POVERTY: Yaws treatment study prompts WHO review

BANGKOK, 11 January 2012 (IRIN)

 Photo: World Health Organization
Boy with skin lesions from yaws

Findings that a one-time oral treatment to cure yaws, a neglected tropical disease, is as effective as the currently recommended penicillin injection have prompted the World Health Organization (WHO) to convene a meeting on how the disease may be wiped out.
"We may be closer now than we have been in decades," Kingsley Asiedu, a yaws expert with WHO's Department of Neglected Tropical Disease Control, told IRIN, calling the study on the bacterial skin disease, which leads to chronic disfiguration and disability in 10 percent of untreated cases, the most significant in half a century.
After a UN-led worldwide control programme cut infections from 50 million to 2.5 million in 1964 in 46 countries, the disease re-emerged in the 1970s when control efforts lagged, affecting an estimated 460,000 people - mostly children - in poor, tropical rural areas mainly in Africa and Asia, according to the most recent figures reported to WHO in 1995.
In 2010, the Lihir Medical Centre in Papua New Guinea (PNG), where the disease is still endemic, gave the one-time oral dose of the antibiotic azithromycin to about half of 250 infants and children from six months to 15 years infected with yaws.
Follow-up exams in 2011 showed the treatment was as effective as penicillin injections, which - unlike oral antibiotics - require trained health staff and equipment often scarce in areas most in need of treatment, wrote the researchers.
In a recent index of health workers' outreach by the NGO Save the Children, PNG ranked in the bottom 20 of 161 surveyed countries.
The meeting of yaws experts convened by WHO in Geneva from 5-7 March will "fully define how we are going to embark [on a new yaws treatment regimen] using azithromycin", said Asiedu.
WHO's yaws treatment guidelines date back to the 1960s and there have been no alternatives since, he added.
In Southeast Asia, WHO set the goal for regional eradication by 2012 in two remaining endemic countries - Indonesia and Timor-Leste. PNG, the Solomon Islands and Vanuatu have also reported cases.
Sub-Saharan Africa was the most heavily affected based on earlier estimates, but the "picture is not entirely clear now", said Asiedu. Cameroon, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic of Congo, Ghana, Sierra Leone and Togo have all reported cases.
More studies are needed to ensure resistance to azithromycin treatment does not develop, said David Mabey from the London School of Hygiene and Tropical Medicine.
While penicillin "has stood the test of time" - still as effective fighting the bacteria causing yaws after roughly 60 years - he noted mass azithromycin had only been used in developing countries for about a decade to treat trachoma, another bacterial disease prevalent in poor rural areas.
Discussions at the upcoming WHO meeting will include a measure to monitor antibiotic resistance, said Asiedu. "Antibiotic resistance is a risk in any treatment and we always have to be vigilant."
http://www.irinnews.org/report.aspx?reportid=94621

TUBERCULOSIS: Australia: Fear clinic closure poses TB threat to Australia

Andree Withey and Charmaine Kane : Jun 10, 2011

A north Queensland university's head of medicine says the closure of tuberculosis (TB) clinics in the Torres Strait, off far north Queensland, will put the Australian population at risk.
Queensland Health is in the process of closing the clinics, which are used to treat Papua New Guinea nationals who cannot access treatment in that country.
Professor Ian Wronski, from James Cook University, says tuberculosis is a re-emerging disease and the closure of the clinics is likely to see it spread into Australia.
"Bit by bit it will re-establish in the Torres - it may well be there now," he said.
"Naturally people in PNG move in the Torres Strait and people in the Torres Strait move in the Cape and we'll see tuberculosis re-establish itself in Australia.
"About 25 per cent of multi-drug resistant TB in Australia actually comes from the PNG border.
"They're very hard to treat and there's one that's extremely difficult to treat.
"We're going to see multi-drug resistant forms grow in number and percentage."
State Health Minister Geoff Wilson says he is talking to the Federal Government about re-establishing funding for the clinics.
Queensland Liberal National Party (LNP) health spokesman Mark McArdle says the distance between PNG and the Torres Strait islands is smaller than people realise.
"With a dinghy and an outboard motor, you can cross from one to the other," he said.
"This could be a very serious situation and we need to get a hold of this very quickly, otherwise it could be a disaster down the track."
http://www.abc.net.au/news/stories/2011/06/10/3240493.htm

POVERTY: PAPUA NEW GUINEA: Tackling clan conflict

  Photo: David Swanson/IRIN:  Defending honour, land and clan

GOROKA, 7 January 2011 (IRIN) - Clan violence is widespread in Papua New Guinea (PNG), where arguments over women, pigs and land can easily spiral into murder, mayhem and civil conflict.
In the volatile Eastern Highlands Province, an estimated 400 people die each year in violence - mostly sparked by land disputes.
During one dispute that lasted 16 years over a coffee plantation in Daulo District, houses were regularly set ablaze and crops destroyed. Six people were killed.
"They [the duelling groups] come and strike, and then move back for two to three weeks a month. If someone comes close to the plantation, they strike again," said Charles Goto, special projects coordinator for the Eastern Highlands provincial administration.
The impact on local communities is severe. After years of fighting, people had taken refuge elsewhere. Children could not go to school.
After the coffee plantation owner was killed, Goto, with a committee of officials and local elders, helped the two parties reach a settlement.
"Everything revolves around mediation, negotiation and compensation, and that's compensation with a capital C," said Don Hurrell, a PNG-born Australian who served 24 years with the police in north-eastern Australia and now advises Goto.
When a woman is killed, compensation is typically US$770, against $1,930 for a man. However, the settlement for the murdered coffee plantation owner - educated with a promising future - was $19,300 plus several pigs.
In 2005, the committee helped restore peace in Daulo. Families returned home and the school reopened.

Fighting for peace
The committee that convened in Daulo was the forerunner of eight district peace management teams (DPMTs) set up in 2008 in the Eastern Highlands.
That year there were 84 conflicts in the province, but with the DPMTs monitoring and mediating, there are now only two to three simmering conflicts at any given time. Patience and persuasiveness are key to resolving the disputes.
Because of customary land tenure, 93 percent of PNG's land is owned by clans with very few secure titles.
"When you're talking about tribal fights, most of it is coming from land disputes," Goto said. "If we can look after the land disputes, then we can reduce the number of tribal fights."
Once hostilities begin, payback can keep conflict alive for decades. Disputes between landowners and the owners of a copper mine on the island of Bougainville, east of the country's mainland in the Solomon Sea, escalated into 10 years of civil war and some 15,000 dead and another 70,000 displaced. The conflict ended in 1999.
"There are some fights that have been going on here for no one knows how long - well over 20 years. No one can even tell you what started it," Hurrell said.

Escalating violence
In the years after independence from Australia in 1975, "the men never touched the women and children. It was with bows and arrows. There was no burning of houses," said Naomi Yupae, executive director of the local family-focused NGO, Eastern Highlands Family Voice.
"Now with these firearms, it's just violence, violence, violence - raping women, shooting children, displacing people from their land."
Clans even hire mercenaries to kill enemies in the capital, Port Moresby, 400km away, fostering constant fear for those involved in the fighting and residents caught in the crossfire.
Donors and NGOs have poured resources into mitigation efforts: PNG-based Peace Foundation Melanesia has conducted conflict-resolution training; Eastern Highlands Family Voice has trained nearly 200 peace mediators; and the Australia Agency for International Development (AusAID) has supported the DPMTs.
Nonetheless, some locals say nothing can quell the thirst for revenge. "I don't think anyone should be involved in mediating peace for them," said Agnes Inape, a women's rights activist in Goroka, capital of Eastern Highlands Province.
"If you force them to make peace, they say 'We haven't settled the score'. They want revenge," she said. "You can spend so much money on trying to make peace, but that money is not enough to compensate for the anger, the heartache that people are going through."

Http://www.irinnews.org/report.aspx?ReportID=91559

MALARIA: Community response to intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea

Christopher Pell et al. Malaria Journal 2010, 9:369 Published: 22 December 2010
Background
Building on previous acceptability research undertaken in sub-Saharan Africa this article aims to investigate the acceptability of intermittent preventive treatment of malaria in infants (IPTi) in Papua New Guinea (PNG).

Methods
A questionnaire was administered to mothers whose infants participated in the randomized placebo controlled trial of IPTi. Mothers whose infants participated and who refused to participate in the trial, health workers, community reporters and opinion leaders were interviewed. Men and women from the local community also participated in focus group discussions.

Results
Respondents viewed IPTi as acceptable in light of wider concern for infant health and the advantages of trial participation. Mothers reported complying with at-home administration of IPTi due to perceived benefits of IPTi and pressure from health workers. In spite of patchy knowledge, respondents also demonstrated a demand for infant vaccinations and considered non-vaccination to be neglect. There is little evidence that IPTi has negative impacts on attitudes to EPI, EPI adherence or existing malaria prevention practices.

Conclusion
The degree of similarity between findings from the acceptability studies undertaken in sub-Saharan Africa and PNG allows some generalization relating to the implementation of IPTi outside of Africa: IPTi fits well with local health cultures, appears to be accepted easily and has little impact on attitudes towards EPI or malaria prevention. The study adds to the evidence indicating that IPTi could be rolled out in a range of social and cultural contexts.
http://www.malariajournal.com/content/9/1/369