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

It is therefore encouraging to learn that the Inter-American Development Bank and the Global Network for Neglected Tropical Diseases intend to mobilize $30 million from the public and private sectors to raise awareness and funding for the control and elimination of neglected tropical diseases (NTDs) in the region – see TropIKA.net Blog. We also report in TropIKA.net News of new efforts to eliminate malaria and filariasis from the Americas.

Meanwhile, the Drugs for Neglected Diseases initiative has announced that it has established a cooperative agreement with a pharmaceutical company for the clinical development of a drug that has been shown in lab tests to have activity against Trypanosma cruzi, the pathogen responsible for Chagas disease. This disease is confined to the Americans and kills at least 200,000 people every year. There is no vaccine and no specific treatment. Control of the disease vectors (triatomine bugs) remains the main focus of efforts to fight the disease and findings reported in a new research article will help guide control programmes in deciding when it is best to spray insecticide.

Oceania is another part of the world where infectious diseases remain an important cause of ill-health but receive little attention from the international media. Nevertheless, efforts are being pursued to control or eliminate these conditions and it is heartening to read a recent report of major successes achieved against malaria in Vanuatu and Solomon Islands.

TropIKA.net continues to highlight and comment upon new research findings, wherever the studies have been conducted. Our recent selections have included an important step forward in understanding how the parasite responsible for leishmaniasis establishes itself in its human host, a prevalence study that confirms the return of yaws to the Democratic Republic of Congo, and a study from China which examines the factors explaining why so many tuberculosis patients fail to complete their course of treatment. An Ethiopian study provides an illustration of the poor performance that is often seen in TB programmes, thus demonstrating the importance of monitoring and evaluation.

The TropIKA.net team cannot, of course, identify all the new reports of research into the infectious disease of poverty that are of particular significance. We need the help of our readers. If a new paper strikes you as being of exceptional importance, let us know about it.

One piece of good news is that an increasing amount of research is being conducted in developing countries. There has been an encouraging rise in the number of researchers in these countries, which doubled in a five-year period according to a report from the UNESCO Institute for Statistics. There is still of course a long way to go for the South to catch up. One initiative that should further speed up progress is the African Network for Drugs and Diagnostics Innovation (ANDI). The network aims to increase new health products developed in Africa by Africans. The ANDI 2009 meeting, which took place in South Africa this month, received in-depth coverage on TropIKA.net.

But sometimes the problem is not a lack of basic research. We highlight an opinion article which argues that the lack of progress against schistosomiasis in Africa represents one of this decade’s greatest failures. Cheap and effective treatments already exist for this disease, the second most common parasitic condition after malaria, but only 5% of Africans who need treatment actually receive it. Progress against the infectious diseases of poverty requires that the needs of neglected people should be met, in whichever part of the world they may live.

Paul Chinnock
Editor, TropIKA.net

A new Wellcome Trust initiative will boost research capacity in Africa, a gene map has been constructed for the parasite that causes schistosomiasis, opening up new avenues for research, and a potential new rabies vaccine has given promising results in mice. A trial has begun of a new drug for river blindness, and a trial of an improved treatment for sleeping sickness has been completed with encouraging results.

Meanwhile the US government has made it clear that, following the broadening of its policies on global health, it will provide new support for the control of neglected tropical diseases (NTDs). Unfortunately, only seven infections from the long list of NTDs have been targeted by the US at this stage. (Leishmaniasis, Chagas disease and dengue fever are examples of the NTDs not yet included.) Nevertheless, this is still an exciting initiative and other countries in the North might now be expected to follow the US lead.

These examples of positive developments contrast with the news from Kenya that over 70% of malaria patients there are given the wrong malaria treatment; they receive older ineffective antimalarials and not artemisinin combination therapy (ACT), the internationally recommended treatment. This finding (from the 2007 Kenya Malaria Indicator Survey, the full report of which is not yet freely available) supports observations in many African countries that ACTs are only getting through to a minority of those who need them.

Coincidentally, within the same month that the Kenyan report was published, the 250 millionth dose of the most widely available ACT, Coartem, was delivered. (TropIKA.net marked the event with an interview with the head of marketing and access for the malaria initiative at Coartem’s manufacturer, Novartis.) Progress is therefore being made but there is a long way to go.

An example of what a malaria control programme can achieve comes from a study conducted in the tiny island of Bioko, Equatorial Guinea where, within four years of the introduction of a multi-intervention strategy, prevalence in children dropped from 42% to 18% and all-cause child mortality fell by two-thirds. Such research demonstrates what is possible, but the challenge remains of bringing the potential benefits of research evidence to entire populations in disease-endemic countries.

“Evidence into policy” is the first part of this challenge. A recent article in Lancet Infectious Diseases noted that, while national guidelines in most Africa countries now list ACTs as the recommended first-line treatment for malaria, the majority of these guidelines have not changed as regards second-line treatment, for which they still recommend oral quinine monotherapy. This is despite the fact that the World Health Organization has stated that ACTs should also be the mainstay of second-line treatment.

But “policy into practice” is the next part of the challenge. In the case of ACTs, practitioners cannot give them to patients, as either first- or second-line treatment, if the drugs are not actually available. I am reminded of the British civil servant who said, after a new directive from his political masters, “If the policy is that pigs will fly, whose fault is it when they don’t?” (Sometimes those who write policy documents and guidelines need to distinguish between aspirational and operational targets.)

Two other research articles highlighted on TropIKA.net have implications for policy making in child health. A systematic review concludes that WHO is wrong in its recommendation that iron supplements should not be given to children under two years, if they live in malarious regions. In contrast, a South African study provides evidence to support the WHO position that children known to be HIV-infected shown not be given BCG, even in countries where the risk of TB infection is high. The interpretation of the evidence in such studies is, however, always likely to be controversial. Putting evidence into policy and policy into practice both present formidable obstacles.

Paul Chinnock
Editor-in-Chief, TropIKA.net

Of the diseases on the TropIKA.net priority list, it is tuberculosis that has been most in the headlines over the last few weeks. We have summed up some of the most important developments in our article, Tuberculosis profile rising. Malaria also receives more attention from the international media than was previously the case. The World Malaria Report for 2008 was reported by many newspapers worldwide and (as I write this latest Editor’s Choice column) news is coming in of agreement at the UN for major new funding for malaria control.

However, the excitement over new developments and innovations should not mean that the lessons of history are forgotten – see Malaria control: ‘faulty intelligence’ led to mistakes.

One such lesson is that gains made in infectious disease control so easily can be lost. Having brought rabies under control for several years, China now seems to be facing a resurgence of the disease – see Renewed rabies vigilance needed in China.

The increasing number of dengue fever cases is a major problem affecting a much wider area. The situation in the Asia-Pacific region and also Latin America is of increasing concern. One recent research article that has been the subject of a commentary on TropIKA.net is a systematic review examining dengue outbreak prediction and detection tools – see What does dengue disease surveillance contribute to predicting and detecting outbreaks and describing trends?

As well as commenting on recently published research article, TropIKA.net highlights review articles of particular importance. Sleeping sickness and Chagas’ disease are often featured on our knowledge platform and a recent review is relevant to both of them – see Trypanosomiasis vector control in Africa and Latin America. An infectious disease that also takes a major toll but which is often forgotten and has not previously appeared on TropIKA.net is bacterial sepsis – see Strategies to Reduce Mortality from Bacterial Sepsis in Adults in Developing Countries.

>blog. Responses to what our bloggers are saying are always welcome.

Paul Chinnock
Editor-in-Chief, TropIKA.net