Out of Control, Malaria in Africa
Posted on April 26th, 2005
World bodies marked Africa Malaria Day on Monday April 25th with various progress reports on efforts at controlling the disease. If they were being marked on a class report assessment card, it would read F because malaria is out of control. In what was an unusually candid statement, the World Bank said global efforts in the past five years came up short. “Experience in the past five years shows that a pledge of commitment … with neither a clearly funded program for malaria control nor the internal budget to ensure that the bank’s malaria team can function effectively, does not lead to success on a large scale,” the bank said. “A different and more robust approach is needed for success.”
An editorial in the Lancet was even more scathing of the International Body Roll back Malaria that was created specifically to tackle malaria, saying “…The Lancet April 23, 2005, Editorial, Africa Malaria Day 2005, on April 24, should have been a milestone for malaria control… But even without the report’s detailed analyses, a quick glance at Africa’s climbing malaria rates (a recent estimate puts the number of cases at almost 500 million) provides a clear indication that the Roll Back Malaria partnership (RBM) has done very little to halt the march of malaria…RBM–an international alliance of more than 90 organisations including WHO, UNICEF, and the World Bank–is the main instrument through which African leaders were hoping to achieve the Abuja goals. But in the 7 years since its inception, malaria rates have increased and the organisation has accumulated an expansive list of missed opportunities and dismal failures…”
There was a time when just getting malaria in the news was seen as a success. I remember writing a short article way back in 2001, “how Malaria is back in the news, and it is good news…”. African governments had put malaria back on the agenda, researchers had achieved artificial synthesis of quinine, and an anonymous benefactor has given US$ 100 million to Johns Hopkins University’s Bloomberg School of Public Health to establish an institute dedicated to finding malaria vaccines and treatments, a much needed shot in the arm of malaria research.
Malaria is out of control. Malaria cases and death are sky rocketing as the mosquito invades new territory, aided by global warming and other environmental changes, some manmade. The arsenal of cheap drugs is increasingly bare as plasmodium the malaria parasite develops resistance. The new drugs in the pipeline are still a pipedream for those who need them most because they are just too expensive and hopes for a vaccine in the next few years are fading.
What has gone wrong? Everything and nothing.
One problem is that despite the number of initiatives created to tackle malaria, funding for control efforts have remained virtually unchanged in the range of $100 million annually, just one tenth of what is needed.
Another problem is that there is no clear plan on how best to proceed in controlling malaria. Every one agrees that the best way is control of the mosquito is the key, but no one can agree on the best way to achieve this. At the moment there are two ideological camps – the ITN (insecticide treated net) group and the IRS (Indoor Residual Spraying) which has the official bodies such as the WHO at environmental action groups in the developed world at loggerheads with malaria researchers, African governments, health workers and policy planners.
ITN’s are insecticide impregnated nets that protect the person from getting malaria by acting as a physical barrier preventing the mosquito reaching the victim, while the insecticide kills the bug. The problem is while very effective, they are far too expensive for the poor people in Africa who are those most affected.
IRS (Indoor Residual Spraying) involves coating or spraying the walls and other surfaces of a house with a residual insecticide. For several months, the insecticide will kill mosquitoes and other insects that come in contact with these surfaces. IRS does not directly prevent people from being bitten by mosquitoes. Rather, it usually kills mosquitoes after they have fed, if they come to rest on the sprayed surface. IRS thus prevents transmission of infection to other persons. To be effective, IRS must be applied to a very high proportion of households in an area (usually >70%). The insecticide used: DDT. Yes you heard right, DDT, the scourge of environmentalists the world over, or at least in the west.
I won’t go into too much detail as to how this sorry state of affairs has arisen, suffice to say that both there is plenty of evidence showing both methods work very effectively. This seems to be an all too familiar scenario in the health world these days…powerful organizations that take a dogmatic stance on how to tackle a health problem despite evidence that these methods are inadequate or just outright failing. While the frontline health workers, health researchers and the victims themselves cry out for something that works…This is not just academic. Malaria kills more than 2 million people a year, 90% of them in Africa and 90% of them children and affects a billion others. Over 40 million people have died of malaria since the start of the AIDS epidemic 2 decades ago, most of them children under 5 years old. Three thousand children a day die from malaria.
For those who publicly oppose the use of DDT, perhaps because of fear of criticism and sympathy for environmental when faced with figures of three thousand deaths a day, I’m sometimes hard pressed to understand how environmentalists can argue against using DDT when it will save lives. I stand in both camps I want some thing that works.
The progress report on malaria shows that new ideas and a new approach is long overdue. There needs to be a shift (leap of faith) by the donor community, WHO and UN ideological resistance to DDT. IRS needs to be included in malaria control programmes. Where IRS is used, it saves lives, where it is not used, people die. The donor community should facilitate the purchase of effective anti-malarial drugs, even the newer one, perhaps by creating some kind of subsidy programme. And more money is needed to fund the fight against malaria. Not much more, just $1 billion dollars a year. Cheap at the price. The thing of it is unlike with AIDS there are drugs that can treat and cure malaria; we can kill the bug that spreads the disease…with effective control programs it is possible to have success and on a huge scale, something that the development community is sorely in need of.
1.Reversing the failures of Roll Back Malaria
2. Roll Back Malaria? The scarcity of international aid for malaria control
3. Malaria: no longer the forgotten epidemic
4. Malaria Rates Underscore Need to Set Aside Costly Taboos
5. MALARIA, DDT & ENVIRONMENTAL PROTECTION
7. . Africa Malaria Day
A,B C or P – Africa Hails Pope Benedict XVI
Posted on April 20th, 2005
On Tuesday Catholics around the world got a new leader when Cardinal Joseph Ratzinger a German was elected Pope. He has taken the name Benedict XVI. All hail Pope Benedict XVI! The new Pope has a fearsome reputation as a hardline conservative. African Catholics who were hoping for an African pope welcomed the news with joy and relief, this is what they want. Reading recent new headlines you may have been led to believe that there is a desire for a Pope with more progressive views. Don’t believe a word of it. At least not amongst Africans are notoriously conservative and Catholics even more so. That’s why Catholics are hailing the new Pope, they know they can rely on him to hold the line against those with an agenda for change, a blessed event indeed. It’s telling amongst all the interviews calling for an African Pope, the person most quoted is Desmond Tutu. The BBC Online Wednesday, 20 April, 2005 reported “South Africa’s Anglican Archbishop Desmond Tutu said he was sad that the new pope was unlikely to end the church’s opposition to condoms …which was more important than an African Pope… We would have hoped for someone more open to the more recent developments in the world, the whole question of the ministry of women and a more reasonable position with regards to condoms and HIV/Aids…”", if you missed it he’s an Anglican.
People don’t get it. As far as religion is concerned there is no room for debate. The African front runner was Nigeria’s Cardinal Francis Arinze whose conservatism reportedly could give the new Pope’s a run for its money. Those who have been burning up the e-waves debating A vs B or C in Uganda on the listservs, should take note. There is no manipulation from the Uganda government orchestrated by the unseen hand of the US government led by the religious right in USA. It has never really been a debate in Uganda. I should know, being Ugandan and Catholic. The whole Abstinence debate really just fits in with the prevailing view of most Ugandans, Catholic, Protestant or Muslim. This is what they believe and what they would prefer. What people say and do are two different things. What they believe is something else entirely. The rest is just pragmatism. At the height of the epidemic when it seemed nothing could work, people were willing to try anything be it A, B or C. But as I say they had their preferences and it was always A. Things are getting back to normal, business as usual. In some weird fashion, the way Abstinence is being promoted in Uganda is a backhand tribute to the success of Uganda has had at reducing AIDS.
By the way I’d welcome a more liberal Pope, but I suspect I’m in the minority.
1. Africans hail conservative Pope
2. Uganda: The battle over Uganda’s AIDS campaign
3. Alphabet Soup – A vs C or B or is it H vs E?
4. US Congress Debates Abstinence vs. Condoms in Fighting AIDS
5. < a href = “http://medilinkz.org/news/news2.asp?page=3&NewsID=10280"> Many Catholics Reject Church Ban on Birth Control, Condoms for HIV Prevention; New Pope Unlikely To Have Differing Views
Africa: No relief in sight
Posted on April 19th, 2005
The recent meeting of finance chiefs from the worlds leading economies ended last Sunday, without reaching an agreement on wiping out the debt for the poorest countries. Africans will rue this day as one of missed opportunities. In a continent where more money is spent per capita on servicing debt than healthcare, debt relief would have been especially welcome.
South African finance minister said the Millennium Development Goals (MDGs) set five years ago can not be achieved without new money. The deadline is 2015. For Africans it will be looked on as a missed opportunity. Consider an African born in the 1960’s, last century.
The 1960’s and early 1970’s were a time of great promise for Africa, many nations achieved independence and were (in the nascent stages of ) on the threshold of achieving economic development. An African who born in Africa in the 1960’s or early 1970’s, came into the world at a time of great promise and hope for the continent. Many nations had achieved independence from colonialism and were (in the nascent stages of) on the threshold of exploiting their vast economic potential for development.
That all changed in the mid 1970’s with the start of prolonged political problems, conflict and civil wars and prolonged economic collapse that lasted almost 3 decades. And in 1981 a little known disease called ‘Slim’ was identified in Rakai district in Uganda. Two decades later it had killed more than 20 million Africans and infected another 28 million. (If current conditions prevail) – By the time this same African is approaching early retirement age in 2025 more than 200 million Africans will have died from largely preventable disease and conditions (100 million from AIDS, 65 million from malaria, 65 million from waterborne and diarrhoeal diseases; two thirds of their lifetimes will have been lived in the shadow of AIDS and their grand children, nephews and nieces will still be at risk from HIV.
Debt relief would mean poor nations would spend less on crippling interest rate payments and have more to spend on essential services such as health, water, food security. Those finance chiefs meeting in their plush surroundings should consider this whenever they fail to come to decisions, it’s not just money they are dealing with, it is the lives and futures of millions.
Outbreaks – Living Dangerously on the Frontlines
Posted on April 17th, 2005
Fear and death have stalked Angola for the last three weeks as health authorities struggle with the worst outbreak of Marburg haemorrhagic fever ever. So far over 200 people have died, not a lot when compared to the millions that have died from AIDS, but when one considers that this virus kills in less than a week and the death rate in this outbreak has so far exceeded 90%, you can understand why it has hit the headlines and has people worried. Marburg is caused by an ebola like virus; there is no cure, treatment or vaccine for the disease and the reservoir or source is still unknown, but it is thought to be some kind of animal. Victims suffer a high fever, diarrhea, vomiting and severe bleeding from bodily orifices and usually die within a week.
Whenever such outbreaks occur, health clinics and hospitals quickly become part of the frontlines of combating the disease as frightened victims and relatives seek urgent help. It means the hospital or health centre can itself become a secondary source for the epidemic as sick people accumulate there often putting the staff at great risk. Already a number of doctors and nurses have died of the disease. As the fear has mounted aid workers in one northern provincial town reported that terrified people had attacked them and that a number of health workers had fled out of fear of catching the disease. Doctors Without Borders, a global relief organization, recommended suspending non-emergency services at the hospital in Angola’s northwestern Uige province, the epicenter of the outbreak, where victims of the fatal virus are being held in isolation. The WHO is taking urgent steps to train and protect staff at the provincial hospital from infection and reduce the risk of is continued transmission. Training for health staff in private clinics and for health workers in the police force is planned for early next week.
Being exposed to dangerous diseases and outbreaks is an occupational hazard for health workers in many African countries, but sometimes people forget how quickly it can happen often without one’s knowledge until it’s too late., especially in the very early stages of an outbreak when you have no idea what you are dealing with, have limited facilities to investigate and are overwhelmed with other patients. Sometimes avoiding exposure is just a matter of luck…one just shrugs and goes on.
My own tale of a brush with an ebola like illness happened about 12 years ago, while working at Mulago hospital, Kampala, Uganda. A sick man in his twenties, fit and in good condition came in with complaints of very high fever, diarrhea, vomiting that had been on for a few days. I had to enlist the help of an interpreter to elicit this information, because we didn’t speak the same language. I examined and admitted him, started the usual investigations, taking blood, sputum etc to rule out the obvious causes for high fever such a malaria, pneumonia and started him on treatment. During the night, the man apparently vomited blood and died. At the time the facilities at Mulago were fairly limited, we were overworked, but this was so unusual, we decided to do autopsy to find out what had killed this individual. On opening him up we were truly surprised, his organs were almost liquefied. It was a wonder the man had actually made it to the hospital. I hit the books and read up on diseases that could have produced such symptoms. I discussed it with my colleagues; of course I suspected ebola, but I had no proof, no outbreaks had been reported; in fact there hadn’t been one reported since it was first reported in the late 70’s…so it was recorded as a dou, death of unknown origin…and I moved on.
Later while talking to one of the nurses and discussing the unusual case, it transpired that the man had actually come from then Zaire now known as the Democratic Republic of the Congo. Was it ebola, or a similar disease? It’s possible. While examining the man, I took no special precautions, neither did anyone else… wherever he came from he had been in contact with numerous people…if it were ebola…. All I can say is I dodged a bullet. In October 2000 an outbreak of ebola in Uganda killed 224 people in Uganda, including health workers and Dr. Matthew Lukwiya, who first identified the outbreak. Since then, the number and frequency of such outbreaks has been increasing and will probably continue to increase as a consequence of the unstable sociopolitical climate in the Great Lakes area forces people into areas where they are more likely to come in contact with the source of such viruses. These days people are more vigilant, reporting unusual cases more promptly, but with many health systems in tatters, and poorly developed surveillance systems, health workers are going to continue to be at great risk on the front lines.
Milestones – 10,000 and still counting
Posted on April 13th, 2005
Almost unnoticed Medilinks passed a small but note worthy milestone when I posted the 10000th news story about health and health related issues in Africa. Okay maybe it’s not something to brag about when compared to other much larger more well known sites, but still 10,000. Phew and with a staff of one, hey I feel pretty chuffed. Actually I only noticed by the time I’d reached 10,156 or thereabouts.
Looking back, what was story number one about? “Focus on nevirapine programme” posted way back in 2001 – even before Medilinks had been officially launched When “All state hospitals in South Africa’s Gauteng province will provide the antiretroviral drug nevirapine to HIV-positive pregnant women this year….” Nine thousand, nine hundred and ninety-nine stories and four years later I posted a story about water and nevaripine was still making news as the controversy about the drug trials in Uganda were rumbling on. And as for the so called drug roll out programme, despite a 100 fold drop in ARV treatment prices, from $10,000 dollars a year to 100 dollars pregnant women are no nearer to having free access to ARV treatment than they were before.
Plus ca change….Plus ca meme – I’ve used this before.
So what has been making the news? A breakdown of the stories by main category shows not surprisingly they were mainly about AIDS, but not exclusively so, though you’ll find many stories are linked to AIDS in one way or another. Somehow it’s a pleasant surprise to find it’s not all just about AIDS which at 38% of the total was considerably lower than I expected. The other surprise is that stories relating to food security are the next largest category. It seems it takes a lot to get people motivated about starving people, considering how often stories about famine and food security related stories make the headlines – remember the famine that threatened Southern Africa a couple of years ago? Well it’s happening again and the UN has no money.
Other stories that made news were drugs and medicines, also not surprising given the ups and downs of prices and reputations in the pharmaceutical world, but now that India has passed a law outlawing generics, surely signing the death knell for the WHO 3×5 campaign perhaps there’ll be fewer stories on medicines. IDPs and Refugees, Humanitarian AID, Conflict were also another large category but not as large as it could have been, with the reduction in the number of conflicts in Africa.
So here is the list of the most wanted
Nutrition and Food Supply – 13%
Drugs and Medicines – 7%
IDPs and Refugees, Conflict, Humanitarian AID – 6%
Development – 3%
Child Health – 3%
Funding and Development – 2%
Global Fund – 2%
Malaria – 2%
Health and Economy – 2%
Water supply and sanitation – 2%
And the rest:
Orphans, Poliomyelitis, Reproductive health, Cholera, Education, Women’s health, Health Systems, Environment, Human Rights, Environmental & Manmade disasters, Gender, Tuberculosis, Meninigitis, Measles, Population, Safe Healthcare, Acute respiratory infections, (ARI), Ebola, Public Health, Vaccines, Capacity Building, Disease Control and Eradication, Sexually transmitted diseases, Health Research, Haemorrhagic Fever, Outbreaks, Immunization, Policy, Youth, Hepatitis, Occupational health, African trypanosomiasis (sleeping sickness), Epidemics, Sight and Vision, Yellow Fever, Traditional Health, Mental Health, Onchocerciasis river blindness), Diarrhoeal disease, influenza, Dracunculiasis, Health Statistics, Prevention, Childhood diseases, Leprosy, Cancer and Malignancies, Sickle Cell, Environmental sanitation,
Waterborne diseases, Chronic Conditions, Infectious Disease, Leishmaniasis (kala azar), Schistosomiasis (bilharzia), Communicable Diseases, Lymphatic filariasis, Buruli Ulcer
Alphabet Soup – A vs C or B or is it H vs E?
Posted on April 6th, 2005
There’s a furious debate currently ongoing on one of the listservs I’m member of concerning the issue of abstinence in Uganda. Yes, that old wrinkled chestnut. It’s reached the stage of BOLD CAPS, so I’m staying well out of the way on the sidelines. It has been on for years, and it will never be resolved. The fact is no one method be it A (abstinence), B (behavioural change) or C (condoms) has solely been responsible for bringing down the HIV rate in Uganda, but a combination of the three. Some researchers have also claimed D (death) as the major contributor to reducing the rates. It all makes for an alphabetical bubbling broth of controversy.
But I ask why, why do people continuously get sucked into this debate or such debates? Is it perhaps a symptom of the way the whole campaign against HIV/AIDS has stalled because people have run out of ideas? However much certain individuals would like to promote one method over the other, the fact is neither is full proof. Until something better comes along, a miracle or a magic cure, we’ll just have to make do with what we have. I’ve noticed more and more of such discussions; which not to put to fine a point on it can only be done by those who have the luxury to engage in what sometime seems like pointless, well, debates. A bit like fiddling while Rome burns.
Debating the issue only serves to divert people attention from the main concern; that of the fight against AIDS. Ugandans and Africans know this well; they do not have the luxury of such debates. AIDS is still killing in huge numbers, so they’ll use whatever means to keep themselves safe. Ugandans did and they had success, perhaps everyone else should take a leaf from them…oh wait I forgot, this is where it started, all the ‘experts’ from the west trying to explain the how Uganda succeeded. People never learn
Has the time come for an African Pope?
Posted on April 4th, 2005
Pope John Paul II, Holy Father and Spiritual Leader of 1.1 billion Catholics passed away on Saturday night. Pope John Paul II will be remembered as a champion of the downtrodden, traveling widely to all over the world, visiting 100 some countries. He will be remembered for condemning wars in former Yugoslavia, genocide in Rwanda calling for peace in the Middle East, preaching peace and respect for human rights. As the world prepares for his burial, thoughts turn to who his successor will be.
Nearly two thirds of the worlds Catholics are from developing countries, with Africa having 13.2%. The Catholic church grew by 4.5 percent in 2003 in Africa reflective of the demographic realities of the modern world. So it is not unexpected that amongst African Catholics the question is being asked, has the time come for an African pope?
But is an African pope a desirable thing at this stage? The late Pope John Paul II was a notable conservative with strong views on contraception and abortion. All but a handful of the 117 cardinals were handpicked by him, undoubtedly with views similar to his. And lets face Africans are notoriously conservative. So it comes as no surprise the African front runner is Cardinal Francis Arinze, a 72-year-old Nigerian who served as a close advisor to the deceased Pope, and is also considered a staunch conservative on religious matters, who would doubtless uphold John Paul’s rejection of homosexual unions, contraception, divorce and abortion.
In a continent that is home to 25 million HIV positive people; where religion plays a large part in Africans lives and a strongly influences their views and beliefs; who is elected as the next pope is not merely an academic argument but one of significant importance. Whomever is elected will wield enormous power and influence. At a time when the fight against HIV/AIDS seems to be faltering, with the arguments raging back and forth on whether abstinence or condoms are better, what is required is far sighted and visionary religious leader; one who will be able to put the well being and welfare of his flock at the forefront while maintaining the cohesiveness and structure of the church. A staunch conservative, African or otherwise is not the best person to do this.
It maybe heresy to say this, but perhaps the time for an African pope has not yet come. We’ll just have to wait a little while longer; after all it’s been 1500 year already, what’s another 10 or 20. Anyway it seems like a long shot, but an African does head the UN, so who knows anything is possible; and if it were to happen, there would be universal rejoicing, from all across the continent, including my entire family.