International Health
Volume 7 Issue 4 July 2015
http://inthealth.oxfordjournals.org/content/current

.
EDITORIAL
Albinism in Africa: a medical and social emergency
Murray H. Brilliant
Extract
People with albinism (PWA) face a variety of medical and social problems, ranging from poor vision and skin cancer to murder for their body parts for witchcraft in East Africa, notably Tanzania. Albinism is an inherited disorder of melanin biosynthesis that results in a variable phenotype classified according to the mutation in one of several genes.
All forms of albinism are associated with problems of the visual system resulting in abnormalities of the retina, nystagmus, strabismus, foveal hypoplasia, abnormal crossing of the optic fibers, photophobia and reduced visual acuity.1 Oculocutaneous albinism (OCA) is a subgroup of recessive forms of albinism and characterized by a significant reduction or absence of melanin pigment in the eyes, skin and hair.2 Several genes are associated with OCA, although the most common forms are OCA1 and OCA2. OCA1 is caused by a reduction or complete lack of activity of the tyrosinase enzyme encoded by the TYR gene. OCA2 is caused by a reduction or complete lack of activity of the P protein—a chloride channel that helps regulate the pH of the melanosome organelle where tyrosinase is active.3,4 Although OCA2 is found in all populations, certain populations have a relatively high incidence. The worldwide incidence of OCA2 is 1 in 36 000, but it is especially common among individuals of African descent.5 The phenotype of sandy colored hair, chalky white skin and blue or hazel eyes is very distinctive in African populations (Figure 1). …

.
Meningococcal meningitis: vaccination outbreak response and epidemiological changes in the African meningitis belt
Francisco Javier Carod Artal*
Author Affiliations
Neurology Department, Raigmore hospital, Old Perth road, Inverness, IV2 3UJ, UK and Universitat Internacional de Cataluya (UIC), Barcelona, Spain
*Corresponding author: Tel: +44 1463706229; E-mail: javier.carodartal@nhs.net
Received February 23, 2015.
Revision received March 25, 2015.
Accepted March 25, 2015.
Abstract
The main approach to controlling epidemics of meningococcal meningitis in the African meningitis belt has been reactive vaccination campaigns with serogroup A polysaccharide vaccine once the outbreak reached an incidence threshold. Early reactive vaccination is effective in reducing morbidity and mortality. A recent paper in International Health has shown that earlier reactive vaccination campaigns may be even more effective than increasing the coverage area of vaccination. Monovalent serogroup A conjugate vaccine programs have recently been launched to prevent transmission in endemic areas in the African meningitis belt. Conjugate vaccines can induce immunological memory and have impact on pharyngeal carriage. However, reactive vaccination still has a role to play taking into account the dynamic changes in the epidemiology of meningitis in this area.

.
Results from a survey of national immunization programmes on home-based vaccination record practices in 2013
Stacy L. Younga, Marta Gacic-Dobob and David W. Brownc,*
Author Affiliations
aConsultant to the World Health Organization, Geneva, Switzerland
bWorld Health Organization, Geneva, Switzerland
cUnited Nations Children’s Fund, UNICEF House, 3 UN Plaza, New York, USA
*Corresponding author: Tel: +1 212 303 7988; E-mail: dbrown@unicef.org
Received December 1, 2014.
Revision received January 29, 2015.
Accepted February 10, 2015.
Abstract
Background
Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused.
Methods
During January 2014, WHO and the United Nations Children’s Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013.
Results
A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was <US$0.50 in 53/77 (69%) of countries providing information.
Conclusions
These results provide a basis for national immunization programmes to develop, implement and monitor corrective activities to improve the availability and utilization of HBRs. Much work remains to improve forecasting where appropriate, to prevent HBR stock-outs, to identify and improve sustainable financing options and to explore viable market shaping opportunities.

.
Hepatitis B vaccination of healthcare workers at the Princess Marina Hospital, Botswana
Tichaona Machiya, Rosemary J. Burnett, Lucy Fernandes, Guido François, Antoon De Schryver,
Marc van Sprundel, and M. Jeffrey Mphahlele
Int. Health (2015) 7 (4): 256-261 doi:10.1093/inthealth/ihu084