RotaFlash, April 2016
This week, Save the Children India (SCI) will begin implementation of its nationwide Stop Diarrhoea Initiative. Officially launched in India in March with support from Reckitt Benckiser, this Initiative implements the WHO/UNICEF seven-point plan to ensure comprehensive diarrhoea prevention and control.
The Initiative grew out of SCI’s work in water, sanitation, and hygiene (WASH). Since January 2013, SCI has been working on an exclusive multi-state WASH project in Delhi, Bihar, West Bengal and Jharkhand to include both rural and urban settings. Under this project, SCI works with school children and teachers, community members, local institutions, community-based organizations in slum villages, brick kiln workers, and users of the community toilet complex.
The programme installed 20 brick kilns and 40 appropriate technologies for improved water and sanitation access in 40 slums, including household toilets, community sanitation blocks, and demonstrations of sanitary protection of water sources. In an attempt to get the message out to children, SCI implemented WASH programs in 90 schools where inclusive design of water, sanitation, and handwashing infrastructures were demonstrated.
SCI has also helped local government institutions deliver efficient services, test alternative approaches to rural toilet designs, and encourage strong community participation to repair and maintain toilet complexes.
Aware about the connection of unsanitary conditions with diarrhoea, one of the major contributors of infant and child mortality and morbidity, SCI launched the multi-state Diarrhoea Control Initiative in partnership with the state governments. States with high incidents of diarrhoea like Uttar Pradesh, Uttarakhand, Delhi and West Bengal will be covered under this intervention.
In these four states, the Initiative will cover six rural districts in Uttar Pradesh and Uttarkhand and four urban poor wards in Delhi and Kolkata. The intervention will also cover 400 schools. The four year project will cover a population of two million. SCI will also promote block models in rural areas and work to achieve Open Defecation-Free status over a period of three years – aligning to India’s ambitious Clean India Campaign.
This project is part of global partnership between ‘Save the Children UK’ and Reckitt Benckiser which is under implementation in India, Pakistan, and Nigeria.
-- Manabendranath Ray is Deputy Program Director and Asad Umar is Team Leader ‘Stop Diarrhoea’ Initiative Save the Children India.
Photo credits: Save the Children IndiaRead more
Partnership between PATH and icddr,b has yielded crucial research results that have not only impacted local communities, but have also informed global policy advances. Today’s blog highlights icddr,b’s important role in research and clinical care, particularly their work to champion cornerstones of preventing and treating childhood diarrhea.
Salt, sugar and water. Over fifty million lives have been saved thanks to oral rehydration solution (ORS), a simple saline solution developed and tested in Bangladesh in the late 1960s by icddr,b, and now the treatment of choice for children suffering from diarrhoeal diseases.
Based in Bangladesh, icddr,b is an international public health research institution with a long history of addressing some of the most critical health challenges facing low-income countries through research and field-based interventions.
Medical officer Dr. Rafia Akter updates a patient’s data during her round in icddr,b’s Matlab hospital.
icddr,b researchers actively engage with NGOs, international agencies and the Government of Bangladesh to ensure that research evidence informs policy and practice, and improves national health outcomes and international health policies.
In its 40-year history, Bangladesh has undergone little short of a health revolution. Despite limited financial resources, the country has achieved significant reductions in child and maternal mortality, and is one of just six countries on track to achieve Millennium Development Goals (MDGs) 4 and 5. This can be attributed, in part, to Bangladesh basing many of its health policies on locally-generated evidence.
Food Safety Laboratory Research Officer Subarna Roy looks at food and waterborne diseases.
Worldwide, diarrhoea is the second leading killer disease in children under five years of age. In Bangladesh however, where ORS is widely known about and used by mothers, it now ranks as the ninth leading cause of death. icddr,b scientists have also led the way in demonstrating the benefits of zinc supplementation, which - when combined with ORS - reduces the duration and severity of diarrhoea and prevents subsequent episodes. This combined therapy is now recommended by the World Health Organization (WHO) for the management of childhood diarrhoea.
With hundreds of patients presenting daily with cholera and other diarrhoeal diseases at icddr,b’s Dhaka Hospital, the technical skills and expert knowledge of icddr,b‘s scientists and clinicians are highly valued when cholera outbreaks occur around the world. A founding member of the World Health Organization’s Global Outbreak and Response Network (GOARN), icddr,b provided technical expertise in the risk assessment and management of cholera outbreaks in Northern Iraq and South Sudan in 2014.
icddr,b’s doctors, nurses, scientists and researchers work together in-house and with global partners such as The Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization, and Save the Children to find science-based, life-saving solutions.
As we look to the future, icddr,b is committed to working with partners locally and internationally to translate the lessons learnt from Bangladesh, and to continue contributing to saving the lives of children and vulnerable populations across the globe.
Photo credits: icddr,b.Read more
Update: This story has a happy ending. On Tuesday, June 23rd, the author did go back, and her son got his last dose of the rotavirus vaccine.
Today is my son’s six-month birthday, and my husband and I took him in for his six-month pediatric appointment. He was due for his third and final doses of TDaP, Hib and IPV (pentavalent), HepB, PCV and rotavirus vaccines – only there was no rotavirus vaccine in stock. My state-of-the-art pediatric practice in Washington, DC, had a stock-out.
Working on vaccine policy, I hear about stock-outs all of the time. Parents (usually moms) walk for miles and make other sacrifices to bring their babies to health clinics for their vaccines, only to find that the clinic has run out of the vaccine or the order never arrived.
For me, this is a mere inconvenience. When the clinic calls that the vaccine is back in stock, I will walk the few blocks with my son, wait a few minutes to see the nurse, and likely show up to work an hour late.
For millions of families around the world who aren’t as lucky as my family, the decision to return carries much more weight and burden.
At the same time that we build vital demand for families to vaccinate their children, we must also ensure that adequate supply is available for the families when they come. Vaccine availability depends on a multitude of factors, but a critical component is the supply chain and logistics systems that ensure vaccines (and related supplies) arrive safely when and where they are needed.
This is why the World Health Organization Immunization Practices and Advisory Committee (IPAC) and Strategic Advisory Group of Experts on immunization (SAGE) issued a Call to Action on immunization supply chains and logistics; WHO and UNICEF launched the Effective Vaccine Management initiative to help low and lower-middle income countries upgrade their immunization supply chains; and WHO, UNICEF, the Bill and Melinda Gates Foundation and Gavi launched a joint Supply Chain Strategy to help countries put the fundamentals in place for improved immunization supply chains.
We need to continue to build on this moment and see greater national action so that appropriate supply is available to meet the demand – so that families don’t make the trek only to be turned away.
For my family, we will return. But who knows about the millions of parents in less fortunate situations who may make the difficult decision not to return.
For more information:
-- This video from UNICEF shows a side-by-side comparison of two mothers whose access to vaccines looks completely different.
-- This isn't Erin's son's first appearance on the blog! Erin's advocacy work came full circle when her son received his first rotavirus vaccine.Read more
Alongside the threats of diarrhea or pneumonia, which children face every day in poor communities, the health of their mothers is another pivotal factor affecting their well-being. The death of a
mother increases the chances of a child’s death in the first year of life. By caring for mothers through quality family planning and reproductive health services, we care for their children as well.
DefeatDD chatted recently with Pamela Barnes, President and CEO of EngenderHealth, about the overlap between maternal and child health, particularly in India, where 120 women die from pregnancy-related causes every day. In the last six months, EngenderHealth has expanded its reach from one to four states and is partnering with the governments of Bihar, Gujarat, Rajasthan, and Uttar Pradesh, to build standards for informed consent, clinical safety, infection prevention, and other aspects of quality service delivery.
Where do you see the connection between EngenderHealth’s work and 0–5 child survival?
At EngenderHealth, we focus on women’s health because we believe that when women thrive, so do their families and communities. Maternal health is inextricably linked to newborn survival. For pregnant women and newborns, the greatest risk comes during childbirth and in the first few hours and days afterwards. If a mother does not survive, the chances of her infant surviving decline. The death of a mother increases the chances of the death of her child in the first year of that child’s life. The bond between a mother and a child is inseparable. Without her, the child will not be breastfed and that itself endangers the child.
The child’s health may also compromised if the mother is an adolescent and undernourished. We all know that anemia leads to high risk of postpartum bleeding. In this case, spacing of children, too, is important. It is important to remember that many of these deaths are preventable or treatable. If a woman receives better maternal health care, this can help reduce the main causes of newborn deaths, including prematurity, complications during delivery, and infection.
I was here in Delhi in 2010 for a meeting on maternal health. On the day of the meeting, there was a poignant story about a woman dying on the streets of Delhi during childbirth. At the meeting, I just felt, “Oh my. What a big job the Minister had at hand—if this was the situation in the capital, New Delhi.”
By addressing a woman’s sexual and reproductive health needs across her lifetime, we can also reduce newborn deaths. If we met the global unmet need for modern contraceptives and basic maternal care, for example, newborn deaths globally would drop by 77 percent.
What is it that you are doing differently?
In addition to encouraging more in-facility deliveries, improving the quality of services is also a priority. Visiting the country after five years, I am encouraged that 50 to 60 percent of the deliveries are now occurring in health facilities. During a visit to Chaksu, 46 km from Jaipur, I was very encouraged when I saw the pride with which the doctors and nurses have learned to work as a team—a visible change in the attitude of service providers. There has been a lot of change in the remote areas where we work, where there were no facilities earlier. There has also been significant improvement in terms of infection control, privacy for laboring mothers, and quality of counseling and services.
An adolescent counseling session in Jharkhand, India.
The situation in Bihar is far better than I had seen earlier. A continued part of our work is to promote the rights of women to make informed decisions and enable access to high-quality services.
Bihar and Rajasthan have among the highest levels of child marriage in the country: 69 percent of girls in Bihar and 65 percent in Rajasthan are married before they reach age 18. The girls are anemic and have greater chances of postpartum hemorrhage, as they are unable to understand the risks of early pregnancy, nor empowered to delay or space their pregnancies.
Nowadays, in the area where parents wait to see the doctor, there is information about nutrition, breastfeeding and child development. This is critical to getting better health messages into the community.
How can diarrheal diseases and nutrition needs of under-5 children be addressed?
It is critical to have a woman-centered approach. Once a woman has access to health care, sanitation, and the power to make informed decisions about when or if to have children, she is more likely to go further in her education, earn more, and have healthier children. This has a transformative impact on the quality of her life and the quality of life for her children.
What is your take on India reaching its MDGs?
India has made great strides toward achieving the Millennium Development Goals, but in particular maternal mortality remains high (178 deaths per 100,000 live births) and most of these deaths are preventable. While the Indian government is very committed and it is a very exciting time to be working in India, there is a great shortage of doctors. There is a continued need to focus on delivering high-quality services, including care that respects the rights and choices of women. I have met with officials to discuss ways in which to support India’s goal to improve health and reduce maternal and child mortality. But there is just so much more to do!
Photo credits: EngenderHealthRead more
Gracy pictured here with her husband, Ramesh, and daughter, Ashira.
Gracy Gompana will very often not entertain a query unless you have your basic facts right. There is a reason for that. Having completed her Masters in Human Genetics she worked as a lecturer for five years before entering the field of clinical research. Beneath that professorial air, though, PATH’s Project Manager for a rotavirus vaccine Phase 3 efficacy trial currently underway in India, is a hard-core professional and—yes—somebody who will not rest until an issue is sorted out.
She moved to PATH in 2011 from the International AIDS Vaccine Initiative (IAVI), where she worked as a Program Officer for two years in the areas of project management, clinical operations, advocacy, and knowledge management. Prior to that she worked at Bioinnovat Research Services as a clinical research coordinator. The mother of the lovely Ashira, Gracy hails from Vishakhapatnam on the Eastern coastline of Southern India and has been in Delhi since 2008.
Tell us about your work on the rotavirus vaccine study.
I work as the Project Manager for the ongoing Phase 3 efficacy trial of a bovine-human reassortant rotavirus vaccine (BRV). My work involves keeping the team abreast of ongoing project activities. I prepare timelines for the project and ensure that the timelines are adhered to – which can sometimes be very challenging. I also prepare and share the project reports with the team and with external stakeholders. I oversee operations of the clinical trials, too, and manage and update our internal file hub.
It’s a very exciting phase in the project right now. We recently completed enrollment – which is a major milestone. Further, as a team, we are looking forward to completing the administration of dose 2 and dose 3 for all the subjects by the end of July.
You completed your Masters in Melbourne. How is that helping you in your current assignment?
I pursued my higher studies at the Royal Melbourne Institute of Technology and earned a Masters in Applied Sciences. It was an enlightening experience in terms of the way they impart education: the resources, basic infrastructure, and state-of-the-art classrooms and laboratories, to name a few. The experience of interacting with students across the globe gave me a unique perspective about how to think and deal with day-to-day situations across cultures. To support myself, I worked as a manager in WatchWorks Australia. This work experience gave another dimension to my perspective about how to understand and deal with people. Melbourne still remains very close to my heart.
What do find most exciting about the work you do in PATH?
I have been working in PATH for the past three and half years in the areas of project management and clinical operations. It gives me a lot of satisfaction that I am working in an organization which works to improve the health of underprivileged people across the world. Its approach is unique, right from vaccines to devices, and encompasses the whole gamut of healthcare. I have always wanted to work in a field that contributed to improving health and quality of lives.
Tell us about a passion of yours.
I am pretty addicted to televisions shows on National Geographic, History Channel, and Animal Planet. I love to cook, too!
For more information:
-- Learn more about PATH's rotavirus vaccine development work
-- About rotavirus vaccines
-- Videos: Meet some of our other vaccine development colleaguesRead more