Malaria: Where’s the problem?

4 Jan, 2012:  Wellcome Trust : Catherine Moyes






The spatial distribution of Plasmodium falciparum malaria endemicity in 2010.

Around 10,000 years ago, the population of Plasmodium falciparum (the parasite species responsible for most cases of malaria) rapidly expanded in Africa and spread worldwide, coincident with human population growth and subsequent diasporas facilitated by the dawn of agriculture. The disease reached out globally but since its height around the turn of the century in 1900, the borders have shrunk and malaria is now largely restricted to the tropics.
Today, malaria is a massive public health problem and occurs in more than 100 countries, inhabited by some 3.3 billion people – half of the world’s population. The logistics of tackling malaria are therefore extremely complicated. In 2005, a group of Wellcome Trust-funded researchers identified the need to know where malaria is in order to to effectively target malaria control measures. They also identified the need to quantify risk when mapping this disease. This is how the Malaria Atlas Project (MAP) was born.
The Malaria Atlas Project is based across four continents: Africa, Asia, Europe and the Americas. We have spent the last six years mapping the contemporary spatial limits and prevalence of the two most deadly strains of malaria – P. falciparum and Plasmodium vivax. Until this work started, malaria maps had either presented the results of parasite surveys or used environmental data to predict parasite prevalence. In the former instance, there are large areas that have never been surveyed, so no data is available. Using environmental data means that parasite prevalence can be predicted in all areas but this approach does not allow for the impact of malaria control measures.
We have developed models that are informed by both real parasite prevalence data and environmental data, and we have improved the models further by including factors such as urbanisation (mosquitoes generally prefer the countryside) and a sophisticated model of the effects of temperature. The outputs from our models predict malaria risk everywhere where the disease is common and can be used to create maps of risk. The most important use of our maps is to visualize the extent of the malaria problem today at global, regional or national scales.
But that is not the only use of our outputs. Further modeling work means that we can generate estimates of clinical burden and populations at risk, and provide national and province-level estimates. We used similar models to study the distribution of inherited blood disorders, whereas we found a very different modeling approach was required to map the mosquitoes that transmit malaria – information about mosquitoes typically comes in the form of occurrence data and it is usually presence rather than absence data that is available. Ecological niche modeling uses occurrence data, environmental variables and expert opinions to model the spatial distribution of a species and this is the approach we used to predict where the 41 dominant mosquito species that transmit malaria are found.
Ultimately our research has a strongly applied focus and aims to provide a sound evidence base for decision-making when planning which control measures to use and where to target scarce resources. With this in mind, we have placed all of our work on a new, freely accessible, web portal.
There you can find maps to download in high (.pdf) and low (.png) resolution formats, and if you are a GIS user you can download the surface data used to create these maps and make your own. Mathematical modellers can obtain our full model outputs to use in their own models and public health groups can obtain tables of estimates of burden and populations at risk.
At the moment the focus is on Plasmodium falciparum and the mosquitoes that transmit malaria but watch this space because there is much more to come over the next few months.

Catherine Moyes is Malaria Atlas Project Manager in the Spatial Ecology & Epidemiology Group at the University of Oxford.
Find out more about the Malaria Atlas Project and access its data and resources at http://www.map.ox.ac.uk

http://wellcometrust.wordpress.com/2012/01/04/malaria-wheres-the-problem/#more-8289

TUBERCULOSIS : Trial of new TB vaccine raises questions on timing

LONDON, June 22 (Reuters)  By Kate Kelland : Editing by Andrew Heavens




A new vaccine designed to fight tuberculosis is less effective when given alongside shots for other diseases, a study has found, suggesting child immunisation programmes in developing countries may need a rethink.
Data from clinical trials of the vaccine, called MVA85A, in babies in Gambia showed it was safe, but the immune response it prompted was lower in babies who got it with other infant immunisations than in those who got it on its own.
Martin Ota of the Medical Research Council Laboratories in Banjul, Gambia, who led the study, said the data should help doctors work out the best way to integrate the MVA85A into infant immunisation programmes in the future.
"We have a real opportunity to make sure that children are protected ... against tuberculosis by introducing effective and well-timed immunisation programmes," he said in a statement about the study. "This can only be achieved with robust information gathered from well-conducted clinical trials."
Standard childhood vaccinations are routinely given in developing countries as part of a plan known as the Expanded Programme on Immunisation (EPI).
It includes vaccines for diphtheria, tetanus and whooping cough, as well as the current vaccine for TB, Bacille Calmette-Guerin (BCG). The plan helps boost vaccine coverage by cutting the need for repeated visits to health clinics, which are often difficult to get to in poor, rural areas.
Although BCG protects against severe forms of TB in childhood, increasing rates of the disease in adults suggest its effect is not long-lasting.
TB is currently a worldwide pandemic that kills around 1.7 million people a year. The infection is caused by the bacterium Mycobacterium tuberculosis and destroys patients' lung tissue, causing them to cough up the bacteria, which then spread through the air and can be inhaled by others.
Experts say there is an urgent need for more effective TB vaccines and MVA85A -- being developed and trialled by Emergent BioSolutions in a joint venture with Britain's Oxford University -- is one of the most advanced potential candidates.
It has already been shown to be safe and capable of eliciting powerful immune responses in clinical trials in adults in Britain, Gambia and South Africa.
This study, published in the journal Science Translational Medicine on Wednesday, was the first trial to evaluate the safety of the vaccine in babies. It involved 214 healthy four-month-old infants who had already received BCG at birth.
The children were given either EPI alone, MVA85A alone, or MVA85A with EPI, and their immune responses were monitored.
Overall, Ota's team reported, MVA85A was deemed to be safe, well tolerated and induced a strong immune response. And importantly, the responses to the standard EPI vaccines were not affected by giving MVA85A at the same time. But the immune response prompted by MVA85A was lower in infants who received it with EPI vaccines, compared with those who got it alone.
"It's reassuring to see that MVA85A does not affect immunity to the other vaccines," said Helen McShane of Oxford University, who helped develop the new shot. But she said scientists would now need to find the best way to integrate MVA85A into infant immunisation plans in future without limiting its effect.
http://www.trust.org/alertnet/news/trial-of-new-tb-vaccine-raises-questions-on-timing/

TUBERCULOSIS: Oxford-Emergent Tuberculosis Consortium Vaccinates Last Infant In Phase IIb Clinical Trial

 03 May 2011
Emergent BioSolutions Inc. announced today that its joint venture with the University of Oxford (Oxford), the Oxford-Emergent Tuberculosis Consortium (OETC), has vaccinated the last of the 2,784 infants in its Phase IIb efficacy trial evaluating MVA85A, the world's most clinically advanced tuberculosis (TB) vaccine in development. This clinical trial in Worcester, South Africa, is being conducted by the University of Cape Town's South African Tuberculosis Vaccine Initiative (SATVI), in partnership with Aeras, the clinical sponsor of the study, and the Wellcome Trust.
"Emergent BioSolutions joined the fight against TB when it formed OETC with Oxford to further develop MVA85A," said Daniel J. Abdun-Nabi, Chairman of the Board, OETC and President and Chief Operating Officer, Emergent BioSolutions. "We are pleased to complete the vaccination of our targeted 2,784 infants, which is the largest number of infants enrolled in any TB vaccine clinical trial. Our quest to fulfill Emergent's corporate mission - to protect life - will come to fruition when we can bring this vaccine candidate to market and ultimately make an impact in patients' lives."
"We are extremely proud of this achievement and are eager to see the study results, which are expected to be available as early as mid-2012," said Dr. Helen McShane, lead scientist and developer of MVA85A from the University of Oxford. "This milestone brings us a step closer to potentially having a new TB vaccine, from which millions of people around the world would benefit."
This Phase IIb clinical trial was initiated in July 2009 and involves a two-year follow up on the infants vaccinated as part of the trial to evaluate whether the vaccine candidate has conferred protection against TB.
http://www.medicalnewstoday.com/articles/224076.php

TUBERCULOSIS: TB vaccines: getting them out of the lab

Mićo Tatalović : 24 March 2011
 Eleven TB vaccine candidates are in clinical trials: SATVI

New TB vaccines are facing a major funding shortfall, says Mićo Tatalović, and some countries seem resistant to accepting a future vaccine.
International tuberculosis (TB) experts are gathering today — World TB Day — in France to discuss advances in research into vaccines.
But the reason there is no effective vaccine to prevent the roughly ten million new cases and two million deaths from TB each year has little to do with the science. There are already 11 vaccines in clinical trials whose progress has slowed or stalled because the funding has dried up.
That is why the TuBerculosis Vaccine Initiative (TBVI), an independent organisation that promotes the development of TB vaccines, is launching a new funding model today.
Joris Vandeputte, senior vice-president of advocacy and resource mobilisation at TBVI, tells SciDev.Net that US$1.5 billion is urgently needed to translate basic research into market-ready vaccines over the next decade. A single TB vaccine can cost up to US$300 million to develop.

Funding gap
Basic research has been adequately funded, he says, resulting in around 40 candidate vaccines because of a huge research effort over the past decade. In addition to the 11 in the faltering trials, a further 30 are languishing in laboratories, some of them in developing countries, waiting to be tested.
But the "second chunk" of funding, needed to get the candidate vaccines through clinical trials, is missing — so vaccine development has effectively stopped, he says.
Under the new funding model, the European Union would provide loans to fill the gaps, possibly through the European Investment Bank. The loans would be administered by the TBVI and paid back once the vaccines start making money.
The model takes into account various logistical difficulties facing the researchers, such as the bottleneck caused by the lack of capacity in clinical trials, by calculating in the costs needed to tackle such issues.
"We will have to look to the east — China, India, Russia — to do more clinical trials," he says, in an attempt to overcome this bottleneck. But he maintains that once there is a new vaccine, it will attract a huge market.
Around 90 per cent of countries currently vaccinate their children against TB with the Bacillus Calmette-Guérin (BCG) vaccine, using 100,000 doses each year. BCG protects children from severe forms of TB but does not protect adults from pulmonary TB — the most common and infectious form of the disease.
A more effective vaccine would save huge amounts on treatment, which costs European countries alone about US$3 billion a year.

Low take-up
But even if the money for trials becomes available and an effective vaccine emerges, further problems may await. Data to be published later this year in a special vaccines issue of the journal Tuberculosis show that some developing countries may be reluctant to accept new TB vaccines.
Several factors seem to determine whether countries are prepared to shoulder the costs of a new vaccine campaign, including whether the vaccine has been tested in their own country.
The study's authors conducted 86 structured interviews with public health clinicians, politicians and senior civil servants from health and finance ministries in countries with the highest burden of the disease: Brazil, Cambodia, China, India, South Africa, Mozambique, Romania and Russia.
Lew Barker, senior medical advisor at the Aeras Global TB Vaccine Foundation in the United States, says their study sought to gauge the opinions of people in high-burden countries who are likely to be involved in making decisions about whether to adopt TB vaccines when they become available.

 US$1.5 billion is needed to get the new TB vaccines on the market: WHO/TDR/Crump

"None of the respondents, when asked about the most important public health issues and needs of their country, spontaneously mentioned TB," Barker says. Instead, primary, rural and mother-and-child healthcare, as well as HIV/AIDS, were identified as the most pressing issues.
"However, when TB was mentioned [by the interviewer], they uniformly said this is a very serious problem and, by and large, they said it's also a neglected problem that needs and deserves more attention then it gets," Barker adds.
Respondents in the survey welcomed the development of better TB vaccines, but around 20 per cent said it was unlikely that such vaccines would be taken up in their countries, and many more were undecided. In most of the vaccine roll-out scenarios presented, less than half said they were willing to commit to a new vaccine and provide funding. One of the main reasons was that they wanted to see strong efficacy data from clinical trials in their own country.

Political priorities
Vaccine deployment might take 20–30 years to reap healthcare benefits because 95 per cent of cases are latent and may take years to show up, and most vaccines only target people who have not been exposed to TB (around one third of the world's population has been exposed), so there will be a long tail of cases before the hoped-for elimination of TB in 2050, Barker says. This explains why other issues such as HIV are given political priority.
Barker concludes that robust data showing efficacy of 90 per cent, rather than a more realistic 60 per cent, and from studies in the countries concerned, are likely to be needed for the introduction of new TB vaccines.
Opokua Ofori-Anyinam, senior clinical development manager at GSK Biologicals, a vaccine manufacturer, said researchers should engage with policymakers to make sure that, after spending millions of dollars on trials and testing vaccines in thousands of individuals, they end up with vaccines that policymakers will want to deploy.
"These are the things we have to think about ahead of time," Ofori-Anyinam tells SciDev.Net.
Vandeputte says the TB research community must engage with the media and policymakers to put TB onto national political agendas.
But he points out that Aeras' market research, presented by Barker, found a mixed response and that the proportion of decision-makers who would go for a new vaccine is bigger than those who would not. Engagement and advocacy before a new vaccine reaches the market may also help convince the undecided.

Focus on the vaccine
Michel Greco, chair of the working group on new TB vaccines at the Stop TB Partnership, says: "I am not one of those people who think that as soon as we have a good TB vaccine it would be taken up. Countries are very wary of potential problems, so they go slowly."
But he adds that although studies are needed to address uptake issues and pave the way for the future deployment of TB vaccines, the priority should be on designing and testing vaccines rather than worrying about their subsequent uptake.
Helen McShane, a TB vaccine researcher at the University of Oxford, United Kingdom, whose vaccine MVA85A is currently in phase IIb clinical trials, told SciDev.Net: "The more effective a vaccine is, the more likely that it will be taken on. It will also depend on cost — I think if you have a very effective vaccine at affordable prices for the developing areas of the world then it will be taken on."
She adds: "There may be certain countries where you have to do some studies in that country to get some safety data but, although those are all important factors, I don't see them as the biggest challenge — the biggest challenge is that we need to get a vaccine that works."
http://www.scidev.net/en/features/tb-vaccines-getting-them-out-of-the-lab-1.html

TUBERCULOSIS: South African babies hold TB vaccine hopes

Justine Gerardy (AFP)
WORCESTER, South Africa — The baby wiggles without care on his mother's lap as the world's most promising hope for the first new tuberculosis vaccine in 90 years is injected into his arm.

The infant is one of 2,784 pint-sized volunteers in a two-year-trial in South Africa's winelands that scientists hope will lead to a more effective inoculation against the lung disease, which kills one person every 20 seconds worldwide.
"There are 12 different vaccines in clinical trials, but this is the most advanced," said Michele Tameris who manages the trial at the South African Tuberculosis Vaccine Initiative (SATVI) site.
"This is the first time you're actually testing to see if a vaccine is effective in real life. Now we've got to show that it's actually protecting against TB in the humans."
And South Africa is a prolific testing ground, with the world's second heaviest rate of TB after Swaziland, according to SATVI.
The disease preys on weakened immune systems so it saw a surge here thanks to one of the world's highest HIV levels, which affects 5.7 million of the country's 48 million population.
In the Western Cape region, the airborne bacterial infection is rife at 900 per 100,000 people, as compared to 15 people per 100,000 in the United States.
And in the Worcester area, a mountainous grape-growing centre 120 kilometres (75 miles) northeast of the provincial capital Cape Town, one in 100 people develop TB every year.
Mothers readily brought their babies to the testing site at a local hospital for the one-off inoculation of either the vaccine or a placebo, with the final shots to be administered in late April.
Typical was Marlene Abrahams holding her tiny son Malico in the waiting area. "I want to know if he's healthy," she said.
The vaccine tested in Worcester, developed at Oxford University and known as MVA85A, is hailed as the most exciting advance since a 1921 shot created by two French doctors which is the sole TB vaccine in use today.
That vaccine, the BCG, is not necessarily effective against all strains of TB, for all age groups or for people with HIV.
"We do absolutely need a preventative vaccine if we want to get rid of tuberculosis," said Uli Fruth, a World Health Organisation scientist scientist working on TB inoculations. He gave a ball mark cost for developing a new vaccine at 150 to 250 million dollars.
"This is the most advanced of all the new TB vaccine candidates by far," he said of the trials at Worcester. "There's a lot of hope about it."
Globally, the disease stabilised in 2009, with 9.4 million new infections and around 1.7 million deaths. The World Health Organisation wants to halve deaths by 2015.
A new vaccine is seen as a key defence against what is mostly a developing world problem -- 85 percent of cases are in Asia and Africa.
But TB has also been on the march in wealthier countries. In London, cases have risen nearly 50 percent since 1999, according to British medical journal Lancet which dubbed the city western Europe's TB capital.
For Fruth, South Africa "is the best place in the world to test such a new vaccine," given what he called the country's huge tuberculosis burden and good research infrastructure.
"I guess that if we ever get a new TB vaccine we cannot do it without South Africa," he said.
The tiny Worcester volunteers will be followed up for two years to check if they develop the disease and the first results will only be known by mid-2012.
If it proves successful, the vaccine will go to Phase III clinical trials involving around 20,000 people to test its efficacy as a booster to the existing shot, the final step before drugs go to market.
Even in the best case, scientists doubt a new vaccine could be ready before 2016 to 2020.
"We say around 2018 if everything goes well," said Fruth.
http://www.google.com/hostednews/afp/article/ALeqM5i0LNk-Tc6akZLmBNCyzg8VWqvobg?docId=CNG.de0b8ea9bea371e7cf772979c14c8895.491

TUBERCULOSIS: Delegates from European Parliament Express Support for Rapid Development of New TB Vaccine

February 25, 2011
ROCKVILLE, Md.--(BUSINESS WIRE)--Emergent BioSolutions Inc. (NYSE:EBS) announced that a joint delegation of Members of the European Parliament (MEPs) and representatives from the Oxford-Emergent Tuberculosis Consortium (OETC) today visited the trial site where MVA85A, the world’s most clinically advanced tuberculosis (TB) vaccine candidate in development, is being studied in a Phase IIb infant efficacy clinical trial. This clinical trial in Worcester, South Africa is being conducted by the University of Cape Town’s South African Tuberculosis Vaccine Initiative (SATVI), in partnership with OETC and Aeras.
“We anticipate that the trial, which involves administering MVA85A as a booster to the BCG vaccine, will reach the enrollment target of 2,784 infants by the end of April 2011. The follow-up period and study results are expected to be completed in 2012.”
"I am very anxious to see a new TB vaccine licensed and I am delighted that this trial of this promising new vaccine candidate is taking place,” said MEP Michael Cashman, Chairman of the South Africa Delegation of the European Parliament. “It is vital for South Africa that a new vaccine is developed as soon as possible, especially for infants and those with HIV. If this trial is successful, South Africa will benefit and so will the rest of the world. Too many lives are lost to tuberculosis and I am pleased to see so many public and private bodies coming together to deliver what could be the first new TB vaccine in 90 years."
“Emergent BioSolutions is proud to be part of OETC, a joint venture established with the University of Oxford in 2008, to further develop the most clinically advanced investigational TB vaccine,” said Allen Shofe, OETC Board Member and Senior Vice President Corporate Affairs of Emergent BioSolutions. “This collaboration is an integral part of a multi-pronged approach to alleviating the global burden of tuberculosis. Through our involvement in OETC, Emergent is given an opportunity to touch the lives of many in fulfillment of our company mission - to protect life.”
The MEPs learned firsthand about the TB vaccine candidate and progress of the clinical trial from lead scientist and developer Dr. Helen McShane from the University of Oxford. "We are extremely pleased with the progress of the trial," said Dr. McShane. "We anticipate that the trial, which involves administering MVA85A as a booster to the BCG vaccine, will reach the enrollment target of 2,784 infants by the end of April 2011. The follow-up period and study results are expected to be completed in 2012."
The delegation also observed the vaccination of infants as part of the trial and visited the hospital facilities with Dr. Hassan Mahomed, SATVI’s Principal Investigator on the study.

About Emergent BioSolutions Inc.
Emergent BioSolutions protects and enhances life by developing and manufacturing vaccines and therapeutics that are supplied to healthcare providers and purchasers for use in preventing and treating disease. Emergent's marketed and investigational products target infectious diseases, oncology and autoimmune disorders. Additional information about the company may be found at www.emergentbiosolutions.com.

http://www.businesswire.com/news/home/20110225005622/en/Delegates-European-Parliament-Express-Support-Rapid-Development

POVERTY: tough loan conditions imposed by IMF has led to health aid being diverted for other uses

Larry Elliott, Economics editor The Guardian, Monday 17 January 2011

Poor countries with IMF loans 'divert aid from public health'Oxford University-led research finds signs that tough loan conditions imposed by IMF has led to health aid being diverted for other uses
 

  The United Nations' millennium development goals for health include a two-third reduction in infant mortality and a three-quarter decline in maternal mortality. Photograph: Martin Godwin for the Guardian


Poor countries that borrow from the International Monetary Fund are spending just one cent in every dollar received in health aid on improving the medical care of their populations, according to new Oxford University-led research.
The study, published in the International Journal of Health Services, said there were signs that the tough loan conditions imposed by the IMF were leading to health aid being diverted for other uses.
In an investigation of more than 100 low and middle-income countries, the report sought to explain why increased aid spending had left many countries well off track to hit the United Nations millennium development goals (MDGs) for health, which include a two-thirds reduction in infant mortality and a three-quarter decline in maternal mortality.
They said one likely explanation was that the curbs on public spending stipulated by the fund were encouraging governments in poor countries to use health aid for other needs. Countries that did not borrow from the IMF were found to have channelled 45 cents into health systems for every dollar of aid received.
The study by Dr David Stuckler of Oxford, Dr Sanjay Basu at the University of California, San Francisco and Professor Martin McKee at the London School of Hygiene and Tropical Medicine looked at 34 low and middle-income countries that borrowed from the fund and 101 countries on a similar income that did not rely on IMF support.
Their analysis showed that health spending in countries borrowing from the IMF in the decade from 1996 to 2006 grew at half the rate of countries that did not have IMF programmes.
Stuckler said: "Countries seeking IMF support are likely to differ from countries that are not and a request for an IMF loan is often associated with severe economic problems. Nonetheless, even in such circumstances, it is reasonable to expect aid from donors to have at least some positive impact on health funding, especially given that health needs are often greatest at such times.
"This study suggests that countries relying on IMF loans are not spending the aid in the way it was intended. A change in loan policies is needed to lift the existing restrictions on finance ministers so they are no longer prevented from spending health aid on the people that urgently need medical help."
According to the research, countries borrowing from the IMF tended to do so when their economies were struggling and needed health aid the most. It concluded that changes are needed to loan conditions so that finance ministers in poor countries had more "fiscal space" to use health aid for its intended purposes – tackling disease and supporting public health projects.
The report's authors said the study was limited to measuring pledges of aid rather than a full picture of what was actually paid. But they said the findings offered a "new rationale that reconciles the failure to achieve the MDGs despite increasing amounts of aid."
Aid channelled through governments was associated with lower public spending than relief through private non-governmental organisations, they said.
http://www.guardian.co.uk/business/2011/jan/17/imf-health-aid-millennium-development-goals

POVERTY: Fairer spending could save 4m children by 2020,

6 September 2010

Selma Shakil, 27, with her daughter Fizar, in Delhi. Her son, Muzzamil, died in July last year aged one. Two million children die before the age of five every year in India, says Save the Children.
Millions of children die before their fifth birthday because developing countries skew public health spending to the rich rather than the poor, a leading charity says today. This misdirecting of money jeopardises the chances of meeting a crucial target of the UN's millennium development goals, says Save the Children.
The charity says that 4 million child deaths could be averted over a 10-year period if the 42 developing countries which account for 90% of all under-five mortality took an "egalitarian approach". The warning comes before a UN summit in New York later this month which will review progress towards meeting the eight goals.
One of the biggest concerns is that not enough is being done to cut the number of child deaths across the globe. Although UN nations agreed to reduce child mortality by two-thirds from its 1990 level by 2015, progress has been steady and slow – and exacerbated by the rising inequalities within poor nations.
Save the Children says this target will not be met at current rates and efforts are in danger of going "off-track" – only 3.5 million more children survive past their fifth birthday today than 20 years ago. The scale of the task is such that at least 1 million more children every year will need to live past five to achieve the UN's 2015 target.
"Nearly three-quarters of the countries with the highest child mortality burden will not reach the goal on current trends," says the report, A Fair Chance in Life.
The charity says cutting child mortality rates does not depend on how rich a country is or how fast its economy is growing. Patrick Watt, the charity's director of development policy, said health depends on fairness not wealth. He pointed out that people in Gabon were as rich as counterparts in Argentina, but had a child mortality rate almost four times higher.
"Growth is not the only answer either," says Watt. "India has had growth of 8% a year, but its current rate of reduction in under-five mortality is just 40% of what's needed to achieve by 2015 … This nails the myth that only growth is needed to end poverty – you need to focus on equity."
The problem, says Watt, is that there is a growing gap between who benefits from public spending: a poor child in Peru is five times less likely to live past five than a rich child; in India three times less likely and in Nigeria two and a half.
The gap in many parts of the globe is widening rather than narrowing, warns the charity. Save the Children says that in developing nations it is the children of the wealthiest fifth of the population who have disproportionately benefited from the focus on infant mortality to the extent that "in some cases the poorest fifth of the population [are] no better or even worse off".
It highlights what has happened in Burkina Faso, where a reduction in child mortality rates masks an actual increase in child mortality among the poorest 20% of the population. Sub-Saharan Africa, where close to one child in seven still dies before their fifth birthday, faces the greatest challenge. Although the mortality rate in the region has fallen, high fertility levels mean the absolute number of child deaths has increased since 1990, from 4.2 to 4.6 million.
Even in this part of the world, fairer access to public health resources would have saved lives. In Kenya, where there was an increase of nearly 150,000 under-fives' deaths between 1993 and 2003, an "egalitarian approach", says the charity, would have actually prevented 214,000 deaths.
Corruption too has played a part – oil-rich Chad has been plagued by bribery, which has undermined faith in government at a time when child mortality has actually increased.
The charity says that the key to saving more lives is to focus on nutrition, sanitation and women's rights – noting that one to three years of maternal schooling would reduce child mortality by about 15%. There is also a need to provide universal health services to mothers – the report highlights innovative programmes in Indonesia and Bolivia. It calls on donors to provide the cash to enable the charity to implement such schemes.
However, some experts said Save the Children should be pressing governments to make equality targets the issue. Kevin Watkins, from Oxford University's global governance programme, said: "If a poor child is fives times more likely to die than a rich one, then that's a human rights issue. We need developing countries … to focus on spending on the poor, not just saying that more donor money is the answer. A country like Vietnam has a great record in cutting child deaths because it taxes and spends progressively."
http://www.guardian.co.uk/society/2010/sep/06/fairer-spending-could-save-4m-children

POVERTY: effect of shame

A major international study will be conducted in eight countries, including India, to examine whether shame is a key part of the experience of being poor. The half-a-million-pound study, led by Professor Robert Walker from Oxford University, will look at whether being poor necessarily results in low self esteem or feelings of shame and whether welfare policies are counterproductive when claimants are stigmatised. The research, spanning eight countries, aims to improve our understanding of the impact of poverty to establish whether anti-poverty measures could be applied more effectively. A team of a dozen researchers will conduct-depth interviews with children and their parents about how being poor affects the way they feel about themselves and the way they are regarded by their own community. They will interview families in UK, Norway, China, India, Pakistan, Uganda, South Korea and Germany. As well as comparing experiences across countries, the study will include differences between rural areas, cities and towns. Professor Walker, from the Department of Social Policy and Social Work at the University of Oxford, said: "Very little is known about the way people in different countries experience and regard poverty. (It) has been suggested that, in China, for example, it might be more important for adults, even in poor families, to maintain 'face' and to uphold their own sense of dignity. "In parts of India and Pakistan it is possible that loss of 'family honour' adds to any sense of personal shame". "This is the first time an academic study has been set up to analyse the importance of shame in understanding the experience of poverty in very different cultures," Walker added. The research team will analyse whether there is a link between poverty and shame: through its portrayal in literature and film; in-depth interviews with low-income households; and focus groups with middle-class people on their view of poverty. The researchers will carry out a statistical analysis of existing data on poverty in the World Values Survey. They will also explore the language and practices used by the agencies responsible for implementing social assistance and anti poverty programmes to see whether they are more or less likely to make people ashamed of asking for help. Professor Walker said: "Language is loaded with all sorts of nuances and subtleties: phrases like 'sink estates', 'hand-outs', 'deserving' and 'undeserving', even 'rights and responsibilities', make judgements on the poor". "We hope this study helps to inform policy development, both in the UK and abroad. Our objective is to use this research to work together with policymakers and agencies to deliver policies that tackle poverty effectively while simultaneously recognising the importance of promoting dignity and a sense of self-respect," he added.
http://economictimes.indiatimes.com/news/news-by-industry/et-cetera/Is-poverty-in-India-linked-to-shame/articleshow/6439969.cms

MALARIA: Plasmodium vivax distribution map

Nearly 3 billion people, or two-fifths of the world's population, were at risk of contracting malaria in 2009 and closer study of the mosquito's life cycle is needed to combat the disease, researchers said in two reports.In the first study, scientists mapped out the geographical spread of the Plasmodium vivax -- the most common parasite that causes malaria -- using reported cases of malaria and details on temperature and aridity."We estimate that the global population at risk of P. vivax malaria in 2009 was 2.85 billion people. Regionally, the great majority of this population (91 percent) resides in central and southeast Asian countries," wrote Simon Hay, a zoologist at the University of Oxford who co-authored the study."P. vivax remains the most widely distributed human malaria parasite even after a century of development and control," he wrote, replying to questions from Reuters.However, chances of infection by this parasite is low across Africa because of a genetic trait that protects mostly people of African origin.But transmission of the parasite does occur in the continent and remains a concern for travellers and people who do not carry the trait, the researchers said.The malaria atlas was published on Wednesday in the journal PLoS Neglected Tropical Diseases.In 2008, there were 247 million cases of malaria worldwide and nearly one million deaths, mostly among children.Knowing where the P. vivax thrives is critical so that plans can be made to control it, wrote Carlos Guerra, another author of the atlas and also from the University of Oxford.Hay said the parasite, which is carried by the female Anopheles mosquito, is sensitive to environmental factors."Low temperatures delay the development of the parasite in the mosquito and if this time exceeds the life span of the vector (mosquito), then transmission is not possible," Hay said."Aridity acts mainly on the vector by increasing mortality through desiccation and also by limiting the availability of suitable breeding sites (i.e. collections of water)."In the second paper, another team of researchers said vector control measures such as insecticide-treated nets and sprays have not been able to break the transmission cycle of the Plasmodium falciparum, another parasite that causes malaria in the most endemic parts of Africa and the Pacific.It is regarded as a more dangerous cause of malaria as it has the highest rates of complications and death."Global commitment to malaria eradication necessitates a corresponding long-term commitment to vector ecology," wrote Gerry Killeen from the Ifakara Health Institute in Dar es Salaam, Tanzania, and colleagues in the journal PLoS Medicine."Priority areas will include understanding aspects of the mosquito life cycle beyond the blood feeding processes which directly mediate malaria transmission.
http://www.reuters.com/article/idUSTOE66R03F._CH_.2400

POVERTY: Poverty haunts India's economic miracle

Jul 17, 2010
ZARUA, India — When flames from an open cooking fire raced through Fida Hussein's shack in northern India, it was a disaster for him and his poverty-stricken family.
"We have nothing," said Hussein as he stood in the ruins of his hut through which the sky could be seen between the burnt roof timbers in a remote corner of Uttar Pradesh, India's most populous state.
India's number of millionaires grew by 51 percent to 126,700 in 2009, according to US investment bank Merrill Lynch and consultants Capgemini, boosted by a buoyant economy which grew 8.6 percent in the last fiscal quarter.
But increasing wealth has not trickled down to the likes of 40-year-old Hussein, a landless labourer whose seamed face is prematurely aged, and his family of six children who have no toys, books or other possessions.
"We have no clothes, no furniture," he said, gesturing to what remained of his burned out shack which he had roughly patched up with plastic bags.
"We have only one quilt -- eight of us sleep under it in winter," he said, as his children played in the dirt yard outside the hut. "But there's no use in crying -- no one hears us," he added.
Like the more than 400 million Indians who have no electricity, Hussein's home has has no lighting and there is no running water in the huts in his village, which lies 60 kilometres (40 miles) from the state capital Lucknow.
In 1947, in his midnight independence address, India's first prime minister, Jawaharlal Nehru, called for "the ending of poverty and ignorance and disease and inequality of opportunity."
It's an end that still seems a long way off.
In April, the Planning Commission, India's premier economic policymaking body, raised its estimate of the number of Indians living in poverty -- unable to meet their nutritional needs -- from 28 percent to 37 percent, which is roughly 440 million of the 1.2 billion population.
A new international Mulitple Poverty Index, developed at Oxford University and measuring a wide range of household-level deprivation, suggests that more people are mired in poverty in just eight Indian states than in the 26 poorest African countries.
"There are two categories growing in the 'Rising India'... the super rich, and the abysmally poor," noted newspaper editor M.J. Akbar in a recent column.
The left-of-centre Congress government was re-elected on a pro-poor platform that promised to do something for its main support base in India's rural hinterlands.
During its first term, it increased social spending, raising health and education budgets and launched a huge public works program -- the National Rural Employment Guarantee Act -- and a big loan repayment waiver for farmers.
But Hussein, who does work for local farmers, says he has not managed to obtain a card needed to work in the jobs scheme. Others in the area complain that they only get a few days work with the programme.
Former premier Rajiv Gandhi once said only 15 percent of development money gets to its intended targets. While things have improved, there is still a lot of "leakage" from poverty programmes.
The government will spend at least 250 billion dollars on services for the poor in the next five years but a recent report by investment house CLSA Asia Pacific Markets estimated more than 100 billion dollars would be skimmed off.
"There's personal gain going on at public cost where people who are supposed to look after the interests of the people accumulate large sums," Anupama Jha, executive director of Transparency International India, said.
Corruption, she said, is rife -- percolating through government, the private sector, the police and the judiciary.
"There are signs of deterioration in behaviour where people who have access to money do not feel accountable to the people they represent," Jha said.
"The poor are not spared even in the case of targeted programmes" and are often obliged to pay bribes to take advantage of public services, according to a recent study by the group.
Hardwari Lal, a labourer who has three children and whose wife is expecting a fourth, says he also has not received the card needed to get work.
Lal, 32, owes a moneylender who is charging five percent interest a month on a 7,000 rupee (150-dollar) loan he took out for his son's hospital bill.
"There is only so much I can do," he said, adding he has no way of feeding his family properly as he can barely keep up with the interest payments let alone make a dent in the principal.
"So many poor villagers are caught up in this cycle of poverty where they get into difficulty and go to a moneylender," said local development worker Vikrant Kumar.
As part of its anti-poverty drive, the government is drafting a Right to Food Act which calls for a government-subsidized minimum of 25 kilograms (55 pounds) of wheat and rice a month for households below the poverty line.
Hussain feeds his six children two meals a day -- potatoes and wheat chapatis or flat bread -- and eats one meal a day himself. Dal, the mainstay of Indian diets because of its high protein, is too expensive, he says.
Malnutrition among under-fives in India stands at 43.5 percent -- worse than sub-Saharan Africa -- and only nine percentage points less than when India's "economic miracle" began in 1991.
During the same period, India's gross domestic product per capita has jumped 50-fold.
"We have gone from being a food deficit country to a food surplus country, which is a big achievement, but there's a lot to be done in terms of getting the food to people who need it," said Indian political author Ajoy Bose.
"You look slightly stupid in claiming to be a major power or even a modern progressive state if you haven't done the very elementary basics for your marginalised population," Bose said.
Mountains of grain and vegetables still rot each year due to poor storage and distribution.
The immense gap between poor and rich has been pointed to by numerous commentators as a factor fuelling a growing Maoist insurgency that has spread across a large swathe of the country and is at its strongest in remote, impoverished regions.
"It is not just poverty that is increasing, it also the inequality," said senior Indian communist leader Brinda Karat.
The government insists it needs double-digit growth to eradicate poverty, but New Delhi-based food and trade policy analyst Devinder Sharma argues that effective distribution of wealth is the real key.
"We are already on a growth trajectory, but people are getting poorer. Eradicating poverty is not woven into growth," he said.
http://www.google.com/hostednews/afp/article/ALeqM5iobZ4vyzpNpFupFdweIojf1VzmRQ

POVERTY: Rethinking priorities

20 Jul 2010
Developments reported on TropIKA.net within the last few days have challenged some common assumptions made about the infectious diseases of poverty…
most of the really poor people in the world live in Africa; most fevers in Africa are caused by malaria; persistent brain damage is an inevitable consequence of cerebral malaria; we know (roughly) the prevalence of TB in countries like South Africa; childhood TB is not a priority area; pneumonia and diarrhoea are not neglected diseases; and innovations in medical research always happen in the North, not in disease-endemic countries themselves…
Whether these recent developments represent good news or bad, they call into question the ordering of many of the current priorities for research, policy and public health practice.
Researchers at Oxford University have applied a new “multidimensional poverty index”, to conclude that there are more poor people in eight of India’s states than in the 26 countries of sub-Saharan Africa combined [1]. Not everyone will agree with this analysis, but the infectious disease burden of India’s poor surely deserves to be accorded a higher priority.
It has for some years been believed that an African child with fever is most likely to have malaria. As confirmatory diagnostic tests are usually unavailable on the frontline of care, the practice of “presumptive” diagnosis and treatment is therefore recommended. However, a mathematical modelling study [2] has concluded that most fevers are not malaria. In some parts of Africa, 80% of children attending public clinics with fever are probably suffering from some other infection. The findings provide strong support for the new rapid diagnostic tests to be made available at all health facilities in Africa.
One of the most serious consequences of malaria is the lasting cognitive damage suffered by children who develop cerebral malaria. A very “early” study [3] with laboratory mice suggests that adding antioxidants to standard malaria treatment may help prevent this. (By coincidence, this research has been published within a few days of an analysis [4] appearing to show that a high prevalence of parasitic infections holds back rises in the average IQ in disease-endemic countries.)
http://blog.tropika.net/editorschoice/2010/07/20/rethinking-priorities/

MALARIA: MDG's

MDGs are eight time-bound goals tackling poverty and its various dimensions that member states of the United Nations and other international organisations have agreed to meet by 2015. "We either win this fight or we lose it. There can be no let-up in the fight against the three diseases," said U.N. secretary-general Ban Ki- moon in a message last month, as he described the progress made by the Global Fund, which has been the main contributor to the health-related MDGs. Professor Kevin Marsh, director of the Kenya Medical Research Institute Wellcome Trust programme in Kilifi, Kenya, cites the experience of Africa to stress the impact of efforts to fight one of the world’s killer diseases on meeting the MDGs. "In Africa, if you control malaria, you can reduce childhood mortality down to the levels to achieve MDGs," he says. In coastal Kenya, for instance, malaria has dropped by 90 percent in the last five years and infant childhood deaths have dropped from 115 deaths per 1,000 under-five children to 74 last year, he recounts. Malaria causes 500 million episodes of illness, almost 40 percent of them in Asia, and one million deaths annually, 90 per cent of them in Africa, says WHO. "The changing epidemiology of malaria in Southeast Asia, including the emergence and spread of drug-resistant strains of the parasite, are posing fresh challenges to regional elimination efforts," says Professor Ric Price of the Menzies School of Health research in Darwin. "To achieve the ultimate goal of malaria control, we estimate that four to five billion U.S. dollars are needed per year, sustained over the next 20 to 30 years." Parts of South-east Asia are already witnessing the emergence of malarial strains that are resistant to ‘artemesinins’, drugs the world depends on to treat malaria. If such a situation is not controlled, "it will be a very serious global health issue," warns Marsh, who is also a professor of Tropical Medicine at Oxford University. There are five species of malaria that commonly infect humans, two of which pose the greatest health risks –‘Plasmodium falciparum’ and ‘P. vivax’ to humans. In Asia, the challenge lies in controlling the ‘P. vivax’ malaria. The emergence of another species of potentially fatal adult malaria, ‘Plasmodium knowlesi’, has also been noted in the region, particularly in Malaysia. Pig-tailed and long-tailed macaques monkeys are the reservoirs of this parasite, says Timothy William, head of the Infectious Disease Unit at Queen Elizabeth Hospital in Sabah, Malaysia. "It is difficult to treat or eradicate the reservoirs for obvious reasons. In our study, about 30 percent of the cases presented with severe disease. Therefore it is imperative that these cases are diagnosed early and treated," he says. Research has shown that more than 60 percent of emerging infectious diseases have been related to animal and human contact. "Of these, 70 percent are due to contact between humans and wildlife. In developing countries, these issues are even more important with increasing land clearing, intensive farming of poultry, and infections passing from wild birds into domestic birds," Sorrell tells IPS. Still another major challenge to the global health community is the growing drug resistance of certain diseases, particularly to antibiotics. These include tuberculosis, typhoid, malaria, and sexually transmitted diseases like gonorrhoea. In recent years, there has been a renewed commitment to vaccine research to prevent and treat these infections and other preventable diseases in the developing world. "The issue in the long term is affording the vaccines in routine use," says Marsh, who adds that immunisation has been "one of the most successful international efforts to curb the spread of diseases." Immunisation is particularly crucial for children at risk for pneumococcal disease, says Dr Andrew Pollard, professor of paediatric infection and immunity and director of the Oxford Vaccine Group at Oxford University. "Streptococcus pneumoniae is the leading cause of pneumonia in childhood and kills more children in South Asia and South East Asia than any other disease," he says.
http://www.ipsnews.net/news.asp?idnews=51795

Pyramax to treat malaria

Coartem is the current "gold standard" for people infected with the mosquito-borne disease. The two-in-one Novartis drug needs to be taken twice a day and requires a fatty diet for optimum absorption.
Pyramax from South Korean drugmaker Shin Poong Pharmaceuticals is taken just once daily.
A randomized Phase III study of Pyramax -- a fixed-dose combination of pyronaridine and artesunate -- showed a treatment response of 99.5 percent compared to 99.2 percent among patients on Coartem, which combines artemether and lumefantrine.
Researchers involved in the study wrote in the Lancet medical journal that a three-day course of Pyramax should be considered for inclusion in malaria treatment programs, especially given its low cost of less than $1 for adults and 50 cents for children.
In an accompanying comment, however, Dr Francois Henri Nosten of the Mahidol-Oxford University Tropical Medicine Research Programme said a limitation of the study was that it consisted of many older African children and adults who had probably acquired some malaria immunity.
http://www.reuters.com/article/idUSTRE63L6CD20100422