NEWS - REGIONS

N E W S  The number of new malaria cases in Gambia fell by 40% between 2011 and 2016, whilst the prevalence of the parasite in children aged under 5 years fell to 0.2% from 4% over the same period. Gambia could be the first country in sub–Saharan Africa to eliminate malaria, but faces a shortfall in funds for the most difficult “last mile” in reaching the goal of no new malaria cases by 2020. It has a funding gap of US$ 25 million, and the possibility of “donor fatigue”, whereby donors turn their attention elsewhere as cases drop, but the country’s new leadership, under the democratically elected President Adama Barrow, may reinvigorate the fight against malaria. In addition to the usual control measures such as antimalarial drugs, bednets and spraying, Gambia has deployed technology to tackle malaria, using GPS, mobile devices and online platforms to track the implementation of the standard control measures, aided by improved internet bandwidth in rural areas. (Reuters, 12 July 2017)

 The European Medicines Agency has cleared the world' s first malaria vaccine, prior to prior to its approval for use in Africa. The vaccine (Mosquirix) was developed by Glaxo-SmithKline, who have pledged not to profit from the vaccine. It is designed to target infection in children in Africa, although it does not appear to be very effective in protecting young babies -children aged 5-17 months seem to benefit the most, with a 33% reduction in cases over four years. Unfortunately, the vaccine cannot be administered alongside other childhood vaccines, and children must receive all shots (including a booster shot) to benefit. However, even a partially effective vaccine can help countries with high infection rates. Prof Adrian Hill of the Jenner Institute, Oxford said "a bed net is more effective that this vaccine, but nonetheless it is a very significant scientific achievement. I see it as a building block towards much more effective malaria vaccines in years to come." (BBC, 24 Jul 2015)  The Islamic Development Bank (IBD) has pledged US$ 360 million of financing to support the post-Ebola recovery effort in Sierra Leone and Guinea. The announcement was made at the UN-organised International Ebola Recovery Conference, held in New York in July 2015. Guinea would receive US$ 220 million and Sierra Leone US$140 million. Liberia is not a member country of the IBD, but the IDB will support post-Ebola recovery by strengthening partnership through other agencies such as the Arab Cooperation Group. The late King Abdullah of Saudi Arabia had also donated US$ 35million to the IBD to support the countries affected by Ebola. (allafrica.com, 28 Jul 2015)  The global disease burden for conditions treatable by surgery is twice that of HIV/AIDS, malaria and TB combined -and 1-in-3 of the world' s population has no access to surgery. Surgery is also dangerous without appropriate equipment and training-including basic equipment like pulse oximeters, which risks 6 million lives each year. Uganda is working to rectify this by introducing several innovations and improvements. First, surgeons are using simple, cheap and innovative drill covers to perform orthopaedic surgery using household drills. The NGO Lifebox has distributed cheap and simple pulse oximeters across Ugandan hospitals. Ugandan hospitals are also adopting the WHO' s surgical safety checklist, which can cut death rates and surgical complications by more than 30% by reducing the most common errors. (Al Jazeera, 17 Aug 2015)  South-east Sierra Leone has been free of Ebola for six months, whereas it continues to linger in the north-west of the country. This is puzzling, as the north-west has received more foreign aid. The south-east is more isolated, which may explain part of its success, but other factors could be more important. In the south-east, prominent locals, doctors, priests, political leaders and chiefs played larger roles in fighting Ebola. In the north-west, Ebola efforts were managed by a politically-appointed co-ordinator, who side-lined non-medical people and traditional healers. By summer 2015 this had improved, with agencies working more closely with traditional and political rulers. Chief Vangahun, one of the south-east' s paramount chiefs at the forefront of the region' s battle against Ebola, commented that "pouring money into the fight against Ebola does not solve the issue." (The Economist, 29 Aug 2015)  The WHO' s global status report on road safety shows that 1.25 million people die each year from road traffic accidents. The risks of dying largely depends on where people live and how they move around. Africa has the highest death rate from road accidents, although all low-and middle-income countries are disproportionately affected by road deaths, despite having fewer vehicles per capita. Countries with the most success in reducing this toll have introduced better legislation, stricter enforcement, and safer roads and vehicles. Although road deaths are stabilising, more must be done to tackle these generally-preventable deaths, including improved public transport and preventing pedestrian deaths and injuries by making cycling and walking safer. "Road traffic fatalities take an unacceptable toll-particularly on poor people in poor countries," says Dr Margaret Chan, the WHO Director-General. (Ghana Business News, 19 Oct 2015)  Africa quakes), a decrease from 32 million in 2012. More than 90% of these displacements were in developing countries,  Following a meeting with government officials, opposition party leaders and ethnic minority groups, Myanmar announced an ambitious target to eliminate malaria in the country by 2030 -at an estimated cost of US$ 1.2 billion. The range of stakeholders reflects a rare consensus over a major challenge. Malaria is a huge burden on Myanmar' s people and economy. Myanmar is a bridge between southeast Asia-where strains resistant to artemisinin first took hold-and India, from which it could spread to Africa and beyond. Malaria cases have fallen from 300 000 in 2013 to 250 000 in 2014, as Myanmar moves from control to eradication. Ahead of the country' s elections in Nov 2015, the leader of the National League of Democracy, the main opposition party affirmed his support. "Whoever wins the coming election, this malaria elimination program will go on, because there will still be this disease threatening our country," said Dr Tin Myo Win. (The Irrawaddy, 5 Aug 2015)  According to UNICEF' s Promise Renewed: 2015 Progress Report, Indonesia has made substantial progress in reducing child mortality. In 1990, there were 85 deaths per 1000 births for children aged under 5 years, falling to 27 per 1000 births by 2015. This represents 5 million lives saved over the period. This success is due to expanding immunisation, promoting breast-feeding, the prompt diagnosis and treatment of common childhood illnesses-all underpinned by strong economic growth. "Saving the lives of millions of children is one of Indonesia' s great achievements over the past 25 years," said UNICEF representative Gunilla Olsson. She noted that further reductions will depend on addressing other issues, such as premature birth, severe infections and asphyxia. (TEMPO, 9 Sept 2015)   North Korea received US$ 21.3 million in humanitarian aid in the first six months of 2015 (US$ 9.64 million of food aid, US$ 6.2 million of health care, and US$ 2.4 million of drinking water). However, there are severe shortages of medicine in the country, with more than 80% of village clinics suffering from chronic shortages of supplies, despite the state' s guarantee of free universal health care. This has led to counterfeit versions of donated medicines flooding local markets. These fake medicines, labelled as "UN medicines" to disguise their origins, are dangerous to patients, and undermine trust in genuine donated supplies.
Much donated aid has also been seized by the country' s elite, leading to debate about the wisdom of sending aid. However, others argue that some supplies will eventually reach the wider population, thus providing some benefit. (  China' s government has launched a new three-year programme to cut the number of under-age drug users, and to raise awareness amongst young people. The average age of drug users in China has fallen, and 1.89 million registered drug users are younger than 35 years-58% of the total number of registered users. The programme will target young people aged 10-25 years, and its large-scale awareness campaign will reach all students. It aims to keep the number of underage drug offenders at less than 0.3% of all drug offenders, and achieve a "notable reduction" in new

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users. Liu Yuijin, the deputy director of China' s National Narcotics Control Commission, pledged that the government will treat the programme as a priority over the next three years. (Xinhau, 30 Jul 2015)  According to a report published by the consultancy firm Clearstate, the health care market in China is undergoing structural change driven by health care reforms, market dynamics and the changing needs of patients in China. Clearstate predicts five key trends that will affect the health care sector by 2020. First, new service providers will emerge, driven by private insurance creating demand for services beyond public hospitals. Second, China' s private insurance market is set to grow by 25-30% for the next 5 years, fuelled by an increasing number of wealthier individuals and enterprises. Third, the government classifies the medical device industry as a priority industry, and plans to support strong domestic pharmaceutical companies.
Fourthly, there will be increased emphasis on prevention (eg, screening programmes for chronic diseases) and health management. Lastly, China is set to become the world' s second-largest mobile-health market, growing by 60% from 2015 to 2018. This is driven by people' s need for reliable health information beyond the limited amount doctors can provide physicians being unable to provide time beyond diagnosis and treatment, and the use of mobile health in rural areas to overcome accessibility difficulties.  Parts of China was covered in smog as levels of the most dangerous particulate PM2.5 reached the highest recorded levels for 2015, and were almost 50 times higher than the WHO' s recommended limits. 21 cities experienced high levels, with the Shenyang city government issuing a "level 1 high alert" emergency response, which includes schools banning outdoor activities, asking residents to use "green transport", and to stay indoors and take health precautions. China' s air pollution is linked to hundreds of thousands of early deaths, and can cause heart disease, stroke and lung diseases. The smog was caused by a surge in coal-powered heating ahead of winter, and heavy pollution being blown in from other provinces. (South China Morning Post, 9 Nov 2015)  European governments are working together to negotiate prices for pharmaceuticals, in the hope that the higher volumes will lead to lower prices. Current partnerships are responding to particular domestic circumstances, but the formation of these bargaining blocs has led to renewed calls for an EU-wide way of negotiating with pharmaceutical companies to help reduce high drug prices. Industry bodies believe that such negotiations should be national, although they admit there is scope for some flexibility. There are advantages in an EU-wide pricing system, but the chances of reaching agreeing on one are remote because health care is seen as a national issue, and the difference between EU economies is too great. From a pharmaceutical perspective, a single European decision-making process would increase the risks of drug development. However, the trend towards joint negotiation could spread, although pharmaceutical companies will try to separate them. (Economist Intelligence Unit, 4 Jun 2015)  Greece' s financial crisis has had a massive impact on its health care system. State hospitals have cut budgets by up to 50%, basic items such as gloves and syringes are in short supply, and the number of doctors and nurses is critically low. Rising unemployment and poverty has left 2.5 million Greek people without health coverage, and screening programmes have been slashed, leading to more diseases being diagnosed at a later stage. Pharmacist are dealing with delays in government payments, difficulties in sourcing imported drugs due to disruptions in the supply chain, and a shortage of funds.

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"While smoking cessation services continue to be the most successful way to help people stop smoking, the highest successful quit rates are being seen among smokers who are also using e-cigarettes. Providing health care professionals with accurate advice and information on their use is necessary if we are to unlock the full potential of e-cigarettes in helping people to kick their habit," says Prof Penny Woods of the British Lung Foundation. (Medical News Today, 19 Aug 2015)  Human rights campaigners warn that Armenia' s mental health laws are open to abuse, contain incentives to detain people unnecessarily, and make it too easy to declare people mentally incompetent. The laws are a relic from Armenia' s Soviet period, where detention in mental institutions could be used to silence trouble-makers. One phone call to the police or a psychiatric unit is sufficient to have someone hospitalised; and if the person refuses to be admitted the courts can be applied to for mandatory admission, without the patient being represented. There is no requirement to periodically review initial assessments, and high payments for hospitalisations create incentives for hospitals to admit and keep patients. Tatevik Khachatrian, Armenia' s state deputy ombudsman, calls for complete revision of the laws, saying that "we have registered cases when people with no mental illness were locked away in institutions where they were tied up and abused." Julietta Amarikian was nearly hospitalised when her brother attempted to have her detained in a psychiatric unit following a family dispute. With the help of a human rights activist, she successfully appealed, but her case highlights the dangers of government inaction on Armenia' s arcane mental health laws. (The Guardian, 12 Oct 2015)  According to the OECD' s annual Health at a Glance 2015 report, the UK has one of the worst health care systems in the developed world. Too many lives are being lost because the quality of care is not improving quickly enough. Cancer survival rates are improving, but still remain in the lower third of OECD countries for some cancer types, and acute care is average. The UK had insufficient staff to ensure basic procedures are being followed, with a poor record on hospital-acquired infections. The UK also lags behind in life expectancy at birth, and in containing obesity in adults and children. This is partly due to the UK spending less on health care than other OECD countries, and too much attention on institutional structures and too little on making the basic processes of care work better. A Department of Health spokesperson claims to be prioritising investment in frontline NHS services, with an additional 10 500 doctors and 7600 nurses since May 2010, and aims to make the NHS the world' s safest health care system. (International Business Times, 5 Nov 2015)  India has more malnourished people than any other country, and 30% of its children are underweight-albeit an improvement on 43% in 2002 -compared to 3% in China. Malnutrition weakens people and renders them more vulnerable to disease, and stunts brain development in children. The Indian government is making limited progress in fighting hunger, due to taboos, corruption and political pride. Measures such as free school lunches have helped, but there are problems of rotten food, stolen subsidies, and banning certain foodstuffs (eg, high-protein eggs) due to dietary restrictions. The Indian government has not published the results of a joint UN survey on child nutrition, hindering states' ability to learn from each other. Critics suspect its suppression may be due to its criticism of Gujarat, the home state of Narendra Modi, India' s Prime Minister. The government should publish all data that could lead to better policies to tackle malnutrition, and focus on girls and women, who are more likely to be malnourished than men and boys. (The Economist, 4 Jul 2015)  According to the WHO, the malaria parasite P. vivax is causing a high disease burden in India.  There are concerns that India' s proposed changes to its intellectual property legislation could threaten the provision of cheap, life-saving drugs to sub-Saharan Africa. India protects drug-making processes not products, allowing pharmacists to "reverse engineer" drugs with different pro-  The`Americas  Cuba has become the first country to receive WHO validation for eliminating (ie, a reduction in transmission to a level that does not threaten public health) mother-to-child transmission of HIV and syphilis. PAHO has worked with Cuba and other countries to roll out a programme to eliminate this transmissions. Measures include improved access to prenatal care, more screening for pregnant women and their partners, caesarean deliveries and substituting breastfeeding. Globally, 1.4 million HIV-positive women become pregnant each year, and antiretroviral treatment reduces the risk of transmission from 15-45% to 1%. In welcoming the validation, Michel Sidibé, the UNAIDS executive director said that "this is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children." (IPS, 30 June 2015)  From 2002 to 2013, US deaths from heroin overdoses rose from 0.7 to 2.7 per 100 000 of population. Rates of use, abuse and dependency increased to 517 000 by 2013-a 150% increase from 2007. Rates are highest amongst males, those aged 18-25 years, people living in urban areas, poorer people and people without health coverage. However, rates increased across all groups over the period. Most overdose deaths involved multiple drugs, and the relationship between heroin and cocaine use is particularly strong. The increased availability, lower price and higher purity of heroin is a potential contributor to the rise, and it is vital that public health works with law enforcement to counter the crisis. Any responses must focus on reducing the rates of non-medical use opioid pain relievers, as the rates of initiating heroin use in this group are 19 times higher than those outside it. It is also vital to improve health insurance coverage to heroin users, in order to reduce usage and addiction, and to reduce HIV and hepatitis transmission. (CDC, 7 Jul 2015)  Bioven, a Malaysian biotech company, will seek an Initial Public Offering (IPO) to raise funds for marketing a promising cancer drug which was developed in Cuba. The IPO is expected to raise US$ 30-35 million for the drug, which targets non-small cell lung cancer. Phase III trials

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involving 419 patients across 10 countries are under way, and a separate trial will take place in the USA under the guidance of the Roswell Park Cancer Institute. More clinical development is under way at the Beatson Institute for Cancer Research in Glasgow, UK. (Xinhua, 30 Jul 2015) Former President of the USA, Jimmy Carter, recently announced that his cancer had spread to his brain. He also spoke about his non-profit Carter Center' s work to combat guinea worm disease. The Carter Center began this work in 1986, when there was 3.5 million cases across 21 countries. Infection from the water-borne guinea worm is painful, and can take months of recovery. Thanks to educational campaigning on the importance of filtering water and avoiding submerging guinea worm lesions in water, there are now only 11 cases left worldwide. When it is wiped out, guinea worm disease will join smallpox as the second human disease to be eradicated. "I'd like the last guinea worm to die before I do," said Mr Carter. (Huffington Post, 21 Aug 2015)  According to PAHO, malaria cases and deaths have fallen sharply across Latin America, with Brazil, Honduras and Paraguay showing the most progress. Cases have fallen by nearly 70%, from 1.2 million in 2000 to 375 000 in 2014, and malaria deaths fell by nearly 80% over the same period. PAHO praised Brazil' s national prevention programme. Worldwide, control and prevention techniques have led to a 60% reduction in mortality rates since 2000. However, 438 000 people died from malaria in 2014-and 91% were in sub-Saharan Africa. The UN aims to cut the numbers of malaria cases and deaths by a further 90% by 2030, which will require an increase of funding from US$ 2.7 billion to US$ 8.7 billion. (Thomson Reuters Foundation, 6 Nov 2015)