Archive for May, 2010

Tropical diseases need an integrated approach

May 28th, 2010

by: William Brieger, Malaria Matters blog

A common critique of the Global Fund to Fight AIDS, TB and Malaria is that there are other major contributors to the burden of disease in tropical countries.  Some are infectious like pneumonia while others are non-communicable like injuries.

From the standpoint of malaria, integration makes sense. From the start, the Roll Back Malaria Partnership made it clear that malaria control (end eventual elimination) could not succeed unless health systems were strengthened. These are the same systems that are supposed to control filariasis, helminthic diseases, diarrheal diseases, and pneumonia as well as promote maternal health, child growth and development as well as immunization programs. It was a weak health system that contributed to the failure of the first effort to eradicate malaria fifty years ago.

Two recent articles exemplify the need for integrated prevention and control services because tropical communicable diseases themselves are ‘integrated’ into the environment and the human host.

Abraham Degarege and colleagues examined Malaria and helminth co-infections in outpatients at Alaba Kulito Health Center in southern Ethiopia. Fifty-four percent of patients having malaria parasites also had at least one of three helminth infections including hookworm, A. lumbricoides and/or T. trichiura. Those with both worms and malaria (P. falciparum and/or P. vivax) had higher rates of anemia. These negative synergies require an integrated approach to patient management as well as to community prevention programs.

Marcia C. Castro and her co-researchers looked into local water sources for larval development of lymphatic filariasis and malaria vectors in Dar es Salaam, United Republic of Tanzania. Larvae of both anopheles and culex species were found in puddles, swamps, mangrove swamps, drains/ditches, human-made holes, water storage, agriculture, rivers/streams, and ponds.

Polluted urban environments are less conducive to anopheles breeding, and culex were more likely to be found in all these urban sites in Dar es Salaam, especially in drains/ditches, but again in this environment both types were found, meaning that both filariasis and malaria ‘co-existed’. Integrated control through larviciding and ITNs would help prevent both diseases.

If basic health services are well funded, staffed and supplied, no tropical disease needs to be neglected.

Bill Brieger is currently a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University as well as the Senior Malaria Adviser for JHPIEGO, JHU’s family and reproductive health affiliate. He was a Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria, from 1976 to 2002. His research interests have focused on the social and behavioral aspects of tropical disease control, and in the area of malaria research, funded by the Unicef/UNDP/World Bank/WHO Tropical Disease Research program (TDR) and USAID implementing partners, this has included acceptability of pre-packaged antimalarial drugs, urban malaria, role of patent medicine sellers in malaria treatment, and community and cultural perceptions of malaria as a basis for village health worker training and health education

Reading List 5/27/2010

May 27th, 2010

Hope everyones had a great week so far! Heres a reading list to get an early start to your Memorial Day weekend. Today were reading about the link between lymphatic filariasis and malaria, the World Banks approval of more than $63 million for the creation of a network of public health laboratories in East Africa, and the effectiveness of drug cocktails to treat HIV. Weve also included TropIKAs blog post about Dr. Peter Hotezs recently released 8-point manifesto paper. Enjoy the reads!

Drains Linked to Lymphatic Filariasis and Malaria, Science Daily World Bank Approves $63.66 Million for Lab Network in East Africa, Green TMC Drug cocktails cut couples HIV transmission risk, Reuters A “manifesto” for combatting NTDs, Patrick Adams, TropIKA

Innovative financing for neglected diseases

May 26th, 2010

Reprinted with permission from: The Global Health Blog – a project of PubHealth.org

By: Sarah Arnquist

List of NTDs

List of NTDs

Neglected tropical diseases attracted the media spotlight this month, starting with a New York Times op-ed by Peter Hotez, president of the Sabin Vaccine Institute.

Now, Hotez and Bernard Pecoul, executive director of Drugs for Neglected Diseases initiative (DNDi), have released a “manifesto” outlining why the global community should increase financial support for NTD control, elimination efforts and research and development.

“About three-quarters of total neglected disease R&D annual spending is for HIV/AIDS, malaria, and tuberculosis, leaving only about US$600 million worldwide for all NTDs per year,” they write.

Last week, the open-access journal, PloS Medicine, hosted a debate over the best approach to tackle neglected tropical diseases. (For a quick overview read the blog post, “Neglected diseases: teach or treat?” from The Scientist.) The debate centered on whether the focus to eliminate the diseases has been overly medicalized at the expense of focusing on social determinants of disease and how future resources and investments should be best allocated to balance implementation and R&D.

The debate and dialogue are great and necessary, but calls for any additional funding, regardless of how it’s allocated, begs the question where will the money be raised.

While global health experienced a “golden age” of new financial commitments during the last decade, international development assistance for health has flat-lined. Given the plurality of funding demands, including HIV prevention and treatment, chronic diseases, trauma and injury and neglected tropical diseases, many say merely sustaining — let alone expanding — financial assistance requires new “innovate financing” models for global health.

Innovative financing examples include:

  • UNITAID — an international fund that uses revenues from taxes on airline tickets to promote lower prices and improved access to drugs, bed nets, etc.
  • Advance Market Commitments (AMCs), in which legally binding commitments to pay for new life-saving vaccines aim to stimulate faster and larger industry investments in R&D.
  • International Financing Facility (IFF) — rich country governments make long-term pledges to collateralize commercial debt financing.
  • Debt Swaps – rich country creditors write off debts owed by developing countries if they convert a portion of the debt value to disease control activities.

Sarah Arnquist is the editor of The Global Health Blog, part of PubHealth.org, a project aimed to create an online mechanism to facilitate harmonization among international health care researchers, practitioners and funders. Arnquist writes case studies on global health delivery issues and previously worked as a journalist. She has a masters in public health from Johns Hopkins School of Public Health.

2005 Gleneagles Communiqué Revisited

May 25th, 2010

The 31st G8 Summit took place in 2005 at the Gleneagles Hotel in Scotland. Addressing global health issues was high on the agenda, and commitments were made to build upon efforts to tackle HIV/AIDS, tuberculosis, malaria basic health care, and of course neglected tropical diseases (NTDs). In fact, a pledge was made to Support the control or elimination of neglected tropical diseases; and reach at least 75% of the people affected by certain NTDs in the highest-burden countries. Despite these strides, four years later in Italy at the 35th G8 summit, new health commitments were not made.

Although G8 leaders reaffirmed their commitments to the pledges made in 2005, still more must be done in the upcoming decade. Activities that should be emphasized include investing in the control and elimination of NTDs, aggressively target issues in maternal and child health, and scaling up prevention methods and sustainable capacity building. To read more, and also to find out what you can do to get the ball rolling on these objectives, please visit www.one.org.

Where’s my Jetpack?

May 25th, 2010

by: Alanna Shaikh

It’s 2010, and I still don’t have a jetpack. My car sticks stubbornly to the ground instead of flying. Food is still food, not high-tech pellets. And we still haven’t eliminated Chagas disease.

 On July 4th, 2007, the World Health organization launched an effort to eliminate Chagas disease by 2010. The effort included a new network devoted to fighting Chagas, which would expand successful efforts by the Pan American Health organization (PAHO) to control the disease.

 Three years later, Chagas is far from eliminated. It is endemic in 21 countries, and over seven million people are currently infected with the disease. True, we have seven more months left in 2010, but it seems unlikely we’ll treat a million people every month this year and get this thing done.

 What I find frustrating is that we failed at something with such a clearly defined scope. This isn’t the Millennium Development Goals here. We’re not trying to dramatically change life on this planet. We were just trying to get rid of one treatable disease that’s endemic only in Mexico and South America.

 So what happened?

 Chagas doesn’t have great drugs to treat it. The two drugs that work on Chagas Nifurtimox and Benznidazole – aren’t 100% effective. They work best in early stages of the disease – they can cure up to 80% of people of you catch the disease early. If you wait until the Chagas is chronic, the cure rate goes down to 10-20%. That means you spend a lot of time, effort, and money on treatments that don’t work. In addition to wasting health system capacity, it’s not exactly an incentive to come in and get treated. The drugs also work better on kids than on adults.

 To make matters worse, Nifurtimox and Benznidazole have unpleasant side effects. They include some digestive stuff from Nifurtimox: stomach pain, anorexia, nausea, and vomiting and some terrifying blood and skin side effects from the Benznidazole: swelling, hypersensitive skin, and anemia. Again, really not an incentive to keep taking your drugs.

 Aside from drugs, you can take a surgical approach to Chagas. Needless to say, surgery for the disease is difficult, painful, risky, and expensive. It’s not a feasible approach to seven million people, many of which are children.

 If we’re going to eliminate Chagas, we need to develop better drugs. That didn’t happen in time for 2010 eradication, but the situation is not hopeless. The Drugs for Neglected Diseases initiative is working on Chagas. They plan to develop an easier to manage children’s version of benznidazole, investigate combination therapies for Chagas treatment, and develop at least one new drug for Chagas by 2014.

 Also we’ll be able to deliver the drug house-to-house via visiting nurses wearing jetpacks.

 Seriously, though – how do we make sure that the 2014 goals actually come true? We pay attention. We hold policymakers to their promises, track the progress of the Drugs for Neglected Diseases initiative, and notice if years pass by and the number of people with Chagas is still almost eight million.  

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.”

Anyak vs. the Guinea Worm

May 24th, 2010

Anyak vs. The Guinea Worm

Check out this amazing video op-ed by Nicholas D. Kristof from The New York Times. Meet Anyak, a young Sudanese boy who is infected by a guinea worm. He lives in a remote area of Sudan where clean water is not easily accessible, which is a contributing factor in his contraction of the water-borne parasite. Follow his journey as he receives treatment from the Carter Center by way of a campaign called The South Sudan Guinea Worm Eradication program; this village-run program will bring our global community that much closer to eradicating this painful disease, leaving the world free of guinea worms for good.

Reading List 5/24/2010

May 24th, 2010

Happy Monday everyone! Below is a brand new list of reads to start your week off! Today were reading about the possibility of parasites being a cure for food allergies, dengue fever in Florida, the announcement of the new Feed the Future program in Liberia, tackling TB in Mexico, the ongoing fight against childhood pneumonia, and lastly Dr. Peter Hotezs interview with The Scientist on his NTD debate paper that was recently released.

Hotez Neglected diseases: Teach or treat?, The Scientist Parasites May Cure Allergies, The Boston Channel Dengue Fever in Florida, Richard Knox, NPR Feed the Future, Charles W. Corey, America Engaging the World Tackling tuberculosis in southern Mexico, Sam Loewenberg, The Lancet The Fight Against Childhood Pneumonia, Traci Siegel, International Vaccine Access Center

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    • The Global Network for Neglected Tropical Diseases is a major advocacy and resource mobilization initiative of the Sabin Vaccine Institute dedicated to raising the awareness, political will, and funding necessary to control and eliminate the most common neglected tropical diseases (NTDs)--a group of disabling, disfiguring, and deadly diseases affecting more than 1.4 billion people worldwide living on less than $1.25 a day.
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