Healthy Dose July 18, 2011

Top Story

WHO Recommends Against Using TB Blood Tests

Tuberculosis

The WHO is concerned that blood tests used to determine if a patient has TB can yield wrong results. Because of that, they are recommending against the use of blood tests.

The U.N. health agency said it will issue an unprecedented recommendation against using such tests for the infectious lung disease that affects some 14 million people worldwide. As much as a third of the world’s population is thought to harbor the bacteria that causes TB.

“The tests are not reliable and a waste of money and time, putting proper care at risk,” said Mario Raviglione, the director of WHO’s Stop TB department.

A review of the tests has shown that they produce too many false negative and false positive, according to WHO.

Raviglione told The Associated Press that the blood tests “are in fact dangerous to patients, since some cases will not be detected and some will be called TB when in fact they do not have it,”

The WHO guidance will be issued later this week. It is the first time that WHO has issued a “negative” policy, specifically counseling against the use of a particular method for diagnosing a disease.

The use of TB blood tests is particularly common in developing countries such as India, where an estimated 3 million people are infected with the disease.

The Lancet medical journal reported in January that some of the blood testing kits used there are made in developed countries where such tests aren’t licensed. They are ordered by doctors who receive greater commissions for the blood tests than for the older and more reliable sputum microscopy method, the journal reported.

“Many of these tests are used in the private-for-profit sector, charging poor people who do not understand the lack of value of the test,” Raviglione said.

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Global Health and Development Beat

Maternal Health – With one of the world’s highest maternal mortality rates, Zimbabwe’s Deputy Prime Minister Thokozani Khupe says that the rate can be reduced by making care more affordable.

HIV/AIDS – Researchers presenting at the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, say that they have inched closer to a vaccine by leveraging a genetically altered version of SIV.

Cholera – An outbreak in Central Ghana last week caused three reported deaths in Agona Nyakrom.

Cholera – In Kenya, students are leading the fight against cholera in their communities through school health clubs that organize awareness events such as plays and local outreach.

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The Players

WHO – Reported cases of measles in Kenya and Ethiopia has the WHO concerned for the potential of an outbreak.

UNICEF – Is collaborating with Pakistani Chief Minister of Balochistan Nawab Mohammad Aslam Raisan to reduce the burden of polio through vaccination in Balochistan.

UNDP – Praised the level of accountability and transparency in the Philippines in using funding allocated in 2010.

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Spotlight on PSI

An All Africa editorial examines how the price of drugs leads to  deaths that could be otherwise averted.

A study of six high-risk nations by Populations Services International Malaria shows that Artemisinin combination therapy, or ACT, drugs made by firms such as Novartis and Sanofi-Aventis can cost as much as 65 times the daily minimum wage in some African countries.

ACTs can cost up to $11 (Sh15,000) to patients buying over the counter, while older to less effective drugs cost just 30 US cents (Sh500). This explains why malaria is still a major killer in developing countries, including Tanzania, despite the proven efficacy of ACTs in treating the disease.

In Tanzania, prices of ACTs dispensed at public dispensaries and hospitals are subsidised by up to 90 per cent, but the drugs are sometimes not readily available at such facilities due to various reasons. In such a situation, patients are left to choose between facing the consequences of the disease and buying the drugs at private pharmacies for anything between Sh10,000 and Sh15,000 per dose.

According to official estimates, half of Tanzania’s population lives on less than a dollar (Sh1,300) a day, and it’s easy to see why malaria remains a major problem in the country. The irony here is that the most effective malaria treatment is still out of the reach of the vast majority of Tanzanians.

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Buzzing in the Blogs

Mark Baird in the Development Policy blog writes about the recent AusAID review and gives recommendations for how the organization can be improved.

There’s a lot to like in the review: from the fundamental objective “to help people to overcome poverty” to the focus on results, innovation and risk management. But, for my money, the biggest contribution is the section on allocating aid. This provides a clear rationale for strengthening the focus of Australia’s bilateral program in South East Asia and the Pacific region while phasing out aid or making better use of other partners to deliver aid elsewhere. Decisions about country allocations are to be guided by a sensible set of criteria: poverty, national interest, capacity to make a difference, and the current scale and effectiveness of aid.

This analysis is pulled together into a set of hard numbers, which show the growth and size of country programs over the next five years. Indonesia is the clear winner, with the bilateral program projected to double to $920 million by 2015-16. Programs in other East Asian countries and South Pacific microstates also expand rapidly, while poor governance currently constrains the expansion of aid to PNG, East Timor and Solomon Islands. While Australian aid will also have thematic and sectoral priorities, which will help determine where to build up capacity, budget decisions will be made primarily in the context of country (and global) programs. This puts the focus rightly on the country strategy: how well it makes the case for the aid program and how well it fits with the priorities of the recipient country. Doing this within a multi-year budget framework is a big step forward.

But, as always, the proof of the pudding will be in the eating. Primary responsibility for implementation lies with AusAID. The review rightly commends recent efforts to improve AusAID’s performance. And the Director General’s initial endorsement of the review is a positive sign. But, like all bureaucracies (as I know from my days at the World Bank), AusAID will have a natural tendency to repackage itself with a minimum of genuine reform. So a lot will depend on the power of others to keep AusAID’s feet to the fire. Here the review’s proposals to strengthen oversight – through the annual strategy review and budget process, an independent review of the four-year strategy and the new independent evaluation committee – are an important piece of the puzzle.

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Capital Events

Monday

12:00 PMExpeditionary Economics – Heritage

12:00 PMHistory of the Future: The Shape of the World to Come Is Visible Today – Hudson

12:00 PMFighting for Women’s Lives: Abortion Rights in Argentina – GHC

7:00 PMTropic of Chaos: Climate Change and the New Geography of Violence – Politics and Prose

Tuesday

9:00 AMWhat Works for Community-based Nutrition Programming? – GHC

12:00 PMPerspectives on the Victims and Land Restitution Law in Colombia – WOLA

3:00 PMPopulation, Health, and Environment Approaches in Tanzania – Wilson Center

Wednesday

1:00 PMRace: Are We So Different? – Museum of Natural History

2:00 PMPromoting Development through Trade: The Need for Trade Preferences – CGD

6:00 PMConference Call/Webinar: Joining the Fight Against Vaccine-Preventable Diseases – GHC

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By Mark Leon Goldberg and Tom Murphy; Photo Credit