POVERTY: 25% of UK farmers 'below poverty line'

(UKPA) – 5 days ago

A quarter of farming households live below the poverty line, the Government's rural watchdog said as it urged ministers to help farmers access benefits and develop their businesses.
The poorest 25% of farms have a household income of less than £20,000 a year, and a third of those failed to make a profit over the past three years, the Commission for Rural Communities (CRC) said.
The CRC said many farmers in the UK had diversified or found ways to earn money away from the farm to survive, with 17% of farms making more money from their additional enterprises than from traditional farming activities. But some do not have the skills or opportunity to branch into new businesses such as farm shops, producing food or letting out farm buildings.
Struggling farmers are more likely to be older people grazing livestock in upland areas including the South Pennines, the South West moors such as Exmoor and Dartmoor, the North Pennines, the Borders and the Lake District.
The problems are particularly acute for tenant farmers, because they do not own their land, can be prevented from diversifying under the terms of their tenancy or find it difficult to access the capital to set up new ventures as the banks view them as having no collateral.
A report by the CRC also said that while farmers are able - like anyone else - to claim benefits when times are tough, the take-up of welfare payments was lower in rural areas than in towns. Around 11% of working-age adults in rural districts claim out-of-work benefits, compared with 16% in towns, the report said.
Just 23 of the 601 Jobcentre Plus offices are in rural areas and the lack of information, transport and internet access makes it hard for people in the countryside to make the most of welfare services. Many farmers feel reluctant to take benefits because they are independent and there is a social stigma attached, the report said.
In addition, some households find it hard to provide up-to-date accounts and tenant farmers struggle to access housing benefit because their tenancy agreements do not separate the rental costs of their home from the land.
The CRC called for the Department for Work and Pensions to actively promote the take-up of benefits for farming households and for the Department for Business Innovation and Skills to support farmers to develop their businesses.
CRC chairman Dr Stuart Burgess said: "While many farming households have successfully increased production, resilience and farm incomes, one in four are living in poverty. These struggling farms are likely to have grazing livestock and be located in upland areas. Many are left trapped in poverty without the resources or support to earn a living wage. Tackling poverty among farming households is long overdue. The Government should actively promote farm business support and the take-up of income-related benefits to eligible farming households."
http://www.google.com/hostednews/ukpress/article/ALeqM5gVvNrjakWi5R6KI5FtQBJeT-VOIA?docId=N0337391291036598683A

MALARIA: The dominant Anopheles vectors of human malaria

The dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East: occurrence data, distribution maps and bionomic precis

Published: 3 December 2010 Parasites & Vectors 2010, 3:117doi:10.1186/1756-3305-3-117

Marianne E Sinka , Michael J Bangs , Sylvie Manguin , Maureen Coetzee , Charles M Mbogo , Janet Hemingway , Anand P Patil , William H Temperley , Peter W Gething , Caroline W Kabaria , Robi M Okara , Thomas Van Boeckel , H. Charles J Godfray , Ralph E Harbach and Simon I Hay
Background
This is the second in a series of three articles documenting the geographical distribution of 41 dominant vector species (DVS) of human malaria. The first paper addressed the DVS of the Americas and the third will consider those of the Asian Pacific Region. Here, the DVS of Africa, Europe and the Middle East are discussed. The continent of Africa experiences the bulk of the global malaria burden due in part to the presence of the An. gambiae complex. Anopheles gambiae is one of four DVS within the An. gambiae complex, the others being An. arabiensis and the coastal An. merus and An. melas. There are a further three, highly anthropophilic DVS in Africa, An. funestus, An. moucheti and An. nili. Conversely, across Europe and the Middle East, malaria transmission is low and frequently absent, despite the presence of six DVS. To help control malaria in Africa and the Middle East, or to identify the risk of its re-emergence in Europe, the contemporary distribution and bionomics of the relevant DVS are needed.
Results
A contemporary database of occurrence data, compiled from the formal literature and other relevant resources, resulted in the collation of information for seven DVS from 44 countries in Africa containing 4234 geo-referenced, independent sites. In Europe and the Middle East, six DVS were identified from 2784 geo-referenced sites across 49 countries. These occurrence data were combined with expert opinion ranges and a suite of environmental and climatic variables of relevance to anopheline ecology to produce predictive distribution maps using the Boosted Regression Tree (BRT) method.

Conclusions
The predicted geographic extent for the following DVS (or species/suspected species complex*) is provided for Africa: Anopheles (Cellia) arabiensis, An. (Cel.) funestus*, An. (Cel.) gambiae, An. (Cel.) melas, An. (Cel.) merus, An. (Cel.) moucheti and An. (Cel.) nili*, and in the European and Middle Eastern Region: An. (Anopheles) atroparvus, An. (Ano.) labranchiae, An. (Ano.) messeae, An. (Ano.) sacharovi, An. (Cel.) sergentii and An. (Cel.) superpictus*. These maps are presented alongside a bionomics summary for each species relevant to its control.
http://www.parasitesandvectors.com/content/3/1/117/abstract

POVERTY: How can Africa grow more food?

Madeleine Bunting 3 December 2010
 
How can Africa grow more food?
Rising food prices are focusing minds on Africa's agricultural output, and on whether or not technology is the best way to boost production


 Photograph: Howard Burditt/Reuters: Food production in Africa is 10% lower than it was in 1960.

African agriculture has become the focus of extraordinary attention and interest. Yesterday a big report was launched by the Harvard academic Calestous Juma with the backing of several African presidents, and next week Chatham House in London is hosting a major conference on food security where the International Fund for Agriculture and Development (Ifad) is launching a new report on rural poverty.

Meanwhile Olivier De Schutter, the UN special rapporteur on the right to food, warned that the current UN climate summit in Cancun needs to launch a "Green Marshall Plan for Agriculture" or risk a possible 40% increase in emissions by 2030 if current agricultural methods are extended.
Rising food prices and terrible future scenarios of the impact of climate change on food production, are focusing minds on what is perceived as Africa's huge untapped potential for agriculture. This week yet another report from the International Food Policy Research Institute warns that climate change could push prices up by 130%, and calls for unprecedented human ingenuity to meet the challenge of feeding a burgeoning population.

Some of this renewed interest from around the world is self interest; countries eyeing Africa as a source of food, which is prompting an unprecedented rush to buy or lease land. But the foreign interest is matched by that of many African countries keenly aware that improving agricultural productivity is key to entrenched problems of poverty – on average 64% of Africans depend on agriculture for their income – and hunger.

Central to all the discussion is the assertion that Africa could produce far more food than it currently does. In contrast with Asia, which has seen huge increases in agricultural yields in the last 40 years, sub-Saharan Africa's track record has been abysmal. Food production is actually 10% lower today than in 1960, yet over this time period the aggregate world food production has increased by 145%.

The reasons are not hard to find. The use of fertiliser is strikingly low – only 13kg per hectare in sub-Saharan Africa compared with a north African average of 71kg. Only 24% of cereal is using improved seeds compared with 85% in east Asia. The lack of investment in nutrients has led to a catastrophic depletion of soils; 75% of farmland in sub-Saharan Africa has been degraded by overuse. As soil fertility has fallen, farmers have expanded into forests to maintain incomes, leading to deforestation – which in turn leads to more problems, for example with soil erosion such as I saw in my visit to Mali recently.

But if there is widespread agreement on the causes of the problem, there is an extraordinarily polarised debate about the best strategy to tackle the problem. On one side there is a powerful lobby which argues that biotechnology, massive investment in irrigation and mechanisation are the way forward, and on the other side are those who argue that these kinds of investments are usually tied up in big corporate deals in which local smallholder subsistence farmers lose out – either they lose their land or access to water, and often both.

Juma and his prestigious panel of international experts have attempted to pick a politically feasible path between these two positions. His report, A New Harvest, is being launched with the backing a clutch of presidents, including those of Tanzania, Kenya, Uganda, Rwanda and Burundi.

Inevitably, his enthusiasm for biotechnology will trigger anxieties among that alliance of European and African activists who believe that this entails Faustian pacts with multinational corporations. Another constituency will also be doubtful on the grounds that this kind of emphasis on biotech and science as the way forward in Africa lacks understanding of how development is largely a political process and crucially depends on the effectiveness of institutions – it is a weakness of westerners to believe that clever technology can sort any problem out.

One old hand in the field told me the other day that, on average, it takes 46 years for agricultural innovations to get from the laboratory to widespread use in the field in Africa; it's not lack of technology that is the problem but effective means to disseminate practical solutions. Technology might be able to achieve quick fixes in health on the continent, but they might be elusive in agriculture because it entails much more complex issues of land rights and power.

But what will delight these very critics is Juma's championing of the smallholder farmer – not as an encumbrance to development but as central to its achievement. At the very beginning – the first page of chapter one – he throws his weight behind the example of Malawi, which in 2005 defied USAid (and initially the World Bank) to put major investment into subsidised fertiliser and improved seeds in an attempt to boost maize production. Yields doubled and Malawi was meeting domestic need and exporting surplus maize within a year. Malawi became a poster-girl for western NGOs because it successfully challenged the best part of two decades of a consensus on aid in Africa – namely that the state should not subsidise smallholder agriculture.

The second example Juma chooses to highlight is even more striking. He argues that China's dramatic reduction of poverty has been achieved by growth primarily in the agricultural sector, not the industrial. Since the late 1970s, improvements in technology and infrastructure helped boost production in smallholder agriculture, with farmers' incomes rising at more than 7% a year. The result is that 200 million small-scale farmers working an average of 0.6 hectare of land are now feeding a population of 1.3 billion.

China offers a fascinating model for Africa that is radically different from the western model of high-investment, export-orientated agriculture – the carnations from Kenya model. The key to China's success, argues Juma, is "a strong, competent, developmental state". Unfortunately, that is what has often been lacking in sub-Saharan Africa. And to be fair, the desperate state of African agriculture is also a product of a history of structural adjustment programmes, which insisted on cutting back the role of the state in funding research and agricultural extension services of many countries.

This report clearly draws a line under that history of neglect. But the question is whether it can really mobilise the kind of investment it believes is urgently needed. The political rhetoric surrounding its launch is warm, but a note of caution. We have been here before: the Maputo declaration of 2003 pledged African countries to 10% of government spending for agriculture. Seven years on, many countries have not even reached 4%.

http://www.guardian.co.uk/global-development/poverty-matters/2010/dec/03/africa-agriculture-food-boost-production

POVERTY: Hungry Africa needs to focus on agriculture

Calestous Juma, a development scientist, says Africa can turn around by improving roads and transportation, training engineers and using irrigation, solar energy and more technology.


The problem: African hunger.
In a nutshell, 250 million Africans are undernourished, a quarter of the population and an increase of 100 million in the last 20 years. Yet 70% of Africans are farmers growing food.

The hope:
Within one generation, Africa will grow enough to feed itself.

But how?
According to Calestous Juma, a Harvard professor and Kenyan development scientist, Africa can turn its fortunes around by improving roads and transportation, training an army of engineers and using irrigation, solar energy and more technology.
Africa's farming record is dismal. As global agriculture has surged in the last four decades, African food production has sagged.
Globally, agricultural production grew nearly 150%. Africa's population recently surpassed 1 billion, but its production of food has shrunk 10% since the 1960s.
To make things worse, global warming is predicted to hit Africa hard. Three-quarters of sub-Saharan Africa is arid or desert, and water resources such as Lake Chad are disappearing. Global warming is forecast to cut per capita income in the region by as much as 5%, compared with the global average of 1%.
Yet Juma, of Harvard Kennedy School's Belfer Center for Science and International Affairs, is convinced that with the right policies, Africa could feed itself within a generation, ending its reliance on food aid.
Juma's prescription, laid out in his new book, "The New Harvest, Agricultural Innovation in Africa," seems almost as optimistic as the Millennium Development Goals set down by world leaders in 2000, which call for halving hunger and extreme poverty worldwide by 2015. (At the current pace, most of the goals will not be met.)
Juma's book is being launched Thursday by Tanzanian President Jakaya Kikwete at a summit of East African leaders in Arusha, Tanzania, to discuss food insecurity. The recommendations of the book, which is published by Oxford University Press, were adopted this year by Africa's largest trading bloc, the 19-member Common Market for Eastern and Southern Africa.
The book's prescriptions come in the wake of some spectacular agricultural debacles in Africa, notably in Zimbabwe and South Africa, where most farms transferred from white farmers to black owners have failed.

The book skirts the contentious issue of land reform.
"We avoided the land [reform] issue deliberately, actually," Juma said in a telephone interview. "A good number of people on the land don't have the effective knowledge on how to use it."
In South Africa, 90% of redistributed farms have failed, according to the government.
In Zimbabwe, where production is sinking, a study by the South-African-based independent Zimbabwe news website ZimOnline reported Tuesday that nearly half the farmland seized from white farmers since 2000, or about 12 million acres, had ended up in the hands of President Robert Mugabe's family, cronies, generals, judges, government ministers, senior police officers and ruling party loyalists.
And in Kenya, said Juma, 30% to 40% of farmland was held by people with no farming expertise.
Juma identifies knowledge, infrastructure and technology as key to developing African agriculture.
At the heart of his book is a sense that African governments have underestimated the importance of farming and how much knowledge and technology it requires.
"We thought we would leave it to the peasants and they would feed themselves," Juma said. "Agriculture has been one of the lowest areas of priority for African countries until recently, when they realized you could not just rely on food aid and, secondly, we realized that the peasants weren't feeding themselves."
His book says an agricultural revolution would transform the economies of Africa and calls on governments to put agriculture at the center of all policy decisions. The only way to rapidly train the army of engineers and scientists needed to drive growth in agriculture, he contends, is to set up new technical academies outside the university system.
Juma's optimism that Africa's agricultural failures can be quickly turned around is based on the continent's vast untapped resources. Only 4% of cropland is irrigated, and most farmers are too poor to buy fertilizers, high quality seeds or machinery without a helping hand. But he says there's room for vast improvement if governments provide investment in infrastructure, technology and education.
"Southern Sudan could feed all of Africa, and it's not in production at all," he said, referring to the vast, dusty region of Africa's largest country, which was torn by decades of war and civil conflict before separatists in the south signed a peace deal with the national government in 2005. "The reason it can't do that is poor infrastructure. Roads are crucial, energy and rural electrification."
Settlements in the south are usually a collection of far-flung huts, and women, who are married off young and denied education, must walk for hours to collect water.
"The ability to adapt to climate change will possibly be the greatest test of our capacity for social learning," Juma says in the book's final chapter. "Much of the current concern on how to foster development and prosperity in Africa reflects the consequences of recent neglect of sustainable agriculture and infrastructure as drivers of development."
robyn.dixon@latimes.com
http://www.chicagotribune.com/news/nationworld/la-fg-africa-food-20101202,0,1094652.story

MALARIA: Malaria and HIV 2010

 Bill Brieger: 03 Dec 2010
Another World AIDS Day has come and passed. Sarah Boseley has commented on the information overload that comes this time of year on the disease and the range of basic health programming and valiant efforts to control it. This led to thoughts on whether there are any new developments concerning the connections between Malaria and HIV.
A quick look at the most recent PubMed listings for “Malaria AND HIV” mostly yielded sentences with the common theme of “AIDS, TB and Malaria” that considered the big disease funding efforts and the combined global burden of disease but few new insights on how each disease affects the other. Some interesting examples were uncovered.
On the biological side, Jiang and colleagues in the journal Vaccine (2010 Nov 23;28(50):7915-22) observed that, “Malaria and human immunodeficiency virus type 1 (HIV-1) infection overlap in many regions of the world.” Using mouse models they found that, “important implications for the development of a new form of bivalent vaccine against both HIV-1 and malaria.”
On the programming side, Lugada et al. examined how “Integrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases,” in rural Kenya, and reported on a campaign that provided, “HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment.” (PLoS One. 2010 Aug 26;5(8):e12435)
Reid reported on how injections for suspected malaria cases in drug shops and stores Tanzania and other rural African settings sets the stage for HIV and other infections. The need to prevent such practices can help both diseases. (Rural Remote Health. 2010 Jul-Sep;10(3):1463)
Noting that, “Co-infection of human immunodeficiency virus (HIV) with malaria is one of the pandemic problems in Africa and parts of Asia,” Oguariri and co-investigators examined, “the impact of pyrimethamine (PYR) and two other clinical anti-malarial drugs (chloroquine [CQ] or artemisinin [ART]) on HIV-1 replication.” They showed that, “10 μM CQ and ART inhibited HIV-1 replication,” while “10 μM PYR enhanced HIV-1 replication.” This is important news for malaria case management in areas with high HIV prevalence. (Virus Res. 2010 Nov;153(2):269-76)
While these studies individually may not be earth-shaking, they do point to the continued need for partnership between Malaria and HIV control programs - common interests do exist together with the common desire to save lives.
http://www.malariafreefuture.org/blog/?p=1103

TUBERCULOSIS: Tuberculosis Vaccine

 Tracy Hampton, PhD
A new tuberculosis vaccine boosts protectiveness of the current bacille-Calmette-Guérin (BCG) vaccine, which becomes less effective over time, suggest preclinical findings from scientists at the Infectious Disease Research Institute in Seattle and Colorado State University in Fort Collins (Bertholet S et al. Sci Transl Med. 2010;2[53]:53ra74).
The new vaccine consists of a single recombinant fusion protein produced from 4 Mycobacterium tuberculosis (Mtb) antigens from Mtb protein families associated with virulence or latency.
The vaccine induced CD4 T helper type 1 cell responses and led to a reduction in the number of bacteria in the lungs of vaccinated mice that were challenged with virulent or multidrug-resistant Mtb strains, prevented the death of guinea pigs that were vaccinated and subsequently challenged with virulent Mtb, and elicited CD4 and CD8 T cell responses in human peripheral blood mononuclear cells from BCG-vaccinated or Mtb -exposed individuals.
http://jama.ama-assn.org/content/304/21/2350.1.extract

TUBERCULOSIS: Dynamic Analysis of Tuberculosis Dissemination to Improve Control and Surveillance

Rita M. Zorzenon dos Santos ^{et al}
Background
Detailed analysis of the dynamic interactions among biological, environmental, social, and economic factors that favour the spread of certain diseases is extremely useful for designing effective control strategies. Diseases like tuberculosis that kills somebody every 15 seconds in the world, require methods that take into account the disease dynamics to design truly efficient control and surveillance strategies. The usual and well established statistical approaches provide insights into the cause-effect relationships that favour disease transmission but they only estimate risk areas, spatial or temporal trends. Here we introduce a novel approach that allows figuring out the dynamical behaviour of the disease spreading. This information can subsequently be used to validate mathematical models of the dissemination process from which the underlying mechanisms that are responsible for this spreading could be inferred.

Methodology/Principal Findings
The method presented here is based on the analysis of the spread of tuberculosis in a Brazilian endemic city during five consecutive years. The detailed analysis of the spatio-temporal correlation of the yearly geo-referenced data, using different characteristic times of the disease evolution, allowed us to trace the temporal path of the aetiological agent, to locate the sources of infection, and to characterize the dynamics of disease spreading. Consequently, the method also allowed for the identification of socio-economic factors that influence the process.
Conclusions/Significance
The information obtained can contribute to more effective budget allocation, drug distribution and recruitment of human skilled resources, as well as guiding the design of vaccination programs. We propose that this novel strategy can also be applied to the evaluation of other diseases as well as other social processes.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014140?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29

TUBERCULOSIS: Illegal immigrants bring tuberculosis to the US

The increase in illegal immigration is a hot topic lately. The debate over amnesty fails to consider the danger of allowing millions of people into the country without medical screening. The rise in illegal immigration and the incidence of communicable diseases such as drug-resistant tuberculosis, malaria, leprosy, plague, polio, dengue, and Chagas disease can't be ignored.

Tuberculosis and illegal immigrants
Dallas County had a decrease in tuberculosis in 2009 due to an aggressive outreach program and a 1.9 million dollar budget. However, according to the Dallasnews.com, the incidence of TB cases in Dallas County, and Texas overall, was much higher than the national average, which was 4.2 cases per 100,000 people in 2008. Experts say there's a reason for the higher incidence: Dallas County and Texas have a large immigrant and refugee population, coming from countries where the disease is endemic.These figures do not consider undiagnosed or new immigrants.

Multidrug resistance tuberculosis
According to the Journal of American Physicians and Surgeons, tuberculosis's return is fatal for about 60 percent of those contracting it because of new multidrug resistant tuberculosis. Until recently MDR-TB was specific to Mexico. This MDR-TB is resistant to major antitubercular drugs. TB usually is cured with six months of treatment and four drugs, costing about $2,000. MDR-TB takes two years and many expensive drugs that cost around $250, 000, with undesirable side effects. Each illegal immigrant with MDR-TB coughs and infects up to 30 people, who will show no symptoms immediately. The latent disease explodes later.

http://mog.com/RGM/blog/2573254

TUBERCULOSIS: The dual epidemic of tuberculosis (TB) and HIV is devastating Swaziland

 IEWY: 2010-12-02
The dual epidemic of tuberculosis (TB) and HIV is devastating Swaziland, cutting life expectancy there from 60 years to just 31, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today in a new report.
The small kingdom of just over one million people is at the epicenter of a co-epidemic affecting the whole of southern Africa. The report, “Fighting a Dual Epidemic: Treating TB in a High HIV Prevalence Setting in Rural Swaziland,” draws upon MSF’s experience since 2007 in the Shiselweni region and outlines the urgent action that must be taken in response to this major health emergency.
“Swaziland has the highest HIV prevalence in the world among adults,” said Aymeric Péguillan, MSF’s head of mission in Swaziland. “Disturbingly, more than 80 percent of TB patients are also co-infected with HIV. Life expectancy has halved within two decades, plummeting from 60 to just 31 years. People are dying in large numbers and tuberculosis is currently the main cause of mortality among adults. As a result, many children are being made orphans and the adult workforce is declining.”

Swaziland also has an alarmingly high prevalence of multidrug-resistant TB, which accounts for 7.7 percent of all new TB cases, as revealed by the joint MSF/National TB Programme 2009-10 Drug Susceptibility Survey. Swaziland is amongst the group of countries with the highest prevalence of multidrug-resistant TB.
Tackling the crisis is hindered by an acute shortage of local health staff, inadequate diagnostic facilities, and by patients failing to complete their treatment, often because of the prohibitive cost of making long and frequent journeys to distant health facilities.
Since November 2007, MSF and the Ministry of Health of Swaziland have followed a decentralized, integrated and patient-centered approach to fight the co-epidemic in Shiselweni, the country’s poorest and most remote region. As a result, innovative ‘one-stop services’ for HIV and TB care are available today in 21 health facilities. The number of people tested for HIV each month has also more than tripled in 18 months, reaching 1,617 in June 2010.
“Decentralizing integrated HIV and TB services all the way down to rural clinics and communities has dramatically improved patients’ access to care, and significantly reduced the number of patients defaulting from treatment,” said Péguillan. “Until 2008, the management of the TB epidemic was extremely centralized. Patients had to travel to the national TB center for treatment, or wait for the sporadic visits of a medical team. Today in Shiselweni, patients can access HIV and TB services closer to their homes.”
Other innovative approaches have been implemented with great success, in particular task-shifting. Given the dire shortage of health professionals, delegating responsibilities to lower cadres of workers—from doctors to nurses, and from nurses to lay community workers—has proved to be an effective model of care delivery.
The challenge now is to build on these successes. MSF’s report highlights measures that urgently need to be expanded nationwide, including improved infection control measures and the implementation of new diagnostic techniques. MSF strongly advocates for an expansion of task-shifting amongst health workers to manage the growing number of people with HIV in need of treatment, which is set to increase in line with the latest WHO guidelines, which recommend that patients begin treatment earlier. “Introducing these measures is vital. The scale of the co-epidemic in Swaziland demands urgent political commitment translated into immediate action,” said Péguillan. “We can save thousands of lives if we act now.”
In 2006, the then Prime Minister of Swaziland made an urgent request for external help to fight the HIV and TB crisis sweeping the country. Since late-2007, MSF, together with Swaziland’s Ministry of Health, has been providing HIV and TB care to patients in Shiselweni. By the end of June 2010, out of almost 20,000 HIV-positive people in need of treatment in Shiselweni region, close to 11,000 patients were on antiretroviral treatment, including 2,845 managed at clinic level. An average of 2,450 patients have been initiated on anti-TB treatment annually since January 2008. A total of 140 patients have been initiated on treatment for drug-resistant TB treatment since January 2008.
 http://www.disabled-world.com/news/africa/swaziland-hiv.php#ixzz17Ewyvn3D

TUBERCULOSIS: Why vaccines do not work as well for some as they do for others

December 2, 2010
 A new discovery by scientists from Singapore may explain why a tuberculosis vaccine is not as effective for some people as anticipated, and potentially explains why other vaccines do not work as well for some as they do for others.
Researchers have shown that Mycobacterium chelonae, a common environmental bacterium found in soil and water, can decrease the effectiveness of the bacille Calmette-Guerin (BCG) vaccine used to prevent tuberculosis, especially in countries outside of the United States.
"Uncovering the reasons why BCG is failing will help researchers in designing new, more effective vaccines against TB. This will give us more tools to fight this globally significant infectious disease," said Geok Teng Seah, a researcher involved in the work from the Department of Microbiology at the National University of Singapore.
To make this discovery, scientists studied mice with and without prior exposure to M. chelonae. When subsequently given BCG vaccine, the mice with prior exposure to M. chelonae produced higher amounts of suppressive chemical signals; these chemical signals are believed to reduce the level of immunity induced by BCG vaccine in the host mice.
Then the researchers extracted certain white blood cells with known suppressive functions from both exposed and unexposed mice. After transferring these cells into separate groups of unexposed mice, they found that recipients of suppressor cells from M. chelonae exposed mice did not respond as strongly to BCG vaccine as recipients of suppressor cells from unexposed donor mice.
This indicates that the suppressor cells from M. chelonae exposed mice are functionally different from those of unexposed mice. Ultimately, the data suggest that these suppressor cells, induced in the host when exposed to M. chelonae, dampen the effectiveness of the BCG vaccine.
The study has been published in the Journal of Leukocyte Biology. (ANI)
http://news.oneindia.in/2010/12/02/whyvaccines-do-not-work-as-well-for-some-as-they-do-foroth.html

BIOTERRORISM: CDC information lists

Bioterrorism Agents/Diseases
A to Z
By Category
http://inetbrowse.appspot.com/emergency.cdc.gov/agent/agentlist.asp

BIOTERRORISM: CDC: General Fact Sheets on Specific Bioterrorism Agents

This is a list of bioterrorism agents for which fact sheets are available from CDC.
Anthrax; Botulism; Brucellosis; Plague;
Smallpox; Tularemia; Viral Hemorrhagic Fevers

http://inetbrowse.appspot.com/emergency.cdc.gov/bioterrorism/factsheets.asp

BIOTERRORISM: Anthrax, also known as 'wool-sorter's disease'

Bob Cudmore:  November 29, 2010
Anthrax — thrust into the news after the 2001 attacks as a bioterrorism threat — was feared during the heyday of Mohawk Valley carpet and leather mills.
Anthrax was called “wool-sorter’s disease.” The disease can infect sheep, and anthrax spores can remain in wool.
Carpets woven in Amsterdam until production ceased in 1968 generally were made from wool. A recent column noted that wool often was shipped to Amsterdam from foreign lands.
“Any time you got a scratch in the mill, or a cut, or any kind of a wound at all you had to report it immediately,” said the late Mohawk Carpet union leader Tony Murdico of Amsterdam in an interview in 2000. “Because anthrax travels around the mill where there’s wool, see. And it can kill you in two days.”
As Murdico pointed out, one way for the disease to enter the human body is through a cut or open sore. Anthrax also can enter the body through the lungs. There are vaccines to ward off anthrax. Some forms of the disease can be treated with antibiotics, but anthrax can be fatal.
An online search of local newspaper clippings turned up two anthrax fatalities at Mohawk Carpet Mills in the 1920s, before the discovery of antibiotics, and a 1916 fatality at a Gloversville leather mill.
William Blakely died from an anthrax infection in 1923 while working at the McCleary, Wallin and Crouse division of Mohawk Carpet, what was called the Upper Mill. The Recorder account indicated his first symptom was a pimple near his eye. On Nov. 16, 1923, a compensation commission concluded after many hearings that Blakely had died at St. Mary’s Hospital from anthrax.
On June 15, 1921, Dominic Cirella of 181 E. Main St. in Amsterdam, died at City Hospital of an anthrax infection. He had developed an ulcer on his neck, which swelled his neck beyond recognition, according to the newspaper account. Cirella’s wife was still living in Italy.
On Feb. 4, 1916, Niles Reynolds of Berkshire in Fulton County died from anthrax contracted at G. Levor and Co. leather mill in Gloversville. The newspaper headline called anthrax the “dread disease of skin workers.” The newspaper reported that Reynolds succumbed a few days after noticing the infection. Physicians unsuccessfully operated on him and said the 53-year-old might have survived if his overall health had been better. Reynolds left three children and five grandchildren.
http://www.dailygazette.com/weblogs/bcudmore/2010/nov/29/112910_cudmore/

POVERTY: Grameen Bank and Professor Yunus

 01 Dec 2010,
The reputation of a Nobel peace laureate, credited with helping to defeat global poverty through micro credit, hung in the balance Wednesday night after allegations that he had diverted £40 million (US$62.4 million) from a bank set up to help the poor.
Muhammad Yunus, internationally feted as banker to the world’s poor, now faces an investigation by the Norwegian government, which donated funds to him, according to The (London) Times.
It marks a further blow to the reputation of micro finance, once hailed as the most effective way to help the most needy out of poverty.
The model of extending small loans to help to stimulate entrepreneurial activity was pioneered by Yunus in Bangladesh. It won him the Nobel Peace Prize in 2006.
But letters obtained by a Norwegian filmmaker suggest that Oslo’s embassy in Dhaka was furious to discover that cash donated to his micro finance vehicle, Grameen Bank, for housing loans was diverted to another company without its knowledge or permission. The arrangement, which Yunus claimed was made for tax reasons, was not mentioned in Grameen Bank’s annual report.
When his actions were challenged in formal correspondence, Yunus wrote to the head of an aid agency, Norad, asking for its help.
“This allegation will create a lot of misunderstanding within the government of Bangladesh. If the people, within and outside government, who are not supportive of Grameen get hold of this letter, we’ll face real problem[s] in Bangladesh,” he wrote.
Yunus was ordered to return the money but while about £17.6 million was repaid, the rest of the funds were used for other social causes including victims of cyclones, according to the Norwegian government.
The chain of events -- which took place between 1996 and 1998 -- came to light this week after the letters were aired as part of a documentary on micro finance that was shown on Norwegian television.
Although it said that there was no suggestion of tax fraud, a minister in the current Oslo administration said that it was “totally unacceptable” that aid was used for purposes other than what was intended. A report into the matter has now been ordered by the International Development Minister after questions in the Norwegian parliament.
A statement released by Grameen Bank said that the claims were false and that a full explanation would be provided at the “earliest convenient time.”
The Norwegian Nobel Institute stood by Yunus Wednesday night, admitting that it was aware of “isolated incidents” relating to Grameen Bank when it awarded him the Peace Prize, but it does not plan to raise any further questions.
http://www.myfoxdetroit.com/dpps/news/nobel-peace-prize-winners-reputation-under-threat-dpgonc-20101201-bb_10895183

TUBERCULOSIS: MYANMAR: Funding, access challenges to TB treatment

  Photo: Lynn Maung/IRIN:  Outside the TB centre in Yangon



A girl eating steamed rice that her mother has obtained from donor agencies in the Myanmar region


YANGON, 3 December 2010 (IRIN)
Access to health services remains a challenge for tuberculosis (TB) patients in rural Myanmar.
"There is a need to improve case-finding because some areas are hard to reach," Eva Nathanson, technical officer for the World Health Organization (WHO), told IRIN in the Burmese former capital of Yangon. "More patients need to be found so that they can get treatment."
According to government figures, 1.5 percent of the country's 53 million people are infected with the TB bacilli annually.
Myanmar has the 19th highest TB burden in the world, according to the WHO.
While this common and often deadly infectious disease ranks as a priority alongside malaria and HIV/AIDS in Myanmar's national health plan, sputum smear microscopy (tissue sample analysis) and chest X-ray services are not easily accessible.
"There is only one microscopy centre per 150,000 people, which is far from the international standard of one per 100,000 people," said one health worker, who asked not to be identified.
There are also only two laboratories performing culture and drug susceptibility testing (DST) for the entire population, against the international standard of one reference laboratory per five million people, the same person said.

Lack of information
The recommended strategy for the detection and cure of TB is the directly observed treatment short course (DOTS), whereby the patient is monitored to ensure they take their medication regularly, in the right combination, and for the full duration of the treatment.
However, in many affected communities, patients do not complete the treatment.
Aung Kyaw Linn, senior programme manager of the Social Franchising Department of Population Services International (PSI) in Myanmar, cites a "lack of knowledge on consequences of treatment interruption" as the primary reason for incomplete treatment regimes.

MDR-TB
One of the consequences when patients fail to take their drugs exactly as prescribed is the development of a multi-drug resistant (MDR-TB) strain, which is immune to standard frontline drugs, more expensive, and harder to cure.
With an estimated 4,800 MDR-TB cases in 2009, Myanmar's National Tuberculosis Program and Médecins Sans Frontières (Holland), with technical assistance from the WHO, began a two-year DOTS-Plus pilot project in July 2009, which aims to provide 275 MDR-TB patients with TB treatment in Yangon and Mandalay.
"NTP has a plan to expand treating MDR-TB patients early next year," said Myo Zaw, a national consultant with WHO.

Funding
Health agencies, however, emphasize that a long-term financial commitment to the first-line anti-TB drugs has to be secured.
According to the country's Five Year National Strategic Plan for Tuberculosis Control (2011-2015), the total cost for TB control was calculated at US$160 million.
"Any interruption in the first-line anti-TB drug supply would be devastating for the TB patients and would lead to increased suffering of patients, an increase in the number of avoidable deaths and lead to the development of multi-drug resistant TB," warned one international healthcare NGO worker.
http://www.irinnews.org/report.aspx?ReportID=91275

MALARIA: COMOROS: The battle against malaria lies in the balance

  Photo: Guy Oliver/IRIN: A man waits for medical attention at the Wanani clinic in Moheli, Comoros

Comoros billboard protesting France's decision to incorporate Mayotte as a French overseas department. "Mayotte is Comorian and will be forever"


FOMBONI, 3 December 2010 (IRIN) - On arrival in Moheli, an island in the Comoros archipelago, you have to prove that you are taking, or have taken, anti-malarial drugs, otherwise you will have to swallow a pill provided by the authorities.
The precaution is part of a three-year campaign sponsored by the governments of Comoros and China to control or even eradicate the mosquito-borne disease by eliminating the parasites that cause malaria from the population, thereby preventing transmission of the disease.
Mosquitoes feed off an infected host, ingesting the gametocyte forms of the parasite, which then transform into infectious sporozoites and are transferred to the next human hosts when the infected mosquito bites them.
In Africa the most dangerous and prevalent malarial parasite is Plasmodium falciparum. Symptoms of the disease include fevers, vomiting, diarrhoea, anaemia, convulsions and muscle spasms, and appear about 10 days, but often longer, after a human host has been infected.
Rachadj Attoumani, who is responsible for Moheli's malaria surveillance, told IRIN that there has not been "one recorded death from malaria [on the island] ... whereas before about two or three people died each month," since the campaign began in October 2007.
The main components of the project are the mass distribution of anti-malarial drugs produced by the Chinese pharmaceutical company, Artepharm, a DDT spraying campaign, and insecticide-treated nets - which now cover 90 percent of the island's beds - provided by the World Health Organization.
Moheli has about 42,000 people, of whom about 82 percent have taken anti-malarial drugs; those who have not were either not on the island, or had refused, Attoumani said.
The drug campaign required "sensitization" of the recipients, but many, including Attoumani, had experienced debilitating and recurring malaria, and the opportunity to rid their systems of it had provided the incentive.
The medication is a formulation based on artemisinin and piperaquine that the producers say on their website "has a synergistic effect which reduces the infectivity of the [malarial] gametocytes and clears the gametocytes in their early stage, therefore blocking malaria transmission."
There has been concern about the anti-malarial drug from some quarters, as it has not been subjected to any rigorous scientific peer review.
The roll-out of the course of medication island-wide - assisted by a team of 11 researchers from China's Guangzhou University of Traditional Medicine - began with two tablets administered in the first 48 hours, a single dose on the tenth day, and then at intervals of ten days for the next six months.
Children between the ages of one and seven years were given the drug in a soluble granular form, but babies and pregnant women were excluded from the campaign.
Surveillance ahead of the project found that rates of infection varied across the island, but all leant towards endemic levels. Ndremeani had the highest rate of malarial parasites - 94 percent of the villagers were infected - in Hagnamoida 48 percent were infected, but in Fomboni, the island's capital, only about 10 percent of the people were infected. 
In the immediate aftermath of the mass drug programme, malarial parasites were reduced to 0.5 percent among the population, and were currently hovering around 1.5 percent, Attoumani said.

Islands as anti-malarial experiments
Islands have often been seen as ideal for malarial elimination because population movements are limited and the land mass is isolated, and a range of approaches have been tried.
The Mediterranean island of Sardinia, where malaria is thought to have arrived in 502 BC during the Carthaginian conquest, has been known since classical times as the "unhealthy island". Between 1946 and 1950 the Rockefeller Foundation spent millions of dollars on trying to eradicate mosquitoes - the vector for the disease - by spraying 267 tons of DDT. The experiment did eliminate malaria, but the stated objective of ridding the island of mosquitoes was not achieved.
On the neighbouring French island of Corsica a multi-pronged approach was adopted. Marshland was drained and now delivers 60 percent of the island's agricultural production. Systematic DDT spraying campaigns were carried out, coupled with the large-scale distribution of the anti-malarial medication, quinine, and the introduction of Gambusia fish, which feed on mosquito larvae, led to the eventual eradication of malaria.
If someone tests positive [for malaria], which is very rare, I immediately give them [anti-malarial] medicine, as well as their family
Mauritius was exposed to the mosquito-borne disease in 1865 and two years later experienced an epidemic that killed between an eighth and a quarter of the population in a calendar year. After a long campaign of indoor spraying, the island was declared malaria-free by the World Health Organization in 1973.
Aneityum, one of the 80 inhabited islands of Vanuatu in the southwest Pacific, successfully eliminated malaria using a similar approach to what is being tried in Moheli.
During a period of about two months in 1991 the entire population of 718 people were administered weekly doses of chloroquine, pyrimethamine/sulfadoxine (Fansidar) and primaquine, and all slept under insecticide-treated nets. A monitoring programme over the next nine years recorded only two instances of malaria, both a consequence of infections from outside of the island.

Risks of re-infection
However, the scale of the Moheli experiment sets it apart from the experience of Aneityum Island, but reducing the malarial parasite on the Comorian island is not without risk.
Attoumani said when people had malarial parasites there was also a level of immunity, but after treatment this immunity tailed off, and should "someone be infected with malaria, the symptoms will develop quickly".
In the 1940s and ‘50s the French colonial government in Madagascar began a DDT spraying and disease monitoring programme to control malaria in the highland regions of the country, but in the 1970s, more than a decade after independence, this came to a halt. A malaria epidemic subsequently broke out in the area and is estimated to have killed 40,000 people in five years.
In 11 of Moheli's 26 villages, monitoring laboratories staffed by single operators with a few months’ training, who are paid US$20 a week, take blood samples and rapidly diagnose any malarial parasites with the aid of a microscope.
Benechieq Chema, 28, studying for his baccalaureate, is on call every day in the laboratory in the village of Wanani, with a population of about 2,500 people in a banana, cassava and potato farming area about 20 km from Fomboni. He told IRIN that "maybe a couple of people will come", complaining about a fever and want to be tested for malaria.
"If someone tests positive [for malaria], which is very rare, I immediately give them [anti-malarial] medicine, as well as their family, and then inform [Fomboni] about the case," he said.
However, it is the friends or family returning to Moheli from visits or work on the neighbouring Comorian islands of Anjouan and Grand Comore, where malaria remains at high levels, that pose the greatest risk of an outbreak.

Nationwide roll-out?
Although the two main points of entry, the airport and seaport, have strict malaria controls in place, an aid worker who declined to be named, told IRIN that in reality "you cannot hermetically seal the island".
Comoros is a nation of seafarers and it is not unusual for people to arrive on Moheli on small fishing boats without going through a formal point of entry. A Moheli resident who preferred to remain anonymous told IRIN that occasionally the officials were not at their posts when a plane or ferry arrived.
Attoumani said the key to sustaining very low rates of malarial infection on Moheli, or even eliminating the disease, was the other two islands in the archipelago.
The government of Comoros is encouraging better transport links between the islands as a way of fostering greater national unity because the three-island nation has endured more than 20 coups and secession attempts since independence from France in 1975, but this also increased the risk of malaria transmission between the islands.
Attoumani said China had dispatched medicines and microscopes to the Comoros for the roll-out of the initiative on Anjouan and Grand Comore - which have much larger populations - but the Comoros government did not have the financial resources to pay staff for the monitoring component of the programme.
http://www.irinnews.org/report.aspx?ReportID=91276

MALNUTRITION: CLIMATE CHANGE: User-friendlier weather data

  Photo: IRIN
Mozambican women collecting water from a rudimentary well in Maputo province

CANCUN, 3 December 2010 (IRIN) - If central Mozambique is expected to get very little rain in the coming months, how should that information be shared with a small-scale farmer planting maize, the staple crop, in a remote village?
“Just simply providing the weather data that there will be 60 or 70 percent chance of less rainfall means nothing … to Ana, a small-scale farmer in Mozambique,” said Jan Egeland, co-chair - with Mahmoud Abu-Zeid, former Egyptian Minister of Water Resources and Irrigation - of the UN High-level Taskforce charged with developing guidelines for disseminating climate information.
“We ought to be able to tell her, ‘Don’t plant maize this season, plant cassava; or, plant your maize early,” Egeland told IRIN. Such information will become increasingly critical as natural events like rainfall, or the lack of it, grow more extreme, and the weather becomes more erratic as climate change takes hold in the coming years.
The guidelines for communicating climate data in a meaningful way to vulnerable people will be part of what the tool for climate action - called the Global Framework for Climate Services (GFCS) - will offer, as well as trying to address gaps in climate information gathering.
“We need the Mozambican government - with the help of UN partners such as FAO [Food and Agriculture Organisation], or NGOs such as the Red Cross - and national weather services to be able to interpret weather information [so that it] will help Ana to make a decision on how to adapt,” Egeland said.
Michel Jarraud, Secretary-General of the World Meteorological Organization (WMO), told reporters at the 16th Conference of Parties to the UN Framework Convention on Climate Change (UNFCCC) in Cancun, Mexico, that so far 2010 was the one of the top three warmest years since instrumental climate records began in 1850. He said it was a sign that global temperatures were rising at a faster rate, as the other two warmest years -1998 and 2005 - were both recent.
Access to good quality weather data and forecasting capacity is essential if poor nations are to respond effectively to the threats that climate change presents to food security, human and animal health, and economic progress, but many are ill-equipped to gather or provide such information.
The WMO notes that there are only 744 weather stations in Africa, and only a quarter of them are of international standard – ideally, Africa should have at least 10,000 stations.
There could be a solution. Bernhard Pacher, an Austrian consultant to the World Food Programme (WFP), who also manufactures easy-to-use automated weather stations in his home country, said local municipalities made climate information easy for everyone to use.
"For example, if temperatures are going to soar and there is risk of infections, the municipality simply posts a message telling farmers to spray pesticide now, and they pin a red flag on the notice board outside so it catches the attention of farmers passing by, and they follow the instructions,” he said.
Mobile phones could be an effective tool for communicating messages to poor small-scale farmers in developing countries. "You would find at least one person with a mobile phone in a village; make that person the focal point and convey messages on actions to be taken through that person."
Pacher said Africa would need at least 30,000 weather stations to provide farmers with accurate data on micro-climates. Climatic conditions varied according to a range of factors, including the topography, amount of water, tree cover and altitude in an area.
"In many instances in Africa, the installation of weather stations does not take those factors into account, so the quality of data generated is not very credible. Often a weather station is installed in an area after taking into account whether it will be secure or not, rather than the other way round.'”
Improving the weather data in developing countries was commendable, said Pablo Suarez, associate director of the International Red Cross and Red Crescent Climate Centre, but the biggest challenge would still be to make it meaningful to the most vulnerable people. “The biggest benefactors of these efforts would be sectors such as commercial farmers - which is great - but we have to work on this a bit more.”
The need for a GFCS to address these gaps was raised at the third World Climate Conference in Geneva, Switzerland, in 2009.
While sharing information about the GFCS team’s work on the sidelines of the UN climate change talks in Cancun, Egeland said it would take an investment of only US$50 million to $100 million a year from 2010 to 2021 to improve the weather services in developing countries. “Our report will be released in January 2011 and submitted to the World Meteorological Congress in May 2011.”
http://www.irinnews.org/Report.aspx?Reportid=91273

MALARIA: Tanzania: Health Workers' Use of Malaria Rapid Diagnostic Tests (RDTs) to Guide Clinical Decision Making in Rural Dispensaries

Abstract.:
Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children < 5 years of age were to be treated empirically per national guidelines. Among the 30,195 patients seen at these 12 health facilities, 10,737 (35.6%) were tested with an RDT for malaria. 88.3% (9,405/10,648) of tested patients reported fever or history of fever and 2.7% (289/10,677) of all tested individuals were children < 5 years of age. The RDT results were recorded for 10,650 patients (99.2%). Among the 5,488 (51.5%) RDT-positive patients, 5,256 (98.6%) were treated with an appropriate first-line antimalarial per national guidelines (artemether-lumefantrine or quinine). Among the 5,162 RDT-negative patients, only 205 (4.0%) were treated with an antimalarial. Other reported treatments included antibiotics and antipyretics. Implementation of RDTs in rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children.
http://www.ajtmh.org/cgi/content/abstract/83/6/1238?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=malaria&searchid=1&FIRSTINDEX=0&volume=83&issue=6&resourcetype=HWCIT

POVERTY: Indian State Empowers Poor to Fight Corruption

Kuni Takahashi for The New York Times:
Villagers work at a road construction site under a government program in Andhra Pradesh, India.

     Kuni Takahashi for The New York Times
A “social audit” in Nagarkurnool in October, part of an experiment to ensure that government benefits actually get to the poor.

By LYDIA POLGREEN: Hari Kumar contributed reporting: December 2, 2010
 NAGARKURNOOL, India — The village bureaucrat shifted from foot to foot, hands clasped behind his back, beads of sweat forming on his balding head. The eyes of hundreds of wiry village laborers, clad in dusty lungis, were fixed upon him.
A group of auditors, themselves villagers, read their findings. A signature had been forged for the delivery of soil to rehabilitate farmland. The soil had never arrived, and about $4,000 was missing. The bureaucrat, a low-level field assistant who uses the single name Sreekanth, was suspected of stealing it.
“I am a very rightful person,” he declared. But the presiding official would have none of it. He ordered that the money be recovered and that Mr. Sreekanth be promptly disciplined.
That simple verdict was part of a sweeping experiment in grass-roots democracy in rural India aimed at ensuring that the benefits of government programs for the poor actually go to the poor.
It empowers villagers to act as watchdogs and to perform “social audits” like the one that meted out quick justice to Mr. Sreekanth. Their success or failure could have broad implications for India’s quest to lift hundreds of millions of people out of poverty.
India is home to more poor people than any country in the world, a fact that stands in mute challenge to its ambitions as an emerging world power. In decades past, fraud and waste have sapped efforts to help the poor. Rajiv Gandhi, a former prime minister, famously estimated that only 15 percent of every rupee spent on the poor actually reached them.
The social audits seek to fundamentally change that equation. In many states, the audits have been perfunctory or hijacked by local officials. But the results here in the southern state of Andhra Pradesh, home to 76 million people, have been remarkable.
Social audits statewide have found $20 million worth of fraud over the past five years, and 4,600 officials have faced administrative or criminal charges, said V. Vasanth Kumar, the minister for rural development in Andhra Pradesh.
The results of the audits, down to the tiniest details, are available online for anyone to study. With the Indian government planning to spend a quarter of a trillion dollars to help the rural poor over the next five years, such audits will be crucial to reducing waste and fraud.
Much of that cash will go to a program created in 2005 to provide people in the countryside with 100 days of work at minimum wage on small-scale village infrastructure projects. This year, the government has budgeted $9 billion for the program, potentially ripe pickings for corrupt businessmen, politicians and bureaucrats.
To safeguard their efforts, the officials who drafted the law required the social audits, in which the beneficiaries themselves ensure that the program is run cleanly.
Villagers scour records and look for fraud, then hold public hearings. Officials like Mr. Sreekanth — whose punishment has not been determined, but who could be suspended or fired from his job or charged with a crime — are held accountable.
The concept has been around for decades, championed by influential social activists like the author Aruna Roy.
In Rajasthan Province, the social movement she helped found, Mazdoor Kisan Shakti Sangathan, popularly known as M.K.S.S., has conducted social audits for years. But Andhra Pradesh is the first state that has put its full political and bureaucratic weight behind them.
“It is not something being done exclusively by a people’s movement — the government has embraced it,” said Sowmya Kidambi, formerly of M.K.S.S., who now runs the social audit program in Andhra Pradesh. “It is not just lip service.”
Officials embraced the audits in part because they realized it was good politics to keep programs for the poor free from corruption. India is the world’s largest democracy, and the rural poor represent the nation’s largest pool of votes. Programs like the one that guarantees 100 days of work for people in rural areas are credited with helping the Congress Party win last year’s election.
“Politicians in Andhra realized there was a lot of political mileage to be gained by keeping this program clean,” said Yamini Aiyar, a senior fellow at the Center for Policy Research in New Delhi, who has tracked the state’s use of social audits.
Auditing the records, which run to thousands of pages, is painstaking work that would tire the sharp eyes of even a seasoned forensic accountant. Most of the auditors are village youths who have been trained, but who also rely on their knowledge of village life to spot fraud.
Zamiruddin, a 24-year-old auditor from Rangareddy, a rural district, explained how he detected fraud in the mountain of documents he examined. Flipping to a muster roll from February, he pointed to a list of names that he found suspicious.
“These names are in different handwriting than the ones above,” he said. “That is the first problem.” All the workers also had signed their names rather than giving thumbprints, which was unusual for rural laborers. And they reported perfect attendance, together earning about 6,400 rupees for five days of mulching.
Zamiruddin went to the village, Manthati, and interviewed the people whose names were high on the list. None of them recalled seeing the workers whose names appeared below theirs in the different handwriting. Indeed, one of those workers was a 16-year-old who was ineligible to work in the program.
In all, Zamiruddin found that more than 139,000 rupees worth of wages had been paid to such ghost workers. At the hearing, the field assistant who filled out the roster was suspended, and the wages were ordered recovered.
“People fear these meetings,” said one local official, Adiba B., who uses her father’s initial rather than a surname, which is common in southern India. “Those who eat money, they cannot speak with their heads high any longer.”
But the audits are far from trouble-free. Here in Nagarkurnool, a senior Congress Party politician elbowed himself onto the dais next to the official who was supervising an audit, trying to take control of it and repeatedly interceding to defend local politicians and contractors.
A contractor, himself a government leader in a nearby village, was called up for falsifying measurements on a project. He disputed the ability of the auditors to take such measurements.
“These people are not qualified,” the contractor, B. Sardharkar Reddy, complained. Besides, he added, “If it is a 10 percent deviation, what is the big deal?”
A ruckus ensued. Dozens of Mr. Reddy’s supporters rushed to the front, trying to attack the village auditors. The police were called.
“These vested interests remain very powerful,” said Kavita Srinivasan, a former activist who now helps lead social audits. “They do not give up easily.”
http://www.nytimes.com/2010/12/03/world/asia/03india.html?sq=india corruption&st=cse&scp=1&pagewanted=all

POVERTY: EU money earmarked for African development winds up in tax havens and African banks

  The headquarters of the European Investment Bank in Luxembourg Photo: Art Directors & TRIP / Alamy

By Leah Hyslop 01 Dec 2010
EU money earmarked for African development winds up in tax havens and African banks, report claims
A new report alleges that the European Investment Bank’s lending practices in Africa facilitate tax evasion and corruption.
Counter Balance, a coalition of NGOs dedicated to challenging the European Investment Bank (EIB), issued the report, entitled Hit and run development: some things the EIB would rather you didn't know about its lending practices in Africa, and some things that can no longer be covered up last week.
In it, the organisation claims that millions of pounds earmarked by the EIB last year for funding development in Africa ended up in tax havens and African banks, one of whose managing directors was being investigated for fraud at the time.
On its website, the EIB says that its aim in the sub-saharan African, Carribean and Pacific countries is "to support projects that deliver sustainable economic, social and environmental benefits”, particularly “private sector-led initiatives that promote economic growth and have a positive impact on the wider community and region."
Counter Balance claims however that the bank is neglecting its traditional role in financing small- to medium-sized enterprises (SMEs) to concentrate on intermediated loans (large loans to private banks, who are then expected to lend to SMEs) and offshore private equity funds.
The group says that these practices not only “prioritise profit maximisation over concerns about sustainable development”, they make it difficult to trace what happens to the money, and can faciliate “sinister practices such as tax evasion, money laundering and personal enrichment".
“When development money is given to unaccountable financial bodies with no development interest or experience, untracked by the EIB and resulting in alleged corruption and money laundering, it is hard to see how the EIB is meeting its legal obligations under its mandate,” the organisation said.
One case study highlighted in the report centred on a €50 million (£42 million) loan to a bank in Nigeria in 2007, when its managing director was under investigation by Nigeria's economic and financial crimes commission.
A spokesman for the EIB said that that the bank had a "zero-tolerance" policy on corruption and that many of the loans to African banks mentioned in the report had been discussed, but never actually made. “When financing projects that contribute to reducing poverty and promoting economic development in Africa the European Investment Bank works closely with fund managers selected for their track record and expertise specialist management skills," he said.
“All projects funded by the EIB and intermediaries are subject to the highest accountability standards, examined and are subject to the Bank's due diligence with this respect both before approval and following signature through the Bank's monitoring process."
Regarding the EIB's use of offshore financial centres, the spokesman added that the EIB "does not do business in blacklisted offshore financial centres, has strict internal rules regarding the use of offshore financial centres and ensures that beneficiaries of EIB funding conform to international standards on the use of offshore financial centres."
Around 10 per cent of the EIB's budget is spent outside of the EU every year. In 2009, this approximated to €10 billion (£8.3 billion) of investment
http://www.telegraph.co.uk/finance/personalfinance/offshorefinance/8168734/EU-money-earmarked-for-African-development-winds-up-in-tax-havens-and-African-banks-report-claims.html

POVERTY: Grameen founder Muhammad Yunus in Bangladesh aid probe

2 December 2010 By Ethirajan Anbarasan: BBC News, Dhaka

  Grameen Bank's micro-finance model has been replicated around the world

Norway says it is examining reports that Nobel Peace Laureate Muhammad Yunus allegedly diverted millions of dollars of aid money from a bank.
International Development Minister Erik Solheim said that it was "totally unacceptable that aid is used for other purposes than intended".
A documentary maker has alleged that cash was diverted from Professor Yunus' Grameen Bank to other parts of Grameen.
In a statement, the bank said that the allegations were false.
It said that a full explanation with more details would be provided at the "earliest convenient time".
The bank was set up by Professor Yunus to provide micro-credit - or small loans - to the poor.
The move by the Norwegians - who insist that no criminal activity has taken place - comes at a time when the reputation of the micro-credit industry has been under attack.
The original aim of the micro-credit concept was poverty reduction, but in recent years some micro-financial institutions have been criticised over exorbitant interest rates and alleged coercive debt collection.
In the south-eastern Indian state of Andhra Pradesh, for example, micro-loans have been blamed for a series of suicides among struggling farmers.
It is estimated some 250 organisations in the state have handed out loans totalling more than £1.65bn (£883m), only a small proportion of which have been paid back.

Objections
The Grameen Bank's denial followed the release of a documentary by Danish filmmaker, Tom Heinemann, who claimed Professor Yunus and his associates diverted nearly $100m of grant money to another company - Grameen Kalyan - which was not involved in micro-credit operations.
Mr Heinemann said he stumbled upon the documents and letters relating to the alleged transfer while doing research for his documentary on micro-credit.
"I got most of the documents from the archives of Norad, the Norwegian aid agency in Oslo," he said.
The Grameen group of more than 30 companies headed by Professor Yunus is divided between those not operating for profit and those which do.
Mr Heinemann's report alleged that after the Norwegian authorities raised objections to the alleged transfer of funds, the Grameen bank returned about $30m. The aid money was from Norway, Sweden and Germany.
Professor Yunus, known as the Banker to the Poor, and the Grameen Bank were awarded the Nobel Peace Prize in 2006 "for their efforts to create economic and social development from below".

Replicated model
The economist founded the bank, which is one of numerous organisations now providing loans to the poor - especially women - in Bangladesh.
The micro-credit lending model has been replicated in other parts of the world.
Reacting to the latest report, the Norwegian authorities say they have no suspicions of tax fraud or corruption committed by Grameen Bank.
"Having said that, the Government of Norway finds it totally unacceptable that aid is used for other purposes than intended no matter how praiseworthy the causes might be," Norwegian International Development Minister Erik Solheim said in a statement e-mailed to the BBC.
Mr Solheim said that he had asked the Norwegian Agency for Development Co-operation for a full report on the matter.
"At the same time it is important to stress that we are firm believers in micro-finance as a tool in the fight against poverty," he said.
The documentary "Caught in Micro Debt" was shown on Norwegian National Television earlier this week.
"I travelled to Bangladesh, India and Mexico to find out whether micro-credit loans have really helped the poor. But I found out that poor people are getting into more and more debt because of micro-credit loans," Mr Heinemann told the BBC.
He said that he was not accusing Professor Yunus of misusing the money or personally benefiting from the transfer.
http://www.bbc.co.uk/news/world-south-asia-11899506

POVERTY: Latin America saw 41 million emerge from poverty since 2002

Nov 30, 2010 
Santiago - Latin American countries managed to get 41 million people out of poverty since 2002 and improved the distribution of income, the Economic Commission for Latin America and the Caribbean (ECLAC) said Tuesday.
Progress was particularly significant in Argentina, Venezuela and Peru, which reduced poverty by 20-30 per cent, ECLAC said.
In Brazil, Chile, Ecuador and Panama the reduction was around 10 per cent, where income distribution was also greatly improved.
'There is a generalized trend towards the reduction of poverty, with the exception of Costa Rica,' ECLAC's executive secretary Alicia Barcena said.
The progress, which still leaves Latin America with some 180 million poor, was accomplished by countercyclical fiscal and social policies.
'This is the first time in history in which Latin America managed to reduce poverty immediately after an economic crisis like that of 2008-9,' Barcena noted.
Given the good economic prospects for 2011, Argentina, Chile and Uruguay had reduced poverty rates to around 11 per cent of the population, the lowest in Latin America.
Countries like Paraguay, Bolivia, Colombia, El Salvador, Guatemala, Honduras and Nicaragua, however, continued to have at least half their population under the poverty line.
'There are indeed very different realities in Latin America, but in all cases we see progress,' Barcena said.
http://www.monstersandcritics.com/news/business/news/article_1602566.php/Latin-America-saw-41-million-emerge-from-poverty-since-2002

MALARIA: Florida: Case of Malaria Found in Duval County

JACKSONVILLE, Fla. -- The Duval County Health Department said a woman who lives in the county has malaria.
Health leaders said the 31-year-old woman had not traveled internationally recently, so this could be the first locally acquired case in the last 10 years.
Florida has reported 111 cases of malaria so far this year, each one originating in another country.
This is Duval's sixth case.
The health department said malaria is endemic in about 100 countries around the world.
Travelers are advised to consult with travel clinics prior to international travel and to take mosquito bite prevention precautions and antimalarials when traveling to areas where there is known risk for malaria.
Locally acquired malaria demonstrates the continuing potential for reintroduction of malaria into the United States.
http://www.firstcoastnews.com/news/news-article.aspx?storyid=179505

MALARIA: An assessment of early diagnosis and treatment of malaria by village health volunteers in the Lao PDR

 December 01, 2010
Author: Viengvaly Phommanivong
Background:
Early diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries. In the Lao PDR, this strategy was introduced in 2004-2005 and an assessment was performed at the community level in January 2007. Methods: EDAT with malaria rapid diagnostic test (MRDT) and artemisinin combination therapy (ACT) was prospectively assessed among 36 randomized village health volunteers (VHVs) and 720 patients in six malaria-endemic provinces of Laos (three pilot provinces (PP), and three non-pilots provinces (NPP)). ACT was also retrospectively assessed among 2188 patients within the same areas from June to November 2006. Two checklists were used and scores were calculated. Results:
EDAT performance of the VHVs was rated better in PP than in NPP (16.67% versus 38.89%, respectively, p=0.004). Nearly all VHVs could diagnose malaria but only 16 (44%) could describe the symptoms of severe malaria. In January 2007, 31/720 (4%) patients tested positive using the Paracheck(R) test, 35 (5%) with microscopy (sensibility: 74.3%, specificity 99.3 %, positive and negative predictive values: 83.9% and 98.7%, respectively). Patients from June to November were at higher risk of malaria: 35.19% of 2,188 febrile patients were positive (OR: 10.6, 95%CI: 7.4-15.5, p
http://www.malariafreefuture.org/blog/

POVERTY: PHILIPPINES: Family planning "urgently needed"

  Photo: Ana Santos/IRIN:  A 16-year-old sits beside her newborn baby. This is her second child.

2 December 2010 (IRIN) - Population and sustainable development experts warn that the Philippine population could reach levels that will prevent the country from ever breaking free from a cycle of poverty.
"We need to lower birth rates to 2.2 percent, which is just the sustainable replacement rate," Malcolm Potts from the Bixby Center for Population, Health and Sustainability, told IRIN, warning that at current fertility rates of 3.03 percent, the Philippine population of 94 million could reach 150 million in just 10 years.
Citing Department of Health studies indicating that women in the poorest quintile have 5.9 children while those in the richest quintile have 1.9 children, Potts said, "It's very simple; poor people cannot separate sex from child-bearing. We must give the poor access to family planning and contraception to give them choices."
The Guttmacher Institute, a US-based reproductive health think-tank, released a study in 2009 showing that 35 percent of poor Filipino women aged 15-49 accounted for 53 percent of the unmet need for contraception.
Highest unemployment rate
The Philippines has the highest unemployment rate in the Southeast Asian region at 8 percent compared with Indonesia at 7.9 percent, Vietnam at 4.6 percent, Malaysia at 3.7 percent and Thailand at 1.5 percent.
According to the World Bank, poverty incidence rose from 30 percent in 2003 to 32.9 percent in 2006.
"Having fewer children will allow the poor to invest more in education and health for their children to improve their lives when they grow up," Ernesto Pernia, a professor at the University of the Philippines School of Economics said, citing the correlation between family size and poverty incidence.
Urgent need for legislation
There is no national legislation on the standardization of budgets for family planning and reproductive healthcare services for the poor.
The Reproductive Health Bill aims to address this by providing a full range of contraceptive options, including the pill and condoms, as well as natural birth-control methods.
However, the bill is staunchly opposed by the influential Catholic Church that only approves of natural family planning methods requiring periodic abstinence.
The Bill has been wildly debated for the past 15 years.
"Natural family planning, also known as the rhythm method, has never played a role in fertility decline in any country, whether Catholic or not," Potts said.
Martha Campbell, president of Ventures Strategies for Health and Development, which studies reproductive healthcare strategies for developing countries said, "Other Catholic countries like Mexico and Brazil have already decided that the Vatican doesn't need to step into their reproductive lives. The Philippines is the only remaining country where the Catholic Church has a stranglehold on women's health."
"Population growth is a public welfare issue that affects the poorest of the poor. Other poverty containment efforts will never be sufficient until we can curb population growth," said Congresswoman Kaka Bag-ao of the Akbayan Citizen's Action Party, which is pushing for the passage of the Bill.
On 8 December, the UN Population Fund and the International Council on Management of Population Programmes (ICOMP) will hold a regional consultation on family planning in Bangkok.
The goal of the three-day meeting is to gain support from governments and civil societies to prioritize family planning programmes and increase investments in family planning to help achieve the Millennium Development Goals, and particularly, universal access to reproductive health.
http://www.irinnews.org/report.aspx?ReportID=91261

POVERTY: KYRGYZSTAN: Violence victims prepare for winter

  Photo: Alimbek Tashtankulov/IRIN: Women in Kyzyl-Kyshtak village in the vicinity of the southern city of Osh which saw violent clashes in June that resulted in hundreds of killed

1 December 2010 (IRIN) - With night-time temperatures currently hovering around zero and forecast to drop to minus 15 degrees Celsius in a few days time, communities badly affected by the June violence in southern Kyrgyzstan are worried about how they will manage over the winter.
Keeping warm is a big challenge. A family of 4-5 people needs at least 2-3 tons of coal to keep warm over the winter, and with a ton of coal costing the equivalent of US$100-110 and very low average incomes, life is tough: Children can easily fall ill.
Nasiba,* who lives in the village of Kyzyl-Kyshtak near the southern city of Osh, has been struggling to look after her three children. “We live off a small plot where we grow vegetables. I try to sell them at a market to earn some money for my kids’ food and clothes. My husband is not working these days as there are no jobs for him,” she said.
Another Kyzyl-Kyshtak resident told IRIN they were receiving food and non-food aid but pointed out that they had large families (at least 3-4 children), with grandparents to look after, and little paid work.
“We have small plots on which we grow potatoes and vegetables. Before the mayhem in June our men used to work in the city [Osh] as taxi drivers or doing other jobs. Nowadays, there are not many jobs, and some men are reluctant to go to the city and work there as they are scared,” she said.
Apart from the cold weather, fears of a resurgence in violence are ever-present: Local media on 29 November reported on a raid on a hideout in Osh in which four Islamist militants are said to have been killed. The city was the scene of inter-ethnic violence in June during which nearly 400 mostly minority Uzbeks were killed, according to BBC.

UNHCR aid
The UN Refugee Agency (UNHCR) said in a statement on 29 November that it was distributing winter aid - warm clothing, blankets, boots, cooking sets, kitchen utensils, water containers, kettles and other relief items - to thousands of families in the Osh and Jalalabad regions. UNHCR said partners were also providing coal to help keep people warm.
”This is a very critical time of year for many families,” said Hans Friedrich Schodder, a UNHCR representative in Kyrgyzstan. “Poor families in all communities need extra help to overcome the winter in dignity. We can see that our aid is having a positive impact on people’s lives. For example, children from poor families, who could not attend school because they did not have any winter clothing, can now go to school, wearing new, warm clothes and boots.”
According to UNHCR, the second phase of its winterization project running from November to February will assist more than 50,000 vulnerable people in the south. Vulnerable people in all communities as well as public and civil society institutions will be provided with winter clothing, folding beds, mattresses, bed linen, blankets, pillows, towels, kitchen sets, heating fuel and other items, UNHCR said.
Meanwhile, Jantoro Satybaldiev, deputy prime minister and head of the state agency for the reconstruction of Osh and Jalalabad provinces, said they were aware of the problems that many southerners faced: “After the shelter project is completed we, in cooperation with our international partners, will work on providing affected communities with fast loans so that they [can] regain their livelihoods,” he said.
http://www.irinnews.org/report.aspx?ReportID=91255

POVERTY: AFGHANISTAN: Marriage, ill health make you poorer

  Photo: Kate Holt/IRIN: Health costs can be devastating for poor families (file photo)

KABUL, 1 December 2010 (IRIN) - Uncertain harvests are a perennial risk for rural Afghans, but two events stand out as exacerbating poverty - ill health, and the high cost of getting married, according to a new report.
“While health expenditures placed considerable financial strain on households across different wealth groups, they hit the poor particularly hard,” says research by the Afghanistan Research and Evaluation Unit (AREU).
A household of seven spends an average of US$252 a year on health costs which can be devastating for poor families, according to the report based on interviews with representatives of 64 households in three provinces - Badakhshan, Kandahar, and Sar-i-Pul.
“Ill health in general is damaging,” Paula Kantor, the report’s author, told IRIN, adding that the ill health of a male worker was particularly detrimental to his household.
Major health crises often led to high debts and asset sales, while many poor families said they were unable to pay for a complete course of treatment as recommended by doctors.
“Poor households have to decide which ill member to treat, a trade off that ideally no family should have to face,” she said.
The situation is particularly grim in rural areas where access to healthcare services is limited.
Free of charge basic health services, financed by donors and delivered jointly by the government and NGOs, reach almost 80 percent of the country, but many Afghans prefer the better quality services provided by the private sector.
“There is misinformation that state hospitals lack capacity and offer bad or low quality services which prompt people to go to private hospitals. The reality is quite the opposite - state health centres are far better than private ones,” Abdullah Fahim, an adviser to the Ministry of Health, told IRIN.
Fahim acknowledged, however, that there was a lack of professional health workers, especially female health workers, at government health centres in rural areas. “In some areas female patients don’t go to a male doctor due to cultural restrictions.”

Poverty itself is considered a major cause of ill-health.
“Poor people who don’t have access to adequate food, water, sanitation and shelter and those who lack an appropriate sense of psycho-social security, are highly vulnerable to diseases,” said Fahim.

Expensive weddings
While marriages strengthen social relations, they are a significant financial outlay. The costs of a wedding feast - ranging from US$3,000-30,000 - can be devastating for a groom and his family, experts say.
“In many instances, financing a wedding led households to mount considerable debts and sell off productive assets,” said AREU’s research which noted that some poorer families were unable to marry off their sons due to prohibitively high bride prices.
In addition to wedding expenses, some families, particularly in rural areas, demand large sums as `Mahr’ (money paid by the groom to the bride at the time of marriage) and as a dowry. Such costs can threaten a family’s future livelihood security, experts say.
Religious scholars and officials say high marriage costs, though proscribed by Islam, are dictated by custom and practice in some areas.
“Unnecessary spending and profligacy at weddings and other parties are illegitimate in Islam,” Mohammad Seddiq Muslim, an official of the Supreme Court, told IRIN, adding that wedding costs were leading to poverty and corruption.
“There is a lot of personal, familial and tribal emulation, competition and rivalry associated with extravagant wedding parties,” said Ahmad Rasoul, a lecturer at the faculty of sociology at Kabul University.
Imposing spending limits from outside will not work, said the AREU report: “To properly counter the pressures of competition, conformity and pride that push bride prices higher, a local consensus on the benefits of spending limits must be built.”
http://www.irinnews.org/report.aspx?ReportID=91254

MALARIA: Nigeria: doctors directed to use ACT

The Federal Government has directed all medical doctors and other health officials in the country to henceforth start using Artemisinin-based Combined Therapy (ACT) for the treatment of malaria disease in the country.
Minister of Health, Prof. Onyebuchi Chukwu, gave the directive yesterday in Abuja during the ministerial press briefing on Affordable Medicines Facility (AMF) for malaria programme.
According to the minister, the spread of malaria had become so critical that everyone in the country was now involved.
He said: “It’s a disease everyone talks about and rightly so. In general hospitals, two-thirds of patients waiting to see the doctor are all about malaria. The launch of ACT will further accelerate our drive to ensure we have 50 per cent reduction in malaria. Thus, Nigeria had to develop another policy which includes the use of ACT.”
Chukwu also stated that the national policy does not recognize Chloroquine. For that reason, he said the government was doing all it could to phase it out.
http://nigerianbulletin.com/2010/11/30/fg-directs-doctors-on-act-for-malaria-treatment-thisday/

POVERTY: A perilous journey: the mortal danger of poverty

Jun 24th 2010

OUTSIDE the main hospital in San Cristóbal de las Casas, women in traditional multicoloured garb queue up to see a doctor. Many are pregnant or carry infants on their backs. One expectant mother says she fears there will not be a bed for her when she enters labour—all too common in the overcrowded hospital. Tales of deaths from hypertension, haemorrhage or infection during or after giving birth are common in the second city of the state of Chiapas. In a nearby village, one doctor recalls a woman whose journey took so long that she died on the street outside his clinic.
Maternal mortality in Mexico has fallen by 36% since 1990, but it is still higher than in other Latin American countries. The problem is far worse among Indians and in the poorer south. Mothers in Chiapas, Oaxaca and Guerrero states die in childbirth 70% more often than the national average, and indigenous women are three times less likely to survive birth than non-indigenous women. Most of these deaths are preventable.

One of the first obstacles for a pregnant woman is transport. To reach a doctor you need to get a car, a driver, petrol, and someone to take care of the other children. The roads to the nearest town hospital are often slow and dangerous. As a result, many women—including one-third of Indian mothers—give birth without any medical help at all.
Another set of problems awaits at the hospital. Laboratory tests and medical supplies are often too costly for the poorest Mexicans. The quality of care is low: 40% of urban maternal deaths are caused by using the wrong medicine, by botched surgery or by other forms of malpractice.

Lastly, there are cultural and social difficulties. Many women are scared to go to a male obstetrician, which is frowned upon in areas with a macho, conservative culture. Those who do may have trouble communicating, since many indigenous women speak poor Spanish. Doctors sometimes make matters worse by denigrating rural patients, discouraging them from seeking medical help.

More spending on midwives and contraceptives would help save mothers’ lives. New money is on the way: the Spanish government and the charities of billionaires Bill Gates and Carlos Slim announced plans this month to spend $150m on health care for the poor in Central America and southern Mexico. But the best way to reduce maternal mortality is via investment in infrastructure, health and education—all of which would help the south catch up in general.

http://www.economist.com/node/16439044?story_id=16439044

MALARIA: use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.

Methods
Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.

Results
Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.
Conclusions
Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.
http://www.malariajournal.com/content/9/1/345