RotaFlash, December 2013
In late November, Zambia expanded a pilot project that originated in Lusaka district...
As you can imagine, convincing attendees of PATH’s recent “PATH After Hours” donor event to sample oral rehydration solution (ORS) alongside their wine and appetizers was somewhat of a difficult sell. Most attendees politely declined my offer to take a swig of briny water as they approached my display table depicting PATH’s diarrheal disease control efforts.
But convincing them of the gravity of diarrheal disease globally was not difficult. Most found it impossible to politely ignore that today children still die from diarrhea--much less 1.3 million of them every year. Maybe attendees didn’t feel like dampening their pallets with some salty water (and who can blame them, really?), but they clung to my words depicting the devastation of diarrheal disease and nodded their heads vigorously to my descriptions of PATH’s multi-pronged approach to combating this disease.
“So what’s your spiel at this table”?
Basically, that diarrheal disease is the second leading killer of children under 5 worldwide, that it is the most common cause of child death in Africa; that while every child in the world is at risk for diarrheal disease and most experience it in their early years, it disproportionately takes the lives of developing-country children simply by dehydration.
“That’s horrible! What is PATH doing to stop this”?
Where resources are limited, diarrheal disease is difficult to control due to its multifaceted causes and influencers. PATH is combating diarrheal disease with a coordinated approach from multiple angles from water and sanitation, to vaccine development, to advocacy. Another one of those angles is encouraging use of ORS, which has been available for decades, as an ideal public health intervention. ORS is a very simple mixture of salts and sugars, extremely low-cost, easily administered by untrained individuals, and nearly 100% effective at reversing deadly dehydration.
“If ORS has been available for so long and is such an ideal intervention, why is its use low?”
The public health sector has developed many hypotheses for the lower-than-desired use of ORS, and PATH is further pursuing a couple of the promising solutions. By pursuing multiple methods to increase use of ORS, PATH hopes to significantly reduce deaths by dehydration globally. Some of PATH’s projects are focusing on:
· Producing ORS in the form of a tablet instead of a dry mixture under the idea that ORS would possibly be used more frequently if it looked more like a medicine than a water additive.
· Researching user preferences for product attributes like color, taste, and packaging to determine if country-specific product variations would increase use .
· Testing a new formulation of ORS that contains a starch additive to treat diarrheal symptoms under the idea that if ORS visibly reduces diarrhea, caregivers will be more likely to administer it as a treatment.
“What can I do to help?”
Keep the conversation open. Diarrhea is not thought of as a very polite topic of conversation, especially over a glass of wine and a plate of appetizers. But, the million-plus deaths per year are reason enough to keep talking about it. Join PATH’s conversation at www.defeatdd.org.
-- Anna Larsen in a Program Assistant for Technology Solutions at PATH
For more information:
-- Fact sheet: ORS Re-formulated: A new addition to an old solution
-- Zinc and ORS: Ready for take off in Cambodia
-- News: The British Medical Journal touts zinc and ORS as one of the best investments to achieve MDG 4.Read more
Last month I had the opportunity to go out into field with my colleagues in Cambodia where PATH is working with the Ministry of Health (MOH) and local provincial health and operating districts to increase the coverage of zinc and ORS. A major new development in this effort has been the approval by the MOH, through the establishment of a new national policy on the control of acute respiratory infection and diarrheal disease, to allow Village Health Groups (VHGs), essentially a team of two community health workers, to distribute zinc. In most countries zinc is regulated as a drug and therefore can only be distributed by licensed pharmacists, doctors and nurses. These regulations, despite the benign nature of zinc (no side effects, no risk of overdose, etc.), greatly hinder access. However, thanks to the new national policy, mothers in our pilot area in Cambodia are being supplied with zinc and ORS by their nearby VHG, greatly improving access and availability to rural areas.
Each quarter the VHGs from each village receive training and information at their nearest health center from staff trained by the provincial health office. In our pilot areas, two quarterly VHG meetings were dedicated to training VHGs to treat diarrhea using ORS and zinc, and to recognizing signs of pneumonia. In turn the VHGs use their regular monthly “mother classes” to build awareness among mothers in their villages about diarrhea and pneumonia, and to encourage the mothers to visit the VHG for zinc and ORS when their child has diarrhea.
At the quarterly meeting, the VHG gets resupplied with zinc and ORS as needed. Never before have the VHGs had the means to provide treatment. Previously, mothers would usually wait until the case was serious enough and then set off for the health center, which is often 20 to 30 bumpy kilometers on the back of a motor bike. Upon arrival at the health center, the child would often need expensive intravenous rehydration and an overnight stay.
As a result of the national policy, which in turn catalyzed this new approach to diarrhea management and the training and supplying of VHGs and the mothers classes, coverage of zinc and ORS is going up, and the number of cases of moderate to severe dehydration showing up at health centers has been falling in our pilot areas, quite significantly.
On my visit to the field I was joined by Dr. Veasna, the head of Cambodia’s Division of Acute Respiratory Infection/Control Diarrheal Disease) and a primary author of the new policy. He was extremely pleased to see the progress and, in partnership with PATH and UNICEF, the MOH is now making plans to take this program nationwide. With help from UNICEF, which will facilitate training down to the health centers, and PATH, which will facilitate reaching from the health centers to the villages via the VHGs and the mother classes, we are poised for achieving dramatic increases in zinc/ORS coverage throughout the country, and subsequently, reduced morbidity and mortality from diarrhea.
For more information:
-- Learn how PATH and the Government of Cambodia are combining strategies to tackle pneumonia and diarrhea through an integrated national policy.
-- Vietnam is bringing all resources to bear on overcoming diarrhea and setting a model for the Mekong region.
--This post was originally published on the ONE Campaign's blog
March Madness? How about tax madness? Ah, tax season. Whether it’s money you owe, or a refund coming your way, I’m sure you know how much it is. But if you’re like most us of, you likely don’t know where your tax dollars actually go. Think about it. Do you know how your tax dollars are spent? Don’t be discouraged, neither did I.
There’s so much talk in the news about social security, Medicare, and foreign assistance spending. It got us wondering how much we contribute to each. Well, thankfully we’ve now got a simple way for you to find out.
Today, we’re launching our new Interactive Tax Tool that shows you where your tax dollars go. Just enter your household income and you’ll see your tax money break down into eight categories -– national defense, social security, health, unemployment, Medicare, interest on US debt, foreign assistance and other. It’s not exact — it assumes you file as a single without exemptions — but you get the picture.
Most importantly, ONE’s tax tool reveals how only a small fraction of the US budget has already dramatically improved the lives of the poorest people on the planet, and how you personally have contributed to that effort. Together, Americans have helped put 5 million people on AIDS medication, halved malaria deaths in 11 African countries and saved the lives of 15 million children. Pretty amazing stuff.
Time and again, research has shown us that when people see how much good is being done for so little, their opinions on foreign assistance change. As a matter of fact, there’s no single message that effectively changes more skeptics into believers than the living proof of what has been accomplished for so little. The problem is, not enough people have seen this proof. That’s where you come in.
I’m asking you to not only check out the Tax Tool yourself, but to share it with all your friends. And ask them to share it with their friends too. Because the more people who see the proof that foreign aid is working, the more people will stand up to protect it. And after all, that’s what ONE is all about.Read more
As Vice President of Field Programs at PATH, I appreciate efforts like World Water Day that call for universal access to the solutions that are the foundation to the health and well-being of communities. I appreciate these efforts both as a public health expert and as a native Nigerian who has seen firsthand the burden of disease in Africa, where diarrhea is now the leading killer of children under five.
I grew up in Nigeria and my family was fortunate enough to have safe drinking water and a toilet. Millions in my country did not, however, and many still don’t today. Later in my life, when I became a doctor practicing in Ilorin, I saw many children who were far too small for their age. I remember one mother in particular who visited my clinic several times with her tiny child, who was severely dehydrated. It wasn’t difficult for me to imagine why he was repeatedly ill. Lack of access to water, sanitation, and hygiene (WASH) is devastating in its own right, but when other family members are ill with diseases like malaria or tuberculosis and waste is not disposed of properly, the dangers are compounded. In these environments, it’s no surprise that diarrheal diseases are perpetual and unforgiving, especially among vulnerable children and those who are already ill.
Those of us living in industrialized nations can easily forget the extent to which we rely on safe drinking water and sanitation to stay healthy and to prevent the spread of disease. In fact, no innovation in the past 200 years has done more to save lives and improve health than sanitation. And anyone who has suffered with a water-borne illness knows how difficult it would be to be productive in that condition. In nations like the U.S. where diarrhea has become a mere inconvenience, too many are unaware that diarrhea is still the second leading killer of children globally. When it doesn’t kill, a long cycle of dehydration and malnutrition takes its toll, and both physical and cognitive stunting are often sad long-term consequences.
Worldwide, millions lack access to safe drinking water and billions lack a latrine: a major contributor to the 1.5 million children who die of diarrheal diseases every year, a security risk for women who have to journey long distances for water and for privacy, and a deterrent to girls’ school attendance. The cost of continuing to ignore this crisis is high. Fortunately, so is the opportunity for effective solutions. To defeat diarrheal disease, we need an integrated prevention and treatment approach, and WASH is essential to that equation. Over half of the hospital beds in low income countries are filled with patients suffering with water-borne diseases. Imagine the impact that simple access to WASH could have in those settings. Imagine the impact it could have had on that mother who repeatedly brought her child to see me at the clinic. Chances are, she never would have needed to come. A cup of safe drinking water and a latrine are so much more than health solutions; they are hope for mothers everywhere, all of whom want the same things for their children.
World Water Day is a great opportunity to celebrate success and to renew our commitment moving forward. The recent achievement of the safe water MDG target ahead of schedule is worthy of celebration and shows us what’s possible, but the lagging behind of the sanitation MDG target, not to mention the many families who still lack access to safe drinking water, is a sobering reminder that we can’t stop here.
We all have a role to play. Just as WASH solutions are simple but powerful, so is our request to advocates on World Water Day: to lend your voice to the cause. Visit waterday.org to sign up your Facebook or Twitter profile and share messages about the incredible impact of WASH. Your voice can help save lives. Join the movement.
-- Ayo Ajayi is Vice President of Field Programs at PATHRead more
Summer 2006, rural China: My colleagues and I take a bathroom break at a rest stop on the side of the road on our way to a health clinic. Unlike many female restrooms around the world, there isn’t a long line of patrons waiting to use the holes in the ground separated by slabs of cement. I walk over to one of the farthest holes in the room and, my colleague stands in front of my “stall” as a human door. Other patrons giggle at how shy we are using the makeshift toilets. I strategically place my feet as far away as possible from the urine and feces on the ground, remnants from previous guests who had missed their chance to score inside the basket of waste collecting beneath the building.
Summer 2006, Ulaanbaatar, Mongolia: I am out in the countryside conducting a site visit. I really have to use the restroom. When I ask where the toilet is located, one of the locals points to an outhouse in the middle of the field and says something in Mongolian for my colleague to translate. “He is embarrassed for you to use the outhouse,” my colleague tells me. “He says it smells very bad and thinks it is better if you hold it until you get to your hotel.”
Fall 2010, Kampong Thom province, Cambodia: We’re observing a village health volunteer train a group of mothers on diarrhea and pneumonia. After the training, I ask her how she thinks it went. She tells me that even if we train the mothers on how to prevent diarrhea and pneumonia, they lack basic, critical supplies like soap, water filters, and latrines.
I have encountered challenging situations when having to use the restroom. Factors beyond my control: no toilet paper, no soap, no water, non-flush toilets; things I took for granted at home, at work, and even at most of the shopping malls back home in Utah. When I started to work on the diarrhea and pneumonia project with the PATH team in Cambodia, I learned first-hand how uncontrollable factors such as flooding, dirty water, and poor sanitation contribute to high rates of diarrhea.
My favorite health theory is the ecological model, which explores how environments influence health behaviors and thus health outcomes. My previous post raised the question of how health policies and behavior changes are linked in order to work with one’s environmental context. In order to gain a better understanding, I spoke to members of the Technical Working Group for Acute Respiratory Infection and Diarrhea Prevention and Control, who are helping revive programming to address childhood diarrheal disease and pneumonia in Cambodia and are providing guidance on key policies:
-- Mr. Ork Vichit, Program Officer for childhood pneumonia and diarrheal disease at PATH
-- Mr. Chum Aun, Health Officer for maternal and child health issues at UNICEF
-- Dr. Chhorn Veasna, Program Manager of the National Program on ARI and Diarrheal Disease at the Ministry of Health in Cambodia
-- Dr. Bun Sreng, Chief of Bureau of Prevention and Control for the Department of Communicable Disease Control at the Ministry of Health of Cambodia
How did the experience of local health staff inform the revision of the national policy on pneumonia and diarrheal disease?
Mr. Vichit: The new policy focuses on community participation. If we want to strengthen the community level, we have to strengthen all health levels: national, provincial, operational, and health center levels in order to properly prevent, manage, and treat diarrhea and pneumonia. For instance, equipping village health volunteers (VHVs) with ORS and zinc was a key piece of the revised policy, which we incorporated based on community feedback.
Mr. Aun: This is the country’s first policy allowing VHVs to administer ORS and zinc. With VHVs being able to provide direct treatment to mild cases, they can prevent severe cases.
Low-osmolarity ORS and zinc are now pivotal parts of diarrhea treatment and prevention in Cambodian clinics.
How important is it that national and local level efforts coincide to prevent and treat diarrhea and pneumonia in Cambodia?
Dr. Veasna: [Because of this pilot] VHVs have now been specifically trained on diarrhea and pneumonia. They are better connected with the National Program and moving forward can bring together national and local-level efforts. This connection is important as we try to have a more coordinated strategy.
Now that the policy has been revised and approved, what needs to happen in order for the changes to take place?
Mr. Aun: Widespread dissemination of the new policy must take place as fast as possible. The accompanying national guidelines should also indicate how health center staff will work with VHVs in ensuring that ORS and zinc are being properly administered in the villages. In addition, the guidelines must also indicate how health center staff will coordinate with VHVs to make sure that they have adequate supplies of ORS and zinc is continuously replenished. Interpersonal communication between VHVs and caretakers of children under five is essential to the success of new programming efforts by the National Program. Furthermore, VHVs must continually be trained on the most updated information on prevention and treatment, made aware of changes in policy, and must communicate this information to caretakers. Residents in rural Cambodia do not have access to mass media such as television and radio, and so VHVs are crucial to linking them with information.
Dr. Sreng: Families, especially the poor in Cambodia, have many things to worry about including making a living and finding food for their children. We need to communicate effectively to them that if they take care of their children by keeping them clean and preventing them from getting sick, they will save money by spending only five cents for a bar of soap instead of $25 (US) to treat severe diarrhea if they were to seek care from a private health care provider.
A Village Health Volunteer educates a mothers’ group in her community.
How do you link policy and behavior change initiatives in an environment where there is a lack of basic resources such as latrines and water filters in order to prevent children from getting sick?
Dr. Veasna: The National Program must continue to work with key stakeholders like PATH and other government arms to fill gaps such as the lack of access to these life-saving supplies. PATH’s work with water filters is a good example of how we can ensure access to populations in need. What has made this pilot successful is the collaborative effort from stakeholders in all areas. These partnerships are important to support the National Program’s core work: helping to decrease morbidity and mortality of the children of Cambodia.
--Gizelle V. Gopez is a Program Associate for PATH’s Cambodia Country Program
For more information:
-- Safe drinking water and sanitation are key for the prevention diarrhea and pneumonia. This World Water Day, raise your voice to bring them within reach of the families who need them most.Read more