2010, compared with a mean of 5·5 h (5·2—5·9) in 119 patients in western Cambodia measured between 2007 and 2010. The proportion of slow-clearing infections (half-life ≥6·2 h) increased from 0·6% in 2001, to 20% in 2010, compared with 42% in western Cambodia between 2007 and 2010. Of 1583 infections genotyped, 148 multilocus parasite genotypes were identified, each of which infected between two and 13 patients. The proportion of variation in parasite clearance attributable to parasite genetics increased from 30% between 2001 and 2004, to 66% between 2007 and 2010.

Interpretation

Genetically determined artemisinin resistance in P falciparum emerged along the Thailand—Myanmar border at least 8 years ago and has since increased substantially. At this rate of increase, resistance will reach rates reported in western Cambodia in 2—6 years.

Funding

The Wellcome Trust and National Institutes of Health.

MALNUTRITION: HORN OF AFRICA: Greater food insecurity forecast

NAIROBI, 5 April 2012 (IRIN)

 Photo: Wendy Stone/IRIN
Poor rains could further undermine food security

 Food insecurity in the eastern Horn of Africa is expected to worsen as a result of less rain than previously forecast falling in the key March-to-May season.
The US Agency for International Development’s Famine and Early Warning Systems Network (FEWS NET) warned that rainfall in this period would be 60-85 percent of the long-term average and that there was a 30 percent chance of the lower figure materializing.
“An expansion in the size of the food insecure population and an increase in the severity of food insecurity is likely,” FEWS NET said in an 3 April report.
The report warned of “significant impacts on crop production, pasture regeneration, and the replenishment of water resources” in a region that in 2011 suffered one of its worst drought-related food crises in decades.
March to May is the major rainfall season for pastoral and agricultural areas of northern Kenya and Ethiopia and parts of Somalia, and accounts for 50-60 percent of annual rainfall in the region.
In an effort to prevent future weather shocks translating into new humanitarian crises, the Intergovernmental Authority on Development (IGAD), a regional body, and international development partners, have launched an initiative to strengthen resilience in the region.
“We have mobilized funds [US$340 million] to support resilience programmes, and while the problems cannot be solved overnight, it is important to appreciate the need for long-term investments in such areas as education, water, and the need to identify problems early and deal with them in good time. People need to be helped to recover quickly from disasters,” Kristalina Georgieva, European commissioner for international cooperation, humanitarian aid and crisis response, told IRIN.
Political commitment from IGAD member countries, apart from development partners’ support, will play a crucial role in creating sustainable solutions to help people cope with the effects of the region’s recurrent droughts, according to Sileshi Getahun, Ethiopia’s minister of agriculture, in whose country some 3.2 million people are in need of humanitarian assistance.
Time to “stand up and be counted”
“We [regional governments] can’t talk about the same thing [drought] over and over and yet do nothing to help people. This is the time for regional governments to stand up and be counted,” Sileshi said.
Speaking to IRIN, the UK’s development minister, Stephen O’Brien, said: “Resilience programme support is an important part of humanitarian support and response and provides a more sustainable way to deal with disasters.”
Among things to be prioritized will be the provision of drought-resistant seeds, water, education, investing in weather forecasting technology, and scaling up nutrition programmes.
Solving the various conflicts in the Horn of Africa, which have seen thousands of people displaced and many more killed, will be crucial in improving the ability of people in the region to be resilient in the face of disasters, Mahboub Maalim, executive secretary of IGAD, told IRIN.
“In the face of disasters like drought and famine, people’s livelihoods are disrupted and efforts towards halting the various conflicts we see [in the Horn of Africa] cannot be ignored, because people can’t cope when conflicts persist,” he said.
http://www.irinnews.org/Report/95247/HORN-OF-AFRICA-Greater-food-insecurity-forecast

POVERTY: EGYPT: Fuel shortage threatens bread supplies

CAIRO, 2 April 2012 (IRIN)

 Photo: Amr Emam/IRIN
Customers buy subsidized bread at a Cairo bakery

It has been three months since a fuel shortage hit Egypt, and people’s patience is wearing thin amid fears the crisis could disrupt the production of subsidized bread.
“I move from one petrol station to another every day to find the fuel necessary for the work of the bakery,” Omar Muselhi, a bakery owner from Giza, told IRIN. “I cannot do this for long. If things get worse, I will close down.”
Most of Egypt’s subsidized bakeries need diesel to operate, and some have had to close, for example in the Nile Delta governorate of Monofiya (Arabic).
Outside Muselhi’s bakery, men, women and children form two long lines, and wait their turn.
“I buy 20 loaves of this bread for one pound, whereas the same number sells for four pounds at unsubsidized bakeries,” said Ayman Farahat, standing in line outside the bakery. “This shows how important these bakeries are for people like me.”
Observers say there is a 35 percent shortfall in fuel supplies. The government blames hoarding for the crisis. Thousands of cars queue outside petrol stations from early morning, while long queues form outside gas cylinder centres.
“We are doing our best to solve the problem, but what is happening is abnormal,” Petroleum Minister Abdallah Ghorab said on 24 March. “Some people take the subsidized fuel and sell it on the black market.”
The Petroleum Ministry has increased daily diesel supplies from 36,000 tons to 38,000 tons; petrol supplies from 16,000 to 18,000 tons; and gas cylinders from one million to 1.3 million.
But despite the move, there are numerous reports (Arabic) of fighting over fuel, reflecting citizens’ exasperation, and the need for further government intervention

Ambulance services are also at risk.
“The drivers go to petrol stations from early morning,” Naeem Rizk, the operations manager at Cairo’s main ambulance point, told IRIN. “Sometimes they spend the whole day waiting, but when their turn comes, they are told the fuel is over.”
When a policeman recently called Rizk to ask for help after he was wounded in a fight against armed men on the outskirts of Cairo, Rizk could not find an ambulance with enough fuel to take the policeman to hospital. The policeman’s colleagues had to call the Interior Ministry to borrow some.
Mohamed Abdullah, a 30-year-old ambulance driver, says his job has become even more stressful. “There are always long queues at petrol stations…This prevents me from reaching patients in time. The patients’ relatives always yell at me.”

Rethinking subsidies
Some economists believe the current crisis may force the government to rethink its fuel subsidies’ policy. Egypt spent the equivalent of US$83.3 billion subsidizing fuel over the past five years, according to the Petroleum Ministry.
“Around 60 percent of these subsidies go to people who do not deserve them,” said Rashad Abdo, a leading economist from Cairo University. “This makes it necessary for the government to rethink these subsidies.”
The government is currently reconsidering its support to major industrial institutions, which account for almost 70 percent of fuel subventions.
“If we can reduce petroleum subsidies by 10 percent, we can channel this money for the building of houses, hospitals, or schools,” said Petroleum Minister Ghorab. “We need to deliver subsidies to those who deserve them,” he was quoted as saying by al Masry Al Youm newspaper (Arabic) on 11 March.
Another government plan envisages the issuing of vouchers to poorer citizens to enable them to buy cooking gas for the equivalent of 83 US cents instead of US$5 for everyone else.
http://www.irinnews.org/Report/95222/EGYPT-Fuel-shortage-threatens-bread-supplies