Getting life-saving malaria care to many more patients

In a new report launched today, the international medical organisation Médecins Sans Frontières (MSF) said many more lives can be saved if newer effective strategies to tackle malaria are more widely implemented.

The report titled "Full Prescription; better malaria treatment for more people, MSF's experience" describes the organisation's work in Sierra Leone, Chad and Mali, and shows that unnecessary deaths can be avoided with simple, affordable treatment and diagnostic tools available today.

"Although still insufficient, increased funding is available for malaria ," said Meinie Nicolai, MSF General Director in Brussels. "Newer and more effective drugs have started to arrive on the shelves, rapid tests exist that can confirm the diagnosis in 15 minutes. But many efforts are failing at the last hurdle and scores of sick people, mainly children, still do not get the treatment they need."

In large parts of sub-Saharan Africa, people do not go to health structures because they are too expensive and too far away. In Sierra Leone, for example, only 12 percent of children suspected of having malaria received efficient treatment in the health services1. MSF's experience and research show that the fees patients are requested to pay are a huge deterrent to seeking care in most of the poor settings where MSF works.

A second barrier to providing malaria care effectively is geographical. Some rural communities are very remote from health structures, or isolated by water during the rainy season. Strategies involving malaria village workers have proved to be highly efficient in reaching and treating malaria patients where they live. By combining free care at health centre level and in the communities that were geographically isolated, MSF's project in Mali succeeded in tripling the number of malaria cases detected and treated over a year's time.

This has been possible without jeopardising the quality of care through user-friendly rapid tests, which allow lay-people with basic training to confirm if the patient's fever is indeed caused by malaria. When cases are identified, the malaria village worker dispenses drugs to the patient or the caretaker free of charge.

"Malaria village workers are not the silver bullet," explains Christine Jamet, Head of Mission for MSF in Chad. "But they allow to efficiently bridge the gap where health structures are not accessible. They should not exempt the authorities from extending access to care, especially as people who test negative for malaria must be treated for whatever causes their fever and complex cases need to be referred to a health structure. To ensure appropriate medical treatment, malaria cases should be systematically confirmed by using a test."

At the moment, the World Health Organisation (WHO) recommends to treat all children with fever, in highly endemic regions, with anti-malarial drugs. But in a Sierra Leone for example, a high-transmission area, systematic use of rapid tests in our project in Bo showed that 30 to 40 % of the suspected cases under five are actually negative.. Not using the tests - as recommended by WHO - means that many will receive treatment for the wrong disease and no further examination will be performed to check what actually causes the fever.

Until more successful prevention and eradication measures bear their fruits, patients will continue to die needlessly if available efficient treatment and diagnostic tools do not reach them. Shipping tests and drugs to the country is not enough, measures to actually ensure their delivery to patients need to be implemented urgently.

Médecins Sans Frontières 

Its researchers found that the two groups operated their own mines and even traded with each other.

The army, with the UN, is supposed to be undertaking a huge operation against the FDLR rebels, accused of taking part in the 1994 Rwanda genocide. For too long this kind of corrupt practice and unrestrained avarice has been destroying the lives of the people of that mineral rich nation. If the vast resources were properly used and disbursed then poverty in that nation could be eradicated for once and for all.

Rwanda has twice sent troops into DR Congo, saying it wants to stop FDLR attacks on its territory.

The DR Congo government has promised to wipe them out, in conjunction with UN peacekeepers.

But Global Witness says there are frequent reports of Congolese soldiers selling weapons and uniforms to the mainly Hutu FDLR. This must be tackled and tackled at once. If the situation is allowed to continue it will only deteriorate and the country will slip back into the grip of a viscous war. As usual the main casualties of that war will be the innocent, women and children. Unfortunately this situation seems to be coming about already.

There has recently been renewed fighting in certain areas between the army and the renegade Tutsi General Laurent Nkunda.

Gen Nkunda has previously refused to disarm, accusing the army of working with the FDLR against Tutsis who live in the region.

Last month, US and European Union diplomats warned that the situation in eastern DR Congo was becoming increasingly tense and that all sides were rearming.

Human rights groups said that tens of thousands of people were fleeing as the situation in the area deteriorated. The UN has 17,000 peacekeepers in DR Congo, supposed to monitor a 2003 peace-deal to end a conflict that drew in at least eight other African countries. The crisis is once again unfolding before our eyes. If the number of UN peacekeepers needs to be increased then it should be. If more direct intervention from the African Union is required then it should intervene more directly. Whatever needs to be done must be done because it is always easier to prevent a war then to stop one.

While researchers and advocates at the International AIDS Conference this week urged donors and governments to rapidly scale up male circumcision programmes, others raised concerns about what this would mean for women.

In March 2007, the World Health Organisation and UNAIDS issued recommendations that gave the green light to male circumcision as an HIV prevention strategy, after studies in Kisumu, Kenya and the township of Orange Farm in South Africa showed that it could reduce the risk of infection by up to 60 percent.

But the recommendations also stressed that not enough is known about whether male circumcision reduces sexual transmission of HIV from men to women, making the intervention "highly problematic" according to Marge Berer, editor of the London-based journal Reproductive Health Matters. "From a public health perspective, we are told that 60 percent protection [for circumcised men] is far better than nothing. But is male circumcision good enough for women?" she wondered.

A study of almost 3,000 men between the ages of 18 and 24 in Kenya, compared sexual function between circumcised and uncircumcised men, assessing sexual satisfaction over a two-year period. The researchers found that the circumcised group had no higher rates of sexual dysfunction than the uncircumcised men.

According to John Krieger of the University of Washington, Seattle the men that had been circumcised reported more sexual pleasure post-circumcision, and that they found condoms easier to use.
In addition, new results from a male circumcision initiative implemented by Population Services International in Zambia suggest that cultural resistance may not pose as serious a barrier as previously thought, and that it is possible to do the procedures safely and effectively in poor settings, using nurses and clinical officers.

Delegates heard that circumcision also lowers the risk of men getting the human papilloma virus (HPV) that causes genital warts, and trichomoniasis, another common sexually transmitted disease.

What about women?

"All I'm hearing [at the conference] is about what it will do for men, the sexual satisfaction of men...but what about the women? What is their involvement?" commented Siphiwe Hlope, a founder of Swazis for Positive Living (SWAPOL), an AIDS support organisation.

Nicolai Lohse a research officer at UNAIDS said mathematical modelling showed women would benefit from male circumcision as long as it did not result in condom use dropping by more than two-thirds. Women's risk of acquiring HIV would also be reduced if circumcision programmes led to fewer HIV-positive men in the population. The risk to women of HIV acquisition would decline by 2 percent if only 5 percent of men were circumcised, and by 20 percent if half the men in a population were circumcised.

While Berer told delegates on Thursday that the potential benefits of male circumcision were "too large a gamble" for women, many countries in Southern Africa are already in the process of developing national policies on the procedure.
"We have to support these programmes, I don't think we have a choice. But one would really argue that these programmes have a responsibility to women," Berer told IRIN/PlusNews.

She called for campaigns expanding male circumcision to involve couples and not to focus solely on men. Women health advocates also had a role to play in drafting national policies. "No one is going to pull out the red carpet for women's involvement in male circumcision ...it is up to women to stop being victims," Berer added.

PlusNews 

Muslim Hands International The Gambia yesterday concluded a two-day workshop at their office in latrikunda German for imams in the Greater Banjul area on malaria prevention campaign.

Speaking at the occasion managing director of Muslim Hands in The Gambia Shariff Sarane Hydara said Muslim Hands is  a UK  based charitable organisation working in The Gambia Since 1983. He said that their work includes sponsorship of orphans and elderly people, educational assistance of students and the distribution of food and  emergency aid.

Mr. Hydara pointed out that malaria is a big problem affecting communities that is why his organization deem it necessary to embark on a malaria prevention campaign for the communities of Ibo-Town, Kotu and Manjai-kunda.

He said the purpose of the campaign is to compliment government efforts in the fight against malaria adding that during the campaign free mosque net distribution will be conducted in the various communities.

For her part, Yamumdaw Leigh Africell Ambassador has called on the communities to clean their environment and use the insecticide treated nets.

She pointed out that the training has come at the right time and called on the Imams to use their sermon and disseminate malaria messages.

Mam Burama Sarr said Imams have a central role to play in the fight against malaria, adding that they should be use as an entry point. Other speakers at the occasion included Mustapha Jallow of NEA, PA Yusupha Sowe of TaYAM, Dawda Joof of CIAM and Dr Omar Jah Jr of the University of The Gambia.

A two-day ECOWAS Regional Consultation on conflict prevention in the Sene-Gambia Zone ended last Friday at the Kairaba Beach Hotel.

Speaking at the occasion, Ambassador Babou Ousman Jobe of The ECOWAS Council of the Wise stated that one of the objectives of the programme is to build the capacity of West African Civil Society coalitions in monitoring governance and human rights with the goal of complementing ongoing activities aimed at promoting regional Security and contributing to security sector transformation processes in West Africa.

The ambassador has called on civil society organisations to work closely with government to prevent conflicts within West Africa.

For his part, the director of Centre for Democracy and Development (CDD), Jibrin Ibrahima, said the reason for organising the meeting in Banjul is meant to reduce and manage the long standing conflicts in the Sene- Gambian Zone citing the Cassamance as one example.

He has assured participants that the recommendation of the meeting will be fully implemented at the level of ECOWAS

NYP’s Ousman Conteh off to South Africa

Hon Ousman Conteh, the Program Officer of the National Youth Parliament, who doubles as the Clerk of Banjul Youth Parliament, is off to attend the International Youth Crime Prevention Summit which is slated for Tuesday, 17th June, in Durban , South Africa.

According to report from the parliament, the summit which is expected to end on Saturday 21st June, 2008, is expected to bring together hundreds of young leaders from across the globe, and their discussion will be centered on crime prevention. The aim of the summit, the report went on, is to raise the profile of youth empowerment issues globally, and it will serve as a strategic platform to come with initiatives and ideas in preventing crime and violence, especially in urban cities.

The summit will also discuss approaches related to youth participation in strategies for crime and violence prevention and encourage collaboration among youth empowerment programs in both national and regional spheres; formulate policies for youths, civic education of youth, with regards to their role in society, as well as development programs, amongst other issues.

 The summit, the report went on, is organized by the UN Human Settlement Program in partnership with the Kwazulu Natal Department of Community.

Hon Conteh’s participation, the report concludes, has been made possible thanks to the financial support of the Kwazulu Natal Provincial Government of South Africa.