MALNUTRITION: Uganda: Experts raise red flag on malnutrition levels

Stephen Wandera & Eve Mashoo : March 25 2011

Population experts have raised a red flag on the high rates of malnutrition, warning that unless immediate intervention measures are taken, Uganda is lying in a death trap.
It is estimated that about 2.3 million children are chronically malnourished and this affects their brains.
“Soon we are going to have these malnourished children with weak brains grow to become part of our labour force,” Dr John S. Ssebuliba, the National Planning Authority expert in-charge of population health and social development, said.
“This means we will be producing a less productive workforce because their slow-thinking capacity will make them less competitive in East Africa and the world at large.”

Dr Ssekamate said this at a dialogue on maternal and child nutrition on the theme, Together We Can End Preventable Deaths, at the Makerere University School of Food, Nutrition and Technology yesterday. The dialogue was organised by Actionaid, Plan Uganda and World Vision.
The NPA Chairman, Mr Kisamba Mugerwa, said this phenomenon is being addressed by developing a five-year Uganda Nutrition Action Plan (UNAP), which is aimed at addressing the neglected nutrition issues in this country.
“Government is aware of the fundamental role nutrition plays in the development of the human capital. We are quickly reformulating their policies to include nutrition as one of the top priorities in development agenda,” he said.
The plan estimated to cost Shs80 billion for the next planned five years proposes a multi-sectoral approach in several key ministries targeting children and reproductive women.
“We have finalised a five-year nutrition action plan focusing on women, children and people leaving with HIV among others. It will create a strong human capital that will propel this country to prosperity in the next five years,” Dr. Ssekamate said.
Ms Rudo Kwaramba, the World Vision boss, noted that much as the NPA has spearheaded so much activity, they still have the mandate to push for political will now that they are done with the planning process.
Uganda may fail to reap full benefits if there is no proper coordination and yet so much money gets in through numerous non-governmental organisations,” Ms Rudo added.

However Prof. Patrick Rubaihayo, an expert in plant breeding, dismissed the plan as unpractical to suit various local governments. Prof. Rubaihayo added that much as numerous stakeholders were proposing to put to task the President’s Office to work on the nutrition issues, he asked what the Vice President’s Office role was.
http://www.monitor.co.ug/News/National/-/688334/1132562/-/c3e2xez/-/

MALNUTRITION: Pakistan 'crop shortage' warning

24 March 2011  By M Ilyas Khan BBC News, Islamabad

 The WFP played an important role distributing food in Pakistan after last year's floods 

Lowering wheat prices would create food shortages in Pakistan and encourage smuggling, officials say, responding to criticism from the UN.
On Wednesday the UN's food relief agency said the government set prices too high and malnutrition was rising.
But an official at Pakistan's food ministry told the BBC farmers would simply switch to more lucrative crops if wheat prices went down.
Devastating floods across Pakistan in 2010 damaged acres of arable land.
Although crop yields in 2011 are projected to be healthy, prices are too high for an impoverished population, the director of the UN's World Food Programme told journalists on the sidelines of humanitarian meetings in Geneva on Wednesday.
"The crop outlook is not bad but the food security situation remains difficult because prices remain so high," Wolfgang Herbinger said.

Smuggling risk
Malnutrition levels in the southern province of Sindh had reached 21% to 23%, according to the WFP.
It is nearly impossible to stop smuggling across the Afghan border, which is extremely porous”
"That is well above African standards. The emergency standard is 15%," Mr Herbinger said.
But lowering prices would do little to help the situation, an official at the food and agriculture ministry, who wished to remain unnamed, said.
He also warned that much of the crop would end up in the hands of smugglers. "Low farm-gate prices lead to lower acreage of wheat crop as farmers switch to other crops and it works as an incentive for smugglers seeking international prices in the neighbourhood. "It is nearly impossible to stop smuggling across the Afghan border, which is extremely porous," he said.
So if prices are lowered, the official said, the risk is that they would eventually rise to even higher than the level they are currently set at.
In the 1990s and between 2007 and 2009 there were severe wheat shortages across Pakistan, leading to extremely high prices.
Pakistani officials also say that malnutrition in Sindh province is not a new phenomenon and is unrelated to the food supply.
"Government statistics show that food consumption has not gone down despite the doubling of food prices since 2007-08," Kaisar Bengali, advisor to Sindh's chief minister said.
A lack of public hygiene facilities and safe drinking water were more important factors in child nutrition, he said.
"These are neglected areas, and there has been hardly any development in the public health sector here in decades," Mr Bengali said.
http://www.bbc.co.uk/news/world-south-asia-12847052

MALNUTRITION: Zimbabwe: One in Three Children in Zimbabwe Suffers From Malnutrition - UNICEF Study

Tatenda Gumbo & Patience Rusere
Washington 24 March 2011


Christian Care Director Forbes Matonga said supplementary feeding schemes were halted two years ago, leaving children far more vulnerable in times of food shortages like those now hitting Zimbabwe
One in three children in Zimbabwe suffers from chronic malnutrition, according to a new study by the United Nations Children’s Fund and the country's public health authorities, who have urged action to help vulnerable women as well as children.
The Situational Analysis on the Status of Women and Children’s Rights concluded that malnutrition could contribute to more than 12,000 deaths a year in the country.
UNICEF says Zimbabwe's malnutrition rates are similar to those of other countries in the region but have climbed sharply since 1994 to reach nearly 40 percent.
The report found that the lack of access by many women and children to basic social services and protections has contributed to their vulnerability, which has also been increased by high levels of poverty and the HIV/AIDS pandemic in Zimbabwe.
Nutritionists say remedial nutrition programs must target children in their first three years or so. Without adequate nutrition a child can fail to thrive, affecting early development, encouraging disease and eventually reducing abilities in adulthood.
World Food Program HIV/AIDS adviser and nutritionist Francesca Elderman told VOA Studio 7 reporter Tatenda Gumbo that regional organizations are putting together nutritional supplement packages to relieve the crisis.
Christian Care, a leading World Food Program distribution partner in Zimbabwe, says the suspension of supplementary feeding schemes could increase malnutrition.
Christian Care Director Forbes Matonga told reporter Patience Rusere that the program was abruptly halted two years ago, leaving children far more vulnerable in times of food shortages like those looming in several Zimbabwean provinces due to drought and rising costs which have put basic foodstuffs out of reach for many households.
http://www.voanews.com/zimbabwe/news/Child-Malnutrition-in-Zimbabwe-Rises-to-One-in-Three-118600144.html

POVERTY: The Global Corruption Index, in graphic form

Back in October, Transparency International released their latest Global Corruption Index. A great new info-graphic about the index has been put together by Graphic-is and it summaries the report quite well. The info-graphic displays a map of the world to show the results of the survey on a color scale. The winners of the survey have the deepest shades of green while the losers have the deepest shades of red. The graphic also shows the most corrupt systems according to respondents with Political Parties leading the way.
Corruption is important when talking about poverty because the greater the corruption the more barriers exist for poor people to move up the economic ladder. When people live in a country where they have to continually pay bribes to police or other government officials it is impossible to get ahead.


 
http://povertynewsblog.blogspot.com/search/label/global%20corruption%20index

TUBERCULOSIS: Global Alliance for TB Drug Development document

FALLING SHORT
Falling short: ensuring access to simple, safe and effective first-line medicines for tuberculosis.

Produced by: Global Alliance for TB Drug Development (2010)
This report presents evidence to document the challenges hindering effective first-line TB treatment worldwide. Many TB patients around the world are at risk because:
they are not receiving the medicines they need, whether because of poor quality, interruptions in the drug supply known as stock-outs
they receive loose, single-drug pills that complicate treatment.
Key recommendations to address these issues include:
preventing stock -outs: national TB programmes and procurement officials should increase supervision and monitoring to catch early signs of stock-outs and respond quickly and aggressively
ensuring quality assured medicines: at the same time, regulators need to work with manufacturers, the WHO and others to ensure that patients are getting quality-assured Fixed-Dose Combinations (FDCs), even in the private sector
increasing the uptake of FDCs: international donors also have a role to play by ensuring timely delivery of funds, supporting Public-Private Mix (PPM) programmes to improve private sector treatment, and providing targeted resources and assistance to regulators and manufacturers for implementation and enforcement of quality standards.

The document argues that there is a need to refocus on the most basic level of TB care to protect the gains of recent years and speed momentum in the fight against TB. A renewed commitment from everyone engaged in the fight against TB is required to ensure all TB patients are getting the treatment they need when they need it.
Every tuberculosis (TB) patient in the world has the right to an uninterrupted supply of simple, safe and effective medicines for TB. But for too many TB patients globally, this is not happening. These patients
are not getting the treatment they need when they need it.
When manufactured, administered and used correctly, first-line TB medicines are one of the most costeffective health interventions in the world. In the 50 years or so since they were developed, these drugs
have been used to successfully treat millions of TB patients. Yet many TB patients around the world are at risk because they are not receiving the medicines they need, whether because of poor quality, interruptions
in the drug supply known as stock-outs, or because they receive loose, single-drug pills that complicate
treatment. Without consistent access to the right medicines at the right time, TB patients can default on their treatment and continue infecting those around them. Worse, they risk the development of drug-resistant TB strains or even death.
http://www.tballiance.org/downloads/publications/Falling_Short.pdf

POVERTY: AFGHANISTAN: Military drawdown could hit aid flows

A young boy carries a heavy bag in an IDP camp in Kabul, Afghanistan : Photo: IRIN

KABUL, 29 March 2011 (IRIN) - The planned drawdown of US-NATO troops in Afghanistan later this year could adversely affect the flow of foreign aid to a country where the achievements since the fall of the Taliban regime in 2001 are still fragile, aid workers warn.
“We saw a drop in humanitarian assistance in Iraq and Kosovo after the international military forces withdrew,” Louise Hancock, a spokeswoman of Oxfam International in Afghanistan, told IRIN. “Afghanistan needs long-term support for development if it is going to become a stable and prosperous country. That requires a long-term commitment of aid.”
The Afghan army and police will begin replacing their foreign allies in July, in accordance with a transition process due to end in 2014. Most of the 140,000-plus US-NATO forces currently fighting Taliban insurgents are expected to leave the country over the next three years.
“We currently see the last spending frenzy in Afghanistan and then things will start slowing down,” said Sussane Schneidl, with NGO Tribal Liaison Office in Kabul.
Donors channel considerable amounts of aid money through the NATO-led Provincial Reconstruction Teams (PRTs) which are set to gradually transfer their responsibilities to the Afghan government. Aid agencies say “the militarization of aid” by NATO-member states over the past few years - in a bid to win hearts and minds - is also likely to impact donor funding priorities after foreign forces withdraw from Afghanistan.
About US$26.7 billion in aid was disbursed in Afghanistan in 2002-2009 which made it the leading recipient of official development assistance in the world, according to the Global Humanitarian Assistance website.
US aid is predicted to drop by at least $300 million - from $4.8 billion in 2009 to $4.5 billion in 2012.
Canada’s aid to Afghanistan will go down by about 50 percent immediately after the planned withdrawal of Canadian forces in July 2011, according to the Canadian International Development Agency.
Flows of foreign aid have also been hit by allegations of corruption. The UK, for example, has delayed channeling $137.6 million to Afghanistan due to a corruption scandal at Kabul Bank, which allegedly involved senior government officials and their relatives.
In July 2010, the US Congress voted to reduce - by almost $4 billion - aid to the Afghan government in response to allegations of rampant corruption.

Fragile achievements
Afghanistan has made some significant progress over the past decade thanks to unprecedented international support. The country has been showered with more than US$40 billion in foreign aid since late 2001, according to the Ministry of Finance.
Access to health and education has improved, while overall annual economic growth is estimated at over 10 percent since 2002, according to the World Bank.
Girls were deprived of an education until 2001, but now about 2.4 million female students are enrolled at schools across the country, aid agencies say.
However, experts say these achievements are fragile and reversible.
“Gains in girls’ education are slipping away as a result of poverty, growing insecurity, a lack of trained teachers, neglect of post-primary education and poorly equipped schools,” 16 Afghan and foreign aid agencies warned in a report on 24 February.
And there are other challenges: Every hour two women die from pregnancy or childbirth complications; one in five children dies before reaching the age of five from preventable and curable diseases; at least eight of the country’s 29 million people are food insecure; 70 percent of Afghans lack access to safe drinking water; illiteracy rates are high. Afghanistan is ranked one of the least developed countries on earth.
In his latest report to the UN Security Council about the situation in Afghanistan, the UN Secretary-General said that the goal of the transition process was to move the country away from conflict. “The generosity of the international community will remain crucial to achieving this transition,” he said on 9 March.
http://www.irinnews.org/report.aspx?reportID=92305

ZIMBABWE: Desperate measures in times of hunger

 Photo: Flickr  The staple maize

HARARE, 29 March 2011 (IRIN) - A mother of four in Zimbabwe’s rural Midlands Province gave her husband custody of her children, after divorcing him three years ago, because the failing crops on her two-acre plot meant she would be unable to feed them.
"I had no choice but to bring the children to their father [in the capital, Harare]... There is so much hunger in Shurugwi, and getting food for them is a real struggle," said Tariro Moyo, 38, who lives with her parents in the village about 85km southeast of Gweru, provincial capital of Midlands.
The father of the children, all of school-going age, has since remarried and earns a small salary as a mechanic at a struggling company in Chitungwiza, a dormitory town about 30km south of Harare, where he lives in a two-roomed cottage. His new wife is not keen on having the children.
"I know life will be difficult for my children but they could have died if I had remained with them. The father will see what he can do to ensure that his children get food and attend school," Moyo said.
The husband's salary will not stretch to pay for school fees and the children will be expected to sell sweets and vegetables to contribute to the household income.
Moyo was allocated the two-acre plot by her father after the divorce, but a prolonged dry spell has put paid to any maize harvest this year.
Like hundreds of others in her community, she relied on monthly supplies of barley, millet and cooking oil from an NGO, but distributions stopped in early March 2011 because the budget had been exhausted.
The US-based Famine Early Warning Systems Network (FEWSNET) has forecast that about 1.7 million people will need food assistance ahead of the main harvest, which usually begins in late March.
Moyo has only been able to produce a small amount of maize in the past two years and has survived on piecemeal jobs.
"Like the other villagers, I have totally become dependent on buying food from local shops because we have not been harvesting much from the fields. It is raising the money that is difficult. The lucky ones have relatives in urban areas, who are working and can send them money every month-end," she said.
The children often went to school on empty stomachs and had a single evening meal of sadza (thick porridge made from maize-meal) and some vegetables. She said most households in her area were in the same position - there was no cash, and most people survived on barter.
A joint report by UNICEF and the government, A Situational Analysis on the State of Women's and Children's Rights in Zimbabwe: 2005-2010, "indicates that between 220,000 and 250,000 rural households in Zimbabwe live in extreme poverty and are food insecure. These households include between 620,000 and 700,000 vulnerable children."
Nationwide about 3.5 million children were living below the poverty line.

A ZANU-PF card gets food
Samuel Tabvure, 52, lives in Nharira village in Chivu district, about 180km southeast of Harare, where he looks after his ailing elderly mother and a sister who was diagnosed with HIV last year.
You have to register your name with the local village head. After that, you should show the ZANU-PF leaders your party card and wait for your turn, which for some of us seems to be taking forever because we are suspected of supporting the opposition
"Both of them need good food but they are surviving on sadza and vegetables most of the time. Whenever I take them to the clinic, I am advised to buy them nutritious food but I am not working and can therefore not buy the required foodstuffs, not even cooking oil," he told IRIN.
The family of nine requires 50kg of maize-meal each week costing US$18, or US$72 every month.
The Grain Marketing Board (GMB), a state-run cereal distribution monopoly, has been moving grain to the local depot and is selling maize-meal and grain more cheaply.
"The process of buying from the GMB is too long and tiresome. You have to register your name with the local village head. After that, you should show the ZANU-PF leaders your party card and wait for your turn, which for some of us seems to be taking forever because we are suspected of supporting the opposition," said Tabvure.
There have been allegations that ZANU-PF - the ruling party since independence from Britain in 1980 until a coalition government was formed in 2009 - has excluded supporters of the opposition Movement for Democratic Change from accessing maize at GMB depots, and has been hampering efforts by humanitarian organizations to provide food assistance.
"The plight of children makes my heart bleed. Their performance at school is clearly affected because they attend school hungry, and over the past four years there have not been any free food handouts in this district," Tabvure said.
"Poor harvests are bad news, particularly for rural people," Innocent Makwiramiti, a Harare-based economist and former chief executive officer of the Zimbabwe National Chamber of Commerce (ZNCC), told IRIN.
"Prices of maize-meal and other foodstuffs will go up," he said, 'but these people don't have dependable sources of income, yet they will not have options but to go to the shops for their food."
http://www.irinnews.org/report.aspx?reportID=92310

TUBERCULOSIS: What's new in TB technology?

 Photo: Gary Hampton/World Lung Foundation
Innovative TB technology

JOHANNESBURG, 28 March 2011 (PlusNews) - In keeping with the focus on innovation as part of World Tuberculosis (TB) Day in March 2011, IRIN/PlusNews brings you a wrap of some of recent developments in TB technology.

1. GeneXpert: The two-hour TB test released in 2010 is a joint project by Cepheid, a diagnostic products manufacturer, the Foundation for Innovative New Diagnostics (FIND), a non-profit organization, and the University of Medicine and Dentistry of New Jersey, in the US.
The desktop computer-based system, approved by the World Health Organization, shaves three weeks off the usual waiting time for diagnoses and can test for TB and drug-resistant TB. Tests cost about US$20 each and are said to be more accurate than previous tests. The system was recently introduced in South Africa.

2. One-hour rapid test: The United Kingdom's Health Protection Agency (HPA) reported it had developed the test shortly after GeneXpert was announced. The one-hour test focuses on detecting a single DNA molecule in TB and expected to be more sensitive than most other rapid tests that look for a sequence of DNA, which may not be present in newer TB strains of TB.
HPA spokesperson Georgina Fletcher said the test did not yet have a name. Clinical trials are to start in the United Kingdom this year and it was too early to say what the cost per test would be.

3. TMC207: The only drug on our list represented a breakthrough in the treatment of TB as well as multidrug-resistant TB when successful trial results were published in the New England Journal of Medicine in the US in 2009. The as yet experimental drug does not need to be refrigerated, potential dosing could be as low as three times a week, and there are only mild side effects. Tibotec, the manufacturers of TMC207, started working with national regulatory authorities in March 2011 to determine the requirements for approval. Tibotec indicated that it might be able to provide some countries, such as South Africa, with accelerated access to the drug.

4. Signature Mapping TBDx: Created by the Aurum Institute, a South African health NGO, imaging specialists Guardian Technologies International, and South Africa's national health laboratory services, the TBDx diagnostic system takes digital pictures of sputum samples and searches them for TB's structural "fingerprint."
In much the same way that airport x-ray machines detect bombs, TBDx uses digital microscopes to detect TB microbes by their shape. After positive results from initial testing in the national health laboratory services, the system is now in the final stages of an independently controlled clinical study in South Africa. Results are expected in April 2011 and tests are expected to cost around $5 each.

5. The 30-minute, "bacteria counter" test: Researchers at Massachusetts General Hospital in Boston and Harvard University, both in the US, developed a half-kilogram hand-held device in 2009 that counts even low levels of TB in sputum samples, using small, iron particles and radio waves. The test is said to be as sensitive as those using TB cultures, which can take weeks to grow in a lab.
At the time of publication, IRIN/PlusNews had received no response to requests for information on whether or not the test had been evaluated in large-scale trials.

6. Computer-aided diagnostics: The Zambia AIDS Related Tuberculosis (ZAMBART) project has partnered with Delft Diagnostic Systems and University of Cape Town Lung Institute to install an easy-to-use digital chest x-ray machine in one of the busiest clinics in Lusaka, the Zambian capital.
Student radiologists take the x-rays, which are stored in an electronic database until a clinical officer can read them. The images in the database are being used to develop a computer-aided diagnostic programme that in the future could help diagnose TB without the help of a trained radiologist.
http://www.plusnews.org/report.aspx?reportID=92301

TUBERCULOSIS: TB vaccines: getting them out of the lab

Mićo Tatalović : 24 March 2011
 Eleven TB vaccine candidates are in clinical trials: SATVI

New TB vaccines are facing a major funding shortfall, says Mićo Tatalović, and some countries seem resistant to accepting a future vaccine.
International tuberculosis (TB) experts are gathering today — World TB Day — in France to discuss advances in research into vaccines.
But the reason there is no effective vaccine to prevent the roughly ten million new cases and two million deaths from TB each year has little to do with the science. There are already 11 vaccines in clinical trials whose progress has slowed or stalled because the funding has dried up.
That is why the TuBerculosis Vaccine Initiative (TBVI), an independent organisation that promotes the development of TB vaccines, is launching a new funding model today.
Joris Vandeputte, senior vice-president of advocacy and resource mobilisation at TBVI, tells SciDev.Net that US$1.5 billion is urgently needed to translate basic research into market-ready vaccines over the next decade. A single TB vaccine can cost up to US$300 million to develop.

Funding gap
Basic research has been adequately funded, he says, resulting in around 40 candidate vaccines because of a huge research effort over the past decade. In addition to the 11 in the faltering trials, a further 30 are languishing in laboratories, some of them in developing countries, waiting to be tested.
But the "second chunk" of funding, needed to get the candidate vaccines through clinical trials, is missing — so vaccine development has effectively stopped, he says.
Under the new funding model, the European Union would provide loans to fill the gaps, possibly through the European Investment Bank. The loans would be administered by the TBVI and paid back once the vaccines start making money.
The model takes into account various logistical difficulties facing the researchers, such as the bottleneck caused by the lack of capacity in clinical trials, by calculating in the costs needed to tackle such issues.
"We will have to look to the east — China, India, Russia — to do more clinical trials," he says, in an attempt to overcome this bottleneck. But he maintains that once there is a new vaccine, it will attract a huge market.
Around 90 per cent of countries currently vaccinate their children against TB with the Bacillus Calmette-Guérin (BCG) vaccine, using 100,000 doses each year. BCG protects children from severe forms of TB but does not protect adults from pulmonary TB — the most common and infectious form of the disease.
A more effective vaccine would save huge amounts on treatment, which costs European countries alone about US$3 billion a year.

Low take-up
But even if the money for trials becomes available and an effective vaccine emerges, further problems may await. Data to be published later this year in a special vaccines issue of the journal Tuberculosis show that some developing countries may be reluctant to accept new TB vaccines.
Several factors seem to determine whether countries are prepared to shoulder the costs of a new vaccine campaign, including whether the vaccine has been tested in their own country.
The study's authors conducted 86 structured interviews with public health clinicians, politicians and senior civil servants from health and finance ministries in countries with the highest burden of the disease: Brazil, Cambodia, China, India, South Africa, Mozambique, Romania and Russia.
Lew Barker, senior medical advisor at the Aeras Global TB Vaccine Foundation in the United States, says their study sought to gauge the opinions of people in high-burden countries who are likely to be involved in making decisions about whether to adopt TB vaccines when they become available.

 US$1.5 billion is needed to get the new TB vaccines on the market: WHO/TDR/Crump

"None of the respondents, when asked about the most important public health issues and needs of their country, spontaneously mentioned TB," Barker says. Instead, primary, rural and mother-and-child healthcare, as well as HIV/AIDS, were identified as the most pressing issues.
"However, when TB was mentioned [by the interviewer], they uniformly said this is a very serious problem and, by and large, they said it's also a neglected problem that needs and deserves more attention then it gets," Barker adds.
Respondents in the survey welcomed the development of better TB vaccines, but around 20 per cent said it was unlikely that such vaccines would be taken up in their countries, and many more were undecided. In most of the vaccine roll-out scenarios presented, less than half said they were willing to commit to a new vaccine and provide funding. One of the main reasons was that they wanted to see strong efficacy data from clinical trials in their own country.

Political priorities
Vaccine deployment might take 20–30 years to reap healthcare benefits because 95 per cent of cases are latent and may take years to show up, and most vaccines only target people who have not been exposed to TB (around one third of the world's population has been exposed), so there will be a long tail of cases before the hoped-for elimination of TB in 2050, Barker says. This explains why other issues such as HIV are given political priority.
Barker concludes that robust data showing efficacy of 90 per cent, rather than a more realistic 60 per cent, and from studies in the countries concerned, are likely to be needed for the introduction of new TB vaccines.
Opokua Ofori-Anyinam, senior clinical development manager at GSK Biologicals, a vaccine manufacturer, said researchers should engage with policymakers to make sure that, after spending millions of dollars on trials and testing vaccines in thousands of individuals, they end up with vaccines that policymakers will want to deploy.
"These are the things we have to think about ahead of time," Ofori-Anyinam tells SciDev.Net.
Vandeputte says the TB research community must engage with the media and policymakers to put TB onto national political agendas.
But he points out that Aeras' market research, presented by Barker, found a mixed response and that the proportion of decision-makers who would go for a new vaccine is bigger than those who would not. Engagement and advocacy before a new vaccine reaches the market may also help convince the undecided.

Focus on the vaccine
Michel Greco, chair of the working group on new TB vaccines at the Stop TB Partnership, says: "I am not one of those people who think that as soon as we have a good TB vaccine it would be taken up. Countries are very wary of potential problems, so they go slowly."
But he adds that although studies are needed to address uptake issues and pave the way for the future deployment of TB vaccines, the priority should be on designing and testing vaccines rather than worrying about their subsequent uptake.
Helen McShane, a TB vaccine researcher at the University of Oxford, United Kingdom, whose vaccine MVA85A is currently in phase IIb clinical trials, told SciDev.Net: "The more effective a vaccine is, the more likely that it will be taken on. It will also depend on cost — I think if you have a very effective vaccine at affordable prices for the developing areas of the world then it will be taken on."
She adds: "There may be certain countries where you have to do some studies in that country to get some safety data but, although those are all important factors, I don't see them as the biggest challenge — the biggest challenge is that we need to get a vaccine that works."
http://www.scidev.net/en/features/tb-vaccines-getting-them-out-of-the-lab-1.html

POVERTY: Ghana shares cocoa know-how with Liberia

Samuel Hinneh : 21 March 2011
 Ghana will help Liberian farmers plant crops more effectively: Flickr/Nestlé

[ACCRA] Liberia's cocoa industry, destroyed by its recent civil war, could be revitalised by a collaboration with Ghana, one of the world's major cocoa producers.
Representatives from both countries signed a memorandum of understanding (MoU) 4 March, with the aim of boosting each other's agricultural research activities. The Cocoa Research Institute of Ghana and Liberia's Central Agricultural Research Institute will set up reciprocal arrangements for visiting scientists and implement mutually agreed projects.
"Liberia used to produce cocoa — it was a member of the old West Africa Cocoa Research Institute," Yaw Adu-Ampomah, deputy chief executive of the Ghana Cocoa Board — which facilitated the MoU with the International Institute of Tropical Agriculture's Sustainable Tree Crops Program (STCP) — told SciDev.Net.
Adu-Ampomah said that the United States, through the STCP, is keen to help Liberia but the country lacks cocoa-producing capacity — which is where Ghana comes in.
Ghana will provide expertise to Liberian farmers on planting crops in the most effective way. "We will send some technicians to Liberia, and Liberia will send some to Ghana to receive training in nursery activities and providing agricultural services," he said.
Adu-Ampomah added that the United States will partly fund seedling production, transport of materials to Liberia, access to credit facilities to enable planting, and costs of technical intervention. The Liberian government is funding its farmers — mostly technicians — and technology transfer.
The first step will involve gathering together Liberia's farmers, producing the seedlings and harvesting and processing them into a form that can be flown to Liberia and transported to the farmers.
The collaboration, Adu-Ampomah said, is driven by the aims of the Economic Community of West African States, which seeks to promote economic integration within West Africa.
Although the collaboration is primarily focusing on cocoa, it can involve other important crops, he added.
"Liberia has a slight advantage in coffee production, which Ghana can learn from. It also has a diverse range of coffee varieties and Ghana could obtain some seeds from Liberia to revitalise its coffee industry."
Derrick Mills, programme officer at the Ghana Agricultural Associations Business and Information Centre, said that the collaboration will improve the agricultural sectors of both countries through technology transfer.
"The capacity building of the research institutions will be enhanced and Ghana will also be able rejuvenate its coffee industry. Liberian and Ghanaian farmers will also be able to share knowledge and so improve productivity," he said.

COMMENT:
Viktor Bengtsson ( www.viktorbengtsson.com Liberia )
Let's attempt to straighten out a few things:
1) Liberia produces and exports cocoa. In fact, several Liberian companies are aggressively expanding cocoa production (LCC, Lofa county, is the biggest one)
2) To say that Liberia has an "advantage" in coffee is stretching the truth a might too far. Coffee plantations in Liberia are in a deplorable state (the cocoa farms have received far more attention) and the export network haven't really cared about coffee up until the 2010/2011 season when some buying activities started.
3) In reading between the lines it seems that the underlying reason for this article is the fact that CRIG and CARI have signed an MOU to get hybrid cocoa planting material to Liberia and train technicians in planting and seed multiplication. This is a worthy topic for an article in and of itself. No need to make it appear that cocoa-rich Ghana is riding in to save cocoa-destitute Liberia.
http://www.scidev.net/en/news/ghana-shares-cocoa-know-how-with-liberia.html

MALNUTRITION: Geneticists and smallholders in quest for perfect cattle for East Africa

Maina Waruru : 24 March 2011
 The majority of smallholders in East Africa lack access to the best quality breeds
Flickr/angela7dreams

[NAIROBI] Dairy farmers in East Africa could soon benefit from superior, affordable cattle breeds through a US$1 million research project.
The Dairy Genetics East Africa (DGEA) initiative aims to help smallholders take full advantage of the region's booming dairy sector and improve their incomes by giving them access to top quality breeds better suited to their local environments.
The International Livestock Research Institute (ILRI) will collaborate with the University of New England, Australia, and non-profit consulting firm PICO Eastern Africa (PICOTEAM), to collect information from Kenyan and Ugandan farmers about which breeds they prefer and why, and collect genetic samples from the animals those farmers currently own.
DGEA will also examine environmental factors such as rainfall and water availability, temperature and available feed resources, to match breeds to local ecological zones.
At the end of the three-year project partners hope to develop a business plan in collaboration with the private sector, through which better quality animals will be bred and sold to smallholders at affordable prices.
"This innovative idea seeks to address historical constraints to dairy development in East Africa more broadly," said Ed Rege, a project leader at PICOTEAM.
The majority of smallholders starting dairy farming or wishing to breed or replace their cows do not have access to breeds that best match their production environments, said Okeyo Mwai, the project's coordinator at ILRI.
Many farmers also lack evidence-based knowledge about which breeds are most appropriate for their production systems or where to obtain them, he said. They usually buy new cattle from their neighbours or large commercial farms — but these are often ill-suited to their local conditions, he added.
"This project aims to use on-farm data to assess the performance of the various dairy cattle genotypes, in order to determine how they perform under a range of farm conditions," said Mwai.
Mathew Kibaara, a private veterinary practitioner and Kenya's former deputy director of veterinary services, welcomed the initiative but warned it would take more than the planned three years to produce results.
"Three years is not adequate to carry out a field study on the cows kept and reasons for preferences, conduct genotyping to come up with improved breeds and have them ready for sale," he told SciDev.Net.
http://www.scidev.net/en/news/geneticists-and-smallholders-in-quest-for-perfect-cattle.html

MALARIA: Anti-mosquito drives stumble at final ten per cent

Masembe Tambwe : 25 March 2011
 Mosquito larvae experience less competition when the population is less dense
Flickr/fakhir.shaheen

[DAR ES SALAAM] Eliminating malaria by controlling mosquitoes may prove impossible unless control programmes consider that mosquitoes reproduce faster as their numbers dwindle, says a study.
Insecticide-treated nets (ITNs) have reduced mosquito populations by 90 per cent in countries like Tanzania, said Gerry Killeen, a researcher at the country's Ifakara Health Institute.
But this is probably the limit of what ITNs can achieve, he added — and achieving the last ten per cent of control may be as difficult as the first 90 per cent because sparse mosquito populations have higher individual fitness.
Killeen conducted field studies in Tanzania — with colleagues from Australia and the United Kingdom — and found that, as mosquito numbers go down, their ability to reproduce faster increases. Mosquito larvae experience less competition when population size is low, enabling each individual to grow larger in size and become more fertile.
The findings reinforce the need to recognise the limitations of current control methods, said Killeen.
"Researchers and field workers need to start working on killing mosquitoes that feed or rest outdoors or, even better, to kill them in the aquatic breeding sites they originate from," Killeen told SciDev.Net.
Many of these complementary strategies to supplement ITNs in mosquito control are being pioneered by young African innovators, he said, adding that the Ifakara Health Institute is working on a follow-up to the study.
But Killeen cautioned that their paper applies only to the last push to eliminate mosquitoes — conventional control methods like ITNs are essential to reduce numbers in the first place.
"This study has little influence on immediate implementation priorities and strategies for ITNs or indoor residual spraying — these are extremely effective and have delivered huge gains, and will remain a priority for many years to come," he said.
Nick Brown, cell team leader at the National Malaria Control Programme, Tanzania, said that the key objective for malaria control, and eventually elimination, should be to reduce, and eventually halt, transmission of the parasite, rather than eliminating the vector.
"If mosquitoes are prevented from securing a blood meal from an infected person or transmitting the parasite further, because most people are protected by nets, then this represents a significant reduction in the possibility of transmission," he said.
http://www.scidev.net/en/news/anti-mosquito-drives-stumble-at-final-ten-per-cent.html

POVERTY: SRI LANKA: Textile sector unaffected by EU subsidy cut

 Photo: Contributor/IRIN
The garment sector is a major component of the Sri Lankan economy

COLOMBO, 28 March 2011 (IRIN) - More than seven months after the European Union (EU) suspended its preferential trade agreement with Sri Lanka in protest over the country’s human rights record, the subsidy cut has had little impact on the sector targeted, according to government officials.
Many of the country’s 250,000 textile workers - who tend to work 12 hours a day, six days a week for a monthly salary of US$150 - had feared they would lose their jobs under the cut. But most are still employed.
"We are still doing good," Nilanthi Perera, 29, a garment worker from Colombo, told IRIN. She supports three younger brothers and is the breadwinner of the family - like many of her colleagues. “Any loss [of jobs] would have destroyed us."
For five years Sri Lanka received a 10 percent tax concession under the EU’s Generalized System of Preferences Plus scheme (GSP), and textiles account for 65 percent of the country’s exports, according to Central Bank data.
But the country failed to prove to the EU its commitment to three international human rights conventions - the International Covenant on Civil and Political Rights, the Convention against Torture and the Convention on the Rights of the Child - said Jehan Perera, director of Colombo-based think-tank the National Peace Council.
“The EU wanted to send an investigation team to the country to see for itself the situation [regarding alleged human rights violations] - but the government refused to let them in,” leading to suspension of the GSP concession.
“The government would have been concerned that permitting the EU investigation team in would set a precedent, and lead to more pressure on the issue of war crimes,” Perera said.
Sri Lanka has been resisting efforts by a UN Secretary-General’s expert panel to conduct an independent investigation into alleged war crimes during the 26-year conflict between the government and the Liberation Tigers of Tamil Eelam (Tamil Tigers) which ended in May 2009.

Lost leverage?
The National Peace Council advocates a step-by-step process and was against the total removal of GSP concessions, according to Perera.
“The GSP Plus concessions should not have been fully suspended but should have been used for further leverage to push Sri Lanka to adhere to a human rights agenda. Now the EU has lost this leverage,” Perera said.
He said the EU should have set more achievable human rights goals and used the GSP concession issue as leverage. "Threats are more effective than the actual punishments in aid policy," he said.
"The GSP Plus suspensions did not have a negative impact on the Sri Lankan economy, exports and apparel industry," Tissa Vitharana, a senior government minister, said.
In fact, the textiles sector notched up nearly 6.5 percent in exports from 2009 to 2010, according to the Central Bank.
Foreign buyers are continuing to place orders for Sri Lankan garments due to their high quality, and timely and efficient delivery, according to Chamara Hettiarachi, a Colombo-based economist. He said the textile industry had maximized capacity by appropriate use of technology.
http://www.irinnews.org/report.aspx?reportID=92296

MALARIA: Intermittent preventive treatment of malaria in children

Background: Intermittent preventive treatment of malaria in children (IPTc) is a promising new approach to the control of malaria in areas of seasonal malaria transmission but it is not known if IPTc adds to the protection provided by an insecticide-treated net (ITN).

Methods and Findings: An individually randomised, double-blind, placebo-controlled trial of seasonal IPTc was conducted in Burkina Faso in children aged 3 to 59 months who were provided with a long-lasting insecticide-treated bednet (LLIN). Three rounds of treatment with sulphadoxine pyrimethamine plus amodiaquine or placebos were given at monthly intervals during the malaria transmission season. Passive surveillance for malaria episodes was established, a cross-sectional survey was conducted at the end of the malaria transmission season, and use of ITNs was monitored during the intervention period. Incidence rates of malaria were compared using a Cox regression model and generalized linear models were fitted to examine the effect of IPTc on the prevalence of malaria infection, anaemia, and on anthropometric indicators. 3,052 children were screened and 3,014 were enrolled in the trial; 1,505 in the control arm and 1,509 in the intervention arm.

Similar proportions of children in the two treatment arms were reported to sleep under an LLIN during the intervention period (93%). The incidence of malaria, defined as fever or history of fever with parasitaemia $5,000/ml, was 2.88 (95% confidence interval [CI] 2.70–3.06) per child during the intervention period in the control arm versus 0.87 (95% CI 0.78–0.97) in the intervention arm, a protective efficacy (PE) of 70% (95% CI 66%–74%) (p,0.001). There was a 69% (95% CI 6%–90%) reduction in incidence of severe malaria (p=0.04) and a 46% (95% CI 7%–69%) (p=0.03) reduction in the incidence of allcause hospital admissions. IPTc reduced the prevalence of malaria infection at the end of the malaria transmission season by
73% (95% CI 68%–77%) (p,0.001) and that of moderately severe anaemia by 56% (95% CI 36%–70%) (p,0.001). IPTc reduced the risks of wasting (risk ratio [RR] = 0.79; 95% CI 0.65–1.00) (p=0.05) and of being underweight (RR = 0.84; 95% CI 0.72–0.99) (p=0.03). Children who received IPTc were 2.8 (95% CI 2.3–3.5) (p,0.001) times more likely to vomit than children who received placebo but no drug-related serious adverse event was recorded.

Conclusions: IPT of malaria provides substantial protection against malaria in children who sleep under an ITN. There is now strong evidence to support the integration of IPTc into malaria control strategies in areas of seasonal malaria transmission.

MALARIA: Net coverage; how much is enough?

 Bill Brieger : 26 Mar 2011
We are unlikely to eliminate mosquitoes, according to Tanya Russell and colleagues, but she notes that this should not stop us from implementing all available interventions. Specifically their study of malaria vectors in Tanzania found that the at reduced densities of mosquito populations, they try to reproduce more, meaning we may never get below 10% mosquito elimination.
Instead, a member of the National Malaria Control Program in Tanzania says our goal “should be to reduce, and eventually halt, transmission of the parasite, rather than eliminating the vector.” If we can achieve no more than 90% elimination of mosquitoes, what is a realistic coverage figure for malaria interventions?
Applications of net and case management strategies in Rwanda and Ethiopia have definitely shown that major drops in malaria incidence are possible. But the RBM targets of 80% coverage (85% for the US President’s Malaria Initiative) are elusive. Demographic and malaria surveys from Senegal, Liberia and Nigeria show that even in homes that own nets, net use among people at most risk, does not reach this target.
Are we really sure that 80% is the right target?
Fred Binka was one of the first to demonstrate that people living in homes without nets can be protected by their neighbors’ nets, which kill mosquitoes in the community. ITNs “provided very good personal protection to children using them, and also protected nonusers in nearby compounds. Among nonusers, the mortality risk increased by 6.7% with each additional shift of 100 m away from the nearest compound” with nets. This led the researchers to speculate on the need to study whether the “mass effect from a small number of highly dispersed nets would provide equivalent protection to complete coverage.”
A few years later William Hawley and co-researchers reported that, “protective effect of ITNs on compounds lacking ITNs located within 300 meters of compounds with ITNs for child mortality, moderate anemia, high-density parasitemia, and hemoglobin levels.”
As part of the move toward universal coverage, Killeen and colleagues examined the importance of considering all household members, not just the ‘vulnerable.’ The group condluded that …
Using field-parameterized malaria transmission models, we show that high (80% use) but exclusively targeted coverage of young children and pregnant women (20% of the population) will deliver limited protection and equity for these vulnerable groups. In contrast, relatively modest coverage (35%–65% use, with this threshold depending on ecological scenario and net quality) of all adults and children, rather than just vulnerable groups, can achieve equitable community-wide benefits equivalent to or greater than personal protection.
Barat has called for ‘data driven decision making‘ in the effort to eliminate malaria. Using data in models as done by Killeen is a further important step. The onchocerciasis control community has been working with such models for over 15 years now. New data are fed into the Onchosim model based on program progress such that it is possible to forecast that onchocerciasis could be eliminated from areas with high initial prevalence if 65% coverage of ivermectin treatment were maintained for at least 25 years.
Unlike onchocerciasis control, malaria elimination rests on multiple interventions. This makes modeling much more urgent, as outlined by malERA’s research agenda for eradication. Since universal coverage unfortunately does not mean universal usage, we need to seek valid data and models to help us plan for distribution of malaria interventions more strategically in ways that are affordable and can be maintained and at the same time can achieve maximum reductions in morbidity and mortality.
http://www.malariafreefuture.org/blog/?p=1181

TUBERCULOSIS: Peru: Fighting tuberculosis in Lurigancho Prison

22-03-2011

Tuberculosis kills more than 50% of its victims if left untreated. The disease thrives in crowded, stuffy, dark environments such as prisons. TB used to be almost 50 times as common in Lima's Lurigancho Prison as it was elsewhere in Peru. The ICRC is helping the management of Lurigancho Prison and other prisons across Latin America to eradicate the disease.
 
ICRC film

http://www.icrc.org/eng/resources/documents/film/01071-w3-peru-tb-prison-film-2010.htm

TUBERCULOSIS: China: 500 million suspected to carry tuberculosis infection

March 23, 2011
The number of infectious tuberculosis patients in China has exceeded 5 million and that of Chinese infected with the tuberculosis bacteria has topped 500 million, accounting for 45 percent of the country's total population, according to the results of the "Fifth National Tuberculosis Epidemiology Site Survey" released by the Ministry of Health on March 21.
China has the world's second largest tuberculosis epidemic only after India, and the number of Chinese tuberculosis patients account for 14 percent of the world's total. According to infectious disease statistics gathered over the past 10 years, the number of tuberculosis and hepatitis B patients has always been higher than that of any other disease. The mortality of tuberculosis is second only to that of HIV/AIDS, said Hao Yang, deputy director of the Disease Prevention and Control Bureau under the Ministry of Health.
What is even worse, many tuberculosis patients know nothing about their conditions. Wang Lixia, director of the Tuberculosis Prevention and Control Center under the Chinese Center for Disease Control and Prevention, said that compared with the 60 percent detection rate required by the World Health Organization (WHO), the detection rate in China has long ranked among several bottom countries. Only 20 percent of Chinese tuberculosis patients could be detected in the 1990s. Many are not aware today that their coughing and low fever signs are possibly the symptoms of tuberculosis.
March 24 is the world's Tuberculosis Day. The WHO initiated a global tuberculosis prevention and treatment program in 2006 in hopes of curing 50 million TB patients by 2015. The United Nations has also formulated the Millennium Development Goals to control tuberculosis, a major killer, by 2015.

By People's Daily Online
http://english.people.com.cn/90001/90776/90882/7329035.html

TUBERCULOSIS: Australia: drug-resistant tuberculosis making comeback

 March 24, 2011
Tuberculosis looks intent to make a comeback following a big increase in cases of multi-drug resistant tuberculosis (MDR-TB) in Australia over the past few years, an Australian health care expert warned .
"The trend has been an increase in multi-drug resistant TB in Australia over the last 10 years, which is worrying," Dr Bernadette Saunders, from Sydney's Centenary Institute, said to mark World TB Day on Thursday.
Saunders has worked in the field of mycobacterial research for over 10 years. She has extensive experience investigating the immunology, pathology and genetics of tuberculosis disease.
"Many people thought tuberculosis would just disappear over time but, really, TB levels have been rising since the 1990s,"she said.
"It's a disease that we need to be aware of, certainly in terms of MDR-TB and, in the last few years, there has been what we call 'XDRs' which are extreme-drug resistant strains," she added.
There was a 30 percent rise in Australian cases of multi-drug resistant tuberculosis (MDR-TB) from 2007 to 2009, while in 2010 the nation recorded another rare case of even harder to kill XDR- TB.
About 1,200 TB cases diagnosed in Australia each year, and the proportion of MDR-TB infections seen in Australia has risen steadily - up from just eight cases in 2000 to 24 in 2007, and 31 in 2009.
About a quarter of all people infected with MDR-TB globally die from it - more than double the mortality rate of non-resistant TB.
Around the world, about eight to nine million new cases of TB infection are reported each year, with about 1.7 million deaths.
"It is a major, major health issue, across the globe," Saunders said.
"In some parts of the world levels of multi-drug resistance is very high and if we're not vigilant, and continue to work very hard, to keep drug resistance low and treat people who are multi- drug resistant, there is a strong potential for it to spread," she said.

Source: Xinhua
http://english.people.com.cn/90001/90782/90880/7330447.html

TUBERCULOSIS: CRS Battling Tuberculosis in Asia

“When I first arrived here, I couldn’t walk. I couldn’t stand. I couldn’t eat.” Maria Sabina Tai, a 40-year-old mother of 7 living in East Timor, sits in the yard of a treatment center for people with tuberculosis. Maria had felt sick for two years, but wasn’t sure what the sickness was. “Then a TB volunteer found me,” she says. She went to the center mainly because of her children: “I was worried about my kids.”
The volunteer who found Maria is part of a CRS-supported program run by Klibur Domin, a local organization in this small, impoverished country near Australia. Though East Timor’s population is only one million, over 470 people die from TB each year here; many more are infected. Klibur Domin runs the 50-bed treatment home, where patients stay and receive a course of antibiotics and good food. Klibur Domin also seeks out sick people in their villages, and raises awareness of the disease.
Tuberculosis festers and spreads easily “where people are crowded together in a small space, and where there is poor ventilation,” says CRS’ Michelle Lang-Alli, who is Asia Regional Technical Advisor for Health. Malnourishment and overwork add to the problem.
TB attacks people who are already weak. One vulnerable group are refugees. In southern India, refugees from Sri Lanka live in cramped warehouses where cooking smoke fills the air. There, residents who contract TB pass it on to other family members, including their children.
CRS programs help TB patients recover and prevent TB from spreading. In East Timor, CRS funds health groups that care for TB patients. In Cambodia, CRS partners do home visits, making sure TB patients are taking their medication properly. In southern India, CRS and its diocesan partners are building new houses for Sri Lankan refugees so they can leave their crowded, unhealthy quarters.
In Timor, Catholic sisters play an important role in running rest houses where patients can take medicine and recover. “In the past, families just thought it was a regular disease,” says Sister Carmelita Martines at the TB home she and her fellow Carmelite nuns run in Timor. If people aren’t in a controlled environment like a rest home, they often make mistakes and don’t take the medicine properly.
The sisters follow up when patients are strong enough to leave the rest house but are still taking the antibiotics. “We call them the champions of TB in East Timor,” says Lang-Alli. “They’re very active. They’ll chase patients up if they don’t finish their treatment.”
Throughout Asia, CRS and its partners are helping the poor breathe easy. “I feel happy and grateful when I see patients return home well,” says Sister Carmelita. “You’re like a bridge that God’s love can flow over to reach them.”
http://crs-blog.org/battling-tuberculosis-in-asia/

TUBERCULOSIS: WHO considers strategy to stop tuberculosis feeble

3/24/11
Luanda – The regional director of the World Health Organization (WHO) for Africa, Luís Gomes Sambo, affirmed that despite the fact that member states have adopted almost universally the strategy to stop tuberculosis, the implementation is feeble.
A message in the ambit of the World Tuberculosis Day (March 24) stated that 49 percent of the cases are annually detected, having 12 countries of the region, in 2008, achieved the internationally required goals recommended of a detection of at least 70 percent of new cases.
Gomes Sambo refers that WHO report on tuberculosis control indicates that in 2010 the African region (which represents only 12 percent of the world population) registered 23 percent of the total cases recorded worldwide.
WHO representative alerted that the cases connected to the increase of new challenges, such as co-infections TB/HIV and TB multi-resistance to medicine, complicates the control of the disease in the region, since about 35% of people with tuberculosis are HIV-positive.
Gomes Sambo said that there is the need for innovating actions to deal with the continuous challenges.
WHO will support countries to adopt new rapid test, which combines diagnosis in a unique test.
Gomes Sambo appealed to the national authorities to reinforce partnerships to stop tuberculosis in order to mobilize additional resources to control the disease, from government and private sectors.
http://www.portalangop.co.ao/motix/en_us/noticias/saude/2011/2/12/WHO-considers-strategy-stop-tuberculosis-feeble,83227e18-797e-4877-b766-45a071a4922b.html