The Daily Impact: Action needed to save the 1 million babies annually

February 26, 2014

A report from Save the Children shows that some one million babies die on their first day of life, each year. The group says the majority of the deaths can be averted. From the Guardian:

Although great strides have been made in reducing the numbers of children dying under the age of five in the past decade – numbers have halved from 12 million to 6.6 million, there has not been enough progress in reducing the preventable deaths of newborn babies, says the charity.

Most of the deaths occur in developing countries. Some lives could be saved by simple interventions such as handwashing to prevent infections and “kangaroo care”, where mothers “incubate” their premature babies by keeping them warm through skin to skin contact.

The charity says there needs to be an increase in the number of women delivering with the help of a trained midwife or health worker, as 1.2 million deaths occur during labour. In cases of obstructed labour, mother and baby are likely to die without a caesarean section.

Save points to the global shortage of health workers who have the skills to help. It is estimated that 7.2 million more midwives, nurses and doctors are needed.

Every year, 46 million women give birth without the assistance of a professionally qualified person, says its report, Ending Newborn Deaths. In sub-Saharan Africa, half of all births are not attended by a midwife or other properly qualified health worker; in Ethiopia, that drops to just 10%. But there are stark inequalities within countries;- in the richest fifth of households in Ethiopia, there are health professionals at 46% of births, compared with 2% among the least well-off.Justin Forsyth, the chief executive of Save the Children, said: “The first day of a child’s life is the most dangerous and too many mothers give birth alone on the floor of their home or in the bush without any life-saving help. We hear horror stories of mothers walking for hours during labour to find trained help, all too often ending in tragedy.

“It’s criminal that many of these deaths could be averted simply if there was someone on hand to make sure the birth took place safely and who knew what to do in a crisis.”

In countries such as the Democratic Republic of the Congo and the Central African Republic, women have to pay for emergency care – usually a caesarean – and there have been reports of some women being detained at the hospital until their families find the money.

Save the Children says the Millennium Development Goal to reduce child deaths by two-thirds by 2015 will not be met unless childbirth is made safer. By 2025, the charity says, every birth should be attended by a trained and equipped health worker and user fees for all maternal, newborn and child health services should be removed.

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The Daily Impact: Outcry Follows Ugandan President Signing Anti-Gay Bill into Law

February 25, 2014

Ugandan President Museveni signed a piece of legislation that further punishes homosexuality in the country, on Monday. Activists campaigned the president to reject the bill, citing rights violations and public health concerns. From VOA:

Homosexuality is illegal in Uganda, but the new law imposes much harsher penalties, including 14-year prison terms for first-time offenders and life sentences for so-called “aggravated homosexuality.”

“Promotion” of homosexuality also has been criminalized, as well as failure to report a gay person to police.

Speaking Monday from the state house in Entebbe, Ugandan President Yoweri Museveni said he was signing the bill because the scientists he consulted had not found a gene for homosexuality.

“There are those who engage in homosexuality for mercenary reasons, especially here; the ones who are recruited mainly for poverty. And then there are those who become homosexual by both nature, some element of genetics, and nurture.”

The move comes despite years of intense pressure from Western countries and human rights groups not to sign the bill.

President Barack Obama has called the new law a “step backward” for Uganda, and said it would “complicate” relations between the two countries. At the moment the United States gives Uganda about $400 million annually in aid.

Gay and lesbian rights activist Kasha Nabagesera said Uganda’s homosexual community has been expecting this move for some time, and that they intend to challenge it in court.

“Right now we are just trying to remain calm, and then we will continue with our focus which is to challenge it in the constitutional court. We are just putting the final touches on our petition,” said Nabagesera.

The bill was passed by parliament in December without the necessary quorum, and many expect it to be ruled unconstitutional.

Nabagesera said the legal challenge will begin later this week.

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Reflections from Unclogging the Blockages: Day 2

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After a long day of presentations and discussions to better understand the current situation and learn from each other’s experience in markets for sanitation, the second day of PSI’s recent sanitation conference took on an entirely different mood: it’s time to think outside the box, be innovative and apply the lessons we’ve learned to addressing the key blockages.

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The Daily Impact: Health Workers Combat Drug-resistant Malaria, in Cambodia

February 24, 2014

An article in the South China Morning Post describes how groups are fighting on frontline of malaria drug resistance in western Cambodia.

In December 2008, researchers published a letter in the New England Journal of Medicine (NEJM) based on a study conducted on malaria patients in the west of Cambodia. The study showed evidence that malaria parasites in the area were developing resistance to artemisinin, which, when combined with other anti-malarial drugs, has formed one of the few effective treatments against Plasmodium falciparum.

While the news was a major setback in the fight against malaria, the source of this new threat wasn’t exactly a surprise; since the 1970s, western Cambodia’s Pailin province, a poor, agricultural area that is still recovering from decades of brutal Khmer Rouge rule, has held the ominous distinction of being ground zero for new drug-resistant malaria strains.

“In the past 50 years, this Thai-Cambodian border area has been the very birthplace of all drug resistance,” says Steven Bjorge, former team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia. “Every drug that has replaced previous drugs has become resistant first in this area before becoming resistant elsewhere.”

(snip)

In December 2008, researchers published a letter in the New England Journal of Medicine (NEJM) based on a study conducted on malaria patients in the west of Cambodia. The study showed evidence that malaria parasites in the area were developing resistance to artemisinin, which, when combined with other anti-malarial drugs, has formed one of the few effective treatments against Plasmodium falciparum.

While the news was a major setback in the fight against malaria, the source of this new threat wasn’t exactly a surprise; since the 1970s, western Cambodia’s Pailin province, a poor, agricultural area that is still recovering from decades of brutal Khmer Rouge rule, has held the ominous distinction of being ground zero for new drug-resistant malaria strains.

“In the past 50 years, this Thai-Cambodian border area has been the very birthplace of all drug resistance,” says Steven Bjorge, former team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia. “Every drug that has replaced previous drugs has become resistant first in this area before becoming resistant elsewhere.”

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Dr. Mitu Khurna’s story

(Image credit: Flickr user SalFalko by CC)

Editor’s note: Indrani Goradia, Founder of Indrani’s Light Foundation, just concluded a trip to India to visit PSI-India’s pilot projects to combat gender-based violence. These are her reflections (see part 1 and part 2)

I think most people would expect an educated woman in the country’s capital city to somehow be immune, or protected, to have the same basic rights of a modern woman.

In 2004, Mitu, a pediatrician, married an orthopedic surgeon. Shortly after her arranged marriage, her in-laws demanded a greater dowry from her parents – a new car, more jewelry and other possessions. Her parents could not give more, and as a result, Mitu suffered abuse at the hands of her mother-in-law – a practice all to common in India.

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The Daily Impact: Malaria Poses Risk to 184 Million in Africa

February 21, 2014

A new research paper shows that the number of people who are at moderate to high risk of malaria in Africa fell from 220 million in 2000 to 184 million today. From VOA:

The findings are based on thousands of community-based surveys in 44 African countries and territories. These are places where malaria has been endemic.

Dr. Abdisalan Noor, co-leader of the team that conducted the research, said, “What we are looking at, first of all, is to try and estimate the level of infection with malaria in African communities. This doesn’t necessarily mean the number of people who die of malaria, but the proportion of people who are likely to carry the most virulent type of the malaria parasite. That’s Plasmodium falciparum.”

Noor and co-leader Professor Robert Snow are with the Kenya Medical Research Institute-Wellcome Trust Research Program. The team also included researchers from Oxford University and the World Health Organization.

The study reflects the effects of the Roll Back Malaria campaign and other programs. The campaign brought together many multi-lateral, private and non-governmental organizations. The goal was to cut in half the number of deaths from malaria by 2010. It had a shaky start and was criticized in its early years for a lack of progress.

Dr. Noor said that the new study finds a mix of good and bad news about efforts to combat malaria.

“The positive news is there has been production in 40 of the 44 African countries for which we were able to estimate change. There has been some reduction in the proportion of people who are likely to be affected with the falciparum parasite. About 218-million people in 2010 lived in areas where transmission – malaria transmission – had dropped by at least one level of endemicity. So that’s good news.”

Endemicity is described as the measure of disease prevalence in a region.

“The other side of it.” said Noor, “is that despite all these gains almost 60 percent of African populations still live in areas where more than 10-percent of the population is likely to carry the malaria parasite. And out of these about 184-million people live in areas where more than 50-percent of the population are likely to carry malaria infections.”

Among the countries where disease transmission remained high or unchanged are DRC, Uganda, Malawi and South Sudan.

Despite the large number of people still likely to be infected, Noor says he does not want to detract from the gains made by the international community – namely, the reduction in risk for 34-million people from 2000 to 2010.

“We haven’t actually looked at the reasons why some places are more resilient to change than others. Epidemiologically, it’s got something to do with the higher the starting transmission, the longer it takes to bring down the disease,” he said.

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CVS takes a page from development playbook

CVS’s decision to quit marketing tobacco products is getting lots of well-deserved attention. And, I’d imagine competitors will follow suit. But its shift from drug store to health care provider is even more striking.

From marketing everything one might want or need (cigarettes, detergent, gum, prescriptions) towards marketing what one needs to want (prescriptions, wellness care, basic curative care… and sure, detergent too) will put CVS on the forefront of marketing for health and could possibly create a new model for health provision in the US.

In the non-profit world, it’s what we call “social” marketing — a practice that’s been around for decades but is getting renewed attention as a creative and cost-effective way to improve health around the world.

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#Unclogit Day 1: Understanding the Blockages

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With nearly 170 participants registered, 21 countries represented, countless organizations and specialties and the loud buzz of excited conversation, the first ever Unclogging the Blockages in Sanitation workshop in Kampala got off to a great start. Day 1′s goal was to Understand the Blockages: an entire day dedicated to informing participants of the challenges faced within the sanitation sector.

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The Daily Impact: Vaccine Storage Breakthrough in Benin

February 20, 2014

The need for cold storage of vaccines has presented challenges in transporting to remote parts of the world. A new form of the meningitis A successfully withstood the heat of Benin. VOA with the exciting news:

Researchers said that health workers in Benin have successfully immunized more than 155,000 people against meningitis A using the first vaccination to be approved for use without constant refrigeration, also known as the “cold chain.”

The World Health Organization (WHO) said the vaccine, which is known as MenAfriVac, can be stored for up to four days in temperatures up to 40 degrees Celsius.

PATH is a U.S.-based non-profit organization that partnered with the WHO on the Meningitis Vaccine Project.  Dr. Marie-Pierre Preziosi, the project’s director, said the new breakthrough could revolutionize the way vaccination campaigns are conducted in developing countries.  She spoke to VOA from Ouagadougou.

“As you know, vaccines are usually kept in cold chains, between 2 to 8 degrees Celsius.  And so you have to have the whole capacity around the cold chain: that is freezers, ice packs, transportation fuel, electricity fuel, all of this.  Sometimes, it is not only costly, but it is also very challenging to reach remote areas with such constraints,” said Preziosi.

Health experts said that because of the cold chain requirement, there is normally a lot of wasted vaccine vials during immunization campaigns, particularly during the “last mile” — the time from when the vaccine leaves the refrigerator at the district health center until it is injected into a person’s arm at the village level.

Many communities in Africa have no access to electricity and are often too remote to be reached before the ice packs in insulated coolers melt.

Preziosi said the flexibility of being able to transport the vaccine outside of the cold chain meant that only nine vaccine vials out of 15,000 had to be discarded during the trial study in Benin.

Being able to work outside the cold chain also meant that health workers didn’t have to travel to and from the district health center each day to replenish vaccine supplies.  This allowed them to vaccinate more people in a shorter amount of time.

PATH’s vice president for product development, Dr. David Kaslow, said that removing the refrigeration requirement for MenAfriVac could also reduce costs.

“The one study that was done with the WHO looked at the modeled scenario, which is: what are all the costs that are incurred in that last mile?  And really, one of the major costs, obviously, are the cold chain costs themselves… And so the analysis was done as to what is the cost savings.  And it’s about 50 percent,” he noted. “On average, from 24 cents per dose delivered to 12 cents per dose delivered.”

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