Showing posts with label sub-Sahara Africa. Show all posts
Showing posts with label sub-Sahara Africa. Show all posts

Monday, 19 March 2012

MALARIA: Typhoid Fever and the Challenge of Nonmalaria Febrile Illness in Sub-Saharan Africa

John A. Crump
In this issue of Clinical Infectious Diseases, 2 papers shed important light on the problem of typhoid fever in Sub-Saharan Africa and stimulate reflection on the challenges raised by the syndrome of fever in low-resource settings. Neil et al [1] report the investigation of an increase in intestinal perforations from rural western Uganda. By improving the clinical microbiology services available in the outbreak area and by implementing active surveillance at healthcare facilities in the district, the research team was able to confirm Salmonella enterica serovar Typhi as the etiologic agent and estimate the typhoid fever annual incidence in the study area at 8092 cases per 100 000 persons. This very high typhoid fever incidence rate was associated not only with hundreds of hospitalizations and intestinal perforations but also with 47 deaths. Lutterloh and colleagues [2] investigated an outbreak of unexplained febrile illnesses with neurologic findings along the Malawi–Mozambique border. Again, making diagnostic services available in the rural and remote outbreak area allowed SalmonellaTyphi to be established as the cause. A careful clinical and epidemiologic investigation, including enhanced surveillance of suspected, probable, and confirmed cases of typhoid fever, characterized 40 patients with debilitating focal neurologic manifestations, including upper motor neuron signs, ataxia, and Parkinsonism, and 11 deaths.Fever is among the most common syndromes prompting persons to seek healthcare in Sub-Saharan Africa, and the numerous causes of febrile illness are often difficult to distinguish clinically. Although malaria may be ruled out by blood film examination or a malaria rapid diagnostic test, clinicians in resource-limited areas often have few diagnostic tools to determine the etiology and inform treatment decisions for those patients without malaria [3]. .....http://cid.oxfordjournals.org/content/early/2012/02/27/cid.cis024.extract

Tuesday, 7 February 2012

POVERTY: SAHEL: Displaced Malians burden food-insecure hosts

BAMAKO/DAKAR, 6 February 2012 (IRIN)

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

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

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

Sunday, 17 July 2011

POVERTY: UN millennium goal to halve poverty may have been achieved

Laurence Chandy, Geoffrey Gertz : YaleGlobal, 5 July 2011 With Little Notice, Globalization Reduced Poverty


A major success in a poverty-reduction goal for the new millennium – halving the proportion of people whose income is less than $1.25 per day – largely went unnoticed. The World Bank estimates poverty levels, but the most recent data is from 2005. By combining the recent country survey data of household consumption with latest figures on private consumption growth, Brookings Institution researchers Laurence Chandy and Geoffrey Gertz generated poverty estimates to the present day. They conclude that the world – even stubborn Sub-Saharan Africa – is in the midst of rapid poverty reduction; they credit economic growth and widespread development brought by globalization. Poverty reduction was one part of a key UN Millennium Goal, and global observers may sit up and take notice after two other key parts are achieved: full and productive employment for all and halving the proportion of people who suffer from hunger. In the meantime, the authors promise far-reaching consequences from rapid poverty reduction via growth. –
 Road to growth: Millions of Chinese have been lifted out of poverty, thanks to trade

It is customary to bemoan the intractability of global poverty and the lack of progress against the Millennium Development Goals. But the stunning fact is that, gone unnoticed, the goal to halve global poverty was probably reached three years ago.
We are in the midst of the fastest period of poverty reduction the world has ever seen. The global poverty rate, which stood at 25 percent in 2005, is ticking downwards at one to two percentage points a year, lifting around 70 million people – the population of Turkey or Thailand – out of destitution annually. Advances in human progress on such a scale are unprecedented, yet remain almost universally unacknowledged.
Official estimates of global poverty are compiled by the World Bank and stretch back 30 years. For most of that period, the trend has been one of slow, gradual reduction. By 2005, the year of the most recent official global poverty estimate, the number of people living under the international poverty line of $1.25 a day stood at 1.37 billion – an improvement of half a billion compared to the early 1980s, but a long way from the dream of a world free of poverty.

Today, it’s estimated that there are approximately 820 million people living on less than $1.25 a day.
Behind these aggregate figures lies a somber reality. In assessing the fortunes of the developing world during the late 20th century, countries can be roughly divided into two categories: China and the rest.China’s stunning economic reversal – 30 years ago, only 16 percent of its population lived above the poverty line, but by 2005, only 16 percent stood below it – masks others’ failings. Excluding China, the 500 million decrease in global poverty becomes an increase of 100 million. In the world’s poorest region, sub-Saharan Africa, the poverty rate remained above 50 percent throughout the period, which, given the region’s rapid population growth, translated into a near doubling in the number of its poor. Similarly in South Asia, Latin America and Europe–Central Asia there were more poor people in 2005 than there were a quarter of a century earlier.

 The number of the world's poor is falling rapidly.

This depressing track record shapes perspectives on poverty that abound today. Global poverty has come to be seen as a constant, with the poor cut off from the prosperity enjoyed elsewhere. Only a radical change to the current global order – an alternative system to globalization or a massive exercise in redistribution – could possibly alter this destiny.
In a new study of global poverty, we upend this narrative. By combining the most recent country survey data of household consumption with the latest figures on private consumption growth, we generated global poverty estimates from 2005 up to the present day. Poverty reduction accelerated in the early 2000s at a rate that has been sustained throughout the decade, even during the dark recesses of the financial crisis. Today, we estimate that there are approximately 820 million people living on less than $1.25 a day. This means that the prime target of the Millennium Development Goals – to halve the rate of global poverty by 2015 from its 1990 level – was probably achieved around three years ago. Whereas it took 25 years to reduce poverty by half a billion people up to 2005, the same feat was likely achieved in the six years between then and now. Never before have so many people been lifted out of poverty over such a brief period of time.

 The MDG poverty target may already have been achieved.
Not only is poverty falling rapidly, it’s falling across all regions and most countries. Unsurprisingly, the greatest reduction has occurred in Asia. But it’s not just the dynamic economies of East Asia, such as China, recording great feats in poverty reduction; South Asian giants including India and Bangladesh, and Central Asian economies such as Uzbekistan also make great strides. Even Sub-Saharan Africa is sharing in this progress. The region finally broke through the symbolic threshold of a 50 percent poverty rate in 2008 and its number of poor people has begun falling for the first time on record.
This stunning progress is driven by rapid economic growth across the developing world. During the 1980s and 1990s, per capita growth in developing countries averaged just 1 to 2 percent a year, not nearly fast enough to make a serious dent in poverty levels. Since around 2003, however, growth in the developing world has taken off, averaging 5 percent per capita a year.
How and why sustained high economic growth in developing countries took hold are questions likely to be debated by economic historians for many decades. Already one can point to a number of probable sources emerging or accelerating around the turn of the century: an investment boom triggered by rising commodity prices; high growth spillovers originating from large open emerging economies that utilize cross-border supply chains; diversification into novel export markets from cut flowers to call centers; spread of new technologies, in particular rapid adoption of cell phones; increased public and private investment in infrastructure; the cessation of a number of conflicts and improved political stability; and the abandonment of inferior growth strategies such as import substitution for a focus on macroeconomic health and improved competitiveness.

The poor countries that display the greatest success today are those that engage with the global economy.
These factors are manifestations of a set of broader trends – the rise of globalization, the spread of capitalism and the improving quality of economic governance – which together have enabled the developing world to begin converging on advanced economy incomes after centuries of divergence. The poor countries that display the greatest success today are those that are engaging with the global economy, allowing market prices to balance supply and demand and to allocate scarce resources, and pursuing sensible and strategic economic policies to spur investment, trade and job creation. It’s this potent combination that sets the current period apart from a history of insipid growth and intractable poverty.
The fight against poverty has long been a moral and strategic goal of Western governments. But the record of the last few years is likely a surprise to them. In their eyes, the fate of the world’s poor largely depended on forging progress on three fronts: debt relief, more aid and freer trade. World leaders convened at numerous meetings to build support and momentum around these priorities, but despite these efforts successes were hard to come by: While more than $80 billion of poor countries’ debt has been forgiven, most countries failed to meet global aid targets, and the Doha Development Round has languished at the World Trade Organization.
Thankfully for the world’s poor, this logic turned out to be flawed. While progress on each of the three fronts would have been helpful for developing countries and their ability to tackle poverty, the significance of each was undoubtedly overhyped and said more about the West’s sense of responsibility and magnanimity than what was actually needed to deliver development.
Taking a long view of history, the dramatic fall in poverty witnessed over the preceding six years represents a precursor to a new era. We’re on the cusp of an age of mass development, which will see the world transformed from being mostly poor to mostly middle class. The implications of such a change will be far-reaching, touching everything from global business opportunities to environmental and resource pressures to our institutions of global governance. Yet fundamentally it’s a story about billions of people around the world finally having the chance to build better lives for themselves and their children. We should consider ourselves fortunate to be alive at such a remarkable moment.

Laurence Chandy is a fellow at the Global Economy and Development Program in the Brookings Institution. Geoffrey Gertz is a research analyst in the same program. Their paper, “Poverty in Numbers: The Changing State of Global Poverty from 2005 to 2015” is available here.

http://yaleglobal.yale.edu/content/little-notice-globalization-reduced-poverty

Sunday, 10 July 2011

MALARIA: Drug Ivermectin Used to Treat Head Lice is Effective Against Malaria

July 06, 2011 : Vidushi Sinha
A Somali man who fled violence and drought in Somalia with his family sits on the ground outside a food distribution point in the Dadaab refugee camp in northeastern Kenya on July 5, 2011Researchers have found that an inexpensive and widely-available drug used to treat river blindness in Africa and head lice in American school children is also effective in reducing malaria transmission, especially during seasonal epidemics of this worldwide scourge.
“Can you kill a mosquito when it’s biting you [with] something that’s in your blood," asked Brian Foy.
Malaria researcher Brian Foy of Colorado State University found out that yes, you can. He is working on a malaria control program and says there are many benefits to killing mosquitos as they bite their hosts.
Foy says that this not only is a clever way of getting a toxin directly to the malaria-causing parasite living in mosquitos, but it also saves the environment from harmful insecticides.
In a field study done on malaria transmission in Senegalese villages, Foy and his colleagues found that a drug already widely used for treating the two most common parasitic diseases in Africa - river blindness and elephantiasis - also has insecticidal properties.
“We are repurposing a really cheap and important drug for worm control potentially to control malaria," he said.
The study shows that after single doses of the drug Ivermectin were administered to residents of several Senegalese villages, there was a 79 percent reduction in mosquitoes found to be carrying the malaria parasite. In villages where the drug was not given, the malarial mosquitoes increased by 246 percent.
Researchers found that the drug circulating in people’s blood killed the mosquitoes. Ivermectin is given once every year in many countries in sub-Saharan Africa to fight common infections. But researchers say that if the drug is given more often, it can provide other benefits.
“If you give it more often, [as] we are proposing for malaria transmission control, it will start to have an effect against the soil-transmitted illness that people have in their guts - things like whip worm, round worm and maybe even hookworms, which cause a lot of hidden illnesses in people," said Foy.
Peter Hotez, president of the American Society for Tropical Medicine and Hygiene, calls Foy's study groundbreaking. He says it proves what many public health researchers have long suspected - that drugs used to combat neglected tropical diseases have important collateral health benefits.
“It opens up a new pathway for discovering an additional class of drugs specifically for this purpose - maybe a drug that can circulate in the body longer and then be better targeted for malaria specifically," said Hotez.
Malaria kills almost 800,000 people around the world each year. Experts say Ivermectin would be a welcome addition to the anti-malaria arsenal of bed nets, pesticides, drugs and, perhaps one day soon, a vaccine. Public health experts say all these weapons will be needed in the years ahead to eradicate malaria permanently.
http://www.voanews.com/english/news/health/Drug-Used-to-Treat-Head-Lice-is-Effective-Against-Malaria-125105569.html

POVERTY: AID POLICY: 10 facts and figures from the 2011 MDG report

NAIROBI, 7 July 2011 (IRIN)

 Photo: Kenneth Odiwour/IRIN
One in 10 people may still be without access to safe drinking water by 2015, according to the latest MDG report (file photo)

 The 2011 Millennium Development Goals Report was released on 7 July with a generally upbeat assessment accompanied by some caveats. Here are some statistics:

1. The poverty reduction goal can be met by 2015, with the number of people in developing countries living on less than US$1.25 a day expected to fall below 900 million (from 1.8 billion in 1990).

2. Sub-Saharan Africa has made the greatest strides in primary school enrolment, from 58 percent in 1999 to 76 percent in 2009; however, 32 million children are still out of school in the region, almost half the global total of 67 million.

3. The number of women in parliament is at a record high - 19.3 percent from 11.6 percent in 1995; Rwanda, Sweden, South Africa and Cuba topped the list. Belize, the Federated States of Micronesia, Nauru, Oman, Palau, Qatar, Saudi Arabia, Solomon Islands and Tuvalu have no female parliamentarians at all.

4. In all regions, a mother's education is key to determining whether her children will turn five, with a child's chances of survival rising markedly with a mother's secondary or higher education.

5. While the demand for family planning will likely increase, in line with rising numbers of women and men of reproductive age, funding for such programmes has actually declined over the past decade, to 2.6 percent of total aid for health in 2009.

6. The use of insecticide-treated mosquito nets has surged, particularly in Africa: between 2008 and 2010, 290 million nets were distributed in sub-Saharan Africa, covering 76 percent of the 765 million people at risk.

7. Water resources are no longer sustainable in Western Asia and Northern Africa, which have exceeded the 75 percent limit on sustainable use. Southern Asia and the Caucasus and Central Asia are at rates of 58 and 56 percent respectively, compared with 3 percent in sub-Saharan Africa.

8. Latin America and the Caribbean, Eastern and Southeastern Asia have met the target of halving the proportion of the population without sustainable access to potable water. Coverage in sub-Saharan Africa rose from 49 percent in 1990 to 60 percent in 2008.

9. By the end of 2010, global mobile phone coverage was 76 percent, with mobile penetration at about 68 percent in developing countries. However, internet penetration was as low as 3 percent in least developed countries, compared with 21 percent in developing countries and 72 percent in developed regions.

10. Donor aid is likely to increase, but at a much slower pace - 2 percent between 2011 and 2013, compared with an average 8 percent per year over the past three years. Aid to Africa is expected to rise by just 1 percent in real terms, against an average of 13 percent over the past three years.

http://www.irinnews.org/report.aspx?reportid=93171

Thursday, 7 July 2011

TUBERCULOSIS: Seminar in "The Lancet"

The Lancet, Volume 378, Issue 9785, Pages 57 - 72, 2 July 2011
Stephen D Lawn MRCP, Prof Alimuddin I Zumla FRCP
Summary
Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects. Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes. Moreover, our fundamental understanding of the pathogenesis of this disease is inadequate. However, increased investment has allowed basic science and translational and applied research to produce new data, leading to promising progress in the development of improved tuberculosis diagnostics, biomarkers of disease activity, drugs, and vaccines. The growing scientific momentum must be accompanied by much greater investment and political commitment to meet this huge persisting challenge to public health. Our Seminar presents current perspectives on the scale of the epidemic, the pathogen and the host response, present and emerging methods for disease control (including diagnostics, drugs, biomarkers, and vaccines), and the ongoing challenge of tuberculosis control in adults in the 21st century.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62173-3/fulltext

Monday, 23 May 2011

MALARIA: in pregnancy

The intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub-Saharan Africa. However, SP has lost parasite sensitivity in many sub-Saharan locations during the same period, rendering its beneficial effect in IPTp debatable. Malaria transmission has also declined in some epidemiological settings. There is no evidence to suggest, however, that the risk of malaria in pregnancy without preventive measures has declined in the same locations. Thus, the urgency to identify efficacious drugs and/or new strategies to prevent malaria in pregnancy remains as great as ever. We summarise the results of recently published SP-IPTp studies from areas of high drug resistance and/or low malaria transmission. We also present the evidence for mefloquine and azithromycin-based combinations (ABCs), two leading drug options to replace SP in IPTp. We discuss optimal dosing for ABCs and their likely protection against several sexually transmitted and reproductive tract infections. We also summarise data from a diagnosis-based alternative to IPTp known as the intermittent screening and treatment (IST) for malaria. Clinical and operational research is urgently needed to compare birth outcomes achieved by IPTp with ABCs vs. IST using an efficacious antimalarial therapy



http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02765.x/abstract




Saturday, 7 May 2011

POVERTY: The GM debate is about more than biosafety

28 April 2011 David Dickson (Director, SciDev.Net)

Biotech lab Flickr/IRRI: Poor farmers must have a say in decisions about GM technology

Biosafety is important, but so is ensuring that GM crops benefit the rural poor and that decisions are based on sound science.
Next month (May), after almost a decade of intense debate, Kenya is expected to become the third country in Sub-Saharan Africa — after South Africa and Burkina Faso — to approve the commercial planting of genetically modified (GM) crops.
Other countries are not far behind. By 2015, Malawi, Mali, Nigeria, Tanzania, Togo and Uganda and could all be growing GM crops such as maize, rice, wheat, sorghum and cotton, according to a report published by the industry-sponsored International Service for the Acquisition of Agri-biotech Applications (ISAAA).
This marks a potential victory for evidence-based policy. Despite claims to the contrary, there are no documented health or environmental problems linked to GM crops.
No one denies that there are potential risks associated with planting GM crops, such as the unknown consequences of implanted genes spreading to native varieties, a concern raised in Mexico after a field trial of GM maize was authorised. But this is a reason to ensure that GM crops are closely monitored and regulated, not banned.
Biosafety laws need to be in place before farmers can grow GM crops, and this is where Nigeria's progress towards adopting the technology has faltered.
Yet by focusing on biosafety, the political debate on GM crops may overlook the broader — and more significant — issue of how such crops will be used in practice. This includes the extent to which they will meet the needs of poor farmers, who are responsible for a large proportion of Africa's agricultural output.
The big challenge ahead for those engaged in the GM debate in Kenya and elsewhere in Africa is not how to promote (or block) the technology, or even demonstrate its safety, although this is clearly important.
Rather, it is to find ways to ensure that GM crops benefit the rural poor, not just the shareholders of multinational corporations who are increasingly looking at African agriculture as a profitable investment.

A question of priorities
The cost of GM seeds is one reason for concern. This is one way that agricultural corporations are keen to generate a profit on their substantial investment in both laboratory research and field trials, just as pharmaceutical companies do through drug prices.
And by using intellectual property laws, corporations can take ownership of genetic material, undermining the staple practice of farmers using (and sharing) their own seed from one year to the next.
Then there is the danger of biodiversity loss — with its impacts on insect and bird varieties — if farmers focus excessively on increasing production of the most profitable crops.
None of these problems are created by GM technology. It is quite possible to imagine GM seeds being distributed at marginal costs (like generic medicines) and being grown and distributed by farmers free of concerns over patent infringement.
Similarly, GM crops can be used to counter biodiversity loss. By introducing viral resistance genes into cassava, for example, scientists aim to increase the range of crops available by helping to preserve farmers' preferred cassava varieties, which are currently being devastated by viral diseases across East and Southern Africa.
Whether GM crops benefit all farmers therefore depends on how the technology is used. National agricultural policies need to take into account the interests and priorities of poor farmers, and give rural communities sufficient leverage over decision-making to ensure that GM crops meet locally defined needs.

Sound science
Even though these are political and economic considerations, not biosafety issues, they can determine the content of regulations in individual countries. These will differ according to national needs and priorities, but they share two essential requirements.
The first is that all regulations, and the debates that occur around them, must be based on sound scientific grounds. Those who make exaggerated and simplistic claims for which there is no evidence — that GM crops are sufficient to eliminate hunger in the world, for example, or that they are a poison that contaminates the environment — are serving no one's interests but their own.
The second requirement is greater transparency. The more that multinational corporations seek to hide their involvement in lobbying for biosafety regulations, the greater the risk of criticism when their involvement becomes known.
For example, when WikiLeaks revealed the involvement of the US Embassy in Nairobi in helping to secure initial approval of Kenya's biosafety legislation two years ago, there was a backlash from environmental NGOs.
Science journalism has a key role to play in ensuring that both these needs are met. It can query the scientific basis of claims both in favour and against GM crops. It can also make the regulatory process more transparent and ensure that it withstands public scrutiny by monitoring and reporting on special-interest groups.
No one expects GM crops to be the magic key to eliminating hunger in Africa. But neither, if they are properly regulated, need they produce the environmental Armageddon that opponents predict.
The real challenge is how best to achieve the benefits, including those it offers to small farmers, while identifying and minimising the potential risks — and maintaining public trust along the way. Sound science, full transparency, and a media committed to both are three steps in this direction.
http://www.scidev.net/en/editorials/the-gm-debate-is-about-more-than-biosafety-1.html

Monday, 7 March 2011

POVERTY: UK aid budget refocuses 'on areas of greatest need'


 Nicholas Watt, chief political correspondent guardian.co.uk,  27 February 2011
UK aid budget refocuses 'on areas of greatest need', including YemenEnd of aid to Russia, Serbia, China, Cambodia, Vietnam and Moldova, as poorer or failing nations prioritised

Britain is to stop sending aid to a series of relatively affluent developing countries as the government focuses resources on countries with the highest levels of poverty, and failing states that have become havens for Islamist fundamentalists.
A review of Britain's £8.4bn international development budget will herald the end of aid to Russia, Serbia, China, Cambodia, Vietnam and Moldova.
Aid to Yemen, regarded by Britain as a failing state whose lack of economic development provides a fertile recruiting ground for al-Qaida, will instead be doubled from £46.7m this year to £90m by 2015.
The changes will be announced by Andrew Mitchell, the international development secretary, who established separate reviews into Britain's bilateral and multilateral aid budgets after the general election.
The UN Educational, Scientific and Cultural Organisation (Unesco) could be a victim of the review of Britain's support for multilateral organisations. Unesco, which was boycotted by Britain for 12 years between 1985 and 1997 on the grounds that it was "pro-Soviet", will have to meet a series of targets to justify its aid after the review found that it wasted the £12m it receives from Britain each year.
Mitchell told the BBC Politics Show that the reviews would lead to Britain's aid budget being "much better focused" on areas of greatest need. "People who live in conflict states are very much part of that," he said.
The reviews are designed to answer opponents on the right and left who have criticised the government's approach to aid from different angles.
A focus on developing countries in greatest need, with a hard-headed payments by results system, is meant to show sceptical Tories that the aid budget is being spent in a sensible way. Many Tories believe it was wrong of David Cameron to ringfence the aid budget, after the prime minister pledged to maintain Britain's commitment to meet the UN target of spending 0.7% of gross national income on aid by 2013.
Targeting resources at a country such as Yemen, some of whose territory is used by al-Qaida as a training ground, is also designed to show that concerns on the left about the securitisation of Britain's aid budget are unfounded.
Charities have warned that aligning aid priorities with Britain's overall foreign and trade policy could lead to a return to the 1990s when the Pergau dam in Indonesia was funded with British aid money. Harriet Harman, the shadow international development secretary, voiced these fears when she warned of "subsuming aid activities into military activities".
Mitchell said it was in Britain's interests to help countries which present a threat. "It's very much in our national interest to tackle these effects of dysfunctionality and poverty, such as piracy, migration, terrorism and disease in Somalia," he told the Sunday Times. "Tackling the causes of poverty upstream is much less expensive than sending in troops."
Mitchell also tackled one of the main criticisms from the right, that it is wrong to provide aid to India, whose economy is growing at such a fast pace that Delhi can afford a space programme. "The fact is that if you want to reach these [UN] millennium development goals, which we are also keen to do by 2015, you have to operate where poverty is greatest," he told the Politics Show. "In India there are more poor people in three states than there are in the whole of sub-Saharan Africa. Operating there in the way that we do is extremely effective in poverty alleviation."

The reviews, which have been subject to independent peer review, will have four main themes:
• A complete overhaul of the way in which Britain distributes aid. Mitchell believes that Gordon Brown announced an overall figure for a grant to a particular country without working out what exactly that would deliver. "Now it is going to be payment by results, so money will only be granted if it is clear how many more children will be educated in a given country and how much clean water will be supplied, for example," one source said.
• Independent evaluation. A four-strong independent panel, including the Kenyan anti-corruption expert John Githongo, will monitor aid spending. The panel will report to parliament.
• Britain has a moral duty to help those in need in line with its values. Mitchell frequently quotes the anti-slavery campaigner William Wilberforce to support the aid cause. "You may choose to look the other way but you can never say again you did not know," Wilberforce said.
• It is in Britain's own national interests to help countries which present a threat, however indirectly.
http://www.guardian.co.uk/global-development/2011/feb/27/uk-aid-budget-andrew-mitchell

Wednesday, 2 February 2011

MALARIA: Methods To Protect Pregnant Women From Malaria Are Still Underutilised In Sub-Saharan Africa



26 Jan 2011
A study published in The Lancet Infectious Diseases finds that methods to protect pregnant women from malaria are still underutilised in sub-Saharan Africa (SSA). A review of national control strategies by a team of international researchers, led by the Malaria in Pregnancy Consortium and funded by the Consortium and the Wellcome Trust, has concluded that despite major efforts, coverage is still inadequate in many areas and needs to be scaled up.

Malaria infection in pregnancy can lead to devastating consequences for both mother and child. The World Health Organization's (WHO) recommended policy for malaria prevention and control is a package of intermittent preventive treatment (IPTp) and insecticide treated nets (ITNs). These interventions have the potential to substantially reduce the disease burden and adverse outcomes of malaria in pregnancy. The Roll Back Malaria initiative (RBM) has ambitions to ensure that 100% of pregnant women receive IPTp and at least 80% of people at risk from malaria are using ITNs in areas of high transmission by 2010.
Specific strategies for malaria control in pregnant women were extracted from national malaria policies and the most recent national household cluster-sample surveys recording IPTp and ITN use were reconciled to sub-national administrative units to compute the numbers of protected pregnancies. Malaria maps generated by the Malaria Atlas Project (MAP, www.map.ox.ac.uk) meant these estimates could be stratified against different levels of malaria risk.
The study found that 45 of 47 SSA countries had an ITN policy for pregnant women and that estimated coverage was 17% among the nearly 28 million pregnancies at risk of malaria in the 32 countries with information. Among 39 countries with an IPTp policy, 25% of pregnant women had received some IPTp, despite 77% visiting an antenatal clinic (ANC), the main delivery channel for reaching pregnant women with ITNs and IPTp.
Professor Feiko ter Kuile, MiP Consortium leader and co author said: "Ten years after the Abuja declaration, it is encouraging that the majority of malaria endemic countries in SSA have now adopted ITNs and IPTp and the number of countries with nationally representative coverage data has increased to 40 out of 47. However, very few countries have reached either the Abuja targets or their own policy ambition, and countries are even further away from the more recent RBM targets set for 2010. In addition, coverage was lowest in areas with high malaria transmission, where the need is greatest.
"In general, low coverage with IPTp and ITNs contrasts with correspondingly high ANC attendance, indicating that there are missed opportunities for coverage and the attainment and maintenance of high coverage of ITNs remains challenging.
"In summary, whilst most countries have adopted national policies aimed at reducing and controlling malaria in pregnancy, it is clear that, with some notable exceptions, not enough progress has been made towards the new RBM goals or the policy ambitions of each country.
"With only five years in which to meet the Millennium Development Goals it is sobering that in countries with a national policy for IPT and/or ITN, an estimated 23 million pregnancies remain unprotected by an ITN and 19 million remain unprotected by IPTp. Greater effort to fully understand the reasons why coverage is so low and to develop strategies to combat this is urgently needed to protect the tens of millions of pregnancies in sub-Saharan Africa threatened by malaria every year."
http://www.medicalnewstoday.com/articles/214767.php

Monday, 31 January 2011

POVERTY: Social protection in Sub-Saharan Africa: Learning from experiences

Giorgia Giovannetti Marco Sanfilippo: 23 January 2011
Can developing countries afford large social-protection programmes, such as unemployment benefits or medical insurance? Summarising studies from across Africa, this column finds that such programmes are politically, fiscally, and administratively feasible – even for low-income Sub-Saharan African countries – and on a scale and scope previously thought out of reach.
Social protection is often considered as something exclusive to developed countries, even though some forms of it, often unstructured, have been in place in every society, also in developing countries. Recently, on the waves of successful implementation in Latin America, social-protection programmes have spread to Sub-Saharan Africa. Some programmes, such as pensions in Namibia and South Africa, have taken systems already in place prior to independence and expanded them to populations previously excluded or marginalised. Others, meanwhile, have been newly developed to protect targeted populations from poverty and vulnerability.
Some common and peculiar features characterise social protection in Sub-Saharan Africa (Ellis and Devereux 2009, Townsend 2009).
First, social protection continues to have limited formalisation, and its expansion is constrained by the lack of formal wage employment among the poor. Most low-income Sub-Saharan African countries have long had contribution-based social insurance schemes, often modelled on systems developed in colonial times. Their key feature is that very few people are covered by formal social insurance: not more than 5% to 10% of the workforce – principally in the form of pensions for civil servants and employees of large (formal) private enterprises (see ILO 2010).
Second, safety nets remain important, as a response to emergencies, and are widespread.
Third, there has been a considerable expansion of the number of specific targeted programmes, aimed at particularly poor and vulnerable groups, though many still remain in the pilot stage.
Fourth, in some countries, especially in southern Africa, schemes based on universality, or broadly defined target groups, are rapidly spreading.
The need and potential for expanding social protection in Sub-Saharan Africa, as well as the feasibility and the likely development outcome, have been recently examined by the European Report on Development (ERD 2010). While the programmes in Latin America have been widely described, evaluated and discussed in the economic and political literature (see, for instance, Grosh et al. 2008), there is much less on those prevailing in Sub-Saharan Africa. However, functioning social protection programmes are crucial for Sub-Saharan Africa, especially in the aftermath of the global financial crisis (see also Gerecke and Prasad 2010). The European Report on Development therefore provides a useful start, analysing the most relevant experiences of social protection in Sub-Saharan Africa, to investigate whether there are preconditions necessary for success, as well as which factors could contribute to scaling up social protection in the continent.

Some African examples on the road to social protection
In some low-middle income Sub-Saharan African countries, different examples of Social Protection are in place:
Ghana’s National Health Insurance Scheme is an intermediate form of health insurance involving social insurance financed by contributions from formal (and to a lesser extent informal) sector employees and by government coverage for those unable to contribute. This programme helped improve the efficiency of the country’s health system and reduce out-of-pocket expenditure on health;
Lesotho’s Old Age Pension is a universal non-contributory scheme including all registered citizens over 70-years-old not receiving any other form of pension benefit. There is no clear evidence on the impact of this programme on poverty, but similar schemes in South Africa had substantial effects for the elderly and their households. Furthermore, this programme has been central for its role in the political elections.
Rwanda’s Vision 2020 Umurenge Programme consists of three core initiatives to redirect social protection programmes to vulnerable populations: (1) public works; (2) the Ubudehe credit scheme; and (3) direct support through an unconditional cash transfer. Payments from the programme are used to satisfy basic consumption needs and stimulate savings. Preliminary evaluations have shown a huge reduction of extreme poor among beneficiaries (from 40.6% to 9%);
Ethiopia’s Productivity Safety Net Programme is probably the most known programme in Sub-Saharan Africa. It is a conditional transfer in cash and/or in kind based on public works. It also includes a small component of unconditional direct transfers to those unable to work. The programme reports a modest but relevant average impact, improving food security (by 11%), livestock holdings (by about 7%) and households’ ability to cope with emergency.
Kenya’s Home Grown School Feeding programme is a conditional cash transfer to schools for local purchase of food, involving half a million children of primary school age. The programme has showed a positive impact on children’s diet quality, health, learning capability and performance, school attendance. Furthermore, has had a positive impact on the economy of communities, because the food provided to the school is locally produced.
Such examples, and many others in different developing countries described in the European Report on Development (2010), allow us to identify some necessary preconditions for success, even though these programs are not necessarily suited to all countries. They also help to illustrate what is feasible in moving towards more comprehensive social protection systems in Africa.
The main message arising from the analysis of the existing cases is that it is politically, fiscally, and administratively feasible, even for low-income Sub-Saharan African countries, to put in place social protection programmes on a scale and scope previously thought out of reach.

The need for political commitment
Specific country conditions, including political commitment and prior experience, however, dictate the scope for tailored solutions. Political will is not only crucial for initially triggering the programme but also for committing to sustainable social protection schemes and to scale them up in the long term. In some cases, the government’s commitment is driven primarily by the need to address the main vulnerabilities affecting the population, in view of achieving long-term resilience. In Lesotho, the Old Age Pension was introduced to reduce the elderly burden, while indirectly supporting their households. In Ethiopia, the Productivity Safety Net Programme is aimed at overcoming dependence on emergency relief, providing predictable support to reduce chronic poverty and protect assets by promoting agriculture as the backbone of growth.
Putting social protection at the heart of the national development agenda can also affirm the social contract between the state and its citizens, thus bolstering the government’s legitimacy. In Ghana, the health insurance programme rose from an electoral promise to a rights-based entitlement, protecting the vulnerable while enforcing government accountability. The political benefits of commitment to social protection can provide significant results: in Lesotho the Old Age Pension contributed to the government’s re-election.
Such political commitment should be complemented by adequate institutional and administrative capacity. In Rwanda the Vision 2020 Umurenge Programme is embedded in a system based on subsidiarity. That is, policies are formulated at the centre, administered by sub-districts and implemented by the villages. The community-based approach – where communities take primary responsibility for identifying eligible beneficiaries – can be a valid alternative to top-down targeting that might not meet local needs, wasting resources. The Ubudehe credit scheme approach in Rwanda shows that decentralisation can contribute to the overall efficiency of interventions and avoid resources’ mismanagement. The Ghana example points in the same direction: taking advantage of the pre-existing community-based health insurance system contributed to a successful targeting and consequent extension of the scheme to the informal sector.

A starting point for social protection programmes
Affordability is often perceived as the greatest obstacle by governments. For many low-income countries in Sub-Saharan Africa, the complete package in the UN social protection floor (ILO 2008) might not be affordable, especially to the extent that revenue-raising capacity remains low and administrative costs are high. But elements of the social protection floor are fiscally affordable in most low-income Sub-Saharan African countries. Social pensions in Lesotho, with a cost of approximately 2% of domestic GDP, have been entirely covered by tax-based resources, quite high in the country (African Economic Outlook 2010). Ghana’s National Health Insurance Scheme, now covering a large part of the population, relies on different domestic sources of finance.
Hence, a good entry point for a social protection programme could be starting with non-contributory old age pensions, child grants or public works. More would be feasible in the longer run, if governments raised their tax to GDP ratios (itself desirable), reallocated resources within their budgets or obtained reliable and long-lasting external support.
Donor support can still be crucial, even when domestic political commitment and ownership of social protection are strong, since domestic resource mobilisation remains low in many Sub-Saharan Africa countries. In Ethiopia, for instance, the government provides only 8% of the total budget for the Productivity Safety Net Programme, while donors provide the rest.
In sum, political commitment, and domestic control over social protection programmes, has been the key to most, if not all, successful schemes. However, there is room for social protection to be an integral part of donors’ development policy. It is important that social protection does not crowd out markets, but forms the kind of social protection needed to enhance social cohesion.

http://www.voxeu.org/index.php?q=node/6041

Sunday, 23 January 2011

POVERTY: Is the Doha round delivering on poverty?



  Photo: Nicolas Boll/BioCotton Project; Cotton farmers in developing countries at a disadvantage

JOHANNESBURG, 20 January 2011 (IRIN) - Scepticism marked discussions at a just-ended global poverty summit in Johannesburg on whether the Doha Development Round of negotiations at the World Trade Organization could help reduce the number of poor people in developing countries.
The Doha talks, which began in 2001, are aimed at reducing barriers to market access throughout the world, with the development of poor countries at the heart of their agenda. They look at three main sectors - agriculture, intellectual property and services.
Jomo Kwame Sundaram, the assistant secretary-general of the UN Department of Economic and Social Affairs and a leading Malaysian economist, said it had been extremely difficult to measure any socio-economic benefits of such access.
He said studies in his country had shown that a paddy farmer’s child had better nutrition than the children of a rubber farmer who now had access to global markets.
Improving income levels did not automatically imply better lives for the poor in any country, as other factors such as the implementation of policies that benefit the poor within countries matter a lot more, said Joseph Stiglitz, Nobel prize-winning economist and chair of the Brooks World Poverty Institute, the organizers of the Johannesburg summit.
He cited the USA as an example of where gross domestic product had grown substantially but not filtered down to the poor, who were worse off than a decade ago. "It [high economic growth levels] had a trickle-up effect," said Stiglitz.

Subsidies
Over the past decade the Doha talks have failed to get developed countries to stop subsidizing their farmers and agricultural exports, something that directly threatens livelihoods and food security in the developing countries.
While some European Union (EU) countries have abolished or reduced agricultural subsidies, the USA has not. It reintroduced subsidies for cotton farmers in 2008, pointed out Bernard Hoekman, an international trade expert at the World Bank, severely affecting cotton farmers in West African countries like Benin, Mali, Chad and Burkina Faso.
The Johannesburg summit called for the rapid elimination of export subsidies, especially for cotton, sugar, groundnuts, dairy products and fish.
Sundaram said sub-Saharan Africa did not stand to benefit from the Doha talks. He pointed out that many least developed countries (LDCs), most of them in Africa, lacked the capacity to compete in the global market.
Experts at the Johannesburg summit said Bangladesh and Cambodia were among the few LDCs to build a competitive edge - in their textile and clothing sectors.

LDCs are seeking duty and quota-free (DFQF) access to markets in developed countries at the Doha talks. “In practice, many advanced and emerging market economies have agreed to allow DFQF market access for LDC products under at least 97 percent of tariff lines. While the difference between 97 percent and 100 percent may seem insignificant, many LDCs export so few product categories that even a small number of exclusions can sharply limit the benefits of trade preference programs,” says the International Monetary Fund.
The Johannesburg summit called for the setting up of an annual reporting mechanism on DFQF.

Fishing
The Doha talks are also discussing EU fishing industry subsidies which encourage European fishing beyond Europe - something that adversely affects the millions of African fishermen, said the World Bank's Hoekman. "If those subsidies are removed it will prevent overfishing, benefiting the poor fishing communities along the African coast and the environment."
The Johannesburg summit also called for improvements in the General Agreement on Trade in Services (GATS) to ease restrictions on labour mobility from LDCs in order to boost such sectors as health, education and call centres.

Not all doom
The Doha talks have made progress in some areas, for instance Trade-Related Aspects of Intellectual Property Rights (TRIPS), which provides minimum standards for intellectual property protection in sectors such as music and medicine, and led to the introduction of greater flexibility in the manufacture of drugs for public health services.
Also under Doha, the EU was forced to abolish preferential access to banana exporters in African, Caribbean and Pacific (ACP) countries - benefiting LDCs which have preferential access under the EU's Everything But Arms regulation, said Hoekman.
The Johannesburg summit warned, however, that “the length of time that the [Doha] negotiations have taken threatens to render aspects of the agenda obsolete."
But now is the time to push for a conclusion on outstanding issues, said Hoekman, as the US Farm Bill, which covers agriculture subsidies and food aid, comes up for review in 2012.
http://www.irinnews.org/Report.aspx?Reportid=91684

Friday, 14 January 2011

MALARIA: Artesunate versus quinine in the treatment of severe falciparum malaria in African children

11 January 2011

Arjen M Dondorp, Caterina I Fanello, Ilse C E Hendriksen, et al
Severe malaria is a major cause of childhood death and often the main reason for paediatric hospital admission in sub-Saharan Africa. Quinine is still the established treatment of choice, although evidence from Asia suggests that artesunate is associated with a lower mortality. We compared parenteral treatment with either artesunate or quinine in African children with severe malaria.
http://www.malarianexus.com/articles/read/116/artesunate-versus-quinine-in-the-treatment-of-severe-falciparum-malaria-in-african-children-aquamat-an-open-label-randomised-trial/

Wednesday, 5 January 2011

POVERTY: MAURITANIA: Activists’ trial puts spotlight on anti-slavery law

NOUAKCHOTT, 4 January 2011 (IRIN)

 Photo: Contributor/IRIN : Former slave in Mauritania

Six anti-slavery activists are in prison in Mauritania in a case rights experts say points to the challenges of ensuring a 2007 law criminalizing slavery is more than just words on paper.
The six men, members of the Mauritanian anti-slavery group Initiative pour la résurgence du mouvement abolitioniste (IRA), are set to go on trial in the capital, Nouakchott, on 5 January after two postponements. The authorities reportedly said the IRA members attacked security forces; the activists said they were simply demonstrating against slavery.
“We suspected that the 2007 law would not be put into effect,” Romana Cacchioli, Africa expert with Anti-Slavery International, told IRIN. “And indeed its application is not yet a reality. Cases that have been brought are either still in process but taking a long time or have not been pursued.”
The law makes keeping slaves a crime in Mauritania, but the practice continues. The NGO SOS Esclaves says nearly a fifth of Mauritania’s 3.1 million people were slaves as of 2009.
On 13 December the six activists were arrested while protesting in front of a Nouakchott police station; the activists were calling for the group’s leader to attend the questioning of two girls - aged nine and 13 - allegedly kept as slaves.
“Each time a slave is questioned, the police don’t want [IRA president] Biram Oula Dah Ould Abeid to attend,” IRA member Hamady Lehbouss told IRIN. “This way the police are able to manipulate the slaves.”
Leïla Ahmed, IRA member and Ould Abeid’s wife, was at the police station; she said she felt teargas and saw policemen beating IRA members, including her husband.
The Mauritanian authorities have declined to comment on the arrests or the protest in front of the Nouakchott police station.
Ineffective law?
The 2007 law - adopted unanimously by Mauritania’s National Assembly - criminalized slavery. But to date, according to IRA and SOS Esclaves, no one has been prosecuted for keeping slaves.
Human rights and anti-slavery activists expressed concern in 2007 that the law alone was insufficient, saying the government must adopt measures to ensure the law would be effective.
The law says slaveholders could be given 10-year prison sentences and fines ranging from US$2,000 to $4,000. Anyone facilitating slavery can be imprisoned for two years. The law also provides for financial compensation to former victims.
The law does not allow representatives of civil society groups to attend trials.
“No legal measures exist for slaves to claim their rights,” IRA secretary-general Boubacar Ould Mohammed told IRIN.
The deputy head of SOS Esclaves in Mauritania, Mohamed Ould Khalifa, said the authorities generally classify such cases simply as disputes between an employer and his or her employees.

Widely practised
Activists said part of the difficulty in criminalizing slavery is that it is so widely practised. “The authorities themselves keep slaves,” Khalifa said.
But also, former slave Haby Rabah told IRIN, many people in slavery do not know their rights or are afraid to leave.
“My masters told me: ‘The slave depends on his owner and in order to go to paradise he must obey his owner. Otherwise he will go to hell’,” said Rabah who, with IRA’s help, was liberated "three years and four months" ago.
“I knew no one but my masters. I belonged to them and that seemed normal to me. When I was young my owners beat me; when I got older they threatened to take me to the police if I disobeyed them.”
Local experts say slavery continues in cities as well as in rural areas in this Sahelian country which lies geographically and culturally between Arab North Africa and black sub-Saharan Africa. Most affected are the Harratin – black Moors, descendants of slaves – who are generally owned by upper class white Moors, the minority ruling elite of Arab-Berber descent, according to SOS Esclaves. Slaves generally do household work or attend to livestock; they are not allowed to own land.
A common saying among Mauritanians is: “The ground is the slave’s bed, fire his clothing.”
http://www.irinnews.org/report.aspx?ReportID=91528

Tuesday, 28 December 2010

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

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

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

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

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

Monday, 27 December 2010

MALARIA: Cerebral malaria, common cause of epilepsy in children

 Sade Oguntola :  27 December 2010
Cerebral malaria, one of the deadliest forms of malaria, is a medical emergency demanding immediate diagnosis and treatment. Experts warn that malaria is best prevented, especially since its severe form is a potential cause of epilepsy in children, reports Sade Oguntola.
What is your impression of malaria? As a mother, do you see it as a deadly disease or one to be handled with levity? Do you belong to that group of mothers that do not bother to treat malaria in your child when you notice its symptoms?
Well, even if you do not bother that malaria could make your child miss some days at school, experts warn that it should concern you that it might turn out to be cerebral malaria, a severe form of the disease, whose aftermath, when not treated promptly, may be epilepsy.
Cerebral malaria is a severe or complicated form of malaria affecting the brain, occurring predominantly in children, with a mortality rate of 15-25 per cent. It affects about one million children every year, primarily in sub-Saharan Africa. Coma, headaches, seizures, and impaired consciousness are frequent manifestations of this infection.
Children less than five years of age are particularly susceptible because of low levels of immunity. It only takes one bite from an infected mosquito to contract the disease that directly affects the brain, causing fever, vomiting, chills, and coma.
In addition, children with cerebral malaria are at risk of developing several adverse neurological outcomes, including epilepsy, disruptive behavior disorders and disabilities characterised by motor, sensory or language deficits. Since most of the neurological effects did not present themselves immediately, they were not evident at the time of the child’s discharge from the hospital after the initial malaria illness.
A new study on cerebral malaria in African children reported that almost a third of cerebral malaria survivors developed epilepsy or other behavioral disorders.
The research, which appeared in journal, The Lancet Neurology, looked at several hundred children during a nearly five-year period in Blantyre, Malawi. The children were evaluated for cognitive function in three major areas: attention, working memory, and tactile learning. Evaluation was done at hospitalisation, six months after the initial malaria episode, and two years after the episode.
They found that at six months, 21 per cent of children with cerebral malaria had cognitive impairment compared with six per cent of their healthy Ugandan peers. At two years, cognitive impairment was present in 26 per cent of the patients, compared with 8 per cent of the community children.
The researchers involved in this first-ever prospective study of cerebral malaria survivors that included a control group suggested that cognitive impairment may begin to manifest itself months after the initial episode. In fact, cognitive function was most dramatically impaired in the area of attention.
The impact of the findings on African society is no doubt immeasurable. By extrapolation, they stated that about 135,000 African children younger than five years might have developed epilepsy due to cerebral malaria-induced brain injury each year, and cerebral malaria may be one of the more common causes of epilepsy in malaria-endemic regions.
Since these are children that had survived the malaria, but their quality of life and what they contribute to society is severely hampered, the experts declared the need to be more aggressive in treating the two major risk factors: seizures and high fever before better treatment for seizure and fever are identified in hopes of minimising the risk of epilepsy in years to come.
Previous studies had linked epilepsy to disruption of brain development during early childhood - roughly between the ages of one and five -because of the fragility of the brain during this period.
Nonetheless, Dr. Ikeoluwa Lagunju, a consultant paediatric neurologist, University College Hospital (UCH), Ibadan, Oyo State, declaring the importance of preventing malaria, stated that cerebral malaria was a severe form of malaria in which you have malaria parasite invading the brain.
Dr. Lagunju stated:“We see cases of cerebral malaria quite often, particularly during the rainy season. Transmission of malaria parasite is quite high during the rainy season and so you tend to have many cases of malaria and its severe forms during this season.”
According to her, “malaria parasite is usually found circulating in the blood stream and that is why you have fever, vomiting, chills and rigours. But in severe cases, these parasites would go through the blood to the brain and when you have a heavy load of malaria parasite in the brain, it is believed that it could block some blood vessels, cause swelling of the brain and some other abnormalities.
“When this happens, the child becomes unconscious, but afterwards, a number of them recover consciousness. But cerebral malaria is highly fatal and can kill rapidly, with poor management, when it is not recognised or involves someone who has not been in a malaria-endemic area.
However, Dr. Lagunju remarked that in those who survived cerebral malaria, the brain had been affected. “It is a form of injury to the brain. The brain is peculiar in the sense that it does not regenerate. You can injure your finger nail and then it grows back. You can have a wound and then you loss the skin and the skin grows back, but the brain is not like that,” she stated.
According to her, ‘If you have a child who has had cerebral malaria, he may recover from the illness, but then he may have problems with vision and hearing and few of them may later continue to have seizures and have what we call epilepsy.
“So, these are the things that we worry about with cerebral malaria and that is why prevention of malaria remains the best option.”
Certainly, nobody can tell which malaria will be severe enough to involve the brain. According to Dr. Lagunju, the best option is to prevent malaria through the use of insecticide-treated nets, ensure clean surroundings, maintain low lawns and clean drains, prevent stagnant waters and ensure a clean environment.
She reiterated the need for mothers to know how to treat malaria. “Gone are the days of: are you a doctor? Why did you then give anti-malarial medicines? We actually expected that mothers should have a pack of rapidly acting anti-malarial drug that they can readily administer as soon as they notice that the child is unwell. This will help to quickly clear the malaria parasite and reduce the risk of the child going on to develop severe forms of malaria.”
Professor Surajudeen Arigbabu, a consultant neurosurgeon at the Lagos University Teaching Hospital, reiterated that once the brain is injured, it cannot recover. According to him,” for any loss of a part of the brain or an injury, the effect is permanent and for that reason, if a person is diagnosed with cerebral malaria and there is a damage to any part of the brains later in life, that part of the brain that is damaged may become an epileptogenic focus and with resultant convulsions from time to time.”
http://tribune.com.ng/index.php/your-health/15291-cerebral-malaria-common-cause-of-epilepsy-in-children

Wednesday, 22 December 2010

MALNUTRITION: On the move in a warming world: The rise of climate refugees

Geoffrey York (The Globe and Mail's Africa bureau chief.)
Dec. 17, 2010
Fatime Owye and her mother, Halime Djime, who travelled 700 kilometres to take the girl to the hospital for emergency care. Fatime's father, who owned a small herd of camels, left the family three years ago in search of work when the climate became too harsh for the camels. - Fatime Owye and her mother, Halime Djime, who travelled 700 kilometres to take the girl to the hospital for emergency care. Fatime's father, who owned a small herd of camels, left the family three years ago in search of work when the climate became too harsh for the camels. | Geoffrey York/The Globe and Mail
 Five-year-old Fatime moves in slow motion, barely able to lift her skeletal arms and legs. Flies land on her face, and she is too weak to brush them away. She struggles to drink a cup of therapeutic milk, the only food she can swallow.
Her parents were nomads who owned dozens of camels that provided meat and milk for their family. Then the rains stopped coming. The thorn trees began dying, the vegetation withered up and the big herds of camels ceased to roam.
 “I've never seen this before,” says her 29-year-old mother, Halime Djime, who has already lost two of her four children to malnutrition and disease. “Even when there were no trees, there would be vegetation. This is the first time that the land is all white.”
Fatime weighs just seven kilograms – barely half of what she should weigh at her age. Teetering between life and death, her emaciated body evokes memories of Ethiopian famines in the 1980s. Yet she is not a poster child for a celebrity benefit concert or a charity campaign. Ignored by much of the world, the starving children of the African Sahel represent a new global challenge: How to respond to the climate crisis that the world's politicians have failed to fix, and how to break the cycle of endless emergency aid in an era of donor fatigue.
Fatime's father has been on the move for years, selling his few remaining camels and seeking work in Libya and eastern Chad. His wife does not even know where he is any more. These are the days of the “climate refugees” – families splitting apart as migrants flee from increasingly harsh conditions where survival is nearly impossible.
As the desert relentlessly expands and rainfall disappears, the villages in this part of the Sahel are almost empty of men. Most have trekked to Libya or Nigeria in search of jobs. Of the people who remain, 80 per cent are women and children.
Across the Sahel, a band of semi-arid land south of the Sahara stretching from the Atlantic Ocean to the Red Sea, an estimated 10 million people suffered food shortages this year, including 850,000 children who are acutely malnourished and could die without urgent care. In the Sahel region of Chad, more than 20 per cent of children are acutely malnourished, on top of a chronic malnutrition rate of about 50 per cent. In some regions, mothers are desperately digging into anthills in search of tiny grains and seeds for their children. And this is just one of many places around the world where the changing climate has left the people dependent on foreign aid.
When the 190-nation climate conference in Cancun, Mexico, staggered to an end last weekend, there was no binding agreement on curbing carbon emissions and no sign of a treaty to replace the soon-expiring Kyoto Protocol. The negotiators will try again next December. But regardless of those negotiations, the facts on the ground will not change: The climate is growing more precarious, and millions of people are on the move. The question now is whether to encourage them to migrate – or to salvage their ravaged land with long-term investment, instead of simply handing out emergency aid.
Unable to agree on a climate treaty, the wealthy nations at Cancun promised to help the poorer countries “adapt” to climate change. The people of the Sahel, however, have already been adapting for years – mostly by voting with their feet, abandoning their barren fields and migrating hundreds of kilometres in search of work.
“Anyone who could afford to leave has left,” says 71-year-old Adji Goukouni, deputy chief of the village of Mampel, a collection of beehive huts and stick fences in the sandy wastes of the Sahel.
“I am too old to move,” he says. “I have no strength left to work. If I have to die, I will die here.”
For more than a decade now, he has been bewildered by the changing weather patterns. Fifteen years ago, he had more than 30 cows, 10 donkeys, five camels and five horses. Then they began dying. Within the past three years, his last remaining livestock perished.
“The rainfall has been diminishing all the time,” he says. “The wind is stronger than before, and animals are fleeing. We have nothing left – we only have goats. All the animals are gone, and the wild animals too, even the geckos and hyenas and guinea fowl.”
This year, the village suffered a perverse twist of fate. When everyone had given up on the rains, suddenly there were torrential storms, more rainfall than the village had seen in many years. But the farmers gained nothing. They had not gambled on the cost of seeding their fields. “We weren't expecting any rain, so I didn't plant anything,” Mr. Goukouni said.
In the region around his village, farmers need 400 millimetres of rain annually to produce a crop. Over the past four years, rainfall has varied from 135 millimetres to 358 millimetres – not enough to sustain a harvest. And much of the rainfall is produced in torrential storms that cause more damage than benefit.
In the nearby town of Mao, the strange combination of drought and sudden torrential rain has had an unexpected result: huge fast-growing ravines that threaten to swallow up the town. This year alone, 350 houses were destroyed by the eroding sand, which also threatens to destroy a local school and the local airport. Sandbags and concrete walls have failed to hold back the rapid growth of the ravines.
A couple of hundred kilometres to the south, fishermen and farmers have been devastated by the dramatic disappearance of Lake Chad, one of the biggest lakes in Africa. The lake, shared by four countries, has lost 95 per cent of its size since the 1960s, partly because of climate change and partly because of overuse for agricultural irrigation. Experts say it could completely disappear within the next two decades.
Where once the lake had 150 species of fish, only about a dozen species are still alive today. The fish catch has dropped by 60 per cent, and thousands of fishermen have been forced to abandon the lake. From an airplane overhead, the lake is now revealed as a vast collection of shallow inlets and fingers of water, choked with weeds. It's an environmental catastrophe that imperils the 30 million people who depend on the lake, yet it has been virtually ignored by the world.
“When the water was deep, I could just throw out a net and it would fill with fish,” says Paul Mbayou, who has been fishing on the lake for 17 years. “I used to get enough to sell in Nigeria. But now the fish are too small.”
He takes a boat to check the traditional basket nets that he left in the weeds at the edge of the lake. But most of the nets are empty, and only one has a few tiny fish in it. “Nothing, nothing,” he mutters as he checks each net.
The region around Lake Chad was once the breadbasket of the Sahel, but its farmers have seen their crops decline by 40 to 60 per cent in the past decade, as irrigation canals are left dry by the receding lake. Thousands of cattle have died, and the surviving cows are producing less than half as much milk. Even in this former breadbasket region, more than a fifth of the children are acutely malnourished.
The village of Ngambia was built in the 1940s on an island in Lake Chad. Then the lake receded, the village was left stranded in the middle of the desert, and the villagers had to stop fishing. They tried to grow crops, but they could produce only enough to feed their families for a few months of the year. So now the men have moved away in search of work, leaving the women and children behind.
The biggest town on the Chad side of the lake, Bol, has lost more than half of its population since the 1990s. Its mayor, Ahmat Tidjani Boukar, says the men have journeyed to Nigeria or Libya to become labourers or security guards, or have joined the Chadian army. Many of the women, he says, have become prostitutes or beggars.
“The community has always depended on the lake, but now there are no fish,” the mayor says. “In the past, we exported fish everywhere. Now, we can't even produce enough for ourselves. It's very likely that people will just keep moving away.”
Evidence like this is convincing some experts that the Sahel is becoming uninhabitable. Across most of Africa, average temperatures have been steadily rising for decades, while rainfall has been declining. The Sahel is one of the worst-hit regions. Climate change and human exploitation have left it vulnerable to extreme weather and a destructive cycle of drought and floods.
For more than a decade, child malnutrition in the Sahel region of Chad has been above the emergency threshold (defined by the United Nations Children's Fund (Unicef) as a 15-per-cent rate of acute malnutrition). The Sahel countries, including Chad and Niger, are among the poorest and hungriest in world, with nearly one-quarter of their children dying before their fifth birthday. An estimated 225,000 children die annually of malnutrition in five Sahel countries: Chad, Niger, Mali, Mauritania and Burkina Faso.
“Before, we had crises, but they came and went,” says Maina Abakar, a nutrition expert in Chad. “Now, the crisis just stays.”
The changing climate has created a dilemma for wealthy donor countries such as Canada. Instead of spending millions of dollars on emergency food for the region's malnourished children, should they be encouraging the people to leave? When the Cancun conference promised $100-billion annually to poor countries to help them adapt to climate change, does it mean helping Africa ship its people out of uninhabitable areas?
“If the conditions in the Sahel continue to worsen because of climatic deterioration, it's obvious that it can't sustain a large number of people,” says Jean-Luc Siblot, director of the Chad operations of the World Food Program, the UN food agency.
The WFP is providing supplementary food rations to about 60,000 children and 81,000 pregnant women and young mothers in Chad alone. It has asked for $300-million from donors to support the Sahel countries this year. But Mr. Siblot questions whether this kind of assistance is the best solution for the region in the long term.
“When it is likely that the climate will worsen over the next 20 to 30 years, I'm not sure whether we'll be able to sustain it,” he says in his office in Chad's capital, N'Djamena.
“The desert is expanding every year. You can't have a big percentage of the population living in those conditions. They're migrating away, in a very disorganized way. I don't see a solution for it. You can dump as much food as you want into the Sahel, but it won't solve the problem.”
Unicef sees it differently. In its view, its primary obligation is to prevent starvation and save the lives of the families in the Sahel, even if this encourages them to remain in a region where the climate is deteriorating and the desert is spreading.
“This is where our parents and ancestors were born,” says Yakoura Maloum, a Unicef officer who was born in the town of Bol. “The tombs of our sultans are here. It's not possible for us to move away. Individuals can move, but the community cannot move.”
In the Sahel region of Chad alone, Unicef is providing food for 50,000 malnourished children in about 200 emergency feeding centres. Last year, it supported 12,000 children, so the number has quadrupled this year as the crisis deepened.
“I've never seen a situation as bad as this,” says John Ntambi, a Unicef nutrition specialist in the Mao district.
“You see thousands of children all the time, and it never ends. It never gets any better. The population is less and less capable of feeding itself, so it's more reliant on external support. The levels of malnutrition are very alarming.”
Even after the feeding centres were created this year, it can be a long ordeal for mothers to reach one. Distances are vast, and roads almost non-existent. When her child fell ill, it took five days for Halime Djime to travel 700 kilometres to the hospital in Mao.
The irony is that the Sahel countries could do more to feed themselves, but they are hamstrung by poor land policies, low education levels, a lack of money for investment, and autocratic regimes that spend more money on weapons than on children. If donor countries refused to help the malnourished children of the Sahel, the children would simply starve.
“I've never worked in a region where the government is so unresponsive,” Mr. Ntambi says. “All of the life-saving supplies are being provided by Unicef, and nothing is being provided by the government. The priorities are wrong.”
Many experts believe that the Sahel has huge potential to sustain crops and livestock if its water resources were managed properly. Scattered among the sand dunes and scrub land, there are thousands of oases and valleys where crops can grow. But less than 10 per cent of the population has access to these oases, which are owned by a privileged few. And since the water is deep underground, the owners often lack the money to dig wells and pump out the water for crops.
In the region surrounding Mao in the Sahel of western Chad, 750 oases are underused because their owners cannot afford to dig wells, according to the UN's Food and Agriculture Organization. It estimates that only 10 per cent of the oases are properly developed for agricultural use.
Another key factor is the government's preference for military spending. Chad has received billions of dollars in oil revenue in recent years (it is the sixth-biggest African supplier of oil to the United States), yet most of this revenue is spent on its security forces, despite its earlier promises to spend the oil money on poverty alleviation.
“People think Chad is a rich country because of its oil – and it's true,” says Jean-Baptiste Ndikumana, the Unicef deputy representative in Chad. “If they used this money for social services, there could be some improvement. Instead, they use it for weapons.”
oor levels of education are another crucial problem. Knowing little about nutrition, many people in the Sahel turn to traditional healers when their children are starving. The “healers” usually do more harm than good: They cut incisions in children's mouths or burn their bottoms to “treat” diarrhea.
Grandmothers, meanwhile, encourage their pregnant daughters to eat less food so that their babies will be smaller; or they advise mothers to give water, instead of milk, to newborns. Both are dangerous practices. Breastfeeding is one of the best ways to improve a child's health, yet only about 3 per cent of Chad's children are exclusively breastfed in their first six months. And because of cultural traditions, women with starving children are reluctant to travel to a feeding centre without the permission of their husbands, who are often unreachable because they have migrated in search of work.
Education and agricultural development are the keys to saving the people of the Sahel from climate change. Yet only a small handful of international agencies are present here, in contrast to the hundreds of agencies in Haiti or Afghanistan.
There are no dramatic earthquakes or civil wars to draw attention to the Sahel – only the slow grind of climate change, wreaking its gradual chaos on the land. Relief agencies tend to respond late, or not at all. The UN was aware of the drought in Chad in the fall of 2009, yet it did not send emergency aid until the spring of this year. “We came too late,” Mr. Siblot admits. “We wasted three months, scratching our heads and trying to decide on a response.”
The FAO is one of the UN agencies that should be helping Chad to improve its agricultural productivity, yet it has only a small presence here. In effect, the UN and the world's donor countries have channelled their funds to emergency aid, rather than long-term agricultural development – which means that Chad will always be dependent on aid. “We are saving lives, but we are not solving the problems,” says Mr. Ndikumana of Unicef.
The Sahel may symbolize the future of foreign aid: responding to climate-related crises that leave millions at risk of hunger and death. The solution, as Mr. Siblot acknowledges, is to do more than “dumping food” into a region. There needs to be much heavier investment in education and agriculture, so that massive numbers of people aren't forced to abandon their homes. And if a regime prefers to spend its billions on soldiers and military weaponry, the buyers of its oil might have to use their influence to press for new priorities. Otherwise, the vast human migration in places such as the Sahel will spin out of control forever.
http://www.theglobeandmail.com/news/world/africa-mideast/on-the-move-in-a-warming-world-the-rise-of-climate-refugees/article1843024/singlepage/#articlecontent

Wednesday, 15 December 2010

MALARIA: WHO World Malaria Report for 2010



Summary
The World Malaria Report 2010 summarizes information received from 106 malaria-endemic countries and other partners and updates the analyses presented in the 2009 Report. It highlights continued progress made towards meeting international targets for malaria control to be achieved by 2010 and 2015. The report outlines the evolving situation of financing for malaria control, how these growing resources have resulted in increased coverage of WHO-recommended malaria control interventions, and the association between this
rapid scale-up and substantial reductions in malaria burden.

International funding for malaria control has risen steeply in the past decade. Disbursements reached their highest ever levels in 2009 at US$ 1.5 billion, but new commitments for malaria control appear to have stagnated in 2010, at US$ 1.8 billion. Countries with smaller populations at risk continue to receive more funding per person at risk than more populous countries. The amounts committed to malaria, while substantial, still fall short of the resources required for malaria control, estimated at more than US$ 6 billion for the year 2010.

The increased financing has resulted in tremendous progress in increasing access to insecticide-treated mosquito nets (ITNs) in the past 3 years. By the end of 2010, approximately 289 million ITNs will have been delivered to sub-Saharan Africa, enough to cover 76% of the 765 million persons at risk of malaria. It is estimated that 42% of households in Africa owned at least one ITN in mid-2010, and that 35% of children slept under a ITN. The percentage of children using ITNs is still below the WHA target of 80% partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries. Low rates of use reported in some surveys are primarily due to a lack of sufficient nets to cover all household members; household survey results suggest that most (80%) of the available ITNs are used.

While the rapid scale-up of ITN distribution in Africa represents an enormous public health achievement, it also represents a formidable challenge for the future in ensuring that the high levels of coverage are maintained. The lifespan of a long-lasting ITN is currently estimated to be 3 years. Nets delivered in 2006 and 2007 are therefore already due for replacement, and those delivered between 2008 and 2010 soon will be. Failure to replace these nets could lead to a resurgence of malaria cases and deaths.

IRS programmes have also expanded considerably in recent years, with the number of people protected in sub-Saharan Africa increasing from 13 million in 2005 to 75 million in 2009, corresponding to protection for approximately 10% of the population at risk in 2009.

Current methods of malaria vector control are highly dependent on a single class of insecticides, the ethroids, which are the most commonly used compounds for IRS and the only insecticide class used for ITNs. The widespread use of a single class of insecticide increases the risk that mosquitoes will develop resistance, which could rapidly lead to a major public health problem. The risk is of particular concern in Africa, where insecticidal vector control is being deployed with unprecedented levels of coverage and where the burden of malaria is greatest.

WHO now recommends that all cases of suspected malaria be confirmed with a diagnostic test prior to treatment. As the incidence of malaria decreases through much of sub-Saharan Africa, the need to differentiate malaria from non-malarial fevers becomes more pressing. The proportion of reported cases in Africa confirmed with a diagnostic test has risen substantially from less than 5% at the beginning of the decade to approximately 35% in 2009, but low rates persist in the majority of African countries and in a minority of countries in other regions. A small number of countries have shown that it is possible to scale up rapidly the availability of malaria diagnostic testing on a national scale, provided that attention is given to adequate preparation, training, monitoring, supervision and quality control. Such experiences have been linked with large savings in the use of artemisinin-based combination therapies (ACTs) and with improved malaria veillance.

Information from manufacturers indicates that the number of ACTs procured has increased in every year since 2005. By the end of 2009, 11 African countries were providing sufficient courses of ACTs to cover more than 100% of malaria cases seen in the public sector; a further 8 African countries delivered sufficient courses to treat 50%–100% of cases. These figures represent a substantial increase since 2005, when only 5 countries were providing sufficient courses of ACT to cover more than 50% of patients treated in the public
sector. However, information on access to treatment is generally incomplete, particularly for the significant proportion of patients treated in the private sector.

The use of oral artemisinin-based monotherapies threatens the therapeutic life of ACTs by fostering the spread of resistance to artemisinins. By November 2010, 25 countries were still allowing the marketing of these products and 39 pharmaceutical companies were manufacturing them. Most of the countries that still allow the marketing of monotherapies are located in the African Region and most of the manufacturers are in India. The spread of resistance to antimalarial medicines over the past few decades has led to an intensification of efficacy monitoring to allow early detection of resistance. Despite the observed changes in parasite sensitivity to artemisinins, the clinical and parasitological efficacy of ACTs has not yet been compromised, even in the Greater Mekong sub-region. Nonetheless, both components of the drug combination are currently at risk and using an ACT with an ineffective partner medicine can increase the risk of development or spread of artemisinin resistance.

A total of 11 countries and one area in the WHO African Region showed a reduction of more than 50% in either confirmed malaria cases or malaria admissions and deaths in recent years. A decrease of more than 50% in the number of confirmed cases of malaria between 2000 and 2009 was found in 32 of the 56 malaria-endemic countries outside Africa, while downward trends of 25%–50% were seen in 8 other countries. Morocco and Turkmenistan were certified by the Director-General of WHO in 2009 as having eliminated malaria.

In 2009, the European Region reported no cases of P. falciparum malaria for the first time. It is estimated that the number of cases of malaria rose from 233 million in 2000 to 244 million in 2005 but decreased to 225 million in 2009. The number of deaths due to malaria is estimated to have decreased from 985 000 in 2000 to 781 000 in 2009. Decreases in malaria burden have been observed in all WHO Regions, with the
largest proportional decreases noted in the European Region, followed by the Region of Americas. The largest absolute decreases in deaths were observed in Africa.

While progress in reducing the malaria burden has been remarkable, there was evidence of an increase in malaria cases in 3 countries in 2009 (Rwanda, Sao Tome and Principe, and Zambia). The reasons for the resurgences are not known with certainty. The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes even if numbers of cases have been reduced substantially. The experiences in Rwanda and Zambia also indicate that monthly monitoring of disease surveillance data, both nationally and subnationally, is essential. Since many countries in sub-Saharan Africa had inadequate data to monitor disease trends, it is apparent that greater efforts need to be made to strengthen routine surveillance systems. Major epidemiological events could be occurring in additional countries without being detected and investigated.