Monday, 2 May 2011

POVERTY: More Than 1 Billion People Are Hungry in the World


ABHIJIT BANERJEE, ESTHER DUFLO : MAY/JUNE 2011

For many in the West, poverty is almost synonymous with hunger. Indeed, the announcement by the United Nations Food and Agriculture Organization in 2009 that more than 1 billion people are suffering from hunger grabbed headlines in a way that any number of World Bank estimates of how many poor people live on less than a dollar a day never did.


But is it really true? Are there really more than a billion people going to bed hungry each night? Our research on this question has taken us to rural villages and teeming urban slums around the world, collecting data and speaking with poor people about what they eat and what else they buy, from Morocco to Kenya, Indonesia to India. We've also tapped into a wealth of insights from our academic colleagues. What we've found is that the story of hunger, and of poverty more broadly, is far more complex than any one statistic or grand theory; it is a world where those without enough to eat may save up to buy a TV instead, where more money doesn't necessarily translate into more food, and where making rice cheaper can sometimes even lead people to buy less rice.
But unfortunately, this is not always the world as the experts view it. All too many of them still promote sweeping, ideological solutions to problems that defy one-size-fits-all answers, arguing over foreign aid, for example, while the facts on the ground bear little resemblance to the fierce policy battles they wage.
Jeffrey Sachs, an advisor to the United Nations and director of Columbia University's Earth Institute, is one such expert. In books and countless speeches and television appearances, he has argued that poor countries are poor because they are hot, infertile, malaria-infested, and often landlocked; these factors, however, make it hard for them to be productive without an initial large investment to help them deal with such endemic problems. But they cannot pay for the investments precisely because they are poor -- they are in what economists call a "poverty trap." Until something is done about these problems, neither free markets nor democracy will do very much for them.
But then there are others, equally vocal, who believe that all of Sachs's answers are wrong. William Easterly, who battles Sachs from New York University at the other end of Manhattan, has become one of the most influential aid critics in his books, The Elusive Quest for Growth and The White Man's Burden. Dambisa Moyo, an economist who worked at Goldman Sachs and the World Bank, has joined her voice to Easterly's with her recent book, Dead Aid. Both argue that aid does more bad than good. It prevents people from searching for their own solutions, while corrupting and undermining local institutions and creating a self-perpetuating lobby of aid agencies. The best bet for poor countries, they argue, is to rely on one simple idea: When markets are free and the incentives are right, people can find ways to solve their problems. They do not need handouts from foreigners or their own governments. In this sense, the aid pessimists are actually quite optimistic about the way the world works. According to Easterly, there is no such thing as a poverty trap.
This debate cannot be solved in the abstract. To find out whether there are in fact poverty traps, and, if so, where they are and how to help the poor get out of them, we need to better understand the concrete problems they face. Some aid programs help more than others, but which ones? Finding out required us to step out of the office and look more carefully at the world. In 2003, we founded what became the Abdul Latif Jameel Poverty Action Lab, or J-PAL. A key part of our mission is to research by using randomized control trials -- similar to experiments used in medicine to test the effectiveness of a drug -- to understand what works and what doesn't in the real-world fight against poverty. In practical terms, that meant we'd have to start understanding how the poor really live their lives.
Take, for example, Pak Solhin, who lives in a small village in West Java, Indonesia. He once explained to us exactly how a poverty trap worked. His parents used to have a bit of land, but they also had 13 children and had to build so many houses for each of them and their families that there was no land left for cultivation. Pak Solhin had been working as a casual agricultural worker, which paid up to 10,000 rupiah per day (about $2) for work in the fields. A recent hike in fertilizer and fuel prices, however, had forced farmers to economize. The local farmers decided not to cut wages, Pak Solhin told us, but to stop hiring workers instead. As a result, in the two months before we met him in 2008, he had not found a single day of agricultural labor. He was too weak for the most physical work, too inexperienced for more skilled labor, and, at 40, too old to be an apprentice. No one would hire him.
Pak Solhin, his wife, and their three children took drastic steps to survive. His wife left for Jakarta, some 80 miles away, where she found a job as a maid. But she did not earn enough to feed the children. The oldest son, a good student, dropped out of school at 12 and started as an apprentice on a construction site. The two younger children were sent to live with their grandparents. Pak Solhin himself survived on the roughly 9 pounds of subsidized rice he got every week from the government and on fish he caught at a nearby lake. His brother fed him once in a while. In the week before we last spoke with him, he had eaten two meals a day for four days, and just one for the other three.
Pak Solhin appeared to be out of options, and he clearly attributed his problem to a lack of food. As he saw it, farmers weren't interested in hiring him because they feared they couldn't pay him enough to avoid starvation; and if he was starving, he would be useless in the field. What he described was the classic nutrition-based poverty trap, as it is known in the academic world. The idea is simple: The human body needs a certain number of calories just to survive. So when someone is very poor, all the food he or she can afford is barely enough to allow for going through the motions of living and earning the meager income used to buy that food. But as people get richer, they can buy more food and that extra food goes into building strength, allowing people to produce much more than they need to eat merely to stay alive. This creates a link between income today and income tomorrow: The very poor earn less than they need to be able to do significant work, but those who have enough to eat can work even more. There's the poverty trap: The poor get poorer, and the rich get richer and eat even better, and get stronger and even richer, and the gap keeps increasing.
But though Pak Solhin's explanation of how someone might get trapped in starvation was perfectly logical, there was something vaguely troubling about his narrative. We met him not in war-infested Sudan or in a flooded area of Bangladesh, but in a village in prosperous Java, where, even after the increase in food prices in 2007 and 2008, there was clearly plenty of food available and a basic meal did not cost much. He was still eating enough to survive; why wouldn't someone be willing to offer him the extra bit of nutrition that would make him productive in return for a full day's work? More generally, although a hunger-based poverty trap is certainly a logical possibility, is it really relevant for most poor people today? What's the best way, if any, for the world to help?
THE INTERNATIONAL COMMUNITY has certainly bought into the idea that poverty traps exist -- and that they are the reason that millions are starving. The first U.N. Millennium Development Goal, for instance, is to "eradicate extreme poverty and hunger." In many countries, the definition of poverty itself has been connected to food; the thresholds for determining that someone was poor were originally calculated as the budget necessary to buy a certain number of calories, plus some other indispensable purchases, such as housing. A "poor" person has essentially been classified as someone without enough to eat.
So it is no surprise that government efforts to help the poor are largely based on the idea that the poor desperately need food and that quantity is what matters. Food subsidies are ubiquitous in the Middle East: Egypt spent $3.8 billion on food subsidies in the 2008 fiscal year, some 2 percent of its GDP. Indonesia distributes subsidized rice. Many states in India have a similar program. In the state of Orissa, for example, the poor are entitled to 55 pounds of rice a month at about 1 rupee per pound, less than 20 percent of the market price. Currently, the Indian Parliament is debating a Right to Food Act, which would allow people to sue the government if they are starving. Delivering such food aid is a logistical nightmare. In India it is estimated that more than half of the wheat and one-third of the rice gets "lost" along the way. To support direct food aid in this circumstance, one would have to be quite convinced that what the poor need more than anything is more grain.
But what if the poor are not, in general, eating too little food? What if, instead, they are eating the wrong kinds of food, depriving them of nutrients needed to be successful, healthy adults? What if the poor aren't starving, but choosing to spend their money on other priorities? Development experts and policymakers would have to completely reimagine the way they think about hunger. And governments and aid agencies would need to stop pouring money into failed programs and focus instead on finding new ways to truly improve the lives of the world's poorest.
Consider India, one of the great puzzles in this age of food crises. The standard media story about the country, at least when it comes to food, is about the rapid rise of obesity and diabetes as the urban upper-middle class gets richer. Yet the real story of nutrition in India over the last quarter-century, as Princeton professor Angus Deaton and Jean Drèze, a professor at Allahabad University and a special advisor to the Indian government, have shown, is not that Indians are becoming fatter: It is that they are in fact eating less and less. Despite the country's rapid economic growth, per capita calorie consumption in India has declined; moreover, the consumption of all other nutrients except fat also appears to have gone down among all groups, even the poorest. Today, more than three-quarters of the population live in households whose per capita calorie consumption is less than 2,100 calories in urban areas and 2,400 in rural areas -- numbers that are often cited as "minimum requirements" in India for those engaged in manual labor. Richer people still eat more than poorer people. But at all levels of income, the share of the budget devoted to food has declined and people consume fewer calories.
What is going on? The change is not driven by declining incomes; by all accounts, Indians are making more money than ever before. Nor is it because of rising food prices -- between the early 1980s and 2005, food prices declined relative to the prices of other things, both in rural and urban India. Although food prices have increased again since 2005, Indians began eating less precisely when the price of food was going down.
So the poor, even those whom the FAO would classify as hungry on the basis of what they eat, do not seem to want to eat much more even when they can. Indeed, they seem to be eating less. What could explain this? Well, to start, let's assume that the poor know what they are doing. After all, they are the ones who eat and work. If they could be tremendously more productive and earn much more by eating more, then they probably would. So could it be that eating more doesn't actually make us particularly more productive, and as a result, there is no nutrition-based poverty trap?
One reason the poverty trap might not exist is that most people have enough to eat. We live in a world today that is theoretically capable of feeding every person on the planet. In 1996, the FAO estimated that world food production was enough to provide at least 2,700 calories per person per day. Starvation still exists, but only as a result of the way food gets shared among us. There is no absolute scarcity. Using price data from the Philippines, we calculated the cost of the cheapest diet sufficient to give 2,400 calories. It would cost only about 21 cents a day, very affordable even for the very poor (the worldwide poverty line is set at roughly a dollar per day). The catch is, it would involve eating only bananas and eggs, something no one would like to do day in, day out. But so long as people are prepared to eat bananas and eggs when they need to, we should find very few people stuck in poverty because they do not get enough to eat. Indian surveys bear this out: The percentage of people who say they do not have enough food has dropped dramatically over time, from 17 percent in 1983 to 2 percent in 2004. So, perhaps people eat less because they are less hungry.
And perhaps they are really less hungry, despite eating fewer calories. It could be that because of improvements in water and sanitation, they are leaking fewer calories in bouts of diarrhea and other ailments. Or maybe they are less hungry because of the decline of heavy physical work. With the availability of drinking water in villages, women do not need to carry heavy loads for long distances; improvements in transportation have reduced the need to travel on foot; in even the poorest villages, flour is now milled using a motorized mill, instead of women grinding it by hand. Using the average calorie requirements calculated by the Indian Council of Medical Research, Deaton and Drèze note that the decline in calorie consumption over the last quarter-century could be entirely explained by a modest decrease in the number of people engaged in heavy physical work.
Beyond India, one hidden assumption in our description of the poverty trap is that the poor eat as much as they can. If there is any chance that by eating a bit more the poor could start doing meaningful work and get out of the poverty trap zone, then they should eat as much as possible. Yet most people living on less than a dollar a day do not seem to act as if they are starving. If they were, surely they would put every available penny into buying more calories. But they do not. In an 18-country data set we assembled on the lives of the poor, food represents 36 to 79 percent of consumption among the rural extremely poor, and 53 to 74 percent among their urban counterparts.
It is not because they spend all the rest on other necessities. In Udaipur, India, for example, we find that the typical poor household could spend up to 30 percent more on food, if it completely cut expenditures on alcohol, tobacco, and festivals. The poor seem to have many choices, and they don't choose to spend as much as they can on food. Equally remarkable is that even the money that people do spend on food is not spent to maximize the intake of calories or micronutrients. Studies have shown that when very poor people get a chance to spend a little bit more on food, they don't put everything into getting more calories. Instead, they buy better-tasting, more expensive calories.
In one study conducted in two regions of China, researchers offered randomly selected poor households a large subsidy on the price of the basic staple (wheat noodles in one region, rice in the other). We usually expect that when the price of something goes down, people buy more of it. The opposite happened. Households that received subsidies for rice or wheat consumed less of those two foods and ate more shrimp and meat, even though their staples now cost less. Overall, the caloric intake of those who received the subsidy did not increase (and may even have decreased), despite the fact that their purchasing power had increased. Nor did the nutritional content improve in any other sense. The likely reason is that because the rice and wheat noodles were cheap but not particularly tasty, feeling richer might actually have made them consume less of those staples. This reasoning suggests that at least among these very poor urban households, getting more calories was not a priority: Getting better-tasting ones was.
All told, many poor people might eat fewer calories than we -- or the FAO -- think is appropriate. But this does not seem to be because they have no other choice; rather, they are not hungry enough to seize every opportunity to eat more. So perhaps there aren't a billion "hungry" people in the world after all.
NONE OF THIS IS TO SAY that the logic of the hunger-based poverty trap is flawed. The idea that better nutrition would propel someone on the path to prosperity was almost surely very important at some point in history, and it may still be today. Nobel Prize-winning economic historian Robert Fogel calculated that in Europe during the Middle Ages and the Renaissance, food production did not provide enough calories to sustain a full working population. This could explain why there were large numbers of beggars -- they were literally incapable of any work. The pressure of just getting enough food to survive seems to have driven some people to take rather extreme steps. There was an epidemic of witch killing in Europe during the Little Ice Age (from the mid-1500s to 1800), when crop failures were common and fish was less abundant. Even today, Tanzania experiences a rash of such killings whenever there is a drought -- a convenient way to get rid of an unproductive mouth to feed at times when resources are very tight. Families, it seems, suddenly discover that an older woman living with them (usually a grandmother) is a witch, after which she gets chased away or killed by others in the village.
But the world we live in today is for the most part too rich for the occasional lack of food to be a big part of the story of the persistence of poverty on a large scale. This is of course different during natural or man-made disasters, or in famines that kill and weaken millions. As Nobel laureate Amartya Sen has shown, most recent famines have been caused not because food wasn't available but because of bad governance -- institutional failures that led to poor distribution of the available food, or even hoarding and storage in the face of starvation elsewhere. As Sen put it, "No substantial famine has ever occurred in any independent and democratic country with a relatively free press."
Should we let it rest there, then? Can we assume that the poor, though they may be eating little, do eat as much as they need to?
That also does not seem plausible. While Indians may prefer to buy things other than food as they get richer, they and their children are certainly not well nourished by any objective standard. Anemia is rampant; body-mass indices are some of the lowest in the world; almost half of children under 5 are much too short for their age, and one-fifth are so skinny that they are considered to be "wasted."
And this is not without consequences. There is a lot of evidence that children suffering from malnutrition generally grow into less successful adults. In Kenya, children who were given deworming pills in school for two years went to school longer and earned, as young adults, 20 percent more than children in comparable schools who received deworming for just one year. Worms contribute to anemia and general malnutrition, essentially because they compete with the child for nutrients. And the negative impact of undernutrition starts before birth. In Tanzania, to cite just one example, children born to mothers who received sufficient amounts of iodine during pregnancy completed between one-third and one-half of a year more schooling than their siblings who were in utero when their mothers weren't being treated. It is a substantial increase, given that most of these children will complete only four or five years of schooling in total. In fact, the study concludes that if every mother took iodine capsules, there would be a 7.5 percent increase in the total educational attainment of children in Central and Southern Africa. This, in turn, could measurably affect lifetime productivity.
Better nutrition matters for adults, too. In another study, in Indonesia, researchers tested the effects of boosting people's intake of iron, a key nutrient that prevents anemia. They found that iron supplements made men able to work harder and significantly boosted income. A year's supply of iron-fortified fish sauce cost the equivalent of $6, and for a self-employed male, the yearly gain in earnings was nearly $40 -- an excellent investment.
If the gains are so obvious, why don't the poor eat better? Eating well doesn't have to be prohibitively expensive. Most mothers could surely afford iodized salt, which is now standard in many parts of the world, or one dose of iodine every two years (at 51 cents per dose). Poor households could easily get a lot more calories and other nutrients by spending less on expensive grains (like rice and wheat), sugar, and processed foods, and more on leafy vegetables and coarse grains. But in Kenya, when the NGO that was running the deworming program asked parents in some schools to pay a few cents for deworming their children, almost all refused, thus depriving their children of hundreds of dollars of extra earnings over their lifetime.
Why? And why did anemic Indonesian workers not buy iron-fortified fish sauce on their own? One answer is that they don't believe it will matter -- their employers may not realize that they are more productive now. (In fact, in Indonesia, earnings improved only for the self-employed workers.) But this does not explain why all pregnant women in India aren't using only iodine-fortified salt, which is now available in every village. Another possibility is that people may not realize the value of feeding themselves and their children better -- not everyone has the right information, even in the United States. Moreover, people tend to be suspicious of outsiders who tell them that they should change their diet. When rice prices went up sharply in 1966 and 1967, the chief minister of West Bengal suggested that eating less rice and more vegetables would be both good for people's health and easier on their budgets. This set off a flurry of outrage, and the chief minister was greeted by protesters bearing garlands of vegetables wherever he went.
It is simply not very easy to learn about the value of many of these nutrients based on personal experience. Iodine might make your children smarter, but the difference is not huge, and in most cases you will not find out either way for many years. Iron, even if it makes people stronger, does not suddenly turn you into a superhero. The $40 extra a year the self-employed man earned may not even have been apparent to him, given the many ups and downs of his weekly income.
So it shouldn't surprise us that the poor choose their foods not mainly for their cheap prices and nutritional value, but for how good they taste. George Orwell, in his masterful description of the life of poor British workers in The Road to Wigan Pier, observes:
The basis of their diet, therefore, is white bread and margarine, corned beef, sugared tea and potatoes -- an appalling diet. Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn't.… When you are unemployed … you don't want to eat dull wholesome food. You want something a little bit "tasty." There is always some cheaply pleasant thing to tempt you.
The poor often resist the wonderful plans we think up for them because they do not share our faith that those plans work, or work as well as we claim. We shouldn't forget, too, that other things may be more important in their lives than food. Poor people in the developing world spend large amounts on weddings, dowries, and christenings. Part of the reason is probably that they don't want to lose face, when the social custom is to spend a lot on those occasions. In South Africa, poor families often spend so lavishly on funerals that they skimp on food for months afterward.
And don't underestimate the power of factors like boredom. Life can be quite dull in a village. There is no movie theater, no concert hall. And not a lot of work, either. In rural Morocco, Oucha Mbarbk and his two neighbors told us they had worked about 70 days in agriculture and about 30 days in construction that year. Otherwise, they took care of their cattle and waited for jobs to materialize. All three men lived in small houses without water or sanitation. They struggled to find enough money to give their children a good education. But they each had a television, a parabolic antenna, a DVD player, and a cell phone.
This is something that Orwell captured as well, when he described how poor families survived the Depression:
Instead of raging against their destiny they have made things tolerable by reducing their standards.
But they don't necessarily lower their standards by cutting out luxuries and concentrating on necessities; more often it is the other way around -- the more natural way, if you come to think of it. Hence the fact that in a decade of unparalleled depression, the consumption of all cheap luxuries has increased.
These "indulgences" are not the impulsive purchases of people who are not thinking hard about what they are doing. Oucha Mbarbk did not buy his TV on credit -- he saved up over many months to scrape enough money together, just as the mother in India starts saving for her young daughter's wedding by buying a small piece of jewelry here and a stainless-steel bucket there.
We often see the world of the poor as a land of missed opportunities and wonder why they don't invest in what would really make their lives better. But the poor may well be more skeptical about supposed opportunities and the possibility of any radical change in their lives. They often behave as if they think that any change that is significant enough to be worth sacrificing for will simply take too long. This could explain why they focus on the here and now, on living their lives as pleasantly as possible and celebrating when occasion demands it.
We asked Oucha Mbarbk what he would do if he had more money. He said he would buy more food. Then we asked him what he would do if he had even more money. He said he would buy better-tasting food. We were starting to feel very bad for him and his family, when we noticed the TV and other high-tech gadgets. Why had he bought all these things if he felt the family did not have enough to eat? He laughed, and said, "Oh, but television is more important than food!"
http://www.foreignpolicy.com/articles/2011/04/25/more_than_1_billion_people_are_hungry_in_the_world?page=full

Sunday, 1 May 2011

POVERTY: Chad: Shea nut into white butter

Francesca Reinhardt: Program Support Officer: Concern Worldwide VIDEO

I’m based in a small town called Goz Beida in eastern Chad. It’s a dusty corner of the Sahel, where the bulk of the traffic comes in the form of slow-moving donkeys and camels. It’s an unforgiving environment, but I’m learning things here that I don’t think I could learn anywhere else.
Chad is a vast landlocked country, covering several eco-zones, and some of the highest rates of poverty on the planet. The challenges are enormous. Chad has the world’s highest child infant mortality rate, and is in the bottom five countries ranked by the United Nations Human Development Index. Chad has experienced not only natural disasters, but also civil conflict, the internal displacement of populations, refugees fleeing violence in neighboring Central African Republic (C.A.R.) and Sudan, the Sahel food crisis, drought, flooding, and cholera outbreaks.
This is a country of extremes. Forbidding deserts stretch to the north. People scratch out a living in small villages across the Sahel, fed by transient rivers called wadis that sink into the sand. As you move south, the cattle get fatter, the mud-brick houses get sturdier, and the savannah gives way to flood plains and rice paddies. Keep going and you reach the humid, tropical south. That’s where you’ll find the town of Goré, about 30 kilometres from the border with C.A.R.
With its heavy soils and massive trees, the area looks like it should be rich and fertile, but the struggling villages tell a different story. Goré now hosts 35,000 refugees from C.A.R., and the soil is exhausted. The harvest feeds most families for just seven months of the year. After that, they are reduced to foraging, debt, and hunger. Raw materials are scarce, and few goods are produced locally. Everything from farm tools to cooking oil comes from hundreds of miles away, shipped in on treacherous roads, at exorbitant cost. Plastic goods come on overloaded trucks from Nigeria, trundling along the wrong side of the road to their final destinations; soap and plastic shoes make the trek here from as far away as China.

Ask the women in Goré what they want and they’ll tell you simply that they want their own source of income: “We have to spend so much on so many things, why not make something we can keep ourselves?” says Lydie Nadjilem, a member of Mekasna. Mekasna is Goré’s biggest Shea butter collective, and it also wants to be the richest. “We are looking at land to plant an orchard; this would make it faster to collect the Shea nuts. So far, we have saved 50,000 Cefa [about 100 USD]. That’s already a third of the way there,” says Mekasna’s President, Maris Mokodji.
Shea nuts are indigenous to southern Chad, and have been traditionally pressed into a black oil to add to foods. While nutritious, it has an odor that many find unpleasant. Processing the Shea nuts into a white butter gives it all kinds of household and commercial applications, opening up new income streams for local women. This is southern Chad’s “white gold.” “Soap is the best,” says Maris “because everyone has to buy it. Cooking oil is good too. Otherwise we wait for it to come from Cameroon, and the money goes back to them.” Concern supports Mekasna, along with 21 other collectives, with training and management of equipment for Shea butter production. Concern also provides the collectives with vital training, guidance, and support on financial management and running cooperatives.
“With the white Shea butter, we can do so many more things,” says Maris. “But above all we want the money. We want our own money. You can’t just wait for the boss [the husband] to come up with school fees. You can’t just fold your arms and wait for him to give you money.” She laughs, “You know the day you come to him for money he will say he has none.”
With 50 members, Mekasna can produce 10-15 litres of Shea butter a week—weather and resources permitting. Hauling the water, nuts and fuel, and pounding the nuts is a long and laborious process. Ask the members though, and they’ll tell you it’s worth it. Shea butter sells for around $6 per pound, and it saves women buying costly commercial soaps and oils. While it’s normally hard to compete with industrially produced goods on price, not having to pay transport overheads makes Mekasna’s prices more competitive. With Concern’s help, Mekasna has plans to invest in a motorized mill to raise productivity.
After several years of bad harvests, it’s hard to know what each year holds. Now these women have a backup plan. “I feel better knowing there will be a little money if things go wrong,” says Lydie. “We have money in our savings box and we all take our share so nobody can cheat us. If I have to borrow money in the market, I might not be able to pay it back. I like to know that my money is safe.”
http://povertynewsblog.blogspot.com/search/label/Chad

MALARIA: Sustain 'Fragile' Successes in Fight Against Malaria

29 April 2011
Robert B. Zoellick and Ellen Johnson Sirleaf: Robert B. Zoellick is President of the World Bank Group; Ellen Johnson Sirleaf is President of Liberia, and the incoming Chair of the African Leaders Malaria Alliance (ALMA), which comprises African Heads of State and Government working to end malaria-related deaths in Africa.


We have encouraging news out of Africa this week of World Malaria Day, as we take stock of the illnesses and deaths caused by this longtime scourge.
Eleven countries in Africa had slashed the number of confirmed malaria cases, malaria-related hospital admissions or deaths by more than 50 percent by end 2009. When 2010 data becomes available we expect it to show that even more countries have shown similar progress.
In a region that has borne a heavy malarial burden of death and debilitating illness, part of the good news stems from the fact that approximately three-quarters of the people at risk of contracting malaria were using insecticide-treated mosquito nets by the end of 2010. With a decisive push, the goal of protecting Africa’s population with bed-nets and effectively preventing the fevers and crushing headaches that are the dreaded symptoms of malaria appears within Africa’s reach.
Even as we mark what may be a turning point, we know that malaria is an ancient foe we can never underestimate. Although global deaths from malaria have fallen from nearly a million a year in 2000, the disease continues to exact a great toll, killing 781,000 people across the world in 2009. More than 90 percent of these deaths occurred in Africa, where the disease accounted for about one in six child deaths.
The collective success is substantial, but is also fragile and must be sustained. The consequences of losing the focus on malaria would be deadly. Mosquito bed-nets last about three years and a failure to replace the over 300 million nets blanketing Africa over the coming three years could lead to resurgent malaria illness and deaths.
Just this past year, Zambia faced a resurgence of malaria in a few provinces when mosquito nets were not replaced in time. Deaths and illness increased within months. Rapid action to address this increase has since been taken by the Zambian government, together with the World Bank, UN Foundation, Bill and Melinda Gates Foundation, Stanbic Bank, the African Leaders Malaria Alliance (ALMA), and the UN Special Envoy’s Office.
While funding is important, it is really the partnerships that have been built with citizens, governments, and healthcare providers as well as the increasing reliance on and use of science, technology and the body of global knowledge on what works that can accelerate progress in this area.
For instance, beyond the wide distribution of mosquito nets, ending malaria deaths will require making sure that effective diagnosis and timely treatment become available to every patient. Health authorities need to keep better track of where malaria still exists and which drugs produce the best health outcomes. We want funding to be effective, not simply throwing money at the problem.
In the wake of the financial crisis, we face difficult choices with limited resources. In Liberia, the priority is to end deaths from malaria above many other pressing needs, for both health and economic reasons. As a result, Liberia is on track to protect its entire population by year’s end.
Liberia is not alone. Thirty-nine African countries have united against the disease under ALMA, chaired by Tanzanian President Jakaya Kikwete. We have determined that the only way we can overcome the disease is through working together. No country is an island when it comes to malaria; mosquitoes do not respect borders.
In mobilizing the money, the bed nets, and the treatment, and in strengthening supply chains for lifesaving medicines, our bedrock guiding principle must be stronger accountability. ALMA’s flagship accountability initiative is a simple tool, commonly employed in the private sector: a scorecard. Currently under development with our partners in the Roll Back Malaria Partnership, the scorecard will track progress, identify what is working, what is not, and highlight where intervention is required. We will further expand the use of new technology platforms, such as SMS and Twitter, to reach hundreds of millions of people to create positive pressure at all levels, and to encourage demand for transparency, accountability and results by citizens.
Africa’s partners, including the World Bank, are committed to ending deaths from malaria. Last year the Bank pledged US$200 million to anti-malaria efforts in Africa, largely to provide bed-nets to families in the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Mozambique, Sierra Leone and Zambia. This helped to close emergency gaps. Consistent with the priorities of African countries, we expect new financing mobilized from the latest replenishment of the International Development Association, the Bank’s fund for the poorest countries, to be committed to the fight against malaria, including through our work on helping African countries build stronger health systems.
So, as we take inspiration this World Malaria Day from African countries that now have malaria in retreat, we also need to recommit to finish the job. Allowing hard-won gains to be reversed cannot be an option.
http://allafrica.com/stories/201104290828.html

MALNUTRITION: BURUNDI: Thousands need food aid after poor crop season

BUJUMBURA, 28 April 2011 (IRIN)


 Photo: Judith Basutama/IRIN : Agricultural officials have appealed for seeds to enable farmers to plant during the next planting season (file photo)

Heavy rains in March in Burundi's eastern province of Ruyigi destroyed beans, banana and cassava crops, leaving thousands of people desperate for food aid, agricultural officials said.
"With regards to the 2011 B agricultural season [February-June], farmers in Ruyigi are expecting nothing from their fields after heavy rains, accompanied by hailstorms, devastated their fields and they lost all the beans, bananas and cassava crops," Festus Ntihabose, agricultural director for Ruyigi, told IRIN.
According to Ntihabose, at least 8,000 families, or 40,000 people, now require urgent food aid and seeds to prepare for the next planting season.
The most affected communes are Butaganzwa, Nyabitsinda, Kinyinya and Bweru and, to a lesser extent, Gisuru, Ntihabose said.
Agricultural officials say the 2011 B agricultural season is the most important in Burundi, accounting for 50 percent of national food production.
Méthode Niyongendako, a consultant with the UN Food and Agriculture Organization (FAO), said the provinces of Ruyigi and Cankuzo (in the east) were the most fragile and "likely to face a serious food crisis during the first semester of the current year. The risk of low production in June is very high in those provinces, which means the food crisis can be prolonged."
Pontien Hatungimana, an adviser to the Ruyigi governor, told IRIN that since an appeal for assistance in February, humanitarian organizations had, so far, not responded.
"Only routine [food] distributions to vulnerable groups were made; but no relief aid, as such, has reached us," Hatungimana said.
However, in February, the Ministry of National Solidarity, Human Rights and Gender distributed 61MT of rice and beans to the affected population. The ministry also distributed 5MT of rice in March.
"This response was a simple support to sustain the population but it is still very little, since the needs are huge," Hatungimana said.

Appeal for seeds
Agricultural officials in Ruyigi have appealed to charitable organizations to provide seeds for the farmers to plant during the next planting season.
"They need to prepare for the next season [season C in wetlands]; they need vegetable seeds and sweet potato cuttings because these are very rare as a result of the rains," Ntihabose said.
They need to prepare for the next season; they need vegetable seeds and sweet potato cuttings because these are very rare as a result of the rains
Niyongendako said approximately 15,000 households would receive seeds for vegetables, sweet potatoes and cassava cuttings as well as Irish potatoes for season C.
Weathermen attribute the rain deficit in the north and east of Burundi to the La Niña weather phenomenon, which cut crop production in season 2011 A.
Niyongendako said the food deficit for the period between January and June 2011 is estimated at 490,000MT of cereals.
However, Niyongendako said the northern province of Kirundo, which is annually prone to food shortages, seems promising this time because farmers planted early and were likely to have a good harvest.
In its April issue, the monthly bulletin of the Burundi Food Security Monitoring Early Warning System said throughout March 2011, countrywide, the UN World Food Programme assisted 244,531 beneficiaries with 1,626MT of food, mainly through general food distribution, food-for-work, as well as aid for the most vulnerable.
"The cumulative food deficit of 1,922 tonnes for all foods is predicted between May and October, equivalent to [US $]1.96 million," according to the bulletin.
http://www.irinnews.org/report.aspx?reportID=92602

MALARIA: Claims about the Misuse of Insecticide-Treated Mosquito Nets: Are These Evidence-Based?

Eisele TP, Thwing J, Keating J (2011) April 12, 2011

There are a number of potentially damaging misconceptions about insecticide-treated mosquito nets (ITNs) in Africa that have been propagated in media reports, almost all of which are based on anecdotal accounts.

While it is clear there is room for improving the level of ITN use among those who have them, and that misuse of nets occasionally occurs, we found very little evidence to support claims of widespread misuse across Africa.
We identified only one peer-reviewed study that reported misuse of ITNs; this study was a non-probability survey of seven beaches on Lake Victoria in western Kenya, making the conclusions non-generalizable.
Inaccurate news stories of widespread ITN misuse should be rebuked directly through the dissemination of empirical data contradicting anecdotal reports and in rebuttal editorials in newspapers and journals.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001019

POVERTY: Stillbirths could be halved

DAKAR, 27 April 2011 (IRIN)

 Photo: MSF
A midwife listens to the foetal heartbeat of an expectant mother in Afghanistan (file photo)

 Preventing stillbirths can cost just US$2.32 per mother if governments, the private sector and international institutions adopt a package of 10 health interventions, rather than allowing stillbirths to be an almost invisible problem.
If ten recommended interventions were 99 percent implemented in 68 priority [low and middle-income] countries, the number of stillbirths could be halved, said Professor Zulfiqar Ahmed Bhutta of the Aga Khan University Medical Centre in Karachi, Pakistan, author of one of a series of papers on stillbirth published in The Lancet medical journal papers.
Even if the interventions were 60% covered, stillbirths could be reduced by one-quarter. Some 2.64 million foetuses die after the 28th week of pregnancy, mostly in low- and middle-income countries.
Interventions include: basic and comprehensive emergency obstetric care; skilled care at birth; detection and management of foetal growth restriction; detection and management of hypertension in pregnancy; elective induction in post-term pregnancies; insecticide-treated bed nets and intermittent prophylaxis to prevent malaria; detection and treatment of syphilis; folic acid supplementation; and management of diabetes in pregnancy.

Identifying solutions
Stillbirths have largely been neglected in policy prioritizing for a variety of reasons. “There was little in terms of verified data for stillbirths and even less for its categories - whether intrapartum [during childbirth] or antepartum [before childbirth] - and risk factors, and little confidence that interventions could make a difference,” said Bhutta.
The Lancet series hopes to change this perception by re-framing stillbirths so that they are not seen as an unexplained event that occurs in the womb, but as something that is potentially preventable if appropriate care is given during pregnancy and birth.
Bhutta suggested in his paper that cheaper solutions, such as improving antenatal care, preventing malaria, detecting and treating syphilis, be adopted immediately, while more expensive interventions, such as training health workers, and procuring equipment for emergency births, could be built up gradually.
Other interventions would require improved long-term funding allocations, including addressing hypertension, diabetes, post-term pregnancy (which lasts longer than usual) and monitoring foetal growth problems.
Providing skilled attendants at birth would reduce intrapartum stillbirths by about 23 percent, said Dr Joy Lawn, of NGO Save the Children, making it the most effective single intervention. Almost half the women in low- and middle-income countries give birth at home, without any skilled assistance.
Voucher schemes or conditional cash transfers could be used to encourage women to have their babies in a facility, since in settings where the highest infant mortality occurs, only half of all births take place in facilities.

Maternal mortality
In high-income countries, where most women receive fairly good quality care while giving birth, the proportion of stillbirths is less than 10 percent of all births.
Sub-Saharan Africa, which has a scarcity of skilled birth attendants, has been making swifter progress than Asia in encouraging women to give birth in a facility. “One year ago, the international community became acutely nervous about the lack of progress on reducing maternal mortality,” Lawn said.
A year later, maternal mortality in sub-Saharan Africa had fallen by 2.6 percent. “This marks significant progress… For stillbirths, a lot of the focus in high-income countries has been because parents have called for it. Setting a global policy goal is one good way of getting it on the agenda.”
One-third of African countries could meet the Millennium Development Goal to reduce childhood mortality (Goal Four) and to improve maternal health (Goal Five), which would also reduce stillbirths.
Some investments in reducing maternal mortality are already having a positive effect on the number of stillbirths, but these results are not given due significance. “Governments could argue for more investment if they counted stillbirths in the work they’re already doing,” Lawn told IRIN.
Saving mothers’ lives costs $23,000 per death averted, but if stillbirths and neonatal deaths are included, the figure drops to $2,700 per life saved. “Our single message is, ‘Care at birth may be more expensive, but it gives you the biggest bang for your same buck if you count it properly’
http://www.irinnews.org/report.aspx?reportid=92590

MALARIA: The truth about DDT


Dichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure.

Data sources and extraction
We conducted a PubMed search in October 2008 and retrieved 494 studies.

Data synthesis
Use restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children.

Conclusions
Although we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.

http://ehp03.niehs.nih.gov/article/info:doi/10.1289/ehp.11748

MALARIA: National Theft of Global Fund Medicines

Millions of dollars of donated antimalarial drugs have been stolen, most often by staff of recipient government medical stores; this strengthens criminal gangs and undermines donor intent. The main culprit donor is the Global Fund to Fight AIDS, TB and Malaria, which worryingly is pushing ahead with further schemes that have the same inherent weaknesses, which may worsen the theft problem. Sweden and Germany have already suspended funding to the Global Fund due to financial irregularities, but it is time for a thorough investigation of drug theft - to ensure that drugs are being used by those intended, rather than encouraging illegal parallel distribution systems, in both recipient nations and nations where products are diverted.
It is likely that the entire incentive system needs to change, so that donors only receive future taxpayer funds when they can show that the drugs they buy actually reach intended patients in developing nations, not just reach their governments’ medical stores.
http://www.fightingmalaria.org/pdfs/AFMBrief_NationalTheftofGFMedspdf

POVERTY: SUDAN: North Darfur water project helps protect women from sexual violence

NAIROBI, 27 April 2011 (IRIN)

 Photo: UN Photo/Albert Gonzalez Farran
A woman in El Fasher, North Darfur, using a Hippo Water Roller

A water project supported by the UN-African Union peacekeeping force (UNAMID) in eight villages of North Darfur will not only facilitate residents' access to water but also help to reduce sexual and gender-based violence (SGBV) in the region, local residents and UNAMID officials said.
“For years we have been afraid of being attacked while fetching water and collecting firewood; it is not always possible to move in groups and we are often escorted by men or UNAMID peacekeepers,” a resident of Kuma Garadayat village, who declined to be named, told IRIN on 27 April.
Kuma Garadayat, 60km from El Fasher in North Darfur, is one of the villages where the water project was launched on 26 April. The eight villages host at least 3,000 returnees.
About 30,000 rolling water containers, with a capacity of 75l each, the equivalent of four jerry cans, were distributed to women in the villages, all with poor access to water and severely affected by drought during the dry season. “I hope through the water carriers, things will become easier for us; we’ll be less exposed,” the villager added.
According to Médecins Sans Frontières (MSF), most SGBV cases in Darfur still occur during water and firewood collection.
Because of generally poor access to justice, a sense of impunity, and the social stigmas attached to SBGV, the international community in Darfur has launched several prevention, protection and response activities, including firewood patrols.
The water project is part of broader UNAMID-backed recovery projects, which include training midwives and helping to improve health and education in villages. Several thousand water hippos will be dispatched over the next two weeks, mainly to women heads of households, the vulnerable and people living far from water points, says UNAMID.
The barrel-shaped water carriers are designed to reduce the physical burden of carrying water and would benefit women and children who are mostly in charge of water collection in Sudan.
“One of the major sources of conflict in Darfur is access to water,” said Ibrahim Gambari, the Joint Special Representative and head of UNAMID, in a statement.
“This project is to make life easier and safer for women, and also to underscore the fact that water hasn’t only been a source of conflict, it is also the solution,” he said. “It is our hope that their [the barrels’] use will not only support former displaced persons but also help protect civilians as they return to resume their lives.”
http://www.irinnews.org/report.aspx?reportID=92597

POVERTY: SOMALIA: Thousands trapped between conflict and drought in Galgadud

NAIROBI, 27 April 2011 (IRIN)

 Photo: Abdijamal Moalim/IRIN
The current drought has made the plight of those fleeing Dusamareb even worse (file photo)

Thousands of families in Somalia's central town of Dusamareb, the regional capital of Galgadud, are caught between an unending conflict and severe drought.
Following a weekend of fighting between Islamist militia groups, hundreds of families fled the town to the drought-ravaged countryside, locals told IRIN.
On 23 April, the Al-Shabab militia attacked Dusamareb, 500km north of the capital Mogadishu, and captured it from the Ahlu Sunna Waljama'a - a traditional Sufi militia group - but withdrew on the same night.
"This month [April], we have had to flee the town three times; every night mothers make sure they have enough clothes and food ready for the children, to run if the town comes under attack," said Hawa Abdulle, a women's activist in Dusamareb.
"The problem now is there is no food or water in the countryside; the current drought has made the plight of those fleeing even worse.
"We are caught between a war and drought. If we stay, we may become victims of the fighting groups and if we run, we are likely to end up in a place with no shelter, water or food - not much of a choice."
Dusamareb, a town of about 30,000 people, has been a war zone between Al-Shabab and Ahlu Sunna Waljama'a groups since 2008.
Sheikh Abdirahman Gedoqorow, the district commissioner, told IRIN another 4,000 families (24,000 people) displaced from Mogadishu were affected by the fighting.
He said most of those displaced over the weekend had returned to their homes. "They have no choice. The rural villages they fled to are some of the worst drought affected in the area.
"We have had a very rough year and if the [expected] rains don't come we will be in very serious trouble."
Kiki Gbeho, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) Somalia, said: "We continue to be concerned about civilians being caught between conflict and drought. Of more concern is the fact that we are unable to raise funds to intervene and mitigate the devastating effects of drought on people's livelihoods."
 Photo: Reliefweb : Galgadud region

Many more at risk
The number of needy Somalis is set to increase as the impact of drought deepens, the UN has warned.
At present, 2.4 million Somalis - 32 percent of the population - need humanitarian aid but with the ongoing conflict, coupled with the drought blighting crops and killing livestock, many more may fall into crisis, the UN Food and Agriculture Organization's Food Security and Nutrition Analysis Unit (FSNAU) and the Somalia Water and Land Information Management (SWALIM) said in a statement on 27 April.
They said Somalia could slide into an even deeper crisis due to the combination of drought, skyrocketing food prices and constant population displacement from ongoing conflict.
"The impact of the drought is affecting most parts of the country, leading to livestock deaths and increasing food and water prices, which are making it increasingly difficult for poor families to feed themselves," said Grainne Moloney, FSNAU's chief technical adviser.
Meanwhile, Gedoqorow also accused Al-Shabab of looting offices of some local NGO offices.
Abdikarim Hashi Kadiye, an official of a local NGO Towfiq, told IRIN that its offices, along with those of another NGO, were looted when Al-Shabab took the town. "They stole a laptop and a desktop [computer] from our offices."
He said there was still fear that Al-Shabab could return. "Normally people used to flee to the villages but now the villagers are coming to towns because they have nothing. Their livestock is either dead or is walking dead."
Kadiye said the economy was based on livestock, "and because of the drought, livestock is not providing meat or milk. They cannot eat or sell what is left."
Abdulle told IRIN: "If we had peace I think we would be able to manage the drought. But we have no peace and with the drought, our situation is much, much worse."
http://www.irinnews.org/report.aspx?reportID=92593

POVERTY: ADB: "Food prices may lead Asians into poverty'

Press Trust Of India : April 26, 2011 Resurgent food prices, which rose by 10% on average in many regional economies in Asia in 2011, can push an additional 64 million people into extreme poverty, an Asian Development Bank (ADB) report says. The study, titled, 'Global Food Price Inflation and Developing Asia', by the multilateral lendin g agency, finds that a 10% rise in domestic food prices could push an additional 64 million people, out of 3.3 billion people living in the continent, into extreme poverty, based on the $1.25 a day poverty line.
"For poor families in developing Asia, who already spend more than 60 per cent of their income on food, higher food prices further reduce their ability to pay for medical care and their children's education," ADB chief economist Changyong Rhee said.
The report said the fast and persistent rise in the cost of many Asian food staples since the middle of last year, coupled with crude oil reaching a 31-month high in March, are a serious setback for the region, which has rebounded rapidly and strongly from the global economic crisis.
As per the report, if the global food and oil price hikes seen in early 2011 persist for the remainder of the year, economic growth in the region could be reduced by up to 1.5 percentage points.
"Left unchecked, the food crisis will badly undermine recent gains in poverty reduction made in Asia," Rhee added.
The short-term outlook looks bleak, as food prices are likely to continue with their upward trend because of factors such as production shortfalls, rising demand for food from more populous and wealthier developing countries and shrinking available agricultural land, the report said.
Other dampening factors behind the double-digit increases seen in the price of wheat, corn, sugar, edible oils, dairy products and meat include the weak US dollar, high oil prices and subsequent export bans by several key food producing nations.
Commenting on the current scenario, Rhee said, "Efforts to stabilise food production should take centre stage, with greater investments in agricultural infrastructure to increase crop production and expand storage facilities, to better ensure grain produce is not wasted."
The report further calls for enhanced market integration and the elimination of policy distortions that create hurdles in transferring food from surplus to deficit regions, besides, controlling speculative activities in food markets.
The ASEAN Integrated Food Security Framework, under which the 10-member ASEAN group of countries has agreed to establish an emergency regional rice reserve system, is a positive step in that direction, the report said.
http://www.blogger.com/post-create.g?blogID=3604033512937490051

POVERTY: Nepal: Climate Change: Community-based adaptation in action

26 April 2011 (IRIN)

 Photo: Peter Murimi/IRIN
Sujit Kumar Mondal and his wife Rupashi Mondal of Gopalgonj district in southern Bangladesh working in their floating garden

Nepal has become one of the first countries to consider scaling up community-based adaptation (CBA) to climate change and making it part of national development policy.
Nepal is vulnerable to rising global temperatures and has already been dealing with the impact of erratic rainfall, frequent droughts and floods, which have been affecting food security. In response the country decided to experiment with a bottom-up approach using Local Adaptation Plans of Action, or LAPAs, in 10 districts across the country in 2010.
In a joint paper on local adaptation plans, Bimal Raj Regmi, a researcher, and Gyanendra Karki, a government official, said the idea of drawing up LAPAs came out of the National Adaptation Programmes of Action (NAPA) process.
They noted that Nepal, as one of the last of the Least Developed Countries (LDCs) to develop its NAPA, was able to incorporate elements omitted from the adaptation plans of other countries.
These include better links to climate change planning processes and mainstreaming national adaptation goals down to the local level, so that the NAPA process moved beyond regional and national consultation to include the input of vulnerable communities in the LAPAs.
The LAPAs are developed by people from various sectors in a village or district who identify local climate risks, vulnerability and needs, and focus on increasing resilience based on the geographical location and assessments made by the community using their knowledge of the local environment.
"This is particularly critical because if communities are unable to distinguish climate change risks from other risks they face, then efforts to develop adaptive capacity might become unfocused or ineffective," said Regmi and Karki.
Nepal's approach and pilot programme were cited at the recent fifth International Conference on Community Based Adaptation to Climate Change in Bangladesh, which discussed scaling up CBA.

Two ways to scale-up
Saleemul Huq, a senior fellow of the International Institute for Environment and Development, a UK-based policy think-tank, which organized the conference, said there were two ways to scale-up: vertical - up the policy chain from the community level to higher levels of decision-making as in the case of Nepal; and horizontal - by replicating projects or initiatives thousands or even hundreds of thousands of times.
Communities have been adapting to climate variability for centuries, sometimes using home-grown and sustainable methods. These measures are known as "autonomous adaptation".
In flood-prone southern Bangladesh, communities grow food on floating islands made of paddy straw and water hyacinth in the waterlogged fields.
On the edge of the Sahara, people bury staple grains in storage pits in the ground to eat in times of drought, while in other areas traditionally nomadic pastoralists are adopting a partially sedentary lifestyle as the spreading desert wipes out grassland.
NGOs have developed a number of CBA initiatives, all still in the pilot phase, but Huq noted that "quite a few NGOs like Oxfam have begun to scale up their pilots".
The UN Development Programme (UNDP) has launched pilot CBA projects in Namibia, Zimbabwe and Ethiopia.
Huq, who is part of the academic team working on the Fifth Assessment of the Intergovernmental Panel on Climate Change, said inputs from the conference would inform the adaptation chapters of the assessment to be published in 2014.
African countries focused on bottom-up approaches and scaling up community-led responses to adaptation at the recent AfricaAdapt symposium held in Ethiopia.
"With up to 40 million pastoralists across the African region, each pastoralist has to be an innovator to some degree to adapt to climate variability," Fatema Rajabali, the climate editor of Eldis, an online knowledge service provided by the Sussex-based Institute of Development Studies, reported.
At the symposium, Yohannes GebreMichael of the Addis Ababa University "asserted that local innovation needs to be recognized, as it provides an entry point for communities with a bottom-up approach to support climate change adaptation, starting with local capacities and ideas".
http://www.irinnews.org/report.aspx?reportid=92585

POVERTY: PAKISTAN: Schools shut as fear drives teachers away

PESHAWAR, 26 April 2011 (IRIN)

 Photo: Save The Children UK
Pupils at a school in Afghanistan. Insecurity has affected school education and literacy rates (file photo)

The local school in Wana, the main settlement in Pakistani’s South Waziristan tribal agency, has been closed for several months, and the children only come to play games in the compound.
“We have no teacher at the school,” Rida Ali, 8, said. “So we just play or do chores at home.” The teacher who taught them before insecurity shut down schools in the area lives only 1km or so away, but is unwilling to come to work. The children in Wana have not attended class since November.
“Due to security issues, teachers, especially female ones, are not going to class and this affects the education of girls,” Syed Fawad Ali Shah, emergency education officer for the UN Children’s Fund (UNICEF) in Pakistan, told IRIN.
According to media reports, fear of the Taliban has meant many teachers have not gone back to work even in areas like Swat, which are now clear of militants.
“I love teaching, but I will never teach again. My husband says I must not do so as it is too dangerous,” Aima Malik, 25, said from the Khyber Agency where she had taught at a school for girls from 2006 to 2009. “Fewer and fewer women are ready to teach any longer,” she added.
“It is better that they be safe and learn how to cook or sew at home,” said Maryum Bibi, a mother of two teenage daughters living in a rural area on the outskirts of Peshawar. Her daughter, Jamila, 13, dreams of being a teacher but now says: “It seems I will never even complete my matriculation.”
Abdul Monib, a secondary school teacher in the Bajaur Agency, told IRIN: “As a teacher, I always feel sad when pupils drop out before completing their education. Now so many can no longer continue because their families need them to work. Others fear the classroom because of bombings in the past at schools and refuse to come any longer.”

Literacy rates down
The insecurity is affecting literacy rates. “Barely 1 percent of women are literate in these areas,” Roohi Bano, regional manager for the Peshawar-based NGO Khwendo Kor, which works for the education of girls, told IRIN.
“It has always been difficult to find teachers in these parts. Few women are educated and families prefer them not to work. The situation that has now arisen following the reign of the Taliban will make matters even worse, with fewer and fewer women wishing to take up this work,” said Azra Khan, headmistress at a private school in Peshawar.
In some cases, she said, threats had been made even against teachers in big cities. “At least two of my teachers no longer wish to work here,” she added.
The problem is compounded by the reluctance of parents to allow men to teach girls. “My husband has insisted we withdraw our daughter from her school because there are some male teachers there. He has orthodox views and says this is unacceptable,” said Zakia Bibi, 40, from the town of Mingora in Swat.
Other factors have also affected education. “There are many families who have suffered financially, using up their savings during the displacement and unable to find jobs now, even when they have returned,” said Ahsan Ullah, 40, who runs a small shoe-making factory in the South Waziristan agency. He says he receives “dozens” of requests for jobs each week, but cannot accommodate more workers.
In the town of Mardan in Khyber Pakhtunkh’wa, Zainab Bibi, from the Orakzai Agency, wonders how to educate her four children. Her husband was part of the Taliban force in the area. “I fled on my own, with the children, in 2010, when fighting became fierce,” she said. “Some relatives helped us. I have not heard from my husband since then; my two older boys, aged 14 and 15, go out to work at an automobile workshop to bring in some kind of income – but I am desperate to see them back in school.”
Bibi is also concerned that unless they are educated, the boys may be tempted to join the Taliban. “A gun is a huge attraction for a young boy,” she said.
http://www.irinnews.org/report.aspx?reportID=92575

MALNUTRITION: Promoting small-scale planting of trees in dryland areas

18 April 2011 This policy brief was written by Henri Rueff from the Centre for Development and Environment in Bern, Switzerland, and Inam-ur-Rahim, from the University of Central Asia, Kyrgyzstan.

Drylands, Nicaragua Tree planting in drylands should be kept to a small scale:
Flickr/CIAT by Neil Palmer

This policy brief, published by the research network NCCR North-South, argues for policies that promote planting trees in drylands on a small scale, because large-scale projects can negatively affect local ecosystems.
International aid agencies and governments have been promoting large-scale planting for more than a century. But the practice is becoming increasingly controversial.
Advocates say it improves land control, raises its value, helps combat desertification and creates jobs. Opponents argue that planting trees in large areas means that communities using the land get evicted. New forests can also change ecosystems and negatively impact biodiversity.
Small-scale forests are a sustainable solution, say the authors. They have none of the drawbacks of large-scale projects yet benefit the environment by storing carbon and restoring degraded land. To encourage this practice, developing countries can use carbon payments as an incentive. As these payments are not high enough, farmers should be allowed to plant tree species that can also provide other services. But future research must evaluate whether using the same piece of land for different purposes brings more benefits.
Other measures could also raise the financial rewards of small-scale tree planting. These include schemes that provide dryland farmers with information about the carbon market, annual payments and microcredit, and support in using the right techniques and predicting how much carbon is stored in trees and soils.
These measures could be funded by public money. And to cut down costs for farmers, local institutions or non-governmental organisations could act as mediators to represent their interests, distribute payments from the sale of carbon credits, and keep them informed about changes in procedures.
http://www.scidev.net/en/policy-briefs/promoting-small-scale-planting-of-trees-in-dryland-areas-1.html

MALARIA: Saudi research centre to target malaria and dengue

Marwan Almuraisy : 22 April 2011
Riyadh, Saudi Arabia The new centre will be based in Jazan, south of Riyadh : Flickr/Abe World!

[RIYADH] The Middle East will soon have a research centre dedicated to the monitoring and control of insect-borne infectious diseases such as malaria and dengue.
Saudi Arabia's Ministry of Health has allocated US$5.5 million as seed funding for a joint research centre to develop innovative ways to monitor, evaluate and control major diseases transmitted by vectors, with help from the UK-based Liverpool School of Tropical Medicine and the Innovative Vector Control Consortium.
"We are very excited about this new venture with two world-class leaders in research and development in infectious diseases," said Saudi health minister Abdullah Bin Abdul Aziz Al Rabeeah at the signing of the agreement this month (4 April).
The deputy health minister, Ziad Memish, told SciDev.Net that the centre, to be based south of Riyadh in Jazan, "is expected to open in early 2012, to act as a link between the research efforts related to infectious diseases of the three parties of the agreement".
He explained that it is part of a larger effort to build national and regional capacity in science and technology. It is envisaged as a regional centre of excellence that would help develop world-class scientists though PhD and Master's courses, as well as shorter training courses.
Staff recruitment and training will start immediately, and the first project will be to develop an Arabic version of the Malaria Decision Support System — a computer package that tracks the incidence of malaria and helps efforts to control the mosquito vectors.
"The centre will trace the infectious diseases in the [nearby] countries of the region, like Yemen, which is facing a rise in the number of patients with infectious diseases compared to other neighbouring countries," said Memish.
It could help to eliminate malaria in Saudi Arabia, he added, where just over half the population is at risk from the disease, according to the WHO. Saudi Arabia is "in the final stages" of eliminating malaria, Memish said, adding that the plan is to make the country malaria-free within four years.
Najia A. Al-Zanbagi, a professor of parasitology at King Abdulaziz University, said that the centre could help Saudi scientists do world-class research. It could help limit the spread of pathogens and "encourage attempts to provide new treatments for many tropical diseases", she said.
Nuha Zelai, a biology lecturer at the same university, told SciDev.Net the centre "is like a dream that came true just in time". She said that a well-equipped centre that specialises in disease research could make it easier and quicker to obtain biological materials for research from abroad and to carry out research projects.
The project's partners will try to raise an additional US$21.5 million, which is needed for infrastructure, education programmes and research activities.
http://www.scidev.net/en/news/saudi-research-centre-to-target-malaria-and-dengue-1.html

MALNUTRITION: Mexican trial of GM maize stirs debate

Cecilia Rosen : 18 April 2011


Maize Mexico is home to thousands of maize varieties : Flickr/CIMMYT

[MEXICO CITY] Mexico has authorised a field trial of genetically modified (GM) maize that could lead to commercialisation of the crop, sparking debate about the effects on the country's unique maize biodiversity.
Although Mexico already commercially grows some GM crops, such as cotton, GM maize is controversial because the country is home to thousands of the world's maize varieties that originated there.
The multinational corporation Monsanto will test a variety of maize resistant to the herbicide glyphosate on less than a hectare of land in north Mexico before it can commercialise the GM crop. Unlike experimental trials, such pilot projects do not require containment measures to prevent the spread of the GM crop.
Mexico's agriculture ministry said the project, approved last month (8 March), will occur "under the strictest biosecurity measures to guarantee the prevention of involuntary dispersion of the GM maize's pollen".
But Elena Álvarez-Buylla, head of the Union of Scientists Committed to Society (UCCS), said: "This opens up the door to contamination of native species in the most important centre of origin [of maize] in the entire world."
The UCCS stated last month (25 March) that the coexistence of GM and non-GM varieties in fields — which may happen if commercial approval is given — could contaminate the unique non-GM varieties.
"There are alternative technologies to address the non-GM maize shortage and loss of crops due to climate events. GM [crops] are not more resistant to droughts and plagues, and they threaten our food sovereignty," its statement says, referring to multinational companies owning GM technologies.
Transgenic crops were banned in Mexico until 2005, but the government has since granted 67 permits for GM maize to be grown experimentally on over 70 hectares. This would be the first trial that could lead to commercialisation if it is successful.
At the third Mexican Congress of Ecology this month (3–7 April) in Veracruz, scientists were cautious about growing GM maize.
Andrew Stephenson, an ecology professor at Pennsylvania University, United States, said the indirect effects of mixing GM and non-GM varieties are largely unknown, especially under Mexico's complex environmental conditions.
And Mauricio Quesada of the National Autonomous University's Centre for Ecosystems Research said Mexico should prioritise research on the natural diversity of local crops instead of "jumping" into GM.
But Luis Herrera-Estrella, chief of the National Laboratory of Genomics for Biodiversity at the Research and Advanced Studies Center of the National Polytechnic Institute of Mexico, said the country's legal biosafety framework should be trusted.
Mexican trial of GM maize stirs debate

http://www.blogger.com/post-create.g?blogID=3604033512937490051

MALARIA: Battling Africa’s Number One Killer

April 22nd, 2011
Jennifer Weiss – health advisor for Concern Worldwide, an international humanitarian organization. She currently manages Concern’s Child Survival programs in Rwanda, Burundi, and Niger. A former Peace Corps volunteer in Honduras, she holds a Masters in Public Health from Tulane University.





Mukarurangwa Cecile, a community health worker in Marebe, Rwanda visits the home of Valentine, 3, to examine the cause of his fever. Photo: Esther Havens, Rwanda.

According to estimates from the United Nations and the World Health Organization (WHO), nearly one million children do not reach their fifth birthday because they die from malaria each year. Ninety percent of these deaths occur in Africa, where malaria remains the number one killer of young children. An additional 30 million pregnant women and their newborns are also at risk of malaria infection, which may lead to stillbirth, spontaneous abortion, low weight, and neonatal death.
Pregnant women and children die from malaria because they lack access to low-cost, effective solutions to both prevent and treat the disease. Concern is working to change this through our USAID-funded Child Survival programs in Rwanda, Burundi, and Niger, which provide life-saving malaria prevention and control to a total of 1.2 million women and children.


 Josepine Mukahirwa, a community health worker of 3 years, visits the home of Tuyishime Sylvie, 26, in Gasambu to educate on the importance of using a bed net. Photo: Esther Havens, Rwanda

The most obvious way to control malaria is to protect people from being bitten by malaria-carrying mosquitoes in the first place. People are at the highest risk of being bitten at night, while they are sleeping. Therefore, sleeping under a mosquito net, which is treated with a long-lasting insecticide, is a simple solution with dramatic results: at an average cost of about $10, long-lasting insecticide treated bed nets have been shown to reduce malaria transmission by 90 percent.
Concern works with local partner and governments to provide long-lasting insecticide treated nets to the people that need them the most: pregnant women and children under 5 years of age. Concern’s cadre of Community Health Workers then provides one-on-one counseling during household visits to further encourage parents to have their young children sleep under the bed net, and answer any questions or address any challenges the family may be facing in their use.
In Rwanda, Concern’s Child Survival Program is on target to ensure that 85 percent of all households own at least one bed net, and that pregnant women and children under the age of five are sleeping under them each night.
Another life-saving prevention technology recommended by WHO is to provide all pregnant women with at least two preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits. Intermittent preventive treatment (IPT), as it is called, has been shown to dramatically reduce maternal anemia and low birth weight, and other adverse effects of malaria during pregnancy. However, many country governments are struggling to provide this service to all pregnant women during their antenatal care visits.
In Niger, Concern’s Community Health Workers are educating mothers about the importance of IPT, and the program is training health facility staff to provide IPT, in order to ensure that 70 percent of all mothers received the recommended two doses of IPT during their last pregnancy.

 Early diagnosis of malaria is critical to ensure prompt access to life-saving treatment. Photo: Esther Havens, Rwanda

However, in 2009, only 35 percent of malaria cases were confirmed with a diagnostic test, which requires a skilled laboratory technician and appropriate equipment. Therefore, the majority of malaria diagnoses in sub-Saharan Africa are based on symptoms alone—many of which (fever, difficulty breathing, reduced appetite) are also symptoms of pneumonia. Treatment of pneumonia alone may result in death from malaria, while the unnecessary, ‘presumptive’ treatment of malaria may result in malarial drug resistance.
However, in 2010, the World Health Organization, approved the use of a a new technology, called Rapid Diagnostic Tests (RDTs), which health facility staff may use to make malaria diagnosis without the use of sophisticated laboratory technologies.
In Rwanda, Concern is partnering with the Ministry of Health to conduct the initial roll-out of this ground-breaking tool, and is already seeing improved results: from December 2010-February 2011, Community Health Workers saw a total of 2,944 cases of fever. With the help of RDT, 33 percent were confirmed as cases of malaria and treated accordingly.
For many people, even if a child has been diagnosed with malaria, the nearest health facility is a several hours’ walk away, and parents may not seek treatment until it is too late. Concern’s Child Survival programs bring malaria treatment directly to people who are most vulnerable through an approach called “Community Case Management.” Concern trains Community Health Workers to screen for and treat simple cases of malaria with locally available, effective and safe anti-malarial drugs.
Through the Community Case Management approach in Burundi, Concern is working to increase the percentage of children treated with an effective anti-malaria drug within 24 hours of registering a fever from 26 percent to 60 percent.


 Bahomwana care group meets in Gasambu village, Rwanda where they exchange ideas and discuss ways to overcome challenges to improve their work as Community Health Workers. Photo: Esther Havens, Rwanda

Following treatment, the Community Health Worker monitors sick children, and, if they are not improving, ensures that they seek further treatment from the health facility immediately.
Much work remains to be done if we are to significantly reduce the rate of death from malaria worldwide. Concern is contributing to the fight against malaria through the application of proven solutions, as well as new technologies, to reach those most vulnerable to malaria. Preventing the huge numbers of child deaths from malaria that occur each year is no longer an impossible dream.

http://blogs.concernusa.org/2011/04/22/world-malaria-day/

MALARIA: Survival prospects boosted for antimalarial mosquitoes

Barbara Axt : 21 April 2011
A flying mosquito Finding a way to allow GM mosquitoes to thrive in wild populations has proven difficult: Wellcome Images

A major stumbling block to using GM mosquitoes engineered to stop transmission of malaria may have been solved with a new genetic technique to ensure that they survive and propagate in natural environments.
The first genetically modified (GM) mosquito was produced in 2000 by scientists at Imperial College London, United Kingdom. Subsequent studies have shown that such modifications could be used to create mosquitoes with a reduced ability to transmit the deadly Plasmodium parasite responsible for malaria.
But finding a way to allow GM mosquitoes to thrive in wild populations has proven difficult. Without a suitable mechanism to ensure their survival, the mosquitoes would simply be out-competed by their native counterparts and die out, together with their disease-proof genes.
"Up to now — almost ten years later — no-one has really found out how to do that," Marcelo Jacobs-Lorena, a professor at the John Hopkins Malaria Institute, United States, told SciDev.Net last year.
Now, scientists at Imperial College have demonstrated a method to spread the beneficial genes through large populations, starting with just a small number of GM mosquitoes. The laboratory-based study was published in Nature yesterday (20 April).
The team bred Anopheles gambiae mosquitoes, the most important carriers of malaria, to contain a green fluorescence gene that makes them glow in the dark.
They then introduced the homing endonuclease gene (HEG) — which makes a copy of itself, ensuring all offspring end up with a copy of it as well — into around one per cent of the population.
The HEG gene, which is found in fungi, plants and bacteria, was designed to replace the glow-in-the-dark genes so that, if it spread through the population over time, less and less mosquitoes in each subsequent generation would glow in the dark.
The researchers found that in just 12 generations, the gene had spread through half of the population.
"We believe [that] in three to four years we will be able to apply this technique in native mosquito populations," Andrea Crisanti, lead researcher and a professor at Imperial College London, United Kingdom, told SciDev.Net.
Crisanti said the next step is to engineer the HEG to displace mosquito genes important for the transmission of malaria, as well as assessing the safety of the technique in human and animal populations.
The researchers plan to perform the first tests in two African countries, to be selected from a list of six that are being assessed at the moment.
"We need countries that not only have a serious malaria problem, but also clear safety and environmental legislation concerning GM organisms, and where we can work with a work with local team of scientists," said Crisanti.
Safety tests with larger populations of mosquitoes in more realistic environmental conditions will also take place, at the new EU INFRAVEC Mosquito Confined Release Facility, in Italy.
"This paper is a significant step forward," said Jacobs-Lorena. "For ten years we've known it is possible to engineer mosquitoes to make them poor transmitters of the disease, but we needed to give them some advantage over the native population. This research is a proof of principle demonstration in this direction."
http://www.scidev.net/en/news/survival-prospects-boosted-for-antimalarial-mosquitoes-.html

MALARIA: China: P. vivax seropositivity in 5 of the 6 nonhuman primate centers

Our survey showed P. vivax seropositivity in 5 of the 6 nonhuman primate centers in southern China, which is a potential health problem for bred cynomolgus monkeys. This finding also indicates the risk for infection with P. vivax for the employees of these nonhuman primate centers. Therefore, studies are warranted that assess the seroprevalence of P. vivax infection in persons who work in these nonhuman primate centers, as well as the seroprevalence of P. vivax infection in wild monkeys.
http://www.blogger.com/goog_1662268132




MALARIA: Plasmodium knowlesi in children in Malaysia

Plasmodium knowlesi can cause severe malaria in adults; however, descriptions of clinical disease in children are lacking. We reviewed case records of children (age <15 years) with a malaria diagnosis at Kudat District Hospital, serving a largely deforested area of Sabah, Malaysia, during January–November 2009. Sixteen children with PCR-confirmed P. knowlesi monoinfection were compared with 14 children with P. falciparum monoinfection diagnosed by microscopy or PCR. Four children with knowlesi malaria had a hemoglobin level at admission of <10.0 g/dL (minimum lowest level 6.4 g/dL). Minimum level platelet counts were lower in knowlesi than in falciparum malaria (median 76,500/μL vs. 156,000/mL; p = 0.01). Most (81%) children with P. knowlesi malaria received chloroquine and primaquine; median parasite clearance time was 2 days (range 1–5 days). P. knowlesi is the most common cause of childhood malaria in Kudat. Although infection is generally uncomplicated, anemia is common and thrombocytopenia universal. Transmission dynamics in this region require additional investigation.
http://www.cdc.gov/eid/content/17/5/814.htm

Malaria: The Forever War


MAGAZINE STYLE SERIES OF COMPREHENSIVE & EXCELLENT ARTICLES
Intro
Malaria—the disease that for millennia has filled cemeteries, killed kings, wrecked empires and thwarted human attempts to quash it—begins modestly enough. About 100 parasites swim in the saliva of a female mosquito.
That humble start spawns personal and global misery. The few parasites that invade a person can quickly expand to trillions, overwhelming the human body. The effect manifests in the dulled eyes of blinded children, the paroxysms of fever and chills racking the victim, the deaths of children and pregnant women, and the hobbled productivity of entire nations. Each year, malaria causes nearly 800,000 deaths and 225 million clinical cases.
Were it not such a horror, the Plasmodium parasite would be one of the wonders of the world. The resilient shape-shifter constantly adapts to its surroundings, masters sexual and asexual reproduction, slips past the immunological defenses of the Anopheles mosquito and human beings, rides in the belly of its arthropod ally to new victims…. A testament to evolutionary engineering, the parasite has a solution to every barrier it meets.
And so, Plasmodium has been virtually unstoppable. Humanity’s last global attempt at malaria’s eradication in the 1950s ended in shambles. Bright hopes were extinguished by the parasite’s resilience (and the mosquito’s growing resistance to insecticides).

However, the malaria story does not end there.
We Homo sapiens have our own brand of resilience, innovation and tricks for survival. As the following pages testify, breakthroughs in genetics, parasitology, entomology, drug development, satellite technology and other areas have summoned new hopes against our old enemy.
http://magazine.jhsph.edu/2011/malaria/intro/index.html

MALARIA: Wellcome Film of the Month

26 Apr, 2011  Yesterday was World Malaria Day and we thought we’d mark the occasion by highlighting some videos about the disease from our archive.
Mosquitoes and malaria, 1988 is one of the Moving Image & Sound department’s definitive films on the subject. The audience for many of the films in Moving Image and Sound has tended historically towards professionals in the field and this film made by a team of Wellcome Foundation Film Unit stalwarts (Dr Len Goodwin with cinematography by the late Douglas Fisher) is unashamedly technical in nature; explaining how to detect the presence of malaria parasites in mosquitoes.
In fact. two films are cunningly fused together in this one title: extracts from an earlier title from 1953, Dissection of a mosquito for malaria parasite have been sourced in order to illustrate the ‘traditional’ and somewhat laborious method (minute mosquito legs and wings are amputated, the evidence studied by sight alone under microscopes). The modern enzyme-linked immunosorbent assay (or ELISA) method for detecting malaria sporozoites and oocysts in female Anopheles mosquitoes are then shown in detail. The impact of this technique relates to epidemiologists’ ability to understand the degree of infection in an area where the mosquitoes are collected (and presumably plan accordingly). ELISA is a biochemical technique and has been used to test for HIV and in the detection of illegal drugs usage. However, some controversy does surround the interpretation of the division between what constitutes a positive and a negative result.

Other films about malaria in the Wellcome Film collection:
Private Snafu vs. Malaria Mike, 1944 is a Warner Brothers film made for the US army. Using the might of Hollywood in its propaganda efforts (Mel Blanc who voiced Bugs Bunny and Dr Seuss, aka Theodore Geisel, as supervising producer), it was one of a series aimed at military personnel; providing information about how easily malaria can be contracted. The eponymous hero, Snafu makes a catalogue of errors such as not using repellent. At the end, the mosquito tells his son what he did in the war – with Snafu’s scalp hanging on the wall.
DDT versus malaria: a successful experiment in malaria control by the Kenya Medical Department, 1946 is a film with a complex provenance. It shows film footage of the campaign to check a malaria epidemic in the Kipsigis tribal reserve in Kenya by spraying village huts with DDT. It shows very sick villagers suffering from malaria with everyday life almost at a standstill. It was decided that the film could also be used for propaganda purposes and so several narrative elements have been fictionalised in the film (which is rather stilted and jarringly patronising in places).
Wellcome’s involvement in tropical medicine is well-documented in our collection. The Story of the Wellcome Foundation, 1955, is an ‘industrial’ film, shot in colour with an upbeat tone, communicating the optimism of the era. Research into malaria is revealed as beginning as early as 1901 and the film shows an image of Wellcome’s floating laboratory on the Nile. The Wellcome Building in the mid-1950s is shown to be a hive of activity at the cutting edge of research into the quest for cures for many debilitating and life threatening tropical diseases – many of which are still being pursued by Wellcome Trust-funded scientists today.

Find out more about malaria research on the Wellcome Trust Malaria website.
You can learn about the Wellcome Film project here. If you would like to make use of this archive footage in your own projects, please visit the Wellcome Library catalogue to download the original files, which are distributed under a Creative Commons Attribution-Non-Commercial 2.0 UK: England & Wales licence.
http://wellcometrust.wordpress.com/2011/04/26/wellcome-film-of-the-month-malaria/

MALARIA: Ghana: Malaria Day in Ghana, a reflection of the odds

25 April 2011
Hayford Siaw, Executive Director : Volunteer Partnerships for West Africa


According to the World Health Organization report on malaria in Ghana, US$27million and US$38million was spent on Malaria in 2008 and 2009 respectively. In spite of the huge amount of money invested, Ghana still recorded very worrying figures with 3,694,671 cases in 2009 compared to 3,200,147 in 2008. Admission to hospitals due to malaria also went up from 272,802 in 2008 to 277,047 in 2009. Death due to Malaria from the records of clinics and hospitals stood at 3,378 in 2009.
It must be noted that, the National Malaria Control Program (NMCP) is on record in it strategic plan that 70% of the Ghanaian population rely on traditional medicines. The absence of data from traditional medicine providers therefore should raise concern on the number of malaria deaths and sickness that goes unreported.
The increase in the scourge of malaria should be accepted as a failure on leadership responsible for controlling and or eliminating Malaria in Ghana. Indeed, the National Malaria Control strategic plan is a failed policy program and should therefore be re-examined. There is too much wastage on personnel instead of actual resources going into interventions that will help reduce both cases of admission and deaths. Over 30% of money allocated for Malaria Control went into Human Resources alone.
Historically malaria has been the cause of deaths all over the world. Of course it is no longer a threat to the developed world and has been modified in the developing countries with the exception of Sub-Saharan Africa where it is endemic. The United States was one of the first Western Counties to eliminate malaria, due to an extended campaign using surplus military aircraft left over from World War 2 which was equipped with insecticide dispersal systems necessary to dispense DDT as a Dust or liquid. This operation was a success and by 1950 only 5 years after the end of the war the Center for Disease Control in Atlanta Georgia, declared the United States malaria free.
Mr. Robert Desowitz in his book THE MALARIA CAPERS writes; from colonial times until the 1940s, malaria was the American disease. One of the first military expenditures of the Continental Congress was for $300 dollars to buy quinine to protect General Washingtons troops. During the Civil War one half of the white troops and four fifths of the black soldiers of the Union Army were stricken with malaria annually.
The malaria mosquito has the reputation of being 9 feet tall in Sub-Saharan Africa, more feared than the mighty crocodile. The truth be told, it is just an insignificant noisy insect, a biological creature, just like us. If the humble mosquito has the ability to infect humans with a parasite, humans should reciprocate in kind and infect the mosquito with an organism, to give as well as we get from this bane of mankind.
To be more specific, I would like to propose at this time we use a biological agent known as a fungus spore. There is a product in commercial production in the United States, used on organic farms that also have applications for the control of adult mosquitoes. Research done on malaria mosquitoes has indicated only one spore has the ability to kill a mosquito. Although it may take up to 10 days to kill the mosquito, after 2 days the mosquito no longer feeds. This product is a soil fungus, most soil insects are immune to its effects. However an airborne insect like the mosquito has no natural immunity to this spore and according to research done at UC Davis in California, the mosquito will never develop immunity to this fungus. When exposed the mosquitoes were 80 times less likely to transmit malaria.
According to Dr. Kenneth D. Vernick, a microbiologist at the University of Minnesota stated a soil fungus that devoured insects, whose mosquito-killing powers were described by British scientists last year, could be used to hunt down the most malaria-susceptible bugs in any swarm and knock them out of the gene pool. He also said for unknown reasons, it weakens plasmodium-carrying mosquitoes more than it does others. Even after exposure to a 12 day old spray, 89% of the mosquitoes died.
This is good news as plasmodium falciparum is the most dangerous parasite of the four malaria parasites that infect man and the most prevalent by far in Ghana where it comprises up to 98% of infections.
This is all fine and dandy you might say, however, how is this fungus spore to be delivered to the recipient, the malaria mosquito? The same way the Americans did it 60 years ago, using aircraft equipped with insecticide, aerosol generators. This is the only effective method.
WHO writes in it 2010 report on Ghana, ‘’there is no evidence of a reduction in suspected malaria cases between 2000 and 2009, while inpatient cases in all ages increased’’.
http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=207445

MALARIA: India: Health workers in Orissa work with rural communities to raise awareness

19 April 2011
Picture of Milu Jani and his family under a bednet.
Milu Jani and his family under their new bednet. Picture: DFID

Milu Jani lives in Labangi, a small village in a remote area of Western Orissa – one of the poorest states in India. The village is around three hours from the nearest district town of Angul and part of the journey needs to be done on foot. There is no health centre, no electricity and no school in the village. Milu works as a forest guard at the Satakosia wildlife reserve, earning a mere 90 rupees (£1.20) a day.
Like most villagers, Milu has lost a loved one to malaria. His eyes tear up as he recalls his father's death last winter. Milu's father fell ill with a high fever and was tragically diagnosed with malaria only a day before his death, leaving no time for proper treatment. Malaria can be treated effectively with drugs, but treatment is most effective when administered within 24 hours of the onset of fever.
Milu knew mosquito bites can cause malaria but didn't know the deadly mosquitos were breeding in the water pools around the village. After his father passed away, Milu met a local health worker who explained the risks of malaria and how to prevent his family from becoming ill with this deadly disease.

Getting healthcare to rural communities
The DFID supported state health programme in Orissa trains health workers to help raise awareness of malaria prevention and treatment among vulnerable tribal communities like Milu's. Health workers like Suhasini Behera in Milu's village are trained in the use of diagnostic tests and how to administer appropriate medicines. They also distribute bednets and promote the proper use of nets to prevent malaria.
"It was not easy to convince people to use bed nets," Suhasini says. "People feared the nets were poisonous as there had been reports of rashes and itching from the insecticide" – misconceptions that she sought to dispel while visiting their homes.
By working with the community to raise awareness of malaria, Suhasini and her fellow health workers help to prevent people from contracting malaria and help the villagers to understand how to access treatment.

Bednets - a simple prevention tool
DFID's support to the Orissa state health programme has helped Milu and his family purchase bednets that will prevent them from contracting malaria in the future. By subsidising the cost of the nets, DFID enables poor families like Milu's to purchase two bednets for only 20 rupees (25p). The nets are treated with insecticide and last up to five years.
Milu's mother is content with her new net. "I always had disturbed sleep due to the mosquitoes. This new net has brought me a lot of comfort and I also use it for my afternoon nap".
Milu is equally satisfied. "Malaria was a huge problem in our area. Now everyone in the village is using a net. I have lost my father but now I can keep my family safe from malaria".

Key facts
DFID India has committed £100 million over 2007-12 to Orissa's state health programme to tackle malaria, among other health and nutrition initiatives. The programme increases efforts to prevent malaria, improve diagnosis and provide access to treatment for pregnant women and tribal children, who are most vulnerable to the disease.
DFID support has helped provide an extra 300,000 bed nets to young expectant mothers, to prevent anaemia and malaria-related deaths.
Orissa's state health programme has trained 20,000 health workers to use diagnostic tests, administer medicines and distribute bednets.
The state health programme distributed 1.2 million bednets to villages in February and March 2010, supported by the education and awareness activities of health workers.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2011/Battling-malaria-in-India/

MALARIA: Ethiopia: Supporting rural health workers to combat malaria

22 December 2010 Extending the fight against malaria in Ethiopia
Supporting rural health workers to combat malaria


Almaz is 24 years old and has been working as a Health Extension Worker (HEW) for the last three years, in her own village which is more than an hour's drive from the nearest small town.
"The work is very hard, I have to work long hours and walk long distances but I am proud to be serving my community and have seen real changes in their health," she says.
A health worker in Ethiopia treating a woman and her baby A health worker in Ethiopia treats a woman and her baby


Almaz is one of more than 34,000 HEWs who have been trained and deployed to deliver a 'package' of basic services to their communities, including the prevention, diagnosis and treatment of malaria, family planning and immunisation.
Ten years ago, only two-thirds of Ethiopians had access to health services. Rural areas, in particular, suffered from a lack of medical facilities and health workers. There was a critical need to bring healthcare to more of Ethiopia's people. And over the last five years, the Health Extension Programme, the flagship programme of the Ethiopian ministry of health, has aimed to do just that.
At the centre of the HEP are female health workers like Almaz who operate within local communities. In each rural "kebele" (a community of about 5,000 people), two women who have completed tenth grade are selected to become Health Extension Workers.
This national programme has helped to deliver real improvements in people's health including reducing the previously devastating impact of malaria. The HEWs teach their communities about how to prevent malaria and to seek help when they have a fever.
They have also been trained and equipped to test people for malaria at the community level, which ensures correct diagnosis and treatment. Additionally, in the last five years more than 35 million insecticide-treated nets have been distributed across the country, which are reducing the numbers of people becoming infected.

Getting healthcare to communities
The UK is supporting the Health Extension Programme through a contribution to the government of Ethiopia district level 'block grant', which pays for the delivery of services. This block grant is used by districts across the country to deliver priority services, including health and education, to its communities.
UK funding is currently supporting more than 3,900 Health Extension Workers to deliver health services to around nine million people. Additionally, the British Government provides direct support to the Ethiopian ministry of health to help it to deliver its ambitious plans to meet all of the health related MDG targets by 2015, including those on malaria.

Facts and stats
The latest World Health Organisation rapid impact assessment in four main regions in Ethiopia shows that between 2001-2004 (annual average) and 2007, confirmed malaria outpatient cases decreased by 67%, malaria admissions by 54%, and malaria deaths by 55%.
The government of Ethiopia's next five year plan includes efforts to further increase utilisation of ITNs and strengthen diagnosis and treatment of malaria.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2010/Extending-the-fight-against-malaria-in-Ethiopia/

MALARIA: Kenya: How scouts are helping in the fight against malaria

Twelve-year-old Aisha Ali really is a well prepared scout. True to the motto of the Scouting movement – 'be prepared' - she is one of more than 21,000 scouts from over 1,000 schools in Kenya who are taking part in a project aimed at preventing the spread of malaria.
"I've always wanted to help others, so joining my school's scouting club gave me great pride." says Aisha.
"When this project was introduced in January 2010, I was very excited at the opportunity to serve my community."
Supported by UK's Department for International Development (DFID) and undertaken in partnership with the Government of Kenya's Division of Malaria Control, the Kenya Scouts Association and Population Services International (PSI) Kenya, the project aims to save the lives of Kenyans living in 36 malaria-prone districts by ensuring people sleep inside well tucked-in, insecticide treated mosquito nets every night, the whole year round.

Members of Kenya Scout clubs in the affected districts 'adopted' some 150,000 homes - equivalent to around 675,000 people - to teach them how to properly hang and use bednets, to avoid being bitten by mosquitoes.

Training
Aisha says 20 scouts from her school were trained about malaria; what causes it, how one can get it and how nets help prevent the spread of the disease. They were also trained on how to hang the mosquito bednets and the importance of sleeping under the nets each night.
"This is where we play an important role in malaria prevention – making sure that everyone in our communities sleeps under a net every night," says Aisha.
Each scout in the scheme is issued with a project booklet containing questions that help them to record how many people live in a home and how many of them sleep under a treated mosquito net.
The scouts are trained to ask to see the sleeping area and ensure the bednets are hung properly. They also show members of each homestead how to hang the nets correctly themselves.
"We were expected to adopt between seven and ten homes and visit them at least once a month to ensure that all the members of the households slept under a net."
One of the homes that Aisha has adopted is that of 'Mama' Hadija Hassan Mwabaha, an elderly widow who lives with four other elderly widows. Aisha recounts how she met Hadija. "I remember the first day I visited Mama Hadija. She is a clever woman and asked me a lot of questions about malaria. I told her about the anopheles mosquito. She was impressed by my knowledge and agreed to be part of our scout's project".
"I showed Mama Hadija how to hang up their nets correctly so that they are not bitten by mosquitoes. I also informed her that pregnant women and children younger than five years are at greatest risk from malaria. I have visited her every month since the first meeting. I like her because not only is she welcoming but she helps me with the project. She is a poor woman but has a very kind heart."
And Mama Hadija has equally good things to say of Aisha. "She has protected us from malaria!" she exclaims.
She goes on to explain that the program has helped to explain the dangers of malaria to the whole community and the importance of everyone using the nets every night.

Serving the community
The whole experience has been very motivating to Aisha: "I am serving my community and that makes me very happy," she says. She also has a certificate of merit from the training, is more enlightened about malaria issues, feels empowered to assist others and is glad that the training has boosted her ranking as a scout.
"When I know that I have helped prevent one more malaria case I feel so proud of my efforts," she concludes with a smile.
Of the ten households that Aisha adopted in January, nine already had the insecticide-treated nets. However not all the homes were using them correctly; over the course of the year, Aisha has assisted her adopted homes to ensure the consistent and proper use of mosquito nets.
http://www.dfid.gov.uk/Media-Room/Case-Studies/2010/Being-prepared-for-Malaria-in-Kenya/

MALARIA: Kenya: How UK aid is helping to save children's lives through a cherry-flavoured malaria drug

20 April 2011 World Malaria Day on 25 April is a chance to mark the efforts that are being made globally to tackle the terrible disease. The UK government is leading the way in pioneering innovative and effective ways of tackling malaria as set out in the recently published framework for results.

Rose and her daughter Shanrol have benefitted from a new anti-malaria drug developed thanks to UK aid. Picture: Novartis
Rose and her two-year-old daughter Shanrol have benefitted from a new anti-malaria drug developed thanks to UK aid. Picture: Novartis

A preventable tragedy
Malaria is a preventable and curable disease, yet a child dies of malaria every 45 seconds. Nearly one million people die of malaria every year, mostly infants, young children and pregnant women and most of them in Africa. Malaria does not only kill, it can have long term consequences. Men and women are unable to work for long periods when they or their children become ill. Entire households can be thrown back into poverty. Severe malaria often leads to brain damage, holding back a child’s mental development resulting in lifelong impacts. But malaria can be treated effectively with existing drugs and treatment is most effective if administered within 24 hours of the onset of fever.

Life is no bowl of cherries
Rose Aluoch Ngala lives in the village of Ombeyi, 15 miles southeast of Kisumu, the third largest town in Kenya and also one of the poorest. Ombeyi is on the edge of Lake Victoria - a region where more children die of malaria than any other disease. Like many people in her village, she is a farmer. She has three young children. When her daughter Shanrol, who is two years old, became ill she was afraid. Children under five years of age die from malaria very fast.
"Her body was hot and she was not eating or playing and she was crying all the time. I took her to the hospital, where she was diagnosed with malaria and I was told that she would be admitted for three days. They kept testing now and then to find out how much of the infection was in her blood and how far the disease had gone.
"This is her fourth time to get malaria and she is only two years old. The first time she was only eight months, and I took her to the hospital where she received drip water and medicine. I fear that she could die because of this disease malaria."
Shanrol was treated with Coartem-dispersible, a new cherry flavoured malaria drug and the first to be formulated especially for children. It dissolves easily in a small amount of water or breast milk. The treatment is fast and effective and will increase the use of malaria medicines by children, saving millions of lives.

A sweeter pill to swallow
As mothers like Rose know, getting children to take bitter medicines is always difficult. Children would often spit out or vomit the life saving medications designed for adults. Now Rose and millions of mothers like her can get better treatment for their children, helping to ensure they recover quickly from this life threatening illness.
"This medicine is good because my child can swallow it fast and it doesn't have any side effects, like rashes. The fever also goes down very fast. She could speak and play quickly after taking this treatment. I have seen a big difference."

Access to life saving medicine
Coartem-d was launched in 2009, the result of a public-private partnership between Medicines for Malaria Venture (MMV), a non-profit organisation funded by DFID, and the pharmaceutical company Novartis. With funding from DFID and other international organisations, MMV has been able to rapidly increase access to and availability of the cherry-flavoured drug. In two years, 64 million treatments of this life saving medicine have been delivered to 35 countries.
http://www.blogger.com/post-create.g?blogID=3604033512937490051&pli=1