The number of HIV-positive children accessing antiretroviral (ARV) treatment in Malawi is increasing, despite a scarcity of suitable paediatric formulas.
An official in the health ministry, speaking under condition of anonymity, confirmed that adult tablets still had to be cut into smaller doses to treat children, but said this was a minor obstacle.
"In all fairness, it should be noted that there are more children on ARVs in Malawi now than ever before ... the treatment is also yielding positive results among children who would otherwise have died," the official told IRIN/PlusNews.
According to the latest government estimates, children constituted nine percent of the more than 12,000 people who had received ARVs from the government's national treatment programme during the last quarter, up from just five percent two years ago. In total, some 5,906 children are benefiting from the national programme.
The local UN Children's Fund (UNICEF) office supports using reduced doses of adult medication to treat children, because the cost of paediatric tablets is unaffordable to many parents and caregivers. Paediatric formulas also need to be kept in refrigerated storage, and home refrigeration is a luxury for most Malawians, who live far below the poverty line.
"It makes more sense, financially, for the government to use adult ARVs, as syrups cost a great deal more, not only in terms of procurement, but also in terms of storage once they are dispensed to patients," said Dr Miriam Shipimo, UNICEF manager for women, youth and HIV/AIDS.
"Ideally, these children should be using Pedimune, a three-in-one tablet that can be easily stored, but it remains out of reach ... so we still halve Triomune, the widely used adult ARV, and it's proving to be quite effective under the circumstances," she said.
Pedimune, manufactured by the Indian generic drug firm, Cipla, is available in most developed countries and at private clinics in Malawi, but still needs the approval of the World Health Organisation to be rolled out in the public sector.
Medicin Sans Frontieres (MSF), the international medical relief agency, welcomed the "innovative" method of treating the nation's HIV-positive children, but expressed concern over the accuracy of reduced adult dosages.
"We are not exactly pleased with this method, but lives are being saved as we wait for suitable paediatric formulas to made more widely accessible," said Ulrika von Pillar, the Belgian head of mission at MSF in Malawi.
An estimated 80,000 children are living with HIV in this resource-limited country, 24,000 of whom are in urgent need of paediatric ARVs.
Wednesday, 9 May 2007
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Last weekend Tyler and I headed out to Kang’oma village which is one of the villages outside of Lilongwe and where our Peace Corps Volunteer friends David and Lauren live. Since we arrived we have been meaning to “travel like Peace Corps Volunteers” which is MUCH different than the way we get around Malawi.
As most of you know, we have a big SUV like you see the white people in Africa drive in the movies. This means that we cruise around Lilongwe and the country on relatively comfortable roads and if they are dirt, our car can handle it. It also means that we travel with music, air conditioning, comfortable seats, seat belts, and otherwise in safety.
The rest of the country does not enjoy this luxury. About 99% of the country travels by minibus if they travel at all. These minibuses look like old Toyota minivans in the US and usually have a bench seat in the front and four bench seats in the back. These four bench seats are MEANT TO seat three people each.
The minibuses are in a terrible state of repair and the drivers are not always the most cautious. Most minibuses have not only a driver, but also a “call boy.” (Not be confused with a “call girl”!) The call boy has the job responsibility of hanging out of the window or door of the minibus and yelling at every person passed on the street telling them how much is costs and asking if they want a ride.
So…this leads me to our story. So we decided that instead of driving our nice, cushy vehicle out to see David and Lauren we would instead travel the way they do when they travel to see us. For us this meant, taking a minibus from my office (in city center for those of you who have been to Lilongwe you know where it is), to the bus station in Old Town, then switching minibuses to go to the end of Area 23, getting off in Area 23 and then finding a bike taxi to David and Lauren’s village. Those of you who haven’t been to Malawi may be immensely confused as to what all of this means.
We caught a minibus to the bus station in Old Town. The bus was broken down and the seats were not attached to the floor – this made turns very difficult for the passengers as we were not only trying to balance ourselves but also keep the seats upright. When we got on the bus there were about five other people on but by the time we reached the bus station there were about 25 and each seat had at least four people on it and sometimes extra if there were kids.
We got out at the bus station – which is actually just a bit of dirt in the midst of the city – and asked our driver how to find a minibus to Area 23. Luckily, he took us over to one quickly where we (strategically, although we didn’t know it at the time) sat in the back corner of the bus together. Again we were some of the first few on the bus. Our back seat got packed with five people and we were smooshed. However, the seat in front of us was even more packed and two different people tried to squeeze their butts into a very tight spot and it didn’t work at all. The minibus drivers won’t go if there aren’t at least four people to a seat…Eventually a smaller women was able to jam her hips into the seat.
Through Area 23 we didn’t stop much because our minibus was already full. We got all the way to the end of the line and got off the minibus. Lauren had instructed us to look for the bike taxis. While this is a common mode of transportation, we had never ridden on a bike taxi before so we were quite nervous. Let me tell you what a bike taxi is – It’s essentially a regular bike with a padded flat piece of wood over the back wheel. It’s about big enough for someone’s butt. Women usually sit “sidesaddle” and men straddle the seat like a horse. The bike taxi drivers did not speak any English which created a bit of confusion when I tried to get on the bike taxi. I thought I was supposed to sit sidesaddle but the bike taxi driver though that was a bad idea (and he was right). So he mimed to me to straddle the seat which I did. We started riding and I was scared to death that I would fall off. The road was dirt and bumpy and there were still some cars passing. This in combination with sitting behind a guy who hadn’t showered in awhile was enough for me…
As we were riding into the village a whole bunch of kids starting yelling out “lala.” This is what they call Lauren because they cannot distinguish between Ls and Rs. (You may remember this from my story about naming the guard’s baby.) So Lauren has been called Rolen, Roleen, Lalen, Rara, and anything else besides Lauren…smart of her to go with her childhood nickname of Lala. I’m not sure if they though I was Lala or they just knew I was Lala’s friend because normally white people don’t ride into their town on bike taxis. You may ask if Lauren and I look similar – not really. We’re about the same age, height and weight but otherwise not much. Some white people will tell you that they find it difficult to distinguish between black Africans. Many people have the same haircut, all have almost the same color of skin and eyes, and most don’t have piercings or glasses that would make someone distinguishable using our normally developed perceptions. Malawians say the same about us – they think that whites look generally the same and there are often times when two white women run into a Malawian and a rural Malawian can’t really distinguish the two. This is just normal. So anyway, for that ride into town I may have been Lala.
We stayed at David and Lauren’s house which is one of three brick houses built for the staff of their local health center. The house is wired for electricity and has pipes and faucets for running water but the village has never been connected to either. The only place in the village that has electricity is the bar – not the health center, school or churches.
So we bathed using a pot of water that was warmed over the fire, we used a hole in the ground in the back as a toilet (called a chim here in Malawi), and we watched David cook us dinner over the fire. In the evening we lit candles, talked and played cards. David and Lauren do have a radio but there’s not a ton to be heard on the radio in Malawi – only at certain times.
In the morning, we went to church with them – a basic cement building which stayed remarkably cool during the whole service. There was an aisle and about twenty wooden benches on either side. The women and children sat on one side and the men on the other. No mixing is allowed so when David and Lauren go to church they have to sit separately. I sat with Lauren and Tyler sat with David.
The total cost of the trip was about 220 kwacha or around $1.75. The most expensive portion was the bike taxi ride which was 100 kwacha one way. (This is about 75 cents.)
On our way home (bike taxi and two minibuses later) Tyler and I commented that we should have done this long ago. It was a great experience and helped us to understand Malawi much better. I often have the feeling that it is better to live in a country as a Peace Corps Volunteer than as a diplomat. Maybe not better per se for everyone, but it is incredibly different – the PCVs have no clue as to some things that exist in Malawi just as we diplomats have no clue as to some things that exist in Malawi.
As most of you know, we have a big SUV like you see the white people in Africa drive in the movies. This means that we cruise around Lilongwe and the country on relatively comfortable roads and if they are dirt, our car can handle it. It also means that we travel with music, air conditioning, comfortable seats, seat belts, and otherwise in safety.
The rest of the country does not enjoy this luxury. About 99% of the country travels by minibus if they travel at all. These minibuses look like old Toyota minivans in the US and usually have a bench seat in the front and four bench seats in the back. These four bench seats are MEANT TO seat three people each.
The minibuses are in a terrible state of repair and the drivers are not always the most cautious. Most minibuses have not only a driver, but also a “call boy.” (Not be confused with a “call girl”!) The call boy has the job responsibility of hanging out of the window or door of the minibus and yelling at every person passed on the street telling them how much is costs and asking if they want a ride.
So…this leads me to our story. So we decided that instead of driving our nice, cushy vehicle out to see David and Lauren we would instead travel the way they do when they travel to see us. For us this meant, taking a minibus from my office (in city center for those of you who have been to Lilongwe you know where it is), to the bus station in Old Town, then switching minibuses to go to the end of Area 23, getting off in Area 23 and then finding a bike taxi to David and Lauren’s village. Those of you who haven’t been to Malawi may be immensely confused as to what all of this means.
We caught a minibus to the bus station in Old Town. The bus was broken down and the seats were not attached to the floor – this made turns very difficult for the passengers as we were not only trying to balance ourselves but also keep the seats upright. When we got on the bus there were about five other people on but by the time we reached the bus station there were about 25 and each seat had at least four people on it and sometimes extra if there were kids.
We got out at the bus station – which is actually just a bit of dirt in the midst of the city – and asked our driver how to find a minibus to Area 23. Luckily, he took us over to one quickly where we (strategically, although we didn’t know it at the time) sat in the back corner of the bus together. Again we were some of the first few on the bus. Our back seat got packed with five people and we were smooshed. However, the seat in front of us was even more packed and two different people tried to squeeze their butts into a very tight spot and it didn’t work at all. The minibus drivers won’t go if there aren’t at least four people to a seat…Eventually a smaller women was able to jam her hips into the seat.
Through Area 23 we didn’t stop much because our minibus was already full. We got all the way to the end of the line and got off the minibus. Lauren had instructed us to look for the bike taxis. While this is a common mode of transportation, we had never ridden on a bike taxi before so we were quite nervous. Let me tell you what a bike taxi is – It’s essentially a regular bike with a padded flat piece of wood over the back wheel. It’s about big enough for someone’s butt. Women usually sit “sidesaddle” and men straddle the seat like a horse. The bike taxi drivers did not speak any English which created a bit of confusion when I tried to get on the bike taxi. I thought I was supposed to sit sidesaddle but the bike taxi driver though that was a bad idea (and he was right). So he mimed to me to straddle the seat which I did. We started riding and I was scared to death that I would fall off. The road was dirt and bumpy and there were still some cars passing. This in combination with sitting behind a guy who hadn’t showered in awhile was enough for me…
As we were riding into the village a whole bunch of kids starting yelling out “lala.” This is what they call Lauren because they cannot distinguish between Ls and Rs. (You may remember this from my story about naming the guard’s baby.) So Lauren has been called Rolen, Roleen, Lalen, Rara, and anything else besides Lauren…smart of her to go with her childhood nickname of Lala. I’m not sure if they though I was Lala or they just knew I was Lala’s friend because normally white people don’t ride into their town on bike taxis. You may ask if Lauren and I look similar – not really. We’re about the same age, height and weight but otherwise not much. Some white people will tell you that they find it difficult to distinguish between black Africans. Many people have the same haircut, all have almost the same color of skin and eyes, and most don’t have piercings or glasses that would make someone distinguishable using our normally developed perceptions. Malawians say the same about us – they think that whites look generally the same and there are often times when two white women run into a Malawian and a rural Malawian can’t really distinguish the two. This is just normal. So anyway, for that ride into town I may have been Lala.
We stayed at David and Lauren’s house which is one of three brick houses built for the staff of their local health center. The house is wired for electricity and has pipes and faucets for running water but the village has never been connected to either. The only place in the village that has electricity is the bar – not the health center, school or churches.
So we bathed using a pot of water that was warmed over the fire, we used a hole in the ground in the back as a toilet (called a chim here in Malawi), and we watched David cook us dinner over the fire. In the evening we lit candles, talked and played cards. David and Lauren do have a radio but there’s not a ton to be heard on the radio in Malawi – only at certain times.
In the morning, we went to church with them – a basic cement building which stayed remarkably cool during the whole service. There was an aisle and about twenty wooden benches on either side. The women and children sat on one side and the men on the other. No mixing is allowed so when David and Lauren go to church they have to sit separately. I sat with Lauren and Tyler sat with David.
The total cost of the trip was about 220 kwacha or around $1.75. The most expensive portion was the bike taxi ride which was 100 kwacha one way. (This is about 75 cents.)
On our way home (bike taxi and two minibuses later) Tyler and I commented that we should have done this long ago. It was a great experience and helped us to understand Malawi much better. I often have the feeling that it is better to live in a country as a Peace Corps Volunteer than as a diplomat. Maybe not better per se for everyone, but it is incredibly different – the PCVs have no clue as to some things that exist in Malawi just as we diplomats have no clue as to some things that exist in Malawi.
Malawi visit was a lesson for local teacher
A LOCAL teacher will give a talk tonight about her experience of visiting one of the poorest nations in the world.
Maureen Miller, head teacher at Canisbay and Keiss associated schools, is to speak in Freswick Village Hall about her visit to Malawi in October of last year and the children and education system she encountered in Mulozo Primary School, which is situated in the south of the country.
Mrs Miller was among nine teachers from Scotland who spent the holiday in Malawian schools. The visit was organised by the League for the Exchange of Commonwealth Teachers.
Mrs Miller will tell the audience tonight that Malawi is one of the poorest nations in the world – a tea-picker there earns just 30p a day – and many of the children have lost one or both parents to AIDS/HIV.
Mulozo Primary School has over 1200 pupils. There are only 17 teachers and the classes often contain over 100 children.
The schools have virtually no resources and in the rural areas they have no electricity and just one tap to provide water for everyone.
In the primary classrooms it is often only the teacher who has a chair – everyone else has to sit on the floor.
With few educational resources, the children have learned to make the most of what they have. Some youngsters make their own abacuses to count on out of things like metal bottle tops. Many of the children use old 1kg sugar bags as school bags because they are just the right size for a jotter.
Speaking ahead of tonight's event, Mrs Miller said: "We heard really brilliant music made with guitars made out of plywood boxes and drums kits out of tin cans."
With money given by the pupils at Canisbay and Keiss, as well as from the Wick town schools, the teacher donated jotters, pens and other basic equipment, as well as leisure items such as footballs and a play parachute.
She also took letters by pupils from a number of primary schools which Malawian pupils replied to.
Mrs Miller hopes that the schools at Canisbay and Keiss will develop stronger links with their Mulozo counterpart. "There is so much we can learn from each other," she said.
Meanwhile, several teachers in local schools are becoming pen pals with teachers Mrs Miller met during the visit.
Mrs Miller is hoping she will be able to go back to a different part of Malawi for a longer visit this summer.
She said: "I would like to go back because I was really inspired by my recent trip but felt it was just too short.
"I am aware that a longer stay would be quite a different kind of challenge and I feel that there would be a greater opportunity to make a bigger difference.
"I also feel that the development of global citizenship in our Caithness pupils is of such great importance."
Maureen Miller, head teacher at Canisbay and Keiss associated schools, is to speak in Freswick Village Hall about her visit to Malawi in October of last year and the children and education system she encountered in Mulozo Primary School, which is situated in the south of the country.
Mrs Miller was among nine teachers from Scotland who spent the holiday in Malawian schools. The visit was organised by the League for the Exchange of Commonwealth Teachers.
Mrs Miller will tell the audience tonight that Malawi is one of the poorest nations in the world – a tea-picker there earns just 30p a day – and many of the children have lost one or both parents to AIDS/HIV.
Mulozo Primary School has over 1200 pupils. There are only 17 teachers and the classes often contain over 100 children.
The schools have virtually no resources and in the rural areas they have no electricity and just one tap to provide water for everyone.
In the primary classrooms it is often only the teacher who has a chair – everyone else has to sit on the floor.
With few educational resources, the children have learned to make the most of what they have. Some youngsters make their own abacuses to count on out of things like metal bottle tops. Many of the children use old 1kg sugar bags as school bags because they are just the right size for a jotter.
Speaking ahead of tonight's event, Mrs Miller said: "We heard really brilliant music made with guitars made out of plywood boxes and drums kits out of tin cans."
With money given by the pupils at Canisbay and Keiss, as well as from the Wick town schools, the teacher donated jotters, pens and other basic equipment, as well as leisure items such as footballs and a play parachute.
She also took letters by pupils from a number of primary schools which Malawian pupils replied to.
Mrs Miller hopes that the schools at Canisbay and Keiss will develop stronger links with their Mulozo counterpart. "There is so much we can learn from each other," she said.
Meanwhile, several teachers in local schools are becoming pen pals with teachers Mrs Miller met during the visit.
Mrs Miller is hoping she will be able to go back to a different part of Malawi for a longer visit this summer.
She said: "I would like to go back because I was really inspired by my recent trip but felt it was just too short.
"I am aware that a longer stay would be quite a different kind of challenge and I feel that there would be a greater opportunity to make a bigger difference.
"I also feel that the development of global citizenship in our Caithness pupils is of such great importance."
Teacher to make a return trip to Malawi
A LOCAL head teacher is to go back to Malawi to help develop village schools.
Maureen Miller, head teacher at Keiss and Canisbay primary schools, will be leaving Edinburgh on Friday, June 29, to spend her summer holiday working to improve education in the African country.
Maureen and her husband, Roger Bamfield, an advisory teacher for the Autism Outreach Service in Dingwall, are the only teachers from the North of Scotland joining 16 central Scotland colleagues as part of the Global Teachers Programme (GTP), run by international agency Link Community Development.
The programme provides Scottish teachers and head teachers with a challenging, rewarding and motivating professional and personal development experience.
The couple spent a short time in Malawi last year and have decided to return for a longer spell this time round. They will live and work in two different village communities, where there is no running water or electricity. They are going to work with staff at their village schools helping to develop leadership, management and teaching practice.
They will also learn a lot themselves as they will be living in the local community and stretching their own professional skills.
The programme lasts 15 months and the highlight for Maureen and Roger will be their five-week placement in LCD's school improvement project. The GTP and the Scotland-Malawi School Improvement Project are supported by the Scottish Executive's education department.
Maureen said: "Last year we had an opportunity to spend a short time in Malawian schools.
"We usually spend the summer holiday taking things easy but when we were offered the opportunity to take part in LCD's brilliant Global Teachers Programme, living in and working with a Malawian community for several weeks, we had to take it up. It is a chance to give and also learn so much, both in Malawi and on our return to Scotland."
Maureen, who is looking to raise £2000 towards the cost of this placement in Malawi, hopes to help Scottish and Malawian children form links so they can learn about each others' lives.
Global citizenship is one of the current key developments in Scottish education and the head teacher is keen that Keiss and Canisbay schools develop formal links with those in Malawi through the LCD's Link Schools Programme which offers ongoing support to the partner schools.
Following his placement, Roger plans to work in Highland to help raise awareness amongst children, including those with autism, of global development issues in Malawi.
To support Maureen or Roger through Link Community Development in Scotland, log on to http://www.justgiving.com/caithnessglobalteacher or http://www.justgiving.com/highlandglobalteacher. For more information about Link Community Development visit http://www.lcd.org.uk
Maureen Miller, head teacher at Keiss and Canisbay primary schools, will be leaving Edinburgh on Friday, June 29, to spend her summer holiday working to improve education in the African country.
Maureen and her husband, Roger Bamfield, an advisory teacher for the Autism Outreach Service in Dingwall, are the only teachers from the North of Scotland joining 16 central Scotland colleagues as part of the Global Teachers Programme (GTP), run by international agency Link Community Development.
The programme provides Scottish teachers and head teachers with a challenging, rewarding and motivating professional and personal development experience.
The couple spent a short time in Malawi last year and have decided to return for a longer spell this time round. They will live and work in two different village communities, where there is no running water or electricity. They are going to work with staff at their village schools helping to develop leadership, management and teaching practice.
They will also learn a lot themselves as they will be living in the local community and stretching their own professional skills.
The programme lasts 15 months and the highlight for Maureen and Roger will be their five-week placement in LCD's school improvement project. The GTP and the Scotland-Malawi School Improvement Project are supported by the Scottish Executive's education department.
Maureen said: "Last year we had an opportunity to spend a short time in Malawian schools.
"We usually spend the summer holiday taking things easy but when we were offered the opportunity to take part in LCD's brilliant Global Teachers Programme, living in and working with a Malawian community for several weeks, we had to take it up. It is a chance to give and also learn so much, both in Malawi and on our return to Scotland."
Maureen, who is looking to raise £2000 towards the cost of this placement in Malawi, hopes to help Scottish and Malawian children form links so they can learn about each others' lives.
Global citizenship is one of the current key developments in Scottish education and the head teacher is keen that Keiss and Canisbay schools develop formal links with those in Malawi through the LCD's Link Schools Programme which offers ongoing support to the partner schools.
Following his placement, Roger plans to work in Highland to help raise awareness amongst children, including those with autism, of global development issues in Malawi.
To support Maureen or Roger through Link Community Development in Scotland, log on to http://www.justgiving.com/caithnessglobalteacher or http://www.justgiving.com/highlandglobalteacher. For more information about Link Community Development visit http://www.lcd.org.uk
Africa - teenage pregnancy
The World Congress on Fertility and Sterility took place last week in Durban. A major point of discussion was the level of teenage pregnancy in Sub-Saharan Africa, where the average birth rate is 143 (per 1000) for females aged 15 to 19. The world average is 65, so putting the figures side by side clearly appears “shocking”. Is it shocking, though? In the year 2000, average life expectancy was 77.7 years in the UK, 79.4 in Canada and 79.0 in Italy, meanwhile the figures for Malawi, Kenya and Ghana were 37.6, 48.0 and 57.4. Not a very scientific comparison, I know, but enough to illustrate the point that people quite simply live a lot longer in the West. We are therefore at liberty to wait until our twenties, thirties or forties to have a child. By the time I was born, my own mother was 37 - had she been a Malawian, she wouldn’t have had much longer to live.
Of course, there are issues that need to be addressed in Sub-Saharan Africa - better sex education, protection for minors to name but a couple, but blanketing them all under the problem of “teenage pregnancy” doesn’t help anyone. From my own experiences of Africa, childhood may be short but it’s a time of innocence in a way that no longer seems to exist in our own society. The World Congress estimates that 40 percent of Sub-Saharan women will experience motherhood by the age of 18. Well, motherhood is a part of life, it’s the natural next step once you stop being a child. Guinea has the highest rate of all - with 229 births per 1000 in the 15-19 age range. The Guinean mothers I have met are so attuned to their child’s needs, so happy in their role, that I really think we need to let them get on with it and stop imposing our own Western notions of what is right, timely and appropriate in very different societal circumstances. Sometimes statistics don’t give the whole picture.
Of course, there are issues that need to be addressed in Sub-Saharan Africa - better sex education, protection for minors to name but a couple, but blanketing them all under the problem of “teenage pregnancy” doesn’t help anyone. From my own experiences of Africa, childhood may be short but it’s a time of innocence in a way that no longer seems to exist in our own society. The World Congress estimates that 40 percent of Sub-Saharan women will experience motherhood by the age of 18. Well, motherhood is a part of life, it’s the natural next step once you stop being a child. Guinea has the highest rate of all - with 229 births per 1000 in the 15-19 age range. The Guinean mothers I have met are so attuned to their child’s needs, so happy in their role, that I really think we need to let them get on with it and stop imposing our own Western notions of what is right, timely and appropriate in very different societal circumstances. Sometimes statistics don’t give the whole picture.
Increasing numbers of children on treatment, despite lack of paediatric drugs
The number of HIV-positive children accessing antiretroviral (ARV) treatment in Malawi is increasing, despite a scarcity of suitable paediatric formulas.
An official in the health ministry, speaking under condition of anonymity, confirmed that adult tablets still had to be cut into smaller doses to treat children, but said this was a minor obstacle.
"In all fairness, it should be noted that there are more children on ARVs in Malawi now than ever before ... the treatment is also yielding positive results among children who would otherwise have died," the official told IRIN/PlusNews.
According to the latest government estimates, children constituted nine percent of the more than 12,000 people who had received ARVs from the government's national treatment programme during the last quarter, up from just five percent two years ago. In total, some 5,906 children are benefiting from the national programme.
The local UN Children's Fund (UNICEF) office supports using reduced doses of adult medication to treat children, because the cost of paediatric tablets is unaffordable to many parents and caregivers. Paediatric formulas also need to be kept in refrigerated storage, and home refrigeration is a luxury for most Malawians, who live far below the poverty line.
"It makes more sense, financially, for the government to use adult ARVs, as syrups cost a great deal more, not only in terms of procurement, but also in terms of storage once they are dispensed to patients," said Dr Miriam Shipimo, UNICEF manager for women, youth and HIV/AIDS.
"Ideally, these children should be using Pedimune, a three-in-one tablet that can be easily stored, but it remains out of reach ... so we still halve Triomune, the widely used adult ARV, and it's proving to be quite effective under the circumstances," she said.
Pedimune, manufactured by the Indian generic drug firm, Cipla, is available in most developed countries and at private clinics in Malawi, but still needs the approval of the World Health Organisation to be rolled out in the public sector.
Medicin Sans Frontieres (MSF), the international medical relief agency, welcomed the "innovative" method of treating the nation's HIV-positive children, but expressed concern over the accuracy of reduced adult dosages.
"We are not exactly pleased with this method, but lives are being saved as we wait for suitable paediatric formulas to made more widely accessible," said Ulrika von Pillar, the Belgian head of mission at MSF in Malawi.
An estimated 80,000 children are living with HIV in this resource-limited country, 24,000 of whom are in urgent need of paediatric ARVs.
An official in the health ministry, speaking under condition of anonymity, confirmed that adult tablets still had to be cut into smaller doses to treat children, but said this was a minor obstacle.
"In all fairness, it should be noted that there are more children on ARVs in Malawi now than ever before ... the treatment is also yielding positive results among children who would otherwise have died," the official told IRIN/PlusNews.
According to the latest government estimates, children constituted nine percent of the more than 12,000 people who had received ARVs from the government's national treatment programme during the last quarter, up from just five percent two years ago. In total, some 5,906 children are benefiting from the national programme.
The local UN Children's Fund (UNICEF) office supports using reduced doses of adult medication to treat children, because the cost of paediatric tablets is unaffordable to many parents and caregivers. Paediatric formulas also need to be kept in refrigerated storage, and home refrigeration is a luxury for most Malawians, who live far below the poverty line.
"It makes more sense, financially, for the government to use adult ARVs, as syrups cost a great deal more, not only in terms of procurement, but also in terms of storage once they are dispensed to patients," said Dr Miriam Shipimo, UNICEF manager for women, youth and HIV/AIDS.
"Ideally, these children should be using Pedimune, a three-in-one tablet that can be easily stored, but it remains out of reach ... so we still halve Triomune, the widely used adult ARV, and it's proving to be quite effective under the circumstances," she said.
Pedimune, manufactured by the Indian generic drug firm, Cipla, is available in most developed countries and at private clinics in Malawi, but still needs the approval of the World Health Organisation to be rolled out in the public sector.
Medicin Sans Frontieres (MSF), the international medical relief agency, welcomed the "innovative" method of treating the nation's HIV-positive children, but expressed concern over the accuracy of reduced adult dosages.
"We are not exactly pleased with this method, but lives are being saved as we wait for suitable paediatric formulas to made more widely accessible," said Ulrika von Pillar, the Belgian head of mission at MSF in Malawi.
An estimated 80,000 children are living with HIV in this resource-limited country, 24,000 of whom are in urgent need of paediatric ARVs.
Report on Child Deaths Finds Some Hope in Poorest Nations
The rate at which young children perish has worsened most disastrously over the past 15 years in Iraq, hard hit by both sanctions and war, and in Botswana, Zimbabwe and Swaziland, devastated by AIDS, according to a report released yesterday by Save the Children. But researchers also found against-the-odds progress in some of the world’s poorest nations.
Bangladesh has profoundly improved the chances that a child would survive by promoting family planning, a strategy that has enabled women to have fewer children, space births and strengthen their own health and that of their babies.
Nepal, despite a decade-long Maoist insurgency, has halved the death rate of children under age 5. It has enlisted the help of 50,000 mothers, most of them illiterate, who have squeezed vitamin A drops into the mouths of every child, hauled laggards in for vaccinations and even diagnosed pneumonia and dispensed medicines to combat it.
And Malawi, with an extreme shortage of doctors and nurses, has made surprising gains by taking simple steps that require no professional skills, for example distributing nets that protect children from malarial mosquitoes.
“In 2007, when we know what to do and how little it costs, that 28,000 kids are still dying each day is just plain wrong,” said David Oot, a public health expert on the team that produced the Save the Children report, “State of the World’s Mothers: Saving the Lives of Children Under 5.”
Despite many hopeful stories, broad progress against infant and child mortality has flagged since international health agencies began a campaign to reduce deaths 25 years ago, the researchers concluded. By the end of the 1980’s, global rates of child mortality had fallen 20 percent, and the lives of 12 million children were saved.
“Much of the momentum behind the child survival revolution has now been lost, and gains achieved in the 1980s and early 1990s have slowed or reversed,” the report says. “Under-5 mortality declined by only 10 percent from the early 1990s to 2000.”
Among the 60 developing countries where 94 percent of the child deaths occurred, 20 have either made no progress or have regressed, while 24 have cut death rates of children under 5 by at least 20 percent.
Iraq experienced the most staggering rise in under-age-5 mortality — 150 percent over 15 years. Since the war began in 2003, deteriorating health services, rising inflation and electricity shortages have worsened living conditions, the report said. In 2005, about 122,000 Iraqi children died before their fifth birthdays.
In countries that progressed, a focus on family planning was central to progress, the report said. In the five countries that made the greatest strides in reducing child deaths — Egypt, Indonesia, Bangladesh, Nepal and the Philippines — women’s use of contraceptives rose and fertility rates declined. In those countries, mothers were less likely to be physically depleted by having too many babies in too short a time. With fewer children, families were also able to invest more in the care of each child.
Political will was also an essential ingredient of success — and in Malawi, Tanzania, Nepal and Bangladesh was even more important than national wealth, the report found. Egypt, which has cut the death rate of children under age 5 by 68 percent since 1990, more than any other country, has shown a particular commitment to children’s health, said the researchers at Save the Children, a nonprofit group, and other experts.
“In words and deed, Egypt has put children more at the center of their social agenda than most other countries,” said Ruth Levine, author of “Millions Saved: Proven Successes in Global Health (Center for Global Development, 2004).
Egypt has carried out a comprehensive effort to improve the health of mothers and children. It invested in clean water and public health campaigns to teach the importance of hand-washing in disease prevention. It built roads that sped access to hospitals. It renovated dilapidated clinics. It made sure most mothers had midwives or other skilled workers to attend births. It strove to perfect immunization campaign strategies.
“There is a way to do a blanket of public health interventions that is very effective,” said Dr. Ayman El-Mohandes, a pediatrician and chairman of the Department of Prevention and Community Health at George Washington University’s School of Public Health, who served as a consultant on a United States-financed maternal and child health program in Egypt.
Bangladesh has profoundly improved the chances that a child would survive by promoting family planning, a strategy that has enabled women to have fewer children, space births and strengthen their own health and that of their babies.
Nepal, despite a decade-long Maoist insurgency, has halved the death rate of children under age 5. It has enlisted the help of 50,000 mothers, most of them illiterate, who have squeezed vitamin A drops into the mouths of every child, hauled laggards in for vaccinations and even diagnosed pneumonia and dispensed medicines to combat it.
And Malawi, with an extreme shortage of doctors and nurses, has made surprising gains by taking simple steps that require no professional skills, for example distributing nets that protect children from malarial mosquitoes.
“In 2007, when we know what to do and how little it costs, that 28,000 kids are still dying each day is just plain wrong,” said David Oot, a public health expert on the team that produced the Save the Children report, “State of the World’s Mothers: Saving the Lives of Children Under 5.”
Despite many hopeful stories, broad progress against infant and child mortality has flagged since international health agencies began a campaign to reduce deaths 25 years ago, the researchers concluded. By the end of the 1980’s, global rates of child mortality had fallen 20 percent, and the lives of 12 million children were saved.
“Much of the momentum behind the child survival revolution has now been lost, and gains achieved in the 1980s and early 1990s have slowed or reversed,” the report says. “Under-5 mortality declined by only 10 percent from the early 1990s to 2000.”
Among the 60 developing countries where 94 percent of the child deaths occurred, 20 have either made no progress or have regressed, while 24 have cut death rates of children under 5 by at least 20 percent.
Iraq experienced the most staggering rise in under-age-5 mortality — 150 percent over 15 years. Since the war began in 2003, deteriorating health services, rising inflation and electricity shortages have worsened living conditions, the report said. In 2005, about 122,000 Iraqi children died before their fifth birthdays.
In countries that progressed, a focus on family planning was central to progress, the report said. In the five countries that made the greatest strides in reducing child deaths — Egypt, Indonesia, Bangladesh, Nepal and the Philippines — women’s use of contraceptives rose and fertility rates declined. In those countries, mothers were less likely to be physically depleted by having too many babies in too short a time. With fewer children, families were also able to invest more in the care of each child.
Political will was also an essential ingredient of success — and in Malawi, Tanzania, Nepal and Bangladesh was even more important than national wealth, the report found. Egypt, which has cut the death rate of children under age 5 by 68 percent since 1990, more than any other country, has shown a particular commitment to children’s health, said the researchers at Save the Children, a nonprofit group, and other experts.
“In words and deed, Egypt has put children more at the center of their social agenda than most other countries,” said Ruth Levine, author of “Millions Saved: Proven Successes in Global Health (Center for Global Development, 2004).
Egypt has carried out a comprehensive effort to improve the health of mothers and children. It invested in clean water and public health campaigns to teach the importance of hand-washing in disease prevention. It built roads that sped access to hospitals. It renovated dilapidated clinics. It made sure most mothers had midwives or other skilled workers to attend births. It strove to perfect immunization campaign strategies.
“There is a way to do a blanket of public health interventions that is very effective,” said Dr. Ayman El-Mohandes, a pediatrician and chairman of the Department of Prevention and Community Health at George Washington University’s School of Public Health, who served as a consultant on a United States-financed maternal and child health program in Egypt.
NO COURT INJUNCTION : Malawi NGOs cave in over Paladin uranium mining project
Popular demand for uranium mining in Malawi has bullied non-governmental organizations (NGOs) in the country into submission following threats that they would take Paladin Resources (ASX, TSX:PDN) to court to stop it from mining uranium in the country's northern region district of Karonga.
Just after the received its mining license from the Malawi government to start developing its Kayerekera Uranium Project, the NGOs announced they would be going to court to stop Paladin from developing the mine. The NGOs argued that people around the area were not happy with the project as it threatened their health and that they could not allow the project to go on until all the claimed grey areas in its Environmental Impact Assessment (EIA) report were addressed.
The development threatened to be a spanner in the works of Malawi's first ever mining venture. However over the weekend the Malawi government interacted with chiefs and people around the mine to hear their take on the project as well as to highlight to them its prospective benefits. From the discussions, it was apparent that there was a popular demand for the uranium mine in the district, which might change Malawi's economy from solely being agro-based as uranium would become the country's second largest forex earner.
"I was very surprised because on the ground people have different opinion on the project than that being championed by the NGOs who are against it and claimed to speak on behalf of the people," said Minister of Mines and Natural Resources Henry Chimunthu Banda after the meeting. "The people including chiefs are happy and spoke in support of the project which they said would transform lives and the district as well."
The NGOs argue that the EIA report submitted to government by Paladin was not conclusive as it does not spell out clearly how it would protect people from radioactivity. One of the NGOs against uranium mining - Catholic Commission for Justice and Peace (CCJP) in Malawi's northern city of Mzuzu - seems to have been bullied into submission and now turns to God for assistance but still insists Malawians are not being told the truth about the effects of uranium.
"We just hope God will guide us that this project does not take off," CCJP's John Chawinga told the local press. "Honourable Minister Banda is an interested party. There is no way he can go there and say people are not happy because government wants this project to take off at all costs and they are not telling the people the effects of uranium mining."
In April government awarded Paladin a 15 year license renewable for further 10 year period. The license covers an area of 55.5 sq. km. According to Paladin, commencement of construction of the Kayerekera Uranium Project marks a "highly auspicious moment in the development of Paladin towards becoming a major uranium supplier to the global markets".
"The Kayerekera Uranium Project is scheduled to commission in September 2008 and reach full production during the 2nd quarter of 2009. Annual production will be 3.3 Mlbs U3O8," reads part of the Paladin statement. "The CAPEX to build the project is US$185M for which the major portion of funding was raised through its US$250M convertible bond raising carried out in December 2006."
Had the NGOs managed to take Paladin to court, the case could have been the first of its kind in the country in recent times between the civil society and a private entity.
Just after the received its mining license from the Malawi government to start developing its Kayerekera Uranium Project, the NGOs announced they would be going to court to stop Paladin from developing the mine. The NGOs argued that people around the area were not happy with the project as it threatened their health and that they could not allow the project to go on until all the claimed grey areas in its Environmental Impact Assessment (EIA) report were addressed.
The development threatened to be a spanner in the works of Malawi's first ever mining venture. However over the weekend the Malawi government interacted with chiefs and people around the mine to hear their take on the project as well as to highlight to them its prospective benefits. From the discussions, it was apparent that there was a popular demand for the uranium mine in the district, which might change Malawi's economy from solely being agro-based as uranium would become the country's second largest forex earner.
"I was very surprised because on the ground people have different opinion on the project than that being championed by the NGOs who are against it and claimed to speak on behalf of the people," said Minister of Mines and Natural Resources Henry Chimunthu Banda after the meeting. "The people including chiefs are happy and spoke in support of the project which they said would transform lives and the district as well."
The NGOs argue that the EIA report submitted to government by Paladin was not conclusive as it does not spell out clearly how it would protect people from radioactivity. One of the NGOs against uranium mining - Catholic Commission for Justice and Peace (CCJP) in Malawi's northern city of Mzuzu - seems to have been bullied into submission and now turns to God for assistance but still insists Malawians are not being told the truth about the effects of uranium.
"We just hope God will guide us that this project does not take off," CCJP's John Chawinga told the local press. "Honourable Minister Banda is an interested party. There is no way he can go there and say people are not happy because government wants this project to take off at all costs and they are not telling the people the effects of uranium mining."
In April government awarded Paladin a 15 year license renewable for further 10 year period. The license covers an area of 55.5 sq. km. According to Paladin, commencement of construction of the Kayerekera Uranium Project marks a "highly auspicious moment in the development of Paladin towards becoming a major uranium supplier to the global markets".
"The Kayerekera Uranium Project is scheduled to commission in September 2008 and reach full production during the 2nd quarter of 2009. Annual production will be 3.3 Mlbs U3O8," reads part of the Paladin statement. "The CAPEX to build the project is US$185M for which the major portion of funding was raised through its US$250M convertible bond raising carried out in December 2006."
Had the NGOs managed to take Paladin to court, the case could have been the first of its kind in the country in recent times between the civil society and a private entity.
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