POVERTY: SAHEL: Displaced Malians burden food-insecure hosts

BAMAKO/DAKAR, 6 February 2012 (IRIN)

 Photo: ReliefWeb
Map of areas affected by fighting and subsequent displacement

Some 12,000 Malians have fled fighting in the towns of Ménaka and Anderamboucane in northern Mali and reached already food-insecure villages around Tillabéri in western Niger, according to the International Committee of the Red Cross (ICRC) in Niger’s capital, Niamey.
The Malian refugees are spread across the villages of Mangaizé, Chinégodar, Koutoubou, Yassan and Ayorou in Niger, according to the Malian Ministry of Foreign Affairs, with the bulk of them - an estimated 7,000 - in Chinégodar, which is usually home to 1,500, according to Franck Kuwonu at the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Niamey.
Fighting broke out between Touareg rebels and former soldiers from Libya, and the Malian army in mid-January. Rebel groups and former Libya fighters have reportedly acquired fresh weapons as a result of the Libya conflict and have launched a new movement, the National Movement for the Liberation of Azawad (MNLA), which calls for the creation of an independent state encompassing the regions of Gao, Kidal and Timbuktu in northern Mali.
Niger’s Tillabéri region has been hardest hit by the 2011 drought and poor harvest and many inhabitants are already facing severe food insecurity, according to the government and aid agencies. Though assessments are still under way, the government estimated late last year that just under half of Niger’s population would be short of food this year.
“Chinégodar doesn’t even have enough grain to feed its own small population,” said Kuwonu, noting there are three tons of millet in the cereal bank. Millet prices in the area are 24,000 CFA francs (US$50) per 100kg bag, up from 19,000 CFA francs ($40) this time last year.
The ICRC and NGO Médecins Sans Frontières have been quickest to respond to refugees’ needs, the former having repaired water pumps in stressed host towns and distributed some blankets, shelter materials and food; the latter sending a nurse with basic medical supplies to help those in need.
However, logistics are slow said Kuwonu, and more food and shelter is needed. The ICRC spokesperson in Niamey, Germain Mwehu, told IRIN there is enough aid to meet immediate needs but not over the long-term.
An inter-agency UN mission evaluated the area last week and agency representatives are meeting tomorrow to discuss their response. Oxfam has also assessed the situation. All agencies will closely coordinate with the government on their response, said Kowonu.

Heading for Mauritania, Burkina, Guinea
According to PANA Press, some 6,000 Malians have also fled fighting in Léré, Niafunké and Goundam in Mali’s northern Timbuktu region, and are sheltering in Fassala Néré in Mauritania, some 1,260km east of the capital Nouakchott. A number of the children among them are allegedly severely malnourished, according to local NGO Association for Research and Development in Mauritania.
The local authorities and UN Refugee Agency (UNHCR) are currently assessing the situation in more detail, UNHCR spokesperson Elise Villechalane told IRIN from Nouakchott. An unknown number of Malians have also fled east to Burkina Faso and western Guinea, says the ICRC in Mali.
Meanwhile, an unknown number of Malians are fleeing south to Mopti, some 640km north of the capital Bamako, and to Bamako itself.
Amina Coulibaly, a producer with national radio in Gao, eastern Mali, told IRIN from the capital: “Fighting has not yet broken out in Gao [town] but given that it is one of the places the Touaregs want to make part of their republic, I prefer to leave now.”
Mali has been struggling for several years to contain rebel groups in the north, the rising power of Al-Qaeda in the Islamic Maghreb (AQIM) factions, and widespread contraband traffickers in its northern regions.
http://www.irinnews.org/report.aspx?reportID=94803

MALNUTRITION: Ethiopia Recruits Health 'Army' to Combat Child Mortality, Malnutrition

November 11, 2011: Peter Heinlein : Addis Ababa

 Photo: VOA - P. Heinlein
Dr. Monica Thallinger treats a severely malnourished child at the Phase Two emergency ward of the Doctors Without Borders health clinic at Hilaweyn refugee camp, Dollo Ado, Ethiopia, (File).

Ethiopia is organizing what it calls a Health Development Army aimed at lowering child mortality rates and improving the quality of care in rural areas where 85 percent of the population lives. The announcement came at an event marking progress in reducing malnutrition, one of the Horn of Africa's biggest child killers.
The 2011 Ethiopian Demographic and Health Survey reports nearly nine percent of the country's children die before their fifth birthday. Minister of State for Health Dr. Keseteberhan Admassu says while that figure is high, it is less than half of what it was 20 years ago.
Speaking Friday at an event to celebrate the drop in child mortality and malnutrition rates, Dr. Keseteberhan said a key factor has been establishment of a network of rural "health extension" posts.
Only a few hundred of these posts existed when the last big drought hit in 2008. Today, there are more than 9,000. The result has been tens of thousands of young lives saved.
Dr. Keseteberhan says the next step will be a military-style mobilization scheme reaching down to the family level.
"The government is setting up what we call the Health Development Army, which is basically organizing the community into small groups and engaging them to further own the programs that are implemented through the Health Extension Program," said Kesteberhan.
The minister told VOA the government hopes to recruit “model families” for the health army, who can help bring about changes in the health habits of rural Ethiopia, where malnutrition and child mortality rates are high.
"We have a very good basis to identify these model families, who can be the leaders in their communities to bring behavioral change and disseminate information," Keseteberhan stated. "So the Health Development Army is basically a way of organizing people, disseminating information and bringing behavioral change across a community."
The 2011 health survey suggests the massive international effort to improve Ethiopia's health is paying off. The number of underweight children has decreased by more than 30 percent over the past decade. During that time, the number of youngsters whose growth was stunted due to malnutrition has dropped from nearly 60 percent to less than 45 percent.
Ted Chaiban, country director of the United Nations children's agency, or UNICEF, called it a "remarkable achievement."
"It is clear that the health system in Ethiopia has established a robust and resilient system that can withstand periodic and cyclical shocks and emergencies without resulting in escalated mortality rates and increased levels of malnutrition," he said.
Friday's event also marked a milestone in achieving full funding for the Ethiopian health initiative. The Canadian government announced a $50 million, five-year donation, narrowing what had been a $95 million funding gap for the $365 million program.
http://www.voanews.com/english/news/africa/Ethiopia-Recruits-Health-Army-to-Combat-Child-Mortality-Malnutrition-133693378.html

POVERTY: MALAWI: The rush to rationalize

JOHANNESBURG, 1 December 2011 (PlusNews) -

 Photo: Laura Lopez Gonzalez/IRIN
With less money available, smarter investments in effective HIV programmes are crucial (file photo)

As international HIV funding declines, nations are bracing for a future with less money and tougher choices. In countries like donor-dependent Malawi, a new UNAIDS tool is already beginning to shape how to rationalize their HIV responses to cope with the altered circumstances.
Malawi seems to have read the writing on the wall and is in the early phases of costing its HIV programming to see what it will take to make the national response sustainable.
It is also receiving UN agency support to evaluate national HIV programme in light of the investment framework recently released by UNAIDS, which is guiding the choices as national programmes bend to the pressures to rationalise expenditure.
The framework, published in a June 2011 edition of The Lancet medical journal, advocates that countries spend money on a basic set of six activities in HIV care and treatment, including prevention of mother-to-child transmission, medical male circumcision, and increasing access to antiretroviral (ARV) treatment.
Modelling suggests that, if implemented, the framework could avert about 12 million new HIV infections and almost 8 million AIDS-related deaths by 2020.
Dr Mary Shawa, Principle Secretary for HIV/AIDS in the Office of the Presidency, said Malawi will look to non-traditional donors like China to shore up HIV programming, and may also explore innovative financing measures. However, the UNAIDS Country Coordinator in Malawi, Patrick Brenny, says there's no denying the impact that reduced funding will have on HIV programmes.
"More countries are going through these formal exercises because the fat days are over, the funds aren't enough to go around or go as far," Brenny told IRIN/PlusNews. "In the past, when there was a lot of money to go around, you could afford to do all kinds of things. As resources become scarcer, we have to ask, 'What are the smartest investments?'"
With an 11 percent HIV prevalence rate, Malawi has already made painful choices in its programming. The country still relies heavily on the Global Fund, which provides as much as much as 70 percent of the HIV and TB response. Yet UNAIDS notes that in 2011 the government is funding only 1 percent of the HIV/AIDS response.
According to international humanitarian medical agency Médecins Sans Frontières (MSF), Malawi's Round 10 funding application to the Global Fund was denied largely because it was deemed too ambitious. The country had to forgo increasing HIV viral load monitoring, improving early infant HIV diagnosis, and scaling up medical male circumcision, MSF said in a recent statement.

Prevention priorities
The alleged refusal of funders to finance overly ambitious proposals may be a sign of the pressure being put on countries to rationalise HIV and development funding, against the backdrop of the global economic downturn, as Brenny pointed out.
This may also be embodied in what UNAIDS describes as a shift away from "needs-based" programming.
"Countries are also feeling the pinch of the global economic meltdown, and are pulling back and tightening their belts, and look at new areas for more investments - HIV is no exception," said Henry Damisoni of UNAIDS in Johannesburg, South Africa.
"Over the years, a lot of money [has been invested] but if we can't demonstrate meaningful results out of those investments, there is no justification for us to ask for more money," he said.
"Demonstrating a need for a particular programme is no longer sufficient. We're going to have to generate concrete evidence to demonstrate the sustainable gains we're going to make [from the money]."
In Malawi, where 305,000 HIV patients are on ARVs, investment will likely focus on prevention, said Robert Ngaiyaye, executive director of the Malawi Interfaith AIDS Association, who also sits on the national body responsible for coordinating Global Fund grants, known as the country coordinating mechanism.
About 70,000 Malawians are newly infected with HIV every year, according to UNAIDS.
"That's a huge future mortgage of people who will need treatment... for the rest of their lives," Brenny noted. "How do we ensure that... [the number of new infections] becomes less? Because if we're not doing that, then we are mortgaging the future."
Malawi may have difficulty in adopting the investment framework's focus on most-at-risk populations because same-sex relationships are still criminalised.
http://www.plusnews.org/report.aspx?reportID=94357

TUBERCULOSIS: MDR-TB remains a difficult diagnosis for children

LILLE, 8 November 2011 (PlusNews)

 Photo: Eva-Lotta Jansson/IRIN/IFRC

Diagnosing MDR-TB in children still difficult Years of treatment and mounds of pills are hard work for older patients with multidrug resistant tuberculosis (MDR-TB), but in children, treatment becomes a minefield for patients and doctors alike.
MDR-TB is resistant to the most powerful drugs used to treat active TB, rifampicin and isoniazid. With weaker immune systems, children who contract TB - most often from parents - progress to active disease in about a year. But just how many children are affected is not known as there is almost no research into children and MDR-TB - and very little useful guidance on how to treat them.
There are only eight studies published on MDR-TB treatment outcomes among children, says Nathan Ford, medical coordinator for Médecins Sans Frontières’ (MSF) Campaign for Essential Medicines. Much of what does exist comes from South Africa's Stellenbosch University, whose researchers work in Cape Town's Tygerberg Hospital. The hospital began collecting data on drug resistant (DR-TB) tuberculosis among children in 2003.
Simon Schaaf, a professor at Stellenbosch, presented the findings of the hospital's latest such survey at the International Lung Health Conference, held recently in Lille, France. Among about 330 children with DR-TB, about 7 percent had MDR-TB - a figure that has remained relatively steady since the hospital began conducting the surveys.
According to Schaaf, paediatric DR-TB cases are often a window on local TB epidemics. In 2010, the Western Cape confirmed 1,400 MDR-TB cases - the second highest in the country.
The study found very low uptake of isoniazid preventative TB therapy (IPT) among paediatric patients, despite a national IPT policy. About 70 percent of children who would have qualified for IPT were never prescribed the preventative medication, which uses one of the main drugs used to treat active TB, isoniazid. About 5 percent of these children subsequently died.
With a small number of studies indicating the scope of MDR-TB among children, high-level awareness of the problem is lacking, according to Carlos Perez Velez, who is leading a study on new diagnostic methods to improve TB case detection among children in his native Colombia as part of his work with the US-based National Jewish Health respiratory hospital.
"You go to a minister of health and you tell them there's a problem with TB in children and he'll ask you for the data,” Perez Velez told IRIN/PlusNews. "You'll say there's no data. He'll say if there's no data then why are you saying there's a problem. It's the chicken and egg paradigm."
Late diagnosis
Children who develop the disease in their spinal column are often diagnosed too late, sometimes leading to long-term neurological effects and spinal deformity. Treatment for MDR spinal TB requires a mix of surgery and a long course of drugs.
Marianne Gale, a doctor with MSF, described the realities of diagnosing and treating children with MDR-TB. In 2010, the MSF clinic in the Nairobi slum of Mathare diagnosed a mother with MDR-TB. Her 18-month-old daughter had TB symptoms and a chest X-ray suggested she also had active TB but getting a culture was impossible.
Samples of sputum from suspected DR-TB patients are used to grow bacteria cultures that are then tested for drug resistance - but these are difficult to obtain from children.
"We actually had the capacity to do sputum induction, which in many sites we're not able to do," Gale said. "There were many attempts that were traumatic to the child and perhaps more traumatic to the staff. We managed to get a sample that actually never [developed] on culture."
Given the difficulties of diagnosing children, about half of all children treated for DR-TB in MSF's projects in Swaziland and South Africa are unconfirmed, leaving clinicians to make tough calls to start young patients on long treatment.
Gauging the dosage
Without a culture, Gale said clinic staff reluctantly started the child on MDR-TB medication - a challenge in and of itself.
"This child was 18 months old but only weighed 7.5kg so calculating the dosages and adjusting them as the child grew was a nightmare," said Gale, adding that the MSF clinic - with an in-house pharmacist - was probably better able to do this than most clinics in similar settings. "Manipulating the formulations was challenging and also how to make those drugs acceptable for this young child."
Both mother and child were doing well on treatment after six months but family pressure led both to discontinue treatment. While the clinic learned that the mother had died, they were unable to trace the child.
Almost all MDR-TB drugs are designed for adults. "Almost all children will need these pills broken into bits, sometimes half, sometimes quarters; sometimes medication needs to be ground and most formulations don't dissolve completely in water," James Seddon, a researcher at the Desmond Tutu TB Centre in Cape Town, told IRIN/PlusNews. "Some [liquid forms] are available... but actually in most high TB burden areas they are not incredibly practical because they require refrigeration and also the glass of the bottle is very heavy for [transporting] to [clinics] that need large volumes."
Some children may also need to take vitamins or HIV medication and so may end up taking a large number of pills a day, Seddon added. Many do not taste good and may cause vomiting. MSF has lobbied the World Health Organization (WHO) to produce effective guidelines about the composition of new paediatric fixed-dose combination drugs that would reduce children’s pill burden and have been shown to improve adherence.
Meanwhile, existing guidelines need work. WHO, the UK and US have developed guidelines for paediatric MDR-TB treatment, but these are largely not evidence-based and, in some cases, may have been simply adapted from adult guidelines, noted Seddon.
http://www.plusnews.org/report.aspx?reportID=94164

MALNUTRITION: Report from Somalia

Jean-Clement Cabrol, M.D. Engl J Med 2011; 365:1856-1858November 17, 2011


War, Drought, Malnutrition, Measles — A Report from Somalia.
Somalia has been in the grips of disaster for two decades. Throughout this past summer, the human catastrophe dramatically worsened. War and drought have driven hundreds of thousands of people from their homes in south and central Somalia, with some families walking for more than a week across the desert in a desperate attempt to seek safety and assistance within Somalia and in neighboring Kenya and Ethiopia.



Between July and mid-October, an estimated 200,000 displaced people settled in scores of overcrowded camps scattered throughout Somalia's capital, Mogadishu. More than 110,000 people arrived in Dadaab, Kenya, bringing the total number of Somalis who have sought refuge there over the years to 440,000 (see slide show). Because the formal camps were already full, most of the newly arrived were forced to settle in outlying areas with limited access to water, sanitation, food, and shelter. Nearly 100,000 Somalis also fled to Liben, Ethiopia, where conditions are similarly overcrowded and aid organizations are trying to respond to people's basic needs. Many people also remain in inaccessible pockets of south and central Somalia.
A variety of political and natural factors are responsible for the current situation. A full-scale war continues, pitting the Transitional Federal Government, the United Nations–backed African Union forces, and Western intelligence agencies against armed opposition groups, most notably the Shabaab militia. Emergency assistance is viewed by all sides as a potential tool to be used in pursuit of their own political, military, or financial goals, and the persistent lack of security hinders an adequate response. Against this backdrop of agendas, severe, prolonged drought has led to crop failures, soaring food prices, and the death of large numbers of cattle, simply pushing many people over the edge.
It is difficult to get an accurate sense of the extent and magnitude of the population's needs. The near-total absence of an effective epidemiologic monitoring system within Somalia limits data on mortality and morbidity. Aid workers — mainly Somalis — cannot conduct proper assessments because of the constant risk of death and abduction. They rarely venture outside the confines of health care structures or compounds, and when they do, it is for short periods under the protection of heavily armed guards. Recently, an initial survey of a camp a few miles outside of Mogadishu had to be conducted from an airplane out of the range of fire from small arms.
What is known from existing medical programs paints a grim picture. Between mid-May and mid-October, teams from Doctors without Borders (Médecins sans Frontières, or MSF) treated more than 20,000 severely malnourished people in Somalia, 18,000 in Ethiopia, and 11,000 in Kenya. Some projects in Mogadishu were seeing rates of severe acute malnutrition of 8 to 9%, and estimates at the Hilaweyn camp in Liben, Ethiopia, were a staggering 20 to 30%. Measles is rampant. An epidemic rages in Mogadishu, and approximately one third of the severely malnourished children admitted to MSF's intensive care units have postmeasles kwashiorkor, an acute form of malnutrition characterized by edema. It is difficult to gain access to areas outside the capital, but aid workers in the town of Marere have already treated more than 70 patients with cholera and 500 with measles

A Severely Malnourished Child Being Examined by an MSF Medical Officer in Dagahaley, Dadaab Refugee Camp, Kenya.
In the coming months, Somalis will need all the essentials: food, water, shelter, and emergency medical care. Yet it has always been hard to provide assistance in Somalia, where conflict, violence, and lack of access for humanitarian organizations have been the norm since the overthrow of Siad Barre's regime in 1991. Somalia's fierce clan rivalries add another element of insecurity. Simple administrative procedures, such as hiring drivers or nurses or securing land for health care posts, require long, arduous negotiations that delay any response.
Even though security concerns continue to restrict access to the worst-affected areas, a massive mobilization by international, regional, and Somalia-based organizations is already under way. MSF is now providing aid in nine locations in south and central Somalia and has opened four programs in Mogadishu, and it is also working in the refugee camps in Kenya and Ethiopia. This assistance includes primary health care, surgery, maternal care, treatment for malnutrition and measles, the provision of drinking water, and the distribution of relief items for the displaced.
A clear medical priority is treating and vaccinating against measles. Measles-vaccine coverage in Somalia is estimated to be only 46%.1 Since 2009, the World Health Organization (WHO) has recommended mass vaccination campaigns even after an outbreak has begun — a policy shift that was based on data from the Democratic Republic of Congo and elsewhere.2,3 Vaccination efforts are currently under way but not at the scale needed. By mid-October, MSF had vaccinated nearly 150,000 people, and teams are trying to expand coverage every day through negotiations with parties to the conflict. The WHO and the United Nations Children's Fund (UNICEF) aim to vaccinate 2.5 million children 15 years of age or younger,4 but until Somalia's various political actors allow vaccination programs to move forward on a much larger scale, measles will continue to take a huge toll.
Responding to malnutrition is also imperative. The ability to treat and prevent malnutrition has been transformed in recent years by strategies relying on ready-to-use therapeutic and supplementary foods. Most children with severe malnutrition can now be treated by caregivers at home, while hospitalization is reserved for those with additional medical complications. Preventive strategies involving ready-to-use supplementary foods have also proven effective.5 These developments, however, occurred in relatively stable countries such as Niger and Malawi. In Somalia, these strategies will face serious challenges. Nevertheless, a scale-up of treatment centers continues, and general food distributions by the World Food Program and other organizations include supplemental foods specifically designed to meet the nutritional needs of young children. At transit points in Kenya and Ethiopia, children from 6 months to 5 years of age are receiving 2-week supplies of specialized supplementary foods.
Preventive approaches will have even greater importance, because the lack of access to health care and limited medical capacity dramatically reduce the chances for treatment once disease strikes. To prevent malnutrition, MSF is adding ready-to-use therapeutic foods to general food rations provided in Mogadishu. And with respiratory tract infections a major cause of illness, MSF hopes to integrate the pneumococcal vaccine — which is already available in Dadaab — into its response in Somalia. Continued training of lower-level medical personnel to assist with vaccinations or to identify and rapidly treat cases of simple diarrhea and malnutrition also helps to prevent the few medical facilities that exist from being overwhelmed, allowing doctors and nurses to focus on the most severe cases. And with malaria season imminent, aid workers must prepare for this additional health threat.
In Somalia and its neighboring countries, the aid community faces challenges not seen for a generation: huge camps for refugees and internally displaced people, measles epidemics, high rates of malnutrition, and the presence of cholera and other diseases associated with displaced populations. We have developed better means for treating people and preventing illness in emergencies over the past 20 years, but it is more difficult in Somalia than in many other countries to reach the people in need. Moreover, these advances are always at the mercy of politics, and continued fighting as well as the mistrust or misuse of aid will make it difficult to meet even a fraction of the enormous needs.
On my recent trip to the region to help scale up MSF's response, I met many young Somali adults who have known little but a life of war and a future with few prospects. The assistance provided now can help people survive this crisis, but unless the means to penetrate the widening, seemingly intractable political morass are found, Somalis born today may meet a similar fate.
http://www.nejm.org/doi/full/10.1056/NEJMp1111238

MALNUTRITION: Doctors Without Borders: The Human Cost of Cutting Global Health Funding

Matthew Spitzer: 11/17/11
There could not be a worse time to pull back from long-standing American commitments to the health of people around the world, which is exactly what the U.S. Congress is threatening with proposals for extensive cuts to the federal government's budget for global health programs.
As Doctors Without Borders/Médecins Sans Frontières (MSF), we have implemented a host of major medical innovations -- as have other organizations -- that have the potential to significantly reduce the death toll from HIV/AIDS, malaria, malnutrition, and other insidious killers. With sustained and increased funding, these innovations could be brought to the scale needed to roll back these global health crises.
Disregarding these advances, both the House and the Senate are pushing significant cuts to the 2012 Obama request for global health funding. The Senate is proposing a 9 percent cut, and the House as much as 18 percent. This debate is about much more than economy; it is about the vulnerable, about people sick, even dying, right now in the poorest corners of the earth.
According to American Foundation for AIDS Research (AMFAR), for every 5 percent reduction in U.S. funding of global health programs, 182,000 people with HIV/AIDS and 2.1 million malaria patients will be left untreated; and millions of children will go without immunization against resurgent diseases like measles that can leave children with pneumonia, blindness, or death. Put another way: A 5 percent cut in US funding for global health is akin to shutting the doors of every MSF hospital and clinic in over 70 countries for an entire year.
The decisions in Washington will not determine the fate of the medical care my MSF colleagues deliver around the world. As an organization, in order to maintain our political neutrality and operational independence, we do not accept funds from the U.S. government. But the millions of patients and families who rely on US-funded health programs are about to face a stark future if the proposed cuts are enacted.
It is particularly brutal to do this now, at a moment when medical science and field research has shown that as a society we have the potential to achieve huge advances in the quality and scope of our actions in global health.
These are the advances that prompted Secretary of State Hillary Clinton to call for an "AIDS-free generation." The latest studies show that HIV treatment not only can restore people to healthy and productive lives, but also prevents new infections and decreases mortality across entire affected communities. The reality remains, though, that there are 15 million people infected with HIV in need of antiretroviral (ARV) treatment now, and only 6 million currently receive it. UNAIDS predicts that 7 million lives could be saved and 12 million new infections prevented by 2020 if treatment is expanded now.
Despite this evidence, countries hit hardest by the AIDS epidemic that rely on funds from the President's Emergency Plan for AIDS Relief and the Global Fund to AIDS, TB, and Malaria will be forced to take the drastic step of not putting new patients on treatment if the cuts are adopted, let alone achieve the ambitions outlined by Secretary Clinton.
For malaria, more effective treatments and rapid diagnostic tests that give results within minutes have made it possible to cure millions more people suffering from this killer parasitic disease. With these effective, high-tech yet simple-to-use tools, MSF has trained villagers to diagnose, treat, and refer patients themselves, overcoming the severely limited numbers of medical personnel, a major constraint in most poor countries.
In the Koulikoro region of Mali, where malaria is the top killer of children under five, MSF's 66 health workers span out to villages miles from the nearest health center. By testing and treating malaria they have cut child mortality in the area in half. This approach is scalable even in the most difficult-to-reach places; in Myanmar's Rakhine state, village workers trained by MSF used these rapid tests to screen 400, 900 people for malaria and administered treatment to more than 122,380 last year alone.
An estimated 200,000 deaths from severe pediatric malaria could be prevented if developing countries had the estimated $31 million required to switch from quinine to the more effective and easier to administer artesunate. Until these innovative advances in diagnosis and treatment are funded and expanded, malaria will continue to claim totals of more than 800,000 lives per year.
Malnutrition affects an estimated 195 million children around the world right now. With the development of protein-dense, micronutrient enriched, ready-to-use foods, the prevention and treatment of childhood malnutrition has been simplified and improved so that 80 to 90 percent of affected children can be cared for by their mothers at home with outcomes surpassing those achieved through hospitalization. These innovations have made it possible for MSF alone to expand from treating less than 10,000 malnourished patients just a decade ago to over 300,000 children last year alone.
In 2010, the government of Niger in collaboration with MSF and several local aid organizations distributed ready-to-use supplementary foods to more than 150,000 children under 2 years of age who were at risk of malnutrition, decreasing mortality rates by 50 percent among the children who received the highly nutritious supplements. We believe that expanding practices like these now could save millions of children.
The ability to make major impacts on health in our global society, are easier, better, and more possible than ever. Rather than slashing global health funding, which represents less than 1 percent of the federal budget, Congress and the Obama administration should be ensuring funding of successful international health initiatives and exploring new ways of generating predictable revenue for vital lifesaving programs.These vulnerable patients should be removed from the political nature of annual Beltway budget fights.
The US government has long played a leading role in the fight against many of the major global health threats, and medical and operational innovations hold the promise of saving a great many more patients with sustained and increased financial support. Turning back now could cost millions of lives.
http://www.huffingtonpost.com/matthew-spitzer/the-human-cost-of-cutting_b_1099870.html

MALNUTRITION: Niger: Breast-Feeding in Niger

SUSAN SHEPHERD : New York, June 29, 2011
Forgive my skepticism at Nicholas D. Kristof’s pronouncement that breast-feeding is the cheap miracle cure for malnutrition and child mortality in Niger (“The Breast Milk Cure,” column, June 23).
Exclusive breast-feeding during a child’s first six months of life is not cheap anywhere. Decisions must be made by women about how to allocate time to earn money to feed the family, tend the fields or nurse a new baby.
As a pediatrician with Doctors Without Borders, I have met plenty of mothers in Niger. They walk for miles or work fields under a broiling desert sky carrying their babies on their backs. When a woman is parched, she suspects that her baby is, too — so she gives the baby some water. Breast milk is the best food for babies, but focusing only on exclusive breast-feeding masks the collective failure to provide safe water.
The severe malnutrition Mr. Kristof describes is far more prevalent in 1-year-old Niger infants — an age when breast milk must be complemented with animal-sourced foods to provide infants the nutritional value they need. The meager plant-based foods typical in the Niger diet are as much a contributor to early childhood deaths as poor water and malaria.
I have seen how combinations of better diagnosis and treatment of malaria, immunization and nutrition supplementation with good-quality foods for 6-to-24-month-olds are saving lives. The only reason these programs work is that mothers are willing partners.
http://www.nytimes.com/2011/07/06/opinion/lweb06kristof.html?_r=1