Tuesday, 30 April 2013

MALARIA: Database at a Glance

Malaria incidence and innovative programs profiled by CHMI
Editor's Note: This edition of our regular database at a glance series excerpted an upcoming brief produced by the T-HOPE Group at the University of Toronto. Arjun Vasan and Rose Reis from the Center for Health Market Innovations also contributed to the post.
Malaria, a 4,000-year old disease that evolved with man, still causes 219 million sicknesses and 660,000 deaths each year. While mortality has decreased by a quarter in the last decade due to increased use of insecticide-treated bed nets and artemisinin-based combination therapies, most people at risk still do not have access to these products.
In Jakarta, a mother watches her child sleep inside a mosquito net.
For malaria to be controlled—and eventually eliminated—prevention, diagnosis, and treatment methods must be made available to all, particularly in Africa, where 90% of malaria deaths occur.
With our colleagues at the University of Toronto, we at CHMI have been looking closely at malaria programs on our digital platform to discover what practices are emerging at the grassroots and global level to eradicate this stubborn disease and save millions of lives. In this post, we are pleased to share an excerpt from a brief on malaria that we will be issuing soon.
In many low- and middle-income countries, the private sector delivers a substantial amount of services, including prevention, diagnosis, and treatment of malaria. According to the All-Party Parliamentary Group on Malaria, an estimated 400 million of the total 550 million treatments provided in 2006 were distributed through the private sector. In addition, according to the Roll Back Malaria Partnership, 40-50% of anti-malarial medications were distributed by the informal private sector. Bednets are also often sold by private vendors.
Among the 63 malaria-focused programs in CHMI’s data set, provider training and social marketing are two common ways to generate demand for appropriate treatments (see graph below).
Click here to view this graph at a larger size.
Provider training helps ensure practitioners and distributors will deliver appropriate care.Information communication technology can help monitor the prevalence of malaria and track the supply of medications to prevent stock-outs. Supply chain enhancements can improve program efficiency and increase the distribution of life-saving supplies.
Among the emerging practices CHMI identified around the world were:
Using vouchers to increase coverage of insecticide-treated nets (ITNs):
  • Several CHMI-profiled programs, such as NetMark and the Tanzania National Voucher Scheme, have used vouchers to help low income families afford ITNs, which are often promoted through social marketing schemes. Vouchers are distributed to a targeted group and these consumers can purchase bed nets from participating retailers at a reduced price.
  • In Tanzania, Hati Punguzo vouchers can be redeemed by pregnant women and mothers of infants at more than 6,600 retailers nationwide.
Scaling up Rapid Diagnostic Tests
  • Rapid Diagnostic Tests are used at the point-of-care to quickly diagnose patients in remote settings where microscopy—the “gold standard” test for malaria—is unavailable or of poor quality. These tests are inexpensive, mobile, and quick, and they can be used by community health workers, and even retail outlets.
  • The m-health platform ChildCount+, which uses SMS to facilitate and coordinate the activities of community workers across ten Sub-Saharan African countries, provides support for home-based Rapid Diagnostic Tests and Artemisinin-based combination therapies (ACTs).
Subsidizing the supply of malaria drugs
  • ACTs are now the first line treatment of choice but can be up to 20 times more expensive than older drugs; subsidies are needed to reach the poor. The Global Fund established theAffordable Medicines Facility-Malaria (AMFm), an innovative financing program to expand access to affordable ACTs through price negotiation and subsidies.
  • The AMFm has been piloted in eight countries (Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, and Uganda), while other CHMI programs, such PSI Sudan, have distributed ACTs at subsidized costs. The final report of an independent evaluation of the AMFm’s pilot phase was made public in October 2012, and an overview of this report can be found here.
Tracking the supply chain and distribution of malaria health products with mobile phones
  • Mobile phones are increasingly being utilized to track inventory levels and, in turn, decrease the likelihood of stock-outs, which leave health workers without the tools to diagnose malaria and patients without immediate access to treatment.
  • SMS for Life tracks the supply chain of ACTs and quinine injectables in Tanzania, using a combination of mobile phones, SMS messages, and electronic mapping technology delivered to all health facilities on a weekly basis.
Protecting employees and communities
  • Many companies invest in malaria prevention and treatment for their employees, families, and communities, especially in rural areas with limited access to health services. The Corporate Alliance on Malaria in Africa encourages member companies to use the ABCD approach, which starts with Awareness and public education, Bite control, Chemoprophylaxis, and early Diagnosis and treatment.
  • Many GBCHealth members including Chevron have led sustained awareness campaigns around malaria. Companies sometimes develop solutions tailored for remote settings likeChevron’s River Boat Clinic. The boat has provided medical serves along the Benin and Escravos rivers in Delta State, Nigeria. The Delta State government deployed staff to the clinic and paid salaries, while Chevron provided logistics, drugs, dressings, and other equipment.
Which of these approaches is demonstrating evidence? We look forward to sharing a brief on innovations in malaria that will delve into these practices and the evidence behind them from both the peer-reviewed and gray literature. Please also contact me if you know of other programs working to improve the quality and affordability of malaria care in the private health sector.
View other blogs in our database at a glance series to learn about the emerging practices our data is uncovering in countries where the private sector delivers the majority of health care.

MALARIA: FDA Hopes Tool Will Help Identify Substandard, Counterfeit Malaria Drugs in the Field

The US Food and Drug Administration’s Counterfeit Detection Device (CD-3) may help clinicians spot fake malaria drugs. Image: FDA
The US Food and Drug Administration’s Counterfeit Detection Device (CD-3) may help clinicians spot fake malaria drugs. Image: FDA
More than half of all drugs used to treat malaria in low- and middle-income countries are substandard or counterfeit, which contributes to preventable deaths and the emergence of drug resistance. But the US Food and Drug Administration (FDA) hopes that a battery-powered device it has used since 2010 may soon help frontline medical workers spot fakes before they reach patients.
Malaria was eliminated from the United States in the 1950s, yet it remains a scourge in many lower-income countries around the world. FDA Commissioner Margaret A. Hamburg, MD, noted at a press briefing held by the agency that each year, millions of individuals are sickened by malaria, and 660 000 die, mostly children. Effective drugs are available to treat malaria infections, but low- and middle-income countries are flooded with products that are counterfeit (20% of the malaria drug supply) or substandard (35% contain suboptimal levels of active ingredients). These fakes can have dire consequences for individual patients and for public health. In addition to preventing individuals from getting effective treatment, substandard drugs also contribute to the emergence of drug-resistant malaria parasites, Hamburg noted.
With the help of an array of public and private partners, the FDA hopes to test whether a tool created by scientists at the FDA’s Forensic Chemistry Center in Cincinnati, Ohio, may help clinicians battle fake drugs. The Counterfeit Detection Device (CD-3) works by shining different wavelengths of light on a product; the light reflects back in a pattern that varies based on the chemical make-up of the product. This pattern can be compared with reference samples of actual drugs, allowing the user to quickly distinguish a potential fake from the bona fide drug.
The FDA has used the CD-3 since 2010 to spot potential fakes among imported drugs, cosmetics, and other products before they are distributed in the United States, as well as in laboratory investigations of suspect products.
The FDA announced Wednesday that it is working with the Skoll Global Threats Fund, President’s Malaria Initiative, US Centers for Disease Control and Prevention, National Institutes of Health, and US Pharmacopeia to test whether the device will be effective in malaria-endemic areas. The testing will take place in Ghana in 2013 and 2014. The agency has also been working with Corning to develop a version of the product that can be manufactured for wider distribution.
Hamburg explained that the testing will help determine how sensitive and reliable this tool is in field conditions. She said the FDA has shown the device can distinguish a counterfeit from a real drug, but they want more information on how well the CD-3 can spot substandard drugs. The tests may also provide public health authorities with insights into the fake drug market.
“We will be learning more about the scope of the counterfeit and substandard drug market,” she said. “We don’t have as much information as we would like about the magnitude of the problem.”

Monday, 29 April 2013

TUBERCULOSIS: North Korea: excellent long article

UNPA, NORTH KOREA—This village in rugged hills 2 hours south of Pyongyang has had it rough. Last summer, a typhoon wiped out most of its corn crop, and a second windstorm ripped stone tiles from roofs. Clinging to a slope facing the settlement, the Unpa tuberculosis (TB) rest home—a tidy gray concrete building with a red roof—took a battering. None of the staff members or 46 patients was harmed. But the hurricane-force gales shattered windows of a ward under construction that will house patients infected with multidrug-resistant (MDR) TB and sent its steel roof sailing down the valley. Surveying the damage, Heidi Linton, executive director of Christian Friends of Korea (CFK), a humanitarian organization based in Black Mountain, North Carolina, jots down a list of materials that CFK intends to purchase for the MDR wing. Occasional booms punctuate the stillness: Distant artillery fi re as North Korea prepares for what it sees as an inevitable military conflict with the South. As war fever reached a frenzied pitch last month, Linton and six other Americans were in the countryside with North Korean scientists and physicians, joining forces against a common enemy: tuberculosis. TB has skyrocketed in the Democratic People’s Republic of Korea (DPRK) in the past 20 years, according to the World Health Organization (WHO). Famines in the mid-1990s ignited the epidemic; chronic malnutrition ever since has added fuel to the fi re. North Korea now has one of the highest TB incidences outside sub-Saharan Africa.

MALARIA: Weekly Update from Malaria Nexus Apri; 28 2013

Latest News
April 25, World Malaria Day 2013!
Posted on 25 April 2013
April 25, World Malaria Day 2013!
A number of events held all over the world underline World Malaria Day 2013.
Elsevier releases a Malaria Research Special for World Malaria Day
Posted on 25 April 2013
Elsevier releases a Malaria Research Special for World Malaria Day
Elsevier issued a press release highlighting some of its latest publications on malaria to underline World Malaria Day.
The changing epidemiology of malaria reviewed in The Lancet
Posted on 24 April 2013
The changing epidemiology of malaria reviewed in The Lancet
The Lancet recently published an important review on the changing epidemiology of malaria.
Feature Articles
Posted on 24 April 2013
The changing epidemiology of malaria elimination: new strategies for new challenges
The Lancet , In Press, Corrected Proof, Available online 15 April 2013
Chris Cotter, Hugh JW Sturrock, Michelle S Hsiang, Jenny Liu, Allison A Phillips, Jimee Hwang, Cara Smith Gueye, Nancy Fullman, Roly D Gosling, Richard GA Feachem
Posted on 24 April 2013
Artemisinin based combination therapy in travel medicine
Travel Medicine and Infectious Disease, Volume 11, Issue 1, January–February 2013, Pages 23-28
Tomas Jelinek
Posted on 24 April 2013
The Cinderella syndrome: why do malaria-infected cells burst at midnight?
Trends in Parasitology, Volume 29, Issue 1, January 2013, Pages 10-16
Nicole Mideo, Sarah E. Reece, Adrian L. Smith, C. Jessica E. Metcalf
Posted on 24 April 2013
Molecular monitoring of antimalarial drug resistance among Plasmodium falciparum field isolates from Odisha, India
Acta Tropica, Volume 126, Issue 1, April 2013, Pages 84-87
Sasmita Kumari Das Sutar, Gunanidhi Dhangadamajhi, Shantanu Kumar Kar, Manoranjan Ranjit

 | www.malarianexus.com.

SciDev Net week April 28 2013

SciDev.NetScience & Development Network 
News, views and information about science, technology and the developing world
Science & Development Network
Articles published on the SciDev.Net website over the last week: 22 - 28 April 2013
How to support online science journalism in Africa
Linda Nordling says a culture of plagiarism undermines the quality of science reporting, whileMarc Mcilhone makes the case for open sharing and novel ways to make science news pay.
Science journalism


Chemical weapons convention fails to address key issues
Chemical weapons convention fails to address key issues 
A conference fails to address the use of chemicals to disable civilians, as indications of chemical weapons' use in Syria emerge. 

Forest conservation could reduce malaria transmission
Forest conservation could reduce malaria transmission 
The biodiversity of tropical forests helps to curb malaria transmission and should be considered in plans to eradicate the disease, say researchers. 
EN | ES 

Men blamed for hindering female Arab scientists
Men blamed for hindering female Arab scientists 
Female researchers in Arab nations are being hampered by a lack of support from research bodies and male scientists, a conference has heard. 

Schistosomiasis control a route to cutting HIV in Africa 
Reducing schistosomiasis infections is a cost-effective way of also cutting HIV transmission in Sub-Saharan Africa, say researchers. 

Nanowire device may help tackle malaria drug resistance 
A diagnostic device no bigger than a smartphone harnesses nanotechnology to detect the specific type of malaria a patient is infected with. 

Mobile and web apps tackle sanitation challenges 
A game and two other mobile apps that help citizens tackle local sanitation problems have won a World Bank-funded technology competition. 

Drug and a syphilis test offer hope of yaws eradication 
A diagnostic test targeting syphilis and an oral antibiotic could be used together to help eradicate yaws disease, a WHO meeting was told. 

WCSJ2013 urged to find new funding model for critical journalism 
A plan is needed to protect critical science journalism as media incomes fall, heard a meeting ahead of the World Conference of Science Journalists. 

Other News

Leading malaria vaccine trial deemed disappointing 

UNESCO commits to support open access in Latin America 

Women are 'key drivers' in climate change adaptation 

More NEWS 


Open access is the future for Africa's science media
Open access is the future for Africa's science media 
Brains Network editor Marc Mcilhone backs open sharing in the second article on how to support online science journalism in Africa. 

Focus on Gender: Give women a say in dryland protection 
Projects to conserve dryland areas must ensure that women have secure access to and control over this land, says Henrietta Miers

A culture of plagiarism is harming Africa's journalists 



Middle East synchrotron seeks peace through cooperation
Middle East synchrotron seeks peace through cooperation 
A research centre in Jordan aims to boost science and foster peace through international collaboration, reportsRehab Abd Almohsen

Jordan-based research project has funding shortfall
An initiative designed to boost science and collaboration in the Middle East still needs to find US$35 million, finds Rehab Abd Almohsen.
Canadian Light Source synchrotron by Flickr/Canadian Light Source synchrotron

MALARIA: Parasite 'resistant to artemisinin'

Plasmodium falciparumThe malaria-causing parasites in Cambodia were genetically different from other strains

Related Stories

New drug-resistant strains of the parasite that causes malaria have been identified by scientists.
Researchers found parasites in western Cambodia that are genetically different from other strains around the world.
These organisms are able to withstand treatment by artemisinin - a frontline drug in the fight against malaria.
Reports of drug resistance in the area first emerged in 2008. The problem has since spread to other parts of South East Asia.
The study is published in the journal Nature Genetics.
The lead author, Dr Olivo Miotto, of the University of Oxford and Mahidol University in Thailand, said: "All the most effective drugs that we have had in the last few decades have been one by one rendered useless by the remarkable ability of this parasite to mutate and develop resistance.
"Artemisinin right now works very well. It is the best weapon we have against the disease, and we need to keep it."
Genetic fingerprint
Western Cambodia has been described by scientists as a hotspot for malaria resistance.

Start Quote

It could be a tool for detecting in real time the emergence of drug resistance”
Dr Olivo MiottoUniversity of Oxford
They do not understand why, but since the 1950s parasites there have developed a resistance to a succession of malaria drugs. The problem has spread to other parts of Asia and Africa.
Now scientists are worried the same thing will happen with artemisinin. This drug is used widely around the world against the mosquito-borne disease and can treat an infection in a few days when it is used in combination with other drugs.
To investigate, scientists sequenced the genomes of 800 malaria-causing parasites (Plasmodium falciparum) collected from around the world.
"When we compared the DNA of the parasites in Cambodia, they seem to have formed some new populations that we have not really seen elsewhere," Dr Miotto said.
The international team found three distinct groups of drug-resistant parasites present in the area.
The researchers said they did not yet understand what genetic mutations had occurred that enabled the parasites to withstand artemisinin treatment.
But they said that understanding their genetic fingerprint would help them to quickly spot and track these strains if they spread further.
Dr Miotto said: "It could be a tool for detecting in real time the emergence of drug resistance."
The World Health Organization has stated that a major objective is to stop the spread of malaria parasites resistant to drugs.
According to its latest estimates, there were about 219 million cases of malaria in 2010 and 660,000 deaths.
Africa is the most affected continent: about 90% of all malaria deaths occur there.

Sunday, 28 April 2013

ODI April 25 2013

ODI - Shaping Policy for Development

Overseas Development Institute (ODI) newsletter 
25 April 2013
 Disaster risk management: preparing for post-2015  
 This report examines options for including disaster risk management indicators in the post-2015 framework, and argues that such targets will be essential in helping to prepare for shocks. 
Politics can help explain why services work better in some countries than others, but how should this inform policy and practice? This report identifies where change needs to happen.
Collage of faces, Twitter
What have we learned from Afghanistan – the longest running experiment in stabilisation? This HPG Working Paper examines civil-military dialogue and stablisation over the last decade.
Shocks, crises and capital in sub-Saharan Africa
Following international crises and financial instability, this research argues that we are now seeing increased private-sector investment in sub-Saharan Africa.
Cash transfers: voices from the village
This multi-country research stresses thatunderstanding beneficiary and community perceptions of cash transfers is essential for designing effective social protection instruments.

Food prices: peering back, looking forward
Five years on from the food price hike in 2007-08, this paper reviews what has been learned, what can be expected in the future, and what the policy implications may be.
At cross-purposes: subsidies and climate finance
Fossil fuel subsidies currently dwarf climate finance. This paper highlights opportunities to unlock climate-compatible investment by linking private climate finance and subsidies.