BBC News, July 2015
A new study by ICDDR,B published in The Lancet is the first to prove the effectiveness...
This is what caregivers in Kenya and India told researchers is most important to them when choosing treatment for their child. Now, you may be wondering ‘did we need a research study to learn that?’ Yes, because of this paradox: the highly effective treatment for diarrhea, oral rehydration solution (ORS), doesn’t really “stop the diarrhea.” What it does is help the child ride out the episode and recover more quickly.
The impetus for this research was to better understand why coverage of and demand for ORS remains low in many countries, despites its tremendous therapeutic benefits. Similarly, the team looked at perceptions and use of zinc, another cornerstone treatment to reduce the length and severity of diarrhea episodes.
The results, recently published in the Journal of Global Health, will help inform how we can do a better job of providing and promoting these treatments. On zinc, the data suggest that “treatment regimens remain unwieldy and unrealistic, perhaps unnecessarily.” Regarding ORS, the researchers learned that “Caregivers feel that the recommended dosing of ORS is impractical and overly ambitious, and they are giving less” and suggest that it would be useful to come up with a more practical yet effective dose.
The caregivers’ concern that the ORS liquid is too much for a child to take really resonated with me. I remember how challenging it was to keep pushing liquids when my infant son was very sick with diarrhea. I was grateful that I could make a call to a nurse whose guidance helped me. Would that parents and other caregivers everywhere can easily access the support and reassurance they need. Absent that, factoring their real-world concerns and needs into the dosing regimens is a great start.
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Because unsafe water supplies and sanitation account for most life-threatening diseases among children in developing countries, the provision of safe water and improved hygiene is a central focus of global health projects. And in addition to current public health research and practices, biology, and engineering, the success of these projects also relies on behavioral change at individual and cultural levels. Psychologists and anthropologists have an important role to play.
For the past three years, my former graduate student Heidi Beebe, now a visiting assistant professor of psychology at Pacific Lutheran University in Tacoma, WA, and I have been evaluating human cognition and behavior related to contamination in Sub-Saharan Africa. As developmental psychologists, we study cognition and its development in social and cultural context. We are especially interested in children’s skill at detecting when water and food are safe to consume, called contamination sensitivity. We are also interested in how people learn about contamination. We largely focus on children 4- to 12-years of age because they spend much time outside of adult supervision and engage in chores involving water. Although our research is based on studies that have shown that contamination sensitivity develops from early to middle childhood, most existing research has been conducted in industrialized settings where the risk of contamination is low.
In the rural Kibaale District of western Uganda, we interviewed 48 people between 4 and 60 years of age, presenting 23 different images of water and food that was contaminated (or not). Most participants rejected contaminated items and did not reject uncontaminated items. However, performance was not perfect, and younger children showed a lack of clarity in some instances. Most participants said they would not drink water from a pond with animals nearby because germs or droppings would remain, suggesting some understanding of residual effects. Most also rejected juice with a bug in it, but some younger children said they would drink the juice if the bug was removed. We also asked how they learned their contamination knowledge. Most children said they learned about contamination from family members or teachers; adults reported learning it in school.
In a second study outside Arusha, Tanzania, we interviewed 74 children, 4 to 9 years of age, about 10 scenarios presented in a set of drawings that depicted contamination (or not). Most children rejected contaminated items, but older children were more likely to, suggesting that children under 7 years have more health risk when deciding about contamination on their own. Children reported learning this information at home, mostly from siblings, and at school.
In Maasai villages in northern Tanzania, where homes do not have running water and people wait hours or days to fill containers at local sources, we interviewed 40 adolescents and 23 adults about their knowledge of stomach illness, germs, and water contamination. Adolescents had more biological knowledge, knew more about germs and preventing stomach illness, and relied more on Western treatments and medicines than adults. They reported learning this knowledge at school and passing it onto children and adults at home.
Overall, our studies yielded some interesting insights:
-- Children’s knowledge of contamination in Sub-Saharan Africa is in some aspects more advanced than has been found among children living in industrialized regions.
-- Younger children may over-correct and avoid uncontaminated substances, which suggests limited understanding.
-- Germ knowledge and causal reasoning about stomach illness is greater among adolescents than adults in rural areas.
-- Adolescents are more receptive to Western medicine and innovative decontamination methods than adults.
-- Adults may be receptive to learning health information from youth.
This information can be useful to health workers as they try to improve water-related practices and sanitation in the developing world. Successful program interventions will rely on bridging clinical and psychological contexts to provide clinical prevention and treatment that are developmentally appropriate and respect local understanding and practices.
Photo credit: PATH/Gareth Bentley.Read more
This may be what the extraterrestrial says when meeting the first earthling, but it also seems like a great opening line for everyone working to reduce childhood undernutrition. In follow on to the seminal 2008 Lancet series on maternal and child nutrition, an impressive and eclectic group of researchers have collaborated on an updated and expanded look at the challenges and the solutions. The new papers appearing in the June 2013 issue are all important contributions to our understanding, but I particularly appreciated article 4: The politics of reducing malnutrition: building commitment and accelerating progress.
The authors thoughtfully parse the factors that influence sustained political momentum—and what it takes for that momentum to generate results. Among the most important is leadership at all levels of government and across sectors. They note that “All the nutrition success stories—e.g. Brazil, Peru, Vietnam, and Thailand—have strong and effective networks of national nutrition leaders at their core.” They also point out the importance of local politicians who care about nutrition and recognize that nutrition can be a vote-winner. Decentralization of decision making and resource allocation requires enlisting and energizing these leaders on the front line.
The authors remind us that “all but the most extreme manifestations of undernutrition have no visible symptoms and are thus open to neglect.” The invisibility of undernutrition underscores the importance of dedicated, even relentless, leaders focusing attention and resources on the cross-sectoral systems and solutions that will have the most impact.
So, to help fight undernutrition, take it up with the leaders, tap new talent into becoming leaders, and take on the opportunity to be a leader. Chances are you won’t meet an extraterrestrial, but you could make a world of difference.Read more
Few initiatives in public health have changed the lives of children and families around the world as much as immunization programs. These simple interventions prevented as many as 3 million deaths in 2011 alone. And the successes continue. Each year more and more children have access to lifesaving vaccines, with over 80 percent of children getting all three doses of the diphtheria-pertussis-tetanus vaccine. During the past decade premature death from measles was reduced by 71 percent and from tetanus by more than 90 percent. Polio is on the path to being eradicated. While clearly there is much to celebrate, we in the U.S. Department of Health and Human Services (HHS) and those of us in the global health community realize there is much work still to do.
Vaccine-preventable diseases still account for a quarter of the deaths in children under five. Pneumonia and diarrheal diseases continue to be the leading causes of death in children, and while vaccines exist, they are not widely available in developing countries. Every year 22 million children go without the full benefits of vaccination, and it is the poorest children who are the least likely to receive immunizations. Moreover, vaccines are still unavailable for a number of preventable diseases such as HIV, malaria, and other neglected diseases.
Recognizing that infectious diseases do not respect international borders, the HHS Global Health Strategy notes that immunizations are a fundamental part of both disease prevention and of protecting the health of people here at home. This global awareness is why one of the goals of HHS’s National Vaccine Plan is directed towards “global prevention of death and disease through safe and effective vaccination.” However, developing and disseminating vaccines cannot be done by one agency alone. Our successes come from our close partnership with other U.S. departments and agencies, non-governmental organizations, international organizations, and the governments of other countries.
The development of a vaccine for meningococcal A meningitis is a prime example of one of these successful partnerships. Meningitis is a terrible disease killing one in ten people two days of the first sign of symptoms, and those who do survive are often left with permanent hearing loss, mental retardation, seizures, paralysis, or infection requiring amputation. A partnership between HHS, the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the Michael & Susan Dell Foundation, the GAVI Alliance, the United Nations Children’s Fund (UNICEF), PATH, and the World Health Organization led to the development of MenAfriVac™. This is the first vaccine developed specifically for African populations and is affordable to low- and middle-income countries at less than 50 cents a dose (compared to more than $80/dose of other meningitis vaccines). It also is the first meningitis vaccine that can be used on infants and is expected to create immunity that lasts at least ten years. MenAfriVac™ is saving lives in African countries where meningitis epidemics have ravaged populations for a century. While we are proud of this success story, going forward, we need to create more opportunities for this type of collaboration.
Another key part of working towards ending preventable deaths is debunking myths about the supposed dangers of vaccinations. Around the world, hundreds of thousands of children are denied lifesaving vaccinations because of the scientifically disproven but still widespread belief that certain childhood vaccinations could lead to autism. We have also seen global immunization efforts derailed by unfounded rumors. For instance, in Nigeria stories that the polio vaccine was a Western ploy to spread HIV and sterilize Muslim girls led to a mass boycott that resulted in a rash of new infections in the country and spread of the virus to a dozen other countries, as far away as Indonesia. This is unacceptable. Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.
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It’s been a year since the United States joined UNICEF and the governments of Ethiopia and India in a bold pledge to end preventable child deaths within a generation. Last week marked the first anniversary of the Child Survival Call to Action, which has since spurred a rejuvenated global movement under the banner “Committing to Child Survival: A Promise Renewed.” In the past year, 174 governments pledged to redouble efforts for children. More than 200 civil-society organizations, 91 faith-based organizations, and 290 faith leaders from 52 countries signed their own pledges of support.
In the Rayburn House Office Building yesterday, members of Congress, PATH, the U.S. Agency for International Development’s (USAID’s) flagship Maternal and Child Health Integrated Program, the US Fund for UNICEF, and partner organizations celebrated the global commitment and the progress made so far. We also reminded ourselves of how critical it is to sustain this momentum because, to borrow the words of Anthony Lake, UNICEF’s executive director, “The story of child survival over the past two decades is one of significant progress and unfinished business.”
Progress: dramatic drop in child deaths
The number of children under age five who die each year has dropped from nearly 12 million in 1990 to less than 7 million in 2011. Translated another way, every day 14,000 children who would have otherwise died now live to see their fifth birthdays.
Particularly heartening is the progress made in countries that have carried some of the heaviest burden of child mortality. Nine countries, from Bangladesh to Cambodia to Rwanda, reduced their under-five mortality rate by 60 percent or more.
How far these countries have come is a testament to the unwavering commitment and sustained efforts of governments, the public and private sector, donors and nonprofits, civil-society groups, and communities. Other factors underpinning this global progress are impressive gains made in the research and development of medical technologies, improved ways of delivering health services, and bold new thinking in how we overcome roadblocks and speed up innovation for health equity.
Unfinished business: 7 million children
Today, almost two-thirds of child deaths are caused by diseases and conditions that rarely take a child’s life in wealthy countries, including diarrhea, malaria, tetanus, and measles. These deaths are also concentrated in a small number of countries—more than four-fifths occur in sub-Saharan Africa and South Asia. This health inequity is deepened by poverty, violence, political fragility, and social disparity.
As the tremendous progress to date has shown, these are not insurmountable factors—but overcoming them requires ongoing cross-sector collaboration, multi-intervention solutions, and investment in innovative approaches.
Innovating health technologies
I joined PATH as head of its Drug Development program just under a year ago because I saw how global health organizations are driving many of the transformative innovations needed to achieve big goals like the Child Survival Call to Action. For more than 30 years, PATH and our partners have advanced innovative health technologies to protect children from devastating illnesses, make childbirth safer, and provide families with tools for a healthy life. Tools like a vaccine against meningitis A developed specifically for Africa, which has been introduced in ten countries and protected more than 103 million people from epidemic meningitis. Or tools like vaccines for rotavirus and pneumonia, which have been introduced in 14 GAVI-eligible countries, or a feeding technology that ensures that premature babies and those with a cleft palate can access lifesaving breast milk.
On the first anniversary of the Call to Action, I feel even more convinced of the importance of research and development of innovative health technologies to fight against the leading causes of child death. This is why at PATH we are currently working on solutions to tackle the top child killers, like diarrhea, on many fronts. We are developing new drugs to shorten the severity and duration of diarrhea before it becomes fatal, while also working to improve the effectiveness of proven diarrhea therapies like oral rehydration solution. PATH is also working on new vaccines against the leading causes of diarrheal disease, helping countries increase access to existing vaccines for both rotavirus and pneumonia, developing and delivering safe water treatment and storage products, and advancing health devices, such as a user-friendly product design for amoxicillin dispersible tablets to treat pneumonia.
The road ahead
Yesterday’s briefing is a reminder of the critical value of sustained commitment to our children. It is an opportunity to emphasize the power of innovation for child health and get inspired by the momentum behind the current efforts to create effective health solutions.
Among other factors, development of innovative health technologies and new methods to deliver these solutions to the people who need them will continue to drive the current momentum forward toward our common goal of ending preventable child and maternal deaths. Because access to necessary vaccines, drugs, basic medical and maternal care, clean water, and adequate nutrition should not be marked by a line of health inequity.
June 14 marked the 1 year anniversary of the Child Survival: Call to Action. One year ago, leaders committed to ending preventable child deaths. Learn more about A Promise Renewed.Read more