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A rapid detection test (RDT) indicates a patient is positive for malaria. Four-year-old Agok, was being carried by his mother, Akuot Yel, when MSF outreach manager and nurse Abdifatah Mohamed encountered them walking from their village of Maluil to the nearby private clinic in town. Yesterday, Akuot took her son to the government-run primary health care unit (PHCU) nearby but they found nobody there. It was closed. PHCUs have no trained personnel to administer quinine intravenously, and often have no oral ACT medication in stock, so they do not open at all, thinking that there is nothing for them to do for patients that come in, the vast majority of which suffer from malaria. The private clinic in town would have cost Akout 15 SSP for the test, and 80 SSP to purchase the medicine needed. Akuot has two twins at home who are also ill, but Agok's state was most serious. Akuot can't afford medication for three sick children all at once so she tried to take care of Agok first. She could have received free medicine at the the government-run health care center in Panthui, but the walk will take about two hours, and there was no guarantee that they will have medicine in stock. The PHCU has a car to provide free transportation for patients that need to be referreed to Panthou health care center for treatment, but that wasn't an option for Agok since they found the PHCU closed. Later, Abdifatah also found Agok had symptoms of severe anemia. Abdifatah, en route to Panthui, offered Akuot and Agok a ride to the health care center there. At home, they use a mosquito net that they received from an NGO who distributed them in the area two years ago. It is old now and tearing.
A rapid detection test (RDT) indicates a patient is positive for malaria.
© Diana Zeyneb Alhindawi

Five epidemics to watch

A rapid detection test (RDT) indicates a patient is positive for malaria.
© Diana Zeyneb Alhindawi
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Geneva — Five diseases with the potential to become epidemics in 2016 are being highlighted by Médecins Sans Frontières (MSF), as the World Health Organization’s executive board meets in Geneva. Without proper investment in preventing and responding to outbreaks of cholera, malaria, measles, meningitis and a group of often-overlooked diseases spread by viruses and parasites, they are likely to pose an ever greater threat to people’s health in the year ahead. 

Current strategies to prevent major outbreaks of disease show only limited success. Epidemics continue to occur, often with devastating consequences for some less developed countries. Epidemics open up cracks in national health systems, exhaust available resources and, in many cases, kill large numbers of people.

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MSF Alert

Epidemics of cholera, malaria, measles and meningitis take place every year, incapacitating and killing many—and this needs to stop. Monica Rull, MSF Operational Health Advisor

“We know that thousands of lives will be at risk in the year to come, although the means exist to prevent these deaths,” says Dr Monica Rull, operational health advisor for MSF. “Epidemics of cholera, malaria, measles and meningitis take place every year, incapacitating and killing many – and this needs to stop. At the same time, the threat posed by emerging and re-emerging virus and parasite-spread diseases – such as dengue fever, Zika, Ebola and kala azar – needs to be faced.”

Along with prevention measures, resources must be provided to build effective emergency response systems. This must be part of a broader effort to help countries strengthen their health infrastructure and capabilities and provide health education to local communities.  

Rapid alert mechanisms must be accompanied by rapid response activities once a disease breaks out, with free and quality medical care provided to all those affected.

The research and development (R&D) agenda must be reoriented towards the greater public good, with a recognition that market forces cannot be counted on to deliver effective, accessible and affordable tools for under-served population groups.

MSF emphasises that the first step to global health security is individual health security, including for the sickest and most vulnerable people.

“Current outbreak response strategies are failing the very people they are designed to help,” says Dr Rull. “If we don’t make significant changes, we will be doomed to repeat past mistakes, and must take responsibility for the consequences.”