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

An important part of TropIKA.net is our Profiles section in which Tatum Anderson interviews key figures working against the infectious diseases of poverty. We are delighted that our latest interviewee is Dr Awa-Marie Coll-Seck executive director of the Rollback Malaria Partnership (RBM). She plays a crucial role in coordinating the activities of the myriad of organizations now involved in international efforts to improve malaria control. One of the many new malaria initiatives is the Affordable Medicines Facility for malaria (AMFm). There is currently much debate, for example in a recent PLoS Medicine article, as to the merits of this scheme and how it might best be implemented.

Another recent Profile interviewee, Brian Greenwood, is probably best known for his work against malaria but in his long career in tropical medicine he has also focused on other diseases, among them is meningitis. We report on the launch of the African Meningococcal Carriage Consortium (MenAfriCar), to be headed by Professor Greenwood, which will make a concerted effort to understand the spread of meningococcal meningitis in Africa.

We also report good news on another disease that is predominantly an African problem – onchocerciasis (river blindness). Mass administration of the drug ivermectin kills the larvae of the parasite responsible but not the adult; repeat treatments (once or twice a year) are therefore given. It has been widely believed that communities living in areas endemic for the disease would need to be given these treatments indefinitely. However, a study in Mali and Senegal found that, after 15-17 years of mass drug administration with ivermectin, only a few people were still infected and treatment could safely be stopped. Ivermectin is not, however, an ideal drug. Many patients find it extremely unpleasant to take and parasite resistance to the drug has been reported. Research to find new ways to control river blindness that do not depend on ivermectin therefore remains important – see TropIKA.net news story on the latest meeting of the SCOOTT Consortium (Sustainable Control of Onchocerciasis today and Tomorrow).

Amongst the other good news has been the announcement by the International Trachoma Initiative that three more countries (Ghana, Mexico and Saudi Arabia) have now met the criteria for elimination of trachoma as a public health problem. It is unusual to see a low-, a medium- and a high-income country mentioned together for the same achievement! Tropical diseases can indeed afflict both rich and poor but it those who live in poverty who are the most vulnerable.

Many of the countries where dengue fever is a problem are emerging economies in Latin America and Southeast Asia. The economic impact of the disease is therefore considerable. Probably the most comprehensive study to date seeking to quantify this impact has just been published. Infectious diseases that affect poor people are by and large neglected, but with increasing wealth in dengue-afflicted nations, perhaps the economic imperative will lead to an expansion of efforts to develop a vaccine and a treatment for this increasingly common disease.

The diagnosis of the infectious diseases of poverty is itself a neglected issue. When advances are made in the treatment of a disease, rapid and reliable diagnosis becomes even more important, as was discussed in the case of malaria in a recent BMJ article.

Two initiatives to address the neglect of diagnosis have made an appearance in TropIKA.net during the last few days. The African Network for Drugs and Diagnostics Innovation (ANDi) has announced that it will present its strategy and business plan in October, and the TropIKA.net blog links to an interview with Joseph Ndung’u of the Foundation for Innovative New Diagnostics (FIND) about the search for a new diagnostic test for trypanosomiasis (sleeping sickness).

- For more on new developments in diagnosis, see also a recent article in TDR News.

Paul Chinnock
Editor-in-Chief, TropIKA.net

Every few days there seems to be an announcement of the launch of a new programme or a new organization that seeks to address in some way the infectious diseases of poverty. When one considers the previous neglect of the disease burden in the world’s poorest countries, new initiatives are to be welcomed. One result, however, is that the so-called “institutional landscape” of global health is growing ever more complicated.

A study in the Lancet, highlighted on TropIKA.net analysed the flow of funding for global health programmes and one of its findings was that the role of the UN system has been diluted in recent years, since the launch of new programmes and agencies. An accompanying editorial asked, “Who runs global health?” The same study confirmed the dominance of HIV/AIDS, malaria and tuberculosis in the funding provided for global health, and another Lancet study bears out the view that big programmes focusing on these diseases can harm the ability of health systems to provide comprehensive health care. There is cause for concern that the proliferation of agencies and programmes, each with their own agenda, may have harms as well as benefits. Are there now too many institutions in the landscape?

Could there also be too many conferences? There are numerous TB conferences and when the annual Pacific Health Summit also chose to focus this year on drug-resistant TB one delegate told the meeting that she was tired of attending expensive gatherings hearing the same people say the same things – see TropIKA.net News. The organizers of this event did have a specific aim in mind – to get industry more involved in efforts to beat drug resistance and – while phrases like “stakeholder engagement” seem to many of us to be the worst sort of jargon – the activity they describe is important and international meetings are a part of the process. That said, many will have sympathy with the view that the global health conference circuit is getting out of hand.

Does it all lead to advances in research, and to progress in the control and treatment of diseases on the front line of health care? There has certainly been no shortage of progress for us to report on TropIKA.net in recent days. There has been media interest in the continuing phase 3 trials of the most advanced vaccine under development for malaria, RTS,S. The development of further malaria vaccines may be assisted by the resources for immunologists made available by the US National Institute of Allergy and Infectious Diseases on the new website of its malaria research programme. Meanwhile, a dengue candidate vaccine is soon to enter a phase 1 trial. The TB Alliance will provide support for the further development of a promising new TB drug.

Vaccination against pneumococcal disease in developing countries has come a step closer with the announcement of a $1.5 billion “Advance Market Commitment” [8].

Reports from Ethiopia describe the successful integration of trachoma and malaria control campaigns. Community level action has been shown in a study to be effective in controlling the mosquito vector of dengue fever in Cuba, and from India there are encouraging reports of community level projects for TB. All this is a long way from complex institutional landscapes and expensive conferences. However, if constant new initiatives and meetings at a global level really are essential to progress on the front line, then we shall have to learn to live with them.

Paul Chinnock
Editor-in-Chief, TropIKA.net

Our remit at TropIKA.net is the infectious diseases of poverty and we cover a wide range of medical conditions and associated issues. However, during the last few days, one disease – malaria – has been the dominant theme of our new content. We marked World Malaria Day 2009 with an interview with Professor Kilama of the African Malaria Network Trust and a News story summing up what happened in the build-up to the Day and the response to it. Many glitzy, glamorous events were held to mark the Day but my editorial focussed on the front line of care, where “Every day is Malaria Day”. There were also numerous new items on malaria within the TropIKA.net blog.

But, since the announcement by WHO on 24th April of a major outbreak of influenza caused by the A/H1N1 virus, the world’s most talked about infectious disease has been swine flu. The TropIKA.net update on swine flu highlights the fact that the epidemic started in a poor community and that, while rich and poor are now at risk, people in the developing world are less likely to receive appropriate diagnosis and treatment.

World Malaria Day and swine flu notwithstanding, we have also reported some important new developments in the fight against trachoma , tuberculosis and dengue fever.

Other recent topics have included human rights , patent pools for drugs for neglected infections and the encouraging rise in the number of publications where the first-named author is from sub-Saharan Africa.

TropIKA.net is an interactive project. Our articles and blogs include the facility to leave comments. Please feel free to share your views or add information that we may have missed.

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

For many months there have been reports from Cambodia of cases of malaria showing resistance to what is now the mainstay of malaria treatment – artemisinin combination therapy (ACT) – see for example a Science paper featured on TropIKA.net last year. There was confirmation of this disturbing finding in a conference presentation in November (see TropIKA.net blog) and in a paper in the New England Journal of Medicine in December.

Now, in TropIKA.net News, we publish details of the launch of a programme seeking to contain the spread of artemisinin resistance. It must be hoped that these efforts will achieve some success. The loss of this drug would be calamitous for malaria control globally.

Since it was first established that artemisinin offered an effective replacement for the older malaria treatments to which the malaria parasite had become resistant, massive investments have been made with the aim of making ACT drugs accessible to those who need them. While these efforts still face many challenges, some resulting from insufficient supplies of artemisinin, there has been encouraging progress. Steps towards the production of a synthetic version of artemisinin (see TropIKA.net blog) have added to the sense of optimism as to what can be achieved. However, should artemisinin resistance now spread rapidly from Southeast Asia to Africa and other malaria-endemic areas, then these investments may turn out to have been wasted.

The sale of substandard ACTs containing inadequate levels of the active drug and the use of artemisinin as a monotherapy both promote the development of resistance. It is essential that these practices should be halted.

And the good news

Not all of the new developments featured on TropIKA.net recently have been so bleak. Two new moves are likely to boost research into the infectious diseases of poverty. See:
- African initiative launched to strengthen health research
- India plans to boost investment in research for drugs for the infectious diseases of poverty.

Some national programmes aiming to eliminate infectious diseases of poverty are achieving success:
- Lymphatic filariasis eliminated from province in the Philippines

Elsewhere existing control efforts are being reinvigorated:
- Kenya plans to eliminate trachoma
- Nigeria tries again on polio

And, somewhat belatedly, the Australian government is getting to grips with a major cause of blindness in its indigenous people:
- Trachoma: Australia’s government at last promises to take action

Paul Chinnock
Editor-in-Chief, TropIKA.net

Sometimes one can read a great number of research articles on infectious diseases and come away with just a single case uppermost in one’s in mind.

In our look at recent research articles on lymphatic filariasis, one paper we featured was a qualitative study on the impact of social stigma on women with this disease in two countries, the Dominican Republic and Ghana. My thoughts keep returning to the comment, recorded by the researchers, of a woman in Ghana:

“If it had not been for my nasty leg, I could have gone to school and been a teacher. I would have been someone, not just the woman with the leg.”

The tragedy of a person whom society defines by the parasitic condition from which she suffers and the waste of her capabilities clearly sets out, in just two sentences, why such diseases can no longer be neglected.

It also demonstrates one of the advantages of qualitative data – a single human story is often more moving, more memorable, and more effective as an advocacy tool than any qualitative statistic.

The considerable impact of stigma revealed in this study adds to the case for more social research on the infectious diseases of poverty. A recent review article considers the current status of such research.

Elsewhere on TropIKA.net there have been a number of good news stories lately:
• a small study has examined a new way of addressing the life-threatening complication of hypoglycaemia in children with malaria
• a reduction in trachoma case numbers has been reported from Nepal
• a new initiative will facilitate the conduct of high-quality clinical trials in Africa.

And there have been curious stories too:
• the introduction of a new malaria drug is seen as a threat to local industry

TropIKA.net is of course an interactive knowledge platform. Please use our Comment function or the blog to give your own views on any of these developments.

Paul Chinnock
Editor-in-Chief, TropIKA.net

Examples of the innovative use of new technology to help to control the infectious diseases of poverty are often featured on TropIKA.net. The mobile phone is a piece of new technology that has been adopted enthusiastically across the developing world and the ready availability of these now ubiquitous devices has been put to good use by a team of software developers. An application which can be downloaded to mobiles has been used within a successful campaign to bring under control Kenya’s first polio outbreak for 21 years. See Mobile phone technology helps contain disease outbreak.

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