http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbThu, 05 Nov 2009 19:33:59 GMTKABUL Thursday, November 05, 2009 (IRIN) - Over 50 people have been diagnosed as HIV-positive in Afghanistan over the past nine months, bringing the number of registered cases to 556, according to the National HIV/AIDS Control Programme.KABUL Thursday, November 05, 2009 (IRIN) -  Over 50 people have been diagnosed as HIV-positive in Afghanistan over the past nine months, bringing the number of registered cases to 556, according to the National HIV/AIDS Control Programme.

"Most of them have got the virus through intravenous drug use," Malika Popal, the Programme's advocacy and communications adviser, told IRIN, adding that three HIV/AIDS patients had died so far this year.

The Health Ministry estimates 2,000-3,000 people are living with HIV/AIDS in Afghanistan. The virus prevalence rate of about 0.5 percent is considered among the lowest in the world.

Armed conflict, lack of awareness of HIV/AIDS, lack of access to basic social services such as education and health, rising intravenous drug addiction, and the poor social status of women are among the factors which, experts say, could lead to a rapid spread of HIV/AIDS.

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http://www.irinnews.org/report.aspx?ReportId=86888CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).

The Egyptian Demographic Health Survey (EDHS) 2008, [http://www.measuredhs.com/pubs/pdf/FR220/FR220.pdf] published in March 2009, recorded a 6 percent increase in undernourishment severe enough to stunt growth in children under five, pushing the percentage of stunted Egyptian toddlers to 29 percent from 23 percent in 2000.

The survey collected data in 2007/2008, when gross domestic product (GDP) grew by 7.2 percent, indicating that strong economic growth had not benefited ordinary Egyptians. A slower GDP growth of 4.7 percent is forecast for 2008/2009.

“Within the recent context of economic crises and economic slowdown, in addition to the growing epidemics of avian and H1N1 influenza, nutrition is not treated as a priority,” said Hala Abu Khatwa, head of communications in Egypt for the UN Children’s Fund (UNICEF).

Government-run food programmes are in place: In partnership with the World Food Programme (WFP), fortified date bars have been distributed in high-risk schools since 1963; and government-subsidized flour and cooking oil - used to make ‘baladi’ bread - are fortified with iron/folic acid and Vitamins A and D.

Chicken cull

Yet some government policies have adversely affected the nutrition of the poorest.

UNICEF and WFP said the EDHS report of a spike in malnourished children was partly attributable to the government’s decision to cull millions of chickens in 2007.

“The culling had a significant and substantial impact on household consumption of poultry and eggs, especially [on] young children, and also put considerable strain on household resources since poultry sales accounted for nearly half of the incomes of many Egyptian households,” said UNICEF’s Abu-Khatwa citing a 2007 study by the Food and Agriculture Organization (FAO) entitled Livelihood Impact Assessment in Egypt. [http://www.fao.org/docs/eims/upload//239037/ai294e.pdf]

Gianpietro Bordignon, the director of WFP in Egypt, attributed growing malnutrition among children to “the successive series of shocks that affected people, especially the poorest. This started with the outbreak of avian flu and the subsequent killing of poultry that lowered the intake of protein, and then the financial and food crises that followed.”

No data has yet been collected on the nutritional status of the estimated 70,000 unofficial garbage collectors and pig farmers in the Cairo area [http://www.irinnews.org/Report.aspx?ReportId=86742] who relied on pigs for meat, income and organic waste.

Economic reforms

Since 1991 Egypt has embarked on economic reform programmes which have not necessarily helped the poorest in society.

A July report by Egypt’s General Authority for Investment and Free Zones, seen by IRIN and entitled Towards Fair Distribution of the Fruits of Growth, found that 66 percent of the wealth generated in Egypt is sector specific, benefiting only those directly employed by the sector rather than the economy as a whole.

“Between 2005 and 2008, the risk of extreme poverty increased by almost 20 percent. Poverty levels are highest in Upper [southern] Egypt where 70 percent of the country's poor live,” Abu Khatwa said. Upper Egypt is home to about 17 percent of the country’s 82 million people.

WFP’s Bordignon also pointed out that since Egypt is not a “least developed country”, it misses out on international food aid.

According to the 2009 UNDP Human Development Report, [http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_EGY.html] 23 percent of the population are below the poverty line. Food riots [http://www.irinnews.org/Report.aspx?ReportId=77691] in 2008 were symptomatic of widespread poverty.

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http://www.irinnews.org/report.aspx?ReportId=86893WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day. WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day.

Such stories are commonly told with a mixture of humour and concern in the semi-arid region of Wajir, where most residents have little access to improved sanitation - with serious health implications.

"Wajir is prone to diarrhoea outbreaks," Francis Njoroge, Wajir East medical health officer, told IRIN. "Diarrhoeal diseases are [the] third [most] common illness in children below five years.

"Several factors could be contributory: the town lacks a sewerage system [and] uses a bucket system... people depend on boreholes... and many of the community water wells are not protected, exposing them to contamination," Njoroge said.

Outside the town, people use water from open dams, which they share with animals. "During the rainy season, run-off water washes animal waste into the dam, contaminating it," he said.

Wajir residents rely on shallow wells, due to increasing water salinity at depth, which are exposed to contamination during flash floods and from seepage.

The larger Wajir, which borders Somalia, Ethiopia, as well as the Kenyan towns of Mandera, Moyale, Isiolo and Garissa, lies in an area with large aquifers supplied by perennial rivers and dry seasonal river basins - also sources of contamination.

Like most of northern Kenya, Wajir has experienced a prolonged drought and livestock deaths. Animal carcasses litter watering points, posing a further health risk.

Contamination

Wajir South Development Association (WASDA) programme manager, Haretha Bulle, told IRIN of the challenges.

"There are [largely] no flush toilets and no pit latrines," Bulle told IRIN. A few flush toilets can be found in some hotels and in newer settlements but are rare in households.

According to a UN World Health Organization report, latrine coverage in rural Wajir is about 5 percent and just a little higher in the town.

Because of the high water table, pit latrines are not viable, and residents mainly rely on unhygienic bucket toilets - improvised from plastic jerry cans.

"Waste is collected from the bucket latrines by a tractor, which serves the whole town," Bulle noted. The town has a population of about 220,000.

"Households are not able to dispose of waste [and] are forced to dispose it anywhere," she said. "When it rains, the whole town smells. The water gets contaminated more easily and changes colour."

Refuse pit and open pit dumping is prevalent.

El Niño threat

According to Wajir town resident, Khadijah Ibrahim, ongoing El Niño-related rains will only exacerbate the situation. Her family of eight shares one bucket toilet with three other households - about 24 people in total.

"Sometimes the municipal council comes to empty the bucket after a week or 15 days. By the time the waste collectors come, the bucket toilet is already overflowing," Ibrahim said.

Her children, the youngest of whom is three, have been trained to wear shoes before going to the toilet to protect themselves, "but they only use soap to wash their hands before they eat", Ibrahim said.

Eco-toilets

The Arid Lands Development Focus (ALDEF) NGO is piloting eco-toilets, which use heat trapped by solar panels to burn human waste, reducing it to ash.

The toilets do not use water, instead relying on a dehydration/evaporation system. Diyad Hujale, ALDEF programme manager, told IRIN the target was mainly the town centre, which requires about 5,000 toilets.

Hujale recommended that Wajir town’s by-laws should make it compulsory for any upcoming construction to have an eco-toilet facility. The challenge, he said, is "how to get rid of the bucket toilet".

However, the cost of setting up an eco-san unit, about KSh60,000 (US$800), is prohibitive for private households.

Health education

Past recommendations to improve drainage and sanitation in Wajir have not yielded much, according to Bulle of WASDA. "It is one disaster after the other. When the rains come, we think of the drainage but forget about it when the drought comes."

At present, village elders in Wajir are being taught how to chlorinate the community wells, according to health officer Njoroge. Health education on the importance of protecting the wells is also being provided.

He said the construction of more toilets is being encouraged in new settlements, where communities are provided with water treatment chemicals.

"Health education is ongoing. Of importance is that there is continued disease surveillance in the district," he said. The solution lay in "providing clean water to the community and safe disposal of human waste via a sewerage system".

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http://www.irinnews.org/report.aspx?ReportId=86896NOUAKCHOTT Thursday, November 05, 2009 (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences.NOUAKCHOTT Thursday, November 05, 2009 (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences.

On 14 October dozens of people living with HIV organized a sit-in in front of the World Bank building in the capital Nouakchott to draw the Bank’s and the international community’s attention to their situation.

"By suspending their programmes without consulting us, donors have not taken our distress into account," Fatimata Ball told IRIN/PlusNews. Ball represents people living with HIV at the SENLS (the national AIDS committee) Executive Secretariat, the government body implementing Global Fund and World Bank programmes.

"We, people living with HIV, did not bring about these problems, so should we suffer the consequences?" she added. "The reason donors give millions to Mauritania is that we are a poor country. They gave us hope of a second life when we had given up on that hope; they should not drop us."

US$21 million of World Bank funding through 2009 was suspended in August 2008 following the military coup against President Sidi Mohamed Ould Cheikh Abdallahi.

Shortly afterwards the Global Fund suspended HIV/AIDS funding, $15 million over five years which was granted in 2006, following suspected irregularities in grant management. An audit in September 2009 confirmed “embezzlement” had occurred, which led the World Bank also to carry out an audit.

In accordance with the Global Fund’s terms for reinstating funding the new government, named in September following June presidential elections, began proceedings against four SENLS members suspected of being involved in the embezzlement. The State has also promised to return $1.7 million to the Global Fund and to provide supporting documents on the use of a further $2 million. Finally, the government has also committed to re-structuring the CCM (Country Coordinating Mechanism), the country’s Global Fund funding management body; weakness of the CCM is seen as contributing to the problems.

Commitments

While SENLS members recognize the problems that have occurred over the last few months, they are convinced that the new government is keen to resolve the situation as quickly as possible. "The State has made a strong commitment to clearing up the situation. We asked the state general inspectorate to carry out audits and they are now underway,” Ahmed Aida, the recently appointed interim SENLS national executive secretary, told IRIN/PlusNews.

"Corrective measures have been taken to ensure things go smoothly in the future. We need [partners] to join us,” he urged.

In the meantime SENLS wants to ensure that medical care and support issues are addressed. "The government is willing to take responsibility for treatment,” Aida said. In theory, access to treatment is safeguarded under a law introduced in 2007.

The Global Fund have said they are aware of the government’s commitment and will do all they can to limit the impact the suspension has on people living with HIV. "We are 100 percent committed not to break up treatments and we will do whatever we can … to continue the grant,” Jon Lidén, Head of Communications at the Global Fund in Geneva, told IRIN/PlusNews.

"There is a difficult situation [because of] corruption… but the Global Fund is very committed to continue working in the long term to re-establish a way to deliver services in a safe and predictable way, and to expand them as planned,” he added.

The World Bank reaffirmed it is keen to clear up the situation as quickly as possible, but also that they are available to help people living with HIV overcome this crisis.

"We are aware of the urgent nature of the situation and we continue to look after the sick,” François Rantrua, World Bank representative in Mauritania, told IRIN/PlusNews. In terms of care and support for new patients, "we are well on our way to finding a very short-term funding solution,” he added.

While Global Fund-financed HIV/AIDS programmes have been suspended this has not affected patients who were already on ARVs before the irregularities were discovered – just over 1,000 people have continued to receive their medication; but it has not been possible to add any new patients (totalling around 40 people a month) to the treatment programme.

And other activities in the fight against AIDS funded as part of these programmes have also come to a standstill, such as prevention activities and support (psychological, socio-economic) for people living with HIV.

"We are not against [donors] checking [the accounts] because this will make our lives more secure", said Ball. "But what is affecting us is that things stopped so suddenly. If we had had some warning we would have been able to mobilize to find other solutions. We are already suffering due to AIDS; we don’t want to be victims of procedures too.”

ail/lchttp://www.irinnews.org/report.aspx?ReportId=86904NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.

“Malaria kills many people in Africa, both children and adults, despite the availability of free treatment in certain African countries. While it is true many governments in Africa, with development partners, give free pediatric treatment for malaria, many still cannot access this facilities and resort to home treatment,” says Merlin Wilcox of the Research Initiative on Traditional Antimalarial Methods and the University of Oxford.

Some specialists at the ongoing 5th MIM Pan African Malaria Conference in Nairobi said medicines drawn from plants that abound in the continent could be utilized to save many people, especially those in poor settings, from malaria.

BN Prakash, a researcher with the Foundation for the Revitalization of Local Health Traditions, based in Bangalore, said Africa could draw on experiences in India where medicinal plants have been used with great success in the control of malaria-related deaths.

“Research in India has shown a 5-10 times reduction in malaria-related deaths among communities who use traditional medicinal plants like Guduchi [tinospore coeditdia], a local medicinal plant found in India,” said Prakash.

Preserving traditional knowledge

Another speaker, Gemma Burford of the Global Initiative for Traditional Systems of Health, said while there had been increased cases of loss of knowledge about traditional medicinal plants, student-led research could be used to preserve knowledge and create a database on these plants.

“When we carried out research involving school children in rural Tanzania about traditional Maasai medicines, we found out that 48 percent of these children already had knowledge about these plants. We used [this knowledge] to create a database for the purposes of preserving the knowledge and these plants too,” said Burford.

“It is important to note that many malarial drugs are still bought from commercial pharmaceutical shops and not many of them are that cheap. Costs also involve how easy or not it is to access these government facilities, especially in Africa where medical facilities are far-flung,” Burford said.

Educating the youth

Speakers at the conference called on African governments to introduce educational programmes that would teach the younger generations about the traditional methods of treating malaria and other diseases plaguing the continent.

“The biggest obstacle to use of traditional medicines is lack of interest from the youth and teaching them about these medicines would be the best way to let them appreciate their values. Evangelical churches and development agencies must also be persuaded to stop fighting traditional African medicine because modernity and tradition can be married to provide a formidable force against malaria,” added Burford.

Effectiveness and dangers

Doumbo Ogobara, director of the Mali Malaria Research and Training Centre, and a lecturer at the University of Bamako, said there should be more research to ensure the effectiveness of traditional medicinal plants in the treatment and management of malaria.

“More research must be directed towards finding out the effectiveness of these traditional medicinal plants and their safety and efficacy because initiatives on using them could be counter-productive if this is not done. More emphasis therefore must be laid on research for plant-based prophylactics for malaria,” said Ogobara.

Mahamadou Sissoko of the Centre called for caution in taking the traditional medicinal route, arguing that many malaria-related deaths have occurred even among communities that have relied heavily on traditional plants for treatment.

“People are dying even in places where there is still widespread use of traditional medicinal plants and unless the efficacy of a traditional plant on malarial treatment can be ascertained through vigorous research, we could have our backs against the wall. Many traditional healers will abuse this and give anything as medicine so long as it is a plant - we must urge caution,” said Sissoko.

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http://www.irinnews.org/report.aspx?ReportId=86866KARACHI Wednesday, November 04, 2009 (IRIN) - Anecdotal evidence suggests breast cancer is on the rise in Pakistan but budgetary constraints, bogus healers and a lack of awareness is hampering early diagnosis, according to healthcare professionals.KARACHI Wednesday, November 04, 2009 (IRIN) - Anecdotal evidence suggests breast cancer is on the rise in Pakistan but budgetary constraints, bogus healers and a lack of awareness is hampering early diagnosis, according to healthcare professionals.

“While we do not have any official data on breast cancer, from my experience I have seen the numbers go up,” said Rufina Soomro, consultant general and breast surgeon at the Liaquat National Hospital (LNH) Breast Clinic in Karachi, one of the country’s leading breast cancer treatment centres.

LNH records shows that in 1994, 1,574 patients visited the clinic and 28 breast cancer surgeries were performed, whereas in 2008, 11,644 patients visited the clinic and 244 surgeries were performed.

A 2008 report [http://www.pinkribbon.org.pk/index.htm] by the Pink Ribbon Campaign Pakistan said 90,000 new breast cancer cases are detected annually, and the disease caused 40,000 deaths a year in an estimated population of about 172 million.

Entitled A Life Worth Living, the report said Pakistan had the highest rate of breast cancer in Asia and spent the lowest percentage of its gross domestic product on health - 0.57 percent. In Pakistan, about one in nine women is likely to get breast cancer at some point in their lifetime, while in India it is one in 22, the report said.

According to information gathered by IRIN at two of the biggest government hospitals in Pakistan - the Civil Hospital Karachi and Jinnah Postgraduate Medical Centre (JPMC) - one in five female patients screened for breast cancer was positive.

The LNH’s Soomro said there was an alarming rise in the number of breast cancer cases and that the situation was made worse by alternative treatments and misconceptions.

“People shy away from this topic. When I came back to Pakistan and joined a public sector hospital, I was stopped from using the resource material I had brought from the UK as it was deemed culturally unsuitable… Things are better now but still there’s a long way to go,” she said.

Soomro said the government needed to do more to promote breast self-examinations and the usage of mammograms. She also recommended that gynaecologists, lady health visitors and general practitioners guide women on how to examine themselves.

Faith healers

“Breast cancer is a disease that is physically, psychologically and financially draining. The whole family unit is hit hard if a female is diagnosed with it. In the long run for treatment to be successful, a patient needs the maximum support of her family. But people generally are so scared they resort to alternative treatments. Going to a `pir’ [faith healer] is very common and so is the use of homeopathy. By the time women come to us, the cancer is in later stages,” Soomro said.

‘Pirs’ are believed to be intermediaries between Allah and the community. There are thousands of them across Pakistan, with millions of followers, particularly in poorer rural areas.

Breast cancer survivor Suriya Suleman, 45, said when she first felt a lump in her breast she ignored it until the pain became unbearable, even with painkillers.

“My mother took me to a `pir’ who gave me some herbs and an amulet saying that the pain would go away. It never went away and then I moved on to homeopathy for a while. I finally went to a doctor when the breast started looking really bad and that’s when my worst fears were confirmed,” she said.

Having breast cancer proved to be more than a health problem for Suleman. “Our finances drained and I could not undergo a breast reconstruction. Moreover, my husband found a younger, `complete’ wife, although he insists that it was kindness on his part that he did not divorce me. I made it through thanks to my children and the support of my doctor,” she said.

Taboo

While `hakims’ (traditional doctors) and homeopathic practitioners distribute pamphlets claiming to cure breast cancer, the disease continues to be taboo in Pakistan’s mainstream media.

A content producer for a private TV channel, who requested anonymity, said breast cancer was a sensitive issue for TV. “Breasts are a very sexual part of the anatomy and it’s hard to get away with talking about them. On TV shows when issues like pregnancy are discussed, people call us up and complain,” he said.

But slow progress is being made. Throughout October, the internationally accepted breast cancer awareness month, TV stations dedicated segments to breast cancer awareness in their morning shows.

Breast cancer survivor Suleman feels much more should be done. “I wish the media was open about this issue. We show people fondling in soaps and music videos, so why is it that a woman touching her breast for detecting a lump is considered a no-no?”

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http://www.irinnews.org/report.aspx?ReportId=86869JAKARTA Wednesday, November 04, 2009 (IRIN) - Thousands of survivors of an earthquake that devastated Indonesia's West Sumatra Province are still grappling with a lack of clean water and adequate sanitation more than a month after the disaster, relief workers say.JAKARTA Wednesday, November 04, 2009 (IRIN) - Thousands of survivors of an earthquake that devastated Indonesia's West Sumatra Province are still grappling with a lack of clean water and adequate sanitation more than a month after the disaster, relief workers say.

Aid agencies are delivering clean water to survivors by truck, but it is insufficient unless water sources damaged by the earthquake on 30 September are restored, said Endang Trisna, programme coordinator for Mercy Corps [see: http://indonesia.mercycorps.org/].

"Water pumps in many houses have been damaged and wells are contaminated with sand and dirt. Some residents have no access at all to clean water," Trisna told IRIN.

Trisna said Mercy Corps was helping villagers fix their water sources and providing treatment facilities, as well as building latrines and distributing hygiene kits in Padang Pariaman and Agam districts, among the worst hit by the earthquake.

"Our staff are also providing training on hygiene. Our target is to help 10,000 households," she said.

The magnitude 7.6 quake left 1,117 people dead and more than 119,000 houses severely damaged or destroyed, according to the National Disaster Management Agency (BNPB).

IDP camps

The UN Office for the Coordination of Humanitarian Affairs (OCHA) said in its 3 November report that funding for transitional shelter, water and sanitation, and agriculture activities was still urgently needed to bridge the gap into the recovery phase.

According to the report, 600,000 people in Padang, the provincial capital, will be reliant on water trucks until year-end.

There are also 4,000 displaced people in three camps in Agam and about 4,000 in six camps in Padang Pariaman who are being supported with water and sanitation activities.

The government declared a recovery phase from 1 November in all but Padang Pariaman and Agam, home to the camps, where the emergency phase continues because sanitation is particularly poor. The camps are providing shelter for some of the thousands of people displaced by landslides triggered by the earthquake, said Tanty Pranawisanty, Mercy Corps emergency response team leader.

"The tents are not up to standard. They are close to each other, causing overcrowding," she said.

The government is expected to announce its rehabilitation and reconstruction action plan on 15 November, the OCHA report stated.

Ade Edward, head of West Sumatra's disaster coordinating agency, said piped water had been restored in 60 percent of households in Padang, while about 1,000 temporary shelters had been built by aid groups.

But he admitted that living conditions for people displaced in Agam and Padang Pariaman were still far from normal.

"They live in makeshift shelters and there's a lack of water and toilets," Edward told IRIN. "There are problems with sanitation, but it's being handled by authorities."

Funding gap

The UN Children’s Fund, UNICEF, said aid groups have complained they lacked funds to deliver water but stressed that the situation would not threaten the emergency relief effort.

"Aid agencies have been helping with the supply of water bladders and other equipment, but the operational cost is being paid by the local tap water company," said Lely Djuhari, a spokeswoman for UNICEF Indonesia.

"We're confident the government will come up with the cost for water trucking for the next three months, or even beyond," she said.

Meanwhile, the government estimates that reconstruction in West Sumatra will cost more than US$700 million, while the BNPB says more than $315 million will be needed for rebuilding damaged houses.

"We are still awaiting the release of the funds by the central government. However, some reconstruction work has begun, even though money from the government has not come," said BNPB spokesman Priyadi Kardono.

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http://www.irinnews.org/report.aspx?ReportId=86873NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year. NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year.

The most recent nutrition survey carried out in July by the Ministry of Health and the UN Children’s Fund (UNICEF) using SMART methodology focused on assessing the nutritional situation for children between harvests.

The survey revealed that three regions of the country (southeast, south and centre) had the highest rates of global acute malnutrition (GAM). In central areas the rate was 19.2 percent, well above the World Health Organization’s emergency threshold of 15 percent.

In rural areas there tends to be various causes for malnutrition, notes Mohamed Moustapha Kane, head of the Health Ministry nutrition service.

General poverty levels in the country – more than 46 percent of the population live below the poverty threshold, according to the UN – and the lean season both contribute to malnutrition, but in addition in rural areas, although they are "agropastoral regions, not everyone has [cattle or land]. People also lack knowledge…of [good nutritional practices]. Isolation and lack of infrastructure are also an issue: access to health, drinking water or [hygiene]".

According to the July 2009 study the GAM rate in Nouakchott (7.9 percent) is much lower than in other areas. However the difference is that in the capital, as opposed to in rural areas, the seasons have little influence on the phenomenon: the December 2008 SMART study during a post-harvest period showed a 5.9-percent rate in Nouakchott compared to 11.9 percent in the central region.

Many observers have noted that the time of year does not affect food availability in urban areas. According to Nené Koné, who has been in charge of child nutrition at the Dar Naim health centre since 1991, in large part a lack of money perpetuates the problem in Nouakchott.

When mothers arrive at the centre with their children, "the main issue that comes across is their extreme poverty,” Koné told IRIN. "If the mother is hungry because she has not been able to eat, then she has no milk [to breastfeed]".

"Families are heavily in debt throughout the year,” said Isabel Marco of Communauté des Filles de la Charité, who support the centre. The huge increase in global food prices in 2008 has made the situation even worse for urban families who do not produce any food and have buy everything: 25 litres of milk cost 35,000 ouguiya (US$134), compared to $53 in 2004, said Marco. Today it costs 24,000 ouguiya ($92) – the equivalent of one month’s minimum wage in a country where "traditionally we drink a lot of milk”.

Child malnutrition in urban areas is also linked to the financial situation of many Mauritanians deteriorating over the last few decades. Tahya Sidiekhreye, in her 50s, has brought up "lots" of children. She arrived at the Dar Naim centre at the start of October with her grandson, who is 15 months old and suffering from acute severe malnutrition.

"I never had these problems with my children: my husband and I always managed to get by [to feed them], but now it’s too hard,” she said. "[My grandson] has been ill for four months and I haven’t got the money to care for him. [His mother] doesn’t work and his Dad is unemployed, so they cannot care for him.”

She is looking after her grandson because her daughter does not know what to do, she told IRIN; the child’s mother is 15. When mothers lack nutritional knowledge and do not have enough milk they are unable to breastfeed, many experts have noted. And in urban areas in particular certain practices that lead to malnutrition have become common.

"In the past breastfeeding was highly socially valued, but there is now a trend of using milk substitute,” Brahim Ould Isselmou, communications officer at UNICEF, told IRIN. Despite the cost of this practice – a tin of baby milk that lasts five days is sold for around 1,600 ouguiyas ($6) – it also changes habits. "After a few months some mothers become confused and sometimes you see [some of] them giving meat to six-month-old babies.”

While health services are more accessible in urban areas than rural, the quality of care and support for malnutrition is not always guaranteed, as Sidiekhreye discovered. Before finally getting care for her grandson at the Dar Naim health centre she spoke with a private doctor who referred her to a hospital as the child was showing worrying symptoms. "He was vomiting a lot and was dehydrated but they did not hospitalize him: they just gave me a prescription for [paracetamol] and sent me away,” she told IRIN.

In order to standardize care and support services for malnutrition and among other things improve quality, the authorities developed a national protocol in 2007, which all centres are expected to follow. The protocol called for standardizing how malnutrition is assessed, referred and monitored and how care and support are provided. At Dar Naim and other health centres staff have been trained on this protocol with support from UNICEF.

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http://www.irinnews.org/report.aspx?ReportId=86874NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.

"My twins are [21 months] and my baby is one month old. I had two children before; the first died at one year and the other lived a month and a half. They were ill and had fever. They refused to breastfeed and then they passed away [due to complications linked to malnutrition].

"My husband is a farmer [near Kaédi] and he grows millet and peanuts. Sometimes we have food but at other times birds eat the seeds and nothing grows. In our region the majority of people eat only once a day, myself included.

"As I wasn’t eating much I didn’t have enough milk for the twins. [Shortly after they were born] the girls became ill so I decided to come to Nouakchott to look after them. I took them to Dar Naim [a health centre in a Nouakchott suburb managed by the State with support from aid agencies and donors including the UN Children’s Fund] each day.

"After six months my twins had recovered so I went back to my husband. I then became pregnant again. But my twins started to get sick again so I returned to Nouakchott. I’ve been here for five months now staying with [relatives]. I come to the centre nearly every day. The twins get porridge made from rice, fish and vegetables and there’s [baby] milk for the little one.

"As soon as my children get better I will go back to the village. I came here just to care for them but I don’t want to stay. I want to go home. My husband and I will get by with the kids.”

ail/lc/nphttp://www.irinnews.org/report.aspx?ReportId=86876MBABANE Wednesday, November 04, 2009 (IRIN) - Swaziland not only has the world's highest HIV prevalence rate, it now also has the highest tuberculosis (TB) rate, but health officials warn that not enough is being done to integrate TB and HIV services. MBABANE Wednesday, November 04, 2009 (IRIN) - Swaziland not only has the world's highest HIV prevalence rate, it now also has the highest tuberculosis (TB) rate, but health officials warn that not enough is being done to integrate TB and HIV services.

Last week the Ministry of Health and Médecins Sans Frontières (MSF), the international medical humanitarian organization, brought together health experts to look at practical solutions for the small landlocked country.

One in four adults is infected with HIV; by the end of 2007 an estimated 170,000 people were living with HIV, and every year an estimated 13,000 people develop TB, the primary opportunistic disease in HIV-positive people.

"When you look at the history of TB in Southern Africa you see that it was considered a very serious disease in the 1950s, but seemed to be under control by the 1980s; but with the arrival of HIV and AIDS, TB rates have really gone out of control," said Prof Alan Whiteside, head of the Health Economics and HIV Research Division (HEARD) at the University of KwaZulu-Natal in South Africa.

Themba Dlamini, manager of Swaziland's National TB Control Programme, said 80 percent of Swaziland's TB cases were also HIV-positive.

But with governments focused on HIV/AIDS, TB has not been getting enough attention.

"Part of the problem is we've been very good at mobilizing for HIV and AIDS, and we sort of forgot about TB as we did that. Unfortunately, I don't think the people mobilizing for TB have been as articulate and as powerful as those mobilizing for HIV and AIDS - we need to put TB higher on the public agenda," Whiteside told IRIN/PlusNews.

Swaziland's Health Minister, Benedict Xaba, reminded delegates that although the country provided free TB medicines, other costs, such as hospital fees and transport, made it difficult for many people to access health services.

"There are several issues that Swaziland needs to face. Access to care is particularly important ... so people who show signs of symptoms can be checked immediately. Free consultation is absolutely imperative - we must think of free care from diagnosis to clinical cure," urged Dr Mario Raviglione, Director of the Stop TB Department of the World Health Organization (WHO).

Raviglione urged the country to step up efforts to integrate TB and HIV services. "It doesn't make any sense for a person taking TB drugs and ARVs [antiretrovirals, to treat HIV] to go to two separate doctors. These must be integrated."

About 58 percent of TB patients completed their six-month course of treatment last year, falling far short of the 85 percent target recommended by WHO. International guidelines also set a 70 percent detection target for TB, but in Swaziland the case detection rate is below 60 percent.

The good news is that, unlike HIV/AIDS, TB is curable. "I know people living with HIV and TB, and their TB has been dealt with," noted Whiteside. "It is a community message we need to get out - that we are capable of eliminating the scourge of TB in your community."

jh/kn/he http://www.irinnews.org/report.aspx?ReportId=86879DAKAR Wednesday, November 04, 2009 (IRIN) - Donors have promised US$40 billion in aid to agriculture in developing countries since the Rome “food summit” in 2008, but in some countries the bulk of this aid is uncoordinated, shortsighted and does not support government priorities, says NGO Oxfam. DAKAR Wednesday, November 04, 2009 (IRIN) - Donors have promised US$40 billion in aid to agriculture in developing countries since the Rome “food summit” in 2008, but in some countries the bulk of this aid is uncoordinated, shortsighted and does not support government priorities, says NGO Oxfam.

“Technical and financial partners are supporting different projects that are totally disconnected from one another and from the agriculture policy framework set up by the government,” Jean-Denis Crola, author of the report ‘Aid to Agriculture: from promises to reality on the ground’, told IRIN.

“And many of the new interventions do not represent new money, but are financial re-allocations from other sectors,” he said.

Rather than working through governments, most donors and technical partners in the three West African countries Oxfam studied – Burkina Faso, Ghana and Niger – channel agriculture financing through UN agencies such as the Food and Agriculture Organization (FAO) or the World Food Programme (WFP), and other international institutions; they also implement projects themselves through consultants, said Oxfam.

Impact

In 2007 in Burkina Faso 27 development donors supported 131 separate agriculture projects, most of which bypassed government structures, Crola told IRIN; in 2008 this had been cut to 80, but this number still overwhelms government administration, he pointed out.

Lack of coordination also weakens governments’ administrative capacity as finance ministries are forced to employ dozens of staff whose sole job is to track and report on a multitude of projects, said Oxfam.

With most projects lasting three to five years, donor timeframes can also stymie long-term planning in government.

But most importantly such policies leave people hungry, as investment in agriculture remains low, Crola said.

In Burkina Faso while the government had stressed the need to streamline agricultural financing through a few grain, produce and livestock cooperatives, the four major agriculture donors – World Bank, Germany, Denmark and Canada – chose to support 30 different networks among them, without sufficient coordination in selecting, Crola said.

As a result some sectors such as sesame, soya, and cowpeas were over-supported while staple foods as rice and maize were under-funded, he said.

“A process”

Emmanuel Nikiema, the World Bank’s programme director in Burkina Faso, told IRIN while there have been problems coordinating in the past, “harmonizing our aid with government policies is now the order of the day for all of the major donors in the country.”

Coordination is a process, and while donors could improve their performance, the government must also fulfill its role by showing strong leadership on agricultural policy, he said.

“We [financial and technical partners] are there to support not to replace the government, and it is up to the government to be at the forefront of the strategy,” he told IRIN.

G8 leaders reiterated the need to coordinate funding when they pledged $20 billion at the September 2009 summit, to help developing countries out of the food security crisis and to support long-term agricultural development.

In September 2008 at a forum on aid effectiveness in Ghana, donors reiterated their commitment to improving the predictability and coordination of aid efforts.

Leadership

Oxfam agrees stronger government leadership is needed. Governments must develop policies, demonstrate better leadership on agriculture and work with the commercial sector to develop stronger regional policies if they are to develop a stronger voice with external donors, says the report.

Many West African governments abandoned agriculture, sidelining it in their national budgets, partly as a result of the Washington Consensus donor strategy.
Between 1995 and 2007 agriculture accounted for less than 5 percent of total official development aid committed to West African states, while about 80 percent of West Africa’s inhabitants depend on agriculture to survive.

Niger and Burkina Faso still have no agricultural policy; their commitments to the sector are spread across several different ministries according to Oxfam’s report.

Opportunity

Donors are improving their coordination and performance in other sectors including health and education, with pooled funds increasingly the norm, said Crola, adding that there is no reason they cannot veer in this direction for agricultural funding.

“The opportunity to change is now while international interest in food security and agricultural development is still a reality,” he told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86883DAKAR Wednesday, November 04, 2009 (IRIN) - Dengue fever continues to spread in Cape Verde, with 748 new suspected cases announced by the government on 4 November bringing the total to 6,707. Health officials say at least three people have died in the country’s first-ever epidemic of the mosquito-borne illness.DAKAR Wednesday, November 04, 2009 (IRIN) - Dengue fever continues to spread in Cape Verde, with 748 new suspected cases announced by the government on 4 November bringing the total to 6,707. Health officials say at least three people have died in the country’s first-ever epidemic of the mosquito-borne illness.

Dengue was first reported in early October in the archipelago of some 432,000 inhabitants, according to the World Health Organization (WHO).

An inter-ministerial committee headed by the Prime Minister is working to contain the spread of the disease, educating communities on prevention and taking measures to control mosquitoes.

The Health Ministry “calls on the population and health institutions to increase efforts to eliminate breeding grounds”, according to a statement on a government website.

Dengue fever is a sudden onset illness with symptoms similar to those of malaria – headache, fever, exhaustion and severe joint and muscle pain. Global incidence of dengue has increased dramatically in recent decades, with about two-fifths of the world’s population now at risk, according to WHO.

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http://www.irinnews.org/report.aspx?ReportId=86886NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.

"I was experiencing a bad smell from my private parts and I wondered whether it was because I was HIV-positive; I could not keep quiet any more and I shared with one of the nurses and she referred me to the doctor," Mworia told IRIN/PlusNews. "I did not even know there was anything called cervical cancer, which I was informed can kill very easily."

According to the UN World Health Organization (WHO) [http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/KEN.pdf], some 2,635 Kenyan women are diagnosed with cervical cancer every year, with 2,111 dying from the disease, making it the most prevalent cancer among women in the country. About 38.8 percent of women in the general population are estimated to harbour cervical human papillomavirus (HPV) infection [http://www.cancer.gov/cancertopics/factsheet/Risk/HPV] - a leading cause of cervical cancer - at any given time.

High risk, low knowledge

For cervical HPV infection to progress to cancer, certain co-factors must be in place, including smoking, long-term hormonal contraceptive use and co-infection with HIV.

"Women who are HIV-positive have weak immune systems and this makes them very susceptible to persistent human papillomavirus that develops into cancer of cervix," said Lucy Muchiri, a senior lecturer in human pathology at the University of Nairobi's College of Health Sciences and a member of the sub-Saharan Africa Cervical Cancer Working Group.

"It takes a relatively shorter time for the HPV virus to develop into full-blown cancer of the cervix for women who have the HIV infection … It would take relatively longer in women who are not infected with HIV."

Pap smear tests - which check for changes in the cells of the cervix - are available at most district health facilities in Kenya, but according to WHO, fewer than 6 percent of women access them.

"I think many women die from the disease for a number of reasons - one is ignorance because knowledge about the disease among women and in the general population is very low and it is mistaken for other diseases," she said. "It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women."

According to Francis Kimani, director of medical services at the Ministry of Health, Kenya is planning a screening programme for early detection and treatment of cervical cancer as well as a widespread education campaign.

Education gap

"I think our best bet is to carry out education to let people know about the disease and that early detection of it can be very helpful," Kimani told IRIN/PlusNews. "It is true that not many people - especially in rural areas - know about the disease."

Studies [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631263] have shown that HPV is higher among women who have multiple sexual partners and unprotected sex.

"Maybe to prevent it in the first place, the same methods used in combating HIV, like condom use, abstinence and keeping to one faithful partner, should be encouraged in this case too," Muchiri suggested.

She noted that the government also needed to invest in making the HPV vaccine - which protects against four major types of HPV, including two types that are responsible for 70 percent of cervical cancers - widely available in public hospitals.

Vaccine availability

The Kenya Pharmacy and Poisons Board approved the sale of an HPV vaccine in the country in 2007, but its availability is extremely limited and it is still prohibitively expensive for most Kenyans.

"HPV is a sexually transmitted virus and with the vaccine in place, it is important to encourage parents to take their young girls between the ages of nine and 15 to be vaccinated before they debut into sex," she said.

A recent study by the local NGO, Centre for the Study of Adolescence, found that four in 10 Kenyan girls had sex before the age of 19, many of them as early as 12.

"Once they [women] become sexually active, it is important to encourage [them] to go for Pap smear tests or visual detection of the pre-cancerous lesions but even vaccination at this stage is still feasible so long as one has not contracted the virus," Muchiri added.

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http://www.irinnews.org/report.aspx?ReportId=86853KABUL Tuesday, November 03, 2009 (IRIN) - A UN World Health Organization (WHO) official has backed the Afghan government’s health emergency declaration which involves a three-week closure of all schools and universities in Afghanistan as a means of preventing the spread of H1N1 influenza. He called it an “appropriate and timely measure” to curb its spread.KABUL Tuesday, November 03, 2009 (IRIN) - A UN World Health Organization (WHO) official has backed the Afghan government’s health emergency declaration which involves a three-week closure of all schools and universities in Afghanistan as a means of preventing the spread of H1N1 influenza. He called it an “appropriate and timely measure” to curb its spread.

“It was the right decision by the minister of health as we see the number of H1N1 cases rising,” Ahmed Abdul Rahman, WHO’s officer-in-charge in Afghanistan, told IRIN on 3 November. The government made the announcement on 1 November.

According to the Ministry of Education there are over nine million children and students at schools, colleges and universities in the country. All of them will be required to stay at home from 2-23 November.

Afghanistan had reported over 320 H1N1 cases with two deaths as of 3 November.

Some observers have suggested that the closure declaration was designed to prevent protests against President Karzai’s controversial re-election announcement, made the following day.

“In a country where two mothers die every hour from pregnancy-related complications, why is the suspected death of only two patients from flu declared an emergency?” asked an international aid worker in Kabul who did not want to named.

“The disease was not widespread and cannot justify a state of emergency in which the entire education system is closed,” Kabir Ranjbar, a member of parliament, told IRIN.

However, the Ministry of Public Health (MoPH) defended its decision and said the state of emergency was in no way politically motivated.

“Countries like Ukraine, the USA and Mexico, which are not in [the midst of] elections, have also declared H1N1 emergencies and so has Afghanistan,” Farid Raaid, MoPH’s spokesman, told IRIN.

“We are in the midst of at least three emergencies namely security, political and now health,” said Ajmal Samadi, director of the Kabul-based rights watchdog Afghanistan Rights Monitor.

Six million at risk?

Health officials told IRIN over six million of the country’s estimated 28 million people risked catching H1N1. Pregnant women and children were particularly vulnerable, they said.

“Through the health emergency we want to mitigate the risks and prevent a major outbreak of H1N1 in the country,” said Amir Ansari, an adviser to Health Minister Mohammad Amin Fatimie.

The government has prepared a snap appeal for over US$60 million to procure medication, such as Tamiflu and seasonal flu vaccines, and undertake other necessary measures to combat the disease, Ansari said.

The MoPH has also asked the World Health Organization (WHO) for support and the provision of over one million doses of Tamiflu, officials said.

Afghanistan only has one virology laboratory capable of diagnosing the H1N1 virus but about 200 surveillance units have been established across the country to quickly report suspicious flu cases. No H1N1 vaccine is available yet but the health authorities have received over 30,000 doses of tamiflu tablets from WHO, according to the MOPH.

The H1N1 type of influenza was first reported in Mexico in April 2009 and quickly spread to dozens of countries around the world. Globally, over 440,000 cases of H1N1 and over 5,700 deaths were reported by WHO as of 25 October [http://www.who.int/csr/don/2009_10_30/en/index.html].

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http://www.irinnews.org/report.aspx?ReportId=86858ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.

"It's a chance to experience life; there is no family, there are no restraints," said Biniam Mohammed, project coordinator of the Modelling and Reinforcement to Combat HIV/AIDS (MARCH) [http://www.aau.edu.et/march] project in the Siddist Kilo Campus of Addis Ababa University (AAU). "Some use it in a good way but some do risky things, such as chewing khat [a mild stimulant] … having [unprotected sex] and using commercial sex workers.

"Some of these students will have limited awareness of the risks of HIV/AIDS, and then there is peer pressure as well," he added.

Ethiopia's overall HIV prevalence is a relatively low 2 percent, but prevalence in the capital, Addis Ababa, is 7.5 percent. According to the Federal HIV/AIDS Prevention and Control Office (FHAPCO), anecdotal evidence of widespread unsafe sexual practices suggests students may be among the more high-risk groups in terms of HIV vulnerability.

MARCH statistics show that 50 percent of AAU students are sexually active, but only half of them use condoms, said Biniam.

High-risk behaviour

"Often they do not use condoms… they are doing it emotionally, without any thought," said Selam, a 19-year-old AAU student.

Selam added that students coming to the city from the countryside usually had less information about HIV and were not as street-smart as Addis youth, leaving them unprepared to resist unwanted sexual advances or insist on protected sex.

Former student Girma Tesfaye, now Addis Ababa project coordinator for HIV-focused NGO Mekdim, says female students often fall prey to “sugar daddies”.

"There are lots of beautiful girls at university and older people with beautiful automobiles stop around the university and look for them," he said. "It is common to take students this way. They have lots of money; they will provide the girls with money and different [presents].

"The older 'daddy' may have three or four partners in such a way, which facilitates the spread of HIV," he added.

Selam agrees that this is a significant problem, noting that in the early evening, heavily made-up and scantily clad female students make their way to the area outside the main gates known as the Debab to try to find a rich boyfriend, usually one who already has a wife, and quite possibly a string of other girlfriends.

"If you have sex because of a threat, or you have a 'sugar daddy', it is one-sided and that makes them more at risk," said MARCH's Biniam. "Influenced or coerced sex is high risk."

Evidence also suggests that male students use local sex workers; a survey [http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/EthiopiaSynthesisFinal.pdf] of Addis-based sex workers found that 5.8 percent of their clients were students. Sex workers in the nearby Arat Kilo area confirmed that many of their clients were AAU students.

MARCH, with funding from the US President's Emergency Plan for AIDS Relief, produces Life 101, a quarterly photo graphic novel that follows the story of three students and one couple at AAU as they experience daily university and city life and deal with issues such as transactional sex, condom use, relationships, testing for HIV, and gender equity. MARCH also facilitates student-led entertainment events to stimulate discussion of the issues.

Recently, more than 20 Ethiopian university presidents initiated a request [http://hapco.gov.et/index.php?option=com_content&task=view&id=103&Itemid=2] to the Ministry of Education and FHAPCO for more HIV activities, including a national HIV/AIDS policy and strategy for universities, an HIV/AIDS research and information centre, gender and HIV/AIDS advocacy efforts and sustainable training and discussion forums.

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http://www.irinnews.org/report.aspx?ReportId=86837DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.

Pneumonia kills over 4,000 children daily – more than measles, malaria and AIDS combined, says the UN Children’s Fund (UNICEF). However, to date, stamping it out has not been prioritized by policy-makers or donors, says the coalition of over 50 health organizations launching the pneumonia movement.

“There has been little traction on the pneumonia issue for years but it now feels like we are at a tipping point,” Orin Levine, executive director of the pneumonia research programme at Johns Hopkins Bloomberg School of Public Health, told IRIN. "Now it is critical for donors, international partners and countries to make protection, prevention and treatment available to all children everywhere with no delay.”

UNICEF and the World Health Organization (WHO) in a Global Action Plan for the Prevention and Control of Pneumonia are calling on donors and national governments to commit US$39 billion to improve prevention and treatment in 68 high-prevalence countries between now and 2015.

Preventing pneumonia requires increasing the number of children vaccinated against common causes of pneumonia, such as streptococcus pneumonia (pneumococcal disease) and Haemophilus influenzae type b (Hib), and improving community-level treatment of pneumonia through training and access to antibiotics, according to the plan.

The plan also calls for improving health, hygiene and nutrition practices by promoting exclusive breastfeeding, hand-washing, reducing indoor air pollution and giving zinc to children during diarrhoea outbreaks.

“Nearly half of [pneumonia] deaths could be prevented with existing vaccines and the vast majority of cases could be treated with inexpensive antibiotics,” Save the Children Board member and former US Senator Bill Frist said in a communiqué launching Global Pneumonia Day. “Yet lives continue to be lost from this preventable and treatable disease, and until recently there was very little outcry.”

Research groups specializing in pneumonia say vaccine roll-out in Africa and Asia has been slow due to lack of money and awareness.

Vaccines

Vaccines against two of pneumonia’s common bacterial causes, Hib and pneumococcus, are routinely used in industrialized countries but are not yet available in most of the developing world, according to GAVI Alliance, a public-private partnership providing immunization and health system support worldwide.

"Vaccine coverage is improving but at a “slower pace than we would like to see," WHO spokesperson Olivia Lawe-Davies told IRIN.

GAVI plans to speed up the introduction of pneumococcal vaccines in 42 countries to reach 130 million children by 2015.

“Millennium Goal four cannot be met without this investment...Immunization is one of the most cost-effective ways to save lives. And improved health is a fundamental driver for long-term development,” said Julian Lob-Levyt, head of the GAVI Alliance, in a 2 November communiqué.

Millennium Goal four aims to reduce by two-thirds the deaths of under-five children by 2015.

Affordable treatment

GAVI Alliance has developed a funding mechanism to encourage pharmaceutical companies to produce a pneumococcal vaccine at 10 percent of the normal price, costing developing country governments on average 15 cents per dose.

For those children who contract pneumonia the antibiotics that could save their lives cost less than $1, but currently less than 20 percent of children receive them, according to WHO and UNICEF.

''Pneumonia contributes to 60 percent of the in-patient admissions in any hospital in Uganda, and the worst scenario is seeing a mother walk into the emergency unit…because she was not aware of the seriousness of her child's illness, and seeing that child pass away because it was too late to intervene,” said Sabrina Bakeera-Kitaka, President of the Uganda Paediatrics Association in a 2 November statement.

Donors who sign on to the Global Action Plan at the 2010 World Health Assembly would agree to increase the supply of antibiotics to health clinics in hard-hit countries and train community health workers in pneumonia case management.

“With increased donor support, we can save many more lives and make an incredible leap towards further reducing child mortality in the world. This is an historic opportunity we must not ignore,” said GAVI’s Lob-Levyt.

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http://www.irinnews.org/report.aspx?ReportId=86838LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.

Bushra and her husband have never considered the possibility that their daughter’s sight problem could merely be a refractive error, easily corrected with a pair of glasses. The couple, who have little formal education, have two other children.

“We have no money to take Kaneez to a doctor or buy glasses,” said Bushra. The family’s income is Rs 8,000 (US$100) a month.

According to Niazullah Khan, country director in Pakistan of the UK-based charity Sight Savers International, there are 1.4 million blind people in Pakistan. Of these, 45,000-48,000 are children under 15.

“Three times that number of children has low vision,” he told IRIN.

The World Health Organization (WHO) defines low vision "as visual acuity less than 6/18 and equal to or better than 3/60 in the better eye with best correction". It also notes there is, globally, a “high burden” of refractive error - which can be rectified with appropriate optical correction.

“We often see children with eye problems and though we refer them to free eye clinics not all parents take [their] children there. They are not aware poor sight can affect learning and quality of life,” said Dr. Nishat Kausar, a general practitioner. “Often people just try to buy cheap glasses from roadside sellers,” she said.

There are at present only 64 schools for blind and visually impaired children in Pakistan (population 165 million).

“We are trying, under new government policies, to facilitate education in mainstream schools for children with low to moderate vision, because the environment in schools for the disabled is not right for them. They need to live with normal people and learn how to manage,” Khan said.

Cataracts

Aroosa Haroon, 12, was diagnosed with cataracts in both eyes a year ago. Her parents, both librarians, were able to pay for surgery, performed on an outpatient basis at a private hospital, and Aroosa says “I can see perfectly again.”

She is fortunate. There are 9,000-10,000 cataract blind children in Pakistan. Cataracts account for 53 percent of all blindness in the country.

According to Sight Savers, 3000-4,500 paediatric cataract surgeries take place annually.

However, there are also other threats to sight, some of them linked to poverty. This is one reason why Kaneez, from a low income family, struggles with an uncorrected vision error, while Aroosa, from a more privileged background, was treated before poor sight could affect her education.

The link between poverty and blindness has been established by some scientific studies.

Vitamin A deficiency

One of the reasons for this is a widespread Vitamin A deficiency, experts believe. Globally, WHO notes, this is the leading cause of childhood blindness.

“Clinical deficiency of Vitamin A causes night blindness that may ultimately end up with loss of vision,” Azhar Abid Raza, health officer for the UN Children’s Fund (UNICEF) Pakistan, told IRIN. “According to the National Nutrition Survey 2001-2002, 12.5 percent of children showed evidence of being vitamin A deficient,” he said.

Pakistan has, with UNICEF support, run a Vitamin A supplementation programme, linked to National Polio Immunization Days, since 1999.

The battle against blindness is being waged in both the public and private sectors, with organizations such as the charitable Layton Rahmatullah Benevolent Trust running 56 eye clinics and hospitals across the country.

“We treat one in every three eye patients [in the country] and our mission is to offer quality eye-care to anyone who needs it,” said Najmus Saquib Hameed, a trustee of the organization.

But despite these efforts, children like Kaneez Fatima remain out of school. “I wish I could see enough to read, like my sisters can,” she said.

kh/at/cbhttp://www.irinnews.org/report.aspx?ReportId=86829WINDHOEK Friday, October 30, 2009 (IRIN) - In Onamutenya village, northern Namibia, the Shigwedha household leaves their homestead at the crack of dawn to make the monthly four-hour walk to fetch antiretroviral (ARV) medication from the local clinic.WINDHOEK Friday, October 30, 2009 (IRIN) - In Onamutenya village, northern Namibia, the Shigwedha household leaves their homestead at the crack of dawn to make the monthly four-hour walk to fetch antiretroviral (ARV) medication from the local clinic.

Wilbard Shigwedha, 9, who is HIV-positive and an old hand at this early-morning routine, willingly gets up at 4 a.m. to make it in time to the clinic. By the time he and his mother Krestina, 35, who is also living with the virus, get to the packed health facility in Onayena after walking 20km, his brown pin-striped three-piece suit is coated in dust.

A return trip by minibus-taxi would have cost them 40 Namibian dollars (US$5) - too expensive for an employed widow and mother of four, two of whom are HIV-positive - and the sandy roads are tricky to negotiate by car, so taxis are also infrequent.

Distance and transportation are among the major challenges in rolling out HIV treatment in Namibia, a vast country, with wide open spaces and a population density of less than 2 people per square kilometre.

About 15 percent of the 2.1 million people in the country are estimated to be living with the HI virus.

The long distances compelled the team of healthcare workers running the Shanamutango HIV clinic at the Onanjokwe Lutheran Mission hospital, in the Oshikoto region, to launch their outreach project to bring HIV services to remote clinics like the one in Onayena.

Northern Namibia is one of the poorest and most isolated parts of the country, where social services, employment opportunities and infrastructure are thin on the ground.

"Our patients travel as far as 100km. We don't provide transport ... a trip to come here can cost them 30 to 50 Namibian dollars one way, so our outreach programme is bringing the service closer to them," said Tutaleni Shilyomunhu, acting nursing manager at Shanamutango.

The Shanamutango HIV Clinic - funded by the US President Emergency Plan for AIDS Relief (PEPFAR) - is one of the largest treatment sites in the country, providing ARVs to 8,000 of its 12,500 HIV-positive patients.

"[The country] is doing pretty well. The government has managed to roll out ARVs in a relatively short period of time ... it's a major achievement," Dr Robert Bennoun, the UNAIDS country coordinator, told IRIN/PlusNews.

The government set out to treat 70 percent of all HIV-positive adults in need of ARVs as part of its goals to provide universal access to care, treatment and prevention; over 55,000 Namibians - more than 80 percent of those in need - are now receiving the life-prolonging medication.

Food, floods and alcohol

The programme still has many obstacles, with lack of food security and transport among the biggest. At the Onanjokwe Lutheran mission hospital, principal medical officer Dr Sithembile Chinyoka commented: "We see it on a daily basis; the great distances our patients travel ... most of the children we admit are chronically malnourished."

Things are not much better in the rest of the country. "Everywhere we go the HIV-positive people we meet are crying of one thing - hunger," said Bernard Kamototo, who works for Lironga Eparu, the national network of people living with HIV/AIDS.

Most Namibians live on less than US$2 a day; having enough to eat is a constant burden, while water scarcity, erratic rainfall and poor soils have made subsistence agriculture even harder in recent years.

Chronic malnutrition is rising: figures from a recent demographic health survey indicate that 30 percent of Namibian children under five are so malnourished that their growth is stunted - in 2000 the stunting rate was 24 percent.

Dr Agostino Munyiri, chief of health and nutrition at the UN Children's Fund (UNICEF), noted that "nutrition is an area we are all grappling with ... the health system doesn't know how to approach this subject."

The worst floods to hit Namibia in four decades have also hampered crop production, affecting more than 350,000 people in six regions with some of the highest HIV-prevalence rates in the country.

Bennoun told IRIN/PlusNews that the treatment of HIV-positive people in the flood-affected regions had been interrupted because they were cut off from health facilities and had no money to travel.

In the Caprivi Strip, a finger of territory bordered by Zambia in the north and Botswana in the south, widespread flooding when the Zambezi River burst its banks meant the only option was to go through Zambia to access ARVs, but most people had no travel documents or cash, he said.

Floods and lack of food were not the only reasons people defaulted on their therapy: colourfully-painted shebeens (unlicensed bars) are a common sight in Namibia's towns and townships, where they sell cheap local brews that have led to high levels of alcohol abuse.

"Too many people are unemployed and struggling, and the only thing they can do to make themselves feel better is to drink ... but that is when the problems start," said Kamototo, who visits shebeens to raise awareness about how to prevent HIV and treatment adherence.

Prevention: the weakest link

The country's treatment success story has been largely due to external funding. Two-thirds of the treatment programme is financed by key donors such as PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria, while the rest of the bill is picked up by the ministry of health. "[The government] is moving towards sustainability, but they're not picking up as much as they can," Bennoun acknowledged.

Namibia is classified as lower-middle-income country, causing it to lose out on some much-needed donor funds; in the current global economic crisis, the country's health budget was going to be placed under even more pressure, he warned.

With the number of new infections still stubbornly high, the treatment programme might not be successful for very much longer. "This is one of the many reasons for the urgency of doing a hell of a lot better on prevention," Bennoun pointed out.

Implementing a treatment programme was always going to be easier than dealing with more complex human behaviour. For instance, the numbers of people being tested for the HI virus are still well below the universal access targets, and there has been no significant decline in HIV prevalence.

There is hope that the new national strategic plan covering 2010 to 2015, which is "very much evidence-based and results focused", will address inadequate prevention efforts.

"[The treatment programme] is a major achievement; the ministry of health is extremely active, vocal and visible," Bennoun told IRIN/PlusNews. "They haven't done well on prevention, but recognise that and are taking steps to lift their game."

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http://www.irinnews.org/report.aspx?ReportId=86812NAIROBI Friday, October 30, 2009 (IRIN) - The use of mid-level health workers rather than doctors to prescribe antiretroviral treatment (ART), a strategy called task-shifting, has enabled Mozambique to triple the number of facilities providing medication within six months, according to a new study.NAIROBI Friday, October 30, 2009 (IRIN) - The use of mid-level health workers rather than doctors to prescribe antiretroviral treatment (ART), a strategy called task-shifting, has enabled Mozambique to triple the number of facilities providing medication within six months, according to a new study.

The report, published in the in the latest edition of the Journal of Acquired Immune Deficiency Syndromes, by Kenneth Sherr from the University of Washington and officials in Mozambique's Health Ministry, found that patients from rural and disadvantaged areas could also access quality ART services as a result of the task-shifting.

Shortly after independence in 1974, the majority of physicians - mostly Portuguese nationals - departed from Mozambique, leaving fewer than 80 physicians to care for a population of 10.6 million.

Since then the country has largely relied on 'técnicos de medicina' - non-physician clinicians who undergo training for 30 months - to provide the clinical and managerial tasks ordinarily carried out by doctors.

Political instability and economic structural adjustment programmes in the 1980s hit Mozambique's health system hard, forcing the closure of up to 50 percent of public health centres. HIV prevalence reached 15 percent in 2003, yet only one percent of people had access to treatment; the government again looked to técnicos to fill the gap.

Rapid expansion

"Because the numbers of existing physicians were inadequate to cover the large number of facilities in the rapid scale-up, the national plan included a renewed effort to train new técnicos as an essential element of workforce expansion for HIV care," the report noted.

By mid-2006, the first wave of newly graduated técnicos had been deployed at health facilities; about a year later 167 health centres covering 147 Mozambican districts and municipalities were providing treatment.

The scale-up also integrated ART into public healthcare, so physicians and técnicos would attend to all patients, not only those infected with HIV.

"Deployment of newly trained técnicos provides opportunities to staff rural and smaller urban clinics with clinical cadres that are more likely to continue to work in public healthcare. Furthermore, training, salaries, and benefits cost less for técnicos than for physicians," the authors said.

"Supported by the integrated care approach, the number of facilities with ART tripled over a six-month period, including predominately small, rural, and peri-urban health centres, 45 percent of which were managed by a técnico de medicina."

A continuing effort

Mozambique is also increasing its number of trained physicians; student intake at the country's main medical school has doubled, and two new medical schools have been opened. According to the study, the quality of care provided by técnicos is equivalent to or better than that provided by medical doctors.

However, an evaluation of the técnicos' training found that they were not sufficiently prepared for actual clinical responsibilities, especially where health system resources were inadequate, and the health workforce would have to be multiplied several-fold to achieve the United Nations Millennium Development Goals.

Nevertheless, the report concluded that "Using a mix of physicians and responsible task-shifting to non-physician providers, the Mozambique health system can maintain its momentum in ART scale-up while strengthening the wider public healthcare system."

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http://www.irinnews.org/report.aspx?ReportId=86813GOZ BEIDA Friday, October 30, 2009 (IRIN) - A three-day nationwide polio vaccination campaign began on 30 October throughout Chad, including in the east where according to the World Health Organization the rate of routine immunizations is among the weakest nationwide.GOZ BEIDA Friday, October 30, 2009 (IRIN) - A three-day nationwide polio vaccination campaign began on 30 October throughout Chad, including in the east where according to the World Health Organization the rate of routine immunizations is among the weakest nationwide.

On 27 October lab results confirmed six new polio cases, bringing the number of confirmed cases in Chad in 2009 to 30. Two regions are newly infected, Wadi Fira in the east and Batha in central Chad.

“Type 3 [poliovirus] has broken out in regions with poor routine vaccinations,” Mohamed Mohammedi, WHO’s polio technical expert covering eastern Chad, told IRIN. Fewer than half of the children living in the eastern districts of Wadi Fira, Ouaddai and Dar Sila have had routine polio immunizations, according to WHO’s weekly polio bulletin as of 25 October.

There are three known strains of the polio virus. Type 3 is not as widespread but is as dangerous as type 1, Mohammedi said.

Vaccination campaigns in Chad have helped to wipe out type 1 cases nationwide, with 18 in 2007 to none thus far in 2009. But the number of type 3 cases has increased 10 times in that period.

The most affected areas are the capital N’djamena, which has half the cases, and Chari Baguirmi in southwestern Chad with eight.

Polio vaccinations are to continue till 1 November. The next round is scheduled to begin on 4 December.

Once established in the intestines, poliovirus can enter the bloodstream and invade the central nervous system – destroying nerves and leading to permanent paralysis in about one in 200 infections, according to the Global Polio Eradication Initiative. There is no known cure.

pt/nphttp://www.irinnews.org/report.aspx?ReportId=86821NAIROBI Thursday, October 29, 2009 (IRIN) - Flash floods caused by four days of torrential rains have displaced more than 15,000 people in the southwestern town of El-Waq near the Kenyan border and submerged most homes and businesses, say localsNAIROBI Thursday, October 29, 2009 (IRIN) - Flash floods caused by four days of torrential rains have displaced more than 15,000 people in the southwestern town of El-Waq near the Kenyan border and submerged most homes and businesses, say locals.

"Most of the town is under water, with people moving to higher ground around the town," Alaso Gurhan, a resident of El-Waq, in Gedo region of southwestern Somalia, told IRIN on 28 October.

The local administration and civil society groups have been able to move many people to safer ground, she said.

She said mothers with small children and the elderly were being given priority in the provision of shelter material. "We are all in the open now with very little help. We don’t have much so we have to give first to the weakest."

A lot of livestock have reportedly died due to the ongoing rains. "Hundreds of goats and sheep weakened by the drought have succumbed to the rains and the cold weather," said Ali Hassan, a civil society activist.

He said El-Waq, like the rest of Somalia, was waiting for the rain but it was "too much in too short a time. If the rain continues the way it has for the last four days we will be in serious trouble."

He said most of the residents, about 18,000 with some 900 displaced families (5,400 people) from Mogadishu, had been affected. "We are no better than the displaced today," he added. He said the population was concentrating on the hills around the town. "Any higher ground in the area is now occupied."

Hassan Hussein, an engineer with Development Frontier International, an NGO, told IRIN they were now trying to dig trenches to allow the water to drain from the town.

He said there was still a danger of more flooding since the rains were ongoing. He said his group was organizing the population to alert them to any more danger. "We are using the loud-speakers in mosques to tell people to help the weak and to get to higher ground."

People who are still in low-lying areas were also being told to move to higher ground, he said.

He said shelter material was urgently needed. "There are many people who are too weak to stay in the open or in the flimsy shelters we have. We need help in the provision of tents and other shelter material if we are to avert a serious health situation."

There are fears that with the rains mosquitoes and waterborne diseases will not be far behind, he warned.

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http://www.irinnews.org/report.aspx?ReportId=86791AKKAR Thursday, October 29, 2009 (IRIN) - In Lebanon’s remote northeastern district of Akkar, teachers and pupils at the Rajam Issa public school are hoping this winter will be the first when the lights stay on. “Electricity is the lifeline of the school,” said head teacher Ibrahim Salame, complaining of frequent and prolonged power cuts.AKKAR Thursday, October 29, 2009 (IRIN) -  In Lebanon’s remote northeastern district of Akkar, teachers and pupils at the Rajam Issa public school are hoping this winter will be the first when the lights stay on. “Electricity is the lifeline of the school,” said head teacher Ibrahim Salame, complaining of frequent and prolonged power cuts.

Upstairs, the new computer room remains unused and unfinished, lacking both trained staff and power. “During the winter if the power goes out and it’s dark we just teach in the dark,” said Salame. “What usually takes one session to explain using a projector takes two hours on the blackboard.”

It is hoped that by the end of November their classroom lights, projectors and photocopying machines will stay on during power cuts thanks to a set of rooftop photovoltaic panels producing renewable electricity from one of Lebanon’s most abundant natural resources, the sun.

“Lebanon has an average of 300 days of sunshine per year, yet we are not making sufficient use of it,” said Jihan Seoud from the Energy and Environment Programme at the UN Development Programme (UNDP) in Beirut.

“The government is looking to reform the electricity sector, but mostly on the supply side. We are working with government entities to reduce load on the demand side. Reducing demand means the government can spend less on electricity generation,” Seoud said.

Burden of oil imports

Lacking oil and gas resources, Lebanon imports some 97 percent of its energy needs as fossil fuel. Government efforts to modernize electricity infrastructure since the end of the Civil War in 1990 have been unable to keep pace with growing demand.

The solution, say many Lebanese environmentalists, is a combination of solar thermal power to heat water, and photovoltaic panels for back-up electricity. These can have a direct humanitarian impact.

“Renewable energy can have huge positive effects both directly and indirectly for humanitarian use. Solar water heaters (SWH) can substantially reduce the energy bills of healthcare and education facilities,” said Pierre Khoury, acting manager of the Lebanese Centre for Energy Conservation (LCEC) in the Ministry of Energy and Water (MEW). “It can also reduce poverty by reducing energy bills of poor people and creating ‘green jobs’.”

After the July War of 2006 further damaged Lebanon’s power infrastructure [http://www.irinnews.org/Report.aspx?ReportId=70043], including destroying 190 of the nearly 500 SWH units installed in south Lebanon and donated by China, UNDP and LCEC teamed up with the Spanish government to install solar water heaters in south Lebanon.

This was followed by the creation of the CEDRO project through the Lebanon Recovery Fund to promote energy efficient reconstruction of homes and public buildings.

With earlier donations from Sweden and Greece, UNDP and MEW/LCEC have successfully installed or repaired over 500 SWH units and identified 180 public sector buildings in which to demonstrate renewable energy applications.

In a study [http://www.lcecp.org.lb/Files/LCEC%20SWH%20analysis%20paper%20Lebanon.pdf] of one SWH system installed in a typical family home in Marjayoun in South Lebanon, the LCEC found that over a year the system offset some 98.6 percent of the electricity previously needed to heat water.

Total annual savings were calculated to be US$195, though the real saving to the state power company, Électricité du Liban, totalled some $415 per system, providing a payback period of two years. The report concluded that around 290,000 SWH systems are needed to offset the need for a 100 MW power plant in Lebanon.

Reduced bills

Lebanese law does not allow citizens to generate their own electricity and connect to the grid, meaning solar photovoltaic electricity remains too costly for all but the largest private businesses, or for small schools like that in Rajam Issa which was given the system.

Heating water from the sun, however, has proved cost effective, and sales of SWH units tripled between 2005 and 2008, according to a survey by LCEC.

As well as is installing an initial 25 photovoltaic systems on the roofs of small schools in North Lebanon, the Bekaa valley and South Lebanon, CEDRO has constructed large-scale solar water heaters on an initial four public hospitals.

One of these is the Abdallah Rassi Hospital, the first public hospital in Akkar, serving half a million people of whom, in the words of Ali Saada, its general manager, “400,000 are poor”.

With the hospital running at an annual deficit of around half a million dollars, said Saada, a third of which is spent on heating water via a diesel generator, the 48 SWH panels now on its roof will soon start making big savings, with a tangible benefit to patients.

“If we can save most of a third of our total running cost then the hospital could break even in three years, perhaps two if we get more patients,” said Saada. “Without the solar panels it would take us five. That means the intensive care department could open earlier and we could afford to buy a new scanner and other equipment.”

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http://www.irinnews.org/report.aspx?ReportId=86796DAKAR Thursday, October 29, 2009 (IRIN) - To detect malaria people might soon be able to chew a stick of gum and swipe it over a magnet or scan a finger with ultra-far infrared light. Neither test requires a blood sample. DAKAR Thursday, October 29, 2009 (IRIN) - To detect malaria people might soon be able to chew a stick of gum and swipe it over a magnet or scan a finger with ultra-far infrared light. Neither test requires a blood sample.

These are some of the winning proposals for the Bill and Melinda Gates Foundation Grand Challenges awards, which invite researchers to find non-invasive diagnostic alternatives for priority global health conditions such as malaria, tuberculosis and HIV. LINK

Other categories include new strategies to prevent malaria and more effective vaccines.

Among the 76 winners are chemists, bioengineers, electronics specialists, mechanical engineers, mathematicians, infectious disease specialists and epidemiologists.

“It is entirely positive for people not necessarily looking at global health issues to use their skill sets from other disciplines to do so, as they will come at a problem from angles that specialists in the global health community may not have thought of,” Gates Foundation spokesperson Melissa Covelli told IRIN.

Beyond blood

Extracting blood or tissue can require advanced skills on the part of health workers or pose high costs for patients, as well as complex logistics chains, many of which do not exist in developing countries, Covelli said.

Non-invasive tests also reduce the potential for HIV exposure, said scientist David Bell at Geneva-based Foundation for Innovative New Diagnostics (FIND). And non-invasive tests are preferable particularly when surveying a disease outbreak, as even a small amount of pain involved in a procedure can be a disincentive for people to seek healthcare.

About one million people are reported to die from malaria every year, mostly in sub-Saharan Africa, according to the World Health Organization (WHO).

But in some countries that have widespread malaria rapid testing, the number of suspected malaria cases has dropped dramatically.

Alternatives to testing blood include testing urine, saliva or sweat; equipment that can scan capillaries or the retina; and electromagnetic properties from crystals, such as hemozoin – an iron-containing pigment which accumulates granules in malaria parasites and is a breakdown product of hemoglobin for malaria.

Challenges

To date, all commercially available malaria tests require extracting blood, according to Bell, partly because up to now it has been more difficult to detect malaria in other body fluids.

But, Bell told IRIN, “New technologies could increase the sensitivity of these non-invasive tests and they could be as good as or better than the [blood-related C] tests that we have now.”

Andrew Fung, who is developing the chewing gum test, told IRIN: “By working in a user’s mouth this test will operate at a higher temperature, and millions of microscopic particles will be examined across a small surface area [the gum] increasing the test’s sensitivity.”

Winner Lu from the University of Michigan, who is pioneering the infrared option, told IRIN by tapping into body level vibrations rather than testing molecules, this test is highly sensitive too.

To date one of the drawbacks of the 60 rapid diagnostic tests currently on the market has been that they are unregulated, so while some are quite sensitive and can provide 95-100 percent accuracy, others provide far less accurate results.

Ensuring that only high-quality tests remain in use requires better standardized evaluations, Bell said. This is just starting to happen.

WHO published a report this year assessing many rapid diagnostic tests in use and is working with FIND to evaluate 29 more by 2010.

If Fung, Lu and the some 74 other researchers’ concepts work, the most promising among them will be eligible for more funding in the future, Gates Foundation’s Covelli said.

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http://www.irinnews.org/report.aspx?ReportId=86804MANILA Wednesday, October 28, 2009 (IRIN) - Weeks after back-to-back cyclones left nearly 1,000 people dead, the Philippines is grappling with an outbreak of a deadly flood-borne disease that has infected survivors from areas where dirty water has yet to subside, officials say.MANILA Wednesday, October 28, 2009 (IRIN) -  Weeks after back-to-back cyclones [http://www.irinnews.org/Asia-Country.aspx?Country=PH] left nearly 1,000 people dead, the Philippines is grappling with an outbreak of a deadly flood-borne disease that has infected survivors from areas where dirty water has yet to subside, officials say.
 
In a report to emergency relief agencies, Health Secretary Francisco Duque said that as of 26 October, there were 2,158 confirmed cases of Leptospirosis infections, with 167 deaths reported by the National Epidemiology Centre [http://www2.doh.gov.ph/nec/app_main.htm].
 
With more than 120,000 people crammed into evacuation centres in Manila and outlying areas that are still submerged in putrid, stagnant water, Duque said the likelihood of more outbreaks was high.
 
The deaths linked to Leptospirosis - a bacterial infection caused by contact with water contaminated by rat and other animal urine - were in addition to the 929 people who died from devastation wrought by tropical storm Ketsana, which hit on 26 September, and Typhoon Parma, a week later. According to the National Disaster Coordinating Council (NDCC) [http://ndcc.gov.ph/home/], more than nine million people were affected by the two storms.
 
"There is a surge in the number of hospitalized cases of Leptospirosis from among the victims of recent typhoons who have [lost] … their homes," Duque said in a memorandum order issued last week to state-run hospitals to prioritize cases of the disease.
 
"Various local government units and hospitals have reported an increasing number of cases of Leptospirosis among communities that have been submerged in flood waters and from among those who have been transferred to evacuation sites,” it read.
 
Duque said the best preventive measure to combat the disease is to drain the flooded areas and force people to move - something that government is hard-pressed to do since many areas remain inundated and some families have returned to their partly submerged homes to prevent looting.
 
As a stop-gap measure, he said the health department had sent teams to provide antibiotics to those infected while at the same time seeking the help of the UN World Health Organization (WHO) in containing the outbreak.
 
Private hospitals have also agreed to take in patients that state-run hospitals can no longer accommodate, Duque said.
 
National epidemiology chief Eric Tayag said the antibiotics were meant to cut the infection rate in half as a preventive measure.
 
Symptoms

The disease is characterized by jaundice and flu-like symptoms and ultimately renal and kidney failure, requiring dialysis.
 
WHO said the Leptospirosis bacteria commonly enters the body through skin cuts and abrasions and could begin manifesting in symptoms including severe headaches, fever, vomiting and blood-shot eyes. Meningitis and bleeding of the lungs may also occur.
 
"One out of 10 of those infected by Leptospirosis can have complications that can cause death. This includes acute renal failure," Tayag told reporters.
 
According to the US Centers for Disease Control and Prevention (CDC) [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm#How%20long%20is%20it%20between%20the%20time%20of%20exposure%20and%20when%20people%20become%20sick] the time between exposure to a contaminated source and falling ill is two days to four weeks.
 
WHO has dispatched a four-man team of experts to the country to help control the outbreak.
 
"They will be assisting the government by providing technical assessments and assistance in the surveillance, epidemiological and clinical care of those who fall sick from the disease," said Soe Nyunt-U, WHO representative to the Philippines, noting that apart from Leptospirosis, thousands still living in evacuation camps where access to water and sanitation remain poor, are in danger of other infectious diseases.
 
"The situation is worsened by the fact that many hospitals and clinics are damaged or still under water, with some staff unable to get to work, either because they are marooned in evacuation centres or are still repairing their homes," he said in a statement.
 
"At the same time, victims of the floods are causing a surge in demand at the health facilities."

Meanwhile, officials are preparing for another storm. Weather forecasters say Typhoon Mirinae is about 837km west-northwest of Guam, moving westward at 32km/hr. Mirinae strengthened from a tropical storm over the Pacific Ocean east of the Philippines and may reach Luzon island, where relief work continues, in the coming days.
 
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http://www.irinnews.org/report.aspx?ReportId=86779BUJUMBURA Wednesday, October 28, 2009 (IRIN) - Following two reported cases of polio in Burundi's northwestern province of Cibitoke, the Health Ministry and UN World Health Organization have begun a three-day immunization campaign, targeting at least 1.5 million children under five, officials said.BUJUMBURA Wednesday, October 28, 2009 (IRIN) - Following two reported cases of polio in Burundi's northwestern province of Cibitoke, the Health Ministry and UN World Health Organization have begun a three-day immunization campaign, targeting at least 1.5 million children under five, officials said.

"By [27 October], initial estimates indicated that at least 75 percent of the children targeted were immunized in the first two days," Olivier Kagabo, head of the national immunization department, said. "But we expect [to immunize] more children on [28 October] as parents generally come on the last day."

Kagabo said local administration officials were assisting health officials to mobilize parents to take their children for immunization. Kagabo stressed that even vaccinated children should get the new vaccine since “it is different from the routine vaccine they were getting”.
 
Burundi had eradicated polio for 10 years but two children caught the disease in September following contamination from neighbouring Democratic Republic of Congo. "The virus, wild polio type 1, originated from India and contaminated Angola and DR Congo and reached Burundi last month," Kagabo said. A second immunization campaign will be held in November.
 
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