As a community health specialist with USAID’s Quality Health Care Project in Dushanbe, Tajikistan, I educate community members, medical workers, patients, and their families about tuberculosis (TB) diagnosis, treatment, and infection control. My job involves being constantly available and responsive to the needs of patients and their families, and I tend to work unusual hours in order to fit into their schedules. Still, I was a bit surprised when I received a call from Safarov Khudodod in the middle of the night last month. Khudodod is an imam, a religious leader at his mosque, and he was so excited about a TB testing referral he made after his sermon that he couldn’t wait until the morning to share it with me.
“I heard the man coughing and approached him to ask him about his symptoms. I encouraged him to get tested. He just reported back to me that he tested positive for TB and will begin treatment immediately,” he said.
Imams in Tajikistan play a major role in the lives of their congregations. They lead ceremonies such as weddings and funerals and provide religious advice to those seeking it. USAID is working with religious leaders in Tajikistan to inform them about the causes and treatment of TB. USAID workshops are helping participants like Imam Khudodod to encourage known TB patients in their communities to get treatment and teach them how to avoid transmitting the disease to others. I meet with workshop participants several times a year to help them complete self-designed outreach plans. The 62 people we’ve trained have already reached approximately 20,000 community members.
Before he attended USAID’s TB workshop, Imam Khudodod told us he knew very little about TB. “Before, we thought that TB was a genetic disease, but now we know it isn’t. Many people in my community think that TB isn’t curable, so they don’t get treatment. I share information about TB at all of my meetings with my congregation, even at weddings and births. I have already reached out to over 5,000 people.”
Tajikistan has the highest rate of TB incidence in Central Asia and one of the highest multi-drug resistant TB rates in the world. Encouraging individuals to complete treatment and teaching them basic rules of infection control are key steps in eradicating TB in countries like Tajikistan.
Imam Khudodod is optimistic about the future of TB in his country: “I think that the next generation will be healthy and will know about TB.”
Some of the fastest growing economies in the world today are in East Asia and Latin America – countries that were among the poorest in the world just 40-50 years ago. A distinguishing common feature of these countries today is that the working age population—those between 15 and 64—is larger than the dependent population—the very young and old.
The demographic dividend is an opportunity that arises when a country transitions from high to low rates of fertility and child and infant mortality. This transition creates a generation that is significantly larger than the generations immediately preceding and following it. As this cohort enters working age, they have the potential to enter into productive economic activities and invest savings at relatively high rates, thus spurring heightened economic growth.
This blog post is published in conjunction with the Child Survival Call to Action, which was convened June 14-15 by the Governments of the United States, India, and Ethiopia, and organized in close collaboration with UNICEF.
On a recent visit to northeast Bangladesh, I had the opportunity to visit rural postpartum women in their homes. My colleagues and I were undertaking site visits to a USAID program that provided integrated newborn, maternal and family planning services at the community level. After we entered the home of our first visit, we congratulated the new mother, who was holding her newborn wrapped in a blanket in her arms. We asked her how many children she had. She replied quietly, “This was my twelfth pregnancy — it is my fifth living child.” She explained that three children died as newborns, two were stillborn, and she had two miscarriages. The woman was only 32 years old. We heard similar stories from other women whom we interviewed.
The first step to ensure that a child reaches their 5th birthday starts even before they are born. USAID promotes Healthy Timing and Spacing of Pregnancy as a vital family planning intervention that helps ensure that pregnancies occur at the healthiest times in a woman’s life. Mothers and children are then more likely to survive and stay healthy.
A USAID analysis found that, by preventing closely spaced births, family planning could save the lives of more than 1.6 million children under five annually.
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This blog post is published in conjunction with the Child Survival Call to Action, which was convened June 14-15 by the Governments of the United States, India, and Ethiopia, and is organized in close collaboration with UNICEF.
The new mothers I met at the Regional Maternity Hospital in Kyzylorda, a province in southern Kazakhstan, were as weathered as the salty desert earth all around us. Their young faces appeared determined but exhausted, hinting at the many hundreds of kilometers they had to travel to reach the hospital in time to give birth.
The newborns these mothers cradled in their arms weighed less than a handful of apples. This region historically has suffered from the country’s highest newborn mortality rates. Kyzylorda suffers from many unhealthy environmental factors, like the Aral Sea pollution crisis and toxic mining, which the local doctors tell us contributes to poor health outcomes for mothers and infants. Prematurity accounts for about 37 percent of newborn deaths worldwide. Asphyxia and infections are other leading causes of newborn deaths.
If these babies had been born before 2008, they would probably not be alive today. Before 2008, when USAID started helping the regional health department adopt World Health Organization (WHO) live birth criteria, these babies would not have received the life-saving interventions such as neonatal resuscitation that kept them alive in those precious hours after birth. In the four years since the Kyzylorda Oblast Health Department introduced neonatal care technology and adopted a 500 gram (1.1 pound) live birth definition, doctors here have saved around 200 babies’ lives. The WHO live birth criteria state that all babies showing any signs of life, such as muscle activity, a gasp for breath, or a heartbeat should be included as a live birth and provided with interventions to keep them alive. Under the Soviet-era definition, infants who were born before 28 weeks, weighing less than 1,000 grams, or measuring less than 35 centimeters, were not counted as live births if they died within seven days.
Dina, age 27, delivered her first baby Diandra at an Indonesian hospital in Central Java. Hospital staff kept Diandra away from her mother in the newborn care unit and fed her formula until they deemed Dina ready and strong enough to feed the baby. Diandra fell sick with severe diarrhea and died at the hospital ten short days later.
Each year, more than 80,000 newborn babies die in Indonesia within the first month of life from treatable conditions, the most common of which are prematurity, low birth weight, birth asphyxia, and neonatal sepsis.
“Every family has a sad story about a baby or mother they know who lost their life from complications during pregnancy, delivery or immediately after child birth. Many attribute the deaths to God’s will but with the right technology, equipment, and training for health care professionals, it can be stopped,” said Evodia Iswandi, Jhpiego deputy director for provincial operations in Indonesia. “Good hospital administration and policies can also go a long way to enable staff to work at their full technical capabilities.”
Through Expanding Maternal and Neonatal Survival (EMAS), a U.S. Agency for International Development (USAID) – funded program in Indonesia, local health care providers receive training from one of Indonesia’s premier maternal and child hospital and other organizations on best practices in neonatal and maternity emergency services. Hospitals and community health centers learn how to prevent and treat hemorrhaging, premature delivery, low birth weight, high blood pressure, birth asphyxia, and other causes of death. USAID’s EMAS program also helps reform Indonesia’s referral system so that mothers and babies get to the right place, at the right time, in order to receive the right medical treatment.
“USAID is partnering with Muhammadiyah, one of the largest and most respected Islamic organizations in Indonesia committed to diversity and pluralism, to save lives and sustain EMAS even after the program ends,” said USAID/Indonesia Mission Director Glenn Anders.
Originally posted as an OpEd in Politico. Actor Ben Affleck is founder and director of the Eastern Congo Initiative. Rajiv Shah is administrator of the U.S. Agency for International Development.
More than 7 million children — most of them in sub-Saharan Africa and South Asia — are expected to die this year before reaching their fifth birthday. These kids will never have the chance to follow a passion or fulfill their potential.
But in our lifetime, we have made remarkable headway toward ending child mortality around the globe. In the past 50 years, the child global mortality rate has declined by 70 percent. In just the past 20 years, the number of child deaths has fallen by 4.4 million each year.
This progress is extraordinary. Yet there are still places, like the Democratic Republic of Congo, that these advances have yet to reach. In Congo, a country buffeted by decades of violence and political instability, nearly 465,000 children die each year from preventable diseases, like malaria, pneumonia and diarrhea. Chronic malnutrition also afflicts nearly 45 percent of all Congolese children, permanently stunting their physical and mental development.
This post originally appeared in Politico.
People often ask me what the global health community can do to have more impact. The answer is easy: We could be more like Tsion Berhanu.
I met Berhanu the last time I visited Ethiopia. My colleagues and I drove to the end of the road, then kept going for 15 more minutes, until we reached the Wuye Gosee Community Health Post, a tiny, three-room, concrete structure with an outhouse.
Berhanu lived in one room and worked in the other two — caring for 1,500 people in her kebele. Women came to her for contraceptives. When they stopped using birth control and got pregnant, they came for pre-natal care. When their babies were born, she gave advice about proper nutrition. When children got a little older, she immunized them. When people were sick, she treated them if she could and referred them to the district hospital if it was serious. She also advised families on how to store clean water and build sanitary pit latrines.
This is how health care is experienced and addressed on the ground. The community of donors, agencies and NGOs dedicated to better health for the poorest— including our foundation— has access to many more resources than Berhanu. What we don’t always do is drive conversation and innovation that can reflect her experience and perspective.
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As of today, 1,000 people around the world have posted photos of their 5th birthday in support of the Every Child Deserves a 5th Birthday awareness campaign. From Secretary Hillary Clinton and Kay Warren to Tony Hawk and Mandy Moore, government representatives, faith-based and civil society leaders, celebrity activists and athletes have uploaded photos of themselves at age five to help rally the world around the goal of ending preventable child death and ensuring all children get to celebrate their 5th birthday.
Age five is an important time. It’s when we start going to school, learning to read and making our own decisions. Age five is also an important milestone in the health and development of children. Over the last 50 years—especially in the last two decades—child mortality has fallen by 70 percent thanks to high-impact interventions like new vaccines, improved health care practices and community health workers.
Despite this progress, more than 7 million children will die this year from largely preventable causes before they turn five. In Africa alone, 1 in 8 children will die before they celebrate their 5th birthday. In order to change this devastating narrative, we must do more.
Today, we have the scientific, technological and programmatic advances to dramatically accelerate progress. Today, the Governments of the United States, Ethiopia and India are working in close collaboration with UNICEF to launch a Call to Action in Child Survival. Designed to end preventable child death by focusing on the survival of newborns, children and mothers, the Call to Action will convene 700 prominent leaders from government, the private sector, faith-based organizations and civil society to kick off a long-term, strategic effort to save children’s lives.
The Millennium Development Goals (MDGs) brought needed and increased attention to child survival. Globally, significant progress has been made in reducing child mortality. The number of under-five deaths declined from 9.6 million in 2000 to 7.6 million in 2010. Under-five mortality fell from 73 per thousand in 1990 to 57 per thousand in 2010. On average, under-five mortality has been falling at a rate of 2.5 per cent per year compared with 1.9 per cent per year over 1990–2000.
The rate of reduction doubled in Sub-Saharan Africa when compared with the previous decade. There is evidence that this rate of decline is accelerating as we approach 2015. New initiatives, such as the UN Secretary General’s Global Strategy for Women’s and Children’s Health, have added guidance and resources to the achievement of the goals. The subsequent establishment of the Commissions on Information and Accountability and on Life-Saving Commodities will add to the benefits for women’s and children’s health.
Still, despite accelerated progress, the global burden of maternal and child mortality is still unacceptably high. Over 280,000 maternal lives and 7.6 million under-fives’ lives were lost in 2010. Most of these losses would have been preventable with interventions that already exist. We know what these interventions are and what they require to be implemented. Unfortunately, we still fail to reach a large proportion of mothers and children with them, particularly in sub-Saharan Africa and South Asia, where most of maternal and child deaths occur. We need to find the ways to ensure that every mother and child has access to these interventions and can benefit from them.