RotaFlash, June 2013
Three recent scientific studies from the U.S. Centers for Disease Control and Prevention...
Back in 2007, I read a job description that included a word in the title I had never heard of. The word was “rotavirus,” and the job was for a global health organization named PATH. In my homework leading up to my interview, I learned that rotavirus was a severe form of diarrhea (which, honestly, I found a little icky), mostly affecting children in the poorest countries in the world. At the interview, I learned that PATH was interested in developing a strategy to bring public attention to diarrhea. When I told my husband I was interested in taking the job, his reaction was a raised eyebrow and a response something like, “Diarrhea, huh? Ok, just don’t bring your work home with you.”
And so in early 2008, my adventures in diarrhea began. (I know, I know.) During that year, we conducted a survey of global donors and policymakers to find out how important the issue was within the universe of global health issues. We knew that diarrhea didn’t top the list, but what we found out surprised us. Interviewees in that study perceived diarrhea as being the least important priority among the international health community, when compared to seven other health issues. And in fact, a bit more research showed that diarrhea was rarely mentioned in the media or by spokespeople in the field. Donor funding for the issue was miniscule, and often those peanuts were hidden within much larger – and more visible – programs. Advocacy efforts were few and far between, and child health and water and sanitation groups shared few coordinating mechanisms. And as the same report confirmed, governments in countries weren’t motivated to request funding from global donors because they saw donor priorities as driving the conversation. That held true even in the places where diarrhea was killing more children than anything else.
Fast forward four years. It’s March 2012 now, and so much has happened in such a short time. For me personally, diarrhea is no longer an icky word; it’s now a reason to get out of bed in the morning (and not just to run to the toilet). While I’ll be leaving PATH in two weeks to travel the world and summon a new chapter in my life, it will be with the wisdom, joy and insights that my colleagues and our partners have shared with me over our day-to-day work together.
But much more importantly, I leave this job confident that the landscape today for the issue of diarrhea has changed significantly over the last four years. Because of the commitment of many organizations and leaders, diarrhea is no longer residing at rock bottom of the health priority list. Today GAVI is supporting introduction of rotavirus vaccines in Africa. The Bill and Melinda Gates Foundation’s leadership on vaccines, sanitation and treatment like ORS and zinc is proving to be a catalyst for interest and funding. A Global Sanitation Fund now exists for countries with low sanitation coverage, and USAID has prioritized an integrated approach to diarrhea as a major child health issue for future programming and funding.
Advocacy efforts by collaborations like the Health/WASH Network has increased. Our flagship website, defeatDD, and its related social media outlets on Facebook and Twitter, have seen dramatic increases in popularity, as have our efforts to spur dialogue around a tough-to-talk-about issue through activities like our Poo Haiku contest. Campaigns by many partner organizations, including Save the Children, World Vision, WaterAid and PSI have also highlighted the importance of funding for diarrhea control interventions, bringing much needed momentum and public awareness.
Most exciting, in the last four years, countries such as Kenya, Cambodia and Vietnam have developed new national policies and strategies to tackle diarrhea. Malawi has worked to begin the policy dialogue about how better to prioritize the issue at the national level. And as a forthcoming report by PATH and UK-based partner Tearfund shows, other high disease burden countries like Mali and Ethiopia are exploring models of addressing diarrhea that encourage collaboration across sectors and prioritize community-led strategies.
Of course, this is just the beginning. We need more interest, more funding, more coordination for diarrhea – on a level that mirrors the toll that diarrhea still takes on children across the world. Most important, that money and awareness needs to make it to the communities, the clinics, the suppliers, and the caregivers who need it most.
For my part, I will watch with interest as diarrhea continues to gain attention and visibility. And no matter where in the world I find myself, I will continue to do my small part – as my colleague would say – to put diarrhea on everyone’s lips. (I know, I know.)
-- Janie Hayes is a communications officer at PATHRead more
As India announced in January 2012 that it has been polio free for a year, the bigger story that missed the headlines may have been the fact that the Indian States of Uttar Pradesh and Bihar – which have long been the endemic states - have remained virus free for even longer. Uttar Pradesh has been free of the deadly P1 virus for the past 25 months and from the P3 virus for the past 22 months, while Bihar has been free from the polio virus for 16 months.
Between 2007- 2008, the credibility of India’s polio campaign was at stake as a result of continued transmission of the polio virus in the high-risk endemic areas of Uttar Pradesh and Bihar. The persistence of polio was despite high coverage of children in the age group of zero to five, with multiple OPV doses. At around this time, along with the sustained efforts towards complete coverage during the campaigns month after month in the endemic states, polio experts identified the vital link between the efficacy of the oral polio vaccine (OPV) and an infant with chronic diarrhea.
Detailed studies were repeatedly pointing out that diarrhea was not only facilitating the transmission of the polio virus, but severely compromising the efficacy of the OPV. Diarrhea was rampant due to biological and ecological factors such as high population density, poor sanitation and hygiene conditions, unavailability of safe drinking water, and poor nutrition. The direct relationship between diarrhea and the efficacy of polio vaccine was, thus, crystal clear. Kids suffering from diarrhea excreted the intake of polio vaccine dose even before it could build immunity in their bodies. Health officials worried that the higher the number of diarrhea cases among children, the greater would be the inefficacy of OPV and more number of polio cases.
This led the State Governments in both Uttar Pradesh and Bihar, to recommend the use of zinc tablet and oral rehydration salt solution (ORS) during diarrhea. This was seen as a successful two-pronged approach to reduce the duration and severity of the episode and the risk of subsequent diarrhea in children, with the hope that the reduction in the number of diarrhea cases would ensure better efficacy of the oral polio vaccine and hence, would lower down the number of polio cases significantly.
As India holds its breath with this sterling achievement – breaking the transmission of the polio virus – efforts towards addressing the causes of chronic diarrhea is logically the next step. The sophistication of the polio program in India and the dedication of the frontline workers actually have their next task laid right out for them. Polio is spread through the oral-fecal route, just the same as severe bouts of diarrhea.
-- Sushmita Malaviya is Communications Officer in Delhi for PATH’s Vaccine Development Program. She previously served as the media consultant to the strategic communications and advocacy team in UNICEF’s polio unit in India.Read more
I have traveled to Africa three times in the past six years. Prior to 2006, I pictured myself in the advertising business, living in a sweet apartment in Manhattan, and, making money. Then my 2-year relationship ended and I wanted to go somewhere. I chose South Africa.
After completing an intensive course on the history of South Africa, I was accepted into a summer abroad program through my university. During those six weeks my group learned about current life in the country, experienced remnants of the recently broken apartheid, and tagged along with Umthombo, an organization devoted to assisting and being the voice of South African street children. I returned from this experience and knew the advertising field no longer appealed to me; I wanted to learn more about Africa and making a difference in the lives of these children.
In February 2008, I boarded a plane to Ghana where I would spend the next 6 months teaching at an orphanage. I grew very close with my host family and the children in the orphanage. Never possessing a previous interest in teaching, all in all, I think I did all right. Teaching 4th grade English and Math did not satisfy my original plan to work in a health clinic, however. Somewhere in month three I decided to teach sex education to the 7 teenagers in the vocational school.
After seeking the appropriate approval from the headmaster I began a course focusing on everything from puberty and menstruation to HIV. What struck me first was the lack of general understanding and connection to why occurrences such as menstruation and other physical changes during adolescence happen. For instance, all teenage girls know bleeding occurs once a month and are taught by elder females how keep clean and perform daily routine as usual. However, they never knew to link menstruation with pregnancy and ovulation. My students were very interested in learning about puberty and how the body changes during this time in their lives. I remember thinking Sex Ed was humorous in high school, but being on the teaching side made me realize how important this information is to a growing adolescent.
Access to basic healthcare information was one of many in which I found myself in experiencing what we take for granted in the US. Another obvious difference, and something I will never forget, is sanitation in Ghana. I was fortunate in that I had a flushing toilet (although I had to manually add water to the tank each time I flushed) and running water for a shower most of the time. This was only for volunteers and my host parents, however. Everyone else at the complex took bucket showers. Even this was somewhat luxurious as opposed to other areas because our living complex had a water well. Washing hands was another matter. If washing was available after finishing their bathroom business, it was rare soap was also available. Also, public toilets cost money. Even a fee as small as 10 to 20 peshwas was a deterrent to many and often resulted in public urination.
My passion for global development and for progress in developing countries only enhanced when I returned to Seattle. I was hired at PATH in 2010 as a program assistant in the vaccine access and delivery program. During this time I came to learn more about diarrheal disease and discovered Ghana was one of several countries (many in Africa) where babies are dying from rotavirus, the most common cause of severe diarrhea in young children worldwide. When I thought back on my 6 months not just in the community where I lived and taught, but when I traveled around majority of the country, diarrhea did not seem to be a cause for concern. Malaria billboards were everywhere, as were condom ads and death tolls due to motor vehicle accidents, but infant mortality from diarrhea was not apparent. As time went by, I began asking more questions about rotavirus and how I spent 6 months in the country and never once heard of diarrhea being a “killer.” I began to realize malaria, cholera, and a vast variety of other illnesses were being named the culprit. Education and awareness is a huge issue.
I returned to Ghana in May 2011 and was thrilled to spend time with my students, most of whom were still living at the orphanage. German volunteers had made great strides with the facility as there were now full washrooms with constant running water for showers, toilets, and sinks. I learned that one child, the third daughter of my host mother, died in infancy. I asked my host family if they knew the cause, and they said no but mumbled something about the skin on her face being an odd color. I asked if diarrhea was a symptom and it almost seemed as though this was not appropriate for discussion. I would explain rotavirus, or even severe diarrhea, to the best of my ability but I do not think this was understood. If signs proclaiming “beware of mosquitoes” and bed nets are seen around the country and most people have a vague understanding of malaria symptoms, further education on diarrheal disease and treatment seems possible. Acceptance and comprehension is a process, of course, but stressing awareness and education to both African communities and those with the tools to make a difference (US!) is one powerful step.
-- Erin Williams, Program Assistant, Vaccine Access and Delivery at PATHRead more
The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday represent a critical but short window of time to ensure a child’s future health and prosperity. Children who are well-nourished during this critical window reap a lifetime of benefits for themselves and their communities. The nutrition that a mother and her baby receive during these 1,000 days has a profound impact on a child’s ability to grow, learn and rise out of poverty.
The tragic reality, however, is that millions of children do not receive the nutrition they need to achieve their full potential. The damage to babies’ brains and bodies caused by poor nutrition during this 1,000 day window can be irreversible. Poor nutrition early in life can make a person more susceptible to disease. It can also impair cognitive development which may lead to lower educational performance and in turn, reduce an individual’s earning potential by more than 10 percent over his or her lifetime. Worse yet, over 3.5 million children do not receive the nutrition they need to see their 5th birthday.
The good news is that malnutrition is completely preventable thanks to a set of proven, simple and cost-effective solutions. They include:
-- Supporting good nutritional and baby-friendly practices, such as breastfeeding
-- Increasing the intake of vitamins and minerals for both mom and baby
-- Promoting therapeutic feeding for malnourished children with special foods
It is estimated that implementing these solutions at scale could save the lives of 1 million children per year. But we know we can’t do it alone. The effects of poor nutrition can be further compounded by infectious diseases that are all too often a result of unsafe water, a lack of proper sanitation or poor hygiene. Diarrheal diseases can complicate malnutrition and turn a healthy child into a malnourished one. This is especially dangerous in infancy and early childhood.
Addressing malnutrition requires action and investment from all sectors – including from partners working to improve access to water, sanitation, and hygiene. It’s why the 1,000 Days Partnership works to bring together a variety of actors from the global health and development communities. Together, we can work to ensure that every child has the best shot at a healthy start to life.
-- Yesenia Garcia, Communications Coordinator, 1,000 Days Partnership
For more information:
-- How can breastfeeding save a child's life?
-- Zinc and other micronutrients are proven to treat and prevent a vicious cycle of malnutrition and diarrheal disease.
-- We're celebrating simple solutions and the healing power of moms everywhere in our latest video.
Photo credit: Gates FoundationRead more
It was just a conference room in Delhi, not the Taj Mahal by any means. No lapis lazuli or other luxuries. (Although many would consider the flush toilets, hot water, and soap in the bathrooms down the hall as luxuries).
Here scientists are going over the details of a clinical trial of a rotavirus vaccine under development. The discussions are very detailed, focusing on things like data management, lab analysis of virus serotypes, and statistical models. Everyone involved (the Indian company manufacturing the vaccine, government officials, international scientists, and PATH) is focused on making sure that the clinical trial will tell us with confidence whether this vaccine candidate will save lives.
What goes unsaid is why this matters so much. This group does not mention the death toll of diarrhea or the children who survive but suffer health and learning impairments for the rest of their lives, sabotaging their chances for succeeding in school and on the job. But that is the real reason for the meeting – not the statistics, lab samples, or data bases: the children whose can survive and thrive if this vaccine turns out to be effective.
Wouldn’t that be a wonder of the world?
-- Eileen Quinn, Communications Director for the Vaccine Development program at PATH
Photo credit: PATHRead more