The performance of national medical supply agencies should be monitored. Uganda’s Auditor General has produced a report on the country’s National Medical Stores (NMS) that has some disturbing findings. NMS has, for example, often run short of malaria drugs but, within the last year, has purchased supplies of the anti-ulcer drug Ranitidine sufficient to last 27 years. (This drug has a shelf-life of 2-4 years.)

The report, discussed in detail in a New Vision article, concluded that wastage of expired drugs at NMS is at an unacceptable level, while poor procurement policies result in “perennial stock-outs” of the most needed treatments, especially antimalarias.

How can drug supplies in the world’s poorest countries be better managed? Clearly, it is an area where research is needed.

A large proportion of the drugs available in developing countries are fake or substandard. A report from Associated Press describes the launch in Nigeria of a system that will allow patients with mobile phones to find out whether a drug is genuine.

“mPedigree” assigns a unique code to genuine malaria medicines, printed on the back of medicine blister packs under a sheet that is scratched off like a lottery ticket. Customers send a text message to a central hot line with the code and get an “OK” response telling them if the drug is registered.

The Nigerian government has adopted the system for antimalarials but intends extending its use to other drugs.

mPedigree is another example of the use of mHealth (mobile phones for health), a topic that has often been discussed in articles in:
TropIKA.net and
the TropIKA.net blog

The imprisonment of two Kenyans, for failing to take their tuberculosis treatment is a worrying development. (The news story from Associated Press does not make it clear whether these are cases of drug-resistant TB or whether they are only being given standard TB treatment.)

Many TB patients fail to take their full course of treatment. This is indeed one of the biggest barriers to effective TB control programmes. It also increases the rate of development of drug-resistant strains. But would there be enough room in the prisons in high-TB-burden nations like Kenya to accommodate all the non-complying patients?

There has to be a better way.

New funding for tuberculosis research in Singapore will be devoted to the search for novel biomarkers that could allow early identification of individuals at risk of disease development and reactivation.

A report on Xinhua News says that Singapore’s Agency for Science, Technology and Research (A*STAR) is providing US$2.2 million to establish a joint laboratory with bioindustrial group Institut Merieux where the research will be conducted.

“We cannot expect the United States and the United Kingdom to shoulder the entire financial burden of global NTD control. The world’s emerging market economies and the nations of the Gulf Cooperation Council must now step up and share this commitment.”

The always outspoken Editor-in-Chief of PLoS Neglected Tropical Diseases says that, while the US and UK have increased their funding for the control of neglected tropical diseases (NTD), other countries are still doing very little.

Not only the developed nations but emerging economies and disease-endemic countries themselves should, according to Hotez, join the fight against these infections. He divides the countries that need to do more into the following categories:

The remaining G8 countries and richest European countries
The ‘BRIC’ countries (Brazil, Russia, India, China and certain other Asian nations) - for their indigenous NTDs
Nigeria, Indonesia, and other emerging market economies - for their indigenous NTDs
China should support NTD control in sub-Saharan Africa
Gulf nations should support NTD control in poor Islamic nations

He also calls for private, philanthropic donors to extent their support for NTD control.

TropIKA.net reader Urbà González has written to alert us to a new study [1] she has conducted with her colleagues at the Research Unit for Evidence-Based Dermatology, Hospital Plató, Barcelona, Spain. Their topic was treatments for cutaneous leishmaniasis (CL), which is considered to be one of the most neglected and serious parasitic infectious skin diseases in many developing countries.

A number of treatment trials have been conducted, both for Old World CL and for New World cutaneous and mucocutaneous leishmaniasis. These trials have been included in two Cochrane reviews [2,3]. However, the Hospital Plató team examined the trials further and found many methodological weaknesses. For example, many of the trials claiming to be randomised are inadequately reported, in that the methods used to generate the randomisation sequence and for concealing allocation are not given. Some of the trials were not blinded. Many studies did not carry out original assigned group analyses.

Such failings lead to bias and cast doubt on the reliability of trial findings. Urbà González and her colleagues have, therefore, proposed guidelines for authors who intend to conduct clinical trials aimed at the development of effective therapies in cutaneous leishmaniasis.

Hopefully, these guidelines will be adhered to in future research on CL treatments. Existing treatments for this dreadful condition are of limited effectiveness, with a risk of serious adverse effects. It is important that new treatments should be developed and evaluated in rigorously conducted trials in which bias is minimised.

The research has been published in Clinical Infectious Diseases, which is not an open access journal. A subscription to the journal is therefore required to read the full paper.

Reference
1. González U, Pinart M, Reveiz L, Rengifo-Pardo M, Tweed J, Macaya A, Alvar J (2010). Designing and reporting clinical trials on treatments for cutaneous leishmaniasis. Clin Infect Dis; 51(4):409-419. Abstract available here.
2. González U, Pinart M, Reveiz L, Alvar J 2008. Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev; 4:CD005067.
3. González U, Pinart M, Rengifo‐Pardo M, Macaya A, Alvar J, Tweed J (2009). Interventions for New World cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev; 2:CD004834.

Maasai vets in East Africa are using mobile phones to monitor diseases - including zoonoses, such as anthrax and rabies - as part of a partnership involving London-based academics.

The Google mobile phones are helping to record how diseases are spreading in order to bolster preventative action, including vaccination campaigns. The new project in rural Kenya is led by the charity Vetaid and is backed by Google UK, which has donated 23 G1 Android devices to the surveillance effort. Data relating to more than 86,000 animals from 1,600 farms has already been logged via the mobile phones in the last month.

More details are available in a news story from the London International Development Centre.

Kenya’s Standard newspaper reports on the official launch of trials there of a potential new TB vaccine. The vaccine is intended to be used to boost immunity levels in children who have already received the BCG vaccination.

The Kenya Medical Research Institute (KEMRI) and the American funded Centres for Disease Control (CDC) will conduct the Kenyan trial in partnership with the Global TB Foundation. Further trials of the vaccine are taking place in South Africa, Mozambique and Uganda.

Dr Kayla Laserson of KEMRI said 192 children would be vaccinated over the next 12 months, all of them in Siaya District in the southwest of Kenya, which is believed to have the country’s highest TB infection rate.

Kenya is the first country in sub-Saharan africa to achieve global targets for case detection and treatment success.

The Head of the Communicable Disease Section of the Philippines Department of Health says that multi-drug-resistant tuberculosis (MDR-TB) has become the biggest threat to TB control in the country. Dr Sancho urged TB patients to complete their full course of medication to reduce the chance of MDR-TB developing.

Dr Enrique Sancho added that while TB drugs were provided free by the government, it did not provide medicines for MDR-TB: “Four percent of regular TB cases become MDRTB and complete treatment duration for these patients requires 18-24 months with multitude of drugs given that are more expensive and not part of the government’s free anti-TB medicines”.

At present MDR-TB treatment is available in only two centres in the Philippines, one in the capital Manilla and one in Cebu Province.

Further information in the Manilla Bulletin.

There are still no effective vaccines available for many of the infectious diseases of poverty, but recent advances in knowledge of pathogen genomics and of innate immunity have provided new opportunities. Progress is already being made. The situation will be reviewed in a meeting at the UK’s Royal Society, London, 15-16th November 2010.

The meeting is being organized by two distinguished professors - Adrian Hill and Brian Greenwood. Speakers include: Professor Shizuo Akira, Dr Martin Bachmann, Dr Rana Hajjeh, Professor Keith Klugman, Professor Margaret Liu, Dr Julian Lob-Levyt, Dr Gary Nabel, Sir Gustav Nossal, Professor Albert Osterhaus, Professor David Paton and Dr Rino Rappuoli.

The meeting is intended for researchers in relevant fields and is free to attend, but pre-registration online is essential. A small number of scholarships are available to scientists from, and resident in, a developing country who have contributed to some aspect of vaccinology and who intend to continue to work in this area.

Further information is available here.