Gone Fishing

Will be posting again on April 9.

Study: Caution on LifeStraw

(Analysis) LifeStraw, a portable gadget for filtering and purifying drinking water, has received far more positive press than it deserves at this stage of its development. A field study by graduate students at University of California--Berkeley (in the U.S.) provides the first evidence that LifeStraw may not be as well received by its intended users--poor people in the developing world--as it has by the media.

There's no question that LifeStraw has been a darling of the press. TIME Magazine (where I used to work) touted it in 2005 as an Invention of the Year. Esquire, Forbes, CNN, The New York Times and Chicago Tribune have all published glowing reviews of the tube-like device. Unlike other point-of-use (POU) water treatment approaches, however, LifeStraw has not yet been field-tested by its manufacturer, Swiss-based Vestergaard Frandsen.

Dan Hymowitz, a Berkeley School of Public Policy Masters candidate, e-mailed me the results of a 20-day test that he and his fellow students Nick Spicer and Sintana Vergara conducted in Bangladesh. Because Vestergaard Frandsen was unable to provide LifeStraw for the test, the Berkeley trio substituted FrontierStraw, a similar treatment/filtration device used by hikers and backpackers.

Hymowitz and his colleagues compared the device to two other low-cost, point-of-use water treatment methods--sterilization based on passive solar treatment (SODIS) and chemical purification (Safe Water System). They expected the 56 Bangladeshi families they studied to favor the portable device because of its convenience. Instead they learned, to their surprise, that the families preferred the solar and chemical treatment options instead.

The biggest apparent obstacle: the Bangladeshi participants thought of gathering water as a communal experience and didn't like FrontierStraw's individualistic aspect. (One Straw takes care of one person, not the whole family.)

I e-mailed Vestergaard Frandsen for a reaction. Roelie Bottema of VF replied, saying that "LifeStraw cannot be compared with POU devices. LifeStraw was designed as a mobile, personal tool and therefore aims at solving the problem we saw with people who are travelling: they need something to take with them."

Now while it's true poor farmers travel away from home more than one might realize, that's not the point that comes across in most media reports about LifeStraw, where it is typically touted as a low-cost technological solution for the much larger issue of getting safe drinking water to the 1.1 billion people around the world who don't have it.

VF plans to start field-testing LifeStraw in Ethiopia in June. So, while Hymowitz-and-company's graduate project is not the last word on this topic, it does raise a warning flag about how widely applicable LifeStraw may turn out to be.

Why Water is Vital to Girls' Education

(News) Quick, name the key factors needed for making sure girls get a good education in the poorest parts of the world. Books, teachers, pencils, paper and perhaps a classroom are at the top of most people's lists. But what about a separate, working latrine for girls?

An Ethiopian girl washes her hands in clean water
Photo credit: Kate Eshelby/WaterAid

Today (March 22) is World Water Day. It's hard for those of us who have grown up being able to drink safely out of tap and to rely on indoor plumbing to fully understand just how much of our health and well-being depends on clean water and proper sanitation. But the ability to go to the bathroom in private--especially after menstruation begins--and to be able to wash hands afterwards turns out to be a greater obstacle to girls' education than most people in rich countries realize.

This simple fact was highlighted at Columbia University in New York City on Tuesday in a seminar presented by WaterAid, a longtime international charity that started in the U.K., and the Earth Institute, the policy-education-services organization run by Economist Jeffrey Sachs.

A study in the West African country of Guinea showed that enrollment among girls increased 17% from 1997 to 2002 after handwashing facilities and separate latrines were installed--and maintained--for girls. A similar study from earlier in the 1990s showed a 15% increase in girls' enrollment in Bangladesh after latrines and hand-washing facilities were installed in schools.

That is why WaterAID, Unicef and others are focusing on getting basic latrines and hand-washing facilities into schools around the world. It helps both boys and girls stay healthy but the added benefit of boosting girls' attendance is especially strong.

Bird Flu, HIV, Malaria

(Headlines) News you might have missed . . .

Japan warns Tamiflu may cause psychiatric problems in teens. Roche says there is no link. (Reuters)

One in seven HIV patients in Uganda drop treatment for at least a month because of cost, side effects or unavailability of medicine. (The Monitor, Kampala)

Vanderbilt University is looking for healthy U.S. volunteers to test potential malaria vaccine (The Dickson Herald, Tennessee)

Caution on Smallpox Treatment

Analysis: There was lots of enthusiasm Monday on the NASDAQ for shares of Siga Technologies, a New York-and-Oregon-based biotech that's working on a possible treatment--as opposed to vaccine--for smallpox. But the rush of positive feeling is premature. The biodefense market may be hot, but there are plenty of caveats in this story.

So why did Siga close at $5.15 a share, up 14% yesterday? A toddler from Indiana became very ill with a life-threatening rash that covered most of his body after his soldier-father was vaccinated for smallpox.

Now the smallpox vaccine is based on a weakened strain of a related virus, called vaccinia, that can cause its own problems. Although vaccinia disease is usually much milder than smallpox, vaccinia can and does kill. In this case, the child caught the vaccinia infection from his father. (Let's be absolutely clear here: the child has vaccinia disease, not smallpox.)

Doctors gave the boy an experimental anti-smallpox drug (ST-246) being developed by Siga Technologies in the hopes that it would help him recover from the vaccinia infection--and preliminary results are encouraging. But the boy is still in critical condition, according to Reuters.

So next things to watch for: How well does the boy recover? How soon after exposure will such anti-viral drugs, if developed, have to be given? How can they be tested since smallpox has been eradicated and the threat is still from accidental or malevolent release? What kinds of scale-up and distribution problems will there be for a drug treatment for smallpox--which we hopefully will never need? Why wouldn't an updated, safer smallpox vaccine be better than any potential drug treatment?

China, Flu, Clinical Trials

Headlines: Click on the links below for news on China's healthcare system, pandemic flu and clinical trials in India

Healthcare: China's Health Minister Bemoans Failing System (Reuters)

Pandemic Flu: ASEAN picks Singapore as location for flu-drug stockpile (Bangkok Post)

Clinical trials: India is a hotbed of clinical trial activity (India Times)

Rotavirus, Chagas, TB

Headlines: Click on the links below for good news on RotaTeq vaccine, bad news on Chagas disease and promising results on new TB blood tests.

Rotavius: Merck's RotaTeq Vaccine Not Linked to Dangerous GI side-effect (CDC/MMWR)

Chagas Disease: Chagas parasite threatens U.S. blood supply (Los Angeles Times)

Tuberculosis: New blood tests better than tuberculin skin test at detecting TB (Washington Post) See also S. Arend, A. Bossink et al in the Am. Journal of Respiratory and Clinical Care Medicine

TB Threatens Progress Made Against HIV

News: George Soros's Open Society Institute pledged $3 million today for a pilot project to detect and treat drug-resistant TB in the tiny southern African nation of Lesotho. The program, which will be based in the Botsabelo district just outside the capital of Maseru will focus on detecting and treating people with drug-resistant throughout the country.

The larger aim, according to Soros and others who held a press teleconference on March 14, is to try to galvanize the global community to realize that drug-resistant tuberculosis is quickly threatening any progress that has been in the AIDS pandemic todate.

For years, drug-resistant TB and AIDS have grown as largely separate epidemics. But now, they are starting to fuel each other. (People with AIDS are more susceptible to tuberculosis because of their weakened immune states.) The recent emergence of extremely drug-resistant TB (XDR-TB) in the South African region of KwazuluNatal is a case in point.

But it's not just HIV-positive patients who are at risk. Women, children and men with TB who don't receive proper care are at risk of infecting HIV-negative caregivers, families and friends.

"People have said is that XDR-TB is untreatable," Dr. Jim Kim of Partners in Health said in Wednesday's press teleconference. "That’s not true. We have treated XDR-TB. If we don’t respond aggressively now, however, we will soon have many patients with completely untreatable TB."

Welcome!

If you're like me, you're convinced that health is a human right for all our planet's citizens. But global health is also becoming big business and needs to be covered like a business. Please join me in the search for what works, what doesn't and what needs to happen next.