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Archives for Global Health

Protecting Mothers and Children From HIV: A Call to Action

Originally published at the Huffington Post.

At this point in history, there is no reason why children should be born with HIV. Yet 390,000 infants around the globe were born with the virus in 2010.

Science has long established that providing mothers with antiretroviral drugs can prevent them from transmitting the virus to their children — as well as keeping the mothers alive themselves. What is needed is to take this intervention, available in affluent nations to prevent mother-to-child transmission of HIV, and make it available in the developing world.

The good news is that we know we can do this, in even the most challenging settings. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been the driver of a remarkable reduction in mother-to-child transmission in recent years. As we push toward the goal of an AIDS-free generation, the need is to broaden the participation in this effort.

This week marks an important opportunity to advance this goal: the Child Survival Call to Action, convened by the governments of the United States, India, and Ethiopia, in close collaboration with UNICEF. This high-level forum in Washington will bring together public and private partners to focus on one ambitious, yet simple, goal — to end preventable child deaths. It’s an inspiring vision.

Helping mothers give birth to HIV-free children is an essential piece of the puzzle of ending preventable child deaths. Beyond keeping the child alive, doing so provides wider benefits by keeping the mother healthy, and preventing the orphaning of other children in the household. Each dollar we invest has a multiplying impact.

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A Role for Business at the Frontier of Development

The social and economic challenges faced by Africa may seem daunting – with many communities suffering from hunger, a lack of clean water and sanitation, and little access to education or a functioning health system. However, if we work together, I believe we can overcome these challenges one-by-one and build a positive, virtuous cycle where we invest in healthcare, which in turn increases economic development.

In many parts of Africa people cannot afford to pay to see a doctor or buy medicines, and in many places they are not readily available even if they could. This results in a situation in which children are prevented from pursuing an education, and illness impedes personal, societal and economic development. We can change this.

We’ve come a long way over the past five years – in addition to medical advances, vaccines and basic healthcare services are now reaching some of the most remote areas of the world, in large part due to international aid from countries including the United States and the United Kingdom, along with generous funding from non-profit groups such as the Bill & Melinda Gates foundation. However, there is still much more to do, and moving to the next level will require a shift in mindset. It is clear than no single person or organisation can find the all answers to Africa’s problems. Only through strong partnerships and innovative collaborations will we find the strength and the resilience, creativity and energy to bring the scale of change required.

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Make Every Mother and Baby Count

In early May, we witnessed a spectacular commitment to “making every mother and baby count” here in Dhaka, Bangladesh.  The United States Agency for International Development (USAID), through their Maternal and Child Health Integrated Program, and in partnership with the Bangladesh Ministry of Health and Family Welfare (MOHFW), convened an important series of meetings focused on saving the lives of mother and their babies.  We wanted to tally for you the numbers that express just how much every mother and baby count:

  • Participation included more than 275 international maternal and newborn health professionals;
  • With over 29 countries represented;
  • Including over 100 individuals from Bangladesh.
  • But why?  Because just 1 maternal or child death is more than just a tragic occurrence. It affects the entire family, it affects social cohesion, and it dampens the economic growth of the countries. Data shows that after a mother dies there is an increased risk of death for surviving children.
  • Here in Bangladesh, about 20 women die every day from childbirth, about half of these due to 2 main causes, postpartum hemorrhage that is to say excessive bleeding and eclampsia (high blood pressure leading to convulsions). These are the very 2 factors that kill 50% of mothers in developing countries around the world.

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Zimbabwe’s Great Leap Toward Preventing HIV in Children

Photo Caption: Josephat was born HIV-negative because of PMTCT in Zimbabwe, and recently celebrated his fifth birthday. Photo Credit: EGPAF/James Pursey

As featured on the Huffington Post

This week, I witnessed a milestone in the fight to end HIV/AIDS in children — and it happened in Zimbabwe.

Much of the news from Zimbabwe over the past decade has been around political and economic challenges, overshadowing a resounding public health success story.

Zimbabwe is one of the key countries to watch in the drive to eliminate pediatric AIDS in Africa.

On Monday, I attended a ceremony at Harare Central Hospital to launch Zimbabwe’s national strategy to prevent new pediatric HIV infections. I joined representatives from government, international partners, donors, health workers and people living with HIV.

It was a diverse group, but all dedicated to a common cause — that no child should be born with HIV — not in Zimbabwe, nor in any other country.

In June 2011 at the United Nations, a Global Plan was introduced to eliminate mother-to-child transmission of HIV by 2015. Zimbabwe was among the first of many countries to answer the call, but its commitment on this issue was evident long before that.

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PMTCT and 5th Birthdays: Not Without the Mothers

The prevention of mother-to-child transmission (PMTCT) of HIV is taking center stage this week during USAID’s 5th Birthday campaign — and rightly so.  Preventing mother to child transmission of HIV is one of the most critical, effective tools to helping kids reach their fifth birthdays.

Ambassador Eric Goosby and UNAIDS Executive Director Michel Sidibé have called for the elimination of pediatric HIV by 2015. Touted as one of the HIV prevention interventions with the most “bang for our buck” by the Copenhagen Consensus Center, there is significant momentum behind continuing scale up of mother to child transmission reduction programming towards elimination of mother to child transmission. But, current recommendations requiring a CD4 test before initiating some sort of ARV prophylaxis for HIV-infected pregnant women may not be the most effective way to prevent MTCT, fully treat the mother, and help kids reach their 5th birthdays.

We can move closer to the goal of eliminating pediatric HIV by 2015 by treating the mother, treating the baby, and continuing to treat the mother.

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Winning the Fight Against HIV in Children

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Originally published at Blog.AIDS.gov.

Over thirty years ago, when the fight against HIV first began, the outlook for tackling the pandemic was bleak. Across the world, AIDS was seen as a death sentence. Within just a few years, it had devastated communities from the United States to South Africa.

But the world continued to fight, and the past three decades have seen tremendous progress in HIV research, prevention and treatment, thanks in large part to the leadership of the United States. Today, we can build on that strong legacy to answer President Obama and Secretary Clinton’s call for an AIDS-free generation.

The 19th International AIDS Society (IAS) conference will be an opportunity to renew our commitment to this incredible goal. It also marks an historic moment, as the United States hosts the conference for the first time in over 20 years now that people living with HIV and AIDS are able to visit the U.S. to attend in-person.

We know that we have a long way to go to win the fight against HIV–especially for children.

Through the President’s Emergency Plan for AIDS Relief (PEPFAR)–the largest international commitment to a single disease by any individual country–the U.S. Agency for International Development (USAID) and other U.S. government agencies provide lifesaving HIV and AIDS services to millions of children, women, and families worldwide. 

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This Week at the 65th World Health Assembly (WHA)

The 65th World Health Assembly (WHA) took place in Geneva and reflected on a decade of progress in global health, particularly in maternal and child health, uncertainty in the current economic climate, new challenges like non-communicable diseases and a sense of urgency to improve health systems.

Dr. Ariel Pablos-Méndez at the World Health Assembly. Photo Credit: USAID

Dr. Margaret Chan was elected for a second five-year term as Director-General of WHO. She is a dynamic leader and a champion for women and child health. In her plenary address, she described universal health coverage, the theme of this year’s WHA, as the single most powerful concept in public health.

In the past, I made the case for health reform to control rapidly growing out-of-pocket expenditures. This message is coming from partner countries as well: sixty countries have requested technical assistance in health finance to shape more efficient and equitable health systems.

An optimistic WHA called for the introduction of new vaccines as well as ensuring support for basic immunization as part of the Global Vaccine Plan. With the global polio campaign facing a “now or never” moment, WHO is launching an Emergency Action Plan. WHA also endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition.

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Reliable Family Planning Supply Chain Delivers Better Health and Prosperity to Ethiopian Families

“I started using contraceptives after I gave birth to my second child,” said Birtukan Bezabih, a 25-year-old married mother of three in southern Ethiopia. “I did not know that I was pregnant with my second child until [he] started moving inside my womb.  It was just a few months after I gave birth to my first child…so my first child didn’t get proper care and he was not well breast fed.”

Nurse Haileshet Bekele at Tulla Health Center counsels Birtukan Bezabih, a mother of three. Photo Credit: USAID

Access to family planning empowers couples, like Birtukan and her husband, to plan and maintain healthier families. After the challenge of breastfeeding her first child and carrying her second at the same time, Birtukan turned to family planning methods to choose the right time to bring a third child into her life.

In Ethiopia, the Ministry of Health is committed to improving access to family planning through programs that have benefitted countless women and families to date. During the past six years, Ethiopia has seen a rapid increase in contraceptive use and a decline in the average number of births per woman. From 2005 to 2011, the percent of reproductive-age women using contraceptives in Ethiopia nearly doubled, from 15 to 29 percent. In the same period, the average number of children born to Ethiopian women declined from 5.4 to 4.8. By having fewer children by choice and ensuring children are spaced a healthy distance apart, mothers in Ethiopia are able to care better for the children they have, helping more children reach their fifth birthdays.

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Community Mobilization

I accompanied our Mission Director on a field trip to northeastern Madagascar in January 2012, where a USAID partner, Santenet2, is implementing a mother and child health and family planning program.

One of the villages that we visited was Amboanio, where poverty is rampant after the closing of a cement factory that used to provide jobs to the local people.  Amboanio is in a remote, poor rural area where access to health care is more than inadequate: the nearest health center is 5km away, and the main hospital another 40km from there.

Marie-Ange and her son Bertrand Photo Credit: Bruno Rasamoel, USAID/Madagascar

In 2010, the USAID-funded Santenet2 program launched a community-based system that helps to identify danger signs in pregnant women and newborn children. It also arranges for their medical evacuation in case of an emergency.

One of the first beneficiaries of this system in the village was Marie-Ange, a fisherman’s wife, who was pregnant in 2010 and started having labor pains when she was in her eighth month of pregnancy. “In March 2010, I was pregnant again with my child—this one, Bertrand. I had a miscarriage two years ago. My water broke but then labor stopped.  The community health worker took me to the local health center—it’s a one-hour walk—where the chief physician recommended that I go to the hospital. My father and the Mayor arranged for transportation up to the central hospital,” she said. Marie-Ange was evacuated to the main hospital, using a rural bus paid by the community through a social solidarity fund. She went straight into the operating room, and her life and her baby’s was saved.

This community-based emergency medical evacuation plan, established under USAID/Santenet2’s “obstetrical and neonatal care” program, works through a Solidarity Fund that is run by a Social Development Committee (SDC). Participating village residents contribute a small amount on a monthly basis. The Fund pays for necessary medical evacuations, using rural taxis called taxi-brousse. One member of the SDC, Samsoudine Ben Said, said: “I’m the Deputy Mayor of Amboanio, and at the same time a member of the Social Development Committee (SDC) that is comprised of representatives of the community at all levels, I mean villages, churches, transporters, local dignitaries. I want to make it clear that referring a patient to the hospital is a decision to be made solely by the physician at the health center. There’s no fixed amount for financial contributions to the solidarity fund. Those who have more money contribute more, and those with less money contribute less.” The SDC enters into an agreement with local transporters that provide regular transportation services between the commune and the main town. Fuel is paid out of the solidarity fund, and the patient reimburses after she is healed.

It is very simple: Marie-Ange’s life was saved thanks to community mobilization. The entire community is now much more aware of the need for emergency services and advance planning.

USAID’s FrontLines – June/July 2012

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Esther Ouma with her son, Barrack, in the Busia district of western Kenya. After losing her first two babies, Ouma successfully delivered Barrack after a visit from a community health worker who provided a link to health services and support groups available to expectant mothers in some Kenyan communities. “I will forever be grateful,” says Ouma, who attributes her good health and that of her child to the health worker’s intervention.  Photo credit: Bibianne Situma, AMREF

Read the latest edition of USAID’s premier publication, FrontLines, to learn more about the Agency’s work on issues surrounding child survival and its portfolio of projects in Ethiopia. Some highlights:

  • Efforts to end preventable child deaths are in their last lap and on a sure path to victory, says USAID’s top doc in the Bureau for Global Health.
  • The Swaziland parents who decide to have their newborn baby boys circumcised are part of a worldwide effort to achieve an HIV-free generation sooner rather than later.
  • UNICEF Chief Anthony Lake has seen firsthand the resourcefulness of this planet’s youngest citizens in the midst some of its worst disasters.
  • Find out why, despite one of the region’s worst droughts last year, the perpetually battered country of Ethiopia escaped the season with no famine.
  • A truce between four groups of people from Ethiopia’s Somali and Oromiya regional states who held longstanding grievances appears to have ushered in an unprecedented period of peace and an end to violent – and sometimes deadly – clashes.
  • Though Earth Day celebrations ended in April, USAID’s work to protect the environment continues 365 days a year. See that work through photos that won the 2012 environment photo contest put on by FrontLines and the Bureau for Economic Growth, Education and Environment as well as those that came in as runners-up.

Subscribe to FrontLines for an email reminder when the latest issue is posted online.

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