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Archives for Global Health

World Health Day: Combating Drug-Resistant Tuberculosis

By: TB Alliance

MDR-TB can be transmitted through the air, and therefore patients like John are advised to wear masks at all times. Photo Credit: TB Alliance

John* can’t remember the names of all the medications he takes—there are just too many. In the morning, nurses watch him swallow 10 pills and give him an injection, and in the evening, they stop by with another two tablets. The regimen is tiresome, says John, but he is sick and has no other options. John is a multidrug-resistant tuberculosis (MDR-TB) patient at Kibo’ngoto National TB Hospital in Tanzania, one of few local facilities equipped to handle TB patients that have grown resistant two or more of the four drugs that comprise the standard treatment for TB.

John is only partially through his expected six-month stay at Kibo’ngoto, but even when he returns home, many more months of daily treatment await. John says it’s easy for patients to become depressed and despondent—and give up hope that they will ever get better.

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From U.S. Aid Recipient to Donor Partner: The Republic of Korea’s Health Ministry Honors USAID

For nearly 50 years USAID has been in the business of providing assistance to individuals in need to alleviate suffering, save lives, and foster a brighter future for families around the world.

Our mission here at USAID is a unique one: to put ourselves out of business.  We seek to carry out development so effectively that people around the world no longer need the assistance we provide.  To achieve our mission, we partner with countries, at their request, to assist them in the process of developing national structures that ultimately can function independently, without foreign aid.

Today, on the behalf of USAID, I accepted an award from the Republic of Korea’s (South Korea) Health Minister Chin Soo-Hee to honor a history of partnership that helped transform a once-struggling nation into a donor partner.

The collaboration began in 1954, when the International Cooperation Association, the predecessor to USAID, coordinated an agreement between the University of Minnesota and Seoul National University that facilitated the post-war exchange of medical education and research at a critical period in Korean medical reconstruction.

In subsequent years, USAID continued to provide health assistance that promoted the ongoing development of the Korean medical system. Today, we recognize the Republic of Korea as one of our longest-standing partners and identify them as a world leader in medical research and technology.

Once a recipient of U.S. development assistance, the Republic of Korea is now a donor partner that itself provides assistance to help the world’s poorest and most vulnerable people.  Today, the country produces high-quality, affordably priced vaccines that have played an invaluable role in preventing disease and childhood death around the world.

In 2010, the Republic of Korea became the newest member of the OECD Development Assistance Committee, or the DAC.  Its DAC membership marks the only time since the OECD was established in 1961 that a country has joined the “advanced nations’ assistance club” after transitioning from an aid recipient to a donor.  To have made this transformation in just a few decades truly speaks to the Republic of Korea’s extraordinary economic rise, the compassion of its people, and its commitment to effective and coordinated assistance.

We are very proud of the role USAID played in helping the Republic of Korea achieve its development goals. Its remarkable transformation in such a short time span is an inspiration and a reminder. It reminds me that our mission is achievable.

An Ancient Disease, A Modern Day Development Challenge, A Child Who Deserves a Future

By: Clydette Powell, Medical Officer, Division of Infectious Diseases

We need a game changer that puts innovation for Tuberculosis diagnosis and treatment at the forefront of our global health agenda. Unsanitary and unhealthy realities bred by third world conditions provide the perfect opportunity for this ancient disease to continue to spread through vulnerable populations. There is one vulnerable population in particular that is greatly affected by this disease and often go unnoticed: children. We don’t have a good estimate of the disease burden in this population; we only know that the numbers of cases continue to increase, or go undiagnosed and untreated or improperly treated;

  • the current diagnostic test dates back to 1907 and is fraught with challenges;
  • newer laboratory diagnostic tests in the pipeline are largely not being tested in this vulnerable population;
  • the “preventive” vaccine we have been using is based on “technology” which is 90 years old;
  • that vaccine has limited efficacy and does not protect against the most common form of the disease;
  • the most recent drug to treat this population was developed in 1967;
  • a full course of treatment consists of up to 1,000 pills, and more if drug resistant;
  • this population continues to experience disability and death from complications of this disease;
  • those who have this disease often acquire it from household contacts, that is, those closest to them – those who are more likely to be diagnosed and treated; yet, few public health staff trace those contacts;
  • preventive measures, which are safe and available, are generally not applied to the vulnerable ones in those households with this disease. Is that fair and just?

So, what is this problem that cries out for a game change? It is childhood TB. Tuberculosis.
Yes, that neglected disease that has been around since 6000 BC. A disease that Moses described as the “fiery consumption” among the Israelites, that knocked downed Incans, Egyptian pharaohs, many in the world of the fine arts, and the wife of one 20th Century American president.

Ka-quarta, an eight year old Angolan boy who suffers from TB of the spine, with Clydette Powell, Medical Officer from USAID’s Division of Infectious Diseases. Photo Credit: USAID/Global Health.

Meet Ka-quarta. An eight year old Angolan boy, whose name loosely means “Wednesday’s child.” Do you recall the rhyme ”Wednesday’s child is full of woe”? Ka-quarta has TB of the spine. That makes him full of woeful TB. He lives away from his rural village family and stays at the local hospital where each day he receives many pills, injections and one meal a day. He will do this for up to one year. Yet, he is hardly full of woe in the other sense of the word.

Flashing a smile, he met me at the entrance to the hospital in Benguela Province, extending a hand from beyond the deformed spine that shortened him, slowed him down and made him an unwelcomed standout in the crowd. He offered me a hospital tour, beginning with the wards he knew best: the TB wards. It was in these wards that Ka-quarta lived, slept and ate with other adults. For one whole year. For 1,000 pills. He hoped for a cure, to someday stand taller than he was, now squatted by the gross deformity of his spine. He hoped to play soccer, to keep up with his friends, to be able to sit in a chair and lean back without his spine arriving much sooner than the rest of his thin frame.

Ka-quarta is the best advocate on two legs for fighting childhood TB. Without a single word, his body tells the community why we need to fight this disease in children. The next time I visited Angola, I sent Ka-quarta a little doctor’s kit, complete with a plastic stethoscope and a play X-Ray viewing box, that conveniently displayed an image of a set of lungs. I am rooting for Ka-quarta to be the local TB specialist, when he grows up in both years and stature, if not the authority on childhood TB for his country. Why not?

So what about you? How about that game change? How about taking some first steps towards eliminating childhood TB? Or would you like us to serve you up 1,000 pills starting today?

Making TB Personal: An Ancient Disease and the Need for Innovative Solutions

By: Christy Hanson, Chief of Infectious Disease Division, USAID

When I began my career working with Tuberculosis twenty years ago, the outlook for future progress against this biblical disease looked very different than it does today.  From 1990 to 2009, the TB community has made tremendous progress—TB related deaths have declined by more than one-third, and incidence is declining globally. The emergence of new diagnostic technologies has made it easier to quickly detect multi-drug resistant TB.

Today, the global incidence rate is falling slowly, and 5 of the 6 regions of the world are on track to meet the UN Millennium Development Goal target to halve TB prevalence and deaths by 2015. We are now looking beyond this goal and are focusing on providing universal access to TB care. This is an effort that will require engaging all providers in the public and private sector, people in communities, and TB patients themselves.

It gives me pause to think this is the same disease that has plagued mankind as far back as the ancient Roman civilization. To understand how this disease has survived for millennia, it is important to know how it works.

This is a disease that is inextricably linked to the socioeconomic realities of the impoverished. TB is activated when an individual’s immune system is weakened by any number of causal factors: old age, malnutrition, pregnancy, HIV, and other concomitant illness, such as diabetes. It is estimated that more than one-third of the population in the developing world who are exposed to these conditions are infected with the disease.

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U.S. and World Bank Strengthen Water Partnership on World Water Day

On March 22nd, Secretary of State Hillary Clinton and World Bank president Robert Zoellick signed a Memorandum of Understanding (MOU) committing to a stronger partnership on water issues.  The agreement, signed at a World Bank ceremony on World Water Day, will bring the U.S. government and World Bank together to work on global water and sanitation challenges.

The need for a combined effort on water issues could not be clearer.  An estimated 880 million people lack access to an improved water source.  More than 5,000 people—most of them women and children—die every day from causes linked to unsafe water, sanitation, and hygiene.  The current outbreak of cholera in Haiti is a stark reminder of this reality.  Beyond health, water is central to a number of development challenges, such as climate change, food security, conflict, energy, and gender.

Secretary Clinton providing remarks at the MOU signing with the World Bank. USAID’s Deputy Administrator Don Steinberg and World Bank President Zoellick looking on. Photo Credit: State Department

The work promised at the signing has already begun: USAID and the World Bank have started to develop a prize to stimulate the development of new technologies related to drinking water and sanitation.  The World Bank is also working with NASA to provide remote sensing technologies around the world.  As speakers at the ceremony emphasized, this type of cooperation is necessary because water issues cannot be confined to just one area.

“The water crisis is a health crisis, it’s a farming crisis, it’s an economic crisis, it’s a climate crisis, and increasingly, it is a political crisis,” Secretary Clinton noted.  “And therefore, we must have an equally comprehensive response.  Now our experts in the United States Government are working on water issues at nearly two dozen agencies – of course, from State and USAID, but also the Millennium Challenge Corporation, NASA, NOAA, EPA, Treasury, and so much else.”

As a result, the United States is one of the largest bilateral donors on water and sanitation; USAID and the Millennium Challenge Corporation together invested more than $770 million in the water sector and on sanitation-related activities in developing countries in fiscal year 2009.

Secretary Clinton highlighted several USAID projects launched since her speech at last year’s World Water Day, which are representative of the new direction set for the U.S. government water program:

-       In Indonesia, USAID has begun a five-year, $34 million water, sanitation, and hygiene project to reach more than 2 million of Indonesia’s urban poor.  USAID also launched a project in Haiti to teach women about sanitation and hygiene so they could better take care of their households.  In India, USAID is supporting a project to provide slum dwellers in eight states with municipal water and sanitation systems.

-       USAID and the Qatar National Food Security Program convened representatives from 17 water centers in 10 countries across the Middle East and North Africa to create a regional network to share technical knowledge to solve the complex water challenges they face.

-       In Kenya, USAID is working with local water utilities, a local cell phone company, and a local microfinance institution to create new ways for poor people to pay for water. They receive a microloan to cover the initial cost of connecting their homes with water systems, then they repay those loans using micro-banking services on their cell phones.

-       In the Philippines, Japan and the United States have worked together to establish a water revolving fund to leverage private investment to improve water and sanitation for more than 100,000 people in 36 villages. Last year, the first USAID guaranteed loan for $2.5 million was granted.

-       To promote science and technology, USAID is working with NASA to use satellite images to monitor and forecast ecological changes in the Himalayas, including the monitoring of glacial melt. USAID has also worked with the private sector to open a ceramic water filter factory in Cambodia.  With ceramic filters, people no longer need to boil water to make it safe to drink, so they don’t need to burn as much wood or charcoal, which in turn reduces greenhouse gases.  The plant has even applied to receive carbon credits for future sales.

At the 2010 World Water Day event, Secretary Clinton stressed the U.S. government’s commitment to strengthening its partnerships; the MOU with the World Bank is reflective of that commitment.

Under the new agreement, the United States and the World Bank will work together in a number of areas, including rehabilitating wetlands, improving irrigation practices, and mobilizing public-private partnerships and private capital to support water projects around the world.

Progress in these areas depends upon the efforts of numerous organizations.  NGOS, private industry, foundations, and international bodies were all represented at the event.  Many of them have ongoing projects with USAID and the World Bank across the globe.  As USAID Deputy Administrator Donald Steinberg emphasized, “our presence here today reflects a basic truth in the development challenges we face: no single government, international institution, civil society group, or private corporation has a monopoly on good ideas, dedicated commitment, or ground truth.”

Our Common Fight – TB in Eastern Europe and Eurasia

Several weeks ago, I visited the Central Tuberculosis Research Institute (CTRI) of the Russian Academy of Medical Sciences in Moscow. It plays a central role in Russia’s battle with tuberculosis (TB)  as the country’s top TB treatment hospital, research center, and medical training facility. Russians with the most difficult multi-drug resistant (MDR) – TB  and extensively drug-resistant  (XDR) -TB are treated there. I was struck by the determination of the Russian doctors in the face of the continued threat of MDR-TB and XDR-TB and I am glad that USAID counts them as partners in our common fight.

As we commemorate World Tuberculosis Day on March 24, it is important for all of us to recognize that Eastern Europe and Eurasia continue to have the highest rates of MDR-TB and XDR-TB infections in the world.  According to the World Health Organization (WHO), 12 countries have reported proportions of MDR-TB of 6% or more among new TB cases: all of these countries are in Eastern Europe and Eurasia. Five countries report MDR-TB proportions of 50% or more among previously treated cases: all of these countries are also in Eastern Europe and Central Asia. The WHO estimates that in Russia, 42.4% of previously treated TB cases are MDR-TB; in Azerbaijan, 55.8%; in Georgia, 27.4%; and in Ukraine, 44.3%.

A TB patient receives care at the Central Tuberculosis Research Institute of the Russian Academy of Medical Sciences in Moscow, an institute dedicated to treating Russians with MDR and XDR-TB. Photo Credit: David Grout/ USAID

In our interconnected planet where people constantly cross borders and millions of people fly every day, not only are U.S. citizens travelling abroad vulnerable to MDR and XDR-TB, but Americans from Georgia to Maine could face this threat at home. Therefore, we have a national security interest in stopping TB around the world and we need the grit of those dogged Russian doctors I met in Moscow.

Tuberculosis is curable but potentially deadly. It is spread through the air and is second only to HIV among infectious killers worldwide. Tuberculosis exacts an enormous personal and economic toll, often striking people in their most economically productive years.  MDR-TB and XDR-TB are major risks to effective TB control. MDR-TB is resistant to the two most important first-line drugs used in the treatment of TB. XDR-TB is resistant to additional drugs. The usual six-month treatment with first-line TB drugs is not effective for MDR-TB and XDR-TB. The treatment for MDR-TB and XDR-TB is more expensive, less effective, with greater side effects, and it requires two years to complete—if that form of TB is treatable at all.

MDR-TB and XDR-TB arise due to a number of controllable factors, such as high patient treatment default rates, late diagnosis, irregular treatment, easy access to first and second line drugs in private sector pharmacies without prescription, and, in some cases, population displacement due to unrest. Therefore, it is possible to prevent and control MDR-TB and XDR-TB.

USAID missions through the Eastern Europe and Central Asian regions are working with host countries to combat MDR-TB and XDR-TB.  There is hope. For example, USAID in Georgia supported the National TB Program and provided technical assistance to create DOTS spots—special TB outpatient centers located inside of the general urban outpatient clinics. As a result, in the capital city of Tbilisi, the clinics reduced treatment defaults from 23% in 2003 to 9% in 2008. With lowered treatment default rates, the risk of MDR and XDR-TB are lessened.  With USAID-supported technical and financial assistance, MDR-TB reported cases decreased in the Balkans from 14.4% in 1996 to less than 9% in 2003. In Ukraine, USAID assisted implementation of laboratory quality control procedures in 8 regions, resulting in 92% of USAID-supported laboratories demonstrating high proficiency in laboratory-based TB diagnosis. These successes show that USAID support is yielding results and helping to control MDR and XDR-TB.

USAID is helping to save thousands of lives and showing the goodwill of the American people.  Together with the people of Europe and Eurasia, we must continue to fight MDR and XDR-TB for their sake and our own national interest. Let us not lose focus, take decisive action and curb the spread of MDR-TB and XDR-TB. It is the right thing to do morally, economically, and for our national security.

USAID Official Featured as Voice of America’s “American Profile of the Week”

Ellyn Ogden, USAID’s worldwide polio eradication coordinator, immunizes a child during a festive kick-off event for a polio vaccination campaign in Kabul, Afghanistan.

USAID’s Worldwide Polio Eradication Coordinator, Ellyn Ogden, has devoted her career to eradicating polio and advocating for children’s health.

Read more about her life and work in this week’s VOA profile.

A Look Ahead to World Water Week 2011

Written by Christian Holmes, USAID’s Global Water Coordinator

As we enter World Water Week 2011, it is a good time to reflect on the significance of this vital resource that we often take for granted here in the United States, but is such a precious commodity in many other parts of the world.

Children Washing Hands at School Handwashing Station in Pahuit, Guatemala Copyright: Water For People/Nancy Haws

For me, World Water Week most importantly and fundamentally is about the harsh reality of life and death.  It is staggering, almost beyond comprehension, that each day approximately 6,000 people, most children under five, die from preventable diarrheal diseases and that diarrheal disease remains the second leading cause of death in children worldwide.  Yet, that is the case. These children die in a world where over 800 million people lack access to an improved water source and more than two and a half billion people lack access to sanitation. This is the world we have to change.

But change is possible.  This is also a world where individuals and organizations have the skills and resources to make extraordinary differences in the lives of others. A great many of these people have come together in Washington this week to express their commitment to saving and improving lives and to helping sustain the environment in which people live and on which they are dependent. In so doing, much of the week involves important activities related to sharing and learning about approaches which will improve our ability to reduce the loss of life and human suffering.

I’ll be participating in a number of events which I’m convinced will help lead to change.

On March 22 I’ll be at a World Bank World Water Day Cross Sectoral Working Group on WASH and Healthy Ecosystems: Advancing Freshwater Management Through Integrated WASH Programming.

Also on March 22, Secretary of State Hillary Clinton will join World Bank president Robert Zoellick to sign a Memorandum of Understanding between the Bank Group and the US Government to expand and enhance our collaboration in the water sector. USAID Deputy Administrator Don Steinberg will also participate, and the event will be webcast live.

On March 23, I’ll join NGO colleagues on the Hill as part of World Water Advocacy Day.

I look forward to sharing thoughts and impressions of these events with you as the week progresses.

Developing Kenya through AIDS Vaccine Research

I was very glad last month to hear Administrator Rajiv Shah describe USAID’s deep commitment to sustainable development and building country-led health systems. These principles characterize USAID’s impact in Kenya, where USAID has supported the Kenya AIDS Vaccine Initiative (KAVI) through our partnership with the International AIDS Vaccine Initiative (IAVI).

Dr. Omu Anzala of the Kenya AIDS Vaccine Initiative (KAVI) during an interview for the 2007 documentary HIV/AIDS: the search for a vaccine. The documentary originally aired as part of BBC World’s “Kill or Cure?” series. Credit: KAVI

Here in Kenya, our people and our resources have been drained by three decades of HIV/AIDS.  We are grateful for all that PEPFAR and the Global Fund have done to make antiretroviral drugs (ARVs) accessible and affordable in our country. At the same time, the existing prevention, treatment, and care available are simply not enough to stop the epidemic.  We need new and more effective prevention strategies, and, more fundamentally, we need to build a sustainable, national response to HIV specifically and to grow our country’s capacity to develop scientific solutions to our health problems more generally.  We are accomplishing all of this with the assistance of USAID.

In 1999, we established KAVI with IAVI, the University of Nairobi, and the UK Medical Research Council. KAVI ran the first clinical trial of an HIV vaccine candidate in Kenya, and another four early-stage clinical trials since then. We participated in the study that led to the discovery of broadly neutralizing HIV antibodies—an advance which is crucial to AIDS vaccine research.

But our work has not only contributed to the development of a desperately needed HIV vaccine, which is the only way to stop AIDS once and for all.  It has also strengthened our country in many ways.  Working closely with the Kenyan government and with support from USAID through IAVI, we have built state-of-the-art laboratories and clinical facilities and trained first-rate Kenyan scientists and technicians.  As a result, KAVI-KNH (Kenyatta National Hospital) was among the first laboratories in Africa to win the stringent Good Clinical Laboratory Practice (GCLP) accreditation.  We have increased our capacity for basic research in HIV immunology.  IAVI provided a liquid nitrogen production plant and helped train teams to produce this frozen gas that is essential to process and analyze samples on site.  At Kilifi, we constructed a family clinic that provides ARVs for HIV-positive individuals and at Mtwapa free counseling and support services.  Volunteers in our clinical trials receive healthcare and family planning services. The Expanded Community Outreach program supports vaccine and research literacy, and trains peer leaders to inform their communities about HIV prevention and AIDS vaccine development.

What USAID invests in building country-led health systems can produce not just extraordinary breakthroughs in health research but also independence, sustainable capacity, and opportunity in the world’s poorest countries. Administrator Shah’s commitment to “advancing science, technology and innovation aimed directly at improving human welfare” will yield a healthier, more secure world.

Professor Omu Anzala is Programme Director of the Kenya AIDS Vaccine Initiative (KAVI) at the University of Nairobi, which recently began enrolling participants in two clinical trials examining the safety and immunogenicity of HIV vaccine candidates. He is also Chair of the University of Nairobi’s Department of Medical Microbiology and an advisor to the African AIDS Vaccine Program (AAVP), the African Childhood Vaccine Program, and the National Polio Eradication Expert Committee.


Bangladesh: Maternal Deaths Decline by 40 Percent in Less Than 10 Years

Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths).   The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.

The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care.  The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.

USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods.  We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh.  Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.

The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).

USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.

Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”

The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.

Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.

The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.

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