POVERTY: UGANDA: Government "won't budge on food prices"

KAMPALA, 3 May 2011 (IRIN)

 Photo: Charles Akena/IRIN
Rising food prices have led to protests (file photo)

The government of Uganda will not reduce taxes or consider food subsidies, despite an increase in violence that has led to a “national crisis”, according to the UN.
Minister of Information Kabakumba Masiko said the consistent government line since the "walk-to-work" protests began on 8 April still stood, though she maintained other measures were in place to address stability in the East African country.
“On the supply side, we are ensuring there will be enough food for our people,” she said. “The Bank of Uganda is also mopping up the excess currency that is contributing to the inflation.”
Opposition politicians and critics have blamed the lack of food and fuel reserves for contributing to skyrocketing prices.
According to the Uganda Bureau of Statistics, inflation jumped another 3 percent last month, reaching an annual 14.1 percent in April from 13.1 percent in March, while crop inflation rose from 29.1 percent in March to 39.3 percent.
The demonstrations against the rising cost of living have been led by opposition leader Kizza Besigye, who has vowed protests will continue.
On 29 April, riots broke out across the capital, Kampala, and five other centres across the country, killing at least five people and injuring hundreds more.
“We just woke up angry,” said George Lubwama, 27, a barber in Kasubi, where one person was confirmed by Red Cross officials to have been shot dead after live rounds and tear gas were used by security forces trying to dispel angry rioters.
The epicentre of violence in the city, Kisekka market, was taken over early in the morning by an elite military group led by President Yoweri Museveni’s son – journalists were reportedly barred from entering the area and threatened.
The height of the violence was widely seen as a protest against the violent arrest of Besigye the day before. Security forces smashed the former presidential candidate’s car window and sprayed him directly in the eyes with tear gas after an hours-long standoff, after which Besigye was thrown into a police vehicle.
The footage of the brutal arrest on 28 April was widely circulated and has brought criticism from domestic and international human rights bodies alike.
On 1 May, the UN High Commissioner for Human Rights, Navi Pillay, called the manner in which Besigye was arrested “shocking”.
“The excessive use of force by security officers was plain to see in the television footage of the event. While I do not condone the violent rioting that followed, the Ugandan authorities must realize that their own actions have been the major factor in turning what were originally peaceful protests about escalating food and fuel prices into a national crisis," Pillay said.
Meanwhile, Ugandans continue to feel the impact of increased food prices following a sharp increase in fuel prices in the past few months.
A Kasubi taxi driver, Robert Kawuki, says the rising costs have severely affected his livelihood. “It’s hurting me to the extremes,” he said.
Lubwama added that the politicization of "walk-to-work" protests was hurting those most affected. “He [Museveni] is fighting Besigye, but the greatest rebel is the economy now,” he said.

http://www.irinnews.org/report.aspx?reportID=92632

MALARIA: Contribution of Integrated Campaign Distribution of Long-Lasting Insecticidal Nets to Coverage of Target Groups and Total Populations in Malaria-Endemic Areas in Madagascar

Manisha A. Kulkarni et al

In October 2007, Madagascar conducted a nationwide integrated campaign to deliver measles vaccination, mebendazole, and vitamin A to children six months to five years of age. In 59 of the 111 districts, long-lasting insecticidal nets (LLINs) were delivered to children less than five years of age in combination with the other interventions. A community-based, cross-sectional survey assessed LLIN ownership and use six months post-campaign during the rainy season. LLIN ownership was analyzed by wealth quintile to assess equity. In the 59 districts, 76.8% of households possessed at least one LLIN from any source and 56.4% of households possessed a campaign net. Equity of campaign net ownership was evident. Post-campaign, the LLIN use target of 80% by children less than five years of age and a high level of LLIN use (69%) by pregnant women were attained. Targeted LLIN distribution further contributed to total population coverage (60%) through use of campaign nets by all age groups.

Am. J. Trop. Med. Hyg., 82(3), 2010, pp. 420-425

http://www.ajtmh.org/cgi/content/full/82/3/420

TUBERCULOSIS: The worldwide epidemic of multidrug-resistant tuberculosis

April 28, 2011

An editorial in The Lancet Infectious Diseases: The worldwide epidemic of multidrug-resistant tuberculosis. Excerpt:
WHO estimates that a third of the world's population is infected with Mycobacterium tuberculosis. In 2009, there were almost 9 million new cases of tuberculosis and the disease killed almost 1 million people around the world. Since the discovery of the BCG vaccine, and the development of new antibiotics in the 1950s, the incidence of tuberculosis has fallen substantially.
From 1995 to 2009, about 49 million people received treatment for the disease, 41 million of whom were cured, saving up to 6 million. However, multidrug-resistant (MDR) tuberculosis—ie, resistance to two of the most potent drugs, rifampicin and isoniazid—threatens to turn the tide against the medical advances of the past century.
Although the problem of tuberculosis and drug resistance is commonly thought to be one that primarily affects developing countries in Africa, a report from the European Centre for Disease Prevention and Control (ECDC) and WHO, released for World Tuberculosis Day on March 24 and summarised by Talha Burki in this issue of The Lancet Infectious Diseases, shows that MDR tuberculosis is a growing problem in Europe.
The number of patients with MDR disease in Europe is alarmingly high, with an overall absolute number of 27 765 patients in 2009.
In 2008, WHO estimated that there were 440 000 cases of MDR tuberculosis around the world; but because culture and PCR methods for diagnosis are unreliable for resistant disease, WHO estimates that only 11% of actual cases were detected in 2009.
In the past 10 years, an estimated 5 million people developed MDR tuberculosis worldwide, of whom only 1% had access to treatment and almost 1·5 million people died. The global prevalence of MDR tuberculosis could be approaching 1 million.
http://crofsblogs.typepad.com/h5n1/2011/04/lancet-the-worldwide-epidemic-of-multidrug-resistant-tuberculosis.html

TUBERCULOSIS: Children and multidrug-resistant tuberculosis

Children and multidrug-resistant tuberculosis : Original Text: CE Jones, B Kampmann
Mercedes Becerra and colleagues (Jan 8, p 147) report high rates of tuberculosis in household contacts of patients with multidrug-resistant or extensively drug-resistant (MDR/XDR) tuberculosis. We welcome their recommendation that a diagnosis of MDR or XDR tuberculosis should prompt systematic surveillance of household contacts and investigations. However, they seem to have overlooked young children present in these households.
Children contribute substantially to the global burden of tuberculosis and young children are at increased risk of disease progression and poor outcome, particularly within the first 12 months after exposure.The prompt assessment of children in a household affected by tuberculosis is therefore essential. Few data exist to guide management of children in close contact with adults with drug-resistant disease. Becerra and colleagues' study provided an excellent opportunity to gather such data, but results on children younger than 5 years seem to have been omitted, and data from older children are not reported separately from the adult cohort. No conclusions relating to the risk of disease in children can therefore be drawn from this study.
We acknowledge that the diagnosis of paediatric tuberculosis can be challenging, which might have been the reason why paediatric issues were not addressed in this paper. Despite these difficulties, however, epidemiological data are urgently required to inform preventive strategies for this vulnerable group.Failure to report paediatric data represents a missed opportunity to inform such strategies. Future household contact studies should include children of all ages and report paediatric data in addition to adults.
The Lancet, Volume 377, Issue 9775, Pages 1404 - 1405, 23 April 2011 http://image.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60570-9/fulltext

TUBERCULOSIS: Sequencing Study Finds Mutations in Latent Tuberculosis Bugs

April 25, 2011   By a GenomeWeb staff reporter

NEW YORK (GenomeWeb News) – An online study in Nature Genetics yesterday hints that drug resistance may arise in tuberculosis-causing bacteria even during latent stages of infection.
A Harvard University-led team sequenced the genomes of nearly three-dozen Mycobacterium tuberculosis isolates collected from nine infected macaques. When they used SNP data to gauge mutation rates at different stages of infection, the researchers found comparable levels of mutation under each of the conditions tested. The findings suggest drug resistance — including resistance to a treatment that relies on the antibiotic isoniazid alone — can likely occur even when tuberculosis infection is not at an active stage.
"We show that [M. tuberculosis] continues to acquire mutations during disease latency," senior author Sarah Fortune, an immunology and infectious diseases researcher with the Harvard School of Public Health, and her co-authors wrote, "which may explain why isoniazid monotherapy for latent tuberculosis is a risk factor for the emergence of isoniazid resistance."
Active tuberculosis is typically tackled with a combination of different antibiotics, the researchers explained. Latent infections, on the other hand, are considered less mutation prone, and are more often treated with a lone antibiotic called isoniazid, or INH.
Nevertheless, some epidemiological studies have reported elevated INH resistance in tuberculosis-causing bugs that had been treated with this preventative monotherapy, the authors explained, raising suspicions that mutations may be more common during latency than previously appreciated — a possibility that the team explored with whole-genome sequencing.
"[W]e sought to define the mutational capacity of the bacterium during infection to better predict the rate at which drug resistance can be expected to emerge in active, latent, and reactivated disease," they wrote.
Using the Illumina Genome Analyzer, the researchers did single-read and paired-end sequencing of a M. tuberculosis strain known as Erdman and of 33 M. tuberculosis isolates from nine macaques that either had active tuberculosis infections, latent infections, or infections that were re-activated after a period of latency.
In the process, they generated sequence that covered 93 percent of each genome, on average, to a depth of about 117 times.
After tracking down variants in the genomes and verifying them with targeted Sanger sequencing, the team was left with 14 SNPs that seem to have arisen over the course of macaque infections. But rather than seeing more mutations in the isolates from macaques with active tuberculosis infections, the researchers found comparable mutation rates in each of the three infection scenarios.
"Our data indicate that in macaques with active, latent, and reactivated disease, the bacterial populations acquire mutations at the same rate over time, regardless of the number of bacterial replications that have occurred," they wrote.
Moreover, their subsequent experiments hint that these mutation rates are similar to those found when M. tuberculosis is grown in a lab setting.
The findings suggest that drug resistance is not only an issue to contend with during active tuberculosis infection, the researchers explained, since bacteria can also mutate during latent infection and in early stages of reactivation.
Those involved in the study emphasize that more research is needed to understand whether M. tuberculosis mutation patterns are similar in infected humans. Still, they say, the results underscore the need for surveillance for resistance-related mutations — particularly if preventative INH treatment becomes more broadly used to treat latent tuberculosis in some populations, including those infected with HIV.
"[INH preventative monotherapy] is now being recommended globally for HIV-positive individuals with latent tuberculosis where bacterial burden and the rate of treatment failure may be higher because of immunocompromise," the authors noted.
"If our data from the macaque model are predictive of the mutational capacity of [M. tuberculosis] in HIV-positive individuals, INH mono-resistance could arise at a substantial rate," they added. "These findings emphasize the importance of drug resistance testing and careful monitoring for treatment in these populations."
http://www.genomeweb.com/sequencing/sequencing-study-finds-mutations-latent-tuberculosis-bugs

TUBERCULOSIS: USA: Tuberculosis Detected In Dairy Cow Headed To Slaughter

April 26, 2011
SAN BERNARDINO (AP) — State and federal officials say bovine tuberculosis has been detected in a dairy cow from a Southern California herd during a routine slaughterhouse inspection.



Officials with the California Department of Food and Agriculture and the USDA said Tuesday the cow was traced to a San Bernardino County dairy and other animals in the herd are being tested as well.
USDA spokesman Larry Hawkins says more cases have been detected in that herd but the disease poses no risk to humans or the milk supply.
Hawkins says cows that are found to have the disease will be killed and milk sold in California is pasteurized, which kills tuberculosis organisms.
He didn’t know how many animals tested positive for the disease.
The last known case of bovine tuberculosis in California was in 2009.
http://losangeles.cbslocal.com/2011/04/26/tuberculosis-detected-in-dairy-cow-headed-to-slaughter/

TUBERCULOSIS:.England: farmers 'live with' bovine TB slaughters

29 April 2011

Cows are routinely tested in areas considered high risk for bovine TB
Bovine tuberculosis is a major problem for farmers in England and led to the slaughter of almost 25,000 animals last year - but what's it like to run a farm affected by the disease?
David Moreton, a dairy farmer near Wotton-under-Edge, Gloucestershire, knew what would happen when 12 of his cows reacted positively to bovine tuberculosis tests last month.
The animals were taken away to be slaughtered and in the first post-mortem tests, nine out of 10 were found to have TB lesions on their glands.
Last year, five of his cows were slaughtered after they were also classed as "reactors" after reacting to routine skin tests.
Mr Moreton's 300 organic milking cows are routinely tested for TB because the farming area, stretching between Bristol and Cheltenham, is considered high risk for the disease.
He has been a cattle farmer for 35 years and sees an outbreak of bovine TB every couple of years and said each time it was upsetting.
"Every one or two years we have a problem and if we don't have a problem one of our neighbours does," he said. "It's something we live with."

'Life and death'
Last year, a total of 24,899 cattle in England tested positive for bovine TB. All were slaughtered, in line with government policy in place because the bovine bacterium can also cause human TB.
In 2009, 25,557 cows had to be slaughtered, under the the bovine TB control measures. The West and South West are the worst affected parts of England.

Tests to find source of bovine TB
In one of the latest outbreaks on a farm near Penrith, Cumbria, 80 cows were slaughtered and a further 20, also classed as reactors, were due to be killed.
The government pays compensation to farmers whose cattle have been slaughtered to control the disease, ranging from £132 to £1,665 per animal, depending on its age and type.
A total of £63m was spent dealing with bovine TB in 2009/10 and the government said it recognised the disease had a "devastating effect on many farm businesses and families".
Last year, the Department for Environment, Food and Rural Affairs (Defra) begun a public consultation on tackling the disease. The result will soon be published.
Mr Moreton said: "On a farm you see life and death every day.
"This disease is out of your control and when there's an outbreak you do understand the animals need to be killed.
"But in the last outbreak we lost animals which were three to four years old - at the peak of their production life. We would have spent two to three years just rearing them with no income."

'Keep morale up'
Mr Moreton said it had been a long-term problem in Gloucestershire, and he had lost 10 to 20 cows in each outbreak on his farm.
"It is upsetting. I have four employees and I have to keep morale up and reassure them it is not their fault and that we have to keep going," he added.
Like many farmers, Mr Moreton believes badgers are the "prime culprit" behind bovine TB. He said among evidence was that when badgers were culled in the area the disease was much less widespread, but it had become "worse and worse" in the last 10 to 15 years.
He said bovine TB was also known to spread from other cattle, but he had not brought any cattle, apart from a breeding bull, which was safely sourced, on to his farm for years.

Many farmers consider badgers cause outbreaks of bovine TB Mr Moreton said he would like to see badgers humanely culled in affected areas, but believed vaccinating cattle against the disease would be the best long-term solution when a cow vaccine becomes available.

In the government consultation, the National Farmers' Union (NFU) has backed a proposal to curb the disease by licensing farmers to tackle TB on their land by killing badgers or vaccinating them.
Ministers have said this was also their "preferred approach".
However, badger culls have been passionately opposed by a range of animal welfare groups who say research has found no link between the species and bovine TB.
The Badger Trust says that government research over decades "had yet to determine how badgers infect cattle" and insisted that instead the badgers "very often" caught the disease from cows.
Meanwhile, some scientists say a badger cull could make the problem worse because it could cause badgers to roam further.
A Defra spokesman said no decision on badger control had yet been taken.
"We received a large number of responses to the public consultation which will be considering carefully in order to make the best decision," he said.
"We will announce our decision as soon as possible as part of a comprehensive and balanced TB eradication programme for England."

http://www.bbc.co.uk/news/uk-england-13227095

TUBERCULOSIS: India: Doctors express concern over wrong diagnosis

Apr 30, 2011,
LUCKNOW: Wrong diagnosis turned out to be a cause of concern for veteran doctors who gathered at Chhatrapati Shahuji Maharaj Medical University's pulmonary medicine department here on Friday.
"Roughly 25% diagnosis for tuberculosis is wrong, as physicians do not examine patients correctly. They go by what the tests reflect and as a result doctors get confused between TB, chronic obstructive pulmonary disease and other lung disease that are different from each other," said Prof Rajendra Prasad, head, pulmonary medicine department and member state task force on tuberculosis.
Acknowledging the fact, Dr P N Tandon, who set up neuro-surgery departments at AIIMS and CSMMU said, "The best diagnosis is done by the eyes and hands of the physicians." Padma awardee and former director of National Brain Research Institute, Dr Tandon added, "Machines may have become important for diagnosis but they can never replace humans."
http://articles.timesofindia.indiatimes.com/2011-04-30/lucknow/29490304_1_diagnosis-doctors-machines

TUBERCULOSIS: USA: decreasing, but rate of decline slows

 Charles C. Chante, MD  May 01, 2011

The tuberculosis in the United States continues to decline, has slowed since 2000 and the rate of infection among racial/ethnic minorities and foreign-born individuals continues to be disproportionately high.
Those were among the findings of a report on 2008 US trends in tuberculosis published by the Centers for Disease Control and Prevention.
In 2008, a total of 12,898 incident TB cases were reported in the United States. Representing a decline of 3.8 percent from 2007 and a rate of 4.2 per 100,000 population.
The 2008 rate was the lowest recorded since TB reporting began in 1953.
Progress has slowed in recent years, however, with the average annual percentage decline in the TB rate decreasing from 7.3 percent per year during 1993-2000 to 3.8 percent during 2000-2008.
Among the 50 states and the District of Columbia, TB rates ranged from a low of 0.5/100,000 in North Dakota to a high of 9.6/100,000 in Hawaii.
California, Florida, New York, and Texas reported more than 500 cases each and together accounted for 49 percent of all TB cases in 2008.
TB rates among Hispanics and blacks were nearly eight times higher than among non-Hispanic whites (8.1 and 8.7 per 100,000, respectively, versus 1.1 per 100,000), while the rate among Asians was nearly 23 times higher than among non-Hispanic whites (25.1 per 100,000).
The report classified persons identified as white, black, Asian, American Indian/Alaska Native, native Hawaiian or other Pacific Islanders or of multiple races, as non-Hispanic. “Persons identified as Hispanic might be of any race,” the report explained.
The 2008 TB rate in foreign-born persons living in the United States was 20.2 per 100,000, 10 times higher than for US-born individuals. People born in Mexico, the Philippines, India, and Vietnam accounted for half of the 7,541 tuberculosis cases in foreign-born persons that year.
However, the rate of TB cases, continued to decline both among foreign-born individuals (down 2.6 percent since 2007), as well as those born in the United States (down 4.7 percent).
Based on the data, the CDC recommended that TB prevention and control capacity be intensified to improve case management and contact investigations. The agency also called for intensified outreach, testing, and treatment of high risk populations; enhanced treatment and diagnostic tools; increased scientific research to be better understand TB transmission; and continued collaboration with other nations to reduce TB globally.
http://www.philstar.com/Article.aspx?articleId=681278&publicationSubCategoryId=64

TUBERCULOSIS: British screening misses most incoming latent TB

 27 April 2011 by Jessica Hamzelou
London may owe its reputation as the tuberculosis capital of Europe to the UK's TB screening programme. A new study suggests the current policy for screening immigrants from countries with a known TB problem misses 71 per cent of those who carry the disease but do not display symptoms. A policy change that would cost little more could bring that number down to 8 per cent.
British policy is to X-ray people arriving from countries known to have 40 or more cases of active TB for every 100,000 people. However, X-rays are effective at identifying active infections only: individuals who don't display symptoms of disease remain undetected. "Their X-ray scans are normal," says Ajit Lalvani at Imperial College London.
Latent TB can take anywhere from a few weeks to a lifetime to develop into an active form of the disease, but around 5 per cent of carriers will develop full-blown TB within a few years, says Lalvani.
Immigrants arriving in the UK from countries with 500 or more cases of active TB per 100,000 people face a more stringent test that will detect latent TB. It involves exposing a blood sample to TB antigens. If a person's immune system has been exposed to such an antigen before, the blood's T-cells will respond by releasing a protein known as interferon gamma; otherwise, the T-cells will do nothing. People with both active and latent forms of the disease can be identified in this way.
Lalvani and his colleagues studied three busy TB screening centres in London, Leeds and Blackburn – regions with high levels of TB in the immigrant population – between 2008 and 2010. Their analysis suggested that the current rules for TB screening were missing 71 per cent of cases of latent TB, which may prove costly to treat if they develop into an active form of the disease.

£3000 per case
To find a cost-effective alternative, the group analysed the estimated costs and benefits associated with lowering the latent TB screening threshold in order to screen more immigrants. They found that by using latent-TB screening for people from countries with TB rates above 150 per 100,000 – rather than 500 per 100,000 – they would be able to catch 92 per cent of latent TB cases.
The overall cost of extending latent screening would be around £20,000 per case of TB averted – "around £3000 more per case averted than the current [screening] programme", says Lalvani. He suggests that extending latent screening this way would actually save money, because it may cost a lot more to deal with cases of full-blown TB arising from latent infections: as well as treating the patient, everyone that they have been in contact with must be screened to make sure they have not become infected, which may be expensive.
However, the group has not yet carried out a full cost analysis to confirm that extra screening is cheaper in the long run.

Journal reference: The Lancet, DOI: 10.1016/s1473-3099(11)70069-x
http://www.newscientist.com/article/dn20424-british-screening-misses-most-incoming-latent-tb.html

TUBERCULOSIS: California: remains a major challenge for Bay Area public health departments

Sandeep Ravindran sravindran 04/25/2011
People think they just have a bad cold, until it refuses to go away.
Often, they have tuberculosis, a curable disease that nevertheless has proved extremely difficult to eradicate, particularly in Santa Clara County.
"The TB case rate in the Santa Clara-San Jose-Sunnyvale area is routinely, if not the highest, at least in the top three in the U.S. every year," said Julie Higashi, deputy health officer for Santa Clara County.
And while TB cases have been decreasing in other parts of California and the United States, Santa Clara County's rate has remained nearly the same for the past three years.
With a troubled economy and cuts to public health, officials say eradicating TB may get even tougher.
"California's financial situation could affect TB control programs, which would be unfortunate," said Lee Riley, a professor of Epidemiology and Infectious Diseases at UC Berkeley's School of Public Health.
Cutbacks to New York City's TB programs led to an explosion in TB cases in the 1990s, he said. TB cases increased from fewer than 1,500 cases in 1980 to a peak of 3,700 in 1992, according to figures from the New York City Department of Health and Mental Hygiene. By 1995, the epidemic had cost the city more than $1 billion.
"It ultimately cost them a lot more money," Riley said. "California should be made aware of that."
Although the disease can be cured, the treatment is long and expensive. Latent TB infections cost the county roughly $250 to $300 per patient, while the active, contagious form can cost from $10,000 to more than $30,000, Higashi said. Patients need to take several pills a day for six to 12 months to get rid of the disease.
Incomplete treatment not only fails to cure TB but can cause the bacteria to become drug-resistant. And each drug-resistant case costs hundreds of thousands of dollars to treat.
The county "plays an extremely important role in managing patients," said Alex Studemeister, an infectious diseases specialist with the San Jose Medical Group.
Each case is monitored by an assigned public health nurse. These nurses are essential to making sure patients complete their treatment regimen, he said. "It's not just a condition where you take pills, go home and you're well," he said.
Budget cuts have meant fewer county public health nurses, but the county says it's coping. The county now has a specialized team of nurses that work only on TB, Higashi said.
"We struggle with resources, but we're continually trying to find ways to meet those needs for public safety," Higashi said. That's particularly important in the Bay Area, with its high rate of TB cases.
One reason why the Bay Area has such high TB rates is "because we're so international," said Masae Kawamura, director of San Francisco Public Health TB Control. More than a third of Santa Clara County's residents are foreign-born, and they contributed 90 percent of active TB cases in 2010, according to county statistics. People catch the disease when visiting countries where it is endemic, or may have been infected before they came to the U.S. Seventy percent have lived in the U.S. for more than five years when they fall sick with TB.
The TB bacteria can infect a person decades earlier, and "can stay living in your body as a time-bomb," Kawamura said. "You never know if it's gonna wake up or not, or when it's gonna wake up."
That why controlling TB means going beyond just people with the active disease.
"Screening would make a difference in identifying and treating the people who have latent TB," Riley said. "But it takes a lot of effort and manpower."
The county requires every new and transfer school student to be tested for TB. To add to the costs, the public health department also has to track down and test every person with whom a TB patient came in contact.
"It's intense, but you can't scrimp on any of it," Kawamura said. Otherwise, the disease is transmitted in the community, she said.
Buoyed by a decrease in San Francisco's TB cases, which fell below 100 for the first time in 2010, Kawamura is confident that rates will go down. New diagnostic technologies should help. These include a blood test that is more accurate than the traditional skin test, and a new sputum test that can identify the TB bacterium within hours rather than two to three weeks, she said. Kawamura said she also hoped for new and better drugs with a shorter treatment regimen.
Until that time, treating TB is going to be costly and a lot of work, she said.
"I don't think I'll ever be out of a job," Kawamura said, "but we're trying really hard to achieve that."
http://www.insidebayarea.com/oaklandtribune/localnews/ci_17915852

TUBERCULOSIS: NYC: cases hit a record low, but disease targets specific immigrant groups

Kathleen Lucadamo  May 1st 2011,
Health officials say immigrants are bringing the contagious lung disease here from their homelands. Related NewsOfficials: Baby boy's death not from swine fluTuberculosis cases hit a record low in the city, but the disease is still rampaging through Chinese and Ecuadoran communities.


Health officials say immigrants are bringing the contagious lung disease here from their homelands.

"The TB we are seeing now is driven by a global epidemic," said Chrispin Kambili, director of tuberculosis control for the city Health Department.
In 1992, the height of the city's TB epidemic, 70% of the cases were in New Yorkers born here. Now 80% of the cases stem from those born abroad.
Doctors suspect the disease is dormant among immigrants until they come to the U.S.
Although a TB test is required for permanent immigration, those who arrive illegally or for school may not get the pinprick exam.
Health officials' priority is early treatment to prevent its spread, but TB often goes undiagnosed because the sufferers are poor, undocumented or leery of government.
"We've been really good at stopping the local transmission of tuberculosis, but our challenge is to identify new cases quickly," said Kambili.
Typically, immigrants surface in the emergency rooms of public hospitals where they aren't required to pay.
"The patient doesn't really ever get better until they can't take it anymore and go to the hospital," said George Alonso, director of tuberculosis surveillance and treatment at Elmhurst Hospital in Queens.
Misdiagnosis is also common. Doctors at local clinics, believing TB is obsolete, can blame pneumonia or bronchitis until a patient is coughing up blood and complaining of chest pains.
And outreach has been difficult in a bad economy since community groups in hard-hit neighborhoods are holding fewer health fairs, said Alonso.
Sunset Park in Brooklyn leads the city for TB cases, followed by western Queens, which includes Elmhurst and Corona.
Of last year's 711 patients - the fewest in the city's history - 15% were Chinese, 6% were Ecuadoran, 6% were Dominican, 5% were Mexicans and 4% were Bangladeshi.
For 18-year-old Akram of Astoria, a Bangladeshi immigrant who asked that only his middle name be used, TB was an interruption in his senior year of high school.
"They tested all my friends in school. I thought people would mock me but they didn't," he said.
He was homebound for a month until he completed treatment with a full course of antibiotics, key to stopping the disease from spreading and becoming drug-resistant.
Akram had passed the Immigration Bureau's test, but when the chest pains and fever came on, he knew it was TB because his twin had it two years earlier in Bangladesh.
"I'm glad I caught it early," said the teen, who was diagnosed at Elmhurst Hospital. "People used to suffer a lot."
http://www.nydailynews.com/lifestyle/health/2011/05/01/2011-05-01_tuberculosis_targets_immigrants_city_rates_low_but_ecuadorans_chinese_suffer.html#ixzz1LJcMVxi2

MALNUTRITION: Somalia has the World’s Highest Rate of Malnutrition in Children

Apart from the conflict that has lasted more than 20 years, Somalia is now compounded with another problem due to drought and that is malnutrition in children. According to Grainne Moloniy of the UN Food and Agricultural Organisation, “one in four children is malnourished – that’s one of the highest rates in the world“. She also stated that many Somalis from the southern part are leaving rural areas to search for work in Somali towns due to drought as a result of shortage of rains. While others are migrating the horn of Africa to other nations such Yemen and Kenya. The drought has rendered the field dry and livestock keep on dying.
Ms. Moloniv claimed that the Somalis are now becoming more reliant on money from their relatives abroad. Unfortunately, the Somalis in the diaspora – like any other immigrant in the West – have also been hit by the now popular global economic crisis. Therefore, they have not been able to help their relatives like in the previous years when the economy was stable. To make matters worse, Ms. Moloniv said that the UN has only managed to raise a third of what it needs for food aid for Somalia while other humanitarian groups are also short of funds.
The drought is anticipated to have affected around two and half million Somalis and there is no sign of the calamity to end soon. Compounded with the continuing insecurity in most Somali regions, the situation is expected to worsen before things get better.
Therefore, before you put food in your mouth make sure you thank The One above for blessing you with the meal you are about to have. Also, I encourage those who can to donate to the poor to do so even if it seems little to you. Remember, what goes around comes around…your good deed will get rewarded!
http://oleafrica.com/recent-post/somalia-has-the-world%E2%80%99s-highest-rate-of-malnutrition-in-children.php

MALNUTRITION: Poverty in plenty

Abdul Bayes: Professor of Economics at Jahangirnagar University. He can be reached at e-mail: abdulbayeseyahoo.com

THE aim of all developmental drives, in Bangladesh and beyond, is to reduce hunger and malnutrition that afflict a vast number of people. Hunger, a general term related to not getting enough to eat, is possibly the worst form of capability deprivation. In fact, it is a denial to development and freedom.
Disconcertingly, however, the twenty-first century dawned with some disappointing disarray allegedly ascribed 'dirty developments'. In a world that takes a pride in plenty, prosperity and progress, millions of people remain chronically undernourished and food insecure; a little over billion live on the equivalent of less than a dollar per day. It's not very difficult to grasp the gruesome gravity of the pitiful position: many people don't have enough to eat to keep them on an even keel. That means that they are in a state of hunger - chronic or transitory.
The ugly face of the discordance between wealth of the few and the woes of the millions is unveiled by an eminent economist named Kausik Basu. Leafing through Forbes magazine and some World Development Reports, he contends that total income (in 1998) of Hollywood's richest 50 individuals would exceed the total income of Burundi's entire population of 7 million. If Bill Gates -- supposedly spearheaded by a spending-spree -- decided to encash and consume the increase in the value of his total assets that he reaped over the past year, he would be able to consume more than the total annual consumption of the 60 million people of Ethiopia. "These numbers reflect both the phenomenal scope for wealth and economic well-being that the modern world makes possible and also how easy it is for this enormous potential to bypass large masses of humanity". But have things changed since Basu exposed the dark side of development? Possibly it has not changed. The world is getting wealthier when, allegedly, woes of the millions are mounting.
A priori, the perception was that inequality would wane, if not wiped out, through spill-over or "trickle down" effects during the process of growth and accumulation. In other words, Nobel laureate Simon Kuznet's hypothesis would work where initial phases of growth would witness rising inequality and later phases would observe a reduction in inequality. But that didn't seem to have happened in many countries. To corroborate the concern, the state of 'poverty in plenty' can be highlighted through the following frightening facts:
* About 925 million don't have enough to eat - more than the population of the USA, Canada, and European Union;
* Ninety eight per cent of world's hungry live in developing countries - 65 per cent living only in seven countries: India, China, DRP Congo, Bangladesh, Indonesia, Pakistan and Ethiopia;
* Women make up a little over half of the world's population but they account for 60 per cent of world's hungry;
* A malnourished child dies every seven seconds; and
* The cost of under-nutrition to national economic development is estimated at US $20-30 billion per annum.
Thus, the failure to fight against hunger may turn out to be a holocaust. If allowed to go unabated, the "have-nots" might swell the society to make hell the lives of the 'Haves' -- a message that abounds history. Hunger hurts the whole society, not the hungry ones alone. The sooner we feel it, the better it is.
As far as Bangladesh is concerned, it can possibly boast of a rising economic growth rate approximating 7.0 per cent per annum. Paripassu the growth, the incidence of income poverty has gone down by a little over 1.0 per cent per year during the last decades, It is estimated that poverty level now stands at 44 per cent in rural areas compared to 60 per cent in the past. It is further found that six - as against 15 in early periods - in each 100 rural households can not meet three satisfactory meals a day. Roughly two-thirds of households do not have access to electricity. Infant and maternal mortality rates have fallen over time but Bangladesh is a country with one of the highest mortality rates in the world. The inequality of income, as reflected by gini co-efficient, has been rising to reach 0.47 to indicate growing inequality of income or unequal distribution of the growth-pie. The bottom 20 per cent has been losing the share in income while the top 10 per cent had been increasing the share.
The principal causes of inequality in the society are loan defaults, rising land prices and corruption. Corruption - mostly bribes and kickbacks - is said to have claimed roughly 2.0 per cent of GDP every year. There are other faces of corruption. Over-and under-invoicing of imports and exports have caused huge amount of foreign exchange to fly out of the country. Just think of the massive amount of money amassed through corruption or collusion in the share market. More painfully, few of them are alleged to be close with policy- makers. Thus, to see a poverty-free Bangladesh means seeing a corruption-free society. The war against poverty is the war against corruption.
Inequality and poverty in the economy cannot be reduced only through adhoc measures like subsidies, rebates, doles etc. It needs a structural change in the operation of the institutions - a matter of deep political commitment -through which people translate their assets into incomes. For example, it requires reforms of the markets and judiciary - two of the institutions that serve the poor. If small investors go broke due to the manipulations in the share market, and the sharks are shielded despite violation, it means weak institutions cause inequality and poverty. Inequality is inevitable with economic growth but the degree of inequality could be controlled via raising the elasticity of poverty reduction with respect to growth. The elasticity coefficient is very low in Bangladesh, say less than 0.60, compared to a rate of more than 2.0 in other countries such as Vietnam. It means, a 1.0 per cent increase in economic growth in Bangladesh reduces poverty by much less than 1.0 per cent, while the same 1.0 per cent increases in economic growth in Vietnam more than doubles poverty reduction.
Thus, the poor must have participation in the process of economic growth. Massive exploration of mining may increase growth at the cost of widening inequality in the society but massive growth in agriculture may result in growth with fair distribution. Agricultural growth, labor intensive manufacturing, widely distributed non-discriminatory quality education, reduction of digital disparity etc., could meet both ends: more pleasure, less pains. There is no pleasure in plenty unless we can reduce the pains of poverty in the society.
http://www.thefinancialexpress-bd.com/more.php?news_id=133718&date

MALNUTRITION: Zimbabwe's startling bad statistics

Latika Sharma on Mon, 04/25/2011 Zimbabwe Thokozani Khupe TNM Health


According to Zimbabwe’s Deputy Prime Minister Thokozani Khupe and UNICEF, every year around 12,000 children die of malnutrition in the country.

The information contained in a dossier titled: ‘A Situational Analysis on the Status of Women’s and Children’s Rights in Zimbabwe, 2005-2010’, was made public, recently.


The food crisis has only served to further exacerbate the situation, caused mainly by land grabs, and further compounded by human rights abuse ensuing against a background of the 2002 drought.
The researchers calling the report’s findings startling said, one of three children in Zimbabwe suffers from chronic malnutrition, with maternal and child under-nutrition contributing to 35% of all child deaths, globally.
The report states, the application of these estimates to Zimbabwe, will likely see under-nutrition contribute to over 12,000 child deaths each year, which alarming figures forecast poor development, considering children are the leaders of tomorrow.
Under-nourished children suffer from life-long consequences, are more susceptible to disease, more likely to have poorer educational and birth outcomes, including reduced economic activity in to adulthood.
These children on gaining weight rapidly later on in childhood and into adolescence, are at an increased risk of chronic conditions like cardiovascular disease later in life.
During the early 1980s and 1990s when Zimbabwe’s economy was faring well, child mortality was the lowest in the region.
It is interesting to note malnutrition in Zimbabwe knows no class, with even the the wealthiest have unacceptably high rates of malnutrition, according to the report.
http://topnews.ae/content/27185-thousands-children-starving-death

MALNUTRITION: US to Supply Healthier Food to World's Hungry

Steve Baragona April 27, 2011
US to Supply Healthier Food to World's Hungry : Focus is on proper nutrition for the 1st 1,000 days of life

 Photo: Sue McIntyre/USAID
A Bangladeshi man receives food aid from USAID following Cyclone Sidr in 2007.

New recommendations call for significant changes in the nutritional content of foods the United States delivers to the world's hungry.
The United States is the world's largest supplier of food aid, reaching 55 million people in 46 countries last year, according to the U.S. Agency for International Development (USAID).
That assistance has saved millions of lives over the years.
But Tufts University nutrition expert Patrick Webb says, "There was a bit of an impression that as long as you delivered food, that was enough. And really, what we have been arguing and demonstrating is that, no, just any old food isn't enough."
Webb says that's especially true for young children, who have greater nutritional needs in the first thousand days of life. In the new report commissioned by USAID and released Tuesday in Washington, Webb and his colleagues note that malnutrition in the period from the womb to age two can cause irreparable damage to a child's growth and brain development. That in turn affects a child's ability to learn and ultimately lowers national productivity.
The report recommends more nutritious foods for children under two and pregnant women.
USAID Administrator Rajiv Shah says the report may lead to significant changes. "We'll look specifically into the recommendations into how to get more animal protein into foods so kids don't just get calories, but get the nutrition they need for brain development and human growth."
The report also recommends improving the vitamin and mineral content of grains and oils. Those are relatively easy fixes that may reach beneficiaries this year. But adding animal protein to food targeted for young children is more difficult to accomplish.

 USAID
A man receives 50 kilograms of US sorghum in southern Ethiopia during 2010.

"Unfortunately, there are manufacturing challenges that come to bear, looking at things like shelf life as well as cost," says Stephen Moody, USAID food technology expert.
But Susan Shepherd with the humanitarian group Doctors without Borders says the report does not go far enough.
"It's not at all clear to me that this report is making a strong stand in terms of improving the quality of foods they're trying to give to children," she says.
Shepherd adds that while the report acknowledges the value of nutrient-packed ready-to-eat foods for treating malnutrition, it continues to rely on cheaper fortified grain and soybean blends that do not provide enough nutrition for young children.
And she says it does not provide aid workers with enough guidance on using ready-to-eat foods.
"If I read this report as somebody in the field, it's all over the map," she says. "I don't know what I should be using when. And as long as they keep focusing on how much it costs, how much it costs, how much it costs, then these kids are never going to get what they need."
But USAID officials say they are already seeing benefits in programs that are currently following the report's recommendations. They say within a year other programs will start to see changes that will fight malnutrition more effectively among some of the world's most vulnerable people.
http://www.voanews.com/english/news/usa/US-Looks-to-Supply-Healthier-Food-to-Worlds-Hungry---120781594.html

MALNUTRITION: FAO man on mission to swap chicken wings for insects diet

Serge Verniau is a man with a mission: to persuade the world to swap the chicken wings and steaks on their plates for crickets, palm weevils and other insects rich in protein and vitamins.




Verniau, the Laos representative of the UN Food and Agriculture Organisation (FAO), is only half-joking when he says his dream is “to feed the big metropolises from Tokyo to Los Angeles, via Paris” with the small arthropods.
He plans to present the lessons drawn from a pilot project to the world at a conference on edible insects, probably in 2012.
“Most of the world’s population will live in urban areas. Trying to feed the whole planet enough protein from cows won’t work,” Verniau told AFP.
It is not by chance that the dream was born in landlocked Laos, one of the world’s poorest countries.
Almost one quarter of its population of six million people, and nearly 40 per cent of children below the age of five, suffer from malnutrition, according to figures from the Laos government.
The typical rice-based diet provides insufficient nutrients for development — a shortfall that could be filled by insects, highly rich in protein and vitamins.
Eaten as snacks, grilled or fried, they are already part of Laos cuisine, but most people do not know how to breed them, said Oudom Phonekhampheng, dean of the faculty of agriculture at the National University of Laos.

Different food
“They just take them in the wild and eat them, and then it is finished and destroyed. They have to think about the future,” he said.
In a modest building in the suburbs of the capital, his department’s laboratory collects scientific data on this new area of breeding.

Along with house crickets — which are already widely farmed in neighbouring Thailand — there are experiments in breeding mealworms, palm weevils and weaver ants, which are appreciated for their larvae.
The students are trying out different foods for the insects in an attempt to reduce costs while maintaining quality, explains Yupa Hanboonsong, a Thai entomologist supervising the project for the FAO.
Up to now, the roughly 20 cricket farms operating in Laos have used chicken feed, like thousands of Thai farms, but it is expensive and must be imported.
Vegetables or waste left over from the production of the national beer, BeerLao, could be one solution, said Yupa, who hopes to “train the whole country”.
Beyond the fight against malnutrition, this new economic activity can also generate revenue for farmers, added Yupa.


Farming insects
Phouthone Sinthiphanya, 61, seized the opportunity in 2007 to supplement his meagre pension after a career in the tobacco industry.
The 27 cylindrical concrete vats, about 50cm (20 inches) tall, installed in the garden of his house in Vientiane produce 67kg (148 pounds) of crickets every two months, he explains.
One kilo of live insects fetches Sh628.80 ($7.5 dollars). The same quantity crushed sells for Sh524 ($6.25).
“I worked for a tobacco company and then retired. My pension was not enough so I started farming insects,” he said.
“Our customers are restaurants, villagers, markets,” he said, adding that breeding the small creatures was “easy”.
It requires little space or natural resources and only their singing might annoy the neighbours.
“Insect farming creates less damage to the environment. It is a green protein,” said Yupa.
Proponents believe such nutritional and environmental advantages could be beneficial beyond Laos, particularly in other developing countries where people are used to eating cicadas and grasshoppers.

“You can make powder from crickets that is very rich in protein. It’s low in fat and it can be added to biscuits in problem areas where food rations are distributed,” said Verniau.
Nor has he given up hope of persuading sceptics in the West.
“When you look closely, a grey shrimp or a cricket, it has the same appeal,” he joked.
http://www.businessdailyafrica.com/FAO+man+on+mission+to+swap+chicken+wings+for+insects+diet/-/539444/1151172/-/item/0/-/kqsp27/-/index.html

MALNUTRITION: USA: History: Andersonville and other POW's

Cliff Sain

Three Confederate prisoners from the Battle of Gettysburg, July 1863 / National Archives

 Confederate prisoners captured in the Shenandoah Valley are guarded in a Union camp in May 1862. / National Archives

 Rations are issued Aug. 17, 1864, at a Confederate prisoner of war camp in Andersonville, Ga., in a photograph by A.J. Riddle. In all, 12,913 of the approximately 45,000 Union soldiers held there died of starvation, malnutrition, diarrhea and disease, according to Wikipedia. / National ArchivesMissouri prisoner exchange

Although records are not exact, it is likely that the first official Civil War prisoner exchange took place in Missouri.
On May 10, 1861, about 700 Missouri militiamen were captured by Union forces at Camp Jackson in St. Louis. They were paroled with the agreement that they would not return to the war until they were officially "exchanged" for Union prisoners. Some of them were officially exchanged on Aug. 30 in an agreement between Union Col. W.H.L. Wallace (who later became a general) and Confederate Gen. Gideon Pillow.

A Civil War battle often resulted in some soldiers becoming prisoners. For many of them, the horrors of war were just getting started.
Because of a combination of circumstances, supply shortages and bad planning, many Civil War prisoners ended up in prisons where malnutrition, exposure and disease were normal parts of everyday existence. An estimated 56,000 soldiers died in prisons that often were not much more than a human stockade.

Gentleman's agreement
Early in the war, soldiers did not have to worry much about prisons because the two sides normally exchanged prisoners.
Very early in the war, because there were few facilities for holding prisoners, both sides would "parole" captured soldiers, often right on the battlefield after an engagement. When paroled, a prisoner would take an oath that he would not return to battle until he had been officially exchanged for another prisoner.
It was a gentleman's agreement that often was violated, with many soldiers returning to battle immediately.
That led to the two sides creating a formal exchange agreement in which soldiers were held until they could be traded with soldiers of an equal rank. There was a complicated system, known as the Dix-Hill Cartel, in which multiple soldiers could be traded for a soldier of higher rank. For instance, a captain was worth 60 privates.
The system slowed down the process, so prisoners began to accumulate.
Another problem surfaced when the North began using black soldiers. The Confederacy refused to exchange black prisoners or their white officers. The South considered black soldiers "rebel slaves" that were subject to harsh punishment and even execution.
In 1864, the exchange of prisoners stopped altogether when Union Gen. Ulysses S. Grant refused to exchange prisoners until black soldiers were included.

Conditions
As the prisoner exchange slowed, then halted, both sides had to quickly build camps to house the prisoners. In all, there were 150 prison camps on both sides.
Prisoners lived in extremely crowded conditions, existing in camps holding as many as five times the number of people intended. Rations were normally inadequate. In the South, rations for Union prisoners were often the same as they were for Confederate soldiers, which was also inadequate.
In some prisons, such as the Confederate Belle Isle Prison in Richmond, Va., or the Union Point Lookout Prison in Maryland, prisoners lived in tents rather than barracks. Some prisoners did not even get a tent and had to spend day and night in the open.

Poor hygiene, lack of nutrition, crowding and lack of medical care meant disease was often rampant. Prisoners suffered from smallpox, typhoid fever, malaria and a host of other contagious diseases. Some prisoners suffered from scurvy, caused by a diet completely lacking in fruit for months.

Andersonville
Camp Sumter was the official name of a prison built in early 1864 in Sumter County, Ga. -- not to be confused with Fort Sumter in South Carolina. It is more commonly known as Andersonville prison, named for the nearby village.
Andersonville became the most notorious of all Civil War prisons. The 26.5-acre site (expanded from 16.5 acres) was built to hold Union prisoners transferred from near the Confederate capital at Richmond, which was in danger of Northern attack.
The prison, intended to hold 10,000 men, opened in February. By June, 26,000 were held there. In August, the prison population peaked at 32,000 prisoners, making it the fourth-largest city in the Confederacy based on the 1860 census.
Prisoners were housed in small tents, if anything at all. Because of the Southern economy and the war effort, food rations were small.
When Union Gen. William Tecumseh Sherman's forces captured Atlanta on Sept. 2, many prisoners were moved from Andersonville to other prisons. The number of prisoners declined from then until Andersonville closed in May 1865.
During the 14 months it operated, Andersonville held 45,000 Union prisoners. Nearly 13,000 died of disease, poor sanitation, malnutrition, overcrowding or exposure.
The camp's commander, Capt. Henry Wirz, was captured and tried for war crimes. A military tribunal found him guilty and he was hanged on Nov. 10, 1865, in Washington, D.C.
http://www.news-leader.com/article/20110426/NEWS05/104260315/Prisoners-experience-horrors?odyssey=mod%7Cnewswell%7Ctext%7CFRONTPAGE%7Cs

MALNUTRITION: DRC: European Union grants 9.9m euros aid

Brussels, Belgium - The European Union (EU) has decided to release an emergency humanitarian aid of 9.9 million euros to cater for children suffering from malnutrition in the Democratic Republic of Congo (DRC), an official source told PANA here. According to a communique issued Wednesday by the European Commission services in Brussels, the funds will serve in providing assistance to the Congolese children under five, suffering from severe malnutrition. 'These funds will serve for financing projects aimed at delivering to those children the treatment required for their survival, whether it be food rations or medical care,' the communique indicated. The European Union said humanitarian aid meant for children completes the longer-term development aid and helps the country to reach the Millennium Development Goals (MDGs), aimed at reducing hunger, poverty, as well as child and maternal mortality.
Official reports indicated that out of 1,000 babies born in DRC, 158 die before five.
According to the reports, despite some progress achieved these last years in the fight against malnutrition in the country, the malnutrition rate remains higher than two per cent in the western provinces of the country.
http://www.afriquejet.com/news/africa-news/european-union-grants-9.9m-euros-aid-to-drc-2011042810230.html

MALNUTRITION: African Potato Lab Fights Malnutrition With Biofortification

Matthew Shechmeister April 26, 2011

Photo: Grant Lee Neuenburg/Wired.com : A technician prepares a sample of sweet potato cells that will be screened for viruses before being propagated.


Although the International Potato Center sounds like a place where Idaho fifth-graders are dragged on field trips, in reality it's a sprawling organization promoting rural development around the globe.
Headquartered in Peru, the potato's ancestral home, The Center operates a seed bank that includes over 4,000 varieties of potato, sweet potato and other crops. Through a network of offices in 30 countries, the Center distributes plants to local farmers and adds new breeds to its library.
The Center and its allies have been on a campaign against vitamin A deficiency, a common problem in less-developed regions of the world. The consequences of vitamin A deficiency are devastating, especially for children, leading to blindness and a higher likelihood of death from measles, diarrhea and other illnesses. Consistently distributing tens of millions of multivitamin tablets could solve the problem, but that option can be difficult to achieve because of shaky distribution networks.
Orange-fleshed sweet potatoes are naturally high in vitamin A, and grow well in countries across the globe. For subsistence farmers, crop yields are a matter of life and death, so biofortification focuses on plants that are particularly reliable and productive
http://www.wired.com/rawfile/2011/04/potato-lab/?pid=791&pageid=4286

MALNUTRITION: India's child malnutrition puzzle

NEERAJ KAUSHAL, Associate Professor of Social Work, Columbia University
Apr 29, 2011
One of the least talked about issues in the debate on India's demographic dividend is child malnutrition. India is home to about a third of the world's underweight and stunted children under the age of 5. A child under 5 is almost twice as likely to be chronically underweight in India as in sub-Saharan Africa.
Sadly, the impressive economic growth of the past decade has made only a modest dent into the obstinately high incidence of severe underweight and stunting of children in the country.
Poverty is one obvious underlying cause. But it does not explain the wide difference in malnutrition between India and sub-Saharan Africa. Unicef data show that about 47% of Indian children under 5 are underweight; the corresponding figure for sub-Saharan Africa is 24%.
The overall poverty rate is lower in India than in many sub-Saharan countries. Besides, the incidence of child malnutrition in India remains high even in non-poor families. According to data from the National Family Health Survey for 2005-06, a quarter of all children below the age of 3 in the wealthiest 20% of families are stunted and 20% chronically underweight.
Of course, children living in families with lower incomes and wealth are at a much higher risk of being malnourished. But the incidence of severe underweight and stunting in non-poor families is not trivial.
What then explains this puzzle that India has much higher rates of underweight and stunting of children than countries with higher poverty and relatively stagnant economies? Is it per capita food availability? No, India has somewhat higher per capita food availability than countries of sub-Saharan Africa.
Is it higher mortality among children under the age of 5 in sub-Saharan Africa? Yes, but only to some extent. Mortality among children under 5 is 140 per 1,000 in sub-Saharan Africa and 66 per 1,000 in India.
A back-of-the-envelope calculation would show that about a third of the gap in chronic underweight among children in India and sub-Saharan Africa is due to higher child mortality in the latter, which simply removes from the data a large number of undernourished children in sub-Saharan Africa.
What explains the remaining two-thirds of the gap? Are we Indians less caring about our children than people in sub-Saharan Africa? Is there something in our traditional social and cultural values and practices that hurt the health and welfare of our children? The answer, sadly, is yes.
In 1996, Vulimiri Ramalingaswami, Urban Jonsson and Jon Rohde wrote a commentary for Unicef investigating the various possible determinants of child malnourishment and concluded "the exceptionally high rates of child malnutrition in South Asia are rooted deep in the soil of inequality between men and women."
How? Here it is worth repeating how the three experts on child health and nutrition reached this conclusion. They studied weights of children at birth in India and sub-Saharan Africa. In India, a third of the children have low birth weight; in sub-Saharan Africa, only one sixth.
A child's birth weight is an indicator of the health and nourishment of the mother when she is pregnant as well as her overall health and nourishment as a child and while growing up. Most African women gain 10 kg of weight during pregnancy, but women in South Asia gain only half as much. They also found that while about 40% women in sub-Saharan Africa suffered from iron deficiency, as many as 60% women in South Asia and 83% of pregnant women in India were anemic.
Dr Ramalingaswami and his co-authors also found a major difference in the feeding practices of children in the two regions. In sub-Saharan Africa, the proportion of breast-fed children aged to 6-9 months receiving complementary foods was almost two-thirds; in South Asia, less than one-third.
Indeed, age-wise pattern of undernutrition studied in a World Bank report on South Asia published in 2006 shows that most of the growth retardation occurs early in life. The difference in length-for-age and weight-for-age between Indian and South African children begins to widen around the time the child is three to four months of age. The report finds that most of the retardation in growth in India occurs either during the pregnancy or during the first two years after birth.
Critics often argue that the economic reforms have failed to reach the poor and deprived sections of society. But malnutrition also prevails in families that are neither poor nor deprived. While it is true that the implementation of government programmes such as the ICDS needs a lot to be desired, and such programmes are not aimed at changing gender relations at home.
A sustained long-term dent in child undernourishment can only be achieved by improving the health, opportunities and rights of the mother, the primary caregiver of children. Not just legislative rights but rights to participate in decision-making both at home and outside it, opportunities for social interactions, rights to improve their lives through education and employment.
The historical pattern of the state and status of women in India reveals that it is largely unrelated to economic growth. Let's look at sex ratio - a number that has been much discussed since the release of the provisional 2011 census results. At 914 women per 1,000 men, the sex ratio at birth is the lowest since Independence. In two of the richest states, Punjab and Haryana, preference for the boy child results in many families abort the girl child or kill her soon after birth. But the story does not really end there.
Women's subjugation continues throughout their lives. One would hope that an adverse sex ratio would increase the value of women in society. Alas, our beliefs are too deeply embedded in traditional cultural norms to allow us to respond to the forces of demand and supply.
http://articles.economictimes.indiatimes.com/2011-04-29/news/29487240_1_saharan-child-malnutrition-underweight

MALNUTRITION: Angola

4/29/11

Luena – The nutrition expert Maria Futi Tati is concerned about malnutrition case that is daily recorded in hospitals of the eastern Moxico province.
Speaking to the press, Maria Futi Tati said that three to four cases of moderate and severe malnutrition are recorded daily during consultations within children aged six months and above.
Maria Futi Tati considered poverty as the main cause of malnutrition in the rural population, as well as bad eating habits.
Maria Futi Tati advised the population to consume natural products for being healthier and accessible because they are rich vitamin and calories.

http://www.portalangop.co.ao/motix/en_us/noticias/saude/2011/3/17/Expert-concerned-about-malnutrition-cases,c145b3ec-cc16-4ad8-ac29-5b9287386cb0.html

MALNUTRITION: Guatemala: Child malnutrition caused by more than lack of food

Susan Martin : American Academy of Pediatrics
DENVER –- Giving poor families land on which to grow crops has been shown to improve child nutrition. New research also shows that giving families non-agricultural land and better housing also is beneficial for children's growth and nutrition. Study shows living conditions, sanitation and community organization play role in child growth

Results of the study of child malnutrition in rural Guatemala will be presented Sunday, May 1, at the Pediatric Academic Societies (PAS) annual meeting in Denver.
Guatemala's rural populations suffer from one of the most unequal land distributions in Latin America. About 2 percent of the population owns 70 percent of all productive farmland. To remedy this, non-governmental organizations (NGOs) have raised money to buy private land and donate it to poor farmers so they can grow crops. However, urbanization and lack of land have led NGOs to distribute land for housing instead of farming.
Asya Agulnik, MD, MPH, and her colleagues looked at the effects of this change in land distribution on child health in coffee-growing areas of Guatemala. Researchers compared child malnutrition rates in five villages, four of which received non-agricultural land and brick houses in organized communities, along with improved sanitation. Families in the fifth community continued to live in squatter settlements on plantations.
Using WHO growth curves, investigators compared weight-for-age measurements of 242 children in these communities before and after the land distribution.
Before the moves, about 37 percent of children younger than 38 months were moderately malnourished, while just over 7 percent were severely malnourished. Twenty months after families received land and houses, malnutrition rates dropped among children in the same age group; roughly 19 percent were diagnosed with moderate malnutrition, and 5 percent were severely malnourished. Older children who were not breastfeeding at the time their family received land allotments and housing experienced the greatest nutritional benefit.
Meanwhile, children who remained in squatter settlements experienced worsening malnutrition.

"Malnutrition is a major problem for the health of children under 5 years of age in rural Mayan Guatemalan villages," said Dr. Agulnik, lead author of the study and a resident at Children's Hospital Boston. "This study demonstrates that in areas where land scarcity is a major problem, land distributions supporting improved housing and community organization can improve child nutrition without changing a family's income. It also suggests that in our population, living conditions, sanitation, crowding and community organization play a major role in causing child malnutrition."
The study underscores the fact that childhood malnutrition is not only about food, said study co-author Paul Wise, MD, MPH, FAAP, who created a program at Stanford University in California called Children in Crisis to improve health care to children living in politically unstable regions. "While this study documents the terrible toll of poverty on child health, it also emphasizes the interaction between the child, infections, community life and the exercise of political power."


The Pediatric Academic Societies (PAS) are four individual pediatric organizations who co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well being of children worldwide. For more information, visit www.pas-meeting.org. Follow news of the PAS meeting on Twitter at http://twitter.com/PedAcadSoc.
http://www.eurekalert.org/pub_releases/2011-05/aaop-cmc042711.php

MALNUTRITION: North Korea: U.N. body starts emergency food aid

Apr 29, 2011 (Reuters)
(Writing by James Mackenzie; Editing by Janet Lawrence)


The United Nations World Food Programme is to start an emergency food programme to help 3.5 million people in North Korea, the Rome-based organisation said on Friday.
"A bitter winter, crop loss and a lack of resources to secure cereal supplies from outside the country have left the Democratic People's Republic of Korea highly vulnerable to food shortages," it said in a statement.
"While acute malnutrition has not reached crisis levels, widespread chronic malnutrition and the poor diet ... mean that if there is any significant reduction in food intake the situation could deteriorate rapidly," it said.
The World Food Programme said government rations provided only about half of daily food needs and some families were being forced to cut down on the size and number of meals.
It said it would provide staple cereals and ingredients to enable local production of nutritious food such as corn-soy milk, rice-milk blend and nutrient-rich biscuits.
Three U.N. agencies visited the secretive communist state in February and March and reported that more than 6 million people needed food aid because of sharp falls in domestic production, adding to pressure for international food aid.
However, diplomatic efforts to resume full contacts between western countries and North Korea, which is technically still at war with South Korea, have been complicated by a stand-off over Pyongyang's nuclear programme.
http://af.reuters.com/article/worldNews/idAFTRE73S27620110429

MALARIA: Fighting malaria is fighting poverty.

April 25, 2011 Tom Paulson

Malaria kills about 800,000 people every year but it also sickens hundreds of millions, causing $12 billion in economic losses annually in Africa alone due to impaired worker productivity, according to economist Jeffrey Sachs and Pia Malaney.
So how are we doing in the battle against this disease of poverty?
Today, at Seattle-based PATH, many of those here leading in the fight against malaria will meet to discuss ongoing efforts in prevention, treatment, research aimed at finding an effective vaccine and evaluating that progress.
Professor Awa Marie Coll-Seck, director of the Roll Back Malaria partnership and former health minister for Senegal, says the massive investment by the international community in expanding access to bed nets, other preventive measures as well as improved diagnostics and treatments is paying off big time:
Change has been most dramatic in Africa, where enough insecticide-treated mosquito nets have been delivered to cover 76% of people at risk and 11 countries have reduced malaria cases and deaths by over 50%.
Coll-Seck notes this translates into an estimated 750,000 deaths, mostly in children, prevented over the last decade.
Coll-Seck credits more than 500 public and private sector organizations who now support the global effort to reduce malaria deaths and illness. She notes that many organizations such as the WHO and UNICEF crafted the strategy that donors are funding through initiatives like the U.S.’ President’s Malaria Initiative and the Global Fund for AIDS, TB and Malaria (which now provides two-thirds of the funding).
But Jeffrey Sturchio, head of the Global Health Council, warns that the gains are fragile as donors tighten their belts and drug-resistance threatens to undermine the effectiveness of treatments. Sturchio urged greater scale-up and investment in research aimed at coming up with better drugs and new “anti-malarial tools.”

Roll Back Malaria

To the left is a (low-rez, sorry) graphic from Roll Back Malaria that basically shows the estimated number of deaths prevented among children under five years old due to the efforts made over the past ten years.
It is dramatic progress, yet the widening color band surrounding the upward trending line is evidence of another problem plaguing the efforts to combat malaria. Uncertainty.
There are a number of kinds of uncertainty in the global effort against malaria.
I’ve written before about the questions some experts have with respect to the reported progress in reducing malaria deaths and illness — specifically, in that case, with regard to a PATH program in Zambia. But the problem does not appear to be unique to PATH or Zambia.
A recent article in the Times of India questions the accuracy of malaria incidence estimates in that country, following up on a Lancet article a while back that suggested India had grossly underestimated its malaria toll.
The Guardian has a good article with links to data but also notes how poor the data is on malaria:
While only 117,704 malaria deaths were officially reported in government records for 2009, the WHO estimates that closer to 800,000 people died of the disease that year.
Epidemiologists are currently hard at work preparing the next round of country-by-country estimates – a process that is long, controversial, and often heavily politicised. Some countries would prefer inflated malaria figures, while others would rather underplay the impact of the disease.
The problem with malaria in these poor countries is that it is often misdiagnosed or not diagnosed at all. In addition, there are many different efforts underway aimed at reducing child mortality — and many different methods used to reduce malaria mortality — so it can be difficult to connect cause and effect.
These are important questions that need to be resolved. But there’s no question that malaria is a global burden that, one way or another, affects us all and that reducing that burden should remain an urgent priority.

http://humanosphere.kplu.org/2011/04/fighting-poverty-on-world-malaria-day/

POVERTY: Nigeria: Election Violence Or Farewell to Poverty

Issa Aremu : 25 April 2011
Mni — In place of post election development agenda (which ordinarily is inclusive of security of lives and properties), Nigerian voters are being weighed down with post election violence of an unprecedented scale and proportions.
As many as 200 had been reportedly killed with hundreds of thousands displaced! With specific reference to Kaduna, in place of clear cut all inclusive electoral campaign issues such water, light and food, urban renewal, revival of collapsed factories prior to rescheduled gubernatorial election next Thursday, we have taken a decade plunge backward to the dark days of mutually destructive primordial issues of ethnicity and "religion" amidst feverish curfew.
Pray, what has election in particular and democracy in general got to do with killings and curfews? Within the two days of seemingly orchestrated violence on all sides of the partisan divides, the gains of reconciliation and conflict resolutions of the last ten years in Kaduna had been brutally eroded as peoples hitherto peacefully coexisting are being thrown to violent identity crisis. In the orgy of violence from Kaduna to Katsina, Kano to Bauchi, poor voters had turned on poor voters leaving in their trails mass destruction of lives and lives. And of course, properties that were never there in the first instance.
Whatever the causes (and obviously election related), the motivation for the latest crisis and mayhem especially in the Northern part of the country, the emerging pattern is that of voters (read; masses) on voters' violence. It was reminiscent of black on black violence of the discredited apartheid South Africa. We are again back to Nigeria's persistent crisis of governance in which the poorest of the poor have become cannon folders in the game of the political elite for political power. It is unfortunate that a decade after the sectarian crisis after which enormous resources had been deployed in peace building and conflict resolution, Kaduna could degenerate to the blind abyss of mutually assured crisis of destruction we have just witnessed. Every aspect of the latest crisis points to a national crisis of governance such that that if care is not taken this singular uncontrolled crisis may engulf the whole nation. Kaduna and indeed the Northern crisis should be seen as a metaphor for deep national crisis. It is commendable the crisis is being put under control. But why should it have been allowed to happen and made to be out of control in the first place? Security challenges have been identified as part of the critical success factors of 2011 serial elections. The buzz word before the election was "crowd control". We were impressed with "show of force" which turned out not be show of security! Why then should the chief security officers of the states be caught napping in the wake of spontaneous reactions to elections results that were expected to legitimately generate so much legitimate passion? The point cannot be over stated; most incumbent governors are too deep in partisanship either seeking for re-election or looking for refuge in the senate. The post election deaths and mayhems are manifestations of the singular fact that many governors are no more on duty to protect lives and properties. On the contrary, what we have witnessed in recent weeks are gross distortions of governance on the altar of excessive executive partisanship. In recent weeks, we have not seen authoritative allocation of resources for the protection, uplift and advancement of the citizens but misapplication of state scarce resources (money and time) on part of most incumbent governors. But all said assuming the governors had been on duty to proactively protect the citizens, what are the fundamentals that led to the mass uprising of the electorate against the electorate? What could make the citizens who had hitherto two days before diligently joined the queues to break all rules of engagement in mass bloody protests? Why would a promising democracy destination turned to dens of deaths on account of elections? Recent crisis points to the fact that Nigeria has serious deterioration of human development index caused mainly by unemployment, factory closures and mass poverty and the growing gap between the rich and the poor. The rich certainly cry and fight. It is also a truism that the poor also fight and cry as we have seen the poor of the Arab countries confronting their ancient unaccountable sit-tight regimes. But only the poorest of the poor can serially engage in self destructions as we are seeing in Nigeria. In fact in Egypt, despite the desperation of Mubarak dictatorship, both Christians and Muslim protesters of Cairo in solidarity confronted injustices.
They did mutually engage in wars of attrition as in Nigeria. Therefore beyond the post election violence and its proactive and reactive management, we must urgent move to uplift our people and economy more than empty growth figures. We must create mass decent employment for our unemployed. There must be minimum social floor below which people must not fall before they appreciate the sanctity of lives. It must task our imagination that thousands could be readily mobilized on working days for mass protests of destructive proportions. Most cities in protests were once functioning industrial cities. We must get these huge potential productive forces engaged otherwise they all become destructive forces as we have witnessed in recent. We must say farewell to poverty and bring back development agenda in Nigeria. Paradoxically elections are supposed to be about development and poverty eradication.
Sadly in the ongoing contestations, it is more about persons rather than programmes. It is a sad commentary that spate of factory closures had not formed the basis of electoral contestation. Voters hardly know what they are voting for. In fact there are no electoral issues as such! It is never late to put development issues on the political agenda otherwise we will all be consumed with personal primordial issues which in turn will push us deeper into underdevelopment. There cannot be sustainable democracy without sustainable development just as there cannot be sustainable development without sustainable democracy.
http://allafrica.com/stories/201104250572.html

POVERTY: Book: "More Than Good Intentions.”

April 26, 2011, 2:00 pm

 DAVID LEONHARDT

Dean Karlan, a Yale economist, and Jacob Appel, a former field researcher in West Africa, are the authors of a new book about fighting global poverty, “More Than Good Intentions.” Richard Thaler has described the book on the Nudge blog, and Tyler Cowen has called Mr. Karlan “one of my favorite young economists.”

I quoted Mr. Karlan in a New York Times Magazine article about economics experiments, and I explained his general approach to economics in a column about some of his colleagues.
My conversation with Mr. Karlan and Mr. Appel follows.

Q. You write that microcredit — small loans to poor people — “has generated more enthusiasm and support than perhaps any other development tool in history.” You agree that microcredit has great potential, but you also suggest that it’s been oversold. What’s known at this point about how it does, and does not, improve people’s lives?
Mr. Karlan: Rigorous evidence about the impacts of microcredit on borrowers’ lives is just beginning to roll in, and the picture for donors is mixed. The three major randomized evaluations of microcredit conducted thus far have not found it to be a universal remedy for poverty, as some advocates claim — but we have observed positive some impacts, at least for some people.
The first major revelation is that, in practice, microcredit often looks and feels very different from the standard story proponents tell: a poor, enterprising woman takes a loan, grows a tiny business into a small- or medium-sized enterprise, and lifts her family out of poverty.
Some of the most positive impacts found yet, in an evaluation conducted in South Africa, actually came from microloans made to employed individuals rather than microentrepreneurs, and at very high interest rates. I have found that most microcredit professionals hate this result, since this version of microcredit bears little resemblance to the traditional version that people are asked to support with donations. But this worker-focused version of microcredit does seem promising.
In this instance, it increased income and reduced poverty. It worked by helping borrowers weather bad times, for example by fixing a broken vehicle needed for work, or by sending money to a sick relative in a rural area instead of leaving work to tend to the relative.
Q. I imagine many people who work in this area believe their own microcredit program is more successful than the ones you and other researchers have evaluated. And they probably have some reasons for believing so. What would you say to them?
Dean Karlan, co-author of “More Than Good Intentions.”Mr. Karlan: Yes, a common retort we hear from advocates is that we have simply evaluated the wrong microcredit programs. We have two responses to this: first, many important features do appear fairly similar across microlenders, although we certainly agree programs are not entirely uniform. Second — let’s evaluate what you think is the special sauce.
Some studies under way now are doing just that, trying to evaluate programs that incorporate business training and health training, for instance. We will see in due time whether these distinctive program features really translate into impact.
A final point I believe is key: many investors, not donors, are pouring their money into large microcredit institutions. Indeed, many microcredit organizations are making a fair amount of profit. Given the positive, albeit not overwhelming, impacts found, I encourage investors to invest in microcredit. But they should be aware their investments, while helpful, are not about to solve poverty. Their rhetoric, too, needs to be toned down a bit. This is not the “bottom of the pyramid” solution to solve world poverty.
And I encourage donors to seek out either ideas proven to be more effective, or to support alternative models of microlending accompanied by rigorous evaluations so that we can find the approach that is most worthy of donor money.
Q. What are those ideas — the ones that so far have been proven more effective?
Adam Zucker
Jacob Appel, co-author of “More Than Good Intentions.”Mr. Appel: There are a few that stand out. In the area of finance, microsavings, a less-celebrated financial instrument for the poor, is emerging as a powerful tool. Specifically, commitment savings accounts, which allow savers to (voluntarily) restrict access to their deposits until they reach a time or balance goal, have stood up to rigorous testing. For example, in the Philippines we saw savings increase by 80 percent for everyone offered such an account, and we saw women gain more power in the household as a result of getting access to their own commitment savings accounts.
In education, there are two powerful ideas. First, deworming — this one is practically a no-brainer. In communities that suffer from intestinal parasites, providing free deworming medication at schools for about 50 cents per student per year can reduce absence rates by about a quarter (not to mention the health benefits from eradicating the worms!), and also lead to higher income later in life.
Second, remedial education to help struggling students: getting kids into schools is a start, but sometimes student achievement stagnates despite increased attendance.
The caveat here is that, with hundreds of rigorous evaluations going on now around the world, we are still learning. Of course, action needs to be taken; we can’t just sit back and wait for all the research to be completed. Dean’s group, Innovations for Poverty Action, just started a fund that keeps zero overhead or administrative charges and passes on 100 percent of all donations received to projects implementing proven ideas. Another source of good ideas is Givewell, a group that uses research and organizational assessments to make recommendations about which groups can most effectively use donations.
Q. You also write about programs that give money to people in exchange for certain behavior, like enrolling a child in school. Oportunidades, in Mexico, was the pioneer here. They’ve also shown to work in many settings. What about in the United States — have any worked here? Could they?
Mr. Appel: Yes, conditional cash transfer programs like Mexico’s Oportunidades have indeed been tried here in the U.S., with some success. A notable example is a series of education-oriented programs evaluated by Harvard economist Roland Fryer in the past few years. These offered cash incentives to students for achievements at school, like $50 for getting an A on a test, or $2 for reading a book.
The results were mixed. The findings suggest that incentives for behaviors students control immediately and directly (like showing up or paying attention in class) work better than incentives for outcomes that the students influence but do not control directly (like test grades). Happily, the process of modifying and rigorously testing these programs is ongoing.
http://economix.blogs.nytimes.com/2011/04/26/a-fresh-look-at-fighting-global-poverty/?partner=rss&emc=rss

POVERTY: China to strengthen efforts to alleviate rural poverty

2011-04-26
BEIJING, April 26 (Xinhua) -- China on Tuesday vowed to intensify efforts to alleviate poverty in rural areas over the next 10 years, in an attempt to improve Chinese citizens' quality of life and narrow the country's growing income gap.
That was learned from a meeting of the Political Bureau of the Central Committee of the Communist Party of China (CPC) held in Beijing on Tuesday.
During the meeting, which was presided over by President Hu Jintao, participants studied the status of China's development-oriented poverty reduction work and the challenges the country is facing in this regard. They also discussed the development-oriented Poverty Reduction Program for Rural China (2011-2020), as well as several other issues.
China had made great strides in poverty alleviation over the past 10 years, with fewer people in poverty than ever before and farmers' incomes rising steadily, said a statement released after the meeting.
China's poverty alleviation has helped to boost the country's economic development and maintain social stability, the statement said.
"Expanding the fight against poverty through development projects is an important step to improve the well-being of the people in China, to narrow the income gap and to ensure that all people share the benefits of China's incredible economic growth," said the statement.
Over the next ten years, the government will intensify its efforts to eradicate poverty by increasing the number of poverty alleviation programs, increasing budgetary poverty-relief funds and enhancing the capabilities of people living in poor areas to develop their local economies, while making active efforts to carry out international cooperation, the statement said.
"China will work to attain a raft of goals by the year of 2020, including providing poverty alleviation aid recipients with adequate amounts of food and clothing, ensuring that these people receive compulsory education and enjoy access to basic medical care and housing," said the statement.
Also, the growth rate of the per capita net income for farmers in poverty-riddent areas will exceed the national average by the year 2020.
Party and government authorities at all levels of the country were told to keep in mind their sense of responsibilities in development-oriented poverty reduction and be conscientious about their work, so as to accomplish the objectives set for development-oriented poverty reduction by the year 2020.
http://news.xinhuanet.com/english2010/china/2011-04/26/c_13846874.htm