Tropical Health Matters

South Africa’s Rural Health Advocacy Project (RHAP) has released a report or fact sheet on rural health in South African provinces. Of interest is the overlap of rural problems and malaria endemicity.  Three Provinces that border Mozambique are also endemic for malaria – from north to south: Limpopo, Mpumalanga and Kwa Zulu Natal (KZN).

Seven of the 10 poorest districts in the country fall in two of these endemic provinces, Limpopo and KZN. The two districts with the highest HIV prevalence are in Mpumalanga and KZN, and those two provinces themselves have the highest HIV prevalence among all the provinces.

The fact sheet also reports that, “Poor rural households in a Limpopo District spend up to 80% of monthly income on health expenditure, travel costs being a significant contributor.”

Limpopo and Mpumalanga are among the four provinces with the lowest distribution (or highest shortages) of human resources for health. Concerning maternal mortality, the fact sheet notes that, “Each year an estimated 4300 mothers die. KZN most affected.”

While one cannot say the exact role malaria plays in rural poverty and rural health disparities, it is important to note that interventions to control and eliminate the disease must have a strong rural focus. Hopefully there will be economic benefits to such interventions.

In response to donor criticism of human rights issues in one malaria endemic country and because of subsequent possible links with future donor cooperation, a prominent government official of that country was quoted as saying, “We don’t like to blackmail others. It’s very dishonest, very irresponsible and unfriendly of persons to attach behavior of another community to their sharing resources.”  (Reuters) This complaint ironically comes from a country that is on record as having squandered Global Fund resources.

Are donors under obligation to ‘share’ their resources with anyone regardless of their ‘behavior’, not just in the field of human rights, but also financial accountability? No country is forced to share its resources, and while all could do more, remarks like those above from recipients add fuel to the fire of those who would be happy to curtail foreign aid all together.

Burkina Faso contributes to malaria drug supplies

It is unfortunate that many countries are highly dependent on donors to solve problems like HIV, malaria TB, NTDs and NCDs for the foreseeable future. But a solution to the perceived manipulation by donors would of course be a greater commitment of domestic resources to solve these problems.

One country that is seeking a good balance is Burkina Faso. While the country does receive major support from the Global Fund and the US President’s Malaria Initiative for its fight against malaria, Burkina Faso is stepping up to play its own part.  Government has in recent years steadily increased its financial support to buy malaria commodities from $2 million to over $4 million annually in the past few years.

Relative to donor amounts this contribution may seem small, but the point is the willingness of the government to step up and help its own people. These additional government funds have played a crucial role in filling medicine and commodity gaps that naturally occur when donor supply schedules do not match needs at a given time.

The fight against malaria will be won by having more action oriented governments like Burkina Faso and fewer complainers and embezzlers.

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego’s President and Vice President

Jhpiego was founded in 1973 to provide technical assistance to countries where the risk of maternal mortality and morbidity was quite high.  While focusing on local capacity building from the start, Jhpiego’s model for technical assistance has evolved.  Burkina Faso first benefitted in 1983 by having health staff attend intensive training at Johns Hopkins Hospital.  Subsequently Jhpiego’s work moved to the field, and some of the early trainees became staff on the ground.

Jhpiego established an office in Ouagadougou in 1996, and one of the earliest projects focused on malaria in pregnancy as part of USAID’s flagship program “Maternal and Neonatal Health” (MNH).  It was during that time that Jhpiego collaborated with partners like CDC to do some of the early testing of the intermittent preventive treatment of malaria in pregnancy (IPTp) in West Africa.  The results of this life-saving intervention were published in the American Journal of Tropical Medicine and Hygiene.

Jhpiego continued to provide technical assistance on malaria in pregnancy interventions and capacity building to the Ministry of Health (MOH) in Burkina Faso through the MNH project and into its successor, USAID’s ACCESS project. Jhpiego worked with partners to update malaria guidelines, training materials, supervisory tools and job aids during this period.

In 2009 USAID presented the Maternal and Child Health Integrated Project (MCHIP) with the opportunity to carry out an integrated package of malaria care and prevention strengthening with the MOH and particularly the National Malaria Control Program (NMCP). Over a period of three years Jhpiego, the lead organization in MCHIP, working with together with partners from the NMCP and MOH, was able to accomplish among others the following:

• Updating Malaria policy and guidelines
• Updating Malaria supervisory tools and training of supervisors
• Updating In-service training materials on malaria and training of health facility staff
• Developing a Strategic communications plan and strategy for malaria
• Forming of curriculum update committee on malaria at national training schools for primary health staff
• Training of US Peace Corps Volunteers to support malaria activities in their communities
• Building the capacity and organizational strengthening for the NMCP itself
• Conducting a situation analysis of rapid diagnostic test acceptance and use
• Undertaking a health systems analysis of the strengths and bottlenecks of malaria program implementation in Burkina Faso

Last week, the Burkina Faso office of Jhpiego hosted the organization’s African Malaria Technical Update Workshop with staff from 15 countries participating. Today Jhpiego is taking its 40^th Anniversary celebrations to Ouagadougou.  Jhpiego will express appreciation to local partners in the fight against malaria and threats to maternal and child health.

Jhpiego has been committed on the ground in Burkina Faso to building national capacity for controlling malaria specifically for over 15 years. The recent award by USAID of its bilateral program “Improving Malaria Care” to Jhpiego last October cements Jhpiego’s commitment to the country and to reducing malaria for another five years.

As World Cancer Day approaches it is worth considering the connections between communicable and non-communicable diseases.  Below are some brief extracts from recent studies that show relationships between malaria and cancers when it comes to diagnostics, drug research, treatment, prevention and epidemiology.

PLoS One has a new article entitled: “Sloth Hair as a Novel Source of Fungi with Potent Anti-Parasitic, Anti-Cancer and Anti-Bacterial Bioactivity.” The authors found that, “Seventy-four isolates were cultivated in liquid broth and crude extracts were tested for bioactivity in vitro. We found a broad range of activities against strains of the parasites that cause malaria (Plasmodium falciparum) and Chagas disease (Trypanosoma cruzi), and against the human breast cancer cell line MCF-7.”

The Nature Group’s Scientific Reports sheds some more light on links between malaria and Burkitts lymphoma in the article “Relationship between Plasmodium falciparum malaria prevalence, genetic diversity and endemic Burkitt lymphoma in Malawi”. The researchers report that, “Endemic Burkitt lymphoma (eBL) has been linked to Plasmodium falciparum (Pf) malaria infection, but the contribution of infection with multiple Pf genotypes is uncertain… Further work is needed to evaluate the possible role of Pf genetic diversity in the pathogenesis of endemic BL.”

Recently KH Khan drew our attention to the fact that, “DNA vaccines against cancer, tuberculosis, Edwardsiella tarda, HIV, anthrax, influenza, malaria, dengue, typhoid and other diseases,” have been explored. It was noted that “These vaccines function by generating the desired antigen inside the cells, with the advantage that this may facilitate presentation through the major histocompatibility complex.”

Hematologists must also deal with a variety of communicable and non-communicable diseases that affect red blood cells. According to Fedovsov and colleagues, “Hematologic disorders arising from infectious diseases, hereditary factors and environmental influences can lead to, and can be influenced by, significant changes in the shape, mechanical and physical properties of red blood cells (RBCs), and the biorheology of blood flow,” as well as broad spectrum of hematologic disorders including certain types of cancer.

Again in the area of drug research, Hooft van Huijsduijnen and colleagues explore the “Anticancer properties of distinct antimalarial drug classes.” Within these drug classes the researcher observed that “Several of the antimalarials tested in this study have well-established and excellent safety profiles with a plasma exposure, when conservatively used in malaria, that is well above the IC50s that we identified in this study. Given their unique mode of action and potential for unique synergies with established anticancer drugs, our results provide a strong basis to further explore the potential application of these compounds in cancer in pre-clinical or/and clinical settings.”

We need to maintain a broader vision of human health past the 2015 Millennium Development Goals and neglect neither communicable nor non-communicable diseases, but see synergies and complementarities in working on both together.