Wearable ECG patch improves AF diagnosis in mSToPS


However, he acknowledged that one of the limitations of the study was the low percentage of patients approached who consented. “Only 5.4 percent of patients who received an invitation to participate in mSToPS actually enrolled in the trial.  Thirty-eight percent of those who initially consented to participate never got to wear the patch due to a lack of built-in digital prompting,” Steinhubl said.
“The quality of data collected through the patch is as good as what we see clinically,” said lead investigator Dr Steven Steinhubl from the Scripps Translational Science Institute in La Jolla, California, US. “At 1 year, patients who wore the chest monitor had nearly thrice the likelihood of being diagnosed with AF. A significant proportion of them was started on anticoagulant therapy to lower their stroke risk.” The primary endpoint of the incidence of AF was 6.3 percent (unadjusted odds ratio [OR], 2.8; p<0.0001) in patients monitored using the ECG patch vs 2.3 percent (adjusted OR, 3.0; p<0.0001) in those monitored with routine care at 1 year.
Active monitoring led to a significantly higher rate of initiating anticoagulant therapy (5.4 percent vs 3.4 percent in controls). There was also a small but significant increase in antiarrhythmic therapy (0.8 percent vs 0.3 percent) and pacemaker or implantable cardioverter-defibrillator placement (0.7 percent vs 0 percent) in the active monitoring group. [ACC.18,18-LB-18063] Steinhubl and colleagues sought to determine if participant-generated data available through the ECG patch can better identify AF relative to routine care and facilitate timely anticoagulation. mSToPs included 1,738 Aetna members aged ≥75 years with prior cerebrovascular accident or heart failure, diabetes and hypertension, or obstructive sleep apnoea, who were enrolled through a web-based platform to undergo active monitoring at home with the iRhythm Zio patch that records an ECG continuously. Patients had no known AF but at moderate risk.
They were taught how to apply the patch and made to wear it for an average of 12 days. Each case was matched with two controls of similar age-, sex-, and CHA2DS2-VASc (n=3,476). Data on AF treatment, physician and emergency department visits, blood clot, and stroke events were collected. Patients on ECG patch had significantly more primary care visits vs controls (78.7 percent vs 75 percent) and cardiology outpatient visits (31.6 percent vs 23.6 percent). There was no difference in stroke rate between groups (1.9 percent vs 2.1 percent). Emergency department visits or hospitalizations were also comparable. “We found that remote AF monitoring is a feasible, scalable, and clinically valuable way to screen for AF in an at-risk nationwide population,” said Steinhubl. “Monitoring is associated with greater initiation of guideline-recommended therapies, with increased healthcare utilization at 1 year.”   AF is the most commonly sustained arrhythmia.
For those over the age of 55, there is about a 37 percent lifetime risk of developing AF, he said. “AF is associated with a fivefold increased risk for stroke and a twofold increased risk for mortality. Fortunately, once recognized, therapeutic anticoagulation can decrease the risk for stroke by about 65 percent and mortality by 30 percent.”Further follow-up through 3 years is planned to better understand the clinical impact of ECG patch monitoring in patients at moderate risk of developing AF, he concluded.

Africa Is Suffering A Silent Crisis Of Stroke


A computer-enhanced scan of a brain shows a hemorrhage due to hypertension.

Last April, Fredua Agyemang, a musician in Kumasi, Ghana, was performing onstage at a funeral, which in this country is often a festive affair with hundreds of guests. Suddenly, he began to feel dizzy, then lost consciousness and collapsed.

When he woke up three days later, his bandmates broke the news: He had suffered a stroke. Immediately, he thought of another doctor visit eight years earlier, when, at the age of 34, he had been diagnosed with hypertension and prescribed medication to reduce his blood pressure. The medication had given him problems with erectile dysfunction, a common side effect, and he soon stopped taking it regularly. That decision seemed foolish, he recalls. He was having difficulty moving and speaking and knew that he wouldn’t be back onstage anytime soon.

“I still have weakness,” he says, nine months later. “I’m not able to walk well, I can’t use my left arm, I can’t sing.”

Doctors found that Agyemang’s stroke was hemorrhagic, meaning that a blood vessel in his brain burst from excessive pressure. In the U.S., this type of stroke is rare; nearly 90 percent of strokes in the U.S. are “ischemic,” meaning they’re caused by a clot or other blockage of a blood vessel in the brain. But according to a new study, the largest-ever of stroke patients in Africa, up to one-third of strokes in this area of the world are hemorrhagic. And while the survival rate for ischemic strokes is around 80 percent, for hemorrhagic strokes the odds of survival are only 50/50. Agyemang is lucky to be alive.

Researchers already knew that the overall rate of stroke in Africa is among the world’s highest, with around 316 new cases each year per 100,000 people. (The U.S. rate, by comparison, is around 246 new cases per 100,000 people, according to the CDC.) But the study sheds new light on the prevalence of hemorrhagic stroke.

“We are seeing way more hemorrhagic stroke [in Africa] than in the West, and we need to understand what’s driving this,” says Dr. Fred Stephen Sarfo, a neurologist at the Kwame Nkrumah University of Science and Technology in Kumasi, who led the Ghana side of the study. “It’s a huge and neglected burden.”

Hemorrhagic stroke is of particular concern because it is so likely to be fatal, Sarfo says. But this type of stroke also highlights the danger of another health issue that is increasingly widespread in Africa: hypertension. The study found that hypertension was to blame in more than 90 percent of hemorrhagic stroke cases.

The link between hypertension and hemorrhagic stroke goes a long way toward explaining why the latter has become such a problem. Cardiovascular problems like hypertension were once rare in Africa, but today, the continent has the world’s highest rate of high blood pressure, afflicting nearly 50 percent of the population, according to the World Health Organization. Epidemiologists have found that as African countries develop and become more urban, the profile of disease is rapidly changing. Infectious diseases like malaria, tuberculosis and HIV, while still major problems, are being joined by noncommunicable, long-term diseases associated with a more sedentary lifestyle and increased consumption of tobacco and processed food.

WHO predicts that cases of such diseases, especially cancer and heart and respiratory disease, will increase 27 percent in Africa in the next 10 years, leading to an additional 28 million deaths and that by 2030, deaths from such diseases will exceed those from infectious disease and other traditional health problems. The number of people in Africa with hypertension is projected to rise from 80 million in 2000 to 150 million by 2025.

Still, the general public in Africa is largely unfamiliar with cardiovascular disease, and people rarely seek the kind of regular check-ups that can identify high blood pressure, says Dr. Prebo Barango, a noncommunicable disease specialist for the WHO in Zimbabwe. Barango said that WHO surveys have shown that in some African countries, as many as 70 percent of those with high blood pressure are not aware of their condition. As a result, it very often goes undiagnosed and untreated. In that respect, Agyemang was an exception to the rule. Many stroke patients never even know they have blood pressure problems until they suddenly pass out and wake up in the hospital.

“They don’t see themselves at risk,” Sarfo says. “They think they’re fine, and then all of a sudden, the pressure goes up, the blood vessel bursts and then they have a stroke.”

Barango adds that WHO is helping to train health care workers, especially in rural areas, to routinely look for signs of high blood pressure. And, he says, health professionals need better access to the right tools.

“You would be surprised how many health-care facilities don’t have a functioning blood pressure gauge,” he says. “The solution starts at the rural and primary health care level.”

In addition to the lack of awareness, Ghanaians face other obstacles to effective hypertension treatment. The medicine can be costly, in a country where average annual income is about $1,400. And it must be taken for life, whereas many people are accustomed to treating diseases that resolve over time. Once the problem escalates to a stroke, the cost becomes even higher, from CT scans in the emergency room to months or years of physical therapy and rehabilitation, during which time many, like Agyemang, are unable to return to work.

“For us within Africa, we need to focus mainly on prevention of stroke, because it’s quite challenging to manage” once it happens, Sarfo says.

To that end, Sarfo recommends at-risk people eat more leafy green vegetables, stop smoking, exercise more and, of course, take their blood pressure medicine as prescribed. He and his fellow researchers are developing a smartphone app for people with hypertension that can read their blood pressure and send reminders to take their pills.

Agyemang says he has learned his lesson and is working hard on his rehab regimen so he can get back onstage.

“I’m rehearsing,” he says. “I have a passion for singing, so I want to continue once I recover.”

History Has Been Made. Female Genital Mutilation Banned In Nigeria.


“More than 130 million girls and women have experienced female genital mutilation or cutting …”

 

Nigeria made history by outlawing female genital mutilation. The ban falls under the Violence Against Persons (Prohibition) Act 2015 that was passed in Senate on May 5 and recently enacted into law.

This was one of the last acts by the outgoing president, Goodluck Jonathan. His successor, Muhammadu Buhari, was sworn into office this past Friday, May 29.

 Female genital mutilation or cutting (FGM/C) is the act of either partially or totally removing the external female genitalia or causing injury to the female genital organs for non-medical purposes.

According to UNICEF:

“More than 130 million girls and women have experienced FGM/C in 29 countries in Africa and the Middle East where the practice is most common.”

With the help of community activism, campaigns and numbers of organizational efforts to end this practice, UNICEF reported that teenage girls were now one-third less likely to undergo FGM/C today than 30 years ago.

Now with the new law criminalizing this procedure, the hope is the ban will fully eliminate this practice and be strongly enforced to combat any existing societal pressures.

The World Health Organization cites immediate harmful effects of FCM/C that include hemorrhage (bleeding), bacterial infection, open sores, and long-term consequences that include infertility, childbirth complications and recurring bladder infections.

In another UNICEF report, communities who practice FGM often do so to reduce sexual desire in women and to initiate girls to womanhood, among other purposes.

According to “The Guardian‘s” analysis of 2014 UN data, a quarter of the women in Nigeria have undergone FGM.

Stella Mukasa, director of Gender, Violence and Rights at the International Center for Research on Women, explains the complexity of the implementation of the new law banning FGM/C.

“It is crucial that we scale up efforts to change traditional cultural views that underpin violence against women,” she wrote in an article for “The Guardian.” “Only then will this harmful practice be eliminated.”

Under hashtag #VAPPBIll, Twitter users celebrated the bill’s passing.

 

 

 

 

 

 

The Violence Against Persons (Prohibition) Act serves to protect women and violence in multiple aspects. BuzzFeed News cited a 2013 version of the bill that highlights its purpose to eliminate violence both in private and public, and end physical, sexual, domestic and psychological violence.

Africa is the Western world’s testing ground for microchip implants, weaponized viruses and experimental vaccines


The African continent continues to be used by Western powers as a testing ground for some pretty heinous things, the latest of which appears to be microchip implants. This is a concept privacy advocates in the U.S. have long warned about.

According to Patriot Truther and BusinessWire, credit card company Visa recently introduced a new specification for the use of biometrics with chip card transactions that can enable palm, iris, facial or voice biometrics. The first-of-its-kind technology is designed to be incorporated for use with the EMV® (Europay, MasterCard, Visa) chip industry standard to ensure the cards can be used around the globe.

With current surveillance technology, the biometric cards will also be traceable and trackable, as will the biometric data. This information will be valuable to merchandising corporations, technology companies and, of course, governments.

“There is increasing demand for biometrics as a more convenient and secure alternative to signatures or PINs, especially as biometrics technologies have become more reliable and available,” claimed Mark Nelsen, senior vice president of Risk Products and Business Intelligence for Visa Inc. “However, to support wide adoption, it is equally important that solutions are scalable and based on open standards. Building on the EMV chip standard provides a common, interoperable foundation, as well as encourages innovation in cutting-edge biometric solutions.”
Africa

More personal data to track

The biometrics are being sold to customers as merely being helpful, modern ways to prevent fraud and help people pay “securely.” The architecture of the design by Visa will enable fingerprints, for example, to be “securely” accepted by a biometric reader, encrypted and then validated.

“Issuers can optionally validate the biometric data within their secure systems for transactions occurring in their own environments, such as their own ATMs,” BusinessWire reported.

Absa Bank, which is a wholly-owned subsidiary of Barclays Africa Group, will become the first to use the new cards.

This comes on the heels of earlier reports stating that Wells Fargo Bank also wants to begin using “secure” biometric card technology.

Not only are such biometrics likely to be tracked, but as more of our personal information is cataloged online and stored in “clouds,” it will become more vulnerable to hacking and cyber theft.

The biometrics “test” in Africa is just the latest evil committed against the people of that continent. As noted in this open letter published by the Liberian Observer, “testing” of the Ebola virus had been occurring in Africa for years before the most recent outbreak.

Laced vaccines, Ebola as a weapon

As noted by our editor Mike Adams, the Health Ranger, in this Oct. 22, 2014 story:

The idea that Ebola might be a genetically engineered bioweapon was openly discussed by a top Liberian scientist named Dr. Cyril Broderick, who published a front-page story in the Liberian Observer containing the astonishing statement, “Ebola is a genetically modified organism (GMO).”

…Broderick goes on to assert that the U.S. Dept. of Defense has been using African women and children for bioweapons experiments.

In his own words, he talks about “…the existence of an American Military-Medical-Industry that conducts biological weapons tests under the guise of administering vaccinations to control diseases and improve the health of black Africans overseas.”

Speaking of vaccines and Africa, Adams reported the following month that “tetanus vaccines given to millions of young women in Kenya have been confirmed by laboratories to contain a sterilization chemical that causes miscarriages” – a cruel and subversive act orchestrated by UNICEF and the World Health Organization (WHO).

“We sent six samples from around Kenya to laboratories in South Africa. They tested positive for the HCG antigen,” Dr. Muhame Ngare of the Mercy Medical Centre in Nairobi told LifeSiteNews. “They were all laced with HCG.”

Learn more: http://www.naturalnews.com/051913_African_human_testing_biometric_cards_personal_data_tracking.html#ixzz3rNw0KlFf

‘Breakthrough’ malaria vaccine developed, but only partially effective – scientists — RT UK


Reuters / Ina Fassbender

Although the drug has only shown a partial effect, it nevertheless represents the most clinically-advanced vaccine against malaria to date.

“We finally have in our sights a candidate vaccine that could have a real impact on this terrible disease that affects many children during their first years of life,” principal investigator Kwaku Asante said in a statement released ahead of World Malaria Day on Saturday.

“The large number of children affected by malaria, sometimes several times per year, means that this vaccine candidate, if deployed correctly, has the potential to prevent millions of cases of malaria,” Asante added.

The British pharmaceuticals giant GlaxoSmithKline (GSK) has spent 30 years developing RTS,S.

During trials, 15,500 children in seven African countries were given the vaccine. The results showed that Malaria cases were halved in the first year.

Although, as time passed, protection wore off (dropping to 28 percent after four years), cases were still reduced by almost a third.

Children who received a booster – meaning an extra dose – showed a significant defense against the disease. The extra dose increased the protection rate in the fourth year to 36 percent, the study claims.

The final results indicate the World Health Organization (WHO) will recommend routine use of the vaccine as early as this year, if regulators approve. The results were published in The Lancet Infectious Diseases reports.

Study co-author Brian Greenwood of the London School of Hygiene and Tropical Medicine, told Reuters: “The results are not quite as good as we would have hoped, but it still works.” However, he is still hopeful the new vaccine could prevent numerous deaths.

“Given that there were an estimated 198 million malaria cases in 2013, this level of efficacy potentially translates into millions of cases of malaria in children being prevented,”he said.

“Unfortunately, this is not as big an effect as that seen with some other vaccines,” like that against measles, he told AFP.

The mosquito-borne disease kills some 600,000 people each year, of whom more than 75 percent are children under the age of five, according to WHO. The disease kills about 1,200 children in sub-Saharan Africa on average per day.

Often, people die of malaria because they don’t have access to quality healthcare.

Last year’s Ebola outbreak has drawn renewed attention to malaria and the lack of sufficient health care in many developing countries.

FDA eases restrictions on experimental Ebola drug as CDC warns of ‘inevitable’ spread to US.


While Ebola, the deadly disease spreading through parts of West Africa, has no cure, specific treatment or vaccine, there are several experimental drugs being tested in US labs. Now the FDA has lifted its hold on one of those drugs.

The US Food and Drug Administration gave Tekmira Pharmaceuticals verbal confirmation that they modified the full clinical hold the regulatory agency had placed on the company’s experimental TKM-Ebola drug, enabling the potential use on Ebola patients, Tekmira said in a statement.

“We are pleased that the FDA has considered the risk-reward of TKM-Ebola for infected patients. We have been closely watching the Ebola virus outbreak and its consequences, and we are willing to assist with any responsible use of TKM-Ebola. The foresight shown by the FDA removes one potential roadblock to doing so,” said Dr. Mark Murray, CEO and president of Tekmira.

“This current outbreak underscores the critical need for effective therapeutic agents to treat the Ebola virus. We recognize the heightened urgency of this situation, and are carefully evaluating options for use of our investigational drug within accepted clinical and regulatory protocols.”

The company, in collaboration with infectious disease researchers from Boston University and the United States Army Medical Research Institute for Infectious Diseases, showed the drug’s ability to protect non-human primates from Ebola in preclinical trials in May 2010, Tekmira said.

A Phase I clinical trial ‒ the first step towards FDA approval ‒ began on humans in January. The agency then approved a fast-track designation for the drug in March, around the same time the Ebola outbreak began in Guinea, Liberia and Sierra Leone. It has since spread to Nigeria. According to World Health Organization figures published on Wednesday, there are over 1,700 suspected and confirmed cases of Ebola in the four countries, and 932 of those patients have died from the disease.

A different drug, ZMapp by Mapp Biopharmaceutical Inc., was used to treat two American aid workers who had contracted Ebola in Liberia. ZMapp, previously only known as “a secret serum,” has not been given the go-ahead to begin human trials yet, Forbes reported. It works by boosting the immune system to battle against Ebola. The treatment consists of antibodies from lab animals exposed to the virus.

After receiving a dose of the serum, both Nancy Writebol and Dr. Kent Brantly were transferred to Atlanta’s Emory University Hospital, near the US Centers for Disease Control and Prevention. Brantly, 33, who is an employee of the international group Samaritan’s Purse, also received a blood transfusion from a 14-year-old Ebola survivor, who had been under his care before. Both American patients appear to be improving, officials have said.

With the arrival of Ebola in the US via the two aid workers ‒ who remain in isolation in Atlanta ‒ CDC Director Tom Frieden told Congress that the disease will “inevitably” spread around the world due to global air travel, but that any outbreak in the US would not be large.

Frieden testified on the epidemic in front of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations on Thursday. “It is certainly possible that we could have ill people in the US who develop Ebola after having been exposed elsewhere,” he said in his testimony. “But we are confident that there will not be a large Ebola outbreak in the US.”

As people who have traveled to West Africa and then return to or continue on to other destinations develop Ebola-like symptoms, such as fever and gastrointestinal distress, other nations have begun testing for the disease. On Tuesday, Great Britain announced a person in Wales was being monitored by health officials following a potential exposure to the virus.

On Monday, the US experienced its first scare. Mount Sinai Hospital in Manhattan performed tests on a male patient with high fever and gastrointestinal symptoms, the hospital said in a statement. He arrived in the emergency room Monday morning, and had previously traveled to one of the West African countries where Ebola has been reported. However, by the end of the day, officials confirmed the patient had not contracted the deadly disease.

“We are all connected and inevitably there will be travelers, American citizens and others who go from these three countries ‒ or from Lagos if it doesn’t get it under control ‒ and are here with symptoms,” Frieden said.

But that does not mean that the US will become the next battlefront against the disease, a CDC spokesman clarified after Frieden’s testimony.

“It is inevitable that people are going to show up with symptoms. It is possible that some of them are going to have Ebola,” CDC spokesman Tom Skinner said, according to AFP.

Neanderthals Passed Along Diabetes Risk Gene.


Kermanshah Pal Museum-Neanderthal

Scientists have determined that a variation of a gene that increases the risk of a person developing type 2 diabetes by 25 percent was likely introduced into human populations by Neanderthals more than 60,000 years ago. Half of people with a recent Native American lineage, including Latin Americans, have the gene, SLC16A11, as do 20 percent of East Asians. The newly seqeuenced, high quality Neanderthal genome, taken from a female toe found in Siberia‘s Denisova Cave, also included the variant, and researchers say that analysis suggests that Neanderthals introduced it into the human genome when they intermixed with modern humans, after the latter left Africa 60,000 to 70,000 years ago. According to the findings from the completed Neanderthal genome, roughly two percent of the genomes of today’s non-African humans are comprised of Neanderthal DNA.

Who next as the world’s elder statesman?


Mandela death: Who next as the world’s elder statesman?

Gandhi, Nelson Mandela and Aung San Suu Kyi

Nelson Mandela was often described as the “world’s elder statesman”, a father figure tackling global problems. His moral authority made him, in some people’s eyes, a successor to Gandhi. Who might play a similar role now?

Lockerbie, Burundi, DR Congo, Lesotho, Indonesia, Israel-Palestine, Kashmir, Stephen Lawrence murder, HIV awareness and World Cup football.

The list of subjects addressed in some way by Nelson Mandela is long and varied.

In some disputes, like Burundi’s long-running conflict, he was a mediator. On other intractable issues, like the stigma of HIV, he was the campaigner and bereaved father who tried to address prejudice.

Not all his contributions were successful or universally welcomed. He opposed intervention in Kosovo in 1999 and often strongly criticised US foreign policy, while his warm relations with Colonel Gaddafi and President Suharto raised eyebrows. Many thought he spoke out too late about the HIV crisis.

But even his critics would concede that he became a figure with unequalled status on the global stage.

“It seems to me that uniquely he negotiated his transformation from prisoner of conscience and iconic human rights leader to practical political leader who became in every single way the father of modern South Africa and then transformed again into elder statesman,” says Simon Marks, global affairs correspondent at Feature Story News based in Washington.

He had unquestioned legitimacy, someone that a very broad array of people looked up to, including pop singers and supermodels, says Marks.

Mandela on…

Mandela and Colonel Gaddafi
  • Lockerbie: Mediated between Libya and UK on transfer of suspects
  • Middle East: Criticised Israel for ‘narrow interests’
  • Lesotho: Ordered troops into country
  • DR Congo: Arranged key summit that led to peace accord
  • Kashmir: Urged India-Pakistan talks
  • Burundi: Closely involved in peace process
  • Indonesia: Visited East Timor politician in prison in Jakarta
  • Stephen Lawrence: Demanded urgency from police, two weeks after killing

Mandela had the capacity to operate as an honest broker in situations where others might not have been able to, says Christopher Alden of the London School of Economics, who points to Indonesia as an example. In 1997, Mandela’s two-hour visit to the imprisoned East Timorese politician Gusmao in Jakarta, against Suharto’s wishes, paved the way for a referendum and Gusmao’s release two years later.

“He accrued a moral authority that transcended the ordinary politics that guide the worst conduct of political actors.”

The unique feature of Mandela is that he was someone whose moral stature was truly worldwide, says Alden – a reflection of the globalised nature of the anti-apartheid struggle by the 1980s.

There have been other elder statesmen and women in recent years, he says, but they are generally figures whose activities are focused on internal politics or they are asked to act on behalf of a state.

“Jimmy Carter has been ‘deployed’ to North Korea to hold discussions on sensitive issues and has played an important role in democratisation efforts in Africa through the monitoring/training of elections but these are more functional – he lacks the emotive power that Mandela generates.

“Blair’s involvement in the Middle East was an attempt, I suppose, at this – and to burnish his post-Iraq reputation – but notably a failure.”

The Elders
Mandela’s organisation, The Elders, drew together some of the world’s leading statesmen and women

Possibly Mandela’s most noteworthy intervention came early in 2005, following the death of his son, Makgatho. With the Aids epidemic still a taboo subject in parts of Africa, Mandela urged South Africans to be more open about the illness.

Biographer David James Smith believes Mandela’s personality was a key factor in his rise to international father figure – a quality few can match.

“There was a purity about Mandela, a simplicity about him like a farm boy looking after sheep, although he was capable of achieving things in immensely complex situations.

“He talked to commoners and kings in the same way. Everyone loves that he remembered names and took time to talk to everyone. He had all those great human qualities that people admire.”

The EldersFormed by Mandela in 2007, it’s an independent group of leaders working for peace

  • Martti Ahtisaari
  • Kofi Annan (chairman)
  • Ela Bhatt
  • Lakhdar Brahimi
  • Gro Harlem Brundtland
  • Fernando H Cardoso
  • Jimmy Carter
  • Hina Jilani
  • Graca Machel
  • Mary Robinson
  • Ernesto Zedillo
  • Desmond Tutu (honorary)

You could go anywhere in the world and show his face and people would know his name, says Smith, and there’s not anyone alive now who you could say that for.

“I can’t think of anyone else who will set the same example. Aung San Suu Kyi embodies some of the values that he had but you can’t say that she would be recognised in the same way.”

The Burmese prisoner turned politician is a really interesting character, says Marks. “Could she become that person? Maybe, except we don’t yet know how the political story will turn out. She has this amazing moral authority because of her experience as a prisoner of conscience but now playing an active political role and there are a lot of things putting her in a tough position.

“And when you take a leadership role you inevitably rub people up the wrong way. Therefore it’s not axiomatic that she fills those shoes, once the brutal world of politics has finished with her.”

Gandhi, Mandela and Suu Kyi were all political prisoners and this personal sacrifice is an important part of the role, says Marks, but there are other prisoners of conscience, in places like China and North Korea, who are not household names.

“They might at some point emerge as the agent of change in these countries. It requires a combination of personal sacrifice and – cynical though it is to say so – personal sacrifice at the right moment, because when the right moment is there politically, and you can capitalise on it as a result of personal sacrifice, you have more of a chance to effect change.”

But it may be that these extraordinary figures only emerge from time to time, says Marks. In the age of social media, it is perhaps more difficult to establish a long-term reputation because judgments are cast so quickly.

On his 89th birthday, Mandela formed The Elders, a group of leading world figures, to offer their expertise and guidance to – according to their website – “tackle some of the world’s toughest problems”.

“It remains to be seen whether an organisation of senior statesmen and women will be able to do what an individual like this has,” says Alden. “It is a one-in-a-generation person. It may work but it’s a novel experiment.

“Humankind needs this kind of person. Without them, the possibility of descending into brutish conflict we are capable of is accentuated. Hopefully there’s cometh the hour, cometh the man or woman. But I scan the horizon and I don’t see anyone of his ilk.”

Nelson Mandela: Aids campaigner


Nelson Mandela in October 2003
Like many others, Nelson Mandela did not at first realise the dangers of HIV

Though at first muted in his approach to the issues surrounding HIV/Aids, Nelson Mandela eventually became a dedicated and extremely effective advocate for a more vigorous approach to the disease.

When Mr Mandela was released from prison in February 1990, HIV/Aids had yet to make its full impact on South Africa.

“Start Quote

We are facing a silent and invisible enemy that is threatening the very fabric of our society”

Nelson Mandela

Following his election as president four years later, Mr Mandela faced huge challenges and – like so many other world leaders at the time – failed to fully understand the depth of the problem and did little to help those with Aids.

At the time, the African National Congress (ANC) was gripped by an ongoing debate about both the causes of, and treatment for, Aids.

Some figures, like Thabo Mbeki, Mr Mandela’s successor as president, openly questioned whether Aids was caused by HIV.

After Mr Mandela left office in 1999, he campaigned for more research into HIV/Aids, for education about safe sex and for better treatment for those affected. However, most South Africans still did not mention the disease in public.

Controversy within ANC

According to UN figures, the rate of HIV infection among adult South Africans rose from less than 1% in 1990 to about 17.9% by 2012.

Aids activists demonstrate outside the US consulate in Johannesburg - 17 June 2010South Africa has one of the highest HIV rates in the world

South Africa is currently home to more people with the virus than any other country – 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children (aged 0-14), out of a population of just over 51 million.

The causes of an epidemic on this scale have been many – primarily poverty, but also economic migration, the poor status of women, and unsafe sexual practices, have all contributed to the rapid spread of the disease.

Apart from the human misery caused by Aids, its economic impact has been huge, with South African economic growth rates badly affected.

Having put the issue of Aids on the back burner when in office, Mr Mandela began to make strong pronouncements on the subject after he stepped down in 1999.

HIV/Aids in South Africa

  • People living with HIV: 6.1 million
  • Rate of infection in adults aged 15-49: 17.9%
  • Children aged 0-14 living with HIV: 410,000
  • Deaths due to Aids in 2012: 240,000
  • Orphans due to Aids aged 0-17: 2.5 million

Source: UNAids 2012

On World Aids Day in 2000, he sent out a hard-hitting message, saying: “Our country is facing a disaster of immeasurable proportions from HIV/Aids.

“We are facing a silent and invisible enemy that is threatening the very fabric of our society.

“Be faithful to one partner and use a condom… Give a child love, laughter and peace, not Aids.”

Mr Mandela said his country should promote abstinence, the use of condoms, early treatment, counselling and drugs to reduce mother-to-child transmission.

Urgency

At the time, there was a marked reluctance on the part of the South African government to fund anti-retroviral drugs for those with HIV.

Nelson Mandela with Makgatho (R) in 2003
Mr Mandela’s son, Makgatho (R) died from Aids-related illness in 2005

The then President Mbeki outraged many people when he told a US journalist that “personally, I don’t know anybody who has died of Aids” and that he did not know if he had ever met anyone infected with HIV.

One of his ministers suggested that people with HIV eat garlic and beetroot to combat the infection.

In November 2003, Mr Mandela – and his Nelson Mandela Foundation – stepped up the campaign, launching an HIV/Aids fundraising campaign called 46664, after his prison number on Robben Island.


Nelson Mandela

1918 Born in the Eastern Cape

1943 Joined African National Congress

1956 Charged with high treason, but charges dropped after a four-year trial

1962 Arrested, convicted of incitement and leaving country without a passport, sentenced to five years in prison

1964 Charged with sabotage, sentenced to life

1990 Freed from prison

1993 Wins Nobel Peace Prize

1994 Elected first black president

1999 Steps down as leader

2001 Diagnosed with prostate cancer

2004 Retires from public life

2010 Last major public appearance at football World Cup in Johannesburg

He compared the urgency and drama of his country’s struggle against HIV/Aids to the fight against apartheid.

Pop stars like Beyonce, Youssou N’Dour and Dave Stewart supported the campaign, and a star-studded concert, held in Cape Town in 2003, was seen by a worldwide television audience of two billion.

The money raised by Mr Mandela’s initiatives has been used to fund research projects and provide practical support for South Africans with HIV/Aids.

The campaign received a further boost in 2005, when Mr Mandela shocked the nation by announcing that his son, Makgatho, had died of Aids.

He urged people to talk about HIV/Aids “to make it appear like a normal illness”.

It was a significant move, which had a huge impact, said Michel Sidibe, head of the UN’s Aids agency Unaids.

“The country has become a leader in the Aids response because of Mr Mandela, and is moving towards an Aids-free generation thanks to his campaigning,” he said.

Mr Mandela also became a central figure in the African and global Aids movement, Mr Sidibe said.

“He was instrumental in laying the foundations of the modern Aids response and his influence helped save millions of lives and transformed health in Africa,” he said.

“He was a statesman who had Aids at the top of his agenda and he used his stature and presence on the global stage to persuade world leaders to act decisively on Aids. His legacy will be felt by generations.”

More than one in 10 babies worldwide born prematurely.


Fifteen million babies, one in 10 births, are born prematurely every year, a global project suggests.

Baby in mother's arms in Nepal

One million of these babies die soon after birth. The joint report, led by the WHO, says three quarters of deaths could be prevented with basic care.

For the first time premature birth rates have been estimated by country, with the highest risk being in Africa.

In the UK about 8% of babies are born too soon and this rate is rising partly due to obesity and later motherhood.

There are nearly 60,000 premature births every year in the UK.

Andy Cole, from premature baby charity Bliss, said “it is worrying that the UK’s preterm birth rate is significantly higher than countries such as Sweden, Norway and Ireland, and highlights the need for well-co-ordinated and high-quality antenatal care for all women identified as high risk”.

“Start Quote

Being born too soon is an unrecognised killer”

Dr Joy Lawn Co-editor of the report

Worldwide problem

A premature or preterm baby is one that is born before 37 weeks after the first day of the mother’s last period. A full term baby is when pregnancy lasts 40 weeks.

Forty-four organisations contributed to The Born Too Soon report, which estimated premature birth rates – the number of babies born too soon, out of the total of number of live births – for 184 individual countries, in the first study of its kind.

Of the 11 countries where over 15% of babies are born too early, all but two are in sub-Saharan Africa. However, the report highlights it is a problem worldwide.

“It is very striking to see that preterm births have a similar burden all around the world – but due to different reasons,” Dr Lale Say from the WHO said.

“In developing countries it is due to things like infections, HIV, malaria and poor nutrition.

Baby in arms
Premature babies are likely to have developmental problems as they grow up

“In developed countries there are totally different risk factors – an older delivery age, diabetes, obesity and multiple births due to IVF.”

The report also mentions caesarean sections before full term, which are not always medically needed, as a reason for increasing premature baby rates.

A leading cause of death

Dr Joy Lawn, co-editor of the report and Director for Save the Children said: “This report shows the problem is much bigger than expected or realised. Being born too soon is an unrecognised killer.”

In children under five, prematurity is the leading cause of death worldwide, after pneumonia. Many premature babies that do survive develop learning difficulties and visual and hearing problems.

“This has been a shocker to those who work in child survival programmes – people were almost falling off their chairs when I reported back our findings,” said Dr Lawn.

“We have been working on problems identified 20 years ago. There has been progress in pneumonia, and diarrhoea as a cause of death has seen a major drop, but preterm birth has not been on anyone’s ‘to do’ list.”

“There is no excuse for 80% of babies, who are less than eight weeks early, to die – it’s lack of food and warmth, not lack of intensive care.”

Easy care

Experts at the UN say simple and inexpensive care, like antiseptic cream to prevent cord infection, one US dollar (60 pence) steroid injections given to mothers to help foetal lung development, and antibiotics to fight infection, can help keep premature babies alive.

They also advocate the use of kangaroo care – where the baby is tied, skin to skin, on the mothers’ front – which reduces infection, keeps the baby warm and makes it easy to breastfeed. This has been proven to dramatically reduce newborn death.

Not surprisingly, there are big inequalities in survival rates around the world.

Countries with the highest premature birth numbers (2010)

Source: World Health Organization

This is highlighted in the US – as, while it is makes the top ten for the highest number of premature births in the world, it is only number 37 for deaths – because of very effective and expensive intensive care.

Dr Christopher Howson, from March of Dimes, a baby charity which collaborated on the study said: “In low income countries, more than 90% of extremely preterm babies die within the first few days of life, while less than 10% die in high income countries.”

“However, this is a solvable problem. A number of countries, for example, Ecuador, Botswana, Turkey, Oman and Sri Lanka have halved their neonatal deaths from preterm birth through improving [care for] serious complications like infections and respiratory distress.”

It is hoped the report will spotlight premature births, especially in sub-Saharan Africa, and make it an urgent priority to help reach the UN Millennium Development Goal 4 set in 2000 – which calls for the reduction of young child deaths by two-thirds in 2015.

Map of premature birth rates across the world Premature birth rates across the world (2010)
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