In recent years Uttar Pradesh—or UP as it is commonly known—and the neighboring state of Bihar have been the source of all the polioviruses that have crippled children in India. As such, they are considered high risk areas, marked for more frequent vaccination rounds than states where polio appears to have been quelled.
Nearly every month the effort is mounted. An army of vaccinators tries to find every child five and younger. Teams visit each house, shanty and tent on their routes, dripping orange polio vaccine into grimacing mouths. In some homes, they meet parental resistance. To those homes they make repeated calls, trying to work through the fear, dispel the misinformation.
The team marks its progress on house doors in chalk. The markings look like hieroglyphics to the uninformed, but to those on Team Polio, there is much to be learned from the chalk scratchings.
Dr. Suhasini More—her surname rhymes with foray—is the World Health Organization’s polio team leader for the Agra sub-region, into which Firozabad falls. She deciphers the chalk marks on one door across from an open lot where water has pooled and garbage festers.
“T means team number. Team Number 7. X is because maybe one or two or all the children are not vaccinated due to any reason. Maybe he’s not at home. Maybe he’s sick. And this,” says More, pointing to an arrow that punctuates the markings, “is the direction the team in going.”
An X can also mean a parent has refused to let a child be vaccinated. That has traditionally been a problem among some in UP’s sizeable Muslim minority. But More says the number of families that reject vaccine for their children has been declining.
Muslim women vaccinators are meant to help overcome what remains of this resistance. In some cases, a community leader—a person of influence—also trails around with the team, a presence meant to persuade those wary of the vaccine that it’s OK from a religious point of view.
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In 2001, most homes did not have electricity, running water or indoor bathrooms; 63 percent got their water from a communal hand pump, 67 percent lit their houses by kerosene and 68 percent did not have indoor latrines.
Some improvements have occurred over the past five years, but sanitation here is still very poor, Vishwakarma says. That lack of infrastructure helps explain why polio has been so hard to root out here. Polioviruses travel from one person to the next via what’s known as the fecal-oral route. In places where people defecate in the open or dump feces into gutters or drains, there are many ways for polio viruses to leach into water and make their way into the guts of the vulnerable—especially during the monsoon season, which is now underway.
"In 1989, when we started our programme, 180,000 people were affected by guinea worm," Dr. Andrew Seidu Korkor, national coordinator for guinea worm at the Ghana Health Service, told IPS in a phone interview. "In 2010 we had only eight cases and today there are none. But it takes three years to get the certification that the disease is not endemic in your country any more."
The guinea worm causes Dracunculiasis, a waterborne parasitic disease that exists in only four countries – Ghana, Mali, Ethiopia and Sudan. It lives in stagnant water. When people drink contaminated water, the parasite grows up to three feet and lives just below the skin, often crippling its human host.
There are no medicines to treat the disease or vaccines to prevent it. The only cure is to slowly, painfully extract it over days. While the disease is not lethal, its disabling effect prevents those affected from working or attending school, putting already vulnerable individuals and communities at further risk of chronic poverty.
"If potable water was provided, then guinea worm could be definitely eradicated," Seidu Korkor continued. "But you cannot get 100 percent water supply immediately, because it is expensive and it takes time. Therefore, we also educate people on prevention measures, we look for cases and treat them, we use filters to improve the water supply and apply chemicals to kill the intermediate host."
If completely eradicated, guinea worm would become the second disease wiped out by humankind - the first since smallpox was eradicated in the 1970s.
It said the epidemic was already beyond the capacity of poorer countries to cope, which is why death and disability are rising disproportionately in these countries.
"As the impact of NCDs increases and as populations age, annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is expected to be seen in low- and middle-income regions," it added.
In many developing countries where the health focus is often on infectious diseases, chronic illnesses are often detected late, when patients need extensive and expensive hospital care.
Most of this care is unaffordable or unavailable, or is covered with out-of-pocket payments which can drive patients and their families into poverty, further risking their health.
Nearly 80 percent of NCD deaths occur in low- and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa, the WHO said. Even in Africa, NCDs are rising rapidly and are expected to exceed other diseases as the most common killers by 2020.
Dr Mubashar Sheikh, executive director of the Global Health Workforce Alliance (GHWA), set up in 2006 to pull together national governments and other organisations interested in promoting health, says this is "a truly global crisis". Health workers move not only to wealthier nations, but also within their own countries, from the countryside to the towns, seeking better working conditions and pay.
"Mobility is a human right," says Sheikh. "You can't stop people from moving. Our argument is that people have a right to move, but access to health is a human right too. There has to be a balance."
Unless things can be improved, says Sheikh, there will be little chance of meeting the UN's health-related millennium development goals (MDGs) by 2015, but the scale of the problem is daunting.
Of the 57 crisis countries, 36 are in sub-Saharan Africa, which is struggling with the MDG targets of cutting child deaths and the numbers of women who die in childbirth. Africa, which bears 24% of the global burden of disease, has just 3% of the health workforce, according to the WHO. An estimated 1.5 million extra health workers are needed across the continent. According to a 2005 estimate, 334,000 skilled birth attendants would need to be trained globally just to reach 72% of annual births.
This is why the global health movement has been moving in recent years away from treating diseases such as HIV/Aids in isolation to support for "health systems" in general. Five million people with HIV in developing countries are now on drugs to keep them alive, but one survey estimated the treatment programmes took up the services of 20-50% of all health workers in two countries and 10% in a further 10. Today's thinking is that it makes no sense for a nurse to treat only HIV when the woman in front of her may have a child with pneumonia or a baby with life-threatening diarrhoea.
Improving health systems doesn't have to mean building smart hospitals, says Dr Sheikh. "We don't necessarily need fancy infrastructure," he says. The crucial part is well-trained and well-motivated people, who need to be able to access the drugs required and emergency care for patients. "There is a general consensus that health workers are the lifeline of the system." He includes not just the obvious doctor, nurse and midwife but also the lab technician, the theatre assistant, the researcher and the manager.
Malaria cases or hospital admissions and deaths have been cut by half in 11 African countries over the past decade, the WHO's world malaria report shows. Outside Africa, in 32 of the 56 remaining malaria endemic countries, the gains have been even greater. Eight more countries have seen reductions in the number of cases of between 25% and 50%. Last year Morocco and Turkmenistan were certified malaria free.
"The results set out in this report are the best seen in decades," said WHO director general Dr Margaret Chan. "After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive. Current strategies work."
A huge push to get insecticide-treated bed nets (ITNs) to families in malaria ridden countries over the past three years, involving UN agencies, governments, charities and celebrities, will have supplied approximately 289m nets to sub-Saharan Africa by the end of 2010, which is enough to protect 578 million people – 76% of the 765 million at risk.
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But what the WHO calls the fragility of the gains is clear. By the middle of this year still only 35% of children in Africa – who are the most vulnerable to malaria – were sleeping under a net. "The percentage of ITNs is still below the WHA [World Health Assembly, the supreme decision-making body for WHO] target of 80%, partly because up to the end of 2009 ITN ownership remained low in some of the largest African countries," says the report.
And the lifespan of the nets, at only three years, represents a "formidable challenge", the report goes on. "Nets delivered in 2006 and 2007 are therefore already due for replacement, and those delivered between 2008 and 2010 soon will be. Failure to replace these nets could lead to a resurgence of malaria cases and deaths."
There are other worries. A single class of insecticide is used at the moment in the nets and mostly for indoor spraying. There is a possibility that the mosquito-borne parasites that spread malaria could become resistant to it.
So far, the cholera vaccine has seen little use in Haiti, where the disease has killed more than 2,000 people and is still spreading. However, major obstacles remain, including supply shortages, transportation problems and the need to administer the vaccine several times for it to be effective.
But the Pan American Health Organization, which represents the W.H.O. in the Western Hemisphere, recently learned that there might be one million to two million doses of vaccine in the world, not just the 200,000 it originally thought, Dr. Jon K. Andrus, the Pan American organization’s deputy director, said Friday. “We recognize that it’s time to rethink our position,” he said. “We don’t want to miss an opportunity.”
His organization will hold a meeting of experts in Washington next Friday to consider whether to buy those doses and move them to Haiti.
Even if the group agrees to move forward, there would be no quick fix. Most of the doses are in bulk form, and it could take up to two months to have them ready, Dr. Andrus said. Also, the vaccines have not been tested by the W.H.O.
Also on Friday, Dr. Paul Farmer, who is well known for fighting AIDS in Haiti, endorsed broader use of the vaccine there, and called for creating emergency stockpiles of millions of doses to keep cholera from spreading to other countries.
He endorsed measures like searching Haiti’s central mountains for people too sick to reach clinics, using antibiotics even in moderate cases and rebuilding the water and sanitation networks shattered by January’s earthquake.
WHO identified 17 diseases and disease groups present in 149 countries one-third of the 2.7 billion people living on less than $2 a day. Thirty countries have six or more of the diseases. In all, more than one-third of the 2.7 billion people living on less than $2 a day are affected.
"They cause massive but hidden and silent suffering, and frequently kill, but not in the numbers comparable to the deaths caused by HIV/AIDs, tuberculosis or malaria," said WHO director general Margaret Chan.
Still, Chan said that the diseases take a serious toll that serves to "anchor large populations in poverty."
Two of the diseases, onchocerciasis, known as river blindness, and trachoma, a bacterial eye infection, cause blindness. Leprosy and lymphatic filariasis, or elephantiasis, leave victims deformed, hamper productivity and normal social interaction, Chan said. Sleeping sickness, or human African trypanosomiasis, debilitates before it kills. Left untreated, rabies is fatal.
Novartis has renewed a commitment to donate drugs to treat leprosy, while GlaxoSmithKline said it would expand donations of a drug to treat worm infections and Sanofi-Aventis will continue its support to help eliminate sleeping sickness and other illness.
Also active in the fight are Bayer, Eisai and Johnson & Johnson, WHO said.
According to a new report Towards Universal Access, the proportion of pregnant women in Sub-Saharan Africa who received an HIV test increased from 43 percent in 2008 to 51 percent in 2009. The report by the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS assessed HIV/AIDS progress in 144 low- and middle-income countries.
It found an estimated 24 percent of the approximately 125 million pregnant women in these countries received an HIV test in 2009, an increase from 21 percent in 2008 and eight percent in 2005. Fifty-four percent of HIV-positive pregnant women in Sub-Saharan Africa received antiretroviral drugs to prevent transmission to their children in 2009, up from 45 percent in 2008.
Speaking to IPS during the launch of the report in Nairobi on Sep.28, UNICEF regional director Elhadj As Sy said the progress made in the prevention of mother-to-child transmission is testimony of the fact that virtual elimination by 2015 is achievable.
"What we need is strong political leadership, funding, good programs and activism. If we build on the progress and with renewed commitment we are well on our way to achieving virtual elimination by 2015," Sy said. However, despite the progress there are still challenges with disparities between regions and within countries.
Four countries in the region report providing HIV testing and counselling to over 80 percent of pregnant women. They are South Africa, Zambia, Namibia and Botswana. These countries have already reached the target set at the United Nations General Assembly Special Session (UNGASS). This is the target of providing 80 percent of pregnant women in need of treatment with antiretroviral drugs to reduce transmission to their children.
Despite the marked progress, countries in Eastern and Southern Africa fared better than their counterparts in West and Central Africa. In Eastern and Southern Africa, 50 percent of pregnant women received HIV testing and counselling, an increase from 43 percent in 2008. In Western and Central Africa, coverage increased from 16 percent to 21 percent between 2008 and 2009.
"While the figures in Western and Central Africa are low, this does not mirror failure on their part. The burden of HIV/AIDS has leaned heavily on Eastern and Southern Africa and this is where most interventions have been directed. Western and Central Africa are just beginning to pick up the problem and their burden of the epidemic is lower," said Dr. David Okello. Okello is director, HIV/AIDS, Tuberculosis and Malaria Cluster at the WHO regional office for Africa.
The statistics in the "Trends in Maternal Mortality" report released by the World Health Organisation. on Sep. 15 cover the period from 1990 to 2008, revealing that maternal mortality fell from 540,000 deaths worldwide in 1990 to 358,000 in 2008 - a 34 percent decline.
Several reasons are cited for the reduction in number of maternal deaths, including improvement in health systems to assist pregnant women and increased education of women, raising awareness of the importance of delivering with skilled help.
Around the world, more midwives are also being trained. The proportion of deliveries attended by skilled health personnel rose from 53 percent in 1990 to 63 percent in 2008. The proportion of women who attended a pre-natal clinic at least once during their also rose from 64 percent to 80 percent.
The use of contraceptives by women aged 15-49 also rose: East Asia which experienced the greatest reduction in maternal deaths has a contraceptive prevalence rate of 86 percent. Sub-Saharan Africa, where contraceptives are used by just 22 percent of women, recorded one of the lowest declines of maternal mortality.
Sub-Saharan Africa and South Asia still account for 87 percent of global maternal deaths.
Nearly two thirds of all maternal deaths take place in just eleven countries - Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan, Sudan and Tanzania.
South Asia recorded an overall maternal mortality rate of 280 deaths per 100,000 live births. Sub-Saharan Africa had a rate of 640 per 100,000. Afghanistan, Chad, Guinea-Bissau and Somalia all recorded maternal mortality rates over 1,000 per 100,000 live births.
The rate of progress recorded in the U.N. figures is less than half of what is needed to achieve MDG target for reducing maternal deaths, translating into an average annual decline of 2.3 percent since 1990. To meet MDG target five an annual decline of 5.5 percent is required
A new report by health experts at several top universities in the United States and the World Health Organization says money spent on programs to prevent malaria work and have saved the lives of hundreds of thousands of children in 34 African countries over the last 10 years. Details were released Tuesday.
The World Health Organization says malaria kills nearly a million people a year, mostly in Africa, where one in five childhood deaths is related to malaria.
But a new report by leading health experts says increased funding for malaria prevention has made a real difference. It says money spent on insecticide-treated bed nets, indoor spraying and preventative medicine, especially for pregnant women, saved some 736,000 children over the last 10 years. And it predicts millions more will live if funding levels remain stable or increase.
The former U.S. Ambassador to Tanzania, Mark Green, is a long-time advocate for malaria prevention.
"Where progress is made in fighting malaria, money and beds and healthcare workers are freed up to take on other challenges but it goes beyond saving healthcare resources," said Mark Green. "Studies show that scaling up malaria interventions would increase economic output in Africa by as much as $30 billion."
The report's findings are based on data gathered using a computer-based tool that tracked the impact of malaria prevention efforts on child survival from the years 2001 to 2009. Gathering this kind of data has been challenging in Africa and having it helps when fundraising in tough economic times.
"People are looking for things that work, that are measurable, that are verifiable," said Green. "People are generous, but they want to know that the resources that are being allocated are in fact making a difference. And what this report shows to me is precisely that."
The report notes that the number of rural households protected by insecticide-treated bed nets and the indoor spraying of insecticides has increased significantly, tracking alongside the rise in funding and the increased political will to fight the disease.
Dr. Halima Mwenesi is a long-time malaria field worker in Kenya. She says she's truly hopeful for the first time in years.
"We are seeing some accelerated progress now with all the resources that have come in in the last five years especially," said Dr. Mwenesi. "There is huge, huge progress."
The release of the report comes as world leaders head to the United Nations next week to review the so-called Millennium Development Goals aimed at reducing global poverty by 2015. Three of the goals relate directly to malaria - reducing child mortality, maternal mortality and infectious diseases, including malaria.
For years, the World Health Organization and partners have fought TB largely with a program where health workers watch patients take their drugs — even though the agency acknowledged in a 2008 report that this treatment program didn't significantly curb TB spread.
Experts said TB isn't only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation.
Some officials questioned whether continued U.N. programs could even combat TB. "The main priority for TB control is improved living conditions and economic growth, which is outside the control of the U.N.," said Philip Stevens, a health policy expert at International Policy Network, a London-based think tank. "TB cannot be tackled in isolation."
Stevens said the global health community also needs to be more vigilant about the drugs they buy for TB programs. According to a 2007 report from the Global Fund to fight AIDS, Tuberculosis and Malaria, half of the drugs the fund bought for poor countries didn't comply with their own drug quality standards.
Dr. Mario Raviglione, head of WHO's TB department, said the recent fall in TB was "very minor" and that the agency was trying to understand how better to fight the epidemic.
Still, WHO said their basic TB programs cured more than 36 million people between 1995 and 2008, and saved up to 6 million from dying of the potentially fatal lung disease.
With a failing economy, rising unemployment and deteriorating power, sanitation and health facilities, the health of Gaza’s population continues to worsen, according to a recent World Health Organization (WHO) report. In contrast, modest improvements have been made in the West Bank.
As a consequence of Israel’s blockade of the Gaza Strip, 98 percent of industrial operations have been shut down since 2007 and there are acute shortages of fuel, cash, cooking gas and other basic supplies.
“We are telling everybody not to build walls all around Gaza. That’s what we have been saying loud and clear,” Filippo Grandi, commissioner-general of the UN agency for Palestinian refugees (UNRWA), told IRIN. “If Gaza gets encircled by walls everywhere, it can only explode. This is almost a law of physics. And that would be a catastrophe for everybody around - for the Egyptians, for the Israelis and for the region as a whole.”
He said the most important thing was to continue negotiating with the Israelis for full access of supplies to be granted legally - through crossings not illegal tunnels.
Import ban
The ban on imports of building materials has prevented the rebuilding of some 6,400 homes destroyed or severely damaged by Israel’s military operation in Gaza in 2008-2009 and prevented the construction of some 7,500 homes to cater for an expanding population. Some 3,500 families are still displaced.
“The Israeli position is that they must be absolutely sure that anything that goes into Gaza through the crossings on the Israeli side is for civilian and humanitarian purposes,” said UNRWA’s Grandi. “The UN has developed extensive tools to monitor [imports], and we have shared this with the Israelis to approve. If they want, we can offer all the guarantees in the world. Our problem is that in spite of all this assistance we cannot import.”
Water-related health problems are widespread in the Strip because of the blockade and Israel’s military operation in Gaza, which destroyed water and sanitation infrastructure, including reservoirs, wells, and thousands of kilometres of piping.
“Gaza is not a refugee camp in a small remote place. It’s a city of one and a half million people with the needs of a developed urban environment that is used to certain standards. It needs certain standards of maintenance. This is what is happening with the water supplies, with sanitation. We’re very worried about that and the Egyptians and the Israelis should be too. Everybody should be worried because contaminated water has no borders,” said Grandi.
An electricity crisis continues in Gaza with the network only able to meet 70 percent of demand due to insufficient money to buy fuel for the Gaza power plant, and a lack of spare parts which is causing technical failures.
In contrast the West Bank economy appears to be growing since the beginning of 2009, partly due to an influx of donor assistance but also because Israel has eased movement restrictions there, and an improved security environment has led to increased investor confidence and more economic activity.
Unemployment, poverty
Unemployment in occupied Palestinian territory (oPt) decreased marginally in the third quarter of 2009 compared to the same period in 2008, to 31.4 percent, though unemployment among young people stood at 67 percent. Just one in seven women were working, and 70 percent of families were living on less than US$1 a day in May 2008, said the WHO report.
In the third quarter of 2008, 51 percent of Palestinians lived below the poverty line (56 percent for Gazans and 48 percent for those in the West Bank), with 19 percent living in extreme poverty.
In the second half of 2008, one third of West Bank households and 71 percent of Gaza households received food assistance, with food accounting for roughly half total household expenditures - making families highly vulnerable to food price fluctuations. In May 2008, 56 percent of Gazans and 25 percent of West Bank residents were deemed food insecure by the UN. Chronic malnutrition has risen in Gaza over the past few years to reach 10.2 percent.
That comes at a time when UNRWA - responsible for providing assistance, protection and advocacy for some 4.7 million registered Palestine refugees in Jordan, Lebanon, Syria and the oPt - is projecting a 25 percent shortfall in its core budget. “UNRWA is a very massive machine to feed and unfortunately, although our donations increase, in fact they don’t increase fast enough to meet the needs,” Grandi said.
Health
Healthcare services have generally improved in the West Bank over the past year because of eased movement restrictions and the efforts of the Palestinian Ministry of Health with the support of donors and other stakeholders. However, the impact of Israel’s “Separation Wall” and the difficulties of access to hospitals in east Jerusalem, where nearly 50 percent of Health Ministry referrals were to in 2009, remain areas of concern.
In Gaza, Israel’s blockade is debilitating the healthcare system, limiting medical supplies and the training of medical personnel and preventing serious medical cases from travelling outside the Strip for specialized treatment.
Israel’s 2008-2009 military operation damaged 15 of the Strip’s 27 hospitals and damaged or destroyed 43 of its 110 primary health care facilities, none of which have been repaired or rebuilt because of the construction materials ban. Some 15-20 percent of essential medicines are commonly out of stock and there are shortages of essential spare parts for many items of medical equipment, the WHO report said.
As a result, the steady decline in the infant mortality rate in recent decades has stalled over the past few years and may have even risen in Gaza, which has a mortality rate around 30 percent higher than in the West Bank. Watery diarrhoea, acute bloody diarrhoea and viral hepatitis are the major causes of morbidity among reportable infectious diseases in the Strip.
Reliable data on maternal mortality and morbidity trends were generally not available.
“Very often journalists ask me whether I define the crisis in Gaza as humanitarian and I give this reply: It’s far beyond humanitarian. It’s much more serious,” said Grandi. “You can address a humanitarian crisis with medicines and food; this is far more serious. It’s a crisis of the economy first of all - people are very poor. It’s a crisis of the institutions and it’s a crisis of the infrastructure. This requires years to fix.”
The WHO report, released on 13 May, was the result of a fact-finding mission to assess the health and economic situation in oPt in response to Resolution WHA62.2, adopted on 21 May 2009 at the 62nd World Health Assembly, which called, among other things on Israel to “lift immediately the closure in the occupied Palestinian territory, particularly the closure of the crossing points of the occupied Gaza Strip that are causing the serious shortage of medicines and medical supplies”.
The revised guidelines, based on those of 2006, recommend that all HIV-positive pregnant women be given ARVs starting at 14 weeks and continuing through the end of the breastfeeding, to reduce the risk of HIV transmission and improve the infant’s chance of survival.
An earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV-related diseases and deaths.
The 2006 guidelines recommended antiretroviral therapy (ART) in the third trimester (beginning at 28 weeks). At the time, there was insufficient evidence on the protective effect of ARVs during breastfeeding. However since then, studies and trials have demonstrated that starting ARV earlier reduces rates of death and disease and increases the efficacy of ARVs in preventing transmission to the infant while breastfeeding.
The latest guideline issued in November 2009, recommends that mothers should continue breastfeeding even when they are positive as they take the drugs with their babies.
“We did a study in National Referral Hospital Mulago and found that the risks of death were higher in those children who were not breastfed because they were prone to diseases like diarrhoea,” Ministry of Health Principal Medical Officer in charge of Child Health Jessica Sabiti said.
The report shows that one in four cases in parts of Russia are drug-resistant. The WHO estimates that 440,000 people worldwide had multi-drug-resistant forms of the disease (MDR-TB) in 2008, the last year for which there are complete figures, and that a third of them died. MDR-TB is defined as cases in which the two most commonly used and most effective drugs, isoniazid and rifampicin, do not kill the bacteria causing the disease.
More alarming is extensively drug-resistant tuberculosis (XDR-TB), which was first identified in 2006 in a small group of people with HIV in South Africa, almost all of whom died. It is resistant not only to the two basic drugs but also to the second-line antibiotics, including fluoroquinolone, amikacin, kanamycin and capreomycin.
In poor areas such as KwaZulu-Natal, where XDR-TB was first seen, aggressive chemotherapy treatment lasting two years, which can still save lives, is unavailable.
The report warns that not enough is known even about the extent of drug-resistant TB and that the cost of checking the spread of the disease will be high.
Not all countries have the surveillance systems to pick up cases of XDR-TB, but in the 40 that were able to submit data to the WHO, 5.4% of all their drug-resistant cases were XDR-TB. In eight countries, such strains accounted for 10% of all resistant cases. So far, 58 countries have confirmed at least one case of XDR-TB.
Drug resistance in general is running at an all-time high, at 3.6% of all TB cases. Almost half of all the cases are in China and India. In 2008, an estimated 150,000 people died of drug-resistant TB.
So back to the WHO/Unicef report which has dismal statistics on how far we have to go. Unhappily this is far more familiar MDG territory. Almost 39% of the world's population - more than a third of the people on the planet - do not have imporved sanitation facilities. "If the current trend continues unchanged, the international community will miss the 2015 sanitation MDG by almost one billion people," they say.
Open defecation, they say, is on the decline, from a quarter of people on the planet in 1990 to 17% in 2008. But this most risky of all sanitation practices is still widespread in southern Asia, says the report, where 44% of people still defecate in the open. Maybe it doesn't need spelling out for a sophisticated western audience who enjoy flush toilets behind closed doors, soap dispensers and taps that pour water if you so much as wave at them, but some of the worst diseases that kill small children are spread from hand to mouth - and that's unwashed hands that have been in contact with the shit that is lying around. I can't get the image of the sewage ditches running through Indian streets out of my head.
"Unsafe water, sanitation and hygiene claim the lives of an estimated 1.5 million children under the age of five each year," says the report. It may not be as big a conversational issue as Aids or malaria, but it sure matters, and this one is not just amenable to healthcare improvements. It needs poverty reduction and education - the basic stuff of development - just as much.
About 33 million people worldwide are infected with HIV, the AIDS virus, and 9.2 million have recently been diagnosed with lung-destroying tuberculosis, according to the World Health Organization.
In many cases, HIV's suppression of the immune system allows the deadly tuberculosis bacterium to thrive. In South Africa, about 73 percent of TB patients also have HIV.
Yet doctors have been reluctant to treat both at once, often choosing to go after TB first. They have been concerned about drug interactions, overlapping side effects and the large number of pills that patients have to take each day.
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They tested more than 600 patients with both TB and HIV.
The death rate was 5.4 percent a year for the volunteers who got treatment for both infections, compared with 12.1 percent for those whose TB was treated first, with HIV therapy beginning about six months later.
The results were so convincing that they already prompted the WHO to change its guidelines to call for treating both conditions at the same time.
A controversial organ transplant bill expected to become law in the next few weeks could regularize organ transplants and curb Egypt’s booming illicit trade in human organs, experts say.
Hundreds and possibly thousands of poor Egyptians sell their kidneys and livers every year to pay off debts and buy food, making the country a regional “hub” for organ trafficking, according to the World Health Organization (WHO).
The bill, which is causing controversy among medics, clerics and rights activists, says organs donated from live donors will be restricted to “family members of the fourth degree”, and that the removal of organs without official authorization would be considered first-degree murder and be punishable by death.
Official authorization for organ removal will come from a three-person panel to be established by the Higher Committee for Organ Transplants, a Ministry of Health-affiliated body.
For dead patients, the law stipulates that the panel reach consensus on whether or not the potential donor is dead - an issue on which there is much contention.
Dead or alive?
The consensus in the medical profession is that if a person’s entire brain is dead, the person is dead, even though their heart may continue to beat for a short time. This provides an opportunity to obtain organs while they are still in good condition for transplantation.
Some Muslim clerics and MPs say a person’s heart must stop before he or she can be pronounced dead.
“Apart from this, the law is totally against Islamic law, because man doesn‘t have the right to donate his or her body, which is God‘s after all,” said Mohamed Awadeen, a professor of Islamic law at Al-Azhar University. “The advocates of the new law are lying. Organ donors won’t lead a normal life later on. A man needs kidneys to live normally.”
However, Mohamed Sayed Tantawi, Grand Sheikh of al-Azhar University, Sunni Islam's most respected institution, has previously endorsed a brain dead standard.
Law for the wealthy?
Some rights activists have said the new law could exacerbate organ trafficking and turn Egypt into a global market for the organ trade.
“This would only benefit the rich,” said Hafez Abu Saeda, secretary-general of the Egyptian Organization for Human Rights, Egypt’s leading human rights organization. He said by offering legal cover for organ transplants, the government was turning the poor into sources for human spare parts and offering the rich - in Egypt and beyond - a well stocked market for organs.
Statistics for organ sales and transplants in Egypt do not exist because they are mostly performed clandestinely, but Abu Saeda said his own research suggested hundreds of unlicensed transplants happen every year.
He said some of the richer recipients who did not trust the skills of local doctors took donors with them to China to have transplants.
“Rich people from the Gulf also come here to buy organs. A law like this can be a great affliction in such a poor country,” Abu Saeda said in a recent discussion in Cairo on the law.
“Wonderful step”
“The approval of this law is a wonderful step that creates hope for thousands of patients who have been waiting a long time for life-saving transplant operations. It is also a significant step towards ending illegal organ trafficking, which usually results in operations conducted under unsafe conditions and harms both donor and patient,” Hussein Gezairy, WHO regional director for the Eastern Mediterranean, said in a statement on 20 January.
WHO estimates there are 42,000 people in Egypt in need of transplants.
“Patients have waited too long for this law to come out,” Mahmud el-Motini, a leading liver transplant specialist, told IRIN. “Tens of thousands of Egyptians are in bad need of legislation that enables them to have organ transplants.”
Around 40 percent of the world's population is at risk of malaria, a potentially deadly disease transmitted via mosquito bites. It kills more than a million people worldwide each year and children account for about 90 percent of the deaths in the worst affected areas of sub-Saharan Africa and parts of Asia.
The fight against malaria has been slowed by resistance to chloroquine, the cheapest and most widely used malaria drug, which is now common throughout Africa.
Resistance to sulfadoxine-pyrimethamine, often seen as the first and least expensive alternative, is also increasing.
As a result, artemisinin combination therapy drugs, or ACTs -- made by firms such as Novartis and Sanofi -Aventis -- are now regarded as the best medicines against malaria, but access to them is limited because they are expensive.
The WHO report found a marked increase in ownership of insecticide-treated nets (ITNs) in 2008 from previous years -- more than half of homes in 13 of the 35 African countries worst affected by malaria have at least one net.
Use of artemisinin-based combination therapies is growing but remains low in most African countries, it said, with fewer than 15 percent of children with fever getting the drugs.
The WHO said that unsafe sex is the leading risk factor in developing countries for these women of childbearing age, with others including lack of access to contraceptives and iron deficiency. This was the WHO's first study of women's health around the globe.
According to the U.N. agency, one in five deaths among women throughout the world in this age group is linked to unsafe sex.
"Women who do not know how to protect themselves from such infections, or who are unable to do so, face increased risks of death or illness," the WHO said in a 91-page report. "So do those who cannot protect themselves from unwanted pregnancy or control their fertility because of lack of access to contraception."
The data was included in a report that highlights the unequal health treatment a female faces from childbirth through infancy carrying on into old age.
Dr. Margaret Chan, WHO’s chief, said that women enjoy a biological advantage because they tend to live six to eight years longer than men. However, she said that throughout the world they suffer serious disadvantages because of poverty, poorer access to health care and cultural norms that put a priority on the well being of men.
