Reflections from Unclogging the Blockages: Day 2

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After a long day of presentations and discussions to better understand the current situation and learn from each other’s experience in markets for sanitation, the second day of PSI’s recent sanitation conference took on an entirely different mood: it’s time to think outside the box, be innovative and apply the lessons we’ve learned to addressing the key blockages.

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The Daily Impact: Health Workers Combat Drug-resistant Malaria, in Cambodia

February 24, 2014

An article in the South China Morning Post describes how groups are fighting on frontline of malaria drug resistance in western Cambodia.

In December 2008, researchers published a letter in the New England Journal of Medicine (NEJM) based on a study conducted on malaria patients in the west of Cambodia. The study showed evidence that malaria parasites in the area were developing resistance to artemisinin, which, when combined with other anti-malarial drugs, has formed one of the few effective treatments against Plasmodium falciparum.

While the news was a major setback in the fight against malaria, the source of this new threat wasn’t exactly a surprise; since the 1970s, western Cambodia’s Pailin province, a poor, agricultural area that is still recovering from decades of brutal Khmer Rouge rule, has held the ominous distinction of being ground zero for new drug-resistant malaria strains.

“In the past 50 years, this Thai-Cambodian border area has been the very birthplace of all drug resistance,” says Steven Bjorge, former team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia. “Every drug that has replaced previous drugs has become resistant first in this area before becoming resistant elsewhere.”

(snip)

In December 2008, researchers published a letter in the New England Journal of Medicine (NEJM) based on a study conducted on malaria patients in the west of Cambodia. The study showed evidence that malaria parasites in the area were developing resistance to artemisinin, which, when combined with other anti-malarial drugs, has formed one of the few effective treatments against Plasmodium falciparum.

While the news was a major setback in the fight against malaria, the source of this new threat wasn’t exactly a surprise; since the 1970s, western Cambodia’s Pailin province, a poor, agricultural area that is still recovering from decades of brutal Khmer Rouge rule, has held the ominous distinction of being ground zero for new drug-resistant malaria strains.

“In the past 50 years, this Thai-Cambodian border area has been the very birthplace of all drug resistance,” says Steven Bjorge, former team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia. “Every drug that has replaced previous drugs has become resistant first in this area before becoming resistant elsewhere.”

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Dr. Mitu Khurna’s story

(Image credit: Flickr user SalFalko by CC)

Editor’s note: Indrani Goradia, Founder of Indrani’s Light Foundation, just concluded a trip to India to visit PSI-India’s pilot projects to combat gender-based violence. These are her reflections (see part 1 and part 2)

I think most people would expect an educated woman in the country’s capital city to somehow be immune, or protected, to have the same basic rights of a modern woman.

In 2004, Mitu, a pediatrician, married an orthopedic surgeon. Shortly after her arranged marriage, her in-laws demanded a greater dowry from her parents – a new car, more jewelry and other possessions. Her parents could not give more, and as a result, Mitu suffered abuse at the hands of her mother-in-law – a practice all to common in India.

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The Daily Impact: Malaria Poses Risk to 184 Million in Africa

February 21, 2014

A new research paper shows that the number of people who are at moderate to high risk of malaria in Africa fell from 220 million in 2000 to 184 million today. From VOA:

The findings are based on thousands of community-based surveys in 44 African countries and territories. These are places where malaria has been endemic.

Dr. Abdisalan Noor, co-leader of the team that conducted the research, said, “What we are looking at, first of all, is to try and estimate the level of infection with malaria in African communities. This doesn’t necessarily mean the number of people who die of malaria, but the proportion of people who are likely to carry the most virulent type of the malaria parasite. That’s Plasmodium falciparum.”

Noor and co-leader Professor Robert Snow are with the Kenya Medical Research Institute-Wellcome Trust Research Program. The team also included researchers from Oxford University and the World Health Organization.

The study reflects the effects of the Roll Back Malaria campaign and other programs. The campaign brought together many multi-lateral, private and non-governmental organizations. The goal was to cut in half the number of deaths from malaria by 2010. It had a shaky start and was criticized in its early years for a lack of progress.

Dr. Noor said that the new study finds a mix of good and bad news about efforts to combat malaria.

“The positive news is there has been production in 40 of the 44 African countries for which we were able to estimate change. There has been some reduction in the proportion of people who are likely to be affected with the falciparum parasite. About 218-million people in 2010 lived in areas where transmission – malaria transmission – had dropped by at least one level of endemicity. So that’s good news.”

Endemicity is described as the measure of disease prevalence in a region.

“The other side of it.” said Noor, “is that despite all these gains almost 60 percent of African populations still live in areas where more than 10-percent of the population is likely to carry the malaria parasite. And out of these about 184-million people live in areas where more than 50-percent of the population are likely to carry malaria infections.”

Among the countries where disease transmission remained high or unchanged are DRC, Uganda, Malawi and South Sudan.

Despite the large number of people still likely to be infected, Noor says he does not want to detract from the gains made by the international community – namely, the reduction in risk for 34-million people from 2000 to 2010.

“We haven’t actually looked at the reasons why some places are more resilient to change than others. Epidemiologically, it’s got something to do with the higher the starting transmission, the longer it takes to bring down the disease,” he said.

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CVS takes a page from development playbook

CVS’s decision to quit marketing tobacco products is getting lots of well-deserved attention. And, I’d imagine competitors will follow suit. But its shift from drug store to health care provider is even more striking.

From marketing everything one might want or need (cigarettes, detergent, gum, prescriptions) towards marketing what one needs to want (prescriptions, wellness care, basic curative care… and sure, detergent too) will put CVS on the forefront of marketing for health and could possibly create a new model for health provision in the US.

In the non-profit world, it’s what we call “social” marketing — a practice that’s been around for decades but is getting renewed attention as a creative and cost-effective way to improve health around the world.

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#Unclogit Day 1: Understanding the Blockages

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With nearly 170 participants registered, 21 countries represented, countless organizations and specialties and the loud buzz of excited conversation, the first ever Unclogging the Blockages in Sanitation workshop in Kampala got off to a great start. Day 1′s goal was to Understand the Blockages: an entire day dedicated to informing participants of the challenges faced within the sanitation sector.

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The Daily Impact: Vaccine Storage Breakthrough in Benin

February 20, 2014

The need for cold storage of vaccines has presented challenges in transporting to remote parts of the world. A new form of the meningitis A successfully withstood the heat of Benin. VOA with the exciting news:

Researchers said that health workers in Benin have successfully immunized more than 155,000 people against meningitis A using the first vaccination to be approved for use without constant refrigeration, also known as the “cold chain.”

The World Health Organization (WHO) said the vaccine, which is known as MenAfriVac, can be stored for up to four days in temperatures up to 40 degrees Celsius.

PATH is a U.S.-based non-profit organization that partnered with the WHO on the Meningitis Vaccine Project.  Dr. Marie-Pierre Preziosi, the project’s director, said the new breakthrough could revolutionize the way vaccination campaigns are conducted in developing countries.  She spoke to VOA from Ouagadougou.

“As you know, vaccines are usually kept in cold chains, between 2 to 8 degrees Celsius.  And so you have to have the whole capacity around the cold chain: that is freezers, ice packs, transportation fuel, electricity fuel, all of this.  Sometimes, it is not only costly, but it is also very challenging to reach remote areas with such constraints,” said Preziosi.

Health experts said that because of the cold chain requirement, there is normally a lot of wasted vaccine vials during immunization campaigns, particularly during the “last mile” — the time from when the vaccine leaves the refrigerator at the district health center until it is injected into a person’s arm at the village level.

Many communities in Africa have no access to electricity and are often too remote to be reached before the ice packs in insulated coolers melt.

Preziosi said the flexibility of being able to transport the vaccine outside of the cold chain meant that only nine vaccine vials out of 15,000 had to be discarded during the trial study in Benin.

Being able to work outside the cold chain also meant that health workers didn’t have to travel to and from the district health center each day to replenish vaccine supplies.  This allowed them to vaccinate more people in a shorter amount of time.

PATH’s vice president for product development, Dr. David Kaslow, said that removing the refrigeration requirement for MenAfriVac could also reduce costs.

“The one study that was done with the WHO looked at the modeled scenario, which is: what are all the costs that are incurred in that last mile?  And really, one of the major costs, obviously, are the cold chain costs themselves… And so the analysis was done as to what is the cost savings.  And it’s about 50 percent,” he noted. “On average, from 24 cents per dose delivered to 12 cents per dose delivered.”

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Geeta’s story

 

Dharavi, Mumbai (India).

Ed note. Indrani Goradia, Founder of Indrani’s Light Foundation, just concluded a trip to India to visit PSI-India’s pilot projects to combat gender-based violence. These are her reflections.   

Today I spent time with prostituted women at Shakti Vahini, India’s leading organization to combat human trafficking and slavery.

It broke me. I felt sorrow, anger, rage, and incredible grief.

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The Daily Impact: TB and HIV co-treatment Reduces Deaths, say Researchers

February 19, 2014

A small study finds that patients with both TB and HIV live longer when receiving simultaneous treatment for both diseases rather than waiting weeks to start the AIDS treatment. From the New York Times:

Although the study was small — it included only 23 South African patients with drug-resistant TB — its results concurred with those of three major studies of people with regular TB and the virus that causes AIDS.

Those three studies, said Dr. Gerald Friedland, a tuberculosis specialist at the Yale School of Public Health, overturned an old belief that it was safer to treat TB first and H.I.V. afterward.

The new study was published in The International Journal of Tuberculosis and Lung Disease.

The old fear was that weak TB patients would be killed by the inflammation and fluids released into their lungs when antiretroviral drugs jump-started their immune systems.

But “immune reconstitution” can usually be managed with anti-inflammatory drugs, Dr. Friedland said, and far fewer patients in the studies died when they received both therapies promptly.

The idea that waiting was best “goes back historically quite a ways,” he said, to the early days of AIDS, when tuberculosis treatment was a long-established specialty and its practitioners were unfamiliar with the new disease. Also, early H.I.V. drugs were more toxic, and patients had to take many pills every day. Since TB patients typically take a four-drug cocktail, pill regimens could become very complicated, and patients often quit.

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Unclogging the Blockages: Building sustainable markets for sanitation products and services

Despite growing attention to sanitation being paid by donors and governments, and the declaration by the United Nations that access to basic sanitation is a human right, progress remains slow. In an effort to get things moving (pun intended), on Tuesday, February 18, the first ever Unclogging the Blockages in Sanitation workshop will commence in Kampala, Uganda.

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