There’s no magic bullet for wiping out malaria, but a new study offers strong support for a method that effectively delays the evolution of drug resistance in malaria parasites, a University of Florida researcher says.

David Smith, associate director of disease ecology at UF’s Emerging Pathogens Institute, said the study will guide scientists and policy makers in extending the longevity of current artemisinin-based malaria drugs combined with partner drugs. Smith is a co-author of a report on the study, scheduled to publish online this week in the Proceedings of the National Academy of Sciences and in print on Sept. 16.

Smith collaborated with lead author Maciej Boni of Resources for the Future and Princeton University, and Ramanan Laxminarayan, also with RFF, to create mathematical models assessing the strategic effectiveness and clinical outcomes of using one, two and three first-line drug therapies to treat malaria within a population over a 20-year period. Their results show that using two or three drugs simultaneously reduced the total clinical cases and number of failed treatments , and slowed the rate at which drug-resistant genes spread within the parasites that cause malaria: Plasmodium falciparum, P. vivax, P. malariae and P. ovale.

"The models indicate that we can slow the evolution of resistance to current artemisinin-based therapies if nations use them in combination with two or more partner drugs," Smith said. "Currently, most nations don’t do this. They use one therapy at a time, wait for it to fail, and then switch to a different therapy."

Artemisinin-combined therapies, or ACTs, are currently not widely implemented due to operational challenges and expense, Smith said. But he said the study offers compelling evidence for global leaders to collaborate and overcome these issues.

"This is not to say that implementing multiple first-line therapies solves all of our malaria problems," Boni said. "Anti-malarial drug development needs to continue so that we have novel and highly effective anti-malarials that can be plugged into the recommended strategy of deploying multiple therapies."

In the past century, chloroquine and sulfadoxine-pyrimethamine were widely used to combat malaria, but the parasites eventually evolved resistance leading to the drugs’ failure. Artemesinin drugs, derived from the herb Artemisia annua, are relatively new and the malaria parasite does not yet appear to have a resistance to it. They work by triggering chemical reactions which damage the Plasmodium parasite.

"We don’t have anything in the pipeline after ACTs, and it’s basically just a matter of time until drug resistance evolves and artemisinin also fails," Smith said. "So the question becomes how do we keep ACTs in our arsenal for as long as effectively possible?"

The researchers’ models also show that cycling through single drugs accelerated the rate at which malaria parasites evolved drug resistance. Smith said this occurred because cycling a single drug degraded the parasite’s average fitness, which made it easier for drug-resistant genes to spread throughout the parasite population.

The cycling models predicted a declining therapeutic value of a single drug within 3.54 years, versus a longer effective therapeutic value of 9.95 years when three drugs were used in equal proportions within a population. The research was funded in part by grants from the Bill and Melinda Gates Foundation, and the National Institutes of Health.

"Using multiple first-line drugs reduces the selection pressure for resistance to a single drug," Smith said. "This is one way to make the ACTs last longer and benefit more people."

Co-author Laxminarayan, a senior research fellow at RFF, said ACTs are the best treatment option for malaria, now as well as in the foreseeable future.

"Novel treatment strategies improve our ability to delay the emergence of drug resistance without the need to deny treatment," Laxminarayan said.

Wil Milhous, associate dean for research at the University of South Florida’s College of Public Health, said the research is "clearly a superb breakthrough in mathematical modeling applied to malaria drug deployment." Milhous has worked to develop new drugs for malaria for more than 25 years and is unaffiliated with the study.

"We have done the math in drug development, but only in terms of the cost of goods for drug combinations to include advanced preclinical and clinical testing. These are extremely time-consuming and costly but critical to regulatory approval," Milhous said. "Now we have a highly quantitative reality check that poor implementation strategies doom drugs to failure."

In work that could lead to new ways of detecting and treating malaria, MIT researchers have used two advanced microscopy techniques to show in unprecedented detail how the malaria parasite attacks red blood cells.

The researchers’ images show red blood cell membranes becoming less flexible, which causes the cells to clump as they try to navigate tiny blood vessels. They also show the destruction of hemoglobin, the critical molecule that red blood cells use to carry oxygen.

The images are made possible by microscopy techniques that reveal tiny vibrations in red blood cell membranes.

"By studying the way the cell membrane vibrations progressively change as the malaria parasite matures inside the cell, we can study the changes in its mechanical, elastic and dynamic properties," said Michael Feld, director of MIT’s George Harrison Spectroscopy Laboratory and a professor of physics.

Feld and Subra Suresh, dean of MIT’s School of Engineering, are senior authors of a paper on the work to be published in the Proceedings of the National Academy of Sciences the week of Sept. 1.

The study establishes the first experimental connection between cell membrane vibration and the pathological state of a living cell.

"You can establish a measurement of membrane-fluctuation changes as a function of the gradual progression from a healthy state to a severely pathological state," said Suresh, who has appointments in materials science and engineering, biological engineering, mechanical engineering and the Harvard-MIT Division of Health Sciences and Technology.

It has been known for more than a century that red blood cell membranes continuously undulate. These vibrations are difficult to study because the measurements involved are so tiny (nanometer, or billionth of a meter, scale), and occur in just microseconds.

Suresh and colleagues have previously shown that the cell membranes of red blood cells invaded by the malaria parasite lose their elasticity, as proteins transported from the parasite attach to the membranes and make them significantly stiffer.

In the new paper, the researchers describe using a technique called diffraction phase microscopy to image living cells over the first 48 hours of malaria parasite maturation inside the cell. They showed that infection reduces elasticity and decreases the vibration frequency of the cell membrane.

The team also used a technique called tomographic phase microscopy, which was developed in Feld’s laboratory and is based on the same concept as a CT scan: To create a 3D image, the researchers combine about 100 two-dimensional images taken from different angles. Those images are produced with a technique known as interferometry, in which a light wave passing through a cell is compared with a reference wave that doesn’t pass through it.

The technique allowed them to study changes in the refractive index of a cell, which is a measure of how much the speed of light is reduced as it passes through the material.

Images generated by tomographic phase microscopy revealed the degradation of hemoglobin as the malaria parasite interacted with the cell.

In the future, the microscopy technology could be used to develop a diagnostic tool that would detect malaria or other human diseases by measuring cell membrane properties. It could also be used to test the efficacy of potential drugs.

The current project got underway about two years ago, after Suresh gave a talk at the Spectroscopy Laboratory on his work studying the mechanical stiffness of malaria-infected red blood cells. Feld and his colleagues were already working on microscopy techniques to visualize red blood cells, so the groups decided to collaborate.

"This project brought physics, engineering, materials science, and cell biology all to bear on a problem of infectious disease," said Suresh.

Lead authors of the paper are YongKeun Park, a graduate student in the Harvard-MIT Division of Health Sciences and Technology, and Monica Diez-Silva, a microbiologist trained at Institut Pasteur and currently a postdoctoral fellow in the Department of Materials Science and Engineering (DMSE). Other authors are Gabriel Popescu, now at the University of Illinois at Urbana-Champaign; George Lykotrafitis, a DMSE postdoctoral fellow; and Wonshik Choi, a postdoctoral associate in the Spectroscopy Lab.

 The South African government is poised to change its regulations for medications, allowing appeals against approvals on unscientific grounds and giving the health minister final say on new treatments.

Opponents say the amendment will strike a blow to evidence-based scientific evaluation of medicines, giving political views precedence over safety and necessity.

The Parliamentary Portfolio Committee on Health approved the Medicines and Related Substances Amendment Bill this week (25 August), which will create a new regulatory authority to replace the 43-year-old Medicines Control Council that currently oversees new medicines entering the market.

The legislation will allow the health minister to make a final decision on all new medicines and potentially pass treatments that have not undergone full scientific testing.

The minister can decline to register products which have passed clinical trials, says Ruth Rabinowitz, an opposition health committee member, calling the legislation ’’counterfeit".

The amendment will also introduce an appeals process, whereby any person can oppose the approval of a medicine.

Announcing the bill, James Ngculu, chairperson of the portfolio committee, argued that though some medications might work for individuals, they might be bad for communities, and people had the right to object to medicines on unscientific grounds.

Thami Mseleku, director-general of South Africa’s health department, claimed the measure would empower members of public to challenge medical decisions on political and economic grounds.

But Mike Waters, health spokesman for opposition party the Democratic Alliance, says the legislation has "opened a can of worms," and created a "bureaucratic nightmare".

Vicki Ehrich, chief operating officer of the Pharmaceutical Industry Association told SciDev.Net that they "strongly advocated" to the portfolio committee that the registration of medicines should be based only on safety, quality and effectiveness and are now "greatly concerned" that this has been replaced by an appeals process.

"This is contrary to our stance that registration should be separate from such considerations," she told SciDev.Net.

"A further concern is that the appeals process itself could be abused and used to delay entry of products to market, for example by competitors."

Abieda Williams, of the Pharmaceutical Industry Association and who testified against the proposals, says the amendment is modelled on a Brazilian system, which led to "significant delays" in medicine approval. As a result, she says, citizens in urgent need of medications that lack approval are suing the Brazilian government.

The bill is expected to be passed into law by the full parliament when it reconvenes in September.

Nongovernmental organisations the Treatment Action Campaign and the AIDS Law Project, acting on behalf of South African HIV patients, say they will take legal action if it is passed. They argue that antiretroviral medications — which the government has opposed in the past — could be blocked

MAKERERE University Medical School is preparing to carry out trials on a malaria vaccine. The African Malaria Network Trust (AMANET) has announced that the GMZ2 vaccine trials will be carried out in Iganga and Mayuge districts.

“Before the end of this year, we shall give the medical school a grant of over 300,000 Euros for capacity building to help them prepare for the trials,” said Prof. Wen Kilama, the managing trustee of AMANET.

The money will be used to train personnel in addition to recruiting and sensitising participants for the trial. Makerere University Medical School is one of the 21 institutions across Africa, which are benefiting from AMANET’s projects.

AMANET is also carrying out trials on three other malaria vaccines. These are: MSP3 LSP in Burkina Faso and Tanzania, AMA1 in Mali and GMZ2 in Gabon.

About 400 people in Uganda die from malaria everyday. The country’s efforts to fight the disease have largely depended on the distribution of insecticide-treated mosquito nets and residual spraying.

However, in May, internal residual spraying in northern Uganda was stopped following a High Court injunction. This was after environmental activists petitioned over the use of the DDT chemical.

While opening the sixth Basic Research Ethics Workshop for African ethics committees at Munyonyo Commonwealth Resort on Monday, health state minister Emmanuel Otaala said: “Our research must be geared towards finding suitable drugs and vaccines for diseases like malaria, tuberculosis and AIDS, which are the main causes of high mortality and morbidity rates on the continent.”

Otaala urged researchers to follow proper ethical practices while carrying out medical trials on human beings.

“There is evidence that some trials have violated the rights of those on whom they are carried out. The poverty in most parts of Africa has made Africans vulnerable to coercion and exploitation by people carrying out medical trials. I urge researchers to protect the participants,” Otaala said.

Kilama also called for the establishment and strengthening of ethics review committees to ensure that medical research participants are well protected.

The Bill & Melinda Gates Foundation announced on 3 September 2008 that it is now accepting grant proposals for Round 2 of Grand Challenges Explorations, a five-year US$100 million initiative to encourage bold and unconventional research on new global health solutions. Proposals for six topics will be accepted online at www.gcgh.org/explorations through November 2, 2008.

Round 2 follow on the heels of the initiative’s first funding round, which closed in May of this year, and generated nearly 4,000 applications from scientists in more than 100 countries. Two new topics are being introduced in Round 2 along with the initial four topics from Round 1.

One of the primary objectives of Grand Challenges Explorations is to involve scientists around the world who do not typically work in global health. This includes those with innovative ideas in Africa, Asia, and other parts of the developing world; people working in the private sector; and young investigators.

The initiative uses an agile, accelerated grantmaking process. Applications are two pages, and preliminary data about the proposed research are not required. In addition, the online application process has been streamlined for Round 2.

The topic areas for which proposals will be accepted in Round 2 are:

1. Create new vaccines for diarrhea, HIV, malaria, pneumonia, and TB.
2. Create new tools to accelerate the eradication of malaria.
3. Create new ways to protect against infectious diseases, including alternatives to traditional vaccination.
4. Create new drugs and delivery systems to limit the emergence of resistance in the disease-causing agent.
5. Create new ways to prevent or cure HIV infection that fall outside current research on vaccines and other biomedical and behavior-change strategies.
6. Explore the basis for latency in TB, with the goal of discovering new ways to identify and eliminate latent infection.

The foundation and an independent group of reviewers will select the most innovative proposals, and grants will be awarded within approximately three months from the proposal submission deadline. Initial grants will be $100,000 each. Projects showing success will have the opportunity to receive additional funding of $1 million or more. Round 1 grants are expected to be announced in October.

Full descriptions of the topic areas and application instructions are available at www.gcgh.org/explorations.

When:
Friday, September 26, 2008 8:00 am - 4:00 pm

Where:
Jurys Hotel Washington
1500 New Hampshire Avenue
Washington, DC 20036
USA

Register at: https://www.regonline.com/builder/site/Default.aspx?eventid=652554

We invite you to a Consultative Forum on the Affordable Medicines Facility-malaria (AMFm) at Jurys Hotel in Washington, DC, on Friday September 26th, 2008.

AMFm is the operational version of the "global subsidy" for malaria drugs first proposed in 2004 by an Institute of Medicine Committee. The purpose of AMFm is twofold: 1) provide widespread financial access to artemisinin-combination therapies (ACTs) and 2) delay the emergence of resistance to artemisinins. AMFm has been approved by the Board of the Roll Back Malaria Partnership and in November, the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria will continue its deliberatations about hosting AMFm.

The purpose of this forum is to discuss the rationale for AMFm, and to explore biomedical, economic and operational challenges related to AMFm.

We would be most appreciative if you could register as soon as possible if you plan to attend. Please forward this invitation to others who you think would be interested in this event. Space is limited but we would like to accommodate as wide a range of perspectives as possible. Attendance at this all-day meeting, including lunch, is free of charge, but you must register in advance.

A webcast of this event is provided by kaisernetwork.org, a free service of the Kaiser Family Foundation and will be available after 9 a.m., September 29th, 2008 at http://www.kaisernetwork.org/healthcast/rff/26sep08.   Along with the webcast, a transcript will also be available.

Sincerely,

Barry R. Bloom
Dean, Harvard School of Public Health
Chair, AMFm Consultative Forum

Ramanan Laxminarayan
Senior Fellow, Resources for the Future

Dates: 23-27 February 2009
Venue: Dar es salaam, Tanzania
Deadline for applications: 31 October 2007

http://www.amanet-trust.org/ext/news/AHRECall2009.html

Background/Rationale

The high disease burden of African countries, the emergence of new diseases, and efforts to address the10/90 gap, have led to an unprecedented increase in health research activities in Africa. In light of the generally poor health delivery systems, the lower levels of education, and poverty of communities and governments, it has become imperative that HRE in Africa be strengthened in order to minimise the risk of unethical research being conducted on the poor populations.

Historically, research participants and research institutions have been exposed to abuse and are inadequately prepared to handle complexities that characterize justice and beneficence desirable for research involving human participants and communities.  This is ever so important in the less developed world where regulatory systems are either very weak or non existent in majority of cases.

Over the next three years, and through a grant from The Bill and Melinda Gates Foundation, AMANET will organize a series of 5 workshops on Advanced Health Research Ethics (HRE) primarily for health investigators and secondarily for Ethics Committee members and policy makers. Since the workshops will be at an advanced level, basic HRE training will be a pre-requisite. The first Advanced HRE workshop was held in Dar es Salaam from 23 to 27 June 2008.

Precedence:

AMANET continues to champion the need for training in biomedical research ethics to various stakeholders of research in Africa. With regard to health research ethics for ethics review committees, the following workshops have been organized by AMANET:

• Workshops on Ethics in Health Research in Africa,  in Kenya (Kisumu, 2001), Ethiopia (Addis Ababa,   2001), South Africa (2002, Pretoria), Gabon, (Libreville, 2002), Sudan (Khartoum, 2003), Cameroon (Yaoundé, 2003), Ethiopia (2007), Ghana (2008) Senegal (in French, 2008), Uganda (2008) and Tanzania (Dar es Salaam, 2005, 2006 and 2007)
• The first Advanced Health Research Ethics Workshop for investigators was held in Tanzania, in June 2008.
• Workshop on Standard Operating Procedures for Ethics Review of Health Research in Africa, 17-21 February 2003, Entebbe, Uganda;
• Workshop on Advanced Ethics in Biomedical Research that Involves Human Subjects, 1-3 December 2004, Zanzibar, Tanzania; and
• Workshop on Protection of Human Research Participants: Writing of Standard Operating Procedures for Ethics Review Committees in Eastern Africa: 29-31 August 2005, Dar es salaam, Tanzania.

Reports on the above activities are available in the various issues of the AMANET Newsletter available online at: www.amanet-trust.org.  

Workshop Pedagogical Methods

The workshop will apply participatory approaches including overviews, case studies, discussion groups, panelists, and participants presentations and other interactive and adult teaching/learning methods. To broaden discussions special panels for some of the topics will be convened. Lecture type presentations will be followed by question and answer sessions. Experienced facilitators have been carefully selected from within Africa.  

Workshop Participants (Selection)

Senior investigators and research project Principal Investigators (PIs) are encouraged to apply. Junior investigators who have successfully completed basic Health Research Ethics (HRE) course available on the AMANET website are also eligible. Participation in the AMANET online HRE Discussion Forum will be considered in the selection process. The online Discussion Forum can be accessed via the AMANET website; some of the case studies discussed online will be used during the workshop. The target candidates are health researchers, but few places may be available for applicants outside these criteria. Interested candidates who meet the selection criteria should submit their applications by 31 October 2008.

Workshop Objectives

This workshop aims firstly to flag topical ethical issues that are relevant to health research in developing country settings, and secondly to explore various schools of thought with the aim of coming up with well thought out positions and/or recommendations. Examples and case studies pertinent to Africa will be used. The following are the highlights of the topics to be covered:

• Applying Ethical principles in Health Research and Ethical review process
• Responsibilities in Health Research
• Ethical issues in research design and recruitment of research participants.
• Research with vulnerable persons and groups
• Legal and social issues in Health Research Ethics
• Ethical Issues in international collaborative health research 
• Models and practicalities of community consultation
• Ethical issues surrounding the 10/90 gap
• Ethical issues in traditional medical practice and “research”
• Professional Ethics
• Animal Research Ethics

Workshop Outcomes

By the end of the five day workshop, it is further hoped that:

• Participants will be brought up to date with topical ethical issues around current research   practices;
• Participants will be able to address ethical issues at the design stage of health research and be able to enhance the protection of the welfare of research participants when implementing health research protocols.  

Language:

The workshop will be conducted in English; there will be no translations to other languages.

Workshop Reports:

Three participants will be nominated to be rapporteurs for the workshop. Proceedings will be recorded for publication in the AMANET newsletter and will be available for participants. 

AMANET Scholarship

Selected participants will be awarded scholarships by AMANET, which will cover costs for economy class airfares (where needed), visas, tuition and accommodation and meals.

Timelines:

• This call sent out on or before 05 September 2008
• Applications should reach AMANET secretariat no later than 31 October 2008
• Please note that only short-listed candidates will be contacted, a list of selected candidates will be made available on the AMANET web site. Selected participants will be informed by 30 January 2009

Applications (with brief CVs and one-half page justification) should be submitted by email to: 

The Managing Trustee,
African Malaria Network Trust,
Tanzania Commission for Science and Technology Building,
PO Box 33207,
Dar es Salaam, Tanzania.
E-mail: info@amanet-trust.org
Fax: +255 22 2700380
www.amanet-trust.org

Acknowledgements

The workshop is supported by a grant to AMANET from the Bill and Melinda Gates Foundation on strengthening institutional health research ethics capacity in Africa.

Blanco YC, Farias AS, Goelnitz U, Lopes SC, Arrais-Silva WW, Carvalho BO, Amino R, Wunderlich G, Santos LM, Giorgio S, Costa FT. Hyperbaric oxygen prevents early death caused by experimental cerebral malaria. PLoS ONE. 2008 Sep 4;3(9):e3126.
Cerebral malaria (CM) is a syndrome characterized by neurological signs, seizures and coma. Despite the fact that CM presents similarities with cerebral stroke, few studies have focused on new supportive therapies for the disease. Hyperbaric oxygen (HBO) therapy has been successfully used in patients with numerous brain disorders such as stroke, migraine and atherosclerosis…

McCollum AM, Basco LK, Tahar R, Udhayakumar V, Escalante AA. Hitchhiking and selective sweeps of Plasmodium falciparum sulfadoxine and pyrimethamine resistant alleles in a population from central Africa. J Pharmacol Exp Ther. Antimicrob Agents Chemother. 2008 Sep 2. [Epub ahead of print]
Sulfadoxine pyrimethamine (SP) resistance in Plasmodium falciparum is encoded by a number of mutations in the genes dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps). Here, we have characterized point mutations in dhfr and dhps and microsatellite loci around dhfr on chromosome 4 and dhps on chromosome 8 as well as neutral markers on chromosomes 2 and 3 in 332 samples from Yaoundé, Cameroon...

Hancock PA, Thomas MB, Godfray HC. An age-structured model to evaluate the potential of novel malaria-control interventions: a case study of fungal biopesticide sprays. Proc Biol Sci. 2008 Sep 2. [Epub ahead of print]
It has recently been proposed that mosquito vectors of human diseases, particularly malaria, may be controlled by spraying with fungal biopesticides that increase the rate of adult mortality. Though fungal pathogens do not cause instantaneous mortality, they can kill mosquitoes before they are old enough to transmit disease. A model is developed (i) to explore the potential for fungal entomopathogens to reduce significantly infectious mosquito populations, (ii) to assess the relative value of the many different fungal strains that might be used, and (iii) to help guide the tactical design of vector-control programmes...

Sowunmi A, Balogun ST, Gbotosho GO, Happi CT. Plasmodium falciparum gametocyte sex ratios in children with acute, symptomatic, uncomplicated infections treated with amodiaquine. Malar J. 2008 Sep 2;7(1):169. [Epub ahead of print]
Amodiaquine is frequently used as a partner drug in combination therapy or in some setting as monotherapy, but little is known about its effects on gametocyte production and sex ratio and its potential influence on transmission in Africa. The effects of amodiaquine on sexual stage parasites and gametocyte sex ratio, and the factors associated with a male-biased sex ratio were evaluated in 612 children with uncomplicated Plasmodium falciparum malaria who were treated with amodiaquine during the period 2000 - 2006 in an endemic area...

Greenwood BM. Control to elimination: implications for malaria research.  Trends Parasitol. 2008 Aug 27. [Epub ahead of print]
Recent reports indicate that a high level of malaria control can be achieved with existing control tools once their use has been scaled up. This has led to renewed interest in the possibility of malaria elimination, an approach that is now supported by several influential organisations. An increasing focus on elimination requires a review of priorities within the malaria research agenda. The development of drugs and vaccines with a strong transmission-blocking potential becomes increasingly important. Novel approaches to surveillance will be necessary to ensure that once elimination has been achieved, it is not threatened by a rapid reintroduction of malaria from neighbouring areas …

Daniel Dodoo, Anastasia Aikins, Kwadwo Asamoah Kusi, Helena Lamptey, Ed Remarque, Paul Milligan, Samuel Bosomprah, Roma Chilengi, Yaa Difie Osei, Bartholomew Dicky Akanmori and Michael Theisen. Cohort study of the association of antibody levels to AMA1, MSP119, MSP3 and GLURP with protection from clinical malaria in Ghanaian children.  Malaria Journal 2008, 7:142
Antigen-specific antibody-mediated immune responses play an important role in natural protection against clinical malaria, but conflicting estimates of this association have emerged from immuno-epidemiological studies in different geographical settings. This study was aimed at assessing in a standardized manner the relationship between the antibody responses to four malaria vaccine candidate antigens and protection from clinical malaria, in a cohort of Ghanaian children…

The package, known as the President’s Emergency Plan for AIDS Relief (PEPFAR), was originally signed in 2003 and helped to buy large amounts of antiretroviral drugs to support medical care for more than 1.4 million people.

Increasingly, experts say, this kind of disease-focused model is defining the global health agenda.

Bush’s reauthorisation of the plan this year aims to provide essential treatment to three million people by 2015. The United States isn’t alone in focusing on AIDS. The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria currently funds treatment for an estimated 1.4 million people, and the U.N. General Assembly and the Group of Eight industrialised nations support universal access to AIDS treatment.

The priority of fighting AIDS and other diseases is also one of the U.N.’s Millennium Development Goals.

However, despite the massive amounts of money driving current efforts, the global health agenda is still in its infancy. Finding the best way to fight poverty and diseases abroad is still a matter of debate.

Ruth White, an associate professor of sociology and anthropology at Seattle University who runs an aid organisation, says that a narrow focus on disease has drawbacks.

"It’s dangerous because it sucks up resources that could be spread around to have more general health impact instead of focusing efforts on people with one disease and ignoring people with others," she said.

"Basic nutrition can help provide immunity support that can prevent or ameliorate malaria, AIDS and tuberculosis. When people have poor nutrition and are generally unhealthy they are more susceptible to these illnesses," White said.

White is hardly the only voice in Seattle speaking on global health. The city is host to undoubtedly the largest private powerbroker in prioritising global health issues in the country, the Bill and Melinda Gates Foundation. The behemoth, which employs more than 620 people, has about 65 billion dollars in assets and has supplied 16.5 billion dollars in grants since its inception in 2000.

Bill Gates has stated that HIV/AIDS is the top priority of his foundation, which has provided large grants towards fighting the disease in Sub-Sahara Africa.

However, according to the Los Angeles Times, the strict disease focus carried out by the Gates foundation has created some problematic results.

The Times found that the high level of grants provided by the Gates Foundation to fight high-profile disease, notably HIV/AIDS, has led to recipients increasing their demands for specially trained clinicians, resulting in a diverting of staff from basic medical care. Such shortages have led to increased neglect of common medical conditions.

According to the article, such focus has shortchanged basic needs like nutrition and transportation. In many instances, patients actually vomit up their free AIDS medication due to malnutrition, and others lack money to travel to clinics providing such life-saving services.

An IPS request for an interview with the Gates Foundation was denied.

Part of the dilemma may be a lack of understanding of local community needs, according to Loyce Mbewa-Ong’udi, president of the Rabuor Village Project (RBV), a Seattle-based aid organisation that works on a super-local level in the rural Kenyan village of its name.

"You can’t go in with a pre-designed programme, and that needs to improve big time," she said. "Communities know what they want and what they need. They understand their priorities."

Mbewa-Ong’udi believes that a pitfall for some organisations comes from being out of touch with a majority of African communities, which are rural. As many aid organisations operate in large urban centres, they fail to see challenges faced in the countryside, and tend to undervalue local knowledge.

The RBV’s approach has been to work in partnership with community members focusing on disseminating health and development knowledge by forming a village committee, and by training 50 men and women in basic health-care knowledge.

"We identify what is going on and address what they’d like to improve," Mbewa-Ong’udi said.

RBV has also worked on solving more than just the AIDS crisis. The organisation is concentrating on developing local industries, including brick making, sunflower oil production and dairy goats, in addition to a micro-lending programme. RBV has also drilled a well and is looking to develop a large-scale water distribution system for households and agriculture.

White agrees with the approach and thinks it needs to be more prevalent.

"There is not enough humility in the willingness to be equal partners in our efforts on the ground," she said. "We may have technical knowledge, but they (locals) have the cultural and practical knowledge we need to be most effective and efficient."

However, the emphasis on diseases like AIDS remains a difficult challenge to overcome.

"AIDS and TB are diseases that scare the hell out of people in developed nations because they are global and spreading," said Charles Piller, an investigative reporter with the Los Angeles Times who has extensively covered the Gates Foundation.

And with good reason. According to the World Health Organization an estimated 33.2 million people worldwide were infected with HIV/AIDS as of 2007, 22.5 million of whom live in Sub-Saharan Africa. A total of 2.1 million died from the disease last year. But other pressing concerns exist.

"Clean water would be a much better way to improve public health in places like Africa in the long run, but it’s very costly infrastructure," Piller said.

Currently, one-fifth of the world’s population does not have access to clean drinking water and two-fifths don’t have access to basic sanitation, resulting in illness and the deaths of more than five million people each year, according to Water First International, a Seattle-based aid organisation that focuses on hygiene and water supplies in the developing world.

This issue of focusing on malaria, AIDS and tuberculosis is important, but the donor community must consider how funding is allocated, said Kirk Anderson of Water First International.

"All you have to do is look at the funding towards those things and funding on water," he said. "Are we going to allocate 100 times the amount of money towards malaria than water?"

"The message is out there and there’s a caring community that wants to take action. But we as individuals need to be better educated on how to be good philanthropists and collect good information," he said.

In the last week of July the malaria community from the East and Southern Africa regions came together in Lusaka, Zambia for their annual planning and review meeting. This important meeting provides a forum to review the malaria control programmes of each of the 22 countries in the region and this year’s specific theme was “Improving Malaria Diagnosis”.

Despite all efforts, malaria continues to be a serious public health concern throughout the world and especially in Africa. It affects over 100 countries and approximately 40 percent of the world’s population. Of the 2.5-billion people at risk between 300- and 500-million become severely sick and over one-million people die from malaria every year. In Africa, the worst affected continent, one in every five childhood deaths is due to the effects of the disease. The World Health Organisation estimates that an African child has on average between 1.6 and 5.4 episodes of malaria fever each year and every thirty seconds an African child dies of malaria.

A human and economic tragedy

Those who survive an episode of severe malaria are likely to suffer from learning impairment or brain damage. Pregnant women and their unborn children are also especially vulnerable to malaria, which is a major cause of stillbirths, low birth weight and maternal anaemia. The disease is not only a human tragedy; it is an economic one as well. The disease is estimated to cost the continent $12-billion in foregone income every year and is estimated to reduce per capita incomes by 1.3 percent per year.

All cases and deaths of malaria occur needlessly because the disease is entirely preventable and curable. Early diagnosis and prompt treatment are essential for those that fall victim to the deadly parasite. However, many primary level health care facilities in Africa lack the tools to detect the malaria parasite. Diagnosis of malaria is thus usually based on clinical symptoms such as fever, but due to the fact that many infectious diseases mimic malaria symptoms this approach leads to over-diagnosis rates of between 30–70 percent — depending on malaria transmission patterns. Over-diagnosis of malaria in turn leads to unnecessary antimalarial drug use which has the potential to lead to increased drug resistance and delays in achieving the correct diagnosis of the patient.

In the absence of a capable lab technician to conduct a microscopic analysis of a blood sample, a rapid diagnostic test (RDT), which takes approximately 15 minutes, provides a good alternative. The former is more accurate but takes time, requires a skilled lab technician and is more expensive than a RDT. However, without correct diagnoses we run the risk of losing a highly effective tool in the fight against malaria — effective antimalarial treatments.

Presently the malaria community only has one effective class of drugs (artemisinin-based combination therapies — ACTs) to treat the most severe form of malaria: plasmodium falciparum. To make matters worse due to the dishonest practices of some pharmaceutical manufacturers that are producing fake or substandard drugs there is an increased probability of resistance building up to the available ACTs. Africa Fighting Malaria recently released a report that was published in the Public Library of Science journal PLoS ONE. The report entitled Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa – A Six Country Study reports on the tests AFM conducted to check the efficacy of drugs collected in six malaria endemic African countries namely: Ghana, Nigeria, Tanzania, Rwanda, Kenya and Uganda.

In the analysis, over 200 samples of antimalarial treatments were collected and tested to see if they met international standards. Overall 35 per cent of the samples were substandard and failed the test. This means that one in three patients is unlikely to be cured by the proclaimed antimalarial treatments purchased. Sub-standard drugs as opposed to outright fakes (where there is no attempt whatsoever to include the active ingredient) are of particular concern because in addition to affecting the patients’ health, they also increase the probability of the malaria parasites building up resistance to good quality drugs. This has the potential of rendering an entire class of drugs useless, which in turn has serious long-term implications for our ability to fight the disease.

Local production puzzler

Given the precarious nature of the situation it is in many instances unfortunate that large multilateral donors are actively supporting and encouraging the domestic production of antimalarial drugs. First impressions may find the local production of drugs appealing, since it has the potential to decrease transportation costs, provide local jobs, increase expertise and cut dependence on foreign suppliers. However, apart from the potential for the production of fake or substandard drugs, local manufacturers may not be as efficient in production as other established manufacturers that are already supplying the market on a no-profit and no-loss basis.

In order to support inefficient and sub-standard home industries, a government may protect local manufacturers from foreign competition by imposing high tariffs on imported pharmaceuticals. At the same time, the government may offer tax incentives and subsidies to local companies. These constrict the supply of imported drugs, which are often of superior quality, without necessarily increasing local supply appreciably.

Despite the donor community attempting to increase access to medicines in developing countries through the development of local manufacturing facilities they should be cautious in their prescriptions, particularly if the wider policy environment in these economies is not conducive to the development of local facilities. Taxes and tariffs on pharmaceutical drugs and devices must be eliminated as a matter of urgency and strict regulatory standards must be adopted in order to clamp down on the production of fake and substandard drugs. It is thus incumbent on African governments to enforce laws on malaria treatment, to work to improve diagnosis and to use only high-quality artemisinin-based combination therapies.

South Africa was one of the first countries in the world to introduce RDT’s to diagnose patients and it was also one of the first countries to change its first line treatment of uncomplicated malaria to ACT’s. South Africa was able to do this because it does not rely on international funding for its malaria control programmes — it bases its decisions on scientific evidence that has been proven to work on the ground. South Africa’s leadership in malaria control continues to be a beacon of light that other African countries strive to emulate and the South African department of health should be applauded for all of its work in malaria control

The culprit: one’s own immune system

Platelets – those tiny, unassuming cells that cause blood to clot and scabs to form when you cut yourself – play an important early role in promoting cerebral malaria, an often lethal complication that occurs mostly in children. Affecting as many as half a billion people in tropical and subtropical regions, malaria is one of the oldest recorded diseases and the parasite responsible for it, Plasmodium, among the most studied pathogens of all time. Still, cerebral malaria, which results from a combination of blood vessel and immune system dysfunction, is not well understood.

In a study described in the August 14 issue of Cell Host and Microbe, Johns Hopkins researchers reveal that when red blood cells are infected with the malaria parasite, they activate platelets to secrete the PF4 protein, which triggers the immune system to inflame blood vessels and obstruct capillaries in the brain; both are hallmarks of cerebral malaria.

In their experiments, the Hopkins team first infected human red blood cells in culture with the malaria parasite and found that this did, indeed, induce platelet activation.

The researchers then infected separate sets of live mice with the malaria parasite: one set treated so that it lacked platelets altogether and two others treated with aspirin or Plavix, platelet inhibitors that prevent the release of PF4.

The survival rate of mice without platelets as well as those treated with inhibitors was improved over that of the mice left alone, but only when the treatment began very soon after infection. When researchers started treating mice with platelet inhibitors one day after infecting them, those mice survived more often than control mice. However, when researchers waited until after three days to treat infected mice with platelet inhibitors, that group did no better in terms of survival.

"Cerebral malaria is lethal 20 percent of the time in the best of hands, and here we’ve shown that something as simple as aspirin, because of its affect on platelets, might be able to improve the outcomes of those who contract this deadly form of the disease," says David Sullivan M.D., an associate professor of molecular microbiology and immunology in the Johns Hopkins University Bloomberg School of Public Health.

To make the specific connection between PF4 and malaria, the scientists compared the responses to malaria infection by so-called "wild type" normal mice and mice genetically engineered to lack pF4. They found that the amount of parasite in the blood was the same in both sets of mice. The notable difference was in the animals’ immune responses to that same parasite burden. More than 60 percent of the mice lacking PF4 were still alive after day 10, while only 30 percent of the mice with PF4 survived that long.

"The take-home lesson is that platelets, by releasing PF4, are playing an early role in the wind-up phase of cerebral malaria," says Craig Morrell, DVM, Ph.D., an assistant professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine. "Our mouse studies show that timing is critical; with the mice, we know when we infected them and controlled when we treated them. A big challenge in translating this to humans is that people don’t know when they get infected.

"Platelets don’t get any respect, but they’re the second most abundant cell in the blood after red blood cells and packed full of factors that rally the immune system to action. By taking what we know about platelets and their activation and applying it to malaria, we have found a driver of cerebral malaria."

###

The research was funded by the National Institutes of Health and supported by the Johns Hopkins Malaria Research Institute.

Authors on the paper are Kalyan Srivastava, Ian A. Cockburn, Anne Marie Swaim, Laura E. Thompson, Abhai Tripathi, Craig A. Fletcher, Erin M. Shirk, Henry Sun, Karen Fox-Talbot, David Sullivan, Fidel Zavala, and Morrell, all of Hopkins: also, M. Anna Kowalska of The Children’s Hospital of Philadelphia, Pa.

Vacancy Notice No: HQ/08/HQ/HTM/FT740
Title: Coordinator, Vector Control and Prevention (VCP)
Grade: P-6
Contract type: Fixed-term appointment
Duration of contract: 2 years (limited duration)
Date: 20 August 2008
Deadline for application : 3 September 2008
Duty Station: Geneva Switzerland
Organization unit: HQ/HTM HIV/AIDS, TB and
Neglected Tropical Diseases (HQ/HTM) /
HQ/GMP Global Malaria Programme (HQ/GMP)VCP

OBJECTIVES OF THE PROGRAMME:

The objectives of the Global Malaria Programme are to facilitate access of populations at risk to effective treatment of malaria; to promote the application of preventive measures against malaria for populations at risk; to build capacity for malaria control; to strengthen malaria surveillance systems, and the monitoring and evaluation of malaria control.

The mission of the Vector Control and Prevention Team is to maintain, update and promote evidence-based and consensus-based recommendations, norms and standards for malaria prevention, and to stimulate the development and testing of new technologies, tools and guidelines for malaria control.

Description of duties:

To plan, direct and coordinate the work of a highly specialized technical and scientific team focusing on Malaria Vector Control interventions and projects. The incumbent works closely with other teams within GMP as well as Malaria Units and Vector Biology and Control units in the Regional Offices to ensure coordinated action.

To liaise and coordinate with other WHO technical areas to provide authoritative expertise and participate in the development of technical strategies, programmes and projects across the Organization.

To direct and/or participate in the development and implementation of new/revised policies, standards, norms and guidelines and promote the acceptance of new malaria control vector norms by all partners based on evidence and technical consensus.

Together with the Director GMP, to coordinate fund raising efforts of GMP.

To ensure the quality of publications, documents, reports and/or databases on technical and strategic issues in malaria vector control.

To allocate and monitor the use of resources, guide, supervise and evaluate staff, promote long term staff development and develop technical and/or administrative solutions in response to new and evolving challenges in the WHO working environment.

To provide technical advice, expertise and ongoing liaison to the RBM Partnership through its Secretariat and other Partners in the development and communication of effective technical approaches to Malaria Vector Control.

To oversee the development of VCP work plans to advocate state-of-the-art and excellence in the field, critically monitoring and assessing performance and results, and demonstrated value, anticipating challenges and recommending further activities and resolving problems, including participation in the departmental strategic planning, management, guiding and motivating staff members at headquarters and in countries, spearheading and encouraging exchanges of information and common understanding within the department, team, WHO

Regional and Country offices, Roll Back Malaria Partnership, academic and research institutions to ensure close collaboration and coordination of Malaria Vector Control activities in a proactive manner.

REQUIRED QUALIFICATIONS

Education:

Essential: Medical Degree and/or postgraduate degree in entomology.

Desirable: Degree or postgraduate training in epidemiology, molecular biology, biochemistry or public health.

Skills:

Thorough knowledge of malaria, medical entomology, and integrated vector management, complemented by demonstrated knowledge of current methods for research on malaria vectors and insecticides, as well as methods for the assessment and management of insecticide resistance and vector bionomics.

Computer literacy. Excellent presentation skills.

Experience:

Essential: Extensive experience in research on malaria vector entomology and vector control in endemic control.

Extensive field experience in operational vector control in endemic countries. Extensive experience in collaboration with the industry on the development of new products, especially long-lasting insecticidal nets and transfers of technologies.

Considerable experience in WHO including leadership and managerial experience.

Desirable: Experience at national or international levels in malaria vector control. Experience in leading national projects/programmes in the field of malaria prevention and control, and assessing their impact on public health, preferably in developing countries.

Languages:

Excellent knowledge of English or French with a (good) working knowledge of the other language. Knowledge of another WHO official language an asset.

Additional Information:

Only on-line applications will be accepted. Similar posts may be filled from this vacancy notice. A written test and/or oral presentation may be used as a form of screening.

Please refer to the WHO competency model on our website: http://www.who.int/employment/competencies/en/index.html

Annual salary: (Net of tax)

89129US$ at single rate
96427US$ with primary dependants

Post Adjustment: 92 % of the above figure(s). This percentage is to be considered as indicative since variations may occur each month either upwards or downwards due to currency exchange rate fluctuations or inflation.

A written test and interviews may be used as a form of screening Online applications are strongly encouraged to enable WHO to store your profile in a permanent database.

Please visit WHO’s e-Recruitment website at: www.who.int/employment.  The system provides instructions for online application procedures.

All applicants are encouraged to apply online as soon as possible after the vacancy has been posted and well before the deadline stated in the vacancy announcement.

Applications from women and from nationals of non- and under-represented member states are particularly encouraged.

Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual.

Only candidates under serious consideration will be contacted.

Currently accepting applications

WHO has a smoke-free environment and does not recruit smokers or other tobacco users.

Deadline for applications: 12 September 2008

The London School of Hygiene and Tropical Medicine (LSHTM), the Medicines for Malaria Venture (MMV) and Pfizer invite letters of interest (LOI) to participate in a Phase III efficacy, and safety study of azithromycin-chloroquine fixed dose combination (AZCQ) versus sulphadoxine-pyrimethamine (SP) for the intermittent preventive treatment of P. falciparum malaria during pregnancy (IPTp). This study will be a pivotal study in the registration of AZCQ for IPTp

The target start date for the study is the beginning of the 2nd Quarter 2009, with the recruitment phase of 18 to 24 months.

Background

Important progress has been made in Africa with the introduction of a preventive strategy for malaria in pregnancy consisting of IPTp. SP is the current standard of care for this indication, but development of safe, efficacious and affordable alternatives for IPTp is one of the main priorities for the control of malaria in pregnancy.

AZCQ is being developed for intermittent preventive treatment of falciparum malaria in pregnant women. AZCQ has demonstrated efficacy, safety and tolerability in two phase III clinical studies in the treatment of symptomatic uncomplicated malaria in adults in sub-Saharan Africa. Both azithromycin and chloroquine are considered safe in pregnant women as individual agents.

The proposed study is a Phase III clinical trial comparing AZCQ with SP, for use in the IPTp.  The protective efficacy of AZCQ in pregnancy against sexually transmitted Infections (STI), and respiratory infections (RTI) will also be evaluated. 

Who should apply

LOI are expected from African research institutions, scientists, research clinics and health care facilities where pregnant women are seeking antenatal care, where capacity for follow-up and delivery of pregnant women and laboratory facilities exist.

Selection process

Responses to this call for LOI will be reviewed by a panel of Pfizer, LSHTM and MMV staff to short-list potential sites to participate. A second round of information will be requested by Pfizer from short-listed sites specifically related to the study protocol and Good Clinical Practices (GCP) compliance. Based on that information Pfizer team may visit the sites for pre-trial assessment and final site selection.     

How to apply

LOI should be 6-8-pages long, in English or French, providing all the following information:

• Name of principal investigator with telephone, fax and e-mail address
• Brief description of the research team/institution and collaborators
• Prior clinical trial experience/ ICH-GCP inspection history / on-going study commitments that may conflict with proposed studies
• Certification in ICH-GCP training, if available
• Information on regulatory / Ministry of Health / ethics committee application process & timelines
• Standard of care in the country for prophylaxis (IPTp) and treatment of uncomplicated P. falciparum malaria during pregnancy
• Level of  resistance to chloroquine in the region (if available)
• Level of resistance to SP in your region (if available)
• Description of current infrastructures:
• antenatal clinic (ANC) and bed facilities
• number of pregnant women seen in the ANC
• laboratory facilities (parasitology, haematology, biochemistry)
• laboratory technique used to routinely evaluate parasitaemia (please provide a short description of the technique(s) used
• any lab accreditation or quality control programme that the lab participates in or any previous lab audit(s) and outcome(s)
• Evidence of malaria season(s). A table needs to be provided within the number of uncomplicated P. falciparum malaria cases collected in the proposed site by month during 2 years from January 2006 to December 2007 (if not yet available from January 2005 to December 2006)
• It would also be helpful if you could confirm that your ministry of health would support the study.
• Top-line estimated cost per patient at your facility and a draft budget justification

LOI should be returned by e-mail or hardcopy no later than Friday 12 September 2008 to:

 Pfizer address:

AZCQ IPTp study
c/o Dr. Richa Chandra
Development Team Leader, Malaria Program
Senior Director, Infectious Diseases, Pfizer Global R&D
50 Pequot Avenue, MS: 6025-B3112
New London, CT 06320, USA

E-mail: richa.s.chandra@pfizer.com
Phone: 001-860-732-5532
Mobile: 001-860-501-3836

Ferguson HM, Ng’habi KR, Walder T, Kadungula D, Moore SJ, Lyimo I, Russell TL, Urassa H, Mshinda H, Killeen GF, Knols BG. Establishment of a large semi-field system for experimental study of African malaria vector ecology and control in Tanzania. Malar J. 2008 Aug 20;7(1):158. [Epub ahead of print]
Medical entomologists increasingly recognize that the ability to make inferences between laboratory experiments of vector biology and epidemiological trends observed in the field is hindered by a conceptual and methodological gap occurring between these approaches which prevents hypothesis-driven empirical research from being conducted on relatively large and environmentally realistic scales. The development of Semi-Field Systems (SFS) has been proposed as the best mechanism for bridging this gap…

van Schalkwyk DA, Priebe W, Saliba KJ. The inhibitory effect of 2-halo derivatives of D-glucose on glycolysis and on the proliferation of the human malaria parasite Plasmodium falciparum. J Pharmacol Exp Ther. 2008 Aug 19. [Epub ahead of print].
The intraerythrocytic stage of the human malaria parasite Plasmodium falciparum relies on glycolysis for ATP generation, and since it has no energy stores a constant supply of glucose is necessary in order for the parasite to grow and multiply. The 2-substituted glucose analogues 2-deoxy-D-glucose (2-DG) and 2- fluoro-2-deoxy-D-glucose (2-FG) have previously been shown to inhibit the in vitro growth of P. falciparum and have been suggested to do so by inhibiting glycosylation in the parasite...

Lines J, Schapira A, Smith T. Tackling malaria today. BMJ. 2008 Aug 19;337:a869. doi: 10.1136/bmj.a869.
Once again, after an interval of 40 years, local elimination and global eradication of malaria is a focus of international health. In 2007, the African Union called for elimination of malaria from the continent, and the Bill and Melinda Gates Foundation challenged partners to adopt the goal of eradication. In this article, we draw on lessons from the first global malaria eradication campaign to argue that in most countries, time...

Watts G. Tightening the net around malaria. BMJ. 2008 Aug 19;337:a1267. doi: 10.1136/bmj.a1267
In so far as attempts to thwart malaria have made progress in recent years, one man in particular is entitled to a share of the credit. He’s Brian Greenwood of the London School of Hygiene and Tropical Medicine—and the recent decision to make him one of the joint winners of the newly created Hideyo Noguchi Africa Prize was a well deserved public acknowledgment of his personal contribution. The citation speaks of his bold and innovative work on the disease...

Jawara M, Pinder M, Drakeley CJ, Nwakanma DC, Jallow E, Bogh C, Lindsay SW, Conway DJ. Dry season ecology of Anopheles gambiae complex mosquitoes in The Gambia.  Malar J. 2008 Aug 18;7(1):156. [Epub ahead of print]
Malaria in The Gambia is highly seasonal, with transmission occurring as Anopheles gambiae s.l. populations expand during and immediately after a single annual rainy season that lasts from June to October. There has been very limited investigation of the ecology of vectors during the dry season, when numbers are very limited and distributions may be restricted…

Uneke CJ, Ogbonna A. Malaria and HIV co-infection in pregnancy in sub-Saharan Africa: impact of treatment using antimalarial and antiretroviral agents.  Am J Trop Med Hyg. 2008 Aug;79(2):185-91
Malaria and HIV infection represent severe public health problems in sub-Saharan Africa, and pregnant women are at increased risk because the two diseases intersect in pregnancy, causing adverse perinatal outcome. As access to antiretroviral drugs is increasing in the sub-region, and new combinations of antimalarial drugs are being implemented while more are being evaluated, there is potential for interactions between these therapies …

Exxon Mobil Corporation announced today a $3.5-million grant to the Global Health Group at the University of California, San Francisco (UCSF), to expand its core support for an unprecedented malaria elimination effort in southern Africa.

"To win the fight against malaria we must attack the disease on many fronts," said Rex W. Tillerson, chairman and chief executive officer. "ExxonMobil is committed to this battle, which is why we’re doing everything we are -- from helping to develop new drugs, facilitating the delivery of insecticide treated bed nets to places where they are desperately needed and supporting programs that prevent the spread of the disease."

The UCSF Global Health Group and its partners currently provide significant support to Botswana and Swaziland in the development of strategic plans to eliminate malaria from those countries. The Group will use today’s funding from ExxonMobil to build on this support, and expand it to additional southern African countries such as Namibia and Zanzibar. This work, conducted in partnership with the Clinton Foundation, is a cornerstone of the Global Health Group’s Malaria Elimination Initiative, which seeks to eliminate the disease in several countries around the world, working inward from the natural global borders of the disease.

Funding will also allow the Global Health Group - Clinton Foundation partnership to support development and enhancement of critical cross-border initiatives between countries with low levels of malaria and their more heavily-affected neighbors, helping to control the disease and pave the way for elimination. Resources will also be used to support rigorous monitoring and evaluation, and sharing of lessons and experiences with the broader malaria elimination community. These efforts are conducted in support of the Southern African Development Community’s (SADC) goal of eliminating malaria from the region.

"ExxonMobil has been a corporate leader in the fight against malaria and we are delighted by their support for our work," said Sir Richard Feachem, KBE, DSc(Med), PhD, director of the Global Health Group. "This funding will greatly strengthen the pioneering malaria control and elimination efforts under way in southern Africa and link them more effectively to similar work in other parts of the world."

Dr. Steven Phillips, medical projects director for ExxonMobil said it is vital to take a new regional approach if the battle against malaria is to be successfully transitioned from one aimed at controlling the disease to outright elimination.

"Malaria knows no borders, it cannot be eliminated in any one country unless we tackle it together as a regional strategy," said Dr. Phillips. "Elimination of this disease requires new levels of regional and international cooperation."

The funding to UCSF will bring ExxonMobil’s commitment to organizations engaged in important community and social development projects in Africa to more than $130 million, which includes more than $50 million committed through the company’s Africa Health Initiative.

The Africa Health Initiative was established in 2000 in support of the Abuja Declaration on Roll Back Malaria in Africa and its goal to halve malaria deaths by 2010. Since then, ExxonMobil has developed on-the-ground public-private partnerships to fight malaria at the community level, progress treatment and vaccine research and raise awareness and international support.

As part of those relationships, Dr. Phillips serves on the board of Malaria No More and as an advisor to the UN Special Envoy on Malaria.

Malaria is a life-threatening disease caused by a parasite and transmitted to humans by the bite of a mosquito. With between 1 million and 3 million deaths annually and 3,000 children deaths daily, it remains one of the globe’s leading infectious killers. The majority of its victims are children under the age of five and pregnant women.

Today’s announcement brings to a total of twelve countries in Africa where anti-malaria efforts are being supported by ExxonMobil, the largest non-pharmaceutical corporate donor to malaria research and development efforts. The others are Angola, Nigeria, Equatorial Guinea, Chad, Cameroon, Kenya and Uganda.

The Integrated Malaria Control Programme embarked upon by the Anglo Gold Ashanti in 2005 which sought to reduce the incidence of malaria within its catchment area has already started yielding positive results, the manager of the Malaria Control Programme of Anglo Gold Ashanti, Samuel O Danso has announced.

This is evidenced by the fact that the programme’s objective to halve malaria cases within two years, through the adoption of a multi-pronged approach has been achieved in six months.

A monthly average of 12,000 reported cases at the two major hospitals in the municipality, has dropped to 3,120, a 74 percent decrease, and within the Anglo Gold Ashanti mine community, there is a drop from 238 cases per 1,000 employees to 29 cases.

Addressing the media, Mr Danso said that the company was able to save over $30,000 a month on malaria medication by cutting down the monthly expenditure of $55,000 on malaria treatment to $12,000.

He attributed the success story to the community’s acceptance of the programme and the diligence of the corps of well trained, motivated and disciplined spray men and added that the mine also succeeded in reducing the man hours lost to malaria from 6,983 in 2005 to 304 in 2008.

The programme, he explained, adopted measures like indoor residual spraying to control the vector (the female anopheles mosquito) and distribution of insecticide mosquito nets to orphanages, maternity homes and the children’s wards of the two main hospitals.

The indoor residual spraying involves the spraying of every item on every inch of space, including interior walls, ceiling and underside of furniture at homes, offices, churches, schools and village huts.

"We have covered the entire municipality about five times already (two rounds a year) and in every round, we covered every room within a 110-mile radius of Obuasi,” he emphasised.

He said in the first year of the programme, the mine spent $1.7 million and thereafter $1.4 million a year adding that the success story of Obuasi earned the company an award at the Global Business Coalition Award in the United States in 2007.

Mr Danso said, “Already, other mining companies in Ghana are approaching us to replicate the programme in their mining areas. Newmont, for instance, has brought 19 of its employees here to be trained.”

“At the national level, the President’s Special Malaria Initiative in the North, is using the Obuasi programme as a case study” he added.

Integrating efforts to control malaria and neglected tropical diseases (NTDs) is an inexpensive and effective solution to reduce the incidence of deadly tropical anemia in sub-Saharan Africa, according to a new analysis published in the Public Library of Science (PLoS) Neglected Tropical Diseases. In this region, many people are co-infected with malaria and NTDs such as hookworm and schistosomiasis. Malaria alone kills more than one million children every year, and NTDs afflict hundreds of millions more.

The new analysis, ’’Tropical Anemia: One of Africa’s Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal,’’ makes a compelling case for integrating approaches to control malaria and NTDs in order to mitigate their devastating impacts in a cost-effective way. Together, malaria and the seven most common NTDs cause almost two million deaths and are responsible for the loss of nearly 100 million disability-adjusted life years (DALYs) annually - almost 20% higher than the disease burden from HIV/AIDS. Both malaria and NTDs cause immense suffering largely through anemia, a deficiency in hemoglobin often accompanied by a reduced number of red blood cells. Anemia accounts for up to half of the malaria deaths in young children, and is a major contributor to both the enormous burden of maternal deaths during pregnancy and to premature births. Chronic anemia in young children is also tied to reduction in physical growth, impaired cognition, and poor school performance.

Co-infection with malaria and one or more NTDs (especially hookworm infection or schistosomiasis, two of the most common NTDs in sub-Saharan Africa) causes a pronounced exacerbation of anemia. Severe hemoglobin deficiencies are the manifestation of co-infection of malaria and NTDs, shown to be markedly higher than in those with only a single infection. This phenomenon is commonly referred to the "perfect storm of anemia."

Malaria control and NTD control have each been found to reduce anemia in both children and pregnant women. "Combining malaria and NTD control practices in a unified anemia framework affords one of the best opportunities to reduce the perfect storm of anemia morbidity and mortality in sub-Saharan Africa," said Peter J. Hotez, MD, PhD, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University.

The analysis also stated that, "in addition to the health improvement that would result from anemia reduction, there is also some evidence that hookworm and schistosomiasis (and possibly other NTDs) may promote increased susceptibility to malaria, so that NTD control would work in synergy with nets and other measures to reduce malaria incidence." The use of bed-nets was shown to increase substantially - in some cases nine-fold - when used alongside NTD control efforts.

"Based on this link, the public-private partnerships of the Global Network for NTDs are working to identify opportunities for integrating malaria and NTD control efforts in sub-Saharan Africa," said Kari Stoever, Managing Director of the Global Network for Neglected Tropical Diseases. "The Network’s effective system of delivering treatment through trained local community coordinators is an ideal way to enhance malaria control and NTD control efforts and, ultimately, reduce deadly cases of these diseases and anemia."

Noting that NTD control can cost as little as 50 cents per person per year, the authors stated that this inexpensive investment would be "another promising, low-cost and highly cost-effective, and complementary approach for potentially reducing the morbidity of malaria in sub-Saharan Africa."

"An integrated control program for tropical anemia in Africa represents one of our better hopes for a quick win in the fight for sustainable disease control and poverty reduction integration," Dr. Hotez and Dr. Molyneux concluded. By taking a more holistic approach to disease control and prevention, we can finally help the people of sub-Saharan Africa break out of the cycle of poverty that has been plaguing them for so long.

Tropical Anemia: One of Africa’s Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal’’ is co-authored by Dr. Peter. J. Hotez (Executive Director of the Global Network for NTDs, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology and Tropical Medicine at George Washington University) and David H. Molyneux (Professor of Tropical Health Sciences at the Liverpool School of Tropical Medicine and Director of the Lymphatic Filariasis Support Centre).

Deadline for applications: 1 September 2008

http://www.amanet-trust.org/ext/news/jobCTC.htm  

The African Malaria Network Trust (AMANET) is a pan-African non-profit institution whose mission is to promote capacity strengthening, performance and impact of African malaria R & D institutions. The Trust was incorporated in Tanzania on 14th March 2002.

Currently AMANET undertakes short- and long-term training of African malaria researchers, infrastructure improvement, equipping research institutions, and sponsorship of clinical and field trials of candidate malaria intervention tools.

AMANET is pleased to invite applications from suitable candidates for a position of Clinical Trials Coordinator to be based at the AMANET Secretariat in Dar es Salaam, Tanzania.

Purpose of the job

The Clinical Trials Coordinator (CTC) shall be responsible for AMANET sponsored clinical trials, and therefore the principal advisor to the Managing Trustee (MT) on all matters relating to clinical trials, including their planning, execution, monitoring and evaluation.

Job description

1. Planning and coordinating clinical trials following ICH/GCP and other international regulations;
2. Overseeing the designing and preparation of trial protocols, investigators’ brochures, informed consent statements, reference manuals, etc;
3. Ensuring compliance to applicable international regulations for all clinical trials  and AMANET’s observance of sponsor responsibilities;
4. Implementation and supervision of Project Managers, Clinical Monitors to ensure  adherence to trial protocols and programme activities;
5. Supervising trials across Africa and ensure adequate capacity for clinical trials is attained;
6. Supervising several professional Secretariat staff members;
7. Preparing  and follow up of minutes of the Expert Committees;
8. Supervision of filing regulatory and ethics review documents;
9. Maintenance of AMANET’s quality assurance programme is up to standard including, but not limited to, preparing & review of SOPs, and coordination of external audits;
10. Representing AMANET interests to stakeholders;
11. Developing funding proposals;
12. Interface between AMANET and key external contacts and collaborators including product developers, contract research organizations and research associates
13. Undertaking any other duties as assigned by the Managing Trustee.

Qualifications:

1. MD or equivalent medical degree, a postgraduate degree (at least MSc or equivalent, preferably PhD in community or public health, clinical research, epidemiology, paediatrics, tropical medicine, communicable diseases, biostatistics or similar area of specialization);  
2. Postgraduate training in clinical research and / or product development is essential;
3. Computer skills are essential as is solid  knowledge and experience with ICH/GCP together with other international biomedical research guidelines;
4. Demonstrable competence as team player with good interpersonal skills;
5. Strong experience in project/programme management with a verifiable record;
6. Familiarity with health research ethics issues in African settings is desirable;
7. Previous training and experience in carrying out and monitoring clinical and field trials of interventions is required; and
8. Experience in research supervision and knowledge of French are added advantages.

Remuneration:

The successful candidate will be based in Dar es Salaam, Tanzania and offered an attractive and highly competitive international salary based on qualifications and experience.

How to apply

If you meet the above criteria, submit by e-mail an application letter with a detailed CV, which should also show your contacts (including e-mail addresses) and names and addresses of three professional /work and personal / study related referees.

Also attach copies of other essential documents e.g. certificates, testimonials, etc. Your application should be received on or before 1st September 2008 and should be sent to:

The Managing Trustee,
African Malaria Network Trust,
PO Box 33207, Dar es Salaam, Tanzania.
Website: http://www.amanet-trust.org
Email: vacancy@amanet-trust.org

Deadline for applications: 26 September 2008

http://www.jobs.ac.uk/jobs/NN198/Malaria_Epidemiologist/

3 Years extendable by mutual agreement

£34,933 - £43,182 per annum

For 60 years now, MRC in The Gambia has been carrying out internationally competitive research on Bacterial Diseases, Malaria and Viral Diseases. We’ve established ourselves as a leading research centre in sub-Saharan Africa, and our reputation is exceptional. Perhaps more importantly, we continue to push forward into new and challenging areas. Both epidemiologists will have vital impact on the future work of the Unit.

Malaria Epidemiologist

You will further develop epidemiological research within the Malaria Programme and, with the Head of Programme, will develop strategic plans to impact on the future direction of malaria control and potential elimination both in The Gambia and the sub-region.

You will have a first degree in science or medicine, a PhD in epidemiology or modelling of biological or health systems and preferably an MSc in epidemiology or statistics. You’ll have solid experience of statistical and other model-based analyses of empirical data, and it will be advantageous to have had significant malaria research experience. A working knowledge of French would be an asset.

We require you to be an excellent communicator and leader with demonstrated potential for working in a diverse team that includes academic, governmental and NGO partners.

Salary will be commensurate with qualifications and experience and will be within the range £34,933 - £43,182 per annum. The package also includes generous overseas allowances, furnished accommodation, flights and other benefits.

For further information and to apply, please visit our website: http://jobs.mrc.ac.uk. If you do not have internet access or experience technical difficulties, please call 01793 301049   quoting reference GAM08/415 (Malaria Epidemiologist). For on line applications please attach a CV and covering letter.

Closing date: 26th September 2008

For further information about MRC UK visit www.mrc.ac.uk and for MRC Gambia www.mrc.gm

Magistrado P, Salanti A, Tuikue Ndam NG, Mwakalinga SB, Resende M, Dahlbäck M, Hviid L, Lusingu J, Theander TG, Nielsen MA. VAR2CSA Expression on the Surface of Placenta-Derived Plasmodium falciparum-Infected Erythrocytes. J Infect Dis. 2008 Aug 13. [Epub ahead of print]
Malaria remains a major threat, in sub-Saharan Africa primarily, and the most deadly infections are those with Plasmodium falciparum. Pregnancy-associated malaria is a clinically important complication of infection; it results from a unique interaction between proteoglycans in the placental intervillous space and parasite antigens. Both placental and chondroitin sulphate A-selected parasites have high-level transcripts of a unique var gene named var2csa…

Efferth T, Romero MR, Wolf DG, Stamminger T, Marin JJ, Marschall M.  The Antiviral Activities of Artemisinin and Artesunate. Clin Infect Dis. 2008 Aug 12. [Epub ahead of print]
Traditional Chinese medicine commands a unique position among all traditional medicines because of its 5000 years of history. Our own interest in natural products from traditional Chinese medicine was triggered in the 1990s, by artemisinin-type sesquiterpene lactones from Artemisia annua L. As demonstrated in recent years, this class of compounds has activity against malaria, cancer cells, and schistosomiasis. Interestingly, the bioactivity of artemisinin and its semisynthetic derivative artesunate is even broader and includes the inhibition of certain viruses, such as human cytomegalovirus and other members of the Herpesviridae family (e.g., herpes simplex virus type 1 and Epstein-Barr virus), hepatitis B virus, hepatitis C virus, and bovine viral diarrhea virus...

Mullen GE, Ellis RD, Miura K, Malkin E, Nolan C, Hay M, Fay MP, Saul A, Zhu D, Rausch K, Moretz S, Zhou H, Long CA, Miller LH, Treanor J. Phase 1 trial of AMA1-C1/Alhydrogel plus CPG 7909: an asexual blood-stage vaccine for Plasmodium falciparum malaria. PLoS ONE. 2008 Aug 13;3(8):e2940.
Apical Membrane Antigen 1 (AMA1), a polymorphic merozoite surface protein, is a leading blood-stage malaria vaccine candidate. This is the first reported use in humans of an investigational vaccine, AMA1-C1/Alhydrogel, with the novel adjuvant CPG 7909. METHODS: A phase 1 trial was conducted at the University of Rochester with 75 malaria-naive volunteers to assess the safety and immunogenicity of the AMA1-C1/Alhydrogel+CPG 7909 malaria vaccine...

Smith T, Maire N, Ross A, Penny M, Chitnis N, Schapira A, Studer A, Genton B, Lengeler C, Tediosi F, DE Savigny D, Tanner M. Towards a comprehensive simulation model of malaria epidemiology and control. Parasitology. 2008 Aug 11:1-10. [Epub ahead of print]
Planning of the control of Plasmodium falciparum malaria leads to a need for models of malaria epidemiology that provide realistic quantitative prediction of likely epidemiological outcomes of a wide range of control strategies. Predictions of the effects of control often ignore medium- and long-term dynamics. The complexities of the Plasmodium life-cycle, and of within-host dynamics, limit the applicability of conventional deterministic malaria models...

Ramharter M, Kurth F, Schreier AC, Nemeth J, Glasenapp IV, Bélard S, Schlie M, Kammer J, Koumba PK, Cisse B, Mordmüller B, Lell B, Issifou S, Oeuvray C, Fleckenstein L, Kremsner PG. Fixed-Dose Pyronaridine-Artesunate Combination for Treatment of Uncomplicated Falciparum Malaria in Pediatric Patients in Gabon.  J Infect Dis. 2008 Aug 11. [Epub ahead of print]
HIV-related immune-suppression increases the risk of malaria (infection, disease and treatment failure) and probably the circulating parasite biomass, favouring the emergence of drug-resistant parasites…

O’Meara WP, Mwangi TW, Williams TN, McKenzie FE, Snow RW, Marsh K. Relationship between exposure, clinical malaria, and age in an area of changing transmission intensity.  Am J Trop Med Hyg. 2008 Aug;79(2):185-91
The relationship between malaria transmission intensity and clinical disease is important for predicting the outcome of control measures that reduce transmission. Comparisons of hospital data between areas of differing transmission intensity suggest that the mean age of hospitalized clinical malaria is higher under relatively lower transmission, but the total number of episodes is similar until transmission drops below a threshold, where the risks of hospitalized malaria decline…

According to a study published in the open-access journal PLoS Medicine, malaria control goals can only be achieved if future funding is tied more closely to level of need.

From the Kenyan Medical Research Institute-Oxford University-Wellcome Trust Collaborative Programme, Bob Snow and colleagues have been working with malaria for several years. They conducted the Malaria Atlas Project, creating a global map depicting the risk of Plasmodium falciparum (the protozoan parasite that causes malaria in humans), and they most recently studied international malaria financing between 2002 and 2007.

Groups such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank, the US President’s initiative, and the Gates Foundation have all committed funds to several parts of the world with the hope of reducing malaria. The researchers compared where these donors were sending fund to an objective assessment of national burdens of malaria. The study revealed that every year, about US $1billion are sent towards the 1.4 billion people exposed to stable P. falciparum malaria risk. This distribution amounts to less than a dollar per person per year at risk. The researchers also found the 40% of international malaria financing comes from the GFATM.

In general, the authors deem appropriate the distribution of malaria funds. Over 75% of GFATM funding has been committed to Africa, the continent with the highest malaria burden. However, countries in South East Asia and Western Pacific regions received a disproportionate amount of support to control malaria. These regions have 47% of the global population risk but only receive 17% of GFATM and 24% of non-GFATM support.

Additionally, the researchers noted a wide variation in spending levels. Suriname in northern South America received from GFATM US$147 per person at risk of malaria, while Myanmar (Burma) received about US$0.01 per person-at-risk. One striking finding was that the 16 countries that represent 50% of the global population risk received less than US$0.5 per person-at-risk from all sources. These countries include 7 of the poorest countries in Africa and India and Indonesia - two of the most densely populated, stable malaria endemic countries.

Snow and colleagues conclude that the goal to cut global malaria in half by 2015 is unlikely to be achieved due to the gaps between funding support and level of stable P. falciparum risk. "We estimate that there remains a 50% - 450% shortfall of funding to achieve the scaling up of malaria control required worldwide," write the authors.

Anthony Kiszewski (Bentley College, Massachusetts) wrote in a related Perspective article: "Despite the inability of the international community to mobilize resources sufficient to meet basic goals, talk of elimination and eradication has again become fashionable. But until shortfalls in funding are rectified, such plans seem quixotic at best."

"To achieve Goal 6 of the Millennium Development Goals, the gap between needs and commitments must be filled quickly. Given recent calls for malaria eradication, Snow and colleagues’ sober assessment should provide an instrument to prod the horse on before the cart disappears too far down the road," he concludes.

International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission
Snow RW, Guerra CA, Mutheu JJ, Hay SI
PLoS Medicine (2008). 5(7): e142.
doi:10.1371/journal.pmed.0050142
Click Here to View the Article

Divergent goals and commitments in global malaria intervention
Kiszewski AE
PLoS Medicine (2008). 5(7): e159.
doi:10.1371/journal.pmed.0050159
Click Here to View Perspective Article

East African researchers have found that most of the breeding sites of malaria-carrying mosquitoes are man-made and can be dealt with by effective environmental management.

On Tuesday, prominent Kenyan scientist Dr Onesmo ole-MoiYoi told a Cape Town audience that it was not necessary to use the deadly pesticide DDT - still used in the northern KwaZulu-Natal area of South Africa, despite being banned in most countries around the world - to control malaria.

He suggested that environmental management of the artificially created breeding sites, when used holistically in conjunction with other anti-malaria measures such as the use of bed nets, bio-pesticidal spraying and affordable prophylactics, could provide an effective control for the dreaded disease that still kills one African person every 30 seconds.

Stressing that a comprehensive intervention package against malaria was necessary and that there was no single solution, he said: "I think a campaign of environmental interventions is what is required, and we actually have that capacity now."

’I think a campaign of environmental interventions is what is required’

Malaria causes one million deaths in sub-Saharan Africa each year, and results in economic losses estimated at $12-billion annually, reducing economic growth by as much as 1,3 percent. Some 300-million to 500-million people are affected by it.

Dr ole-MoiYoi has been director of research and partnerships at the International Centre for Insect Physiology and Ecology (ICIPE), based at Kenyatta University in Nairobi, since 2001.

He was speaking on Tuesday at a three-day conference at Kirstenbosch where global climate change experts and journalists are discussing the topic: "Practising the craft: writing about climate change & global warming".

The conference, which aims to promote public understanding of climate change and its social consequences, is hosted by the newly established Fynbos Foundation, in association with the Nieman Foundation for Journalism at Harvard, and the Nieman Society of South Africa.

Dr ole-MoiYoi also revealed that researchers from the centre had made the amazing discovery that mosquitoes, the vector of the protozoan parasites that cause malaria, could rid themselves of these parasites by feeding on particular plant species.

’Mosquitoes have discovered a cure for malaria’

He explained that it had been known that mosquitoes feed on plants to obtain sugar, but when the researchers looked at what plants the insects utilised they discovered that they were "fussy feeders", choosing only some species. One of their favourites was wild quinine.

They had found a 100 percent reduction of the malaria parasites in some mosquitoes feeding on these plants, he said.

"Mosquitoes have discovered a cure for malaria."

While researching epidemics of so-called "highland malaria", the researchers had discovered that many of the breeding sites of the mosquito species involved were man-made pits associated with brick-making operations in the Kenyan highlands.

Other human-created breeding sites elsewhere in the country included abandoned swimming pools and blocked drainage infrastructure, which created sites for stagnant water.

Dr ole-MoiYoi said climate change would have far-reaching effects and would "profoundly" influence all biological and physical life-support systems on Earth necessary for human survival.

"We can’t really predict what will happen, but different regions will be affected in different ways."

Referring specifically to malaria, he said: "There may be epidemics if we don’t put interventions in place."

He said there also had to be new interventions to control Tsetse flies and locusts.

He warned: "What we’re doing at the moment is completely disastrous."

Resistance to ciprofloxacin has emerged in people without access to the antibiotic, but who have taken a related antimalarial

A new study shows that overuse of a drug used to prevent and treat malaria may be contributing to growing antibiotic resistance. Researchers report in the journal PLoS ONE that Escherichia coli bacteria resistant to the antibiotic ciprofloxacin were detected in the digestive tracts of villagers from remote rainforest communities in Guyana who had been given the drug chloroquine to prevent and treat malaria, a potentially fatal disease spread by mosquitoes. This is the first study to show that resistance can emerge in individuals never exposed to the antibiotic, which is used throughout the world to treat bacterial infections, including pneumonia, urinary tract infections and sexually transmitted diseases.

"Ten to 15 years ago, resistance to ciprofloxacin was rare. [Now], outside of remote populations, cipro resistance in hospitals and the community at large is becoming a problem," says Andrew Simor, a senior scientist at the Sunnybrook Health Sciences Center at the University of Toronto, who was not involved in the study. "E. coli is one of the most common causes of infections in humans. A decade ago it was nearly universally susceptible to ciprofloxacin." Today, he says, as many as 30 percent of hospital patients tested have E. coli that failed to respond to ciprofloxacin, which is the drug of choice for treating these bacteria.

Drug-resistant bacteria  are known to arise from the overuse of antibiotics, which is why researchers were surprised to discover that they can develop in areas that do not have access to ciprofloxacin, says study co-author Michael Silverman, an infectious disease specialist at Lakeridge Health Network in Ontario. In fact, he says, ciprofloxacin-resistant E. coli were even more widespread in remote Guyanese villages than in U.S. intensive care units "where every second person is on antibiotics."

During a three-year study, the researchers monitored the levels of antibiotic-resistant E. coli in patients at their clinics. They found that rates of resistance were over three times higher in February 2003 than they were just a year earlier, Silverman says. The jump corresponded to the increased use of chloroquine—a drug widely prescribed to prevent and control malaria —after a large outbreak of the disease (which causes high fevers, chills, nausea and headaches) in late 2002.

Chloroquine, taken daily by some villagers, is a close chemical cousin of ciprofloxacin. In the early 1960s, the creation of the antibiotic class (quinolones), which includes ciprofloxacin, was based on the by-products of chloroquine synthesis. In laboratory experiments, the team confirmed that chloroquine concentrations similar to those seen in the human intestinal tract prompted E. coli ciprofloxacin resistance.

These findings may have far-reaching implications for the escalating problem of antibiotic resistance. The worldwide use of ciprofloxacin pales in comparison with the use of drugs to counter malaria, which the U.S. Centers for Disease Control and Prevention estimates strikes 350 million to 500 million people (mostly in Africa, Asia, and Central and South America) annually. "It is very possible that the antimalarial drugs may be inducing a large amount of the antibiotic resistance that occurs in the tropics," Silverman says.

John Turnidge, chief of laboratory medicine at Women’s and Children’s Hospital in North Adelaide, Australia, called the study "fascinating," noting that he has long suspected that the overuse of antibiotics was not the only cause of bacterial resistance. This shows, he says, that certain drugs such as chloroquine (which works by targeting the parasites inside red blood cells) may drive resistance to other classes of drugs such as the antibiotic ciprofloxacin.

Traditionally, scientists have targeted viruses, bacteria and parasites in different ways and assumed that the treatments had little to do with one another. But this finding indicates that one may play off the other when it comes to encouraging resistance in human pathogens.

Christopher Plowe, an infectious disease specialist at the University of Maryland Medical Center, says more study is needed to determine whether health officials should reconsider the widespread use of chloroquine to battle malaria. Researchers plan to test the effect of antimalarials other than chloroquine to  determine if they can do as effective a job without also hobbling the power of ciprofloxacin.

Silverman stressed that the study highlights the need to continue to try to prevent malaria through the use of insecticide-treated bed nets, along with the development of an effective vaccine.

Website: http://www.who.int/globalatlas/

There is a growing need for high quality information on human resources in health systems to inform decision making for policies and programmes at the national and international levels. The WHO Department of Human Resources for Health has been collecting and compiling cross-nationally comparable data on health workers in all WHO Member States.

Estimates of the stock (absolute numbers) and density (per 1000 population) of the health workforce are available here for 193 Member States. National-level data refer to the active health workforce, that is, all persons currently participating in the health labour market. Counting health workers poses challenges, including how to define them. The World Health Report 2006 defines health workers as "all people engaged in actions whose primary intent is to enhance health." Various permutations and combinations of what constitutes the health workforce potentially exist depending of each country’s situation and the means of measurement. The information presented here reflects a framework for harmonizing the boundaries and constituency of the health workforce across contexts.

Two sets of data are contained in the Global Atlas: a main (aggregated) set and a disaggregated set. The aggregated dataset includes estimates of the stock and density of health workers for up to 9 occupational categories. This includes:

1. physicians;
2. nursing and midwifery personnel;
3. dentistry personnel;
4. pharmaceutical personnel;
5. laboratory health workers;
6. environmental and public health workers;
7. community and traditional health workers;
8. other health service providers; and
9. health management and support workers, that is, those who do not provide services directly but are critical to the performance of health systems.

In the disaggregated dataset, estimates of the stock of health workers are available for some countries for up to 18 occupational categories, reflecting greater distinction of some categories of workers according to assumed differences in skill level and skill specialization. More information on the framework for categorizing health workers can be found in the definition notes: http://www.who.int/globalatlas/docs/HRH/HTML/Dftn.htm

Following the launch of its new strategy and the biggest reconfiguration in its 30 year history, TDR is recruiting the following fixed term positions. All positions are based in Geneva, Switzerland.

TDR is organized in several functional areas:

Research for Neglected Priorities (11 posts advertised) consisting of a series of business lines addressing focused research activities with the goal of partnering with global research expertise to address research on neglected priority needs, delivering enhanced access to superior interventions addressing infectious diseases of poverty;

Empowerment (4 posts advertised), which aims to develop excellence and leadership in health research and decision-making so that institutional and national systems can identify and manage research priorities; Stewardship (2 posts advertised), which is oriented to facilitating and fostering knowledge management, needs assessment, priority setting and progress analysis on infectious diseases of poverty, providing a neutral platform for stakeholders to discuss and harmonize activities;

Portfolio Policy and Development (2 posts advertised), with the goal of leading operational policy, strategic monitoring and r