The Daily Impact: Funding cuts threaten progress against TB in New York City

June 2, 2014

Two decades after health care workers turned the tide on tuberculosis in New York City, no one in the few remaining TB clinics can celebrate its demise. Al Jazeera reports that things could get worse if funding starts to decline. An excerpt:

For the first time in a decade, the number of confirmed cases in the city has gone up, according to the New York City Health Department’s 2013 report, and the once declining rate of active infection has slowed to a constant. Even if the current infection numbers remain low, budget cuts could result in the city being ill prepared for any future outbreaks. New York’s last wave of TB, in the 1980s and 1990s, killed thousands of people.

Facing funding cuts, some clinics have closed, and at least one has started charging for TB screenings. With TB most common among the homeless, immigrants arriving with little money and the immune-compromised, the $30 that is sometimes needed to be tested is often hard to come by.

At the African Services Committee (ASC) clinic in Harlem, workers at times waive the fee for patients at risk of TB, such as Ibrahim, a man in his late 20s, who asked that his real name not be used. After he arrived in New York from Burkina Faso two years ago, it was determined that he was a potential candidate for TB. With no health care, his case might have gone undetected if he’d had to pay the full price.

Lillian Agyei, testing coordinator at ASC, said that since the clinic started charging most patients, the number of visits had dropped dramatically. In 2009, about 4,500 people were tested for tuberculosis. Last year, only 534 clients sought the service, according to internal statistics. Agyei said these were mostly people who needed the test for administrative reasons related to employment or study, not individuals who found themselves at risk of infection.

The ASC director, Kim Nichols, said the dramatic fall in people being tested could hamper efforts to battle the disease. “There will be those few cases that we would have treated or screened in previous years who will not be picked up on until they have active TB, or have already infected other people in their households,” she said. “You lose the opportunity to intervene before a person develops active symptoms.”

Nichols said the drop in screenings at ASC is the result of municipal and federal budget cuts, which have been enforced despite confirmed cases in the New York area rising from 651 in 2012 to 656 in 2013, according to the latest figures.

“You hope it’s not a trend,” Lee Reichman, executive director of the New Jersey Medical School Global Tuberculosis Institute and former New York City health director, told Al Jazeera.

Reichman oversaw the city’s response to the TB outbreak of the late 1980s and 1990s, in which more than 12,000 people died. At the time, authorities scrambled to spend $1 billion to quell the epidemic. Now, he said, the numbers are still in their “early stages.”

“If we don’t do something about it, [this] may increase more. It may actually affect the rate. It’s a warning sign,” he said.

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The Daily Impact: African Union launches campaign to end child marriage

May 30, 2014

The UN celebrated the first-ever campaign by the African Union to put an end to child marriage. From UNICEF:

“Before we heard concerned individuals from Africa raising their voices. What we are seeing today is an Africa-wide movement of leaders and organizations collectively saying ‘No to Child Marriage,’” said Martin Mogwanja, Deputy Executive Director of UNICEF, speaking from Addis Ababa.  “This push led by Africans for Africans must not stop until every girl in every family and every community has the right to reach her 18th birthday before getting married.”

Although civil society actors have been pressing hard on the issue of child marriage for several years, it is the first time that such a large range of government officials, organizations, United Nations agencies and individuals, including youth and children, vow to collectively end a practice that cuts short the childhood of over 17 million girls – 1 in 3 – across the continent.

“Data makes it clear that child marriage is first and foremost a grave threat to young girls’ lives, health and future prospects and a breach of girls’ fundamental human rights”, said Dr. Julitta Onabanjo, UNFPA Regional Director for East and Southern Africa region. “The costs of inaction, in terms of rights unrealized, foreshortened personal potential and lost development opportunities, far outweigh the costs of interventions. Together we can end child marriage, it is happening in Ethiopia, in Malawi, in Niger and in so many other countries.”

The campaign is set to run for an initial period of two years with national launches anticipated in 10 countries. Additional countries are also poised to join the movement. Policymaking and grassroots efforts aim to enhance awareness across the continent of the impact of marriage on children and their societies. As girl brides often come from the most marginalized families in African societies, it will require strong and sustained political commitment to adopt appropriate legal, institutional, social and economic measures to keep them away from child marriage.

Globally, 9 out of the 10 countries with the highest rates of child marriage are found in Africa –namely Niger (75 per cent), Chad and Central African Republic (68 per cent), Guinea (63 per cent), Mozambique (56 per cent), Mali (55 per cent), Burkina Faso and South Sudan (52 per cent), and Malawi (50 per cent).

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The Daily Impact: UN targets end of open defecation by 2025

May 28, 2014

The practice of open defecation must be totally eliminated by 2025, announced the UN. IPS reports:

Barbara Frost, chief executive at the London-based WaterAid, told IPS South Asia still has the most people without basic sanitation, more than one billion in 2012, although sub-Saharan Africa also has a large number, just fewer than 644 million.

“The situation by sheer numbers is most difficult in India where there are nearly 800 million people without basic sanitation, and 600 million of those are still practising open defecation,” she said.

In sub-Saharan Africa, Nigeria is bucking the trend and has seen large increases in open defecation between 2000 and 2012.

“Many African nations are seeing the number of people without basic sanitation drop, but in Nigeria this is increasing,” Frost said.

Chris Williams, executive director at the Geneva-based Water Supply and Sanitation Collaborative Council (WSSCC), told IPS open defecation is a serious health risk in the world’s poorer countries, spreading disease, effecting economic productivity and claiming lives unnecessarily.

“People who do not have access to a hygienic toilet and a place to wash their hands are exposed to an array of faecally transmissible and potentially deadly diseases that with improved sanitation are easily preventable,” he said.

“That is why we have to make equitable access to improved sanitation a key priority in the post-2015 development agenda,” Williams added.

He also said sanitation and hygiene are motors which drive health, and social and economic development around the world.

“An environment that lacks sanitation and clean water is an environment where achieving other development goals is an impossible dream,” declared Williams.

Mark Neo, deputy permanent representative of Singapore, a country that spearheaded the move to declare Nov. 19 ‘World Toilet Day’ at the United Nations, told IPS the lack of basic sanitation profoundly impacts key constituencies like women and girls.

For example, without proper toilet facilities, women and girls constantly risk rape and sexual assault while defecating in the open, and pubescent girls drop out of school because of the lack of privacy, he said.

Accordingly, for its commemoration of World Toilet Day this year, Singapore is planning an event focusing on the unique and particular challenges of open defecation for women and girls.

“There are taboos within taboos, so we want to focus on the unique vulnerabilities of women without access to basic sanitation and toilets,” he added.

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The Daily Impact: Aid needed in Somalia to prevent 200,000 children from starving to death

May 28, 2014

UNICEF warned that 200,000 children may die of starvation this year in war-ravaged Somalia if it does not raise enough funds to provide vital aid. From the AP:

“If funding is not received immediately, UNICEF will have to suspend essential life-saving health services within one month,” spokesman Christophe Boulierac said.

UNICEF, which has been providing 70 percent of all health services in Somalia, has so far received just 10 percent of the $150 million it needs for its activities in the country this year, he said.

The lack of funding is dramatic, amid warnings that the troubled country, which was hit by an extreme famine less than three years ago, could be sliding back into a food crisis.

Some 50,000 children under the age of five are already suffering from severe malnourishment and UNICEF warned that could balloon to 200,000 without aid from the UN agency.

Somalia was the hardest hit by extreme drought in 2011 that affected over 13 million people across the Horn of Africa, with famine zones declared in large parts of the war-ravaged south.

Some 250,000 people, around half of them young children, died in Somalia during that famine, according to the UN, which has warned that poor rains and conflict could be paving the way for a new food emergency.

“Today we have an early warning, with the ingredients of a perfect storm for a humanitarian crisis,” Andrew Lanyon, head of the Somalia Resilience Programme, a coalition of aid agencies, said earlier this month.

Life-saving health care services, such as treatment for diarrhoea or pneumonia and antibiotics, currently given to 620,000 Somali children would also be suspended without more funds, Boulierac said.

Around 280,000 pregnant women would also lose access to antenatal check-ups, Boulierac told reporters in Geneva.

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Building the evidence base for preventing HIV among key populations

An HIV rapid testing kit. (Credit: John Rae/PSI)

Evidence of effective HIV prevention for key populations is an urgent need. Too often these programs remain small-scale pilots and never reach intended scale, while evaluations are sparse because target populations are hard to reach. PSI network members and their partners are looking to change that.

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The Daily Impact: HIV experts divided over Option B+ roll out plan in Kenya

May 27, 2014

HIV experts are divided on whether to roll out Option B+ nationwide or just to pilot it in high volume facilities such as major referral hospitals. From IPS:

In the earlier Options A and B, mother and baby were given antiretrovirals (ARVs) during pregnancy and breastfeeding; only women with CD4 counts under 350 were prescribed ARVs for life. CD4s, or helper cells, fight infections in the body.

Option B+ consists of lifelong provision of ARV therapy to pregnant women, regardless of their CD4 count.

Dr John Ong’ech, assistant director at Kenyatta National Hospital, told IPS that when discussion begun in 2013 on whether to start option B+ in Kenya, “at the national policy level, people were divided on whether to roll out Option B+ fully.”

Currently, Option B+ is only available in the two major referral hospitals, Kenyatta National Hospital (KNH) in Nairobi province, the Moi Referral Hospital in the Rift Valley province, and in a few mission and district hospitals.

“There are those who felt that we need to first fix systems in the health sector,” said Ong’ech.

“To begin patients on Option B+, you need clinicians because there are things to be considered, such as drug toxicity, at the treatment entry point, after which nurses can manage,” he added.

In 2013, nearly 20,000 HIV positive pregnant women were given Option B+ lifelong ARV therapy.  Another 55,860 should be enrolled to achieve 100 percent coverage, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Maurice Okoth, a clinician at a prevention of mother-to-child transmission (PMTCT) centre in Nyanza province, told IPS that Option B+ is not just a matter of ensuring drug availability.

“Clinic records must be organised, they must show if patients are defaulting and how these defaulters can be tracked. This is nearly impossible at the moment due to understaffing. We are facing a human resource crisis in the health sector,” he said

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The Daily Impact: US launches multi-sectoral nutrition strategy

May 23, 2014

USAID and National Security Advisor Susan Rice launched a new initiative to reduce by 2 million over five years the number of chronically malnourished and “stunted” children worldwide and also to keep acute malnutrition below 15 percent in places experiencing humanitarian crisis. From Devex:

The new strategy will focus on “the 1,000 days from pregnancy to a child’s second birthday” and seek to integrate that focus into USAID’s largest programming streams — health, agriculture and humanitarian assistance — according to an agency release. Adequate nutrition during that 1,000-day time period is critical to a child’s development, and under-nutrition for mothers and children during that time can cause stunting, which has been linked to cognitive impairment and poor health outcomes.

“Nothing demands more of our attention than ending preventable child and maternal death. The health of our mothers and children is the anchor of global prosperity, and that is why USAID is focusing on new, innovative ways to reduce severe malnutrition, which causes half of all child deaths worldwide,” said Rajiv Shah, the USAID administrator.

The announcement took place at the Chicago Council’s Global Food Security Symposium in Washington, where most of the attention focused on the threat posed by climate change to food security and the international community’s lack of preparation for food-related climate change impacts.

Several U.S. officials already championed the new “360-degree approach” to nutrition in the weeks leading up to its unveiling. In her March testimony before a House subcommittee, USAID Acting Assistant to the Administrator Tjada McKenna told Congress, “USAID will address nutrition with more discipline than ever before, developing country nutrition frameworks … setting country-specific targets, and tracking and reporting on nutrition progress.”

McKenna hinted, “The USAID strategy is informing a broader U.S. government-wide nutrition coordination plan, which is currently being developed. For the first time, the U.S. Nutrition Coordination Plan will bring together all the U.S. government agencies working in global nutrition with the purpose of maximizing impact through better coordination of U.S. government global nutrition investments.”

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The Daily Impact: Melinda Gates applies pressure on world leaders for newborn health investments

May 22, 2014

Melinda Gates told world leaders gathered at the World Health Assembly that more needs to be done to prevent newborn deaths. The Canadian Press reports:

Gates issued an international call for more funding as she helped launch new research in the medical journal The Lancet on the plight of new mothers, babies and young children in developing countries.

The frank talk from Gates means there will be more pressure on Prime Minister Stephen Harper to make further spending commitments as he hosts a major international meeting next week on his signature aid initiative — maternal, newborn and child health.

Harper committed $2.8 billion to cause at the G8 summit Canada hosted in 2010, and is chairing a three-day international meeting in Toronto May 28-30 as a follow-up to raise awareness.

Each year 2.9 million newborn babies die around the world, while another 2.6 million are stillborn, the Lancet study concluded.

That’s half as many as in 1990, but the mortality rate is still too high, according to the 55 experts from 18 countries that contributed to Tuesday’s report.

“While the statistics about newborn babies are dire, they point to opportunity for improvement. Many newborn deaths could have been prevented with existing interventions,” Gates writes in a piece co-authored with Rwanda’s health minister, Agnes Binaghawo.

“These babies are dying not because we lack the knowledge to save them; they are dying for a lack of attention and investment.”

Gates is the co-chair of the foundation named after her and her husband, Bill. Their foundation joined six countries in contributing to Harper’s initiative in 2010.

Gates and Binaghawo argue that more money should be spent because “the evidence shows that a few inexpensive, proven interventions can go a long way.”

That includes better care for pregnant women and newborns at the time of birth and modest improvements in the care of sick newborns.

The Lancet study estimates that by 2020 it would cost about 91 cents per person to lower the annual death rate of newborns by 1.3 million, while reducing stillbirths by 530,000 each year.

“More funding is essential for change to take place in countries,” the study says.

Dr. Mickey Chopra, the chief of health for the UN Children’s Fund (UNICEF), said funding has been steadily increasing, but more money is needed.

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The Daily Impact: CIA Pledges to No Longer use Vaccine Campaigns to Collect Intelligence

May 21, 2014

The US will no longer use fake vaccine campaigns for its intelligence, like was done to try to catch Osama Bin Ladden in Pakistan. From the New York Times:

In a letter to leaders at a dozen schools of public health, President Obama’s senior counterterrorism adviser said the C.I.A. had banned the practice of making “operational use” of vaccination programs, adding that the agency would not seek to “obtain or exploit DNA or other genetic material acquired through such programs.”

 The letter from the adviser, Lisa O. Monaco, comes more than a year after public health officials wrote to Mr. Obama expressing anger that the United States had used immunization programs as a front for espionage. The educators were protesting the C.I.A.’s employment of a Pakistani doctor, Shakil Afridi, to set up a hepatitis B vaccination program in Abbottabad to gain access to a compound where Bin Laden was believed to be hiding.

 “While political and security agendas may by necessity induce collateral damage, we as a society set boundaries on these damages, and we believe this sham vaccination campaign exceeded those damages,” the educators’ letter said.

 The intelligence operation failed to determine whether Bin Laden was in the compound. The Qaeda leader was killed shortly afterward, in May 2011, in a nighttime raid carried out by Navy SEALs. Dr. Afridi was arrested days after the raid and remains in jail in Pakistan.

 While in custody, Dr. Afridi told interrogators that he was introduced to C.I.A. officers in Pakistan by an employee of Save the Children. Both the C.I.A. and Save the Children have denied the aid group was used for spying, but the revelation led it to close its operations in Pakistan.

 Since the C.I.A.’s vaccination program became public, dozens of public health workers in Pakistan have been killed, with militant groups sometimes announcing that the workers had been suspected of being spies.

John O. Brennan, the agency’s director, put the new policy into effect last August, an agency spokesman said. “By publicizing this policy,” said Ned Price, the spokesman, “our objective is to dispel one canard that militant groups have used as justification for cowardly attacks against vaccination providers.”

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