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Editor’s choice

From the range of articles recently featured on TropIKA.net, Editor Paul Chinnock offers a personal selection of items of particular importance.

Archive for November, 2009

Nov 30 2009

Reporting the debate – Testing the tests

Posted by: Paul Chinnock - Editorial Team

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Once again, the TropIKA.net team has been out and about. We have provided in-depth coverage of Forum 2009, the latest conference of the Global Forum for Health Research (GFHR) held in Cuba. Highlights from our in-depth reports include interviews with Anthony Mbewu, President of the Medical Research Council, South Africa and next Executive Director of GFHR. He described his plans for moving the global health research agenda forward and also the steps now being taken to establish a biotechnology platform in South Africa.

Also interviewed was Carlos Morel, Director of the Center for Technological Development in Health at Fiocruz, Brazil. He discussed the difficulties in transferring innovations in health technology developed in one part of the South to other countries, where circumstances may be very different.

Forum 2009 made it possible for delegates to exchange their sometimes very different views on innovative approaches to health. For example a session on digital health care in rural India led to some lively exchanges.

Testing the tests

Rapid diagnostic tests (RDTs) will, it is hoped, play a major part in advancing efforts towards the elimination of malaria. The successful management of other infectious diseases of poverty would also benefit from the development of simple, affordable tests that can be used on the front line of care. However, such tests must themselves be tested for their accuracy and, when tests are tested, rigour is required both in the conduct of the work involved and in its reporting. It is therefore disturbing to read the findings of a review evaluating the quality and reporting of diagnostic accuracy studies in TB, HIV and malaria. It would appear that the required rigour has been lacking in much of the testing so far conducted. This does of course raise again the question of how much we can depend on the RDTs themselves.

The dependability of the drug supply has for many years been a topic of great concern – a large proportion of the drugs available in developing countries are faked or substandard. It is good news that efforts to control counterfeiting are to receive a boost with new support from USAID.

For some neglected infections, the drugs that are really needed do not yet exist. This is particularly the case for the three kinetoplastid diseases: Chagas disease, human African trypanosomiasis and leishmaniasis. The Drugs for Neglected Diseases initiative (DNDi) continues its remarkable work in the search for new treatments and a few days ago announced a collaboration with drug giant Pfizer, which will allow screening of its library of compounds to identify any that may have potential for use against these three diseases.

Other new developments also featured on TropIKA.net include Brazilian research demonstrating that the movement of people may be more important than previously thought in the transmission of dengue fever; the findings suggest that the disease is often transmitted outside the home, for example at school or in public spaces. And from Nigeria there is worrying news that the savannah-dwelling blackflies that transmit blinding onchocerciasis are becoming more common in the southwest of the country. Meanwhile, from southeast Asia comes the unwelcome, though predictable, news that resistance to the key antimalarial artemisinin has now spread from the Cambodia–Thailand border to China, Myanmar and Vietnam.

Facilitating communication between professionals seeking to address the infectious diseases of poverty is at the centre of our efforts on TropIKA.net and we are well aware of the dominance of English as the medium in which most communication on global health takes place. We welcome the news that the Portuguese-speaking health community will benefit from a newly launched email forum.

Paul Chinnock
Editor, TropIKA.net

Nov 17 2009

Virtual participation

Posted by: Paul Chinnock - Editorial Team

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A major component of the TropIKA.net project is the “knowledge hub”, where we feature international meetings of major importance to efforts to combat the infectious diseases of poverty. A TropIKA.net team attends each meeting and – on a specially created section of the TropIKA.net website – the team posts summaries of individual sessions and overviews of each day’s proceedings. Interviews with delegates, news stories and commentaries are also provided. Not only does this service enhance the experience of those who attend the meeting, but it also allows people who are not present to become “virtual participants”. Three meetings have been featured this year, two of them within the last two weeks! Our coverage of the 5th MIM Pan-African Malaria Conference in Nairobi is our most ambitious so far, featuring interviews, news and commentaries, as well as summaries of individual sessions and day-by-day overviews. We are now in the process of covering the 13th Annual Meeting of the Global Forum for Health Research in Havana. Keep up to date with what is happening at this event by visiting the hub for this meeting.

The expert deliberations in Nairobi are of course not all that is going on. TropIKA.net has reported in the last few days on epidemics of leishmaniasis in southern Sudan and dengue fever in Cape Verde. The latter is the biggest ever dengue outbreak ever recorded in West Africa.

Many diseases afflict the world’s poorest people continuously and not just in the form of major epidemics. Pneumonia is both the world’s biggest infectious killer and the most common cause of death in children under five in developing countries. It can only be hoped that a new pneumonia action plan devised by the World Health Organization may be a signal this most neglected of diseases is at last winning recognition as a global health priority. Another WHO report featured on TropIKA.net has highlighted the unequal position of women in health care.

As well as reports, we also continue to highlight articles published in the journals – see our Research, Reviews and Editorial opinion sections. It is always an invidious task to suggest which of the recent articles in the literature are the most significant but I should like to recommend two. A review article on the global burden of blindness due to trachoma is important in its own right – at least 1.3 million people are living with blindness as a result of this infection. However, in their discussion of the assumptions that must be made in calculating disease burden, the authors demonstrate how hard it is to reach firm conclusions for any infectious disease of poverty. In contrast, there is good evidence that prevention and treatment strategies for trachoma are highly cost effective. Whether we know precisely how many DALYs or dollars are lost, the human cost of this readily preventable disease is clearly on such a scale that every effort should be made to step up action against it.

I was also impressed by the insights emerging from a systematic review of qualitative data on the barriers to effective treatment and prevention of malaria in Africa. Qualitative studies often provide such insights, and what is most striking here is the finding that only a minority of people in Africa are aware that malaria is transmitted by mosquito bites. If people do not understand how an infection is spread (or indeed that is an infection) then this will clearly have in impact on their participation in control efforts and treatment seeking behaviour.

Finally, a magazine article that I can particularly recommend was referred to in our TropIKA.net blog; it deals with the encouraging growth of public-private partnerships (PPPs) in the development of new technologies to address the infectious diseases of poverty. Let us know if you spot something in the media that is worth highlighting on the blog.

Paul Chinnock
Editor, TropIKA.net

Nov 02 2009

A place to confer: TropIKA.net

Posted by: Paul Chinnock - Editorial Team

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As I write this blog, some 1,500 malaria specialists are taking part in the first day of a major conference being held in Nairobi this week. Many important presentations on malaria research will be delivered during the event, but a conference is a place to confer and should not be merely a series of lectures delivered to passive audiences. To help make the 5th Multilateral Initiative on Malaria Pan-African Malaria Conference a more interactive affair, TropIKA.net has established a “knowledge hub” for the meeting, where we are providing background documents, news, summaries and blogs. Everything we publish on the site allows registered users to add their own observations and opinions on the latest developments in Nairobi.

TropIKA.net spoke, before the conference began, to ten researchers making presentations of particular importance. These interviews have been published within the knowledge hub. We will be conducting further interviews, in which we ask young African scientists and senior figures in malaria control for their reactions to these presentations. Some of the presenters we spoke to have views that could prove highly controversial. Frank Baiden from Ghana says we need to take a long, hard look at the data on malaria in Africa: “Do we have the numbers right?” he asks, “How confident are we that these cases are all malaria?” He and others we spoke to query whether the declines now being seen in case numbers in several parts of Africa are the result of new interventions, or whether something else is going on. James Tibenderana (Uganda) alleges that previous efforts to promote the integrated management of childhood infections have “died a natural death”. Paul Milligan (UK) says that the way in which data from vaccine trials are analysed should be changed, in order to provide better measures of their impact on disease burden. And Hilary Ranson (UK) says “alarmingly high” levels of insecticide resistance are now being recorded. Let other TropIKA.net readers know your opinion on what these researchers have told us.

Thanks to the Internet, there are now also virtual places to confer and TropIKA.net provides such a facility throughout the year – not just in the present ‘conference season’. We continue to report on major new developments relating to the infectious disease of poverty. A recent example is the publication of new estimates showing that Streptococcus pneumoniae and Haemophilus influenzae type B are responsible for as many child deaths as AIDS, malaria, and tuberculosis combined.

Epidemics of other infectious diseases have also featured in our pages. This has been a very serious year for meningococcal meningitis in Africa’s meningitis belt, and cholera outbreaks have afflicted many parts of the African continent, including Nairobi – a city in which ironically malaria is not actually transmitted, according to new findings.

We have also highlighted reviews that provide updates on what is known about cholera and about fascioliasis, and a major report on global progress with vaccination programmes.

But we do not neglect the basic end of research. It will be interesting to see whether some very preliminary findings recently reported may one day lead to a role for chocolate in malaria treatment or for anti-obesity drugs to treat dengue fever. What do you think? Let us know.

Paul Chinnock
Editor, TropIKA.net