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The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief. [ABSTRACT FROM AUTHOR]

The authors reflect on the question of whether the active recruitment of health workers from sub-Saharan Africa should be viewed as a crime. They suggest that shortages of health care staff are endemic in sub-Saharan Africa and that the insufficiency of health care staff is an impediment to the delivery of health care services. They argue that if recruiting does not stop the health consequences of health worker recruitment for Africa are dire.

The article presents the views of Executive Director of the United Nations (UN) Children's Fund Ann Veneman on the progress of achieving the UN's Millennium Development Goal 4 of reducing child mortality by two-thirds by 2015. The article discusses health issues that directly affect children's mortality, including the prevalence of HIV/AIDS in Africa. The article also discusses areas in which there has been progress in the fight against child mortality, such as vaccines for pneumococcus.

Background: Many countries in Africa are considering a change to combination treatment for falciparum malaria because of the increase in drug resistance. However, there are few effectiveness data for these combinations. Our aim was to study the effectiveness of three drug combinations that have proven efficacious in east Africa compared with amodiaquine monotherapy. Methods: We undertook a randomized trial of antimalarial drug combinations for children (aged 4--59 months) with uncomplicated malaria in Muheza, Tanzania, an area with a high prevalence of resistance to sulfadoxine-pyrimethamine and chloroquine. Children were randomly allocated 3 days of amodiaquine (n=270), amodiaquine sulfadoxine-pyrimethamine (n=507), or amodiaquine artesunate (n=515), or a 3-day six-dose regimen of artemether-lumefantrine (n=519). Drugs were taken orally, at home, unobserved by medical staff. The primary endpoint was parasitological failure by day 14 assessed blind to treatment allocation. Secondary endpoints included day 28 follow-up and gametocyte carriage. Analysis was by intention to treat. Findings: Of 3158 children screened, 1811 were randomly assigned treatment and 1717 (95%) reached the 14-day follow-up. The amodiaquine group was stopped early by the data and safety monitoring board. By day 14, the parasitological failure rates were 103 of 248 (42%) for amodiaquine, 97 of 476 (20%) for amodiaquine sulfadoxine-pyrimethamine, 54 of 491 (11%) for amodiaquine artesunate, and seven of 502 (1%) for artemether-lumefantrine. By day 28, the parasitological failure rates were 182 of 239 (76%), 282 of 476 (61%), 193 of 472 (40%), and 103 of 485 (21%), respectively. The difference between individual treatment groups and the next best treatment combination was significant (p 0.001) in every case. Recrudescence rates by day 28, after correction by genotyping, were 48.4%, 34.5%, 11.2%, and 2.8%, respectively. Interpretation: The study shows how few the options are for treating malaria where there... [ABSTRACT FROM AUTHOR]

The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century. INSETS: Panel 1: Data inputs and methods used to obtain estimates...;Panel 2: Key messages for neonatal health. [ABSTRACT FROM AUTHOR]

Major advances have been made during the past decade in the way the international community responds to the health and nutrition consequences of complex emergencies. The public health and clinical response to diseases of acute epidemic potential has improved, especially in camps. Case-fatality rates for severely malnourished children have plummeted because of better protocols and products. Renewed focus is required on the major causes of death in conflict-affected societies--particularly acute respiratory infections, diarrhoea, malaria, measles, neonatal causes, and malnutrition--outside camps and often across regions and even political boundaries. In emergencies in sub-Saharan Africa, particularly southern Africa, HIV/AIDS is also an important cause of morbidity and mortality. Stronger coordination, increased accountability, and a more strategic positioning of non-governmental organisations and UN agencies are crucial to achieving lower maternal and child morbidity and mortality rates in complex emergencies and therefore for reaching the UN's Millennium Development Goals. [ABSTRACT FROM AUTHOR]

Summary BACKGROUND New antimalarial treatments are urgently needed in sub-Saharan Africa. Improved therapies should decrease failure rates in the short term, but their effect on incidence of subsequent episodes of malaria is little studied. We aimed to compare the short-term and long-term effectiveness of three antimalarial regimens in children from Kampala, Uganda. METHODS We randomly allocated healthy children aged 6 months to 5 years to receive 25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine plus either placebo, 25 mg/kg amodiaquine, or 12 mg/kg artesunate. Participants were followed up for 1 year and received the same preassigned treatment for every new episode of uncomplicated malaria diagnosed during follow-up. Recrudescent and new infections were distinguished by comparison of polymorphisms in merozoite surface protein 2 (MSP2). Our primary endpoint was the total number of treatments for malaria per time at risk. Analyses were done per protocol. FINDINGS 183 (61%) of 316 participants were diagnosed with at least one episode of uncomplicated malaria. A total of 577 episodes of uncomplicated Plasmodium falciparum malaria were treated with study drugs; all regimens were safe and well tolerated. Clinical treatment failure after 14 days was significantly more frequent in the sulfadoxine/ pyrimethamine group (38 of 215, 18%) compared with either the sulfadoxine/pyrimethamine plus amodiaquine group (two of 164, 1%; p

The Global Alliance for Vaccines and Immunization (GAVI) is seen as a model for the new Global Fund to Fight AIDS, Tuberculosis and Malaria, to be launched early in 2002. We did an assessment in four African countries to report the experiences of ministries of health and their partners in applying to GAVI for funds to strengthen health systems and for new vaccines. Countries welcomed the introduction of hepatitis B vaccine, safe injection equipment, and the financial support to strengthen immunisation programmes. All reported that the pace of the application process was too rapid. District visits revealed low staffing levels, insufficient transport and fuel, poorly functioning cold chains, and infrequent supervision. Information systems were unreliable, which will be an obstacle to GAVI when monitoring and rewarding improvements in immunisation coverage. Also, the high cost of expensive new vaccines will be difficult to sustain if GAVI funding stops at the end of its 5 year commitment. Our study suggests that applications for support and planning for AIDS, tuberculosis, and malaria control under the new Global Fund, will be more complex and demanding on already over-stretched ministries of health. Further, the rapid onset of activities, coupled with uncertainty about the time-scale of donor commitment, could be problematic. A limited and carefully assessed set of initial activities, focusing on where and how to strengthen existing country systems, is more likely to be successful and could provide useful models for scaling-up to larger programmes in different contexts. [ABSTRACT FROM AUTHOR]

Background: Information on the cost-effectiveness of malaria control is needed for the WHO Roll Back Malaria campaign, but is sparse. We used mathematical models to calculate cost-effectiveness ratios for the main prevention and treatment interventions in sub-Saharan Africa.Methods: We analysed interventions to prevent malaria in childhood (insecticide-treated nets, residual spraying of houses, and chemoprophylaxis) and pregnancy (chloroquine chemoprophylaxis and sulfadoxine-pyrimethamine intermittent treatment), and to improve malaria treatment (improved compliance, improved availability of second-line and third-line drugs, and changes in first-line drug). We developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability-adjusted life year (DALY) averted for each intervention in three economic strata. Data were obtained from published and unpublished sources, and consultations with researchers and programme managers.Findings: In a very-low-income country, for insecticide treatment of existing nets, the cost-effectiveness range was US$4-10 per DALY averted; for provision of nets and insecticide treatment $19-85; for residual spraying (two rounds per year) $32-58; for chemoprophylaxis for children $3-12 (assuming an existing delivery system); for intermittent treatment of pregnant women $4-29; and for improvement in case management $1-8. Although some interventions are inexpensive, achieving high coverage with an intervention to prevent childhood malaria would use a high proportion of current health-care expenditure.Interpretation: Cost-effective interventions are available. A package of interventions to decrease the bulk of the malaria burden is not, however, affordable in very-low-income countries. Coverage of the most vulnerable groups in Africa will require substantial assistance from external donors. [ABSTRACT FROM AUTHOR]

The authors reflect on task shifting for antiretroviral treatment delivery in sub-Saharan Africa. They suggest that task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa but should be part of an overall strategy that includes measures to increase, retain and sustain health staff. They argue that task shifting should not become an excuse for failing to remedy deficient public health resources.

The article reports that pneumonia kills more children under the age of 5 globally than any other illness. It is particularly prevalent in South Asia and sub-Saharan Africa. Preventative measures include immunizations and promoting adequate nutrition. Prompt treatment once a child develops pneumonia is essential, but the majority of caregivers in the developing world do not know the two key symptoms of pneumonia, which are fast and difficult breathing.

Focuses on the Commission for Africa (CFA), an international group focused on economic development and public health. Reference to a report by the CFA in which economic and social conditions in Africa are assessed; Comments on the potential for Africa to meet the Millennium Development goals as outlined by the United Nations; Impact of HIV/AIDS on public health in Africa; Recommendations of the CFA for improving health services administration in Africa; Critique of the CFA and its policies toward Africa.

The article focuses on the failure of international response to the outbreak of Ebola in Africa due to lack of available funds and not suited methods for the disease. Topics include the health-care systems in countries affected by Ebola which cannot respond to emergency, the lack of medical equipment and untrained staff at public health structures, and the need for high-income countries' health-care workers to help their colleagues in Africa develop strategy for preventing such disease.

The article discusses the report of Africa's health opportunities supported conducted by researcher Morten Jerven. It states that the health gap for Africa within generation is achievable. It cites that the report is central to the condition of the health industry in Africa for the coming years. It mentions the importance of advocacy, investments in higher education, and regional cooperation.

A letter to the editor is presented regarding the issue of low-income countries in sub-Saharan Africa having minimum obstetric volume with no superior organization of child birth care.

A letter to the editor is presented in response to the article "Countdown to 2015: a report card on maternal, newborn, and child survival" by Richard Horton in the April 12, 2008 issue.

This article focuses on the World Health Organisation (WHO) and its efforts to improve health conditions in Africa. The article argues that despite WHO Director-General Margaret Chan's emphasis on improving the health conditions in Africa, results are not evident. The WHO regional office for Africa, or AFRO, faces difficulties in operating effectively including its location, power cuts, and lack of accommodation for staff. The article cites the health problems in Africa including high maternal and child mortality rates as well as a need for antiretrovirals.

The authors offer opinions on a study published elsewhere in this issue which found less correlation between wars and civil wars in Africa and the spread of the HIV/AIDS virus on that continent. The study challenges the conventional wisdom that the dislocations and atrocities of those wars, including widespread rape, and prostitution in displaced populations, contribute to the spread of the virus, finding no such correlation. While many relevant statistics are unavailable, the data collected by the researchers appears to validate their contention. Sexual violence is a critical issue in Africa by itself, as is the spread of the HIV virus, and each needs to be addressed separately.

Comments on antimalarial cocktails which are studied in this issue of 'The Lancet.' How combining drugs has been effective in treating infections caused by mycobacteria and human immunodeficiency virus; Drug-combinations used in trials for patients with malaria in Africa, including atovaquone-proguanil, artemether-lumefantrine and sulfadoxine-pyrimethamine.

Discusses the international public view of social conditions in Africa. Mention of the International Conference on Financing for Development in Monterray, Mexico; Efforts of the conference to improve social conditions in Africa; Mention of other conferences, including the Millennium Development Goals; Policy of the administration of United States President George W. Bush regarding funds for impoverished nations.

The article discusses the spread of the Ebola virus in West Africa. Topics discussed include the effects of the disease on the region, communities, economies and health systems, the United Nations' (UN) expectation that the epidemic would be eradicated by June 2015, developments that pose challenges on efforts to control the spread of the Ebola disease and the shift of the UN containment strategy to public health approach.

The author discusses the impact of the outbreak of ebola virus disease on various African countries including Liberia, Sierra Leone, and Guinea. The author discusses the High-Level Meeting on Building Resilient Systems for Health Ebola-Affected Countries of the World Health Organization (WHO) regarding the use of the epidemic to develop and change the health system of the world.

The author comments on a report released in December 2014 by the African Child Policy Forum about the challenges facing children with disabilities in Africa. Topics covered include how children with disabilities are treated in Africa, the priority actions proposed in a report to improve the situation of children with disabilities in different African nations and the report's goal of reorienting society's thinking and treatment of children with disabilities.

Presents an essay regarding the health programs in Africa. How the author came to live in West Africa after moving from Canada; Status of hospitals in the region; How Africans need to be assured that health care will be permanent and not temporary; What the author has learned.

Editorial. Discusses a World Bank report on the entrenched economic crisis facing sub-Saharan Africa in the 1980s and its implication for human welfare. Deteriorating welfare conditions; Bank advises economic reforms; Other.

The article presents a profile of Miriam Were, the joint winner of the 2008 Hideyo Noguchi Africa prize. Her work as a doctor in Africa is discussed. Her personal history is detailed including growing up in a Quaker family, her educational background, and the death of her own children. Work that Were has done to promote public health in poor rural communities is described. Were's work with UNICEF and the World Hunger Organization is given. Also discussed is criticism Were faced when she started as a doctor.

This article editorializes on the promises made by the leading industrialized nations to Africa during a G8 summit. The G8 leaders promised to increase aid to all developing nations with the bulk of the aid going to Africa to reduce poverty and increase health care services. The author questions if the promises will be kept. Two studies of 2005 commitments says they are not on track to keep those promises because they included debt relief in the figures.

The United Nations World Health Organization (WHO) is portrayed as in need of streamlining and overhaul if African countries are to realize substantial health benefits. The year-long delayed first African Regional Health Report was released and touted by the incoming Director of WHO's African Regional Office Luis Sambo. The author finds the report long on rhetoric and short on substance. Sustainable health improvements will require implementation of United Nations Secretary General Kofi Annan's recommendations in "Delivering as one" for a unified, multilateral system and an end to fragmentation of policies and practices: for each country one leader and budget, perhaps one office.

Examines the efficacy of the Roll Back Malaria (RBM) program, an alliance of international organizations, including the United Nations (UN), the World Health Organization (WHO) and the World Bank (WB). Details of the Abuja Declaration of 2000, in which 53 African heads of state pledged to reduce malaria mortality by half by 2010; Criticism for the progress of RBM; Results of an external assessment, which found RBM to be incapable of fulfilling its mission; Impact of the failure of RBM on international efforts to prevent the spread of malaria.

Reports on the launch of an international Commission for Africa by UK Prime Minister, Tony Blair. Commission which was the brainchild of Bob Geldof will aim to counter the current piecemeal approach to reversing Africa's decline; Plan of the Commission to report in one year and provide a foundation for action; Resource mobilising mechanisms which are likely; Possible themes of the Commission; Commissioners involved.

Debates on the practice of paying a bride price in sub-Saharan Africa. Claim by women's rights campaigners that the practice should be abolished because it facilitates the spread of HIV/AIDS and compromises the reproductive health of women by treating them as commodities; Discussion at the International Conference on Bride Price in 2004; Prevalence of polygamy in cultures where a bride price is paid.

Reports that West African farmers have begun receiving seeds for a new breed of rice, called New Rice for Africa, that scientists hope will help combat food shortages and reduce African nations' reliance on imported rice. Distribution of the rice to farmers; How the rice was produced; Details of the project to distribute the rice, known as the African Rice Initiative, and how it was created.

Focuses on human rights violations highlighted in the 2001 annual report of Amnesty International. Role of globalization in human rights violations; Torture, sexual assault, rape and other ill-treatment by police in Turkey; Treatment of refugees and asylum seekers in the United Kingdom; Results of civil war and natural disasters in Africa; Executions in China.

Offers information from a report on economic conditions in Africa issued by the World Bank in February 2001. Decrease in two sources of finance for health care, foreign aid and foreign direct investment, in sub-Saharan Africa; Trend of most money going to oil-rich countries; Ineffectiveness of economic and social reforms promoted by the World Bank and others; Impact of HIV/AIDS on Africa's economy; Other factors which have influenced the African economy.

Comments on HIV-1 infection and AIDS interventions in sub-Saharan Africa. Limitation of resources; United States funding of Leadership in Investment in Fighting an Epidemic (LIFE), to expand intervention activities nationally; Author's assertion that there is a need to pursue fundamental changes to break the cycle of poverty and HIV infection.

Comments on the health crisis facing Africa in the late 1990s and focuses on some of the topics in the book 'Africa in Chaos,' by George Ayittey. Some of the health dangers that a nine-year-old girl growing up in Kenya may face in her life; The dangers of infections, multidrug resistant tuberculosis, HIV and other health problems; Views of the director-general of the World Health Organization (WHO), Gro Harlem Brundtland about how Africa might avoid this health care crisis.