<< Back To Home

WHAT'S NEW THIS SUNDAY: BOOK REVIEW, 'ERADICATION,' ; MALARIA PREVENTION & TREATMENT; NEW TREATMENT FOR E. HISTOLYTICA

Friday, 20th of July 2012

WHAT’S NEW: BOOK REVIEW, ‘ERADICATION,’ BARRIERS TO PREVENTION AND TREATMENT OF MALARIA IN AFRICA; NEW TREATMENT FOR E. HISTOLYTICA

BOOK REVIEW: ‘ERADICATION’

From The Lancet Infectious Diseases

, Volume 12, Issue 5, Page 372, May 2012

Eradication: ridding the world of diseases forever?

Original Text

Salmaan Keshavjee

Eradication: Ridding the World of Diseases Forever?

Nancy Leys Stepan

Reaktion Books, 2011

£25·00, pp 312 ISBN-978-1861898616

In this well researched and well written book, historian Nancy Leys Stepan uses the diaries and aspirations of Fred Soper—former Director General of the Pan American Health Organization, described in the book as an arch-eradicationist—to recount a social history of public health. In so doing, she critically analyses the very idea of eradication, exposes the weak scientific basis of many of the past century's greatest battles against disease, and provides lessons for the challenges that lie ahead.

Stepan argues that the drive for eradication of disease was linked to the reliance on scientific solutions to social problems—the triumph of technology over disease—and the idea that eradication would improve economies, rather than the other way around. After World War 2, Stepan contends that the absence of the Soviet bloc from participation in WHO until 1958 allowed politicians to use a very narrow interpretation of international health in which social, political, and economic determinants of disease took a back seat to technocratic, vertically structured eradication campaigns that did not require the involvement of political or economic life. This approach continued after the Declaration of Alma Ata with selective primary health care and a health agenda dominated by the World Bank.

For those involved in addressing the diseases of our time, Stepan's work is a must-read. Her analysis of the public health successes and missteps of the past century serves as a thorough examination of dos and don'ts that are to be ignored at great peril. For example, Stepan links the failure to eradicate yaws, despite years of effort, to the neglect of latent, sub-clinical cases, the absence of health services capable of taking over vertical programmes on a routine basis, lack of grass-roots support, and failure to address patients' economic and political circumstances (eg, rural poverty, poor housing, poor sanitation, and other structural factors). This is familiar territory for those engaged in the daily struggle for access to treatment for HIV, tuberculosis, malaria, and other communicable and non-communicable diseases.

Sadly, Stepan does not end on a high note. She suggests that although some models of integration exist—moving us beyond the narrow scope of the eradicationists and towards more comprehensive health care—little has changed in the global health architecture. We live in a world with weak international health institutions and dominated by so-called philanthro-capitalist foundations that still believe in technological solutions as a panacea to the ills and diseases of poverty. I hope that Stepan's lesson on the recent history of public health will provide much needed food for thought.

BARRIERS TO THE EFFECTIVE TREATMENT AND PREVENTION OF MALARIA IN AFRICA

Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies

David M Maslove1,4, Anisa Mnyusiwalla1,4, Edward J Mills2,3,4, Jessie McGowan3,4, Amir Attaran3,4 and Kumanan Wilson1,4*

* Corresponding author: Kumanan Wilson kwilson@ohri.ca

Abstract below; full text is at http://www.biomedcentral.com/1472-698X/9/26

Author Affiliations

1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada

2 Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada

3 Faculty of Health Sciences, University of Ottawa, Ontario, Canada

4 Institute for Population Health, University of Ottawa, Ontario, Canada

For all author emails, please log on.

BMC International Health and Human Rights 2009, 9:26 doi:10.1186/1472-698X-9-26

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries.

Methods

We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention.

Results

The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39).

Conclusion

These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.

A HIGH-THROUGHPUT DRUG SCREEN FOR
ENTAMOEBA HISTOLYTICA IDENTIFIES A NEW LEAD AND TARGET

Anjan Debnath,¹ Derek Parsonage,² Rosa M Andrade,^{3, 4} Chen He,³ Eduardo R Cobo,³ Ken Hirata,³ Steven Chen,⁵ Guillermina García-Rivera,⁶ Esther Orozco,⁶ Máximo B Martínez,⁶ Shamila S Gunatilleke,¹ Amy M Barrios,⁷ Michelle R Arkin,⁵ Leslie B Poole,² James H McKerrow¹ & Sharon L Reed^{3, 4}

Received 03 October 2011 Accepted 30 March 2012 Published online 20 May 2012

Excerpt below; full text available to subscribers of Nature Medicine

Also at http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2758.html

Entamoeba histolytica, a protozoan intestinal parasite, is the causative agent of human amebiasis. Amebiasis is the fourth leading cause of death and the third leading cause of morbidity due to protozoan infections worldwide¹, resulting in ~70,000 deaths annually. E. histolytica has been listed by the National Institutes of Health as a category B priority biodefense pathogen in the United States. Treatment relies on metronidazole², which has adverse effects³, and potential resistance of E. histolytica to the drug is an increasing concern^{4, 5}. To facilitate drug screening for this anaerobic protozoan, we developed and validated an automated, high-throughput screen (HTS). This screen identified auranofin, a US Food and Drug Administration (FDA)-approved drug used therapeutically for rheumatoid arthritis, as active against E. histolytica in culture. Auranofin was ten times more potent against E. histolytica than metronidazole. Transcriptional profiling and thioredoxin reductase assays suggested that auranofin targets the E. histolytica thioredoxin reductase, preventing the reduction of thioredoxin and enhancing sensitivity of trophozoites to reactive oxygen-mediated killing. In a mouse model of amebic colitis and a hamster model of amebic liver abscess, oral auranofin markedly decreased the number of parasites, the detrimental host inflammatory response and hepatic damage. This new use of auranofin represents a promising therapy for amebiasis, and the drug has been granted orphan-drug status from the FDA.