EurekAlert!, December 2015
New research by the University of Virginia and icddr,b suggests that food alone is...
You might think that coming home from abroad after attending a conference on the leading cause of bacterial pneumonia only to find your grandmother severely ill with bacterial pneumonia sounds too ironic to be true. But that’s what precisely happened to me in March.
I came home fresh off the plane eager to see my grandmother (who lives with me), but as I entered her room, I knew instantly that something was wrong. Sunken into the couch, a pale, weak, and scared woman looked back at me where my normally vibrant grandmother should have been. She’d had what seemed like a common cold earlier in the week, but the illness had suddenly taken a turn for the worse and she was having difficulty breathing. A trip to the emergency room later confirmed our fears. Bacterial pneumonia had set in—a disease particularly threatening to people my grandmother’s age (which I shall tactfully leave undisclosed.)
According to the attending physicians at the hospital, pneumonia probably didn’t just strike out of thin air. More likely, my grandmother was a victim of something called co-infection—a simultaneous infection by separate diseases. Her symptoms suggested that an initial viral infection had weakened her immune system, making her more susceptible to the pneumonia-causing bacteria that put her in the hospital.
My grandmother, pictured here with her great grandson, made a full recovery thanks to quick, affordable access to medical care.
Her case, though a standout ordeal for our family, isn’t necessarily unique. Children, the elderly, and others with weak or compromised immune systems are particularly susceptible to co-infections. The risk of co-infections are even greater in the developing world where malnutrition, unsanitary living conditions, and lack of access to disease prevention and treatment tools (like vaccines and antibiotics) leave people especially vulnerable to contracting multiple diseases at once.
Many diseases can be culprits of co-infections. For pneumonia specifically, one commonly cited risk factor is influenza. Non-respiratory diseases like diarrhea have also been linked to increasing the risks of pneumonia—meaning that the two deadliest diseases for children worldwide are capable of working both alone and together to kill.
The co-infection dynamic is one of many compelling reasons why integrated approaches to tackling the world’s most devastating diseases are so important. More and more, these kinds of strategies are making inroads. In the case of diarrhea and pneumonia, the global health community is currently implementing the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea, which simultaneously leverages health interventions across these diseases. Such tools include basic sanitation, safe drinking water, hand washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Alone, this integrated effort could avert the deaths of over two million children by 2015.
After three days of breathing treatments and antibiotics in the hospital, my grandmother went home feeling better than she did before she got sick. She was lucky. We had affordable, state-of-the-art medical care just minutes from our house. But many around the world aren’t so lucky. Tailoring global health strategies to tackle diseases simultaneously, particularly in the world’s most underserved regions, is one way of making prevention and treatment tools go farther against risk factors like co-infections. Since diseases can team up together to take lives, why shouldn’t we do the same… to save them?
Photo credits: PATH; Lauren NewhouseRead more
To the average passerby, Dar es Salaam is a busy, bustling city. With a lovely coastline, welcoming people, and so much culture, it seems Tanzania is humming. And undoubtedly, it is. However, for all of Tanzania’s development and progress—like many Sub-Saharan African countries—there remains a hidden burden that impedes the country’s ability to fully recognize it’s potential.
Child mortality rates, particularly those from pneumonia and diarrhea, are not decreasing rapidly enough for Tanzania to meet its Millennium Development Goal 4 target of a two-thirds reduction. Children continue to succumb to these preventable killers; a vicious tether to slow progress and development concerns.
However, as outlined in PATH’s recent Tanzania policy report, a few key updates to the country’s policies and strategies could save more children’s lives. In honor of the Global Week of Action, here are six ways Tanzania can turn policies and plans into lifesaving action:
1. Register a co-packaged Oral Rehydration Product (ORS) and zinc product: Research has shown that packaging ORS and zinc together into a “diarrhea treatment kit” improves the chances that a caregiver will understand that zinc is an essential component of diarrhea treatment. Registration is crucial to make this co-packaged product available in Tanzania.
2. Officially revise Integrated Management of Childhood Illness (IMCI) guidelines to identify diarrhea treatment as ORS plus zinc: It’s commonly understood—and recommended by the Integrated Global Action Plan for Prevention and Control of Pneumonia and Diarrhea (GAPPD)—that comprehensive diarrhea treatment means to use ORS and zinc together. However, it’s important that Tanzania’s national guidelines officially define diarrhea treatment according to global best practices.
3. Revise IMCI guidelines to denote amoxicillin as first line treatment: By using amoxicillin dispersible tablets as first line pneumonia treatment, Tanzania has been a leader in following recommendations outlined by WHO and the GAPPD. Now it’s time to officially align national guidelines with global best practice and list amoxicillin dispersible tablets.
4. Allow community case management by Village Health Workers (VHWs): Children in rural Tanzania should be able to access the same high quality care as those in urban areas. Policy updates are needed to lift the ban on stocking VHWs with treatment commodities and to bring trained, supervised VHWs into the more remote areas of Tanzania to help close the equity treatment gap between rural and urban communities.
5. Allow Accredited Drug Dispensing Outlets (ADDOs) to provide treatment: While ADDOs are already trained and supervised by the Tanzanian government, they only serve as a referral mechanism to other providers–even if they are the only provider in the community. If policies were updated to allow ADDOs to stock diarrhea and pneumonia treatment commodities themselves, more communities could have access to these life-saving drugs.
6. Allocate funds to treatment of diarrhea and pneumonia: Government prioritization and resources go a long way in Tanzania. Now is the time for the government to take action by specifically highlighting diarrhea and pneumonia as a child health priority and allocating specific funds for comprehensive treatment.
These policy changes won’t happen overnight. In today’s world of quick-fixes and immediate satisfaction, we can’t lose sight of long-term investments to make lasting change. Now is the time for the government of Tanzania to take global action and chart a new path to reduced child mortality. The lives of Tanzania’s children depend on it.
Photo credit: Gareth Bentley/PATH.Read more
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