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O'Brien M.,Global Access to Pain Relief Initiative | Mwangi-Powell F.,African Palliative Care Association | Adewole I.F.,University of Ibadan | Adewole I.F.,African Organisation for Research and Training in Cancer | And 7 more authors.
The Lancet Oncology | Year: 2013

WHO expects the burden of cancer in sub-Saharan Africa to grow rapidly in coming years and for incidence to exceed 1 million per year by 2030. As a result of late presentation to health facilities and little access to diagnostic technology, roughly 80% of cases are in terminal stages at the time of diagnosis, and a large proportion of patients have moderate to severe pain that needs treatment with opioid analgesics. However, consumption of opioid analgesics in the region is low and data suggest that at least 88% of cancer deaths with moderate to severe pain are untreated. Access to essential drugs for pain relief is limited by legal and regulatory restrictions, cultural misperceptions about pain, inadequate training of health-care providers, procurement difficulties, weak health systems, and concerns about diversion, addiction, and misuse. However, recent initiatives characterised by cooperation between national governments and local and international non-governmental organisations are improving access to pain relief. Efforts underway in Uganda, Kenya, and Nigeria provide examples of challenges faced and innovative approaches adopted and form the basis of a proposed framework to improve access to pain relief for patients with cancer across the region. © 2013 Elsevier Ltd.

News Article | October 28, 2016

The Federal Government of Nigeria has signed a Memorandum of Understanding on Rebranding the impact of Climate Change on health as a Public Health Issue in Nigeria. The Memorandum of Understanding was signed by the Federal Ministry of Health and the Africa Clean Energy Summit (the consortium of Always Green Power & Systems Limited and The Environment Communications Limited).

-- The Government of Cross River State through the Ministry of Climate Change and Forestry in collaboration with the Africa Clean Energy Summit/Group, the Federal Ministry of Environment, the Federal Ministry of Health, the Federal Ministry of Industry, Trade & Investment, NEPAD Nigeria, Covenant University, ADC Energy USA, Development Partners, Always Green Power & Systems Limited and The Environment Communications Limited is hosting a Global Summit on Climate Change and Green Entrepreneurship in April 2017 to coincide with the World Earth Day Celebrations.The summit will bring together international and national stakeholders from governments, private sector, non-governmental organizations, development partners and international investors, to address matters that would support the state's transition to a low-carbon and climate-resilient economy - building a sustainable green economy in Cross River State.The Cross River State Global Summit on Climate Change and Green Entrepreneurship with focus on Jobs Creation Opportunities and the First Ever Wealth Creation Parks for Low Carbon Development in Africa will hold from April 17th to April 22nd 2017 with a Special Marathon Race for Climate Change - ''Cross River Climate Marathon'' at the CALABAR INTERNATIONAL CONVENTION CENTRE.The global event will include a World Class Summit; the 2017 World Earth Day celebrations;High Level Climate Solutions Segments, an International Exhibition; Technical Conferences;Business Sessions; Investment Forums; Green Energy Empowerment for MSMEs; Green Wealth from Tree PlantingProgram; Green Investment Tours; Carbon Credit Train; Official Solarization of the Cross River State Government House with energy efficient and saving devices as the driving force for promoting clean energy in Nigeria and leading to the establishment of the FIRST EVER GREEN ENERGY EXPORT PROCESSING HUB IN WEST AFRICA FOR SMART CITIES AND COMMUNITIES;the International Green Hall of Fame; Flag-Off of the Distribution of Clean Cookstoves in Cross River State (under the Rebranding Climate Change Clean Cookstoves Initiative); and concurrent activities such as the incorporation of RACE FOR THE CLIMATE – A Special Marathon Race for Climate Change (''Cross River Climate Marathon'' ''with special sport foot wears for recharging mobile phones"), Green Marketplace -"COME SEE AND BUY", a Climate Walk, Green Road Show and Clean Energy Technology & Green Business Solution Hub for Africa.The CROSS RIVER STATE $250M GREEN ENTREPRENEURSHIP FUND:A $250Million Green Entrepreneurship Fund (the first ever in Africa) will be launched on the 22nd of April 2017, as part of the World Earth Day Celebrations. The Fund will empower a minimum of 150,000 Green Entrepreneurs and Enterprises;creating more than 600,000 Direct jobs and over 1,200,000 Indirect Jobs in 18 months. With a population of more than 3.5Million, Cross River State would provide employment for a reasonable number of young people in the state. The $250Million Green Entrepreneurship Fund is the first phase of a $1 Billion Green Entrepreneurship Fund … Green Entrepreneurship for massive empowerment in Nigeria and Africa!CONSEQUENTLY, A NATIONAL BUSINESS AND ENVIRONMENT ROUNDTABLE (NBER) SHALL BE FLAGGED OFF BY THE HONOURABLE MINISTER OF ENVIRONMENT.The Global Climate Summit is programmed to deliver the customized strategic roadmap of climate and green bonds/finance secrets through the following rationale: -•Financial institutions represent the largest source of public of finance for technology for adaptation/mitigation and low carbon sustainable economic development for operationalizing our signed Nationally Determined Contributions(NDCs);•They therefore have the ability and can play a pivotal role to direct capital and demonstrate to markets the opportunities, risks and potential returns of sustainable investments, while at the same time being active actors in policy dialogues to assist in mainstreaming the sustainable development agenda in all sectors.MEDIA FORUM @ THE GLOBAL SUMMIT:More than 40 international and national journalists would be joining decision makers, policymakers, industry leaders, investors, experts and major stakeholders around the world to explore and further understand the challenges and opportunities that arise from Climate Change.The Global Summit on Climate Change and Green Entrepreneurship promises to be the biggest and best of all, in the history of Climate Change and Clean Energy Summits, Conferences and Programmes in Africa.It is worthy to note that Cross River State is the first and only subnational government that has a ministry for Climate Change in Africa. Cross River is also strategically positioned to host global events of this nature as an eco-tourism state.

Tusting L.S.,London School of Hygiene and Tropical Medicine | Willey B.,London School of Hygiene and Tropical Medicine | Lucas H.,Institute of Development Studies | Thompson J.,Institute of Development Studies | And 3 more authors.
The Lancet | Year: 2013

Background: Future progress in tackling malaria mortality will probably be hampered by the development of resistance to drugs and insecticides and by the contraction of aid budgets. Historically, control was often achieved without malaria-specific interventions. Our aim was to assess whether socioeconomic development can contribute to malaria control. Methods: We did a systematic review and meta-analysis to assess whether the risk of malaria in children aged 0-15 years is associated with socioeconomic status. We searched Medline, Web of Science, Embase, the Cochrane Database of Systematic Reviews, the Campbell Library, the Centre for Reviews and Dissemination, Health Systems Evidence, and the Evidence for Policy and Practice Information and Co-ordinating Centre evidence library for studies published in English between Jan 1, 1980, and July 12, 2011, that measured socioeconomic status and parasitologically confirmed malaria or clinical malaria in children. Unadjusted and adjusted effect estimates were combined in fixed-effects and random-effects meta-analyses, with a subgroup analysis for different measures of socioeconomic status. We used funnel plots and Egger's linear regression to test for publication bias. Findings: Of 4696 studies reviewed, 20 met the criteria for inclusion in the qualitative analysis, and 15 of these reported the necessary data for inclusion in the meta-analysis. The odds of malaria infection were higher in the poorest children than in the least poor children (unadjusted odds ratio [OR] 1.66, 95% CI 1.35-2.05, p<0.001, I2=68%; adjusted OR 2.06, 1.42-2.97, p<0.001, I2=63%), an effect that was consistent across subgroups. Interpretation: Although we would not recommend discontinuation of existing malaria control efforts, we believe that increased investment in interventions to support socioeconomic development is warranted, since such interventions could prove highly effective and sustainable against malaria in the long term.

Mangal T.D.,Imperial College London | Aylward R.B.,WHO | Mwanza M.,WHO | Gasasira A.,WHO | And 3 more authors.
The Lancet Global Health | Year: 2014

Background: The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world's cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical efficacy estimates for the oral poliovirus vaccines (OPV) currently in use. Methods: We used acute flaccid paralysis (AFP) surveillance data from Nigeria collected between January, 2001, and December, 2012, to estimate the clinical efficacies of all four OPVs in use and combined this with vaccination coverage to estimate the effect of the introduction of monovalent and bivalent OPV on vaccine-induced serotype-specific population immunity. Vaccine efficacy was determined using a case-control study with CIs based on bootstrap resampling. Vaccine efficacy was also estimated separately for north and south Nigeria, by age of the children, and by year. Detailed 60-day follow-up data were collected from children with confirmed poliomyelitis and were used to assess correlates of vaccine status. We also quantitatively assessed the epidemiology of poliomyelitis and programme performance and considered the reasons for the high vaccine refusal rate along with risk factors for a given local government area reporting a case. Findings: Against serotype 1, both monovalent OPV (median 32·1%, 95% CI 26·1-38·1) and bivalent OPV (29·5%, 20·1-38·4) had higher clinical efficacy than trivalent OPV (19·4%, 16·1-22·8). Corresponding data for serotype 3 were 43·2% (23·1-61·1) and 23·8% (5·3-44·9) compared with 18·0% (14·1-22·1). Combined with increases in coverage, this factor has boosted population immunity in children younger than age 36 months to a record high (64-69% against serotypes 1 and 3). Vaccine efficacy in northern states was estimated to be significantly lower than in southern states (p≤0·05). The proportion of cases refusing vaccination decreased from 37-72% in 2008 to 21-51% in 2012 for routine and supplementary immunisation, and most caregivers cited ignorance of either vaccine importance or availability as the main reason for missing routine vaccinations (32·1% and 29·6% of cases, respectively). Multiple regression analyses highlighted associations between the age of the mother, availability of OPV at health facilities, and the primary source of health information and the probability of receiving OPV (all p<0·05). Interpretation: Although high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery. Funding: Bill & Melinda Gates Foundation Vaccine Modeling Initiative, Royal Society. © 2014 Mangal et al.

News Article | February 16, 2017

The global proliferation of overweight and obese people and people with type 2 diabetes is often associated with the consumption of saturated fats. Scientists at the German Diabetes Center (Deutsches Diabetes-Zentrum, DDZ) and the Helmholtz Center in Munich (HMGU) have found that even the one-off consumption of a greater amount of palm oil reduces the body's sensitivity to insulin and causes increased fat deposits as well as changes in the energy metabolism of the liver. The results of the study provide information on the earliest changes in the metabolism of the liver that in the long term lead to fatty liver disease in overweight persons as well as in those with type 2 diabetes. In the current issue of the "Journal of Clinical Investigation", DZD researchers working at the German Diabetes Center, in conjunction with the Helmholtz Center in Munich and colleagues from Portugal, published a scientific investigation conducted on healthy, slim men, who were given at random a flavored palm oil drink or a glass of clear water in a control experiment. The palm oil drink contained a similar amount of saturated fat as two cheeseburgers with bacon and a large portion of French fries or two salami pizzas. The scientists showed that this single high-fat meal sufficed to reduce the insulin action, e.g. cause insulin resistance and increase the fat content of the liver. In addition, changes in the energy balance of the liver were proven. The observed metabolic changes were similar to changes observed in persons with type 2 diabetes or non-alcoholic fatty liver disease (NAFLD). NAFLD is the most common liver disease in the industrial nations and associated with obesity, the so-called "metabolic syndrome," and is associated with an increased risk in developing type 2 diabetes. Furthermore, NAFLD in advanced stages can result in severe liver damage. "The surprise was that a single dosage of palm oil has such a rapid and direct impact on the liver of a healthy person and that the amount of fat administered already triggered insulin resistance", explained Prof. Dr. Michael Roden, scientist, Managing Director and Chairman at the DDZ and the German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung, DZD). "A special feature of our study is that we monitored the liver metabolism of people with a predominantly non-invasive technology, e.g. by magnetic resonance spectroscopy. This allows us to track the storage of sugar and fat as well as the energy metabolism of the mitochondria (power plants of the cell)." Thanks to the new methods of investigation, the scientists were able to verify that the intake of palm oil affects the metabolic activity of muscles, liver and fatty tissue. The induced insulin resistance leads to an increased new formation of sugar in the liver with a concomitant decreased sugar absorption in the skeletal muscles - a mechanism that makes the glucose level rise in persons afflicted with type 2 diabetes and its pre-stages. In addition, the insulin resistance of the fatty tissue causes an increased release of fats into the blood stream, which in turn continues to foster the insulin resistance. The increased availability of fat leads to an increased workload for the mitochondria, which can in the long term overtax these cellular power plants and contribute to the emergence of a liver disease. The team of Prof. Roden suspects that healthy people, depending on genetic predisposition, can easily manage this direct impact of fatty food on the metabolism. The long-term consequences for regular eaters of such high-fat meals can be far more problematic, however. This paper is promoted by the Federal Ministry of Health, the Ministry for Innovation, Science and Research of the state of North Rhine-Westphalia, the Federal Ministry for Education and Research (Deutsches Zentrum für Diabetesforschung e.V.), as well as the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG), the German Diabetes Society (DDG) and the Schmutzler Foundation. Elisa Álvarez Hernández, Sabine Kahl, Anett Seelig, Paul Begovatz, Martin Irmler, Yuliya Kupriyanova, Bettina Nowotny, Peter Nowotny, Christian Herder, Cristina Barosa, Filipa Carvalho, Jan Rozman, Susanne Neschen, John G. Jones, Johannes Beckers, Martin Hrab? de Angelis and Michael Roden, Acute dietary fat intake initiates alterations in energy metabolism and insulin resistance, J Clin Invest. 2017, January 23, 2017. doi:10.1172/JCI89444. The German Diabetes Center (DDZ) is the German reference center for diabetes. The goal is to contribute to the prevention, early detection, diagnosis and treatment of diabetes mellitus. At the same time, the research center aims at improving the epidemiological data situation in Germany. DDZ is in charge of the multi-center German Diabetes Study. It is the point of contact for all players in the health sector. In addition, it prepares scientific information on diabetes mellitus and makes it available to the public. DDZ is part of "Wissenschaftsgemeinschaft Gottfried Wilhelm Leibniz" (WGL) and is a partner of the German Center for Diabetes Research (DZD e.V.). The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Zentrum München - German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of the Helmholtz Zentrum München at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Zentrum München at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. The Helmholtz Zentrum München, the German Research Center for Environmental Health, pursues the goal of developing personalized medical approaches for the prevention and therapy of major common diseases such as diabetes and lung diseases. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The Helmholtz Zentrum München is headquartered in Neuherberg in the north of Munich and has about 2,300 staff members. It is a member of the Helmholtz Association, a community of 18 scientific-technical and medical-biological research centers with a total of about 37,000 staff members

News Article | August 31, 2016

Abdulsalam Nasidi's phone rang shortly after midnight: Nigeria's health minister was on the line. Nasidi, who worked at the country's Federal Ministry of Health, learnt that he was needed urgently in the Benue valley to investigate a cluster of dying patients. People were bleeding out of their noses, their mouths, their eyes. Names of spine-chilling viruses such as Ebola, Lassa and Marburg raced through Nasidi's mind. When he arrived in Benue, he found people splayed on the ground and tents serving as makeshift hospital wards and morgues. But Nasidi quickly realized that the cause of the mystery illness was millions of times larger than any virus. The onset of the rainy season had brought the start of spring planting for farmers in the valley, and flooding had disturbed the resident carpet vipers (Echis ocellatus). Many farmers were simply too poor to buy boots — and their exposed feet became targets for the highly venomous snakes. Nasidi wanted to help, but he found himself with limited tools. He had only a small amount of antivenom with which to neutralize the toxin — and it quickly ran out. Once the hospital exhausted its supply, people stopped coming. No one knows how many people were killed. In an average year, hundreds of Nigerians die from snakebite, and that rainy season, which started in 2012, was far from average. Snakebites are a growing public-health crisis. According to the World Health Organization, around 5 million people worldwide are bitten by snakes each year; more than 100,000 of them die and as many as 400,000 endure amputations and permanent disfigurement. Some estimates point to a higher toll: one systematic survey concluded that in India alone, more than 45,000 people died in 2005 from snakebite1 — around one-quarter the number that died from HIV/AIDS (see 'The toll of snakebite'). “It's the most neglected of the world's neglected tropical diseases,” says David Williams, a toxinologist and herpetologist at the University of Melbourne, Australia, and chief executive of the non-profit organization Global Snakebite Initiative in Herston. Many of those bites are treatable with existing antivenoms, but there are not enough to go around. This long-standing problem became international news in September 2015, when Médecins Sans Frontières (MSF, also known as Doctors Without Borders) announced that the last remaining vials of the antivenom Fav-Afrique, used to treat bites from several of Africa's deadliest snakes, were about to expire. The French pharma giant Sanofi Pasteur in Lyons had decided to cease production in 2014. MSF estimates that this could cause an extra 10,000 deaths in Africa each year — an “Ebola-scale disaster”, according to Julien Potet, a policy adviser for MSF in Paris. Yet, because most of those affected by snakebites are in the poorest regions of the world, the issue has been largely ignored. In May, however, the crisis was discussed for the first time at the annual World Heath Assembly meeting in Geneva, Switzerland. The world's handful of snakebite specialists gathered in a small conference room in the Palais des Nations — although they shared concern over the problem, they were split about how to solve it. Many want to use synthetic biology and other high-tech tools to develop a new generation of broad-spectrum antivenoms. Others argue that existing antivenoms are safe, effective and low cost, and that the focus should be on improving their production, price and use. “From the physician perspective, patient care and public health comes before anything new,” says Leslie Boyer, who directs an institute dedicated to antivenom study at the University of Arizona, Tucson. The debate mirrors those around many other developing-world challenges, from improving agriculture to providing clean drinking water. Do people need high-tech solutions, or can cheaper, lower-tech remedies do the job? The answer is simple to Jean-Philippe Chippaux, a physician working on snakebite for the French Institute of Research for Development in Cotonou, Benin. “We have the ability to fix this problem now. We just lack the will to do it,” he says. Every December, Williams sees snakebite victims flood into the Port Moresby General Hospital in Papua New Guinea. Nearly all of them were bitten by the taipan (Oxyuranus scutellatus), one of the world's deadliest snakes, which emerges at the start of the rainy season. The venom stops a victim's blood from clotting, paralyses muscles and leads to a slow, agonizing death. It seems a far cry from Australia, where Williams is based. “There's this incredible suffering just 90 minutes away from the modern world,” he says. Yet Williams knows that these people are the lucky ones. The hospital ward, which might be treating as many as eight taipan victims at any time, is often the only place in the country with antivenom drugs. Without them, some 10–15% of all snakebite victims die; with them, just 0.5% do. The situation is reflected around the world. “Many countries don't want to admit that they have such a primeval-sounding problem,” Chippaux says. The method used to make antivenom has changed little since French physician Albert Calmette developed it in the 1890s. Researchers inject minuscule amounts of venom, milked from snakes, into animals such as horses or sheep to stimulate the production of antibodies that bind to the toxins and neutralize them. They gradually increase doses of venom until the animal is pumping out huge amounts of neutralizing antibodies, which are purified from the blood and administered to snakebite victims. Across much of Latin America, government-funded labs typically produce antivenoms and distribute them free of charge. But in other areas, especially sub-Saharan Africa, these life-saving medications are too often out of reach. Many governments lack the infrastructure or political will to purchase and distribute antivenom. Bribery and corruption often jack up the price of an otherwise inexpensive drug from a typical wholesale cost of US$18 to $200 per vial to a retail cost between $40 and $24,000 for a complete treatment, according to a 2012 analysis2. Not all hospitals and clinics can afford the antivenom, and some won't risk buying it because their patients either can't pay for it or won't, because they doubt that it really works. With no reliable market for the medicines, some pharmaceutical companies have halted production. Sanofi Pasteur stopped making Fav-Afrique because, at an average retail price of around $120 per vial, it just couldn't sell enough to make production worthwhile. A total of 35 government or commercial manufacturers produce antivenom for distribution around the world, but only 5 now make the drugs for sub-Saharan Africa. In the absence of medicines, snakebite victims have been known to drink petrol, electrocute themselves or apply a poultice of cow dung and water to the bite, says Tim Reed, executive director of Health Action International in Amsterdam. But there are also problems with the drugs themselves, says Robert Harrison, head of the Alistair Reid Venom Research Unit at the Liverpool School of Tropical Medicine, UK. They often have a limited shelf life and require continuous refrigeration, which is a problem in remote areas without electricity. And many are effective against just one species of snake, so clinics need an array of medicines constantly on hand. (A few, such as Fav-Afrique, combine antibodies to create a broad-spectrum product.) Venoms from spiders and scorpions typically have only one or two toxic proteins; snake venoms can have more than ten times that amount. They are a “pandemonium of molecules”, says Alejandro Alagón, a toxinologist at the National Autonomous University of Mexico in Mexico City. Researchers do not always know which proteins in this toxic soup are the damaging ones — which is why some think that smarter biology could help. Ten years ago, teams led by Harrison and José María Gutiérrez, a toxinologist at the University of Costa Rica in San José, began parallel efforts to create a universal antivenom for sub-Saharan Africa using 'venomics' and 'antivenomics'. The aim is to identify destructive proteins in venoms using an array of techniques, ranging from genome sequencing to mass spectrometry, and then find the specific parts, known as epitopes, that provoke an immunological response and are neutralized by the antibodies in antivenom drugs. The ultimate goal is to use the epitopes to produce antibodies synthetically, using cells rather than animals, and develop antivenoms that are effective against a wide range of snake species in one part of the world. The scientists have made slow but steady progress. Last year, Gutiérrez and his colleagues separated and identified the most toxic proteins from a family of venomous snakes known as elapids (Elapidae). By combining information about the abundance of each protein and how lethal it is to mice, the team created a toxicity score to indicate how important it was to neutralize a protein with antivenom, a first step towards making the treatment3. In March this year, a Brazilian team reported that they had gone further, designing short pieces of DNA that encode key toxic epitopes in the venom of the coral snake (Micrurus corallinus), a member of the elapid family4. Mice were injected with the DNA using a technique that enabled some to generate antibodies against coral-snake venom, and the group enhanced the mice's immune responses by injecting them with synthetic antibodies manufactured in bacterial cells. These and other advances led Harrison to estimate that the first trials of new antivenoms in humans could be just three or four years away. But with so few researchers working on the problem, a paucity of funding and the biological complexity of snake venoms, he and others admit that this is an optimistic prediction. Despite the growing literature on antivenomics, Alagón and Chippaux aren't convinced that the approach will help. Alagón estimates that newly developed antivenoms would need to be priced at tens of thousands of dollars per dose to be financially viable to produce, and that no biotech or pharma company would manufacture one without substantial government subsidies. Compare that, he says, to the rock-bottom price of many existing antivenoms. “You can't get cheaper than that,” he says. “We can make an entire lot of antivenoms in one day using technology that's been available for 80 years.” Finding someone to produce new medications might be a greater challenge than actually developing them, Williams acknowledges: governments or non-governmental organizations (NGOs) will almost certainly have to step in to help to defray the development costs. But he argues that now is the time to research alternative approaches. These could “revolutionize the treatment of snakebite envenoming in the next 10–15 years”, Williams says. All these tensions, brewing for nearly a decade, came to a head at the Geneva meeting in May. Around 75 scientists, public-health experts and health-assembly delegates crowded around three long tables in a third-floor conference room at the United Nations Headquarters. Spring rain pelted the tall windows. Lights were dimmed, and then the screams of a toddler filled the room. A short documentary co-produced by the Global Snakebite Initiative told the story of a girl bitten by a cobra whose parents carried her for days over rocky roads in Africa to find antivenom. They arrived in time — the girl survived — but she lost the use of her arm. Her sister had already died after a bite from the same snake. Convincing attendees of the scale of the problem was the meeting's primary goal; how to solve it came next. For 90 minutes, scientists and NGOs made short, impassioned speeches laying out the scope of the issue and the variety of problems that they faced. At the centre of each presentation was the same message: we need more antivenom. But the meeting was strained. Chippaux and representatives of the African Society of Venomology were disappointed and angry that so few Africans had been invited to speak, even though the continent is where antivenom shortages are most acute. “Our voice, our issues, were completely overlooked,” Chippaux says. Seated at the front of the room, group members whispered and gestured frantically to each other, and Chippaux barely managed to keep them from storming out. They argue that the current antivenom shortage stems from Africa's reliance on foreign companies and governments for its drugs, and that the only solution lies in building up infrastructure in Africa to produce its own high-quality antivenom. Alagón views antivenomics as a dangerous diversion. “It's distracting many brilliant minds and resources from improving antivenoms using existing technology,” he says. “Perhaps by 2050 this will be the standard technique, but the problem is now.” Williams and Gutiérrez take a middle ground. They feel that the problem requires attacks on all fronts. As well as innovation, Gutiérrez calls for existing manufacturers to step up the production of current drugs. There are signs of this happening already. Latin America has a long history of producing antivenoms both for its own needs and for those of countries around the world, and even before Sanofi Pasteur announced that it would cease production of Fav-Afrique, Costa Rica, Brazil and Mexico were testing antivenoms for different parts of Africa. One product, EchiTAb-Plus-ICB, is produced by Costa Rica and effective against a range of African viper species; it completed clinical trials in 2014 and is now available for use. Several other antivenoms are expected to be ready in the next two years. The drugs should be affordable: government labs in Costa Rica have already indicated that they will not seek to make money from the antivenoms, just recoup their expenditures. But beyond that, the way forward remains murky. Williams knows that the World Heath Assembly meeting was just a start. Inevitably, more meetings will be needed to produce a concrete action plan. But the discussion still gave him and some others a renewed sense of hope that the international community is beginning to take snakebite seriously — momentum they hope to build on by banging away at the topic at conferences and in the media. Boyer says that whatever solution the snakebite field decides on, the most important thing is to “break the cycle of antivenom failure in Africa”. Doing that requires building trust from governments, health-care workers and the public that the drugs are safe and effective, that clinics will have antivenom on hand, and that people will be able to afford treatment. “Without that, you've got nothing,” Boyer says. Educating local clinics on how to care for snakebite victims and administer treatments in a timely manner would also go a long way towards preventing deaths. Speaking of the devastation he saw in Benue, Nasidi says that something as simple as providing boots for poor farmers would have helped to prevent much of the suffering and death that he witnessed. It's perhaps the ultimate in low-tech methods in snakebite protection: shielding vulnerable human skin.”

Althaus C.L.,University of Bern | Low N.,University of Bern | Musa E.O.,World Health Organization | Shuaib F.,Federal Ministry of Health | Gsteiger S.,University of Bern
Epidemics | Year: 2015

International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2-15.6). We also found that the net reproduction number fell below unity 15 days (95% CI: 11-21 days) after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers. © 2015 The Authors.

Assefa Y.,Federal Ministry of Health | Van Damme W.,Institute of Tropical Medicine | Hermann K.,Institute of Tropical Medicine
Current Opinion in HIV and AIDS | Year: 2010

Purpose of view: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. Recent findings: The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. Summary: Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Abdelrahim M.S.,Federal Ministry of Health
AIDS | Year: 2010

Objectives: To measure the prevalence of HIV and related risk behaviors among female sex workers (FSW) in Khartoum State in northern Sudan. Methods: We conducted a cross-sectional survey using respondent-driven sampling (RDS) that included 321 FSW in Khartoum from April to May 2008. A face-to-face interview was completed using a standardized questionnaire and blood was collected for HIV testing. Population point estimates and 95% confidence intervals (CI) were generated using RDSAT to adjust for the peer-referral recruitment patterns of RDS. Results: HIV prevalence was 0.9% (95% CI 0.1-2.2). The majority (69.1%) had multiple clients in their last working day and 71.3% were married or cohabitating. A condom was used by 45.0% of respondents at their last sex with a client and consistently in the last month by 35.9%. Comprehensive HIV/AIDS knowledge was demonstrated by 25.4% of FSW. Only 7% of respondents had sought voluntary HIV counseling and testing in the preceding 12 months. Conclusion: For the present, HIV prevalence among FSW in Khartoum appears lower than the previous estimates. However, conditions may foster wider transmission in the absence of concerted interventions. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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