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Posts Tagged ‘Sub-Saharan Africa’


Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa

Reporter and Curator: Larry H. Bernstein, MD, FCAP 

 

In the immediate preceding article we discussed the problem of small subsistence farming and dependence on crop, and milk as a main source of food. We discussed the dilemma of unavailability of adequate nutrition, that posed a dilemma.  Insects invade and destroy the vegetation.  That can be avoided by either of two choices, crop-treatment with pesticide or by GMO crops resistant to types of destruction, both having unaffordable costs that impose an austere challenge and abject poverty with marginal after sales gains, in no way comparable to farming in Iowa, Wisconsin, Minnesota, or California, U.S.  So the situation could be improved by the introduction of/or development of a practical genome-based synthetic tehnology that might be free of Western dominance, if there were the home-based universities and scientific research.
I also touched on the consequences of the malnutrition in that region because of a diet that imposes either marasmic or kwashiorkor-like feature, the distinction being made based on the body compartment related to loss of fat mass or the loss of lean body mass, the latter being more serious.

Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa

The abstract of this discussion is directly taken from an article published in Clinical Medicine Insights: Cardiology; 2008: 2: 25-31,  Libertas Academica, ISSN(s):1178-1165.  Added to DOAJ: 2008-05-01
http://la-press.com/article.php?article_id=529

Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa: What should the Priorities be in the Absence of Global Risk Evaluation Tools?

Subjects: Diseases of the circulatory (Cardiovascular) system, Specialties of internal medicine, Internal medicine, Medicine, Cardiovascular, Medicine (General), Health Sciences
Andre Pascal Kengne, Alfred Kongnyu Njamnshi, Jean Claude Mbanya

Keywords: diabetes mellitus, cardiovascular disease, risk factors, prevention, Sub-Saharan Africa

Background

The growing burden of type 2 diabetes in Sub-Saharan Africa (SSA) and related cardiovascular complications call for vigorous actions into prevention. Comprehensive cardiovascular risk evaluation is important for the success of such actions.

Methods

We have reviewed 3 currently existing sets of recommendations for cardiovascular prevention in diabetes in SSA. Distribution of major risk factors and patterns of reported cardiovascular outcomes are used to suggest orientations for cardiovascular prevention in diabetes in this region. Papers and reports published over the period 1990 to 2007 were used.

Results

Existing guidelines share some similarities, but also have areas of inconsistencies. They are generally adaptations of existing guidelines, focused more on individual risk factors, and are not usually backed-up by local evidence.

  • They all have a projection on blood pressure lowering.

This focus is supported by the high prevalence of hypertension among people with diabetes in SSA.

  • Blood pressure and tobacco smoking are the modifiable risk factors accessible to evaluation and interventions on a wide scale in SSA.

Appropriate blood pressure control will have a major impact on stroke (the commonest cardiovascular disease) through

  • a reduction of the cerebrovascular risk, and
  • to a lesser extent on coronary heart disease and
  • total deaths in diabetes in this region.

Conclusions

In the absence of global risk evaluation tools,

  • the use of blood pressure lowering as a primary focus of cardiovascular prevention strategies is relevant for SSA.

However, there is a need to set-up diabetes and stroke registers

  • to monitor outcomes and generate tools for accurate risk prediction and management in diabetes in this region.
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Food Insecurity in Africa and GMOs

Reporter and Curator: Larry H. Bernstein, MD, FCAP 

 

This Report is a presentation from several articles since mid-2013 on the food shortage in Sub-Saharan Africa, where crop yields are among the lowest in the worlds.  In this series we have presented modiable  and epigenetic causes of CVD, among other topics, including diabetes, obesity, and exercise.  We have mentioned that while magnesium, fiber, a sufficient source of n-3 polyunsaturated fatty acids (from seafood or seaweed, or from flaxseed), and a functional methyl transporter as well as a source of methionine ( which requires a meat source, as B9 folate is plant sourced and does not fix the problem).  In this discussion we have both a voluntary and an involuntary course of living that leads to CVD and brain dysfunction, depending on where one lives, a “perfect storm”.

Part 1.  Tensions over Food Insecurity in Africa   Oct 8, 2013

Sharon Schmickle

Sub-Saharan Africa’s agricultural yields are among the lowest in the world, and nearly one-third of its people are malnourished. That much, tragically, is well established. Less clear are the reasons Africa’s farm output remains depressed despite hands-on work and billions of dollars invested by individuals, organizations and governments. News reports often explore specific aspects of the problem such as drought. This series takes the novel approach of looking at intertwined tensions underlying the many problems. Through stories told across the continent, Sharon Schmickle focus on several key themes:

  • Africa is caught in an ideological struggle over the nature and scope of agriculture with European—and, sometimes, American—organizations pitted against agribusiness and many agricultural scientists.
  • Institutions have failed African farmers. Public and private agencies often work at cross purposes, neglecting to follow through on crop-saving opportunities. Investments in research and agricultural extension have been inadequate.

Scientists have made impressive gains against the scourges that threaten crops. But they risk losing their breakthroughs against malnutrition, crop-destroying pests and drought if they overlook local tastes and customs.

The series, which also incorporates the work of local journalists, begins with an overview of Tanzania where government officials are divided in the global ideological standoff. Despite a government initiative called Kilimo Kwanza (Farmers First), many farmers lack access to the improved seeds and tissue cultures that could help them thwart yield-stealing diseases and pests. And many farmers are so locked into practices of the past that change comes hard if at all.

This narrative is not twisted to an anti-GMO slant, and could be viewed as a need for GMO harvests without the independence to develop them, and the struggle against a powerful industrial source that takes from an impoverished people.

Sharon Schmickle has been a journalist for MinnPost.com since 2007, and before that she worked for the Minneapolis Star Tribune where she reported from the paper’s Washington bureau…

http://pulitzercenter.org/sites/default/files/styles/responsive_cropped/public/09-16-13/1382/lunch_line_at_engaruka_primary_school_0.jpg

Roiling tensions underlie efforts to improve food security in Africa, often pulling at cross purposes on farmers, consumers and their countries.

Tanzania: Mixed Feelings on Genetically Modified Crops
Tanzania faces the question of whether food from GM crops will sell at markets like this one in Dar es Salaam. Image by Sharon Schmickle. Tanzania, 2013.

Part 2.  Nathanael Johnson lets the anti-GMO movement off the hook

By MICHAEL EISEN | Published: JAN 10, 2014

For the last six months, Nathanael Johnson has been writing about GMOs for the lefty environmental magazine Grist. The goal of his ultimately 26 part series was to try and bring some journalistic sanity to a topic that has gotten nasty in recent years. As Grist editor Scott Rosenberg is quoted on Dan Charles’ blog:
GMOs “were a unique problem for us,” says Rosenberg. On the one hand, most of Grist’s readers and supporters despise GMOs, seeing them as a tool of corporate agribusiness and chemical-dependent farming.

On the other hand, says Rosenberg, he’d been struck by the passion of people who defended this technology, especially scientists. It convinced him that the issue deserved a fresh look.

I’ve enjoyed reading the series. Johnson has investigated a wide range of issues related to GMOs with a generally empirical eye – trying to find data to help answer questions, while avoiding the polemicism that dominates discussions of the topic. Although I don’t think everything he has written is right, the series is a very useful starting point for people trying to wrap the heads around what can be a complex topic. He has clearly tried to delve deeply into every topic, and to not let dogma or propaganda from either side affect his conclusions.

Unfortunately, if the series has had an effect on what I presume is its target audience – the anti-GMO readers of Grist – it hasn’t shown up in online debates about GMOs. When I and others have pointed to Johnson’s series in response to outrageous statements from anti-GMO campaigners, he is dismissed as either a naive fool or just another Monsanto tool.

So I was surprised to read his concluding piece in the series, “What I learned from six months of GMO research: None of it matters“.

The most astonishing thing about the vicious public brawl over GMOs is that the stakes are so low.

His basic point is that a lot of hot air and political energy is spent trying to decide between two alternative futures that aren’t all that different.

In the GMO-free future, farming still looks pretty much the same. Without insect-resistant crops, farmers spray more broad-spectrum insecticides, which do some collateral damage to surrounding food webs. Without herbicide-resistant crops, farmers spray less glyphosate, which slows the spread of glyphosate-resistant weeds and perhaps leads to healthier soil biota. Farmers also till their fields more often, which kills soil biota, and releases a lot more greenhouse gases.

The banning of GMOs hasn’t led to a transformation of agriculture because GM seed was never a linchpin supporting the conventional food system: Farmers could always do fine without it. Eaters no longer worry about the small potential threat of GMO health hazards, but they are subject to new risks: GMOs were neither the first, nor have they been the last, agricultural innovation, and each of these technologies comes with its own potential hazards. Plant scientists will have increased their use of mutagenesis and epigenetic manipulation, perhaps. We no longer have biotech patents, but we still have traditional seed-breeding patents. Life goes on.

In the other alternate future, where the pro-GMO side wins, we see less insecticide, more herbicide, and less tillage. In this world, with regulations lifted, a surge of small business and garage-biotechnologists got to work on creative solutions for the problems of agriculture.

Genetic engineering is just one tool in the tinkerer’s belt. Newer tools are already available, and scientists continue to make breakthroughs with traditional breeding. So in this future, a few more genetically engineered plants and animals get their chance to compete. Some make the world a little better, while others cause unexpected problems. But the science has moved beyond basic genetic engineering, and most of the risks and benefits of progress are coming from other technologies. Life goes on.

In many ways he’s right. GMOs on the market today – and most of the ones planned – are about making agriculture more efficient and profitable for farmers and seed providers. This is not a trivial thing, but would global agriculture collapse without these GMOs? Of course not.

We rarely see transformative technologies coming. And remember that we are still in the very early days of genetic engineering of crops and animals. I suspect that you could go back and look at the early days of almost any new technology and convincingly downplay its transformative potential.

Most new technologies ultimately fail to deliver. But the proper stance to take is to say that we just don’t know. What we do know is that there are many pressing and complex problems facing the future of agriculture. And, given that there is no compelling reason not to allow GM techniques to proceed, why take this tool out of the hands of scientists?

People care about GMOs because they symbolize corporate control of the food system, or unsustainable agriculture, or the basic unhealthiness of our modern diet. On the other side, people care about GMOs because they symbolize the victory of human ingenuity over hunger and suffering, or the triumph of market forces, or the wonder of science.

What is most disturbing about the GMO debate – and why it matters – is that the anti-GMO movement at almost every turn rejects empiricism as a means of understanding the world and making decisions about it. GMO opponents have largely rejected Johnson and his series.

They do not appear to believe that the kind of questions that Johnson asks – “Does insect resistant corn reduce the amount of insecticide used on farms?” – can even be asked. They already know the answer, and are completely unmoved by evidence.

The world faces so many challenges now, and we can only solve them if we believe that the world can be understood by studying it, that we can think up and generate possible solutions to the challenges we face, and that we can make rational decisions about which ones to use or not to use.

– See more at: http://www.michaeleisen.org/blog/?p=1530#sthash.GVFidZev.dpuf

Part 3.  Africa: Context is Crucial to Seeing Challenge of Hunger

October 17, 2013 / Des Moines Register
http://pulitzercenter.org/sites/default/files/styles/slideshow/public/10-16-13/farmerprocessingmilkintobutter640.jpg

Women farmers are processing more of their milk. Image by Sharon Schmickle. Tanzania, 2013.

To understand food security in sub-Saharan Africa, context is crucial. Some 500 million small farms feed 80 percent of the people who live in regions that are perilously close to hunger.
Published Oct 17, 2013  SHARON SCHMICKLE

Iowans who take in this year’s World Food Prize Borlaug Dialogue in Des Moines can gain a wealth of expert perspectives on the important challenge of nourishing a growing world population during the next century.
Learning the full measure of the challenge, though, calls for reaching beyond the lectures and panel discussions — reaching into the local reasons it has been so difficult to achieve global food security.
Context is crucial in a world where some 500 million small farms feed 80 percent of the people who live in regions that are perilously close to hunger.
To visit farms in those regions is to learn why it has been so difficult to stand up to the moral challenge the late Norman Borlaug delivered time and again, insisting that access to adequate food is a basic human right.
It is to meet female farmers like Sharifa Said Nambanga, who struggles to feed five children with the rice she can grow on a small plot in Zanzibar. Women do a hefty share of the farm work around the world. Often, though, they are shut off from the extension services that should deliver improved seeds, fertilizer and the know-how to use agriculture’s modern methods. Feeling abandoned, they limp along as best they can on their own.
It is to meet pastoralists like Parmelo Ndiimu. He is a Maasai elder who watches helplessly while the trees he needs to feed his goats are cut to make charcoal for cooking in urban kitchens. “If we won’t be able to feed our goats, we will not be able to feed our children,” Ndiimu said. “And we will be gone.”
It is to meet Tanzanian farmers who work their small plots throughout a full growing season only to see weevils destroy half their bean harvest. They know firsthand the tension between farmers and the ever evolving pests that attack crops in the field and after harvest.
It is to see corn planted from family seed wither in the field, stalks barren and green leaves giving way to limp yellow strips. Theoretically, the simple remedy should be improved seeds. But nothing is simple in the process of getting those improved seeds to small-scale farmers, especially when the improvement involved genetic modification of the plants.
In his later years, Borlaug addressed context in sub-Saharan Africa, recognizing that along with improved seed, farmers also needed to knock down barriers in their marketing, storage and processing systems. He challenged African leaders to invest more in agriculture.
Within that framework, it is clear that millions of small-scale farmers — especially those in Africa — operate amid tensions that limit their opportunities to extract more food from the technology that has filled porridge bowls and bread baskets elsewhere.

Part 4. Betting on the Impact of Synthetic Biology In Healthcare – By Jenny Rooke

Jenny Rooke drives innovation in the life sciences field through investing and business building around brilliant scientists and engineers with novel technologies. Prior, Jenny held multiple executive roles at U.S. Genomics.

I am an ardent believer in the potential of synthetic biology – its technologies, methods, and talented practitioners – to transform human life on just about every dimension: What we eat, how we make things, the character of our environment and how we move through it, how we are born, and, eventually, how long we live.

My more circumspect investor side is forced to admit that the evidence base of practical (not to mention profitable) applications of synthetic biology remains, shall we say, a work in progress. The first wave of synthetic biology companies that focused on energy/biofuels has been largely disappointing commercially, despite some notable technical successes, due in part to challenges related to scale-up, feedstock economics, and distribution.

It seems reasonable to search for proof cases of synthetic biology’s utility in human health; after all, the vast majority of biotechnology’s impact to date (practically and financially) has been in healthcare, including the creation of entirely novel categories of therapeutics and molecular diagnostics.

To be fair, it’s early yet to expect too many synthetic biology success stories in medicine. Synthetic biology as a field is just over a decade old and if it takes on average a decade for a new drug to move from the lab to the market, well, the math is obvious. In addition, there remain a great deal of technical, clinical, and safety risk inherent to applying synthetic biology technologies to human health problems (consider the painful lessons from the analogous field of gene therapy). This helps explain the reluctance of incumbent healthcare companies and traditional healthcare investors to make big bets on synthetic biology until the technology’s practical utility is more proven.

In 2011 and 2012, the Bill & Melinda Gates Foundation put out a call for grant applications to “Apply Synthetic Biology to Global Health Challenges” under its Global Health division, which aims to harness advances in science and technology to save lives in developing countries. The foundation’s Grand Challenges Explorations, or GCE, program is an ideal mechanism for fostering applications of synthetic biology.

Synthetic biology will play a critical role in enabling novel, affordable healthcare solutions for developing countries. Image source: GrandChallenges.org

For more information on the Grand Challenges in Global Health program, including a brief description of each project and a discussion of observed themes, see the review article “Synthetic biology as a source of global health innovation” (Syst Synth Biol (2013) 7:67–72).

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