Slowdown in fight against malaria

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An effective concerted effort to strengthen malaria control globally in the last decade has had the greatest impact in countries with high malaria transmission. Close to 60 percent of the 1.1 million lives saved during this period were in the 10 highest burden countries. However, the expansion of funding for malaria prevention and control has leveled off in recent years, and progress in the delivery of some life-saving commodities has slowed. These developments are signs of a slowdown that could threaten to reverse the recent gains in the fight against one of the world’s leading infectious diseases, according to the World Malaria Report 2012.

World Malaria Report 2012The number of long-lasting insecticidal neets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. The expansion of indoor residual spraying programs also leveled off, with coverage levels in the World Health Organization (WHO) African Region staying at 11 percent of the population at risk (77 million people) between 2010-2011.

The malaria burden is concentrated in 14 endemic countries, which account for an estimated 80 percent of malaria deaths. The Democratic Republic of the Congo and Nigeria are the most affected countries in sub-Saharan Africa, while India is the most affected country in South-East Asia.

The report indicates that international funding for malaria appears to have reached a plateau well below the level required to reach the health-related Millennium Development Goals and other internationally-agreed global malaria targets.

While the plateauing of funding is affecting the scale-up of some interventions, the report documents a major increase in the sales of rapid diagnostics tests, from 88 million in 2010 to 155 million in 2011, as well as a substantial improvement in the quality of tests over recent years. Deliveries to countries of artemisinin-based combination therapies (ACTs), the treatment recommended by the WHO for the treatment of falciparum malaria, also increased substantially, from 181 million in 2010 to 278 million in 2011, largely as a result of increased sales of subsidized ACTs in the private sector.

The report summarizes information received from 99 countries with on-going transmission and other sources, and updates the analyses presented in the 2011 report. Malaria is an entirely preventable and treatable vector-borne disease. In 2010, an estimated 219 million cases occurred globally, while the disease killed about 660,000 people, mostly children under age five years.

1. World Health Organization. World Malaria Report 2012. Geneva, Switzerland: WHO, 2012.

Stigma, discrimination against HIV-positive patients by healthcare providers

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Equipping healthcare providers with knowledge of HIV, through the provision of protocols and trainings, is of paramount importance in reducing stigma and discrimination against people living with HIV amongst healthcare providers, according to a study conducted in Southwest Ethiopia.

The healthcare providers who were aware of anti-stigma and anti-discrimination rules and regulations were less likely to contribute to stigma and discrimination.

The study also found that healthcare providers share stigma and discrimination not only related to their occupation but also present in their communities. This implies that community-based anti-stigma and anti-discrimination interventions may also be helpful.

The study makes the following recommendations for ministries/departments of health at the national, regional, or local levels, as well as healthcare institutions and non-governmental organizations working with HIV-positive patients:

  • Make available protocols related to HIV to each healthcare provider in healthcare settings.
  • Orient healthcare providers about the contents and relevance of the HIV-related policies.
  • Provide the opportunity for trainings on stigma and discrimination to healthcare providers from time to time.
  • Extend HIV-related care and support services and anti-discrimination interventions to local areas.
  • Involve people living with HIV and religious leaders in these activities.

And lastly, healthcare providers themselves should strive to update their knowledge on HIV/AIDS.

1. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012; 12: 522. (open access)

Chronic care integration for NCDs

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Partners in Health is making available the Guide to Chronic Care Integration for Endemic Non-communicable Diseases. This guide is for district-level health care providers and policy makers designing a health system for care of non-communicable diseases (NCDs) in rural Rwanda and other very low-income populations.

The guide focuses on NCDs such as cardiovascular diseases, kidney disease, diabetes, hypertension, rheumatic heart disease, and respiratory diseases. It also covers the role of community health workers, family planning, mental health and social services in the treatment of chronic disease.

1. Bukhman G, Kidder A. The PIH Guide to Chronic Care Integration for Endemic Non-communicable Diseases. Boston: Partners in Health, 2011.

Open Access Africa 2011

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Open Access Africa 2011, now in its second year, will once again bring together researchers, librarians and funding bodies to discuss the benefits of open access publishing in an African context.

Hosted by BioMed Central, in partnership with Computer Aid International, Open Access Africa 2011 will take place at Kwame Nkrumah University Of Science And Technology (KNUST) in Kumasi, Ghana, from 25-26 October 2011.

Speakers at this free event include representatives from Google, BMJ and Pan African Medical Journal. A full list of speakers can be accessed from the Open Access Africa 2011 website.

English language editing company, Edanz, will run a free pre-conference workshop on 24 October providing an introduction to their training program and online materials designed to address publishing challenges faced by non-native English speakers.

The conference is free to attend but registration will be necessary. For more information visit the Open Access Africa 2011 website or email

Sexual behavior changes reduce HIV rates in Malawi

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The HIV epidemic in Malawi has been on the decline. A study indicates that between 2000-2004 the prevalence of HIV dropped from 26 percent to 15 percent in urban areas among pregnant women and reduced by 40 percent among women aged 15-24 years. The study linked substantial positive changes in sexual behavior—such as increased condom use and fewer sex partners—to the decline.

In the 2000-2004 study period, the percentage of adolescents aged 15–19 years who first had sex before age 15 decreased from 29 percent to 18 percent among males and 17 percent to 14 percent among females. The proportion of men who had sex with multiple partners reduced from 15 percent to nine percent among men aged 15–49 years and from 12 percent to seven percent among young adults aged 15–24 years. Only one percent of women reported having two or more partners and this did not change between 2000-2004. The rate of men with multiple partners that used condoms increased from 14 percent to 20 percent among men aged 15–49 years and from 27 percent to 35 percent among young men aged 15–24 years.

“The declines in prevalence in urban areas were associated with the behaviour changes and…if the changes are maintained, this will have cumulatively averted 140,000 HIV infections by 2010,” the study concluded.

1. Bello G, Simwaka B, Ndhlovu T, et al. Evidence for changes in behaviour leading to reductions in HIV prevalence in urban Malawi. Sexually Transmitted Infections, published online 23 March 2011. (open access)

Secondhand smoke levels unacceptably high in Ghana

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In Ghana, as in most countries in Africa, little is known about the extent of secondhand smoke exposure in public places. A study found that seconhand levels were unacceptably high in public places in Ghana where smoking is allowed, comparable to those measured in American, Asian and European countries without or before smoking bans.

The study measured particulate matter and air nicotine concentrations in hospitality venues and hair nicotine concentrations in non-smoking employees in Ghana.

Implementing a comprehensive smoke-free legislation that protects workers and customers from secondhand smoke exposure in indoor public places is urgently needed in Ghana, according to the study.

1. Agbenyikey W, Wellington E, Gyapong J, et al. Secondhand tobacco smoke exposure in selected public places (PM2.5 and air nicotine) and non-smoking employees (hair nicotine) in Ghana. Tobacco Control 2011; 20: 107-111. (open access)

Teen smoking and socioeconomic disparities in Ghana

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Teenagers of lower socioeconomic status are more likely to take up smoking than their more affluent counterparts, finds a study from Ghana.

Those teens in the study who are expected to end up in adulthood in a lower socioeconomic status than their families (downwardly mobile) are more likely to use tobacco than those teens who are stable in the high socioeconomic status.

Health promotion and tobacco control strategies aimed at reducing teen smoking should pay attention to adolescents of lower socioeconomic statuses and those in danger of dropping out of school, the study concludes.

1. Doku D, Koivusilta L, Raisamo S. Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents. BMC Public Health 2010; 10: 758. (open access)

HPV infection and cervical cancer in Nigeria

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A study confirms that in Nigeria, as elsewhere, women infected with the human papillomavirus (HPV) types 16 and 18 are at higher risk of developing invasive cervical cancer than those infected with other high-risk HPV types. Current HPV16/18 vaccines have enormous potential to reduce cervical cancer in Nigeria, the study concluded.

In the general population, 26.3 percent of women were HPV-positive, among whom the prevalence of HPV35 and HPV16 were equally frequent (12 percent). Among those with cervical cancer, however, HPV16 predominated strongly (67.6 percent of HPV-positive cases), with the next most common types being 18 (10.3 percent), 35, 45 and 56 (each 5.9 percent).
Comparing among HPV-positive women only, HPV16 and HPV18 were over-represented in cervical cancer cases versus the general population. Other high-risk HPV types, as well as low-risk and multiple HPV infections were less common in HPV-positive women with cervical cancer than from the general population.

1. Okolo C, Franceschi S, Adewole I, et al. Human papillomavirus infection in women with and without cervical cancer in Ibadan, Nigeria. Infectious Agents and Cancer 2010; 5: 24. (open access)

Malaria death trends among children in Mali

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Children under age 5 are disproportionately affected by malaria in Mali

Presumptive malaria diagnostic rates have decreased by 66 percent between 1998-2006 among health care-seeking children under age five years in the twin towns of Mopti and Sévaré in Mali. Up to 37 percent of this decrease is likely due to the distribution of bed net treatment kits initiated in 2001.

In Mali, malaria is the leading cause of death and of outpatient visits for children under five. Nationally, 76 percent of deaths attributed to malaria occur in children under five.

The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50 percent by 2011 as compared to levels in 2000.

1. Rose-Wood A, Doumbia S, Traoré B, Castro MC. Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006. Malaria Journal 2010; 9: 319. (open access)

Famine linked to non-communicable diseases in Nigeria

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Fetal and infant undernutrition is associated with significantly increased risk of hypertension, overweight and impaired glucose tolerance or diabetes among Nigerians who were born during the famine that afflicted the Biafra region of Nigeria during its civil war (1967-1970). Of the one to three million Igbo people that are estimated to have lost their lives during the Nigerian Civil War, only about 10 percent died of military violence. The majority succumbed to starvation.

 Prevention of undernutrition during pregnancy and in infancy should therefore be given high priority in health, education and economic agendas.

1. Hult M, Tornhammar P, Ueda P, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran Famine. PLoS ONE 2010; 5(10): e13582. (open access)

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