POVERTY: SENEGAL: Poorly-trained midwives pose danger

DAKAR, 30 June 2011 (IRIN)

 Photo: Tiggy Ridley/IRIN
Midwives need better training on how to cope when things go wrong (file photo)

 Poorly-regulated, privately-run training schools in Senegal are churning out midwives who do not have a solid grasp of birthing or ante- and post-natal care, causing women and babies to die needlessly, according to the UN Population Fund (UNFPA).
Other basic competencies, as defined by the World Health Organization, include referral in high-risk pregnancies or births; addressing miscarriages; and family planning.
Most women who die during labour in Senegal do so because of post-partum haemorrhaging, according to UNFPA’s joint Senegal director, Edwige Adekambi.
“We know the causes of maternal mortality; we know that if a haemorrhaging woman does not get care within two hours she is likely to die, but many private training schools don’t even include this care in their curriculum,” she told IRIN.
Some 401 women died per 100,000 live births in Senegal, according to the latest government health survey in 2005, ranking 144 out of 181 countries studied; and only 52 percent of births in 2005 were accompanied by a qualified birth attendant, though for the poorest 20 percent of women this drops to 20 percent. While performing better on maternal mortality than most of its West African neighbours, Senegal still has a lot of work to do to reach the Millennium Development Goal on maternal mortality, according to UNFPA.
These and other issues were discussed at the Senegal launch of UNFPA’s State of the World’s Midwives report on 29 June.

Unregulated
Senegal has dozens of private midwife training schools which are in theory, regulated, but with just two government inspectors to do this, many get away with low standards, said Adekambi.
Bigoué Ba, vice-president of the National Association of Midwives, told IRIN “Anyone can open a school in Senegal. There’s no monitoring.”
While there is a national test that all midwives must pass to be recruited into a public hospital or clinic - and generally those who pass have been trained in public institutions, according to UNFPA - many who fail the exam can still obtain a diploma and find a job in a private clinic, said Adekambi.
The government has tried to improve regulation of schools, but cannot be expected to do it all, Health Minister Modou Diagne Fada told journalists at the report launch. “We are committed to improving maternal mortality rates and addressing the midwife problem, but partners have to help with this too,” he said.
UNFPA is working with the government, the National Association of Midwives, and aid groups to improve the national curriculum; it calls on the government to impose stricter regulation across the sector.
The current curriculum, while thorough, excludes vital aspects of birthing support, including how to administer antibiotics, to give oxytocin to stimulate uterine contractions; and using ventouse (a vacuum device) during birth to ease delivery. UNFPA teaches these techniques in “post-training” for midwives in several regions including Kolda and Tambacounda in central Senegal.

Rural shortage
As well as better training, more midwives are needed across the country: Senegal has just two midwives per 1,000 population, which is one-third of the recommended international norm, according to WHO.
Density of midwives, nurses and doctors per 1,000 population : Mali 0.3; Niger 0.2; Nigeria 2.0;
Liberia 0.3; Senegal 0.5; Sierra Leone 0.2

Shortages are particularly acute in rural areas: Matam, on the eastern border, has just 14 state-trained midwives and requires 389; Tambacounda has 38 (only one of whom is trained in family planning) and requires 515; while Dakar has 445 but requires a further 1,566, according to 2008 statistics from the Ministry of Health and Prevention’s human resource unit.
There is no gynaecologist or obstetrician at all in Kolda, so for complicated births women have to travel to Tambacounda, which takes more than the precious two-hour window, if something goes wrong.
To reach Millennium Development Goals four and five to improve child and women’s mortality and health, Senegal needs to recruit 250 additional midwives per year, according to UNFPA.

Recruitment drive
In 2010 the government did a countrywide recruitment push, hiring hundreds of additional midwives to work in rural areas.
While partially successful, half of all midwives recruited to rural areas “found a reason why they had to return to Dakar within the year,” said Health Minister Fada.
He puts the onus on them to stay. “It is their duty if they accepted this profession, to work where the needs are,” he told journalists at the report launch in Dakar, and he also called on the Midwives’ Association to encourage midwives to stay.
But the government also needs to think of more creative ways to encourage midwives to work in rural areas, said Ba of the National Midwives Association. Incentives have been discussed but few yet put into practice. These include providing midwives with lodging, a vehicle, health insurance for their families, or career development training.
The Health Ministry should also consider training up the hundreds of traditional birthing attendants, known as “matrones”, who work in villages throughout the country, said Ba.
More also needs to be done to make midwifery an “attractive” career, according to Ba. Midwives are paid on average US$200-300 per month at first but, given that there is very little career development, this could rise by just $100 over two decades of work. Career development training would also incentivize women to commit over the long term, she said.
All recognized the progress the Health Ministry has made since 2010: trying to regulate training more carefully; requiring the minimum of a baccalaureate certificate to enter midwife training; and delegating more medical tasks to midwives.
Most significantly, the government made all births, including Caesarean sections, free of charge in all regions of the country, except Dakar.
Further improvements will cost more than recent additions to the health budget will allow, said Fada. New income sources for the health sector, such as additional taxes on cigarettes and other goods, are being considered.
http://www.irinnews.org/report.aspx?reportID=93111

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

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

.Hedge funds 'grabbing land' in Africa

8 June 2011

 

Foreign firms are snapping up farming land in Africa, a new report says
Hedge funds are behind "land grabs" in Africa to boost their profits in the food and biofuel sectors, a US think-tank says.
In a report, the Oakland Institute said hedge funds and other foreign firms had acquired large swathes of African land, often without proper contracts. It said the acquisitions had displaced millions of small farmers.
Foreign firms farm the land to consolidate their hold over global food markets, the report said. They also use land to "make room" for export commodities such as biofuels and cut flowers.
"This is creating insecurity in the global food system that could be a much bigger threat than terrorism," the report said.
The Oakland Institute said it released its findings after studying land deals in Ethiopia, Tanzania, South Sudan, Sierra Leone, Mali and Mozambique.

'Risky manoeuvre'
It said hedge funds and other speculators had, in 2009 alone, bought or leased nearly 60m hectares of land in Africa - an area the size of France.
What is wrong with renting out African land?
"The same financial firms that drove us into a global recession by inflating the real estate bubble through risky financial manoeuvres are now doing the same with the world's food supply," the report said.
It added that some firms obtained land after deals with gullible traditional leaders or corrupt government officials.
"The research exposed investors who said it is easy to make a deal - that they could usually get what they wanted in exchange for giving a poor tribal chief a bottle of Johnnie Walker [whisky]," said Anuradha Mittal, executive director of the Oakland Institute.
"When these investors promise progress and jobs to local chiefs it sounds great, but they don't deliver."
The report said the contracts also gave investors a range of incentives, from unlimited water rights to tax waivers.
"No-one should believe that these investors are there to feed starving Africans.
"These deals only lead to dollars in the pockets of corrupt leaders and foreign investors," said Obang Metho of Solidarity Movement for New Ethiopia, a US-based campaign group.
However, not all companies named in the report accept that their motives are as suggested and they dismiss claims that their presence in Africa is harmful.
One company, EmVest Asset Management, strongly denied that it was involved in exploitative or illegal practices.
"There are no shady deals. We acquire all land in terms of legal tender," EmVest's Africa director Anthony Poorter told the BBC.
He said that in Mozambique the company's employees earned salaries 40% higher than the minimum wage.
The company was also involved in development projects such as the supply of clean water to rural communities.
"They are extremely happy with us," Mr Poorter said.

--------------------------------------------------------
In the field

Umaru Fofana : BBC African Service, Sierra Leone
When I visited Lungi-Lol in rural Sierra Leone I saw men hoeing thousands of hectares of farmland owned by Addax, a Swiss-based bio-energy company.
They are growing sugarcane to produce biofuels.
Campaigners say this contributes to food insecurity, but many people here welcome Addax's presence.
Francis Koroma, who works on the farm, says: "We thank God for Addax. I am gainfully employed and I receive about $70 (£46) a month. Before, I spent a whole year without getting $50."
Villagers are unaware of the controversy surrounding biofuels.
Abdulai Conteh , a local traditional leader, said: "Some people are doing business here but I have no idea what they are doing with our land. I see them growing sugarcane. That's all I know."
http://www.bbc.co.uk/news/world-africa-13688683

POVERTY: Evidence is piling up against acquisitions of farmland in poor countries

May 5 2011
THE farmers of Makeni, in central Sierra Leone, signed the contract with their thumbs. In exchange for promises of 2,000 jobs, and reassurances that the bolis (swamps where rice is grown) would not be drained, they approved a deal granting a Swiss company a 50-year lease on 40,000 hectares of land to grow biofuels for Europe. Three years later 50 new jobs exist, irrigation has damaged the bolis and such development as there has been has come “at the social, environmental and economic expense of local communities”, says Elisa Da Vià of Cornell University.

When deals like this first came to international attention in 2009, it was unclear whether they were “land grabs or development opportunities”, to quote a study published that year. Supporters claimed they would bring seeds, technology and capital to some of the world’s poorest lands. Critics, such as the director of the UN’s Food and Agriculture Organisation, dubbed them “neo-colonialist”. But no one had hard evidence to back up their claims. Now they do. Two years on, a conference at the Institute of Development Studies (IDS) of the University of Sussex, the biggest of its kind so far, examined over 100 land deals. Most judgments are damning.*

Land grabs have been strikingly popular. Preliminary research by the International Land Coalition, a non-governmental organisation, reckons almost 80m hectares have been subject to some sort of negotiation with a foreign investor, more than half in Africa (see chart). This estimate is far higher than a previous one, by the World Bank, which last year said that foreign investors had expressed interest in 57m hectares. It is higher still than one by the International Food Policy Research Institute (IFPRI) which put the figure in a 2009 study at 15m-20m hectares. It would be wrong to draw a line between these numbers so as to conclude that land deals have grown fourfold. Since most are secret, knowing what to count is difficult, and the figures refer to different periods.



Yet each time someone has looked at the phenomenon, the result has been a figure roughly twice the earlier estimate. It is also clear that the overall scope is vast: 80m hectares is more than the area of farmland of Britain, France, Germany and Italy combined. And land deals are continuing, possibly even speeding up. Over a tenth of the farmland of South Sudan has been leased this year—even before the country has formally got its independence. GRAIN, an advocacy group, says it has seen proposals that would allow Saudi business groups to take control of 70% of the rice-growing area of Senegal.
It is not just the size of land deals that remains uncertain. Their contractual basis often is, too. Few contracts have been made public, so details are sketchy. But an investigation of 12 that have been, by Lorenzo Cotula of the International Institute for Environment and Development, declares many “not to be fit for purpose”. The rights and obligations of each side, Mr Cotula says, are usually extremely vague, while traditional land-use rights are frequently ignored. As one farmer asked when a British company acquired forestry rights in Tanzania: “How come others are selling our land?”
Even after the contract is signed, there is no guarantee a land deal will go ahead in accordance with it. A survey by the World Bank† showed that in the Amhara region of Ethiopia, only 16 of 46 projects were working as intended (the rest lay fallow or had been rented back to smallholders). In Mozambique only half the projects were working as planned.
Still, some conclusions seem warranted. When land deals were first proposed, they were said to offer the host countries four main benefits: more jobs, new technology, better infrastructure and extra tax revenues. None of these promises has been fulfilled.
Locals usually regard jobs as the most important of these. But so far they have been scarce, and only partly because many projects are not yet up and running. In Mozambique, the World Bank found, one project had promised 2,650 jobs and created a mere 35-40 full-time positions. A survey by Thea Hilhorst of 99 smaller projects in Benin, Burkina Faso and Niger reported “hardly any” rural job creation. Only one of the publicly available contracts studied by Mr Cotula even specifies a number of new jobs to be created. And when there are jobs, foreign investors often bring in outsiders to staff them, leading to “conflict or accusations of cheating”, according to the World Bank. The manager of one project was killed during an argument about jobs.
Evidence of the transfer of technology and skills is mixed. Ms Hilhorst found almost no impetus towards greater professionalism in farming, although she concedes that closer links with food processors and distributors might improve matters. The World Bank’s study argued that technological improvements in Ukraine and Mexico had helped reduce rural out-migration (though this was surprising: you might have expected new labour-saving technologies to encourage underemployed farmers to leave the land). Mr Cotula’s study of land-deal contracts found few examples in which the foreign investor was obliged to exchange materials or ideas with local farmers. At the moment, land-grabbing foreigners seem to be creating islands for themselves, cut off from the poverty-stricken countryside.

Grabbing sans giving
Some projects’ operators have done better in building new schools, clinics and other “social infrastructure”. Madagascar may be a surprising example as it witnessed what is perhaps the most notorious land grab of all: a South Korean company was offered half the country’s arable land—a proposal that fuelled protests which eventually toppled the government who approved the deal. Two years later Perrine Burnod of CIRAD, a French research organisation, found that the number of land deals on the island had fallen by two-thirds. And those that remained had begun to look more like aid projects, with investors committing themselves to building schools and clinics. Local mayors were welcoming them in to help finance projects no longer supported by the cash-strapped central government.
Yet this is atypical. Most land deals contribute little or nothing to the public purse. Because markets for land are so ill-developed in Africa and governments so weak, rents are piffling: $2 per hectare per year in Ethiopia; $5 in Liberia. Tax and rent holidays are common. Indeed, it is not unusual for foreign investors to pay less tax than local smallholders. And upfront compensation to local farmers for use of their land is derisory: often just a few months of income for agreeing to a 100-year lease.
“The risks associated with such investments are immense,” concludes the World Bank. “In many cases public institutions were unable to cope with the surge in demand…Land acquisitions often deprived local people, in particular the vulnerable, of their rights…Consultations, if conducted at all, were superficial…and environmental and social safeguards were widely neglected.”
So why are land deals popular? That is surprisingly easy to answer: strong demand and willing suppliers. The big investors tend to be capital-exporting countries with large worries about feeding their own people. Their confidence in world markets has been shaken by two food-price spikes in four years. So they have sought to guarantee food supplies by buying farmland abroad. China is by far the largest investor, buying or leasing twice as much as anyone else.
Local elites have also played a vital role in spreading land deals. In a Tanzanian project described by Martina Locher of the University of Zurich, “local people who refer to customary law have a very low level of knowledge [and cannot] defend their land rights.” In contrast, she writes, “state law is mainly represented by district officials, who…enjoy a high level of respect by local people.”
Then there is corruption. Many of the west African “land grabbers” described by Ms Hilhorst are local politicians, civil servants and other urban elites who bribe local chiefs with gifts of motorbikes. Madeleine Fairbairn of the University of Wisconsin, Madison, argues that in Mozambique, an informal division of the spoils has emerged. Local bigwigs use their influence to get “facilitation fees”, while national leaders manipulate the law and promote (or obstruct) projects to their own and their supporters’ advantage.
Many development projects work this way. What makes land grabs unusual is their combination of high levels of corruption with low levels of benefit. Ruth Meinzen-Dick, one of the authors of the IFPRI study, says that in 2009 the balance of costs and benefits was genuinely unclear. Now, she argues, the burden of evidence has shifted and it is up to the proponents of land deals to show that they work. At the moment, they have precious few examples to point to.
http://www.economist.com/node/18648855?story_id=18648855

MALARIA: Sierra Leone: Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in .

Thomson A, Khogali M, de Smet M, Reid T, Mukhtar A, Peterson S, von Schreeb J. Malar J. 2011 Apr 17;10(1):94. [Epub ahead of print]


BACKGROUND:
Malaria is hyper-endemic and a major public health problem in Sierra Leone. To provide malaria treatment closer to the community, Medecins Sans Frontieres (MSF) launched a community-based project where Community Malaria Volunteers (CMVs) tested and treated febrile children and pregnant women for malaria using rapid diagnostic tests (RDTs). RDT-negative patients and severely ill patients were referred to health facilities. This study sought to determine the referral rate and compliance of patients referred by the CMVs.

METHODS:
In MSF's operational area in Bo and Pujehun districts, Sierra Leone, a retrospective analysis of referral records was carried out for a period of three months. All referral records from CMVs and referral health structures were reviewed, compared and matched for personal data. The eligible study population included febrile children between three and 59 months and pregnant women in their second or third trimester with fever who were noted as having received a referral advice in the CMV recording form.

RESULTS:
The study results showed a total referral rate of almost 15%. During the study period 36 out of 2,459 (1.5%) referred patients completed their referral. There was a significant difference in referral compliance between patients with fever but a negative RDT and patients with signs of severe malaria. Less than 1% (21/2,442) of the RDT-negative patients with fever completed their referral compared to 88.2% (15/17) of the patients with severe malaria (RR=0.010 95% CI 0.006 - 0.015).

Conclusions
In this community-based malaria programme, RTD-negative patients with fever were referred to a health structure for further diagnosis and care with a disappointingly low rate of referral completion. This raises concerns whether use of CMVs, with referral as backup in RDT-negative cases, provides adequate care for febrile children and pregnant women. To improve the referral completion in MSF's community-based malaria programme in Sierra Leone, and in similar community-based programmes, a suitable strategy needs to be defined.

PMID: 21496333 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21496333

MALNUTRITION: Sierra Leone: More than 300,000 children under five are malnourished

More than 300,000 children under five in Sierra Leone are malnourished, UNICEF Country Representative Mahimbo Mdoe said at the weekend.

Addressing a meeting on National Nutrition and Food Security, Mdoe said chronic malnutrition remained the most critical development challenges in Sierra Leone, with over 300,000 children under the age of five had been suffering from chronic malnutrition.
According to a survey conducted in 2010 by the UNICEF, one third of children below five years were chronically malnourished, 7 percent acutely malnourished whilst 10 percent under weight.
If immediate remedies were not taken, the UNICEF official said, a large proportion of the next generation of children would not live up to their full physical and mental potential.
She urged the Sierra Leonean government to accelerate progress in reducing child hunger and malnutrition as they were central in the United Nations millennium development goals in the West African country and to ensure long term economic growth and social stability.
Malnutrition was the leading cause of child death and morbidity in Sierra Leone and one of the resultant effects which limit the physical, mental and emotional development of children and adults thereby restricting the potential economic and social development of Sierra Leone.
According to UNICEF research, Sierra Leone has the highest child mortality rate in the world and children represent about a third of the country’s population.
In April, the government introduced the free health care for lactating mothers, pregnant women and children under five to address the high rate of children mortality and morbidity.
The government has also introduced a school feeding program to help enhance the nutrition status of the children.
However, the government effort is yet to make any significant impact.
http://www.sierraexpressmedia.com/archives/20821

BIOTERRORISM: U.S. anti-terror outpost tackles rat-borne virus

KENEMA, Sierra Leone (Reuters) - In a far-flung laboratory in West Africa, American researcher Matt Boisen drops serum from a woman infected with Lassa fever onto a slim strip, testing a new way of diagnosing the deadly virus. Soon a tell-tale red horizontal bar appears.
Boisen's laboratory in southeastern Sierra Leone is an outpost of the U.S. government's "war on terror," funded by a surge in bio-defense spending since the airplane and anthrax attacks on New York and Washington a decade ago.
American research aims to limit the vulnerability of western interests to biological agents. In the case of Lassa swift and simple diagnosis is seen as critical to doing that.
"There's been a renewed emphasis on those tropical diseases that (government health officials) consider biothreats," explained Boisen of his work on Lassa, which, similar to Ebola, can cause victims to bleed from multiple orifices.
Lassa fever, named after the Nigerian town where it was first identified in 1969, is among a U.S. list of "category A" diseases -- deemed to have the potential for major public health impact -- alongside anthrax and botulism.
The disease is carried by a species of rodent, Mastomys Natalensis, found across sub-Saharan Africa and often eaten as a source of protein. It infects an estimated 300,000-500,000 people each year, and kills about 5,000.
"There's a recognition that this is a higher level threat agent," said Dr. Thomas Geisbert, an academic at the University of Texas and a former researcher at the United States Army Medical Research Institute for Infectious Diseases.
"It would be naive not to think some terrorist group could use one of these things to create terror."
In 2001 -- prior to the September 11 attacks -- the U.S. National Institutes of Health budget for bioterrorism and related research was $53 million. But by the fiscal year 2007 the NIH was requesting more than $1.9 billion.

IT TASTES GOOD
In Sierra Leone the current Lassa research -- a $40 million project involving Tulane University in New Orleans -- is run out of the government hospital in Kenema in the southeast of the impoverished country.
The regular stream of Lassa fever patients, kept in an isolation ward, provide researchers with access to the virus.
Staff hope their new diagnostic product will eventually be cheap, simple and robust enough to take into the field - comparable to current tests for malaria or HIV - replacing complicated laboratory procedures.
Such a test could quickly identify an outbreak in the United States, and also should dramatically reduce the disease's impact in its home territory. A patient's chances of survival increase if they receive early treatment.
In Kenema, 300km (200 miles) from the capital Freetown, it is impossible to create the same levels of protection for researchers that they would experience a western lab.
In the United States, Lassa virus is handled in bio-safety level four facilities, where researchers wear "space suits" - but in Kenema measures include goggles, gloves and masks.
"Certainly we have less safety, less containment, but we do have the ability to do a lot more in the same amount of time," said Boisen.
While expatriates predominantly work in the laboratory, a local outreach team tries to persuade local people not to eat the Mastomys rodent -- a difficult task.
"It tastes good," said staffer Lansana Kanneh. "That is why it is very difficult for us to take people off from eating rat."
(Editing by Richard Valdmanis)
http://www.sciencemagnews.com/u-s-anti-terror-outpost-tackles-rat-borne-virus.html

BIOTERRORISM: Biodefense Scientists Fight Lassa Fever

Simon Akam, Reuters/Yahoo!News,  Feb. 15, 2011

Scientists are at work in Sierra Leone studying the rat-carried Lassa fever with the aim of developing a speedy and uncomplicated process for diagnosing the virus in the event of a bioterrorism attack, Reuters reported yesterday (see GSN, Nov. 23, 2010).
A laboratory in Sierra Leone's southeast is conducting U.S.-funded research on Lassa fever, which is classified as a "category A" pathogen, a designation given to biological agents such as botulism and anthrax that can produce significant health threats.
The disease is found in a particular species of rat that is widespread in sub-Saharan Africa and regularly consumed for protein. It is estimated to cause between 300,000 and 500,000 infections annually and roughly 5,000 deaths.
"There's been a renewed emphasis on those tropical diseases that (government health officials) consider biothreats," said U.S. scientist Matt Boisen, who is studying Lassa fever in Sierra Leone.
Tulane University is participating in the Lassa fever research effort with the West African state. Researchers in the $40 million diagnostic initiative would like to see their new testing strip method one day ready for use in the field and in the United States.
"There's a recognition that this is a higher level threat agent," one-time U.S. Army Medical Research Institute of Infectious Diseases researcher Thomas Geisbert said. "It would be naive not to think some terrorist group could use one of these things to create terror"
http://www.globalsecuritynewswire.org/gsn/nw_20110215_6068.php

POVERTY: Diamonds in the Central African Republic

Diamonds are feeding cycles of poverty and conflict in the CAR in much the same way as they did in Sierra Leone and Liberia in the 1990s and early 2000s. The scale of the problem is smaller, because the CAR has fewer diamonds, and its armed groups are less organised, but the dynamics are identical and the human suffering just as real. Misguided governance of the mining sector, in part a legacy of decades of misrule and state fragility, rewards the lucky few, leaves thousands of artisanal miners and their families fighting for their livelihoods and encourages smuggling.

Widespread poverty and well-oiled illicit trading networks enable armed groups to profit from diamonds, and weak security forces can do little to stop them. It is high time the government and international partners paid
more attention to these interlinked issues and committed to genuine reform of the mining sector. The first step is to prise control of the sector from the regime’s grip and open it to national and international scrutiny
http://www.crisisgroup.org/~/media/Files/africa/central-africa/central-african-republic/167%20Dangerous%20Little%20Stones%20-%20Diamonds%20in%20the%20Central%20African%20Republic.ashx

MALARIA: Sierra Leone - nets without the Global Fund

 Bill Brieger

28 Nov 2010
Widespread efforts to scale up insecticide treated net ownership to meet 2010 Universal Coverage targets are underway in most endemic countries of Africa. The majority have been using their Global Fund grants to make this leap, supplemented by contributions of other partners.
What happens when a country does not have Global Fund resources at this time? Current efforts in Sierra Leone to reach its nearly 6 million citizens provide a lesson on how to cope.
The AFP has reported on a “20-million-dollar campaign to distribute mosquito nets has been funded by the World Bank, the British Department for International Development (DFID), the Federation of the International Red Cross, the United Methodist Church and other health partners.” These partners are “attempting to get insecticide-treated mosquito nets into each household in the country and to ensure their proper use,” using a house-to-house campaign, which is challenged by poor road conditions.
VOA quotes Lianne Kuppens of Unicef in Sierra Leone who said, “”We have roughly 6 million people and we have 3.2 million bed nets already in the country as we speak. So it’s the first time ever that we are going for universal coverage of bed nets.”
Kuppens also noted that ITN use by children below 5 years of age was below 25%, a problem exacerbated by net mis-use - “nets often find their way into the marketplace or are used as fishing nets or shower scrubs. Vegetable growers use mosquito nets to protect cabbages and carrots from harmful bugs.”
VOA also reports that the campaign has a strong “hang up” component that is using “Street theatre, community radio and religious leaders (to) help convince people that hanging their nets over their beds is better in the long run than selling them or catching fish with them.”
But back to the Global Fund …
Sierra Leone’s experience with the Global Fund (GF) may certainly be influenced by its status as a post-conflict country. The Principal Recipient of the current Round 7 Grant, the Ministry of Health, has, according to GF progress reports, experienced some management challenges.
The Round 7 grant has been running for 2 years and just recently received a “conditional Go” for Phase 2 funding. ITNs were a small piece of this grant that aimed more at improving malaria treatment. By 30th April 2010 the grant had distributed only 277,093 of a targeted 312,498 nets for young children and pregnant women.
While the GF does not attempt to strengthen health systems directly, it certainly makes it possible for countries to use grants for their own health system strengthening efforts. More countries should take advantage of this potential. In the meantime, partners should continue to pull together as is the case in Sierra Leone to ensure Universal Coverage.
http://www.malariafreefuture.org/blog/?p=1089

MALARIA: Sierra Leone to distribute three million mosquito nets

FREETOWN — Sierra Leone health workers Friday began a massive campaign to distribute three million mosquito nets in an effort to cut malaria by up to 40 percent in the country of six million people.
"It is the most radical move ever embarked on against the disease in Sierra Leone," Dr Foday Samai, a member of the campaign team, told AFP.
UNICEF Immunization Specialist Nuhu Maksha explained that "every household in the country will receive one to three long-lasting insecticide treated nets (LLIN) depending on the size of the family."
Each net costs some six dollars and lasts up to five years.
A 2009 epidemiological report published by the health ministry ranked malaria as the number one cause of outpatient visits to hospitals throughout the country.
It also indicated there was a high resistance among Sierra Leoneans to the malaria drug chloroquine.
According to health ministry statistics, the average Sierra Leonean suffers three to four bouts of malaria per year.
The 20-million-dollar campaign to distribute mosquito nets has been funded by the World Bank, the British Department for International Development (DFID), the Federation of the International Red Cross, the United Methodist Church and other health partners.
In Bo, the country's second largest city, distribution began early Friday with housewives opening their doors to the team.
"This is like giving us a Christmas present for our health," said 45-year-old Sarah Daramy who has three children.
"We cannot afford to buy the net as my husband is only a farmer. Now we can sleep in peace."
In Makeni, in the north, 200 miles (320 kilometres) from the capital Freetown, the distribution took on a carnival-like atmosphere as local bands and musicians moved around with the team.
http://www.google.com/hostednews/afp/article/ALeqM5i-Oiu45HXWNU_qCYbNb1JvkKM8fQ

MALARIA: Use of bed nets -- populations compared

Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use.
Methods
A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger.
Results
The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations.
Conclusions
The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.
http://www.malariajournal.com/content/9/1/133

MALARIA: Bed net use statistics

Background
Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use.
Methods
A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger.
Results
The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations.
Conclusions
The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.
http://www.malariajournal.com/content/9/1/133