Sustainable financing to fight HIV/AIDS, TB and malaria: lessons learned from the African Union's Abuja Declaration.

BACKGROUND: Investment in malaria control has been proven to contribute to socio-economic development. Concomitant investment in HIV/AIDS and Tuberculosis further augments these socio-economic gains. Africa has used this evidence to guide policy-making, especially for investment in the control of malaria and other infectious diseases. Pursuant to the objective of developing Africa, the Heads of State and Government of the OAU met in 2001 to address the challenges of HIV/AIDS, Tuberculosis and Malaria, a scourge that was ravaging the continent. Noting that the health sector in Africa needed more financial investment, the African leaders adopted a declaration that pledged to allocate at least 15% of their national annual budgets to the health sector. MATERIALS AND METHODS: Data was collected through review of documents and observations. RESULTS: The implementation of the Abuja declaration drew a number of mixed results, positive ones which could be scaled up and some challenges that could be used as lessons for improvement. CONCLUSIONS: Taking everything into account, the Abuja Call was a relatively unprecedented success for Africa. With continuous improvement, the initiative could even do better. The African Union should consider revising the Abuja Call, based on lessons learned and emerging issues.

Assessment of the therapeutic efficacy of a paediatric formulation of artemether-lumefantrine (Coartesiane) for the treatment of uncomplicated Plasmodium falciparum in children in Zambia.

BACKGROUND: Sentinel site surveillance of antimalarials by in-vivo therapeutic efficacy studies in Zambia is one of the key activities ear-marked for monitoring and evaluation. The studies are conducted annually in order to provide timely and reliable information on the status of the recommended regimens for malaria case management. The findings of the therapeutic efficacy of an artemisinin-based combination therapy of pediatric artemether-lumefantrine (Coartesiane) are reported. METHOD: The design is a simple, one-arm, prospective evaluation of the clinical and parasitological response to directly observed treatment for uncomplicated malaria. The study was conducted in sentinel sites using the WHO standardized protocol for the assessment of therapeutic efficacy of antimalarial drugs (WHO 2000) in children under five years of age, weighing less than 10 Kg. The study was conducted at two clinics, one in Chongwe (Lusaka Province) and Chipata (Eastern Province). The 28-day follow-up period was used coupled with PCR genotyping for MSP1 and MSP2 in order to differentiate recrudescence from re-infections for parasites that appeared after Day 14. RESULTS: 91/111 children enrolled in the study, were successfully followed up. Artemether-lumefantrine (Coartesiane) was found to produce significant gametocyte reduction. The Adequate Clinical and Parasitological Response (ACPR) was found to be 100% (95% CI 96.0;100). CONCLUSION: Coartesiane was effective in treating uncomplicated malaria in Zambian children weighing less than 10 kg, an age group normally excluded from taking the tablet formulation of artemether-lumefantrine (Coartem).

Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organisations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.