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In brief

18 Mar 2010

Paul Chinnock

Source: Media reports

Diarrhoeal infections have slipped off the global health priority list but they remain the second biggest cause of death in children. (Pneumonia is the biggest.) A website has been launched to help promote the core messages of a joint UNICEF/WHO report published last year. The website, http://7pointplan.org/, focuses on the seven actions needed to cut the diarrhoeal death rate. Two of these actions concern treatment: fluid replacement to prevent dehydration and treatment with zinc. The other five are preventive measures: rotavirus and measles vaccinations, early and exclusive breastfeeding and vitamin A supplementation, handwashing with soap, improved water supplies, and community-wide sanitation promotion. (The UNICEF/WHO report was featured earlier on TropIKA.net.)

The infectious diseases of poverty in southeast Asia are the focus of a special issue of the Bulletin of the World Health Organization. It is thought likely that, over the coming decade, this region will achieve the Millennium Development Goal targets for communicable diseases but many challenges lie ahead. An editorial discusses tuberculosis, which is a particular concern. Another article deals with the prospects for the elimination of four neglected infections – leprosy, lymphatic filariasis, visceral leishmaniasis (kala-azar) and yaws. (Every year around 67% of all new leprosy cases and 60% of all new cases of visceral leishmaniasis worldwide occur in this region, where as many as 850 million inhabitants are at risk of contracting lymphatic filariasis.) Further articles present new research and report lessons learned from progress so far, for example with India’s polio eradication efforts.

A study that showed rectal artesunate prevents death and disability in severe malaria has been chosen as the BMJ’s research paper of the year. The award recognizes original clinical research that contributes significantly to improving health and health care. The judges said that the research team had produced an outstanding study: “Time is of the essence in treating severe malaria, yet many sufferers live days away from definitive treatment. This trial provided a rigorous test of a treatment strategy adapted to such circumstances. The researchers demonstrated that those children who received the study treatment early were less likely to die or be left with a disability”.

Just published are the latest WHO malaria treatment guidelines, which stress the need for diagnosis. This new emphasis reflects the finding that in 2008, only 22% of suspected malaria cases were tested in 18 of 35 African countries reporting. WHO’s Guidelines for the Treatment of Malaria aim to, “...provide countries with the necessary policy recommendations and tools to ensure that patients with malaria are promptly and appropriately diagnosed and then treated with safe and efficacious medicines that are procured from quality-assured sources”. The main changes from the first edition of the guidelines, published in 2006, are the addition of a new artemisinin-based combination treatment (ACT) to the list of recommended treatments, and the emphasis on testing before treating. Also, for the first time, the guidelines have a specific section recommending home-based management of malaria (HMM) by trained community members. It is recommended that rectal artesunate (suppositories given to patients too sick to take oral medicine) be included in home-based management where feasible.

A call has been made for universities in the USA to take a leading role in increasing the level of research activity devoted to the infectious diseases of poverty. The authors of an editorial in PLoS Neglected Tropical Diseases point out that, “The innovation gap for the diseases of poverty is growing at a frightening pace. For instance, some estimates indicate that the total research and development funding for diabetes is more than 15 times that of malaria, and more than 100 times that of other parasitic infections such as hookworm, elephantiasis, and schistosomiasis”. They want US universities to do three things: set up new funds to promote neglected disease research, training and education; eliminate intellectual property barriers around neglected disease research; establish new performance indicators that value neglected disease research to reward their staff”.

And we end with some bad news – a small study involving 50 men in Burkina Faso found that those who drank beer were more likely to be bitten by malarial mosquitoes. Beer drinkers attracted 45–65% more Anopheles gambiae mosquitoes than those who drank only water. (The volunteers in the study were not directly exposed to the possibility of being bitten by the mosquitoes.) No explanation is proposed for the mosquitoes’ preference for beer drinkers but the researchers conclude that, “These results suggest that beer consumption is a risk factor for malaria and needs to be integrated into public health policies for the design of control measures”.

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