May you get a clean bill of health fromyour dentist, your cardiologist, your gastro-enterologist, yoururologist, your proctologist, your podiatrist, your psychiatrist, yourplumber and the I.R.S.
May your hair, your teeth, your face-lift, your abs and your stocks notfall; and may your blood pressure, your triglycerides, your cholesterol,your white blood count and your mortgage interest not rise.
May New Year's Eve find you seated around the table, together with yourbeloved family and cherished friends. May you find the food better, theenvironment quieter, the cost much cheaper, and the pleasure much morefulfilling than anything else you might ordinarily do that night.
May what you see in the mirror delight you, and what others see in youdelight them.
May someone love you enough to forgive your faults, beblind to your blemishes, and tell the world about your virtues.
May the commercials on TV not be louder than the program you havebeen watching, and may your check book and your budget balance - andinclude generous amounts for charity.
May you remember to say "I love you" at least once a day to your spouse,your child, your parent, your siblings; but not to your secretary, yournurse, your masseuse, your hairdresser or your tennis instructor.
And may we live in a world at peace and with the awareness of God's lovein every sunset, every flower's unfolding petals, every baby's smile,every lover's kiss, and every wonderful, astonishing, miraculous beat ofour heart.
In most African countries, health is in crisis. Staffing and resourcing remain serious problems in all aspects of health care,1 including essential public health functions and research.2 At the same time, there is a new optimism: Africa is definitely not where it was 50 years ago.3 Many years of capacity-building have increased the number of senior staff in spite of the continued “brain drain”, and globalization of communication has contributed to an increasing democratization and accountability of education and politics. Combined with attitudinal changes in donor countries and institutions,4 there is a stronger awareness of the need to phrase answers to problems in terms of local ability rather than of foreign assistance interests, although problems in “vertical programming” remain.5 While it is too early to judge the sustainability of these political realities, it is time to greatly enhance system support to enable nations and regions in Africa to govern and manage their health sectors. In particular, it is high time to enable Africa to educate its own leaders in public health – those needed to execute essential public health functions, improve system performance and form an African voice for public health.
Results Overall, 29/53 countries (54.7%) offer no postgraduate training in public health, 11/53 countries (20.7%) have one programme and 11/53 countries (20.7%) offer more than one programme. If the analysis is stratified by language group, major differentials appear: anglophone sub-Saharan African countries as well as those in north Africa have more developed postgraduate public health training programmes than francophone, lusophone and the one Hispanic country
It is obvious that the largest gap occurs in lusophone countries (91% of the population lives in countries without graduate public health programmes) followed by francophone Africa (34%; Fig. 1, Table 2).
In total, there are 854 staff members working in institutions offering postgraduate public health programmes, only 493 of whom work full-time. Male staff is in the majority (63%) and this differential increases if having a doctoral degree is taken into consideration (73%). Viewed in another way, 89.2% of male staff have either a master’s or doctoral qualification, in contrast to only 71.6% of female staff (Table 3, Table 4).
The age-distribution of staff skews towards younger age groups: 15% are aged 35 years or younger, 66% are aged between 36 and 50 years, and only 19% is older than 51 years of age. There is therefore a shortfall of senior staff in institutions of public health. This study did not allow an understanding of this dynamic, including whether it relates to migration, illness, internal transfer to better-paying externally funded positions, or to other causes. Finally, there are few foreign staff members working in institutions in Africa: of the 554 staff about whom information was available, 11 (2%) were nationals from other African countries and 40 (7%) were nationals from outside Africa.
A dwindling supply of wild medicinal plants is threatening South Africa's traditional medicine industry, according to new research.
In a paper published by the nongovernmental organisation Health Systems Trust this month (4 December), researchers found that the demand for traditional medicine is higher than ever — stimulated by HIV/AIDS, unemployment and rapid urbanisation.
"Many customers report that they choose to use traditional healers as they feel the treatment is more holistic than western medicine," the authors write. They go on to explain that it is this dual "spiritual and physiological treatment" that customers appreciate.
South Africa's traditional medicine industry is estimated to be worth 2.9 billion rand (around US$415 million) — 5.6 per cent of the country's health budget.
The researchers say that at least 133,000 households are dependent on the trade in medicinal plants. The majority of those harvesting the plants are rural women who depend on money they make from selling the plants to feed their families.
At risk are 550 plant species. At least 86 per cent of the plant species harvested will result in the death of the entire plant. African Wild Ginger, for example, is now reportedly extinct in the wild.
The authors make practical suggestions on how a crisis can be averted. Most obvious is developing communication between all players, followed by the development of a strategic vision for the industry.
They also suggest incentives that promote the development of technology in harvesting, farming, storage, packaging, dosage and treatment.
Sazi Mhlongo, chairman of the National Professional Association of Traditional Healers in South Africa, told SciDev.Net, that traditional healers understood the issues surrounding the sustainability of medicinal plants and were planting what they needed.
"We are holding meetings with role players to discuss the building of warehouses in Johannesburg and Durban where herbs can be packaged and sold on to traditional healers," says Mhlongo. This way, he says, plant gatherers could also be told when a certain herb was not needed to avoid waste.
"There are also plans to register traditional healers and plant gatherers to ensure better control," he adds.
"The Bill & Melinda Gates Foundation grant will help DNDi fill critical gaps in the HAT and VL drug development pipelines by supporting our lead optimization drug discovery programs for HAT and VL, which will in turn fuel our drug development projects," stated Dr. Bernard Pecoul, Executive Director of DNDi. "With the goal of providing better, low-cost treatments, we are intensifying neglected diseases research and are endeavoring to rekindle the hopes of the many people who suffer from these diseases in the poorest regions of the world."
The grant, to be disbursed to DNDi over five years, will provide critical funding for the research and development of new drug candidates for HAT and VL. DNDi will foster the development of the drug candidates through the preclinical stages and select one lead candidate for each disease to advance into Phase I human clinical trials.
"The pledge of $25.7M highlights the urgent need to accelerate R&D for neglected diseases," remarked Dr. Shing Chang, Director of Research & Development at DNDi. "This important commitment to HAT and VL drug discovery will serve to encourage research into new, innovative treatment options for these diseases."
"Far too little R&D is devoted to neglected diseases such as trypanosomiasis and visceral leishmaniasis, which threaten millions of people in the developing world but are virtually unheard of in rich countries," said Dr. Regina Rabinovich, Director of Infectious Diseases Development at the Gates Foundation. "By helping to close this research gap, DNDi is bringing us closer to the day when the word 'neglected' no longer applies to these diseases."
About the Diseases - HAT and VL
A fatal disease if not treated, HAT threatens more than 50 million people in 36 countries in sub-Saharan Africa. The few drugs currently in existence to treat either Stage 1 or Stage 2 of the disease have a number of serious limitations including severe toxicity, the difficulty of administration, cost, and lost efficacy in several regions. The difficulty of diagnosis, stage determination, and increasing numbers of treatment failures pose additional clinical challenges.
The urgent need for new drugs to treat VL is also deeply compelling. A potentially fatal disease, VL threatens 200 million people in 62 countries and has a fatality rate as high as 100% within 2 years in some developing countries. Of the 500,000 new cases each year, almost all (~90%) arise from recurrent epidemics in poor, rural areas of the Indian subcontinent, Brazil, and Sudan, with approximately 60,000 deaths each year. Therapeutic options for VL are limited as there are significant drawbacks like route of administration, toxicity, or cost.
The Drugs for Neglected Diseases initiative (DNDi) is an independent, not-for-profit drug development initiative established in 2003 by five publicly-funded research organisations - the Malaysian Ministry of Health, the Kenya Medical Research Institute, the Indian Council of Medical Research, the Oswaldo Cruz Foundation Brazil, and the Institut Pasteur - as well as an international humanitarian organisation, Médecins Sans Frontières. The UNICEF/UNDP/World Bank/WHO's Special Programme for Research and Training in Tropical Diseases (TDR) is a permanent observer. With a current portfolio of 18 projects, DNDi aims to develop new, improved, and field-relevant drugs for neglected diseases, such as malaria, leishmaniasis, human African trypanosomiasis, and Chagas disease that afflict the very poor in developing countries.
DNDi needs an additional EUR 200 million in funding in order to achieve its objectives of building a robust pipeline and delivering six to eight new treatments by 2014. To date, DNDi has secured EUR 74 million from public and private donors, including a significant initial contribution from Médecins Sans Frontières/Doctors Without Borders
Dr Asrat Mengiste arrives at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania. It’s 8am, and already 70 patients are lined up for a consultation. In the operating room are 20 local doctors. Dr Mengiste talks them through every action and explains every decision. After four days he will have operated on 40 patients and passed his knowledge and expertise on to another group of medical staff, eager to put into practice what they have learned.
Outreach patients travel for miles to reach Dr Mengiste’s team. Dr Mengiste insists: “The operations make a big difference to the lives of my patients. Most of them have suffered for a long time, often since birth. It may be a cleft palate so that one is unable to talk, eat or go to school. It may be a burn that has left one unable to walk or to hold things.”
More than 60% of the patients waiting in line are children. Amongst those awaiting surgery is four-month-old Angelina, whose mouth and nostrils are badly disfigured due to a cleft lip and palate. Angelina’s mother carried her for six hours to the nearest bus stop in order to bring her to the AMREF team in Moshi. Angelina cannot be breastfed because of her disfigurement - her mother has to feed her milk andporridge drop by drop.
Angelina is first on the operating table. Like with all his operations, Dr. Mengiste explains to observing medical students what has caused the condition, answers their questions, talks them through the surgery, and discusses aftercare.
This simple operation will transform Angelina’s life and her mother is overjoyed by the results: “Before the operation I had so many worries, that she would not survive, have friends or find a husband, now I am sure she will survive and live a normal, happy life”.
Next in line is a boy who injured his hand by falling into an open cooking fire. His little fingers were badly burned and have not healed well; his forefinger is now attached to his thumb by scar tissue. Nearly 99% of Tanzanians cook on open fires. Too often children fall into fires or scald themselves with boiling liquid. If the burns are not treated they form thick cobwebs of scar tissue, causing crippling deformities, making the simplest of tasks such as dressing or eating impossible.
During surgery Dr Mengiste separates the boys thumb and finger so they move independently again. Such a small operation will make an enormous difference to this little boy’s life. While recovering from surgery the boy tells Dr. Mengiste he is looking forward to going back to school and being able to write like the other children in his class.
Dr Mengiste and his team spend their lives travelling to remote rural hospitals. The challenges of performing surgery in these hospitals are immense. Water supplies are often scarce, surgical facilities and basic medical equipment are poor or non existent, and power cuts happen every day.
Despite these challenges, Dr Mengiste has carried out 1,702 consultations and 801 operations during 80 outreach trips in the last twelve months. “The fact that we are able to make a difference in the lives of many desperate people in our region makes me proud.”
The world is running a deficit of more than 4 million healthcare workers, but a proposed new shift in healthcare delivery may alleviate the shortage and bring new players to the field. An article in the 13 December edition of the New England Journal of Medicine, Rapid Expansion of the Health Workforce in Response to the HIV Epidemic, introduces the World Health Organisation's battle plan to combat the shortage and revolutionise the way we think of healthcare.
The plan, called Treat, Train, Retain, aims to treat and prevent HIV among healthcare workers, train newcomers to facilitate "task shifting", and attempt to retain existing workers. In Swaziland for example, a 2006 WHO report found that the public health sector has been crippled by staff shortages: 44 percent of posts for physicians, 19 percent of posts for nurses and 17 percent of nursing assistant posts are unfilled. The authors argue that the plan's second focus - training - presents the most challenging imperative to expanding the healthcare workforce, while in task shifting duties like administering treatment are moved to less specialised healthcare workers. Task shifting has been implemented in both low- and high-income settings with positive results.
The Democratic Republic of the Congo introduced the practice in the 1970s and '80s in response to a shortage of fully trained healthcare workers. Studies found that doctors could delegate standardised tasks to auxiliary workers without reducing the quality of care. In recent years, American and Australian nurses have increasingly taken on medical interventions previously handled by doctors, with studies showing an enhanced quality of care with reduced costs.
Clinical officers or medical assistants are already crucial to administering HIV treatment in Kenya,Ethiopia and Malawi, while Zambia is said to be moving in the same direction. But the WHO's new model of healthcare moves beyond medical personnel like nurses and clinicians to include communities, an approach already practiced in countries like South Africa, Zambia, India and Lesotho. However, the authors caution that a shift to innovative healthcare will need to be accompanied by a shift in mindset, and that the new systems will not offer a quick fix: training and credential systems will have to be developed, as will standardised protocols, including simplified drug regimens. Adopting these new models will involve political and financial commitments by governments, donors and international organisations.
The Guidelines for Treat, Train, Retain will be launched at the first-ever global conference on task shifting, to be held in Addis Ababa, Ethiopia, in mid-January 2008.
UNITED NATIONS, Dec 10 (IPS)- By Philip Rouwenhorst - The U.N. children's agency UNICEF says that increased cooperation among developing countries is benefiting the lives of poor children around the world, particularly in the critical first months of life.
"What we have seen is a very exciting new South-South collaboration in some of the areas of child health, specifically in the last few years," Peter Salama, UNICEF chief of health, told IPS. "One of the most exciting is actually around neonatal help."
"There've been [community-based] models that have been developed in India, for example," he said. "Over the last couple of years, we've seen that a team from India is actually traveling, particularly in East and Southern Africa, to do capacity-building and training in similar community-based models to reduce mortality in the first months of life."
In its "Progress for Children" report launched Monday, UNICEF highlighted several areas in which progress is being made, but also stressed the importance of more urgent action.
"This [report] is new in terms of the large number of countries that this is applicable for. It's relevant because it is data that has been taken mainly in 2006, which is roughly halfway through the period of the Millennium Development Goals from 2000 to 2015," said Alan Court, UNICEF chief of programmes.
"It gives a very good indication of how the world is doing and how different countries are doing in relation to those goals," he said.
In 2000, the world's countries and major development institutions agreed on eight goals, known as the MDGs, to ease severe poverty and promote environmental conservation by a deadline of 2015.
The MDGs include a 50 percent reduction in extreme poverty and hunger; universal primary education; promotion of gender equality; reduction of child mortality by two-thirds; cutbacks in maternal mortality by three-quarters; combating the spread of HIV/AIDS, malaria and other diseases; ensuring environmental sustainability; and developing a North-South global partnership for development.
To achieve the MDGs in the next eight years, U.N. Secretary-General Ban Ki-moon has stressed the growing importance of South-South cooperation.
In his latest report on this trend, Ban noted that, "Recent years have witnessed impressive increases in South-South development assistance... The stage is set for the ushering in of a new and more participatory form of international cooperation for development."
Reducing child mortality in the first five years of life is one of the major improvements highlighted in the UNICEF report. For the first time in modern history, the annual number of children younger than five who died worldwide fell below 10 million, to 9.7 million -- a reduction of 60 percent since 1960.
The report shows a significant increase in key survival interventions. For example, children receiving doses of vitamin A, which promotes healthy bone growth and prevents many diseases, increased more than four-fold since 1999.
Many countries in sub-Saharan Africa are expanding the use of insecticide-treated bed nets to prevent malaria infections, with 16 of 20 surveyed at least tripling coverage since 2000. In the 47 countries where 95 percent of measles deaths occur, measles immunisation coverage increased from 57 percent in 1990 to 68 percent in 2006.
There was also a modest reduction in the number of primary-school-age children without access to education. In 2005-2006, 91 million children were out of school, down from 115 million in 2002.
UNICEF also found evidence suggesting a decline of HIV prevalence in some sub-Saharan African countries. Court told IPS that international networking among experts and policymakers was one likely factor.
"For instance, there was a forum a week ago in South-Africa looking specifically at mother-to-child transmission, in which there were delegates from many, many countries who shared information on what works and what doesn't work. There are mechanisms for that sharing of information and for developing countries to learn from each other rather than necessarily programme jointly," he said.
Almost two-thirds of all people with HIV/AIDS live in sub-Saharan Africa. The report notes that only 11 percent of more than two million pregnant women living with HIV in low- and middle-income countries in 2005 received antiretroviral drugs to prevent them from infecting their babies. Botswana, Brazil and Thailand are among seven countries that gave such drugs to more than 40 percent of pregnant women with HIV.
In low- and middle-income countries, only 15 percent of children under age 15 in need of antiretroviral treatment in 2006 actually received it.
However, Salama told IPS that the news is not all bad. "There are many other examples where African countries themselves are really showing strong progress. One of them is Ethiopia, where in the last few years the government has made a very ambitious plan to train 30,000 community health workers."
"This model is attracting a lot of interest in southern Africa from surrounding governments because they see this as a potential way to really get around one of our major constraints in progress on the health-related Millennium Development Goals," i.e., cash-strapped public health systems and persistent misconceptions about how to prevent HIV/AIDS.
While Court also pointed to higher rates of exclusive breastfeeding, particularly in West Africa, as helping to lower child death rates, the UNICEF report found little progress in the area of maternal deaths, which total five million women each year.
According to Court, "This has been something that's been very difficult to move for sometime. This is particularly difficult because the numbers in a sense are not so alarming enough in any one culture to create the kind of crisis approach to dealing with the problem."
Early next year, UNICEF will release its annual "State of the World's Children Report". Court said "it will be looking at community-based approaches to care regarding health-related issues."
"This is going to be a major shift and one based on the lessons that we've learned coming from this database. This circulates through in terms of how we work in the United Nations country teams and countries and how we interact with governments."
GENEVA (AFP) — Deaths from measles fell by 91 percent in Africa over the past six years, the World Health Organisation (WHO) announced Thursday.
But the WHO warned that figures were still far too high in South Asia, singling out India and Pakistan for criticism.
Measles deaths between 2000 and 2006 in Africa dropped from 396,000 to just 36,000, contributing to a worldwide decline in measles deaths of 68 percent, according to the Geneva-based health organisation.
"This is a major victory, but our job is by no means done," Peter Strebel, measles officer for the WHO said.
"We need to expand the successful vaccination strategy used primarily in Africa to South Asia," he added.
"Large countries with high numbers of measles deaths, such as India and Pakistan, need to fully implement the proven control strategy," the WHO warned in a statement accompanying the report.
The WHO-led vaccination campaign is thought to have saved around 7.5 million lives. However, measles still kills nearly 600 children under five every day around the world.
Since 2000 nearly half a million children have been vaccinated in the 46 countries the most affected by measles, with "major gains" seen in Nigeria, Democratic Republic of Congo, Angola and Ethiopia, Strebel said.
But the vaccination campaign has been less well-applied in South Asia, where more than half of new-born babies are never vaccinated.
South Asian measles deaths last year stood at 178,000 -- more than five times the African figure.
The WHO's objective is to reduce measles' deaths by 2010 by 90 percent from the year 2000. Doing that will require an additional 200 million dollars (135 million euros), the WHO reckons.
Last year 80 percent of the world's infants had been vaccinated, compared with 72 percent in 2000.
To see the highly contagious virus eradicated, at least 93-95 percent of the population must be vaccinated -- which will require greater assistance from some countries' health services, emphasised Strebel.
"We know that the virus could be eradicated. It is biologically possible," he added, pointing out that measles transmission had completely disappeared on the American continent since 2002.
But one of the problems in entirely eradicating the virus, Strebel added, was that the major Western countries no longer considered it a "major threat" in terms of public health. Measles is more often fatal in poor countries because it attacks malnourished children.
ScienceDaily (Nov. 15, 2007) — For some families, the cancer diagnosis of a child strengthens existing religious ties or prompts new ones. Now, a new study by researchers at Brandeis University and the University at Buffalo - SUNY in Pediatric Hematology and Oncology reports that while most pediatric oncologists say they are spiritual, and many are open to connecting with the families of very sick children through religion or spirituality, they typically lack the formal healthcare training that could help them build such bridges.
"Increasingly, religion and spirituality are being recognized as important in the care of critically ill patients and we know that many parents draw on such resources to cope with their child's illness," said coauthor Wendy Cadge, a Brandeis sociologist. "This study suggests that we should consider training to help physicians relate spiritually to families confronting life-threatening illness such as cancer."
"Research shows that many patients do not feel the medical system adequately meets their spiritual needs," said Cadge. "By shedding light on how religion and spirituality connect to the practice of medicine, this study is a first step toward addressing such needs of patients and their families during a profoundly threatening chapter of life."
Source: Brandeis University (2007, November 15). A Dose Of God May Help Medicine. ScienceDaily. Retrieved November 15, 2007, from http://www.sciencedaily.com /releases/2007/11/071114111135.htm
Child mortality in impoverished Ethiopia has fallen over the past 15 years and steady development progress is being made in other areas as well, the visiting head of the United Nations Children’s Fund (UNICEF) has said, while stressing that more work is needed to build on these successes.
Under-five mortality rates have steadily declined to 123 out of every 1,000 live births, down from peak levels in 1990 when 204 out of every 1,000 children died before the age of five. However with close to 400,000 children under five still dying from preventable causes each year, Ethiopia continues to have one of the highest child mortality rates in the world. “Child mortality in Ethiopia has declined by 40 per cent in the last 15 years. We must build upon these gains to further improve the lives of children,” said UNICEF Executive Director Ann Veneman, while highlighting the importance of the Government, affected communities, donors and UN agencies working closely together for development.
“Partnerships are essential for Ethiopia’s success against the challenges of poverty, disease, nutrition, protection and education. We must act with urgency and build on our achievements so that Ethiopia’s children not only survive, but thrive.” The Enhanced Outreach Strategy for child survival – the largest ever collaboration between the UN and the Government of Ethiopia – and the water, sanitation and hygiene (WASH) campaign, are two examples of these partnerships.
Ms. Veneman’s trip to Ethiopia, which included visits to a commercial flower farm and a coffee cooperative, also saw her participate in the opening of the Plumpy’Nut factory in Addis Ababa, which is producing a ready-to-use-therapeutic food.
“Therapeutic foods such as Plumpy’Nut will help save the lives of severely malnourished children and help fight malnutrition across the country,” she said.
Ethiopia ranks second in Africa on the list of countries most affected by tuberculosis, a new survey has shown.
According to the research by the Africa Public Health Rights Alliance (APHRA), the 10 most TB-hit countries in the continent in descending order are: Nigeria, Ethiopia, Kenya, DR Congo, South Africa, Tanzania, Uganda, Sudan, Ivory Coast and Mozambique.
The findings were unveiled on Thursday at the start of the 38th Union World Conference on Lung Health that run from November 8-12 in Cape Town, South Africa. APHRA also launched the 15% Now! Campaign, urging governments to dedicate 15% of their budgets to health.
"Due to the abysmally low levels of health financing, millions of Africans are unable to receive treatment," APHRA Coordinator, Rotimi Sankore, said in a statement. "Demoralized health workers are being poached in thousands by more developed countries taking advantage of the situation." Sankore said it is a cause for great anxiety that on a continent where poor reproductive health has already led to maternal death levels of 261,000 a year, TB is now emerging as the biggest killer of women.
The Alliance urges African governments to first show commitment towards saving their own continent, and take donor funding as complimentary.
He said governments have largely failed to act. "Many have acted like the proverbial home owner that went back to sleep after being alerted by neighbors to the burning roof," he said. "The fact that pivotal countries like Nigeria, Ethiopia, Kenya, DRC and South Africa are carrying the greatest TB burden shows how easily they could drag down the regions that revolve around them." Globally, Nigeria ranks 4th, Ethiopia 7th, Kenya 9th and DR Congo 10th. Also, 33 of the 40 most infected countries in the world are in Africa, according to the survey. It shows that the 10 most infected countries globally are also among the highly populated. They include India, China, Indonesia, and Pakistan.
TB spreads through close contact with the infected. Its symptoms include protracted cough, weight loss, and fever.
Health officials and legal experts on Wednesday gathered for a two-day meeting in Accra, Ghana, to discuss intellectual property laws that could make antiretroviral, malaria and tuberculosis drugs available, accessible and affordable in the country, the GNA/Accra Daily Mail reports. The workshop, under the theme, "Increasing Access to Medicines in Ghana; The Role of WTO/ Trade Related Aspects of Intellectual Property Flexibilities," is being attended by representatives from local and international pharmaceutical companies, the World Health Organization, the World Trade Organization and donor organizations.Health Minister Maj. Courage Quashigah, speaking at the opening of the meeting, called on officials to make a concerted effort to reduce the burden of the three diseases. "A significant component of that effort must be to make effective drugs accessible to people at risk," he said. Elias Kavinah Sory, director-general of the Ghana Health Service, noted that many essential medicines remain too costly in relation to local buying power. Sory said essential medicines have saved lives and improved health but "only if they are available, affordable and properly used." Quashigah said that there are overwhelming disparities in access to medicines, adding that some current treatments for diseases in developing countries might soon become irrelevant because of the widespread drug resistance. William Ofori, chair of the Association of Representatives of Ethical Pharmaceutical Industries, raised concern about the inability to find new TB treatments and called for collaboration between local and multinational companies to produce quality, affordable drugs (GNA/Accra Daily Mail, 11/7).
Keith Alcorn, Thursday, November 08, 2007 Aidsmap news
The growing problem of multidrug-resistant (MDR) tuberculosis threatens to derail TB control efforts unless there is greater investment in control and diagnosis, TB experts warned this week in the run-up to the 38th World Lung Health conference, which opens tomorrow in Cape Town, South Africa.
This year’s conference is taking place in South Africa in order to highlight the growing challenge of drug-resistant tuberculosis in the regions of the world most seriously affected by HIV.
Last year’s discovery of an outbreak of extensively drug-resistant TB among HIV-positive patients in the rural KwaZulu Natal town of Tugela Ferry rocked the worlds of TB and HIV treatment, and highlighted the need for greater integration of TB and HIV care.
“XDR TB is a wake-up call to ensure a better future of HIV treatment by strengthening TB control,” said Dr Haileyesus Getahun of the World Health Organization Stop TB department, speaking at a workshop on XDR and MDR-TB in the context of HIV, organised by the Treatment Action Group and the Stop TB Partnership.
The XDR outbreak has now spread to every province in South Africa, and two cases have been identified in Mozambique, Dr Lindewe Mvusi, TB director of the South African department of health, reported at the International Union Against Tuberculosis and Lung Disease African regional meeting on Wednesday. Four hundred and eighty-one cases have now been identified in South Africa, 188 in KwaZulu Natal, 157 in Eastern Cape and 64 in the Western Cape, with 281 deaths to date. Two hundred and thirty-five patients are currently receiving treatment in hospital, while 18 patients have been discharged to receive directly observed therapy in the community following conversion to a smear-negative state. Although extensively drug-resistant tuberculosis has been spotted before, notably in China, India and the Russian Federation, this is the first time it has emerged in a region where HIV prevalence is high. The consequences have been particularly bleak in people with HIV, said Dr Neel Gandhi, part of the research team that identified the Tugela Ferry outbreak. Almost all HIV-positive patients died within weeks of being examined for suspected tuberculosis, often before the results of sputum tests could confirm tuberculosis, and XDR-TB was confirmed retrospectively in many patients.
The Church of Scotland hospital in Tugela Ferry has seen little improvement in survival rates since the initial outbreak was identified in April 2006, Dr Gandhi said this week. Where has the XDR-TB outbreak come from? Although there’s little doubt that the current outbreak is due in large part to transmission from person to person, particularly in health care settings, and that proper implementation of infection control measures could greatly reduce the incidence, the initial XDR case must have developed as a result of the evolution of drug resistance in persons receiving first and second-line TB treatment. Molecular analysis of the XDR-TB strains present in Tugela Ferry patients has been able to uncover the gradual accumulation of resistance to more and more drugs.
The road to XDR-TB in KwaZulu Natal began around 1994, when patients first began to develop strains resistant to all first-line drugs. As the decade went on, these drug-resistant strains, circulating in the community, began to accumulate resistance to additional drugs used in second-line TB treatment, until by 2001 the first strain classified as extensively drug resistant is now known to have been present in a patient in KwaZulu Natal. But at the time no one knew just how much drug resistance was already present in some TB patients due to the lack of drug sensitivity testing. The critical step appears to have been presumptive treatment of patients who had failed first-line TB therapy, using a standard regimen of second-line drugs.
Why should it have emerged in KwaZulu Natal? Probably because the province has consistently had the lowest TB cure rate in South Africa; just 45% of patients who commenced TB treatment were pronounced cured in 2006, compared with just over 70% in the Western Cape province. A national drug sensitivity survey carried out in 2001/2002 showed that although the highest prevalence of MDR-TB per capita occurred in the northern provinces of Mpumalanga and Limpopo, the largest numbers of cases of multi-drug resistance were found in KwaZulu Natal and the Western Cape. In addition, KwaZulu Natal has the highest HIV prevalence in South Africa, in excess of 30% in many communities, compared with levels closer to 10% in the Western Cape. HIV-positive people are particularly vulnerable to TB, and likely to have a faster and more virulent course of MDR-TB. All these factors explain why KZN was the site of emergence, but what’s still unclear is whether the outbreak spread across the country from the province, or whether greater vigilance coupled with drug sensitivity testing uncovered a phenomenon that was emerging simultaneously in every province of South Africa.
Other countries in Africa have reason to be concerned about the potential for home-grown outbreaks of XDR-TB. The World Health Organization estimates that alongside South Africa, Nigeria and Ethiopiaare the hotspots for MDR-TB in Africa, followed by Tanzania, Malawi, Zambia, Rwanda, Mozambique and the Democratic Republic of Congo. Countries in southern and central Africa are currently investigating whether XDR-TB is present, but surveillance will be hampered by the severe shortage of drug sensitivity testing. Few laboratories are equipped to do it, the equipment is expensive and trained staff are thin on the ground. For most countries, the likelihood that XDR-TB is present will be present is governed by the extent to which patients already have access to second-line TB treatment. Second-line TB treatment is expensive ($1500 - $4000 for a course of treatment), it’s hugely labour intensive and requires hospital beds to be set aside for six to eight months until the patients achieves conversion to smear-negative. Just under 40% of TB programmes in Africa and Asia currently include MDR TB treatment as part of their routine activities, says Dr Haileyesus Getahun of WHO. The WHO and Stop TB Partnership has set a target for the expansion of MDR-TB treatment from 30,000 patients worldwide in 2007 to 1.6 million in 2015. The target is based on the estimated number of patients who fail TB treatment and develop drug resistance to components of the first-line regimen.
Unless efforts to control MDR-TB succeed, said Dr Mario Raviglione, director of WHO’s Stop TB department, “MDR-TB will replace the drug-susceptible strain as the dominant strain. There are countries in the former Soviet Union already approaching 15 – 20% [of new TB cases MDR] today.” But, says Dr Rhehab Chimzizi of Malawi’s National TB Programme, “What is slowing us [in MDR response] is laboratory capacity. We have one lab to do drug sensitivity testing and sputum culture for a country of 12.8 million people!” Until countries can carry out drug sensitivity testing, their requests for free or subsidised second-line drugs are likely to be turned down by WHO’s Green Light Committee, which approves requests for second-line TB drugs based on the capacity of a country to preserve the efficacy of those drugs. Currently, drug sensitivity testing is not only expensive but slow. It can take five to six weeks to establish whether a TB isolate is resistant to rifampicin or isoniazid, or both, often leading to presumptive treatment with an inappropriate combination of drugs that can serve to increase the level of drug resistance. Tests of a new method of diagnosing isoniazid and rifampicin resistance without the need for culturing TB bacteria are currently underway in southern Africa, and if successful, could lead to the approval of a new diagnostic method by WHO within a year.
This would have the potential to speed up MDR treatment, if the investment in laboratory standards takes place now. But, as Dr Mario Raviglione points out, unless donors begin to invest in combating the MDR-TB crisis now, we will fall further and further behind in the fight against MDR-TB. Earlier this year WHO and the Stop TB Partnership issued a call for $2.15 billion to back an extensive plan to combat MDR and XDR TB. So far, he says, there is a funding gap of close to half a billion dollars in 2007, despite the fact that more than 400,000 MDR-TB cases are expected to be diagnosed this year alone. More on MDR and MDR-TB Further reporting on MDR and XDR-TB, including new models of community-based treatment, will appear during the coming week from the 38th World Lung Health conference in Cape Town at http://www.aidsmap.com/
More than a third of patients on HIV medication in sub-Saharan Africa die or discontinue their treatment within two years of starting it, a survey shows.
The study found that many were too late taking up anti-retroviral (ARV) drugs, while for some it was impractical to travel to distant clinics.
The US researchers also found evidence that in cases where patients had to pay for ARVs, some stopped treatment. But it showed success rates vary depending on the programme and country.
Daily stress Details of the study by the Boston University School of Public Health are published online by the Public Library of Science.
The researchers looked at antiretroviral programmes for HIV patients in 13 sub-Saharan countries. They found that two years on from the commencement of treatment, only 61.6% of all patients were still receiving medication. The researchers say there are many reasons for the fall-out rate. Many patients were too late in taking up ARVs in the first place and died within a few months of commencing treatment. Other patients dropped out because of problems with accessing the drugs - they may live some distance, for example, from the clinic which provided the medication.
There was also evidence, the researchers say, of patients discontinuing treatment because of the cost of the drugs in those cases where patients were charged for their ARVs. Boston University's Dr Christopher Gill says in many cases, taking the ARVs may take a back seat to more pressing daily needs. "Receiving the drug itself is a major investment of a patient's time, so if you live 8 km from the nearest clinic and have to go there once a month and you don't have a ready means of transport it's a huge investment of your own time," he told the BBC. "And if you're feeling well and you're worried about other things in terms of finding enough to eat or maintaining a job or finding a job I suppose if you were feeling well you might be tempted to see treatment as being a second-order priority.
Poverty For the director of the Association of People with Aids in Kenya, poverty, a lack of education and an element of stigma are all part of the problem. "If people are not well educated on how to take the drugs, then some patients fall out, and if they do fall out then they develop resistance," Roland Gomol Lenya told the BBC. "We find some people also suffer from stigma: in some workplaces, people are not able to carry their ARVs and take their ARVs freely at workplaces. "I think there are also the issues of poverty, and the people who administer ARVs should also look at the poverty element, because sometimes because of poverty people are not able to access the centres. "The centres are normally far away from where people live, and that has been a problem." The study shows that retention rates between individual ARV programmes vary widely across Africa. One programme in South Africa retained as many as 85% of their patients after two years while another in Uganda retained only 46% of patients after the same period of time.
The rate of the number of people tested for HIV/Aids in Ethiopia since February-August 2007 and found to be positive showed 26 % increase; compared to similar test conducted from November, 2006 -January 2007, a report compiled in September, 2007 disclosed.
The report entitled Millennium Aids Campaign Ethiopia (MAC-E) prepared FHAPCO (M&E Department) states the plans and actual performances carried out on HIV council ling and testing, ART treatments and the momentum for the continuation of the campaign to the third phase where the first two are already completed.
According to the report, in the first phase of the campaign that lasted from Nov 2006-Jan2007, 705,619 people were tested for HIV/AIDS and 37,943(5.4%) were found to be positive. In the second phase, out of the 982,452 people tested, 70,470 were found to be positive (7.3%), according to the report, which showed a 26% increase by the end of August 2007.
The two major objectives of the campaign in the first phase were testing 320,000 people and enrolling 22,000 new patients to ART service; and more than double were tested. The ART plan for new patients fell short of the set target 11,582 but nevertheless a substantial increase from the previous trend, the report states.
In phase II of the campaign, though it was planned to test and council 1.8 million individuals over the seven months period, 982,452 were actually tested (53%) and 31,359 new individuals started ART (77%) from the 40, 710 planned to initiate.
In a round table discussion prepared yesterday at Internews meeting room, Dr. Yibeltal Assefa, health program officer at HAPCO discussed about the plan for the third phase of the program and the comprehensive Universal Access Program (UAP) set for 2010. He said, "three million test kits are prepared for the new year which will render by far better testing and counseling services than the past years." Sensitization, social mobilization and community conversation are also the major areas of emphasis given in the third phase, according to the officer. In the (UAP), it is planned to achieve to have one health center one test post in each woreda o f the country, Dr. Yibeltal indicated.
'Dawn of Hope' in Ethiopia (World Bank News) June 12, 2007 - In 2000, while finishing a university degree in plant sciences and then working as an agronomist, Sileshi Betelei suffered two serious bouts of illness and found out he had HIV. Counseling helped him find the courage to tell his family, and they were very supportive. He believes their positive attitude stemmed from their understanding that anyone can get HIV.
He returned to work and continued to live a normal life, until 2001 when his CD4 (T-cell) count dropped to a dangerously low level, and he became extremely weak. Though Sileshi wanted to start on antiretroviral medications, he could not afford the drugs then available in Ethiopia. He refers to this period of his life as “the disaster time.”
A year later, Sileshi learned about Dawn of Hope – a local nongovernmental organization in Ethiopia that supports people infected and affected by HIV. He decided to join them, and work on the advocacy campaign to get public provision of free anti-retroviral treatment (ART). During this period he received drugs for opportunistic infections through Dawn of Hope – financed by the Ethiopia MAP. This enabled him to manage his health well enough to keep going, and to get married. His wife is also HIV-positive.
As an activist, Sileshi and others lobbied the government as well as officials from UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In 2004 Ethiopia’s ART program was launched, with money from the Global Fund.
After 18 months on treatment, Sileshi’s CD4 count improved and he felt strong enough to start a second university degree in management. Seeing a future for themselves, Sileshi and his wife began a family. Today, Sileshi is a leader in the Ethiopian AIDS community, representing people living with HIV on the National AIDS Council and the National AIDS Committee Management Board. He is also the proud father of an 18 month-old son, who is HIV-negative, thanks to treatment to prevent transmission from mother-to-child. While it is access to free antiretroviral drugs that is keeping him and his wife healthy today, Sileshi says that they and many other Ethiopians with the virus would not have survived if not for the free drugs to fight opportunistic infections, financed by the World Bank’s Multi-Sectoral AIDS Program.
“The MAP made a big difference in people’s lives,” Sileshi says. “Before treatment, people were dying of opportunistic infections. The MAP enabled us to arrive at the era of antiretroviral treatment.”. He also points out that counseling and home-based care provided through the MAP were essential. “Without counseling, there is no positive living, there is no hope.”
Addis Ababa, Ethiopia - A new 100 mln birr medicine factory, Cadila Pharmaceuticals Limited, which is operating in 43 countries throughout the world, has begun production in Akaki-Kaliti sub city.
The factory is an Indo-Ethiopian joint venture with local company ALMETA Impex and Indian parent company Cadila Pharmaceuticals, with the expatriates holding the majority shares. According to Mr. Nalini Nayak, Marketing Manager of Cadila, the factory will be the first of its kind in East Africa, when it will soon be qualified by the United States Food and Drug Administration (US FDA). Cadila India has recently qualified to the World health Organization (WHO) Good Management Practice (GMP). "Ethiopia has a very good potential market, which is not yet explored," said Mr.Nayak. Besides, we are happy to work in Ethiopia; where there is a strict drug regulation. It is difficult to find such an atmosphere in other African countries," he said. Nearly 200 employees have begun operations at CADILA Pharmaceuticals. Anti biotics, anti-malarias, anti-acids, anti-fungal and multivitamins are the medicines that the company is currently producing. Anti-tuberculosis and anti-AIDS drugs are also being planed for production. In addition to local demand, CADILA Pharmaceuticals will also export its products to neighboring markets such as Kenya, Sudan, Uganda and Djibouti. Sunshine, Addis, Bethlehem, Pharmacur and Epharm Pharmaceuticals are the existing factories engaged in medicine production. The opening of CADILA Pharmaceuticals will raise the number of medicine factories to six.
Tibotec Pharmaceuticals Ltd. Of Ireland on Wednesday announced that it has signed a royalty-free, non-exclusive license agreement with the South African company Aspen Pharmacare. According to a press release from the two companies, Aspen will register, package and distribute the protease inhibitor PREZISTA (darunavir, DRV) in sub-Saharan Africa.
Traditional medicine has been defined by the World Health Organization (WHO) as “the sum total of all knowledge and practices, whether explicable or not, used in the diagnosis, prevention and elimination of physical, mental or social imbalances and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing.” This system of health care is also known as folk medicine, ethnomedicine, or indigenous medicine. In some countries, including the US, the terms complementary or alternative medicine are used interchangeably for traditional medicine.
Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence Abstract: Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health ; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research ; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems. Key words: biodiversity, deforestation, ecosystems, emerging infectious diseases, land use, Lyme disease, malaria, urban sprawl, wildlife, zoonosis. Environ Health Perspect 112:1092-1098 (2004) . doi:10.1289/ehp.6877 available via http://dx.doi.org/ [Online 22 April 2004]
Ethiomedicine strives to raise awareness about the inequitable access to health care services around the world, focusing more on Ethiopian/African health issues.
Awareness to action promotes meaningful change.
I am open to suggestions as to how, as a collective or individuals, we can help best; email me at michael.lethiopia@gmail.com or check the TAKE ACTION sites in my blog...
Health is a social good. Healthy society is a happy society!
Thank you for visiting Ethiomedicine.
THE FISTULA FOUNDATION
