TropIKA.net has often reported on projects involving the use of mobile phones in health care delivery – or “mHealth” as this has become known. These projects, most of which are small pilots, are encouraging examples of the innovative use of technology for the improvement of health, but care must be taken in the interpretation of what has so far been published about these projects.

We simply don’t know how many projects are in operation; it is quite possible that we only get to hear of those that are considered to be successful. And how is success defined? If a TB programme distributes phones, so that patients can be reminded to take their treatments, then success could be considered to have been achieved once the phones have been distributed to those who need them, or on the basis of whether health workers and patients are enjoying using them. What we need is hard evidence that more patients are indeed completing their full course of treatment and that cure rates have been improved.

TropIKA.net has published a review article [1] on the current progress in mHealth that describes some exciting examples of what is being done, but also looks at efforts being made by researchers to assess what these programmes are actually achieving.

Innovation in drug development has been the theme of some of our other recent articles. Efforts are under way to improve the efficiency and cut the cost of producing the drug praziquantel, used in the treatment of schistosomiasis. This project involves the use of an innovative approach to research – “open-source science” [2].

Another drug, flubendazole is widely used to treat worm infestations in animals but delivered disappointing results when used in humans against the filarial worms responsible for elephantiasis (lymphatic filariasis) and river blindness (onchocerciasis). A project [3] is investigating whether a reformulation of the drug can make it viable as an effective treatment for people with these conditions.

But even when effective drugs are available, getting them through to all those who need them remains a considerable barrier. One reason for this is the number of fake and substandard products on the market – see, for example a new report on substandard antimalarials [4]. A meeting in West Africa heard of the need to develop innovative techniques to stop the flow of these drugs [5].

Elsewhere on TropIKA.net we have reported some good news. The finding that Buruli ulcer, if diagnosed at an early stage, can be successfully treated with antibiotics without resorting to surgery [6] is one such development. This appalling condition is becoming more common and surgery has been recommended for all cases, despite the fact that it is often hard to access in the areas where the disease is most common and that patients do not like it. Now the challenge is to see that they are diagnosed in good time.

And President Obama has, in his budget placed before Congress, proposed significant increases in what would be spent on the infectious diseases of poverty [7]. The overall budget for global health would rise by a useful amount but the re-prioritization of particular diseases and issues is perhaps of greater interest.

Infectious diseases claim the lives of millions, both in peace time and in war. A study published in the Lancet [8] found that, for some 80% of the 300,000 people who died as a consequence of the war in Sudan’s Dafur region, the cause of death was not violent injury but infectious conditions, most notably pneumonia and diarrhoea.

Sadly, those who seek innovative ways to deliver health care most endeavour to develop mechanisms that will also prove effective in conflict situations.

Paul Chinnock
Editor, TropIKA.net

How many research papers have we all read that conclude with a statement that further progress against an infectious disease, while technically possible, is hampered by a lack of “political commitment”?

African presidents, in common with heads of state in other parts of the world, have varied in their level of commitment to the welfare of their people and in their position on the proportion of the national budget that should be devoted to health care. The creation of the African Leaders Malaria Alliance (see TropIKA.net News) must therefore be welcomed. ALMA is the first alliance at head-of-state level to combat the disease and has the potential both to improve the efficiency of control efforts, through international cooperation, and to mobilize national populations to work towards the elimination of malaria.

But commitments made by politicians are not always honoured. African presidents have previously pledged to spend 15% of their budgets on healthcare but few have delivered. Western leaders have also in many cases failed to provide the full level of development support that they have promised. Given the continuing global economic difficulties, there may be disappointments ahead. But malaria must surely be regarded as a special case. The disease burden is so great and the prospects for progress towards elimination are so much better than ever before that, if ever there were a time for commitments to be honoured, it must surely be now.

Meningitis also claims many lives in Africa. The latest of our TropIKA.net Profile articles features an interview with Marc LaForce, head of the Meningitis Vaccination Project. He describes how, once the final few hurdles have been cleared, a new vaccine designed specifically for Africa will become widely available.

Buruli ulcer (BU) is one of the most severely neglected of all the infectious diseases of poverty, but there have been modest increases in the funding available for research into this dreadful condition. We report on new genomic research on BU and on a planned study that should advance knowledge on the BU disease reservoir.

One way we can increase the attention paid to neglected conditions is to feature them in the media, but this has to be done in the right way – accurately and without scaremongering. Pakistan is one of many countries where the media has rightly highlighted the steady advance of dengue fever, but in such a way that a dengue diagnosis is now often interpreted by patients as being a death sentence. (The case fatality rate with dengue is of course very, very small.) Somehow a balance must be struck by the media to create sufficient public concern to prompt preventive action, without leading to widespread panic.

The TropIKA.net blog seeks to highlight items in the news that you may have missed. In recent days, these have ranged from the bizarre to the tragic. Some South African TB patients are reported to be selling their sputum to healthy people, who use it to fake a diagnosis of the disease and to be awarded a disability grant. In Papua New Guinea, which is experiencing its first cholera epidemic on record, fear of the disease is such that patients are said have been left to die at the side of the road, as no one is willing to take them to hospital.

For progress to be made against the infectious diseases of poverty we need, not only commitment, but also a better understanding - at all levels - of the true nature of the dangers they pose.

Paul Chinnock
Editor, TropIKA.net

A Chinese medical team expects to be able to announce soon that it has eliminated malaria from Mohéli, an island in the Indian Ocean. The team says its methods – mandatory mass drug administration using artemisinin combination therapy – would also be successful if used across Africa and globally, but the approach is not favoured by Western scientists. Will it lead to artemisinin resistance? Is it unethical? Is it only feasible in a small-island setting? It would be a pity if the experience gained in Mohéli were to be rejected entirely out of hand, and sadder still if a great divide were to open up in malaria elimination, between those who favour the currently accepted strategy and those opting for the new ideas put into practice by this Chinese team.

China itself has a malaria problem in parts of the country, although it is not on the scale faced by Africa. The Chinese government has announced that, using more conventional methods, it expects to be able to eliminate malaria as a public health problem by 2015.

New ideas on cholera are badly needed, given the current African epidemic (see our report on the situation in Mozambique) and the high case numbers still found in many parts of Asia. No one believes that the global threat of cholera can be resolved solely through the development and deployment of an effective vaccine; this is truly a disease of poverty and it will be with us as long as millions of people are denied the right to safe water and sanitation. Nevertheless, an effective vaccine would make a major contribution and the low effectiveness of cholera vaccines in the field has always been disappointing. A possible explanation comes from a study in Bangladesh which indicates that people infected with intestinal worms have a reduced response to V. cholerae. Deworming programmes, important in their own right, could become an important part of cholera prevention efforts. The study has been published at a time when a new cholera vaccine is about to be brought into use in India. This vaccine was found to be 70% effective in an Indian trial and its performance within a public health programme will be followed with great interest.

New threats require policy makers to act swiftly and appropriately. Health systems have so far responded too slowly to the worsening problem of drug-resistant forms of tuberculosis. It is thought that fewer than 5% of cases are detected and fewer than 3% are treated according to WHO standards. In Beijing a meeting of representatives of 27 countries facing a high burden of drug-resistant TB heard the current situation described as “potentially explosive”.

New information on Buruli ulcer is sadly in short supply. There is considerable public alarm in many countries regarding this dreadful condition but at a conference in Cotonou it emerged that there is still no clear understanding as to how it spreads or even how commonly it occurs.

Regular readers of my Editor’s choice blog will know that I like to conclude by highlighting a new success in disease control. The encouraging progress made against onchocerciasis in Guatemala is a suitable way for me to sign off, but the last word must belong to the readers TropIKA.net. We are an interactive platform so please use the ‘Leave a Reply’ function below in order to share your views on some of these new developments.

Paul Chinnock
Editor-in-Chief, TropIKA.net

The infectious disease of poverty that has been most in the news over the last few days is tuberculosis. Its high profile during this period has been largely due to World Tuberculosis Day and to the publication of the latest WHO annual report on the disease.

While it is easy to be cynical about the increasing number of annual days focussing on particular health or social issues, World TB Day does succeed in getting TB into the media, which can often be difficult, even for charities paying for fund-raising advertisements. In the TropIKA.net blog, we reported on the charity which was told by a TV company that its film about Buruli ulcer was too shocking to show during the daytime. This was despite the very restrained and tasteful nature of the film, in which the ulcers themselves were carefully blurred. Perhaps this is one reason why most infectious diseases of poverty are so severely neglected – they are too upsetting for us even to think about. The Second International Conference on Buruli Ulcer is incidentally now taking place in Benin.

Sleeping sickness (human African trypanosomiasis) is another much neglected disease. TropIKA.net has taken a look at research articles published on the disease within the last few months and we have attempted to sum up the key developments in a review article.

A non-government organization specialising in the leading infectious cause of blindness, trachoma, has announced that it is merging with a larger NGO. Should there be organizations that focus on just one disease or does this promote a ‘vertical’ approach to health care? And does it help when such bodies merge; does it make bureaucracy worse or reduce it? It would be interesting to have the opinions of TropIKA.net readers on these questions. Each of our articles and blogs has a facility for comment, so please do get in touch. We have had some good feedback on a number of our articles lately - see the following examples: 1, 2, 3.

But I shall finish this latest Editor’s choice by returning to World TB Day. The Stop TB Partnership has this year stressed the economic benefits of TB control. Dr Marcos Espinal, Executive Secretary of the Partnership said, “Most highly affected countries could gain nine times or more their investments in TB control”. In the current economic climate it is indeed important to emphasise such points to policy makers, with regard not just to TB but all the infectious diseases that blight the lives and reduce the productivity of the world’s poorest people. However, we must keep in mind the humanitarian as well as the economic imperative. It is unfair and unjust that millions of people continue to suffer from diseases like trachoma, Buruli ulcer and trypanosomiasis. Regardless of the financial costs and benefits, action against all these diseases must now be stepped up.

Paul Chinnock
Editor-in-Chief, TropIKA.net