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  • In Tara Mangal and colleagues report the results of their


    In , Tara Mangal and colleagues report the results of their case-control study into the persistence of poliomyelitis in Nigeria, which identified low vaccine efficacy, poor vaccine coverage, suboptimum ginsenoside rg3 immunity, rejection and refusal of vaccine, and lack of awareness as issues responsible for the persistence of the virus in Nigeria. A report by the Nigerian Expert Review Committee on Polio Eradication following their 25th meeting in September, 2012, also identified a lack of shared sense of emergency by some states, slow improvement in poliomyelitis campaign performance in some local government areas, and neglect of routine immunisation as reasons compromising the success of the programme. Although these findings represent substantial quantifiable and perceivable reasons, and have added to the understanding about poliomyelitis in Nigeria, in our opinion there are other obscure and intractable factors contributing to the problems facing poliomyelitis eradication in Nigeria. The issues affecting poliomyelitis eradication can be linked to larger problems affecting the whole country. Political, cultural, and religious considerations often dictate attitudes and the course of action in Nigeria. Notably, the 2004 rejection of the oral poliovirus vaccine in the northern part of the country followed the election result, which some leaders from the northern part of the country felt was not in their favour. Nigeria was close to eradicating poliomyelitis in 2004 when the campaign against the oral poliovirus vaccine began. That action is still affecting the programme now, although its effect has been significantly reduced by the involvement of political, community, and religious leaders, and intensified communication strategies.
    The decrease in malaria burden in the past decade has coincided with a greater than 15-times increase in international spending on malaria control and a shift in approach towards a goal of local elimination in many endemic countries. Although investment growth rates have slowed, the decrease in malaria transmission is expected to continue, with some indications that these gains are more resilient than expected. In , Ubydul Haque and colleagues assess the performance of the Bangladesh National Malaria Control Program (NMCP) in delivering malaria control activities in the country\'s remaining endemic areas after 5 years of investment from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The analysis has several strengths and weaknesses that are informative for economic assessments of malaria control programmes in countries moving towards elimination.
    The Global Burden of Disease Study 2010 revealed that increasing population sizes, substantial increases in the average age in most world regions, and falling death rates have all led to a transition in the burden of disease towards disorders that cause disability but not substantial mortality. Age-related macular degeneration is one of these disabling and degenerative diseases, mostly targeting elderly people. In 2010, an estimated 32·4 million people were blind (defined as presenting visual acuity of less than 3/60), and roughly 191 million people had moderate-to-severe vision impairment (defined as presenting visual acuity of less than 6/18 but equal to or better than 3/60). Although the age-standardised prevalence of blindness for older adults decreased from 3·0% in 1990 to 1·9% in 2010, and visual impairment decreased from 14·3% to 10·4%, the number of blind people increased by 0·6 million and the number of visually impaired people increased by 19 million. This tendency was due to the increase in the global population size and mean population age. In both 1990 and 2010, macular degeneration—mainly age-related—was the third most common cause of blindness (6·6% of all cases in 2010). It was also the third most common cause for visual impairment, accounting for 3·1% of all cases. From 1990 to 2010, the prevalence of blindness and visual impairment due to macular degeneration increased, a trend that will further continue until a prophylaxis or a markedly effective therapy has been developed.