A recent blog post at the Center for Global Development highlights a shortage of dollars at The Global Fund.
Lead donor The United States has issued a “Call to Action,” holding the GF accountable for better distribution and implementation of resources, and asking for specific reforms that will lead to multilateral initiatives.
Will PEPFAR and other US programmes be held to the same standards? What might this mean for worldwide aid, particularly in fighting the three biggest killers in the developing world (AIDS, TB, Malaria)?
I spent the summer in India during the peak of monsoon, the rainy season. Everywhere I went were signs like, “know your Lepto,” or “how to identify dengue before it identifies you.” I jest, but seriously. The rains, anxiously awaited by millions across the subcontinent, represent growth, fertility, the harvest, and, unfortunately, disease. In an economy that is as much agrarian as IT, and as dependent on weather as independent of time zone, monsoons are a blessing and a public health curse. Malaria incidence, too, was unprecedented this year, with public hospitals erecting overflow tents just to accommodate the hordes of patients flooding their grounds.
The flood has left 20 million homeless, and more than half a million suffering from waterborne and other diseases.
And this was just in areas of “normal,” seasonal rain. Imagine the situation in Pakistan. The floods have been catastrophic, not only for the devastation they have wrought, but also for the illness they bring. Diarrheal diseases have already claimed thousands of lives, and skin and respiratory illnesses follow closely. Waterborne diseases such as typhoid, jaundice, and diarrhea are particularly virulent, but higher incidence of H1N1 and other respiratory viruses also seems to be associated with the moist, cool climate.
As the situation in Pakistan evolves, it is increasingly clear that the flood’s chronic pathology will include large-scale infectious and health concerns, which must be addressed as urgently as any epidemic.
Members of Operation Hernia with a large piece of mosquito-net mesh. During the last several years, Operation Hernia has treated more than 1,000 hernias, trained both European and Ghanaian surgeons, and just opened its second hernia treatment center in Ghana. It plans to expand capacity to establish centers in the Ivory Coast and Nigeria.
An interesting additional use for mosquito-nets…
Despite the much higher prevalence and severity of inguinal hernias in many African countries compared to high-income countries, inguinal hernia repair has been overlooked as a public health priority due to the belief that insufficient infrastructure, human resources and funding are available for effective delivery of care. Interestingly, many recent studies indicate that these hernias can be repaired with low-cost techniques using locally produced mosquito-nets. Briefly, hernias can be repaired using either the Bassini or “tension” technique, where the edges of the defect are sewn together without use of any prosthesis or reinforcement, or the “tension-free” Lichtenstein method using prosthetic mesh. The tension-free method is generally recommended to minimize short- and long-term recurrence and complications, but most African surgeons favor the Bassini technique due to the low associated cost. However, inexpensive polyester or nylon mosquito-net mesh has been found to be a suitable alternative to the prohibitively expensive, commercial mesh.
In 2006, a randomized double-blind study in Burkina Faso found no increased incidences of complications or mesh rejections in hernia repair with sterilized 100% Nylon mosquito-net mesh available in most African village markets, when compared to hernia repair with commercial grafts (Ultrapro). The total cost to buy and autoclave a 10 cm x 15 cm locally produced mesh is less than $1.50 whereas an Ultrapro mesh of the same size, purchased in Europe and shipped to Burkina Faso, costs $108. Imported meshes are also sold in Burkina Faso for about 200% of the price paid in the U.S. The 250% reduction in cost would make tension-free hernia repair much more affordable for local patients. Tension-free repair is also easily learned by local surgeons who found little difficulties handling the mesh.
A more recent 2009 study in western Ghana, where 2.7% of the adult male population have inguinal hernias (compare to 0.4% prevalence of TB and 2.2% prevalence of HIV), assessed the cost-effectiveness of using mosquito-net meshes to be only $68.31 per DALY (Disability-Adjusted Life Year) averted. Combined with the proper training of local surgeons, use of low-cost mesh holds great potential for scaling up capacity to address the high prevalence of inguinal hernias. The use of locally produced mosquito-nets also encourages eventual self-sustainability, which should be the ultimate goal of any public health intervention.
While walking through DC’s Dupont circle, I got accosted by some young activist in a mosquito outfit. Surreal. I quickly took whatever they were handing out and went on my way–I try to keep my conversations with Anopheles to a minimum.
I’ve finally had a chance to look at the little card my arthropod-friend gave me:
156 of ‘em per inch, to be exact. These holes are part of a bed net–one of the most effective ways to prevent malaria, a leading killer of children in Africa. The holes are so tiny that mosquitoes can’t get through to bite and spread malaria. It’s a simple, life-saving solution, and all it takes is $10 to buy a bed net, distribute it to a family, and explain its use.
Malaria kills. Send a net. Save a life
NothingButNets.net
Nothing But Nets is a campaign working diligently to prevent malaria infections in at risk populations:
Malaria is a disease caused by the blood parasite Plasmodium, which is transmitted by mosquitoes. Malaria, from the Medieval Italian words mala aria or “bad air,” causes 350 million to 500 million illnesses per year and kills more than one million people – mostly children under the age of five. Malaria is particularly devastating in Africa, where it is a leading killer of children. In fact, there are 10 new cases of malaria every second. Every 30 seconds, a child in Africa dies from a malaria infection.
Consequently, Nothing But Nets is working with the United Nations to provide insecticide-treated bed nets to those living in malaria risk areas:
Studies show that use of long-lasting insecticide-treated bed nets can reduce transmission as much as 90 percent in areas with high coverage rates.
Bed nets prevent malaria transmission by creating a protective barrier against mosquitoes at night, when the vast majority of transmissions occur. Malaria-carrying mosquitoes generally bite between 10:00 p.m. and 4:00 a.m. A bed net is typically hung above the center of a bed or sleeping space so that it completely covers the sleeping person. One bed net can safely last a family for about four years, thanks to a long-lasting insecticide woven into the net fabric.
A net treated with insecticide offers about twice the protection of an untreated bed net and can reduce the number of mosquitoes that enter the house and inhabit the surrounding areas. Currently, bed nets are treated with pyrethroid insecticides. These insecticides have very low levels of toxicity to humans, but are highly toxic to insects.
And the most amazing thing is that it only takes a $10 donation to provide a bed net…from manufacture to bedside, just $10.
So, if you want to prevent malaria infections, please donate at NothingButNets.net
he Center for Global Development highlights a shortage of dollars at The Global Fund.
