MALNUTRITION: Community mobilizers help to fight childhood malnutrition in Somalia

By Mike Pflanz : Somalia/2010/Pflanz

 © UNICEF Somalia/2010/Pflanz
Halima Awali, a UNICEF-trained social worker, visits a family in Hargeisa, Somalia during regular door-to-door visits in the community to monitor children’s health.

HARGEISA, Somalia, 22 December 2010 – Halima Awali, 60, shushes the crowd of boisterous children gathered around her and proclaims, “I was there to bring almost all of these babies into the world.” Squinting into the fierce noon Somaliland sun, the smiling grandmother adds, “Now I am here to make sure all of them stay here.”
For most of her adult life Ms. Awali has been a village midwife, helping the community’s poorest residents through childbirth in places too remote for them to access professional obstetric care.

Door-to-door visits
Ms. Awali is one of an army of UNICEF-trained community mobilizers carrying out daily door-to-door visits and advising mothers how to keep their families healthy.
The community mobilizers’ programme aims to ensure that children who are identified as malnourished are treated before they need to go to hospital. It is supported by UNICEF, with funding from the European Commission humanitarian aid department, the UK Department for International Development, the Governments of Italy, Spain and Denmark, and the Italian and French National Committees for UNICEF – as well as the Somalia Common Humanitarian Fund.


 © UNICEF Somalia/2010/Pflanz : Khadara Ahmed Nur holds her baby girl, Amran Yusuf, outside her rag-and-thatch home in Hargeisa, Somalia.

There is widespread lack of knowledge about the benefits of breastfeeding, better diets, hygienic handling of food and generally making a child’s environment as sanitary as possible, according to Ms. Awali’s colleague, Fatuma Gayid.
“These things were not so much of a problem for our mothers when we were children,” says Ms. Gayid, 52, who was a traditional birth attendant for many years.

Breastfeeding essential
As they conduct their tours through their neighbourhoods, the community mobilizers also give mothers advice on how to avoid health risks to their children. Chief among those suggestions is for them to breastfeed their babies from birth to six months.
“It’s a social problem,” explains Kaltun Hussein, National Health Officer for the Somali Red Crescent Society, which works with UNICEF across Somaliland. “A problem of lack of education, a problem of women thinking that the bottle is civilized and the breast is barbaric. It means babies are exposed to germs from far too young an age.”

© UNICEF Somalia/ 2010/ Pflanz : Halima Awali, a UNICEF- trained social worker, measures three-year-old Hodan Mohamed’s mid upper arm circumference during door-to-door visits in Hargeisa, to check on the health of the neighbourhood’s children.

For Khadara Ahmed Nur, the recommendation to breastfeed her first child came too late.
“He died when he was six months old,” she says during a visit by Ms. Gayid to check on her two other children.

Mobilizers provide support
As Ms. Awali and Ms. Gayid continue their rounds one recent afternoon, they are greeted by dozens of mothers who, before, had nowhere to turn for free advice on how to keep their children well.
“At first, when she came here offering help, I was not friendly. I thought that I needed no help,” says Tagiallah Mohammed, a mother with 10 children living in Sheikh Nur, on the outskirts of Hargeisa. As she speaks, she holds her three-year-old daughter Hodan while Ms. Awali expertly measured the circumference of her upper arm – a quick way of checking any child’s state of malnutrition. On this occasion, all is well.
“Now we are close friends,” Ms. Mohammed adds. “Three times, Hodan has fallen sick, and these ladies have stopped it from becoming much worse. Without them, maybe she would not be with me still today.”
http://www.unicef.org/infobycountry/somalia_57294.html

MALNUTRITION: India: Madhya Pradesh tops child mortality, malnutrition rates

2010-12-24

Bhopal, Dec 24 (IANS) Madhya Pradesh tops the child mortality and malnutrition rates among children in the country, a central health ministry report has said.
The latest report of the National Rural Health Mission (NRHM) says that Madhya Pradesh has also fared poor in the mother mortality rate, remaining behind three states.
According to the NRHM, which works under the central ministry of health and family welfare, malnutrition among children is most prevalent in Madhya Pradesh. Here 60 out of 100 children suffer from malnutrition while the national average is a mere 42.
At the other end of the spectrum are Sikkim and Mizoram witb a mere 19 percent. While they remain at the bottom of the chart, Kerala and Manipur at 22 percent jointly hold the second position from the bottom.
The 2010 report also says that child mortality rate in Madhya Pradesh is 70 out of 1,000 children born while the national average is 53. Kerala (12) has the most healthy record in this area. Tamil Nadu (31) and Maharastra (33) are second and third respectively from the bottom.
Again, Madhya Pradesh is only behind Bihar, Utter Pradesh and Rajisthan in mother mortality, the NRHM report says. While 100,000 children were born, 335 mothers lost their lives in the state. The national average is 254.
However, S.R. Mohanty, the state health department secretary, feels that Madhya Pradesh is doing fine. 'The state has tried hard to reduce the mother and child mortality rates. Earlier, 73 percent of women used to give birth at home. Now its only 19 percent,' he says.
Recently, the Asian Human Rights Commission also voiced concern over increasing cases of malnutrition in the state.
http://www.sify.com/news/madhya-pradesh-tops-child-mortality-malnutrition-rates-news-health-kmyqEkdbedi.html

BIOTERRORISM: Judge shares bench secrets

December 29, 2010 :  RaeLynn Ricarte

With only days left on the bench, Wasco County Circuit Judge John Kelly reflected back on the 25 years spent overseeing trials that ranged from murder to custody disputes. He remembers the 1984 bioterrorism attack on The Dalles by followers of Bhagwan Shree Rajneesh, later known as Osho, an Indian mystic, as the most interesting time of his years in the elected office. In 1981, the cult set up headquarters at the Big Muddy Ranch in south Wasco County, which was renamed Rajneeshpuram and inhabited by about 7,000 people. Acrimony quickly developed between Rajneeshees and local authorities over the use of agricultural land for urban purposes. After taking over the government of Antelope, a town with about 50 residents, by sheer voting numbers, some Rajneesh officials decided that the best way to change the land use rules in their favor was to gain control of two county commission seats in an upcoming election.

To incapacitate local voters, they sprayed salmonella into salad bars at 10 restaurants in The Dalles and sickened 710 individuals, with 45 of these patients hospitalized. No one died during the attacks and two leading Rajneeshpuram officials ended up serving time in prison for the crimes
“That was a hugely fascinating time in our history,” said Kelly, a native of The Dalles.
He had been in office only two months before being faced with a lawsuit to seize the assets of the Rajneesh to pay for the judgments against them. He was spared ruling on the issue when the Oregon Attorney General intervened and determined that the assets could not be transferred. The Bhagwan was later found guilty of immigration violations and deported.
http://www.thedalleschronicle.com/news/2010/12/12-29-10-01.shtml

BIOTERRORISM: Keep a close eye on synthetic biology

By the Monitor's Editorial Board / December 28, 2010
A presidential commission lays out a reasonable path forward in exploring the potential of synthetic biology, a possible boon to energy, environmental cleanup, and medicine. But its report should also spark an ongoing debate.
The emerging field of synthetic biology epitomizes the promise and perils of our biotechnological age.
New organisms that have never existed in nature, but instead come from government or commercial laboratories, could produce wonders: inexpensive and abundant biofuels, substances that render toxic wastes harmless, or new drugs.
But they bear the potential for great mischief, too, if thoughtful and sufficient precautions are not firmly in place.
A US presidential commission looking into synthetic biology issued 18 recommendations for action on Dec. 16. The panel’s work offers an important first step in understanding the ethical and environmental questions being raised. But the recommendations should be seen as just that – a first step – and not a final blueprint.
The 188-page report from the Presidential Commission for the Study of Bioethical Issues suggests that the White House itself oversee research into synthetic biology, though it stops short of calling for a special “czar.” No new laws or regulations are needed at this time, it says, nor is a moratorium on research or deployment of new organisms.
The report does call for making public all US government-funded projects involving synthetic biology within the next 18 months. It also recommends mandatory ethical training for those working in the field. And it urges the creation of an independent fact-checking website that would provide the public with accurate information, and debunk wild rumors about the emerging field.
It says any synthetic organisms should have built-in “suicide genes” or other fail-safe features that would prevent them from spreading in the environment on their own.
The commission began its work in May at the behest of President Obama, after bioentrepreneur J. Craig Venter and colleagues published a paper saying that they had created a “synthetic organism.” Venter and his group transplanted a complete, different genome into an existing bacterium, which replaced its genome and transformed its identity.
The Venter team did not “create life,” since an existing living organism was used. Such a feat is not likely in the immediate future, the commission says.
Bioterrorism remains a major concern. In theory, synthetic biology could be used to create new air- or water-borne pathogens, for example.
Nearly three score environmental and other public interest groups from 22 countries have sent a letter to the US officials calling the report “deeply flawed” and urging a moratorium on the release and commercial use of synthetic organisms until the risks are better known and new regulations can be formulated.
The letter urges use of the “precautionary principle,” a term which, it says, “is recognized by international treaties.” Instead the commission recommends what it calls “prudent vigilance,” which the letter says is an unclear concept without recognized legal standing or precedence.
By placing too much reliance on industry self-regulation, the commission’s report “means no real regulation or oversight of synthetic biology,” the letter concludes.
Many biotech researchers, including Venter, have welcomed the report as representing a reasonable path forward, as has the Biotechnology Industry Organization.
Government must always weigh the benefits of rapid scientific innovation against potential harms. The commission’s report seems to adequately embrace both these roles – for the present. But it should not end the debate, but rather stir more dialogue among citizens, scientists, and government officials.
The 1993 film “Jurassic Park” offered moviegoers a prescient warning on the dangers of underestimating what new forms of life forms can do. “Life breaks free,” cautions one character, “expands to new territory, and crashes through barriers – painfully – maybe even dangerously.”
Such unfortunate results need to be confined to science fiction, not played out in real life
http://www.csmonitor.com/Commentary/the-monitors-view/2010/1228/Keep-a-close-eye-on-synthetic-biology

BIOTERRORISM: We’re Not Ready

If a major disease incident or bioterrorism attack were to occur today, the United States would not be read for it. That’s according to a new report supported by a grant from the Robert Wood Johnson Foundation.
In fact, the report says “there’s an emergency for emergency health preparedness in the United States.” It calls attention to significant local, state and federal budget cuts and the impact they have had on public health departments’ ability to maintain staff capabilities, and their ability to respond to crises.

Key findings include:
* 21 states were not able to rapidly identify disease-causing E.coli O157:H7 and submit the lab results in 90 percent of cases within four days during 2007-2008.
* 33 states and D.C. cut funding for public health from Fiscal Year 2008-2009 to FY 2009-2010.
* Seven states can not currently share data electronically with health care providers.
* 10 states do not have an electronic syndromic surveillance system that can report and exchange information.
* Six states reported that pre-identified staff were not able to acknowledge notification of emergency exercises or incidents within the target time of 60 minutes at least twice during 2007-2008.
* Six states did not activate their emergency operations center a minimum of two times in 2007-2008.
* Two states did not develop at least two After-Action Report/Improvement Plans (AAR/IPs) after exercises or real incidents in 2007-2008.
http://www.cattlenetwork.com/Report--We-re-Not-Ready-For-Bioterrorism/2010-12-28/Article.aspx?oid=1294626&fid=

POVERTY: Dirty Deals on the "Dark Continent" Perpetuate Poverty

Michael Tennant : 23 December 2010

Why has Africa, a continent rich in human and natural resources, remained mired in poverty while the rest of the world has generally become more prosperous? As a December 21 New York Times report indicates, one of the biggest reasons is the lack of property rights. Poor Africans who have worked tracts of land for generations “are discovering that African governments typically own their land and have been leasing it, often at bargain prices, to private investors and foreign governments for decades to come,” according to the newspaper:

These arrangements are not, of course, for the benefit of the displaced villagers but for the enrichment of their governments and the leaseholders. The governments collect the rent — although the government of Mali, which has leased 250,000 acres to Libya, merely required Col. Muammar el-Qaddafi’s government to develop the land in exchange for a 50-year lease — and the leaseholders reap the rewards of developing the land. Abou Sow, a Malian official, “acknowledged that outside investors like the Libyans … are expected to ship their rice, beef and other agricultural products home,” writes the Times. Similarly, Mamadou Goita, director of a nonprofit research organization in Mali, told the paper, “The Libyans want to produce rice for Libyans, not for Malians.”
Food is, in fact, the biggest driver of the land deals. The 2008 food crisis led to an enormous increase in such agreements, from fewer than 10 million acres per year prior to 2008 to over 110 million acres in just the first 11 months of 2009, according to a World Bank study. “More than 70 percent of those deals were for land in Africa,” says the Times, “with Sudan, Mozambique and Ethiopia among those nations transferring millions of acres to investors.”
In addition to the vast tracts of land being leased in Mali — at least 600,000 acres, according to Sow, with others claiming the leases cover over 1.5 million acres — the paper describes other dubious deals what was once known as the Dark Continent:
The breathtaking scope of some deals galvanizes opponents. In Madagascar, a deal that would have handed over almost half the country’s arable land to a South Korean conglomerate helped crystallize opposition to an already unpopular president and contributed to his overthrow in 2009.
People have been pushed off land in countries like Ethiopia, Uganda, the Democratic Republic of Congo, Liberia and Zambia. It is not even uncommon for investors to arrive on land that was supposedly empty [and find people living there]. In Mozambique, one investment company discovered an entire village with its own post office on what had been described as vacant land, said Olivier De Schutter, the United Nations food rapporteur.
In the developed world some people, believing too much land has been developed, are fighting to prevent further development. Why, then, does Africa face the opposite problem? Why has the land not been developed?
The answer lies largely in the socialist, if not communist, nature of most African governments. In Mali, for example, “about three million acres along the Niger River and its inland delta are controlled by a state-run trust called the Office du Niger,” the Times reports. Government ownership of land is a huge impediment to its productive development, which explains why, according to the newspaper, “in nearly 80 years, only 200,000 acres of the land have been irrigated.”
African governments’ attempts to develop the land by means of leases have not exactly been pictures of success, observes the Gray Lady:
But many investments appear to be pure speculation that leaves land fallow, the [World Bank] report found. Farmers have been displaced without compensation, land has been leased well below value, those evicted end up encroaching on parkland and the new ventures have created far fewer jobs than promised, it said.
This should not surprise anyone possessing even a passing familiarity with such public-private partnerships. The development of the transcontinental railroad in the United States is a classic example. The famous government-funded railroad that met at Promontory Point, Utah — and then had to be rebuilt after the photo op was over — was a model of waste, fraud, and corruption, while James J. Hill’s privately funded Great Northern Railroad was enormously successful — so successful, in fact, that it was the only transcontinental railroad that never went bankrupt. Public-public partnerships (i.e., those where one government leases land from another) are likely to be even more disastrous.
Farmers in Mali have not stood idly by while their land is being stolen from them. The Times writes: “In a rally last month, hundreds of farmers demanded that the government halt such deals until they get a voice. Several said that they had been beaten and jailed by soldiers, but that they were ready to die to keep their land.”
What was the government’s response to the farmers’ complaints? Kassoum Denon, the regional head for the Office du Niger, told the paper, “We are responsible for developing Mali. If the civil society does not agree with the way we are doing it, they can go jump in a lake.” Give Denon credit for straight talk; American politicians would couch their similar attitudes in soothing phraseology. But the problem is precisely that the government is in charge of development and that it does not respect the opinions, let alone the property rights, of its subjects. As long as this is the case, Mali — and other African nations in like circumstances — can never expect to prosper.
The U.S. government, which has nearly as much contempt for its citizens’ property rights (witness the Supreme Court’s Kelo decision), is, oddly enough, actually doing something to protect Malians’ property via a $224 million project that the Times says “will help about 800 Malian farmers each acquire title to 12 acres of newly cleared land, protecting them against being kicked off.” Yes, foreign aid is unconstitutional and usually counterproductive, but this program at least has the potential to achieve some good, though critics, the paper explains, “have said villagers will still be displaced.” Jon C. Anderson, the project director, told the Times, “We want a revolutionized relationship between the farmer and the state, one where the farmer is more in charge.” Let’s recall this guy from Mali to D.C. We could use that kind of a relationship between the citizen and the state here.
The World Bank report points to other, more successful development approaches than those being taken in Africa:
Along the Pacific coast of Peru, the government auctioned off public land with relatively low yields through a transparent process, which required investors to pay a hefty deposit and spell out how many jobs they would create and how to protect the interests of existing landholders. In Mexico, registration of land rights helped communities bargain with investors and improve governance and accountability in rural areas. In Argentina and Brazil, some big producers often lease land through competition, pay landowners for the lease, but earn enough to make a profit by improving yields.
In other words, says the report, “respecting existing land rights is key to legitimate and economically viable projects.” Or, as columnist Bill Walker put it, “There is no human progress without property.”
Until African governments abandon their collectivist ways, their people have little hope of escaping poverty.
http://www.thenewamerican.com/index.php?option=com_content&view=article&id=5622:dirty-deals-on-the-dark-continent&catid=18:africa&Itemid=27

POVERTY: The Poverty of 'Rich' India

JMD, London : Dec 26, 2010

'For to those who have, more will be given, and they will have an abundance' (Mat 13:12). India is one of the developing and emerging global economic powers of the world. Everyone eyes India as it rightly projects to West as an economy generating power. Most companies tend to or at least aspire to base their business outsourcing firms in India.
There are loads of call-centres and BPO's spread across the country. And of course, these firms do raise job opportunities. As I walk the streets of London I feel proud to be an Indian because everyone thinks Indians have money. Newspapers report about the latest economic figures as improving at faster level as opposed to British Economy. Is this true? Are we as rich as 'India' or only some of us are rich in India? Does the world know that at least 38% of the population lives below the poverty line? Does the media and business world show the slums in Mumbai or just the multimillion house of Mukesh Ambani?
It is all irony for me when I tune into news channels. I am sure there are so many issues that India as a nation should be responsible for when showing the world that we are emerging economy. Look at our neighbour China, Do we really know the economic status of China in exact figures? Every tiny or large material I touch in the market is Chinese made or assembled in China. Why does not China showcase its economic power?
Let us do some in-depth enquiry into the economic well-being of India. I am proud to be a part of an emerging global economic power, but my question is, do we really need to showcase it when we have so many other issues being swept under the carpet? Our GDP is pretty consistent and there is significant growth at $1,235 trillion (nominal) for 2009, and GDP per capita income is $1,032. Our GDP growth rate as of 2010 is 8.8%. GDP per capita income is necessary to measure the wealth of the people in a country. Now this is measured, as you may know, by averaging the GDP of the country.
I am apprehensive about the whole business of averaging. How can someone average the total wealth of a whole country where there is a giganitc gap between the rich and the poor and proclaim that it is the wealth or income of the People? Does it give us genuine figures when there is such a huge gap between the poor chaiwala and the rich Ambanis?
Now the misery of the low income earners is doubled since there is a significant growth in the inflation rate. In September 2010, inflation rate stood at 8.62%. Does inflation add to misery of the poor? Price of rice (staple food for most Indians) going up by even 5% will result in foregoing a meal among the poor. I am sure people around the world can figure out these figures, I am no mathematician. Therefore, digital figures that appear in the international business news cast a shadow on the poor and the marginalized resulting in projecting India as an emerging global power. This might curb our access to the International aids and funds that help developmental projects.
A month ago Guardian (British newspaper) had a whole page dedicated to showcase Mukesh Ambani's expensive house in Mumbai. Some patted on my back saying 'well done Indians.' It was rated the most expensive house in the world. I was thrilled to read that India has the 4th richest man in the planet but I am also fully aware that India has the poorest person in the world too. I used to work in the slums in Ramwadi in Pune where people struggled to make their ends meet. They lived in absolutely miserable conditions, along the sewage canal. The stench and mosquitoes brought deadly diseases like malaria, dengue, cholera and so on. Their children would succumb to sickness because of malnutritions.
On the other hand, there were huge multimillion buildings like Gold Adlabs, McDonalds, ect right next to the slum. How can one stomach this? I don't think I need to blabber on after giving a short but clear glance at the reality of India.
Therefore, are Indians really rich? Does the world read India in its real form or a glamorous haven bubbling with wealth? I would emphatically say that a few Indians are rich but a majority of them are poor and many of them live below the poverty line. When Obama made trade deals with India everyone was fascinated with the idea. How does the new trade deal of America help the poor people in the slums and remote villages? For instance, the deal includes jet aircraft - do we think an ordinary person can afford flying in India?
'Grass is greener on the other side of the fence' is what many of us seem to feel. This can stray us away and stunt the growth of our economy. Gigantic international firms might replace our traditional domestic industries resulting in further poverty. Let me leave it at that allowing you to ponder over it.
http://www.daijiworld.com/chan/exclusive_arch.asp?ex_id=1485

POVERTY: In poverty-struck Yemen, al-Qaida a low priority

Dec 22, 2010 : SANAA, Yemen (AP)
A doctor would have recognized the signs of chronic malnutrition immediately in the 7-month-old girl — the swollen stomach, the constant cough. Her mother, though, had only traditional healers to turn to in her Yemeni mountain village, and they told her to stop breastfeeding.
Her milk had spoiled, they said. Their solution: stuff the baby's nose with ghee.
When that didn't work, the young mother, Sayeda al-Wadei, made the arduous 60-mile journey through the mountains to the closest hospital with facilities to treat her daughter, in the capital Sanaa.
More than 50 percent of Yemen's children are malnourished, rivaling war zones like Sudan's Darfur and parts of sub-Saharan Africa. That's just one of many worrying statistics in Yemen.
Nearly half the population lives below the poverty line of $2 a day and doesn't have access to proper sanitation. Less than a tenth of the roads are paved. Water is running out. Tens of thousands have been displaced from their homes by conflict, flooding into cities. The government is riddled with corruption, has little control outside the capital, and its main source of income — oil — could run dry in a decade.
As a result, al-Qaida is far down on a long list of worries for most Yemenis, even as the United States presses the government to step up its fight against the terror network's affiliate here.
Donor nations are meeting in February in Riyadh, Saudi Arabia to gather millions of dollars for development in Yemen. Aid groups, economists and officials are scurrying to develop poverty reduction and economic restructuring plans for this nation of 23 million.
The United States has already dedicated $150 million in development money, alongside its counterterrorism aid to fight al-Qaida, which is to grow to from $150 million to $250 million over the next year. Other donor countries have given millions more, acknowledging that the terror network cannot be uprooted unless Yemen is pulled out of poverty.
"The neighboring countries and Europeans and U.S. have a lot at stake, not only in Yemen, but in the Middle East. I don't think anyone wants to see Yemen failing," said Benson Ateng, the World Bank's Yemen country manager.
Some aid workers fear that the government, which clings to power through patronage, will direct aid to allied tribes while leaving others out in the cold, fueling resentment. A focus by donors on steering aid to areas with a known al-Qaida presence, not necessarily the poorest zones, may also backfire.
"Donors are focusing on development as a tool to address security issues, and not as an end in itself," said Ashley Clements, Oxfam representative in Sanaa. "There is a risk that the tendency will increase over the years. Focusing on one issue alone will be to the detriment of the well-being of Yemen's people."
Malnutrition typifies how overlapping problems lead to crisis. Much of Yemen's agriculture — and 30 percent of its water — has turned to cultivating qat, the mildly stimulating leaf that Yemenis addictively chew, leaving the country a net food importer with little cash to pay for it. At the same time, health infrastructure and education is lacking, the rate of breastfeeding for children under six months is only 10 percent.
Moreover, the rise in malnutrition was able to pass largely unnoticed because the weak government was not keeping valid statistics and had no commitment or ability to head it off.
"There is no single other country in the world where we ever have seen such high levels of malnutrition," said Greet Cappelaera, Yemen country director of UNICEF.
At the Sanaa hospital, al-Wadei's daughter Maram has recovered after treatment. But another of her four children — a 2 1/2-year-old daughter — can barely stand, another malnutrition symptom, and the family can't afford to treat her.
"I don't want kids anymore," mourns al-Wadei. "I don't even want myself."
Yemeni officials say their resources are strained by security challenges, including a northern rebellion, a southern separatist movement and al-Qaida.
"If there is no security and stability, there will be no development, no poverty alleviation and no investment," said Hesham Sharaf, deputy minister of planning and international cooperation.
Oil revenues make up at least three-quarters of the government budget, but oil production is steadily declining. Yemen could become a net importer in the next five years and its oil reserves could run out completely by 2021, according to IMF and World Bank estimates.
What development there is in Yemen is a patchwork, depending on where the government has thrown its limited cash. Oil money has fueled a consumption boom among a small slice of the population. In Sanaa, new hotels and restaurants have arisen, along with shopping complexes boasting Baskin Robbins branches and Porsche and BMW dealerships. Large video billboards advertise new housing projects.
But just beyond the capital's edge, rural Yemen immediately emerges, with little infrastructure. Donkey carts replace SUVs, and government authority largely vanishes, replaced by highly independent local tribes.
In Wadi Dhaher, a village just 10 kilometers (6 miles) outside Sanaa, floods have left mud houses partially demolished and deserted. Muddy roads lead to the village's qat plantations, which consumes most of the village water.
For water, Wadi Dhaher relies on a local well dug 400 meters (yards) deep to search for disappearing ground water, despite a national law limiting wells to 60 meters (yards) to prevent overconsumption.
Its residents belong to the Hashed tribe, which is nominally pro-government but brooks little interference from authorities.
"We are self-sufficient here," said Abdullah Muhsen, a 27-year-old who operates the village bath. "Our authority is the (tribal) sheik. Even the president needs his approval."
In a country with the seventh highest population growth in the world — 2.9 percent a year — the tens of thousands of Yemenis entering the work force each year find few opportunities. Many pour into Sanaa for jobs, straining the infrastructure.
Mourad Hamoud dropped out of high school in the southern town of Taiz and moved to Sanaa, hoping for a government job. But he found such jobs go mainly to northerners, so he opened a barber shop. "I couldn't keep up with studying and working," he said. "If things were right, I wouldn't have to leave studying to work."
Mohammed Abdel-Malik Mutawakel, a Sanaa University political science professor, said the danger is that Yemen's youth find "the economy is closed to them."
"So they will only think of a political struggle," he said. "If that also is closed. they will fight then, either through al-Qaida, the southerners, or any other way."
http://www.google.com/hostednews/ap/article/ALeqM5iQ6hw5wspWi_HY_V7APhNnca4yqQ?docId=7db7afc8f64940d7a7bb1b2abba20345

TUBERCULOSIS: Georgia USAID-Tbilisi

USAID has supported tuberculosis control efforts in Georgia since 2003 and is the largest bilateral donor working in TB in the country. USAID/Georgia’s current TB project, the Tuberculosis Treatment and Control Program, will end in March 2011. The new TB activity will continue to support TB control in Georgia. The new TB Prevention project activities will focus on the areas in which USAID’s funds will have the most impact for not only controlling but also reducing the number of TB cases in Georgia: Provide training and increase awareness of general medical practitioners to recognize the symptoms of TB in order to limit the spread of the disease through earlier detection of TB cases; Provide technical training and monitoring of DOTS clinics across the country rather than focusing on several geographic areas; Rehabilitation of selected TB outpatient clinics nationwide.
http://www.grants.gov/search/search.do?mode=VIEW&oppId=60813

TUBERCULOSIS: Angola: Over 100 Tuberculosis Cases Recorded in Uige Province

15 December 2010
Uíge — At least 119 people with tuberculosis received medical treatment since last October in the northern Uíge Province, including 55 patients who had been admitted in the local hospital, ANGOP has learnt.
According to the director of the hospital, Carlos Alberto de Sousa, the number of admitted patients included 24 men, 20 women and 11 children.
While 55 others (36 men, 19 women and nine children) received ambulatory treatment.
On the other hand, the source quoted 11 people as having died of the disease

http://allafrica.com/stories/201012150671.html

TUBERCULOSIS: New method for the standardized comparison of the genetic polymorphism within and between members of the Mycobacterium Tuberculosis Complex

Demelash Biffa
As part of his doctoral research at The Norwegian School of Veterinary Science, Demelash Biffa has carried out extensive field and laboratory work on bovine tuberculosis (TB) in Ethiopia since 2007.
The main aims of his study were to investigate risk factors associated with prevalence of the disease and to discover the molecular genetic characteristics of mycobacteria, which cause serious pathologic lesions in cattle. The work has led to the development of a new numeric expression approach known as Spoligotype Evolutionary Index (SEI).
Since Antiquity, tuberculosis has been one of the most ravaging and deadly diseases in both animals and humans worldwide. The main causative agents are Mycobacterium bovis (M. bovis) and Mycobacterium tuberculosis (M. tuberculosis) respectively in animals and humans, though humans are highly susceptible to the bovine strain.
In Ethiopia, bovine TB remains a major threat to animal and human health and an obstacle to international trade. Many aspects of the epidemiology of the disease, particularly of the causative agent M. Bovis, are not known.
Using molecular methods, Biffa has shown that TB in cattle is caused by a heterogeneous population of M. bovis. Some diseased animals were found to harbour multiple genotypes, indicating a high degree of infection pressure. This finding will have useful implications for any livestock vaccination program, as it appears that prior exposure to the pathogen may not provide sufficient resistance to the disease in some animals. This revelation is likely to challenge the paradigm of monoclonal infection of TB recognized in humans, but not yet in animals.
Biffa's research reaffirmed that TB in cattle poses a major threat to humans, animals, and to international trade. The thesis sets out recommendations for policy formulation with a view to achieving proper disease surveillance and control programmes in Ethiopia.
Demelash Biffa presented his doctoral thesis to the public on 7th December 2010 at The Norwegian School of Veterinary Science (NVH). The title of his thesis is “Epidemiological and Molecular Genetic Studies of Mycobacterium bovis Infections in Cattle in Ethiopia”.

Biographical data:
Demelash Biffa was born and brought up in Ethiopia. He took veterinary science at the Faculty of Veterinary Medicine at Addis Ababa University and graduated with a DVM degree in 1994. He won the competitive quota scholarship and joined The Norwegian School of Veterinary Science, obtaining a Master degree in Food Safety in 2007. He then won a scholarship to take a PhD at the same school. Biffa is a member of several professional associations and has also taken international postgraduate courses in different countries. Before commencing his doctoral research, he worked as head of the veterinary service division at the Ministry of Agriculture in Ethiopia, as NGO Project coordinator, and finally as senior lecturer at Hawassa University, Ethiopia.
Contact information: Demelash Biffa E-mail: demelash_b@yahoo.com
Magnhild Jenssen, Information Consultant, NVH: Email: magnhild.jenssen@nvh.no
http://www.nvh.no/en/Home/News/News-stories/New-method-for-the-standardized-comparison-of-the-genetic-polymorphism-within-and-between-members-of-the-Mycobacterium-Tuberculosis-Complex/

TUBERCULOSIS: Wales: Outbreak of Tbc, and a death

HEALTH chiefs are set to carry out an investigation after a West Wales man died from tuberculosis.
Last week Public Health Wales announced that three people from Llanelli had contracted the disease.
A spokesperson for Public Health confirmed the death in the same area, but said that it was not linked to the other known cases currently being investigated.
She said: “There has been a death from TB in the Llanelli area in the past few days, but it is not linked to the outbreak.
“We will now carry out an investigation looking at who they lived with or worked with, and if there are people who need to be screened, we will contact them.”
Transmission occurs through coughing of infectious droplets, and usually requires prolonged contact.
“You have to spend eight hours with someone to catch TB,” the Public Health spokeswoman said.
“Unless you live with someone or have slept in the same room as them you won’t be at risk.”
http://www.walesonline.co.uk/news/wales-news/2010/12/23/inquiry-launched-after-tb-death-91466-27873468/

TUBERCULOSIS: England: Policewoman's death in Manchester

Wed Dec 22 2010,
An Indian-origin policewoman in UK’s Manchester died from tuberculosis two days after she was attacked by her estranged husband, an inquest has ruled. The body of mother-of-four Vijay Singh, 37, was discovered by her son (8) and daughter (16).
Two days earlier, her ex-husband Wlati Singh, 39, had punched her in the head and chest. The couple’s son Kiran Singh, 19, told the inquest that his mother, who served with Greater Manchester Police for 14 years, was suffering from gallstone problems, but the family had no idea she had TB.
Coroner Nigel Meadows, who ruled she actually died from TB, said: “The gallstone problem may have triggered or coincided with the TB coming back. She hadn’t suffered any injuries as a result of any alleged assault that contributed to her death.”
http://www.indianexpress.com/news/NRI-cop-died-of-TB--not-assault-by-husband/727959

Tuberculosis Incidence in Prisons: A Systematic Review

Editors' Summary
Background

Every year, nearly 10 million people develop tuberculosis (TB)—a contagious bacterial infection usually of the lungs—and nearly two million people die from the disease. TB is caused by Mycobacterium tuberculosis, which spreads in airborne droplets when people with the disease cough or sneeze. Most people infected with M. tuberculosis never become ill—their immune system contains the infection. However, the bacteria remain dormant (latent) within the body, and a latent TB infection (LTBI) can cause active disease many years after the initial infection if host immunity declines. The symptoms of TB include a persistent cough, weight loss, and night sweats. Infection with M. tuberculosis can be diagnosed using the tuberculin skin test; tests for TB itself include chest X-rays and sputum cultures (in which bacteriologists try to grow M. tuberculosis from sputum samples, mucus brought up from the lungs by coughing). TB can usually be cured by taking several powerful antibiotics daily for several months.
Why Was This Study Done?
Last century, global control efforts began to reduce the incidence (number of new cases in a population in a given time) and prevalence (the number of affected people in a population) of LTBI and TB in many countries. Now, the emergence of antibiotic-resistant bacterial strains is thwarting these efforts. Consequently, it is important to identify settings where TB transmission is particularly high. One such setting is thought to be prisons. In these facilities, overcrowding, late case detection, inadequate treatment, and poor implementation of infection control measures (including incomplete segregation of people with active TB) might increase the TB transmission rate. However, it is not known how many people in prison become infected with M. tuberculosis or develop TB each year compared to the general population nor what percentage of LTBI and TB in the general population is attributable to exposure to M. tuberculosis in prison (the population attributable fraction or PAF%). Here, the researchers undertake a systematic review (a study that uses predefined criteria to identify all the research on a given topic) to investigate the incidence of TB in prisons.

What Did the Researchers Do and Find?
The researchers identified 23 studies that reported the incidence of LTBI and/or TB in prisons among both staff and prisoners. They estimated the incidence of TB in relevant general populations using World Health Organization data; estimates of the incidence of LTBI in the general population came from the studies themselves. The researchers then calculated the ratio between the incidence rates for LTBI and TB in prison and in the general population (incidence rate ratios or IRRs) for each study. For both LTBI and TB, the IRR varied widely between studies. The average IRR for LTBI was 26.4. That is, the average incidence of LTBI in prisons was 26.4 times higher than in the general population; the average IRR for TB was 23.0. The researchers also estimated the fraction of TB in the general population attributable to within-prison exposure to M. tuberculosis for each study. Again, there was considerable heterogeneity between the studies but, on average, the PAF% for TB in high-income countries was 8.5% (that is, one in 11 cases of TB in the general population was attributable to within-prison spread of TB); in middle-to-low–income countries, the average PAF% was 6.3%.

What Do These Findings Mean?
These findings suggest that the risk of LTBI and TB is at least an order of magnitude higher in prisons than in the general population and that the within-prison spread of LTBI and TB is likely to substantially affect the incidence of LTBI and TB in the general population. The accuracy and generalizability of these findings are limited by the small number of studies identified, by the relative paucity of studies from countries other than the USA, by study heterogeneity, and by assumptions made in the calculation of PAF%. Even so, these findings suggest that improvements in TB control in prisons would not only help to protect prisoners and staff from within-prison spread of TB but would also reduce national TB burdens. Further studies are now needed to identify the specific conditions in prisons that influence TB transmission so that rational policies can be developed to improve TB control in correctional facilities.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000381

TUBERCULOSIS: Canada: History: When death stalked Ottawa

Elizabeth Payne, December 23, 2010 The landmarks are familiar -- there's Billings Bridge, Carling Avenue and Immaculata High School, among other places. It almost sounds like the Ottawa you know. But it isn't. The city Clara Raina Flannigan and her sister Anne Raina describe in the newly released book Clara's Rib could be on another planet.
This is an Ottawa before antibiotics, when death was a familiar visitor to families and when tuberculosis lurked in the shadows. When it struck, as it did frequently, it changed everything.
Clara Raina Flannigan virtually grew up in the Royal Ottawa Sanatorium on Carling Avenue -- now the site of the city's main mental health facility, the Royal Ottawa Hospital, where people are treated for other ailments that can't always be cured. She spent her childhood battling tuberculosis, for which, at the time, there was no cure, only treatment of rest, fresh air and, medieval-sounding surgeries. She entered the Sanatorium in 1939 when she was just 12 and, except for brief periods at home, stayed there for more than a dozen years, enduring painful operations -- including the removal of ribs -- loneliness, and the death of friends and family members, including two brothers and her father, as well as her fiance. Other family members were also infected and spent time away from home receiving treatment.
Growing up in the sanatorium meant Clara couldn't attend school, something she longed to do. That was not all she missed. Her first glance of her baby sister Anne was through the window of her hospital room.
Her life during those years was recorded in a series of letters home to her family, as well as diaries and a manuscript, that, before Clara's death in 1998, Anne promised her sister she would some day have published. They reveal a humour and determination that must have helped her survive the ordeal and go on to live a productive and happy life, but also the bleakness of her situation at a time when the death rate from tuberculosis was in the range of 40 per cent.
"Father Latendresse brought Holy Communion and I certainly welcomed the comfort of religion today," she wrote on Jan. 5, 1946 as she, once again, left home to go to the sanatorium for treatment. "As I walked out the door I wondered if I would ever again be coming home to stay. So many of the girls with whom I am in the San are now dead. However, I am trying to think of brighter things and am very thankful for the six wonderful months I had at home."
Today we live in a world in which the death of a child from the flu is enough to create a panic, as happened last year during the H1N1 outbreak, when people flooded vaccine clinics. Reading Clara's Rib is a lesson in how lucky we are -- or most of us, at least.
We have vaccines to prevent the kinds of childhood diseases from which generations have suffered. We have antibiotics to treat serious and even not-so-serious infections to prevent them from turning deadly. And, until recently, the word tuberculosis was a dusty relic of another era.
"When I was a child, if someone had asked me what tuberculosis was, I would have had to stop and really think about my answer because it was simply the way life was," Anne Raina wrote in the postscript to her sister's book. "However, if pressed, I would likely have responded that it was the disease that took most of my brothers and sisters and father to a big hospital and that I could hardly ever get to see them."
"I always took the attitude," she wrote, "that I could handle anything, and next to TB, nothing really counted."
Clara's Rib is a lesson in perseverance and acceptance. It is, incongruously, a story with a happy ending. Despite her health challenges, Clara eventually has a family and lives into her seventies. It is also a reminder of how far we have come from the days when TB stalked this city.
But the book should also sound a warning about the reemergence of tuberculosis.
While it remains relatively rare and, mostly, treatable in Canada's affluent south, there is growing concern about cases of drug resistant tuberculosis around the world.
And in Canada's Far North, tuberculosis remains a modern, and growing, plague. Canadian Inuit are 185 times as likely to contract tuberculosis as others born in Canada, according to the Public Health Agency of Canada. And the same kinds of problems that made people in Ottawa vulnerable to the disease when Clara was being treated in the 1930s and '40s, are playing a role in its deadly resurgence in the North -- overcrowding, poor housing construction, poor nutrition and poverty among them.
Clara's Rib is a touching historical read, but also a reminder of why we must not lose sight of the dangers of diseases such as TB.
http://www.ottawacitizen.com/life/When+death+stalked+Ottawa/4017296/story.html

TUBERCULOSIS: TB spread in prisons, ups TB elsewhere

VERCELLI, Italy, Dec. 23 (UPI) -- The spread of tuberculosis in prisons increases the incidence of tuberculosis in the general population, researchers in Italy and Britain say. Iacopo Baussano of the University Amedeo Avogadro in Italy and the Imperial College London and colleagues suggest improvements in prison TB control would not only help to protect prisoners and staff, it would help reduce national TB burdens.
Using data from previous studies and the World Health Organization, the study authors calculated the ratio between the incidence rates for TB and latent TB in prison and in the general population.
The average incidence of TB in prisons was 23 times higher than that of the general population, and for latent TB, was 26 times higher in prisons than in the general population.
The authors estimated the fraction of TB in the general population attributable to within-prison exposure to TB and found that, on average, one in 11 cases of TB in the general population was attributable to within-prison spread of TB.
"These data may prove useful to inform the development of rational policies to control TB transmission in correctional facilities," the study authors say in a statement. "Future studies should assess the population attributable risk of prison-to-community spread and describe the conditions in the prison that influence TB transmission."

The findings are published in the journal PLoS Medicine.

http://www.upi.com/Health_News/2010/12/23/TB-spread-in-prisons-ups-TB-elsewhere/UPI-71241293085127/

TUBERCULOSIS: Giant Rats Detect Tuberculosis

Nathan Seppa, Science News : December 23, 2010

Animals can be trained to sniff out TB in sputum samples, adding to accuracy of microscope test

Low-income countries struggling to keep tuberculosis under control might get a boost from an unlikely source—giant African rats.
The big rodents spotted hundreds of TB-positive sputum samples that a standard microscope test missed on first pass, researchers report in the December American Journal of Tropical Medicine and Hygiene.
The TB bacterium currently infects one in three people worldwide, the World Health Organization estimates, with the highest rates in Africa.
Giant African rats, also called Gambian pouched rats (Cricetomys gambianus), are native to much of Africa and have been used before to sniff out land mines. Training captive-bred rats to detect TB takes about five or six months, says study coauthor Alan Poling, a psychologist and animal-learning expert at Western Michigan University in Kalamazoo. Attempts to train captured giant rats didn’t work because the animals proved unmanageable, he says. “In the wild, they’re really nasty.”
The rats are exposed to sputum samples through holes in the floor of a cage, and if they correctly pause for five seconds to smell a TB sample, they are rewarded with a mouthful of banana. Lingering over non-TB samples gets no reward. Eventually, the rats can check a string of holes moving “about as fast as they can walk,” Poling says.
In the largest analysis to date, Poling and a research team in Tanzania collected sputum samples from more than 10,000 people and tested them using a standard microscopic analysis for TB. The researchers found that about 1,400 people had the disease. The TB samples had been rendered noninfectious using heat and pressure, a safety measure designed to prevent transmission of live TB from dropped or spilled samples, Poling says.
When the rats sniffed the same sputum samples, the animals correctly identified more than 90 percent of those found as positive in the lab. But the rats also tagged more than 1,400 additional people as positive. When reanalyzed more closely under the microscope, those samples turned out to include 620 people who indeed had TB. Thus, while the standard test found that 13.3 percent of people were TB-positive, the rats bumped that figure up to more than 19 percent.
It may seem that the rats turned in a lot of false positives, sensing samples as TB-positive that a second microscope test couldn’t confirm. But many might not be false, Poling says. “We’re thinking that in at least some of these people, there are bacteria present that our people [using microscopes] didn’t see. There might be low concentrations.”
The gold standard for TB testing is to culture the bacteria in the sputum, but that can take weeks. “There’s a need to deploy a new generation of technologies to get new diagnostics out there against TB,” says Peter Hotez, a physician and microbiologist at George Washington University in Washington, D.C. “[Using rats] is definitely a low-tech approach,” he says.
But he says the rats’ accuracy rate would need to improve for this to become a standard screening strategy. A new lab test that uses a polymerase chain reaction is 98 percent accurate in detecting TB, researchers reported in the Sept. 9 New England Journal of Medicine. That technique, which copies key bacterial DNA, appears to be the TB test of the future, Hotez says. It is being tested in the field and may become commercially available soon.
Poling and his group are using the DNA test to verify results from the standard microscopy and the rat tests. But the DNA test currently costs about $20 per sample, he says, which is far too high for developing countries. It’s unclear how much the rats would cost per sample, he says, since the method has not been scaled up commercially. But once the rats are trained, they can whip through a dozen samples in less than a minute and be used again and again.
http://www.usnews.com/science/articles/2010/12/23/giant-rats-detect-tuberculosis.html

TUBERCULOSIS: Massachussetts: Worcester teacher tests positive for tuberculosis

Renee Nadeau Algarin : December 23, 2010
About 100 students and staffers at a Worcester elementary school must be tested for tuberculosis after a teacher tested positive for the contagious disease, health officials announced today.
“In this specific case, this was a very low risk to the students and faculty here at the school. Our approach is, we want to be very cautious,” said Derek Brindisi, Worcester’s director of public health
http://www.bostonherald.com/news/regional/view/20101223worcester_teacher_tests_positive_for_tuberculosis/srvc=home&position=recent

MALARIA: The impact of maternal malaria on newborns.

Hartman TK, Rogerson SJ, Fischer PR.:  Ann Trop Paediatr. 2010;30(4):271-82.
BACKGROUND: Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible.

METHODS: We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised.

RESULTS: Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life.

CONCLUSIONS: Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.
http://www.ncbi.nlm.nih.gov/pubmed/21118620

POVERTY: Has the world met its Paris aid commitments?

 Jonathan Glennie  3 January 2011
Has the world met its Paris aid commitments?
Governments have missed most of the 2010 targets agreed in the Paris Declaration on Aid Effectiveness, but there are good reasons why we should not give up on the process in 2011


Aid packages from the UK Department for International Development. Photograph: AP

In 2005, donor governments, accompanied by some key recipient governments and a smattering of international NGOs, agreed a set of principles for how to make their aid better support development. The Paris Declaration on Aid Effectiveness was the direct result of civil society's campaign to ensure better as well as more aid. Measurable targets were outlined and a deadline to meet them was set: 2010. So how has the aid world performed?
The short answer is not very well. The results from the 2010 survey are not yet in, so we don't know what progress has been made in the last couple of years, but apart from one or two significant steps forward, it seems progress has been weak. Of the 14 indicators of progress, the OECD, which is managing the process, thinks three are on track (relating to untying aid, better coordination between donors of technical assistance and better public financial management), a further three are within reach (on aid predictability, reducing the creation by donors of parallel project implementation units and recording aid in recipient country budgets), with the remaining eight requiring "very special efforts", which is the politically correct way of saying "we're miles off".
So it would be fairly easy to scoff at the Paris process as a wasted effort. Apart from the slow progress, it has come in for some fairly damning criticism over its methodology, with the targets being only mildly related to real development progress – ownership, conditionality and dependency cannot be measured by asking the World Bank to give countries scores on how good their development strategies are, for example. The Paris agenda does not really measure aid effectiveness, but aid efficiency, ie it looks at bureaucratic processes, but not the actual impact aid has on reducing poverty. After five years of evidence gathering, nothing in the Paris process will tell us if any more lives have actually been saved on account of changes in aid giving.
Another important criticism is that, as the middle-income countries become ever more important in aid giving (from China and India to Brazil and South Africa), the Paris process fails to involve them, giving the public in donor and recipient countries only a very partial view of the reality of aid. It's all very well accounting for OECD aid to Nicaragua, but what about the millions of dollars transferred by Venezuela's president Hugo Chavez, reportedly to a private presidential account?
But despite all this, there are good reasons not to give up on Paris just yet. Firstly, while I and others have argued that the most important issues are sidelined in the Paris agenda, some important principles are articulated, and this is the first time concerted effort has been made to implement them. You have to walk before you can run. A focus on transparency, in particular, is a substantial step forward, as Owen Barder wrote on the Poverty matters blog recently.
The fact that progress has been slow is disappointing, but hardly surprising to anyone who has worked in a complex political bureaucracy. It takes time to alter ways of working and incentives (a salutary lesson for donors with a habit of trying to force poor countries to introduce huge reforms in short periods of time). A meeting in Accra in 2008 led to improvements to the Paris declaration, with a particularly important focus on civil society as a vital complement to the state in ensuring that good decisions are made about aid and development.
Importantly, recipient countries are becoming more interested in the Paris declaration, just as, ironically, enthusiasm among donors appears at risk of waning. Presumably this is because more people in recipient governments realise that the principles enshrined in the declaration are broadly in their interests (except, perhaps, "harmonisation", which risks strengthening the bargaining power of donors). While fewer than 40 countries took part in the baseline survey in 2005, 55 took part in the monitoring survey in 2008, and more than 80 are expected to take part in the 2010-11 evidence gathering initiative.
Finally, while it is right to criticise the Paris agenda for being overly bureaucratic and for failing to clearly link a fairly technical set of targets with real changes for real people, there is something to be said for a focus on systems. The millennium development goals, another process that is broadly a good thing, has been criticised for looking at the "what" but not the "how", with some perverse results. Development is not just about reaching better health and education outcomes in the short-term, but about state-building and institutional strengthening. The Paris agenda, for all its many flaws, addresses some of those issues, and we should should try to refine and improve this important process in 2011.
http://www.guardian.co.uk/global-development/poverty-matters/2011/jan/03/paris-declaration-aid

POVERTY: Afghanistan: Morning Star

BARBARA COTTER: January 02, 2011

  Courtesy John Albaugh

In 2009, Morning Star:
• Served about 38,000 medical patients, including 19,000 under 5 years old and 1,000 women for maternal care
• Provided education to about 1,800 literacy and English students; 324 computer training students; 514 female literacy students and 250 girls at home-based schools
• Distributed $70,000 worth of seeds and provided agricultural training
• Had 106 students graduate from its Institute for Leadership Development
• Handed out food and blankets to 1,200 families displaced by fighting in southern Afghanistan, and provided more than 100,000 pounds of winter clothing, shoes, medical kits and educational supplies in rural areas.
Morning Star Development’s focus is on economic and community development in Afghanistan’s rural areas, where about 85 percent of the population lives. To address that broad agenda, Morning Star has built four community centers that serve about 50 villages each, launched a leadership training program, distributed food and clothing to thousands of impoverished Afghan citizens, helped with agricultural development and embarked on an “Elevating Women Initiative” to improve education and literacy for women.
Morning Star also operates four medical clinics that work to combat high infant and child mortality rates and stem the spread of infectious diseases, and helps with small-business development.
“We’re not just building buildings. We’re building people’s lives,” says Batchelder.
Helping the people of Afghanistan didn’t make Batchelder’s to-do list until 1997, when a friend who had lived in the country asked if he’d help do some humanitarian work there.
“I thought I was cruising toward an early retirement,” says Batchelder, a Vermont native who worked in land-use planning and natural resource management. “I didn’t come into this with a passion for Afghanistan.”
But during his trip, he visited a refugee camp for Afghanis who had fled to Pakistan, and was struck by the number of big families crammed into pup tents.
“As far as you could see, there was nothing but these tents, and that’s when something clicked for me,” he says.
He helped start one organization, but its focus turned more toward agricultural help. So in 2002, he founded Morning Star, which has an annual budget of about $1 million — about 90 percent of which goes to programming — and employs 153 people in Afghanistan and seven in Colorado Springs. It’s a faith-based organization, but there’s no evangelical work going on in a country where Islam is the predominant religion, he said.
“Here, and in other countries where evangelism is allowed by law, we might engage in evangelism,” Batchelder says. “However, in Afghanistan it is against the law to proselytize, and we all agree to obey the laws and respect the religion of Afghanistan. All our initiatives in Afghanistan are approved by the Afghan government; they are non-religious and we do not proselytize in Afghanistan.”
Adnan R. Khan wrote a story early last year for AOL News about the Afghan village of Jegdalek , where Morning Star operates a community center with a school, computer lab, medical clinic and recreational activities. Morning Star wasn’t aware that Khan was writing the story, and the nonprofit received only a passing mention, but he wrote about the results that it’s trying to achieve: buy-in from the Afghan people to better their lives, brighten their futures and control their destiny.
“Since the fall of the Taliban regime at the end of 2001, Jegdalek has been transformed from a desolate ruin left behind after the Soviet war into a thriving community...,” wrote Khan, who also quotes one of Jegdalek’s senior elders as saying that if the Taliban tries to take over their area, “the entire village will rise up against them.”
That’s what Batchelder wants to hear. Fundamentalists “don’t like what we do at all,” he said, but the nonprofit’s emphasis on community centers with medical clinics, educational facilities, computer labs and more fosters buy-in. And it helps to have a council made up of about half-dozen villagers to help run the show.
“Our strategy is to start by connecting with the community elders. If they invite us to come, we say ‘you provide the land,’” Batchelder said.
His hope is that enough of Afghanistan’s sizable population of people 20 years old and younger will get the educational and leadership opportunities they need to work for and sustain a better life. Already, he says, they’ve been exposed to other cultures because of the influx of diplomats and NATO and U.S. troops, and Morning Star is exposing them to what could be.
“That’s what’s really going on in Afghanistan,” Batchelder says. “There’s a whole new generation coming online; they want what we have to offer.”

To learn more about Morning Star, go to www.msdev.org.

http://www.gazette.com/articles/afghanistan-110477-endorsements-brokaw.html#ixzz19ytKpjib

MALARIA: Can Southern Sudan Vote for Independence from Malaria?

Bill Brieger : 31 Dec 2010
The UNDP is also responsible for the Global Fund Round 7 Malaria Grant in Northern Sudan. It may be doing a better job with its malaria assignment. The most recent grant progress report rated them well with a ‘B1′, but raised the concern that, “The cash absorption rate during this reporting period is only 56% of the budget. This is attributed to delays in procurements.”
The North has a mix of malaria transmission situations, while the South is squarely in the endemic zone (as seen in map to right). When the South votes soon for Independence, what will be their own chances of becoming independent from malaria?
The Round 7 Malaria Grant in the South is managed by PSI. The Grant started 2 years ago and currently also rates a ‘B1′. At the most recent grant progress report dated October 2010, the following were achieved:
86% of ITNs had been distributed
10 BCC media campaigns had been implemented and over 6000 community organization staff had been trained, exceeding targets
Only 17% of targeted children had been treated with ACTs in the community
Health facilities exceeded expectations in terms of maintaining ACT stocks
The progress report concludes that, “Strengthening the capacity of the health system to deliver health services including malaria interventions have fallen behind set targets, due to late SR selection and contracting, and the PR focusing on the LLIN mass distribution campaign. Nevertheless, results seem to be gaining on set targets.”
Southern Sudan is not without malaria partners. For example, PSI has been working Southern Sudan since “January 2005, distributing Serena long-lasting insecticide-treated nets (LLIN) through the commercial sector … (and providing) support to the Ministry of Health (MOH), Government of Southern Sudan, and county health departments to prevent and treat malaria.” The IRC has trained “villagers to recognize and treat young children for malaria, diarrhea and pneumonia has helped to reduce child deaths by 81 percent in one area of Southern Sudan.”
USAID is also working to help tackle the malaria problem in Southern Sudan. The area has been one of three ‘non-focus’ countries - that is not formally under the US President’s Malaria Initiative (PMI). Two of these countries, Nigeria and Democratic Republic of the Congo, have been added to the formal PMI roster. One wonders whether the fate of malaria control in Southern Sudan rests on the election outcomes.
The BBC quotes a Southern Sudanese nurse who compares the upcoming referendum, “.. as a mother giving birth to twins - once the labour pains are over, the two children can grow up as friends .” We know that malaria during ‘pregnancy’ and during ‘infancy and young childhood’ are threats to survival. We hope that all donors will continue to work for the survival of these Sudanese ‘children’ and bring about a true independence from malaria.
http://www.malariafreefuture.org/blog/?p=1142

MALARIA: Factors affecting treatment-seeking for febrile illness in a malaria endemic block

Factors affecting treatment-seeking for febrile illness in a malaria endemic block in Boudh district, Orissa, India: policy implications for malaria control
Ashis Das and TK Sundari Ravindran : Malaria Journal 2010, 9:377

Background
Orissa state in eastern India accounts for the highest malaria burden to the nation. However, evidences are limited on its treatment-seeking behaviour in the state. We assessed the treatment-seeking behaviour towards febrile illness in a malaria endemic district in Orissa.

Methods
A cross-sectional community-based survey was carried out during the high malaria transmission season of 2006 in Boudh district. Respondents (n=300) who had fever with chills within two weeks prior to the day of data collection were selected through a multi-stage sampling and interviewed with a pre-tested and structured interview schedule. Malaria treatment providers (n=23) were interviewed in the district to gather their insights on factors associated with prompt and effective treatment through a semi-structured and open-ended interview guideline.

Results
Majority of respondents (n=281) sought some sort of treatment e.g. government health facility (35.7%), less qualified providers (31.3%), and community level health workers and volunteers (24.3%). The single most common reason (66.9%) for choosing a provider was proximity. Over a half (55.7%) sought treatment from appropriate providers within 48 hours of onset of symptoms. Respondents under five years (OR 2.00, 95% CI 0.84-4.80, P = 0.012), belonging to scheduled tribe community (OR 2.13, 95% CI 1.11-4.07, P = 0.022) and visiting a provider more than five kilometers (OR 2.04, 95% CI 1.09-3.83, P = 0.026) were more likely to have delayed or inappropriate treatment. Interviews with the providers indicated that patients' lack of trust in community volunteers providing treatment led to inappropriate treatment-seeking from the less qualified providers. The reasons for the lack of trust included drug side effects, suspicions about drug quality, stock-outs of drugs and inappropriate attitude of the provider.
Conclusion
Large-scale involvement of less qualified providers is suggested in the malaria control programme as volunteers after appropriate capacity development since the community has more trust in them. This should be supported by uninterrupted supply of drugs to the community volunteers, and involvement of the community-based organizations and volunteers in the planning, implementation, and monitoring of malaria control services. There is also a need for continuous and rigorous impact evaluations of the program to make necessary modifications, scale up and to prevent drug resistance.
http://www.malariajournal.com/content/9/1/377

MALARIA: Comparing two artesunate-based combination treatments on Plasmodium falciparum malaria

An open randomized clinical trial in comparing two artesunate-based combination treatments on Plasmodium falciparum malaria in Nigerian children: artesunate/sulphamethoxypyrazine/pyrimethamine (fixed dose over 24 hours) versus artesunate/amodiaquine (fixed dose over 48 hours)
Idowu Adejumoke Ayede, et al., Malaria Journal 2010, 9:378Background

Several studies have demonstrated the efficacy of artemisinin-combination therapy (ACT) across malaria zones of the world. Fixed dose ACT with shorter courses and fewer tablets may be key determinants to ease of administration and compliance.
Methods
Children aged one year to 13 years presenting with uncomplicated Plasmodium falciparum malaria were recruited in Ibadan, south-western Nigeria. A total of 250 children each were randomly assigned to receive three doses of artesunate/sulphamethoxypyrazine/pyrimethamine (AS + SMP) (12 hourly doses over 24 hours) or three doses of artesunate/amodiaquine (AS + AQ) (daily doses over 48 hours). Efficacy and safety of the two drugs were assessed using a 28-day follow-up and the primary outcome was PCR- corrected parasitological cure rate and clinical response.

Results
There were two (0.4%) early treatment failures, one in each treatment arm. The PCR corrected cure rates for day 28 was 97.9% in the AS + AQ arm and 95.6% in the As + SMP arm (p = 0.15). The re-infection rate was 1.7% in the AS + AQ arm and 5.7% in the AS + SMP arm (p=0.021). The fever clearance time was similar in the two treatment groups: 1 - 2 days for both AS + SMP and AS + AQ (p = 0.271). The parasite clearance time was also similar in the two treatment groups with 1- 7 days for AS + SMP and 1- 4 days for AS + AQ (p = 0.941.). The proportion of children with gametocytes over the follow-up period were similar in both treatment groups. Serious Adverse Events were not reported in any of the patients and in all children, laboratory values (packed cell volume, liver enzymes, bilirubin) remained within normal levels during the follow-up period but the packed cell volume was significantly lower in the AS/ SMP group.
Conclusions
This study demonstrates that AS + SMP FDC given as three doses over 24 hours (12-hour intervals) has similar efficacy as AS + AQ FDC given as three doses over 48 hours (24-hour interval) for the treatment of uncomplicated Plasmodium falciparum malaria in children in Nigeria. Both drugs also proved to be safe. Therefore, AS+SMP could be an alternative to currently recommended first-line ACT with continuous resistance surveillance
http://www.malariajournal.com/content/9/1/378

POVERTY: World Migration Report 2010 - The Future of Migration: Building Capacities for Change

Migration is a constant and dynamic phenomenon increasingly requiring diversified policy intervention in order to maximize its potential benefits and minimize related costs for both countries of origin and destination as well as migrants themselves. Better knowledge and enhanced capacities in different policy areas are essential to ensure the protection of migrants, the facilitation of legal migration, the integration of migrants into the country of destination, the support for sustainable voluntary return and the greater interlinking between migration and development.
The challenge remains in translating improved understandings into policy and practice on the ground. State capacities around the world for managing migration are limited. Legal frameworks may need to be updated or overhauled to focus on new areas of migration, or to handle new influxes or outflows of migrants; staff working on the front line may need equipment, training and support; civil society and migrants themselves may not be adequately integrated into the process of data-gathering and making and implementing policy; vulnerability factors and health risks inherent to the migration process need to be better understood and addressed.
International migration is likely to transform in scale, reach and complexity, due to growing demographic disparities, the effects of environmental change, new global political and economic dynamics, technological revolutions and social networks. These transformations will be associated with increasing opportunities, exacerbate existing problems and generate new challenges.
The World Migration Report 2010 provides a tool for self-evaluation in terms of future scenarios, and demonstrates the need for a far more comprehensive approach to capacity-building for migration than has typically been adopted. The aim is not to prescribe ‘one-size-fits-all’ policies and practices, but to suggest objectives of migration management policies in each area, to stimulate thinking and provide examples of what States and other actors can do.
Part A of the report focuses on identifying core capacities in key areas of migration management, raising key concepts and outlining important examples of existing practices in these areas. Part B provides an overview of migration in the world today, from both the global perspective and through six regional chapters, drawn from the most up-to-date data.
http://publications.iom.int/bookstore/index.php?main_page=product_info&cPath=37&products_id=653&language=en

POVERTY: Prepare now for future migration surge, says IOM

  Photo: WorldVision
More people will be displaced internally because of environmental factors in Africa

JOHANNESBURG, 3 January 2011 (IRIN) - Decisions taken by local authorities on land use, building regulations and access to health services probably affect migrants more than decisions taken nationally, “yet in most countries, migration policy is set at the national level with little attention to capacity-building at the local level, where policy is usually implemented,” says the new World Migration Report 2010.
The report, published every two years by the International Organization for Migration (IOM), highlights several such gaps, and explores the extent to which countries are prepared for a surge in migration over the coming decades. The current number of 214 million migrants globally, according to IOM, could rise to 405 million by 2050.
It says new trends in migration could be affected by varying rates of population growth (slowing in the developed world and prompting an even greater demand for labour); environmental change; and shifts in the global economy.
The current “lull” in international migration due to economic recession, IOM says, should be used by countries to prepare for larger flows of people: capacity-building and better managed databases could be areas to look at. The report provides a self-evaluation checklist to help countries and organizations assess their preparedness levels.
http://www.irinnews.org/Report.aspx?Reportid=91513

MALARIA: Evolutionary forces on Anopheles: what makes a malaria vector?

Cohuet, A., et al.Institut de Recherche pour le Développement, Montpellier, France
In human malaria, transmission intensity is highly dependent on the vectorial capacity and competence of local mosquitoes. Most mosquitoes are dead ends for the parasite, and only limited ranges of Anopheles are able to transmit Plasmodium to humans. Research to understand the determinants of vectorial capacity and competence has greatly progressed in recent years; however, some aspects have been overlooked and the evolutionary pressures that affect them often neglected. Here, we review key factors of vectorial capacity and competence in Anopheles, with a particular focus on the most important malaria vector Anopheles gambiae. We aim to point out selection pressures exerted by Plasmodium on Anopheles to improve its own transmission and discuss how the parasite might shape the vector to its benefit. © 2009 Elsevier Ltd. All rights reserved.
http://www.scopus.com/record/display.url?eid=2-s2.0-77049109244&origin=inward&txGid=F43pX9mfrGMCwIyvjybA0R1%3a12

MALARIA: The DFID plan

   Picture: Vergaard Frandsen / Roll Back Malaria

Malaria is a preventable and treatable disease. Yet more than half of the world's population is at risk of malaria and nearly 250 million people become severely ill with it each year.
In Africa, one in five child deaths is caused by malaria. It is also a disease and cause of poverty; the map of malaria illness and death closely matches that of global poverty.
Malaria has significant direct and indirect impacts; it places a major constraint to economic development and interacts with other health conditions such as undernutrition and HIV to worsen health outcomes.
Malaria is a serious cause of maternal and newborn deaths. Malaria illness limits mental and physical development in children and is an important cause of school absenteeism.
Addressing malaria is one of the main priorities of the UK government. We believe we can make a real difference to reducing the global burden of malaria by doing more of what we know already works, innovate to reach more people with prevention and treatment services and finding new tools to tackle malaria even more effectively in the future.
As part of this we have pledged to contribute to at least halving malaria deaths in at least ten high burden countries by 2014/2015.
Supporting countries to achieve this goal will contribute directly to reaching the Roll Back Malaria Partnership objectives set out in the 2008 Global Malaria Action Plan, targets agreed at the World Health Assembly (2005) and the Millennium Development Goals.

The UK government will:
Focus on the poor and vulnerable populations in high-burden countries in Africa and Asia
Achieve results by supporting national malaria control programmes that are embedded in health sector plans using funding approaches appropriate to country circumstances
Seek opportunities to link malaria with other health and non-health programmes to increase benefits and value for money
Improve the quality and availability of data on malaria so that results are measurable, transparent and strengthen accountability to communities and the UK public
Base investment on evidence of what works and innovate where needed
Work with international partners to ensure that global efforts support countries to tackle malaria as efficiently as possible
http://www.dfid.gov.uk/Global-Issues/Emerging-policy/Malaria/

MALARIA: The role of mathematical modelling in guiding the science and economics of malaria elimination

Maude, R.J. et al., Mahidol-Oxford Tropical Medicine Research Unit,
Unprecedented efforts are now underway to eliminate malaria from many regions. Despite the enormous financial resources committed, if malaria elimination is perceived as failing it is likely that this funding will not be sustained. It is imperative that methods are developed to use the limited data available to design site-specific, cost-effective elimination programmes. Mathematical modelling is a way of including mechanistic understanding to use available data to make predictions. Different strategies can be evaluated much more rapidly than is possible through trial and error in the field. Mathematical modelling has great potential as a tool to guide and inform current elimination efforts. Economic modelling weighs costs against characterised effects or predicted benefits in order to determine the most cost-efficient strategy but has traditionally used static models of disease not suitable for elimination. Dynamic mathematical modelling and economic modelling techniques need to be combined to contribute most effectively to ongoing policy discussions. We review the role of modelling in previous malaria control efforts as well as the unique nature of elimination and the consequent need for its explicit modelling, and emphasise the importance of good disease surveillance. The difficulties and complexities of economic evaluation of malaria control, particularly the end stages of elimination, are discussed. © 2010 Royal Society of Tropical Medicine and Hygiene.
http://www.scopus.com/record/display.url?eid=2-s2.0-78649631980&origin=inward&txGid=F43pX9mfrGMCwIyvjybA0R1%3a8

MALARIA: Challenges to implementation of artemisinin combination therapy policy in Uganda

Batwala, V. et al. Department of Community Health, Mbarara University of Science Technology,  Uganda
Uganda launched an artemisinin combination therapy (ACT) policy in 2006, using artemether-lumefantrine (AL) as first-line treatment for uncomplicated malaria, but insufficient information is available regarding its implementation. Semi-structured interviews were conducted with key personnel: 32 clinical and four laboratory staff from 32 health centres (HCs) in Bushenyi and Iganga districts and the Ministry of Health. Structured interviews with 613 patients receiving malaria treatment at six randomly chosen HCs were held. Data were collected on availability of antimalarials, treatment guidelines, staffing and malaria treatment decisions. Posts for clinical staff were inadequately filled. Only 15 (46.9%) HCs stocked AL for all weight categories. Nationwide, AL was out-of-stock March-July 2007. Twenty-one (65.6%) HCs stocked chloroquine. Out of 193 patients, 177 (91.7%) used antimalarials other than AL before coming to HCs. The unrecommended antimalarials were mainly sourced from the private for profit (PFP) sector yet there were no guidelines regarding provision of AL in the PFP sector. Only 53/613 (8.6%) patients were examined for parasites and only 8 (15.1%) had a positive blood slide. The majority of the patients attending HCs (560; 91.4%) received antimalarials but only 323 (57.7%) received AL. In order to improve the implementation of the current policy, AL should be availed in adequate amounts at all points of care including the PFP sector; non-recommended drugs should be withdrawn from the market and it should be ensured that malaria is confirmed by laboratory diagnosis. Study registration: Clinicaltrials.gov NCT00565071. © 2010 Royal Society of Tropical Medicine and Hygiene.
http://www.scopus.com/record/display.url?eid=2-s2.0-78649632428&origin=inward&txGid=F43pX9mfrGMCwIyvjybA0R1%3a6

MALARIA: Antimalarial herbal remedies of Msambweni, Kenya

Nguta, J.M. et al. Department of Public Health, Pharmacology and Toxicology, University of Nairobi,
Malaria is a serious cause of mortality globally. The disease is of regional concern in Africa and of national interest in Kenya due to its high morbidity and mortality as a result of development of resistant strains of Plasmodium falciparum to many existing drugs such as chloroquine. Alternative medicine using herbal remedies are commonly used to treat malaria in Kenya. However, plants used in some rural areas in Kenya are not documented. Many antimalarial drugs have been derived from plants. This study was conducted to document medicinal plants that are traditionally used by the Msambweni community of Kenyan South Coast to treat malaria, where the disease is endemic. Herbalists were interviewed by administration of semistructured questionnaires in order to obtain information on medicinal plants traditionally used for the treatment of malaria. Focused group discussions held with the herbalists supplemented the interview and questionnaire survey. Twenty-seven species of plants in 24 genera distributed in 20 families were reported to be used in this region for the treatment of malaria. Labiatae, Rutaceae and Liliaceae families had each eleven percent of the plant species reported and represented the species that are most commonly used. Thirteen plant species, namely; Aloe deserti Berger (Liliaceae), Launea cornuta (Oliv and Hiern) C. Jeffrey (Compositae), Ocimum bacilicum L. (Labiatae), Teclea simplicifolia (Eng) Verdoon (Rutaceae), Gerranthus lobatus (Cogn.) Jeffrey (Cucurbitaceae), Grewia hexaminta Burret. (Tiliaceae), Canthium glaucum Hiern. (Rubiaceae), Amaranthus hybridus L. (Amaranthaceae), Combretum padoides Engl and Diels. (Combretaceae), Senecio syringitolius O. Hoffman. (Compositae), Ocimum suave Willd (Labiatae), Aloe macrosiphon Bak. (Liliaceae) and Laudolphia buchananii (Hall.f) Stapf. (Apocynaceae) are documented from this region for the first time for the treatment of malaria. These results become a basis for selection of plants for further pharmacological, toxicological and phytochemical studies in developing new plant based antimalarial drugs.
http://www.scopus.com/record/display.url?eid=2-s2.0-77649191020&origin=inward&txGid=F43pX9mfrGMCwIyvjybA0R1%3a2

MALARIA: Malaria Framework for Results (DFID)

The Department for International Development (DFID) conducted a public consultation to seek inputs for the development of its new Malaria Framework for Results. The Framework is part of the UK’s ongoing commitment to supporting progress on Millennium Development Goal 6c, to halt and to begun to reverse the incidence of malaria and other major diseases and a contribution to the goals set out in the Roll Back Malaria Partnership Global Malaria Action Plan (2008).
The 12-week consultation took place from 2 August to 26 October 2010. It gathered views from UK and international experts and the public through an interactive website, individual and group submissions, and technical workshops.
We received over 540 responses through online and technical submissions questionnaires. This report summarises the main messages contained in these responses and identifies how they have been reflected in the Malaria Framework for Results. This report is thus a summary of the wide range of views and ideas presented. It does not attempt to summarise individual responses.
In general, responses showed strong support for DFID’s role and current approach to health and to malaria. There is consensus that malaria needs to be addressed as part of a broader focus on improving health and health services. This includes integrating malaria control services with other health interventions, strengthening health information systems, improving commodity supply chains, building management capacity and human resources for health all with an increased emphasis on the district level.
Specific issues of particular interest included: community based delivery and the role of community; education and participatory approaches for prevention/awareness; and how to work with the private sector. Vector control/management (beyond bednets) and more effective coordination with other sectors were also emphasised. Respondents noted that significant knowledge gaps exist in the malaria field: there was a crucial role for research, both for new products and on how best to deliver services.
The scale and focus of responses to the consultation have confirmed both the potential for increased UK government investment in malaria to deliver results and helped to shape the Framework for how this will be done. In the words of one respondent, ‘build on what DFID has done well in the past and work to your comparative advantage’. Respondents welcomed the responsiveness and flexibility of UK government funding – including the willingness to innovate and develop new instruments; a capacity to focus on the health system; and an ability to partner with different types of organisations, while also supporting governments to take leadership.
DFID is grateful to all those individuals, groups and organisations that contributed submissions and took part in technical meetings. The consultation process was an influential element in the development of the Malaria Framework for Results as a result.
The UK government will publish a mid-term review in 2013 and a framework evaluation in 2015, so that partners and countries can judge what progress has been made in tackling malaria.
http://ht.ly/3wvi0

MALARIA: Universal Coverage - if not now, when?

Bill Brieger : 30 Dec 2010
As of October 2010 Nigeria had distributed long lasting insecticide-treated nets (LLINs) 14 of the 36 states and the Federal Capital Territory and about 40% of the targeted 60 million plus nets. A key challenge was, “The lack of operational funds to support campaigns in 22 states significantly resulting in undue delays in the delivery of LLINs.” More progress was made during the remaining months of the year.
Where are we on 31st December 2010? The Roll Back Malaria Partnership’s most recent report on progress toward targets (the country road maps) is seen in the chart. Intervention coverage progress is based on the number of countries that are actually implementing nets, medicines and spraying.
As can be seen the best progress comes with treatment and preventive medicines (ACTs and IPTp respectively). Only 64% of countries have distributed at nets to at least 80% of the targets. The biggest gap in in the area of rapid diagnostic testing.
Distribution of an intervention does not mean actual coverage has been achieved. A recently reported study from Nigeria shows the challenges once nets reach the household.
Oyeyemi and colleagues found that 95.2% of households has received a net after a campaign. Unfortunately progress went downhill from there: “87.3% of the LLINs received were present in the households during the survey and 52.1% of households hung their LLINs … (and) utilization rate of a LLIN among the sampled population was 59% the previous night before the survey.”
Recent Demographic and Health and Malaria Indicator Surveys from places like Liberia, Senegal and Nigeria show that possession of a net by a household is not a guarantee that it will be used.


From the chart we can see that efforts to attain universal coverage - or more accurately universal distribution - will have to proceed into 2011. Distribution goals require health systems strengthening. The coverage goals will require more intensive community outreach and education to ensure these interventions are actually used.



We are achieving outputs - commodities distributed; we are struggling with outcomes - commodities used. What will we see in terms of impact by 2015 - the latest on the list of public health targets where we started this posting?
http://www.malariafreefuture.org/blog/?p=1141