The Guardian, March 2015
Drawing on data from 54 countries, nearly 40% of health clinics lack...
I grew up in an educated middle class Bangladeshi family in Dhaka, the capital of the country. I grew up with the idea that immunization is not important, that vaccines could have an adverse effect on vital organs of your body. Having a strong immune system without intervention was more desired. My siblings and I never could tell if we had received routine vaccines during our childhood or not. My elder siblings could confirm receiving the vaccine against tuberculosis from school, because it left marks on their body. I remember my father not being so happy about it.
Almost thirty years after, when my nephews were born, I saw a big change in my father’s attitude. I observed a growing awareness among young and elder mums in my family and neighborhood, too, irrespective of socioeconomic background. I observed my sister-in-law taking my nephews to receive polio vaccines on National Immunization Day (NID). In one instance, my cousin’s wife took my six-month old nephew to the nearest NID camp since his mother was at work. Most surprisingly, my father didn’t oppose it; he was more at ease, which was certainly a big change of attitude.
A final result of this massive change in attitude came when the World Health Organization declared Bangladesh as polio-free, along with ten other countries in WHO’s South East Asia region, on 3 May 2014.
A study published in the journal of Health Policy and Planning (1997) assessed the impact of the first two National Immunization Days in terms of immunization coverage and change in knowledge among women living Dhaka city. NIDs educated women, both slum and non-slum dwellers, about the prevention of polio through vaccination.
The drive to eradicate polio from Bangladesh required participation from the civil society, media, development partners, and the Government of Bangladesh. One of the key players of this joint effort is the International Centre for Diarrheal Disease, Bangladesh (icddr,b), an international organization based in Dhaka and known globally for its excellence in public health research. In 2013, icddr,b joined forces with scientists and health experts from 80 countries around the world to ratify a comprehensive new strategy to secure a lasting polio-free world by 2018.
icddr,b was established as a cholera research laboratory in 1960. icddr,b’s journey in the world of cholera and enteric diseases is commanding, as it gave the world the simplest solution to treat diarrheal disease: Oral Rehydration Solution (ORS). Till today, the discovery has saved an estimated 50 million lives worldwide, the majority of whom are children under five.
icddr,b’s fight against cholera and diarrhea continued and yielded another groundbreaking discovery that zinc, when taken with ORS, further reduces fatality rates from diarrhea. It also reduces duration, severity, and the likelihood of hospitalization during diarrheal episodes. As with ORS, Bangladesh was the first country to implement a national scale-up programme for ORS-zinc combination therapy.
Achievements as such these have earned icddr,b national and international recognition. While icddr,b is based in Dhaka, it addresses many urban and rural health challenges that affect not only Bangladesh but many other low-income countries in the world. Over time, icddr,b has expanded its initial research on diarrheal and enteric diseases to include other developing priorities to address health challenges worldwide—with a focus on children. The fight against polio in the region, for example, has been significantly boosted through the commitment of iccdr,b’s highly qualified and diverse group of researchers and scientists.
In addition to its research expertise, Bangladesh deploys one of the largest cohort of female health care volunteers in the world. icddr,b is one of the leading organizations who started recruiting female volunteers, starting in the 1970s. These volunteers are trusted members of the community who have been providing primary care and services regarding immunization, family planning, and maternal and child care. Many of the volunteers have been working for more than two decades. These volunteers are providing immunization support through icddr,b’s hospital and sub-centres located in Matlab.
Through important research at icddr,b, the education of communities by health care volunteers, and the commitment of many partners including national government, attitudes about immunization among skeptics like my father have made a lifesaving turnaround in my country.
Photo credit: M.DorgabekovaRead more
The first week in August, African Leaders – including about 50 heads of state, CEOs of multinational corporations and others – will meet in Washington, DC for the first (potentially annual) US-Africa Leaders Summit. The general focus of the summit is about fostering stronger ties between the US and African Nations, with an emphasis on the next generation.
Many topics will be addressed – trade, security, environment – and I will be watching closely to see how the Administration addresses global health , and specifically how the US government intends to use this platform to address shared goals of ending preventable maternal and child death in a generation.
There is no more important investment in the future health and stability of African than saving the lives of mothers and children.
In June of 2012, the United States Government, in partnership with leaders from around the world, committed to ending preventable maternal and child death in a generation. President Obama has since echoed this message through two consecutive State of the Union Addresses – the primary platform where the US President shares his policy priorities. On June 25th of this year, USAID released a new report, Acting on the Call, which outlines what progress is needed to save 15 million children and nearly 600,000 women by 2020. At the same time, USAID made several announcements on realigning resources and developing new partnerships toward reaching this goal.
USAID is making great strides, but with existing resources and commitments, we will not reach our targets. Action is needed by the President to truly accelerate the rate of progress – putting the weight of multiple agencies behind this goal and catalyzing financial resources to truly realize the full potential of American partnerships with African Nations in maternal and child health.
August 6th is a pivotal day. During this time, President Obama will stand on the stage with other heads of State and carve out his legacy for partnership with African nations. Will he use this platform to drive forward a White House driven agenda on maternal and child health? Will this be a key moment for turning the President’s words into transformative action? Only time can tell.
I encourage my fellow advocates out there to be watching on social media and preparing to respond to any concrete actions laid forth.
Official Moments to Watch:
· August 4th: [Signature Side Event] Investing in Health: Investing in Africa's Future
o Chaired by USAID Administrator Rajiv Shah and HHS Secretary Sylvia Matthews Burwell, this official event will celebrate the global health successes Africa has already achieved and the progress still needed.
o Look for announcements made by Administrator Shah and participating heads of state.
· August 6th: [Official Heads of State Meeting]– Investing in Africa’s Future
· The opening session will discuss inclusive, sustainable development, economic growth, and trade and investment.
· Look for announcements by President Obama and other heads of state
Hashtags to follow:
Photo credit: David Jacobs/PATH.Read more
Step-step, pause… step-step… plop (down on her bum)! And just like that, my little one is walking. Completely unaware of the monumental shift she’s created in our lives, my daughter happily crawls toward the kitchen to play with Tupperware lids. I wipe away tears.
She’s taken her first steps out into the world, a strong and healthy girl. I’ll take a little credit for getting her there, starting with one of the earliest “firsts” we shared. Minutes after her birth, before her first bath, before her first diaper change, I gave my daughter her first meal. I happily joined a global community of mothers that early morning.
Not only perfect for providing nourishment, breastfeeding is one of the most basic and universal steps mothers can take to protect their young ones. Vitamins, nutrients, and antibodies develop tiny immune systems, keeping threats like diarrhea and pneumonia at bay, promoting quicker recovery when infections do strike, and improving infants’ response to vaccines.
Despite the proven benefits, too many children worldwide never realize the promise of their mothers’ milk. More than one in ten of all child deaths are due to suboptimal breastfeeding. Without the vital nutrients provided by breastmilk, children are caught in a vicious cycle of malnutrition and illness, often including repeated bouts of diarrhea. If their lives are spared, malnourished children often suffer shortfalls in physical and cognitive growth.
What will make the difference? Efforts to educate mothers and health workers and to provide breastfeeding support are crucial for keeping infants healthy. Breastfeeding may be simple – but it is not always easy. I am fortunate that my daughter and I worked out early kinks fairly quickly. But had we not, support groups and clinical counselors were a phone call away. Latching problems, over- or underproduction, mastitis, clogged ducts, negative perceptions in public or even among family members… any number of things can undermine a mother’s attempts to breastfeed her baby, or even cause her to call it quits. Just one conversation with an informed counselor or community advocate about the benefits of breastfeeding and simple strategies to overcome impediments could truly save a mother’s confidence and a child’s life.
If 90% of mothers exclusively breastfed their infants during the first six months, and continued complementary breastfeeding through the baby’s first two years, more than 200,000 child deaths could be avoided each year. Breastfeeding’s dramatic potential is one of the reasons it’s almost always included in child health strategies, from the Millennium Development Goals to village outreach. But even with targeted promotion at the most global and local levels, fewer than half of infants worldwide are exclusively breastfed through the first six months of life, according to UNICEF. The benefits of breastfeeding are irrefutable. But mothers need our support: their children’s lives depend on it.
When you spot a mother nourishing her infant with the most fundamental of foods, celebrate her! When a friend or relative confides in you her troubles and uncertainties, help her find support. Raise your voice to a global pitch, sharing important messages about breastfeeding with online communities to influence policymakers and encourage the inclusion of breastfeeding goals in the Sustainable Development Goals now under consideration.
We all can take steps to create a monumental shift.
-- Deborah Kidd is a Senior Communications Officer for the Vaccine Development Program at PATH.
Photo credits: PATH/Evelyn Hockstein; PATH/Lesley Reed.Read more
Twenty-five year old Durga has travelled 15 km from her village to get to Darbhanga (Bihar), the district headquarters, following the advice of the local auxiliary nurse and midwife (ANM). Her daughter Puja, who is 10 months old and severely malnourished, lies listless on her lap. At the Nutrition Rehabilitation Centre (NRC), Puja is at the right place, where hopefully she will be brought back from an extremely critical situation. For Durga, being at the NRC is also an opportunity to learn how to look after this child. Sadly, she lost her first born two years ago.
Conceived and operationalized by UNICEF in 2010 and now run by the Government of Bihar in collaboration with a non-governmental organization Nidan, the Darbhanga NRC has become the model for the State. Officials of the in Darbhanga NRC, say that the center’s maintenance, cleanliness, quality of food provided to the mother and child; brightly painted walls that have pictorial messages for the mother; and basic television entertainment are among the reasons why this center has been successful. To date 1,116 children, who were on the verge of wasting away, have been to the center from not only from the immediate area of Darbhanga but from even further away.
Dr. Mahadev Chaudhary, District Immunization Officer in Darbhanga and medical officer in charge when the 20-bed NRC was set up, says “In the 20 days that the mother and child are at the NRC, we keep track of their diet. The mothers are provided health education – how to stay clean, how to keep the children clean, how to keep their environment clean. They are also encouraged to adopt better behavioral practices such as hand washing.”
A link worker, working closely with Accredited Social Health Activist (ASHA) and ANM look for malnourished babies in the villages adjoining Darbhanga district and they are brought to the NRC by the ASHA. Apart from the incentive to improve the health of the child, the mother is given Rs 100 ($2) a day for the 20 days she is at NRC with the child. The ASHA too gets an incentive of Rs 100 for each malnourished child she identifies and brings to the center.
Often times, when the infants are brought to the center, like Puja, they are debilitated, listless, and have a foul odor. Both mother and child are bathed, cleaned, and weighed on arrival. Each child is administered nutrition according to their weight. For the first seven days, children are put on a diet of milk, water, puffed rice powder, oil, and sugar. In the next seven days mashed potatoes are added to the diet. The targeted weight gain is 8 to 10 grams per kg of body weight per day. This weight gain target is achieved in 75 per cent of the cases. With this care, there is a dramatic improvement in the physical appearance within a few days of admission to the center. The aim is to try to help the child gain 1.5 to 2 kilograms by the time s/he leaves.
To monitor the progress, mother and child are expected to return after 15 days for the first check up, followed at 15-day intervals for two months. The majority of the malnourished children are from the poorest of the poor in Bihar.
Says Nidan’s counselor, Richa Kumar, “We try our best to help mothers be able to take better care of their children even when they go back home. During the period that they are here we try to cover important topics – cleanliness, nutrition.” She adds that most of the women who have come to the center have had up to five children and are often from the most socioeconomically deprived communities of the State. Unfortunately, ten percent of the cases relapse into malnutrition, due to the absence of functioning Integrated Child Development Services (ICDS) facilities or parents’ inability to access care in their villages.
Extremely acute cases of malnutrition are referred to the Malnutrition Intensive Care Unit (MICU) in the Darbhanga Hospital, which has 30 beds and the medical equipment to deal with very sick children. This unit has recently been set up by Medicine Sans Frontier (MSF). Each batch of the 20 children admitted at the NRC has three to four children who are very sick and sent to the MICU.
UNICEF social mobilization coordinator Chandra Bhushan Kumar recalls a child, like Puja, that he still keeps track of, who was brought to the NRC in a critical situation a few years ago. Today Kumar says, not only is the child alive and healthy, but the mother keeps the child clean and works to provide basic nutrition from the resources available to her despite the challenge of poverty. That is why Puja is at the right place at the right time.Read more
Why is it that many children in the developed world don’t get sick from drinking water? Is there something in the water? Or is it actually what’s not in the water?
In the poorest regions of the world, children don’t have access to safe drinking water. Instead, they are forced to drink contaminated, dirty water that is often miles away from their homes. These children also become extremely sick because many of them don’t have even the most basic toilets and sanitation infrastructure in the communities where they live.
The result? Millions of people are left with no choice but to go to the bathroom outdoors where they can. Open defecation contaminates living areas and water sources with human waste and other harmful bacteria. As a result, children are highly susceptible to potentially life-threatening illnesses like diarrhea and intestinal worms. In fact, the World Health Organization found that over 1,400 children die every day from diarrhea linked to dirty drinking water and poor sanitation and hygiene practices. Think about it: more kids die every single day than the entire student population of most city high schools.
748 million people still do not have access to safe water, and 2.5 billion people do not have proper sanitation – that is over one third of the world’s population! To safeguard public health, communities must have access to what we like to call “WASH”: safe and clean water, basic toilets, sanitation infrastructure, and hygiene education programs.
Water for the World Act of 2013: Everyone, Everywhere Deserves Drinking Water and a Toilet
Less than one percent of the funds for international assistance is used for water and sanitation (in turn, the total international affairs budget is less than 1% of the entire Federal Budget!). Allow me to repeat that: less than one percent of the all the money the United States provides to developing countries goes toward water and toilets.
The US taxpayer dollars that are used for international development are already very limited—only $50 billion, which pales in comparison to the $496 billion for the Department of Defense! That’s why we need to make sure that the money is efficiently allocated to the right places in order to help the people most in need. The Senator Paul Simon Water for the World Act of 2013 (H.R. 2901)introduced by Representatives Ted Poe (R-TX-02) and Earl Blumenauer (D-OR-03) will do just that.
The Water for the World Act of 2013 will ensure that WASH projects are sustainable and long lasting. It will also make sure that they are put into action in the poorest regions of the world. And it will increase federal agency transparency, and monitoring and evaluation so as to improve the way projects are developed and implemented. Water for the World takes existing taxpayer dollars and makes sure that the money going to water and sanitation projects abroad is used ever-more responsibly and efficiently. We don’t need to spend more money to have more impact for the world’s poorest people.
NOW is the time to have your voice heard. This session of Congress has a couple of months left to pass legislation, so time is of the essence. Protect children’s health, ensure your tax dollars are well spent, and stand up for people in need: for those in the developing world who do not have safe drinking water and toilets like we do. Contact your member of Congress TODAY and tell him/her to SUPPORT Water for the World!
-- Robyn Fischer is Policy & Advocacy Officer for WaterAid AmericaRead more