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Archive for May 29th, 2012

Infection control at home

Posted by African Press International on May 29, 2012

Infection control at home

KISUMU,  – Elsie, Bernard and their five children share a tiny tin-walled single room in Nyalenda, an informal settlement in Kisumu, in Kenya’s Nyanza Province. They are both infected with HIV and TB.

“We can’t infect them [children] with HIV that easily unless something bad happens, but we know if we don’t take care, we could give all of them TB,” Elsie, told IRIN/PlusNews.

Studies show that children are likely to acquire TB infection from adults living in the household as well as those having a relationship with them or the family but living away.

Good hygiene practices are an important component of TB infection control and prevention, but maintaining them is not easy in an informal settlement, where houses are crammed together and sanitation facilities hard to come by.

Regular hand-washing, good ventilation, and coughing and sneezing away from other people are all useful tools in TB prevention. Through a community-based organization, Hygiene at Home, Elsie and her family have been receiving lessons on how to have good hygiene in their household.

“When the house is this small, even if you sneeze or cough away from the rest, that ‘far away’ is still close – you can’t help it. We have no proper toilets, and water is scarce and you can’t use the little available to wash your hands all the time,” Elsie said.

“Now I make sure I have some water in my house just for hand-washing, and I have a tin where my husband and I can spit sputum and close it again tightly… the children are a little safer,” she said.

Peninah Sewe, the coordinator of the Hygiene at Home initiative, told IRIN/PlusNews that if TB infections in informal settlements were to be contained, proper hygiene was vital.

“Hygiene in health facilities is emphasized, but little is done to promote hygiene amongst TB-infected households, which is important. People living in poor conditions must be helped to keep good hygiene within their homes,” she said. “Providing people with handkerchiefs, giving them antiseptics or soap to take home might appear small-time gestures, but are very important in keeping infections under control.”

Through a network of volunteers, Hygiene at Home contacts households in informal settlements in Kisumu and educates them about how to prevent the infection from spreading.

“We teach them how to sneeze and cough in a way that protects the person closest to them. We also teach them how to use small amounts of water to ensure good hand hygiene,” Sewe told IRIN/PlusNews.

Kenya is ranked at 13 on a list of 22 countries with the highest TB burdens in the world, and has the fifth highest burden in Africa.

Senior government officials say they recognize the need to improve prevention methods in tandem with treatment programmes.

“As we step up treatment programmes, we might hit a brick wall when we don’t promote measures that help in curtailing new infections or re-infections, because… our treatment programmes are strained,” Joseph Sitenei, director of the National Leprosy and TB Control Programme, told IRIN/PlusNews.

Door-to-door initiatives could have more impact than big campaigns. “There are campaigns on prevention covering even issues like hygiene, but many people cannot conceptualize them,” Victor Amata, a clinical officer, told IRN/PlusNews. “With face-to-face initiatives, where households are visited, it easy for them to understand.”


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Donors worried

Posted by African Press International on May 29, 2012

One of 2,600 South African women who participated in a clinical trial of a gel scientists hoped could help prevent HIV infections

LONDON,  – The more medical successes there are, the more it costs to find the next one, prompting donors to demand more from researchers carrying out large-scale trials of drugs, vaccines and global health impacts.

“As a funder, I hate clinical trial applications,” said Jimmy Whitworth, head of international activities at the science funding division of UK-based Wellcome Trust, which finances health research.

Clinical trial costs have spiralled in recent years – one recent report estimated a 70 percent cost rise per patient between 2008 and 2011 – but without sound evidence of beneficial medicinal effect, regulatory agencies will not approve.

A clinical drug trial can take up to 12 years, enrol thousands of participants across continents, and cost from as much as US$1.3 billion to nearly $12 billion for each new drug before it is approved for public use.

And the costs keep climbing. “We need other ways of funding that are more flexible, quicker,” said Geoff Garnett, deputy director of the HIV Department at the US-based Bill & Melinda Gates Foundation.

“I think a lot of what we should be doing is public health trials rather than clinical trials,” Garnett commented. “If we bog down our public health trials with clinical trial requirements, then we miss out on some of the important behavioural and organizational interventions that make clinical care and prevention work much better.”

Why so costly?

A greater number of participants must be tested in more settings, including those living where reports of a particular disease are falling, to determine whether improvements are the result of the proposed intervention or are being produced by existing ones.

Bloated trials mean more researchers, institutes and funders, which in turn increases regulatory requirements.

“The reality is, trials are getting steadily larger and more expensive… regulation is becoming ever more complicated,” said Chris Witty, research director at the UK Department for International Development (DFID). “We’re paying more and more for less and less.”

Too ambitious

As researchers compete for dwindling research and development dollars, donors criticize overly ambitious proposals.

“The timetables are often extremely optimistic, so there is a real problem in that funding may run out before the research question is actually answered, said the Wellcome Trust’s Whitworth. “Frankly, very often clinical trials don’t look great value for money.”

HIV research has tended to carry out trials in the most expensive way, Witty said, noting that researchers often make poor correlations between cost and the potential impact of a study.

Donors and researchers are looking at partnerships and other ways to bring down costs, including “adaptive testing”, which uses real-time data to modify an ongoing trial.

New funding

In 2010, the Bill & Melinda Gates Foundation pledged $10 billion to research and develop vaccines for some of the world’s poorest countries and its grants database shows more than $70 million going to clinical trials since 2004.

In the UK, the Wellcome Trust, the Medical Research Council (MRC) and DFID have committed $57 million to fund late-stage trials of interventions in cash-strapped countries.

“Give us the evidence,” said Wendy Ewart, deputy chief executive and director of strategy at MRC. “Make the case for future funding.”


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Minority rights ignored

Posted by African Press International on May 29, 2012

Non-Arab minorities in Libya are calling for equal rights with other Libyans

SEBHA/OUBARI/MURZUQ,  – Since Muammar Gaddafi’s fall seven months ago, Libya’s non-Arab minorities, including an estimated 250,000 Tuaregs, have begun more vehemently to insist on their rights.

“Gaddafi’s policy was ‘keep your dog hungry so that he follows you’,” said one Tuareg activist, al-Hafiz Mohamed Sheikh. “This means keeping people in need. With Tuaregs, he said many times that we would have our rights, but he never fulfilled his promises. Sometimes he would favour some individuals, but not whole communities.”
Flying over the ramshackle houses in Tayuri settlement in Libya’s southwestern city of Sebha are the blue, green and yellow flags of the Imazighen (non-Arab minorities). During Gaddafi’s time, the Imazighen, including the Tuaregs, experienced cultural and political marginalization, with the regime instituting an all-encompassing pan-Arabic ideology and refusing to recognize them as a distinct ethnic group indigenous to the country and the region.

Since Gaddafi’s fall, nine new local associations have emerged in Tayuri promoting the rights of Tuaregs.

According to the International Crisis Group, the Arabization of Imazighen communities, “advanced more rapidly and completely in Libya than in any other Maghreb country”.

Law 24 forbids the Imazighen, including Tuaregs, from giving their children non-Arab names, and those who attended cultural celebrations in neighbouring countries were arrested upon their return to Libya.

While Gaddafi absorbed a large number of Tuaregs into his army and is said to have used a number of them as mercenaries during the uprising, many suffered from the same historic marginalization as other minority groups.

Nine-tenths of Libyans live along the Mediterranean coast, and many see non-Arab southerners as belonging more to “Africa” than Libya. Tuaregs, a nomadic pastoralist group, are also found in Algeria, Mali, Niger and Burkina Faso.
“Unacceptable” conditions

Some Tuaregs are optimistic about the future, but despite the renewed sense of freedom, those living in Tayuri say the conditions in which they live are “unacceptable”. By comparison with other neighbourhoods in Sebha, homes in Tayuri are arranged haphazardly; the communities here say they receive little assistance from the state; and there is no proper sewage or refuse disposal system.
“There is no infrastructure here at all,” said Mohamed Ahmad Othman, walking gingerly around electric cables scattered across the ground in between the houses. “The electricity here is not organized according to the laws and sometimes the kids that run around die from electric shocks,” he said.
According to UN Refugee Agency (UNHCR) Chief of Mission Emmanuel Gignac, levels of poverty in Tayuri and other Tuareg neighbourhoods exceed those of other areas in Libya. “They have built the houses themselves, and malnourishment is probably more widespread,” he told IRIN. “Also there is a problem with education since many can’t register their children in schools. It is not a humanitarian crisis, but more of a structural problem.”
Without access to the same services and opportunities as other Libyans, the future for many Tuareg youth is difficult. Those that manage to continue studying to university level are often later denied access to good jobs. “At the end of the day, the ones who are literate are in the same position as the ones who are illiterate, so they often get demoralized and there is no motivation to study or to do anything. Everywhere there is an obstacle,” said Sheikh.

Citizenship and statelessness
Thousands of non-Arabs like Tuaregs have no official documentation attesting to their citizenship. In Libya, the main proof of citizenship is the family booklet, in which all members of the family are listed and which is presented when applying for jobs, university studies and scholarships, or when taking out a loan from the bank.

Tuaregs who have been in Libya for 100 years have managed to obtain these documents, but those who settled in the country 40 or 50 years ago were denied a family booklet and possess neither Libyan nor any other citizenship.
“This camp is a result of a political problem, not an economic problem. Very few of us have nationality or passports, only identity cards,” said Issa Azaoui, a member of the Toumast Association in Tayuri. “We cannot travel for study or for medical treatment outside Libya, and we cannot even become a high-ranking officer in the army, or a minister, or buy property of our own.”
In Oubari, a predominantly Tuareg region about 120km outside Sebha, Abdulsamad Mohamed, 60, told IRIN he is an original Libyan, but cannot apply for a passport or a family booklet. He pulls out the only two documents he has – one a piece of paper on which is listed the members of his family, the other a national ID card which he says he received after returning from a visit to Algeria. Under “nationality” is written “returnee”. “What does this mean? If someone asks which country I come from, do I say `returnee’?” he said.
UNCHR’s Gignac said the Tuaregs are essentially stateless. “Under the former regime, there was no process to get nationality. Now it’s a legal and also an administrative issue, but you will need a system in future to apply the law,” he said.
According to the activists in Tayuri, community members approached Libya’s National Transition Council (NTC) chairperson Mustafa Abdel Jalil to grant citizenship to those who have Libyan origins but were told that this would only happen after the 19 June elections. As a result, determining who has Libyan origins remains a challenge, especially for those who do not have any documents.
And in a place like Sebha where porous borders to the south have exacerbated xenophobic fears of the country being infiltrated by foreigners, and already existing prejudices against communities like the Tuaregs, the question of who is truly Libyan might become a highly explosive issue in future.
“The term `Libyan origins’ is unclear. If you look at the history, the Imazighen are the original people of Libya. But for the government, the original Libyan is one who speaks Arabic. It’s a kind of racism,” said Khamena, a Tuareg elder in Tayuri.
Political representation
Ahead of the June elections, the absence of family booklets among large numbers of minority communities in the south threatens to exclude them from registering as voters. To circumvent the problem, the government has allowed those with an alternative family document, as well as a driver’s license or national ID card, to register.
Voting in the elections, however, constitutes only one aspect of wider political participation. Some are afraid that when they are eventually given documents, these will not be the same as the ones held by other Libyans, continuing the ongoing cycle of discrimination. Another concern is that those without documents cannot run for political office.
In Murzuq, an area said to be currently controlled by the minority Tubu community, a large percentage of the population do not have documents. “Elections here are based on tribal affiliations. In some countries minorities have some kind of representation, but we are afraid that we will have no parliamentary representation at all,” said Yusuf Soghi, the outreach coordinator for the local council in Murzuq.
The NTC had one Tuareg member from Oubari, Mossa Elkony, but he resigned over frustrations concerning the way Tuareg communities in Ghadamis have been treated by the central government.
He told IRIN he is not optimistic about the future, but said whoever takes his place following the elections will have to work very hard. “There are even some people who think the Tuaregs should have all their documents removed and be sent out of Libya,” he said. “And now, it seems like a minor problem, but it could spiral into something bigger, like in Mali. The Tuaregs there have established their own country, Azawad.”

Those living in Oubari concur that Libya will pay the price if minority communities are not given their full rights like other Libyan citizens. “It’s a strategic and a security problem for Libya. If the Tuaregs are given full rights, they know this area and they can bring stability against trafficking and illegal immigration. The government does not realize this,” said Mohamed Abselwelik al-Ansari, head of the al-Ansar Tuareg community sub-tribe.

“Otherwise, the suffering of the Tuaregs in each country can become a major threat to the stability of the region.”

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