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Monday, December 08, 2008

Cambodian NGOs, officials fight to ban toxic pesticides

PHNOM PENH, Dangerous pesticides pose serious health risks to farmers and consumers, say NGOs and agricultural officials who have rallied for a national ban, national media reported Monday.

Cambodia spends nearly 30 million U.S. dollars on chemical sprays every year, many of which are illegal in the countries where they are manufactured, according to the Phnom Penh Post.

Cheang Sovannrath, a project officer with the nongovernmental group Chemical Spray Reduction and Sustainable Agriculture, said the campaign, which included a march through Phnom Penh, aims to educate consumers about the dangers of chemical sprays and encourage the government to stop importing them.

"I think this campaign can sound an alarm for consumers and authorities to restrict the import of chemical sprays," Cheang Sovannrath said.

Meanwhile, the campaign is supported by the NGO Forum on Cambodia.

"I think if we don't start this kind of campaign now, we will face real danger in the future," said Keam Makarady, research project coordinator for the Cambodia Center for Study and Development in Agriculture (CEDAC).

Ninety percent of chemical spray users have suffered adverse health effects, with at least 10 percent of these experiencing serious problems, he said.
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Give the gift of a better world

By CAROL PUCCI

This is the time when I look under my desk where I store some of the oddball travel gadgets sent my way during the year. It’s a reminder that few of us really need a plastic cup holder that hooks to the side of a suitcase, a disposable pillow or a GPS-trackable dog collar.

Here’s a suggestion: If you’re looking for a holiday gift for the globe-trotter on your list, chuck the junk and instead consider a gift that gives back to the people in the countries we visit.

A few ideas:

• Support a banking system that’s not in need of a bailout. Give a gift certificate for a loan through Kiva.org, and let a friend or family member discover how far $25 can stretch.

This past year, I tracked the progress of two women with whom I forged a special connection: Nguyen Thi Nama, with six children and a small business selling groceries in Vietnam, and Diana Beleva, a Bulgarian sock peddler. I loaned them each $25 through Kiva, a San Francisco nonprofit that links third-world entrepreneurs with first-world lenders who pool their money into short-term, interest-free business loans.

My two business partners paid the money back a few months ago, and I recycled the cash into new loans, this time for Phan Ny, a blacksmith in Cambodia, and Joise Yabu, who sells rice and fried eggs at a hotel in Sudan.

Kiva has so far arranged nearly $50 million in loans in 41 countries. Vetted by micro-financing organizations in their home countries, the borrowers pay the money back in monthly installments. Pictures, bios and updates appear on Kiva’s Web site.

The program has become so popular that lenders sometimes outnumber borrowers. The recipient of your gift certificate may have to wait awhile to find an entrepreneur to support, but once the two connect, your gift truly will be one that keeps on giving. See www.kiva.orgfor details.

• Shop for handmade crafts, jewelry, textiles and other gifts at stores and online retailers dedicated to supporting fair wages and decent working conditions for third-world artisans.

Ten Thousand Villages, a nonprofit trading organization sponsored by the Mennonite Church, sells the work of artists from more than 30 countries.

Far East Handicrafts in Seattle, supplies handmade arts and crafts from artists and cooperatives in Nepal, Cambodia, Vietnam and Laos, where the organization supports medical and educational projects. Gifts under $50 include wind bells, singing bowls and handmade paper products.

Nonprofit Aid to Artisans works with retailers to develop new markets for products that foster artistic traditions and help communities in countries such as India and Mozambique. Check its Web site for a list of retailers that carry its products, or buy online.

Andy and Tammy James opened Market Street Traders after vacationing in Thailand. They bought $500 worth of goods from a remote village after an elder told them that was enough money to send all the village kids to school for a year.

Global Exchange, a San Francisco-based international human-rights organization, operates an online Fair Trade store stocked with items such as hand-woven leaf earrings from Swaziland and laptop sleeves made by a women’s cooperative in Rwanda.

• Buy a gift subscription to a publication that promotes responsible, sustainable travel. When my favorite, Transitions Abroad,, ceased print publication, subscriptions were transferred to a Canadian publication called Verge,. Yearly subscriptions are $25.

International Travel News targets active and armchair travelers with articles and reader advice on budget travel and independent adventuring, much of it aimed at older travelers. This 100-page plus monthly packs hundreds of useful tips into each issue. Travelers do most of the writing. A subscription is $24 or call 800-486-4968.

• Build a school, help protect a forest or send a child to school. Dozens of organizations in the Pacific Northwest support third-world relief efforts. One of my favorites is Friendship with Cambodia of Eugene, Oregon. I traveled to Cambodia a few years ago with its founder, Bhavia Wagner, the author of “Soul Survivors,” a book about women and children who survived the Khmer Rouge.

In the United States, we dream of college educations, houses and good-paying jobs. In Cambodia, villagers dream of raising $15-$20 to buy a bicycle or a few pots and pans to use to start a business that can support a family. You can help.

The economic downturn is taking a toll all over the world, especially in countries that depend on tourism. The U.S. dollar is gaining strength just about everywhere. If you have a job and the money, it’s a good time to start planning a trip. Travel itself is the best gift of all, and, for now at least, it’s on sale. Happy holidays!
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Evidence of Artemisinin-Resistant Malaria in Western Cambodia

Figure 1. Parasite Density, Parasite-Clearance Time, and 50% Inhibitory Concentration (IC50) among Patients Receiving Artesunate, According to Clinical Outcome.


Panel A shows the parasite-reduction curves for the 56 patients who were cured, the 2 patients classified as having artemisinin-resistant infections, and the 2 with drug failures (i.e., patients who had recrudescence but who were not classified as having artemisinin-resistant infection, since the drug level was inadequate). The data points and horizontal I bars denote the means and standard errors. Panel B shows the parasite-clearance times in the artesunate group, as compared with the IC50 for dihydroartemisinin (R=0.31, P=0.03). Orange circles indicate patients whose infection was classified as artemisinin-resistant, and blue squares patients in whom treatment failed but whose infection was not classified as resistant.

To the Editor: Although artemisinins are potent and rapidly acting antimalarial drugs, their widespread use for treating patients with Plasmodium falciparum malaria raises the question of emerging drug resistance.1,2 Artemisinin monotherapy should not be used in areas where malaria is endemic; it requires an extended administration period and may lead to treatment failure, most frequently because of problems with compliance. Recent reports of high failure rates associated with artemisinin-based combination therapy, as well as in vitro drug-susceptibility data, suggest the possibility of clinical artemisinin resistance along the Thai–Cambodian border.3,4 We studied the potential emergence of artemisinin resistance using in vivo, in vitro, molecular, and pharmacokinetic methods specifically designed to address the question of potential artemisinin resistance.

We randomly assigned, in a ratio of 2:1, 94 adults from Battambang Province presenting with uncomplicated P. falciparum malaria (100 to 100,000 parasites per microliter) to receive either high-dose artesunate therapy (4 mg per kilogram of body weight per day, orally, for 7 days) (60 patients) or quinine (30 mg per kilogram per day) plus tetracycline (25 mg per kilogram per day) in a split dose every 8 hours for 7 days (34 patients). The study was approved by ethics review committees in Cambodia and the United States and was conducted from October 2006 through March 2007. Written informed consent was obtained from all study participants.

Patients were admitted for 28 days to rule out reinfection. The clinical outcome was recorded, plasma drug concentrations and in vitro drug susceptibility were measured, and molecular assays were performed to investigate genetic resistance markers and to rule out reinfection. Only patients who met all the following criteria were classified as having artemisinin-resistant infection: persistence of parasites 7 days after the start of treatment or reemergence of parasites within 28 days after the start of treatment; adequate plasma concentrations of dihydroartemisinin, a major artemisinin metabolite; prolonged time to parasite clearance; and reduced in vitro susceptibility to dihydroartemisinin.5

Four of the 60 patients who received artesunate had reemergence of parasitemia between days 21 and 28 after the start of treatment (with a Kaplan–Meier probability estimate for cure at day 28 of 93.6%; 95% confidence interval [CI], 84.7 to 97.7); 2 of these patients (3.3%) were classified as having artemisinin-resistant infection, according to the criteria listed above (Figure 1A). These two patients had parasite-clearance times that were prolonged (133 and 95 hours, as compared with a median of 52.2 hours for patients who were cured), and the plasma drug concentrations after the first dose were classified as adequate (greater than the mean for the cured patients minus 1 SD) (see the Supplementary Appendix, available with the full text of this letter at www.nejm.org). For these subjects, the 50% inhibitory concentrations for dihydroartemisinin were up to 4 times the geometric mean for cured patients and almost 10 times that for the reference clone W2. In the artesunate group, 47.9% (95% CI, 36.1 to 60.0) of the patients still had parasitemia 48 hours after the start of treatment, as did 21.9% (95% CI, 13.1 to 33.1) 72 hours after the start of treatment. Clinical and in vitro data suggest that artemisinin resistance may be more accurately portrayed as the long tail of a single distribution than as the result of a sudden change in sensitivity (Figure 1B). Resistance did not appear to be mediated by the number of copies of the P. falciparum multidrug resistance gene pfmdr1 or selected PfATPase6 polymorphisms tested in this study.

The high overall treatment efficacy seen in patients treated with artesunate indicates that relatively few parasite isolates have crossed the threshold of artemisinin resistance as defined in our study. Artemisinin resistance does not seem to be a widespread epidemiologic phenomenon at this time. The prolonged parasite-clearance times and the two cases meeting our definition of artesunate resistance are nonetheless a concern.

Harald Noedl, M.D., Ph.D.
Medical University of Vienna
A-1090 Vienna, Austria
harald.noedl@meduniwien.ac.at

Youry Se, M.D.
Kurt Schaecher, Ph.D.
Bryan L. Smith, M.D.
Armed Forces Research Institute of Medical Sciences
Bangkok 10400, Thailand
Duong Socheat, M.D.
National Center for Parasitology, Entomology, and Malaria Control
Phnom Penh, Cambodia

Mark M. Fukuda, M.D.
Armed Forces Research Institute of Medical Sciences
Bangkok 10400, Thailand

for the Artemisinin Resistance in Cambodia 1 (ARC1) Study Consortium

Supported by the U.S. Department of Defense Global Emerging Infections System Program. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

This letter (10.1056/NEJMc0805011) was published at www.nejm.org on December 8, 2008. It will appear in the December 11 issue of the Journal.

References

Duffy PE, Sibley CH. Are we losing artemisinin combination therapy already? Lancet 2005;366:1908-1909.

Krishna S, Bustamante L, Haynes RK, Staines HM. Artemisinins: their growing importance in medicine. Trends Pharmacol Sci 2008;29:520-527.

Jambou R, Legrand E, Niang M, et al. Resistance of Plasmodium falciparum field isolates to in-vitro artemether and point mutations of the SERCA-type PfATPase6. Lancet 2005;366:1960-1963. [CrossRef][Medline]

Vijaykadga S, Rojanawatsirivej C, Cholpol S, Phoungmanee D, Nakavej A, Wongsrichanalai C. In vivo sensitivity monitoring of mefloquine monotherapy and artesunate-mefloquine combinations for the treatment of uncomplicated falciparum malaria in Thailand in 2003. Trop Med Int Health 2006;11:211-219. [ISI][Medline]

Noedl H. Artemisinin resistance: how can we find it? Trends Parasitol 2005;21:404-405.
[CrossRef][ISI][Medline]
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Cambodia cuts military budget after IMF concern

PHNOM PENH (Reuters) - Cambodia's government has slashed its proposed military budget for 2009 after the International Monetary Fund questioned the big increase it had announced, officials said on Monday.

In a parliamentary debate on next year's budget, the government proposed military spending of just $160 million for next year, way below the $500 million it had earmarked earlier after a border clash with Thailand in October.

"Before, we planned to divert resources to defence and security, but once we announced the plan, there was some criticism from donors," said Cheam Yeap, head of the National Assembly's finance commission.

"We don't want donors to get nervous about spending in the field so we decided to reduce it," Yeap told Reuters.

The IMF expressed concern about the big increase in military spending at a meeting of international aid donors in Phnom Penh last week.

Cambodia's opposition has also worried about the government's plan to spend more on the military at a time when donors such as the World Bank are contributing millions of dollars to help demobilise troops and slim down the country's bloated army.

The budget for military spending in 2008 is $108 million. Total spending on security, including the police force, is around $250 million.

Officials said the proposed increase in military spending next year would go towards better pay and welfare in the army, not weapons.

Cambodia's total budget for next year is now likely to be around $1.4 billion rather than the $1.8 billion proposed earlier.

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Former Cambodian monarch says his health is deteriorating

PHNOM PENH (AFP) — Cambodia's former king Norodom Sihanouk said his health was deteriorating and hinted that he did not have long to live, in a letter seen on his website Monday.
The 86-year-old, who left for Beijing in July for his annual medical treatment, wrote in a message titled "The deterioration of the state of my health" that his "eminent Chinese doctors" had told his wife, former queen Monineath, that he should be hospitalised in case of emergency.

"My important and respected Chinese friends dare not speak about my death (from old age) in the not so distant future. But I told them I would prefer to die in 'my' residence instead of a hospital, where I have very comfortable apartments," Sihanouk said.

In the message, dated December 1 but only posted recently on his website, the former monarch added that doctors had increased their examinations from once a week to many times a week, and sometimes twice a day.

Sihanouk has suffered from a number of ailments, including cancer, diabetes and hypertension.

Despite giving up his role as monarch, he remains a prominent figure in Cambodia who often uses messages to weigh in on matters affecting the country.
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