February 1, 2013

Ethiopia’s poor health systems are holding back further progress against maternal mortality. IRIN reports:

“There have been interventions, but the impact these have made has not been as significant. The health system is still very weak,” Luwei Pearson, chief of the health section at the UN Children Fund (UNICEF) in Ethiopia, told IRIN.

“There must be efforts to ensure that health facilities are not just available but that they are also functional by, for instance, fitting them with electricity and piped water.”

According to a 2010 report, Ethiopia is one of five countries that together account for 50 percent of the world’s maternal deaths. In 2011, the country recorded 676 maternal deaths for every 100,000 live births, up from 673 in 2005. Ethiopia intends to bring this down to 267 by 2015.

The number of expectant mothers who delivered with the help of a skilled provider rose from 6 percent in 2005 to 10 percent in 2011, according to the 2011 Ethiopia Demographic and Health Survey (EDHS).

Curbing maternal death

Studies show that abortion complications, ruptured uterus, puerperal sepsis, postpartum haemorrhage and preeclampsia/eclampsia were the five major causes of maternal mortality in Ethiopia.

The government says it has established measures to curb maternal deaths, such as the use of a scorecard to measure the effectiveness of the health system for mothers and children.

“The scorecard is a very powerful tool… You can really track at facility, community, region and national levels. So it will also give you the opportunity to make sure that you have an equitable health service delivery system across the country and to try to address the disparities we have in different parts of the country,” Kesetebirhan Admassu, the health minister, said.

Ethiopia’s health extension programme, through which the government has trained some 30,000 lay extension health workers, is also expected to improving women’s access to skilled attendants during delivery.

So far, however, just 1 percent of expectant mothers deliver with the assistance of a health extension worker, according to the 2011 EDHS, largely because there are so few of them. According to the Ministry of Health, these workers each serve an estimated 2,500 people.

January 31, 2013

Health authorities in Malawi are taking efforts to prevent the outbreak of cholera during this year’s rainy season. From VOA:

Henry Chimbali, the spokesperson for the ministry, says “The first thing is to provide [free] safe and treated water to people so they can use it in their homes by distributing chlorine and also promoting [a sodium hypochlorite solution called] Water Guard especially in areas where access to safe water is limited.”

Chimbali says the ministry has intensified community education on the construction and utilization of toilets to avoid the unsafe disposal of human waste which may help spread cholera-causing germs.

He says the country is likely to win the battle based on records showing no districts in the northern and southern regions have had any cholera in the past years.

Harold Kabuluzi, a spokesperson for Dedza District Hospital in Malawi’s central region, ““We do intensify health education all over the districts, and we distribute cholera materials in time like chlorine and other things to all the people [in the district]”.

Chimbali says to win the fight at the national level the government is working with various partners including international NGOs and the media.

“Fearing there could be some shortfalls in medical supplies, ” he explained, “we have different partners including UNICEF have  shops that are supported by USAID.  They have been in forefront in the provision of some cholera supplies. The media must be oriented so that they understand what cholera is all about. [Next, they must educate the public about how to prevent the disease.]”

A police officer protecting polio vaccine workers in northwestern Pakistan was shot dead on Tuesday. From the AP:

The attack took place as dozens of polio workers — including several women — were going door to door to vaccinate children in Gullu Dheri village of Swabi district in Khyber Pakhtunkhwa province, said senior police officer Izhar Shah. None of the polio workers the police officer was protecting were hurt in the attack, he said.

“The polio workers were terrified and immediately went back to their homes after the attack,” Shah told The Associated Press. “The anti-polio drive in that village has been suspended.”

Some Islamic militants oppose the vaccination campaign, accuse health workers of acting as spies for the U.S. and claim the polio vaccine is intended to make Muslim children sterile. Pakistan is one of the few remaining places where polio is still rampant.

In a separate incident in the northwest, a man wounded a polio worker with an axe.

The attacks occurred on the second day of a three-day campaign against polio that was launched by the provincial government. No one claimed responsibility for the shooting in Gullu Dheri, but suspicion fell on militants.

(snip)

The latest campaign in Khyber Pakhtunkhwa was launched Monday to give oral drops to children who had missed it the first time around.

Pakistan is one of only three countries where the crippling disease is endemic. The virus usually infects children living in unsanitary conditions. It attacks the nerves and can kill or paralyze. As many as 56 polio cases were reported in Pakistan during 2012, down from 190 the previous year, according to the United Nations.

Most of the new cases in Pakistan were in the northwest, where the presence of militants makes it difficult to reach children for vaccination.

Pakistan is also struggling to maintain control of its southern province of Baluchistan.

On Tuesday, gunmen driving in a car opened fire on two police constables who were patrolling on motorcycle in a neighborhood of the provincial capital, Quetta, said Nadir Khan, a local police chief. Both the police officers were killed, he said.

There was no immediate claim of responsibility, but similar attacks against security forces are believed to be the work of Baluch nationalists who have been pushing for a greater say in use of the province’s resources.

January 29, 2013

New research indicates that the spread of dengue is influenced by social visits which means that more needs to be done beyond vector control in response to an outbreak. SciDev.Net reports:

The main tools to combat the dengue virus target its mosquito vector, but these are often only partially effective, according to the study.

Insecticide spraying campaigns are focused on households and are guided by the observation that Aedes aegypti mosquitoes — the disease’s main vector — travel less than 100 metres from the homes that they live in and around.

“When a case of dengue pops up, we draw a circle around this home — usually 100 to 400 metres [across] — and focus insecticides there,” says Steven Stoddard, the lead author of the research and a medical entomologist at the University of California, Davis.

But the new study suggests that spraying may be insufficient as, through coming into contact with infected mosquitoes, people can spread the disease outside insecticide-sprayed areas.

By tracking people’s movements and dengue transmission in two neighborhoods in Iquitos, Peru, the researchers found that infection risk and transmission rates are substantially elevated among households visited by people infected with dengue.

On average, each infected person would spread the fever to three houses, two of which would be outside the usual insecticide application area of 100 metres, the study says.

This means that “conventional control misses important foci of transmission, resulting in ineffective allocation of resources to locations where risk is low”, it says.

“Our data suggest that the circle [of insecticide spraying] probably should be smaller and that every case should have three or four circles associated with it, drawn around all the houses identified [as being part of that person's social network],” Stoddard says.

Ricardo Gürtler, an Argentine epidemiologist at the University of Buenos Aires, says the study is “unprecedented in several respects”, such as its focus on how human movement helps the disease to spread.

“The study brings up a new perspective based on social networks, rather than on geographic distance per se,” he says. “It may have important implications for dengue control in non-endemic cities where transmission depends on the introduction of the virus via travelers to endemic areas.”