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This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

The WHO has provided its own estimates of how non-communicable diseases are set to rise in developing countries. These authors pool data from national registries and international databases to compare data on the differing burden from individual diseases. They outline the risk factors associated with the diseases.

The main three killers are cardiovascular disease, diabetes, and cancer. The paper ranks different types of cancer by how many people in developing countries they kill (lung and breast cancer are the deadliest) and also ranks diabetes prevalence by country (India, followed by China, has the highest prevalence).

To tackle these diseases, say the authors, people need to look closely at the risk factors in their life – eating healthily and exercising can do much to reduce the chances of getting one of these diseases.

This document presents the proceedings of a conference at the Royal Netherlands Academy of Arts and Sciences in December 2001. The conference papers deal with themes relating to the role of scientific research in the development of Northern countries and the need for North–South research cooperation. They document the experiences of research cooperation involving, among others, India, South Africa and a number of East African countries. Several papers deal with innovation and scientific cooperation, with case studies.

Good prescribing practices are important in tackling antibiotic resistance, and diagnostics are key to ensuring good practice. Knowing who not to treat is as important as knowing who to treat. The article reports on analyses by the Global Health Diagnostic Forum of the Bill & Melinda Gates Foundation to assess how many lives could be saved by better diagnostics for six major illnesses, including malaria and tuberculosis. The researchers assessed the technical issues associated with implementing the diagnostic tests in developing countries for three classes of laboratory infrastructure — none, minimal, or moderate to advanced.

They found that for acute lower respiratory infections, syphilis, gonorrhoea, chlamydia and TB, outcomes could be much improved if tests were sent to sites with minimal or no laboratory infrastructure. In these types of settings, the practicality of obtaining a specimen is important. For example, obtaining a blood sample correctly to test HIV viral load is almost impossible where there are no laboratory facilities. Using sputum to test for TB has similar issues because of the impracticability of the sample medium. Thus, new biomarkers might be needed to test for diseases with specimens different from those currently used. Combination tests that look for a range of infectious organisms in one sample would be useful in resource-poor settings.

The researchers also highlight the importance of taking into account cultural and social sensitivities when designing interventions – blood sampling is not always accepted in some regions of the world, for example.

This study outlines the findings of the 2003 TIMSS for the participating Arab countries, namely, Bahrain, Egypt, Jordan, Lebanon, Morocco, the Palestinian National Authority, Saudi Arabia, Syria and Tunisia. TIMSS is a study of cross-national achievement in mathematics and sciences for fourth and eighth grade students since 1959.

The report provides useful data on each of the participating countries, and compares Arab and international average scores. It includes data on average achievement scores, resource availability, access to computers, the number of curriculum hours designated, teacher characteristics and credentials, and classroom characteristics and instruction quality.

The study finds that while most Arab countries lag behind the international averages, a few have made progress since the last exercise in 1999. It also highlights interesting aspects of this difference and suggests measures to improve student achievement. The document is especially useful for educators in Muslim countries seeking credible data and analysis on student achievement.

This research article, by Rosemary Wolson at the University of Cape Town, assesses South Africa's biotechnology policies, reviewing three major initiatives — the national research and development strategy, biotechnology strategy and proposed laws to govern intellectual property rights derived from publicly funded research. Wolson explains the origins, goals and implementation of each.

The projects aim to create a coordinated strategy for promoting biotechnology in South Africa. Wolson concludes that the efforts are an encouraging sign of governmental commitment, but notes the continuing challenge of integrating the individual projects into a coherent framework. This may depend on promoting social networks to catalyse innovative industries.

She calls for the government to encourage more private enterprise and investment while remaining committed to basic research.

This article is useful to anyone hoping to understand the policy framework for biotechnology in one of sub-Saharan Africa's key scientific and industrial powers.

This research article assesses the potential for biotechnological approaches to overcome major pests, diseases and weeds undermining food security in Africa. The eight authors review three major constraints — parasitic weeds and herbicide-resistant grasses, insect pests, including those carrying plant diseases, and mycotoxins that damage stored grains.

They note that biotechnological solutions to some of these are already being explored, such as insect resistance in maize, but they say that others, like the control of parasitic weeds, will require longer-term study. The authors argue that these should be prioritised in public research programmes and supported by the private sector through donations of useful genes and technologies.

Their methodical discussion helps identify key priority areas for crop biotech research in Africa. This article will be useful to policy analysts, decision makers and research managers working in the field.

This issue of the African Technology Development Forum Journal highlights technology transfer in Africa. In particular, it looks at the different ways technology is transferred to and from Africa, and how these vary across the continent. It discusses international organisations' role in agricultural technology transfer and examines how both international and local public-private partnerships can help transfer technology in all sectors of the economy.

This summarises an electronic conference moderated by the UN Food and Agriculture Organization on agricultural biotechnology research and the needs of developing countries. The conference considered a number of questions that are detailed in a related background document.

The key conclusions were:

• The agricultural research agenda of developing countries should be based on a "bottom-up" approach defined by the needs of domestic communities in those countries.
• Agricultural biotechnology research should complement research on conventional technologies. Participants agreed that it is important to allocate resources to non-GMO biotechnology research in developing countries, but opinions diverged about using scarce research resources for GMO research.
• Research collaborations, both within and between countries, are fundamental to science in developing countries, but public-private sector collaborations should be treated with caution to ensure that research geared to the needs of the poor is not ignored.

This paper was prepared as a background document for the conference organised by the UN Food and Agriculture Organization's Electronic Forum on Biotechnology in Food and Agriculture in 2002. The paper addresses the role and focus that biotechnology should have in agricultural research agendas in developing countries.

The paper outlines key trends in agricultural research and agricultural biotechnology research, and identifies the questions with most relevance to developing countries that were addressed in the forum.

In the light of the resource constraints that developing countries operate under, the paper highlights the following key issues facing policy makers in developing countries regarding agricultural biotechnology research:

• How much importance should developing countries give to biotechnology research?
• How should they allocate biotechnology research resources with respect to the different agricultural sectors or to the different kinds of biotechnologies available?
• How should they prioritise the different kinds of problems (and specifically those affecting poor farmers) that might be addressed by the research?
• How should developing countries carry out this research — by focusing on their national agricultural research systems (NARS), by collaborating with other countries in their region, or by working with the private sector or universities in the developed world?

These questions were dealt with in an electronic conference and in a related summary document — which provides a summary of key conclusions on the issues.

This 'sounding board' article in the New England Journal of Medicine is the most substantive of the three articles that stimulated international debate about the ethics of placebo-controlled trials in developing countries (the other two were editorials in the New England Journal of Medicine (see above) and The Lancet).

Lurie and Wolfe take the view that placebo-controlled trials of a less expensive course of antiretrovirals to prevent mother-to-child transmission of HIV were unethical and would lead to hundreds of preventable HIV infections in infants. They identify 18 placebo-controlled trials involving more than 17,000 women, of which two trials were conducted in the United States and the remainder in developing countries. All the participants in the US studies received some form of antiretroviral treatment. In contrast, some or all of the participants in 15 of the trials in developing countries (nine of which were funded by the US) were not provided with such treatment.
 
The authors list areas of agreement between the critics and supporters of such trials, and conclude that the sole point of disagreement is over what is the most appropriate standard of care to provide to the control group. They argue that given the current scientific evidence it would be possible to design shorter, more affordable antiretroviral treatment programmes without the need to conduct placebo-controlled trials.

In this article Mahomed A Dada and Ruweida Moorad discuss the first review undertaken of the research ethics committee at the Nelson R. Mandela School of Medicine in Kwa-Zulu Natal, South Africa. The review aimed to provide insight into the structure, composition, procedures and workload of the committee, and to assess its strengths and weaknesses.

The findings of the review included a need to review membership of the committee so that it better reflected the demography of the region, and included representation from faith-based organisations and consumer groups, as well as a member with expertise in statistics and epidemiology.

Other findings included difficulties related to ongoing monitoring of research, concerns about consent and conflicts of interest, long delays in the turnaround of protocols and the need for formal training of committee members.

The so-called 10/90 gap in health research — which refers to the fact that only about 10 per cent of funding is targeted to diseases which account for 90 per cent of the global disease burden — is a well recognised phenomenon which is being targeted by a number of initiatives. This article, by members of the Drugs for Neglected Diseases Working Group at Médicines Sans Frontières, analysed the outcomes of pharmaceutical research and development over the past 25 years and reviewed current public and private initiatives aimed at addressing the lack of research into controlling important infectious diseases in developing countries.

The authors found that of nearly 1400 new drugs marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis (all of which had been developed with public-sector involvement). There is a 13-fold greater chance of a drug being brought to market for central nervous system disorders or cancer than for a neglected disease.

The authors conclude that there is no indication that drug development for "non profitable" infectious diseases will significantly improve in the near future and that new strategies are required to stimulate such development. They argue that a sustainable solution will require the establishment of an international pharmaceutical policy for all neglected diseases. Private sector research obligations should be explored further, and public sector not-for-profit research capacity promoted, particularly for the most neglected diseases.

(Free registration with The Lancet is required to view this article.)