SciDev.Net

This journal article, written by three researchers in Trinidad and Tobago, looks at malaria in the Caribbean. It asks why there are still outbreaks — including a big one in Jamaica in 2006/2007 — when the disease was allegedly eliminated in the late 1950s. The authors review malaria and vector data from across the Caribbean, summarising the pattern of imported cases as well as indigenous ones.

They identify three essential conditions for malaria transmission: presence of the vector, imported organisms and susceptible human hosts — all of which the authors show still exist across the Caribbean.

The authors suggest specific actions for regional policymakers to combat malaria. These include enhancing vector control skills, strengthening surveillance with new technologies, upgrading malaria therapy, increasing prevention strategies such as bed nets and raising public awareness of malaria. They emphasise that the role of climate change must be considered too, saying that rising temperatures could lead to new malaria vectors entering and colonising Caribbean islands and transmitting malaria on a major scale. But the authors are also careful to point out that the link to climate change is uncertain and remains contested in scientific circles.

Paul Reiter, a researcher on insects and infectious disease at the Institut Pasteur in France, is not convinced that climate change will cause a rise in malaria in tropical regions. In this opinionated review he sets out to dispel widely held "common misconceptions" about the effect of climate variability on future transmission.

To do so, he examines the history of malaria. He finds that in the past, contrary to expectations, climate has often not affected the transmission of the malaria parasite. Researchers claim that the Anopheles mosquito that carries the parasite cannot survive extreme temperatures, yet Reiter cites examples of the mosquito finding ways to adapt. In Sudan, for example, they can survive temperatures of over 55 degrees Celsius by hiding in buildings in daytime and only feeding after midnight.

Reiter's main disagreement with prediction models is that they only look at how one climate variable, temperature, is likely to interact with mosquito populations. Temperature, rainfall and humidity are interconnected and cannot be analysed separately, he says. The ecology of mosquitoes and humans is too complex to predict future malaria prevalence and incidence from temperature alone, he adds.

This paper, published in the New England Journal of Medicine, examines how the Internet can help monitor, prevent and control emerging diseases. The authors argue that the emergence of influenza A(H1N1), or 'swine flu', in April 2009 shows the value web-based information holds for early disease monitoring.

Informal internet channels such as blogs, chat rooms and search engine request analyses can help identify outbreaks more quickly, prevent governments suppressing information and facilitate public health responses. Google and Yahoo data searches can be used to generate epidemic curves that show the number of new infections plotted against time, and are comparable to those derived from traditional influenza surveillance methods.

The Internet also connects experts — through wikis and social networks — to quickly disseminate reports and responses. There is also great potential from public information.

The authors give examples of approaches being taken to monitor infectious diseases, including swine flu, and highlight some of the online resources available, including Google Flu Trends, HealthMap and ProMED.

This feature, published by The Lancet, discusses the world's capacity to cope with a A(H1N1) influenza, or 'swine flu', pandemic. The author outlines some of the progress made in pandemic preparedness since severe acute respiratory syndrome (SARS) and H5N1 influenza (bird flu) hit the world a few years ago, but points out that many countries' plans are flawed.

Many countries in the Asia–Pacific focus on early containment of disease and "social distancing", a strategy particularly important for developing countries as many lack access to antiviral drugs and vaccines. But, on the other hand, countries that focus on surveillance end up with problems if the virus becomes pandemic.

Scientists are struggling to predict what the likely health impact of a pandemic will be because influenza viruses can become more dangerous as they mutate. And epidemiologists are trying to assess which groups of people are most vulnerable and why some people have more severe symptoms than others.

This collection of features and commentaries, published by Nature, reflects the broad spectrum of activities and opinions of members and associates of TWAS, the academy of sciences for the developing world.

With more than three dozen articles written by prominent scientists working on research or policy issues in the South, the collection examines a range of topics in science-based international development — from the relevance of subjects like mathematics or physics, to the increasing roles of biotechnology and renewable energy.

The achievements made and challenges still facing developing countries in key areas like agriculture, health, climate change and energy are also discussed. And evidence from across the South is presented to show how strengthening science can help achieve economic goals and what more is needed to ensure that knowledge and development are shared by all.

This series of commentaries and research articles — published by The Lancet, the Peking University Health Sciences Centre and the China Medical Board — addresses China's major health challenges, strategies and future. It has been produced by a group of 63 scientists from 10 countries with Chinese scientists making up two-thirds of the authors.

The research papers give scientific evidence on key health issues including the emergence and control of both infectious and chronic non-infectious diseases in China as well as the performance of China's healthcare system.

Authors of the series' commentaries further discuss a range of topical issues affecting China's health system, including the state of biomedical science and technology (see 'Progress in Chinese biomedicine a massive challenge'), medical research ethics, the lessons learnt from China's schistosomiasis control programme and the challenges the country faces in controlling HIV/AIDS.

This article examines the rising rate of antibiotic resistance, and proposes action to reverse the trend. The authors call for leadership at international and national levels, a change in the behaviour of consumers and providers, and the development of antibacterial agents to match existing public health needs.

They suggest that international bodies such as the WHO should provide coordination and resources for generating key information on the burden of antibiotic resistance, and call for individual governments to set up multidisciplinary action programmes. They also examine the methods needed to better inform the public and discuss alternative approaches to developing new antibacterials, including product development partnerships and gap analyses.

The Millennium Development Goals (MDGs) practically define health efforts in the 21st century, but they virtually ignore non-communicable diseases such as mental health, say these authors. This is despite evidence that mental health disorders are among the most important cause of sickness and disability and even premature mortality. The authors argue that tackling mental health problems will be vital to achieving the MDGs, and three in particular — eradicating poverty, reducing child mortality, and improving maternal health.

Poverty and hunger are well-recognised risk factors for mental health, but mental health also makes it harder for people to escape the hunger trap. Mothers who are depressed during pregnancy and post natally, are more likely to have underweight babies; not only that, the illness means these mothers are more likely to stop breastfeeding and less likely to ensure their children are properly immunised than mothers without depression.

The authors advocate that strengthening basic health-care systems should be holistic. For example, developing countries need more and better-trained health workers but they should not only know how to deliver babies but also how to counsel new mothers. HIV/AIDS programmes, as another example, should ensure that individuals not only have good access to antiretrovirals but also to treatment for depression if they need it.

Schizophrenia is relatively rare — affecting 1% of the world's population — but is arguably one of the most severe mental illnesses. Diagnosing and treating it can be hard enough in developed countries; the challenges are magnified in developing nations with inadequate health systems; few trained staff; and pervasive social stigma. So how best to treat it? In this debate, three psychiatrists offer their different viewpoints.

Vikram Patel, at the London School of Hygiene and Tropical Medicine, says the shortage of mental health specialists means that the most effective way of spreading the expertise around might be for non-specialist health workers or community representatives to be trained to bear the brunt of providing first-line mental health services. Saeed Farooq, at Pakistan's Lady Reading Hospital, argues that the principles of the WHO's DOTS TB programme, in which patients are given an uninterrupted supply of medication taken under close supervision, could be used to treat schizophrenia. The rationale is that missing medication for schizophrenia, which can be common given the cognitive impairment associated with the illness, has serious consequences and can lead to much higher risks of relapse. R. Thara, director of the Schizophrenia Research Foundation, Chennai, India, advocates tackling stigma by offering proper treatment. In India at least, he says, the mystification of mental illness is intensified by a lack of awareness about schizophrenia and also by "magico-religious" beliefs. Effective treatment that shows the symptoms to be an illness rather than a religious curse is the best antidote to stigma, he says.

Antibiotics are used to prevent or treat disease or to encourage growth in animals intended for human consumption. Opinion is divided over the potential of the practice to cause health problems in people. This forum presents different perspectives from human and animal medicine experts.

The remarkable variation of views indicates the complexity of the debate. For some, there is no doubt that antibiotic use in animals causes resistance in people; for others, the link is present but unclear; and for the rest, not nearly enough is known to start taking action, and they suggest monitoring the situation. All agree, though, that whether in animals or people, antibiotics should be used with caution.

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This report looks at the future consequences of climate change in the greater Himalayan region. Experts predict that global climate change will lead to major shifts in the strength and timing of climate systems affecting the region, and expect this to intensify in mountain areas.

The authors focus on changes in glaciers, permafrost and avalanches, as well as the implications for water supplies, ecosystems and hazards such as glacier lake outbursts and how these threaten regional populations.

The authors emphasise that because the poor and marginalised are likely to suffer the earliest and most, identifying changes in the environment likely to affect them is of utmost importance.

The authors highlight the need to work on policies and strategies — in land use, water management, disaster management, energy consumption and human health — in order to improve the adaptive capacities of communities at risk. They argue that community-led adaptive strategies and capacities, as well as substantial efforts to reverse the human drivers of climate change, are needed.

A detailed discussion paper that presents a human rights approach to intellectual property rights. The paper was submitted to the UN Committee on Economic, Social and Cultural Rights for its discussion on "The right of everyone to benefit from the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author", which took place in Geneva in November 2000.

The paper starts with the premise that the manner in which creative works, cultural heritage, and scientific knowledge are turned into property has significant human rights implications. Various international human rights instruments have enumerated the right of an author, creator, and inventor to some form of recognition and benefit from their intellectual products — including the International Covenant on Economic, Social and Cultural Rights Article 15 (1) (c).

Recent trends underscore the need for a human rights approach to intellectual property; as various economic actors rush to stake claims over creative works and forms of knowledge — for example, through the provisions of the international agreement on Trade-Related Aspects of Intellectual Property Rights — human rights are being trampled. The author warns that unless human rights advocates provide an effective intellectual and organisational counterweight to economic interests, the intellectual property landscape will be reshaped in the years ahead without adequate consideration of the impact on human rights.