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Archive for April 3rd, 2013

CAR ousted president took power through a coup himself in 2003.

Posted by African Press International on April 3, 2013

 Central African Republic Ousted leader Bozize now blames Chad for aiding troops that overthrew him on Sunday – The foprmer leader is now hiding in Cameroon,

Mr Bozize, took over power in a coup in 2003. He later organised elections and won two subsequent elections, but ii is believed his syle of leadership forced the people to vote for him.

Now he blames Chad saying “We had a solid and friendship relation with the Chadian authorities. Chad alone can give an explanation,” he said.

The man should not cry now when he himself forced himslef into leadership through a coup.

The Chadian President Idriss Deby who have been providing Mr Bozize with his personal guards, lost trust in him after the later started courting the South African government. A thing that did not please the Chadian leader.

The new leader now in CAR says he will rule until 2016 when elections is due. But with the ECOWAS meeting now being held in Chad, it is not known if the union wants to sent an army to return the country to Civilian rule.



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Mohamed Garba, the new president of the Federation of African Journalists (FAJ)

Posted by African Press International on April 3, 2013

  • By Dickens Wasonga.

The President of Nigeria Union of Journalists (NUJ), Mohamed Garba, has been elected in Casablanca (Morocco) as the new president of the Federation of African Journalists (FAJ) following the third congress of that continental body representing the interests of over 50,000 journalists in Africa.

Mohamed Garba replaces Omar Faruk Osman Nur, who served as FAJ President for the past six years. - The new FAJ President Mohamed Garba from Nigeria (in glasses, checked shirt seated front) address the delegates after his election – The new FAJ President Mohamed Garba from Nigeria (in glasses, checked shirt seated front) address the delegates after his election - Newly Elected members of the FAJ Steering Committee immediately after their election in Casablanca, Morocco. – Newly Elected members of the FAJ Steering Committee immediately after their election in Casablanca, Morocco. - - Newly Elected members of the FAJ Steering Committee immediately after their election in Casablanca, Morocco. – Newly Elected members of the FAJ Steering Committee immediately after their election in Casablanca, Morocco. - Members of the FAJ Elections Board consult during the conference and elections. – Members of the FAJ Elections Board consult during the conference and elections. - A panel discussion on improving Gender parity in the Media in Africa during the Congress – A panel discussion on improving Gender parity in the Media in Africa during the Congress

The Congress in accordance with Article 9.4 and 9.5 of the FAJ Constitution, elected a 9 members steering committee, which later elected Mohamed Garba as the new President.

In the same vein, Maria Louisa Carvalho of the Angolan Journalists Union was elected as the Vice President of the Federation, while Stanis Nkundiye of the National Syndicate of Media Professionals in the Democratic Republic of Congo retains his position as the Treasurer of FAJ.

Other members of the Steering Committee include Ibrahima Khalilloulah Ndiaye (Senegal), Alexandre Niyungeko (Burundi) Muheldin Ahmed Titawi (Sudan) Credo Tetteh (Togo) and the former Vice President of the Federation, Foster Dongozi, from the Zimbabwe Union of Journalists (ZUJ) and Mouhamed Bchir Chakakou (Tunisia).

Three reserve members to the Steering Committee were also elected namely, Edouard Adzotsa (Congo Brazzaville), Collin Haba (Rwanda) and Rolland Affail Monney (Ghana).

In his inaugural speech to the participants at the Congress, FAJ new President Mohamed Garba, said that the primary concern of the new Steering Committee will be to unite the affiliates in the continent and moreover to ensure that unions in the continent are strengthened in order for them to defend the rights and welfare of their members.

The Steering Committee, he emphasised, cannot do their work effectively without the existence of strong unions. “We will endeavour to confront the major challenges before us and will always do the best we can to promote respect of the rights of journalists and to promote quality journalism in Africa”.

Mohamed Garba paid tribute to the outgoing FAJ President, Omar Faruk Osman Nur, who he said had demonstrated a lot of determination for the past six years to ensure that FAJ meets objectives that it has set out for itself at its inception.

This new Steering Committee, he said, will utilise that working programme set up by the former Steering Committee, and will not at any time hesitate to contact and consult with Faruk, in order to tap from his wealth of experience.

FAJ President Mohamed Garba thanked the Moroccan Union of Journalists for hosting the Congress. He also thanked the IFJ President, Jim Boumelha for his unflinching support to the unions in the continent and his commitment to ensure safety and protection of journalists in Africa and the world at large.

He assured the IFJ President that he will continue to work with the IFJ in the most effective manner and will make its doors continuously open to all the regional associations in the continent.

This two day congress was the occasion for delegates from 34 countries to have a look at the governance and policies of the Federation.

Delegates scrutinised and discussed the activities and financial reports, debated and approved motions, reviewed constitutional amendments and working programme for 2013-2016 as well as elected new leaders. Delegates also addressed pressing issues facing journalists and their organisations such as increased attempts to criminalise journalism work, working conditions in the media industry, gender equality, safety of journalists and impunity.

For the first time since FAJ has been created the congress included an event specifically dedicated to the working programme to achieve gender women equality. The pan-African gender council committee has been formally put in place sanctioned by the congress, making FAJ the first IFJ continental federation that has special structures dedicated to address the needs, interests, and issues of women journalists. In this regard, the congress elected Mrs Mounia Belafia (Morocco), Fatima Abdulkareem (Nigeria), Carla Lima (Cape Verde), Angele Chisimba (Zambia) and Kadiatou Diallo (Guinea Conakry) as members of the gender council committee. Delegates said they are very confident on the new FAJ leadership on which they are expecting to score more key successes to promote and protect the rights of journalists.

The congress was hosted by the Syndicat national de la presse marocaine (SNPM). Younes M’Jahed president of SNPM expressed deep pleasure to welcome delegates in Morocco, and called on them to develop more solidarity and to stand up together for a better recognition of the work of journalists in Africa.

FAJ over the years has received recognition and support from its parent organization, the International Federation of Journalists and claims the position of legitimate voice of journalists and journalism in Africa. Delegates asked the new leadership to rebrand its image in order to maintain a high-level profile with partners and the trade union movements.

FAJ represents 50,000 journalists in 34 countries in Africa


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Third FAJ continental congress kicks off in Casablanca with a call for organising journalists and defending press freedom

Posted by African Press International on April 3, 2013

  • By Dickens Wasonga.

The third continental congress of the Federation of African Journalists (FAJ) held in Casablanca, Morocco ended with a call for organising journalists, building stronger unions and defending press freedom in Africa

The event which is hosted by the Syndicat national de la presse marocaine (SNPM) is attended by 38 delegates from 34 countries in Africa.

Journalists’ trade unions and associations affiliated to the International Federation of Journalists have formed since 2008 a continental body representing the interests of their members in all media sectors either electronic, broadcasting or print, working as reporters, presenters, producers, freelancers or even editors at national, regional and international levels with the common objective to work to improve the social and professional rights of their members, be they full-time or freelance.

Delivering the welcome address, Younes M’Jahed, president of SNPM said the congress is the occasion to consolidate the Federation of African Journalists. “FAJ is now a big African organization which has demonstrated on the ground its force to strengthen journalists’ unions and fight against all press freedom abuses and attacks against journalists,” said Younes M’Jahed. “African journalists’ unions are mature. They are working in difficult conditions but are resisting and defending their independence from all powers and foreign interference. That’s why we consider that the strengthening of union bodies is capital for our future.”
Speaking at the opening ceremony, Jim Boumelha, president of the International Federation of Journalists (IFJ) said strengthening the pan-African solidarity among journalists is a very important objective, because Africa needs good journalists practicing good journalism, freely, safely and professionally. Looking at FAJ’s report of activities and programme of work, Boumelha stated: “anybody who wants to know what you have achieved should read your document of work. They will of course realise the huge challenges you had to confront, from the issue of safety of journalists and impunity to criminalization of journalists, the fight for better working conditions and the implementation of international labour standards”. “They will see at the same time, how with very limited resources FAJ has set out to lift and upgrade its democracy and structures, to increase its capacity to confront employers and governments and to break the walls between media sectors and between men and women”.
He called on FAJ members to consolidate their work on protecting the free flow of information which is a cornerstone for the IFJ’s mandate. “Indeed freedom of expression is imperative for sustaining development, consolidating democracy and initiating dialogue. And I am proud that you have taken it as a central battle line not only within FAJ but in many of your respective unions,” Boumelha added.
Everywhere in Africa there are still many obstacles to freedom of expression and free press. Boumelha highlighted the issue of censorship, violence, intimidation and harassment of journalists, pressure and threats, poor working conditions, lack of financial resources and training as areas where FAJ can make a difference, while assuring them of the IFJ’s unflinching support.
Approaching the issue of safety and security of journalists, Jim Boumelha said, in the past decade more than 2000 media professionals have been killed in the exercise of their profession, most of them victims of targeted killing and most of them local journalists working in their communities.
“The murderers of journalists are too seldom held accountable. For both killings in war zones and under other circumstances only very few cases are investigated. In even fewer cases the perpetrators are brought to justice. Indeed, impunity stands in the way of justice in about eighty percent of these cases, and as long as this pervasive culture of impunity exists, journalists will remain easy targets.”
On the other hand, the Minister for Communication of Morocco Honorable Mustapha El Khalfi, said the country’s commitment is to be a model for press freedom. “Africa’s future depends on the emergence of a strong, free and responsible press. This mission involves credible media and respect for press freedom,” El Khalfi said, highlighting the process in Morocco to reinforce press freedom and freedom of expression through a new legal framework provided by Article 27 of the country’s new Constitution which guaranties the right to access to information.
Delivering a speech to delegates, Mr. Driss Yazami, president of the national human rights Council of Morocco, said Africa has to take up two challenges: respect for human rights and freedom of expression, and the achievement of a sustainable development and social justice. “The role of journalists is at the cornerstone to meet these objectives and we need to join our efforts to better defend freedoms and the expansion of a human rights culture,” Yazami concluded.
Omar Faruck Osman, president of the Federation of African Journalists said the Federation has made tremendous gains since 2010. “We extended solidarity and support to ever combat ready unions and their members; we strongly campaigned for the safety of journalists and tackled the culture of impunity in Africa; we sought justice for victim journalists and their families; we helped strengthen the voice of journalists at the national regional and continental levels. Journalists in Africa and their unions are more organized than ever before. We struggled against all odds in the past three years. We fought to decriminalize journalism and the entire media work,” Osman said.
He nevertheless stated that FAJ is meeting in the middle of unprecedented crisis for journalists which threaten to undermine all the gains FAJ has made over the past three years. “Violent repression and the injustice against journalists are relentless. The number of journalists detained in Africa for their work since the last congress has increased. More than 70 % of journalists are working under precarious conditions. Ethical standards are declining due to external life-threatening pressure and lack of decent salaries”, he stated.
FAJ has a mandate to enforce trade union development in the media industry in Africa, to address professional matters, to protect and defend freedom of expression and information as well as journalists’ human rights, as laid down in the Declaration of Principles of Freedom of Expression in Africa.

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Kenya: KCA Calls for Swift and thorough probe into journalist’s death

Posted by African Press International on April 3, 2013


Kenya Correspondents Association (KCA) is shocked by the sudden death of Star Newspaper Reporter Bernard Ochieng Wesonga, who was found dead in his house in the Coastal City of Mombasa on Sunday.

KCA calls on the police to swiftly investigate the death of the journalist and to bring those who may be culpable to death, given the suspicious circumstances of his death.

Wesonga’s body was reportedly discovered by his room –mate, Eric Onyango, with blood oozing from his nose and mouth in their Kachonjo Estate in Tudor in Mombasa around on Sunday.

Wesonga, a young journalist, was a committed member of KCA and has been one of 20 journalists currently under the association’s journalists’ mentorship project in the Coast Region on capacity building for investigative reporting.

It would be important for the police to investigate claims that he recently received threats in relation to a story he wrote on corruption.

Many journalists have recently faced threats, both related to the just conclude Elections and on corruption and it would be important that the investigations re-assure journalists of their safety and security.




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Kenya: GOVERNORS induction in Naivasha faces challenges

Posted by African Press International on April 3, 2013


The induction workshop for governors and their deputies in Naivasha kicked off on the wrong footing with the elected leaders walking out on the Transitional Authority last evening.

Drama unfolded at the Great Rift Valley Lodge, Naivasha where the meeting was going on as the irate leaders staged a protest.

The incident occurred barely an hour after President Mwai Kibaki had left the hotel after opening the high level meeting.

Earlier, a group of governors tried to meet the Head of State to express their worries and their problems facing them.

Later they headed into a closed-door meeting with the Transitional authority chairman and his CIC colleague over the impasse.

One of the governors was overheard complaining over the manner in which the authority was treating them noting that they should be accorded the respect they deserve.

Confirming the impasse, Machakos County governor Alfred Mutua said that there was no way they could work without funds.

He said that majority of them had been forced to use their personal vehicles and pay their drivers and security officers as there were no funds.

The former government spokesman noted that despite getting assurance from treasury of getting funds, the promise was yet to be fulfilled.

On the issue of the National flag, the governors in unison said that they would ignore the directive from the AG and fly the flag on their vehicles.



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Holding politicians to account

Posted by African Press International on April 3, 2013

Humanitarian and development actors should develop a method to hold poli ticians to account for aid pledges, UK Minister of State for International Development Alan Duncan said. 

“A promise is only a promise until it’s in the bank,” he told IRIN. “It’s exciting to get headline pledges, but it’s important to make sure that money translates on the ground.”He shared his idea at the Dubai International Humanitarian Aid & Development (DIHAD) conference this week, telling participants:

“One thing that would help the whole system would be the establishment of a universally accepted process under which any pledge to spend money was registered, measured, monitored and implemented, because if a politician wins the floors by making a promise, then he must be made to follow it through with the concrete action that was promised.”

The aid community has an increasing number of systems to track how money is spent, but it has few systems to track pledges.

Get it in writing

One model, Duncan said, is the World Bank pledging process used in Yemen last year, when states that collectively pledged US$8 billion in two pledging conferences signed on paper how much they had pledged and what the money would go towards, “so that they can be held to account.”

The brain child of the idea was Wael Zakout, who manages the World Bank’s work in Yemen. With government support, he has created a system whereby donors will meet with government officials every three months – with media present – to report on four sets of figures: the original pledge; the amount that has been programmed (the number of projects to be financed and their amount); the amount in approved programmes, where a project agreement has been signed between the donor and the government; and the amount of money already disbursed. (The Yemeni government is also developing a more detailed database to track projects.)

The first such meeting was held in February and ended with a listing of those donors who had not delivered on their promises, which was then presented to the Friends of Yemen meeting of foreign ministers.

“We are using name-and-shame,” Zakout told IRIN. “That has been very effective.”

“In the past, the countries pledge and don’t deliver and, somehow, nothing happens,” he said. In 2006, for example, donors pledged $4 billion to Yemen, much of which never materialized. With the new approach, he said, “the pledges will not be forgotten.

“I do hope this will become an example for the international community in other contexts.”

Donor transparency groups say that aid pledges are almost never fully realized. Only a fraction of the $9 billion pledged to the Haiti earthquake recovery reportedly ever made it. In late January, the international community pledged more than $1.5 billion in humanitarian aid to Syria, yet UN response plans requiring the same dollar figure remain only 30 percent funded.

Other promises in recent years, described by the anti-poverty group ONE as “welcome but vague”, include: a $50 billion increase in global official development assistance (ODA) promised at the Gleneagles G8 Summit in 2005; $60 billion for health ODA promised at the Heiligendamm G8 Summit in 2007; $20 billion for agriculture and food security committed at the 2009 L’Aquila G8 Summit; and $100 billion for climate finance promised at the Copenhagen climate summit in December 2009.

Agreed principles

Daniel Coppard, director of research and analysis at Development Initiatives, a group which uses data to advocate for better development work, says the more important starting point is garnering support for a set of commonly agreed principles on how pledges should be made, especially in the context of a shift in recent years towards more qualitative than quantitative pledges.

“The type of commitments made continue to be vague and very slippery,” Coppard told IRIN. “The challenge is getting clarity on the commitments made in the first place. That would be the number one priority.”

The Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC) and ONE have both created guidelines for transparent pledges with more clarity on the funding, including: a specific timeline; whether it is additional, and if so, what the baseline is; whether it will be disbursed in a lump sum or over several years; whether it is conditional; its expected outcomes; and a mechanism through which the pledge’s implementation will be monitored. Global Integrity, which advocates transparent and accountable governance, also uses the SMART criteria &ndas h; Specific, Measurable, Attainable, Relevant and Timely – to measure governments’ commitments. The challenge now is getting widespread support for and use of these guidelines.

The lack of consistency and specificity in pledges has created challenges in monitoring them, even where mechanisms do exist.

For example, the G8 has regular reporting to monitor fulfilment of pledges made at its summits, but spends more time arguing over interpretations of what the commitments were than on whether they were actually fulfilled, Coppard said. The trouble is that commitments are often made by politicians first, and then ministries try to figure out how to implement them, instead of the other way around.

Once pledges are made clearly, there are many ways they can be monitored, through both civil society and formal mechanisms, for example: a global independent body, domestic mechanisms created through parliament, or mechanisms tied to a specific summit.

One such mechanism is The Mutual Review of Development Effectiveness in Africa (MRDE), an annual report by the UN Economic Commission for Africa and the OECD that assesses progress against commitments made by African governments and the international community. In support of the MRDE, the Commit4Africa website provides a searchable database of pledges made at international summits over the last decade or so (it is out-of-date due to a lack of funding, but hopes to soon be revived).

“This thinking is already well underway,” Coppard said. “A discussion around having some kind of accountability mechanism will force these issues into the open even more.”

ha/rz source

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Still hunting for Kony

Posted by African Press International on April 3, 2013

KAMPALA,  – The search for the Ugandan rebel group the Lord’s Resistance Army (LRA) in the rainforests of the Central African Republic (CAR) will continue despite the oust er of President François Bozizé by rebel group Séléka, officials say.

Séléka overran the capital, Bangui, on 24 March, putting Bozizé to flight. The rebels named their leader, Michel Djotodjia, the new head of state.

“I don’t think the overthrow of President Bozizé by Séléka will change our mission and position in the hunt down of LRA rebels. We are in CAR with the mandate from [the] AU [African Union] and UN [United Nations],” Uganda’s state minister for international relations, Henry Okello Oryem, told IRIN, adding that his country is committed to capturing LRA leader Joseph Kony.

Uganda has some 2,500 soldiers deployed around the border areas of CAR, the Democratic Republic of Congo (DRC) and South Sudan, where Kony and his fighters are thought to spend most of their time. The Ugandan troops are joined by 500 Congolese fighters, 500 South Sudanese and 350 CAR troops, all operating under the auspices of the AU. In late 2011, the US deployed 100 special forces to the region as military advisers to the effort.

Ploughing on

According to Thierry Vircoulon, Central Africa project director for the think tank International Crisis Group (ICG), “the fall of Bozizé will not change much the situation on the ground, except if the Séléka leaders insist on the departure of the foreign troops as stipulated in the Libreville agreement [a peace agreement brokered in January and breached by the latest fighting? but never successfully implemented].”

Potential problems

Some analysts say, however, that the AU’s decision to suspend CAR from the organization following the coup could have negative consequences for the hunt for the LRA.

“The AU’s suspension of CAR poses a great challenge and will slow down the hunt for Kony and his rebels. Uganda has to re-negotiate with Séléka rebels… in order for its troops to have the mandate to operate in their territory,” Ronald Ssekandi, a regional political analyst based in the Ugandan capital, Kampala, told IRIN.

Angelo Izama, a political affairs analyst at the US-based Open Society Foundation, said the hunt for Kony and the LRA would largely depend on Séléka’s control of the country.

“The deterioration of government in CAR is a significant complication for the hunt against Joseph Kony. The LRA’s asymmetrical, low-tech survival strategy thrives in conditions of lawlessness and violence, especially in the hinterland,” he told IRIN.

“Already the geographical terrain, as well as the size of CAR, has been a practical constraint against the forces hunting Kony. If Séléka is unable to consolidate control, it would further the physical and tactical net within which LRA can seek opportunities to rebuild weapons caches,” he added. “The Séléka rebels do not have the capacity [to limit LRA activities]… In addition, Kony is not their problem; there are much more important emergencies to deal with.”

According to Lt Gen Edward Katumba Wamala, commander of the Uganda People’s Defence Forces’ (UPDF) Land Forces, Kony’s fighters currently number about 400, and they continue to roam around CAR, DRC, Sudan and South Sudan. He said some LRA defectors recently reported that Kony was in Sudan’s western region of Darfur, while his senior commanders, Dominic Ongwen and Okot Odhiambo, are thought to be in CAR.

Kony, Odhiambo and Ongwen are wanted by the International Criminal Court (ICC) for alleged war crimes and crimes against humanity committed in Uganda.

LRA still a threat

“The LRA no longer pose a big threat, but there are still [a] few pockets of LRA rebels operating in CAR under Odhiambo and Ongwen. They are a nuisance. They have continued to abduct, maim and kill unarmed people,” Katumba told IRIN.

“It is important to recall that, despite [the] relatively small number of remaining elements, the LRA continues to pose a serious threat to civilians, with dire humanitarian consequences, in the affected areas in CAR, DRC and South Sudan,” Abou Moussa, head of the UN Regional Office for Central Africa (UNOCA), told IRIN via email.

In February, the UN Office for the Coordination of Humanitarian Affairs reported that in the country’s southeast, “there has been an increase in the LRA attacks against communities and hostages being taken.”

According to LRA Crisis Tracker, the LRA was responsible for 13 civilian deaths and 17 abductions in CAR February 2013. UNOCA says an estimated 443,000 people are currently displaced in LRA-affected areas, many of them depending on international assistance for food, shelter, health care, water and sanitation. This includes an estimated 347,000 people in Province Orientale’s Haut-Uélé and Bas-Uélé districts in DRC.

Fatou Bensouda, the ICC’s chief prosecutor, recently sent a message to the LRA, assuring them that, should they be arrested, they would not be “tortured or killed” and would receive a fair trial.

Commitment to the cause

Analysts say if the LRA threat is to be laid to rest once and for all, countries in the region must show more commitment to finding Kony.

“It requires committed governments to arrest Kony. The ICC can only base its optimism in this practical possibility. There is no government in CAR, soft states in South Sudan and Chad, and support for LRA from Sudan. It’s plausible that the situation above favours the LRA and not the ICC,” said Open Society Foundation’s Izama.

“Kony’s continued existence, and that of his entire group, is part of a much larger problem in the Great Lakes region: failure by governments to resolve internal political problems and to work together in a concerted way to bring to an end cross-border insurgencies in the region,” said Frederick Golooba-Mutebi, a political scientist and senior research fellow at Makerere University’s Institute of Social Research. “Their proliferation points to the existence of problems or grievances that ought to be addressed – questions to do with citizenship and nationality, land ownership, access to services and opportunity.”


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Dealing with drug-resistant TB

Posted by African Press International on April 3, 2013

LONDON,  – Twenty years ago, tuberculosis (TB) was one of the least glamorous branches of medicine. The cause had long been known, as had the cure, so all that was left was the unromantic slog of reducing the poverty, hunger and overcrowding that fostered the disease, and working out better ways to get patients to comply with the lengthy course of treatment needed to cure it. 

But in 1993 the sudden upsurge in TB cases associated with HIV and AIDS, and the growth of multidrug-resistant (MDR) strains of the bacterium, led the World Health Organization (WHO) to declare the disease a global emergency, which unlocked research funding. Now we are beginning to see the results.

Authors contributing to a special series of articles published by the London-based medical journal, The Lancet, note that “these investments have led to the most promising pool of new tuberculosis drug and vaccine candidates in more than 40 years, with several new drugs and drug regimens poised to enter late-stage clinical trials throughout the next few years.”

The new drugs are not here yet, so much of the scientific debate centres on new tools for managing the MDR outbreak, used with the available drugs. One of the most promising, but also one of the most controversial, of these new tools is a diagnostic kit known as the GeneXpert MTB/RIF assay, endorsed by the WHO in 2010.

It works by identifying DNA sequences and their mutations, in this case of the TB bacterium and the changes that make it resistant to the most basic of TB drugs, Rifampicin. The GeneXpert is a lot more sensitive than the traditional microscope test for TB, and far quicker than more accurate tests where the bacteria are grown in a laboratory. Culture tests, used for smear-negative patients, take an average of 56 days from acquiring the sample to getting the patient started on a suitable treatment. The new machine cuts that delay to less than a week.

In the first article in The Lancet series, a group of researchers led by Prof Alimuddin Zumla, of University College, London, describe the testing kit as ‘a landmark event in tuberculosis research’, but debate whether the benefits are worth the very substantial development costs. Even at the most discounted price for the poorest countries, the equipment and software amount to $17,000, plus just under $10 for the cartridge needed for each individual test. In South Africa, which has gone furthest in adopting the technology, it is expected to increase the annual cost of the TB diagnosis programme by more than 50 percent.

The authors conclude that although the tests are very good, they are still far from perfect. Live bacteria can’t be distinguished from those killed by treatment, so tests can’t be used to discover whether treatment has been successful. The technology also does not work as well on children or people co-infected with HIV, although this is also the case with older testing methods.

The GeneXpert tests are easy to do, and staff don’t have to be trained lab technicians, but the equipment is delicate. It needs air-conditioned surroundings with constant power, and a good supply chain for the cartridges, which don’t have a long shelf life. These requirements make it difficult to put the equipment where it is needed most – the clinics, often in rural areas, where patients first arrive with TB symptoms.

The study group points out that other diagnostic tools are in development, including hand-held systems the size of smartphones, urine dip-sticks, and even breathalyzers. “Several fully automated assays that compete with the Xpert MTB/RIF assay, and that will be more applicable for point-of-care, are likely to be developed in the future. However, how the donor assistance that has heavily subsidized the implementation of Xpert MTB/RIF in resource-limited settings will affect the development and entry of newer diagnostic assays to the marketplace in not clear. Commercially, funding is not a level playing field.”

“The world needs to acknowledge the serious threat of drug-resistant tuberculosis before it overwhelms health systems”

Other writers contributing to The Lancet series are more excited about the GeneXpert system’s potential for tracking drug resistance, which is spreading at a frightening rate, especially in countries that can afford first-line TB drugs but have weak healthcare systems, such as India, China, Russia and Brazil. In Minsk, Belarus, almost 50 percent of TB cases are multidrug-resistant.

A group led by Dr Marco Schito, of the National Institutes of Health in Bethesda, Maryland, discusses how the test should be applied in a paper entitled ‘Drug Susceptibility Testing, a Framework for Action’. Should every patient be tested for both the TB bacterium and the resistant strain? Test all patients diagnosed with TB? Or only those treated for TB in the past – a more economical approach when rates of resistance are not high?

The paper also argues that we need to develop tests for new drugs most likely to be the backbone of treatment in the future, so that surveillance work can track emerging drug resistance. “Generally, surveillance is restricted to activities that align with current rather than future treatment priorities,” the authors comment. “Such data are insufficient to assess development and implementation priorities for new tuberculosis regimens and diagnostics.”

The emergence of MDR and extremely drug-resistant (XDR) TB is alarming – at present, scientists can only guess how widespread these new forms of TB are. In 2011 less than 4 percent of new TB cases and 6 percent of previously treated cases were tested for resistance to first-line drugs. The new DNA-based assays could improve this dramatically, but would then raise the question of how to treat a possibly far higher number of drug-resistant patients.

The second-line treatments now available are lengthy, expensive, poorly tolerated and not very effective. People with strains of drug-resistant TB could spread these, but there is also no way that a large volume of patients could be kept in hospital for the length of time needed to effect a cure. New drugs and new combinations of drugs are urgently needed.

The Lancet series calls for visionary global leadership. “The global economic crisis and reduced investments in health services threaten national tuberculosis programmes and the gains made in global tuberculosis control. The world needs to acknowledge the serious threat of drug-resistant tuberculosis before it overwhelms health systems, as is being seen in several countries in the Soviet Union.”

eb/he source

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