MALNUTRITION: In remote areas, bush meat still plays pivotal role in people’s diet

 Peter Reuell : November 21, 2011
Postdoctoral fellow Christopher Golden conducted a yearlong study in the northeast corner of Madagascar that found that lost access to bush meat would lead directly to a 30 percent relative increase in malnutrition among children 12 years old and younger.
How do you balance the need for biodiversity conservation with human health? For Christopher Golden ’05, that question is at the core of a paper he wrote. It says that in societies where people rely on bush meat for important micronutrients, losing their access to wildlife — either because of unsustainable harvesting or strict conservation enforcement — could harm some children.
Published in the Nov. 22 issue of Proceedings of the National Academy of Sciences, Golden’s research paper reports on a yearlong study, conducted in the northeast corner of Madagascar, that found that lost access to bush meat would lead directly to a 30 percent relative increase in malnutrition among children 12 years old and younger.
“This research highlights a tension between conservation policy and human health and livelihoods, but solutions could be designed to benefit both,” said Golden, a postdoctoral Fellow at Harvard’s Center for the Environment. “I wanted to study this question through the lens of ecosystem services. If the wildlife is the natural capital, and the surplus is the harvested meat, what benefit do we receive from being able to rely on this source of food?
“This is an area that is extremely poor,” Golden added. “Madagascar is often ranked among the top 10 poorest nations in the world, and this region is among the most impoverished in Madagascar. People there eat beef maybe one to four times a year, and chicken maybe once a month. So the wild foods they’re receiving are enormously important, because the meat is providing the nutrients they aren’t getting elsewhere.”
Though his paper points toward potential negative consequences of strict conservation action, Golden emphasized that it isn’t a call to halt all conservation efforts.
“I’m just looking at one possible way in which biodiversity impacts human health,” he said. “There are a host of other ways in which maintaining intact ecosystems benefits human health that this paper does not explore. In my heart, I believe that conservation is a powerful and positive process that, were it not in place, it’s very likely that these animals would be unsustainably harvested. Ultimately, in this region, we’re dealing with the confluences of cultural preference, policy restrictions, and food necessity. It’s a very difficult area to traverse.”
Though the word malnutrition conjures up images of starving children, the most prevalent form of the condition is actually anemia, Golden said. Globally, nearly 2 billion people suffer from iron deficiency, a form of anemia that causes drops in hemoglobin, the protein that helps to ferry oxygen through the body.
Even small dips in hemoglobin levels, Golden said, have been linked to problems in cognitive development, increases in maternal mortality, and mental retardation.
To examine whether and how the consumption of bush meat affects hemoglobin levels, Golden designed a study that closely monitored the diets of children in one part of Madagascar. Over a year, researchers took monthly blood samples from children 12 or younger to measure hemoglobin levels. In addition, the children’s diets were precisely measured and recorded.
“Every scrap of fish, every bit of meat, it was weighed before it went into the cooking pot,” Golden said. “The goal was to create a study that would examine the causal links between biodiversity change and human health. Because of the longitudinal study design, we were able to disentangle the true effect of bush meat on hemoglobin levels.”
Armed with those results, Golden and colleagues were then able to model the health effects of cutting off access to bush meat. The results, he said, were a 12 percent absolute increase in anemia, and a 30 percent relative increase.
The findings suggest that the norm shouldn’t be unrestricted hunting or strict conservation, but a happy medium, where conservation efforts maintain forests as a sustainable resource that people can rely on to supplement their diets, or where there’s a system that allows people to reduce hunting in favor of raising domestic animals for food.
Going forward, Golden said, his goal is to broaden his research to see whether the same effect is observed in other populations, and to bring together the public health and conservation communities in a search for possible policy solutions that can maintain health while also protecting wildlife.
“The interesting thing about this research is it’s empirical. It’s data-driven,” Golden said. “There are very few papers in the literature that examine how changes in people’s environment or their natural resources are impacting human health.”
In an effort to expand the literature on the topic, Golden and colleagues from the University of California, Berkeley, earlier this year received a grant from the National Science Foundation to expand the research in Madagascar, and to bring the study to Ghana and Kenya. Golden, through Harvard, is part of a 24-institution consortium seeking to conduct similar studies in Southeast Asia with his new advisers, Samuel Myers and Walter Willett of the Harvard School of Public Health.
“I’m hoping that this research brings together people from the development, public health, and conservation communities,” he said. “The theoretical framework of how these things work together has always been there. People like to say, ‘Healthy environment, healthy people.’ It’s intuitive, and it makes sense. But until now, the empirical evidence to support it hasn’t been well supported.”
Golden’s research was supported by the National Geographic Society Conservation Trust, the Margot Marsh Biodiversity Fund, the Mohamed bin Zayed Species Conservation Fund, and the National Science Foundation, and was conducted while he completed a Ph.D. at Berkeley.
http://news.harvard.edu/gazette/section/science-n-health/

MALNUTRITION: India: Women Malnutrition

As per National Family Health Survey-3, 2005-06, the prevalence of chronic energy deficiency (measured as low Body Mass Index) is 36.4% and 35.1% in Hindu and Muslim women aged 15-49 years and prevalence of anemia is 55.9% and 54.7% respectively. Thus, there appears to be no Hindu - Muslim divide on women suffering from malnutrition, the Minister of Women and Child Development Smt. Krishna Tirath stated in reply to a question in Rajya Sabha today. The problem of malnutrition is complex, multi-dimensional and inter-generational in nature. The approach to dealing with the nutrition challenges has been two pronged: Multi-sectoral approach for accelerated action on the determinants of malnutrition in targeting nutrition in schemes/ programmes of all the sectors. As the multi-sectoral approach takes some time to show results and when implemented together, have a trickle down and horizontal effect to benefit the population over a period of time, other part of the approach is direct and specific interventions targeted towards the vulnerable groups such as children below 6 years, adolescent girls, pregnant and lactating mothers, she replied.
The Minister stated that the Government has accorded priority to the issue of malnutrition and is implementing several schemes /programmes of different Ministries/Departments through State Governments/UT Administrations which directly or indirectly have an impact on the nutritional status of the children. Several of the schemes namely, Integrated Child Development Services (ICDS) Scheme, National Rural Health Mission (NRHM ), Mid Day Meal Scheme (MDM, Total Sanitation Campaign (TSC), National Rural Drinking Water Programme (NRDWP) have been expanded in recent years to provide for increased coverage and improved services to the people and the impact of these schemes are likely to be visible after some time.
Further, to improve the nutritional status, nutrition education of the people, individually and collectively, forms an integral component of several of the above schemes such as the ICDS, NRHM, etc and is also undertaken by using different media such as mass media, print media, folk media etc
http://pib.nic.in/newsite/erelease.aspx?relid=77491

MALNUTRITION: Phillipines: I-rice: Key to eradicating malnutrition by 2015

Easter Anne Doza BACOLOD CITY, Nov. 16 (PIA) -- According to the Food and Nutrition Rice Institute (FNRI), iron deficiency anemia (IDA) is still a public health concern in the Philippines. In the latest 2008 National Nutrition Survey conducted by the FNRI, IDA is prevalent among children 6 months to less than 1 year, pregnant and lactating mothers.
Thus, NFA-Negros Occidental is conducting a series of advocacy campaigns on Iron-Fortified Rice that would encourage consumption of iron fortified rice. NFA Provincial Manager Marianito Bejemino said that I-Rice was designed to curb malnutrition especially among children.
“I-rice is priced the same as ordinary NFA rice. Generally, there is no change in taste, it's just psychological since I-rice is somewhat yellowish in color but that’s what makes it nutritious because of the yellow grains containing iron rice premix,” Bejemino said. He added that it has slowly gained acceptability since it was launched two years ago.
Provincial Nutritionist Alice Matti revealed that the government targets to eradicate malnutrition by the end of 2015 to reach the Millennium Development Goal, thus, it launched the micronutrient supplementation especially to children and mothers in their productive age from 15 to 49 years old.
In Negros Occidental, 8 out 100 children are malnourished and in Western Visayas 61 out of 100 mothers are anemic, 44 out of 100 pregnant mothers are anemic while those children below five years old 29 out of 100 are anemic, Matti added.
This means that there is Vitamin A deficiency, IDA, and iron deficiency disorder among these children and mothers.
The Philippine Food Fortification Law of 2000 or the Republic Act 8976 calls for the mandatory fortification of staples such as rice, flour, cooking oil, and refined sugar, among other food. (JSC/EAD-PIA6 Negros Occidental)
http://www.pia.gov.ph/?m=1&t=1&id=64346

MALNUTRITION: Nigeria: Saving a child could be down to a couple of nutrients

Anna Angbazo : July 10, 2011



Poor diets retard children’s growth and their development, including their cognitive development. Photo: REUTERS

Although the federal government has expressed its commitment to meeting the Millennium Development Goals, especially as relates to health, some experts say investment in quick gains projects such as improved nutrition would be cheap but eventually productive for the nation.
In 2000, for instance, the World Health Organisation (WHO) ranked Nigeria’s health system 187th out of its 191 member states, particularly due to problems such as hunger and malnutrition, which have become increasingly severe over the years.
Jane Miller, the country representative of UK’s Department for International Development (DFID), explains the rationale behind Nigeria’s poor ranking rather succinctly.
“Malnutrition, malaria and communicable diseases such as measles, diarrhoea and pneumonia significantly contribute to maternal and child mortality and morbidity,” Miller says, adding that “one million Nigerian children under the age of five die each year.”
Malnutrition has been a serious concern to the WHO, which insists that it is by far the major factor behind child mortality, with underweight births and inter-uterine growth restrictions causing 2.2 million child deaths every year.
The global health agency says mothers’ neglect of infants’ breast-feeding also causes about 1.4 million deaths, while describing malnutrition as the most serious single threat to public health across the world.
Linus Awute, the permanent secretary of the Federal Ministry of Health, concedes that Nigeria is one of the countries that are mostly affected by deaths of children under the age of five years due to factors such as malnutrition.
He stresses that over two-thirds of malnutrition-related deaths of children usually occur within the first year of their existence, adding that the children’s undernourishment is associated with inappropriate feeding practices.
“Appropriate feeding of infants and young children remains a key factor in promoting health and child survival. However, many mothers have yet to imbibe the required child-feeding attitudes and practices, in spite of many public sensitisation campaigns,” he says.
Going from the general to the specifics, the WHO says malnutrition is also responsible for about 14 percent of infants born with low birth weights in Nigeria and more than 75 percent of children, under the age of five, who are anaemic.
Mr Awute, on his part, stresses that babies who undergo exclusive breast-feeding do well in their first six months of life, adding, however, that such babies subsequently need adequate and appropriate complementary feeding for them not to become malnourished.
He also said malnutrition usually crops up because of deficiencies of macro- and micro-nutrients in the babies’ food, adding that these deficiencies induce ”protein-energy malnutrition, iron-deficiency anaemia, iodine-deficiency disorders and Vitamin A-deficiency.”
Lawan Tahir, a paediatrician, also called on new parents to ensure that infants are given healthy, balanced diets after stopping their breast-feeding.
“To reduce child mortality, mothers should feed their children with balanced diets after they have been weaned,” he says.

Killer of young ones
Mr Tahir, a senior registrar at the National Hospital, Abuja, who said two out of every three child deaths are related to malnutrition, adding that a malnourished child is prone to numerous diseases because of the child’s poor immune system which cannot resist infections.
After breast-feeding, the next thing most mothers do is introducing the babies to cereals, as the infants feed on mainly carbohydrate diets.
“Nevertheless, what the child needs at that point is actually not carbohydrates alone but proteins, fats and oils, as well as micro-nutrients to enable him or her to have a balanced nutrition,” he said. “Unfortunately, most children are not given well-balanced diets, probably due to their parents’ poverty or ignorance.”
Mr Tahir adds that poor diets retard children’s growth and their development, including their cognitive development. The paediatrician explains that malnutrition is a health condition which signifies poor nutrition, as well as an imbalance between the intake of nutrients and what the body actually requires.
Experts say rising cases of malnutrition in Nigeria can be attributed to the lack of food security in the country, poor feeding habits, waning exclusive breast-feeding of newborn babies and poor quality complementary feeding of infants after the age of six months.
Another paediatrician, Azeez Ibrahim says micro-nutrients deficiency is a direct cause of child mortality.
“Micro-nutrients such as iron, iodine, and Vitamin A are necessary for the healthy development of children, while their absence in diets can cause serious disorders,” he said He, however, said malnutrition is not a health problem of children alone, adding that “many adolescents are also having malnutrition problems and these affect their learning processes and productivity.”
Mr Ibrahim, nonetheless, insists that some cases of malnutrition in adolescents are due to increased intake of carbonated drinks (soft drinks), as such drinks only provide “empty calories” that are insufficient to meet the body’s requirements for proper growth.
“Malnutrition in a female adolescent is worse because as the young ladies prepare for marriage, they need a balanced diet for them to attain their potential as women,” he says.

All together on safety
As part of efforts to foster improved nutrition in Nigeria, the Global Alliance for Improved Nutrition (GAIN) is working with the federal government via the National Fortification Alliance (NFA). The NFA comprises government regulatory agencies such as National Agency for Food, Drug Administration and Control (NAFDAC) and the Standards Organisation of Nigeria (SON).
Hauwa Keri, NAFDAC’s director of Establishment Inspection, says the aim of the government policy on fortified foods is to get more nutritious staple foods like wheat and maize flour, vegetable oil and sugar into the markets and homes of vulnerable families whose diets lack the essential micro-nutrients.
“The goal of the effort, which began in March 2007, is to change the lives of the citizens by giving them a chance to eat more balanced diets every day,” she says.
Ms Keri stresses that the Federal Government has been leading a national campaign to add essential micro-nutrients to food products such as wheat and maize flour, refined sugar and vegetable oils since 2002.
Besides, Ms Keri said, a pilot programme is underway to fortify table salt with iron so as to provide the needed micronutrients for the people, adding that table salt is already being fortified with iodine.
“The project is at a pilot stage in three zones and it aims at ascertaining whether fortifying salt with iodine and iron will be acceptable,” she says. “It is also at a research and study stage; the outcome of the investigations will determine whether to adopt the iron fortification scheme or not.”
Larry Umunah, the country representative of GAIN, says Nigeria has been identified as one of the countries that are determined to tackle the menace of malnutrition frontally.
He, however, stresses the need to ensure that mothers and children have proper nutrients so as to curb the rising menace of maternal and child mortality in the country.
Umunah said if Nigeria is able to effectively tackle the issue of malnutrition among mothers and children, the country will definitely be in a better position to achieve the health targets of the UN Millennium Development Goals (MDGs).
“Ensuring that mothers and children have proper nutrients is of paramount importance. If Nigerian mothers and children are able to have improved nutrients, the country will move toward achieving the MDGs,” he said.
Dr Orhii, the director general of NAFDAC, however, stresses the need for regulatory agencies to enforce the full compliance of food industries with the extant regulation regarding the fortification of their products.
Mr Orhii bemoans the inability of the vast majority of the rural people to have access to fortified foods, adding that the prevalence of ”hidden hunger” among the rural populace has been a source of public health concern.
The NAFDAC director says that fortified foods contain all the essential vitamins that prevent diseases, adding that lack of iodine in salt, for instance, can make a child dull.
“Iodine deficiency can also interfere with the reproductive system of girls in future,” he said. “We insist on the fortification of foods with essential vitamins to prevent diseases which usually affect vulnerable groups like pregnant women and children below the age of five.”
http://234next.com/csp/cms/sites/Next/Home/5728780-146/saving_a_child_could_be_down.csp

MALARIA: Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine against Malaria and Anemia in Pregnant Women

Nana O. Wilson*, Fatou K. Ceesay, Samuel A. Obed, Andrew A. Adjei, Richard K. Gyasi, Patricia Rodney, Yassa Ndjakani, Winston A. Anderson, Naomi W. Lucchi and Jonathan K. Stiles
Abstract.
The effectiveness of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) against malaria and anemia is unclear because of the spread of SP-resistant Plasmodium falciparum. This study evaluates the effectiveness of IPTp-SP among pregnant women attending the antenatal clinic at Korle-Bu Teaching Hospital in Accra, Ghana. A cross-sectional study comparing malaria and anemia prevalence among pregnant women using IPTp-SP with non-IPTp-SP users was conducted during June–August 2009. A total of 363 pregnant women (202 of IPTp users and 161 non-IPTp users) were recruited. A total of 15.3% of IPTp users had malaria compared with 44.7% of non-IPTp users (P < 0.001). A total of 58.4% of non-IPTp users were anemic compared with 22.8% of IPTp users (P < 0.001). When we controlled for other variables, the difference in the prevalence of malaria (odds ratio = 0.18, 95% confidence interval = 0.08–0.37) and anemia (odds ratio = 0.20, 95% confidence interval = 0.12–0.34) remained significant. The recommended IPTp-SP regimen is useful in preventing malaria and anemia among pregnant women in Ghana.

http://www.ajtmh.org/content/85/1/12.abstract

MALARIA: Sierra Leone: Quarter of Vital Donated Drugs Missing or Stolen

14 Jun 2011 : IPS News
Sierra Leone - Three-year-old David bolts up from his feverish stooper as a needle pricks his thumb, producing a tiny bead of blood. He looks down horrified but is too exhausted to cry and falls back into his mother's lap as the blood is wiped away. Juane K. Nabieu, a community health officer in the district's main Peripheral Health Unit (PHU) drops the specimen of blood onto a strip. Within seconds two fine lines appear and David's mother Naomi Sam is told that her son has malaria.
Malaria is endemic in the country - it is one of the biggest killers of children. David is lucky. He is treated with the last batch of Artemisinin-based Combination Therapies (ACT) that Nabieu has just collected from the neighbouring district government drug storeroom. But poor record keeping, wastage and theft may be responsible for the loss of a quarter of vital aids drugs that have gone missing from the central government warehouse in Freetown, denying other children like three-year-old David the chance of survival.
The regular UNICEF stocktake found a preliminary figure of 25 percent of the aid was unaccounted for, UNICEF said in a statement on Jun. 14. The drugs are thought to include vital life-saving drugs like ACT. "An internal stock take report revealed the possible loss of drugs destined for government health clinics and that we asked the authorities to review... At present we are still looking into how much of the losses can be attributed to poor record keeping at health centres and district warehouses or to wastage due to improper storage or theft."
A UNICEF representative said that the internal stock take began at the end of 2010, and has just been completed. It reviewed stocks from the rural health posts across the country in a bottom-up check of drugs. It also follows reports from district hospitals across the country and PHUs about an ongoing shortage of ACT, vital in the treatment of malaria. At the Khailahun PHU there are only two more packets of ACT left - serving 156 PHUs. When the remaining doses run out, Nabieu, will refer his patients to the government district hospital.
"Most of the people who come here will not be able to afford the ACT sold privately - they rely on the free drugs," he says sitting behind a desk with an array of medicine bottles all lined up in front of him. "You can see we have many drugs, but the supply of fast moving essential ones like ACT always arrives in spurts - every month there is a shortage, and every month there will be people who suffer because of it." Sierra Leone's government took a massive step when it announced last April that health care for children under five and pregnant women would be free. The Free Health Care Initiative is 90 percent funded by international donors like UNICEF, the African Development Bank, UNFPA and the government of Sierra Leone.
In Khailahun district, drugs that were given as aid by the Global Fund and UNICEF are reported to be found in private drugs shops and sold by street market traders. "We have patients who come from neighbouring Liberia, which puts a strain on our resources, but the drugs in the local market may also be drugs that have come from Liberia or Guinea - the aid that comes into West Africa is generic and that makes it easy to sell anywhere," Nabieu explains. On the other side of Khailahun town, at the district hospital, things are no better. In the paediatric ward, tightly packed with mothers and babies all eerily quiet, nurse Alice Mansaray has a stack of paperwork and a new baby with complications from malaria to admit.
"Most children come to us with severe anaemia or convulsions - sometimes their mothers suppress their child's fever with paracetamol, when there are no free stocks of ACT in their PHUs, and they can't afford the private drugs. "When I run out of ACTs I send them to a private drug store. They have to go because they can't see their children die. We have seen more cases of malaria and more children with complications," she says as she holds up a strip of ACT. Though the government's hospital monitors say malaria cases have decreased compared to last year in Khailahun, there is no record kept of how many patients come back with complications. There is also no record of those who were entitled to free drugs, or who had to purchase them from the private sector because of the shortage of aid.
The Civil Society organisation, Health for All Coalition (HFAC), implemented a monitoring system, parallel to the government's. Alhassan Kamara at HFAC estimates that 45 to 50 percent of the aid that comes in disappears finding its way to the market - though no survey has been conducted to substantiate this. "Our monitors travel in drug delivery trucks. We insist community and district hospital representatives receive the consignment." This has reduced the "leakages" Kamara calls the thefts. "Transportation from district to the PHU needs to be strengthened. There is less transparency, and scope to sell on route."
This is not the first time such irregularities have been discovered in Sierra Leone. In 2008 a BBC report discovered UNICEF's malaria drugs in Kono (Eastern Province) were being re-sold in private pharmacies. "If there was such mass pilfering, the system would collapse," says Dr Amara Jambai, director of Disease Prevention and Control at the ministry of health and sanitation. "The community are very active and watch supplies very closely." Jambai admits that the capacity of the government is too weak to deliver the drugs to each PHU. "The cause of the shortage is not because there are thefts, but because demand is great, and the system is new."
The district hospitals in Khailahun, Pujehan in the South, and Bo in Central Sierra Leone, say that when they have approached Freetown for ACT, they still have supply issues. Pujehan hospital said they had not received a delivery since February - though they had a small supply remaining of ACT, other essentials like antibiotics and paracetamol had long been unavailable. Mahimbo Mdoe, UNICEF country representative says that UNICEF is due to take over the operation to run the logistics themselves. "We are hiring an international company to manage the central warehouse, and they will be responsible for doing a "milk-round" to all 1,200 PHU's across the country. "A year ago 80 percent of people didn't go to the doctors because of the cost. Sierra Leone is a fragile state. The numbers of people accessing the aid for the first time is an important step forward."
Meanwhile, Naomi Sam says that she could not have gone to the private drug store to buy the ACT that has just saved David's life if it were unavailable, because "I have no money," she says simply. She knows that coming to the PHU means that David will get free treatment. But, the 20 or so women with sick babies waiting outside may not be so lucky today.
http://www.ipsnews.net/news.asp?idnews=56071

MALNUTRITION: West Africa: Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections

June 9, 2011 : Matt Artz
Ricardo J. Soares Magalhães and Archie C. A. Clements

“Background: Childhood anaemia is considered a severe public health problem in most countries of sub-Saharan Africa. We investigated the geographical distribution of prevalence of anaemia and mean haemoglobin concentration (Hb) in children aged 1–4 y (preschool children) in West Africa. The aim was to estimate the geographical risk profile of anaemia accounting for malnutrition, malaria, and helminth infections, the risk of anaemia attributable to these factors, and the number of anaemia cases in preschool children for 2011.
Predictive geographical risk of anaemia in children aged 1–4 y, based on a model-based geostatistical Bernoulli model.

“Methods and Findings: National cross-sectional household-based demographic health surveys were conducted in 7,147 children aged 1–4 y in Burkina Faso, Ghana, and Mali in 2003–2006. Bayesian geostatistical models were developed to predict the geographical distribution of mean Hb and anaemia risk, adjusting for the nutritional status of preschool children, the location of their residence, predicted Plasmodium falciparum parasite rate in the 2- to 10-y age group (Pf PR2–10), and predicted prevalence of Schistosoma haematobium and hookworm infections. In the four countries, prevalence of mild, moderate, and severe anaemia was 21%, 66%, and 13% in Burkina Faso; 28%, 65%, and 7% in Ghana, and 26%, 62%, and 12% in Mali. The mean Hb was lowest in Burkina Faso (89 g/l), in males (93 g/l), and for children 1–2 y (88 g/l). In West Africa, severe malnutrition, Pf PR2–10, and biological synergisms between S. haematobium and hookworm infections were significantly associated with anaemia risk; an estimated 36.8%, 14.9%, 3.7%, 4.2%, and 0.9% of anaemia cases could be averted by treating malnutrition, malaria, S. haematobium infections, hookworm infections, and S. haematobium/hookworm coinfections, respectively. A large spatial cluster of low mean Hb (95%) was predicted for an area shared by Burkina Faso and Mali. We estimate that in 2011, approximately 6.7 million children aged 1–4 y are anaemic in the three study countries.

“Conclusions: By mapping the distribution of anaemia risk in preschool children adjusted for malnutrition and parasitic infections, we provide a means to identify the geographical limits of anaemia burden and the contribution that malnutrition and parasites make to anaemia. Spatial targeting of ancillary micronutrient supplementation and control of other anaemia causes, such as malaria and helminth infection, can contribute to efficiently reducing the burden of anaemia in preschool children in Africa.”

http://gisandscience.com/2011/06/09/mapping-the-risk-of-anaemia-in-preschool-age-children-the-contribution-of-malnutrition-malaria-and-helminth-infections-in-west-africa/

MALARIA: Plasmodium knowlesi in children in Malaysia

Plasmodium knowlesi can cause severe malaria in adults; however, descriptions of clinical disease in children are lacking. We reviewed case records of children (age <15 years) with a malaria diagnosis at Kudat District Hospital, serving a largely deforested area of Sabah, Malaysia, during January–November 2009. Sixteen children with PCR-confirmed P. knowlesi monoinfection were compared with 14 children with P. falciparum monoinfection diagnosed by microscopy or PCR. Four children with knowlesi malaria had a hemoglobin level at admission of <10.0 g/dL (minimum lowest level 6.4 g/dL). Minimum level platelet counts were lower in knowlesi than in falciparum malaria (median 76,500/μL vs. 156,000/mL; p = 0.01). Most (81%) children with P. knowlesi malaria received chloroquine and primaquine; median parasite clearance time was 2 days (range 1–5 days). P. knowlesi is the most common cause of childhood malaria in Kudat. Although infection is generally uncomplicated, anemia is common and thrombocytopenia universal. Transmission dynamics in this region require additional investigation.
http://www.cdc.gov/eid/content/17/5/814.htm

MALNUTRITION: India: Iron rich salt to fight malnutrition

Apr 21, 2011,
With high prevalence of anaemia in the country, the government has decided to promote iron fortified iodised salt as a measure to deal with malnutrition.
The decision was taken at a meeting held in the Prime Minister's Office on promoting consumption of iron fortified iodised salt.
The meeting attended by various ministries called for the urgent measures to tackle anaemia in India's population, particularly among adolescent girls, women and children.
Anaemia is caused by inadequate intake and poor absorption of iron. It can be prevented and cured by promoting consumption of iron rich foods and iron supplements.
The National Institute of Nutrition (NIN), Hyderabad, has developed technologies for the double fortification of salt with iodine and iron.
http://articles.timesofindia.indiatimes.com/2011-04-21/health/29458814_1_iodised-salt-iron-fight-malnutrition

MALNUTRITION: Malnutrition Plagues Guatemala's Children

BY TALEA MILLER: Feb. 16, 2011 Guatemala has the highest rate of chronic malnutrition among children in Latin America, and the health consequences continue on through adulthood.


Children ages 3 and 4 in Guatemala; Photo by Talea Miller


Kayla is months away from her fifth birthday and weighs just 18 pounds, about half what a girl her age should by World Health Organization standards.
She suffers from chronic malnutrition and can barely move. Even breathing appears difficult. During a recent visit to Hospitalito Atitlan in rural Guatemala, she was cradled in her mother's arms and whisked from examination room to examination room.
 Kayla's brain development is not progressing, her physical development is stunted,and she can't do simple tasks for herself, said her physical therapist Andrea Maria Sojuel.
Sojuel works for a small non-profit called ADISA, serving disabled patients in the indigenous community of Santiago Atitlan. She sees quite a few children with the same condition. Another patient of hers, a 20-month-old, weighs just eight pounds.



Kayla with her mother at Hospitalito Atitlan.
About 49 percent of children in Guatemala are chronically malnourished according to the World Food Program—the fourth highest ratein the world. In indigenous communities the rate is closer to 70 percent.
While most won't manifest symptoms as grave as Kayla's, they will all suffer health consequences because of the condition. Chronic malnutrition causes stunted growth, the most obvious and widespread indicator in Guatemala, but also increases the chances of children developing heart disease, diabetes and kidney damage down the line. It can cause anemia as well, greatly increasing the risk of a woman dying in child birth.
Infections that cause diarrhea play a big roll in malnutrition of infants, but for many families the root problem comes down to numbers—too many mouths to feed, not enough food.
"Sometimes it's a question of too many children. The boys will sometimes preferentially get food over the girls, I have seen that," said Mark Lepore, a visiting physician working at the hospital.
Asuncion Don Diego, from Alotenango, near Antigua, knows just how difficult these choices can be. She and her husband have seven children. He plants corn for a living, she took a job washing clothes to help pay for food.
"We would at least try to have tortillas, even if that is all we could feed them," she said through an interpreter.
Jose Andres Botran , who helped create an office in the Guatemalan government specifically to address the problem of food security, said a lack of education on what foods are important for children is part of the problem.
"A person can have 12 tortillas and a Coke and will not be hungry but they won't be well nourished," he said.
Awareness about malnutrition has grown, but necessary monitoring has not been put in place to see if the situation is improving, Botran said. The food security office has helped connect stake holders and runs initiatives to provide fortified foods and educate the population.
USAID also contributes between $16 to $18 million a year in food assistance to the country, including some higher protein commodities like beans and grains fortified with soy.
Still, says Chessa Lutter, regional advisor for the Pan American Health Organization, Guatemala continues to have some of the poorest nutrition indicators in the region and once a child has been malnourished through crucial early development, it has long-lasting implications.
PAHO reports that Guatemala has the highest rates of obesity among poor countries in Latin America, linked to malnutrition. Once a person is stunted and below-average height, it is much easier for them to become overweight.
"The same type of diet, that is heavy in carbs and cheap fats, which makes kids short and anemic also makes adults fat," Lutter said.
For Kayla, the road ahead holds more immediate concerns. She has sores in her throat that make her not want to eat, and she is actually losing weight instead of gaining. It's hard to imagine that she will ever be able to attend school.
"What I worry about most [with these children] is education, the ability to learn" said Lepore, her doctor.
http://www.pbs.org/newshour/updates/latin_america/jan-june11/nutrition_02-16.html

MALNUTRITION: Niger between two seasons of hunger

04 Feb 2011
Despite the large-scale response to the nutritional crisis from Médecins Sans Frontières (MSF) and many other organisations, tens of thousands of children suffered from malnutrition in Niger in 2010. In spite of better harvests, 2011 also looks set to be a critical year. I travelled to the Zinder region, in the east of the country.



  © Philippe Latour
Village elder Salouf Kina and his son Abukar discuss the latest village events.

Around a hundred years ago, the father of Salouf Kina, 80, founded the small village of Gueza, three hours' drive east of Zinder, the former capital of Niger.
"He was taking his cows to a new grazing ground and decided to settle here with his family. There was plenty of greenery and water here at the time. I've always lived here, but this year [2010] is the worst I've seen," he recalled with a faltering voice.
Today, Gueza, with 2,000 inhabitants, is a patchwork of mud huts built along sandy streets, where the odd tree provides some rare shade. In the surrounding area, a few scrubby fields of millet left over from the recent harvest give the hills an air of neglect.
Salouf Kina's son, Aboukar, has been one of the village wise men for more than 50 years. Aboukar, who is also a neighbourhood chief, tells of the terrible lean period that the inhabitants of Gueza experienced in 2010.
"At the end of 2009, the harvests were very bad and some families harvested nothing at all because of the drought,” he explained. “When people's stocks ran out and they could no longer borrow, they had to leave the village - young men at first, to go and work in Nigeria, then whole families.
“Between May and September, more than half of the village fled, leaving behind only women, young children and the elderly. We're a long way from everything and few people are interested in us. If MSF hadn't set up a feeding centre at the health centre, all of us would have left and the village might have died."
Gueza's Integrated Health Centre is one of the only concrete buildings in the village. It is the young Mamane Bashir, the centre manager, who greets us. During this period in late December, there were few consultations and MSF had packed up its out-patient nutrition education and rehabilitation centre for cases of severe malnutrition (CRENAS). It is hard to imagine that three months ago some 300 children were being treated by the MSF team here.
"The rains came very early this year and the malnutrition situation was exacerbated by malaria, which hit the weakest children,” explained Bashir. “Last August, we treated around 600 children, compared with just a hundred or so in August, 2009. This is also linked to MSF's presence, which ensured that the medicines and therapeutic foods didn't run out."
In Zinder and Magaria, the main towns in this region of Niger, at the end of December, there are still some 200 children in the beds of the CRENIs, the intensive hospitalisation centres set up by MSF for the most serious cases of malnutrition. However, these facilities - rows of beds under large tents - now seem relatively empty. At the height of the nutritional crisis, in August and September, more than 800 children were being treated there, the majority of them on the brink of death.
Kelima, 32, and a mother of four, took her youngest child, Djamilou, aged 15 months, to the Zinder CRENI in early December. He had lost a lot of weight. The MSF doctor diagnosed him with severe anaemia combined with malaria. After being immediately put on a drip and then fed therapeutic foods, he gradually gained weight. Two weeks later, he smiles and waves his hands when spoken to. "Soon we'll be able to go back to the village" explained Kelima, relieved. "But this year, it was really too difficult to feed the children; there were only a few handfuls of millet for the whole family...".
"Unfortunately, 2010 was the year that broke every record,” underlined Dr Moïse Moussa Gabrial, head of the Magaria CRENI. "Since January 2010, we've seen more than 6,200 children. At the end of August, we had around 500 hospitalised children. We had planned to recruit and train medical staff, but the situation was so bad that we had to hire people locally and train them on the job.
“At the height of the malnutrition crisis, 280 people were working for MSF at the CRENI. And tragically, we saw the deaths of many children - 133 in September alone - who had arrived in a desperate nutritional state and were often suffering from malaria".
However, 2010 was also the year of unprecedented mobilisation to fight famine in Niger. The government, born of a coup d'état at the beginning of the year, made food security one of its central causes and called upon international organisations to help. A number of organisations, including MSF, provided extensive support for care facilities and implemented large-scale prevention strategies, particularly based on appropriate food supplements, making it possible to limit the damage.
"We dare not imagine what would have happened if no one had rallied to help", explained Patrick Barbier, MSF's Head of Mission in Niger. "But what worries us today is that, despite some good harvests at the end of 2010, 2011 still risks being a very difficult year, in a context which remains one of extreme poverty, often combined with a lack of access to care.
“In nearly all the country's regions, families are heavily in debt and must now, after the harvest, pay back three or four measures of millet for every two borrowed. Added to which, many families’ livestock assets have been reduced from a whole herd at the start of the year to just a few goats and sheep. International organisations and aid agencies must remain extremely vigilant and prepare to intervene on a large scale again in 2011."
In Gueza, Salouf Kina's grandson and Aboukar's son has just turned 20 and already has the serious face of an old man. In a few days, he will set off for Nigeria to sell tea in the street to enable his family to survive in the village and keep the hope that a life there is still possible alive.
http://www.msf.org/msf/articles/2011/02/niger-between-two-seasons-of-hunger.cfm

MALNUTRITION: Burundi : Fortified Rice for 15,000 School-Children

Burundi is set to benefit from a rice fortification technology that will not only be the first in Africa but will also help check malnutrition in children through school-feeding programmes.
International organizations PATH and World Vision will introduce Ultra Rice, made from rice flour and enriched with micronutrients, including iron, zinc and folic acid, to about 15,000 children from April.
Marc Neilson, a public information officer for the World Food Programme (WFP), told IRIN that "the purpose of the Ultra Rice project is to conduct a field trial to test the operational feasibility and biological impact of introducing fortified rice through a large food-aid programme".
Thomas Ruttoh, operations director for World Vision Burundi, said the project was "primarily about improving the nutritional quality of the food being taken by the children; anaemia is about 31 percent in Burundi".
The end result of the project, he said, would be to address malnutrition, which is considered "very high" in Burundi.
"Children can eat cassava, they can eat potatoes, but it is not the right food for a child because there is something missing," Rutto said, adding that the rice fortification was done mainly with iron as a micro-nutrient.
In October 2010, PATH received US$1 million from the US Department of Agriculture and the National Institute of Food and Agriculture for the project.
"With the USDA grant, PATH will bring the benefits of Ultra Rice to the African continent for the first time, and we are thrilled to do so in collaboration with World Vision," Dipika Matthias, director of PATH's Ultra Rice Project, said in a statement. "Our pilot [project] will generate critical data and also serve as a model for improving the nutritional quality of rice-based food aid."
Matthias said the project would focus on generating both operational and biological impact data to demonstrate that PATH's Ultra Rice is an effective rice fortification method for food aid programmes.
World Vision Burundi will provide technical expertise and training as well as the warehouse facilities for the storage and distribution of fortified rice to about 15,000 children through a school-feeding programme supported by WFP.
http://www.portalangop.co.ao/motix/en_us/noticias/africa/2011/0/1/Fortified-Rice-for-000-School-Children,3e589159-70df-45f3-8c30-9517e882585b.html

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

MALNUTRITION: In Northern Thailand

OUSA THANANGKUL M.D., JO ANNE WHITAKER M.D.and ELEANOR G. FORT
Department of Pediatrics, Chiengmai Hospital, University of Chiengmai, Chiengmai, Thailand

One hundred and eleven patients with protein-calorie malnutrition were admitted to the Pediatric Department of Chiengmai Hospital from January 1 to December 31, 1964, representing 9.1 per cent of total admissions. Blood chemical studies were performed and hematologic data were obtained in forty-five children, and another nineteen children were studied hematologically from January 1 to March 1, 1965. The age range, clinical behavior and biochemical results were essentially similar to the patterns reported from other countries where the disease represents a major problem.
Hemoglobin levels of less than 10 gm. per 100 ml. were found in 69 per cent of the patients upon admission. It is thought that the anemia of protein-calorie malnutrition is probably due to multiple deficiencies. The effects on bone marrow and peripheral blood of treatment with vitamin E, folic acid and iron, singly and in combination, are being investigated.
Low income is not the sole factor of etiologic significance in the development of protein-calorie malnutrition. "Displacement" of a child due to the birth of a sibling before weaning would ordinarily occur, and dietary habits which, by custom, include inadequate amounts of protein and large quantities of "overmilled" vitamin-depleted rice, are equally contributory.
http://www.ajcn.org/content/18/5/379.short

MALARIA: Lessons from 3 Rounds of Malaria Indicator Surveys in Zambia

Bill Brieger

20 Dec 2010

Todd Jennings of MACEPA (Malaria Control and Evaluation Partnership in Africa, PATH) and the National Malaria Control Centre, Lusaka, provides us with an update on the newly completed Malaria Indicator Survey from Zambia.

Earlier this month Zambia’s Ministry of Health released results from their 2010 National Malaria Indicator Survey (MIS). The full report, summary and technical brief are available on the National Malaria Control Center website.
Zambia is the first African country to have conducted three of these surveys, continuing a trend in benchmarking progress and providing evidence for decision makers to guide malaria control needs. First the good news:
The use of insecticide-treated mosquito nets increased for children under the age of five increased to 50%, and to over 60% in household that owned nets in 2010.
Over 70 percent of Zambian households are now covered by at least one treated mosquito net or recent indoor residual spraying. This represents a 69 percent increase since the 2006 survey.
Pregnant women are more protected from malaria with 70% receiving at least two doses of preventive anti-malarial medicine during pregnancy.
Among children using anti-malarials for treating fever, more children are receiving Coartem®, the first line treatment for malaria, rising from 30% in 2008 to 76% this year.
These figures are among the best in Africa. Better diagnostics nationwide, especially with rapid tests to confirm malaria parasitemia, mean fewer patients with symptomatic fever are being given anti-malarial drugs and more receive better treatment counseling based on the rapid and accurate results.



But these encouraging figures are tempered with news that Luapula, Northern and Eastern Provinces reported higher levels of malaria and severe anaemia. This can partly be attributed to heavy, late rains that possibly extended the length and intensity of the transmission season and partly because net ownership and use of nets in Luapula and Northern Provinces saw a marked decrease since 2008.



The MIS is a powerful tool needed to maintain predictable funding streams to sustain levels of commodity coverage. Gains are fragile; any interruption in supply, e.g. bednets, can quickly result in a malaria comeback. Zambia and partners are already taking steps to address the country’s gap in bednet coverage. Other countries could benefit from more timely surveys and stronger partnership responses.
http://www.malariafreefuture.org/blog/?p=1129

MALNUTRITION: Spirulina

Hazem Badr
23 November 2010
Can spirulina transform from a gourmet ingredient in the West to a nutritious food source for the developing world?
A nutritious blue-green algae, known as spirulina, has been added to school meals in Jordan to combat chronic malnutrition and anaemia among children.
Almost one in ten Jordanian children suffer from chronic malnutrition, or long-term protein or energy deficiency, while a third are anaemic, according to a survey by the Jordanian Department of Statistics (DOS) made public in March.
The Intergovernmental Institution for the use of Micro-algae Spirulina against Malnutrition (IIMSAM), which has observer status with the UN Economic and Social Council, says spirulina is rich in protein and vitamin B, and contains beta-carotene that can overcome eye problems caused by Vitamin A deficiency. A tablespoon a day can eliminate iron anaemia, the most common mineral deficiency.
According to IIMSAM, a pilot feeding programme in two Kenyan schools from April 2009 to April 2010 helped cure 1,350 pupils suffering from malnutrition. The World Food Programme estimates that 22 per cent of children under the age of five in Kenya are malnourished, significantly higher than the 15 per cent level which the World Health Organization uses as a threshold to describe an emergency situation.
Naseer S. Homoud, director of IIMSAM's Middle East Office, said spirulina has a role in fighting malnourishment, especially in children, and referred to "its low cost of farming as it can be grown even on infertile land and without a large water supply."
"Climatic changes are affecting our traditional ways of producing food — we had to find unconventional sources of nutrition," Jordan's minister of agriculture Mazen Khasawneh said. But he would not comment on the spirulina trial. "It is still too early to know if it is a successful experiment or not," he said.
First indications are that children at the early stages of primary education don't take to school meals with added spirulina. Pupil Khaled Sarhan said that, at first, he did not like the taste of school biscuits containing spirulina, but "after my teacher told me how useful it is, I got used to the taste after two or three days."
"Spirulina's bitter taste will be the main problem in spreading its use among children," Ahmed Khorshed, professor of food industries at Egypt's Agricultural Research Centre said, "but adding it to other food, like biscuits, could solve the taste problem partially."
The project will report to the minister of agriculture by June 2011. If successful, spirulina meals will be expanded and could be rolled out elsewhere in the Middle East.
"Egypt will be our next stop," IIMSAM director-general, Remigio Maradona, said.
http://www.scidev.net/en/news/-wonder-food-spreads-to-middle-east.html

MALARIA: Changing trends in blood transfusion in children and neonates

Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya

Rosalon Pedro , Samuel Akech and Kathryn Maitland
Malaria Journal 2010, 9:307doi:10.1186/1475-2875-9-307
Published: 30 October 2010
Abstract (provisional)
Background
Severe anaemia is a common cause for hospitalization in children in sub-Saharan Africa. Malaria plays an important aetiological role, resulting in a substantial burden of paediatric transfusion in hospitals. A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently. This review aims to investigate whether this trend affected clinical burden, clinical severity of anaemia and requirements for paediatric transfusion.
Methods
Eight-year retrospective review of paediatric admissions to Kilifi District Hospital, Kenya describing the frequency of moderate and severe anaemia, blood transfusion and case fatality over time. Definitions for severe anaemia were Hb <8 g/dl for newborns and <5 g/dl for other age groups and for moderate anaemia was Hb 8 to <11 g/dl for newborns and 5 to <9.3 g/dl for other age groups. Life threatening anaemia was defined as severe anaemia (Hb <5 g / dl) complicated by either deep breathing or prostration or profound anaemia (Hb <4 g / dl) alone.
Results
Of the 35,139 admissions 13,037 (37%) had moderate anaemia and 2,265 (6%) had severe anaemia; respiratory distress complicated 35% of cases with Hb <5g/dl. Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia between 2002 (8%) and 2009 (<4%) (chi2 for trend=134, P <0.0001). The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend= 152, P <0.0001). Of the 2,265 children with severe anaemia 191 (8%) died. Case fatality remained unchanged during this period (P <0.26) and was largely explained by the unchanged proportion with life-threatening anaemia, present in 58-65% of cases throughout the study period.
Conclusion
The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion. Despite an overall reduction in paediatric transfusion requirement, case fatality of severe anaemia remained unchanged over this decade. Further research is required to improve outcome from severe anaemia, particularly in the high-risk group with life threatening features.
http://www.malariajournal.com/content/9/1/307

MALNUTRITION: Health Leaders Endorse Major Effort to Fight Chronic Malnutrition in Latin America and the Caribbean

 September 30, 2010
PAHO strategy targets multiple causes of stunted growth throughout the life course
Top health authorities from throughout the Americas today endorsed a major new effort to reduce chronic malnutrition, the most serious nutrition problem in Latin America and the Caribbean.
Nearly 9 million children under 5 in the Region suffer from chronic malnutrition. Some 22.3 million preschoolers, 33 million women of childbearing age, and 3.6 million pregnant women suffer from anemia. These figures are ethically unacceptable in a Region where food production exceeds the nutritional requirements of the entire population by 30 percent.
Malnutrition affects physical growth and mental development, increases the risk of illness and death and negatively affects human capital and economic well-being. In addition, malnutrition is a major factor perpetuating the cycle of poverty. Recent research suggests that malnutrition also contributes to chronic noncommunicable diseases. Low height-for-age, or stunting, is the primary indicator for chronic malnutrition and is also considered a proxy indicator for the overall living conditions of a population.
The causes of chronic malnutrition are multiple and include maternal malnutrition, poor diet, and repeated infections as immediate causes. But underlying causes such as lack of access to basic sanitation and health services, low educational levels of mothers, food insecurity, and social inequality also play major roles.
To be effective, policies and programs must address the determinants of malnutrition rather than just its effects and must intervene across the life course, rather than just during pregnancy or childhood.
The Pan American Health Organization (PAHO) strategy approved today calls on countries to:
Implement policies and programs that address the social determinants of nutrition and health, emphasizing education for girls and women, food security, household income and purchasing power, housing, and adolescent, maternal and child health.
Ensure the participation and coordination of different ministries and adequate resources at the national, municipal, and local levels.
Place priority on implementing these programs in communities that have rates of chronic malnutrition of 15 percent or more.
Develop human resources to manage and implement these programs and provide health workers with training on key food, nutrition, and health issues.
Promote partnerships between the public and private sectors, academia, international cooperation agencies, and society at large, and strengthen links between national and regional initiatives geared to promoting nutrition, health, and development.
Improve nutritional surveillance by collecting data on gender, ethnicity, and geographical area to improve policymaking, forecasting and prevention of nutritional problems. Report periodically on the prevalence of chronic malnutrition, acute malnutrition, overweight, obesity, and anemia in pregnant women and children under 5.
Promote international and national sharing of information and lessons learned about successful strategies to reduce chronic malnutrition.
The strategy calls on PAHO to provide technical cooperation in all these areas to support countries' efforts.
The PAHO Directing Council meets each year to set priorities for Pan-American cooperation in health and to guide PAHO's technical cooperation programs in its Member States.

PAHO was established in 1902 and is the world's oldest public health organization. It works with all the countries of the Americas to improve the health and quality of life of the people of the Americas and serves as the Regional Office for the Americas of the World Health Organization (WHO).
http://www.pharmpro.com/News/Feeds/2010/09/agencies-and-organizations-pan-american-health-organization-health-leaders-endorse-major-effort-to-fight-chron/

MALARIA: Cohort trial reveals community impact of insecticide-treated nets on malariometric indices in urban Ghana

02 September 2010
The efficacy of insecticide-treated nets (ITNs) in prevention of malaria and anaemia has been shown in rural settings, but their impact in urban settings is unknown. We carried out an ITN intervention in two communities in urban Accra, Ghana, where local malaria transmission is known to occur. There was evidence for a mass or community effect, despite ITN use by fewer than 35% of households. Children living within 300 m of a household with an ITN had higher haemoglobin concentrations (0.5 g/dl higher, P = 0.011) and less anaemia (odds ratio 2.21, 95% CI 1.08–4.52, P = 0.031 at month 6), than children living more than 300 m away from a household with an ITN, although malaria parasitaemias were similar.

With urban populations growing rapidly across Africa, this study shows that ITNs will be an effective tool to assist African countries to achieve their Millennium Development Goals in urban settings. [Registered trial number ISRCTN42261314].
http://www.malarianexus.com/articles/read/63/cohort-trial-reveals-community-impact-of-insecticide-treated-nets-on-malariometric-indices-in-urban-ghana/

MALARIA: Retinopathy in severe malaria in Ghanaian children - overlap between fundus changes in cerebral and non-cerebral malaria

12 August 2010
Background
In malaria-endemic areas, reliably establishing parasitaemia for diagnosis of malaria can be difficult. A retinopathy with some features unique to severe malaria with a predictive value on prognosis, has been described. Detection of this retinopathy could be a useful diagnostic tool. This study was designed to determine the diagnostic usefulness of retinopathy on ophthalmoscopy in severe malaria syndromes: Cerebral malaria (CM) and non-cerebral severe malaria (non-CM), i.e. malaria with respiratory distress (RD) and malaria with severe anaemia (SA), in Ghanaian children. Secondly, to determine any association between retinopathy and the occurrence of convulsions in patients with CM.
Methods and subjects A cross-sectional study of consecutive patients on admission with severe malaria who were assessed for retinal signs, at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, from July to August 2002 was done. All children had dilated-fundus examination by direct and indirect ophthalmoscopy.
Results
Fifty-eight children aged between six months and nine years were recruited. Twenty six(45%) had CM, 22 with convulsion; 26(45%) had SA and six(10%) had RD. Any retinopathy was seen in: CM 19(73%), SA 14(54%), RD 3(50.0%), CM with convulsion 15(68%) and CM without convulsion 4(100%). Comparison between CM versus non-CM groups showed a significant risk relationship between retinal whitening and CM(OR=11.0, CI=2.2- 56.1, p= 0.001). There was no significant association with papilloedema(OR=0.9, CI=0.3 - 3.0, p=0.9), macular whitening(OR=1.6, CI=0.5 - 4.8, p=0.4), macular haemorrhage(OR=0.28, CI=0.03 - 2.7 p=0.2), retinal haemorrhage(OR=1.9, CI=0.6 - 5.6, p= 0.3), vessel abnormality(OR=1.9, CI=0.6 - 6.1, p=0.3) and cotton wool spots(OR not calculated, p=0.08). Tortuous and engorged retinal veins, not previously described as a feature of CM, was the most common vascular abnormality(15/58 = 26%) and was detected even in the absence of papilloedema.
Conclusion
Retinal whitening, a sign suggestive of retinal ischaemia, was significantly more common in CM than in non-CM syndromes. However, the high prevalence of any retinopathy in the latter suggests that the brain and the retina may be suffering from ischaemia in both CM and non-CM.
http://www.malariajournal.com/content/9/1/232