TUBERCULOSIS: SOUTH AFRICA: What the world's largest preventative TB study taught us

JOHANNESBURG, 13 March 2012 (PlusNews) -

 Photo: WHO
Slow implementation of IPT

Even though the world's largest study of preventative tuberculosis therapy indicated that community-wide isoniazid preventative TB therapy (IPT) failed to lower community TB levels among 27,000 South African gold miners, that was not Thibela’s only result. We review some of the others over its seven years:

1. You do not always need an X-ray: In southern Africa, health workers and patients in rural areas often cannot access X-rays to confirm or rule out active pulmonary TB. Without X-rays to verify that patients did not have active TB, many physicians were unwilling to start patients on IPT. Thibela found that health workers could exclude at least 90 percent of active TB cases through sputum testing and symptom screening – asking patients if they were experiencing night sweats, a persistent cough or weight loss. Based in part on these findings, South Africa's latest IPT guidelines issued in June 2010 no longer require chest X-rays and TB skin tests to start HIV-positive patients on IPT.
However, in high TB prevalence settings, researchers noted that chest X-rays increased TB case detection.

2. IPT and HIV: People living with HIV, which compromises the immune system, are up to 37 times more likely to develop active TB. Findings from Thibela were able to confirm what many had long suspected but had failed to prove: that IPT provision to people living with HIV reduced their likelihood of dying. In fact, Thibela researchers showed it halved the risk of death among HIV-positive patients on or just starting antiretrovirals (ARVs). Based on this finding, South African guidelines no longer discourage the use of IPT in ARV patients.

3. Slamming side-effects: Although the World Health Organization had been recommending IPT since 1999, implementation has been slow, partly due to challenges in TB screening and doctors' fears of possible side-effects, most notably liver damage. Thibela researchers, however, found only a small number of cases of liver damage and these were among heavy drinkers. The most commonly reported side-effect of IPT was increased appetite.

4. Ignorance is not always bliss: IPT roll-out has been slow globally but in South Africa, coverage was below 1 percent in 2010 - eight years after the country introduced the preventative therapy. Zambia has only recently begun piloting IPT.
Thibela researchers found that doctors were unwilling to prescribe the drug to patients because they did not know about the drug's TB prevention benefits and did not have experience in prescribing it. Some doctors said they preferred to wait to treat TB with more familiar drug courses than to prevent it.

5. Mobilizing men: Although Thibela eventually included about 27,000 mine workers, mostly men - 80,000 indicated they would be willing to participate in the study. Thibela published research on the community mobilization and education strategies it used to get men on board in a November 2010 supplement of the medical journal, AIDS.
"The uptake we achieved was truly remarkable, especially when you consider it was almost an exclusively male population and men are notoriously poor adopters of health strategies," said Thibela's lead researcher and chief executive officer of South Africa's Aurum Institute for Health, Gavin Churchyard. "We've shown that it is possible to mobilize an entire population to adopt a health prevention strategy."
Strategies that worked well to drive up men's willingness to participate included the use of peer educators, community events and incentives tied to project phases. Less popular were the use of mobile-phone messaging due to frequent phone number changes, and treatment buddies, which sparked privacy concerns among actual trial participants.
http://www.plusnews.org/Report/95064/SOUTH-AFRICA-What-the-world-s-largest-preventative-TB-study-taught-us

POVERTY: SOUTHERN AFRICA: Floods leave Angolan returnees stranded

JOHANNESBURG, 6 January 2012 (IRIN) -

 Photo: Tomas de Mul/IRIN
The Zambezi is prone to flooding annually
Several thousand Angolan returnees from the neighbouring Democratic Republic of Congo (DRC) are stranded by floods in northeastern Angola. They are among the first casualties of what promises to be a very wet rainy season in parts of southern Africa.
“At least 50,000 people - 24,000 of them returnees - in 10 villages in Uige Province [northeastern Angola near border with DRC] have been affected by the flooding, rains and hailstorms in the past four months,” said Antonio Maiandi, head of the Evangelical Reformed Church of Angola, which has been trying to help those affected. The rainy season here tends to be longer than elsewhere in Angola.
“It is still pouring hard. At least 1,142 houses have been destroyed by the rains. Each family with shelter is now hosting other families,” said Maiandi, adding that the returnees, who had sought refuge from the civil war in Angola which ended in 2002, were putting enormous pressure on locals, and organizations such as his.
“The local population who are mostly farmers have been severely affected. Their cassava [staple food in Angola] and groundnut crops have been destroyed, so there is not enough food to go round.”
The UN Refugee Agency (UNHCR) restarted formal repatriation of Angolans in November 2011 after logistical and other problems forced the process to stop in 2007. DRC is home to some 80,000 Angolans refugees, according to UNHCR.
The new return initiative comes after a UNHCR survey in 2010 found that 43,000 wanted to return home, and following a tripartite agreement between Angola, DRC and UNHCR (signed in June 2011), around 20,000 people signed up for help to return. The agreement came about after years of tense relations between the two countries: Angolan and Congolese nationals have been expelled from the two countries regularly.
Each family with shelter is now hosting other families
“The local population is extremely poor and unable to support the returnees,” and “people are still coming in every day,” said Maiandi.
UNHCR in Angola told IRIN they took a break in December 2011 and would resume formal repatriation on 17 January, but did not have an update on the number of people who had already arrived.
According to aid workers, increasing instability in the DRC following the recent disputed elections could be prompting more people to leave.
Maiandi said the returnees had not received adequate support from the authorities and church organizations had limited resources.
Meteorologists for the Southern African Development Community (SADC) have predicted normal to above normal rains for most of the region from January to March 2012 largely because of the continuing effects of the 2011 La Niña event. Thousands of people in the region were displaced and scores killed in early 2011 as a result of heavy rains and flooding associated with La Niña.

Zimbabwe
As the rainy season begins here, aid workers and disaster prevention teams are closely monitoring water levels in the all-important Zambezi river, the continent's fourth largest.
The authorities have issued a flood alert after being forced to release water from the swollen Kariba Dam on the Zambezi earlier than usual in the rainy season.
The Zambezi River Authority (ZRA) which usually opens the spillway gates of Lake Kariba in the last two weeks of January was forced to open one of the gates on 3 January. It has advised people living downstream to evacuate their homes.

Zambia
Zambia is in for a mixed season. Dominicano Mulenga, national coordinator of Zambia's Disaster Management and Mitigation Unit, said a plan had been drawn up to help 368,953 people likely to be affected by rain and dry spells. While northwestern and western parts of the country had seen heavy rain, southern, eastern and parts of central Zambia were likely to receive little or no rain, he said.
The water level in the Zambezi was higher than at the same time in 2011, he added. “We have had three seasons of heavy rainfall and the ground is saturated with water, making it more prone to flooding.”

Namibia
Namibians, currently experiencing a heat wave, are eager for rain, said Guido van Langehove, chief of the Namibia Hydrological Services. Southern African Development Community (SADC) meteorologists have forecast normal to above normal rains for Namibia over the next three months. “It was the same forecast last year and we recorded three times the normal rain,” van Langehove pointed out.
The Caprivi Region, Namibia’s poorest area, is prone to annual flooding.
Japhet Itenge, director of Disaster Risk Management in the Office of the Prime Minister, said they were prepositioning essential commodities and relief tools as part of their contingency plans.

Lesotho
Lesotho has not received adequate rainfall in the past few months, a spokesman for the country’s meteorological services told IRIN. “SADC has forecast heavy rains for Lesotho in the coming weeks. We are worried it can cause early frost and destroy crops that have already been planted,” he said.
Lesotho and Namibia have food insecurity levels greater than their five-year averages due to the severe flooding experienced during the last growing season, according to FEWSNET.

Mozambique
The Mozambican authorities have begun to release water from the Cahora Bassa Dam on the Zambezi. People living mainly along the lower Zambezi basin and in Buzi, Save, and Pungue basins, including Beira city, are on alert.
Sofala Province in central Mozambique is currently distributing items such as bicycles, stretchers, masks, gloves, megaphones and boats, according to the Mozambique Red Cross; and members of seven local disaster risk management committees established in Beira City are cleaning the drainage system.
The National Institute of Disaster Management (INGC) is monitoring the rivers Montepuez, Licungo, Mutamba, Pungué, Buzi, Save, and Maputo, said FEWSNET. In the Zambezi and Limpopo river basins, FEWSNET warned of a near-average-to-high probability of flooding.
João Bobotela, CARE’s emergency response coordinator in Mozambique, said INGC and local authorities had been running flood simulation exercises since November 2011 to prepare communities for sudden evacuations.

Botswana
Arid Botswana has not received good rains in the past few months. “We are expecting average rains which might help crops,” said a spokesman for the Botswana Meteorological Services.

Malawi
More rains have been forecast for southern Malawi, where land adjacent to the River Shire, one of the most food-insecure parts of the country, is prone to flooding. Parts of the region, which has seen an outbreak of foot and mouth disease and a hike in food prices, are in crisis mode, warned FEWSNET.

South Africa
Much-needed rain has fallen in South Africa’s major maize-producing northern Free State area in the past few weeks. The government and USAID’s Famine Early Warning Systems Network (FEWSNET) say the country has adequate supplies, but global maize stocks are low, putting considerable upward price pressure on South African white maize.

http://www.irinnews.org/report.aspx?reportID=94598

POVERTY: MIGRATION: Misperceptions of migration fuel tensions

JOHANNESBURG, 8 December 2011 (IRIN)

 Photo: Tebogo Letsie/IRIN
Thousands of migrants living in South Africa were displaced by xenophobic violence in 2008

About 214 million people were living and working outside their home country in 2010, and international migration has continued to grow despite the global economic crisis, but in many countries negative attitudes towards migrants are also rising.
The International Organization for Migration (IOM), focusing on the importance of communicating more effectively about migration in its World Migration Report 2011, released on 6 December, notes that such attitudes stem in part from misinformation and misperceptions about migration that have been fuelled by opportunistic politicians and poor media reporting.
"Few areas of public policy are subject to greater misrepresentation... yet more influenced by public opinion, than international migration," write the report's authors. "Accurately informing relevant stakeholders and the wider public about migration may be the single most important policy tool in all societies faced with increasing diversity."
During periods of economic recession, national debates on migration issues are often politicized, and evidence of the economic benefits that migration can bring is ignored in favour of assumptions that migrants are fuelling unemployment and draining public resources.
People in migrant-receiving countries tend to significantly overestimate the size of their country's migrant population, and often blame them for social ills ranging from crime to unemployment.
A 2010 public opinion poll, cited in the report, found that 57 percent of Americans felt immigration had a negative effect on the country. Another recent study of eight migrant-receiving countries found that an American perception of 39 percent of the US population being migrants differed significantly from the actual figure of 14 percent. Italians believed 25 percent of their population were migrants, more than three times the actual number.
With more and more migrants heading to rapidly developing nations in their own regions, such views are not limited to the developed world. A 2006 survey of South African citizens found that 84 percent felt "too many" foreign nationals were being allowed into the country and 37 percent wanted a total ban on immigration.
Bernardo Mariano-Joaquim, IOM's regional representative for southern Africa, commented that not enough had been done in South Africa, the region's largest recipient of migrants, to highlight the positive effects of migration on the country's economic development.
"In the Mpumalanga region, strong development has been thanks to Mozambican visitors and migrants, who come and purchase good and services and work on the farms," he told IRIN, adding that even in countries with high rates of unemployment like South Africa, certain jobs, particularly of a seasonal nature, are more attractive to migrants than to locals.
Few areas of public policy are subject to greater misrepresentation...yet more influenced by public opinion, than international migration
Southern Africa has a long tradition of intra-regional migration, with South Africa's mining sector attracting workers from neighbouring Lesotho, Swaziland, Mozambique and Botswana. Since the end of apartheid in 1994, however, the country's booming economy and progressive refugee legislation have attracted much larger numbers of economic migrants and asylum seekers from all over the continent.
The influx has led to rising tensions, especially in townships where migrants have started businesses and are perceived to be faring better than the locals. In May 2008, hostilities erupted in widespread xenophobic violence that left 60 people dead and displaced about 100,000 others. Commentators have since accused the government of not doing enough to prevent continuing sporadic attacks on foreigners.
The IOM report asserts that such episodes could be avoided by "a fundamental shift in the way we communicate about migration" so as to foster more informed debate and "prevent migration from being used as a platform for other political, social and economic issues".
Mariano-Joaquim notes that in South Africa, as in many migrant-receiving countries, politicians tend to use anti-migrant rhetoric to gain votes and also to make migrants the scapegoats for much wider socio-economic problems.
With their focus on the sensational and the dramatic, local media portrayals of migrants have not helped. "We need more balance," he said. "There are South African business people who are becoming richer thanks to migrant workers; there are migrant workers who have started from nothing employing South Africans."
The IOM report makes the point that "distorted communication about migration can trigger a vicious cycle that leads to misinformation being perpetuated through government policy, the mass media, the public at large and... can, in turn, skew discourse at all levels."
The way forward, according to Mariano-Joaquim, includes de-politicizing debates around migration. "If you looked at migration through the lens of economic development, policies would be completely different," he said, citing the example of Canada and Switzerland, where annual quotas are set for migrant labour depending on the country's needs.
He also called for discussions about migration to include migrants themselves, and for the perspectives of migrant-sending as well as receiving countries to be considered in formulating migration policies.
http://www.irinnews.org/report.aspx?reportID=94423

TUBERCULOSIS: a disease of the poor

Kristin Palitza : 6.07.2011
The prices of medicines for DR-TB are rising around the world.

Access to treatment for drug-resistant tuberculosis (DR-TB, its acronym in English) remains compromised, especially in developing countries of the South, because very few pharmaceutical companies make quality drugs. In addition, the lack of competition has driven up the prices of drugs.

In the last decade, about five million people worldwide have developed the DR-TB. But a "shockingly low number" of patients (less than one percent) have access to appropriate treatment, according to Medecins Sans Frontieres (MSF).
About 1.5 million patients died in the past 10 years. The situation is particularly acute in poor countries with high numbers of HIV infections (human immunodeficiency virus, which causes AIDS), particularly where antiretroviral treatments are inadequate. South Africa is one of them.
One of the main barriers to treatment is the limited availability and high cost of quality medicines to treat DR-TB. For some drugs, there is only one manufacturer of assured quality or a single source for the necessary active ingredient.
"There is little investment in research and development of drugs against tuberculosis because it is a disease of the poor, and therefore a lucrative market doesn't exist for the pharmaceutical industry," said the office coordinator for MSF South Africa, Eric Goemaere.
 This has pushed up prices of most drugs for DR-TB. Treatment can cost a patient $9,000, according to MSF, almost 475 times more than the common treatment of tuberculosis.
Costs have increased further in recent years. "While drug prices usually fall with higher demand, in the case of drugs against drug resistant TB, they grow, some up to 600 or 900 percent. That is simply wrong," said Goemaere, who heads a project of treatment for HIV and tuberculosis in Khayelitsha, the third largest informal settlement in South Africa.
The exorbitant increase in prices is due to the lack of effective control mechanisms that no longer exist and subsidies don't exist to keep them low. It is also a reflection of insufficient competition in the market.
Only six products (for five different drugs for DR-TB) have been prequalified by the World Health Organization, and only four sources (for two different drugs) are recommended for purchase this year.
WHO responded to the growing need for drugs against drug resistant TB in 2000, creating the Green Light Committee, which reviews official health and non-governmental projects and the possibility they would allow access to medicines of proven quality at reduced prices.
Although the Committee is theoretically useful, the bureaucracy has prevented several treatment programs around the world from being of benefit.
In 2010, only 12,000 patients were enrolled in treatment programs approved by the Committee, against 440,000 new cases of the disease and 150,000 deaths, according to MSF. Only 13 percent of the estimated market of drugs for DR-TB is currently channeled through the Global Drug Facility of the WHO.
"WHO has responsibility for this disaster," Goemaere said.
Non-governmental organizations lobbied WHO for years until it created the Committee. But strict conditions and cumbersome administrative procedures prevent many health care providers from benefiting.
"The Committee provides few incentives because their quality guarantee endorsement is much more bureaucratic and centralized. The rules are self-limiting, making WHO into a doorman more than someone who provides support," Goemaere pointed out.
WHO's chief medical officer for TB in South Africa, Kalpesh Rahevar, recognized the Committee's administrative barriers, but said the agency had begun a reform process in early 2010.
"We're trying to simplify the request process," said Rahevar. "WHO also plans to extend its mandate to monitor TB programs worldwide, not just those that are involved with the Committee."
But until then, hundreds of organizations and health departments will have to keep on buying drugs to treat drug resistant TB from pharmaceutical companies that offer products of doubtful quality and high prices.
The Health Department of South Africa is one of them. Instead of requesting membership to the Committee, the ministry purchases drugs at fixed prices directly from South African subsidiaries of U.S. manufacturers, Sandoz Aventis and Sandoz.
According to the temporary Director of the department for treatment of tuberculosis, communications and social mobilization, Garvon Molefe, the ministry decided to buy medicines exclusively local, even if more expensive, in order to benefit the national economy.
"The reason why the Department doesn't continue the Committee's initiative is that after an alarming unemployment rate in South Africa, they do not want to waste the local pharmaceutical firms that give work to South Africans," he told IPS.
The Department currently spends $4,400 for treatment for each DR-TB patient. Goemaere said MSF, through the Committee, pays about 30 percent less for the same drugs, which means more patients can be treated for the same money.

Translated from the Spanish version by: Lisa Karpova
http://english.pravda.ru/health/06-07-2011/118403-Tuberculosis_disease_of_the_poor-0/

TUBERCULOSIS: KwaZulu-Natal Research Institute for Tuberculosis and HIV

June 30, 2011 : Nicole Wyatt



In the African nation where the first extensively drug-resistant case of tuberculosis (XDR-TB) was found a few years ago, the doors soon will open on a new TB research facility. University of Alabama at Birmingham researcher Adrie Steyn, Ph.D., is the first scientist recruited to work at the facility (shown below).
Steyn, associate professor in the UAB Department of Microbiology, is the first investigator for the new KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH) in Durban, South Africa, a collaboration between the Howard Hughes Medical Institute (HHMI) and the University of KwaZulu-Natal in South Africa. HHMI has committed $60 million to the initiative.

Worldwide, somebody dies every 10 seconds from TB, but the statistics are much worse in South Africa, Steyn says. “In some regions, the TB incidence is extremely high — about one in 100 people are affected. Many who are HIV-positive also have TB; obviously that is a major concern.
“We plan to study the mechanisms of micro-bacterial persistence, or dormancy. How does it escape drug therapy? How do we develop new vaccines? We will make full use of the resources at K-RITH,” Steyn says.
“It’s an incredible, once-in-a-lifetime opportunity in my home country,” says Steyn, who was born in Cape Town, South Africa.
Steyn will retain his faculty position and lab at UAB, an affiliation that will foster the educational and research goals of both UAB and K-RITH. One possibility is an educational exchange for students, post-doctoral research fellows and other faculty between K-RITH and UAB.
“Sending students or post-docs overseas is an unique experience in training and changing perceptions of the disease by contact with it. Many of us in the United States work in infectious diseases, but we have no real-life experience seeing ways in which these diseases affect people in countries like South Africa, and this will allow that,” Steyn says.
Aisha Farhana, Ph.D., a post-doctoral student in Steyn’s lab, is looking forward to working with him at K-RITH.
“I have learned a great deal in the laboratory here. But the most important thing is to work closer to patients. We will have more facilities and a strong focus on TB, which is a global effort,” Farhana says.
A groundbreaking ceremony for the new facility will take place in mid-July in Durban. Steyn will be there to deliver a seminar. The health and science ministers for South Africa will attend, as will consular officials from the U.S. and several European countries

http://www.uab.edu/news/latest/item/1393-uab-professor-taking-lead-in-global-effort-against-drug-resistant-tb-hiv

POVERTY: SOUTH AFRICA: Midwife shortage impacts maternal health

DURBAN, 27 June 2011 (IRIN)

 Photo: Anthony Kaminju/IRIN
Midwives can improve outcomes for mothers and babies
At Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, the largest township outside the South African port city of Durban, using midwives to provide maternity services has positively impacted maternal care in the area, but a national shortage of these specialist health personnel has made it difficult to replicate the model elsewhere.
“Midwives are integral to ensuring that we take quality care of our mothers and babies,” Rachel Gumbi, the hospital’s CEO, told IRIN. “The success story of this hospital is because of the teamwork between doctors and midwives.”
The maternity ward at PMMH is one of the busiest in the country, with more than 1,200 deliveries a month, but the staff of 123 midwives and 15 doctors have managed to reduce both infant and maternal mortality rates.
Although 40 percent of the women visiting the hospital’s antenatal clinic are HIV positive, the midwives play a key role in ensuring that 95 percent of those in need of antiretroviral (ARV) medication receive it, and that the rate of mother-to-child transmission of HIV is below 3 percent.
The midwives are involved in every aspect of a pregnant woman's health, from pregnancy screening to post-delivery care and the provision of family planning and pap-smears to detect cervical cancer.
They receive ongoing training through monthly meetings where they discuss difficult cases, and information-sharing sessions that ensure they are up-to-date on the latest policies and protocols. An outreach mentorship programme is also in place for midwives in outlying clinics who may need to refresh their skills.
Such success stories are relatively rare in South Africa. Rather than making progress towards the Millennium Development Goal of reducing maternal mortality by 75 percent by 2015, the number of deaths resulting from pregnancy or childbirth has doubled in the past 20 years.
For every 100,000 babies born, up to 625 mothers die due to childbirth complications. Mortality in children under five has also risen steadily and remains stubbornly high at 104 deaths per 1,000 live births, according to government figures.
Loveday Penn-Kekana, a maternal health researcher at the Centre for Health Policy, University of the Witwatersrand in Johannesburg, believes South Africa’s poor maternal health outcomes are linked to the lack of midwifery services.
“In order for us to address South Africa's maternal health we need to invest in more and better trained midwives,” she said. “Doctors only come into maternity wards from time to time, but it is the midwives who are running the entire service and they are overworked.”
For us to address South Africa's maternal health we need to invest in more and better trained midwives
Midwives are classified as nurses in South Africa so there are no figures on their numbers, but it is clear that there are too few. Low enrolment at nursing colleges is part of the problem but many midwives have also left the public sector to work for higher salaries overseas or in managerial positions because of the limited opportunities for career development and advancement in the clinical area.

No more home deliveries
Although pregnant women in South Africa are entitled to free healthcare, Penn-Kekana noted that some face difficulties accessing services because they lack money for transport. The Department of Health has initiated the use of maternal ambulances to transport pregnant mothers to health facilities but challenges remain in rural areas where there are no roads.
“I have no job and it is expensive for me to get to the hospital,” said a woman at PMMH who was expecting her seventh child. “I am happy with the service, but it is sometimes very difficult for me to get to my appointments here… because I have no money.”
In the past, midwives helped women give birth at home, but there are no longer enough of them for this to be possible. “It makes more sense for the few trained midwives to be stationed at facilities so that they can see more women than for them to be scattered across areas,” said Meisie Lerutla, National Programme Officer for Sexual and Reproductive Rights at the United Nations Population Fund in South Africa.
Deliwe Nyathikazi, President of the Society of Midwives of South Africa, noted: "The biggest challenges for us as midwives in South Africa is that there are not enough of us to provide the best care possible. Because people are first trained as a nurse and then given midwifery skills, midwifery is not prioritized.”
A plan by South Africa’s Health Minister, Dr Aaron Motsoaledi, to reopen unused nursing colleges across the country and increase the number of nurses should also result in more midwives being trained.
Lerutla pointed out that “Once we have increased the number of midwives in South Africa dramatically, the practice of midwife-assisted births at home for women in remote areas can be revisited.”


This building has two outside taps to serve six floors containing 700 tenants



http://www.irinnews.org/report.aspx?reportID=93071

POVERTY: South Africa: Poverty and social unrest in South Africa

Poverty and social unrest in South Africa. Although the United Nations Development Programme’s (UNDP) Human Development Index ranks South Africa as a middle-income country, the way in which income is distributed across the population is highly skewed. Some 39 per cent of the population, estimated at more than 49 million people, lives on less than R 388 a month. One consequence of poverty and high levels of unemployment is social unrest. A large proportion of South Africa’s poor population live in the eastern half of the country, which is also the area with the largest share of black population.
http://maps.grida.no/go/graphic/poverty-and-social-unrest-in-south-africa

POVERTY: South Africa: Education the way out of poverty: Motlanthe

Sapa : 25 June, 2011
Image by: Elmond JiyaneSave & Share EmailPrint

Deputy President Kgalema Motlanthe said the most effective way of eradicating poverty was by encouraging young people to go to school and learn skills, SABC radio news reported.
Motlanthe was visiting Phillipstown near De Aar in the Northern Cape as part of his assessment of the War on Poverty programme.
He said a number of young people in the area who dropped out of school, had been identified and said when it came to education, immediate intervention was needed.
The children had to be taken back to school after the winter holidays.
An educated society was the key to winning the battle against poverty, Motlanthe said.
http://www.timeslive.co.za/local/2011/06/25/education-the-way-out-of-poverty-motlanthe

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/

POVERTY: Can small loans reduce poverty?

June 10, 2011 Small loans, somewhere in the neighborhood of $100 to $500 dollars, are an increasingly popular weapon in the fight to reduce poverty. Called microcredit, institutions dole out these monetary advances to help extremely poor people engage in successful entrepreneurship and improve their quality of life.
While proponents extol its virtues, researchers look for evidence; they want to know if it works. Does it really increase financial development and help individuals make solid monetary decisions as its supporters claim?
"Microfinance works," said Dean Karlan, economics professor at Yale University. "But it isn't the Hollywood ending that we've been sold."

 Vendors like these in this market in the Philippines can apply for and receive small loans of $100 to $500 dollars. This microcredit is designed to help extremely poor people engage in successful entrepreneurship and improve their quality of life. But new research says microcredit works in ways proponents don't expect. (Photo Credit: Innovations for Poverty Action)

Karlan, coauthor of a recent book More Than Good Intentions that also discusses research on this topic, and Jonathan Zinman, an economics professor at Dartmouth College in Hanover, N.H., recently published the results of a 22 month study that examined how individuals make economic decisions over time and whether micro-lending policies aid economic development.
"Proponents argue microcredit mitigates market failures, spurs microenterprise growth and boosts borrowers' well-being," the researchers write in a report, which appears in the June 10 issue of Science. The National Science Foundation's Division of Social and Economic Sciences funds the work.
The researchers found "microloans increase ability to cope with risk, strengthen community ties and increase access to informal credit." But they also found the subjective well-being of loan awardees slightly declined. In addition, they found awardees reduced their overall number of business activities and those in the study did not increase investment in their businesses.
"Enterprise growth is the canonical story that the microcredit industry promotes," said Karlan about the amount of financial investment. "This isn't to say that microcredit never produces such an impact. But it should not be seen as the singular story. We need to know more about how people actually use their loans, and we should not be judgmental if the answer is not always for investment in enterprise."

 Traditional microlenders target women who operate small-scale businesses and use group lending mechanisms. But the expansion of microlending means it often ends up looking more like traditional retail or small business lending that has the same impact on women and men. (Photo Credit: Innovations for Poverty Action)

"Traditional" microlenders target women who operate small-scale businesses and use group lending mechanisms. But the expansion of microlending means it often ends up looking more like traditional retail or small business lending that has the same impact on women and men.
Optimism, calmness, worry and job satisfaction was about the same for both men and women in the study. "We do not find any evidence that treatment effects are more pronounced for female borrowers," the researchers write.
Treatment effects refer to the financial and psychological outcomes of the mircoloans.
Karlan and Zinman designed an innovative experiment that randomly assigned individual microloans of, on average, $225 through credit scoring to 1,601 individuals in the Philippines. The loans, assigned to microentrepreneurs, were short-term and were required to be repaid on fixed schedules with equal periodic repayments.
The research design employed credit scoring software to approve loans randomly for marginally creditworthy applicants and then used survey data to measure how the loans impacted the awardees' later access to credit.
By randomizing the marginal credit decisions, Karlan and Zinman were able to measure the impact of the loans, screening off other causal factors. Moreover, these standard, first-time-borrower loans were made through a lender that had no ties to the survey firm--important for eliminating potential bias.
Loans were to be paid back in 13 weeks, with weekly repayments and a monthly interest rate of 2.5 percent charged over the declining balance. But several upfront fees combined with the interest rate to produce an effective annual interest rate greater than 60 percent.
Karlan and Zinman say the high annual interest rate may have contributed to a marginal improvement in risk management. "We do find that microloans increase ability to cope with risk," they write, "strengthen community ties, and increase access to informal credit. Thus microcredit may work, but through different channels often hypothesized by its proponents."
Informal credit was loans provided by family members and friends. The researchers found awardees had greater access to these loans once they had been the recipient of a microcredit loan.
"Access to credit lowered the demand for risk mitigation tools elsewhere," said Karlan. "We also found a similar result in our earlier South Africa study, in which individuals with access to credit were more able to keep their jobs--more able to absorb some sort of shock, which if they did not absorb would have meant losing their job."
Karlan is the president and founder of Innovations for Poverty Action, a non-profit organization that seeks to bridge the gap between academia and economic development policy. Zinman is a research affiliate of the organization.
"The biggest lesson we see here is one of process, and of shedding ourselves of preconceived notions on what credit is for," said Karlan. "People use credit for many reasons, beyond business investment, and that is good."
"What we need now is more studies like this that help understand the patterns of how credit is used, and if credit is being used to alleviate poverty, then we need further studies to learn how and when that happens."
http://www.sciencecodex.com/can_small_loans_reduce_poverty

POVERTY: Migration of health care workers from Africa

JOHANNESBURG, 10 June 2011 (IRIN) -
Tens of thousands of health workers have left their countries in the developing world in search of better opportunities abroad. Lungile Ndaki, 58, trained as a nurse in South Africa but eight years ago she moved to the UK to take up a post at a private hospital in Bath. She talked to IRIN on the phone about what pushed her to make the move, and why she is now considering going home.

"I only worked in the public sector when I was training. When I completed my training I was pregnant… and the only way you could get a job [in the public sector] as a newly qualified nurse was to be sent to rural clinics, and I didn’t want to work in a rural area. Most of my career I worked in private hospitals and I was earning about R5,000 or R6,000 (US$740 or $888) a month.
“I left for the first time in 1999 to come to the UK for a year… just to come and see what it was like; I worked in a public hospital in Birmingham. I went back to South Africa for four years and then I returned to England in 2003.
“Most nurses… come for the financial benefits. Myself, because I was divorced I just couldn’t make ends meet in South Africa with my salary.
“There is no comparison to working in South Africa - nurses in South Africa are highly skilled. When you come here you lose your skills because nursing here is quite restricted. They don’t let nurses handle many things - it is frustrating for most of us.
“Most nurses from South Africa end up working in nursing homes doing very basic work. They don’t come here for experience, they come for money and the nursing homes pay more because they can work overtime. The cost of living here is high and the salaries are not so great, but the reason we come here is because of the exchange rate.
“Now I’m working in Bath at a private hospital. I’ve been qualified for 30 plus years and I’m working with young girls - when you come here you’re treated as a second-class citizen. There is an element of racism. It takes time for people to accept you as a professional; because you’re from a third-world country they assume you know nothing.
“Now, because of the numbers [of patients] in South Africa with HIV and all those opportunistic illnesses, the workload is more, but the salaries have been revised. You actually earn more now in the public sector [than in the private sector] and there are more chances of professional development.
“I am thinking about coming back for professional and personal reasons. It’s lonely here, there’s no support system; you just work. I’d like to work in a community or in a private clinic where I can work normal hours, 9 to 5, and be able to just take it easy. I don’t want to be really working hard at my age. I would consider the public sector if I could work in a community and have good working conditions.
[Various initiatives aimed at discouraging the migration of health workers from developing countries have been introduced, but Lungile doubts they will have much impact.]
“There’s no way you can stop people from moving, I think adults should have a choice to do whatever they want. If I’d stayed in South Africa I wouldn’t have bought a house. Just leaving your country and going somewhere else is a learning curve."
http://www.irinnews.org/report.aspx?reportID=92948

POVERTY: CONGO-SOUTH AFRICA: Land deals raise food security hopes

BRAZZAVILLE, 8 June 2011 (IRIN)

 Photo: Laudes Mbon/IRIN : Hardly hi-tech... but the hope is investors will improve farming methods by introducing mechanisation

 By handing over 80,000 hectares of untilled land to a few dozen South African farmers, authorities in the Republic of Congo are confident they will greatly improve domestic agricultural expertise and reduce the country's chronic dependence on food imports.
"In terms of nutrition, we are in a constant state of need," said Minister of Agriculture and Livestock Rigobert Maboundou. "This is why we are giving over these lands, to employ local labour and benefit from the South African expertise." He said it was essential to surrender the farmland to those who could invest in it.
"Congo has been waiting for an investment initiative like this, the creation of thousands of jobs. More than anything else, the country is expecting abundant food since the South African farmers will produce crops and raise livestock," said Minister of Land Affairs and Public Domain Pierre Mabiala.
The 40 farmers are leasing government-owned land for 30 years, with the provision to extend it for two terms. The farmlands include 63,000ha in Niari and 17,000ha in Bouenza, in the southwest.
There are 10 to 12 million hectares of land with agricultural potential in Congo, according to government data, but only 2 percent is farmed, mostly with rudimentary tools. "It's difficult to achieve food self-sufficiency like this," said Maboundou.
Wynand du Toit, vice-president of the Association of South African farmers who signed the deal, dismissed suggestions that it was really a covert land grab, with production aimed at the export market. "Our understanding with the government is that we are here to help the country's food production - we plan to set up an agricultural college and train local farmers," he said.
Our priority is to help produce enough to feed the country - we are not looking at exports for at least two or three years
"Our priority is to help produce enough to feed the country - we are not looking at exports for at least two or three years and then only if we produce a surplus which we cannot sell to the domestic market," he said. "If we do end up producing more than we can sell here then we might consider selling to neighbouring Gabon and the Central African Republic."
Du Toit said since not all of the land was arable, the farmers would receive about 1,000ha apiece. South African ambassador to the Congo, Genge Manelisi, said they would focus on raising livestock as well as rice and vegetables.
Congolese officials said the policy of granting land to investors was aimed not just at combating the food crisis, but also diversifying a national economy that was too dependent on oil, which contributes more than 80 percent of the state budget.

Concerns
Land concession agreements have proliferated across Africa and elsewhere, leading to concerns that the promised benefits for locals - especially jobs - are never realized, while potential environmental and political damages are undersold. A 2011 World Bank report studied the increasing number of land deals from the past two years and concluded that "the risks are often large".
"Case studies demonstrate that even some of the profitable projects do not generate satisfactory local benefits, while, of course, none of the unprofitable or non-cooperational ones do."
Du Toit said the farmers viewed the acquisition as a business venture, and a way of diversifying investments. "When Pick 'n Pay [a South African retailer] opens a shop in Nigeria, no one raises an eyebrow, why so many questions about us?" He said the South African farmers were borrowing "millions of dollars" from international banks to fund the project. "We are making a big investment - we are taking in big pieces of machinery," he said.
The farmers hope to begin growing maize in January 2012. Although there are no official production estimates, they plan to produce 30,000MT between June and July 2012, and grow staples such as rice, cassava and vegetables.

Food imports
The country relies heavily on imported food to feed its population. The Food and Agriculture Organization estimated that Congo spent 130 billion CFA (US$260 million) every year bringing in foodstuffs. In its 2010 report, the International Food Policy Research Institute (IFPRI) described food insecurity in Congo as "serious", with 11.8 percent of children underweight, and about one in five Congolese undernourished.
However, at the beginning of the 1990s, 40 percent of Congolese were undernourished, it said.
The government announced plans to become food self-sufficient by the year 2000 in the 1980s, remembered Joseph Moutanda Kassao, president of a cooperative of 320 growers based in Brazzaville. "We did not get any of the results we hoped for," he said.
The government announced in 2010 that it would invest 40 billion CFA ($80 million) a year for four years in the agricultural sector.
Congo has also been testing a policy of creating farming villages north of Brazzaville, with the input of Israeli technicians. Opened in October 2010, the "experimental" farming village of Nkouo, which is 83km from the capital and cost 13 billion CFA ($26 million), is able to produce two million kilogrammes of manioc.
Critics of the new land concession say bringing in foreign farmers is not the way to address food insecurity in the country. "We don't actually need operators or farmers from elsewhere to nourish us. We have a clear problem: our authorities do not assist our own farmers as they should," complained Dieudonné Mingui, head of the NGO Initiatives for Development and Progress. "Farmers right here don't lack initiative, they lack the means to develop large projects," he said.
Despite these sentiments, the project has not encountered resistance from local growers, who say they want to benefit from the experience of the South Africans.
"South Africa is the continent's economic powerhouse. Its agriculture is strong, and powerful," said Kassao. "If the South African farmers are really coming to produce and sell all the produce on the local market, it's a good thing. But if they're coming for their own interests, it will be a shame."
"I think the project is just getting started," said Kassao. "Let's wait and see."
http://www.irinnews.org/report.aspx?reportID=92934

MALNUTRITION: South Africa: Alarm raised over decline in maize crop

NIREN TOLSI - Jun 03 2011

 

The production of maize, a staple for millions of South Africans, is predicted to plummet by 35% in Southern Africa by 2030 if climate change continues unabated, a report published this week by Oxfam warns.

The report, "Growing a Better Future - Food Justice in a Resource-Constrained World", also warns that the price of maize exports is likely to increase by 180% in the same period, exacerbating hunger and malnutrition.
"Higher prices will translate into a depressed demand for food in the [sub-Saharan] region, which already has the world's lowest calorific intake," the report states.
According to it, sub-Saharan Africa faces "some of the gravest threats" to its population's wellbeing, with child malnutrition levels likely to "revert to the same level as [at] the turn of the 21st century -- around 30-million" by 2050.
The report warns that "atmospheric concentration of greenhouse gases is already above sustainable levels and continues to rise alarmingly".
Most of the blame for this is placed at the door of Western governments for their inertia over response strategies to climate change, which the report, in turn, attributes mainly to lobby groups associated with big business.
But if adaptation strategies gain momentum, the report forecasts that export maize price increases could be restrained to about 50% by 2030.
The report does come with a caveat -- it notes that its research and projections "highlight plausible outcomes based on business-as-usual scenarios [in the response of governments and big business to climate change]. Other futures are possible."
Raj Patel, the author of the bestselling book, Stuffed and Starved, which criticises the global food system, warned that Southern Africa is "likely to be one of the epicentres of hunger and malnutrition in decades to come if current policies are maintained". He told the Mail & Guardian: "The South African government has made poor choices in its agriculture policy, choosing to shore up the status quo of pre-apartheid land ownership. But with higher food prices South Africa's unequal food economy looks increasingly unsustainable."
He also warned that food instability in South Africa would not just be constrained to hunger and malnutrition: "Look to the continent to see what happens when people reach a zenith of frustration with high food prices, persistent unemployment and a government that won't listen. Policymakers here and around [the world] know all too well -- high food prices are revolution's kindling."
Patel said that Oxfam's report was "teasing the consequences of our present system out into the future … What Oxfam are pointing towards is the compounding effects of climate change. This matters in particular for Southern Africa, which is projected under some models to experience a 5°C increase in temperature by the 2080s.
"Food prices have been driving inflation recently. Higher global food prices themselves are the result of high oil prices, food price speculation, bad weather and poor government policies. It's important to ask, though, why these factors matter, why ought oil to have anything to do with food? Why do we allow speculation in markets? Where are the grain reserves to protect us from external price shocks? Why have we become vulnerable to bad weather?
"Answer these questions and you begin to see that the real culprit is the international food trading system, which discourages grain reserves, encourages the world to be dependent on a few grain-producing countries and requires oil-fuelled industrial agriculture," Patel said.
http://mg.co.za/article/2011-06-03-alarm-raised-over-decline-in-maize-crop/

POVERTY: China and SA's partnership to tackle poverty

 May 29 2011
The Comprehensive Strategy Partnership (CSP) between South Africa and China could positively address poverty and unemployment in the country, the department of trade and industry (DTI) said on Saturday.
"The CSP that was signed by President Jacob Zuma last year and his Chinese counterpart Hu Jinato could contribute positively in addressing poverty and unemployment [in South Africa]," said acting minister of the DTI, Ebrahim Patel.
He was speaking on Saturday night at the South Africa-China business dinner that was hosted by the Chinese Embassy in Pretoria.
The event was in honour of Wu Bangguo, the chairperson of China's National People's Congress, who is on a four-day visit to South Africa at the invitation of his local counterpart, Speaker Max Sisulu.
"The CSP committed ... to concerted effort between the two countries to develop a balanced trade profile and encourage trade in manufactured value-added products.
"It also committed to assist in securing funding for industrial development and small business development at concessionary rates in order to promote sustainable development," he said.
He urged negotiators to conclude the discussions between the developmental institutions "as soon as possible and on terms that help to strengthen the commitments in the CSP between our countries and for the benefit of our joint developmental agenda".
He said this would enable South Africans to find ways to tap into the Chinese capital markets, as well as investment in our productive sectors. - Sapa
http://mg.co.za/article/2011-05-29-china-and-sas-partnership-to-tackle-poverty/

TUBERCULOSIS: Worry over TB-Aids infection

May 16, 2011
THE extent of tuberculosis and HIV co-infection rates in South Africa has firmly placed TB on the agenda of the South African National Aids Council.
This after studies have shown that in some parts of the country, like in Khayelitsha in Western Cape for example, about 73 percent of HIV-infected people also have TB.
The South African National Aids Council (Sanac) took a decision to include TB as part of its mandate after a World Health Organisation (WHO) review in 2009 of South Africa's national TB control programme. The review found that the levels of TB and HIV co-infection were enormously high. About 70percent or more of TB patients in some parts of the country were also found to be HIV-positive.
Following that report, it was decided that all of the country's collaborative responses to TB and HIV would fall under the oversight of Sanac. That means that Sanac will be responsible for developing and coordinating policy and practice to deal with the dual epidemic.
"What we've got now is experts on TB represented on the Sanac structures, the treatment task team of Sanac now includes the TB-HIV experts. In the last year what we also did was manage to get guidelines for the public sector on how to integrate TB and HIV collaborative activities. "What we also have is (a) guideline that was approved by the International Labour Organisation on the management of TB and HIV in the workplace,'' says Sanac's CEO Dr Nono Simelela.
Simelane says TB has taken priority at Sanac, with suggestions being made that the organisation should change its name to reflect the enormity of co-infection levels in South Africa.
"There have been proposals at the plenary level to look at whether we shouldn't actually be having a South African Council on HIV and Tuberculosis. And I really believe that that is the route we need to take.
"South Africa should consider itself to be having a TB-HIV epidemic instead of just Aids because I think Aids is something we are managing. We're getting more and more people on treatment. So, we will see less and less of Aids, but higher levels of co-infection,'' she says.
One of Sanac's priorities is to prevent TB infection in HIV-positive people. Current policy is that HIV-infected individuals who don't have TB be given six-month prophylactic treatment of Isoniazid or INH to prevent them getting the bacterial infection. She is concerned that the distribution and uptake has been very low.
http://www.sowetanlive.co.za/news/2011/05/16/worry-over-tb-aids-infection

TUBERCULOSIS: South Africa: non-uptake of HIV testing:

N Kigozi, J Heunis, Edwin Wouters, Henriette Van den Berg Credits/Source: BMC Health Services Research 2011, 11:110

Tuberculosis patients'reasons for, and suggestions to address non-uptake of HIV testing: a cross-sectional study in the Free State Province, South Africa

South Africa endorses the global policy shift from primarily client-initiated voluntary counselling and testing (VCT) to routine/provider-initiated testing and counselling (PITC). The reason for this policy shift has been to facilitate uptake of HIV testing amongst at-risk populations in high-prevalence settings.
Despite ostensible implementation of routine/PITC, uptake amongst tuberculosis (TB) patients in this country remains a challenge. This study presents the reasons that non-tested TB patients offered for their refusal of HIV testing and reflects on all TB patients'suggestions as to how this situation may be alleviated.

Methods:
In February-March 2008, a cross-sectional survey was conducted amongst 600 TB patients across 61 primary health care facilities in four sub-districts in the Free State.
Patient selection was done proportionally to the numbers registered at each facility in 2007. Data were subjected to bivariate tests and content analysis of open-ended questions.

Results:
Almost one-third (32.5%) of the respondents reported that they had not undertaken HIV testing, with the most often offered explanation being that they were 'undecided'(37.0%).
Other self-reported reasons for non-uptake included: fear (e.g. of testing HIV-positive, 19.0%); perception of being at low risk of HIV infection (13.4%); desire to first deal with TB 'on its own'(12.5%); and because HIV testing had not been offered to them (12.0%).
Many patients expressed the need for support and motivation not only from health care workers (33.3%), but also from their significant others (56.6%). Patients further expressed a need for (increased) dissemination of TB-HIV information by health care workers (46.1%).

Conclusions:
Patients did not undergo HIV testing for various patient/individual-related reasons.
Non-uptake of HIV testing was also due to health system limitations such as the non-offer of HIV testing. Other measures may be necessary to supplement routine/provider-initiation of HIV testing.
From the TB patient's perspective, there is a need for (improved) dissemination of information on the TB-HIV link. Patients also require (repeated) motivation and support to undergo HIV testing, the onus for which rests not only on the public health authority and health care workers, but also on other people in the patients'social support networks.
http://7thspace.com/headlines/383267/tuberculosis_patientsreasons_for_and_suggestions_to_address_non_uptake_of_hiv_testing_a_cross_sectional_study_in_the_free_state_province_south_africa.html

POVERTY: MOZAMBIQUE: North overwhelmed by asylum seekers

JOHANNESBURG, 12 May 2011 (IRIN)

 Photo: Manoocher Deghati/IRIN
Somali refugees at a camp in northeastern Kenya (file photo)

Thousands of frustrated Ethiopian and Somali asylum seekers trying to make their way to South Africa have been marooned in overcrowded camps in northern Mozambique since the government introduced measures limiting their movements.
The Maratane Refugee Camp in Nampula Province, which normally accommodates around 5,500 long-term residents from the Democratic Republic of Congo, Burundi and Rwanda, now has a population of over 10,000, while an additional 1,000 asylum seekers are staying at a temporary site in the coastal town of Palma, near the border with Tanzania.
"We did our best to expand facilities - building additional shelters, [drilling] boreholes, and by procuring food and non-food items, but given the sheer volume of the numbers, we're obviously overwhelmed," said Girma Gebre-Kristos, country representative of the UN Refugee Agency (UNHCR) in Mozambique.
A steady stream of Ethiopians and Somalis started arriving in Mozambique in 2010, mostly by boat, but as long as the number of new arrivals at the Maratane Camp roughly equalled the number of departures, authorities were able to cope, Gebre-Kristos told IRIN.
However, this changed unexpectedly at the beginning of 2011, when the number of new arrivals increased significantly and the government of Mozambique put in place strict measures controlling the movements of asylum seekers outside the camp.
Gebre-Kristos said groups of Somalis and Ethiopians making their way south towards the border with South Africa had been picked up by police and returned to Maratane.
Aderito Matangala, acting head of the National Institute for Refugee Assistance (INAR), the local government counterpart of UNHCR, explained that while the law in Mozambique allowed asylum seekers freedom of movement, they first had to complete a registration process at the camp, which took three months.
"The existing law gives [asylum seekers] freedom of movement even before being granted refugee status," Matangala told IRIN, and many Somali and Ethiopian asylum seekers chose to come to Mozambique because of its reputation for treating refugees well.
We did our best to expand facilities...but given the sheer volume of the numbers, we're obviously overwhelmed
"My personal view is that not all of them want to go to South Africa," he said, noting that some of the new arrivals were economic migrants rather than genuine asylum seekers.
Reports in recent weeks that the local police commander in Palma had deported about 150 Somali and Ethiopian asylum seekers to Tanzania, and that four Somali asylum-seekers were shot dead by border police on 29 April in Cabo Delgado, Mozambique’s most northerly province, suggest that police and immigration officials are not always aware of their country's obligations to asylum seekers. The government is investigating the shooting and the deportations.
UNHCR and INAR are appealing for help to deal with the food, shelter, water and sanitation needs of the new arrivals in Maratane and Palma. So far the World Food Programme and the Mozambique Red Cross have stepped in with contributions of tents and food.
However, the situation in Palma remains dire. The camp is located next to a swampy, mosquito-infested area with no potable water, but Gebre-Kristos said an alternative location had been identified and would be ready soon.
Besides a lack of infrastructure, the Maratane Camp is struggling to balance the needs of the new arrivals with those of more established residents from the Great Lakes region, many of whom are involved in self-reliance projects and no longer need food assistance.
By contrast, said Gebre-Kristos, the newer residents were often "frustrated and angry young men who think their journey to South Africa has been interrupted".
http://www.irinnews.org/report.aspx?reportID=92690

POVERTY: SOUTH AFRICA: Poor marks for education

CAPE TOWN, 11 May 2011 (IRIN) -

 Photo: Obi-Akpere/Flickr
Many schools in poor areas like basics like text books

Instead of providing much needed opportunities, South Africa’s ailing education system is keeping children from poor households at the back of the job queue and locking families into poverty for another generation.
By the age of eight, school children from the most affluent 20 percent of South Africa’s population are already significantly out-performing children from poorer backgrounds, according to new research by the Social Policy Research Group at Stellenbosch University.
The study, "Low Quality Education as Poverty Trap", found that the schooling available to children in poor communities is reinforcing rather than challenging the racial and economic inequities created by South Africa’s apartheid-era policies.
Using newly available data sets, including those linking information on income with numeracy skills, the report analyzed how low-quality tuition in the post-apartheid education system is perpetuating "exclusion and marginalization".

Money not enough
The government allocated R190 billion (US$28 billion) or 21 percent of its 2011/12 budget to education, but 80 percent is spent on personnel and the remainder is not enough to supply thousands of schools in mainly poor areas with basic requirements like electricity and textbooks.
Yet the top 20 percent of state schools - which largely correspond to historically white schools and charge fees to compensate for insufficient public funding - enjoy adequate facilities and attract the best teachers.
South Africa's status as one of the wealthiest countries on the continent has not helped its educational performance - the poorest 25 percent of students ranked 14th out of 15 sub-Saharan countries in reading performance, and 12th for mathematics, according to the Southern and Eastern African Consortium for Monitoring Education Quality surveys of 2000 and 2007.
"When seen in regional context, South Africa grossly under-performs, given that it has more qualified teachers, lower pupil-to-teacher-ratios and better access to resources," the report on the study noted.
Nomusa Cembi, spokesperson for the South African Democratic Teachers' Union (SADTU), whose nearly 250,000 members make it the country's largest public sector union, said many teachers had received an inferior education as a result of apartheid's "Bantu" education system, which was deliberately designed to disadvantage black learners and only ended in 1994 when a new democratic government came into power.
There are a host of other problems besetting schools in poor areas. According to Yoliswa Dwane, spokesperson for the education advocacy group, Equal Education, over 2,000 schools had no piped water supply, 3,600 lacked electricity, and over 90 percent were without libraries or a functioning laboratory.

Poorly trained teachers
SADTU and other teachers’ unions have opposed national calls for education to become an essential service, which would prevent strike action. In August 2010 a teachers' strike closed schools across the country for three weeks, contributing to a public perception that SADTU and some of its members did not have learners' interests at heart.
"The focus needs to be on teachers' development," said Cembi. "We've had changes in the curriculum since the new [post-apartheid] era, but we find not much focus on training teachers."
Many teacher training colleges were closed in the late 1990s after new legislation required them to merge with existing higher education institutions. Plans to transform the training colleges into university-level institutions have not materialized, leaving thousands of teachers without any specialized training.
In recent years, SADTU has called for the reopening of training colleges because the shortage of teachers has meant that some schools in poor and rural areas have had to hire individuals who do not meet the official requirement of holding a teaching diploma.
According to the report, insufficient teacher knowledge is a problem, with many teachers scoring poorly in basic reading and mathematics tests.
A large number of changes to the national curriculum, beginning with the 1997 adoption of Outcomes Based Education, many subsequent adjustments, and the final decision -announced in 2010 - to scrap it, have further stressed an already failing system.

The way forward
Equal Education's Dwane said the debate needed to move past "blaming teachers" and towards how to achieve a "serious commitment to a national education programme that would spell out what needs to be done over the next 20-30 years".
Such a plan would have to include an assessment of existing teacher knowledge, followed by a national teacher training programme, but Dwane stressed the need to consider factors beyond teacher knowledge, including teacher motivation, and a lack of community and parental involvement.
Her view was backed up by the Stellenbosch study, which identified the lack of regular and meaningful student assessments and feedback to parents as another major weakness in the education system.
"For the parents to know how their child is performing, and by proxy to know how the teachers are performing, is very helpful," said Ronelle Burger, one of the study's lead researchers. "Very few top-down measures can be as effective as getting the people who are affected to act to correct the problems."
The researchers found that the job prospects of school leavers were determined not only by the number of years of education attained, but the quality of that education.
“The labour market is at the heart of inequality, and central to labour market inequality is the quality of education,” they concluded.
“Policies that address inequality by intervening in the labour market will have limited success as long as the considerable pre-labour market inequalities in the form of differential school quality persist.”
http://www.irinnews.org/report.aspx?reportID=92677

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

MALNUTRITION: Agriculture, Forestry and Fisheries Minister says SA farmers should expand into other African countries.

BEKEZELA PHAKATHI phakathib@bdfm.co.za
2011/05/04



 Photo: Financial Mail

Agriculture, Forestry and Fisheries Minister Tina Joemat-Pettersson.
CAPE TOWN — South African farmers should expand their business interests into other African countries, Agriculture, Forestry and Fisheries Minister Tina Joemat-Pettersson said yesterday.
Speaking during a press briefing after a conference on rural poverty hosted by the United Nations’ International Fund for Agricultural Development (Ifad), Ms Joemat-Pettersson said expanding into Africa would enhance food security on the continent, not compromise it.
"We are not saying that our farmers should relocate or move their business operations from SA to other countries; they should use SA as a base and then expand their business operations into the rest of Africa," Ms Joemat-Pettersson said.
In her keynote address during the conference, Ms Joemat-Pettersson said an equitable ownership of land remained essential to safeguarding democracy in SA.
"Our government has tried to bring in this balance between land reform and food security and it’s a very tight balance — it’s like walking on a tightrope."
The minister also said it was not sustainable for the country to rely on a small group of farmers for its food requirements .
She said the continent was capable of improving food security and boosting economic growth through increasing support for smallholder farmers.
While Africa was still facing challenges in reducing poverty, "a vision of economic renaissance" led by smallholder farmers was beginning to take hold.
"There is a growing belief that Africa can produce enough not only to feed its own citizens, but to export a growing surplus to the rest of the world," Ms Joemat-Pettersson said.
She said SA was in the forefront of developing a railway system that would link the entire continent and allow farmers to take goods from road to rail across Africa.
The agricultural value chain had been identified in the New Growth Path as one of the key sectors to grow the number of jobs, she said.
Speaking at the same conference, the Ifad fund’s president, Kanayo Nwanze, said the African Union had recognised the central role of agriculture in reducing poverty when its members pledged to increase spending on agriculture to at least 10% of national budgets.
"This pledge was made in 2003 in Maputo. By last year, eight countries had met or surpassed that target; the continent as a whole has not," Mr Nwanze said.
To grow the agricultural sector, African countries also needed to maintain political stability, encourage more youths to turn to farming and, importantly, invest more in rural infrastructure, he said .
http://www.businessday.co.za/articles/Content.aspx?id=141630