Voice of America, June 2014
At the second anniversary of USAID's Child Survival Call to Action, USAID...
Everybody poops / but not everybody knows / that poo can kill, too.
Raising awareness that diarrhea is a leading killer of children is our central focus at defeatDD.org. Here in the US, we have the luxury of laughter, because diarrhea is merely an inconvenience rather than a fatal threat.
But is it okay to joke about diarrhea, a serious health problem for so many? When I was a newcomer to PATH, I was surprised by the levity with which my colleagues approached the issue; they welcomed me to my place on the “Poo Crew” and quipped that we don’t really do anything but “talk sh*t” all day! But @oh_mara spoke truth when she said:
It's more indecent / to let kids get sick from poo / than writing this tweet.
Many of the puns exchanged in our office banter have since made their way to social media, and I’ve learned that humor has the power to spark conversations that catalyze change. Last year’s inaugural Poo Haiku contest was an experiment that became a resounding success; we received more than 100 entries and lots of support and awareness for defeating diarrheal disease. When we announced that we were running the contest again this year, responses were enthusiastic, and we’re hoping even more participants will join the movement!
Saving children’s lives from preventable illness can sometimes seem like an overwhelming endeavor, but it’s heartening to know that laughter and creativity can not only boost our spirits, but generate meaningful conversation. Isn’t it great to know that making the world a healthier place can be fun, too?
Big change can start with a few strategic syllables. Will you join us?
We have all the tools. / Combat diarrheal disease / Do your part. Re-tweet!! - @SumDPRead more
Zinc deficiency places children at greater risk of illness and death due to diarrhea and pneumonia, particularly children under five years old in low-resource settings. Evidence shows that zinc is beneficial in managing acute or persistent diarrhea in children ages 6–59 months, showing clinically important reductions in illness duration and severity. Preventive zinc supplementation has been shown to reduce the incidence of diarrhea, and research has also demonstrated that zinc supplementation reduces the incidence of acute lower respiratory infection among children under 5. Several studies show that preventive zinc supplementation reduces by 18 per cent deaths among children ages 12–48 months. However, use of zinc in countries with the highest under five mortality rates due to diarrhea is limited.
Kenya is ranked 14th among countries with highest number of under-five deaths due to diarrheal disease with 32,000 children dying annually from diarrhea. According to the Kenya Service Provision Assessment 2010, only 49% of children with diarrhea received treatment from a skilled health care provider. In addition, zinc sulphate is used in fewer than 1% of diarrhea cases, despite its proven effectiveness as a high-impact, low-cost intervention for children under five years old.
Considering that majority of children with diarrhea are treated at home, it is imperative for Kenya to increase access to Zinc Sulphate and oral rehydration salts (ORS) at the community level using the existing Community Strategy through the Community Health Workers (CHWs). The Kenyan Division of Child and Adolescent Health, together with civil society partners, including PATH, has been advocating to the Pharmacy and Poisons Board (PPB)— the national drug regulatory authority—to revise the legal categorization of zinc from a prescription-only drug to an over-the-counter drug. In August 2012, the PPB granted this application, creating an opportunity in scaling up management of diarrhea at community level through access to zinc sulphate, a commodity that has been prioritized at a global level for saving lives of children. Scaling up access to zinc sulphate is already a priority in the policy guidelines, whose development, printing and launch was supported by PATH on control and management of diarrheal diseases for children under five years in Kenya. Besides accessing zinc sulphate through the healthcare facilities, parents and other caregivers can now access it through nearby pharmacies, local chemists, shops, and kiosks. More importantly, zinc sulphate will now be much more available through the community health workers (CHWs) who are especially effective at reaching the marginalized and poorer children even at household levels, who have limited access to healthcare.Read more
Something great happened this week. Having worked in global health for some years now, I’m used to the madness that seizes New York City every September during the Clinton Global Initiative and UN General Assembly sessions. A head-spinning array of political leaders, global health legends, and celebrities come together to celebrate progress, wrestle with persistent problems, and make bold commitments. It is epic and amazing at what can be accomplished in such a few short days. At the same time, it’s easy to lose sight of some of the truly remarkable accomplishments amidst the media frenzy, traffic gridlock, and general hullabaloo of meetings and receptions. But great things happen at the little and big moments in these sessions – things that make a difference to the lives of millions of people across the globe.
One of the great accomplishments this week was the bold recommendations of the UN Commission on Life-Saving Commodities for Women and Children. Every year, nearly 7 million children die from preventable diseases and nearly 300,000 women die from complications during pregnancy and childbirth. The vast majority of these deaths could be prevented by existing medicines and supplies – but these products are not reaching the patients who need them. For example, over 700,000 children die from diarrhea annually – the #2 cause of death among children worldwide; even though over 90% of these children could be saved by treatment with zinc and oral rehydration salts (which cost less than $.50), less than 2% of children globally are receiving this recommended treatment. The goal of the Commission was to identify actionable, time-bound strategies to dramatically improve access to 13 priority commodities (including ORS and zinc) that will have the greatest impact on reducing child and maternal mortality.
It’s no secret that many global reports end up as dust collectors on neglected office shelves; but this report is different than most. First, it is focused. Rather than tackling every cause of mortality – the report distills out the greatest drivers of maternal and child deaths – where existing high-impact and cost-effective medicines and products are available to prevent these deaths. It highlights opportunities that we can seize now to reduce these unnecessary deaths. The recommended steps include bulk buying, local manufacturing and innovative marketing to help transform the supply, demand and use of these life-saving products.
Second, strong leaders are involved. The Commission is driven by country leadership; President Goodluck Jonathan of Nigeria and Prime Minister Jens Stoltenberg of Norway co-chaired the effort, and from the outset, they have made sure that solutions are practical and realistic for implementation in the countries where these deaths are occurring. The Commissioners included executive level participation from the private sector, government, donors, and NGOs alike, and Executive Directors Anthony Lake (UNICEF) and Dr. Babatunde Osotimehin (UNFPA) serve as vice-chairs of the Commission.
Third, tangible support for implementation is already underway. Good ideas lead to nothing without implementation. The Commissioners have made headway in generating momentum and resources to support implementation. For example, the Government of Nigeria has set an ambitious goal of saving one million lives and improving the quality of care in Nigeria by scaling evidence-based interventions including childhood essential medicines. Additionally, the both the Governments of Norway and Sweden have made commitments to significantly expand their global health investments in 2013 by over 100M. Former President Bill Clinton announced a new partnership that cut prices of long-acting contraception in half, allowing access for 27 million women in the developing world. Private sector firms have also made remarkable new commitments, such as the IKEA Foundation which announced this week that it will provide USD $24 million over the next four years to save 40,000 lives by 2015 by increasing access to diarrhea treatment for children in Kenya and one of the poorest states of India, Madhya Pradesh.
Overall, the real impact of this report will only be known in the coming weeks and months. Implementing these recommendations has the potential to drastically reduce child and maternal mortality – but success depends on continued focus, leadership and resources. As UNICEF Executive Director Anthony Lake said, “It is simply wrong that millions of children and women still die every year when we have the products and the knowledge to save their lives. With the Commission’s help, we have still more practical solutions. What is needed now is the political will to implement them.”Read more
It all seemed that it would be easy back in 2006. The New England Journal of Medicine published landmark articles reporting the safety and efficacy of two new rotavirus vaccines in January of that year. And within weeks the US announced that it would recommend one of these vaccines for routine use in all US infants. Within months other countries in Latin America followed suit announcing inclusion of rotavirus vaccines into their National Immunisation Programmes (NIP). By 2007 there were over 25 countries that became “early-adopters” of rotavirus vaccines. But then progress appeared to slow rather than accelerate.
The ground work had appeared to have been well laid to help public health policy-makers in all other countries to quickly follow with similar recommendations to rapidly introduce rotavirus vaccines. “Proof of local disease burden” and “evidence of cost-effectiveness” were identified as key information that would drive policy decisions on vaccine introduction. From the late 1990s, the World Health Organisation (WHO) and the US Centers for Disease Control and Prevention (CDC) facilitated the establishment of regional Rotavirus Surveillance Networks to collect this all important disease burden data. The Asian Rotavirus Surveillance Network was the first to be formed in February 1999. A range of high-, middle- and low-income countries in the Asian region started to collect information on how many children were admitted to hospital with diarrhoea and the proportion of these admissions that were due to rotavirus. A WHO generic protocol to collect these data was simple to follow and required that participants only needed to select a small number of sentinel surveillance hospitals.
As more and more data emerged showing the rotavirus virus was the dominant pathogen causing admission for diarrhoea in children under-five years of age, it seemed more and more likely that decision-makers would enthusiastically embrace these new vaccines. The WHO made a recommendation in 2007 that rotavirus vaccines should be considered for inclusion in the NIPs of countries were efficacy had been demonstrated. This essentially meant the Americas and Europe, as these were the sites of the initial efficacy studies published in the New England Journal of Medicine. However by 2009 data became available from studies done in Asia and Africa and the WHO updated its recommendation to advise that rotavirus vaccines should be included in ALL NIPs, and for those countries with high mortality from gastroenteritis in children under five years old, the WHO emphasised that the vaccines were STRONGLY recommended.
Yet despite this unequivocal recommendation, the response from many Health Ministers, vaccine advisory committees, and public health officials has been somewhat underwhelming. There was no clamouring to obtain the rotavirus vaccines following the announcement of the WHO recommendation. Yet 2009 was the same year that many Health Ministers were rushing to buy stockpiles of pandemic H1N1 influenza vaccine – at a stage in many countries when it was already obvious that the likely impact of this virus on mortality would be no greater than that of normal seasonal influenza. Why the urgent high-level meetings to discuss influenza vaccine but not similar meeting to discuss how to expedite introduction of these important new rotavirus vaccines?
Some “early-adopter” countries (Australia, Austria, Belgium, Brazil, El Salvador, Mexico, Panama, and the US) have witnessed approximately 70% fewer hospital admissions due to rotavirus illness and approximately 35% fewer hospital admissions due to diarrhoea of any cause during the first two years of life. In high- and middle-income countries gastroenteritis can account for around 15% of all general paediatric admissions in children under five years old. If we could reduce these admissions by 35%, it means that overall there will be 5% less paediatric admissions every year. This is a massive effect. Think of the impact on the front-line medical and nursing staff. Think of the impact on hospital beds. Think of the reduced risk of nosocomial infection. Hospital Administrators should be jumping up and down demanding that rotavirus vaccines be introduced as quickly as possible. Sadly they don’t yet seem too excited about this potential intervention that could boost their limited resources.
In 2008, there were an estimated 453,000 deaths from rotavirus in children under-five years, making it one of the leading causes of death in this age group. In Asia in the same year there were an estimated 188,000 deaths from rotavirus. This is equivalent to about 500 child deaths every day. Nearly 95% of these deaths occur in the low-income developing countries where access and availability to health care is limited. Even if the Health Ministers of these poorer developing countries do not have the resources to immediately include rotavirus vaccines in their NIPs, one would at anticipate (naively) that rotavirus vaccine introduction should be high on the Agenda of every G8 meeting – ahead of the GFC (global financial crisis) and similar mundane topics.
2.4 million child deaths could be prevented by 2030 by accelerating the introduction of rotavirus vaccines. To achieve this goal GAVI and its partners plan to support the introduction of rotavirus vaccines in at least 40 of the world’s poorest countries by 2015, immunising more than 50 million children. GAVI initially gave support for rotavirus vaccines in 2006 and since then, introductions have occurred in Nicaragua (2006), Bolivia (2008), Honduras (2009), Guyana (2010), Sudan (2011), Ghana (2012), Rwanda (2012), Moldova (2012) and Yemen (2012).
As of August 2012, 41 countries have introduced rotavirus vaccines into their NIP. Although many countries in Latin America started using rotavirus vaccines in their NIPs more than 5 years ago, no country in Asia had done so until the Philippines announced in January 2012 that it planned to vaccinate an estimated 700,000 children annually from the poorest communities. Thailand is the second country in Asia to announce the partial introduction of rotavirus vaccine into it’s NIP (Sukhothai Province). Currently no GAVI-eligible Asian country has introduced rotavirus vaccine.
Clearly Asia needs to do more and try harder – and to do this quickly. It has lost the opportunity to be an “early adopter” region – let’s hope that Asia won’t be known as the “last-adopter” region.Read more
Social entrepreneurs with boundless creativity are redefining the outer limits of what’s possible in global health. Two such visionaries, Simon and Jane Berry, have harnessed their mental oomph and creative prowess in the public health community in Zambia to address one major global health dilemma: access. They tasked themselves with the following: identify an existing distribution channel whose reach is vast, design an innovative commodity that is culturally relevant with user-friendly messaging, and enroll champions along the supply chain instrumental to product delivery in target communities.
Who has the farthest reaching arm to even the most remote villages in Zambia and in much of the world? Coca-Cola. A willing partner, but not extensively involved in the project, Coca-Cola agreed to let ColaLife, Simon and Jane’s organization, piggy back on their existing end-to-end supply chain to deliver life-saving public health treatments: oral rehydration solution (ORS) and zinc.
Packaged in a tidy reusable plastic cup with pictorial, culturally appropriate instructions and hygiene messaging, along with a bar of soap to boot, the AidPod is a wedge-shaped container that fits between glass Coca-Cola bottles inside of a plastic Coca-Cola crate. One AidPod contains 8 200ml packets of ORS and 10 tablets of zinc. Local testing determined the kits should be locally labeled Kit Yamoyo (Kit of Life) anti-diarrhea kit.
ColaLife enrolls and motivates champion distributers to ensure the product reaches the market at the far and remote end of the supply chain. Each kit is labeled with a number, which is tracked via cell phone to monitor and create real-time sales and distribution data. Health promoters, such as community health workers, can also receive feedback regarding uptake in any given community.
“I was reading in the paper, and there, page 3, lower corner, '1 in 5 kids will die before their 5th birthday' and I thought, can that really be, 1 in 5?” Simon reflected. “When someone said they are going to put a brown fizzy water [Coca-Cola] in a glass bottle in a plastic crate and send it to the outer reaches of the earth, I’d have said no way is it possible. This, what we are attempting to do, should be a no brainer.”
Access to basic solutions to prevent deadly diarrhea, such as zinc and ORS, remains elusive to many households in peri-urban and remote rural communities. Misunderstanding and misuse of products that do exist in the market complicates the situation. Simon and Jane are reducing child mortality due to dehydration and diarrhea among the most isolated and underserved communities by creating access to a user-friendly, culturally relevant, and affordable public-health intervention.
We salute you, Simon and Jane, two champion social entrepreneurs who don’t waste time, who create novel public health approaches, and who, with their hearts of gold, enroll public & private sector partners to deliver desperately needed solutions to isolated communities, where the impact will be great.
-- Lisa Anderson is a Program Assistant for Vaccine Development at PATH
For more information:
See other blogs inspired by defeatDD's trip to Zambia:
-- Soccer goals and other victories: Ministry of Health official Vichael Salavwe recalls a moment that inspired his career path.
-- Defeating a leading child killer in Zambia: The country prepares for a national rotavirus vaccine rollout.
-- Finally, firsthand: After 10 years in development work, Deborah Phillips visits an African clinic for the first time.
-- On balance and empathy: It really is a small world after all.
-- Diving into Zambia's water challenges: Not literally!
Photo credit: PATH/Gareth BentleyRead more