The Washington Post, December 2014
[Dad joke alert] “Yesterday, I swallowed some scrabble tiles by mistake. The next time I go to the toilet, it could spell disaster”. Bit of a stupid joke, I apologise, but the dubious function it performs in this blog is to show how what you put into your mouth is an important factor in what comes out the other end. This might sound a little obvious, but a healthy diet is a key determinant in the health of your gut and consequently whether or not you suffer from diarrhoea.
A child who is undernourished is at a higher risk of suffering from diarrhoeal disease – and diarrhoeal disease kills more children than AIDS, malaria, and measles combined. Undernourished children are at risk of suffering from diarrhoea because the lack of nutritious food doesn’t give the gut what it needs, and because the lack of nutritious food damages their immune system’s ability to fight off infections. To complete the picture, when children are suffering from diarrhoeal disease they are less able to absorb nutrients into their body. So diarrhoea is both a symptom and a cause of under-nutrition.
I recently went to visit Kinshasa, in the Democratic Republic of Congo (DRC), to talk to a range of people about what is being done to tackle the incredibly high level of child under-nutrition there. Currently, 43%, or about 5.5 million children, under the age of five are chronically undernourished. As part of a research project we are asking about how governments in fragile and conflict-affected states are combating the under-nutrition crises in their countries.
In countries suffering from persistent conflict and instability, nutrition is not always seen as a governmental priority. Government departments like health and agriculture which could, with sufficient budget and focus, make a real difference on child malnutrition just do not have the wherewithal to make it happen.
A refreshingly honest, if depressing, reason for this lack of government urgency was given to us by a Member of Parliament: they had decided to prioritise the defence budget; they want to deal with the conflict in the east of the country before they had the space to deal with human development issues like health and nutrition.
The conflict in the Kivus in the east of the country is forcing people to flee from some of the most fertile land. This means that cultivation and harvest is disrupted, significantly depressing yields and leading to scarcity and higher prices. In turn, lack of access to fertile land and therefore food exacerbates the conflict. However, conflict is largely restricted to the east, with the majority of the country relatively peaceful. Even in these non-conflict contexts, agricultural investment is low and undernutrition extremely high; these areas are largely forgotten, especially by the development community.
This leads to a really key question: should undernourished children be a higher or lower priority than dealing with an ongoing conflict in a restricted area of the country? We in the development community have isolated ourselves from difficult questions like this – our role is to care about the undernourished child. But the government of a country dealing with a long-term and protracted conflict feels like it has to make these difficult choices.
During the last resettlement programme for combatants in the east of the Democratic Republic of Congo, there was an attempt to help demobilised soldiers to settle on land as farmers; however it was not well managed, and ex-soldiers found themselves with no land and nothing to do – many of them simply went back to fighting and the conflict became worse. This was a lost opportunity, both for the conflict and for nutrition.
The government of the DRC with the help of the international community really must find a way of prioritising childhood undernutrition; not just to deal with the injustice but for pragmatic reasons as well. Without dealing with the underlying causes of the conflict, they will never see a lasting peace; those underlying causes include lack of access to food and the land to grow it on. Furthermore, good nutrition is central to the development of a healthy workforce, necessary to help a country grow its economy.
For instance, it has been shown that poor nutrition can make people 10% less productive, and it is estimated that Bangladesh has lost over $1 billion because of undernutrition.
The Government of the Democratic Republic of Congo is rightly concerned about the conflict in the east, but it simply cannot tackle the conflict while ignoring the nutrition crisis. The two problems are linked and neither will be solved through simply investing in the army.Read more
"The antibodies in your breast milk have prevented any serious illness.” At those words from the pediatrician, I pulled my head out of my hands, astonished.
There I was doubled up in the corner of the doctor’s office with a 104°F fever, a mask covering my face, and the worst stomach virus I had ever had. Yet, my two-month old son, who had been exposed to the same gut-wrenching bug, was lying on the exam table smiling and cooing. It seemed impossible that this tiny baby, whose immune system was not yet fully developed, could stave off what my mature immune system could not. I had taken my son to the doctor because I was worried that his symptoms (some slight diarrhea, vomiting, and loss of appetite), would snowball into the same severe gastrointestinal symptoms I was experiencing. But, as the doctor explained, my breast milk was not only providing all of the nutrients and fluids that my son needed to grow and thrive, it was also protecting him from getting really sick.
The truth is I shouldn’t have been so surprised. I make my living as a global health communicator at PATH where talk about disease prevention is routine. We communicate widely about the importance of tools such as vaccines, medicines/treatments, clean water/air, AND breastfeeding as essential components of an integrated strategy for controlling some of the world’s leading child killers, including pneumonia and diarrhea. I knew well how antibodies that help me fight disease can pass to my son through my breast milk. But, despite my awareness, I was seeing the power of breastfeeding in action through a “new mom” lens and could hardly believe my eyes.
Here, in the United States, we are used to having ready access to a whole suite of tools for helping our children make it to adulthood. We have the vaccination and treatment resources to protect our children from many life-threatening infectious diseases, including diarrhea and pneumonia. We have clean water and sanitation systems that run to virtually every household, preventing the spread of water-borne illnesses. The stoves in our well-ventilated homes most often use resources other than fossil fuels, keeping the air our children breathe clean and avoiding harmful air contaminants that can be contributing factors to pneumonia and other respiratory complications. While easily accessible for us, these resources are often out of reach for children in the developing world. As a result, too many children die because they cannot access or afford the interventions that could have saved their lives.
Breastfeeding is one of few tools that mothers around the world already have in their arsenal to protect their children from disease, no matter where they live. It provides ideal nourishment that prevents malnutrition, assists in the development of children’s immune systems, and enables the transfer of disease-fighting antibodies from mother to child. When direct vaccination is not an option, breastfeeding is a good way for infants to receive at least some immunity to some diseases in the critical early months of life, including several causes of pneumonia and diarrhea. When clean water and sanitation are unavailable, exclusive breastfeeding can also help children avoid exposure to diarrheal and other diseases caused by contaminated water.
Reflecting on how I was able to help my son fight off a strong stomach bug by breastfeeding, I feel a sense of empowerment and solidarity with mothers around the world. This is something we can do naturally with great benefit to our children. Here in the United States, getting my son to the doctor took a phone call, a five minute drive, and a nominal co-pay to my insurance. In other parts of the world, mothers travel long distances at great financial hardship to get their children to the care they need. Sometimes they arrive too late. Some mothers have no access to health care at all. In an ideal world, all children would have access to the highest standard of health care, which includes the full suite of disease prevention and treatment tools. While obstacles to this access are not going away any time soon, I am reassured that breastfeeding is at least one lifesaving tool inherently capable of crossing the geographic and socioeconomic divide.Read more
In this country, diarrhea tends to be shrugged off as a mild nuisance, but in parts of the developing world, it can be a death sentence. Health workers like Salif in Mali know this all too well.
He recently treated a young boy, Sekou, who had refused to nurse or drink. On top of that, the one-year-old was also suffering from diarrhea and vomiting. Unsurprisingly, this perfect storm of conditions led to Sekou developing dehydration and severe malnutrition. By the time his parents reached Salif, Sekou’s life was in danger. His eyes were sunken and he was very thin.
Luckily, Salif knew from his training with Save the Children to take baby Sekou to the health center immediately—a critical decision that likely saved the boy’s life. While Sekou is not back to his playful self yet, he is home again, where Salif visits often to help him achieve a full recovery. He counsels Sekou’s mother on breastfeeding and other nutrition practices that can make all the difference.
Salif is one of the many frontline health workers in the developing world who are working to treat childhood diseases like diarrhea in their own communities—even when doctors and hospitals are not within easy reach.
At Save the Children, we’re trying to raise awareness about the critical need for more frontline health workers like Salif through campaigns like Every Beat Matters and the REAL Awards. Without them, millions of people would be cut off from the health care system entirely, and our incredible progress in slashing child deaths over the last two decades would be curtailed.
Babies like Sekou will thank you.Read more
Reposted from path.org.
In Cambodia, an innovative idea to treat pneumonia and diarrhea at the same time—profiled in this post—was so successful that the Ministry of Health plans to join with us and UNICEF to extend the project throughout the country. But the project’s future wasn’t fully assured until just last month, when PATH contributors generously gave us support to help carry the work toward scale-up. Thank you!
Weaving between homes in the village of Duan Tom, trying to avoid slipping in the mud, Yeksim Chea talks animatedly about the heavy rains: how they’ve made it tough for villagers to get to the health center, how families are drinking contaminated water. The flooding means more disease, especially diarrhea and pneumonia, a duo responsible for 40 percent of the deaths of young children in Cambodia.
Yeksim is vice-chief of this village in central Cambodia. She’s also a village health volunteer and part of a PATH project that’s taking a unique two-in-one approach to curbing diarrhea and pneumonia.
To reach kids in Duan Tom, we began in Phnom Penh, working with the government of Cambodia to draft a national policy that addresses diarrheal disease and pneumonia. The new policy incorporates up-to-date prevention practices, training for health workers, and easier access to lifesaving treatments.
With a draft in hand, we needed to show that what looked good on paper works in the village. We chose one province to train health workers—from hospital staff all the way down to village volunteers—to prevent and treat diarrhea and pneumonia.
Yeksim was eager for the training and committed to bringing what she learned back to Duan Tom. “During the four years that I’ve been vice-chief of my village, pneumonia and diarrhea among children have been the biggest health issues,” she says. “Many parents don’t know how to prevent the child from getting sick, and they certainly don’t know the symptoms of when a child has a cold versus when the child has pneumonia. If parents knew the signs of these illnesses and when to bring their children to the health center, many children would not have to die.”
Yeksim herself wasn’t aware of all the symptoms of pneumonia until she took the training. When she was shown a picture of a child with a swollen chest, she realized her five-year-old neighbor had severe pneumonia. As soon as she returned to Duan Tom, Yeksim convinced the boy’s mother to take the child to the health center for treatment.
While parents can’t control the rain, when armed with information they can prevent severe illness—and that’s what Yeksim offers them. At classes for mothers and other caregivers, she passes along what she’s learned about good nutrition and hygiene. She also reminds them, “Good health means families spend less money on medicines that don’t work and helps reduce poverty.”
Cambodia’s new national policy equips health centers with oral rehydration solution (ORS) and zinc to treat diarrhea. In a bold step, it also puts these lifesaving tools in the hands of the village health volunteers who see parents and kids on a daily basis. Zinc can reduce the severity and duration of diarrhea, but in most countries, it’s regulated as a drug and can only be distributed by licensed health professionals and pharmacists. Now parents in Cambodia can get it directly from volunteers like Yeksim, saving precious time.
“The introduction of zinc has stopped most of the cases of diarrhea,” Yeksim says. “I’m very happy when I see the kids are healthy.”
The integrated approach works: fewer children are arriving at local hospitals with severe dehydration or pneumonia. Now Cambodia’s Ministry of Health is partnering with PATH and UNICEF to take it nationwide, with plans to reach more than 1.6 million children by 2014. Nature may be unpredictable, but we’re determined to keep diarrhea and pneumonia from threatening young lives.
Photo credit: PATH/Heng Chivoan.Read more
In a recent survey completed by PATH on perceptions of ORS and zinc in India and Kenya, caregivers in both countries demonstrated some encouraging similarities in knowledge and behavior:
· More than 90% of caregivers recognize the need to rehydrate a child suffering from diarrhea.
· Lethargy and lack of appetite are much more concerning symptoms to caregivers than the diarrhea itself.
· The goals for seeking treatment, in order of importance, as articulated by the caregivers, are: prevent the child’s illness from getting worse, restore the child’s energy, and stop the diarrhea.
Health interventions only help to the extent to which they are understood and used, and this evidence should make global health communicators proud that these messages are taking root in rural communities and becoming incorporated into new caregiving practices.
That said, the research also indicated that there are still some unanswered questions and opportunities for better communication. Though there seems to be a basic understanding that ORS rehydrates children, caregivers also understand that it doesn’t stop the diarrhea – and often, they feel that’s not good enough. Antibiotics and other medicines are often perceived as the best treatment and that it will always stop the diarrhea, which is only true in some cases.
In other cases, our messages have exacerbated misunderstandings. The image of water over a fire on ORS sachets is meant to suggest that caregivers should boil their water, but is sometimes interpreted to mean that the ORS needs to be cooked and served hot.
And still at other times, our messages are irrelevant. For communicators and advocates, we consider the fact that zinc can prevent future diarrhea episodes a huge selling point. But this doesn’t ring true for caregivers, whose priorities are tightly focused on the life-or-death situation at hand, without the luxury of wondering whether the product may be useful in the future.
We should celebrate the encouraging trends that point to successful communication efforts, but let’s not forget the necessity of innovating new approaches when messages fall short. Community health workers will continue to play an essential role in framing the messages appropriately.
What are some of your ideas? Weigh in using the comment field below.
Photo credit: PATH/Tony Karumba.Read more