Efficacy of chloroquine, sulphadoxine-pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria in Kajo Keji county, Sudan.

To provide advice on the rational use of antimalarial drugs, Médecins Sans Frontières conducted a randomized, an open label efficacy study in Kajo Keji, an area of high transmission of malaria in southern Sudan. The efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) were measured in a 28-day in vivo study, with results corrected by PCR genotyping. Of 2010 children screened, 115 children aged 6-59 months with uncomplicated Plasmodium falciparum malaria were randomized into each group to receive a supervised course of treatment. Of these, 114, 103 and 111 were analysed in the CQ, SP and AQ groups, respectively. The overall parasitological failure rates at day 28 were 93.9% [95% confidence interval (CI) 87.3-97.3] for CQ, 69.9% (95% CI 60.0-78.3) for SP, and 25.2% (95% CI 17.7-34.5) for AQ. These results provide important missing data on antimalarial drug efficacy in southern Sudan. They indicate that none of the drugs could be used in monotherapy and suggest that even in combination with artemisinin, cure rates might not be efficacious enough. We recommend a combination of artemether and lumefantrine as first-line treatment for uncomplicated P. falciparum malaria cases in Kajo Keji county

Protracted crisis, food security and the fantasy of resilience in Sudan

In the past decade, food security and nutrition practices have become central in the promotion of resilience in protracted crises. Such approaches have been welcomed by the aid community because of their potential for linking relief and development. Social and political analysts, however, have criticized resilience approaches for failing to consider power relations and because they entail an acceptance of crisis or repeated risk. In this context, regimes of food security and nutrition practices have become increasingly targeted, privatized and medicalized, focussing on individual behaviour and responsibility rather than responsibility of the state or international actors. This article uses examples from Sudan to examine how and why the resilience ‘regime of practices’ has functioned as a form of neoliberal governmentality, and argues that it has created a fantasy in which conflict in Darfur is invisible. This allowed food aid to be withdrawn and removed the need for protection despite ongoing conflict and threats to livelihoods; thus crisis-affected populations have been abandoned

The littoral sea cucumbers (Echinodermata: Holothuroidea) of Guam re-assessed - a diversity curve that still does not asymptote

The Micronesian island of Guam has been an important site for the study of littoral tropical holothuriantaxonomy for almost 200 years. Despite substantial attention by both expeditions and resident taxonomists, new records arestill regularly added to the fauna, demonstrating the challenge of documenting even such large and well-known animals ina small hyper-diverse area. Guam is the type locality of species described by Quoy & Gaimard (1833) and Brandt (1835).A survey of the sea cucumber fauna by Rowe & Doty (1977) led to one of the most used guides for the identification oftropical Pacific sea cucumbers because of the color illustrations of living animals it presented. Focus on echinodermsincluding holothurians continued with numerous new records added in the following decades. Paulay (2003a) summarizedthe fauna last, recording 46-47 species. At this stage the fauna was thought to be well documented. A week-long workshopon holothurian systematics sponsored by the National Science Foundation PEET (Partnerships for Enhancing Expertise inTaxonomy) project in 2010 included a substantial field work component, sampling both during the day and night, withsnorkeling and SCUBA, across a variety of habitats. This survey yielded 40 species, including numerous new records andeven species. Further sampling by Kerr’s lab since the workshop has added additional records. The littoral holothuroidfauna of Guam now comprises 65 species in 17 genera and 7 families. Half of the 19 newly recorded species are the resultof unravelling cryptic species in complexes, the other half are based on new collections. Eleven species are known fromsingle specimens, suggesting that much still remains to be learned about the fauna

Public health emergencies: a new peacekeeping mission? Insights from UNMIL’s role in the Liberia Ebola outbreak

The UN Security Council meeting on 18 September 2014 represented a major turning-point in the international response to the Ebola outbreak then underway in West Africa. However, in the light of widespread criticism over the tardiness of the international response, it can be argued that the UN, and particularly the Security Council, failed to make best use of a potential resource it already had on the ground in Liberia: the United Nations Mission in Liberia (UNMIL). This article examines whether UNMIL could have done more to contribute to the emergency response and attempts to draw some lessons from this experience for potential peacekeeper involvement in future public health emergencies. UNMIL could have done more than it did within the terms of its mandate, although it may well have been hampered by factors such as its own capacities, the views of Troop Contributing Countries and the approach taken by the Liberian government. This case can inform broader discussions over the provision of medical and other forms of humanitarian assistance by peacekeeping missions, such as the danger of politicising humanitarian aid and peacekeepers doing more harm than good. Finally, we warn that a reliance on peacekeepers to deliver health services during ‘normal’ times could foster a dangerous culture of dependency, hampering emergency responses if the need arises

Adherence of community caretakers of children to pre-packaged antimalarial medicines (HOMAPAK(®)) among internally displaced people in Gulu district, Uganda

BACKGROUND: In 2002, home-based management of fever (HBMF) was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. Implementation is through community drug distributors (CDDs) who distribute pre-packaged chloroquine plus sulfadoxine-pyrimethamine (HOMAPAK(®)) free of charge to caretakers of febrile children. Adherence of caretakers to this regimen has not been studied. METHODS: A questionnaire-based survey combined with inspection of blister packaging was conducted to investigate caretakers' adherence to HOMAPAK(®). The population surveyed consisted of internally displaced people (IDPs) from eight camps. RESULTS: A total of 241 caretakers were interviewed. 95.0% (CI: 93.3% – 98.4%) of their children had received the correct dose for their age and 52.3% of caretakers had retained the blister pack. Assuming correct self-reporting, the overall adherence was 96.3% (CI: 93.9% – 98.7%). The nine caretakers who had not adhered had done so because the child had improved, had vomited, did not like the taste of the tablets, or because they forgot to administer the treatment. For 85.5% of cases treatment had been sought within 24 hours. Blister packaging was considered useful by virtually all respondents, mainly because it kept the drugs clean and dry. Information provided on, and inside, the package was of limited use, because most respondents were illiterate. However, CDDs had often told caretakers how to administer the treatment. For 39.4% of respondents consultation with the CDD was their reported first action when their child has fever and 52.7% stated that they consult her/him if the child does not get better. CONCLUSION: In IDP camps, the HBMF strategy forms an important component of medical care for young children. In case of febrile illness, most caretakers obtain prompt and adequate antimalarial treatment, and adhere to it. A large proportion of malaria episodes are thus likely to be treated before complications can arise. Implementation in the IDP camps now needs to focus on improving monitoring, supervision and general support to CDDs, as well as on targeting them and caretakers with educational messages. The national treatment policy for uncomplicated malaria has recently been changed to artemether-lumefantrine. Discussions on a suitable replacement combination for HBMF are well advanced, and have raised new questions about adherence

Are agriculture and nutrition policies and practice coherent? Stakeholder evidence from Afghanistan

Despite recent improvements in the national average, stunting levels in Afghanistan exceed 70% in some Provinces. Agriculture serves as the main source of livelihood for over half of the population and has the potential to be a strong driver of a reduction in under-nutrition. This article reports research conducted through interviews with stakeholders in agriculture and nutrition in the capital, Kabul, and four provinces of Afghanistan, to gain a better understanding of the institutional and political factors surrounding policy making and the nutrition-sensitivity of agriculture. Semi-structured interviews were conducted with a total of 46 stakeholders from central government and four provinces, including staff from international organizations, NGOs and universities. We found evidence of interdisciplinary communication at the central level and within Provinces, but little evidence of vertical coordination in policy formulation and implementation between the centre and Provinces. Policy formulation and decision making were largely sectoral, top-down, and poorly contextualised. The weaknesses identified in policy formulation, focus, knowledge management, and human and financial resources inhibit the orientation of national agricultural development strategies towards nutrition-sensitivity. Integrating agriculture and nutrition policies requires explicit leadership from the centre. However, effectiveness of a food-based approach to reducing nutrition insecurity will depend on decentralising policy ownership to the regions and provinces through stronger subnational governance. Security and humanitarian considerations point to the need to manage and integrate in a deliberate way the acute humanitarian care and long-term development needs, of which malnutrition is just one element

Tracking Climate Change Vulnerability at Municipal Level in Rural Haiti Using Open Data

In least developed tropical countries, vulnerability to climate change (CC) at local scale follows an indicator-based approach and uses information gathered mainly through household surveys or focus groups. Conceived in this way, the vulnerability assessment is rarely repeatable in time, cannot be compared with those carried out in other contexts and usually has low spatial coverage. The growing availability of open source information at municipal level, routinely col-lected, now allows us to switch to vulnerability tracking (continuous, low cost, consistent with global monitoring systems). The aim of this chapter is to propose and verify the applicability of a VICC-Vulnerability Index to Climate Change on a municipal scale for Haiti. The chapter identifies open source information on na-tional, departmental and municipal scale, selects the information on a municipal scale on the basis of quality, identifies the indicators, evaluates the robustness of the index and measures it. The index consists of 10 indicators created using infor-mation relating to monthly precipitations, population density, flood prone areas, crop deficit, farmers for self-consumption, rural accessibility, local plans for CC adaptation, irrigated agriculture and cholera incidence. This information is gath-ered for the 125 mainly rural municipalities of Haiti. The description and discus-sion of the results in followed by suggestions to improve the index aimed at do-nors, local authorities and users

Community-based assessment of human rights in a complex humanitarian emergency: the Emergency Assistance Teams-Burma and Cyclone Nargis

<p>Abstract</p> <p>Introduction</p> <p>Cyclone Nargis hit Burma on May 2, 2008, killing over 138,000 and affecting at least 2.4 million people. The Burmese military junta, the State Peace and Development Council (SPDC), initially blocked international aid to storm victims, forcing community-based organizations such as the Emergency Assistance Teams-Burma (EAT) to fill the void, helping with cyclone relief and long-term reconstruction. Recognizing the need for independent monitoring of the human rights situation in cyclone-affected areas, particularly given censorship over storm relief coverage, EAT initiated such documentation efforts.</p> <p>Methods</p> <p>A human rights investigation was conducted to document selected human rights abuses that had initially been reported to volunteers providing relief services in cyclone affected areas. Using participatory research methods and qualitative, semi-structured interviews, EAT volunteers collected 103 testimonies from August 2008 to June 2009; 42 from relief workers and 61 from storm survivors.</p> <p>Results</p> <p>One year after the storm, basic necessities such as food, potable water, and shelter remained insufficient for many, a situation exacerbated by lack of support to help rebuild livelihoods and worsening household debt. This precluded many survivors from being able to access healthcare services, which were inadequate even before Cyclone Nargis. Aid efforts continued to be met with government restrictions and harassment, and relief workers continued to face threats and fear of arrest. Abuses, including land confiscation and misappropriation of aid, were reported during reconstruction, and tight government control over communication and information exchange continued.</p> <p>Conclusions</p> <p>Basic needs of many cyclone survivors in the Irrawaddy Delta remained unmet over a year following Cyclone Nargis. Official impediments to delivery of aid to storm survivors continued, including human rights abrogations experienced by civilians during reconstruction efforts. Such issues remain unaddressed in official assessments conducted in partnership with the SPDC. Private, community-based relief organizations like EAT are well positioned and able to independently assess human rights conditions in response to complex humanitarian emergencies such as Cyclone Nargis; efforts of this nature must be encouraged, particularly in settings where human rights abuses have been documented and censorship is widespread.</p