Development assistance for health (DAH), the value of which peaked in 2013 and fell in 2015, is unlikely to rise substantially in the near future, increasing reliance on domestic and innovative financing sources to sustain health programmes in low-income and middle-income countries. We examined inno...vative financing instruments (IFIs)—financing schemes that generate and mobilise funds—to estimate the quantum of financing mobilised from 2002 to 2015. We identified ten IFIs, which mobilised US$8·9 billion (2·3% of overall DAH) in 2002–15. The funds generated by IFIs were channelled mostly through GAVI and the Global Fund, and used for programmes for new and underused vaccines, HIV/AIDS, malaria, tuberculosis, and maternal and child health. Vaccination programmes received the largest amount of funding ($2·6 billion), followed by HIV/AIDS ($1080·7 million) and malaria ($1028·9 million), with no discernible funding targeted to non-communicable diseases.
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Buruli ulcer is a chronic, progressive skin disease caused by infection with Mycobacterium ulcerans. It is currently considered to be one of the neglected tropical diseases; less common than tuberculosis but more common than leprosy. The initial lesion is a painless subcutaneous nodule, usually less... than 5 cm diameter and adherent to skin. The nodule typically breaks down centrally after days to weeks forming an ulcer with undermined edges. Thus, the external appearance of the ulcer underestimates the true size of the affected area. The patient remains well and there is no pain unless secondary bacterial infection occurs. Other forms of M. ulcerans disease include a firm plaque lesions that behaves in the same way as the nodule or an oedematous lesion that is more aggressive and extends rapidly resulting in a very large ulcer.
Any age group can be affected by Buruli ulcer diseases, but the incidence peaks at 5 to 15 years. Ulcers are most frequently on the limbs but can be on the trunk or head, sometimes with catastrophic consequences such as loss of sight or loss of breast or genital tissue. Healing close to a joint can result in contracture, and sometimes there is so much tissue destruction on a limb that amputation is unavoidable. Occasionally osteomyelitis occurs in bone adjacent to a skin lesion but involvement of other organs is rare. Disseminated disease with HIV has been reported.
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Nat Commun 9, 5370 (2018). https://doi.org/10.1038/s41467-018-07804-8. Mycobacterium ulcerans is the causative agent of Buruli ulcer, a neglected tropical skin disease that is most commonly found in children from West and Central Africa. Despite the severity of the infection, therapeutic options are... limited to antibiotics with severe side effects. Here, we show that M. ulcerans is susceptible to the anti-tubercular drug Q203 and related compounds targeting the respiratory cytochrome bc1:aa3. While the cytochrome bc1:aa3 is the primary terminal oxidase in Mycobacterium tuberculosis, the presence of an alternate bd-type terminal oxidase limits the bactericidal and sterilizing potency of Q203 against this bacterium. M. ulcerans strains found in Buruli ulcer patients from Africa and Australia lost all alternate terminal electron acceptors and rely exclusively on the cytochrome bc1:aa3 to respire. As a result, Q203 is bactericidal at low dose against M. ulcerans replicating in vitro and in mice, making the drug a promising candidate for Buruli ulcer treatment.
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WHO/CDS/TB/99.272
Distr.: General, Original: French
Antimicrobial Resistance and Infection Control 2014,3 :31
Key populations brief
Accessed November 2017
Chapter 8, Prison and Health, published
Clinical Medicine
JCI Insight. 2017;2(7):e91963.
PLOS ONE | DOI:10.1371/journal.pone.0133869 July 28, 2015, p.1-16