Global Health News Last Week

POLICY

  • Assistant Senate Majority Leader Richard Durbin (D-IL) and Senator Bob Corker (R-TN) introduced the Water for the World Act of 2011, a bill in the Senate which will make providing safe and clean drinking water around the world a priority for US foreign aid.
  • More than 60 world nutrition experts met at WHO headquarters last week to revise guidelines and to identify solutions to tackle the growing problems of both malnutrition and obesity around the world.
  • Ministers of health and other high-level health officials from throughout the Americas called for a series of actions to reduce the toll of chronic noncommunicable diseases, in a declaration issued last week in Mexico City.
  • The Global Fund announced that former President of Botswana Festus Mogae and former U.S. Health and Human Services Secretary Michael O. Leavitt have agreed to lead a high-level panel of experts that will conduct an independent and thorough review of the Global Fund’s financial safeguards.
  • UN agencies are concerned that reduced donor funding due to the recession, combined with free trade agreements, will reduce the availability of low-cost HIV medications in developing countries.
  • The United Nations General Assembly will convene a high-level meeting in September this year to discuss the financial burden caused by non-communicable diseases (NCD) on countries.

RESEARCH

  • A study done is Malawi by the World Bank attracted attention (and criticism) from Businessweek. Young women were given to stay in school and deter them from accepting money and gifts from “sugar daddies” in exchange for sex. The study found that HIV infection rates were 60% among schoolgirls who received cash compared to those who received nothing.
  • A recent review of malaria treatment clinical trial results, published in the Chochrane Library, shows that artesunate was more effective that quinine at treating severe malaria.
  • A personalized text messaging reminder service significantly boosted antiretroviral (ARV) adherence over a six-week period compared with a standard beeper reminder system, according to a study published in the March issue of AIDS Patient Care and STDs.
  • About 600 people gathered at the Global Health Metrics and Evaluation conference in Seattle to discuss issues surrounding the evaluation of effectiveness of health programs.

PROGRAMS

  • Global health blogger Alanna Shaikh discusses how micro-credit and the Green Revolution, two of international development’s biggest successes, are being re-evaluated.
  • The Nepalese government is planning launch a large vaccination campaign against elephantiasis in 40 high-risk districts.
  • Dubai’s Ministry of Health introduced Pneumococcal Conjugate Vaccine PCV13, a vaccine that protects young children from the worst effects of illnesses including pneumonia, blood infections and meningitis.
  • The National Influenza Center of the Chinese Center for Disease Control and Prevention has been designated as a World Health Organization Collaborating Centre for Reference and Research on Influenza, making China the first developing country to house such an institution.

DISEASES AND DISASTERS

  • Europe is concerned by the growing incidence of drug-resistant TB, particularly in children.
  • The world continues to follow the aftermath of the earthquake and tsunami in Japan, including the unfolding situation at the Fukushima Dai-ichi nuclear power plant. The WHO has assured that there is no danger to individuals being exposed to radiation in nearby nations (e.g. China).
  • As if Haiti needed any more bad news, a study published in the Lancet says that the UN estimate of 400,000 cholera cases in Haiti this year is nearly half of what the real projection should be for the recovering nation. Meanwhile, health officials in Lagos have called on residents to observe high standards of personal and environmental hygiene and have designated emergency numbers to call in case of suspected cases; the Ghana Health Service has set up cholera centers in Accra to deal with the outbreak there; and the interim federal government of Somalia on Tuesday denied reports of an outbreak of cholera in the country, responding to an Associated Press story over the weekend that Somali doctors had reported that more than 20 people had died from the disease.
  • In the February 2011 issue of PLoS Neglected Tropical Disease Journal, contributing editor Serap Aksoy discussed the triumphs behind the control of human African trypanosomiasis, or African Sleeping Sickness.
  • Although women get diagnosed for tuberculosis (TB) later than men, treatment outcomes among women are better than men with higher TB treatment success rate and lower default (drop-out) rate in the female patients. The finding was announced at a meeting on TB and women in New Delhi, India.
  • While the total number of newly reported HIV positive people and AIDS patients are still low in Japan compared with other countries, the number of newly HIV-infected people in Japan has doubled in the past decade due to public complacency and lower awareness.

Global Health News Last Week (plus interest in a new working group!)

Attention IH Section Members: Dr. Kaja Abbas, MPH student at the University of Rochester, is gauging interest in forming a working group focused on using system science to improve global health, similar to the intitiaves being promoted by NIH. Her interests are in conducting system science research on global health policy by modeling population and disease dynamics and economic evaluation of public health interventions and systems, with a focus on HIV and TB. Dr. Malcolm Bryant, our section chair, has encouraged the expansion of our section’s activities in areas of technical expertise, and Dr. Abbas is enthusiastic about a working group within the section that promotes system science methodologies for global health solutions. She welcomes your thoughts and suggestions at kaja [dot] abbas [at] gmail [dot] com.

Global Health Delivery online’s HIV prevention community is hosting a “virtual expert panel” March 7-11 to continue the dialogue around PrEP as a novel approach to prevention. Panelists from Uganda, South Africa and the United States will lead the online discussion, highlighting various barriers and opportunities to implementing PrEP in clinical settings; how to encourage long-term adherence; and what additional research questions need to be answered. Panelists include (1) Douglas Krakower, MD, a fellow in Infectious Diseases at Beth Israel Deaconess Medical Center/Harvard Medical School, (2)Andrew Mujugira, MBChB, MSc, the East Africa regional medical director for the Partners PrEP study, and (3) Vivek Naranbhai, PhD, who was involved in CAPRISA microbicide gel study. All GHDonline members can participate in this online discussion. You can sign up here if you are not currently a member.

POLICY

  • Paramount Chief Mpezeni of the Ngoni people in the Eastern Province of Zambia has urged his subjects to get circumcised in order to reduce the chances of spreading HIV/AIDS and other communicable diseases in his land.
  • Britain is threatening to pull out of the Food and Agriculture Organization due to “patchy” performance.
  • Due to uncertainty in past estimates, the Indian government has formed a 16-member expert group to determine the annual death rate caused by malaria in the country each year.
  • The breakdown of the air conditioning in the plenary hall of the Philippines’ House of Representatives stalled the heated debate of a controversial reproductive health bill. The bill is vehemently opposed by the Catholic Church and pro-life groups and has caused a stir in the largely Catholic country.
  • A massive demonstration rally was held in New Delhi to protest a free trade agreement between India and Europe, which many fear may threaten the production of low-cost generic drugs, particularly HIV medicines.

RESEARCH

PROGRAMS

DISEASES

Reflections on Community Based Participatory Research

Guest Blogger: Xeno Acharya

As an MPH student at University of Washington, Seattle, I have often wondered if Community Based Participatory Research (CBPR) is a philosopher’s stone in the academics’ head. Having worked in Ethiopia and Sudan (as the researcher) and having been born and raised in Nepal (as the researched), I have come face to face with both sides of this idealistic myth.

In short, CBPR is a research method that has three core elements: participation, research, and action. It emphasizes “authentic partnership” between the researcher and the community, in which perspectives, knowledge, resources, and skills of both are combined.

It is important to remember that most of the time it is the researcher that initiates the research, no matter how participatory. For purposes of convenience, let’s call the researcher M and the researched N. M brings in research funding, manpower, technology, and white man’s knowledge. N (hopefully) brings in local experience, networks, subjects, manpower, and consensus to have been intervened/researched. When I was in Sudan and Ethiopia, I was a Caucasian-looking male who was struggling with the language and cultural nuances, but who was also clearly better paid than most staff working in the same company although I neither had the educational background or the experience the local staff members did. My positionality affected the way my colleagues spoke to me about their work and about themselves, and no amount of CBPR could overcome that.

In Nepal, too, the same power dynamics played out. Although I am a native there and speak the language, I look “white,” and the clothes I wear and the way I walk scream the fact that I have clearly not been around in Nepal for a while. I work for a small non-profit based in Portland, Oregon, that runs a school for untouchable refugee children in Kathmandu. When I visit the school every couple of years, I get the attention (I like) from kids and parents alike, not just because I am the founder but also because of the same power dynamics that comes back to bite at me again and again. So I have settled for the fact that the imbalance is always going to be there no matter what. To me, CBPR is a theory that can never fully come to fruition. Like communism, the idea itself is good and is meant to do well, but a hundred percent CBPR is only a goal to strive for, never a reality.

That said, I think CBPR is still an idea to strive for. There are things I (as a researcher) can change to reduce the imbalance of power between myself and the researched/intervened, and they are still important to do. Reflecting on my own positionality and being aware of this power dynamics is something that I can constantly incorporate in my work; so can you!

Xeno Acharya, originally from Kathmandu, Nepal, is an MPH candidate at the University of Washington. In Nepal, he has worked with local NGOs on awareness campaigns on disability among children, taught in mobile schools for displaced populations, and currently runs a school for children of victims of the civil war (1996-2008) through Namaste Kathmandu; he has also worked on short-term projects in Ethiopia and Sudan. He is currently a research assistant in the Health Systems Strengthening division of a Seattle-based non-profit called International Teaching & Education Center for Health (I-TECH) and is interested in infectious disease prevention, refugee populations, and health systems strengthening.