RotaFlash, October 2014
New data show that rotavirus vaccines indirectly protect household members of...
Pneumonia and diarrhea are the leading killer diseases of children globally. National policies that incorporate the latest global standards of care can help drive down these numbers. Kenya adopted an integrated national diarrheal disease policy in 2010, and today, PATH and partners are encouraging the country’s adoption of global recommendations for pneumonia treatment.
I recently became an aunt to a boisterous little boy, well, that’s if you count 2 years as recent! Since then, I’ve developed an even more personal interest in supporting work that focuses on preventable childhood diseases that continue to contribute to my country’s less-than-ideal child mortality rates. One such disease is pneumonia. Globally, pneumonia kills more children below age five than any other disease and this statistic is largely mirrored in Kenya. Pneumonia accounts for roughly 16% of child mortalities in Kenya, or in other words, approximately 122,000 children under five each year.
Why is Kenya falling behind on its commitments to reducing child mortalities, and why does pneumonia remain a ‘silent killer’ of children? Only half of children with suspected pneumonia receive the recommended antibiotic. This very simple statistic is symptomatic of the breakdown of the UNICEF/WHO framework which highlights 3 essential steps to reducing child mortality due to pneumonia. Basically, to better address pneumonia in children, the first step is to accurately recognize that a child is unwell with pneumonia; however, many caregivers cannot correctly identify the tell-tale signs of pneumonia (fast breathing and difficult breathing). Secondly, caregivers then have to immediately seek appropriate care from providers that can accurately diagnose and treat pneumonia. Finally, since the majority of pneumonia cases in Kenya are caused by bacteria, a full course of appropriate antibiotics should be provided as the recommended, affordable and effective treatment.
So how or where does policy change make a difference in how we address childhood pneumonia? To start off, by adopting the global recommendations on how pneumonia is classified and treated. WHO now recommends amoxicillin as first-line treatment; however, Kenya’s treatment guidelines still reflect the old treatment regimen, which called for co-trimoxazole. While the country is currently scaling up integrated community case management (iCCM), which includes amoxicillin as first-line treatment, this is not reflected in the care provided by facility level health care providers.
PATH is currently working in partnership with the Kenya Pediatric Association (KPA) and UNICEF to advocate for this critical policy change that will align national treatment guidelines with current evidence and global recommendations. A critical component of this work is supporting the Ministry of Health in conducting a critical analysis of the global and local evidence that backs this change in treatment guidelines. But this is only a first step. Next we have to work on ensuring that the commodity is available in the country. This means having amoxicillin registered and included on the Essential Medicines List specifically for treatment of childhood pneumonia. And finally, work has to go into harmonizing treatment guidelines and training curricula for health providers to ensure standardized treatment within the country.
Kenya’s recent step in introducing the pneumococcal vaccine is a step in the right direction, but as I have highlighted, more needs to be done. Implementing these important policy changes will institutionalize the simple actions we can take to save our children. So as I watch my nephew thrive and grow stronger and faster, I remain committed to ensuring that mothers and caregivers around the country can do the same with their little ones.
Photo credit: PATH.Read more
In the spirit of World Immunization Week (and in homage to the imminent departure of top 10 list king David Letterman from late night television), Dr. John Boslego, director of PATH’s vaccine development program, presents his top 10 list of ways that vaccines make a difference in global and child health. At risk of going too far with the late-night theme, dare we say, HERE’S JOHN!
10. Vaccines lower the risk of getting other diseases
Contracting some diseases can make getting other ones easier. For example, being sick with influenza can make you more vulnerable to pneumonia caused by other organisms. The best way to avoid co-infections is to prevent the initial infection through vaccination.
9. They keep people healthier longer
Some vaccines protect people for a limited time and require booster doses, others protect for a lifetime. Either way, vaccinated people are dramatically safer against many serious diseases than non-vaccinated people in the short and long term.
8. They are relatively easy to deliver
Through national immunization programs and mass vaccination campaigns, vaccines can be delivered quickly to large numbers of people, providing widespread protection. Thanks to creative strategies, delivery in even the remotest parts of the world is becoming easier.
7. They prevent disease where medical care isn’t an option
Too many children die because quality care is unavailable. When a child in poverty gets sick, medical care could be several days travel away or inadequate. Stopping disease before it starts could be that child’s only lifeline.
6. They play well with other interventions
Vaccines complement other global health tools. We’re seeing this with the integrated strategy to protect, prevent, and treat pneumonia and diarrhea through basic sanitation, safe drinking water, hand washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, AND vaccines. Leveraging these tools across diseases could save the lives of over two million children by 2015.
5. They continue to evolve
Tackling unmet health needs requires continuing to pursue the next generation of better and more affordable vaccines. Candidates like RTS,Sfor malariaand ROTAVAC ®for the leading cause of severe diarrhea—rotavirus—are two examples of innovative technologies on the horizon givingfamilies and communities more cause for hope.
4. They indirectly protect loved ones and communities
For many diseases, immunizing a significant portion of a population can break the chain of transmission and actually protect unvaccinated people—a bonus effect called herd immunity. The trick is immunizing enough people to preserve the bubble of protection.
3. They are safe and effective
Vaccines are among the safest products in medicine and undergo rigorous testing to ensure they work and are safe. Their benefits far outweigh their risks (which are minimal), especially when compared to the dire consequences of the diseases they prevent. Vaccines can take some pretty terrible diseases entirely or nearly out of the picture too—think smallpox and polio—with others to follow.
2. They are a public health ‘best buy’
Preventing disease is less expensive than treating severe illness, and vaccines are the most cost-effective prevention option out there. Less disease frees up health care resources and saves on medical expenditures. Healthier children also do better developmentally, especially in school, and give parents more time to be productive at home and at work.
1. They save children’s lives
Roughly two to three million per year, for that matter. In short, vaccines enable more children to see their fifth birthdays, let alone adulthood. That’s reason enough to top my list.
Photo credits: PATHRead more
When you survey the low income area of Ndirande, Blantyre in Malawi from the crest of a hill you notice the density of the homes mashed together, the uneven, almost crater-like nature of the unpaved roads, and the sites and the sounds of a town. What you can't notice from this perch is that this area, informally planned, has no sewer network, so people make do, doing their business mostly in basic pit latrines.
Until recently, when those pits became full, there were few solutions. Families with full pits resorted to sharing toilets with their neighbors or emptying their pit into a nearby ditch, creating a public health risk.
In 2010, Water For People set out to support small scale entrepreneurs to be in a position to solve this problem for customers in Blantyre. One of these was a man named Matthias John.
Initially Matthias was not alone. Water For People identified 12 potential pit emptying business people, but one by one they found the business to be too hard and not for them. They even ridiculed Matthias and tried to get him to leave the business, but he persevered and now he grins as he says, "Those same people that teased me, come asking for a job."
But building up the business has not been easy, and Matthias' story points to the difficulty faced by sanitation entrepreneurs and why they are in need of ongoing and specialized support over time to succeed. In the early days of the business, Matthias struggled to find customers, didn't keep good accounts, didn't have the support of the City Council; he even lost some friends.
What he and Water For People tried out was something new and risky. Equipped with a revitalized technology called the Gulper (a hand-powered bilge-pump-like sludge-sucking device) he could enter the areas of town unreachable by cesspool trucks and relieve customer of their sludge, carrying it away in drums to the city dumping site. Initially there was resistance by the City Council but they soon realized with Water For People's advocacy that this was -- while still imperfect -- a much better solution than what existed.
All through this Matthias kept his dream alive to make his business successful and have a better life for his family. "This sanitation business has really moved my life," he says. Now he believes his services are known to about 50 percent of his target market. He has opened an office and a bank account; he has three employees; and his wife Ruth helps him with the bookkeeping. His customer base has grown and he has repeat customers. Whereas previously he had struggled to pay for rent and food, now with his earnings Matthias has bought a plot of land where he has started construction on a house. He is also sending his oldest girl to preschool and envisions his three girls and boy all receiving a good education.
But he is not resting on his success. "Where I have come from is nothing, where I am going is huge," he predicts. He even gets calls for his services from Lilongwe, the neighboring city four hours away. Water For People's market analysis identified a large untapped market for Matthias to serve, as roughly half a million people in Blantyre need manual pit emptying services. This translates into about $4.2 million worth of business. His goal in 2014 is to double his number of customers and start to diversify his business into latrine construction and toilet upgrading services. He believes he has an edge up on his competition (in the past 18 months other pit emptying businesses have started), because he has several years of experience in the business and his customers recognize his better quality, and more honest, service.
But there are still challenges. The dumping fee is still very high and transport costs eat into his margins. Ideally he wants to own a one-ton pickup truck, but finding financing for an entrepreneur of Matthias' size is next to impossible. There is also a need for a better and cleaner pit emptying device.
Water For People continues to address these challenges, creating linkages to government, private sector, and finance partners, and encouraging other actors to look more seriously at the sanitation space. There are promising, cleaner and more efficient pit emptying technologies being developed by Water For People in Uganda, which will also be tested in the coming year in Malawi. This will hopefully support Matthias to further grow his business reach. Another one of Water For People's partners in Malawi, the private company called Tools for Enterprise and Education Consultants (TEECs) has recently registered as an MFI in Malawi and begun to give out sanitation loans. Water For People is supporting TEECs and linking with other finance partners to try to solve some of the finance challenges that exist for sanitation businesses and households looking for sanitation financial products.
The Sanitation business will never be easy, but with the right encouragement and assistance, a Matthias can emerge. Now when you look from that same hill, you'll see a new sight, Matthias standing in front of his shop smiling.
This post was originally published on the Huffington Post.
Photo credits: John Sauer.Read more
Communications Officer Sushmita Malaviya interviews James Chauvin, President of the World Federation of Public Health Associations and Co-Chair of the 14th World Congress on Public Health, which will be held in Kolkata in 2015: www.14wcph.org.
Your comments on India reaching its MDG goals?
While I am no expert on India, I would like to say that I am impressed with the Government of India’s efforts on health. It is also important to commend the support of Indian civil society towards reaching these goals. India is seen as a model for others, because of the 50 percent decline in infant mortality. This is an amazing achievement. Although there have been big challenges at the national level there have been remarkable progresses too.
However, it is important to look at these achievements through the equity lens to understand where these benefits have gone. Have all socio economic levels been covered? Are there some population groups and ethno-cultural communities that have been left out?
While a few countries like Rwanda are close to achieving their MDGs, it is important to understand the MDGs are milestones. They are not the end of the road. The MDGs should not stop Governments from continuing to invest in health, housing, education and job security, all of which have an impact on health.
Your views on India’s stride on public health, vis a vis maternal, newborn and child related diseases.
India has made great strides in areas such has immunization especially in the difficult to reach populations. This has to be appreciated, given its great geographical breath and width, its diverse population. India has also done very well on reproductive health by introducing new services and this has made it a role model for many other countries. It has also had considerable progress in childhood vaccine preventable diseases.
One area though that I feel India and many other countries need to work on is the issue of violence against women and girls. It is one thing for governments to pay lip service to this issue; but real progress has to be made at the front line. I would also add that it is also important to factor in mental health issues.
On the battle against diarrhea and pneumonia
Essential elements of water and sanitation a key way to prevent these diseases. In this direction, a lot has been done for access to safe drinking water, but work on sanitation remains. Not much attention has been paid to sanitation and there is still too much sensitivity around the subject. Attitudes around this have to change, we have to domore about sanitation. The returns on investment on sanitation are phenomenal.
What is a close link with your work and you as a person?
For 25 years I was involved in organizational and community capacity building and this has been my passion. The strong civil society voices around public health policy and best practices that are emerging are essential for democracy and a healthy society.Read more
In February, the Global Public-Private Partnership for Handwashing hosted a Handwashing Behavior Change Think Tank. This event gathered handwashing experts from the public and private sectors to take stock of the best, identify the gaps, and articulate the way forward for handwashing behavior change. The Think Tank covered handwashing-related topics such as the latest research, determinants of handwashing, social norm formation, and the role of technology in handwashing. In addition to the participants in the room in Washington, D.C., we engaged with virtual participants around the world. We have two interesting findings we’d like to share here—one relating to the ‘software’ or behavioral component of handwashing and the other focusing on the ‘hardware’ or infrastructure component.
Social norms are a powerful behavioral motivator. A social norm is a rule by which group or community members abide. Ignoring a social norm could have consequences, such as social exclusion or censure. For example, if a community’s social norm is that people do not smoke in the home, then an individual who visited a neighbor’s home and smoked might be asked to stop, to leave, or perhaps would not be invited over again. A strong handwashing social norm can encourage and sustain improved handwashing behavior in a community. Social norms are inherently dependent upon the interaction of people; therefore, being alone or unobservable might decrease someone’s propensity to abide by the norm.
This is a challenge for handwashing as it is often a private, hidden behavior. Research indicates that people are less likely to wash their hands with soap after using the restroom if they are alone in the restroom and unable to be observed by a peer. In fact, there is evidence that even the illusion of being watched can improve handwashing behavior. Some programs have actually put cartoon eye stickers on the wall near handwashing facilities to cue people to wash their hands. Making this typically private act a public one can increase handwashing frequency. As a result, Think Tank participants were challenged to consider how we can make handwashing more visible as a way to foster a strong handwashing social norm.
Another area of interest to participants was regarding the ‘hardware’ component of handwashing behavior change, which includes water, soap, and a device for washing hands. There was broad agreement that while building and installing handwashing devices won’t lead to handwashing behavior alone, it is a vital part of changing behavior and one that we should focus on as a sector.
If there is no affordable, durable, and attractive device available for handwashing, it is likely to be a difficult behavior to sustain. Tippy-Taps are an easy “small doable action” that can facilitate handwashing initially, but according to findings presented at the Think Tank, Tippy-Taps often don’t last and are not used after a few months. In Kenya and Cambodia, two new, more durable commercial handwashing devices are being tested in the market. We will track the progress of these devices in the coming months and years to see if similar commercial devices are viable alternatives in other markets.
Through exploring the components of handwashing behavior change at the Think Tank, we learned about both the social and environmental drivers of handwashing behavior to help implementers find practical ways to increase handwashing in their community. To learn about additional findings please visit us online.
Photo credit: PATH/Gareth Bentley.Read more