RotaFlash, April 2016
A first photo of my hours-old niece, who joined the world in April 2013.
“Aunt Hopey, stand UP!” commands my three-year-old niece from atop her parents’ bed, pulling me up into her imaginary kingdom (with surprising force, I might add!) and leading the way as we stomp in a circle and shout together an authoritative staccato refrain: “March! March! MARCH!” (Pro tip: Don’t introduce a little one to a new game unless you are willing to repeat it several hundred times.)
I wonder to myself, yet again, is this the same little person I held in my arms as a cooing, helpless bundle two and a half years ago, now giving playful orders, walking and running and marching?
Anyone who has parented (or helped nurture) an infant is an intimate witness to the unbelievable changes that occur within the first few years of life. The physical and cognitive growth in this phase is unmatched in its intensity – so much so, that if children don’t absorb enough nutrients during this window, they carry the damage with them throughout their lives. Good nutrition is a matter of utmost urgency, explains Dr. Roma Chilengi.
Addressing malnutrition might seem straightforward on the surface – more fruits and vegetables seems simple enough – but the reality is that this won’t completely, or even nearly, fix the problem. In fact, according to the 2016 Global Nutrition Report, direct nutrition interventions, even when applied at a 90% coverage rate, addresses only 20% of the stunting burden.
At DefeatDD, we spend a lot of time thinking about the essential role of safe drinking water, sanitation, and hygiene (WASH) on nutrition, and we were thrilled to see that this year’s Global Nutrition Report gives special attention to WASH as an “underlying driver” of stunting outcomes.
You see, diarrheal disease – caused in large part due to poor access to WASH – and malnutrition are inextricably linked. One of the most unforgiving examples of this is a condition called environmental enteropathy (EE): damage to the gut caused by ingesting enteric pathogens in the environment. Once this happens, a child may receive nutritious food, but EE prevents the absorption of nutrients. It’s one reason why malnutrition can be so difficult to treat. Like many health-related solutions, we can’t lose sight of the fact that the answer is a multi-faceted one; I’ve never met a child whose life fit neatly into health intervention buckets, have you?
Thanks to her loving family and access to her basic needs, my niece marches strongly through toddlerhood.
“Though she be but little, she is fierce,” said William Shakespeare about my niece (okay, so maybe it was about Hermia from A Midsummer Night’s Dream). I know that her fierceness is possible because my family had the resources to give her body and mind the strength to become so. And I think it’s only fair that other fierce little girls and boys have an equal shot to become their strongest selves, too.
I believe my niece might suggest a march as part of the solution.Read more
His Excellency Ibrahim Boubacar Keita, President of the Republic of Mali, at the Opening Ceremony of the 10th African Rotavirus Symposium. Photo credit: Mama Traoré and Kamory Diallo.
Living and working in Mali, I have seen many family members, friends, and patients suffer from severe diarrhea. My brother nearly died from diarrhea as a young child and I will never forget my mother’s worry. Far too many Malian children lack easy access to medical care and die needlessly from vaccine-preventable diseases.
Our goal at the Center for Vaccine Development (CVD) – Mali is to prevent, control, and treat endemic and epidemic infectious diseases, particularly those that are vaccine-preventable. We were honored to have hosted the 10th African Rotavirus Symposium in Bamako, Mali on 1 – 2 June 2016. Over 150 people from 33 countries, 29 in Africa, joined forces to address the theme “Reaching Every Child in Africa with Rotavirus Vaccines.”
Dr. Samba Sow, Director General, CVD-Mali and Duncan Steele, Deputy Director and Strategic Lead for Enteric Vaccines, Bill & Melinda Gates Foundation. Photo credit: Mama Traoré and Kamory Diallo.
This year’s symposium, the first held in francophone Africa, occurred at an unprecedented time when 30 African countries have introduced rotavirus vaccines into their national immunization programs. The opening ceremony led by His Excellency Ibrahim Boubacar Keita, President of the Republic of Mali, and Dr. Marie Madeleine Togo, Minister of Health, marked this historic event. During the ceremony, attended by more than 400 dignitaries, government officials, and symposium attendees, there was an outflowing of praise for the leadership and dedication of the Malian government in introducing rotavirus and other lifesaving childhood vaccines and catalyzing introductions in other African countries.
Scientists, clinicians, public health officials, policymakers, vaccine manufacturers, and international rotavirus experts discussed diarrheal disease burden, rotavirus vaccine effectiveness and safety, advances in rotavirus science, and sustainability of vaccine programs and diarrhea control efforts in Africa. Rotavirus prevention, through vaccination, is critical to saving children’s lives in countries where health care is inaccessible, unavailable, and/or cost prohibitive.
The symposium organizers issued a Call to Action to: introduce rotavirus vaccines to the 22 African countries that have yet to introduce the vaccine and expand access in the countries that have introduced it to reach all children; continued surveillance and post-impact evaluations; new research in strain diversity, effect of the microbiome, and alternative schedules and doses; and the need to prioritize financial planning.
The popular saying that “it takes a village to raise a child” applies to this event, which would not have been possible without its organizers and sponsors. CVD-Mali will continue to work tirelessly to train and educate health care professionals, and to test the safety, immunogenicity, and efficacy of vaccines. We must not stop until we reach every child in Africa with rotavirus and other lifesaving vaccines.
A proud new mother in India cradles her newborn. Photo credit: Richard Franco.
Baby Whitney arrived fourteen weeks early in 1980. Her mother Lisa Kidd traded visions of first snuggles in a newly minted home nursery to long days and nights at the neonatal intensive care unit (NICU) of Portsmouth Naval Hospital in Virginia. More than two hundred miles from home, what the hospital lacked in convenient location it made up for with the region’s leading technology and expertise. Far from their families, Lisa and the other NICU moms supported one another through some of their most harrowing days. But round-the-clock vigilance was not feasible for everyone, and when many mothers had to leave for trips home or others could not even afford travel to the hospital, Lisa extended support to her new community – she donated her excess breast milk. (Full disclosure: Lisa is not only a generous and fantastic mother; I can directly attest that she is a great mother-in-law too).
Human milk is the single most powerful intervention to save babies’ lives, providing the unique nutrition and immune support they need to survive and thrive. Compared with formula, according to the American Academy of Pediatrics, breast milk reduces the risk of sepsis and necrotizing enterocolitis in neonates, reduces the time hospitalized infants remain in care, and reduces feeding intolerance, diarrhea, gastric issues, and other dangers. But while breastfeeding may seem like a simple, straightforward—not to mention rigorously scientifically proven—intervention, neonatologists worldwide report that between 15 to 40% of infants in NICUs do not have access to their mothers’ milk.
The World Health Organization recommends the safe use of donor milkfor vulnerable babies who cannot be fed their mother’s own milk. When a mother has died or has a health issue that makes breastfeeding impossible for either short- or long-term, donor breast milk is a safe and effective alternative. Facilities pasteurize donated milk to ensure it is safe, and then freeze it until needed. However, scaling up this lifesaving intervention has been challenging in poor countries.
Hospitals in low-resource settings face technological barriers to safe milk banking (more on that later), and challenges persist among communities in the general population, as well. Inappropriate, aggressive marketing of breast milk substitutes like infant formula can undermine parents’ confidence in breast milk and distort perceptions. Lack of awareness is a crucial contributor to the alarmingly low rate of exclusive breastfeeding (37%) in low- and middle-income countries. In fact, the WHO International Code of Marketing of Breast-milk Substitutes calls on countries to protect breastfeeding and enact laws against the inappropriate marketing of breast-milk substitutes, feeding bottles, and teats. When breast milk substitutes are necessary, the code aims to ensure they are used safely. A new report provides an update on country-specific progress to enforce laws on marketing breast milk substitutes.
Appropriate infant and young child feeding, including breastfeeding, is so essential that efforts must extend beyond a single intervention to promote a shared understanding of its value and make the case for sustained investment. Through our Mother and Baby Friendly Initiative Plus, PATH applies a comprehensive model for improving infant and young child feeding practices, including increased access to donor breast milk for at-risk mothers through human milk banking. Our projects in South Africa, India, Kenya, and Vietnamfocus on developing locally adapted, government-led, quality systems for ensuring safe access to human milk for all infants. We are also working on innovative and cost-saving technologies for low-income settings, like our mobile-phone app that directs and monitors a simple flash-heat pasteurization process and a rapid, point-of-care diagnostic device for screening donations. On the flip side, for a smaller group of infants who have difficulty breastfeeding, such as those with cleft-palate or who are born pre-term, we are partnering to accelerate access to the NIFTY cup, which features unique reservoir and flow channels that allow infants to lap or sip at their own pace. This comprehensive approach also prioritizes caregiver counseling on infant and young child feeding practices and kangaroo care (skin-to-skin contact). Counseling emphasizes WHO recommendations for exclusive breastfeeding during the first six months, addresses problems with breastfeeding including insufficient breast milk, and highlights complementary breastfeeding through two years of life.
In Kenya, we are documenting improvements on exclusive breastfeeding rates through the Baby Friendly Community Initiative, funded through the USAID Maternal and Child Survival Program (MCSP) and conducted in partnership with the Ministry of Health and UNICEF. Success at the community level is informing the development of an implementation package to guide scale-up. Through MCSP, PATH is also working to revitalize the Baby Friendly Hospital Initiative in Malawi in partnership with Ministry of Health, partner organizations, and WHO. But these interventions can only be taken as far as government commitments, resources, and funding allow. That’s why PATH is helping to promote supportive policies that enable countries to set aside targeted resources for comprehensive breastfeeding strategies.
Evidence is overwhelming for the pivotal benefits of a mother’s milk, and when a mother is unable to provide her own, ensuring access to safe donor milk helps keep this promise of a healthy start to vulnerable infants. This network of care—built on the generosity of mothers like Lisa and her peers around the world—can save lives simply and safely. But it is only as strong as the comprehensive programs and policies that sustain it.Read more
I am often asked why I chose sanitation as a focus area and what makes the India Sanitation Coalition (ISC) different.
My work and interest in water efficiency and also empowerment of women led me to the need for sanitation. In global events I would hear about India having the highest percentage of open defecation (accounting for 59 per cent of the 1.1 billion people in the world who practice open defecation) and the lack of toilets. My husband, who has worked in NGOs for the last 15 years, and I began to dig into the subject about a year before the Swachh Bharat Mission was established. Then our Prime minister put it on the national agenda – we could not have hoped for more.
I always believed that sanitation as a sector cannot be understood or tackled in isolation. In particular, the differential impact of poor sanitation practices and infrastructure on maternal and child health and safety is well documented. Repeated diarrhea caused by open defecation leads to death and stunting, which affects the child’s physical and mental development, affecting the productivity of our people. A large number of our girls are not being able to go to school for lack of toilets, and women hold themselves between dawn and dusk leading to various illnesses. The lack of awareness of the health aspects of open defecation needs to be addressed through education and communication.
At the ISC we recognise that there are strong players who have expertise in implementation, capacity building, are repositories of knowledge, and that donors and corporations are interested in funding.
That is where the ISC sees its role – bringing different actors together to share their learning and expertise, to collaborate and partner, to leverage each other’s strengths in different geographies, and to synergize where possible. We build on this wealth of experience for everyone to gain, and support mechanisms that make it easier for various stakeholders to engage in the sanitation space. ISC is therefore a platform to empower, to act as a catalyst, and to galvanize stakeholders, enabling all players to do their job better and support Government in its Mission. Doing so will help build a sustainable sanitation ecosystem.
At the Coalition, we strongly advocate for sustainable sanitation that includes addressing the entire value chain of Build, Use, Maintain and Treat (BUMT). Infrastructure creation alone will not move us towards the government’s target to make India Open Defecation-Free (ODF) by 2019. Today, we have a historic opportunity to address the problem of sanitation in its entirety using the momentum generated by the Swachh Bharat Mission (SBM) to realize the ambition of sustainable sanitation.
Photo credit: PATH/Satvir Malhotra.Read more
A scientist has a mandate: objective, data-driven fact-finding; research with an open mind and a solid protocol. But a scientist is more, too. Behind the standards of practice and quality control checks are life experiences, a full range of emotions, motivations, and passions. Scientific evidence is key to confirming unequivocally that diarrhea still sickens and kills too many children; chronic illness stunts growth and development; and vaccines can prevent severe disease. But in telling the story of diarrheal disease – as a complement to figures, findings, and data points – we wanted to explore that other side of science, to get at the human stories behind these stats. We asked a few researchers to reflect.
Dr. Deborah Atherly studies the cost-effectiveness of vaccines against rotavirus and other child health threats. Her findings tell of life-years lost to disability from repeated illness; she investigates the burden of health care costs on poor families. Beyond the numbers, we asked Debbie, what does this cost burden mean for a family? “That might mean one less meal with protein for the family… that school fees can’t be paid for one of the children in the household,” she shared. “Those small amounts can have a tremendous impact on a family.”
Dr. Richard Rheingans builds statistical models to parallel the potential impact of vaccine introduction with patterns of immunization coverage in poor countries. His research demonstrates that recognizing disparities in access across different communities is an important consideration for maximizing the benefits of and achieving the greatest return on investments in vaccines. When we asked him to reflect on his motivation in teasing out these complex calculations, Rick told us “It’s about making a difference for families that might otherwise be ignored. I’m passionate about data that helps decisionmakers, funders, governments, families make decisions that will improve life for kids who would otherwise be marginalized.”
As a researcher and a clinician, Dr. Roma Chilengi has not only evaluated the health and development of children in his community through routine care and wellness checks, he also partners with international teams to evaluate new vaccines that could mean the difference between life and death for these and millions more children. Roma has served as both chief medical officer and chief research officer at the Centre for Infectious Disease Research, Zambia. He shared his perspective on the the very real, lasting power of vaccines and immunization. “If you look historically on the fight against infectious diseases, where there has been remarkable progress for the developing country setting, it’s really with the help of vaccines. In developing countries, the health systems are so weak that even preventable diseases have a big toll on the population. But when you vaccinate a child, they are basically empowered to live on and meet whatever illness and survive it.”
These scientists had compelling stories to share, and we believe that behind every protocol and methodology, underneath each result, there are many different human stories; not only among the beneficiaries of advances in global health, but in spotlighting the people who dedicate their careers to finding ways to maximize those benefits, as well.
Spotlights are tough for anyone unaccustomed to them! (Us included.) And we are so grateful for the partners and colleagues who have allowed us to turn a spotlight--and sometimes even a video camera—on them to help tell stories of defeating diarrhea. With so many great minds working on this crucial cause, we’re excited to continue exploring this avenue.
For now, we invite you to hear more from Drs. Atherly, Chilengi, and Rheingans in a new video, sharing their perspectives and expert knowledge about the tangible impact that repeated, chronic illnesses like diarrhea have on families where poverty and pathogens are ever-present—and the motivation for their research on solutions to best relieve those burdens.
We loved Roma’s take on why it’s so important to apply his expertise and experiences to protect the lives of vulnerable children, as both a scientist and an advocate. “We cannot just accept what is,” he declared. “We have enough knowledge and ability to say ‘no’ to some things, and not just to say ‘no’ but to be able to do something about it; to fight to make a difference.”Read more