TUBERCULOSIS: Chembio Awarded Phase II NIH Grant for Rapid TB Test

 March 29, 2011
Chembio Diagnostics, Inc. has been awarded a three-year $ 2.9 million Small Business Innovative Research (SBIR) Phase II grant from the United States National Institutes of Health (NIH) to continue development of a simple, rapid, accurate, and cost-effective serological test for active tuberculosis that can be utilized in resource-limited settings. Chembio developed a prototype of this test in the Phase I work in collaboration with the Infectious Disease Research Institute (“IDRI”); this collaboration will continue in this second phase of the research and development grant as well. The grant is effective March 1, 2011.
Tuberculosis is a chronic infectious disease, with an estimated 2 billion people currently infected worldwide and several million new cases each year. Current methods of diagnosis are slow, unreliable, and/or impractical in the field settings where the disease burden is the greatest. New diagnostics are urgently needed to address this global health problem by improving control programs.
The prototype test developed during the Phase I work uses the innovative Dual Path Platform (DPP®) technology developed and patented by Chembio, together with selected antigens from a large panel of novel recombinant antigens identified at IDRI, a Seattle-based biotechnology research organization dedicated to technologies that address diseases in the developing world.
Chembio is budgeted to receive approximately 63.5% of the awarded amount, or approximately $ 1,842,700, if award funding continues over the full three years as is expected; IDRI would receive the balance as a subcontractor to Chembio. The grant award budget is approximately equal in each grant year, or approximately $ 967,000 per year. As in all such grants, award funding in the second and third years is subject to satisfactory progress and availability of funds.
The Phase I studies demonstrated the feasibility of developing a rapid and accurate test for tuberculosis with required diagnostic performance characteristics (sensitivity > 80%, specificity > 95%). Scientists at Chembio and IDRI have identified novel serodiagnostic targets involved in the antibody response in patients with pulmonary tuberculosis and designed a set of polyepitope fusion proteins. Integrating these high-performing antigens in the Chembio proprietary DPP® technology resulted in developing a test prototype showing sensitivity of 81% and specificity of 95% in pilot evaluations of patients with active tuberculosis in endemic regions. In Phase II, the proposed rapid (15 minutes) point-of-care DPP® test for tuberculosis will be fully developed, optimized, and evaluated in multi-center clinical trials in several countries, followed by validation of production protocols, preparation for regulatory approval and commercialization.
Lawrence A. Siebert, Chembio’s President, commented, “We look forward to completing the Phase II work so that we can provide a practical tool in the diagnosis of tuberculosis. We appreciate the outstanding work that Dr. Konstantin Lyashchenko, the Chembio TB project team and our collaborators at IDRI, have all done to receive this Phase II grant and to address a large global health need.”
Dr. Steven G. Reed, IDRI’s Founder and Head of Research and Development, indicated, “We at IDRI see this Phase II funding as validation that our proprietary reagents, combined with Chembio’s DPP® technology, can contribute to more effective management of tuberculosis — and a reduction in the burden of this dangerous disease. IDRI’s collaboration with Chembio is a nice example of how public private partnerships translate good science into field-appropriate solution.”
http://www.technologybo.com/chembio-awarded-phase-ii-nih-grant-for-rapid-tb-test-2656.html

TUBERCULOSIS: The BCG World Atlas: a world first in the fight against tuberculosis

March 27, 2011
McGill, RI MUHC researchers launch free online atlas of TB vaccination policies from around the world
Tuberculosis (TB) continues to pose a major global health threat. Someone in the world is newly infected with TB bacteria every second. Every year, more than 9 million people develop active TB and it claims about 2 million lives. In Canada, the overall incidence of TB has declined, but rates remain high among immigrants from endemic countries and among Aboriginal populations. Currently, Nunavut is facing the largest TB outbreak in the territory’s 10- year history.
In the days leading up to World TB Day 2011 on March 24, a team of researchers from McGill University and the Research Institute of the McGill University Health Centre (RI MUHC) is officially launching the BCG World Atlas: a first-of-its-kind, easy-to-use, searchable website that provides free detailed information on current and past TB vaccination policies and practices for more than 180 countries.
“The Atlas is designed to be a useful resource for clinicians, policymakers and researchers alike,” said co-author Dr. Madhukar Pai, who is an assistant professor at McGill’s Dept. of Epidemiology, Biostatistics & Occupational Health and a researcher in the Respiratory Epidemiology and Clinical Research Unit at the Montreal Chest Institute and the RI MUHC. “It has important implications on diagnosing and treating TB and on the research that’s being done on developing a new TB vaccine.”
Pai is a senior author on a paper about the BCG World Atlas that will be published in the March edition of the journal PLoS Medicine.
The Bacille Calmette-Guérin (BCG) vaccine was introduced in 1921 and continues to be the only vaccine used to prevent TB. Despite nearly a century of use, the vaccine remains controversial, with known variations in efficacy, strains, policies and practices across the world. Clinicians need to be aware of the various BCG policies in different parts of the world, as well as changes to those policies over time, especially when dealing with foreign-born adults who were vaccinated as children and who are unlikely to have retained their childhood vaccination records.
Ms. Alice Zwerling, BCG Atlas project leader and PhD candidate in epidemiology at McGill, explained that BCG vaccination can cause false positives in the skin test that’s routinely used to screen for latent TB. “As a clinician, if you’re trying to interpret the skin test in a foreign-born person, you’re going to want to know when the BCG vaccination was given back home and how many times it has been given. The Atlas provides this information and can help doctors decide on when to use the newly available blood tests for TB that are not affected by BCG vaccination,” she added.
“I am pleased that the Public Health Agency of Canada (PHAC) could play a part in such an important project,” said Dr. David Butler-Jones, Canada’s Chief Public Health Officer and the head of PHAC, which provided funding for this project. “The BCG World Atlas will be a vital resource for practitioners across Canada, one that will help us prevent and control the spread of TB here at home.”
The Atlas project began in 2007 with the compilation of detailed information on past and present BCG vaccination policies on as many countries as possible. The data were assembled through respondent-completed questionnaires, published papers, reports, government policy documents and data available from the World Health Organization Vaccine Preventable Diseases Monitoring System. The beta version of the site went live in 2008 and over the past year more than 6,000 visits have been recorded with a steady increase in traffic over time. The Atlas is constantly being updated and its authors welcome input from countries that are currently not covered.
http://www.mednewsafrica.com/2011/03/27/the-bcg-world-atlas-a-world-first-in-the-fight-against-tuberculosis/

TUBERCULOSIS: Afghanistan commemorates World TB Day

 31 Mar 2011

Kabul (29 March, 2011): ‘Women and children, the vulnerable segments of population should be our focus in fight against tuberculosis in Afghanistan now’. Dr Surryaya Dalil, the acting Minister of Public Health emphasized this while addressing the main event of World TB Day held at Ministry of Public Health building in Kabul.



The ceremony was well attended by TB patients, activists, health workers, national & international partner organizations, school children, media and parliamentarians. Dr Dalil said that drug resistant forms of tuberculosis may become a major challenge treatment of such case will not cheap. She highlighted the importance of vaccination among children, developing comprehensive package of services for women affected by TB based on a nation wide research.
Dr.Seema Samar the chairperson of Stop TB Partnership, also a Director of Human Rights organization in Afghanistan stressed on the need to address the link between TB and poverty and its consequences. She said that fight against TB is not just the responsibility of Government and every one will have to come forward. While WHO Representative Dr Ahmad Shoudul lamented the fact that despite being preventable and curable, TB still causes the death of more than 110,000 lives in Eastern Mediterranean Region (which includes Afghanistan as well). He shared the message of Regional Director of WHO Dr Hussein A Gezairy with the audience. He highlighted working on TB among women and children, addressing national capacity gaps and developing interventions for cross border collaboration with neighboring countries as major areas of focus in current year.



The ceremony ended with a Stop TB song sung by children. TB Day was commemorated across Afghanistan on 24th of March except Kabul where the main event took place on 29 March because of national holidays on the eve of Nauroz. In summary following activities were held in different region including 34 provinces and 320 health facilities with support of TBCAP, BRAC and WHO in association with TB Day:
 Recognition of good performers among NTP team including field staff Afghanistan is among 22 TB high burden countries of the world. In 2010 alone, there were 53000 cases of TB and 9000 lost their lives due to TB in previous year. For TB care in Afghanistan, NTP is supported with a coalition of national and international partners represented by a national partnership constituted in 2009.
http://www.worldtbday.org/on-the-move-against-tuberculosis-afghanistan-commemorates-world-tb-day/

TUBERCULOSIS: Uganda

Abubaker Kirunda : , April 3 2011
At least 1,287 people have been found with tuberculosis in Jinja leaving the district authorities scared. The District Tuberculosis/Leprosy Control Supervisor, Mr Bernard Mugabi, on Thursday told journalists that this figure puts the case detection rate for TB in Jinja at 82 per cent which is higher than the 70 per cent national figure.
He said men are the most affected with 724 of them having the TB virus and 563 females, according to the latest survey conducted at Jinja Referral Hospital.
Mr Mugabi said lack of information about the availability of TB drugs, refusal to go for testing and smoking together with drinking alcohol have been the major root causes of the big number of TB patients in the district.
“TB drugs are available at health centre IIIs and IVs but people do not utilise them. Some people even completely refuse to go for testing even when they feel persistent cough which is always associated with TB,’’ Mr Mugabi said.
He said among the people discovered to be having TB, 1.5 per cent of them were found to be with incurable complications above the level of the hospital as a result of defaulting on taking drugs.
He said to cure such patients it would require them to get a strong TB drug dosage which goes for Shs10m.
http://www.monitor.co.ug/News/National/-/688334/1137468/-/c3am4tz/-/

TUBERCULOSIS: Guyana: $35M x-ray system to boost tuberculosis care

March 27, 2011  KNews


An estimated $100M is going to be expended by the Ministry of Health as part of its effort to improve the treatment and prevention of tuberculosis. As part of its plan, the Ministry will in a matter of weeks commission its first digital radiology system in the public health sector, a move which is valued at $35M, according to Minister of Health, Dr Leslie Ramsammy.
According to FXB Guyana Programme Director, Nicole Jordan, “That machine is going to create a one-stop shopping centre right at the Georgetown Chest Clinic…where patients can come and get their chest X-rays and they can be guaranteed their diagnosis will come earlier and health workers can guarantee that you will not lose them.”
The FXB Guyana Programme, which is slated to come to an end shortly, has been working for a number of years with the Ministry of Health and has helped the National Tuberculosis Programme (NTP) to develop a standard package of services which can be accessed within the public health sector.
The Ministry of Health as part of its efforts to further raise awareness about TB, on Thursday launched its ‘B TB free’ campaign as part of the local observance of World TB Day which is observed globally on March 24.
The campaign which represents a collaborative effort between the National AIDS Programme Secretariat and the National TB Control Programme, was designed to dispel myths about TB, as well as to disseminate factual information to the public about the disease, according to NAPS Prevention Coordinator, Jennifer Ganesh.
This move is seen as especially crucial as efforts are made to address the daunting “double-whammy” effect of HIV-TB co-infection, Ganesh added.
According to NTP Programme Manager, Dr Jeetendra Mohanlall, over the years the NTP had had the sustained support of one Non-Governmental Organisation, the Guyana Chest Society, but it is in need of more involvement from civil society to battle the dreaded disease.
The ‘B TB Free’ initiative, according to Dr Mohanlall comprises of a brochure, a poster, two radio messages and two television messages. And while it is intended to reach the general population, he noted that the male faction is especially being targeted. He disclosed that male TB patients are the ones that mostly default as it relates to the consistent use of their treatment.
In recognition of the fact that the fight against TB has remained a global challenge over the years, Minister Ramsammy said that Guyana has been making significant strides. At the moment there are 20 TB testing sites and there are plans to expand such facilities to Kamarang, Mahaicony and East Bank Demerara.
“While we are fortunate in Guyana to have access, we need to ensure that there are easier methods to test for TB that provide immediate results.”
The Ministry just over a few years ago was able to introduce the PCR-DNA test which could provide results in two hours and also detect multi-drug resistance strains, allowing health workers to treat and manage TB patients better.
According to Minister Ramsammy, the world has an opportunity, with the support of global partners, to make sure that (faster) tests become available to citizens in every part of the world, whether they live in poor or rich environments.
“I can make a commitment to Guyana that as soon as it is possible we will have that test in Guyana. We have already made contact …the World Health Organisation (WHO) is working with us, but the test is not yet commercially available for scaled-up activities.”
Efforts must also be directed to accelerate the availability of new, better and more potent TB vaccines, Minister Ramsammy said. He alluded to the fact that although the BCG vaccine is used in this regard it does not provide universal coverage and is less effective in adults.
“We need better vaccines and we need more research, therefore we need to commit ourselves to addressing barriers if the trajectory of elimination will become possible in Guyana and the world.
Detailing global statistics, the Minister said that there are nine million TB infections and 1.7 million deaths on an annual basis. He reported, too, that about two billion people carry the latent form of the disease, adding that one out of every three persons in the world has been exposed.
http://www.kaieteurnewsonline.com/2011/03/27/35m-x-ray-system-to-boost-tuberculosis-care/

TUBERCULOSIS: India: Rourkela Steel Plant has launched project for diagnosis and treatment of Tuberculosis patients

Mar 31,2011
Rourkela, Mar 31 (PTI) As a step to extend health care facilities to the poor and underprivileged in and around the steel city, Rourkela Steel Plant (RSP) has launched project 'Akshya" for diagnosis and treatment of Tuberculosis patients.The project was formally inaugurated by RSP Managing Director S N Singh at Ispat General Hospital (IGH), run by the steel plant here yesterday.Singh said the project will help in fighting the menace through a committed, planned and proactive appraoch based on the twin strategies of awareness and intervention.Presenting a total picture on tuberculosis, Singh said more than 13 million people around the world were suffering from an active infection. Almost 20 percent of the TB patients were Indians.Director Health and Medical Science Dr S K Mishra presented a list of initiatives being taken by the IGH for enhancing the quality of care and focussed on the ABC of patient care -- Attitude to serve, right body language and adequate communcation.

http://ibnlive.in.com/generalnewsfeed/news/rsp-launches-project-akshya-for-treatment-of-tuberculosis/631242.htm

TUBERCULOSIS: U.S. Cases of Drop, But Not Fast Enough

Patrick Corcoran: March 28, 2011
Federal authorities say reported cases of tuberculosis in the U.S. dropped to an all-time low in 2010.
As the Los Angeles Times reports, the Centers for Disease Control and Prevention say that the total fell 3.9 percent, to 11,181 cases.
However, the figures disappointed some experts. The 3.9 percent decline paled next to the 11.9 percent drop in 2009, and, more than 20 years ago, 2010 had been set as a target year for the eradication of TB in the U.S.
Four states accounted for 49 percent of the cases: Florida, New York, California and Texas. Among patients whose nationality was reported, 60.5 percent were foreign-born, with natives of Mexico accounting for the most cases in that category, followed by the Philippines, India and Vietnam.
The release of the U.S. numbers came as international efforts are intensifying to crack down on multi-drug-resistant TB, or MDR TB. The Stop TB Partnership, an international coalition, recently announced that without expanded efforts, the number of people inflected with MDR TB could swell to 2 million worldwide by 2015, causing hundreds of thousands of deaths.
In the U.S., there were 113 cases of MDR TB in 2009, the most recent year for which complete data are available
http://www.fairwarning.org/2011/03/u-s-cases-of-tuberculosis-drop-but-not-fast-enough-for-some/

TUBERCULOSIS: Pakistan: Over 3,000 in Swat suffer from Tuberculosis

Fazal Khaliq: April 1, 2011
The number of Tuberculosis patients in Swat has risen to over 3,000 despite a government-sponsored disease control programme, The Express Tribune has learnt.

“Of the 3,300 known cases, 1,400 people have been treated free of charge and the others are under proper treatment,” said Dr Mushtaq, who is incharge of the National Tuberculosis Control Programme (NTP) in Swat.
Tuberculosis, also known as TB, was declared a national danger by the Pakistan government in 2001 and the NTB was initiated to arrest the disease’s spread until 2012.
Speaking about the spread of TB in Swat, he said the two main causes were poor nutrition and lack of sanitation which are both directly connected to poverty. “Swat went through mayhem [during Talibanisation and the army operation] and then, it was hit by the floods. Poverty levels increased, particularly in rural areas where people are more prone to contract TB,” he said.
Pakistan ranks eighth on the list of 22 high-burden TB countries in the world. About nine million fresh TB cases are reported globally every year, of which 0.3 million are from Pakistan.
Dr Mushtaq said that although TB is a dangerous disease, it is curable and can be treated for free in many hospitals. “[But] religious scholars, teachers and civil society members need to create awareness about the disease in order to eradicate it,” he said.
But while NTP professionals claim success, other doctors point out flaws with their data.
“The most alarming thing about the disease is that people who live in far-flung areas are inaccessible,” says Swat-based Dr Ihsan. “They don’t go to hospitals. So they are not included in data collection and this means that figures collected by the TB control programme may not be very authentic. Rural areas need to be given more attention.”
http://tribune.com.pk/story/140784/over-3000-in-swat-suffer-from-tuberculosis/

TUBERCULOSIS: Alabama High School

Mar 31, 2011 MONTGOMERY, AL (WSFA) -
The State Health Department confirms 32 people at Jeff Davis High School in Montgomery have tested positive for Tuberculosis.

Results show that 26 students and six staff members returned positive skin tests. This does not mean they have an active case of TB, however. Symptoms usually accompany an active case.
Health department officials did a symptoms screening on all the students and teachers and said they did not see any red flags. All 32 individuals also had a chest x-ray done.
http://www.wsfa.com/Global/story.asp?S=14361107

TUBERCULOSIS: Angola

3/28/11
Benguela – At least 317 cases of tuberculosis were diagnosed from January to March 26, by the anti-tuberculosis dispensary of Benguela.

According to the official of the institution, Vasco Domingos Tchambasuku, who would not reveal the data comparing to the same period of last year, the most hit age group is from 15 to 45 years old.
He said that the adherence of the population to the treatment centre is bigger due to the sensitization and mobilisation of the population to join the treatment.
Vasco Domingos added that there are still people who suffer from this disease or symptoms compatible with tuberculosis and do not look for proper places for the treatment, which concerns the institution.
http://www.portalangop.co.ao/motix/en_us/noticias/saude/2011/2/13/Over-300-cases-tuberculosis-reported-three-months,ec66dd32-f585-4acb-837e-51fcad57563f.html

TUBERCULOSIS: Phillipines: Tuberculosis disease no longer among the ten leading causes of death in Southern Leyte

March 31, 2011:  ES Gorne

MAASIN CITY, Southern Leyte, Mar 31 (PIA) - Former IPHO Technical Department Chief Dr. Zenaida Abiera, who is now the Provincial Coordinating Committee (PCC) Co-Chairperson of the Public-Private Mix Directly Observed Treatment Short –Course Chemotherapy (PPMD-DOTS) congratulated Southern Leyte since tuberculosis (TB) is no longer among the top ten leading cause of death in the province but still the fight against TB continues.
In 2009, TB ranks seventh in the top leading causes of morbidity and mortality in the province of Southern Leyte, Dr. Abiera revealed during the DySL Kapihan sa PIA , Wednesday at PIA Southern Leyte Provincial Office , however, this year the province no longer identifies the said disease among the top ten leading cause of death in the locality.
She noted the trend in TB prevalence in the province from 1990 recorded reduction from 38.2 to 31 per hundred thousand in 1995.
She added that the commitment of the provincial government in the fight against TB is worth commending as she once was among the technical experts working on the health problems in the province.
Abiera said however, the province still continues to fight for a “TB free” Southern Leyte in line with the vision of the country where the province joins in a joint collaboration and cooperation for both public and private sector to fight TB.
That Southern Leyte is among the provinces –recipient of the Philippine Coalition Against Tuberculosis (PhilCAT) through a grant by the Global Fund to Fight AIDS, TB and Malaria in close coordination with Department of Health (DOH) in the installation of service delivery units and coordinating structure of PPMD-DOTS, Abiera added.
She also disclosed that the PHilCAT-PCC in Southern Leyte through Provincial Health Officer II, Chief of Hospital Dr. Joselito Trumata, who is also the PCC- Chairman will spearhead an advocacy symposium for Public –Private Mix in TB Care and Control on April 6, 2011 at Kuting Reef Resort and Spa in Macrohon, Southern Leyte to orient and enlighten a multi-sectoral audience about the global, national and local TB burden through the PPMD- DOTS approach in TB control to realize the vision of a “TB Free” Philippines.
The program aims to engage the private sector in the care and control of TB in the province, she added.### (PIA Southern Leyte/esg)
http://www.pia.gov.ph/?m=1&t=1&id=25301

TUBERCULOSIS: WHO warns of multi-drug resistant tuberculosis

April 2, 2011

The World Health Organization (WHO) warned that over 2 million people will become infected with multidrug-resistant tuberculosis (MDR TB) until 2015, exactly on the day that the World TB Day is celebrated on, March 24, recalling that, despite milestones achieved, further efforts are needed for all those affected by this disease so they can have access to treatment.
According to the director general of WHO, Dr. Margaret Chan, ""many countries have made progress"" in this field, but ""despite the recent growth efforts, the world needs to do much more for all MDR TB patients accessing the treatment they need.""
""We cannot allow drug-resistant tuberculosis to spread unchecked,"" she says. To live with untreated MDR-TB increases the risk of spreading TB strains resistant to drugs in the world.
Programs funded by the Global Foundation and subsequent WHO standard treatments are expected to diagnose and treat about 200,000 people of MDR-TB by 2015, a figure that is four times that of patients receiving treatment at present, only about 50,000 .
The Global Foundation will provide 84 percent of international funding for TB control in 2011. However, according to WHO, both international countries and organizations should increase their efforts against TB and progress in the fight against tuberculosis.
According to Professor Michel Kazatchkine, executive director of the Global Foundation, ""MDR-TB is a challenge for all countries because it is difficult and expensive to treat.""
""Unless there is not a special effort made to address this problem, our ability to finance and ensure progress against tuberculosis in general might be threatened,"" he warns.
For the special envoy for 'Stop TB' of the UN, Jorge Sampaio, ""it is time that countries with rapidly growing economies and a high burden of multidrug-resistant tuberculosis increase their commitment and funding for their programs against this disease.""
Since 2009, the 23 countries most affected by MDR-TB have almost doubled their burden of this disease. From 2002 to 2010, the Global Foundation has funded programs throughout the world that have provided treatment to about 7.7 million people, saving the lives of 4.1 million patients.
In 2009, WHO reported that 9.4 million people became infected with tuberculosis and 1.7 million died from this cause, among which 380,000 people with HIV-associated tuberculosis are included. In 2008 there were about 440,000 cases of MDR-TB and 150,000 deaths.
(Source: Latin Daily Financial News)
http://www.tehrantimes.com/index_View.asp?code=237853

TUBERCULOSIS: New test can quickly distinguish infection from tuberculosis disease

Apr 2, 2011

A group of scientists have developed a potential new experimental diagnostic test that is able to quickly distinguish individuals with active tuberculosis (TB) from those with latent TB infection.
If the preliminary results of the study will be confirmed in a larger population sample, the new diagnostic system could allow more effective strategies to control the spread of the re-emerging pathology.
The work was performed by a group of scientists from the Catholic University of Rome, the National Institute of Infectious Diseases "L. Spallanzani" of Rome.
TB is an infection caused by Mycobacterium tuberculosis, the bacterium known as Koch's bacillus, named after its discoverer (Robert Koch) in 1882. Following infection with the bacillus, two different scenario may occur: "active disease", clinically evident, and that - if not properly treated - can lead to death and the so called "latent infection," that is asymptomatic and that can last for a lifetime.
"The tuberculin skin test- explains Delia Goletti, corresponding author of the paper - has several drawbacks, primarily that is unable to differentiate between infection with environmental mycobacteria (typically not dangerous to humans), vaccination with Bacillus of Calmette et Guerin (BCG) and infection with M. tuberculosis. A new assay is being used since ten years, which includes a blood test, based on specific proteins of Mycobacterium tuberculosis. The new blood test, called "Interferon - release assays (IGRA)", based on the release of interferon - in response to M. tuberculosis-specific antigens, is able to selectively identify those who have contracted TB infection.
"However - continues Goletti - IGRA, as well as the tuberculin test, are not able to distinguish people with latent TB infection compared to those with active TB disease ".
"The results of our study", said Giovanni Delogu, first author of the article, - demonstrate that it is possible to distinguish those infected from those with the disease, by simply performing an extra blood test using a protein of the bacillus named HBHA".
"In order for the test to be effective, the HBHA protein must have special features, and to date it has been difficult to obtain large amounts of this protein. - continued Delogu -. Well, our research group has developed an innovative experimental protocol to obtain large amounts of protein with limited costs, opening the possibility to use this test on a large scale ".
"In this study we have developed an innovative diagnostic algorithm, which consists of a response to the protein HBHA in combination with the IGRA and the results have shown that the response to HBHA associates with latent TB infection. This procedure allows to rapidly identify those who really need the treatment for active TB," concluded Goletti.
"The response to HBHA can be used as a biomarkers for latent TB infection and then to some extent can be considered as a response of protection to TB. It is important to understand what are the mechanisms triggered by the infection which can cause the appearance or not of the disease", said Stefania Zanetti, professor of Microbiology at the University of Sassari.
"These results - concludes the researchers - open the road to a multicenter study -- "In the future we plan to extend the study to a larger number of patients, giving priority to certain groups where diagnosing active TB can be challenging, such as immunocompromised individuals and children. We also plan to tests the new assay in countries with a high burden of TB".
The study has been published on the international journal PLoS One.
http://www.dnaindia.com/scitech/report_new-test-can-quickly-distinguish-infection-from-tuberculosis-disease_1527532

TUBERCULOSIS: Share your bong -- get tbc!

PEOPLE who share bongs to smoke marijuana may be at risk of contracting pulmonary tuberculosis, Australian medical researchers say.

Research to be presented at the Thoracic Society of Australia and New Zealand conference in Perth on Monday suggests a link between active TB cases and shared bongs - water pipes commonly used in marijuana smoking.
Dr Michael Hayes and Dr Susan Miles from the Department of General Medicine at Calvary Mater Hospital in Newcastle conducted the research, centred on three recent TB cases in the Hunter-New England area of NSW.
Dr Hayes said the three young patients were regular or heavy cannabis users and more recently a fourth person in the region with similar characteristics had been diagnosed with TB.
TB is caused by the bacteria Mycobacterium tuberculosis, which can be contracted by breathing in air droplets coughed from an infected person.
In Australia, about 1000 people are infected with TB each year, while globally an estimated 1.7 million people die from the disease annually.
Dr Hayes, who is also a specialist in the respiratory and sleep unit at the John Hunter Hospital in NSW, said the incidence of TB in the non-indigenous Australian-born population was historically low.
He said although the three initial cases were not related, there was concern about the high rate of positive contacts among people who had shared bongs with the active cases.
Close contacts of the three patients were tested for latent TB and more than 30 showed positive results, Dr Hayes said.
If the contact had shared a bong with the active case, there was a six-fold increased risk of being positive, he said.
"Smoking marijuana is a cough-provoking activity and it is usually conducted in a confined environment that is conducive to the spread of the organism.
"While there is no conclusive proof that TB has been spread by bong smoking, there is sufficient reason to suggest an association between this activity and the spread and severity of the disease."
He said greater awareness of the issue was needed among health professionals and the general public, particularly those who may be at risk through bong smoking.
But Dr Hayes said the risk of TB was just one of the minor risks associated with marijuana use.
"The other health problems associated with long term marijuana use are quite clear and well laid out.
"It does cause lung disease and heavy use does cause psychiatric problems."
http://www.heraldsun.com.au/news/breaking-news/bongs-linked-to-tuberculosis-by-researchers/story-e6frf7jx-1226031971601

BIOTERRORISM: Amid Japan crisis, hunt for better radiation care

WASHINGTON (AP) — Japan’s nuclear emergency highlights a big medical gap: Few treatments exist to help people exposed to large amounts of radiation.

But some possibilities are in the pipeline — development of drugs to treat radiation poisoning, and the first rapid tests to tell who in a panicked crowd would really need them.
The U.S. calls these potential products “countermeasures,” and they’re part of the nation’s preparations against a terrorist attack, such as a dirty bomb. But if they work, they could be useful in any kind of radiation emergency.
“Thinking of terrorist events is what drives us. Mother Nature can be much of a terror, too,” says Dr. Robin Robinson, who heads the federal Biomedical Advanced Research and Development Authority, or BARDA, that funds late-stage research of products the government deems most likely to pan out.
BARDA has invested $164 million for research into anti-radiation treatment candidates since 2008, and $44 million for radiation testing — in hopes of adding such products to the nation’s emergency medical stockpile soon. That’s in addition to research dollars from the National Institutes of Health and the Defense Department.
Japan’s crisis — where last week two nuclear plant workers were hospitalized for radiation burns — is sure to renew attention to a field that’s long been overshadowed by the hunt for protections against bioterrorism, not radiological emergencies. Among the radiation projects considered farthest along in development:

—Rapid tests that could spot dangerous radiation doses with mere finger-pricks of blood. Already, a prototype machine sits at New York’s Columbia University that could check thousands of people.
—Some drugs now used to help cancer patients boost their infection-fighting blood cells, sold under such names as Neupogen. They may do the same thing for radiation victims.
—An injection that saved monkeys from highly lethal beams. It seems to protect the body’s two most radiation-sensitive spots, the bone marrow and lining of the gut.

Today, there are only a few proven therapies for radiation injuries. Good supportive care — lots of fluids, infusions of blood-clotting platelets, and infection-fighting antibiotics — is key for acute radiation syndrome, an overall poisoning that can begin causing symptoms days to weeks after a super-high exposure. To guard against longer-term harm, doses of potassium iodide can protect against future thyroid cancer by shielding the thyroid from one type of fallout, radioactive iodine. A few other treatments can help the body eliminate radioactive cesium and a few other isotopes.
Part of the challenge is radiation’s variety of injuries — burns, bone marrow and gastrointestinal damage, lung scarring, the later-in-life cancer risk. Yet outside of an immediate blast zone where open wounds and burns make injury clear, there’s no fast way to tell who got a huge dose.
Those Geiger counter-style monitors used on power-plant workers in Japan? They detect contamination on clothing or skin that might not enter the body, not what the body has absorbed, says medical physicist David Brenner, director of Columbia’s Center for Radiological Research.
Moreover, previous emergencies have shown that sheer stress can cause nausea and diarrhea that mimic some early symptoms of radiation sickness in people who weren’t exposed, he adds.
“Before you can start to treat people, you need to know what radiation doses they got,” Brenner says. “If you take a guess and get it wrong, you might do more harm than good.”
So his team developed a way to detect early, DNA-based signs of radiation damage that estimated dose — using a drop of blood like diabetics use to test their blood sugar.
Brenner’s team built a robotic machine named RABiT — for “rapid automated biodosimetry tool” — that can analyze those bloodspots quickly. The eventual goal is to be able to test 30,000 blood samples in a day. Brenner is working with Northrop Grumman to make the machinery smaller, even portable.
Brenner says federal approval is still a few years away but that the prototype could be used in an emergency if health officials shipped blood samples to his lab.

What about treatments?
Cells in the bone marrow and GI tract are extremely vulnerable to radiation. They overreact to what should be reparable damage and commit cellular suicide, says Dr. Andrei Gudkov of the Roswell Park Cancer Institute.
Gudkov’s team created a drug based on a protein from normal gut bacteria, named flagellin, that blocks some of the cellular destruction and also stimulates recovery of remaining cells. It dramatically improved the survival of monkeys treated up to 48 hours after they were zapped. And safety testing in 150 healthy people so far suggests the main side effect is a flulike reaction, Gudkov says. Cleveland BioLabs Inc. is doing further work needed for Food and Drug Administration evaluation.

BARDA’s Robinson says that closest to the emergency stockpile may be those cancer drugs that spur growth of infection-fighting blood cells. Later this year, his agency will begin a push for research to prove they could work similarly in a radiation emergency.
“There isn’t going to be a simple solution to any of this,” cautions Dr. Nelson Chao of Duke University’s countermeasures program, who also co-chairs the Radiation Injury Treatment Network. “There will be a lot of little steps to address the plethora of toxicities that come from radiation.”
http://dailycaller.com/2011/03/28/amid-japan-crisis-hunt-for-better-radiation-care/#ixzz1IZ26iyHG

BIOTERRORISM: Michael Crocker and ricin, plea entered

March 29, 2011


A 57-year-old Massachusetts man is expected to serve 15 years in prison after acknowledging on Monday that he illicitly held the lethal toxin ricin and threatened a federal prosecutor, the Boston Globe reported (see GSN, April 16, 2010).
Michael Crooker is scheduled for sentencing on June 20 in U.S. District Court in Boston. Crooker was arrested in 2004 when federal authorities descended on his house in Agawam after determining he had tried to send a handmade gun sound suppressor through the mail system. Along with potential bomb-making material, investigators discovered seeds that could be used to produce ricin and the deadly poison abrin, along with equipment to draw the toxins out of the seeds, according to U.S. Attorney Carmen Ortiz. In July of that year, Crooker sent a letter to the federal prosecutor handling his case, making reference to Oklahoma City bomber Timothy McVeigh. “As Martyr McVeigh’s T-shirt says: ‘The Tree of Liberty must be refreshed from time to time by blood of patriots and tyrants,'" the letter stated.

Crooker suggested that even from jail it was possible to deliver dangerous materials through the nation's postal delivery system, Ortiz said.
The next month, Crooker's father discovered a small container of ricin stashed underground on his land. Crooker acknowledged that the material was his and had been interred in that location for three to four years, according to Ortiz (Stewart Bishop, Boston Globe, March 29).
"The quantity of ricin in the vial was enough to kill 150-750 people," the Justice Department said in a release.
The toxin is derived from castor seeds and was most famously employed in the 1978 assassination of Bulgarian exile Georgi Markov (see GSN, Sept. 11, 2008). It is considered a potential bioterrorism threat (Agence France-Presse/Yahoo!News, March 28).
Crooker has been held by authorities since 2004, the Globe reported. A plea deal calls for him to receive the total possible 15-year sentence on iindividual federal charges of mailing a letter containing a threat to injure an officer or employee of the United States and possessing the toxin, ricin, without the required registration. Along with the prison term, he faces penalties of $500,000 (Bishop, Boston Globe).
http://www.globalsecuritynewswire.org/gsn/nw_20110329_5116.php

MALNUTRITION: NIGER: New approaches needed in tackling malnutrition

NIAMEY, 1 April 2011 (IRIN) -

 Photo: Claire Barrault/ECHO
Traditions around food often mean people do not eat the variety they need (file photo)

 Having experienced a series of droughts and food security crises over the past 40 years, Niger is now looking to move beyond simply countering emergencies, investing instead in development and recovery strategies - and changing gear in its efforts to feed a rapidly expanding, highly vulnerable population.
The need for new approaches in tackling malnutrition and chronic food insecurity has been one of the main themes of the Conférence Internationale sur la Sécurité Alimentaire et Nutritionnelle au Niger (CISAN), a two-day scientific and technical gathering in Niamey.
But is Niger ready to make the necessary changes? The country was at the epicentre of the Sahelian food crisis in 2010. Among those worst affected by the food shortages were children, with NGOs recording dramatic rates of severe acute malnutrition (SAM).
The government recognizes that tackling child malnutrition problems is crucial, and has been running an annual feeding scheme in partnership with the UN Children’s Fund (UNICEF) and the World Food Programme (WFP), targeting children aged 6-23 months. The programme reaches 200,000-300,000 children in a normal year, but the number shot past 600,000 in 2010 as the food crisis took hold.
“The timing is right,” said Guido Cornale, the UNICEF representative in Niger. He stressed that donors would be willing to invest more in nutrition interventions if they realized the country was serious about tackling malnutrition.
Development experts have warned that Niger requires long-term sustainable intervention if it is to avoid facing the same scenarios year in year out. Conference contributors emphasized the need to increase the quantity and quality of food and to secure better access to it, while also raising awareness about hygiene, the importance of a balanced diet and the nutritional value of different kinds of food.

Appeal for more resources
Dr Guero Maimouna from Niger’s Public Health Ministry (MSP) said the country had come through two crises in the past six years and had gained the necessary experience to take on bigger and longer-term interventions.
“But to do that we require resources. We are using our existing resources and money to handle the huge problem that we have at hand… We have a large population of malnourished children every year.”
Everyone is hoping the money that long-term interventions can attract will enable Niger to find sustainable solutions.
“You cannot rely on short-term emergency interventions - which are brought in at great cost - forever,” said Charlotte Dufour of the Food and Agriculture Organization (FAO). She stressed the importance of teaching people to do the best with what they had.

Traditional beliefs hamper progress
Recurring drought and the subsequent decline in agricultural production left Niger without food, but the main causes of malnutrition were traditional beliefs about food that prevented people from eating balanced meals, said Mele Djalo, head of health and social action in the prime minister’s office.
“For example, the Fula people, who live in the Maradi Region, do not eat fish; then we have ethnic groupings which consider chicken dirty; some don’t eat eggs, and so on. Creating awareness across these communities is a very difficult job and it requires resources,” she said.
The MSP’s Maimouna acknowledged that in some parts of Niger rations of fortified corn-soya blend, cooking oil and sugar were an attractive package for a family with no food or income: “They keep bringing their child back sick, as the mothers sell the rations given for the child.”
UNICEF’s Cornale said at the height of the 2010 food crisis they discovered that the monthly ration meant for a child lasted only a week. “We found that the families did not have any food and were consuming the rations.”
If you go to areas where there are no NGOs, there are no efforts under way to treat malnutrition
UNICEF then started a large cash transfer programme in the southwestern Maradi and Tahoua regions, targeting 35,000 households with about $126 each over three months to protect the children’s rations. An independent evaluation found the measure had been effective. “Families used 80 percent of the money to buy food,” Cornale said.
There are no national safety net programmes, but food was subsidized in times of crisis, and some emergency distributions were made.

Blanket feeding?
Conference participants debated whether communities should be trained to treat moderate malnutrition, which has a high incidence and affects almost half the children in some areas. An aid worker pointed out that communities were often unable to handle cases of malaria or even severe diarrhoea.
Stéphane Doyon, head of the Médecins Sans Frontières (MSF) nutrition campaign, said their research had shown it was more effective to provide blanket feeding for all children aged 6-24 months in vulnerable areas as a response to moderate chronic malnutrition, and rather use the limited resources, including personnel, to just treat children with SAM.
The mortality rate in children with moderate chronic malnutrition was 25 percent, while among those with SAM it was 75 percent.
Malam Kanta Issa of Forum Santé Niger (FORSANI), a local NGO comprising medical professionals, said there was a lack of budgetary support for improving health services. “If you go to areas where there are no NGOs, there are no efforts under way to treat malnutrition.” Aid workers pointed out that they had lobbied to get nutrition on the conference agenda.
Nevertheless, infant mortality has been a declining trend, and the UN Millennium Goal to reduce child mortality by two-thirds by 2015 might be the only one Niger is on track to achieve.
“There are 2,100 health posts in this country, which manage malnutrition in the rural areas,” UNICEF’s Cornale noted. “They seem to be doing their work.”


A breeder with cattle in the village of Danganari, 40km from Zinder in Southern Niger


http://www.irinnews.org/report.aspx?reportID=92344

TUBERCULOSIS: MYANMAR: Call for new government to boost health spending

YANGON/ BANGKOK, 4 April 2011 (IRIN)

 Photo: Contributor/IRIN: For some Burmese hospital patients, ad-hoc debt forgiveness (file photo)
With a new government recently sworn in, a former Myanmar health official is calling on leaders to invest more in healthcare for the country's poorest.
"Our country is sorely in need of a health insurance programme. The government should introduce a health insurance programme like the 30 Baht scheme that Thailand adopted for poor households," said Aung Tun Thet, former Health Ministry director-general of planning and statistics and secretary of the inter-ministerial National Health Committee from 1989-1992.
In 2001, Thailand introduced a universal coverage scheme to improve healthcare access for its poorest citizens. Low-income patients are charged 30 Baht (approximately US$1) per medical consultation. The service is free for those younger than 12, over 60, and the very poor.
Though there is no national health insurance in Myanmar, all public hospitals offer a medical cost-sharing plan - first introduced in 1993 - where patients cover medicine and laboratory fees and the state pays doctors' fees.
Soldiers in military hospitals are exempt from paying for medicine or lab tests, and tuberculosis patients are not required to pay for drugs at a public hospital.

Cost-sharing
According to state media, Health Minister Kyaw Myint recently rejected a proposal by opposition parliamentarians to boost coverage for the poor, stating that the existing cost-sharing system was sufficient.
But for Ma Oo*, mother of a nine-month-old child, medical and lab fees were unaffordable on her husband's income as a rickshaw and bicycle repairman in the economic capital, Yangon, when their baby needed an emergency operation.
"When doctors and nurses told me I had to buy medicine for the operation, I felt so sad and helpless because I could not afford it." She said nurses "scolded" her for not having the money. After realizing the child would not get the life-saving operation otherwise, Ma Oo said the medical staff asked her to sign a letter testifying her family could not afford the medication to justify not paying for drugs.
Aung Tun Thet said these ad-hoc arranagements offered some hope to poor patients. "There are some healthcare providers that give free healthcare to poor people so the poor can get treatment even if they cannot afford medical fees."
A new medical graduate who preferred anonymity confirmed that hospitals could not "deny any patient".
Instead, hospitals ask patients who can afford to do so to purchase extra medication, and even medical supplies such as syringes, to donate to the poor. A doctor working in central Myanmar who gave his name as Htway said this stock is then distributed. "We health workers always check the [leftover] drugs donated by some patients to find out whether they are still valid."
Myanmar had the world's 44th highest rate of child mortality in 2009, with an estimated 71 children dying before their fifth birthdays out of every 1,000 live births.
While government data show an estimated 66 percent of children in this age group with suspected pneumonia infections - a leading childhood killer - were taken to a health facility from 2005-2009, there is no record how many of them received antibiotics.

Stop-gap measures
A technical officer and health financing specialist at the UN World Health Organization (WHO), Riku Eloviano, said community-based health insurance plans - such as higher-income patients subsidizing care for poorer patients - "have had some positive impact in making access to care and medicines more affordable for people... They [community health insurance schemes] provide a formal expression of solidarity where [the] rich can subsidize the poor and the healthy can subsidize those who are sick."
However, she said: "These schemes often... cover only a relatively small number of the population, which means that the resources gathered through member contributions are low, which in turn hampers the ability of these schemes to act as an effective risk protection mechanism... They are often not financially viable as a long-term solution."
Rather, the government should boost medical spending to ensure everyone from "hawkers to farmers" could afford care, suggested Aung Tun Thet. "Hopefully a new government will consider investing more in the health sector."
Of WHO member countries that supplied information in 2007, Myanmar devoted the lowest percentage of its GDP to healthcare, about 1.9 percent. But this was still an increase over previous spending, according to government records.
Total government spending on healthcare increased more than 100 times from 464.1 million kyat in 1988-89 (approximately $72.4 million at the official exchange rate) to 51.7 billion kyat in 2008-09 ($8 billion).
Health administration and insurance accounted for 4 percent of total spending in 2009.
http://www.irinnews.org/report.aspx?reportID=92352

POVERTY: Microfinance: Some Insights into Over-indebtedness: Fresh data from India

Karuna Krishnaswamy: March 29, 2011

This post is the next in the blog series on over-indebtedness. In the coming weeks we’ll be featuring a variety of voices from across the globe on this topic. We welcome your participation in this discussion through comments. (Tables in original are not reproducable here)


Microfinance Institutions in Andhra Pradesh and elsewhere in India are keen to avoid over-indebtedness or place clients in distress. A joint effort by EDA Rural Systems and CGAP investigated the mass defaults of 2009 in Karnataka. The study draws from a representative survey of 900 customers in two mass defaults towns, Kolar and Ramanagaram and from two nearby comparable comparison towns in Karnataka that did not witness mass defaults (Nanjangud and Davanagere). Both defaulters and non-defaulters were interviewed.

Repayment distress
Since it is difficult to define over-indebtedness, we focused on repayment stress and regret amongst customers about having taken on so many loans on hindsight. Many borrowers had taken on more debt than they think they should have, found repayment a burden, wouldn’t have taken on so much debt on hindsight and show symptoms of distress such as skipping meals or important expenses or selling assets to repay.

What explains repayment distress?

For each respondent, we created an index which is set to “1” if the respondent reported both repayment burden and regret over having taken so much debt on hindsight and zero otherwise.  In terms of borrower characteristics, lower income (in turn correlated to income variation over the year and income shocks), higher debt, and lower numerical literacy are the main factors. We further find that a customer is more likely to have an index value of one if the Center Manager had not conducted loan utilization checks after disbursement or if she was using the loan for non-business purposes. This suggests that for some customers, using the loan for non-income generating purposes, which may be in part due to fewer loan utilization checks, increases the difficulty to repay.

Financial Capability

Customers were asked three questions to gauge numerical literacy.
a) You want to buy baskets worth Rs. 47. If you pay the shopkeeper with a 100 Rupee note, how much change will you get?
b) Suppose you have weekly instalments of Rs.100 and Rs.200 on two loans respectively. What is your total monthly loan repayment amount?
c) Suppose you have 3 loans with weekly repayments of Rs.100, 100 and 200 each. Your monthly income is Rs.5000 and your monthly expenditure is Rs.3300. Suppose you are offered a new loan with weekly repayment of Rs.50, can you take it and still be able to repay without decreasing your expenses?

It is surprising that large numbers of customers were not able to answer question 1 correctly. We see that the percentage of correct responses is lower among those whose index value is one. We further find that even controlling for other factors such as debt, income, religion, and education and other characteristics, those not being able to answer these questions correctly are more likely to have an index value of 1.
This suggests that while MFIs certainly need to have good credit appraisal and monitoring processes, we cannot always assume that the client can gauge the right amount of debt to take.

Has repayment distress made people worse off?
It is interesting that despite large incidences of repayment stress, only 2% of the clients in the mass default towns reported that their economic lives had become worse after taking MFI loans. Close to 89% said that their household condition had improved because of increased income generation from business and due to lower interest rates of MFI loans compared to outside options, while 9% reported no change. While we should not draw strong conclusions from these self-reported responses, it provides a perspective in the discussion on how much is too much debt for borrowers.

What can MFIs do?
We find that those who report no repayment stress or regret have an average monthly loan repayment to household income ratio of close to 40%. This is consistent across the five questions. While there is a large variance in the values of this ratio around the mean, the average of 40% may be a useful guiding figure in the Indian context.
Augmenting the loan application form to ask a couple of simple numeracy questions will help identify some high risk clients at low cost. Asking the customer a simple verifiable question such as how much can she repay every week given her stated current monthly income and expenses is easily done. If she gets it wrong, she could (be) offered a smaller loan and monitored more carefully. This further implicitly places more responsibility on the customer to borrow responsibly.
http://microfinance.cgap.org/2011/03/29/some-insights-into-over-indebtedness-fresh-data-from-india/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+cgap%2FUaRp+%28Prod+-+CGAP+Microfinance+Blog%29&utm_content=Google+Reader

MALARIA: Doxycycline for Malaria Chemoprophylaxis and Treatment:

Doxycycline for Malaria Chemoprophylaxis and Treatment: Report from the CDC Expert Meeting on Malaria Chemoprophylaxis
Kathrine R. Tan*, Alan J. Magill, Monica E. Parise, AND Paul M. Arguin
Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Walter Reed Army Institute for Research, Silver Spring, Maryland

Abstract.:
Doxycycline, a synthetically derived tetracycline, is a partially efficacious causal prophylactic (liver stage of Plasmodium) drug and a slow acting blood schizontocidal agent highly effective for the prevention of malaria. When used in conjunction with a fast acting schizontocidal agent, it is also highly effective for malaria treatment. Doxycycline is especially useful as a prophylaxis in areas with chloroquine and multidrug-resistant Plasmodium falciparum malaria. Although not recommended for pregnant women and children < 8 years of age, severe adverse events are rarely reported for doxycycline. This report examines the evidence behind current recommendations for the use of doxycycline for malaria and summarizes the available literature on its safety and tolerability.
http://www.ajtmh.org/cgi/content/abstract/84/4/517?maxtoshow=&hits=23&RESULTFORMAT=&andorexacttitle=and&andorexacttitleabs=and&fulltext=malaria&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

MALARIA: the potential for elimination

Eventually two issues called into question the validity of algorithms and clinical judgement if malaria were to be eliminated eventually. First, if we actually went to scale in providing malaria treatment for all suspected cases of malaria, we might never find adequate funding to buy all the needed ACTs, which cost upwards to 10 times that of the predecessors. Secondly, if we were ever to gain a true picture of the malaria situation as interventions were scaled up and prevalence decreased, we could no longer base our health information systems on clinical or suspected cases....
http://www.malariafreefuture.org/blog/?p=1185

MALARIA: vaccinating the mosquito

William Brieger

O'Neill's approach vaccinates mosquitoes instead of patients. In his lab, under a microscope, workers inject the bacterium Wolbachia pipientis, which is harmless to humans and common among insects, into eggs of Aedes aegypti mosquitoes, a major carrier of the dengue microbe.
O'Neill has found that Wolbachia makes A. aegypti resistant to-and unable to transmit-the disease.
What is more, all progeny inherit immunity.
ScientificAmerican/apr2011/advances
http://www.malariafreefuture.org/blog/

MALARIA: Bitter melon

William Brieger


Bitter Melon
Momordica charantia, called bitter melon or bitter gourd in English, is a tropical and subtropical vine of the family Cucurbitaceae, widely grown in Asia, Africa, and the Caribbean for its edible fruit, which is among the most bitter of all fruits. There are many varieties that differ substantially in the shape and bitterness of the fruit. (Wikipedia: http://en.wikipedia.org/wiki/Bitter_melon)

Antimalarial
It has been claimed that bitter melon's bitterness comes from quinine.[citation needed] Bitter melon is traditionally regarded in Asia as useful for preventing and treating malaria. Tea from its leaves is used for this purpose also in Panama and Colombia. In Guyana, bitter melons are boiled and stir-fried with garlic and oignons. This popular side dish known as corilla is served to prevent malaria. Laboratory studies have confirmed that species related to bitter melon have anti-malarial activity, though human studies have not yet been published.
Waako PJ, Gumede B, Smith P, Folb PI (May 2005). "The in vitro and in vivo antimalarial activity of Cardiospermum halicacabum L. and Momordica foetida Schumch. Et Thonn". J Ethnopharmacol 99 (1): 137–43. doi:10.1016/j.jep.2005.02.017. PMID 15848033.
Two plants Cardiospermum halicacabum L. and Momordica foetida Schumch. Et Thonn traditionally used to treat symptoms of malaria in parts of East and Central Africa were screened for in vitro and in vivo antimalarial activity. Using the nitro tetrazolium blue-based parasite lactate dehydrogenase assay as used by [Makler, M.T., Ries, J.M., Williams, J.A., Bancroft, J.E., Piper, R.C., Gibbins, B.L., Hinrichs, D.J., 1993. Parasite lactate dehydrogenase as an assay for Plasmodium falciparum drug sensitivity. American Journal of Tropical Medicine and Hygiene 48, 739-741], water extracts from the two plants were found to have weak in vitro antiplasmodial activity with 50% inhibitory concentrations (IC50s) greater than 28.00 microg/ml. In vivo studies of water extracts from the two plants showed that Momordica foetida given orally in the dose range 10, 100, 200 and 500 mg/kg twice daily prolonged survival of Plasmodium berghei (Anka) infected mice from 7.0+/-1.8 to 17.9+/-1.8 days. The water extract of Cardiospermum halicacabum L was toxic to mice, none surviving beyond day 4 of oral administration, with no evidence of protection against Plasmodium berghei malaria. The study emphasizes the discrepancy that might be found between in vitro and in vivo testing of plant-derived antimalarial extracts and the need to consider in vitro antiplasmodial data with this in mind. Further studies on Momordica foetida as a source of an antimalarial remedy are indicated on the basis of these results.
http://www.malariafreefuture.org/blog/

POVERTY: Tackling fake drugs needs technology and collaboration

David Dickson and Anita Makri : 30 March 2011
 Flickr/ Quinn_anya
Counterfeit drugs can undermine confidence in life-saving medications including antibiotics

Developing countries must be given all the scientific, technical and legal help they need to counter the growing trade in fake medicines.
One of the most important ways in which modern science actively contributes to the reduction of poverty and the promotion of well-being in the developing world is through the development of drugs against disease.
Yet such drugs will only be bought and used if those who purchase them are confident they will work. And this confidence risks being undermined by the rising menace of counterfeit medicines — defined by the World Health Organization as "medicines that are deliberately and fraudulently mislabelled with respect to identity and/or source".
The problem exists in both developed and developing countries. In the former, where regulatory and law enforcement systems tend to be strong, the incidence of counterfeit medicines is relatively low — most estimates put it at less than 1 per cent of the total market.
But many parts of the developing world — particularly in rural areas of Africa, but also in much of Asia and Latin America — have weaker infrastructure for regulation. Here the problem is much larger: one estimate suggests that in some regions at least a third of the drugs supplied to patients are counterfeit.
And by using new technologies, counterfeiters are getting better at replicating genuine drugs, mass-producing them and expanding their market via the Internet.
The result is massive fraud with potentially lethal consequences. Counterfeit drugs can harm patients either directly or by increasing resistance to treatment for serious diseases such as malaria.
Detecting and identifying counterfeit drugs has become a major scientific and technical challenge for developing countries, and its urgency is becoming ever more widely recognised.

Rising to the challenge
This week, we explore in a series of articles how new technologies and regulations are helping to combat counterfeit drugs.
A background article by Priya Shetty summarises the challenges facing the public health community in fighting the trade. At a basic level, the target is far from clear: counterfeit medicines can be confused with substandard ones that have little medicinal value but are produced lawfully.
Things get more complicated when anti-counterfeiting laws are so broad that they encompass generic drugs. The article outlines technologies designed to outsmart the increasingly sophisticated techniques used by counterfeiters, and describes international initiatives to chase down fake drugs and stop them reaching patients.
In the accompanying feature, science journalist Yojana Sharma describes how mobile phones, mini labs and simple kits can all help to detect counterfeits quickly and cheaply. Patients and pharmacists can use these technologies to make sure that the medicines they buy are genuine. These tools can pick out the worst offenders — but to make the drug supply safe, there's no substitute for regulation.
Three opinion articles give different perspectives on the major challenges and successes of preventing the trade in counterfeit drugs.
Leena Menghaney, project manager for Médecins Sans Frontières' Campaign for Access to Essential Medicines in New Delhi, India, argues that initiatives set up to fight counterfeit drugs are on the wrong track and should refocus on poor-quality medicines. She says the legal definition of 'counterfeits' is a threat to the legitimate trade in generic medicines that happen to resemble trademarked ones, and diverts attention from substandard drugs.
But Aline Plançon of Interpol, based in Paris, France, who heads an anti-counterfeiting unit that works closely with the WHO, describes how law enforcement operations have successfully intercepted large volumes of counterfeit drugs. Criminals are adept at exploiting loopholes in health systems, she says, so cooperation between countries and stakeholders is essential.
Charles Delacollette, coordinator of the Mekong Malaria Programme in Bangkok, Thailand, says that both counterfeit and substandard drugs are fuelling the emergence of resistance to antimalarial drugs in the Mekong region. He describes efforts to gather evidence about the problem and strengthen capacity for detection and surveillance. But developing countries need more support to build on current efforts to tackle the trade and document good results.

Effective partnerships
This collection of articles makes clear that there are no quick fixes or easy solutions. Thwarting the trade in counterfeit drugs will take a mix of measures to help developing countries mount a lasting response.
New technologies are helping. But counterfeiters waste no time in finding ways around new protection procedures.
A large group of organisations have enlisted in the fight against counterfeits, from law enforcement agencies to health and medical organisations and nongovernmental organisations.
Also involved are pharmaceutical companies, for which counterfeit medicines can mean not only a loss of income, but also a loss of reputation if the counterfeits cause substantial damage.
But drug manufacturers are coming under fire, accused of pushing anti-counterfeiting initiatives that also threaten the supply of generic drugs in the developing world. To counter these claims, they must join forces with other groups to refine the definition of counterfeits and improve technologies to target the right drugs.
Collaboration is the name of the game here. As these articles show, a significant amount is already taking place. But more needs to be done.
Effective partnerships between national and international organisations will allow developing countries to build robust capacities for good manufacturing, regulation of the drug supply, and detection of counterfeits.
This can reduce their reliance on global agencies and help tackle the trade in medicines of poor quality, whether they are fake or substandard.

David Dickson, Director; Anita Makri, Commissioning editor : SciDev.Net
This article is part of a Spotlight on Detecting counterfeit drugs.
http://www.scidev.net/en/health/detecting-counterfeit-drugs/editorials/tackling-fake-drugs-needs-technology-and-collaboration-1.html

MALARIA: Counterfeit drugs: Facts & figures

Priya Shetty: 30 March 2011

Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.


 Flickr/Pranjal Mahna
At least a third of medicines available in some parts of the developing world could be fake

Priya Shetty explores the tools and partnerships that help the public health community counter the threat of counterfeit medicines.
Counterfeiting is as old as industrialisation. For as long as the idea of intellectual property or branding has existed, counterfeiters have schemed to cheaply mimic products for profit.
Far from being merely a nuisance, counterfeit medicines can cause serious illness and even death.
The trade in counterfeit drugs has grown into a global industry worth billions of dollars, targeting mostly developing countries [see Table 1]. The World Health Organization (WHO) estimates that 10–30 per cent of the medicines on sale could be fake in the developing world; the proportion is probably higher in some parts of Africa, Asia and Latin America. [2]
But public health experts believe poor regulatory and surveillance systems in the developing world mean the problem is even more widespread than it seems. This has spurred the global health community into action, with agencies including the WHO and Interpol launching initiatives to fight drug counterfeiting.

A key challenge in tackling counterfeiting lies in subtle differences between fake and substandard drugs. [3]
Many fake medicines are dummies deliberately created to resemble genuine drugs. Often they are utterly devoid of any active ingredient — but sometimes they may contain harmful or poisonous chemicals.
Substandard drugs do have some medicinal value, but may contain far lower doses of the active ingredient than they should. They are usually the product of negligent manufacturing and poor quality control rather than malicious criminal activity.
But both fake and substandard drugs have an immediate impact on patients who don't receive the treatment they need. And more so in the case of substandard medicines, they can also have the disastrous side-effect of increasing resistance to treatment for serious diseases.
For instance, if a patient with malaria takes antimalarial drugs that contain a weak dose of the active ingredient, the malaria parasite will only be partially cleared from the body. The parasites that remain will be those that have resisted the drug. When these multiply and go on to infect new individuals, drug resistance spreads.
To complicate matters further, legal definitions of counterfeit medicines are often so broad that they include generic drugs. [4] Generics are non-brand versions of pharmaceutical drugs that are produced cheaply either after the brand exclusivity has expired, or through special licensing laws. Millions of people rely on inexpensive generic drugs to fight potentially fatal diseases such as malaria or HIV/AIDS. Counterfeiting laws that blur the boundary with these essential drugs can seriously threaten access to life-saving medicines.

Why is counterfeiting flourishing?
There are several reasons why counterfeit drugs are most common in developing countries.
Many rural areas have few pharmacies or health clinics, and the ones that exist are often open only irregularly. Many people buy drugs in non-regulated outlets, such as markets, which are more likely to trade in counterfeits.
Fake drugs are often sold more cheaply, appealing to poor people for whom cost is a huge barrier to the healthcare they need. And often, both stolen and 'knock-off' goods are widely and openly sold in markets in countries such as Thailand — so counterfeit drugs may be mistaken for stolen, and therefore cheap, genuine medicines.
The dismally poor legislative and regulatory framework monitoring drug quality and sale in developing countries also allows counterfeiting to thrive. Even when counterfeiters are caught, the penalties tend to be far lower than for smuggling heroin or cocaine, for instance. [5]
Meanwhile, globalisation eases the way for counterfeiting, spreading distribution networks and making them more complex. As a result, drugs are harder to track. And it is no surprise that the Internet has made selling counterfeit drugs far easier, both in developed and developing nations. The European Alliance for Access to Safe Medicines suggests that over 60 per cent of prescription medicines sold through the Internet are fakes. Advances in technology have also made high-quality labels and packaging relatively easy to produce, and pharmaceutical chemicals cheap to mass-produce.

How to spot a counterfeit
There are sometimes very obvious telltale signs of counterfeiting — faulty spelling, for example, incorrect packaging or tablet size.
Yet counterfeiters are fast becoming better at replicating genuine drugs correctly, and are increasingly sophisticated when mimicking specific anti-counterfeit measures such as brand logos. This has pushed manufacturers to enhance anti-counterfeit technology
Medicines can be marked in ways that make it easy even for consumers to identify fakes. For instance, packets and bottles can have tamper-evident seals. And like banknotes and credit cards, medicines can be marked with embossed graphics, or holograms — security inks that change in colour according to the angle they are viewed at.

Invisible markings
These are usually identifiable only to the supplier or distributor, not the consumer. They make use of invisible inks that can be detected in UV light, digital watermarks that encode data in graphics, anti-scan designs that reveal a watermark when copied, or inks imbued with specific micro-encapsulated odours.

Forensic labelling
Manufactures can use 'lock and key' systems, applying specific biological or chemical tags, such as DNA, that are not detectable by standard analysis and can only be revealed by specific reagents. Other forms of tagging can include silicon dioxide micro or nano tags, applied to the surface of a pill, that emit a unique light signature.

Track and trace labelling
In this system, each pharmaceutical package is uniquely labelled either with a barcode or some other non-sequential unique number. The label should then be read at the final point in the supply chain, when a pharmacist dispenses medicines to a consumer. This helps to ensure drugs are genuine and not past their expiration date. A more complex system is radio frequency identity (RFID) tagging, in which the tag is an antenna with a microchip. This means that the data can be read at a greater distance and do not need to be scanned like a barcode.

Who is fighting the counterfeit trade?
In 2006, the WHO set up the International Medical Products Anti-Counterfeiting Taskforce (IMPACT). This Taskforce has been leading international action, offering guidance on how to strengthen legislative and regulatory frameworks. Through IMPACT, the WHO has joined forces with regulatory agencies such as Interpol (panel 2) to uncover counterfeit operations.
In 2010, Operation Pangea III, coordinated by Interpol and IMPACT, collated data from 45 participating countries and uncovered a vast network of counterfeit drug sales on the Internet. The operation revealed 694 websites engaged in illegal activity, 290 of which have now been shut down.
Customs seized over 1 million counterfeit pills worth a total of US$2.6 million. These pills included antibiotics, steroids, anti-cancer, anti-depression and anti-epileptic pills, as well as slimming or food supplement tablets.
This success followed on from Operation Storm II, carried out earlier in 2010, which targeted eight countries across South-East Asia: Cambodia, China, Indonesia, Laos, Myanmar, Singapore, Thailand and Vietnam. That led to the seizure of 20 million fake medicines including antibiotics, anti-malarial and birth control tablets, anti-tetanus serums, aspirin and erectile dysfunction drugs. Over 100 pharmacies and illicit drug outlets were shut down.
The Medicines Transparency Alliance (MeTA) — launched in 2008 with support from the UK Department for International Development (DFID), the WHO and the World Bank — has set up multi-stakeholder forums to examine every aspect of the medicines supply chain in seven pilot countries: Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia.
Counterfeiting seriously infringes on intellectual property, and since patents for medicines tend to be held by drug manufacturers, they are heavily involved in fighting the trade in fake drugs.
In some cases, the only way to detect a counterfeit drug is through chemical analysis. Since the pharmaceutical industry has a vested interest in quickly detecting fake drugs, several companies have sent mini-labs around countries in Africa and Asia (especially China) to assess the quality and ingredients in drugs.
The pharmaceuticals industry has also formed an alliance called the Pharmaceutical Security Institute (PSI), which counts 21 R&D-focused drug manufacturers as members. PSI works with the WHO and Interpol to exchange information on counterfeiting operations.
The problem is that strict anti-counterfeiting operations and vague legislation tend to target essential generics too.
Some scientists are very concerned about a new treaty to combat counterfeit drugs, the Council of Europe's Medicrime Convention. Signed in December 2010, this treaty criminalises the manufacture and trade in counterfeit medicines and contains a definition of counterfeiting so broad that most generics could come under its banner. [8]
To fight counterfeit medicines effectively, governments will need to focus on a few key areas.
The foremost of these is inter-country collaboration, since much of the trade in fake drugs occurs across national borders. Pharmacies, hospitals and other points in the supply chain need to keep lines of communication open and to exchange information.
And the entire medical supply chain will need to be tightened to eliminate loopholes in surveillance and monitoring. Legislation will also need to be updated and clarified to keep pace with the scale of the problem, and to provide a sufficient deterrent to criminal activity.
Finally, the global health community and national governments will need to engage with consumers so that patients understand the importance of buying medicines through regulated outlets.
But for any of these initiatives against counterfeit drugs to work, countries need a strong dose of political will — enough to strengthen the legal regulatory framework, improve education and invest in technologies that can detect counterfeit drugs and prevent further damage to public health.
http://www.scidev.net/en/health/detecting-counterfeit-drugs/features/counterfeit-drugs-facts-figures-1.html

POVERTY: CAMBODIA: Rural poor most at risk from rabies

 Photo: Contributor/IRIN:
Hundreds of people die of rabies in rural Cambodia

KAMPOT, 1 April 2011 (IRIN) - Yinn Siet, 65, recalls in horror when a snarling dog bit her husband four years ago. Before he died, the farmer hallucinated and convulsed. “He barked like a dog,” she said. “We put a chain on him and locked him up.”
He had contracted rabies, a virus that kills nearly all victims who develop symptoms.
Yinn could not afford to bring her husband to the capital Phnom Penh, the only city in Cambodia that has a centre offering free treatment.
Even if she had, it would have been too late.
He left behind his family of seven, who are struggling to make ends meet through farming.
Cambodians in the countryside have little access to treatment for rabies, a preventable disease that disproportionately affects the rural young and poor.
If dog-bite victims do not seek immediate treatment, they are likely to die. The virus is untreatable after symptoms appear, which can be anything from 10 days to a year after being bitten.
“The loss of a family member to rabies has a profound psychological impact on the family,” said Deborah Briggs, head of the Global Alliance for Rabies Control, a US-based NGO. “The disease is frightening and it is devastating to watch a loved one die.” In 2007, the most recent year data are available, 810 human rabies deaths may have occurred in Cambodia, says a study in Neglected Tropical Diseases, a science journal.
The number is only an estimate. Hundreds of cases in the countryside go unreported, because patients are rarely hospitalized and tend to die at home.
The estimated rabies mortality for 2007 exceeded that of malaria (240 deaths) and dengue fever (400 deaths), the study said.
The report concluded that free post-exposure prophylaxis, an injection after a bite that prevents infection, is really only relevant for residents of Phnom Penh. Injections must be administered promptly, usually within 10 days of an infection.
The Pasteur Institute, a non-profit medical research and treatment centre in Phnom Penh, is the only institution in Cambodia offering free post-exposure treatments.
The rural poor often cannot afford lengthy and expensive visits to the capital and therefore miss out on the free treatment.
“We see maybe five patients per year who arrive with symptoms,” says Philippe Buchy, head of the virology unit at the Pasteur Institute, “and the only thing we can do is to send them to Calmette Hospital where they will die after few days.”
The fact that poor people are most susceptible to rabies means campaigns against the virus tend to be given lower priority, said François-Xavier Meslin, the Geneva-based team leader for neglected zoonotic diseases at the World Health Organization (WHO).

Epidemiology
Warm-blooded mammals, mostly dogs, spread the virus through bites, scratches, and licks on open wounds.
Typically between 10 days and a year after exposure, patients experience insomnia, headaches, a fever, and twitching around their wound.
Two to 10 days after those first signs appear, they hallucinate, have seizures, become fearful at the sight of water and experience paralysis. Most rabies patients die from respiratory failure.
Each year, about 55,000 people around the world die from rabies. More than 80 percent of cases are in Asia, according to WHO, which says half of all human rabies deaths occur in children under 15.
“Every one of those deaths could have been prevented as we have the vaccines… available to save their lives before clinical signs begin,” Briggs told IRIN.
In Bali, Indonesia, authorities culled 100,000 dogs to prevent the spread of rabies by shooting poison blow darts at them, but the authorities halted this policy last September in favour of a mass inoculation programme of 400,000 dogs (70 percent of the island’s dog population).

WHO’s Meslin does not advocate killing dogs because it is “inhumane,” he told IRIN.

In Cambodia, the Pasteur Institute recommends setting up a national rabies control programme to improve disease surveillance and access to treatment. It also recommends starting vaccination campaigns for dogs.
http://www.irinnews.org/report.aspx?reportID=92334

MALARIA: symptoms in pregnant women in Benin

Background
It is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to malaria and when infected they present few or no symptoms. However, longitudinal cohort studies investigating the clinical presentation of malaria infection in pregnant women in stable endemic areas are lacking, and the few studies exploring this issue are unconclusive.

Methods
A prospective cohort of women followed monthly during pregnancy was conducted in three rural dispensaries in Benin from August 2008 to September 2010. The presence of symptoms suggestive of malaria infection in 982 women during antenatal visits (ANV), unscheduled visits and delivery were analysed. A multivariate logistic regression was used to determine the association between symptoms and a positive thick blood smear (TBS).

Results
During routine ANVs, headache was the only symptom associated with a higher risk of positive TBS (aOR=1.9; p<0.001). On the occasion of unscheduled visits, fever (aOR=5.2; p<0.001), headache (aOR=2.1; p=0.004) and shivering (aOR=3.1; p<0.001) were significantly associated with a malaria infection and almost 90% of infected women presented at least one of these symptoms. Two thirds of symptomatic malaria infections during unscheduled visits occurred in late pregnancy and long after the last intermittent preventive treatment dose (IPTp).

Conclusion
The majority of pregnant women were symptomless during routine visits when infected with malaria in an endemic stable area. The only suggestive sign of malaria (fever) was associated with malaria only on the occasion of unscheduled visits. The prevention of malaria in pregnancy could be improved by reassessing the design of IPTp, i.e. by determining an optimal number of doses and time of administration of anti-malarial drugs
http://www.malariajournal.com/content/10/1/72

MALARIA: Tanzania: national campaign to distribute nine million free LLINs

Background
After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidized insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania.

Methods
The ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Government contractors trained and facilitated local government officials to supervise village-level volunteers on a registration of all U5s and the distribution and issuing of LLINs. The registration results formed the basis for the LLIN order and delivery to village level. Caregivers brought their registration coupons to village issuing posts during a three-day period where they received LLINs for their U5s. Household surveys in five districts assessed ITN ownership and use after the campaign.

Results
Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles / malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions.

Conclusion
A national-level LLIN distribution strategy that fully engaged local government authorities helped avoid additional burden on the healthcare system. Distribution costs per net were comparable to other public health interventions. Particularly among rural residents, ITN ownership and use increased significantly for the intended beneficiaries. The upcoming universal LLIN distribution and further behaviour change communication will further improve ITN ownership and use in 2010-2011.
http://www.malariajournal.com/content/10/1/73

POVERTY: NAMIBIA: Floods cause an emergency

 Photo: Jaspreet Kindra/IRIN; Flooding in January 2010

JOHANNESBURG, 1 April 2011 (IRIN) - Namibia has declared a state of emergency in response to widescale flooding in the north that has claimed 62 lives since January 2011.
"The most severe flooding is occurring in the regions of Oshana, Ohangwena, Omusati and Oshikoto, which form the Cuvelai Basin," said a situation report by the Office of the UN Resident Coordinator on 30 March 2011.
The Cuvelai Basin, in northern Namibia, is one of the country's most densely populated regions, as well as one of its poorest.
"However, surrounding areas are also being affected, specifically Caprivi and Kavango. An estimated 62 people have died. In Oshakati town, in Oshana region, an estimated 5,000 people are already being housed in relocation sites, and this number is increasing," the report noted.
"Following weeks of heavy rain, water levels in northern Namibia are already 30cm to 40cm higher than they were in 2009, when a flood emergency was also declared."
The Namibia Meteorological Service has forecast more rain for the central and northern parts of the country next week, and the situation is expected to be compounded by "a new flood wave" approaching the Cuvelai Basin, beginning on 1 April.
The government has set aside about US$4.4 million for its response to the floods, but allocation of the funds has not yet been decided.
The International Federation of the Red Cross (IFRC) has sourced US$328,000 from its Disaster Relief Emergency Fund (DREF) to support the local Red Cross in providing "assistance to 2,000 families in the northern regions of Caprivi, Kavango, Ohangwena, Omusati and Oshana, as well as in the southern region of Karas, which was affected by flooding earlier in the season," the report said.
Preliminary assessments showed that the priority requirements were food, shelter, transport and education. Over 100,000 learners in 324 schools were affected by flooding, of which 163 were closed, and 22 health clinics were either submerged or completely surrounded by water.

Southern Africa
In the past few months many countries in the region have been afflicted by flooding. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) noted in its Southern Africa flood and cyclone update on 30 March 2011 that according to media reports, the Cunene provincial government, in southern Angola, was airlifting medical supplies to areas cut off by floodwater.
"The government has also started building dykes and hydraulic systems around Ondjiva [capital of Cunene Province] to ensure that the flooding that has affected the city for three successive rainfall seasons does not recur," the OCHA update said.
Flooding in Angola has caused the deaths of 113 people in 2011, displaced about 35,000 people and destroyed nearly 5,000 homes, OCHA said.
Recent floods in South Africa killed 91 people, and 34 died in Madagascar, mainly in the flooding caused by Cyclone Bingiza, which struck the Indian Ocean island on 14 February 2011.
In contrast, parts of Zimbabwe have suffered an unseasonal dry spell that is expected to have a severe impact on the food insecure country's main harvest, which starts in April.
http://www.irinnews.org/report.aspx?reportID=92343