POVERTY: THAILAND: Two days in the life of an urban flood expert

BANGKOK, 2 December 2011 (IRIN)

 Photo: Shermaine Ho/IRIN
Adri Verwey visiting water pumping station at the Bang Sue canal in Bangkok, November 2011

As 16 billion cubic metres of flood water bore down on Bangkok in early October, international experts flew in to help the government deal with an unprecedented potential calamity.
One was Adri Verwey, an urban flood specialist from the Netherlands, another low-lying "delta" country that has honed its international reputation for water management through investments that protect the country's highest-density areas from even unlikely catastrophes that would only occur once in 10,000 years.
Verwey has worked for the past 40 years on flood forecasting systems, mostly in Asia, and is now the senior specialist on modelling systems at the Netherlands-based water resources management think tank, Deltares.
IRIN followed Verwey and his team in the Thai government's flood command centre from 10-11 November, when three out of Bangkok's 50 districts were ordered to evacuate while rising waters threatened to overwhelm the city's hastily constructed sandbag dykes and water pumping system.
"We do not have experience in dealing with such a serious flood; many local experts have never expected a flood would happen in Bangkok," said Barames Vardhanabhuti, a lecturer in the engineering department at Kasesart University.
One of the first steps was to gather data and satellite images from multiple government agencies, and then enter the information on topography, water levels and the city's drainage system (number of water pumps, canals, drainage capacity and speed) into a multi-dimensional modelling software, which generated worst-case flood scenarios.
The result was cartoon-like images of water spreading through the city, frame by frame.

Brainstorming
With northern Bangkok already under 1.6m of water and the capacity of existing dykes far too low to handle such a massive flood, Verwey proposed using soldiers to speed up sandbagging.
The city's main 170km King's Dyke needed to be sandbagged up to 1-2m higher to save the city's business and tourist hub from flooding, said Verwey.
According to the Ministry of Interior's department of disaster prevention and mitigation, 350,000 sandbags had been produced as of 2 November. The department planned to distribute an additional 250,000 sandbags to save the country's administrative and economic heart from the deluge.

 Photo: Shermaine Ho/IRIN : Sandbagged and waiting

In case water pumps and sandbagging failed to hold back the deluge from inner Bangkok, Verwey and army officials brainstormed possible next steps: cargo containers placed in openings under the railway tracks to block water from flowing into central Bangkok? Blowing up the sea dykes near the Gulf of Thailand to quicken drainage if floodwater made it to the southern coast?
But the focus was still on gathering data and working with the army on sandbagging plans.
Verwey met the army's chief of staff and presented the plan to the prime minister, who agreed to mobilize about 1,000 soldiers to inspect 80km of The King's Dyke twice a day and to help local residents place additional sandbags.
If the dykes were not reinforced by sandbags in time, said Verwey, water sneaking under the dykes could lead to a breach up to 100m wide - causing widespread flooding across almost all areas in Bangkok; at the time only 30 percent of the city was flooded.

Water pump inspection
Besides sandbagging to hold back floodwaters, the excessive amount of water that had already inundated the northern and eastern parts of the city needed to be drained.
Verwey's team inspected three of the city's 14 water pumping stations and declared two sites functional. At the third station, the team found eight out of 45 pumps non-functioning and the remaining ones working at less than capacity.
It was almost 9pm on 11 November when Verwey waded through floodwaters to inspect the Bang Sue canal, the last barrier between the water and Bangkok's inner city. He declared all of them functional.
"We are monitoring the pumps around the clock," said the water pump station master, who had used his own money to buy a fan to cool down overheated control units.
Nearby, residents filled the waterways with lotus-shaped boats made from curled banana leaves and marigold flowers as the country celebrated Loy Krathong - an annual full-moon festival to pay tribute to the water goddess.
Verwey left Bangkok on 20 November - one day after the prime minister declared central Bangkok safe, with floodwaters receding from most parts of the city, much in line with his simulations.

But for Verwey, the job is far from complete.
"We can expect the flood to continue to recede, but it will still take quite some time before outer Bangkok is completely dry," he said. "What is needed next is a thorough analysis of what has happened and how such a flood can be prevented in the future."
In December he and his colleagues will help the government draft a new plan for water resources management for the Chao Phraya Basin - which covers 30 percent of the country and houses 40 percent of the population.
http://www.irinnews.org/report.aspx?reportID=94367

MALARIA: President Bush urges US not to abandon Africa projects

Former president George W Bush urged his country to continue supporting Africa as he arrived in Ethiopia to promote US-funded projects fighting HIV/AIDS, malaria and cervical cancer. Bush, who is on a regional tour, said the US should “not retreat from the world”. “It’s also important for the American people to know if we don’t continue to support people who have HIV or are dying because of mosquito bites more and more people will die,” he told reporters in Addis Ababa. Bush and his wife visited a hospital supporting people living with HIV/AIDS and providing cervical cancer screening and also toured a compound where people living with HIV/AIDS receive home-based care.
http://www.gulf-times.com/site/topics/article.asp?cu_no=2&item_no=473888&version=1&template_id=43&parent_id=19

POVERTY: SUDAN-SOUTH SUDAN: Returnees left in limbo

NAIROBI, 5 December 2011 (IRIN)

 Photo: Hannah McNeish/IRIN
Homeward bound... Southern Sudanese arrive by barge in Juba

Some have camped for months waiting for promised transport to South Sudan, others have been and returned, disappointed with life in the world's newest state.
Five months after the South gained independence, the fate of hundreds of thousands of southerners living north of the border remains uncertain, particularly so as the Northern military battles borderland rebels it - and Washington - accuse Juba of supporting.
Even their numbers lack any consensus: 700,000, according to the UN, 150,000 according to Khartoum.
Most lost their Sudanese citizenship after secession on 9 July and were given nine months - until 9 April 2012 - to "regularize their status", but were not told what this means in practice.
Many have spent their entire lives in the north; dual nationality has been ruled out.
More than 350,000 people of southern origin have headed south on their own over the past year, another 130,000 with help from the UN Refugee Agency (UNHCR) and the International Organization for Migration. By the end of the year, UNHCR expects a further 140,000 to register for assisted return.
Tens of thousands still in the north, who have made the first steps to returning, selling their homes and many of their possessions, have found themselves stuck in temporary camps with limited access to basic amenities.
"The hardest thing is that nothing has changed since the independence of South Sudan," said Victor Rabbi, leader of a camp called Al-Andaluz, in Mayo near Khartoum.
"We sold everything months ago because we thought we would go back to our homeland in July. We have nothing left. Not even a job. Since independence, as South Sudanese we no longer have the right to work in the public sector or for NGOs," he said.
The camp consists of hundreds of shelters made from wood and fabric and is home to 3,600 people.
Water is brought in by mules, and two four-litre jerry cans are sold for five pounds (US$1.80), a considerable expense for the residents.
Children cannot go to school any more, as they are no longer considered Sudanese. In the absence of electricity, power cables serve as skipping ropes for the girls.
"We are waiting for someone to tell us to leave," said Rabbi.
Forty families arrived at Al-Andaluz over a year ago. In the run-up to independence, there were promises of lorries paid for by the South Sudan government.

Roads closed
But the conflict in the border states of South Kordofan and Blue Nile has led to the closure of all land routes between the two countries. In any case, seasonal rains also make it almost impossible to travel by road.
Since April, the journey south can only be made by river barge or train.
While six train services have been funded, departures are not easy to programme.
"The train is protected by soldiers from Sudanese army until [the railway junction at] Babanusa. Then, SPLA [South Sudanese army] soldiers take over. The train goes through areas vulnerable to attacks. The journey to [the southern railhead town of] Wau takes 17 days," said Paul Urayo, who works in the Khartoum office handling the registration of South Sudanese from the Bahr al-Ghazal region.

 Photo: Maryline Dumas/IRIN
And back again...Many southerners return to the north because of insecurity and harsh conditions in the south

"It is impossible to say how long the return trip will take in such difficult conditions," Urayo said.
After independence, the local government in some states in South Sudan chartered 16 trucks to carry returnees' luggage.
Months later much of the luggage is still stuck in Al-Andaluz, held by transport companies, which say they have not yet been paid for their services by local authorities in South Sudan.
"If it goes on like this, we'll have to write off our things," said Rabbi. "Then we really will have nothing when we arrive in South Sudan to rebuild our lives."

Slow boat to Juba
The main departures point for those heading to the southern and central states of South Sudan are the near-adjacent river Nile ports of Kosti and Renk, which more or less straddle the border.
But in the absence of commercial traffic, the 12-day passage to Juba is only possible on barges operated by the International Organization for Migration (IOM), meaning an average wait of more than 100 days. According to the IOM, once barges carrying 3,000 people leave Kosti soon, some 8,000 to 10,000 people will still be left waiting there, with another 22,000 in Renk, on the South Sudan side of the border.

Doubling back
Many returnees, if they have the means to do so, double back to the north, despite the uncertainty. This is particularly the case in South Sudan states experiencing armed conflict. Some 12 percent of those who travelled to Upper Nile, Unity as well as Western and Northern Bahr el-Ghazal have returned north, according to Ismael Ibrahim, an internal displacement expert working in North Sudan's Ministry of Humanitarian Affairs.
Among them was Paul*, who arrived with his wife and three children in Unity's capital, Bentiu, to the sound of landmine explosions and clashes between government forces and rebels.
"It was too dangerous. One day, I was the victim of an ambush on the way to my job as a school teacher. I decided to come back to Khartoum," he told IRIN, adding that he plans to send his children to school in either Uganda or Ethiopia.
The stark contrast between living in a city with some semblance of amenities and trying to get by in a rural area almost entirely lacking in public services and infrastructure is another reason returnees head back north.
"I sent my wife and my children to Juba in March [2011]," Santurino, an English teacher, told IRIN in Khartoum.
"There was no electricity or running water in their hut. My two eldest children [eight and five years old] couldn't go to school because the classes were overcrowded, and it was hard for them to understand Juba Arabic [a mix of Arabic and Kiswahili spoken in Juba], which the other children spoke.
"My children were happy to come back to Khartoum. I agree that everyone has to make sacrifices, but only if it is to build the country. But six years after the peace agreement [ending years of north-south civil war], the government has done nothing and I absolutely don't believe that there will be an improvement by April," he said.
But most southerners living in Khartoum lack the means to make such choices and some do not even believe anyone doubles back once they have headed south.
"That's just propaganda from the Khartoum government!" insisted Garang Akog Madi, who lives in Al-Youssif, a northern district of the capital.
Exactly what status the "foreign" South Sudanese will be accorded if they stay in the north after the April deadline - whether, for example, they will be allowed, like Egyptian nationals, to travel freely in and out of the country - depends on the outcome of post-secession negotiations between the two governments.
But there has been little sign of progress in these stop-start talks, which also focus, with seemingly more priority, on oil, financial arrangements, border demarcation, and the status of the Abyei region.
http://www.irinnews.org/report.aspx?reportID=94395

POVERTY: BANGLADESH: Border killings mount despite no-shooting decree

RANGPUR, 6 December 2011 (IRIN)

 Photo: Maher Sattar/IRIN
Bangladeshi brothers Anis Ahmed (L) and Shohir Jamal (R). Shohir is standing on the border between the two countries, with Bangladesh located on the right side of the photo. Anis is on the Indian side

The death toll at the Bangladesh-India border continues to mount three months after the Indian government instructed its border security forces to stop shooting civilians suspected of being undocumented migrants or a threat to national security, say local residents.
NGOs have denounced the border killings as extrajudicial.
The abuse continues, according to Bangladeshi human rights NGO, Odhikar, which accuses India's border security force (BSF) of circumventing the recent no-shooting decree with beatings, stonings or poisoning.
However, the First Secretary of the Indian embassy in Bangladesh's capital, Dhaka, told IRIN that any killings had been linked to border crime.
"The BSF does not attack civilians. This is not happening any more. Only in a few cases, they have acted in self-defence," said Manoj Kumar Mohapatra.
Some 347 Bangladeshis and 164 Indians have been killed by Indian forces since 2006, when the Indian government built the wall, according to BSF.
Mohammad Baten, the latest man allegedly killed by the BSF - the 24th this year - was reportedly beaten to death, according to Bangladesh's border security.
The 4,000km fence has been dubbed the "Great Wall of India" by international media, while locals simply know it as the "wall of death".
India's government built the wall to restrict movement of "illegal immigrants, smugglers and suspected Islamic militants", according to officials quoted in local media.
Farmers corralled by the barbed wire find it increasingly difficult to lead ordinary lives.
"They have surrounded the people of Bangladesh on three sides with barbed wire," said Adilur Rahman, secretary of Odhikar. "It's like the Berlin Wall. You have brothers, even husbands and wives, separated on both sides."
Distant neighbours
"When they turn [the floodlights] on, the night becomes day here," says nine-year-old Anis Ahmed.
The barbed wire is visible from Ahmed's house at the border near the village of Amgaon in Bangladesh's Dinajpur District. Ahmed and his 11-year-old cousin, Shohir Jamal, work on their family's farm every day. Their crops grow right up to what is known as the zero point of the border, where Bangladeshi and Indian soil meets.
On this particular day, Ahmed and Jamal walked towards the border while two guards monitored them with binoculars.
"We go up to the fence all the time," they told IRIN. Wary adults lingered behind, warning them not to go further.
Ahmed and Jamal work on their farm side by side with Indian farmers, who cross the border to work on their land.
"The Indian farmers never speak to us," says Ahmed, "If they do, the BSF yells at them. If we try to talk to them, they don't pay any attention to us. They are worried that the BSF will accuse them of being smugglers, or helping illegal immigrants."

Suspicion
There is mistrust on the Bangladeshi side of the border too. "At night we put our cows inside the house and lock up all the animals," said Jamal.
Against the backdrop of border crimes, villagers become suspicious, according to a local primary school teacher, Jalal Ahmed.
"Everyone else thinks we're all smugglers here, so our people have to deal with that prejudice. And there are [actual] criminals here, not just cattle smugglers but a lot of drugs are smuggled here too," he said. "It's very bad for our society, for our children."
Felani Khatun, 15, an undocumented Bangladeshi immigrant in India, was shot while climbing the wall to cross back home on 7 January this year. A photo of her lifeless body hanging from the barbed wire sparked widespread uproar in Bangladeshi media.
Nur Islam, Khatun's father, had successfully climbed over the fence seconds before Felani was shot.
"There was no shout, no warning," he told IRIN. "I don't understand why they didn't shout anything. I saw them. They just got up and shot. And my girl cried out."
http://www.irinnews.org/report.aspx?reportID=94399

MALARIA: Improving Quality Performance among Community Health Volunteers

Bill Brieger : 05 Dec 2011

Improving Quality Performance among Community Health Workers Providing Integrated Community Management of Febrile Illnesses in Nigeria



A Poster Presentation at the 60th ASTMH meeting by Bright C. Orji, William R. Brieger, Emmanuel O. Otolorin, Jones Nwadike, Enobong Ndekhedehe, Olugbenga Ishola, Godfrey Akro, Nancy Ali



Efforts to improve access to quality case management of febrile illness include the engagement of Community Health Workers (CHWs) to use Rapid Diagnostic Tests (RDTs), dispense ACTs and manage pneumonia and diarrhea. Use of CHWs reduces challenges like a weak public sector, human resource constraints, and variable quality of the private sector.
Studies have suggested that CHWs are able to perform case management services in a training setting, but not much has been done to measure quality performance among CHWs in the field. Jhpiego and the Akwa Ibom State, Nigeria health authorities trained CHWs and developed simple quality performance standards (one-page tool) for CHWs providing community services in Akwa Ibom State, Nigeria.
All 131 trained CHWs in two local government areas providing malaria, pneumonia and diarrhea case management were assessed using the standards. The tool has 37 performance criteria (PC) to measure CHW knowledge, skills and competence in 3 sections: History taking and Examination; Conducting RDTs for Malaria and Illness Management,
Trained assessors observed CHWs providing services. Each correctly performed criterion was scored 1 point. Three rounds of assessments were conducted at an interval of two months from May-November, 2011.
At the end of each round assessors provided feedback and refresher training for CHWs during their monthly meetings. During Round 1 CHWs achieved an average of 19 (52.2%) PC. This rose to 25 (67.5%) PC at Round 2 and 28 (75.6%).
PC that needed most improvement included checking signs and symptoms to distinguish among the illnesses. CHWs also needed reinforcement on checking RDT expiry date, entering results on records, safe disposing of sharps, and counseling on preventive measures.
In conclusion feedback after Rounds 1 and 2 helped CHWs improve their performance. Additional quarterly assessments and feedback sessions are planned. CHW supervisors can use this tool to enhance the quality of services provided by the CHWs and improve CHW training.
http://www.malariafreefuture.org/blog/?p=1337

POVERTY: Remittances to developing countries rebound

JOHANNESBURG, 6 December 2011 (IRIN)

 Photo: Maria Font de Matas/IRIN
Remittances to developing countries are expected to continue increasing

A slump in the amount of money migrants sent home during the global financial crisis appears to have ended with officially recorded remittances to the developing world reaching an estimated US$351 billion in 2011, an 8 percent increase from 2010.
"Growth of remittances in 2011 exceeded our earlier expectations in four regions, especially in Europe and central Asia... and sub-Saharan Africa," write lead economists at the World Bank's Migration and Remittances Unit in a brief released on 1 December.
The top recipient countries were India, China, Mexico and the Philippines, but smaller nations such as Tajikistan, Lesotho, Nepal and Lebanon received a greater flow of remittances as a percentage of their gross domestic product (GDP) - Lesotho, for example, relied on remittances for 29 percent of its GDP in 2011.
Money sent home by migrants now represents three times the amount of official development aid to countries receiving assistance and is crucial to alleviating poverty, according to the World Bank.
But the news is not all good. The ongoing debt crisis in Europe and high unemployment in many developed countries "is affecting employment prospects of existing migrants and hardening political attitudes toward new immigration", the World Bank economists note. Saudi Arabia recently introduced an indigenization programme that limits the number of foreign workers companies can hire and the United Kingdom has imposed tougher admission criteria for non-EU migrants.
http://www.irinnews.org/report.aspx?reportID=94401

POVERTY: KENYA: Floods, rains wreak havoc

NAIROBI, 6 December 2011 (IRIN)

 Photo: Richard Lough/IRIN
Over 40,000 people have been affected by flooding since the start of short rains in October (file photo)

Heavy rains in Kenya have washed away bridges and rendered many roads impassable, complicating efforts to reach thousands of people made homeless by the flooding, an official of the Kenya Red Cross Society (KRCS) told IRIN.
"We are currently undertaking an assessment through our branches countrywide to establish the magnitude of the problem [and identify] the most vulnerable of those affected and areas which we have not reached because of logistical challenges," Nelly Muluka, the KRCS public relations and communications officer, said on 5 December.
So far, Muluka said, at least a dozen people have died and more than 40,000 others have been affected since the start of short rains in October.
"Three people died in a mudslide in Keiyo [North Rift] three days ago, bringing the number of those who have died in the [Rift Valley] province to five since October; seven have died in Nyanza [western Kenya] and two at the Coast," Muluka said. "We are concerned about the livelihoods of those displaced by floods or heavy rain in various parts of the country and we have started distributing non-food items to those we have been able to reach.
"In Garbatula [Isiolo district] for instance, hundreds of farmers have lost crops... we now have to look ahead and see how they will be assisted in terms of livelihood support," Muluka said. "In other areas, there is the danger of waterborne diseases breaking out after latrines and boreholes were submerged and in other areas, water pipelines have burst."
According to the Kenya National Commission on Human Rights (KNCHR), whose monitors are on the ground in northern Kenya, floods have affected all of Isiolo County, with Ewaso Nyiro River bursting its banks. Garfarsa, Kombola, Sericho, Merti and Garbatula are some of the worst-affected areas, KNCHR said.
The displaced and those affected by the floods urgently require relief aid such as food, mosquito nets, tents, blankets, cooking utensils and medicine. KNCHR said the situation had been especially dire for 21 people who had been marooned in the past six days on higher ground between two streams in Merti. The group was taken to Merti town by helicopter on 5 December.
River Nzoia burst its banks on 3 December, displacing thousands of people in Budalang'i, Bunyala and Funyula areas of western Kenya. Thousands are also displaced in Nyando and Nyatike areas in Nyanza, as well in Coast Province.
Teams comprising government, KRCS and UN officials are involved in rapid assessments of the flooding situation, a humanitarian official, who requested anonymity, told IRIN.
In October, flash floods in Coast Province claimed several lives, damaged schools and destroyed sewage systems. Some of the affected areas included Changamwe, Kisauni, Kongowea and Likoni estates in Mombasa, where flood waters submerged large areas, making it difficult for residents to access clean water.
In November, the Global Disaster Alert and Coordination System issued a flood alert for Kenya, after more than 300 families were displaced and livestock swept away by flash floods in Wajir, northern Kenya; and 5,000 families relocated to higher ground in Kerio Valley in Rift Valley Province.
http://www.irinnews.org/report.aspx?reportID=94402

MALARIA: More than a shield: The RTS,S malaria vaccine trial

6 Dec, 2011: Meera Senthilingam
Meera Senthilingam is a freelance science journalist based in London, UK.
 My ride to the clinic

The RTS,S vaccine is one of the most promising malaria vaccine for years, currently doing well in clinical trials. And the benefits of the trial go beyond the vaccine itself, as Meera Senthilingam discovered.
On a recent trip to Kenya, I decided to visit the quiet, coastal town of Kilifi. Unlike the busy, tourist laden beaches of Mombasa just 60 kilometres to the North, Kilifi is scenic, peaceful and far less polluted. But it also has one of the highest prevalences of disease in the country. Its warm, moist climate, combined with a poor population, mean that diseases such as malaria are quite common. As a result, Kilifi is a trial site for many malaria treatments and vaccines, including the RTS,S vaccine, the most developed malaria vaccine to date.
RTS,S has now reached phase III clinical trials involving over 15,000 participants across seven African countries. Of the eleven trial sites across these countries, three are in Kenya, taking place at the Kenya Medical Research Institute (KEMRI) bases in Kisumu in Western Kenya and, of course, Kilifi.
Equipped with a four-wheel drive and a few medical deliveries, Dr Patricia Njuguna, the principle investigator on the Kilifi trial, took me to see how such a large-scale trial works in the field. Our destination was the Madamani dispensary, one of the three clinics conducting the trial within Kilifi.
We passed acres of land where drought was evident by the dry soils followed, surprisingly, by a conserved area of natural forest. But as farmland and forest turned to huts, wells and people going about their daily lives, the car made numerous stops for women and their children to come aboard. Although initially confused as to whether the KEMRI vehicle doubled up as a taxi to increase funding, I soon learned this was all part of the service offered as part of the vaccine trial.
“As well as routine visits, if participants are unwell we provide them access to the facility for free healthcare,” says Njuguna. “Our vehicles come in every day bringing in mothers from various homes. This is coordinated by fieldworkers living within the community who have close contact with the mothers who call them when they need to be seen”.
Our driver was one of these fieldworkers and the women on board had called him that morning about various ailments affecting their children. They joined us for the remainder of the journey so their children could be examined examination by the local clinician.
The trial it seems is not just the testing of a vaccine, but a complete health service, and a very good one at that.
 Rapid malaria test

Developing a vaccine
In Sub-Saharan Africa, malaria is caused predominantly by infection with the parasite Plasmodium falciparum. Creating a vaccine has been a challenge to date due to the fact that the parasite, and its genome, is larger than bacteria and viruses, the complex nature of the parasite’s life-cycle and the fact that it can alter the proteins on its surface, limiting our ability to design a vaccine to find it and induce an immune response.
“Imagine Joseph and his Technicolor Dreamcoat that’s showing a different colour every time. If you’re trying to take down someone in red and the coat shows blue, you’ll miss it,” says Dr. Njuguna as we draw closer to the dispensary.
“This is the challenge for the vaccine and if it misses it you get malaria. Every time the parasite goes through a life cycle it changes the protein it’s presenting, so your vaccine needs to be very clever”.
Once bitten by an infected mosquito, the parasite enters the body in its immature form, known as a sporozoite, where it then travels to the liver in order to replicate within liver cells before moving on to invade red blood cells. This latter stage is when the main symptoms of disease, such as fever and chills, occur, and it’s also when the rapid production of new proteins takes place as the parasite frantically replicates within the blood cells.
RTS,S aims to overcome these issues of adaptation by targeting the parasite early on in its life cycle the sporozoite stage when the parasite first enters through the skin and travels to the liver This can happen within 3–5 minutes of infection.
When we arrive at the dispensary the first thing I notice is the high degree of organisation on site. As we enter the building, we walk straight into a large waiting room catering comfortably for tens of people at one time. Away from this stems two consultation rooms and a pharmacy. The clinician, Dr Pauline Akoo, is busy examining a child in one of the rooms while the women from our car journey are registered by fieldworkers noting down the symptoms of their children.
The trial targets two age groups of children, both under the age of 5 as this is the group at most risk of infection with malaria. The first cohort is made up of children aged 5 to 17 months and the second are infants aged 6 to 12 weeks all receiving three monthly injections followed by a booster vaccine 18 months later. This is, however, a randomised trial, so half of the participants act as a control group receiving a pretend vaccine. By comparing the number of children experiencing Malaria for the first time within each group, the researchers will see if the vaccine really has an effect.
As I join Dr Akoo for a few of her consultations, mothers bring in children with ear infections, upper respiratory tract infections and fevers. Any child brought in with a fever is given a rapid malaria test to, which diagnoses on site, allowing for immediate prescription of anti-malarials, if need be, while a sample is sent to a lab for confirmation. Medicines for the other ailments are also prescribed.
“Each time the child visits they get an opportunity to be seen by a clinician. Whether they’ve come for screening, vaccination, or some other problem they will always get a thorough medical examination,” says Akoo. This is a complete medical package for participants, and, more importantly, it is free of charge.
With such care provided in an otherwise poor region, it’s easy to imagine the flooding of volunteers to the dispensary but, as with many trials in developing regions, there was some initial anxiety and resistance.
“Initially they were shy because this is a research-naïve area – they don’t understand the difference between research and treatment,” says Akoo. “But with time we have explained the trial and the people realised it would not harm them and there were health benefits.”

 Madamani dispensary charter

Vaccine on the horizon?
RTS,S is the first vaccine to reach Phase III of clinical trials, with Phase II trial results demonstrating 53 per cent protection against malaria in children aged 5 to 17 months. Phase III is currently halfway through its intended timeframe, with encouraging preliminary results published recently in the New England Journal of Medicine.
The early results analysed 6000 of the trial participants across Africa and demonstrated 56 per cent protection against standard clinical malaria and 47 per cent against severe malaria (when the parasite enters the brain). However these results are, again, for a subsection of the study – the cohort aged 5 to 17 months – with results from the infant group expected by the end of 2012.
Without getting our hopes up too high, it does look like a vaccine against malaria could soon become a reality. Even the costs of scaling up and production have been accounted for, with pharmaceutical company GlaxoSmithKline promising to provide it almost at cost price with any return invested back into further improvement of the vaccine.
Although incidence of malaria has been on the decline in recent years, according to the World Health Organization, 781,000 people still died of the disease in 2009 – 90 per cent in Africa. Although a 56 per cent success rate may not sound significant enough to justify rolling the RTS,S out in a wider scale, when the burden of disease is considered globally, it’s certainly worth having. And from what I saw at the dispensary, the RTS,S trial has not only provided a possible shield against malaria, but also improved the understanding, and general well-being, of the people most affected by it.
The KEMRI-Wellcome Trust Research Programme is supported by the Wellcome Trust.
http://wellcometrust.wordpress.com/2011/12/06/more-than-a-shield-the-rtss-malaria-vaccine-trial/#more-7757

POVERTY: PAKISTAN: SWAT women face dual burden

MINGORA, 6 December 2011 (IRIN)

 Photo: Sarah Naqvi/Flickr
Women in Swat Valley are struggling to keep their households running (file photo)

Women in the Swat Valley in the Khyber Pakhtoonkh'wa province are working harder than ever to keep their households running.
To some extent this makes them happy, allowing them to reclaim lives put on hold during the militant Taliban reign, which ended in July 2009 after a military operation, allowing tens of thousands of IDPs to return.
"We are no longer compelled to wear the suffocating blue burqas imposed by the Taliban; the girls are back at school and women are again working in the cosmetic factories, the schools and so on from which they were forced out," Aqila Khan, 42, a social activist, who once again is wearing a white chador, told IRIN in Mingora, the principal town of Swat.
But though militancy has receded, women in Swat face a double burden. The devastating floods of 2010, followed by less intense but still damaging flash floods in 2011, took a big toll on agriculture, chiefly the maize crop. "This was our main money-earning crop," farmer Riaz Khan told the media in the town of Kabal in Swat.
The District Coordination Officer of Swat told IRIN that "reconstruction work in the valley following the floods was well on track". Bridges have been built by the military with foreign donor support and some efforts have certainly been made to restore livelihoods.
But still things are difficult and women frequently bear the brunt. "Lots of men work in the tourist industry here. Hotels and cafes were washed away in the 2010 floods, destroying all they had built after the militant conflict, and then there were major agricultural losses in both 2010 and 2011," Aqila Khan said.
Many women are struggling simply to put food on the table. "I sold the bangles I received for my wedding 10 years ago. It was all the gold we had but my husband had lost his job as a hotel waiter, and with the money we bought hens, goats and began replanting vegetables," Salma Bibi, 30, told IRIN.
Her problems are not over, however. "My husband is out all day looking for work. He is desperate. I tend our three young children, the animals, look after the fields, fetch water from a stream [7km] away from our village near Mingora, cut timber to cook and perform all the household chores. Other women work like me too to bring in money - but by the end of the day we are worn out. Look at my cut, torn hands," she said displaying her palms.

Taliban concerns
"I worry about the militants coming back because my sister and I were forced out of college for nearly two years and we cannot seem to catch up again. This means we cannot help our elderly parents by earning an income in the coming years," said Zaitoon Bibi, 18. Her brothers struggle to restore their fields and replant the peach trees they lost.
Many other women must take on the dual burden of earning an income and running the household as their husbands try to rebuild homes, lives and livelihoods. Given the acute losses experienced by the tourism industry, which employed tens of thousands, people are asking for more help.
"We have received no compensation and no help from anyone. We know that right now it is our wives who are keeping the households running. But this is unfair on them. We have to find a way to get back to work, and we believe the authorities must somehow help us," said Sharaft Ahmad, 36, whose wife works as a schoolteacher, as well as looking after the household and cattle.
"Things cannot continue like this for ever. We also live in fear of another disaster and somehow normality has to be found here so that families can live with some peace of mind and without continued strain," he said.
http://www.irinnews.org/report.aspx?reportID=94400

AID POLICY: Cash catches up

NAIROBI, 6 December 2011 (IRIN)

 Photo: The Cash Learning Partnership
Smart cards...cash transfers are deemed more efficient and flexible than in-kind aid...

Cash and voucher transfers are becoming increasingly integrated into humanitarian relief efforts across the Horn of Africa, particularly in areas of protracted conflict and insecurity.
Restrictions on access in Somalia and in areas of northeast Kenya have led the humanitarian community to rethink traditional ways of delivering aid.
“We have to criticize our programming decisions and formulate better ways to get assistance to the people in need,” said Nick Maunder at a recent workshop in Nairobi, where the private sector, NGOs, UN agencies and donors met to debate, share experiences and develop ways to improve and increase the use of cash transfer programming during emergencies.
The World Food Programme (WFP) and several NGOs, notably Horn Relief and Oxfam, have scaled up their cash-based programming across the region this year. According to Horn Relief, US$81 million in cash and vouchers is going into Somalia, reaching more than 1.8 million people.
“This is the largest NGO cash response thus far on this scale, mainly because food aid is no longer an option in south-central Somalia,” said Degan Ali of NGO Horn Relief.
“Cash for assets has also started going to scale in Kenya, targeting just under half a million beneficiaries at KSh3,000 [$33] per household per month,” said Sheryl Harrison of WFP.
Most humanitarian assistance in the Horn of Africa has so far been provided in-kind, through the distribution of food, shelter, tools and seeds. In many areas, relief efforts have been beset by delays, high delivery costs, and in Al-Shabab-controlled areas, high taxation. There is a growing body of experience in the region that is using cash or vouchers as a critical complement, or at times an alternative to in-kind assistance.
“Cash is less visible, more dignified, uses fewer intermediaries, is in transit for less time and a more flexible resource to meet needs beyond food,” said Ali.
When food is available in local markets, or can be supplied quickly through market mechanisms, cash and voucher transfers are perceived to be the most efficient and cost-effective way of delivering humanitarian aid. Once the implementing agency has conducted an in-depth market assessment of the area, and the context is deemed suitable, money can transferred directly to beneficiaries, with or without conditions.
“The reason why there is so much momentum around cash is because the humanitarian world is starting to recognize that more and more people are living in a market economy, taking that into account and beginning to work in it rather than in isolation from it,” explained Breanna Ridsdel, communications and advocacy officer at the Cash Learning Partnership (CaLP), which organized the workshop.
Concerns have been raised about whether injecting cash can disrupt local economies and cause inflation but implementing agencies believe the amount of money being transferred to households is too small to have a detrimental impact on markets; according to a recent report by CaLP, the fear of inflation is disproportionately applied to cash rather than in-kind programmes, which can also have a massive influence on markets. Breanna Ridsdel of CaLP explains “Its all context specific, if you are looking at going into a very remote area and setting up a financial system, then that may not be the most appropriate intervention but if you are looking at a financially insecure community, living in urban area, in a developed financial system, then cash is likely to be more appropriate then food distribution which is working against the market... It’s all about good programming”.

Going private
The challenging environment in which relief agencies are operating in the Horn of Africa, characterized by insecurity and corruption, has led the aid community to create partnerships with the private sector and adopt new technologies to deliver cash safely to hard-to-reach areas.
Representatives from Visa, Equity Bank and Safaricom, a mobile phone operator, attended the workshop to lobby implementing agencies to use their products, saying it would be more efficient.

 Photo: Jaspreet Kindra/IRIN
...and help preserve the dignity of those caught up in emergencies

“Exciting new partnerships are being forged between the private sector and humanitarian community to improve the delivery of cash,” said Ginger Baker of Emerging Market Solutions at Visa.
Money is being transferred electronically through mobile-phone service providers, such as MPesa in Kenya, and through traditional remittance networks, such as Somalia’s Hawala system.
“When Al-Shabab closed telecommunications service in Somalia, we began to realize the value of Hawala, which became critical to our relief efforts,” said Ali.
“In Kenya, 21 percent of the population have bank accounts and 87 percent have mobile phones… MPesa can be used as a poverty eradication tool,” according to Safaricom.
With increasing scrutiny from the media, public, and donor governments over the cost-effectiveness of aid and at times, inefficiency of traditional distribution mechanisms, emerging partnerships between the banking and humanitarian sector are being welcomed. “Partnerships with the private sector will encourage more efficient and effective ways of delivering humanitarian assistance,” said head of International Federation of the Red Cross Regional Office, Alexander Matheou.
“The profit motive is not a bad thing. Safaricom and Visa may take a nominal fee for sending cash to impoverished households but at least it will be done quickly in a cost effective manner” said an independent aid consultant at the event.
Over the past few years, the private sector has played an important role in facilitating cash transfer programming yet the engagement of humanitarian actors still appears to be limited.

Some worry that the pursuit of profit sits uncomfortably with humanitarianism.
“The private sector are concerned with the rich, we are concerned with the poor… We need to be careful, but also respectful of each other’s motivations, and meet somewhere in between, ” said the chair of the CaLP steering committee, Austin Davis.
Another challenge is introducing electronic payments in low-income countries which need existing financial institutions and wide mobile-phone network coverage. Safaricom admitted that large parts of the Horn of Africa were still not covered and a proportion of vulnerable populations did not have access to mobile phones. However, according to a recent report on the impacts of mobile cash transfer programmes, the widespread growth of mobile-phone coverage, cheaper handsets and mobile-money services in developing countries suggests these constraints could be easily overcome.

Reservations and recent progress
“The momentum is building but any change happens slowly, any adoption of new techniques meets resistance at first, it has to go through the process of building evidence, proving itself, making mistakes, correcting itself and building systems; this is the biggest obstacle to adoption at scale,” explained Ridsdel.
According to the Oversees Development Institute’s (ODI) Good Practice Review for Cash Transfers in Emergencies, “Experience in very uncongenial environments such as Afghanistan, Somalia and the DRC shows that cash or vouchers are a possible response even where states have collapsed, conflict is ongoing and banking systems are weak or non-existent.”
One of the main challenges is a negative institutional mindset that can be overcome with an increase in such programming, according to advocates.
Sarah Bailey of the ODI says: “Transferring cash directly takes the power away from the humanitarian community and puts it into the hands of the beneficiaries, a notion that people still remain uncomfortable with.”
Experience of cash-based programming is largely based on recovery operations, with less experience at the very early stages of a relief or emergency response phase.
“We should have begun transferring cash much earlier in Somalia where the markets are very important and continue to function despite collapsing livelihoods and weak purchasing power,” said Grainne Moloney, nutrition technical manager at the UN Food and Agriculture Organization’s Food Security and Nutrition Analysis Unit (FSNAU).
In January, FSNAU began assessing 44 markets across Somalia, monitoring the prices of about 40 commodities every week. “In some markets, it became clear that cash transfers at scale were a valid option early on. Unfortunately, there was a lot of hesitation and concerns over inflation, insecurity and cash diversion. Donors were hesitating as the crisis deepened.”
The three major donors to the crisis, the US, the UK and the EU, are now backing cash transfer programmes across the region.
“DfID is successfully using transfers to reach particularly impoverished populations in challenging places in Ethiopia and Kenya. Transfers reach their recipients more quickly and transparently than more widely prevalent ways of delivering aid,” according to the UK’s National Audit Office.
http://www.irinnews.org/report.aspx?reportid=94396

POVERTY: MIGRATION: The risks of rescue at sea

JOHANNESBURG, 5 December 2011 (IRIN) -

 Photo: Kate Thomas/IRIN
A boat carrying migrants from Libya arrives in Lampedusa

 Two years ago, Abdiselam Sheik Omar left his home town of Jijiga in Ethiopia’s eastern Somali region and embarked on a journey he hoped would take him across the Gulf of Aden to Yemen and eventually to Saudi Arabia. “It’s easy to find work there,” he told IRIN. “The problem is crossing the sea.”
Omar was well aware of the risks and hardships, having made the journey twice before. He knew that during the three- to five-day crossing from Puntland in northern Somalia there would be little to eat or drink, and his smugglers would not hesitate to beat uncooperative passengers or even throw them off the boat.
When the rickety, overloaded boat he was on started sinking, one of the migrants drowned before the remaining 34 were rescued by the Yemeni Coast Guard. The passengers and their smugglers were arrested and jailed on reaching Yemen, but Omar was glad to be alive.
After 20 days he was released and made it as far as the border with Saudi Arabia before being arrested again. This time he was deported back to Ethiopia. “I won’t try it again, even though I’m jobless,” he said.
Every year, thousands of migrants risk hazardous sea crossings in a desperate bid to escape poverty, persecution or conflict. If they run into trouble, as many do, their only hope of being rescued is a long-standing maritime code of conduct backed by numerous international protocols that compel passing ships to render assistance to any vessel in distress.
In the last year alone, cruise ships have picked up Cuban migrants off the coast of Florida, the Indonesian navy has rescued Afghan nationals trying to reach Australia, and Spanish authorities have assisted African refugees and migrants drifting in the Mediterranean.
Many other sinking or capsized vessels were either missed or ignored, and countless migrants have lost their lives at sea. The UN Refugee Agency (UNHCR) estimates that between February and October this year, 2,000 mostly African migrants fleeing the crisis in Libya drowned while trying to cross the Mediterranean. Since the beginning of 2011, a further 131 Somali and Ethiopian refugees and migrants have perished in the Red Sea and the Gulf of Aden trying to reach Yemen.

Disincentives
The discovery of a small vessel in apparent distress represents a dilemma for ships’ masters, particularly in the Gulf of Aden and the Indian Ocean, where pirates are most active.
“It’s very difficult to distinguish from a distance whether it’s a boat with migrants or with pirates, so they assume it may be pirates,” said Captain Hartmut Hesse of the International Maritime Organization.
It's very difficult to distinguish from a distance whether it's a boat with migrants or with pirates, so they assume it may be pirates
Current guidance to the shipping industry on the threat of piracy advises ships to keep their distance from small vessels. It does not deal with the possibility that they could be carrying migrants in need of assistance, said John Murray of the International Chamber of Shipping (ICS). "The other big issue is that ships must know that coastal states will meet their obligations in disembarking people rescued at sea."
For ships’ masters everywhere, the biggest disincentive for picking up migrants in distress is the real possibility that they will waste time and money looking for a country willing to let them come ashore.
The International Convention for the Safety of Life at Sea (SOLAS Convention) and the International Convention on Maritime Sea and Rescue (SAR Convention) both outline the duty of relevant countries to cooperate and coordinate rescue operations at sea, but many are unwilling to accept undocumented migrants.
“They should be offered a place of safety in the closest country from where they were picked up,” said Christopher Horwood, coordinator of the Regional Mixed Migration Secretariat (RMMS), run by the Danish Refugee Council in Nairobi, which provides information and support for migration responses between the Horn of Africa and Yemen. "There are worrying signs that countries are not living up to their responsibilities... some are not even permitting [ships with rescued migrants] to dock."
Whether the ship is a commercial vessel contracted to deliver cargo by a certain date or a military vessel patrolling a coastline, the probability of a delay in disembarking migrants "is likely to undermine some of the commitment to picking people up," said Murray. "That’s the real world; that’s the world we live in."
Most ships these days have small crews and are not equipped to provide food and accommodation to extra passengers for days at a time.

Lack of cooperation
The problem is not new. A decade ago, Australian authorities refused to permit a Norwegian freighter, the MV Tampa, carrying 438 Afghan nationals rescued from a fishing boat drifting in international waters near Christmas Island, to enter Australian waters. The episode sparked a political controversy in Australia and a diplomatic spat between Australia and Norway.
Despite much debate about how future incidents could be avoided and amendments to maritime law, the problems have continued, said Anja Klug, head of the UNHCR asylum/migration unit. “We think the real problem lies in the lack of cooperation among the different states involved in these situations."
At an experts meeting convened by UNHCR in Djibouti recently, Klug and her colleagues presented some practical tools aimed at improving cooperation and burden-sharing of sea rescue operations between states in regions affected by high levels of migration.
One such tool is a model framework that provides for government cooperation in establishing regional task forces to oversee rescue operations, identifying the most appropriate countries for disembarkation, and ensuring that adequate arrangements are in place to receive and process rescued migrants with varying claims to international protection.
"We’re not aiming for this to be adopted on a binding global level," Klug told IRIN. "We want countries to come together and assess their needs. [UNHCR] can facilitate, but ultimately governments need to come to agreements."
At the meeting, UNHCR also proposed that “mobile protection response teams”, staffed by experts from government, UNHCR and other international organizations, be dispatched to countries lacking the resources or capacity to deal with an influx of migrants and asylum seekers arriving by boat.
"Normally, reception arrangements are a task of governments but they sometimes don’t have the capacity," said Klug. UNHCR, together with the International Organization for Migration and other NGOs, are already providing such assistance along the coast of Yemen and on the Italian island of Lampedusa, where large numbers of migrants have come ashore in recent months as a result of the crisis in Libya.

Need for guidance
Another UNHCR document suggests some basic standard operating procedures for ships' masters who encounter migrants in trouble at sea, such as what constitutes a "distress situation" and what information should be sought from rescued persons.
Murray, who attended the Djibouti meeting for the International Chamber of Shipping, said there was a need for such guidance but emphasized that it was not the role of a ship's crew to categorize people. "We feel very strongly there should be no pressure on the ship’s master to engage in any processing or profiling of people who’ve been recovered. As far as the ship is concerned, they’re people in distress at sea," he told IRIN.
Noting that boats rescued at sea often contain a complex mixture of asylum seekers, economic migrants and people with special needs, such as minors, Horwood of RMMS agreed that "It shouldn’t be the burden of a ship captain to decide if he’s got economic migrants or refugees. Many of the migrants don’t qualify for international protection, even though they might be on the same boat as those that do. This is the phenomenon of mixed migration."
Horwood welcomed the UNHCR initiative. "These people are victims of situations [that cause them to migrate] and on top of that they find themselves rejected when they’re genuinely in distress at sea."
http://www.irinnews.org/report.aspx?reportID=94383

GLOBAL FUND: Further Details on Fund's Tough New Policies for Grant Renewals

David Garmaise (david.garmaise@aidspan.org),
Funding will be severely restricted for some upper-middle-income countries
Transitional measures will "soften the blow" for countries hardest hit by the new policies
Editor's note: This article is based on documents submitted to the Global Fund Board for its recent meeting in Accra, Ghana; on the decisions made by the Board at that meeting; and on information received from the Global Fund Secretariat. Not all of the decisions made by the Board had been anticipated in advance. The Secretariat is still thinking through the implications of these decisions for the Global Fund's processes related to grant renewals. As a result, there may be changes to the processes described in this article. Readers are advised to watch for future communications from the Secretariat. The Secretariat said that questions should be directed to fund portfolio managers or to Grant.Renewals@theglobalfund.org.

As a result of decisions made at the Global Fund Board meeting in Accra on 21-22 November, significant changes are being made to the policies and procedures for grant renewals. (GFO first reported on this in Issue 167; this article provides more details.)
The main changes can be summarised as follows:
A new, iterative process will be introduced for grant renewals.
Effective 1 January 2012, Group of 20 (G-20) upper-middle-income countries (UMICs) will no longer be eligible for grant renewals unless they have an extreme disease burden (as defined by the Global Fund).
Effective 1 January 2012, certain provisions of the Global Fund's policies on eligibility, counterpart financing and prioritisation (ECFP), which currently apply only to new proposals, will be applied to renewals. The specific provisions are (a) counterpart financing and (b) focus of proposal.
The one-year grace period for changes in country income classification will be rescinded.
Funding for renewals will now be committed in one-year tranches. For a three-year renewal, therefore, the commitments will be 1+1+1, instead of the current 2+1 (the first two years and then the third year).
Transitional measures will be introduced for countries renewing in 2012 that are significantly impacted by the new policies. (This is quite separate from the new Transitional Funding Mechanism which the Global Fund has established for grants that will be expiring before the next new funding opportunity; see Article 2.)
Funding for low income countries must represent at least 55% of the total funding for renewals in each calendar year.

POVERTY: MYANMAR-THAILAND: Slow pace of registering migrants

MAE SOT, 5 December 2011 (IRIN)

 Photo: David Longstreath/IRIN
Burmese family registers their child for a Thai birth certificate as part of a drive to issue identification documents to all children born in Thailand regardless of their parents' legal status. At Mae Tao clinic in Mae Sot, Thailand

For decades, children of Burmese refugees and migrants in Thailand could not obtain an official birth certificate, vital to access healthcare and education. Even though legislation entitling them to a formal identity has been in place since 2008, registering and coaxing forth the undocumented has been "painstaking", according to community groups.
"Birth registration is the basic fundamental right of any human being. If you don't have birth registration, you lose all your rights," said Naing Min, project director for the community-based organization, Committee for Protection and Promotion of Child Rights (CPPCR), at Thailand's border with Myanmar in Mae Sot.
With no proof of identity or age, those without birth certificates are vulnerable to abuse, exploitation and trafficking. When they grew older, their troubles are compounded: unable to get any form of identification, they cannot open a bank account or apply for a formal job.
Following the amendment in 2008 to Thailand’s Civil Registration Act of 1991, all children born in the country are entitled to birth registration and government-issued birth certificates, regardless of their parents’ legal status.
In Burmese refugee camps, more systematic birth registration - coordinated by camp and government authorities with assistance from NGOs and the UN Refugee Agency (UNHCR) - began in September 2010, but only a fraction has been documented.
The law has taken time to be implemented, in part because of the slow pace of assigning and training government staff. It has also been a challenge to register Burmese who cannot provide any proof of identity whatsoever - not registered at birth, they have been unable to get any identity papers later in life.

Backlog
“The law in the Civil Registration Act, as amended in 2008, is retroactive. It went back for all children born in Thailand, so with Myanmar refugees in the camps, you could be dealing with 25 years of birth registrations,”," said James Lynch, Thailand's representative for UNHCR.
About 1,600 people - mostly newborns - have been registered in nine refugee camps along the border housing an estimated 150,000 people, including some 60,000 unregistered refugees, according to the Thailand Burma Border Consortium, an umbrella group of organizations providing services for migrants and refugees.
The next group to register is children born to Burmese refugees between 2008 and September 2010, and then further back to 1984 when the first major waves of refugees, fleeing violence in Myanmar, poured into Thailand.
"I'm not sure of exact numbers [left to be registered], but if you go back 25 years, it's a painstaking task, but an important one," Lynch said.
Each year, about 5 percent of children born in Thailand - about 40,000 babies primarily from poor families, ethnic minorities or migrants - are not registered at birth, according to the UN Children's Fund (UNICEF).

Catch-22
“The issue with the unregistered camp population is that they could report to the district office, but they fear if they’re not registered and they go to report, they might be deported, so they may be reluctant,” Lynch said.
Unregistered Burmese refugees cannot get birth certificates for their children through camp authorities and face the same problem as migrants.
"They have to go to the district office, but practically, this is difficult because they have no permission to leave the camp, and if they do leave the camp, then they can be arrested and deported, so it is a Catch-22 classic ," said Joel Harding, senior protection officer for the NGO International Rescue Committee.
It is a problem UNHCR and other agencies are working with the government to fix, but providing birth registration for even registered Burmese refugees - there are about 100,000 - is taking time.

A better future
When Ma Lay, 27, gave birth in August 2011 to her third son at Mae Tao Clinic, a health centre for Burmese refugees and migrants in Thailand, she immediately registered him. Her two older sons, six and four, were born in Myanmar, and like her and her husband, have no papers.
"For the two boys, there have been no problems yet, but for me and especially my husband, sometimes on our way to work, we run into the police and get arrested," said Ma Lay. "It makes me feel better if my baby is delivered and registered here, for my baby's future."
Some 200 babies born each month at Mae Tao Clinic are registered on site.
CPPCR now encourages people to get Thai civil birth registration, yet still continues unofficial registrations for those who do not in the hopes such documentation will help them access education and health services as well as claim land and inheritance if they return to Myanmar.
"Some are afraid to go to the office or to ask for a recommendation letter from the village chief, because they are here illegally. They don't know their rights," Naing Min said.
Over the past eight years, CPPCR has unofficially registered 180,000 children."When there was no system to recognize the children born in Thailand, we collected the information, so that when there is true democracy [in Myanmar], we can make claims for their [Burmese] citizenship," Naing Min said.
http://www.irinnews.org/report.aspx?reportID=94382

POVERTY: South Sudan: Returning refugees

JUBA , 5 December 2011 (IRIN) - SOUTH SUDAN: Iklas Monu Ahmed, “Since I’ve been here, nobody has come to talk to me or show us where to go”


 Photo: Hannah McNeish/IRIN
Iklas Monu Ahmed and one of her children

A steady stream of barges from the North arrives at Juba Port but Iklas Monu Ahmed and her four children are still camped out at the dock three months after their ship came in. More than 350,000 South Sudanese have come back of their own accord over the past year, and the International Organization for Migration will have helped 20,000 returnees since January, when the country voted to secede from Sudan. Up to a million are thought to be in the North as the 9 April deadline approaches to “get legal or get out”. Many returnees need support with food and basic items, plus a plot of land, to build a new life in a new nation lacking opportunities. Ahmed is desperate as three-year-old Mamdu lies prone on a bare bedframe and the family is stuck, facing sickness and hunger.
“I was taken to Khartoum at the age of 11... Now I’m 31. The life was ok in Khartoum. I was working... and I was able to feed the family.
“But since I came here there is no one to receive us and nobody to take us home. Life is difficult, there is no food, and I came with children. Now the younger one is sick and the elder ones went to town looking for something to treat him.
“Of course, Juba is my place where I want to stay but I have nowhere to go and nobody to take care of me. If only I could take a piece of land to put the family and my luggage that is down here, I would be able to get something to do for myself, like making tea, and the family would be sustained.
“Since I’ve been here, nobody has come, either the government or any of the agencies, to talk to me or at least show us where to go.
“We were given cards, [ration] cards, but we have not been served any food or non-food items up to now.
“I left Juba after my mother died when I was 11 and my father was gone. So when I went to Khartoum I stayed with the relatives of my mother there and got married to a Darfuri and we separated.
“I do work in hotels helping to wash dishes and fetch water. They pay me 10 pounds [US$3.70] a day and I buy food every evening for the children.
“But for three days I have not gone as my son is sick. I took the child to the hospital and he has been prescribed drugs but they are not the easiest to buy from the clinics as we don’t have the money.
“He has malaria and he vomits whenever he tastes something.
“We sleep outside here on this floor.
“I’m here because the country now is at peace and it is a separate nation and I have come back home like any other national.
“If only I can get a piece of land, I can sustain the family, just like in Khartoum.
“There are many changes in Juba, but for me to be able to join in this race of changes, I need a piece of land.
“In the north, you live like refugees as no one is settled and you live under threat. Here with a piece of land, you can settle.”
http://www.irinnews.org/report.aspx?reportID=94393

MALARIA: EurartesimR (dihydroartemisinin-piperaquine)

 November 30, 2011

 ACT to combat malaria receives marketing authorization from EMA
EurartesimR (dihydroartemisinin-piperaquine)
ACT to combat malaria receives marketing authorization from EMA
. A fixed-dose combination therapy to combat malaria, EurartesimR, (dihydroartemisinin-piperaquine) the product of Italian research conducted  by Sigma-Tau and MMV, approved by the European Medicines Agency (EMA)
Therapy with a simple dosage regimen, up to 3 tablets once a day for 3 days. Studies have demonstrated high cure rates, above 95%, and a significant reduction of re-infection rates compared to leading
antimalarial treatments
Every year almost 250 million people all over the world are affected by malaria. The disease takes the lives of over 780,000 people, mainly in sub-Saharan Africa, 85% of whom are children under 5
Geneva, 30 November 2011. For the very first time, the European Medicines Agency (EMA), using a centralised procedure, has granted regulatory approval to an artemisinin combination therapy (ACT) for the treatment of uncomplicated P. falciparum malaria. This ACT, EurartesimR (dihydroartemisinin-piperaquine), was developed collaboratively by Sigma-Tau s.p.a Industrie Farmaceutiche Riunite, Italy, and the
not-for-profit product development partnership Medicines for Malaria Venture (MMV). The development of Eurartesim has made Sigma-Tau the first Italian company to be granted marketing authorization for an antimalarial drug by the 27 EU Member States from the EMA.

Eurartesim, a fixed-dose combination of two antimalarials, dihydroartemisinin and piperaquine (DHA-PQP), is generally well-tolerated and is administered once a day for 3 days instead of twice a day, making the drug more patient friendly. In addition, clinical trials have shown that compared to other approved ACTs, Eurartesim provides better and longer protection from new malaria infections. This is good news for
children in high transmission areas who often succumb to another life-threatening malaria episode after they have recovered from the first1.

The EMA's authorization is based on the results of a series of large-scale clinical trials that assessed Eurartesim's safety and efficacy in comparison to artemether-lumefantrine or artesunate + mefloquine. The
studies tested this ACT in more than 2,700 patients in Africa (Burkina Faso, Zambia, Kenya, Mozambique and Uganda) and in Asia (Thailand, India and Laos), in around 1,036 African children aged 6 months to 10 years, all affected by uncomplicated P. falciparum malaria.

"Clinical studies carried out on patients treated with Eurartesim have confirmed high cure rates, above 95% - says Marco Corsi, Sigma-Tau's Medical Director. Moreover, compared to comparator drugs, Eurartesim has shown a secondary protective effect - an almost 50% reduction in the number of new infections in the 2 months following treatment. In highly endemic countries, where treated patients often become newly infected,
this secondary protective effect might have a positive outcome on public health. The marketing authorization for Europe will allow us not only to provide a highly effective treatment to vulnerable populations of endemic
countries, where malaria has a devastating impact on health and socio-economic systems, but also to European citizens."

Developed to high internationally recognized standards, Eurartesim meets the therapeutic guidelines outlined by the World Health Organization (WHO) which, on the basis of clinical evidence, recommends the combination of two active ingredients in the same tablet: an artemisinin derivative with a high antimalarial efficacy (dihydroartemisinin) and a second antimalarial drug (piperaquine), which helps protect the artemisinin
component from the risk of resistance.

"The approval of Eurartesim by the EMA comes at a critical time in the fight against malaria - says David Reddy, CEO, MMV. This high quality treatment is a much-awaited addition to the malaria arsenal and will be welcomed by health care professionals in a number of malaria-endemic countries. Eurartesim is the product of a close collaboration between MMV and Sigma-Tau. The partnership between Sigma-Tau and MMV will continue as we focus on the development of a paediatric formulation of the treatment targeted at children under 5 years of age."

Jaya Banerji: e-mail: banerjij@mmv.org

MALARIA TB AIDS: Pakistan may downsize programmes

December 05, 2011
A meeting is likely to be held in Planning Commission on December 7 to decide the fate of National Aids Control Programme (NACP).
The meeting would also take decisions regarding downsizing and regularisation of the employees working under health sector.
The Malaria Control Programme, National TB Control Programme and Expanded Programme of Immunisation (EPI) would also came under discussion in the meeting.
Well-placed sources told Business Recorder here on Saturday that due to the lack of funds, it has been decided that the above-mentioned health programmes would be downsized especially the NACP.
"The decision regarding regularisation of some employees working on contract basis in NACP would also to be taken in the meeting," the sources added.
Minister for Religious Affairs Syed Khursheed Shah is likely to chair the meeting.
NACP was established in 1986-87 with focus on diagnosis of cases that came to hospitals, but progressively gained community focus.
Its objectives are the prevention of HIV transmission, safe blood transfusions, reduction of STD transmission, establishment of surveillance, training of health staff, research and behavioural studies, and development of programme management.
Pakistan is the second largest country in South Asia that stands only a few steps behind India and Nepal in terms of HIV epidemic.
Until recently Pakistan was classified as a 'low prevalence high risk' country but now Pakistan is in 'concentrated phase' of the epidemic with HIV prevalence among more than 5 percent injecting drug users (IDUs) in at least eight major cities.
Sources revealed that on the directive of the Planning Commission, the senior officials of NACP have prepared a list of 14 employees that are likely to be terminated from their jobs when the process of downsizing would be started.
After the devolution of the Health Ministry to the provinces, it was decided to devolve the National AIDS Programme and it was placed in the devolution list.
But the programme was revived on November 14 due to unknown reasons.
Now it has been decided to downsize the programme by reducing the total number of employees from 30 or 32 to 15 or 16.
The employees have not been provided their salaries for the last 5 months.
Sources said that the employees working under NACP might go for a strong protest after downsizing.
http://www.brecorder.com/general-news/single/599/172/1257972/

MALARIA: Reducing Malaria Misdiagnosis

BMC Infect Dis. 2011 Nov 3;11(1):308. [Epub ahead of print]


Reducing Malaria Misdiagnosis: The Importance of Correctly Interpreting ParaCheck Pf "Faint Test Bands" in a Low Transmission Area of Tanzania.
Allen LK, Hatfield JM, Devetten G, Ho JC, Manyama M.

ABSTRACT: BACKGROUND:
Although malaria rapid diagnostic tests (RDTs) have been extensively evaluated since their introduction in the early 1990's, sensitivity and specificity vary, limiting successful integration into clinical practice. This paper reviews specific issues surrounding RDT use in field settings and presents results of research investigating how to interpret "faint test bands" on ParaCheck Pf in areas of low transmission in order to reduce malaria misdiagnosis.

METHODS:
A multi-phase cross-sectional study was conducted at a remote hospital in the northern Tanzanian highlands. Capillary blood samples were taken from consenting participants (n=319) for blood smear and ParaCheck Pf testing. Primary outcome variables were sensitivity, specificity and proportion misdiagnosed by ParaCheck Pf and local microscopy. ParaCheck Pf "faint bands" were classified as both true positives or true negatives during evaluation to determine appropriate clinical interpretation. Multivariate logistic regression adjusted for age and gender was conducted to determine odds of misdiagnosis for local microscopy and ParaCheck Pf.

RESULTS:
Overall, 23.71% of all ParaCheck Pf tests resulted in a "faint band" and 94.20% corresponded with true negatives. When ParaCheck Pf "faint bands" were classified as positive, specificity was 75.5% (95% CI= 70.3% - 80.6%) as compared to 98.9% (95% CI= 97.0% - 99.8%) when classified as negative. The odds of misdiagnosis by local microscopy for those > 5 years as compared to those [less than or equal to] 5 years are 0.370 (95% CI=0.1733 - 0.7915, p=0.010). In contrast, even when ParaCheck Pf faint bands are considered positive, the odds of misdiagnosis by ParaCheck Pf for those > 5 years as compared to those [less than or equal to] 5 years are 0.837 (95% CI= 0.459 - 1.547, p=0.5383).

CONCLUSIONS:
We provide compelling evidence that in areas of low transmission, "faint bands" should be considered a negative test when used to inform clinical decision-making. Correct interpretation of RDT test bands in a clinical setting plays a central role in successful malaria surveillance, appropriate patient management and most importantly reducing misdiagnosis.

PMID: 22054069 [PubMed - as supplied by publisher]

MALNUTRITION: Ecuador Vows to Eradicate Malnutrition

November 8, 2011 : Amara Channell

A group of children outside their school in the Chimborazo region of Ecuador

Last week the President of Ecuador, Rafael Correa, announced that the country will eradicate malnutrition within the next four years. The government will focus on pregnant and breastfeeding women, as well as young children. The pledge is a response to the fact that Ecuador has the fourth highest rate of malnutrition in Latin America, hovering around 19 percent of the country's population. Yet, according to UNICEF, the Chimborazo region of Ecuador -- where MEDLIFE conducts most of its Mobile Clinics and patient follow-up work -- has an even higher malnutrition rate of 44 percent. The Chimborazo region is home to many poor, rural communities, as well as indigenous groups.
“Aliméntate, Ecuador" is a new program that provides pregnant women and mothers of infants with a small stipend to get regular checkups. The program also helps teach mothers about exclusive breastfeeding (when an infant only receives breast milk without any additional food or drink) as well as complementary foods (when additional foods are introduced into a child's diet). According to the program's website, "Aliméntate" has already been successful in reducing rates of anemia by 12 percent during the past year in the community of Manta.
The program uses local residents and trains them to be health promoters. The promoters must attend six workshops, where they learn about healthy food pairings, reducing fats and sugars, and how to incorporate local foods into their diets. The focus on returning to ancestral foods works well with the newly released Food and Agriculture Organization (FAO) report, “The State of Food Insecurity in the World 2011,” which gives suggestions on how to improve the incidents of hunger and malnutrition in Latin America. The report points out that many Latin American countries have become dependent on imported foods which are expensive and subject to huge price jumps based on inflation. Outside of price concerns, there is also a risk that cheap imported foods can replace more nutritious regional options. MEDLIFE staff workers also see this in Peru where processed white rice has replaced traditional protein-rich Inca grains such as Quinoa and Tarweii. The FAO suggestions have already spurred local-food pushes in both Bolivia and Argentina. Bolivia’s campaign is subsidizing farmers who grow nutrient-rich, ancestral foods that are easier on the soil and require less chemical fertilizers. Latin American countries have a wealth of extremely nutritious foods -- hugely significant resources in the fight to overcome malnutrition. Hopefully, Ecuadorian programs will continue to be successful in reducing this crippling disease and be able to convince people to return to some of their ancestral eating habits.
http://www.medlifeweb.org/blog/item/47-ecuador-vows-to-eradicate-malnutrition.html

MALNUTRITION: Kenya: USAID activity

Jill Richardson :: What Our Friends at USAID Are Up To in Kenya, Part 1


A document entitled "Strategic Review" from the Feed the Future program in 2010 shows what is likely a powerpoint presentation on Kenya. It includes several maps, and honestly, I can't make heads or tails of them. One of them shows poverty in terms of density (density of poor people in an area). As you might guess, where there are more people, there are also more poor people. I don't find that nugget of information very useful.
Next are maps of malnutrition and food insecurity by percent of the population, not absolute number. These are more helpful - or should be - but they have a bit of conflicting data. That is, where the children are the most stunted, they are not the most wasted. (Stunted means low height for age; wasted means low weight for height. Stunting is due to chronic malnutrition, whereas wasting is due to acute malnutrition.) However, the area with the most stunting is also the area with the highest food insecurity. The high population areas seem to have the least amount of malnutrition and food insecurity as a percent of the population, but might have higher absolute numbers of both because they just plain have more people, both rich and poor, well-fed and malnourished. Coast province (the southeastern most province) seems to be moderately bad but not the worst in all three measures.








Out of Kenya's population of 38.6 million people, some 17.8 million are considered poor. Those break down as follows: 7.2 million live in rural areas with high rainfall; 5.5 million are urban poor; 2.9 million live in semi-arid rural areas; and 2.2 million live in arid rural areas. They broke the country down into the following regions:





They chose which areas to focus on based on three factors. First, which regions have the most rural poor? HR1, HR2, SA2, and A2. Of those, which produce the most food? That eliminates A2. From there, which set of regions would represent the most diverse group of people receiving aid? That narrows it down to HR1 and SA2.
As I've noted before, Kenya's ethnically very diverse. The map used by USAID shows Kikuyu majorities in Western and Central provinces. Nyanza province is Luo and Kisii. My friend who I will visit there in Luo. Rift Valley is mostly Kalenjin. North Eastern province and the northern half of Eastern province are dominated by a Somali majority. The southern half of Eastern Province (SA2) is a mix of Kamba, Embu, and Meru. Last, Coastal province (in the southeast) is a mix of Mijikenda, Taita, and Swahili.

Here's an excerpt from a longer, more detailed version of USAID's plan in Kenya.
As part of their intrinsic market-based approach, all Mission value chain programs will be coordinated closely with USAID/EA programs in promoting private- sector-led market and trade development and regional integration and investment.
At the same time, to ensure access to food in lower potential areas, the USG through the Mission and partners will make markets work better for the poor and for women by investing in affordable inputs, delivery of services adapted to their needs, and development of better market linkages.
In other words, they want to turn peasants into entrepreneurs.
In 2010, they planned to focus on 5 areas:
1. Staple food value chain development, including livestock and livestock products;
2. Rural finance;
3. Policy analysis, advocacy and capacity-
building;
4. Agricultural research and technology transfer, and
5. Water and sanitation.

#1. Staple Food Value Chain Development
They list "Current and Potential USG and Development Partners" as:
USDA's Animal & Plant Health Inspection Service (APHIS)
USDA's Foreign Agriculture Service
USAID East Africa
Foreign Commercial Service
U.S. State Dept
Peace Corps
Agricultural Sector Coordination Unit (Govt of Kenya)
Dept for International Development (UK)
EU
UN Food & Agriculture Organization (FAO)
International Fund for Agricultural Development
Japan International Cooperation Agency
World Bank
Kenya Agricultural Research Institute (KARI)
Kenya Bureau of Standards
Kenya Dairy Board
Kenya Plant Health Inspectorate Services
Eastern Africa Grain Council
Kenya Livestock Marketing Council
UNICEF
UN World Food Programme
Gates Foundation
Rockefeller Foundation
Alliance for a Green Revolution in Africa

This investment focuses on improving agricultural productivity through value-added techniques, market linkages, diversification, and off farm income generation. Farmers will be linked to input and output markets through private agribusiness...
Two early areas being targeted are: 1) expanding smallholder farmer participation in structured grain markets, allowing greater use of the nascent grain warehouse receipts system for maize and staple food crops; and 2) addressing key market and trade constraints, including animal health sanitary issues, within livestock value chains.
Programs include: Kenya Maize Development Program (KMDP), Staple Food Crops Program, Kenya Dairy Sector Competiveness Program (KDSCP), Kenya Horticulture Competitiveness Program (KHCP), Kenya Access to Rural Finance (KARF), Drylands Livestock Development Program, and WFP pilot program Purchase for Progress (P4P).

And check this one out:
To further sound market-based policies for agriculture, the Mission value chain programs will undertake interventions to improve the institutional, policy and regulatory environment. They will continue to collaborate with USAID/EA programs such as COMPETE and the USAID/East Africa pastoral livestock and livelihoods activities, to promote policy initiatives and institutional structures that foster more and efficient marketing and trade of food crops and livestock. This includes harmonized commodity standards and inspection systems in the region.
This collaboration will be furthered through expansion of the Eastern Africa Grain Council's Grain Warehouse Receipts System and the strengthening of regional markets for livestock. The Mission will continue to engage with the Kenya Food Security Steering Group to improve early warning systems and build capacity to better integrate data and methodologies with the WFP G/EWS and FAO FAOSTAT systems.
This is getting long, so I'm going to end it here and continue in another post in the next day or so. Ultimately, I'd like to dig deeper into what each of these programs does and where each one is operating.
http://www.lavidalocavore.org/diary/4974/what-our-friends-at-usaid-are-up-to-in-kenya-part-1

MALNUTRITION: Revamp African ag policy to address hunger and poverty - experts

02 Nov 2011  Katie Murray

A worker prunes tomato plants in the Dube AgriZone greenhouse situated at King Shaka International Airport, north of Durban, South Africa,

LONDON (AlertNet) – New approaches to agricultural productivity could help alleviate widespread poverty, malnutrition and hunger in many African countries, international development and agriculture experts said at a conference this week in Ethiopia focused on boosting agricultural output in Africa.
In 2003, African heads of state agreed to allocate 10 percent of their national budget to agriculture and rural development policy within five years. That target was not reached, but as a whole African countries have since managed to double their spending on agricultural and rural policy from an average of 3 percent to 6 percent of national spending, said Shenggen Fan, the director of the International Food Policy Research Institute, an organization that works to find sustainable solutions to ending poverty and hunger.
The problem is “that is not enough,” Fan said in a telephone interview.
Agricultural productivity in Africa is particularly imperiled by climate change impacts, including more extreme and unpredictable weather. Reducing climate-changing emissions and finding ways to adapt to changes already underway will be key, Fan said.
African countries suffer disproportionately more from climate change than most places in the world, in part because many farmers are poor and lack resources to prepare for climate impacts or respond to setbacks from problems like crop failure, experts say.
African countries are very prone to weather shocks, Fan said, and these will continually happen “more often, more frequently than before.”
Fan stressed the importance of finding new crop varieties that are resistant to drought and more resilient when weather shocks occur. He also said unconventional approaches, like organic farming, should be looked into as potential farming strategies for some parts of the continent.
“Increasing agricultural productivity is not the panacea to all problems, but it can make a significant positive contribution to resolve issues of food insecurity in Africa,” he said.
The conference, which brought together policy makers, academics, member of private companies and representatives from farmer and trader organizations, aimed to help create a broad new policy framework for improving agricultural productivity in Africa.
“Increasing agricultural productivity in Africa calls for broader policy and strategic frameworks that encompass the whole agricultural value chain,” said Josué Dioné, a food security and sustainable development expert from United Nation’s Economic Commission for Africa.
Agro-businesses, as well as small-scale farmers, need to be taken into account and included in the new agricultural policy for it to be effective, he said.
Fan believes the five most effective approaches for African governments can employ to boost agricultural productivity are to increase investment in agriculture, ensure Africans – rather than outsiders – make policy for the continent, focus on the small-scale farmer’s role in the agricultural chain, promote trade and access to markets and enhance agricultural technology and infrastructure.
According to Monty Jones, executive director of the Forum for Agricultural Research in Africa, “Strengthening extension services and infrastructure, and implementing policies that support agricultural productivity and increase rural incomes, will reduce hunger and poverty.”
http://www.trust.org/alertnet/news/revamp-african-ag-policy-to-address-hunger-and-poverty-experts/