TUBERCULOSIS: The TB Vaccine Blueprint

Against a backdrop of growing concern about the impact of tuberculosis on children, top scientific experts today published a global plan of action for developing the vaccines that are seen as critical to eliminating the disease. Published today in a special issue of the journal, Tuberculosis, the strategic blueprint for the TB vaccine field represents consensus reached by the TB vaccine community.

"The TB Vaccine Blueprint provides an enormous opportunity to coordinate efforts to halt the spread of this devastating disease," said Dr. Aaron Motsoaledi, the Minister of Health of South Africa, a country that has played a vital role in ongoing clinical trials for TB vaccines. "Governments have an important role to play, and guided by this common strategy we will do our part to make a vaccine a reality."
The Blueprint editors conclude that effective solutions will remain out of reach unless the world scales up efforts to solve the scientific puzzles now hindering development of vaccines against the airborne pathogen. According to the World Health Organization, more than 10 million children have been orphaned by the disease. In addition to great human suffering, the disease causes significant financial and economic damage, and more is expected. Worldwide, there are well over half a million cases of multi-drug resistant TB, representing a trend that adds urgency to the Blueprint’s call to action.
"To develop a new TB vaccine that will be fully effective, researchers, donors and other partners will need to collaborate and coordinate their efforts as they address tough research questions," said Dr. Lucica Ditiu, Executive Secretary of the Stop TB Partnership. "We cannot allow ourselves to be overwhelmed by either the costs or the obstacles. It is time to be bold and dare to do more in TB, especially in supporting the development of a new vaccine."
To address the many challenges posed by TB, ideal vaccine regimens must protect babies at birth from childhood TB, and prevent infection with the organism in older children and adults. The only currently existing vaccine is limited in its ability to impact the global TB epidemic. Known as BacilleCalmette-Guérin (BCG), it protects children from severe forms of TB in the first years of life, but it doesn’t prevent pulmonary TB, which affects the largest group of people infected with the disease - adolescents and adults.A vaccine also is needed to protect people with latent TB who have not yet developed signs of disease.
Creating more effective, safe vaccines against TB is a task that no one country or organisation can do alone. The blueprint, titled ‘Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade’ emphasizes that effective vaccines will remain out of reach unless the world scales up efforts to solve the scientific puzzles now hindering development of vaccines. Authors call for researchers, scientists, clinicians, advocates in endemic communities, vaccine manufacturers, and governments around the world to work together on creative new approaches from initial research in the laboratory to clinical trials in the field to global introduction.
"The new Blueprint represents the best thinking of the field," said Dr. Jelle Thole, director of the TuBerculosis Vaccine Initiative (TBVI) and co-editor of the Blueprint with Dr. Michael J. Brennan, senior advisor for scientific and global affairs at Aeras. "It makes clear that the next 10 years will be vital in moving forward the global search for a dramatically improved vaccine against tuberculosis."
TB vaccine research over the past decade has made advances that would have been unimaginable a decade ago. Between 2000 and 2010, scientists in the public and private sectors were able to move an unprecedented 15 vaccine candidates into clinical trials in a quest to see which scientific approaches held the most promise. Still there is much work to be done and now, more than ever, there is a need for intensified global collaboration, leadership, partnership and commitment.
"We began 10 years ago with an empty clinical pipeline, and we have made astounding progress," said Aeras’ Brennan. "But we have to persevere. Given the trends we are seeing globally, failure to develop effective new vaccines for this disease puts everyone at risk."

About the Blueprint:
Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade was produced under the auspices of the Stop TB Partnership Working Group on New Vaccines with support from the World Health Organization, Bill & Melinda Gates Foundation, Aeras (www.aeras.org), TuBerculosis Vaccine Initiative, the EC FP 7 framework programme and the US National Institutes of Health, National Institute of Allergy and Infectious Diseases. The complete Blueprint, including relevant opinion editorials, was published in the journal Tuberculosis (Brennan, MJ and Thole, J, Vol. 92, Supplement 1, ppS1-S35, March 2012) and is available at http://www.tuberculosisjournal.com./

POVERTY: MIGRATION: Too many migrant children locked up

JOHANNESBURG, 21 March 2012 (IRIN)

 Photo: Masoma Mohammadi/IRIN
“Detention, even for a short time, has a very toxic effect on children” (file photo)

Arun*, a refugee from Myanmar, was just eight when he was arrested by immigration authorities in Malaysia and taken to a detention camp where he spent five months separated from his mother and six-year-old sister.
“I got one small bowl of food a day. We were never allowed to go outside. In the night I had to give massages to some of the men,” he told researchers from the International Detention Coalition (IDC) which has spent the last two years collecting testimonies from refugee, asylum-seeker and irregular migrant children about their experiences of detention in 11 different countries around the world.
By the time IDC’s researchers interviewed Arun, he and his family had been released but his sister was too traumatized to eat, and she and her mother cried as Arun spoke about being detained.
“Detention, even for a short time, has a very toxic effect on children,” said Jeroen Van Hove, coordinator of the IDC’s campaign to end the immigration detention of children, which was launched on 21 March at the 19th session of the UN Human Rights Council in Geneva.
The UN Convention on the Rights of the Child, which has been signed by every country in the world with the exception of the USA and Somalia, states that detention of children be used "only as a measure of last resort, for the shortest appropriate period of time and taking into account the best interests of the child".
However, according to the IDC, an umbrella organization with more than 250 member groups working in 50 countries, as the use of migration-related detention has increased globally, so too has the detention of migrant, asylum-seeker and refugee children. They estimate there are tens of thousands of children in detention every day and hundreds of thousands every year.

Australia
In Australia, one of the few countries to regularly publish statistics on the numbers of children in immigration detention, there were 1,079 children in custody in January, just under half of them in prison-like facilities in remote locations such as Christmas Island. Following public pressure, Australia’s immigration minister made a commitment in October 2010 to remove most children from locked detention by June 2011.
According to Sophie Peer, campaign director for ChilOut, a local group advocating the release of all children from Australia’s immigration detention centres, the minister has kept to that commitment by a very slim margin, but the process by which children are selected for transfer to community-based accommodation where they are allowed to live a relatively normal life, remains unclear.
“It seems to us completely arbitrary,” she told IRIN, adding that the youngest child remaining in a detention facility is an unaccompanied seven-year-old who has been locked up for nine months.
When we interview the children, the overwhelming words are that they feel helpless and hopeless
She described the conditions in the detention centres, with their lack of educational and recreational facilities, as “completely inappropriate for children”. The centres’ often remote locations also make regular visits from lawyers and organizations like ChilOut prohibitively expensive.
“When we interview the children, the overwhelming words are that they feel helpless and hopeless,” said Peer. “They ask us, ‘What have I done wrong?’ To which our answer is, ‘Nothing’.”
She added that many of the children suffered from mental health issues: "We’re seeing self-harm on an almost daily basis.”
Research from numerous studies cited in a new report by the IDC, has found that immigration detention of children "has profound and far-reaching implications for their development and physical and psychological health". The longer children are detained, the more likely they are to suffer from mental health problems including anxiety, depression and post-traumatic stress disorder, but there is evidence that even short-term detention has negative impacts on children.

Thailand, USA
In Thailand, detention periods for migrant children can be as long as five years. Thailand is not a signatory to the 1951 Refugee Convention and, under its immigration law, refugees and asylum-seekers living outside camps are subject to arrest and detention regardless of their age.
“Those who cannot go back to their country or who can’t be settled in third countries are kept [in detention] indefinitely,” said Veerawit Tianchainan, founder and director of the Thai Committee for Refugees Foundation (TCR), which has been negotiating with the country’s immigration bureau since 2010 for the release of asylum-seekers and refugees with children. In June 2011, they had their first major success with the release of 96 Ahmadi refugees and asylum-seekers, including 40 children, into accommodation paid for by TCR through its Refugee Freedom Fund.
Although no official figures are available, Tianchainan estimates that 100 children remain in Bangkok’s International Detention Centre where children are separated from parents of the opposite sex, conditions are over-crowded and unhygienic, and schooling is available only two days a week.
“Some of them are really desperate,” he told IRIN. “After six months they look terrible because of the conditions inside and the poor quality and variety of food.”


The USA has taken steps to improve its treatment of migrant children in detention but still averages around 9,000 unaccompanied minors a year in custody with the conditions they are kept in varying from “detention-like facilities” to well-run shelters with fewer restrictions on movement, according to Michelle Brané, director of the detention and asylum programme at the Washington DC-based Women’s Refugee Commission.
Officials complain that the average length of stay for such children, many of whom are teenagers fleeing abuse or gang violence in Mexico and Central America, has increased in recent years because of the amount of checks required before they can be released to family members, sponsors or foster families. “It’s striking a balance between detention and protection and making sure they’re safe,” said Brané, adding that unaccompanied children, in particular, are extremely vulnerable to exploitation.
The focus of the IDC’s campaign also goes beyond encouraging countries to release children from immigration detention to recommending what kind of arrangements children should be released into.
Drawing on best practices from countries such as Belgium and Japan, the IDC’s five-step model includes assigning guardians to unaccompanied migrant children or caseworkers to those with families, and placing them in community settings while their immigration status is determined. Key to the model is the goal of protecting children’s rights and best interests.
“Treating them humanely outside of detention is a big element,” said IDC’s Van Hove, “but also making sure they understand what is happening to them and that all options haven’t been exhausted for legalizing their stay.”
Brané is hopeful the IDC's campaign will put a global spotlight on the detention of migrant children. "Most people around the world don't realize that children are being detained in these conditions," she said. "My hope would be that seeing this raised at an international level will encourage governments to move on it."
*Not his real name
http://www.irinnews.org/Report/95115/MIGRATION-Too-many-migrant-children-locked-up

POVERTY: Cracking open the LRA to better eliminate it

DUNGU, 21 March 2012 (IRIN)

 Photo: Guy Oliver/IRIN
Troops of the UN Stabilization Mission in the DRC (MONUSCO) providing an armed escort on the road from Dungu to Faradje

 After seven years held captive by the Lord’s Resistance Army (LRA), 16-year-old Apiyo Tabisa’s release five months ago in the Democratic Republic of Congo (DRC) along with a dozen or so others was as sudden as her abduction from Uganda.
Vincent Binany - deputy to senior LRA commander and International Criminal Court (ICC) war crimes indictee Dominic Ongwen - “gave us no reason. He left us by the side of the road and just told us to go to the soldiers [Armed Forces of the DRC (FARDC)],” she told IRIN.
She spent seven years wandering the frontier lands of the DRC, South Sudan and Uganda as a porter and cook and witnessed “too many [killings] to remember. There were just too many,” said Tabisa, who is awaiting repatriation from Dungu (northeastern DRC) once her relatives have been traced.
“Some were shot or beaten with pieces of wood. I don’t know why. If you make a mistake they kill you. If you have witchcraft, they kill you. There does not have to be a reason,” Tabisa said. “Seeing the killings and the beatings - that was always the worst. If you say something [to object to the killings] they kill you.”
Matthew Brubacher, political affairs officer working with the UN Stabilization Mission in the DRC (MONUSCO)’s Disarmament, Demobilization, Repatriation, Reintegration and Resettlement (DDRRR) unit, and an LRA specialist based in the eastern DRC city of Goma, told IRIN: “We still don’t know why they were released [by Binany],” but answering such questions is key to developing strategies to dismantling the armed group.

Why so durable?
Why has Joseph Kony’s LRA, which has raped, abducted and pillaged for the past 25 years survived so long?
From the early 1990s, the LRA conducted raids into northern Uganda from bases in eastern Equatoria in southern Sudan (now the independent state of South Sudan), where President Omar al-Bashir co-opted and supplied the group to fight the then-rebel Sudan People’s Liberation Army, which in turn enjoyed support from Ugandan President Yoweri Museveni.
From 2005, the LRA began moving into areas of the DRC close to the border with Sudan. More recently, the LRA has also been active in the Central African Republic.
The undeveloped frontier lands with scarce infrastructure, weak government and isolated communities enabled the LRA to forage for food, and kidnap - boys for child soldiers and girls as sex slaves.
At the core of the LRA’s ability to survive and outwit their numerically superior opponents was “maintaining secrecy in the LRA”, said a World Bank June 2011 report entitled Diagnostic Study of the LRA authored by Philip Lancaster, Guillaume Lacaille and Ledio Cakaj.
“Kony appears to understand that one cannot defeat the enemy one does not know, and consequently masks the LRA behind a curtain of mystery. The rituals performed in the LRA, some military in nature, others religious, are in part designed to maintain the secrecy and mystery of the LRA - much like a secret society or a cult,” the report said.

Runners and fliers
The LRA’s few hundred core fighters are dispersed across a region about half the size of France spanning three fragile countries. Modern methods of communication, such as satellite phones (there is little to no coverage for mobile phones in much of the region) are eschewed as they can be tracked by satellite and reconnaissance aircraft. Runners are used to carry messages, with this task often entrusted to the senior ranks.
Onen Unita - an officer serving under senior LRA commander Okot Odhiambo who, like Kony, is wanted for war crimes by the ICC - was used as a runner to convey decisions to other commanders in the DRC taken at a meeting in CAR in June 2011.
Lt-Col Golam Faruque, chief coordinator of MONUSCO’s Joint Intelligence Operating Cell based in Dungu, which collates information about the armed group, told IRIN: “We know about the meeting, but we don’t know anything of what decisions were taken,” but added that in the second half of 2011 the number of violent incidents in the DRC attributed to the LRA decreased substantially. He also noted that armed groups have high and low periods of activity.
Ian Rowe, DDRRR head of Orientale Province based in Dungu and working to eliminate the group, tries to gather intelligence based on snippets of information.
Unlike his counterparts in eastern DRC where mobile phone communication with potential defectors is a vital tool in convincing the officer class of the Democratic Forces for the Liberation of Rwanda (FDLR) to defect, no such avenue exists with the LRA.
Instead, there is a reliance on leaflet distribution guaranteeing amnesty, except for those indicted by the ICC, and a network of FM radios conveying a similar message to LRA combatants in a variety of languages, including Acholi and Lingala, in the three affected countries.
Rowe said the fliers are either air-dropped by MONUSCO, or distributed by FARDC in the DRC and by the Uganda People’s Defence Force (UPDF) in CAR and South Sudan, “and put on trees or along waterways, as historically the LRA follow waterways”.
MONUSCO’s DDRRR has produced 30,000 flyers for distribution, showing photographs of recent escapees in the past few years, which those still “remaining in the bush” were likely to recognize, Rowe said.
"We just had a Kony wife surrender in Djema. She saw the wife of Odhiambo on one of our leaflets disseminated by the UPDF in eastern CAR. That convinced her to leave, despite Kony telling her that the woman had been killed shortly after the picture was taken," Brubacher said.
“Our inability to communicate, deal or negotiate with the LRA directly and effectively… means that for the most part, we have very little idea as to the extent our messages are getting through,” Rowe said
It was difficult to put a precise number on the penetration of the messaging by DDRRR, but he said some estimates of 75 percent were probably an “overestimation of the number of escapees we're receiving in Dungu who state having seen or heard our messaging.”

Assembly points
In September 2011, another LRA commander, Ocan Bunia, died, reportedly of malaria, in the DRC, and a number of captives were released. At their debriefing there were indications that fighters in the group had also wanted to defect, but had no way of safely doing so.
The last LRA commandant who surrendered jumped onto the road naked in front of a Caritas motorcycle. When the motorcycle driver agreed to help him surrender, the LRA fighter went back into the forest and got his gun and uniform. That is how hard it is to surrender
Ugandan LRA defectors are met with hostility by affected communities and MONUSCO’s DDRRR programme has embarked on an awareness-raising programme to try and convince people to hand them over to the authorities rather than mete out their own form of justice, which acts as another barrier to the LRA's disarmament and demobilization, Brubacher said, and has led to bizarre acts by LRA fighters.
“The last LRA commandant who surrendered jumped onto the road naked in front of a Caritas motorcycle. When the motorcycle driver agreed to help him surrender, the LRA fighter went back into the forest and got his gun and uniform. That is how hard it is to surrender,” he said.
The incident with Bunia acted as a catalyst to develop the concept of assembly points, which are at least 10-15km from the closest communities. Two sites have been identified northeast of Dungu, one north of Faradje, one in Garamba National Park, and one south of Bangadi.
Rowe said 30,000 fliers detailing the locations, funded by the San Diego-based NGO Invisible Children, would be distributed to make these sites known, and it was expected the concept would be rolled out regionally.
MONUSCO has agreed to send patrols to these sites twice a week to check-up on any LRA defectors. “It is the best we can do for these people [defectors]. Although they might have to hang around for a few days before being picked-up.”
http://www.irinnews.org/Report/95109/SECURITY-Cracking-open-the-LRA-to-better-eliminate-it

TUBERCULOSIS: WHO report on children

Tuberculosis (TB) often goes undiagnosed in children from birth to 15 years old because they lack access to health services - or because the health workers who care for them are unprepared to recognize the signs and symptoms of TB in this age group. With better training and harmonization of the different programmes that provide health services for children, serious illness and death from TB could be prevented in thousands of children every year, the World Health Organization (WHO) and Stop TB Partnership said today.


"We have made progress on TB: death rates are down 40% overall compared to 1990 and millions of lives have been saved," said Dr Mario Raviglione, Director of the WHO Stop TB Department.. "But unfortunately, to a large extent, children have been left behind, and childhood TB remains a hidden epidemic in most countries. It is time to act and address it everywhere".

Most families who are vulnerable to TB live in poverty and know little about the disease and how to obtain care for it. All too often, when an adult is diagnosed with TB, no attempt is made to find out whether children in the household also have the disease. This is a crucial step, since most children catch TB from a parent or relative. Any child living with a TB patient and that has an unexplained fever and failure to thrive may have the disease and should be evaluated by a health worker for TB. Those who are not ill with TB should be protected against the disease through preventive therapy with the drug isoniazid. Those who are ill should receive treatment.

"Two hundred children die from TB every day. Yet it costs less than 3 cents a day to provide therapy that will prevent children from becoming ill with TB and 50 cents a day to provide treatment that will cure the disease," said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. "But before we can give prevention or treatment we have to find the children at risk of TB, and this will only happen if governments, civil society and the private sector work together. From now on let us agree: It is unconscionable to let a single child die of TB."

Another problem is that TB can be hard to diagnose. While high-income countries now use sophisticated childhood molecular tests to detect TB, most developing countries still use a method developed 130 years ago. The patient must cough up a sample of sputum, which is then checked under the microscope for the bacteria that cause TB. Young children generally are unable to produce a sample. Even if a child with active TB succeeds in providing a sample, it often contains no detectable bacteria.

Recent studies have shown, however, that when health programmes do start looking for children with TB, they find far more cases than expected. In Karachi, Pakistan, in 2011, researchers trained community members in the Korangi and Bin Qasim Towns to use an electronic score card on a mobile phone to find people who needed a TB test and then accompany them to the hospital or clinic. One result was a 600% increase in detection of pulmonary TB among children. Another recent study in Bangladesh found that the number of children found to have TB more than trebled when workers at 18 community health centres received special training on childhood TB.
WHO and the Stop TB Partnership point to three key actions needed to improve TB care and prevent TB deaths in children, which are outlined in a No more crying, no more dying; Towards zero TB death in children
http://www.stoptb.org/assets/documents/news/ChildhoodTB_report_singles.pdf, released today.

POVERTY: PAKISTAN: Sharp rise in human trafficking in Sindh Province

KARACHI, 21 March 2012 (IRIN)

 Photo: Groundreporter/Flickr
The traffickers pay the families for allowing their children to be taken away, but often exploit the children like slaves (file photo)

Pakistan’s Sindh Province has recorded a sharp increase in reported cases of human trafficking since the beginning of the year, and the trend could continue unless the authorities take action to contain it, say activists.
Some 190 cases have been reported in the province in the first two months of 2012, according to Zia Ahmed Awan, chairperson of Madadgaar Helpline, an NGO helping women and child victims of abuse and trafficking. In 2011, the NGO recorded 288 cases.
Families receive a payment for allowing their children to be trafficked: Traffickers pick up women and children from villages with the promise of getting them jobs in cities. However, once a certain amount has been paid to the family, the traffickers exploit the woman or child, often treating them as little more than slaves. .
“Most of the victims are from Bangladesh and Afghanistan, where poverty and strife have made it difficult for people to meet their basic needs,” Awan said. “Combine this with illiteracy and unemployment, and you will have people willing to sell their children.” (he is talking about the reported cases here)
She urged the Pakistani government to devote more resources to fighting trafficking and drafting new legislation to ban it.
Talking to IRIN, an official of the Ministry of Human Rights in Sindh blamed poverty. “Poverty forces people to give away their children,” said the official who requested anonymity. “In big cities like Karachi, Hyderabad, Larkana you will find kids as young as five being employed as servants. The constitution grants protection to minors but sadly no one is willing to take up this matter.”
After the floods in 2010 and 2011, poverty increased in Sindh and many families dependent on farming had no other option but to send their children to bigger cities, say aid workers.
“How do you curb human trafficking and bondage when some of the most influential figures - even those in the women ministry, human rights and child protection committees - have young children as servants?” asked a social worker in Sindh who only identified herself as Aswa.
“A child of seven or eight years is available 24/7 to clean your house, carry your groceries and do other chores, for Rs. 1,000 a month,” she said. “For the same amount of work an adult servant would easily charge Rs 4,000 a month. Most people carry out the worst possible abuse of these children and if the child runs away, false cases of theft are lodged,” she said.

Call for police vigilance
Awan of Madadgaar Helpline called for increased police vigilance. “Our police personnel need sensitization trainings as often they can’t differentiate between human smuggling and child trafficking. As long as there is a feudal system in the country, we will have human trafficking and child labour,” he said.
Pakistan is listed as “a source, transit, and destination country” for trafficked persons, according to the US State Department’s Trafficking in Persons report for 2011. Pakistan's largest human trafficking problem, according to the report, is that of bonded labour. Concentrated in Sindh and Punjab provinces, it is particularly common in brick kilns, carpet-making, agriculture, fishing, mining, leather tanning, and the production of glass bangles.
According to the International Labour Organization, more than 12 million people are trafficked each year worldwide. An estimated 70 percent of those trafficked are females under 25.
http://www.irinnews.org/Report/95117/PAKISTAN-Sharp-rise-in-human-trafficking-in-Sindh-Province

POVERTY: THAILAND: Rice pests multiply post-floods

BANGKOK, 12 March 2012 (IRIN)

 Photo: Sylvia Villareal/IRRI
Of pests and pesticide in Thailand: a province hit by the brown planthopper

Heavy flooding across parts of Thailand in 2011 has fuelled outbreaks of a rice pest that can decimate harvests, experts say.
The pest, known as brown planthopper (BPH), transmits two viruses that hit yields as well as eating away at rice plants.
"The floods have certainly made things worse," Kong Luen Heong, principal scientist for the Manila-based International Rice Research Institute (IRRI) told IRIN.
"Moreover, they will impact [on] upcoming harvests as well."
"BPH is attacking the rice bowl of the country for the eighth time in a row [over the past four years]," said Kukiat Soitong, from the Thai government's Rice Department, based in the Agriculture Ministry, adding that "150,000 hectares have already been seriously damaged in the central plains, in the basin of Chao Phraya river".
Affected provinces lost 30 percent of their rice production due to BPH in early 2010, amounting to around 1.3 million tons for the country, or more than 15 percent of the nationwide harvest, which takes place twice a year, reported the Rice Department.
According to the Thai Rice Exporters' Association, Thailand produces 4-5 percent of the world's rice, and is the largest exporter, with 10.8 million tons in 2011.
Last year's flooding, which affected more than two million people across 28 provinces and damaged more than two million hectares of farmland, worsened the longstanding pest problem by drowning natural enemies of BPH, including insect parasites and spiders.
"Because of the floods and the killing of BPH's natural enemies, farmers are more dependent on insecticides for several seasons. And the fact is that using insecticides makes BPH even stronger," added Kukiat.
Most insecticides kill BPH's natural enemies, rather than BPH itself. The brown planthopper has an "unmatched" capacity to become resistant to any molecule used against it, according to Keng Hong Tan, a retired entomology professor based in Malaysia.
He says the pest has even developed resistance to one of its own hormones when applied as a control measure.
And while IRRI and Thailand's Rice Department launched a campaign in July 2011 to ban the two insecticides most often used in rice cultivation, cypermethrin and abamectin - known to cause BPH's resurgence - the ban is unlikely to have a significant impact.
"This campaign will have limited immediate effects because of the floods," said Heong. "It will take some strong will to break the vicious circle that helps BPH."
Yet banning insecticides is the only way to control BPH outbreaks in the long term, said Ho Van Chien, director of the Vietnamese government's plant protection centre for southern Vietnam.
According to IRRI, BPH damaged hundreds of thousands of hectares across Asia, leading to hundreds of millions of dollars in lost production.
Since 2009, Bangladesh, Cambodia, China, India, Indonesia, Japan, Malaysia, Myanmar, the Philippines, Thailand and Vietnam have been severely affected at least once.
"BPH puts the whole rice ecosystem in jeopardy," said Erma Budiyanto, director of plant protection in Indonesia's Ministry of Agriculture.
"There could be a humanitarian situation because of this pest in the future if insecticides remain as widely used as today," said Heong.
http://www.irinnews.org/Report/95058/THAILA

MALARIA: KENYA: Malaria drug effectiveness hit by under-dosage

NAIROBI, 12 March 2012 (IRIN)

 Photo: IRIN
Malaria accounts for 22 percent of all childhood deaths in Africa

Lack of adherence to the full course of Artemisinin-based combination therapy (ACT) treatment is threatening the effectiveness of the drug recommended as first-line treatment for uncomplicated malaria in countries where the disease is endemic, according to recent studies.
In Siaya district of western Kenya, where malaria is particularly prevalent (38 percent incidence in 2010), a study revealed that only 47 percent of participants reported completing the given doses.
“There have always been concerns about whether patients are fully adhering to their treatment regimens once they receive the recommended Artemisinin-based combination therapy. Our study reveals that adherence is poor among many patients,” Eric Onyango, lead researcher, told IRIN.
The study investigated ACT adherence levels, factors associated with non-adherence and household access to ACT. It involved 297 participants, all of whom had tested positive to Plasmodium falciparum, the parasite responsible for causing malaria, at the time of the study. A household’s education level was found to be the highest predictor of poor adherence. Others included household income and age.
Another study carried out in five outpatient government health clinics in two Kenyan districts, all with high malaria prevalence, concluded that while 64.1 percent of the 918 patients included in the study were probably adherent, the rate was lower than that of previous studies.
The authors concluded that “targeted information, education and communication activities at the community level may help to increase awareness of the treatment regimen and its uptake, and reduce the risk of contributing to the development of parasite resistance”.

Early treatment
According to health experts, proper adherence to malaria treatment drugs is important in improving treatment outcomes, reducing cases of drug resistant malaria and controlling the disease.
“People who have malaria infection should always be diagnosed in good time and put on treatment early. If they fail to adhere to their treatment, there could be increased cases of drug-resistant malaria, which affects better treatment outcomes and the management of the disease,” Andrew Sulleh, a doctor, told IRIN.
“People are likely to adhere when they seek treatment early. This means it is important that they are educated on the symptoms of possible malarial infection so that they are able to seek early diagnosis and treatment,” he said.
In 2010, malaria caused 655,000 deaths, many of them in Africa, where the disease accounts for 22 percent of all childhood deaths, according to the World Health Organization (WHO).

Effective drug
Many malaria-endemic countries in Africa have switched to ACT, after malaria parasites developed resistance to mono-therapies. The WHO estimates that in 2010 alone, some 181 million courses of ACT were procured worldwide in the public sector.
While some earlier studies done soon after the roll-out of ACT have shown high prevalence –change to - adherence rates of up to 75 percent, health workers say the high number of tablets involved in ACT regimens to complete a full three-day dose could be contributing to poor adherence. Adult patients are expected to take eight tablets a day within eight hours for three days, while children take four tablets daily within a similar period.
“The tablets that a patient is expected to take daily are very many and they are unpalatable and this makes others just take the medicine for a short time and throw away the rest. Some also feel they are fine after taking a few tablets and stop their medication halfway,” said Lillian Natembea, a nursing officer at the Kenyatta National Hospital, Kenya’s largest referral facility.
In a small study in rural Ethiopia, 37.3 percent of the patients who were reported as definitely non-adherent blamed the many tablets, while another 25 percent said they did not continue because they felt better before finishing the dose.
Health officials say patient education and counseling are important in ensuring adherence to ACT regimens.
“What happens at the time of the interaction between the patient and the healthcare worker is important in maintaining adherence. Health workers need to counsel and educate patients on how to take the drugs and on the importance of completing their doses,” said Sulleh, who is also head of the Mbagathi District Hospital in Nairobi.

Prevention
According to Elizabeth Juma, head of malaria control at Kenya’s Ministry of Public Health, proper malaria treatment is as important as malaria prevention, saying strategies such as the use of insecticide treated mosquito nets should be promoted.
“Proper treatment for those already infected with malaria is important, but even more important is the promotion of prevention strategies like the use of insecticide treated nets, which is still low in the country,” she said.
The Kenya Malaria Indicator Survey 2010 shows that while 48 percent of Kenyan households own at least one insecticide treated mosquito net, just 32 percent use it.
http://www.irinnews.org/Report/95059/KENYA-Malaria-drug-effectiveness-hit-by-under-dosage

MALARIA: Acidosis, cerebral involvement, renal impairment, and chronic illness are key independent predictors for a poor outcome in African children with severe #malaria.

Abstract Background. Data from the largest randomized, controlled trial for the treatment of children hospitalized with severe malaria were used to identify such predictors of a poor outcome from severe malaria.
Methods. African children (<15 years) with severe malaria participated in a randomized comparison of parenteral artesunate and parenteral quinine in 9 African countries. Detailed clinical assessment was performed on admission. Parasite densities were assessed in a reference laboratory. Predictors of death were examined using a multivariate logistic regression model.
Results. Twenty indicators of disease severity were assessed, out of which 5 (base deficit, impaired consciousness, convulsions, elevated blood urea, and underlying chronic illness) were associated independently with death. Tachypnea, respiratory distress, deep breathing, shock, prostration, low pH, hyperparasitemia, severe anemia, and jaundice were statistically significant indicators of death in the univariate analysis but not in the multivariate model. Age, glucose levels, axillary temperature, parasite density, heart rate, blood pressure, and blackwater fever were not related to death in univariate models.
Conclusions. Acidosis, cerebral involvement, renal impairment, and chronic illness are key independent predictors for a poor outcome in African children with severe malaria. Mortality is markedly increased in cerebral malaria combined with acidosis.

http://www.blogger.com/goog_1971624915

POVERTY: SRI LANKA: Cutting post-harvest losses

COLOMBO, 15 March 2012 (IRIN)

 Photo: Contributor/IRIN
Dinner is on its way...maybe

Inefficient transportation and storage methods are resulting in as much as one-third of Sri Lanka's produce going to waste, experts say.
Vegetables are still transported in plastic, burlap, locally produced coconut-husk fibre bags or homemade wooden boxes, stacked tightly in trucks, causing severe wastage en route. This lack of proper storage reduces the length of time produce can last, said Brian Roberts, a professor at the Australia-based University of Canberra, who has researched Sri Lanka's food supply chain.
"The transport systems to local markets and national markets are not good, resulting in a high level of damage to fruit and vegetables. There is also a loss in the handling of food and vegetables along the various stages of the supply line."
Most drivers visit regional supply centres (government buildings rented by private suppliers), such as the main one in Dambulla in Central Province, to purchase produce.
"The more we transport the more money we make," Ajith Wijesinghe, a driver, told IRIN.
By the time the vegetables are delivered to clients in the suburbs of the capital, Colombo, some 150km away, Wijesinghe said the produce had gone through at least four transactions. "The farmer will sell to a village supplier. He will then sell to a regional supplier. We buy from the regional supplier and sell to our buyers."
Multiple handling means more costs on top of the wastage, noted Roberts. "At each one of the stages, agents would take commissions and [there] will be additional costs associated with handling food."
Wijesinghe, 50, said he had never received any kind of training or instructions on transporting or stacking vegetables in more than two decades of work. "I don't think anyone in this business has."

Time pressures
Transporters care little about food loss and worry more about getting products to the buyer on time, said Haridas Fernando, deputy general manager of agribusiness at Cargills Ceylon, one of Sri Lanka's largest private wholesale vegetable buyers.
"Our market orientation is still such that transporters feel their job is to transport and nothing else."
Cargills has tried to cut down on losses over the past decade by setting up 11 regional buying centres that purchase directly from farmers, buying more trucks and hiring handlers. It also advises some 10,000 farmers on stacking, transport and quality control.
"We transport in crates. Overall we probably record a wastage level of about 3 percent," said Fernando.
Working more closely with farmers helps to cut losses, noted Roberts.
"Shortening the supply chain means reducing the number of steps in the process from when food leaves the farm until it is consumed. The way of doing this is that supermarkets buy directly from farmers under contract."
Over the past decade Cargills has brought costs down by about 10 percent, said Fernando.
But increasing efficiency had initial costs for the company - trucks, warehouses and plastic crating.
Recently the government tried to legislate crates as compulsory for vegetable transport, but backed down when drivers and wholesalers protested, as local media reported. The law now only applies to a limited number of fruit and vegetables.

Income boost
Werrakoddi Arachchige Premadasa, a farmer from the rural town of Tanamalvilla, about 300km southeast of Colombo, said most farmers were still reluctant to invest in crates, which cost on average US$8 each. Bags measuring 120cm by 60cm take up less space and are cheaper, added the farmer, who supplies to Cargills in crates he purchased in 2008.

 Photo: Contributor/IRIN
Precarious packaging for produce en route

"Taking 500kg [of fruits and vegetables], in a three-wheel vehicle is simple if it is in bags. If we are using crates, you need a small lorry," he said.
Crates have cut his waste to almost zero, boosting his average monthly income by close to $80 in a country where the average monthly income is close to $200.
Produce lost in Sri Lanka is greater than in other countries in the region, said Roberts. Until public transport conditions - including railways, roads and government-owned trucks - and delivery systems improve, private companies will be the only ones able to afford cutting post-harvest food losses, he added.
"There are significant inefficiencies in the way that the government supply chains work in Sri Lanka. Much of the infrastructure, such as goods handling and railway systems owned by government facilities, are old and result in significant damage to perishable food."
According to L.P. Rupasena, deputy director of research at the government-run Hector Kobbekaduwa Agrarian Research and Training Institute: "We need a fully integrated market, where packing [and] distribution are streamlined to ensure the delivery of quality goods. We don't have such a system in place yet. As long as we don't invest to organize the distribution network, the introduction of crates will not work."
During the past three decades, less than 5 percent of the funding provided for horticultural development worldwide has gone on post-harvest factors, while the rest has gone towards increasing production, according to the Food and Agriculture Organization.
http://www.irinnews.org/Report/95078/SRI-LANKA-Cutting-post-harvest-losses

MALARIA: Typhoid Fever and the Challenge of Nonmalaria Febrile Illness in Sub-Saharan Africa

John A. Crump
In this issue of Clinical Infectious Diseases, 2 papers shed important light on the problem of typhoid fever in Sub-Saharan Africa and stimulate reflection on the challenges raised by the syndrome of fever in low-resource settings. Neil et al [1] report the investigation of an increase in intestinal perforations from rural western Uganda. By improving the clinical microbiology services available in the outbreak area and by implementing active surveillance at healthcare facilities in the district, the research team was able to confirm Salmonella enterica serovar Typhi as the etiologic agent and estimate the typhoid fever annual incidence in the study area at 8092 cases per 100 000 persons. This very high typhoid fever incidence rate was associated not only with hundreds of hospitalizations and intestinal perforations but also with 47 deaths. Lutterloh and colleagues [2] investigated an outbreak of unexplained febrile illnesses with neurologic findings along the Malawi–Mozambique border. Again, making diagnostic services available in the rural and remote outbreak area allowed SalmonellaTyphi to be established as the cause. A careful clinical and epidemiologic investigation, including enhanced surveillance of suspected, probable, and confirmed cases of typhoid fever, characterized 40 patients with debilitating focal neurologic manifestations, including upper motor neuron signs, ataxia, and Parkinsonism, and 11 deaths.Fever is among the most common syndromes prompting persons to seek healthcare in Sub-Saharan Africa, and the numerous causes of febrile illness are often difficult to distinguish clinically. Although malaria may be ruled out by blood film examination or a malaria rapid diagnostic test, clinicians in resource-limited areas often have few diagnostic tools to determine the etiology and inform treatment decisions for those patients without malaria [3]. .....http://cid.oxfordjournals.org/content/early/2012/02/27/cid.cis024.extract

TUBERCULOSIS: SOUTH AFRICA: What the world's largest preventative TB study taught us

JOHANNESBURG, 13 March 2012 (PlusNews) -

 Photo: WHO
Slow implementation of IPT

Even though the world's largest study of preventative tuberculosis therapy indicated that community-wide isoniazid preventative TB therapy (IPT) failed to lower community TB levels among 27,000 South African gold miners, that was not Thibela’s only result. We review some of the others over its seven years:

1. You do not always need an X-ray: In southern Africa, health workers and patients in rural areas often cannot access X-rays to confirm or rule out active pulmonary TB. Without X-rays to verify that patients did not have active TB, many physicians were unwilling to start patients on IPT. Thibela found that health workers could exclude at least 90 percent of active TB cases through sputum testing and symptom screening – asking patients if they were experiencing night sweats, a persistent cough or weight loss. Based in part on these findings, South Africa's latest IPT guidelines issued in June 2010 no longer require chest X-rays and TB skin tests to start HIV-positive patients on IPT.
However, in high TB prevalence settings, researchers noted that chest X-rays increased TB case detection.

2. IPT and HIV: People living with HIV, which compromises the immune system, are up to 37 times more likely to develop active TB. Findings from Thibela were able to confirm what many had long suspected but had failed to prove: that IPT provision to people living with HIV reduced their likelihood of dying. In fact, Thibela researchers showed it halved the risk of death among HIV-positive patients on or just starting antiretrovirals (ARVs). Based on this finding, South African guidelines no longer discourage the use of IPT in ARV patients.

3. Slamming side-effects: Although the World Health Organization had been recommending IPT since 1999, implementation has been slow, partly due to challenges in TB screening and doctors' fears of possible side-effects, most notably liver damage. Thibela researchers, however, found only a small number of cases of liver damage and these were among heavy drinkers. The most commonly reported side-effect of IPT was increased appetite.

4. Ignorance is not always bliss: IPT roll-out has been slow globally but in South Africa, coverage was below 1 percent in 2010 - eight years after the country introduced the preventative therapy. Zambia has only recently begun piloting IPT.
Thibela researchers found that doctors were unwilling to prescribe the drug to patients because they did not know about the drug's TB prevention benefits and did not have experience in prescribing it. Some doctors said they preferred to wait to treat TB with more familiar drug courses than to prevent it.

5. Mobilizing men: Although Thibela eventually included about 27,000 mine workers, mostly men - 80,000 indicated they would be willing to participate in the study. Thibela published research on the community mobilization and education strategies it used to get men on board in a November 2010 supplement of the medical journal, AIDS.
"The uptake we achieved was truly remarkable, especially when you consider it was almost an exclusively male population and men are notoriously poor adopters of health strategies," said Thibela's lead researcher and chief executive officer of South Africa's Aurum Institute for Health, Gavin Churchyard. "We've shown that it is possible to mobilize an entire population to adopt a health prevention strategy."
Strategies that worked well to drive up men's willingness to participate included the use of peer educators, community events and incentives tied to project phases. Less popular were the use of mobile-phone messaging due to frequent phone number changes, and treatment buddies, which sparked privacy concerns among actual trial participants.
http://www.plusnews.org/Report/95064/SOUTH-AFRICA-What-the-world-s-largest-preventative-TB-study-taught-us

POVERTY: Microfinance - possibilities and limitations

LONDON, 13 March 2012 (IRIN)

 Photo: Guy Oliver/IRIN
Benefits in the balance? Small-scale gold trader, Ankavandra, Madagascar

The scope of microfinance to lift poor people out of poverty and provide mechanisms of empowerment is being challenged as questions are raised about the supporting evidence.
In a discussion hosted by the UK's Overseas Development Institute (ODI), the academic evidence was concluded to be unclear, unreliable and inconclusive.
"[There is] no clear evidence that microfinance has any positive or negative impacts," said Maren Duvendack, ODI fellow and author of a recent systematic review of microfinance, while David Roodman, of the Centre for Global Development, added: "I [wouldn't] say microfinance doesn't work, I would say it does not systematically reduce poverty. We do not have credible academic evidence that microcredit on average lifts people out of poverty... We [also] do not have evidence that microfinance is systematically making people worse off."

Range of services
"I think a lot of people think that microfinance equals microcredit [providing small loans]," Duvendack told IRIN. "[Microfinance is] not just credit and savings, [but also] insurance, business skills, training, financial literacy."
Most studies consider the impact of microcredit, but Roodman suggested another of the microfinance portfolio products - microsavings - could have positive impacts on poverty reduction.
Duvendack, however, who is completing a study on the impact of microsavings, said it showed no significant benefits over microcredit.

Microfinance risks
The predominance of microcredit as a microfinance tool could be a significant hindrance to poverty reduction, as the risk of indebtedness is high.
According to former ODI fellow, Milford Bateman, micro-enterprise failure after funding with microcredit can strip poor people of all their remaining assets.
"It is the overall lack of access to credit for small and medium enterprises that prevents micro-enterprises growing into anything more substantive," Bateman added in an ODI paper. Microfinance initiatives have provided a social legitimacy for poor people to become indebted, commented Bateman, and the commercial business model has meant high interest rates for microcredit.

"This year, I expect even a larger profit"
Just three years ago, Shila Rani Mazumder and her husband were struggling to make ends meet in Bangladesh. Her husband earned just US$3 per day as a carpenter and she worried she would never be able to send her two children to school.
"Each month, we were short of money. Quarrelling became a regular part of our daily life," the 31-year-old told IRIN.
In 2010, she learned about a microfinance initiative in her village to help poor people and decided to take a chance. With a loan of $63 payable over one year, she invested in growing vegetables in their fields. She was also provided agriculture, fisheries and livestock training by the microcredit organization.
"After one year, I paid back the loan and earned a good profit," she said.
In 2011, she borrowed another $360 and is working to pay that back now. "This year, I expect even a larger profit," she said. But the dividends are already being realized in other ways; both children now attend school.
Many people in the Adampur village in Comilla District, 60km east of the capital Dhaka, have changed their lives with the help of micro credit from the Centre for Community Development Assistance (CCDA), a local NGO, which has been operating providing microfinance for poor people in Bangladesh since 1992.
According to CCDA, close to 2,300 residents, mostly women, in Mazumder's village receive microcredit support, with almost 100 percent repayment rates. Across Bangladesh, the organization is supporting close to 60,000 people by providing microfinance support, offering one-year loans at 24.72 percent interest per year.
MA Samad, executive director of CCDA, said farmers in the area needed money at certain times of the year, particularly in September and October.
"The micro-finance support is helping the farmers in the area. Many poor people have changed their lives with the help of microcredit," he said, noting that it was not easy for them to get loans and microcredit was largely the only option available to them.
He denied that the interest rate was high. "Before the introduction of microfinance, people used to take loans from 'mohajan' [informal money lender] and they often charged even two or three times the amount microfinance organization charge," Samad said.
"Microfinance institutes [are] now required to generate high financial rewards for their managers (salaries, bonuses) and owners/shareholders (dividends and capital gains)," Bateman explained.
"The fear is that significant financial flows are flowing out of the poorest communities, rather than being retained and recycled within them to underpin productive investment as the precursor to an escape from poverty."
Consensus is growing that microcredit should not be offered to the poorest of the poor due to the risk of harm, said Ruth Stewart of the Social Science Research Unit at the Institute of Education, University of London, at a London International Development Centre event.

Limitations and advances
The limitations in evidence of microfinance for poverty reduction result from poor study design and unreliable data, despite more than 30 years' experience. Hopes remain that robust and well-designed research, including randomized controlled trials and systematic reviews, will provide clearer conclusions in coming years.
Microfinance initiatives will not be successful in a vacuum, according to Duvendack. They will need to operate as part of a broader poverty reduction strategy with appropriate large- and small-scale economic frameworks to support advancement for poor people.
Another forthcoming systematic review co-authored by Duvendack will also show no firm conclusions of microfinance as a tool to empower poor women, although it does increase recognition of poor people as consumers of financial services, and can result in the development of regulatory frameworks around consumer rights. These factors were argued as possible forms of empowerment and new regulatory frameworks for India were cited.
"There are indigenous models and we need to investigate these models," said Will Derben, head of community relations at Barclays Africa.
Indigenous community models to provide finance for poor people, like the Susu men in Ghana, have been overlooked during implementation of microfinance tools.
Potential customers, as well as existing community models, need to be better understood so as to be better supported by microfinance initiatives.
Also overlooked, Duvendack told IRIN, may have been other potentially important development interventions, such as targeted welfare programmes, conditional cash transfer programmes, or small-scale agricultural growth programmes.
"I think we need more studies to be clearer about what is the actual impact of the various products," said Duvendack. "Do we have to have credit plus savings together or savings alone, or credit alone - or what is it now?"
Growth
By 2008, the microfinance industry had grown to include at least 2,420 microfinance institutes in 117 countries, according to microfinance institute exchange; the number continues to grow annually.
Microfinance institutions are able to be relatively self-sufficient, to innovate, to provide jobs and to compete in financial markets.
For Barclays Africa, Derban said, "Microfinance is a concept. It's about finding that balance between providing a financial service that will improve people's lives but yet be viable commercially.
"We need to provide financial services and we need to find ways of improving the system. Everybody wants to be banked."
To maintain a balance between doing social good and implementing successful financial products, Derban explained, Barclays Africa combines its commercial expertise with regulations bound to the philanthropic budget used to invest in community projects.
"I think it used to be the case where a lot of people that came into the microfinance sector came via the NGO route, where it's all about helping. [Now] we're seeing... more commercial people are coming in."

Regulation
"Certainly we shouldn't just let the market do its own thing," added Roodman. "Government does need to play a major role, setting the rules of the game and ensuring that it stays on an even keel."
Continuing to increase funds invested in microfinance, Roodman reflected, would not only be unnecessary, but could also potentially create harmful "microcredit bubbles".
"We cannot assume that more is always better. The amount of money going into microcredit these days poses the largest threat to the largest strength of microfinance."
Microfinance, argued Roodman, offers "a cautionary tale about putting a lot of money into things where the impacts are not rigorously dealt with".
http://www.irinnews.org/Report/95067/Development-Microfinance-possibilities-and-limitations

MALNUTRITION: CHAD: Fighting malnutrition with “dysfunctional” health sector

MAO, 19 March 2012 (IRIN)

 Photo: Anna Jefferys/IRIN
A mother feeds her severely malnourished son at the feeding centre of Mao district hospital in Kanem, western Chad

Hovering at around 20 percent in some places, Kanem Region in western Chad is well-known for having some of the world’s highest continual severe acute malnutrition rates. “Emergency” aid agency malnutrition responses have continued year on year since the 1980s.
Part of the problem is due to chronic food insecurity and drought that has affected much of the Sahel this year: This year some 3.6 million Chadians are food insecure due to poor rains, according to the World Food Programme. Dangerous care practices also play their role: Giving babies dirty water instead of breast milk, burning their chests when they have diarrhoea, among others.
But unless something is done to improve the country’s “dysfunctional” health system (as described by half a dozen interviewees), these malnutrition rates are unlikely to change significantly.
IRIN spoke to Ministry of Health staff, aid workers, government officials and mothers to find out if anything can be done to wean Chad from its dependence on emergency nutrition interventions.

"What doesn't need fixing?"
Taking a tour of the district hospital in Mao - one of two in Kanem Region - it quickly becomes clear the structure is a hospital in name only: most of the rooms are empty, without equipment, and there are few health staff around, other than in the aid agency-supported nutrition wing.
This low capacity is region-wide. Kanem has just six doctors for 410,385 people, according to the health district’s nutrition focal point, Maina Mahamat Abakar Sadick; 65 percent of health clinics are not operational because they have no staff; over half are run by someone unqualified to do so; and 65 percent of them are made of non-durable materials. One in four has no cold-chain facilities and so cannot administer routine vaccinations. As one nutrition expert put it: “What doesn’t need fixing?”
Nutrition, as a sub-set of the health sector, is de-prioritized and poorly understood, according to Dallam Adoum, who runs the Ministry’s of Health’s Centre of Nutrition and Technology (CNTA), which covers everything from prevention to treatment of malnutrition, and was set up before 1960 but still has no budget.
According to him, there are just 15 nutritionists officially working in the Health Ministry - excluding those who have been trained by aid agencies.
Understanding of the causes of malnutrition is pretty low within the Ministry, said Adoum.
This was backed up by Céline Bernier, nutrition coordinator at Action Against Hunger (ACF), who said little nutritional surveillance takes place other than that carried out by aid agencies (such as ACF, UNICEF, Médecins Sans Frontières and Worldvision, among others.) “The government recognizes there is a problem but it doesn’t necessarily know how to fix it,” she told IRIN.

Things, not people
When the government does invest (5-6 percent of the annual budget is spent on health, according to UNICEF), it tends to focus on “things” rather than people and processes, several analysts told IRIN. “The main problem is human resources,” said Roger Sodjinou, nutrition manager for UNICEF in Chad. “There is no clear idea of the HR strategy of the government.”
Francois Ndoubalhidi who runs the ostensibly independent organization to monitor the country’s petrol resources (CCSRP), says the same is true for the estimated US$1.9 million of petrol funds that are, according to him, directed to the health sector each year.
“The government is more into concrete investments - building health clinics for instance - human resources is not a priority,” he told IRIN.
Building up pools of trained staff requires vision and planning, but most of the 22 regional governments have no nutrition or health plans, according to a nutrition expert at one large aid agency, and “even national plans are not very clear.”
Due to support from aid agencies, 261 health centres across ten regions are now treating acute and severe malnutrition according to UNICEF. But this number must double to reach the 127,000 children expected to suffer acute severe malnutrition over the next six months, said UNICEF head Bruno Maes.

Picking up the pieces
On the nutrition front, aid agencies for the most part pick up the pieces, treating acutely malnourished children all over the country’s Sahelian zone - though gaps remain in parts of several districts, according to EU humanitarian aid body ECHO. LINK
The number of acutely malnourished children being admitted to ACF and UNICEF’s therapeutic feeding and treatment centres at the district hospital in Mao has shot up in recent months, according to Bernier and UNICEF’s nutrition coordinator in Mao, Augustin Ilunga.


 Photo: Anna Jefferys/IRIN
A nurse at Mao district hospital registers new patients into the nutrition wing

In 2011 they treated 14,400 severely malnourished children, and as of the end of February had already treated 2,000. “It looks like the numbers will be even higher this year,” he told IRIN.
Women come from all over the region to treat their children. Harmatta Ousmane,17, brought her 10-month-old son Abakar from the neighbouring sub-district of Kékédiné, after hearing about the Mao centre through neighbours. “I am learning a lot here about how to feed children - what food to give them, to boil water if they need to drink it,” she told IRIN.
However, many mothers often head too late to the centre so their children die en route - health clinics may take far too long to refer them, said Seydou Dicko, head of the ACF nutrition programme in Mao, or mothers go to the health clinic too late because they prefer to visit traditional healers.
These “healers”, however, often end up inflicting tremendous harm, said UNICEF’s Ilunga, burning children when they vomit or have diarrhoea; cutting off a part of their mouth when they have a cough; and pulling out their baby teeth when they are sick. “These healers are brutal, they do not understand the importance of diet or vaccinations,” said Naga Tibé who, as a member of a women’s association in Mao, tries to warn people against visiting them.
But while part of the solution lies in education and convincing families to change, unless health clinics are operational, many women have no alternative, they told IRIN.
Aid agencies are trying to boost government capacity. ACF trains and pays district health staff in nutrition prevention and care, and then tries to reintegrate them into the district health system - 28 have been reintegrated thus far.
UN and donor partners have helped the government develop a recruitment strategy, which aims to boost health staff by 1,000 countrywide this year. UNICEF’s role in this is to help the government recruit and deploy 400 parademics to regions in the Sahel belt.
People working to develop Chad’s water and sanitation sector - lack of drinking water and latrines has a big impact on children’s nutrition - now work hand in hand with nutritionists, and UNICEF is pushing for all health clinics to at least have latrines and running water (over half currently have no water source). Incremental progress in the water and sanitation sector should also improve nutrition statistics, some staff say: the government will sign off on its first sanitation strategy in April, and for the first time has set aside a national budget for sanitation.
The Health Ministry should take note and develop a malnutrition prevention and treatment strategy, with its own budget line, say aid agency staff. “We must profit from the current political stability to progress on malnutrition,” said UNICEF’s Maes.
The ministry could increase its nutrition performance by increasing its recruitment budget so there is at least one state-registered nurse at each health centre; include it in basic medical training; and up the number of places available in medical schools, said Bernier.
“Everything is a question of priority… Malnutrition is rarely a priority for men in power. Health care is expensive, and the more you develop your health system, the more expensive it gets… but there are also economic dividends, at least in the long term.”
The ministry can do little to impact the increasing frequency of droughts decimating harvests in the Sahel, but it can at least do what it can to improve its own systems. If not, said Ilunga, “We’ll just be here giving Plumpy’nut forever.”
http://www.irinnews.org/Report/95093/CHAD-Fighting-malnutrition-with-dysfunctional-health-sector

MALNUTRITION: Niger River: Joined-up thinking on water, energy and food

JOHANNESBURG, 15 March 2012 (IRIN)

 Photo: Jaspreet Kindra/IRIN
The Niger river in Ayorou town in Niger's Tillaberi region, one of the worst affected by the current food crisis in the country

Africa’s third longest river, the Niger, is a source of water, food and energy for nine West African countries. But frequent droughts induced by a changing climate, and exacerbated by rapidly growing demand, pose a threat to water availability and livelihoods.
Big hydroelectric projects involving the building of dams on the river are restricting flow rates and affecting the lives of a million downstream herders, rice growers and people engaged in fishing, scientists warn.
The problem is that plans to harness water for electricity, irrigation and other uses were being developed separately both at the national and regional levels. Relevant officials were not talking to each other about the river and its ecosystems, said Sébastien Treyer, director of programmes at the Paris-based Institute for Sustainable Development and International Relations (IDDRI) who led a recent study on the basin.
However, countries and communities can overcome the problem of how to share water resources if they adopt what scientists call “the nexus approach”, a key agenda item at the week-long Water Forum in Marseilles, France. The Consultative Group on International Agricultural Research will convene a high level panel on the approach at the Forum on 16 March.
The nexus approach seeks to find solutions based on the interconnections between various sectors or disciplines and is being widely regarded along with “resilience” as a term that could revive sustainable development.
The term “sustainable development” - given currency by the 1992 Earth Summit - is a “nexus” between environment and development.
“However, after Rio [the 1992 summit] we lost a little of this feeling and the nexus faded away. Now, 20 years later, we must reinvigorate this message of sustainable development through a nexus approach," said Klaus Topfer, executive director of the Institute for Advanced Sustainability Studies in Germany, at a conference on the nexus approach in Bonn in November 2011.

Scenario
Imagine a mango orchard which is home to three groups of people. One of the groups depends on the orchard for twigs and branches which it sells as firewood (wood sellers); another harvests the fruit and sells it (fruit sellers); and the third depends on fishing in a pond protected by the trees (the fishing community).
Over a period of two years, the area begins to experience rather severe winters, creating a huge demand for firewood. To keep up with the demand, the wood sellers begin to cut down trees, affecting the fruit sellers’ income. In a few years, with the loss of tree cover, the land in the orchard begins to degrade; the pond begins to silt up, affecting the fishing community. With the loss of forest cover, rains in the area become erratic, affecting the growth and flowering of the mango trees. Within a decade the communities become poor, food insecure and conflict-ridden.
At least 15 million people are estimated to be at risk of food insecurity in countries in the Sahel at the moment
What if the wood sellers (with sustainability of the orchard in mind) had consulted the other two groups before cutting down the trees? Consultation could possibly have led to a decision to log trees selectively - older ones with low yields and those growing at a distance from the pond. The groups could also have made plans to plant new and faster growing varieties of mango to maintain tree cover. This would have been a “nexus approach” - with each community taking into account the interconnections between the differing demands they make on a shared resource.

Case study - Niger basin
In their case study on the Niger basin, Treyer and his team adopted the nexus approach with the support of the Economic Commission of Western African States (ECOWAS).
“The first idea was to organize a dialogue between these different plans and policy processes, so that they can assess to what extent they are or aren’t exerting too much pressure on water resources,” he said.
Ideas began to emerge from the dialogue process: energy sources should be diversified; and officials began to consider accessing photovoltaic technology to produce solar energy. Too much emphasis on irrigation schemes which used dams to boost food security was ruled out.
Most countries in the region need to prioritize food security over other needs such as energy, said Gil Mahe, a scientist with France’s Institut de recherche pour le développement, based in Morocco. With scarce water resources, countries should rather focus attention on other ways to increase crop yields such as investing in improved soil fertility, added Mahe who has done considerable research on climate change impacts in West Africa.
It emerged that many small farmers would not benefit from irrigation schemes, "as their farms lie too far away from the river", said Treyer. The policy dialogue therefore also highlighted the need for investment to help rain-fed agriculture become more productive and stable.
The study is now involved in compiling data on the competition between food and energy production and ecosystems in the upper Niger and the inner Niger delta to help create awareness among policymakers.

Bonn conference
Development experts are urging governments and communities to focus on the nexus between water, food and energy - where linkages are evident and critical.
Prominent among them is Holger Hoff, a scientist with the Stockholm Environment Institute. His paper formed the basis of the November 2011 Bonn conference (jointly organized by the German government, the World Economic Forum and the World Wide Fund for Nature) which focused on the nexus approach.
Hoff offered a word of caution. "It remains important to work on sectoral solutions with sectoral expertise and data, and not lower ambitions by simply referring to the nexus (`everything is connected with everything else’).
At the Bonn conference, experts proclaimed "nexus" as a bridge that could close the gap between the social, environmental and economic pillars of sustainable development.
Han Seung-Soo, chairman of the governing board of the Global Green Growth Institute in the Republic of Korea, echoed the views of many experts at the Bonn conference by saying that “the key word - nexus - signifies the challenge of Rio, which is to connect the dots between financial, social and environmental aspects of sustainable development."
http://www.irinnews.org/Report/95080/GLOBAL-Joined-up-thinking-on-water-energy-and-food

POVERTY: SOMALIA: Thousands displaced by fighting in Gedo

NAIROBI, 15 March 2012 (IRIN)

 Photo: Mohamed Gaarane/IRIN
The violence has cut off Gedo from trade with the capital, Mogadishu and the town of Baidoa (file photo)
Several thousand people have been displaced by clashes between Al-Shabab insurgents and Somali troops assisted by Ethiopian and Kenyan soldiers in Somalia's southwestern Gedo region, locals told IRIN.
"In the last couple of weeks, we have had some 5,000 people displaced by the conflict; we already had hundreds of families who were displaced," Mohamed Abdi Kaliil, governor of Gedo, told IRIN from Garbaharey, the regional capital. "We are trying to find some help for the displaced in our area but so far nothing."
Families have been "forced to move from one town to another and from one village to another", because of Al-Shabab activity, he told IRIN. "Their main aim is to hide from the violence; the people desperately need help with shelter, health, water and food."
The fighting has cut off the region from trade with the capital, Mogadishu, and the town of Baidoa, and public services have not fared any better. According to Kaliil, more than 10 health centres across Gedo region have closed due to the conflict.
Adan Abdi Hashi, administrator of the main hospital in Garbaharey, said its laboratory was burned down a week ago. "We had an attack by Al-Shabab and our facility was hit by an exchange of gun-fire and it caught fire," he said.
The hospital serves four districts in Gedo. "We have no way of testing any patient for anything," Hashi said. "We currently have dozens of patients with TB [tuberculosis] who need to be tested every two months to see how they are responding to the treatment but we cannot even do that."
Drugs too were in short supply, he added.

Education hit
Apart from hospitals, the fighting has also affected schools. "In the parts still controlled by Al-Shabab, they closed down schools and are forcing children to take up guns," the governor told IRIN.
Some schools in areas under the control of the pro-government forces have also closed for various reasons. In the only secondary school in Garbaharey town, many students are absent because they have already left the area, according to the principal, Ali Mohamed Isse.
"The trend is that people are still wary of the situation, so they left for safer areas and are not sending their children to school; I cannot really blame them," Isse said.

Uncertainty
A local journalist, who requested anonymity, said Al-Shabab - which has lost Garbaharey and other parts of Gedo to the combined forces of the Transitional Federal Government (TFG), Ethiopian and Kenyan troops - "is close by and carries out attacks at will.
"This has created a great deal of apprehension and uncertainty as to what will happen next," the journalist said, adding that Kenyan air raids in parts of southern Somalia, including Gedo, were causing fear among the population.
"This has forced many people to flee any area they think is close to Al-Shabab," the journalist said, adding that this had contributed to the displacement in the region. "It is a confused and continuous movement of people."
According to the UN Refugee Agency, UNHCR, Gedo region is home to an estimated 77,000 displaced people. But for almost a year, Kaliil said, the area has been inaccessible to aid agencies due to the presence of Al-Shabab.
http://www.irinnews.org/Report/95077/SOMALIA-Thousands-displaced-by-fighting-in-Gedo

MALNUTRITION: SWAZILAND: Diets downsized by financial crisis

MBABANE, 16 March 2012 (IRIN)

 Photo: James Hall/IRIN
Half of rural households have cut their number of meals
It is 6am in rural Mliba in central Swaziland, and Melody Thwala and her seven-year-old granddaughter Thandi are busy with their daily task of harvesting wild `umbhidvo’ weeds before Thandi goes to school. Thwala will use what they have gathered to make a spinach-like dish to supplement the family’s one daily meal.
“My grandchildren have a meal at school and this is a relief to me. At our home we have only one evening meal,” said Thwala, a widow who lives with her unmarried daughter and four grandchildren.
According to a report by the UN Country Team in Swaziland, released on 16 March, a fiscal crisis which started early in 2011 has put an additional strain on poor households like Thwala’s and worsened poverty in a country which already had high rates of unemployment and food insecurity and the highest HIV rate in the world.
The report, based on a November 2011 survey of 1,334 households, found that poor households have had to adopt extreme measures to cope with reduced incomes resulting from job losses and wage cuts, as well as higher food and fuel prices and reduced access to social services. About half of rural households and one third of urban households have cut their number of meals or meal portions and in more than one out of four rural households, meals were skipped for the entire day.
“In rural areas and especially among female-headed households, coping mechanisms are supplemented by other budget management methods, such as gathering of wild food and harvesting immature food,” write the authors, who warn that the crisis threatens to halt or reverse progress Swaziland had made in reaching the Millennium Development Goals in health, education and food security.
Swazis usually eat their `umbhidvo’ with maize meal, the national staple food which is grown in almost every garden and farm. But a year of low rainfall reduced the usual yield from Thwala’s maize garden by half and she cannot afford to buy maize meal.
“That is why our meals are one a day,” said Thwala, adding that the family had been forced to sell a cow which had provided them with milk.
Cutting back on food and selling household assets were found to be two common coping mechanisms among households which experienced economic “shocks”, the most common of which were rising food prices and reduced labour income.
“Starting from an already weak situation, food security seems to have deteriorated as households have been coping with the consequences of the fiscal crisis combined with the rising food price,” notes the assessment.
A significant drop in revenue from the Southern African Customs Union in the wake of the global economic slowdown helped precipitate Swaziland’s financial meltdown over the past year, but according to Sibusiso Hlatshwayo, an independent financial consultant in Mbabane, the capital, this was not the only factor.

Vanity projects
“Government’s spending choices on vanity projects that have been criticized by the IMF [International Monetary Fund] have not changed, and the government’s unaffordable public service employee rolls that are the highest in Africa per capita have not been cut back. Secondly, Swaziland’s economy was shrinking long before the global recession; large, decades-old businesses have been relocating from the country and there is no new investment,” he said, adding that the government’s lack of money to pay its suppliers had resulted in small companies going out of business, putting more people out of work.
The financial crisis has also hit social services with grants to the elderly which had helped women like Thwala support their families suspended, and the government no longer paying school fees for many orphaned and vulnerable children, including two of Thwala’s grandchildren.
UN Children’s Fund (UNICEF) representative and acting UN resident coordinator in Swaziland Jama Gulaid pointed out that the financial crisis had also led to an acute shortage of fuel for government vehicles. “If vehicles are grounded for lack of fuel, how does one deliver outreach services and or conduct field supervision?” he said.
A spokesperson at the Ministry of Health and Social Welfare confirmed that its officers had had to curtail visits to impoverished households in remote, rural areas.

Children moved to cheaper schools
The report suggests that households living in rural areas have been harder-hit by the crisis than those in urban areas, and that female-headed households and those with members living with HIV were most likely to resort to cutting educational expenditure. Among these households, almost one fifth had withdrawn children from school, and more than 10 percent had moved children to lower quality schools.
Samantha Zwane, a single mother of two children, has held the same job of receptionist for 10 years, but her rare pay increases have not kept up with the ever-escalating costs of food, electricity, bus transport and other supplies.
“I had to choose between moving from a three-room to a two-room flat, even if it meant we would have to all sleep together in a room, or enrolling my daughter and son in a cheaper school. The only flat I could find was far away and it would mean higher commuting costs [so] I had to change the children’s school,” she said.
While the grim economic situation is prompting people to make necessary if painful decisions, so far they are managing to cope. Starvation is not yet a problem although malnutrition is widespread and is leading to an unreported crisis of stunting in children’s growth, according to UNICEF.
“Nutrition is a challenging area for most countries in East and Southern Africa, including Swaziland,” said Gulaid. “Yes, external shocks worsen the situation but there are many contributory factors. We need multiple strategies to address child malnutrition and everyone must do more - the government, households/communities, development partners and the private sector.”
The survey concludes with several recommendations for improving public financial management, increasing employment and setting up social welfare services which would better prepare households for occasional economic downturns.
http://www.irinnews.org/Report/95088/SWAZILAND-Diets-downsized-by-financial-crisis

POVERTY: SUDAN: Aid needs urgent as refugees head south

YIDA, 16 March 2012 (IRIN) -
The international community should act urgently to provide assistance to thousands of people affected by conflict in Blue Nile and South Kordofan states in Sudan, and the many refugees who have fled across the border into South Sudan, say South Sudan officials and NGOs. The refugees are fleeing ongoing fighting between the Sudan Armed Forces (SAF) and the Sudan People's Liberation Movement-North (SPLM-N) in the two states. In South Kordofan, a nine-month conflict has left thousands there vulnerable. "It was as the UN resident and humanitarian coordinator for Sudan in 2003-04 that I saw what genocidal violence was doing in Darfur. When I asked the world to heed my warnings, it looked away until it was too late," said Mukesh Kapila, a former head of the UN in Sudan, who visited South Kordofan's Nuba Mountains earlier this month. "From what I have seen in the Nuba Mountains, I fear that much the same scenario is unfolding there. Will the world listen this time around?" Kapila, visiting the region as special adviser to the anti-genocide group the Aegis Trust, said he had seen burnt villages, destroyed food stores and damaged schools with civilians sheltering in churches. "I heard an Antonov [plane] myself and watched women and children running away shrieking [in] fear, as well as fields on fire from dropped bombs destroying what little food crops were being planted. "I also saw the anti-personnel landmines and cluster bombs that had been used in places where women and children go to fetch water and firewood." Refugees' plight For the 20,000-30,000 South Kordofan refugees who have made it across the border into neighbouring Yida region, in South Sudan's Unity State, the situation is not much better. "Even here across the border, they have been bombed by Antonovs belonging to the Sudanese military," said Kapila. The air raids are causing concern among aid agencies, with some of them withdrawing from border areas towards the capital Bentiu. In Yida refugee camp refugees spoke of their flight: A disabled old woman, who was struggling to care for five visibly traumatized grandchildren, told IRIN how they had been forced to flee their village in the Nuba Mountains region after the children's parents were killed by bombing; another elderly woman said she had been beaten by soldiers after being arrested on suspicion of attempting to flee to rebel-held areas; a nine-year-old girl there had broken her collar bone while diving for cover during one of the many air raids. In Blue Nile State, thousands have also been displaced into neighbouring Upper Nile State in South Sudan where "the refugee population continues to increase steadily", according to a bulletin by the UN Office for the Coordination of Humanitarian Affairs (OCHA). [ http://reliefweb.int/sites/reliefweb.int/files/resources/OCHA%20Sudan%20Weekly%20Humanitarian%20Bulletin%2027%20February%20-%204%20March%202012.pdf ] Between 22 and 29 February some 2,300 new refugees were registered in the Doro and Jammam refugee sites there, said OCHA. South Sudan is hosting at least 103,000 refugees, 80 percent of whom are from Blue Nile. "Window of opportunity" As the April rains approach, there are fears of a worsening humanitarian situation. "The lives of tens of thousands of Sudanese refugees in South Sudan depend on the scaling up of humanitarian aid now," warned Julien Matter, Médecins Sans Frontières (MSF) emergency coordinator. "The scale-up must take place in the short and rapidly closing window of opportunity before the rainy season starts in late April." Life in the remote Doro and Jammam sites is already hard for the refugees who are largely dependent on humanitarian assistance. "They have sought a safer place but they have found a harsh environment where their ability to survive is stretched to breaking point," said Matter. "All organizations providing assistance in the camps must focus on an emergency push during the coming weeks to ensure that refugees can survive the coming months," he added. In Jonglei State, South Sudan, aid agencies are also calling for the stepping up of aid for an estimated 140,000 people affected by interethnic clashes. "Further fighting could lead to further insecurity, uncertainty and displacement," Unni Krishnan, head of disaster preparedness at Plan International, told IRIN. "The crisis has already reached a tipping point. Rains could also cut the lifeline which impacts the food aid to the displaced population which is already going through a critical situation." Jonglei has a poor road network connecting remote villages, and there are many swamps. According to Kapila, the affected population needs food and medical aid as well as agriculture inputs. "After two seasons of badly disrupted agriculture, hunger is rapidly increasing in a wider region that is seriously food-insecure anyway," he said, calling for aid to be provided through local structures and community groups in both government and rebel-held areas if access for international organizations continues to be a problem.

 http://www.irinnews.org/report.aspx?reportID=95090

MALARIA: ACCESS TO FACILITIES AND CHILD MORTALITY

For those who are reluctant to enable rural communities to participate in primary health care – perform RDTs, provide essential medicines, etc. note that the result can be a death sentence

Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia: A Community Based Cross Sectional Study
Background There have been few studies that have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia.
Methods and Findings This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived ≥1.5 hrs from the health centre had a two to three fold greater risk of death than children who lived <1.5 hours from the health centre (children with travel time 1.5–<2.5 hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5 hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5 hrs adjRR 2.5[1.1–6.2]).
Conclusion Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.
Abstract and full text,
http://www.blogger.com/goog_1965862787

MALARIA: Misuse mosqito nets - Or are they?

PLANS by the government to fight malaria through the use of mosquito treated nets seem to be failing after it emerged that nearly 50 per cent of those who acquired the nets use them for different purposes.

A study by Population Service International revealed that 51 per cent of those having nets use them to protect their gardens and keep rodents from their kitchens.
Speaking during a tour of parts of Nyanza province to assess the feasibility of use of nets, in a programme dubbed hang up campaign, director maternal and child health division Antony Gitau said despite the fact that most of the homes have mosquito nets, they hardly use them to protect themselves against mosquitoes. According to the study, most of the people who have the nets do not use them either out of ignorance or taboo. Gitau said more than 200,000 people from 36 districts who had objected the use of mosquito nets are currently embracing them and through the campaign use of mosquito nets has seen a 10 per cent increase.
The campaign is funded by the United Kingdom to the tune of Sh9 million. Public health officials have in the past decried the misuse of mosquito nets in Nyanza with most of the people using them to cover gardens, green houses for mangoes and fishing activities. Nyanza provincial director of public health and sanitation Jackson Kioko said the misuse of mosquito nets is rampant in the province with others using them to make wedding dress.
Last year in an effort to curb the misuse of nets, the Ministry of Public Health and Sanitation teamed up with members of the provincial administration to apprehend and prosecute those who misuse nets. However, the campaign did not bear much fruit and the ministry together with PSI has launched a campaign spearheaded by scouts to tame misuse of insecticide treated nets through enlightening the community on their use.
http://allafrica.com/stories/201203130095.html

OTHERVIEWS
I work in Nyanza but most of the nets I see used this way (gardens, chicken, fishing etc) are old nets which the residents are no longer using. Remember nets are not issued out together with a disposal mechanism and I think we cannot begrudge the residents their innovation to apply old ones for other uses. However, it would be a public health nightmare if well conducted compliance studies would show that residents actually prefer to use their nets elsewhere other than when sleeping.. I doubt it if there is any taboo anymore in Nyanza regarding the use of nets for sleeping. Statements like ‘hardly use’ remain speculative in the absence of programmatic evidence.


Peter Otieno: KEMRI_Nyanza province: Kenya

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Incredible stories about net mis-use in African countries continue to come up. In Nigeria, field evidence also show net mis-use. This is mostly among farming communities where there similarly used for protection of gardens, animals such as goats as well as for finishing.

Mass nets campaign has actually increased nets availability in households but may not have influenced use accordingly. This might be due to the quality of health education on net use provided during the exercise. Available evidence like the one(10%) coming from the Kenya campaign and elsewhere has shown that with proper and appropriate information on net, use can be improved. Hope the Kenyan campaign is not a one time event. Also using Community directed intervention (CDI)approach to distribute and promote use has also improved net ownership and use. The approach involved communities selection of volunteers that are trained by the health service. These volunteers are responsible for net distribution in their respective communities as well as helping communities to hang and use their nets. The volunteers also visit homes of those that received nets from them using the community register developed for the purpose. Through this approach, communities are empowered to take their health in their own hands. This might not be for only the nets but other components of malaria prevention and control such as IPTp, and RDTs as a component of home management of malaria. Usually the community volunteers work under the guidance of the health service in clinic-community continuum of care. The CDI concept is an approach made popular by African Program for Onchocerciasis Control (APOC) that for several years reached hundreds of villages across Africa.
Community participation remains the vital missing link in our primary health care system. There is need to strengthen community health system that would improve the activities of primary health care. If we have done things one way and get poor results, there is need to try innovative and evidence-based method that would help improve our results. Well if we continue to insist on the traditional approach, perhaps the MDGs will only be but a mirage!

Sent from my BlackBerry® smartphone from MTN Ghana
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Peter,

Thank you for your very sensible response. The newspapers often make huge statements which are very misleading and can be quite destructive in terms of donor sentiment.
I would be VERY surprised if the nets being used for other purposes were brand-new or still viable for use over a sleeping space. Once a net has too many holes etc to use to protect a sleeper, it is not “mis-use” to use them for other purposes.
Matt Lynch
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There will always be issues around the use of nets. What is important is to keep our feet on the pedal to get people sensitized to increase usage. In a state in Nigeria, certain colour of the nets were not used because by their culture they are used to cover corpses. With net campaign strategy, this is fast becoming a thing of the past.

My worry is the distribution strategy which is the same for every state and community instead of customizing to meet the processes of the people. We need more effective approach to distribution with the engagement of community stakeholders.
By the way, where did we miss it? Net were part of the compulsory items you have to take to the college at resumption. It is no longer so. What happened? Can we reach and surpass that again? Why has net suddenly become a new thing?
Dr. Fatai Wole Bello, ES CCM Nigeria