Impatient Optimist: All women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future.

All women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future. APRIL 26, 2012 The Case for Contraception on the Global Agenda MELINDA GATES April 26, 2012 I have learned a lot from following the reaction to the talk I gave at TedxChange two weeks ago. My talk was about the uncontroversial idea that all women and men should have the power to plan for their lives and give their children the chance at a healthy and productive future. One of the ways they can get that power is through access to birth control, and I tried to make the case for why the world should put birth control back on the global health agenda. Because I’m so passionate about the issue, I’m excited to see so many people talking about it online. The more people talk, I think, the more they’ll realize how much agreement there is around the basic argument that birth control saves lives and helps families build a better future. I believe in giving women the methods they want to use so they can do what’s best for themselves and their families. In my talk, I spoke a little bit about my own Catholicism and how it fits in to my advocacy around this issue, since the Catholic Church officially prohibits the use of modern contraceptives. Many people have asked whether I support natural family planning methods like the rhythm method that the Church supports. The answer is, unequivocally, yes. I support putting options and power in the hands of women and their husbands, period. While available evidence indicates that modern contraceptives—for example, pills, injectables, implants, and intrauterine devices—are more effective, I realize that there are families that are not comfortable using modern contraceptives for religious reasons or other matters of conscience. That is their right, I respect it deeply, and I believe they should have access to the most appropriate education and tools to follow through on their plans for their children. The large majority of women do want to use modern contraceptives, and I also support giving them options that are right for them. I believe in giving women the methods they want to use so they can do what’s best for themselves and their families. In some cases, that means natural family planning. In many cases, it means modern contraceptives. I hope we can agree that there really is no controversy around this idea.   DETAILS CATEGORYHealth TOPICSFamily Planning TAGSContraception, TEDxChange

Malaria and Me - By Liam Fox

ELIZABETH JACKSON: Living in exotic places often means exposure to exotic illnesses. Before setting out for Papua New Guinea Liam Fox was vaccinated for all kinds of diseases. But there's no vaccination for malaria, only short-term preventative medication. Liam had managed to avoid the disease for three years but sadly his luck finally ran out. LIAM FOX: It was 2am and I was standing under a steaming hot shower but couldn't stop shaking with cold. Several hours earlier a wave of fatigue had hit me like a bullet train. Not long after that my whole body began to ache. Shivering under the shower I thought something is really wrong here. Sleep was impossible. When the sun came up I said to my wife 'I think I've got malaria'. A quick search on the internet confirmed the symptoms: shaking chills, tiredness and muscle aches. While malaria is common throughout PNG, the risk of contracting the mosquito-borne disease in Port Moresby is thought to be low. Few residents take preventative medication. The side effects of taking anti-malarials over an extended period of time can range from an upset stomach, to sensitivity to sunlight, to a severe neuropsychiatric reaction. Some large multi-national companies require their workers to take the drugs and carry out tests to make sure they do. But most expats are pretty blasé about it, me included, and most locals couldn't afford the drugs even if they wanted them. Moresby's been home for three years and a few friends have had malaria in that time. But despite many, many mosquito bites I had avoided it, until now. I hauled my aching body down to the local clinic and the friendly doctor said it looked to be a case of malaria and ordered a blood test. It came back negative but the doctor said that wasn't unusual and could be because I was in between attacks. The more likely cause of the negative result he said was because the lab technician examining my blood sample wasn't paying close attention. He diagnosed malaria, prescribed me two kinds of drugs and sent me on my way. The shaking chills didn't return and the aches soon went away, but the intense fatigue persisted for several days. Despite the initial sickness I was pretty lucky. I had quick access to medical care and the money to pay for it. It's a different story for most Papua New Guineans, who live outside the major cities and towns where health care is rudimentary at best, non-existent at worst. According to the World Health Organisation nearly 10 per cent of all children who died before reaching the age of five in PNG were lost to malaria. There has been some promising news in the fight against the disease recently. Last week Australian researchers announced a PNG trial of a new drug cut rates of infant malaria by 30 per cent. But the disease remains a fact of life, and death here, and will do for some time. And it could still be factor in my life as well. People who've been infected with can have additional attacks after months, even years without symptoms. That's because the parasites that cause the disease can remain dormant in a person's liver. So even when I return to Australia, I could bring a little piece of PNG with me. This is Liam Fox in Port Moresby for Correspondents Report.

Severe imported malaria in an intensive care unit: a review of 59 cases

Severe imported malaria in an intensive care unit: a review of 59 cases Research Lurdes C Santos, Candida F Abreu, Sandra M Xerinda, Margarida Tavares, Raquel Lucas and Antonio C Sarmento For all author emails, please log on. Malaria Journal 2012, 11:96 doi:10.1186/1475-2875-11-96 Published: 29 March 2012 Abstract (provisional) Background In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU). Methods Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. Results Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort. Conclusion Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.