Photo: Mercedes Sayagues/PlusNews

JOHANNESBURG,  – Cervical cancer is a leading killer among women living with HIV, but a low-cost screening programme developed in Zambia is proving that simple techniques can go a long way in saving lives.

New research presented this week at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco has shown that cervical cancer screening among HIV-positive women prevented one death for every 32 women screened.

Presented by Dr Groesbeck Parham of the University of Alabama at Birmingham, the research originated from a pilot study of about 6,600 HIV-positive women examined as part of the Cervical Cancer Prevention Programme in Zambia (CCPPZ), an ongoing low-cost screening project. More than half the women had abnormal results, and about 20 percent were diagnosed as having lesions at varying stages from pre-cancerous to advanced cancer.

According to the World Health Organisation, cervical cancer – which is caused by the human papilloma virus (HPV) – is the second biggest cause of female cancer mortality worldwide.

It is thought that women living with HIV are at a higher risk of cervical cancer, but the number of women being screened for the cancer remains low, especially in developing countries.

In Zambia, cervical cancer is the biggest gynaecological burden we have, and the numbers of doctors that are equipped to handle it are few.

Results raising awareness

Dr Mulundi Mwanahamuntu, CCPPZ co-director alongside Parham, said screening was virtually nonexistent before the programme was set up.

“The [cancer] was still found, but usually at a stage where it was untreatable,” he told IRIN/PlusNews. “In Zambia, cervical cancer is the biggest gynaecological burden we have, and the numbers of doctors that are equipped to handle it are few.”

He said the programme had helped propel cervical cancer onto the national health agenda, and had prompted high-level discussion about the possible introduction of the HPV vaccine in the public health sector.

Screening by the programme’s service costs about US$1 as compared to pap smears that cost about $15 and remain prohibitively expensive even in richer countries like South Africa. To keep costs this low, the programme enables health workers and nurses to carry out screening and treatment, allowing doctors – already in short supply – to perform other tasks.

The technique has been implemented nationally by training staff members at organizations like the Marie Stopes clinics for women’s health, and the Zambian armed forces., including Botswana, Tanzania and Cameroon, which have sent delegations for training.

The benefit of early cervical cancer screening seems to be undeniable, but Mwanahamuntu said questions remained as to how the cancer progressed in HIV-positive women, and how women at different clinical stages of HIV reacted to treatment for cervical cancer.

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Photo: Brennon Jones/IRIN

More milk and meat will come at a high cost

JOHANNESBURG,  – Did you know that 70 percent of all newly emerging infectious human diseases originate in animals? The links between diseases, livestock and climate change are raised in the flagship annual report of the UN Food and Agriculture Organization (FAO), which put the spotlight on livestock.

“What is more uncertain is to exactly what degree heat [from global warming] affects the biology of animals and the promotion of new diseases,” said the report. FAO did its last comprehensive review of the livestock sector in 1982.

The researchers underlined that the question of how climate change would alter the already “fragile relationship” between human beings and livestock was “fraught with uncertainty”.

About 70 percent of the world’s 1.4 billion “extreme poor” – people earning less than US$1.25 per day – are known to depend on livestock for their livelihood.

The livestock population is exploding as demand for meat and milk products grows in developing countries – by 2007 developing countries had overtaken developed countries in meat and egg production, and were closing the gap in milk production, the report said.

What is more uncertain is to exactly what degree heat [from global warming] affects the biology of animals and the promotion of new diseases

To meet rising demand, global annual meat production is expected to expand from 228 million tons to 463 million tons by 2050, with the cattle population estimated to grow from 1.5 billion to 2.6 billion, and that of goats and sheep from 1.7 billion to 2.7 billion, according to FAO estimates.

“During the early stages of intensification of livestock production, large-scale livestock production units tend to be established near to growing urban centres, which places large livestock populations in close proximity to large human populations.”

The report noted that city residents in poor countries often kept livestock in cramped and unsanitary conditions close to their homes. “This can foster the emergence and spread of diseases affecting both animals and humans.”

Highly infectious diseases that originated in animals, such as severe acute respiratory syndrome (SARS) and the influenza caused by the A (H1N1) virus have recently hit the headlines.

Vaccines and effective treatments might not be available, the report pointed out, and some diseases, such as rabies and new variant Creutzfeldt-Jakob disease, a degenerative neurological disorder, were incurable.

“Vaccination, for example, is relatively simple to apply in large, intensively managed flocks and herds, but tends to be much less cost-effective in small-scale systems because of the costs of delivering it to many small production units.”

Small-scale livestock farmers did not always understand the immediate benefits of vaccination drives, and the report underlined the need for strong awareness campaigns to inform communities of new or emerging health threats and how to spot them.

FAO called for urgent measures, such as beefing up surveillance systems by involving villagers and animal health workers, and the development of animal-health protection tailored to local circumstances. It also recommended stronger collaboratsion between national and international animal health and food safety authorities.

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Photo: Adel Yahya/IRIN

There are an estimated 250,000 people displaced by the five-year intermittent war

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SANAA,  – Government officials and aid workers are gearing up to carry out humanitarian needs’ assessments in previously inaccessible areas, thanks to an 11 February truce between Yemen’s army and Houthi rebels in the northern province of Saada which appears to be holding.

“Once security conditions allow it, a comprehensive needs’ assessment will be carried out in all war-affected districts,” Pratibha Mehta, the UN resident coordinator in Yemen, told IRIN.

“This [the ceasefire] will enable humanitarian assistance to reach civilian populations who have been cut off from services since the outbreak of the sixth round of fighting in August 2009,” she said.

Aid workers and local government officials are keen to make the most of the calm, but the track record of such ceasefires is not good, and helping the 250,000 internally displaced persons [IDPs] – scattered in several camps or staying with relatives – is difficult.

According to Saada Governor Taha Hajer, the ceasefire would help the government reconstruct Saada and allow IDPs to return to their homes. “We should put the tragic past [six months of fighting] behind us.”

Photo: Adel Yahya/IRIN

According to aid workers and analysts, IDPs will be dependent on humanitarian aid for some time after the truce, if it holds

“Fragile”

But analyst Mohammed al-Dhahri, a Sanaa University political scientist, told IRIN the truce was “fragile because it was not built on resolving the real causes of the problem”.

“The government should go beyond calming the situation to looking at the real causes of the five-year-old war and working on addressing them if it wants the truce to remain in effect.”

He believed Houthi fighters had little option but to agree to a ceasefire because they had run out of supplies, and that they would use the calm to regroup and launch fresh attacks – and he did not think the plight of IDPs had been a consideration in the ceasefire.

“The government might have faced pressure by the international community at the London conference earlier this month to stop waging a war that was getting more and more complicated without any indicators of victory,” he said.

Six conditions

The government has forced the rebels to agree to six conditions: their withdrawal from official buildings; the reopening of roads in the north; the return of weapons seized from military and security forces; the release of all military and civilian prisoners, including Saudis; a pledge not to attack Saudi territory; and the abandoning of military posts in the mountains.

“We willingly accepted all the ceasefire conditions to stop bloodshed and alleviate the suffering of civilians affected by the war,” Houthi spokesman Mohammed Abdussalam told IRIN.

He said the rebels had abandoned their strategic positions, withdrawn from the perimeter of Saada airport, had begun dismantling roadblocks and were in the process of handing over Saudi prisoners of war to chief mediator Ali Karsha, a reputed tribal leader from the war-torn governorate.

Photo: Adel Yahya/IRIN

Mazraq IDP camp one in Hajjah Governorate is home to some where 20,000 displaced people. It is uncertain when they will leave and where they will go

Sceptical

Al-Dhahri was sceptical about IDP returns: “It is too early for IDPs to think about returning home… They need to wait for months or years until the sedition is completely exterminated.”

He recommended that IDPs remain in camps so as to be easily accessible by aid agencies. “Many of them lost their homes and livelihoods to the fighting and it will be difficult for them to cope when they return home,” he said.

Post-conflict calm phases can lead to the mass movement of people – either returning home or heading to the main cities where services and humanitarian aid are available, Rabab al-Rifai, spokesperson for the International Committee of the Red Cross, told IRIN. “People will be dependent on humanitarian aid for some time.”

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