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Archive for May 19th, 2011

IMF Chief has resigned due to sexual assault and attempted rape charges

Posted by African Press International on May 19, 2011

WASHINGTON – France’s Dominique Strauss-Kahn chose to resign Thursday as managing director of the International Monetary Fund.

In a statement issued he says, “It is with infinite sadness that I feel compelled today to present to the Executive Board my resignation from my post of Managing Director of the IMF,”. and continues; “I want to say that I deny with the greatest possible firmness all of the allegations that have been made against me,”.

He is jailed in New York awaiting a grand jury decision on whether to indict him.

The complainant is an African West African woman 32 year-old who works Manhattan hotel who alleges she was sexually assaulted.

He still maintains his innocence.

By Chief editor Korir

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Kenya: Is a life-saving mask too much to ask?

Posted by African Press International on May 19, 2011

KENYA: For want of a mask – how TB targets health workers

Is a life-saving mask too much to ask?

NAIROBI, 17 May 2011 (IRIN) – Peter*, a lab technologist at a government-run health facility in the Kenyan capital, Nairobi, recently took the last dose of his six-month course of tuberculosis medicine; he is fairly sure he contracted the disease at work.

“This is a big facility and we come into contact with many patients infected with TB – it is by no accident that I got infected,” he told IRIN. “As health workers, we can’t escape coming into contact with people with highly infectious diseases like TB because it is our work to help them.”

Kenya ranks 13th on the UN World Health Organization’s (WHO) list of 22 high-burden TB countries globally, and has the fifth-highest burden in Africa. According to WHO, the country has more than 130,000 new TB cases every year.

Safety equipment – including protective masks and proper waste disposal facilities – are rarely available in rural centres, something health workers say must be addressed urgently.

According to Victor Were, a clinical officer in western Kenya’s Mumias town, over-crowded and poorly ventilated clinics pose a big risk to health workers.

“We don’t have protective gear and only one hospital in Mumias has proper waste disposal facilities where they incinerate their medical waste,” he said. “We have about 40 TB health workers in Mumias – we don’t regularly screen them for TB, but last year four who presented with signs of the disease were tested and treated.”

Were said the government urgently needed to address the issues of training health workers on risk reduction, provision of masks and ensure proper ventilation or even outdoor clinics to reduce the risk of infection.

“Many health workers are bogged down by heavy workloads and therefore even those who are infected [with TB] stay for long without treating themselves and by the time they do, they might have infected quite a number of people, including their colleagues,” said Andrew Suleh, medical superintendent of Nairobi’s Mbagathi District Hospital.

Supply chain problems

Government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear.

“Health personnel cannot stop treating or offering services to patients even without these [safety] commodities and during that time, they risk getting infected by the very patients they treat, so it is [down to] us as the government to ensure facilities don’t run out – at times stock-outs do occur and this is due to procurement challenges, which makes it hard to expedite the delivery of these commodities to health facilities,” said Joseph Sitienei, head of the National Leprosy and TB Control Programme. “Sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out.

“One cannot ignore the financial challenges faced at times and they do lead to stock-outs, but we have seen increased funding to the health sector recently and I hope this will soon change for the better,” he added. “What we have started doing is to make waiting areas in health facilities well ventilated, making the consultation rooms more spacious, and of course providing protective masks… the government is streamlining procurement and supply of commodities including protective gear to health facilities.”

According to local NGOs, corruption within the health system is also to blame for the haphazard availability of medical supplies, with drugs often ‘disappearing’ from government health facilities and sold to private pharmacies by government pharmacists.

Sitienei noted that the risk of TB infection ran both ways between patient and health worker, and the government encouraged “frontline” staff such as nurses and lab technologists to regularly test for TB and if found positive, to seek treatment immediately.

“Also, availability does not always translate to use – we have to constantly sensitize personnel on the need to use the protective gear,” he said. “To reduce stigma, it is also important – we have done this – to sensitize patients too on why those attending to them must have a mask, for example.”

He said that to reduce health facility-related infection, isolation wards were being established in health centres that attended to large numbers of TB patients.

In November 2010, WHO, UNAIDS and the International Labour Organization launched international guidelines to protect health workers against HIV and TB. Among the recommendations were development and implementation of free regular TB and HIV screening, free HIV and TB treatment for infected health workers and the incorporation of training for all health workers on HIV and TB prevention, treatment, care and support into existing training programmes. 

*Not his real name

ko/kr/mw source

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South Africa: Long road to free treatment

Posted by African Press International on May 19, 2011

SOUTH AFRICA: Ten years of HIV treatment – a look back

Long road to free treatment

KHAYELITSHA, 17 May 2011 (PlusNews) – Ten years ago, Khayelitsha, in Cape Town, was the first place to make antiretroviral drugs available to the public sector, marking a milestone in the beginning of the end of AIDS denialism and the fight for treatment in South Africa.

With more than half its population unemployed, Khayelitsha is one of South Africa’s largest and fastest-growing townships, and home to one of the highest burdens of HIV and TB infection nationally and globally. In 2009, antenatal HIV prevalence was 30 percent and the case notification rate for TB was at least 1,500 per 100,000 people annually – among the highest estimated TB incidence rates in the world.

Alarming as those figures may be, Khayelitsha is a beacon of hope for the AIDS epidemic in South Africa, where the provision of ARVs had been fraught, marked by a bitter stand-off between AIDS activists and government over the slow pace of the rollout.

“It was scary back then [in the late 1990s]. No one would say ‘I’m HIV positive’. It was very stigmatized,” recalled 42-year-old Xoliswa Liba. An estimated 80,000 of Khayelitsha’s population of 500,000 are HIV-positive. Liba tested positive in 2006.

“At first, I wouldn’t have even spoken to you about my status. But as time goes on and I’m around people who are HIV-positive and we talk about it, it’s become easy for me to say I’m HIV-positive,” Liba told IRIN/PlusNews.

The Khayelitsha story

“I rushed to Khayelitsha … expecting everyone speaking about HIV, everybody dealing with HIV, people in the streets, pamphlets being distributed. But actually it was total silence,” recalled Eric Goemaere, medical coordinator for Médecins Sans Frontières (MSF) in South Africa, describing his first days in the township in 1999.

Goemaere, who was supporting a provincial pilot programme preventing mother-to-child-transmission of HIV, was shocked to discover it ran in a “semi-clandestine” manner because of government denialism.

“ARVs were not available before 2002, so people used to die in high numbers. There was much denialism – also from the government’s side if you remember,” Monde Kenneth Hobongwana, 37, who tested positive in 2008, said.

After a two-year struggle to gain permission from pharmaceutical patent-holders to use generic drugs without government involvement, in May 2001 the first patient in Khayelitsha received antiretroviral therapy through an MSF-supported pilot programme.

In 2002, MSF’s treatment programme had 180 slots. That number grew to 400 by the end of the year. In 2004, the national government finally came on board with free treatment for anyone whose CD4 count was below 200.

Stigma and adherence

In 1998, Khayelitsha conducted 450 HIV tests, and ART was not available to the public sector. In 2010, 55,000 HIV tests were done, and nearly 20,000 people now receive ART. Under the current guidelines of a 200 CD4 count treatment threshold, 75 percent coverage has been achieved.

Those numbers are attributed first to the availability of treatment, but also to the tremendous awareness-raising efforts spearheaded by the Treatment Action Campaign (TAC), which has led the fight for HIV prevention and treatment since 1998. It clashed with the government – particularly former President Thabo Mbeki and former Health Minister Dr Manto Tshabalala-Msimang on numerous occasions during their nine-year tenure – most notably during a Constitutional Court battle that eventually compelled the health department to provide ARVs to HIV-positive pregnant women to prevent mother-to-child transmission.

 “I remember there was a stigma in our communities [attached] to the people living with HIV. They would insult their neighbours, calling them names, all kinds of bad things. I think it’s getting more normal now. People are more open with their status,” said Abongile Tikolo, 25, who tested positive in 2009.

“If you have a very good support system you can survive HIV. When you’re sick and you see these people around your bed … you have something to live for,” commented Liba, who slipped into a coma almost immediately after her diagnosis.

Liba, who became a TAC peer educator, said TAC’s awareness-raising campaigns, which include household visits to educate community members, as well as educational workshops for HIV-positive people, have changed what it means to be HIV-positive in Khayelitsha.

“Here people know their rights and they talk openly about their status,” agreed Nonqaba Jacobs, 28, originally from the Eastern Cape, who tested positive in 2004.

TAC also emphasizes the importance of disclosing one’s status. Tikolo said his disclosure to his family helped him stick to his treatment. “Sometimes they remind me when it’s time to take my pills: ‘It’s 9 o’clock, have you taken your pills?'”

The way forward

“Up to now, [the challenge was] to get people to survive,” Goemaere told IRIN/PlusNews. “Challenges for tomorrow are mostly two-fold: keep the ones treated on treatment, and to have an impact at the population level: meaning reduce incidence of both HIV and TB. But the one will go with the other.” Seventy percent of TB patients in Khayelitsha are also HIV-positive.

Goemaere explained that treatment probably remained the best prevention method. “It’s the best-known way today to reduce HIV incidence, all other things being equal. Once their viral load is undetectable, they are hardly contagious,” Goemaere explained.

Meanwhile, MSF and TAC have targeted men and the young as the population gaps in treatment. MSF is piloting two youth-specific family planning/HIV clinics with outreach activities, including testing in schools, and a walk-in clinic offering testing for sexually transmitted diseases and HIV for men. Goemaere says the latter is the most popular testing unit for men in the township.

Though the challenges are still immense, hope is palpable. Norute Nobola, 47, said: “I was very sick and sad. I was lonely, black in my eyes, I was telling myself my life was over. Now I’m 10 years on treatment, I’m not scared and I feel strong.”

lm/kn/mw source

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Dengue is endemic in Cambodia

Posted by African Press International on May 19, 2011

CAMBODIA: Dengue officials brace for “nightmare season”

Dengue is endemic in Cambodia

PHNOM PENH, 17 May 2011 (IRIN) – As Cambodia enters its dengue season, with outbreaks in four out of 24 provinces, the National Dengue Control Programme (NDCP) is warning that a repeat of the 2007 epidemic – when about 40,000 people were hospitalized, more than 10,000 in one week – may be imminent.

“Based on my experience, I see the same pattern as 2007 emerging now,” said To Setha, a vector control specialist at the NDCP, pointing to the higher number of cases than usual during the final months of last year and the first two months of this year.

Rekul Huy, chief of epidemiology at the NDCP, is also alarmed by the high number of cases during months when dengue is usually rare.

A change in the serotype of the virus (which has four) from DEN2 to DEN1 detected in the middle of last year also concerns him, as does the increase in the percentage of patients with dengue hemorrhagic fever (DHF) in the first four months of this year: from about 50 percent last year to two-thirds this year.

An increase in DHF patients signals the possible presence of a new serotype, he said.

In Cambodia, where dengue is endemic, the number of cases spikes in June and July – a period NDCP director Ngan Chantha refers to as the “nightmare season” – with major outbreaks occurring in three- to five-year intervals.

Chantha said the number of cases at the beginning of this year had reached the “alert” level, signalling a possible nationwide outbreak during the rainy season.

This year, however, his department faces severe financial constraints to implement the swift interventions necessary to contain local outbreaks before they spiral out of control as in 2007.

Funding shortfalls and data gaps

The Asian Development Bank, which contributes about three-fifths of the NDCP’s less than US$500,000 annual budget, has yet to disburse the funds, while the decentralization of health services that began in 2008 has left the NDCP’s 12 staff unclear about what many of their provincial counterparts are doing.

Furthermore, there has been only one test so far this year to detect the prevalent serotype, according to Huy. Testing is not conducted at the hospitals where most dengue patients are treated, which are run by a Swiss foundation that offers free treatment for children and a high level of service but operates outside the state-run system.

National officials do not even know where or when the larvicide Abate, their primary preventative tool, is being distributed because it is now held by provincial officials, Huy said.

Steven Bjorges, team leader of the malaria and vector-borne diseases department of the World Health Organization (WHO) in Cambodia, explained that the high turnover of officials at the provincial level meant that in some provinces they lacked experience in preventing or containing outbreaks.

“Everyone likes decentralization, but the adverse consequences can perversely result in less optimal public health outcomes,” he said.

He is, however, less alarmed than officials at the NDCP that a repeat of the 2007 epidemic is imminent because there have been fewer cases reported nationwide this year than last. “But that could change next week,” he added.

Bjorges agreed that the chronic lack of funding undermined the NDCP’s efforts to prevent or contain outbreaks.

“We’re begging for funds year after year. If the dengue programme could get sustained, even limited funding, for a long period, it could accomplish so much more,” he said.

“Foreign funding of public health in Cambodia is often not directed at the primary health needs of Cambodians, and it sometimes distorts the delivery of services,” Chantha said. “What is more alarming than a dengue outbreak is the lack of funding to deal with it.”

Prevention tools

The NDCP has been trying to expand its most successful project for preventing dengue for the past four years, using guppy fish to get rid of the larvae of the mosquito that transmits dengue from water storage containers. In the 16 villages where this project has been operating since 2004, there have been no outbreaks, Setha said.

The small amount of funding to expand the project, which costs about $1 per household a year to maintain, has been restricted to either one- or one-and-a-half-year grants, which have been insufficient to allow for its sustainability in other villages, he said.

It takes about four years for a health centre and its surrounding villages to develop the physical and social infrastructure needed to sustain it, he said.

vm/ds/mw source

Posted in AA > News and News analysis | Leave a Comment »


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