The World Health Organization is now issuing regular updates on the worsening cholera situation in Zimbabwe, where a total of 26 497 cases, including 1 518 deaths, have been reported by the Ministry of Health. Of great concern is the fact that case fatality rates (which are averaging over 5%) are much higher than the internationally accepted norm of 1%.

WHO also has a photo gallery of its work against cholera in Zimbabwe.

Yemen has just begun the 4th phase of its national campaign to eliminate schistosomiasis. Public Health and Population Minister Abdul-Karim Rassa said the campaign would last five days, targeting 405,800 people aged 6-18 years.

More information is available from the Yemen news agency Saba News.

For further details on schistosomiasis control in Yemen (population 2.5 million), see this report on the WHO website.

Is this a piece of satire intended to raise awareness of dracunculiasis (guinea worm disease) or do they really mean it?

If efforts to eradicate guinea worm disease succeed (and there is indeed encouraging progress to report), then it will also mean the eradication of the guinea worm itself. The ‘Save the Guinea Worm Foundation’ seems to be alarmed at this prospect.

The authors of this website say that they are not too upset that a virus had to be wiped out in order to eradicate smallpox but that to deliberately render extinct a higher life form (the guinea worm) is a step too far. They claim that malnutrition and toxins are in any case the real culprits responsible for dracunculiasis. (Another blogger says this exposes the Foundation as a piece of satire, as similar absurd claims are routinely made by AIDS denialists.)

But read the Foundation’s website for yourself. Perhaps you would like to join their band of volunteers willing to host guinea worms in order to save the species? Alternatively, you may prefer to read a recent press release from UNICEF, which outlines the valuable work being done in Niger to combat dranculiasis.

The infectious diseases of poverty are increasingly considered from the perspective of human rights. See for example this selection of recent items on TropIKA.net. It is therefore of interest that the Lancet published a special report on the right to health on International Human Rights Day (10 December ) to mark the 60th anniversary of the Universal Declaration of Human Rights.

The report comprises a number of commentary articles and a major 40-page study. The commentaries look at several aspects of human rights, including gender inequality, and there is an interesting discussion of rights-based approaches to improve health in Peru.

The authors of the study - Health systems and the right to health: an assessment of 194 countries - point out that countries have a legal obligation under human-rights law “…to progressively realise the right to the highest attainable standard of health and therefore to improve their health systems progressively”. Their article provides very extensive recommendations for governments, international bodies, civil-society organisations, and other institutions as a suggested basis for the monitoring of health systems and the progressive realisation of the right to health.

None of the articles focuses specifically on infectious diseases but it is good to see a leading medical journal continuing to highlight the connection with human rights.

However, a key issue seems to have escaped attention in this series of articles. The estimable Neil Pakenham-Walsh of the Global Health Information Network points out in the HIFA2015 mailing list that the right of access to health information is not discussed.

To quote from the website of HIFA2015 (a global campaign for healthcare information for all by 2015): “Tens of thousands of people die every day, often for the simple reason that the parent, carer or health worker lacks the information and knowledge they need to save them”. Anyone who is not already aware of this campaign should find out more about this neglected issue.

Scientists at the Sackler Institute for Comparative Genomics at the American Museum of Natural History say they have shown that malarial parasites in tree-dwelling rats have close evolutionary relationship with P. falciparum. The claim is based on so far unpublished data but has been reported in an online news service Huliq News.

Susan Perkins, Assistant Curator of Invertebrate Zoology at the Museum is quoted as saying: “This is the first time that a relationship has been found between human and rodent malaria. In all past studies, P. falciparum seemed to not be closely related to anything else but the chimpanzee parasite. But this study places it in a sister group of parasites from rodents … The link between human malaria and rodent malaria is exciting because, if they really are that closely related, our laboratory models might be more powerful for helping to study how to fight the disease.”

When I recently learned of the organisation Chemists Without Borders, I first noticed that this small and relatively new group is involved in initiatives relevant to the infectious diseases of poverty and to other health concerns. And then I reflected, not for the first time, that we are seeing something of an explosion of organisations and websites featuring the ‘Without Borders’ tag in their title.

It all seems, I think, to have started with the decision by Medicins sans Frontieres, for many years now a highly esteemed organisation, that - while it would retain its original name in most countries - it would be necessary for it to be known in the US as Doctors Without Borders.

The example of MSF seems to have inspired other professions to offer their services in the cause of humanity. There are now, to give a few examples, Scientists, Mental Health Workers, Teachers, Librarians and MBAs… all of them Without Borders and all seeking to provide their professional assistance to developing countries.

The alternative medicine sector has also been inspired by the growing, though still unofficial, Without Borders movement and there are now groups for Acupuncturists and Osteopaths. And in Afghanistan there is a development project called Beauty Without Borders.

The cynic in me wonders which profession will be next to embrace the Without Borders tag. I have been unable to find any Chartered Accountants or Hedge-fund Managers who have adopted the title but perhaps it is only a matter of time. There is indeed considerable potential for humour here but perhaps that would undermine what is a very positive phenomenon. Poverty and disease know no borders, and neither should those who want to participate in the fight against them.

TropIKA.net, of course, aims to be a knowledge platform without borders! We welcome readers, and particularly comments, from disease-endemic and other countries worldwide. And if you can add to the above list of Without Borders organizations with a particular interest in infectious disease do please let us know.

“Science and Community - engage to empower” was the theme of a Wellcome Trust (WT) international conference (http://scienceincommunity.wordpress.com) which I attended two weeks ago at the Africa Centre for Health and Population Studies, South Africa (www.africacentre.ac.za). The conference reinforced the importance of public engagement, particularly in developing countries who have a lot to gain from biomedical and public health research. The theme suggests public engagement is more than just a unilateral flow of information but a dynamic, interactive, participatory process that serves to inform, educate, and stimulate people.

A quick and dirty study with ten of my academic colleagues shows that public engagement in Malawi is either unknown or misunderstood. According to Wikipedia - Public engagement is a term that has recently been used, particularly in the UK, to describe “the involvement of specialists listening to, developing their understanding of, and interacting with, non-specialists” (as defined by England’s university funding agency, HEFCE, in 2006). This definition is somehow lacking and fails to portray public engagement as a process with specific goals and outcomes. Further web searches suggest public engagement is rooted in several domains: in politics (participatory democracy), and in marketing (public relations). The WT Public engagement website (www.wellcome.ac.uk/Funding/Public-engagement ) states ‘WT wants to encourage people of all ages and from all walks of life to consider, question and debate the key issues of now and the future’. This objective is clear with an outcome that can be measured.

Evaluating public engagement and providing evidence of its value is major challenge for implementers. This was discussed during a session on the value of engagement with John Young, Overseas Development Institute, UK. Participants suggested community trust, positive health/behaviour outcomes, legislative reform, new links and networks are convincing evidence of the value of public engagement.

In corporate environments, public relations melds strategy and communications, constituting an essential bridge between corporations and their stakeholders. In science, this would be analogous to a bridge between research institutions and stakeholders. Stakeholders could be media, policy makers, communities, or specific target groups like pregnant mothers or school children. Thulani Cele, public relations officer, Africa Centre, captured this during his presentation on media engagement. Public relations and likewise public engagement must be part of business strategy and policy formulation, in addition to being responsible for communicating decisions.

What qualifies as engagement? Several creative approaches were not only discussed but experienced: from a science cafe on the day in the life of a field worker; to a visit to the University of Zululand science centre; to a debate on research and activism; to a play on peer pressure by DramAidE. Approaches may differ in style, format, and audience with similar approaches even having different adaptations e.g. adult vs junior science cafes. Despite these variations, they all strive to achieve the same outcome, of a making science more welcoming and accessible, and deepening its social impact and relevance.

For engagement to be effective it needs to involve influential actors. To be influential today does not require academic or professional credentials alone. It needs person that have a personal experience, passion, and a desire to contribute to general knowledge. Through public engagement, we build trusted relationships with a broad set of influencers be it policy makers, community leaders, or media.

Participants in the four thematic areas of the conference -  media engagement, policy engagement, creative approaches, and community engagement discussed several challenges. These ranged from ‘dejargoning’ the science, getting the interest of stakeholders, poor funding, lack of recognition of the role of public engagement, to evaluating public engagement programs. Where solutions were not available in the form of presentations and dialogue, contacts and networks were established for further exploration. The conference stimulated the minds of the participants, presented exciting ideas,  set up networks and partnerships, and offered new opportunities.

Engagement is here to stay. Science communicators must rise to the challenge, by creating new forms of expression that will work in local contexts. Just like any new process, it will take some time to take-hold and become fully standardized, but it is undeniably a multifaceted and powerful process that can provide value to science and research –especially before research even starts.

A $18.7 million grant from the Bill & Melinda Gates Foundation will be used by the University of Georgia, USA to research ways to reduce morbidity from schistosomiasis in low- and middle-income countries in Africa, the Middle East and the Americas.

The project grew out of a consensus research agenda developed in 2007 with broad input from the schistosomiasis research and control community. It focuses on operational research, and its overall goal is to answer key strategic questions about controlling schistosomiasis to ensure that future programmes operate with increased efficacy, cost-effectiveness and sustainability. Secondary goals for the project are to integrate global schistosomiasis control efforts with other programmes, monitor the effectiveness of current treatments, develop survey and diagnostic tools and overcome barriers that currently prevent effective control.

Dan Colley, director of the university’s Center for Tropical and Emerging Global Diseases, is principal investigator for the project. Further details can be found on the University of Georgia website and information on the Center’s other activities may be found here.

The Three Gorges Dam on the Yangtze River is the largest hydro-electric project in the world, intended to combine the generation of clean power with downstream flood control, and enable shipping in China’s interior. Its full environmental impact while undoubtedly huge is hard to predict. It is unclear whether changing water conditions in Poyang Lake, China’s largest freshwater lake, will create more favourable conditions for the snails which are the intermediate host of schistosomiasis. A team of US scientists intends to use satellite data on changing water levels to predict the likely changes in snail numbers.

Motomu Ibaraki, an associate professor of earth sciences at Ohio State University and the leader of the research project says: “What we hope we can do is point to the most dangerous areas for schistosomiasis transmission based on predictions we can calculate about the snail habitat.” Dr Ibaraki described the research at the American Geophysical Union annual meeting in San Francisco, according to a report from the NewsWise service. The researchers have collected field data from the Poyang Lake region over the last two years. This has been fed into a geographic information system documenting water levels, vegetation characteristics and air temperatures that, when combined, identify areas favourable for the host snails to thrive. For future measurements, all Poyang Lake water level data will come from the European Space Agency’s ENVISAT satellite, which measures the water level of the lake every 35 days. The radar readings have been calibrated to compare to baseline levels recorded in the field data.

Schistosomiasis affects 200 million people worldwide. People are infected through contact with water contaminated with the Schistosoma parasite which burrows into human skin and when mature settles in various parts of the body. The infection can lead to a variety of health complications, including bladder cancer, kidney and liver damage. The adult parasites lay eggs which are released into water sources through human waste, perpetuating the cycle of contamination. Tiny worms hatch from the eggs in the water, and use snails as an intermediate host until they are large enough to float freely in the water. No vaccine is available to prevent the illness, and medications to treat it generally are not effective at breaking the disease cycle, especially in poor, developing areas of the world.

Dr Ibaraki said, “Really, the only prevention is to not touch the water … There are huge signs there that tell people not to go into the lake. People know about the dangers of infection, but they have to touch the water to some extent. It’s part of their lifestyle.” Local fishermen are the most at risk.

Reports on the occurrence in wealthy countries of ‘tropical’ diseases (infectious diseases of poverty) are of some value. These are not of course the countries where such diseases have most impact, but it is useful to be reminded that everyone is potentially vulnerable to infectious disease. Without this realisation, there is a danger that policy makers in the developed world will forever think of infections like dengue fever, Chagas disease and leishmaniasis as ‘exotic’ conditions only affecting strangers in far away lands.

It has been reported that more cases of advanced leprosy (Hansen’s disease) are being seen in the USA. American doctors, being unfamiliar with the condition, often fail to diagnose it early on.

Dr James Krahenbuhl, Director of the US Department of Health and Human Service’s National Hansen’s Disease Pogram said, “We are seeing more and more cases that are advanced.” Speaking at the annual meeting of the American Society of Tropical Medicine and Hygiene, Dr Krahenbuhl said that about 150 new cases of leprosy were diagnosed in the US every year. In total, about 6,500 people currently have leprosy, with about half needing active medical management. He called for greater awareness of leprosy among American doctors.

Another leprosy specialist Dr David Scollard, said, “Although this disease is not common, it’s also not gone.”