Through examining the experience of the Ugandan Coalition for Health Promotion and Social Development (HEPS-Uganda), Rosette Mutambi highlights the extent to which ordinary Ugandans remain without effective official health care. While stressing the role of government in empowering local communities, she argues that genuine improvement in primary health care rests on involving an informed population in the planning and implementation of the system overall, a consideration of even greater importance in a resource-poor nation like Uganda.

The main factors behind Africa’s health tragedy are the lack of foresight and political will required to ensure sustainable health development, financing and universal primary health care, argues Rotimi Sankore. Through exploring comparative statistics for African and Western health systems and by underlining the effects of institutional under-funding and the brain drain, the author contends that future generations of Africans may yet look back and conclude such policy to be the equivalent of institutional ‘manslaughter’.

Thirty years on from the Alma-Ata Declaration, Chan Chee Khoon explores the history and continuing influence of biomedical science on public health care in the 21st century. With many African countries still facing burdensome infectious disease, the population health perspectives pioneered and promoted by McKeown and the Lalonde report continue to be relevant in addressing contemporary epidemics.

After years of ‘neglect’ in favour of health and education assistance in Africa, the food crisis has concentrated the donor community’s minds on the need for overseas development aid for African agriculture. This is welcome, but what sort of policies are being proposed and what impact will they have for the African farmer? This report reviews policy documents of some of the major donors providing aid for African agricultural development – between 2004 and 2008 – as well as United Nations, international finance, agricultural research and African institutions.

Combination antiretroviral therapy significantly reduces the risks of women with advanced HIV disease having an HIV-infected baby, but increases the risk of having a low birth weight baby, according to research conducted in the Cote d’Ivoire and published in the September 12th edition of AIDS. But the investigators found that low birth weight did not increase the risk of infant mortality – the only risk factor for this outcome was HIV infection in the infant.

The scaled–up delivery of antiretroviral drugs through primary healthcare offers an important opportunity for health care systems to manage the transition towards caring for people with chronic illnesses as populations age and cancers and cardiovascular disease become more common, according to the authors of a South African study looking at causes of death over 13 years in rural South Africa.

Taking antiretroviral drugs at the same time as TB treatment halved the death rate when compared with delaying HIV treatment until after TB treatment was completed, a major South African study has found. Trial investigators announced on September 17th that they have terminated an arm of the study in which patients waited until they had completed TB treatment before starting antiretroviral therapy, because patients in this arm had a significantly higher risk of death.

Cholera has killed 122 people and new cases have been reported in the last three weeks alone in Guinea Bissau. The epidemic is uncontrollable in the capital Bissau and elsewhere, experts told IRIN. The hardest hit regions are Bijao Island 158 cases, Biombo 836, Quinara 216, Oio 215 and Bissau 4,500.

We are hungry and angry Kenyans who have chosen to stand up and demand that the government ensures the right to food for all Kenyans. We are tired of eating "airburgers"; we are tired of watching our children go to bed hungry and we can no longer keep to the-skip-a-meal program.

Dunga Beach, along the shores of Lake Victoria in Kenya's western city of Kisumu, erupts into activity when the boats bring in their catch. Female fishmongers scramble along the beach to buy fish, shouting themselves hoarse to get the attention of the fishermen and middlemen, who control whether or not the women will have anything to sell that day. Mingling with the jostling fishmongers is 19-year-old Lillian Onoka; stylishly dressed and with neatly plaited hair, she is easily noticed. "I do not sell fish but my aunt does, and she brings me along with her. I just help her get the fish without her

A rate of adverse events, infections and delayed healing described as ‘shocking’ and ‘unacceptable’ by the investigators has been revealed by a survey of both traditional and medically performed circumcisions amongst a traditionally-circumcised ethnic group in Kenya.

During the pre-antiretroviral therapy era, the mortality rate in HIV-infected Zambian children was 7- and 25-fold higher than in HIV-uninfected Zambian children, respectively, according to the results of a prospective study published in the September 15th edition of Clinical Infectious Diseases.

Hundreds of Zambian men are enthusiastically queuing to be circumcised as part of measures to curb HIV/AIDS in that country. Reports say men are put on waiting lists for close to four months or more and are sometimes turned away due to lack of doctors and inadequate health centers for such cases.

Drought conditions and high staple food prices have left more than 340,000 people - over half of Djibouti's population - highly or extremely food insecure and in need of emergency food and non-food assistance through the end of 2009. Four consecutive years of minimal rains to support pastoral and agropastoral production have left rural and urban Djiboutians even more dependent on food imports at a time when international commodity prices have risen steadily.

Uganda's rising HIV prevalence is forcing policy makers to look for inventive ways of educating people about the virus. Their latest tool is mobile phone technology, whose rapid growth has provided an avenue that could potentially reach millions with messages.

'Express care', a new model for providing care to people starting antiretroviral therapy in which most of the burden for seeing patients is shifted to nurses, is associated with reduced death rates (by about 50%) and reduced losses to follow-up among people with CD4 cell counts of less than 100 cells/mm3, according to a Kenyan presentation made earlier this month at the International AIDS Conference, in Mexico City.

HIV prevalence and incidence in rural Uganda appear to be increasing, researchers report in a study published in the August 20th edition of AIDS. Coinciding with these increases, the investigators observed changes in HIV sexual risk behaviours in certain groups. The study was conducted in villages in rural Uganda and the trends it revealed mirror other evidence from Uganda pointing to increases in HIV prevalence and incidence.

There is a “hidden epidemic” of HIV amongst African migrants living in the United States, according to investigators writing in the September 12th edition of AIDS. The researchers found that African-born individuals in the US had a disproportionately high prevalence of HIV – although they comprised only 0.6% of the study population, almost 4% of HIV diagnoses were amongst African-born individuals. Furthermore, the investigators found that in one health area approximately 50% of HIV infections amongst black people were amongst individuals originating in Africa.

South Africans who believe in a conspiracy theory that HIV was introduced by white people as a way of controlling the black population are significantly less likely to have had an HIV test, according to a study published in the September 1st edition of the Journal of Acquired Immune Deficiency Syndromes. For the South African government to restore the public’s faith in their response to HIV, they need to “present a consistent and strong prevention platform about the importance of testing”, argue the investigators.

There may be limits to which medical tasks can be shifted to non-medical staff in resource-limited settings with only limited training and supervision, according to a report from The Lighthouse Trust in Malawi presented at the XVII International AIDS Conference last month.