Rwanda is using drone technology as an effective and innovative way of eradicating malaria in breeding sites. Credit: Aimable Twahirwa/IPS

By Aimable Twahirwa
KIGALI, Feb 8 2024 (IPS)

Experts recommend that the current prevention of malaria in highly endemic countries in Africa should integrate “locally appropriate” control measures to cope with the highest burden of mosquito-borne disease on the continent.

The latest 2023 World Malaria Report shows that the life-threatening disease remains a significant public health challenge, with both malaria incidence and mortality higher now than they were before the start of the COVID-19 pandemic on the African continent.

According to a World Health Organization (WHO) report, the effects of climate change and other issues pose a threat to the advancement of the disease-fighting effort.

Official statistics show that the African region disproportionally bore the brunt of the malaria burden in 2022, accounting for 94 percent of global malaria cases and 95 percent of all malaria deaths, which were estimated at 608,000, a nearly 6 percent increase since 2019.

WHO’s Africa office’s Tropical and Vector Borne Disease Lead, Dr. Dorothy Fosah-Achu, told IPS that vector control interventions in Africa have remained challenged, with bednets being one of the most effective vector control tools the continent is relying on.

“Most endemic countries [in Africa] are adopting new treated bednets to replace those having the issue with resistance, but these improved nets are more expensive, which makes it challenging for countries to cover large zones using this intervention,” Fosah-Achu said in an exclusive interview.

The latest WHO report on malaria places a special focus on climate change as a critical factor threatening progress in the fight against malaria. Climate-related disruptions, such as extreme weather events, may have exacerbated the spread of the disease.

Alongside climate change, other issues are threatening efforts to fight malaria.

The funding gap has grown, the report says. “Total spending in 2022 reached USD 4.1 billion—well below the USD 7.8 billion required globally to stay on track for the global milestones of reducing case incidence and mortality rates by at least 90 percent by 2030 (compared with a 2015 baseline).” This funding would include both control, diagnosis, preventative therapies, and treatment.

Growing resistance to available control tools, such as insecticides and antimalarial drugs, remains an increasing concern.

According to experts, most African countries do not have enough bednets.  They do have insecticides that can be used to spray homes at breeding sites, but those interventions are very expensive.

While the high proportion of the population without access to quality medicines for malaria in Africa continues to be another issue, Fosah-Achu is convinced that the consequence of high mortality in Sub-Saharan Africa is also related to the limited health facilities and hospitals that provide access to treatment in a timely manner to the population living in remote zones.

In addition, health experts say that any success of antimalarial interventions in endemic countries in Africa will require appropriate coordination of efforts in terms of fighting against the resistance of vectors to insecticides and the resistance of parasites to medicines.

According to experts, another challenge is that endemic countries in Africa have technical capacity gaps because their national health facilities are not equipped with the right human resources who are able to manage programs and monitor some of these biological threats, such as vector resistance.

The latest estimates by the World Health Organization (WHO) show that in Africa, an estimated 233 million cases of malaria occur each year, resulting in approximately 1 million deaths. More than 90 percent of these are in children under five. Official statistics show that currently the African region bears the heaviest malaria burden, with 94 percent of cases and 95 percent of deaths globally, representing 233 million malaria cases and 580,000 deaths.

Dr. Ludoviko Zirimenya, a medical researcher at the Uganda Virus Research Institute (UVRI), told IPS that the changing climate across many endemic regions in Africa poses a substantial risk to progress against malaria.

“Africa is the most affected due to a combination of factors, the major one being climate change,” Zirimenya said.

In Rwanda, like other endemic countries across Africa, malaria is often found in rainy seasons, and meteorological factors and altitude are described by experts as the major drivers of malaria incidence on the continent.

Both Zirimenya and Fosah-Achu believe that the burden of malaria transmission on the continent can be reduced when countries put in place appropriate mechanisms to strengthen the data management system to ensure they have strong surveillance systems.

Public health experts observe that climate change is a growing issue, and countries in some endemic countries have little support to set up programmes to counter its impact.

The WHO report acknowledges this saying: “Equally crucial is the need to position the fight against malaria within the climate change/health nexus and to equip communities to anticipate, adapt to, and mitigate the effects of climate change, including the rise of extreme weather events. As you will see in the report, there are a range of actions—strategic, technical, and operational—that countries and their partners should begin to pursue now.”

Currently, numerous interventions to control malaria have been implemented across many African countries, but experts note that the incidence of the killer disease has increased in recent years.

“There are financial capacity gaps to be filled by some countries. Most African governments still need to learn how to mobilize resources and ensure that [malaria interventions] programs deliver on the plans that they have developed themselves,” Fosah-Achu said.

Despite these challenges, there have also been achievements. Recent progress includes the launch of the first malaria vaccine, RTS,S/AS01, and the endorsement by WHO of a second vaccine, R21/Matrix-M. Additionally, the use of new dual-active ingredient insecticide-treated nets and expanded malaria prevention for high-risk children have been crucial advancements, offering new avenues for combating the disease.

IPS UN Bureau Report

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A child health consultation at Obunga Dispensary in Homa Bay, one of the eight counties participating in the malaria vaccine pilot program. Credit: Joyce Chimbi/IPS

By Joyce Chimbi
NAIROBI, Oct 25 2021 (IPS)

One morning in 2016, Lillian Nekesa’s 3-year-old woke up with flu-like classic symptoms of malaria. This was not Kevin’s first encounter with the killer disease.

Kevin was nonetheless not immediately rushed to Busia County Referral Hospital for advanced treatment in keeping with his severe symptoms.

Nekesa rushed him to a village dispensary because the referral hospital is an hour’s walk away from their home in Mayenje, Busia County.

“Two days went by, and Kevin did not improve, and by the time we got him to the referral hospital, it was too late,” she recounts.

This is not an isolated incidence, says Desmond Wanjala, one of 10 Community Health Volunteers serving a Community Health Unit of 1,000 households in the area.

He says malaria is commonplace in Busia, situated near the Lake Victoria region. Malaria incidence in Busia is six times higher than the national average of 5.6 %.

Government estimates further show that counties around the lake region bear the highest malaria disease burden, with a prevalence rate of 19 %.

“Over 70 % of the population in Busia is at risk of malaria, and help is not always within reach, especially in emergencies. We are deep in the village, and the main mode of transport to the referral hospital is a motorbike that charges $2 to $5, which people struggle to afford,” he says.

Malaria is a primary health concern, as per World Health Organization (WHO) statistics. In 2019, malaria caused an estimated 229 million clinical episodes and 409,000 deaths.

Approximately 94 % of these deaths were recorded in the WHO African Region. In Kenya alone, about 3.5 million new clinical cases and 10,700 deaths are recorded annually, according to government data.

Against this backdrop, Dr Bernhards Ogutu, Malaria Lead Researcher at the Kenya Medical Research Institute (KEMRI), tells IPS that RTS,S with a brand name Mosquirix, has the potential to reverse this trend.

It is the only approved malaria vaccine.

Thirty years in the making, he says that Mosquirix is a lifeline for children, especially in rural malaria-endemic areas. He says that children continue to die despite free malaria treatment, largely due to late presentation to health facilities.

Currently piloted in Kenya, Ghana and Malawi, Dr Christopher Odero tells IPS that the vaccine targets infants and young children in Africa because it was developed to build immunity specifically against the plasmodium falciparum.

Odero, a technical advisor and specialist on malaria and vaccines at PATH, says that Plasmodium Falciparum is the world’s deadliest malaria parasite. The parasite is predominantly found in Africa, accounting for about 90 % of the total Plasmodium parasites on the continent. The female Anopheles mosquito transmits it.

He explained that the vaccine would work best in malaria-stricken regions of sub-Saharan Africa region and other areas of Africa with moderate-to-high malaria plasmodium falciparum transmission.

Odero emphasises that even though the reported vaccine efficacy is 40% against clinical malaria, the public health benefits of using this vaccine are enormous. The benefits of using the vaccine, alongside other malaria prevention measures endorsed by WHO, far outweigh the risks.

He particularly stresses that the vaccine is a complementary malaria control tool that should go hand-in-hand with the routine use of insecticide-treated bed nets, indoor spraying with insecticides and timely access to testing and treatment of malaria.

The potential impact of the vaccine cannot be ignored. Four out of 10 vaccinated children will not get malaria and, three out of 10 vaccinated children will not get severe malaria, says Odero.

He says the vaccine takes the pressure off resource-strapped health systems as six of 10 vaccinated children with severe malaria would not require a blood transfusion.

In Western Kenya, home to the ongoing pilot program across eight counties, Odero says that the vaccine can reduce the average episodes of malaria attacks per child from five to two per year. A crucial outcome as repeated malaria attacks can have lifelong effects such as chronic anaemia and stunted growth.

This proven capacity to reduce child deaths, severe malaria, and safety in the context of routine use has informed WHO’s policy recommendation on the broader use of the vaccine, he says.

Ogutu agrees, emphasising that the vaccine quality and risk-benefit profile are favourable. The feasibility of implementation, potential public health impact and likely cost-effectiveness of rolling out the vaccine are not in doubt.

Despite the ongoing COVID-19 pandemic, he says that the vaccine has achieved equitable coverage. Ogutu says that at least 250,000 children in Kenya have already received all four recommended doses, and they will remain in the pilot program until 2022.

Ogutu says that there is a need for continued assessment to gather additional information on the vaccine’s effectiveness over a more extended period and assess long-term effects on the community and any other issues that could emerge with routine use of the vaccine.

The ongoing pilot malaria vaccination program is financed through the collaboration of three global health funding bodies: Gavi, The Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.

Additionally, WHO, PATH and GSK are providing in-kind contributions. GSK, for instance, the vaccine manufacturer, will donate up to 10 million doses of Mosquirix. To date, over 2.3 million doses have been administered across Kenya, Ghana, and Malawi.

Ogutu says that the vaccine could be available for broader use in Kenya in the next year to 18 months – a step in the right direction for all children at risk and the coastal areas near the Indian Ocean and Lake Victoria region.
He cautions against vaccine-related myths and misconceptions associated with any new vaccine that could compromise the use of the ground-breaking scientific innovation.

To increase and sustain a high vaccine coverage, Wanjala urges the government to continue supporting the training on vaccines for community health volunteers (CHVs). The CHVs remain the primary link between communities in rural areas and health facilities.

As of 2019, Kenya had about 6,000 Community Health Units out of a targeted 10,000 units supported by at least 86,000 community health volunteers like Wanjala.

“Each community health unit is supported by ten community health volunteers. We need support to use this community system to promote vaccine uptake,” Wanjala concludes.

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Malaria still kills 400,000 people every year, most of them African children under five years old. RTS,S is the first malaria vaccine shown to reduce malaria and life-threatening severe malaria in young children. Credit: Mercedes Sayagues/IPS

By Kesete Admasu
Sep 1 2021 (IPS)

In the midst of the tragedy and turmoil caused by the COVID-19 pandemic, it’s gratifying to see work continuing in Africa to find new ways of fighting malaria, a very old disease that has been a formidable foe for thousands of years and still kills 400,000 people every year, most of them African children under five years old.

Scientists from the London School of Hygiene and Tropical Medicine and their colleagues at the Institut de Recherche en Sciences de la Santé in Burkina Faso and the University of Bamako in Mali published results
from a phase 3 trial that involved the world’s first and only malaria vaccine.

The new evidence from Mali and Burkina Faso shows that RTS,S—which is also being introduced in Ghana, Kenya and Malawi in a landmark pilot introduction —could be an even more valuable tool than originally expected. And those of us involved in the fight against malaria are certainly eager for good news.

RTS,S is the first malaria vaccine shown to reduce malaria and life-threatening severe malaria in young children. Approximately 2.1 million doses of the vaccine have been provided and more than 750,000 children have received their first vaccine dose through the pilot programme where malaria risks occur year-round

Working in areas where malaria surges during the rainy season, the researchers report a dramatic reduction in malaria illness and deaths among young children who received the RTS,S vaccine just before the rains began. They found the vaccine worked as well as the standard prevention practice in these regions, known as seasonal malaria chemoprevention (SMC), which involves administering treatment doses of common antimalaria drugs monthly during the rainy season, usually through a door-to-door campaign.

This is an important finding. SMC is a resource-heavy intervention, and in some settings an annual pre-season single dose of a vaccine could be an attractive alternative.

However, the most striking results occurred in the group of some 1700 children who received both interventions—the medications and the vaccine. They experienced a 60% – 70% additional reduction in severe disease and hospitalizations compared to the already impressive stand-alone interventions—the prevention drugs or the RTS,S vaccine—and also more than a 70% reduction in deaths from malaria. Equally important: the combination was found to be safe and well tolerated.

I was one of a group of African Ministers of Health in June 2016 who served on the Board of Gavi, the Vaccine Alliance, and passionately supported the funding for a RTS,S pilot to learn more about its public health potential. These new results are heartening.

RTS,S is the first malaria vaccine shown to reduce malaria and life-threatening severe malaria in young children. Approximately 2.1 million doses of the vaccine have been provided and more than 750,000 children have received their first vaccine dose through the pilot programme where malaria risks occur year-round. Results from the pilot programme indicate strong community demand for the malaria vaccine as well as the capacity of childhood vaccination to deliver it. This new study in Burkina Faso and Mali provides additional evidence of RTS,S safety and effectiveness.

Just before the COVID-19 pandemic arrived, Africa’s fight against malaria was stalling at what the World Health Organization (WHO) called an “unacceptably high level” of deaths. Regaining momentum in the malaria fight will require new tools, especially with existing preventive interventions threatened by emerging insecticide resistance.

New tools to fight malaria are especially needed in countries like Mali and Burkina Faso, located in a region known as the African Sahel—a semi-arid ribbon of land that spans the continent from Senegal to Sudan. There, the danger of malaria flares dramatically with the arrival of the rainy season. Today, six of the ten African countries singled out by the WHO as requiring “high impact” malaria interventions are in the Sahel, where malaria remains a primary cause of childhood death despite substantial reductions in malaria achieved through a combination of SMC and insecticide treated nets (ITNs).

Through the development of the RTS,S vaccine over the last 30 years, scientists have discovered that the protective efficacy of RTS,S is particularly high in the first months following vaccination. This feature prompted researchers to study whether RTS,S could be provided strategically, just before the peak malaria season, to fight seasonal malaria transmission.

Giving the RTS,S malaria vaccine seasonally was found to be safe and effective—and combining SMC with the vaccine was especially powerful—and could expand the options available for fighting malaria.

In October, global advisory bodies for immunization and malaria will convene to review available RTS,S evidence and consider a potential WHO recommendation for wider use of the vaccine across Africa.

If WHO recommends the vaccine for wider use, African governments should be prepared to seize on the life-saving opportunity. They must be ready to make smart and strategic decisions to deploy this vaccine while continuing to promote the use of other proven malaria interventions to maximise impact.

We have seen in COVID-19 what the global health community can accomplish when it comes together to fight a killer disease. It would be a welcome turn of events to see Africa emerge from the pandemic with a new tool to take on the old foe of malaria with renewed vigour to get progress in malaria control back on track.

Dr Kesete Admasu, CEO of Big Win Philanthropy, former CEO of the RBM Partnership to End Malaria, and former Minister of Health of the Federal Democratic Republic of Ethiopia

Two decades of investments in malaria so far have saved a staggering 7.6 million lives and prevented 1.5 billion malaria cases. But progress plateaued by the end of 2019 with political will and funding declining. Credit: Mercedes Sayagues/IPS

By Joy Phumaphi and Sarthak Das
Apr 23 2021 (IPS)

The occasion of World Malaria Day amidst a global pandemic warrants an examination of the intersection between our decades long battle against the world’s oldest known fever and the newest known pathogen fueling a global pandemic.

In our estimation, one theme is abundantly clear: effective management of COVID-19 through coherent public health responses protecting their people are underpinned by strong leadership. For months now, we are largely operating with the same set of public health guidance such as physical distancing and masking.

When national leadership decide to prioritize an issue, there is no question that progress will follow; malaria provides an excellent example. After two decades of strong political commitment and effective interventions, 21 countries from every region worldwide eliminated malaria, and many more are on the cusp of elimination. 7.6 million deaths have been averted since 2000

From Singapore to Spain, Mauritania to Manhattan, outcomes, however, have been radically different. Yes, capacities to test, track and treat vary widely; the poor face greater risk exposure. Even with these disparities, it is clear that leadership is key: from accepting the guidance of science to the role of communities in translating policies into action.

When national leadership decide to prioritize an issue, there is no question that progress will follow; malaria provides an excellent example. After two decades of strong political commitment and effective interventions, 21 countries from every region worldwide eliminated malaria, and many more are on the cusp of elimination. 7.6 million deaths have been averted since 2000.

How then, in the midst of a global pandemic, can we accelerate the fight against malaria? Indeed, what are relevant lessons from malaria for public health amidst COVID-19?

Three areas are critical to re-accelerate the momentum and ensure malaria elimination remains a viable goal.

First, we must maintain the political will that drives leadership at multiple levels– families to communities to districts up to the national level.

Second, we need sustained financing for malaria and to communicate effectively to leaders the return on investment in terms of improved health outcomes.

Third, we must clearly articulate the link between malaria and health systems strengthening.

1. Leadership & continued renewal of political commitment

Progress to date has shown that political will is fundamental to elimination. Leaders in the two regions have demonstrated this political will.

From the 2000 Abuja Declaration, 2006 Abuja Call, 2012 African Union Roadmap, 2013 Abuja Declaration to the 2014 commitment of East Asia Summit Leaders to eliminate malaria in Asia Pacific by 2030 and the commitment of the Heads of State and Government of Africa to eliminate malaria also by 2030.

We believe that with continued political leadership; reinforced by increased public and private sector funding to expand access to life-saving tools, we can – and must – end malaria. The establishment of the Global Fund to Fight AIDS, TB and Malaria, the President’s Malaria Initiative as well as ALMA and APLMA were due to this political commitment and demonstrates shared responsibility and global solidarity.

To effectively translate political will to action and impact, sub-national leadership at the district, provincial and state levels is also critical, particularly as we approach elimination. Strong local leadership can support sub-national tailoring of interventions based on locally available data to maximize impact in both the Asia Pacific and in sub Saharan Africa.

To drive the malaria response, joining the dots coherently between all levels of Governments, from Heads of State right to the hearts of communities, including the most vulnerable and hard to reach, is the only way to ensure sustainable change.

2. Sustain Financing for Malaria

Political will translated to financial commitment for malaria must be sustained. We have come so far and have a historic opportunity to end a preventable and curable disease, in a time marked by devastating communicable disease impact.

Two decades of investments in malaria so far have saved a staggering 7.6 million lives and prevented 1.5 billion malaria cases, which in turn has significantly reduced burdens on health systems worldwide, improved maternal and child health, survival and prosperity.

But WHO’s 2020 Global Malaria Report shows progress plateaued by the end of 2019 with political will and funding declining. There is too much at stake if we do not sustain the momentum on the gains we have made to date: Malaria can put immense strain on economies, having a damaging impact on some nations’ GDP by as much as an estimated 5 – 6%.

It has been estimated that the malaria “penalty” to GDP ranges from 0.41% of GDP in Ghana to 8.9% in Chad, all of which could be regained following elimination of malaria. Complete eradication of the disease would increase GDP in Uganda by 50 million USD.

In Asia, despite the progress made, malaria elimination has the potential to save over 400,000 lives and avert 123 million malaria cases, translating to almost $90 billion in economic benefits for Asia Pacific.

Countries in Africa are rolling out and leading multisectoral End Malaria Councils and Funds which are keeping malaria high on the local political, development and local funding agenda. These institutions have resulted in increased action from the private sector and the public, sustaining the countries’ responses.

Surging investments in ending malaria is the pathway to eradication and will strengthen our ability to respond to future threats in this pandemic era. Investments in malaria have supported the scaling up of a community health workforce that serves as the eyes and ears on the ground for millions of fever-suffering children, adolescents and adults that don’t reach health clinics.

3. Fighting malaria to build stronger health systems

The basic yet most critical component of the fight against malaria, infectious disease management and public health at large is to test, track and treat. Strengthened surveillance, real-time data, and diagnostics are critical for early detection of malaria and other infectious diseases like COVID-19.

Africa has established the Africa CDC and its Regional Collaborating Centres to support African countries in their efforts to strengthen health systems and improve surveillance, emergency response, prevention and control of diseases. Asia Pacific countries are looking to establish similar mechanisms in the wake of the pandemic.

Countries that invested in frontline malaria capacity and interventions – especially Community Health Workers– are now leveraging them effectively for the COVID-19 response. Last year alone, malaria control efforts prevented ~500 million fevers, and one million Community Health Workers equipped with malaria Rapid Diagnostic Tests diagnosed 267 million fevers. Seven of ten symptoms overlap between malaria and COVID-19, led by fever.

This speaks to the importance of integrating the surveillance of malaria within the broader health system. From 40,000 Health Extension Workers and an estimated three million Women’s Development Army Volunteers in Ethiopia, 33,000 trained front line healthcare workers in Uganda, to 1 million Village Health Volunteers in Thailand – all are managing COVID-19 while continuing to provide effective malaria case management during the outbreak.

While there is no single magic bullet for malaria elimination, evidence suggests that investments in the fight against malaria can in turn strengthen health system preparedness and help protect against current and future pandemics.

This World Malaria Day, we must come together as political, social, religious, administrative and economic leaders and recommit the political will and combined action to protect our people, to re-accelerate gains against malaria, and leverage malaria investments to fight COVID-19 and emerging diseases.

We have the tools and technology to test, track, and treat the most prevalent forms of the malaria parasite. Countries like Bhutan or Botswana have shown us what progress is possible; places the ten highest burden countries in Africa as well high burden countries in Asia Pacific such as India, Indonesia, Papua New Guinea reveal what work remains.

We know these challenges can be addressed; seizing this moment to double down on accelerating the task of malaria elimination while strengthening health systems is not only possible, but critical for our planet in the age of pandemics. To support this, platforms that allow for the exchange of expertise among leaders across districts and across national borders, that help track policy progress towards the end goal and drive accountability, can help make the difference.

Ms Joy Phumaphi is Executive Secretary, African Leaders Malaria Alliance (ALMA), former Minister of Health, Botswana

Dr. Sarthak Das is DrPH, Chief Executive Officer, Asia Pacific Leaders Malaria Alliance (APLMA) & Communicable Disease Threats Initiative

Africa is grappling with managing diseases like malaria, HIV/AIDS, and tuberculosis as health systems that are unable to cope with both this and the coronavirus pandemic. Sleeping under a net and taking antimalarial pills helps prevent malaria. Credit: Mercedes Sayagues/IPS

By Busani Bafana
BULAWAYO, Zimbabwe, May 11 2020 (IPS)

Experts across Africa are warning that as hospitals and health facilities focus on COVID-19, less attention is being given to the management of other deadly diseases like HIV/AIDS, tuberculosis and malaria, which affect millions more people.

“Today if you have malaria symptoms you are in big trouble because they are quite close to COVID-19 symptoms, will you go to the hospital when it is said we should not go there?” Yap Boum II, the regional representative for Epicenter Africa, the research arm of Doctors Without Borders, told IPS.

“Hospitals are struggling because they do not have the good facilities and equipment; it will be hard to take in a patient with malaria because people are scared. As a result the management of malaria is affected by COVID-19,” Boum, who is also a Professor of Microbiology at Mbarara University of Sciences and Technology in Uganda, said, pointing out that HIV/AIDS and tuberculosis were also being ignored.

In fact, the World Health Organisation (WHO) has warned that four times as many people could die from malaria than coronavirus.

“With COVID-19 spreading, we are worried about its impacts on health systems in Africa and that this may impact negatively on the delivery of routine services, which include malaria control. The bans on movement will affect the health workers getting to health facilities and their safety from exposure,” Akpaka Kalu, team leader of the Tropical and Vector-borne Disease Programme at the WHO Regional Office for Africa, told IPS.

The WHO has urged member countries not to forget malaria prevention programmes as they race to contain the COVID-19 spread. Without maintaining prevention programmes, i.e. should all insecticide-treated net campaigns be suspended and if access to effective antimalarial medicines is reduced because of lockdowns, malaria deaths could double to 769,000 in sub-Saharan Africa this year.  At the same time the agency has predicted that some 190,000 people could die of COVID-19.

According to the WHO, as of today, May 11, Africa has recorded over 63,000 confirmed COVID-19 cases with 2,283 deaths in 53 affected countries in the region.

• Though preventable and treatable, Africa is battling to eliminate malaria despite a decline in cases over the last four years.
• The continent has the highest malaria burden in the world, accounting for 93 percent of all cases of the disease.
• Malaria is one of the top ten leading causes of death in Africa, killing more 400 000 people annually.

Poorly equipped and understaffed national health services in many countries in Africa could compromise efforts to eliminate the malaria scourge, noted Kalu.

Africa must cope with COVID-19 without forgetting malaria

Mamadou Coulibaly, head of the Malaria Research and Training Center at the University of Bamako, Mali, concurred that the pandemic was straining health systems in developing countries. He urged malaria-endemic countries not to disrupt prevention and treatment programmes.

“To avoid this catastrophic scenario, countries must tailor their interventions to this challenging time, guaranteeing prompt diagnostic testing, treatment, access and use of insecticide-treated nets,” Coulibaly, who is also the principal investigator of Target Malaria in Mali, told IPS. 

Mali is one of the top 10 African countries with the high incidence of malaria.

Malaria needs more national money

Kalu stressed that domestic financing for malaria was needed. He commended the Global Fund to Fight AIDS, Tuberculosis and Malaria and other private sector partnerships that have provided funds for malaria. But he pointed out that this was neither ideal nor sustainable unless national governments contributed a lion’s share to malaria control.

• There is a $2 billion annual funding gap when it comes to malaria prevention, which should be closed to sufficiently protect people in malaria affected countries, according to the RBM Partnership to End Malaria, a global private sector initiative established in 1998. The partnership has sourced funding and equipment for malaria prone countries, providing mosquito nets, rapid diagnostic tests and antimalarials.

More action, less talk

While pleased with progress made towards eliminating malaria in Africa since 2008 when the Abuja Declaration on Health investment was signed, Kalu said Africa could do better.

• In 2001 African governments drew up the Abuja Declaration to invest 15 percent of the national budgets in improving health care services.

• Nearly 20 years later, a handful of countries such as Swaziland, Lesotho, Ethiopia, Liberia and Burundi have invested in building their health systems, according to 2016 WHO assessment report on public health financing for health in Africa. Many African countries have reduced their spending in health as a percentage of total public expenditure than they did in the early 2000s.

• For every $100 that goes into an African nation’s state coffers, on average $16 was allocated to health. Of this amount  only $10 was spent, with less than $4 going to the right health services.

“For the first time in our lifetime, the human being and the world is realising that the most important thing we have is our health,” said Boum, questioning why African governments have all not prioritised health spending despite the Abuja Declaration.

“With our borders closed we are all being taken care of in the poor health system that we have built,” Boum, told IPS. “There is no more flying to India, London or the United States. We are all in the same boat because we have not invested what we were supposed to invest and I hope beyond the pandemic, we will make health care a just cause and even manage to go beyond the 15 percent health investment agreed upon.”

With the current level of investment in health systems, the WHO fears Africa will not achieve the United Nations Sustainable Development Goals (SDGs), particularly SDG3 on ensuring healthy lives and wellbeing for all and ending malaria by 2030.

“We do not want a situation where we are protecting people from COVID-19 and they die of malaria and other diseases,” Kalu told IPS.

“We are not asking governments to put money in malaria alone but in national health systems. COVID-19 is showing that Africa needs facilities and equipment which it does not currently have to effectively deal with the pandemic.”

Sixty-five years after a major international summit here on malaria, the mosquito-borne disease remains a scourge and its incidence may even be rising in parts of sub-Saharan Africa due to the combined effects of climate change, agricultural practices and population displacement.

Almost half the world’s population is deemed at risk of malaria, and an estimated 214 million people will contract it in 2015, with nearly half a million dying.

Credit: FAO

“Malaria is the number one public health problem in our country,” says Babria Babiler El-Sayed, director of Sudan’s Tropical Medicine Research Institute. Sudan has begun, with the assistance of FAO and the IAEA, to release sterilized male mosquitoes into the air in hopes that they crowd out their virile brethren and lead to reduced mosquito populations.

The Unite d Nations Food and Agriculture Organization (FAO) and the International Atomic Energy Association (IAEA) have used this “nuclear” technique with success against the lethal tsetse fly and the produce-destroying fruit fly. Malaria is a new area, and the two agencies are experimenting across East Africa with this so-called Sterile Insect Technique (SIT) of pest control.

And yet malaria is demonstrably preventable – and that is why it is explicitly named in Sustainable Development Goal No. 3 as something to be ended by 2030.

The key is not to rely on one method or tool but to develop integrated efforts to subdue the disease, notes El-Sayed.

That fits FAO’s broader approach. While working with the IAEA on the logistics and technology of SIT, field officers emphasize the need to integrate agricultural practices ranging from crop selection, tilling technique, water use and even rural home locations.

It’s a shift from 1950, when a World Health Organization conference held in Kampala resolved to support the intensive use of Dichlorodiphenyltrichloroethane (DDT) to eradicate the disease. As was learned the hard way, even such a potent chemical cannot on its own sustainably solve the problem. Indeed, in the emblematic case of the Tennessee Valley in the United States, it was a mass anti-poverty campaign coupled with a huge hydroelectric public-works program that led to the rapid demise of malaria without the use of chemicals in the 1930s.

Warmer climate helps bugs fly higher

Particularly alarming is malaria’s literal ascent into the densely-populated highlands of east Africa. Inhabitants of southwest Uganda and parts of Zambia and Rwanda typically lack the genetic resistance to malaria developed by farmers in mosquito-prone areas.

Climate change wreaks all sorts of changes in the risk profile of the human environment. For example, more and more Zambians are killed by crocodiles, lions and buffalos as they travel further for water in times of drought. Less headline-grabbing, but more pervasive, is the way one poor harvest can wipe out livelihoods, driving people to sell their livestock, tools and even land in a bid to survive and ending up mired in poverty. Similarly, pressure on the land – sometimes linked to civil conflict – is driving record flows of migrants, the majority of whom don’t leave their countries, but move into new ecosystems, as scores of Ugandans are doing by moving to the hilly southwest regions of this country and ultimately taking up a form of farming that enhances the risk of malaria.

Add to this the steady climb in average temperatures, which increase the potential habitat for the main malarial vectors and are “related to altitude rather than latitude,” according to recent research done by the International Food Policy Research Institute into why the incidence of malaria has risen so dramatically in Uganda’s upcountry. That spells special risks for elevations above 2,000 meters in Kenya, Ethiopia and Burundi, too.

Strategies must be integrated and local

Despite popular images today, malaria is not particularly a tropical disease. Indeed, it was the successful use of DDT in postwar Italy that galvanized the Kampala conference, even though it now appears the rising incomes linked to Marshall Plan-funded economic growth was the determining factor.

Integrated methods – farming techniques, crops themselves, and human practices such as the use of nets – are all part of any success story in malaria. Zambia’s Malaria Institute at Macha has, with international support, practically eliminated malaria in its southern district, and the credit should go primarily to an engaged community effort, according to Dr. Phil Thuma, one of the institute’s mainstays and an advocate of what he calls “full court press” tactics in battling the epidemic.

FAO has long been involved in distributing mosquito nets, one of the simple but critical tools in any effort. Indeed, one current FAO project promotes the use of insecticide-treated nets around livestock barns in Kenya and has led to a sharp uptick in dairy production as both humans and animals are healthier.

The media has long indulged in donor-depressing tales about Zambian fishermen using anti-mosquito nets to boost their catch or – in one quirky story from Uganda but published in Botswana – p eople using the nets to make bridal dresses. But in fact most people in eastern Africa have and use their government-provided nets today, and many buy another one in a sign of conviction about their utility, according to a detailed survey of actual behaviour in Tanzania.

The real problem is that many farmers have to get up before dawn, or stay out in their fields late, and as a result their work forces them to forgo protection during the biting hours.

Almost everybody knows the basics about malaria, but few had heard about climate change. Intriguingly, those with secondary or higher education tended to worry about unpredictable rain patterns while those with only primary education are focused on rising temperatures.

Empirical surveys clearly show that where cultivation practices reduce vegetation cover, temperatures rise in mosquito breeding sites. That means land use and reforestation efforts need to be part of the community-driven policy mix. Farmer field schools, a longtime FAO priority focus, are key to spreading knowledge that is locally useful, such as casting shade on breeding places or fostering fish in ponds.

Developing “malaria-smart” programs need to be drawn up with that in mind, especially given efforts to increase irrigation infrastructures to boost agricultural yields in sub-Saharan Africa. One survey in Ethiopia found that the rate of childhood malaria was seven times higher in villages within three kilometres of a microdam for irrigation than children living more than eight kilometres away.

Maize cultivation, a huge force in the region, may also be lifting the incidence of malaria because the higher-yield hybrid varieties used pollinate later in the year, helping fatten up mosquito larvae – meaning more, bigger and longer-living adult ones.

(End)

Malaria has dreadful health consequences for HIV positive pregnant women and their babies. Sleeping under a net and taking antimalarial pills help HIV positive pregnant women have healthier babies. Credit: Mercedes Sayagues/IPS

By Kitty Stapp
UNITED NATIONS/ADDIS ABABA, Jul 13 2015 (IPS)

Although malaria is both preventable and curable, it still killed an estimated 584,000 people in 2013, the majority of them African children.

According to the World Health Organization (WHO), mortality rates have fallen by 47 percent globally since 2000. But in Africa, a child dies every minute from malaria.

The economic toll is also high: each year, malaria costs the African continent alone an estimated 12 billion dollars in lost productivity, and in some high-burden countries, it can account for as much as 40 percent of public health spending.

As the Third International Conference on Financing for Development (FfD) kicked off Monday in Addis Ababa, Ethiopia, leaders presented a new strategic vision for malaria elimination that calls for doubling current financing by 2020.

“The new 2030 malaria goals – and the 2020 and 2025 milestones laid out in the WHO and RBM [Roll Back Malaria Partnership] strategies – are ambitious but achievable,” said Dr. Pedro Alonso, Director of the WHO’s Global Malaria Programme.

“We must accelerate progress toward malaria elimination to ensure that neither parasite resistance to drugs, mosquito resistance to insecticides, nor malaria resurgence unravels the tremendous gains to date. We can and must achieve even greater impact to protect the investment the global community has made.”

The result of worldwide expert consultation with regions, countries and affected communities, the strategy aims to reduce global malaria case incidence and deaths by 90 percent – compared to 2015 – and eliminate the disease in an additional 35 countries.

Experts at the RBM say that just over 100 billion dollars is needed to eliminate malaria by 2030, with an additional 10 billion to fund research and development of new tools, including new drugs and insecticides.

To achieve the first milestone of reducing malaria incidence and mortality rates by 40 percent, annual malaria investments will need to rise to 6.4 billion dollars by 2020.

“Reaching our 2030 global malaria goals will not only save millions of lives, it will reduce poverty and create healthier, more equitable societies,” said U.N. Secretary-General Ban Ki-moon. “Ensuring the continued reduction and elimination of malaria will generate benefits for entire communities, businesses, agriculture, health systems and households.”

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between dusk and dawn.

Approximately half of the world’s population is at risk of contracting malaria.

“Investing to achieve the new 2030 malaria goals will avert nearly three billion malaria cases and save over 10 million lives. If we are able to reach these targets, the world stands to generate 4 trillion dollars of additional economic output across the 2016-2030 timeframe,” said Dr. Fatoumata Nafo-Traoré, Executive Director of the RBM.

The fight against malaria has been one of the great success stories of the Millennium Development Goals (MDGs), with more than six million deaths projected to have been averted between 2000 and 2015, primarily of children less than five years old in sub-Saharan Africa.

The new Sustainable Development Goals (SDGs), to be approved by the United Nations in September, offer a fresh opportunity to ramp up funding for the disease and stamp it out for good, experts say.

They note that easing the malaria burden would advance development efforts across sectors by reducing school absenteeism, fighting poverty, increasing gender parity and improving maternal and child health.

Edited by Kanya D’Almeida

Prof Grace Irimu shows IPS a drip feed bag and a copy of Kenya’s ‘Basic Paediatric Protocols’ as she explains the importance of intravenous treatment in saving the lives of young children affected by acute watery diarrhoea. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 23 2015 (IPS)

Acute watery diarrhoea is a major killer of young children but misunderstanding over the benefits of fluid treatment is preventing many Kenyan parents from resorting to this life-saving technique and threatening to reverse the strides that the country has made in child health.

The 2014 Kenya Demographic and Health Survey, released in April this year, reports that the country’s under-five mortality rate fell to 52 deaths per 1,000 live births in 2014, down from the 74 deaths in 2008-09, but still far from the 32 per 1,000 live births targeted under the Millennium Development Goals (MDGs).“Parents must … understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea” – Prof Grace Irimu, Associate Professor of Paediatrics, University of Nairobi

The primary treatment for acute watery diarrhoea is rehydration, administered intravenously in the most severe cases of very young children suffering from shock after losing excessively high quantities of body fluids. A fluid bolus – or rapid liquid dose – delivered directly through an intravenous drip allows a much faster delivery than oral rehydration.

However, notes nurse Esther Mayaka at the Jamii Clinic in Mathare, Nairobi, “parents of children brought to hospital with acute watery diarrhoea are refusing to have them put on [drip] fluid treatment and this is a major concern because diarrhoea is a leading killer among children and giving fluids is still the main solution.”

She told IPS that the ongoing rains and floods in many parts of the country “have created a comeback for diseases like cholera whose most telling sign is watery diarrhoea which needs to be managed with fluids.”

In February this year, Kenya’s Director of Medical Services, Dr Nicholas Muraguri, issued a cholera outbreak alert following an increase in cases of acute watery diarrhoea in several counties, including Homa Bay, Migori and Nairobi.

According to Prof Grace Irimu, Associate Professor of Paediatrics at the University of Nairobi, the reluctance to resort to drip fluid treatment has arisen due to misunderstanding generated by a Fluid Expansion As Supportive Therapy (FEAST) study in 2011 to establish whether the bolus technique was the best practice to use among children diagnosed with shock.

The FEAST study, which was conducted among children in Kenya, Tanzania and Uganda, found that fluid boluses increased 48-hour mortality in critically-ill children with poor blood circulation or shock in these resource-limited settings in Africa, but Irimu told IPS that the study excluded diarrhoea and only studied illnesses associated with fever, such malaria and sepsis.

“Parents must therefore understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea,” she said.

The Kenya Paediatric Association is also trying to set the record straight and, in a statement shared with IPS, the association reiterated that “diarrhoea complicated by severe dehydration is one of the biggest killers of children globally.”

According to the paediatrics association, the FEAST study excluded children with diarrhoea and dehydration because “the value of giving fluids in this group is well known. Giving appropriate fluid therapy is essential.”

Prof Irimu told IPS that the FEAST study had led to a revision of the ‘Basic Paediatric Protocols’, Kenya’s national guidelines for paediatric care, and clauses that address the treatment of diarrhoea were also revised.

Previously, a child diagnosed with shock as a result of diarrhoea would be given fluids in three cycles, every 15 minutes depending on the response. Now, the child receives the fluids in two cycles and if there is no response, health providers are advised to proceed to slower fluid administration where the child is given the amount that the body needs, depending on the level of dehydration.

Meanwhile, the country continues to make strides in dealing with HIV/AIDS – another critical health issue covered by the MDGs – among children. Studies show that the number of children with HIV aged between 18 months and 14 years fell from 184,000 in 2007 to 104,000 in 2012, according to the most recent Kenya Aids Indicator Survey.

However, Prof Joseph Karanja, a reproductive health and HIV/AIDs expert in Nairobi, says that the country can still do better because “through available antiretroviral drugs as a preventive measure among HIV positive mothers, HIV transmission to the infant can be reduced to as low as one percent.”

Dr Pauline Samia, a paediatric neurologist and a board member of the Kenya Paediatric Association, says that there is also a commitment to address conditions that challenge the management of HIV among children such as epilepsy.

“Though research in this area is limited, an estimated 6.7 percent of children with HIV also have epilepsy, with at least 50 percent of children with HIV having central nervous system problems such as delayed development, behavioural challenges and convulsions,” she observes.

Regarding progress in other MDGs, some progress has been made in reducing the prevalence of underweight children less than five years of age, one of the goals set for eradicating extreme hunger and poverty.

The 2014 Kenya Demographic and Health Survey reports that not only has childhood malnutrition declined significantly, from 35 percent in 2008 to the current 26 percent, but the prevalence of underweight children also decreased from 16 percent in 2008 to 11 percent in 2014.

On the front of improving maternal health, the survey says that while maternal mortality remains high at 488 deaths in every 100,000 live births, in the past five years more than three in five births (61 percent) took place in healthcare facilities, a marked improvement compared with the 43 percent in 2008.

Edited by Phil Harris   

Dr. Fatoumata Nafo Traoré

By Dr. Fatoumata Nafo Traoré
UNITED NATIONS, Apr 20 2015 (IPS)

Later this week, communities around the world will commemorate World Malaria Day for the last time in the context of the global development priorities set in 2000.

Aspiring for a world free from hunger, poverty and disease, the eight Millennium Development Goals (MDGs) were endorsed by the largest gathering of world leaders in history.Humanity’s quest for a sustainable, more equitable and healthier global society cannot succeed without systematic, effective, long-term malaria control and elimination measures in endemic countries.

Most of those world leaders have since moved on, but the goals they determined galvanised the planet to work together toward a better future for humanity and spawned health and development partnerships which continue to this day.

These unique alliances have evolved over time to meet the changing environment, and, in the case of malaria control and elimination, succeeded exponentially where other development efforts have stalled.

Since 2000 and the dawn of the new millennium, over four million lives have been saved by mass distribution of insecticide treated nets, insecticide spraying of interiors, improved malaria treatments and rapid, on the spot, diagnosis of malaria. Over the past 15 years, malaria mortality has decreased by 47 percent worldwide and by 55 percent in Africa alone.

In fact, 64 countries have achieved the malaria-specific Millennium Development Goal – to have halted and begun to reverse the incidence of malaria by 2015. This means less newborn, infant and maternal deaths, fewer days missed at school and work, more productive communities, stronger health systems and more vibrant economies.

But these gains are fragile and their impact unevenly distributed. As we shift gears – from the Millennium Development Goals to the broader Sustainable Development Goals – we must not forget the unfinished business of the MDGs, the unmet targets – the populations still at risk and the continuing unnecessary deaths, suffering and loss of livelihood caused by malaria.

The Roll Back Malaria Partnership (RBM) has come a long way in the last 15 years – but we still have some distance to go.

Universal coverage with insecticide treated nets, effective treatments, rapid diagnostics and indoor spraying has not yet been achieved. Too often, migrant workers, mobile communities and other remote populations do not yet receive adequate malaria services.

In Africa today, 10,000 women and between 75,000 and 200,000 infants are estimated to die annually, with many millions suffering worldwide, as a result of malaria infection during pregnancy. It is unacceptable that the most vulnerable in our society remain the least protected.

Greater investment in future generations, in the protection of mothers and their unborn babies from malaria, is a moral imperative. We can and must do better.

In this critical transition year, the RBM Partnership will launch its second generation global malaria action plan called “Action and Investment to defeat Malaria (AIM) 2016-2030: for a Malaria-Free World.”

It makes the global case for eliminating the scourge of malaria over the next 15 years and avoiding the resurgence of the disease, with its associated crippling economic cost and devastating suffering and death.

The AIM calls for heightened investment within the new Sustainable Development framework and emphasises a people-centred approach, which leaves no one behind. It also shows clearly how engaging all sectors of society will boost global efforts and generate the much needed human and financial resources to win the race against malaria.

With the drug and insecticide resistance eroding effective tools, malaria control and elimination efforts will need smart investments and increased international and domestic spending as endemic countries move from low to middle income status and shift their sights to ambitious elimination targets.

An investment in malaria control and elimination is an investment in the future, and it’s undoubtedly one of the best buys in global health. The tools are cost-effective and the return on investment high. If we can eliminate the disease in sub-Saharan Africa alone by 2030, the world stands to gain an estimated 270 billion dollars.

If we are to make malaria history we will need new tools – innovations that will help us realise our ambition towards a malaria-free world, particularly those that can accelerate elimination in the near future and tackle the challenges we face today, like drug and insecticide resistance.

We will also need transformative technologies – effective vaccines and rapid malaria tests that can be used in remote areas and can detect cases that have no visible symptoms.

Going forward, the malaria fight will need new focus: strengthening country ownership, empowering communities, enhancing data quality for decision making, engaging multiple sectors outside health and exploring ways to do things better at all levels, with maximum value for money.

The Roll Back Malaria Partnership will be ready to adapt strategies and approaches, amplify political will and country readiness, so that together we can win the race against malaria.

Humanity’s quest for a sustainable, more equitable and healthier global society cannot succeed without systematic, effective, long-term malaria control and elimination measures in endemic countries.

Winning the fight against malaria means that families, communities, and countries will thrive as never before.

By working together we can put an end to this needless suffering and strengthen the potential of individuals, communities and countries to achieve our ultimate goal – a world free from malaria.

Note: World Malaria Day was instituted by WHO Member States during the 2007 World Health Assembly and is celebrated on 25 April each year to highlight the need for continued investment and sustained political commitment for malaria control and elimination. The theme for the 2013-2015 campaign is “Invest in the Future. Defeat malaria”.

Edited by Kitty Stapp

Excerpt:

Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

A medical centre at the Bandama checkpoint in Kenema to test people in transit for symptoms of Ebola. Credit: Mohamed Fofanah/IPS

By Mohamed Fofanah
KENEMA, Sierra Leone, Jul 12 2014 (IPS)

Adikali Kamara is a 36-year-old student nurse working in the government hospital in Kenema, a sprawling town on the fringe of the Sierra Leone’s Gola tropical rain forest.

On June 19, he began feeling unwell, complaining of fever and a headache, and went to a chemist near where he lived to buy anti-malaria drugs and antibiotics to treat typhoid fever. “I thought that my symptoms indicated either malaria or typhoid because these are the most common ailments suffered by everybody here,” said Kamara.

However his condition did not change and two days later he decided to seek proper treatment at the hospital. That was when the doctors discovered he was suffering from Ebola, a disease that causes fever, vomiting, bleeding and diarrhoea and kills up to 90 percent of those infected.

Kamara was admitted immediately and just seven days later he was discharged after receiving supportive treatment.“People are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community” – Michael Vandi, Public Health Education Officer for Sierra Leone’s Eastern Province

Kamara is one the fortunate 51 persons in Sierra Leone who have survived the current Ebola scourge that is also ravaging two other West African neighbours – Guinea and Liberia. So far, 99 have died in Sierra Leone and a further 315 men, women and children have tested positive.

The Public Health Education Officer for Sierra Leone’s Eastern Province, Michael Vandi, who is based in the Kenema hospital which houses the country’s only Supportive Treatment Centre and testing laboratory for Ebola, said that the country is far from winning the fight against the disease, blaming people’s fear and denial of the disease.

Vandi said that “people are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community before we are aware of cases.”

According to Vandi, people are accusing doctors of administering lethal injections to the Ebola patients or removing vital organs for sale in European markets. He said that some even claim that people are being deliberately infected with the virus to reduce the population.

As a result, doctors and nurses in the hospitals have been attacked and many nurses are not wearing their uniforms on the way to work for fear of being attacked in the streets.

“Patients who were admitted – both male and female – are abandoning the hospitals,” said Vandi. “They are now going to pharmacies or being treated by quack doctors or nurses in their homes. This is worrisome because the signs and symptoms of Ebola mimic the prevalent malaria and typhoid fever in the country and, before they know what they are dealing with, it will be too late.”

The Senior Human Rights Officer who heads the Human Rights Commission’s Office in the Eastern Province, Hassan Yarjah, blames the government’s Ebola awareness raising strategy for fanning mistrust and disbelief among people.

He pointed out that the eastern part of the country, in which almost all cases of Ebola have so far been identified, is an opposition stronghold. “What the central government is doing, which I think is wrong, is sending people to these communities that the people cannot identify with; they are parliamentarians, they are ministers, they are executives from the ruling All People’s Congress party and this is a country where everything is polarised,” he said.

According to Yarjah, people in the country’s Eastern Province are saying that “because a census is scheduled for September, the politicians want to scare people away from this part of the country so that their number will dwindle; then, when they delimit the boundaries for constituency seats, this will mean less representatives for the opposition in parliament in the next election.”

“I think government should use the local structures, like the paramount chiefs, the medical personnel on the ground, and the local councils,” Yarjah told IPS.

Meanwhile, the government has announced a ban on regular trade fairs in Kailahun, one of the districts in Eastern Province worst hit by Ebola. There has also been an executive order for placing medical personnel at a number of checkpoints on roads from the Eastern Province to check people for Ebola-related symptoms.

“This has affected our agriculture,” complained Lamin Musa, a farmer from Kailahun. “We cannot sell our produce now at the trade fairs and this had heaped more hardship on our poor people. Even bush meat, which had been a lucrative trade for us, has been banned. It is difficult for us to understand all the suffering we have to undergo because of Ebola.”

Whatever the misgivings, misconceptions and accusations, the virus is thriving, in part due to dysfunctional medical systems and weak disaster management structures in Sierra Leone and its neighbours.

At the beginning of July, the World Health Organization (WHO) held an emergency meeting in Accra, Ghana, with health ministers from 12 West African countries to discuss and propose suggestions to combat the outbreak of Ebola virus that has hit the three West African countries.

The ministers adopted a common inter-country strategy calling for accelerated response to the Ebola outbreak in West Africa. The strategy stressed the need for regional, sub-regional and national leadership, coordinated actions by all stakeholders, enhanced cross border collaboration and the involvement of communities.

For his part, Kamara is optimistic. “I was able to beat this disease and any of you out there can,” he said. “You have to believe that Ebola is real, set aside prejudice and go to the hospital early if you experience the symptoms.”

The problem is that while Ebola may be a killer, a potentially greater threat to Sierra Leoneans and West Africans in general lies in less spectacular diseases. During the current outbreak of Ebola, other diseases are quietly taking their toll. Malaria is still rampant, and there is concern that cholera, which usually attacks during this period of the rains, will resurface to claim more lives.

Malaria has dreadful health consequences for HIV positive pregnant women and their babies. Sleeping under a net and taking antimalarial pills help HIV positive pregnant women have healthier babies. Credit: Mercedes Sayagues/IPS

By Zarina Geloo
LUSAKA, Apr 25 2014 (IPS)

Zambian Martha Nalishupe is torn between taking one more pill with her daily regimen of antiretrovirals, or run the risk of a miscarriage.

Struggling to adhere to her antiretroviral (ARVs) therapy, she now has to add a tablet to prevent malaria.

Though she only has to take the malaria pills three times, every four weeks, till she gives birth, Nalishupe is weary: “I already struggle to take my ARVs, now this tablet… I don’t like taking tablets, they leave an after taste in my mouth, but the nurse said if I catch malaria, I may lose my pregnancy.’’

Five months pregnant Ruth Malikaso, who is HIV negative and has been put on the malaria prophylaxis Fansidar, is also in two minds: ”Fansidar makes me nauseous; I don’t want to be sick so close to delivery.”

But their midwife Keren Zulu is adamant. She says she is a ”bully’’ when it comes to helping women at the Chawama clinic in the outskirts of Lusaka avoid malaria.

“If I don’t trust that they are taking their medication, I make them do it in front of me. That does not always make me the midwife of choice, but I am not in a popularity contest,” she tells IPS.

Zulu follows the World Health Organisation (WHO) protocol where all pregnant women in high malaria areas are given intermittent preventive treatment in the second trimester and must sleep under insecticide treated nets.

For HIV positive pregnant women, WHO recommends a course of the antibiotic Septrin, and for HIV negative women, the three tablet Fansidar.

Malaria in pregnant women is dangerous as it lowers their immunity. WHO calls it a major health problem, with adverse effects such as anaemia, low birth weight, prematurity, maternal death, stillbirth and miscarriage.

Zulu says it’s worth enduring side effects for a couple of days, considering this could save lives.

“I have seen too many mothers and babies die or suffer because this simple regimen was not adhered to,” she says.

For HIV positive women like Nalishupe, the situation is especially precarious. In a compromised immune system, acute malaria increases viral load and quickens progression to AIDS.

Research suggests that malaria infection during pregnancy can increase the risk of mother-to-child transmission of HIV in the womb, during birth and breastfeeding.

Valentina Buj, a health specialist with the United Nations Children’s Fund (UNICEF), emphasises the need for early antenatal care and malaria prevention.

“Malaria infections are often asymptomatic when the parasite sequesters in the placenta,” she explains. Because malaria symptoms resemble those of a pregnancy and of HIV-related infections, like fever, nausea, vomiting and headache, it is vital that the women are properly diagnosed.

Double threat

The geographical overlap in HIV and malaria infections poses special problems. A UNICEF study reports that the largest burden of co-infection lies in Africa, the continent with the greatest burden of malaria, and where more than three quarters of all HIV-infected women live. 

Most affected by HIV and malaria co-infection are the Central African Republic, Malawi, Mozambique, Zambia and Zimbabwe, where some 90 per cent of adults are exposed to malaria and average adult HIV prevalence surpasses 10 percent.

WHO studies describe a negative interaction: HIV increases the risk of malaria infection and the development of clinical malaria. Conversely, malaria increases HIV replication, and antimalarial treatment failure may occur in HIV infected adults with low immunity.

HIV positive pregnant women are twice as susceptible to clinical malaria, says UNICEF, while children endure special risks.

Malaria in HIV positive women can restrict foetal growth, result in low-birthweight babies and reduce the transfer to children of maternal immunities to infectious diseases such as streptococcus pneumonia, tetanus and measles.

Taboos

Kebby Musokotwane, a medical doctor with the Ministry of Community Development, Mother and Child Health, told IPS that in Zambia one in six pregnant women is HIV positive. “This is quite high,’’ he warns.

Zambia tests pregnant women for HIV at the first antenatal care visit;  those found HIV positive are immediately put on ARVs and anti-malarial medication.

The problem, says Musokotwane, is that many women start antenatal care late.

“There are some myths surrounding announcing pregnancies early, so women wait until they are advanced before going to the clinic,” he says.

Buj confirms that the uptake of antenatal services is very low in most African countries.

Malikaso was at the clinic only to ”book’’ in her last trimester. This means obtaining the antenatal card that will ensure her a bed, a birth certificate and postnatal care without a long registration process.

The taboos around discussing pregnancy delayed Malikaso’s first visit to the clinic.

“We are taught not to announce early as you are inviting bad luck,” she says. ”Culturally, you are not supposed to announce to your in-laws or people around you that you have been having sex, they will just see.”

In Zambia, malaria accounts for 20 percent of maternal deaths and AIDS for 30 percent, according to U.N. estimates.

Against this unacceptably high rate, Zambia will distribute 5.6 million insecticide treated nets in 2014.

This is good, says Zulu, but, as she reaches retirement age this year, she has regrets: “I had hoped that in my lifetime we would eliminate malaria in pregnant women.”

“The helplessness that overcomes me is only matched by the anger that it is a preventable disease, whose solution lies in a small change in how a woman perceives her health,’’ she says.

Children in India’s southern city Mangalore promote demonstrations of guppy fish feeding on mosquito eggs. Credit: Stella Paul/IPS.

By Stella Paul
MANGALORE, Apr 25 2014 (IPS)

Thirteen-year-old Sampreeth Monteiro’s neighbours are suddenly taking his advice seriously. “Buy a Guppy fish, it will eat all the mosquito eggs in your house. You will not get malaria again.”

Last month the St Aloysius’ high school in Mangalore city of southern India where Monteiro studies, launched a “Guppy movement” – an anti-malaria campaign in collaboration with the Mangalore City Corporation. The campaign aims to control malaria using natural means – such as the Guppy fish.“Buy a Guppy fish, it will eat all the mosquito eggs in your house. You will not get malaria again.”

Volunteers who have joined the campaign visit local hospitals and schools carrying jars of water with mosquito larvae and Guppy (Poecilia reticulate) to demonstrate how the fish feeds on mosquito larvae.

The campaigners also stage street plays to spread anti-malaria messages. Monteiro learnt about Guppy fish at one of these plays. The campaign is drawing particular attention around Malaria Day on Friday Apr. 25.

Far away from Mangalore in Shillong, a hill city in northeastern India, the state government is organising a workshop on malaria prevention. Those attending include government staff and health activists, and they are being taught that breeding fish like Guppy is an effective way to control vector-borne diseases.

“We are doing satellite mapping to identify malaria prone areas,” Carter Sangma, district medical and health officer for the West Garo hills district tells IPS. “Once the mapping is done, the fish can be easily distributed and grown in those areas.”

Sangma says the state has already seen a 50 percent drop in all mosquito-borne diseases since it took up breeding Guppy fish for malaria control in 2012.

The first known use of Guppy fish in India for such purpose was in 1908 when a British army officer who had suffered frequent mosquito bites brought the fish from England. The officer, remembered as Major Selvy, introduced the Guppy to breed in water bodies surrounding the army cantonment in Bangalore where he was posted.

Around the same time, authorities in Mumbai also started to use Guppy to prevent malaria, importing the fish from Texas, U.S.

But despite more than a century of known use of the Guppy to control malaria, the government did not scale up such prevention. The reason, says Mangalore-based health activist Suresh Shetty, is that the government failed to introduce the practice in rural India where mosquito-borne diseases claim thousands of lives each year.

According to the World Health Organisation, an estimated 3.4 billion people are at risk of malaria. In India, malaria kills nearly 20,000 people a year, by conservative estimates. About 15 million get malaria.

Poor sanitation, untreated garbage, stagnant water and changing climatic conditions are seen as the main reasons behind the spread of malaria. Spraying of insecticide and use of bed nets are the most popular means to check malaria – which is completely preventable. But use of larvivorous fish like Guppy is the cheapest and the most effective malaria fighting tool, say experts.

In Assam state in the north-east, scientists at the Malaria Research Centre near state capital Guwahati are breeding Guppy fish large-scale now.

“Bio-control has helped Assam reduce its malaria cases significantly,” says Nripendra Kumar Sarma from the public health engineering department. “Till 2012, we had over 30,000 cases each year. But now they are no more than 3,000-4,000. This approach can very well be initiated in areas (of the country) that are prone to malaria, dengue and encephalitis, all of which are mosquito-borne diseases.”

Sarma says the government must rope in village based NGOs, community organisations and the private sector.

Bringing in corporate and financial institutions could be a good way to ensure funding, says entrepreneur Somasekhar Gowda from Mysore city, 181 km south of the southern Indian city Bangalore. Gowda has been breeding the fish, and distributing them free since May last year after four children died of dengue fever in D Salhundi village near Mysore.

The deaths spread fear, and several families fled the village with their children. It was then that Gowda went to D Salhundi, and with the help of the villagers, released Guppies in more than 50 small tanks and puddles.

Better cooperation between government departments, and private-public partnerships can help eradicate malaria anywhere, says Gowda. “In Mumbai, lunchbox (dubbawala) carriers are now campaigning against malaria. In Mangalore, the municipality has tied up with colleges and financial institutions like the Corporation Bank to get enough funds and to find volunteers.”

But while there is no doubt about the effectiveness of larvivorous fishes in controlling malaria, some scientists say that large-scale introduction of Guppy can endanger the country’s biodiversity, because the fish feeds on other fish species besides mosquito larvae. The solution, they say, is to breed indigenous larvae-eating species.

“There are many larvivorous fish species that are native of India such as Tilapia, Gambusia, Manathu kanni (Aplocheilus) and Karinkana (Pseudosprhomenus),” Subrata Deb, formerly professor of pharmacy at Tripura University in the north-east of the country tells IPS. “Alongside Guppy, these species can also be used to control mosquito and malaria.”

Vellore city in India’s southern Tamil Nadu state has been malaria-free for nearly a decade now, says local entomologist Raja Gopal. But even so, city authorities distributed 4,500 Guppy fish last month for release into local wells, to guard against spread of malaria from the thousands of medical tourists visiting Vellore each year.

Rotarians Against Malaria display one of the insecticide treated mosquito nets being used throughout Papua New Guinea. Credit: Catherine Wilson/IPS

By Jim Lobe
WASHINGTON, Dec 11 2013 (IPS)

Enhanced efforts to fight malaria have saved an estimated 3.3 million lives and nearly halved the disease’s global mortality rate since 2000, according to the latest edition of the World Health Organisation’s (WHO) annual “World Malaria Report”, released Wednesday.

But much more needs to be done to eliminate the disease, which last year killed an estimated 627,000 people worldwide, about 483,000 of whom were children under the age of five. That pace averages one malaria-caused child death almost every minute, according to the 253-page report.

Prevention and control measures by multilateral organisations, national governments, private foundations, business and civil society organisations over the past dozen years have been particularly effective in sub-Saharan Africa, which, along with South Asia, has suffered most from the mosquito-borne illness, the report said.

While malaria mortality rates fell by 45 percent worldwide since 2000, the percentage in Africa was 49 percent and 54 percent among African children under five. Similarly, while malaria infections fell by 29 percent globally, infections in Africa, where about 80 percent of malaria cases are found, were reduced by 31 percent, according to the report.

“The remarkable gains against malaria are still fragile,” Robert Newman, who directs WHO’s Global Malaria Programme, told reporters at the report’s release. Several countries over the past 75 years have come close to eliminating the disease only to see it resurge due to complacency and reductions in funding. “A 50 percent reduction is great, but we can’t get to the endgame with that.”"The greatest threat to continued success in malaria efforts is financial."
-- Robert Newman

“In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress,” he emphasised. “The greatest threat to continued success in malaria efforts is financial: we have less than half of the 5.1 billion dollars needed annually to ensure universal access to life-saving interventions.”

Last year’s toll of malaria deaths might have been fallen even more if funds had been available to procure insecticide-treated bed nets, a major prevention measure, in malaria-endemic countries. But, for the second year in a row, bottlenecks caused by insufficient funding resulted in the delivery of only 70 million new bed nets, far below the 150 million annual target.

In 2013, however, that problem appears to have been overcome, as 136 million nets were delivered, and WHO officials are predicting that some 200 million more will be delivered in 2014.

“We are going to see a much more rapid procurement process,” said Joy Phumaphi, executive secretary of the African Leaders Malaria Alliance, a group that includes 39 African heads of state and a former vice president of the World Bank’s Human Development Network.

Due to a recent restructuring of the Global Fund to Fight AIDS, Tuberculosis and Malaria, she said, the time between fund allocation and actual delivery of nets has fallen from 18-24 months to three months. “This is an example of the new efficiencies that have come with the restructuring” of the Fund, she said.

The Fund, a multilateral agency that is by far the most important single source of funds for anti-malaria projects, received a boost earlier this month when donor countries pledged a record 12 billion dollars to its fourth replenishment, which will take it through 2016.

While that total fell short of the 15-billion-dollar goal that the Fund set for itself, it marked a three-billion-dollar increase from its third replenishment in 2009.

That amount should help the global anti-malaria effort come close to the goal of reducing malaria mortality rates for children under five by 75 percent from 2000 levels. The WHO report estimated that if the annual rate of decrease that has occurred over the past 12 years is maintained through 2014, then mortality rates should decrease by 56 percent in all ages and 63 percent for children under five.

Currently 59 countries are on track to meet the 75 percent goal, but they account for only four percent of total estimated malaria cases. That goal will be much harder to reach in the 18 most-affected countries, which include 17 African nations and India. Two African countries – Nigeria and the Democratic Republic of the Congo, whose sheer size makes it difficult to track malaria cases – account for fully 40 percent of all malaria deaths worldwide.

“We can reach 75 percent, but it’s going to take efforts by all of us,” said Newman.

International spending for malaria control rose from 100 million dollars in 2000 to just shy of two billion dollars in 2013, while national governments of affected countries have also increased their funding since 2004. In 2012, they contributed an estimated 522 million dollars.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund is testimony to the success of the global partnership,” said Fatoumata Nafo-Traore, executive director of the Roll Back campaign. “But we must fill the annual gap of 2.6 billion dollars to achieve universal coverage and prevent malaria deaths. This is our historic opportunity to defeat malaria.”

In addition to the distribution of bed nets, the most effective interventions now in use include indoor residual spraying (IRS), diagnostic testing, and artemisinin-based combinations therapies (ACTS), which are recommended as the first-line treatment for the most deadly form of malaria.

The proportion of the at-risk population in sub-Saharan Africa sleeping under a bed net in 2013 was 36 percent in 2013, according to the report, which cited studies showing that 86 percent of the population with access to a net actually used it.

IRSs were much less prevalent, accounting for only eight percent of the at-risk population. Mosquito resistance to at least one insecticide used for malaria control has been identified in 64 countries worldwide and represents a major challenge in the anti-malaria fight.

Meanwhile, diagnostic testing to determine whether a patient who shows symptoms of malaria actually has the disease and is treated accordingly and ACTS have been increasing rapidly. In 2012, 331 million ACT courses were procured by public and private facilities in endemic countries – up from only 11 million in 2005.

In addition to ensuring increasing access to these tools, Newman stressed the need for improving surveillance and monitoring systems in most-affected countries. Much more funding is also needed for research and development (R&D) of new insecticides and drugs to overcome resistance to existing products by mosquitoes and the parasite itself.

He also noted the importance of R&D into malaria vaccines, one of which – RTS,S – was shown to almost halve the number of malaria cases in young children (aged 5-17 months at first vaccination) and to reduce the number of cases by about a quarter in infants in late-stage trials in Africa announced in October.

(l – r) Josiah Kavuma, Simon Lubambo, Joshua Businge and Brian Gitta, otherwise known as team Code 8, have developed a mobile phone app to diagnose malaria. Courtesy: Microsoft.

By Amy Fallon
KAMPALA
, Aug 13 2013 (IPS)

In his 21 years Brian Gitta has had malaria too many times to count. And over the years, because of the numerous times he has had to have his blood drawn to test for the disease, he has developed a fear of needles. It is little wonder then that he and three of his fellow computer science students worked hard to develop a mobile phone app that detects malaria – without the use of needles.

“I was two or three years old when I first contracted it,” says Gitta, who is studying computer science at Makerere University in Kampala.

“It’s very unusual to meet people in Uganda who haven’t had malaria. If you go to a clinic, you might find that 90 percent of patients have it.”

Annually an estimated 70,000 to 100,000 Ugandans die from the tropical disease, which is transmitted to humans by mosquitos carrying the malaria parasite. That makes it the country’s biggest killer, according to the NGO Malaria Consortium Uganda. Experts say nearly half (about 42 percent) of Uganda’s 34.5 million people are host to the malaria parasite, although they do not display any signs of being ill.“With this test people may be able to avoid a doctor’s consultation and treat malaria in its early stages before it causes anaemia and brain damage. Once this app comes out, the impact’s going to be great.” -- Moses Kizito, director of SAS Clinic

Gitta’s most recent bout of malaria, just before Christmas in 2012, was severe. He contracted brucellosis, an infectious disease contracted by the consumption of unsterilised milk or meat, and typhoid at the same time and had to be hospitalised for a month.

“I had to undergo lots of blood tests. I was in lots of pain and the doctor’s queue was long,” he says.

Gitta was bedridden during his convalescence, and during that time he had a light bulb moment. He imagined a “mobile medical centre” that offered a quicker and pain-free diagnosis without needles and pricks. Gitta envisaged using a small device for this – but it was a big vision.

But as soon as he recovered he set to work on realising it.

And this July in St Petersburg, Russia, Gitta, Joshua Businge, Simon Lubambo and Josiah Kavuma, known as team Code 8, were announced the winners of the inaugural Women’s Empowerment Award at Microsoft’s global student software competition, Imagine Cup. The all-male group was recognised for their development of an application that they call Matibabu, Swahili for medical centre.

In Uganda, malaria is diagnosed via either the microscopic examination of blood films or a rapid diagnostic test.

The microscopic diagnosis usually takes about 30 minutes or longer and requires a lab technologist. It is considered the “gold standard” of testing, as it is the most reliable method. It reveals the presence or absence of the parasite in the blood, the parasite species and the extent to which they have multiplied in the body.

However, a rapid diagnostic test can be done anywhere and without a qualified microscopist. It usually takes about 15 minutes to get the results, though it cannot show the number of parasites as a microscopic diagnosis does.

Matibabu uses a custom-made portable device called a matiscope, which is connected to a smartphone, to do a rapid diagnostic test. The user’s finger is inserted into the matiscope, and the application uses a red light to penetrate the skin and detect the red blood cells.

“It’s been shown that infected red blood cells have a different physical, chemical and biomedical structure from a normal red blood cell, hence [we] used light-scattering technology to determine the scatter patterns of both normal and infected cells,” Kavuma tells IPS.

“Through the difference in the patterns, the app is able to diagnose for malaria without a blood sample.”

The hardware has a light-emitting diode and a light sensor, and it transmits the test results to the user’s phone for processing.

Matibabu then sends the results to the Microsoft file hosting service, Skydrive, and these can be shared with the patient’s doctor almost immediately, preventing the long delay in getting results.

Code 8 says that Matibabu, which can currently only be used with the Windows phone operating system, will help pregnant women in particular. According to the World Health Organisation, half the world’s population is susceptible to malaria. Pregnant women, young children and people living with HIV/AIDS are especially vulnerable.

“When a pregnant woman gets malaria it affects the baby,” Lubambo tells IPS. “But if it’s able to be detected very early it could reduce miscarriages.”

However, the team hopes to have Android and other OS versions by mid-2014. They say when they begin introducing other versions for different platforms, they may start using file hosting services, like Dropbox, to store the results.

The students hope their device will be on the market within two years and say the application will be free to download. The hardware may cost between 20 and 35 dollars. The young developers concede that this is a lot of money for many Ugandans.

Currently, in Uganda’s private health sector both the microscopic diagnosis and the rapid diagnostic test cost under five dollars, Dr Jane Achan, professor at the department of paediatrics and child health at the Makerere University College of Health Sciences tells IPS.

Malaria affects mostly rural dwellers, she says, adding that in Apach district, northern Uganda, a patient receives over 1,500 infected mosquito bites a year. These people may not have access to smartphones.

“The urban settings are already a little more advantaged in that their health facilities are more accessible, they have more doctors and they have more accessible diagnostic facilities,” Achan explains. “At the end of the day this app has to be compared with what is existing and available.”

Moses Kizito is the director of private SAS Clinic in Kampala, where they test no less than 50 patients a day for malaria and receive eight to 10 positive results.

He says at the moment Matibabu seemed “quite expensive” but in the long run it may prove economical.

“Once people are forced to go to the clinic [with malaria] it’s expensive to manage the disease,” Kizito tells IPS.

“With this test people may be able to avoid a doctor’s consultation and treat malaria in its early stages before it causes anaemia and brain damage. Once this app comes out, the impact’s going to be great.”

Kavuma says that Microsoft has offered the group mentoring and business training, but they are considering other options to market and manufacture the product.

“We are planning on contacting Chinese companies for this,” he says.

Gitta hopes other diseases can be diagnosed in a similar way. “The future is bright and anything can happen…,” he says. “Let’s watch out for the next great thing.”

A child is vaccinated for polio outside Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS

By Katelyn Fossett
WASHINGTON, Apr 9 2013 (IPS)

A U.S.-based civil society coalition is calling on Congress and President Barack Obama’s administration to keep spending on global health aid at current levels, warning that recent budget cuts risk a dangerous backslide in health and development gains achieved over the past three decades.

The new brief has been published by InterAction, a Washington-based umbrella of international NGOs, is supported by 37 organisations. It warns that any future cuts to these programmes would endanger important health milestones achieved in part due to U.S. assistance.We have a choice: we can invest now or pay forever.

These include the near-eradication of polio and the treatment of over five million people living with HIV/AIDS. In addition, the brief warns that austerity-related budget cuts that went into effect on Mar. 1 could lead to the re-emergence or worsening of critical global health threats, like those posed by the spread of malaria and tuberculosis.

“The U.S. is at a critical juncture in its global health efforts: budget pressures threaten the global health gains that have been made and jeopardize programming … Capitalizing on our successes and meeting emerging global health challenges will require increased and sustained commitments by all donors,” the brief says.

But the warning is competing with snowballing enthusiasm for budget-cutting that has seized Washington since the recent cuts, known here as the “sequester”, went into effect. Cutting roughly five percent of all federal budgets, analysts say the sequester would slice around 433 million dollars from U.S. global health aid for the remainder of this fiscal year alone.

The United States is the world’s largest individual donor to a spectrum of global health initiatives.

“We see the brief as a resource for members of Congress and their staff on U.S. investments in global health,” Danielle Heiberg, one of the authors of the brief, told IPS. “By highlighting how current and past U.S. investments have made significant progress in global health, we hope that Congress will understand the value and importance of maintaining appropriate funding for the global health accounts.”

“Sustained US investments in global health programs and health systems strengthening are crucial – health problems will only be more expensive and more difficult to resolve in the future, especially with the rise of non-communicable diseases (cancer, lung and heart-disease and diabetes) in all populations,” the brief says.

Sequester-related cuts have been forced to impact on nearly all federal programmes, with Congress purposefully designing them so that neither policymakers nor agency heads could target the reductions at waste or initiatives of low priority. Critics note that foreign aid generally only constitutes about one percent of the U.S.’s total budget – with just a tenth of that for global health.

Nonetheless, U.S. spending still has an outsized impact on global health projects. Indeed, the United States has taken on an even more expanded role since the 2008 financial crisis led other donor countries to cut their aid programmes.

Newly released data from the Organisation for Economic Co-operation and Development (OECD), a grouping of rich, industrialised countries, has revealed a 5.4-billion-dollar decline in general international aid flows worldwide in the past year.

Advocates have expressed particular concern about the future of U.S. health assistance because it does not have the deep political support that bolsters other kinds of foreign developmental assistance. Projects for which mutual economic opportunities for donor and recipient countries are far more visible – such as improving infrastructure or trade, for instance – tend to benefit from deeper political support than that for health aid.

“Domestic donor interests have much more influence in donor capitals where aid decisions are being made,” Gregory Adams, head of the aid effectiveness programme at Oxfam International, a humanitarian group, told IPS. “The more locally owned and demand-driven aid gets cut first.”

Adams listed the Global Fund to Fight Aids, Tuberculosis, and Malaria, an international financing organisation, as one of the groups that is affected by this decision-making bias.

Indeed, on Monday the Global Fund announced a massive new 15-billion-dollar fundraising goal. If it attains this goal, the group says it will be able to prevent a million new HIV infections and save the lives of almost six million people with tuberculosis.

“We have a choice: we can invest now or pay forever,” Mark Dybul, executive director of the Global Fund, said Monday. “Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering.”

Double problem

Oxfam’s Adams further warns that there is a “double problem” with foreign aid.

“It’s not just that the [aid] is not getting to the people who need it, but you take these countries that trusted the United States and give them reason not to trust the U.S,” he said.

“We keep asking partner countries to show more leadership – to do a better job of leading and meeting their own countries’ needs, but sometimes the global donor country makes it very difficult for those countries to plan their leadership by changing the goal posts.”

In addition, failure to follow through on health assistance could introduce the additional obstacles of reduced immunity and new drug-resistant strains of a disease, particularly with malaria and tuberculosis.

“History shows that if we scale back funding, malaria will re-emerge worse than ever, especially since populations with reduced immunity will face an increase in morbidity,” the InterAction brief states.

In March, the World Health Organisation issued a statement on the increasing spread of drug-resistant tuberculosis, a growing public health crisis due in part to its history of incomplete treatments in developing countries. A study in August 2012 found that almost half of TB patients were not responsive to either first- or second-line treatments, suggesting the disease could become “virtually untreatable”.

For now, health and aid groups are expressing fear, uncertainty and a fair amount of outrage as they wait to feel the concrete effects of the March cuts.

“The sequester is going to have a significant and detrimental effect,” Oxfam’s Adams said. “[But] it’s a blunt instrument – it’s hard to predict how the axe is going to fall.”

HIV-positive children in Muhanga, a village in Rwanda. Credit: Aimable Twahirwa/IPS

By Carey L. Biron
WASHINGTON, Apr 4 2013 (IPS)

A first-time ranking of 54 top research universities in the United States and Canada has found that a miniscule percentage of funding goes to neglected diseases, despite the outsized influence that public universities play in developing medicines for illnesses often ignored by the private sector.

According to the University Global Health Impact Report Card, released Thursday, less than three percent of research funding at these 54 universities went to neglected diseases in 2010. This includes not only the tropical illnesses, such as Chagas disease and sleeping sickness, but also paediatric HIV/AIDS, malaria and multi-drug-resistant tuberculosis.Universities have a big role in making sure their research is translated into affordable medications for people in developing countries.

Altogether, more than a billion people globally suffer from these diseases, primarily in poor communities, according to data provided by the Universities Allied for Essential Medicines (UAEM), an international student coalition that carried out the research for the report card. Further, around 10 million people a year are said to die because they are unable to access required medicines, many of which are simply too expensive for them to purchase.

“We often hear from students in university labs who really want to focus on these issues but find that the same resources aren’t available to them as in more traditional areas of study,” Bryan Collinsworth, UAEM executive director, told IPS.

“This is not just about bringing in more grant funding – though that’s huge – but also about universities taking more concrete steps to say they’ll support this area of focus. For instance, hiring more faculty in these areas, making sure students have more fellowships in both the field and lab on these issues, and perhaps officially establishing a centre to ensure a specific focus.”

Indeed, 15 of the universities studied had created such a centre, and 10 of those succeeded in offering higher funding for neglected diseases, Alex Lankowski, a BostonUniversity student that participated in the UAEM research, told IPS.

Over the past three decades, some 1,556 new drugs were created, UAEM reports, but only 21 – less than two percent – were for neglected diseases.

“Universities are non-profit institutions operating in the public interest, heavily funded by government grants – meaning taxpayer-funded sources – so students know this means they have a special responsibility to serve the public good,” Rachel Kiddell-Monroe, president of the UAEM board, said Thursday at the report card’s unveiling.

“Universities regularly position themselves as places of learning, operating for the good of the world. Unfortunately, leading research institutions are not living up to their missions … So, students are demanding that these schools start taking concrete steps.”

The UAEM ranking does not focus solely on neglected diseases. Rather, it uses some 14 metrics to look more broadly at whether academic institutions are investing in research that addresses the health of poor communities worldwide.

This includes how those schools are licensing any research discoveries for commercial development, particularly whether they are doing so in socially responsible ways that ensure that related products will be affordable in developing countries. It also includes looking at university programming aimed at creating a subsequent generation of global health practitioners, as well as analysing the extent to which those attempts include a focus on low-income countries and quality of health worldwide.

Under these parametres – the data for which comes only from self-reported, publicly available sources – some of the world’s highest-profile universities fare poorly. Out of 54 schools listed, for instance, 15 are given “D” ratings, including the Massachusetts Institute of Technology (at 39th), New YorkUniversity (40) and ColumbiaUniversity (45).

By deadline, none of these schools had responded to request for comment for this story.

Clear challenge

Kiddell-Monroe notes that global health is no longer the sole prerogative of the United Nations or private foundations. Rather, universities are “increasingly a site of key research and development in medicine – a role that is only set to increase,” she says. “For this reason, we need to examine the impact they’re having and hold them to account.”

Researchers have estimated that up to a third of new medicines are developed within the university system, including at least a quarter of current HIV/AIDS treatments.

“Universities play a huge role, yet we really need to consider this role a bit more carefully,” Dr. Unni Karunakara, international president of Medecins Sans Frontieres (MSF), a humanitarian group, told reporters Thursday.

“It is a problem not only when universities are failing to conduct research on diseases that afflict the developing world. But further, when a university discovers a lifesaving new medicine and licenses it to a drug company in such a way that developing world patients can’t afford – that impedes global health.”

Karunakara notes that Glivec, the anti-cancer drug whose renewed patent was recently denied by the Supreme Court of India, was developed largely through research done in universities. It was subsequently priced out of the market in developing countries, however, when the drug was licensed to the Swiss pharmaceutical company Novartis.

“If universities make commitments to prioritise low-income communities, we can go a long way towards improving global public health,” Karunakara says. “Universities have a big role in making sure their research is translated into affordable medications for people in developing countries.”

The study does turn up some mixed data in this regard. For instance, 21 of the universities reported having come up with standards for socially responsible licensing, while more than half of research licenses are “non-exclusive” – though that figure drops to around a third for medical technologies.

Further, “Self-reporting universities rarely seek to patent their technologies in developing countries, at least within the first year of disclosure, meaning that generic drug manufacturers could develop affordable developing-world medical products from these discoveries without fear of patent restrictions,” a report accompanying the report card states.

“Even in the emerging BRICS economies (Brazil, Russia, India, China, South Africa), universities sought patents on new technologies less than 9% of the time, and less than 2% for all other low- and middle-income countries.”

Still, “provisions to promote global affordability in exclusive licenses” were found to be “exceedingly rare”, being included less than 11 percent of the time.

Together, these statistics present a “clear challenge” to universities, MSF’s Karunakara says: “As institutions dedicated to the public good, now is the time for them to step up and play a major role in improving health worldwide.”

As Thailand braces itself to combat drug-resistant malaria, a spread of small, nondescript buildings scattered close to corn and rice fields along its hilly, western border are being cast into a bigger, international role.

Hundreds of these health clinics and malaria posts have become a pivotal frontline to detect the genetic mutation of Plasmodium falciparum, which makes the deadly parasite resistant to artemisinin, the most effective anti-malaria drug used globally.

“They have been equipped to test and treat local people and migrant workers who come down with fever in that malaria belt,” says Wichai Satimai, director of the bureau of vector-borne disease at the Thai Public Health Ministry. “The results of a blood test are given in 15 minutes and the staff will be able to assess if the patient has malaria and what strain.”

This healthcare for the largely farming and migrant labour community has taken on added significance after medical researchers revealed signs of drug-resistant malaria along the border Thailand shares with Myanmar (or Burma) in April this year.

“These blood tests have to be carried out more regularly and frequently in the environments that are conducive to spread the parasite from carriers of drug-resistant malaria,” Wichai told IPS. “The health staff must regularly monitor and treat the patients.”

The efforts to contain drug-resistant malaria in the isolated areas along the border “makes the fight more difficult,” noted Fatoumata Nafo-Traore, head of the Roll Back Malaria Partnership, a global initiative coordinating the drive against the disease, following a recent visit to health clinics along the Thai-Myanmar border. “There are communities living in forest areas and remote areas.

“We need to contain the resistance in these local areas,” she said in an interview with IPS. “This has to be seen as a global concern because there is no other highly effective anti-malaria drug than artemisinin therapy.”

But even as the border health clinics begin to shoulder a bigger role, concerns about funding the free health services offered to local and migrant communities are also growing. Officials of the Thai health ministry warned early this month that the Southeast Asian nation may have to meet the cost of containing drug-resistant malaria if international funding dries up.

Currently, the Global Fund to Fight Aids, Tuberculosis and Malaria, which finances programmes to combat these three killer diseases in the developing world, remains a major contributor. It has disbursed 40 million dollars for a range of malaria control programmes, including the running of the 300 malaria posts and health clinics along the Thai border.

Thailand’s fear of a looming funding crisis was echoed in the ‘World Malaria Report 2012’, which was released by the World Health Organisation (WHO) this week. “International funding for malaria appears to have reached a plateau” that is below the estimated level to meet internationally-agreed global malaria targets, it states.

“An estimated 5.1 billion U.S. dollars is needed every year between 2011 and 2020 to achieve universal access to malaria interventions in the 99 countries with on-going malaria transmissions,” it adds. “While many countries have increased domestic financing of malaria control, the total available global funding remained at 2.3 billion U.S. dollars in 2011 – less than half of what is needed.”

The need for sustained funding was underscored by malaria’s global transmission, with 2010 witnessing an estimated 219 million cases occurring, while the disease killed about 660,000 people, mostly children under five years in Africa, according to the WHO’s report.

While South and Southeast Asia’s number of 2.4 million malaria cases in 2010 may be dwarfed by the global rates, the annual malaria report singled out the Mekong River region – shared by Cambodia, Myanmar, Thailand and Vietnam – as the epicentre of drug-resistant malaria.

“If resistance to artemisinin develops and spreads to other larger geographical areas, the public health consequences could be dire, as no alternative anti-malarial medicines will be available for at least five years,” the WHO warned.

Artemisinin is the active ingredient in the anti-malarial drug artesunate. It comes from the wormwood plant in China and is the most potent antidote to falciparum malaria, the parasitic strain of malaria responsible for most deaths.

Artemisinin replaced chloroqunine, a once potent anti-malarial drug, following a resistance strain which emerged in Thailand’s eastern border it shares with Cambodia. The resistance to chloroquinine was first detected in Pailin, a Cambodian town that was once the stronghold of that country’s genocidal Khmer Rouge regime, and was then detected along the Thai-Cambodian border before spreading across the world.

Fear of such a repeat with artemisinin also haunts health clinics and malaria outposts along the Thai-Cambodian border, where artemisinin-resistant strains have been detected and contained.

“Good malaria control and elimination will contain the artemisinin-resistant malaria,” said Steven Bjorge, head of the malaria and vectorborne disease section at the WHO’s Cambodia office. “There is no way of knowing that a case of malaria is resistant or sensitive a priori, so detecting and treating each and every case is the proper and necessary means of containing the resistant cases.”

Cambodia’s western provinces such as Pailin, Oddar Meanchey and Battambang – once the spawning ground for the lethal parasite – have seen a reversal of the falciparum strain. “This is an indication of success in preventing transmission,” Bjorge told IPS. “The overall incidence rate has dropped. Deaths have dropped.”

Innovation in the pharmaceutical industry has declined drastically in the last ten years despite the high profitability of the so-called “research-based” industry, and the availability of better and more powerful science and technological tools. Not only has productivity in terms of research fallen, but the vast majority of new molecules introduced to the market do not provide new therapeutic solutions since other treatments already exist, normally at a lower cost.

Funding for research is focused on areas with the greatest potential for profit. Those areas that would actually have the biggest impact on public health remain largely ignored. A clear indicator is the lack of investment in fighting diseases that are prevalent in developing countries, such as Chagas’ disease, tuberculosis and malaria.

The problem is that although millions would benefit from this type of investment, the majority of them are poor people who do not create an attractive market for big companies. Neither can they benefit from treatments for non-communicable diseases such as cardiovascular insufficiencies and cancer: even where treatments are available, the high prices of patented medications make them inaccessible.

As a result, in the 21st century, communicable diseases cause more than 10 million deaths per year -according to Health Action International (HAI)- of which 90 percent take place in developing countries; a third of the global population does not have regular access to the medicines that they need. The situation is worse in least developed countries (LDCs) in which up to half of the population does not have access to medicinal treatment.

From both a moral point of view as well as a human rights perspective ­ the right to health is recognised in international conventions and in numerous national constitutions ­ this situation calls for greater responsibility by governments and a new research paradigm centered on public health interests, especially to meet the needs of developing countries.

On May 26, 2012, the World Health Assembly adopted a resolution that could mark the first step toward a change in the current pharmaceutical research model. The members of the World Health Organization (WHO) decided to undertake an in-depth examination, at the governmental level, of a report produced in April 2012 by an international group of experts that recommended the adoption of a binding convention on research and development (R&D). If approved and implemented, such research could generate the medicines needed, particularly in developing countries, to address communicable and non-communicable diseases.

Some of the conclusions and recommendations of the report were the following:

– the present incentive systems, in particular intellectual property rights, fail to generate enough R&D in either the public or private sector in order to meet the health needs of developing countries;

– recent trends in the pharmaceutical industry show a decline in innovation, as reflected by the small number of approval of new molecular entities (NMEs), the majority of which do not represent a therapeutic novelty;

– to promote better financing and coordination of research, an open approach should be promoted, with the results of R&D being treated as “public goods” not subject to the exclusive rights conferred by patents;

– new forms of shared financing, direct subventions, prizes and patent pools (to increase access to health products) should also be promoted, and mechanisms to coordinate research should be established at the global level.

The report recommended that all countries should dedicate at least 0.01 percent of their gross domestic product to R&D relevant to meet the health needs of developing countries. As regards coordination, it advised the establishment of a global observatory on R&D, advisory services and a network of research institutions.

The main purpose of the report was, however, more ambitious: to start discussions regarding a possible binding international convention to promote R&D centered on diseases prevalent in developing countries, including non-communicable diseases.

This recommendation caused the biggest controversy between developed and developing countries at the World Health Assembly. A possible explanation is that developed countries perceive the suggestion of a new research model as a threat towards the present system based on the appropriation of profits from innovation through the patent system.

But the convention, if adopted, would generate more resources and greater efficiency in terms of research by means of better coordination and a fixation of priorities. Although the main beneficiaries would be developing countries, developed countries could also utilise the results of the research. Some of these countries face a severe crisis in their public health systems owing to the increase in the cost of treatment and a reduction in budgets.

The magnitude of the problem that must be confronted in order to generate enough R&D for pharmaceutical products needed by developing countries is such that this objective cannot be reached without effective commitment from all countries. Voluntary contributions from foundations or governments do not offer a sustainable, structural solution. In fact, many of the most promising initiatives for developing new pharmaceutical products to address the diseases that affect the poor are extremely vulnerable, as they depend on the continuity of charitable financing.

In order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current research model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not accessible to those who need them. (END/COPYRIGHT IPS)

Carlos M. Correa is special advisor on trade and intellectual property of the South Centre, and a member of the Consultative Expert Working Group of the World Health Organization. For further analysis see South Bulletin 67 Article ( http://www.southcentre.org).

HIV/AIDS has caused a steady increase in the number of orphans in South Africa. Credit: Kristin Palitza/IPS

By Sarah McHaney
WASHINGTON, Nov 14 2012 (IPS)

After weathering the departure of its executive director amidst a misallocation scandal earlier this year, the world’s largest funder of programmes to address HIV/AIDS, tuberculosis and malaria is poised to announce a new leader Thursday.

The performance-based Global Fund is a giant in the field of multilateral health financing, channeling 82 percent of the funds for TB, 50 percent for malaria, and 21 percent of the international financing against HIV/AIDS. To date, it has approved 30 billion dollars’ worth of spending.

“They need to do reform 2.0 which focuses on better measurement and accountability on actual disease results,”
Amanda Glassman, director of global health policy at the Centre for Global Development, told IPS.

“We focus too much on paperwork being consistent instead of on what we want the paperwork to achieve,” she said.

The former executive director, Michel Kazatchkine, resigned at the beginning of this year after the AIDS Health Foundation wrote a report in September 2011 urging him to step down amidst a funding misallocation scandal.

More than a year later, the Global Fund is still attempting to recover from that experience, which saw millions of dollars go unaccounted for in four African countries.

“The Global Fund has a terrific record of saving lives,” Deb Derrick, the president of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, told IPS. “They have cut their staff by 20 percent and are operating under a tightened budget. I think a good manager is very well-positioned to do even more with the resources at hand.”

The vast majority of that money, 95 percent, has come from the public sector. The United States leads donations, followed by France, Japan, Germany and the United Kingdom.

For this reason, however, the global financial crisis has hit the Global Fund hard, resulting in a large decrease of public sector donations. In May 2011, the Fund stated that it was 1.3 billion dollars short of its proposed budget for 2011-13.

The Global Fund gives grants based not only on need and vulnerability, but also on the results that recipient countries are able to show. Countries apply for each new round of funding and measure their results against the goals set by previous grants.

In November 2011, the Global Fund was forced to cancel its 11th round of funding due to inadequate resources from donors.

The Fund also suffered, both politically and financially, following the misallocation scandal that came to light in early 2011. Months prior, the Global Fund’s independent Office of the Inspector General had published reports finding that 34 million dollars had gone unaccounted for in four African countries receiving grants.

Germany and Sweden both suspended their donations following this discovery, although they resumed funding in 2011.

In direct response, in September 2011 the Global Fund announced a new five-year strategy for 2012-16 that supports more “aggressive management and oversight of grants, encourages more flexibility in tailoring activities to specific country’s needs, and embraces more country ownership of programs through increased involvement of country governments.”

Still, the Global Fund remains one of the most transparent aid organisations in the world – a fact that led to the discovery of misallocation in the first place. According to the Aid Transparency Index, a ranking of 77 aid-giving organisations and countries, the Global Fund is the fourth in the world.

“I think the inspector-general has done a fabulous job in looking at how to make the Fund more transparent and has undertaken a lot of the reforms and activities to achieve this,” Derrick told IPS.

In September, the Board approved a new funding model for the Global Fund based on the decrease in donations. The new model changes the way in which countries apply for grants, with the aim of putting more money into the most vulnerable populations.

However, there is concern that this will stray slightly from the performance-based funding for which the Global Fund is renowned.

“In order for the Global Fund to remain distinguishable from other organisations that can handle the money such as the World Bank, it needs to build out their performance base model and their accountability for results,” Glassman told IPS.

“If the Global Fund does this it will thrive in the next 10 years of its existence.”

Others are concerned that the new funding model would virtually leave Latin America and the Caribbean out of the Global Fund’s granting, due to how the Fund categorises income levels.

Commenting on this criticism, Derrick says, “Part of this whole reform effort is adjusting to this fiscally constrained environment, getting the money to where it is most needed, and trying to make sure that all vulnerable populations have money allocated to them.”

In October, the U.S. government passed a budget that included a 27-percent increase in funding for the Global Fund. However, the budget also included significant cuts to programmes that addressed only one of the diseases focused on by the Global Fund.

This will likely result in an increase of applications for grants from the Global Fund as money dries up from the U.S. malaria and TB programmes.

“In my view, this budget assignment shows a moving towards multilateral efforts and away from U.S. bilateral efforts. In terms of multilateral aid, the Global Fund performs well,” Glassman told IPS.

The new executive director will have to manage the new funding plan as well as the likely increase of applications while still maintaining the Global Fund’s defining principles.

Researchers unveiling critical trial results of a potentially major anti-malaria vaccine are expressing disappointment that the drug’s efficacy levels have proved lower than they had anticipated.

The malaria plasmodium. Credit: Image by Ute Frevert; false color by Margaret Shear/cc by 2.5

Following on decades of research, the third phase of testing on a vaccine known as RTS,S found that the drug reduced malaria rates among infants (age six to 12 weeks) by about a third, far lower than expected.

The study, funded largely by the Bill & Melinda Gates Foundation, is part of the largest malaria trial ever conducted, taking place in seven African countries. Results were published Friday in the New England Journal of Medicine, a U.S. publication.

While still significant, the results were disappointing in having followed surprisingly positive findings last year, when a similar study suggested that RTS,S was almost twice as effective (47-56 percent) on slightly older children, those five to 17 months old.

If this most recent phase could replicate that level of efficacy among infants, researchers had hoped that RTS,S doses could become incorporated into the standard round of initial vaccinations commonly given to newborns – an approach that has now been proven safe.

“It’s a little frustrating that we’re seeing different levels of protection in different age groups compared to last year and this year,” Andrew Witty, the CEO of GlaxoSmithKline, a major drugs manufacturer and one of the central partners in developing RTS,S, told journalists Friday from London.

“As it turns out, this phase of study was not the final step that I think many people might have hoped. But it’s an important step and takes us further forward towards the goal we’ve been working toward over the past 50 years … this remains the lead and most encouraging candidate vaccine.”

Indeed, the new research constitutes the first time that scientists have found such high efficacy for an anti-malarial vaccine for infants. Witty notes that if the two rounds of study had been reversed, the psychological impact would be far different and the findings would undoubtedly have been widely lauded.

Further, the higher efficacy among the slightly older cohort remains extremely important, given that scientists have found that this age category has greater susceptibility to severe cases of malaria than do infants. While the ease of a single early vaccination would have been the most efficient scenario, researchers say they will now be looking into additional strengthening options, such as giving toddlers a booster later on.

“Two things are very, very encouraging,” Witty says. “One, the trial is successful, despite the fact that it doesn’t achieve quite the high level we would have hoped. Two, the benefit we’ve seen is higher than bed nets, which themselves deliver about 30 percent gain over nothing.”

This last point is an important one, and hints towards the approach that researchers appear to be taking to continue moving forward. Although there are still at least 12 months of additional testing planned ahead of a 2015 projected release date for RTS,S, it now seems clear that the drug will need to play a more limited role among a package of additional interventions.

This will include treated bed nets, which the study reports 86 percent of children under observation were using. Additional research will now look into how to tweak the usage of RTS,S based on age, location and other demographic characteristics.

“In combating malaria, one size does not fit all,” David Kaslow, director of the PATH Malaria Vaccine Initiative, a U.S.-based non-profit that has led the RTS,S research, said Friday from Cape Town, South Africa.

“There is a need for new options for controlling malaria, and we expect that different combinations of tools will be appropriate in different settings in Africa. So, to understand the optimal use for RTS,S, it is critical that we get input from African researchers, because they’re on the frontlines.”

Kaslow notes that the wealth of information coming out of the RTS,S-related studies will also provide “a lasting legacy in Africa for the capacity to develop solutions for malaria and other infectious diseases for years to come.”

Not-for-profit development

Today’s global malaria burden falls most dramatically on Africa, where there are thought to be some 175 million cases of the disease. Ever year, around 655,000 people die of malaria, most of them children in sub-Saharan Africa.

Beyond health and wellbeing, such high numbers inevitably have a massive impact on the prospects for both individual and national economic development.

Yet even as the RTS,S studies move towards the projected 2015 release date, questions remain on how to ensure that the drug could feasibly get to the people that need it the most – whether its price can be kept low enough and whether it can be moved to areas that are often difficult to access.

On the first question, Witty says that GlaxoSmithKline has “made a very firm commitment that this vaccine will be priced at the cost of manufacture plus five percent margin, and all of that margin will be reinvested into future malaria research. So this will be a not-for-profit activity for GSK, where we seek to have the lowest possible cost to maximise access for families and children in Africa.”

On the second question, Salim Abdulla, director of the Ifakara Health Institute, an organisation based in Tanzania that is heavily involved in the current studies, says that Africa has a surprisingly positive record on getting drugs into the hands of those who need them.

“The experience so far with vaccination programmes in Africa has showed that this is one intervention that can be scaled up to reach many children,” he told journalists Friday from Cape Town. “This is one of the major reasons we’ve been able to control many types of diseases in rural Africa, even in remote areas.”

Testing will now take place on the longer-term efficacy of RTS,S, including 30 months after a third dose, as well as the impact of an additional booster. Results should be released by the end of 2014.

Rotarians Against Malaria display one of the treated mosquito nets being used around Papua New Guinea. Credit: Catherine Wilson/IPS

By Catherine Wilson
PORT MORESBY, Jul 26 2012 (IPS)

In Papua New Guinea, a Pacific Island nation located south of the equator, 90 percent of the population is at risk of malaria and 1.9 million cases are reported every year.  But, according to a recent medical study, a programme to distribute long-lasting insecticide treated mosquito nets to every district in the country has dramatically reduced malaria infections.

The World Health Organisation (WHO) claims half the world’s population is susceptible to the infectious disease transmitted to humans by mosquitoes carrying the malaria parasite, with pregnant women, young children and people living with HIV/AIDS especially vulnerable.  In 2010 there were 216 million reported cases of malaria worldwide and 655,000 fatalities, representing a 25 percent drop in the mortality rate since 2000.

This progress, while still short of the global target of 50 percent mortality rate reduction, is attributed to the widespread use of insecticide treated bed nets, improved diagnosis and access to medicines.

In Papua New Guinea, which accounts for 36 percent of all confirmed malaria cases in the Western Pacific region, prevention is vital, as mosquitoes quickly adapt to greater human mobility and higher recorded temperatures.

“Malaria has always been highly endemic in all lowland areas of Papua New Guinea and higher areas up to about 1600 metres have been prone to epidemics whenever weather conditions made transmission possible, for example, a combination of slightly (increased) humidity and higher temperatures,” said Manuel Hetzel, head of the Population Health and Demography unit at the Papua New Guinean Institute of Medical Research.

The Pacific Climate Change Science Programme reports that maximum temperatures in Port Moresby have increased by 0.11 degrees Celsius per decade since 1950 and believes they could rise by 0.4-1.0 degrees Celsius by 2030.  The government predicts climate change could result in 200,000 more people in highland regions being affected by malaria epidemics.

Jacob Ekinye, director of the adaptation division at the Office of Climate Change and Development (OCCD), which was established in 2010, confirmed his office was developing a national strategic response to the impact of climate change on the vector borne disease through a Sub-Technical Working Group on Malaria, comprising representatives of the OCCD, WHO and Papua New Guinean Institute of Medical Research.

In the meantime, the National Malaria Control Programme (NMCP), a partnership between the National Department of Health, Rotarians Against Malaria, Population Services International, OilSearch Health Foundation and the PNG Institute of Medical Research, is working to improve vector control strategies, including distribution of Long Lasting Insecticidal Nets (LLINs).

An LLIN is a mosquito net treated in a factory with insecticide, which repels or kills mosquitoes that come into contact with its surface. Each net has a life span of at least three years.

The nets are most effective when used at night when the main malaria carrying mosquitoes are active, thus protecting people as they sleep.

Use of LLINs is officially endorsed by WHO as a form of vector control and, therefore, malaria prevention at the community level.  The health organisation claims that vector control “is the only intervention that can reduce malaria transmission from very high levels to close to zero” and suggests the most effective way to achieve widespread net protection “is through provision of free LLINs, so that everyone sleeps under an LLIN every night.”

Following the world’s first trial of insecticide treated mosquito nets in Papua New Guinea in 1986, a national distribution programme was implemented in 1989. Papua New Guinea’s success in obtaining a Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004 was critical for Rotarians against Malaria (PNG), which has overseen the dissemination of 5.5 million nets in the country since 1997, partnering with the National Department of Health to distribute LLINs to 80 percent of the population.

According to Tim Freeman, the organisation’s project manager, the emerging factor of climate change has not altered the distribution programme.

“We are responsible for ensuring LLINs are distributed to every household in the country, regardless of whether they are considered high or low risk,” he said.

In Gulf Province alone, which has a population of 149,726, the NGO worked with provincial and church health services, village leaders and health volunteers during the second distribution programme in 2010 to issue 72,533 LLINs to households.  A further 1,540 nets were given to ante-natal clinics, 1,100 to boarding schools and 227 to hospitals.

Freeman confirmed that “all LLINs funded by the Global Fund are free to households and vulnerable groups, such as pregnant women.”

Despite the challenge of poor road and transport infrastructure in rural areas, with many villages only accessible by air, boat or long distance walking, an evaluation of the effectiveness of LLINs by the Institute of Medical Research, with a full report due this year, has shown positive results: household ownership of LLINs has risen to 80 percent, compared to 10 percent prior to systematic national coverage.

“Based on two large countrywide surveys, the data we have analysed so far indicates that the proportion of people infected with malaria decreased from approximately 12 percent in 2009 to below eight percent in 2011,” Hetzel said. “We also found that the distribution of LLINs resulted in a decrease in clinical cases in health facilities.  In some places, this decrease was quite dramatic.”

The Institute of Medical Research reported, “In the absence of any other major malaria control intervention, the observed reduction in malaria incidence and population prevalence can be considered a direct consequence of the net distribution.”

But there are challenges to sustaining the achievements, notably behavioural resistance of mosquitoes and continuation of funding.

“Studies conducted by the Institute of Medical Research have shown no resistance to the insecticide Deltamethrin used on the PermaNet brand of LLINs which are being used in Papua New Guinea,” Hetzel explained. “However, we saw mosquitoes starting to change their behaviour and start biting earlier in the evening.”

WHO has also highlighted that international funding, which peaked at two billion dollars in 2011, still remains short of the annual five to six billion required to meet global malaria control targets.

The Global Fund grant to Papua New Guinea will end in 2014 and new financing will be needed to ensure the fight against malaria remains on track.

(END)