All patients with rickettsial infections reported by Dittric
All patients with rickettsial infections reported by Dittrich and colleagues presented with fever at admission, and few patients presented with typical eschars of inoculation (only 3·6% of patients with murine typhus and 6·7% with scrub typhus). This finding might be a result of poor awareness about pathognomonic signs of rickettsioses among clinicians rather than an absence of such disease.
Rickettsioses are treatable but remain underestimated. Besides murine typhus and scrub typhus, tick-borne spotted fever group rickettsioses cause much fever of unknown origin in tropical countries. is one such rickettsia; it has been detected worldwide in arthropod hosts (mainly fleas), with the cat flea the only confirmed biological vector. A growing number of reports implicate in human disease, particularly in the tropics. It has been detected in 3–4% of cases of fever of unknown origin in rural Mali and Kenya, and 6% of cases in rural Senegal. has also been detected in mosquitoes and it is common in countries in Africa with high prevalences of malaria. Cases of infection in Thailand have also been reported.
In recent months, the International Monetary Fund (IMF) has announced US$430 million of funding to fight Ebola in Sierra Leone, Guinea, and Liberia. By making these funds available, the IMF aims to become part of the solution to the crisis, even if this involves a departure from its usual approach. As IMF Director Christine Lagarde said at a meeting on the outbreak, “It is good to increase the fiscal deficit when it\'s a E-4031 of curing the people, of taking the precautions to actually try to contain the disease. The IMF doesn\'t say that very often.” Yet, could it be that the IMF had contributed to the circumstances that enabled the crisis to arise in the first place? A major reason why the outbreak spread so rapidly was the weakness of health systems in the region. There were many reasons for this, including the legacy of conflict and state failure. Since 1990, the IMF has provided support to Guinea, Liberia, and Sierra Leone, for 21, 7, and 19 years, respectively, and at the time that Ebola emerged, all three countries were under IMF programmes. However, IMF lending comes with strings attached—so-called “conditionalities”—that require recipient governments to adopt policies that have been criticised for prioritising short-term economic objectives over investment in health and education. Indeed, it is not even clear that they have strengthened economic performance.
The response to the Ebola crisis in west Africa is shining light on the weak health systems in these countries, which have been crippled by years of underinvestment. Sierra Leone, one of the three countries at the epicentre of the Ebola outbreak, is a small country with a population of 6 million and an average income of US$513. As of Dec 13, 2014, Sierra Leone had recorded 6638 confirmed cases of Ebola and 2033 deaths. The weak health infrastructure is generally explained in the media as resulting from the civil war which ended in 2002. However other factors, including those that precipitated the civil war, need to be considered, such as structural adjustment which caused the collapse of the education system. The combination of jobless youths and income from diamonds provided fertile ground for the formation of the Revolutionary United Front, a group that claimed to be on the side of the population against the government. To pay for health systems, governments need to raise revenue. The most predictable and sustainable way to do this is through taxes, and both the UN and west African heads of state have agreed that governments need to raise 20% of their gross domestic product (GDP) in tax to meet their development needs. However, although the economy has been growing at 6% per year, Sierra Leone currently only raises 11% of its GDP in taxes. The three main categories of tax are customs duty, goods and services tax, and corporate income tax. Waivers and special deals are given to foreign mining and agribusiness companies to attract foreign investment into the country, despite little evidence to suggest that such incentives attract investment or promote economic growth. When several countries provide widespread tax incentives at the same time, there may be a race to the bottom, with multinational companies being the beneficiaries and the population being the losers, in the form of lost potential revenues that could fund public services. Individualised tax arrangements reached between a small number of government officials and companies, with lack of transparency, also increases the likelihood of corruption. Looking at just five mining companies in Sierra Leone, one recent study found that the country will lose $44 million per year simply from corporate income tax exemptions, nearly all from two UK companies. Losses from exemptions on customs duties and taxes on goods and services granted to companies, non-governmental organisations, and embassies amounted to an average annual loss of $200 million during 2010–12 in Sierra Leone. Overall, tax incentives are estimated to have cost the people of Sierra Leone 14% of their GDP in 2011 and 8% in 2012.