USAID Impact Photo Credit: Nancy Leahy/USAID

Archives for Health

From Lab to Communities: Pioneering Low-Cost Approaches to Prevent Death and Treat Severe Illness

The third installment of the 2010 Health Research Report to Congress is newborn health. Today, we look at USAID’s seminal role in working to focus global attention on the issue of newborn survival as well as its investments in establishing the research foundation for action in this area.

By: Neal Brandes, Health Advisor

USAID works to accelerate innovations through the complete development cycle — out of the labs and through a massive scale-up, into the communities to directly benefit the world’s poor. Our goal is to develop ways to save more lives and reduce the burden of diseases as effectively and efficiently as possible.

Of the estimated 8.8 million children under 5 that die each year – 3.7 million are newborn infants who die within the first four weeks after birth. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth. USAID develops and tests simple, low-cost approaches with the greatest potential to prevent death and treat severe illness in low-resource settings with limited access to quality facility-based care.

An Afghan nurse checks a crying newborn boy who was born that morning in the maternity ward of a hospital in Kabul on March 15, 2010. Afghanistan has one of the highest maternal mortality rates in the world with an estimated 1,800 maternal deaths per 100,000 live births. Photo Credit: AFP PHOTO/BEHROUZ MEHRI

A growing body of knowledge has shown that home visits by appropriately trained workers to provide newborn care can significantly reduce neonatal mortality even where health systems are weak. Building on an evidence review, WHO/UNICEF released recommendations in 2009 providing new guidance on the importance of home visits in a baby’s first week of life. USAID is promoting and supporting partner country adoption of these recommendations into national programs, encouraging further investment in this area and assisting with capacity building efforts for health care providers and community cadres providing home-based care.

In countries with high mortality rates and weak health systems, high impact community-based approaches such as diagnosis and treatment of child pneumonia and newborn sepsis must be as accessible when it is needed to the people who stand to benefit the most. Approximately one-third of newborn deaths can be attributed to infections caused by birth in unhygienic conditions. A multi-country trial supported by USAID, in partnership with the Bill & Melinda Gates Foundation’s Save the Children/Saving Newborn Lives program; and WHO, is researching different combinations of oral and intramuscular antibiotic regimens for simplified treatment of newborn sepsis in the community.

Each year, 10 million babies suffer from birth asphyxia; 10 percent of these newborns do not survive. USAID has supported the development and validation of newborn resuscitation training materials and devices used to develop the American Academy of Pediatrics’ Helping Babies Breathe (HBB) training curriculum. The Helping Babies Breathe Global Development Alliance (GDA), a public-private partnership launched by USAID along with several partners, is introducing HBB in multiple countries and offers evidence-based training and technical support on newborn resuscitation and high quality, affordable resuscitation devices to birth attendants in low-resource settings.

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Photo Essay: Riding for Health in Lesotho

The USAID-supported Horse Riding for Health program engages pony riders and motorcycle riders to transport blood tests, drugs, and supplies to Lesotho’s remote mountain health clinics.

Maamohelang kisses her son

Maamohelang kisses her son. In August 2008, her baby was born, HIV-free. His name is Rebone, which means "we have witnessed." Maamohelang continues to take HIV treatment, thanks to the support of USAID and the Riders for Health program. Photo Credit: Reverie Zurba/USAID

The system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.

In this photo essay, follow the riders to homes and clinics throughout tiny Lesotho to meet:

Maamohelang Hlaha: An HIV-positive mother of four whose village is inaccessible by vehicles and a three-hour hike from the nearest health clinic

Potso Seoto and Thuso Khanare: Dedicated riders who transport life-saving medicines while supporting their families through a stable job

Dr. Leopold Buhendwa: The Elizabeth Glaser Foundation’s Lesotho country director who works to prevent mother-to-child transmission of HIV

Integrating Family Planning, HIV, and MNCH Services in Ethiopia and Kenya

By Ed Scholl, AIDSTAR-One Project Director,  AIDSTAR-One is funded by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.

Alice arrives at a health center in Western Province, Kenya, with her nine-month-old baby girl, who has a recurrent fever. Alice suspects malaria, which is endemic in the area. Two hours later, she leaves with malaria medication and a free insecticide-treated bed net. To the casual observer, Alice got what she came for and had her health needs met. She even received a bed net she wasn’t expecting.

A nurse in Meshualekia Health Center, in Addis Ababa, explains how to use the injectable contraceptive, Depo-Provera. The client will also be offered an HIV test as part of the Ministry of Health's efforts to integrate HIV and family planning services. Photo Credit:Ed Scholl, AIDSTAR-One

But consider what Alice didn’t receive. Had her daughter been weighed, the nurse would have noticed that her growth was faltering because Alice is not yet supplementing her diet with nutritious weaning foods. Her daughter also missed the measles immunization she was due for. Alice was not offered an HIV test, which would have revealed that she is HIV-positive. Finally, no one asked Alice, who has six children and does not want to get pregnant again, if she is using a family planning method or would like information about contraceptives available at the health center. In short, Alice’s immediate need was met, but multiple underlying health needs went undetected by the health center staff.

Alice’s story is unremarkable. Similar scenes play out every day in health care settings around the world. In sub-Saharan Africa, where the burden of HIV, unintended pregnancies, and infant mortality is highest, missed opportunities to meet health care needs, such as those of Alice and her baby, can be deadly.

Fortunately, programs in Kenya and Ethiopia are leading the way in integrating family planning, HIV, and maternal/neonatal and child health (FP/HIV/MNCH) services. In Kenya, the government has made integration of FP and HIV a national policy. USAID/Kenya’s AIDS, Population and Health Integrated Assistance II (APHIA II) project promotes integrated service delivery throughout the country in public, private, and faith-based facilities. Visiting the APHIA II project in Western Province (implemented by PATH), I noted that the Ministry of Health trains nurses and health officers to deliver both FP and HIV services. The project has supported FP/HIV/MNCH integration at 276 health centers and hospitals in Western Province. USAID/Kenya’s new APHIA Plus Project will expand integrated services in 2011.

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Pic of the Week: “A Historical Look Back”

USAID 50th Anniversary Logo

The work of USAID has been far-reaching and long-standing as evidenced by this photo of a Peace Corps volunteer working in the ORT center funded by USAID. In the mid 1970's Joan Wadelton, a Peace Corps Volunteer from Princeton, New Jersey, holds one of the children she helps at a maternal and child health center in Niger. The center is operated by ORT, a voluntary agency, and the Nigerienne Ministry of Health, is financed by USAID. Photo Credit: USAID

Maternal Death Preventable and Treatable with Low-Cost Interventions

Submitted by Deborah Armbruster, Sr. Maternal and Newborn Health Advisor

In September, the World Health Organization (WHO) reported that fewer women die each year from complications during pregnancy and childbirth than previously estimated, but efforts to sharply cut maternal mortality by 2015 are still off track. A new report found that 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. While the number of deaths is disturbing enough, it is estimated that an additional 15-20 million women suffer debilitating consequences of pregnancy.

Despite the challenges faced in reducing maternal mortality, USAID has helped to demonstrate that real progress can be made.  Our work proved that many of the major causes of maternal death are substantially preventable and treatable with low-cost interventions.  USAID has sharpened its focus on a set of effective interventions targeting high-mortality complications of pregnancy and birth – hemorrhage, hypertension, infections, anemia, and prolonged labor.  Together, these complications account for two-thirds of maternal mortality.  Hemorrhage alone accounts for almost one-third, and USAID has been in the forefront of promoting “active management of the third stage of labor (AMTSL),” a highly-effective technique for preventing postpartum hemorrhage.

The active management of the third stage of labor is a combination of actions to speed the delivery of the placenta and prevent up to 60% of postpartum hemorrhage cases. Through these simple actions, trained providers can prevent postpartum hemorrhage and play a vital role in saving women’s lives.

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How You’re About to Help Save the Lives of 4 million Children

By Amie Batson, Deputy Assistant Administrator, Global Health Bureau

You may not know that the leading killers of children in the poorest countries are diarrhea and pneumonia.  You almost certainly don’t know that your contributions can help save the lives of 4 million children – many because of the introduction of two new vaccines to protect against those diseases.

Last week, I was in Rwanda, helping the Global Alliance for Vaccines and Immunization plan the introduction of vaccines for rotavirus and pneumococcal diseases, major causes of diarrhea and pneumonia.  With your support as well as corporations, foundations, and countries rich and poor, GAVI, will save the lives of 4 million children in the next five years.

That sounds ambitious, but it’s very doable – and you’re a big part of the reason. With your help, GAVI supported childhood immunization in poor countries over the last 10 years, saving the lives of 5.4 million children, and shielding millions more from the long-term effects of illness on growth and development.

The U.S. has been a leader in immunization, but we can’t do it alone. Working with and through groups like GAVI helps ensure that other donor countries, companies and foundations, as well as developing countries themselves, all contribute their share: a global solution to a global problem. In addition to the U.S., fourteen other countries and the European Union are donors, and The Bill & Melinda Gates Foundation is also a generous supporter.

People have been a big part of that success as well. GAVI has had strong, high-level leadership – the Rwanda meeting marked the last for Mary Robinson, the former president of Ireland who served as chair of GAVI’s board, who deserves thanks for her advocacy. Norway has been a global leader in the fight to immunize children in the poorest countries, and its former health minister, Dagfinn Hoybraten, took over as chair – underlining Norway’s continuing commitment.

U.S. leadership isn’t just a matter of money.  The expertise of people at USAID has been crucial as well.  Since the ‘70s, USAID professionals have worked with partners across the globe to confront the challenge of vaccine-preventable diseases and help immunize children in remote parts of the world.  Working with an efficient partner like GAVI that mobilizes resources from other countries, foundations and companies multiplies the impact of U.S. expertise, as well as dollars.

GAVI is a model for the new approach the U.S. is taking through the Global Health Initiative: an innovation approach, a public-private partnership seeking innovative sources of finance for vaccines for poor countries, investing in children, with a clear focus on measurable results.  GAVI is a true partnership, accomplishing more than any nation could do on its own, and doing it efficiently, with a small staff.

As the U.S. expands the life-saving impact of our global health assistance through the Global Health Initiative announced by President Obama, our support for immunization will continue, because it is one of the most cost-effective ways to save lives and promote health.  Reaching children with this simple, affordable intervention is one of the smartest investments in global health – and the right thing to do.  And we can do it in a way that builds national systems, so they won’t need help forever.

These times demand that we provide more health for the money we invest in global health. Despite the success of immunization programs, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year.

We will help because compassion is a fundamental American value — and so is efficiency in using the resources we have, innovation to make those resources go further, and realism to know we can’t do it all by ourselves.  Working with and through GAVI, we have changed the future of millions of children and families. That’s effective, efficient realistic compassion, and it’s worth doing more.

Zambia: Where the Roads End, Logistics Continue

During the rainy season, an ox cart is the only reliable way to get health commodities across the flooded plains to rural health centers in Zambia’s Western province. Photo Credit: USAID/Zambia

Mwanawina Rural Health Center is located approximately 80 kilometers from Mongu, the capital of Zambia’s Western province. Each year, during the rainy season, the facility becomes inaccessible by motor vehicles.

To get drugs and medical supplies to the health center, the District Health Office hires an ox cart—the only reliable transport through the flooded plains between December and June. The journey takes no less than six hours.

With its expertise in logistics, particularly in challenging environments, the USAID | DELIVER PROJECT is partnering with Zambia’s Ministry of Health (MOH) to help bring drugs and medical supplies to patients by strengthening the supply chain.

In the Western province, the project trains health center staff in logistics and provides technical guidance and mentorship to MOH staff in provinces and districts, and at individual health centers.

The project is also enhancing the computerized systems in all hospitals and major health centers to include important logistics information. The new information will help improve systems performance and increase commodity security in the province.

The USAID | DELIVER PROJECT works in all of Zambia’s provinces to improve access to health commodities. For more information, please visit http://deliver.jsi.com.

U.S. Provides Equipment To Female Health Workers in Pakistan

More than 1,500 Lady Health Workers who work in areas in the areas of Punjab and Sindh provinces in Pakistan will receive kits of basic equipment to help them as they offer vital health care services to families in their communities. This donation is part of the United States’ continuing support for Pakistan’s flood relief and recovery efforts.

Deputy USAID mission director Rodger Garner is speaking to the lady health workers; Sakina Shanwari, supervisor of the lady health workers, thanks the American people. Photo Credit: USAID/Pakistan

The kits were donated by the U.S. Agency for International Development (USAID) to Pakistan’s National Program for Family Planning and Primary Health Care.  Kits include blood pressure monitors, scales, thermometers, blankets, tents, and basic furniture.  This equipment will enable Lady Health Workers to set up health houses to provide basic services in flood-affected communities.

Read more here.

Microbicide Gel Offers Protection Against HIV Transmission

By Lee Claypool, USAID Biologist

Microbicide. That’s kind of a funny-sounding — perhaps even scary — word for something pretty powerful. It certainly has a scientific “ring” to it, and that tends to turn people off. It’s complicated, it’s detailed, and it’s… boring, right?

If you think something that can empower women, save lives, and possibly change the course of history is boring, then yes. Here at USAID, we actually think it’s pretty exciting. For nearly 50 years, we’ve been investing in science, research, and innovation to enable game-changing interventions and breakthroughs to reduce poverty and improve livelihoods. This year, such an investment provided the first-ever proof that a microbicide, Tenofovir 1% vaginal gel, can safely and effectively protect women from HIV transmission.

An estimated 33.3 million people are living with HIV globally. Nearly 23 million of these individuals, 60 percent of whom are women, live in sub-Saharan Africa. In many countries, women lack the power to negotiate the use of prevention tools and approaches to protect themselves from exposure to HIV through conventional methods such as condom use, partner reduction, and negotiating delay of sexual debut.

The results of the USAID and South African-supported Center for the AIDS Program of Research in South Africa (CAPRISA) 004 trial are encouraging, and provide hope that a new method that will enable women to have greater control over HIV prevention will soon be available.

The next steps are to confirm these results in further studies; once this happens we could have on our hands a unique HIV prevention tool for women who are not able to negotiate other HIV prevention methods with their male partners. Once this new technology is ready, USAID will work with all our partners to make it available to vulnerable women and girls as soon as possible.

But, since everyone is different, we know that we need a variety of HIV prevention methods to choose from. For just this reason, other next-generation ARV-based product leads are in the pipeline and will be tested clinically if they continue to show good results in preclinical testing. We will continue to support clinical studies of promising products.

We are thrilled our Administrator thinks microbicide is an exciting word as well. Just two weeks ago he convened a meeting to determine the next steps following the success of CAPRISA. There will also be an additional meeting with technical experts in the field to discuss how to aggressively roll out microbicide treatments to those most in need.

Microbicide: Does one word say it all? Perhaps not. Is the word off-putting? Even a little too scientific? Perhaps. We just see it as the future of HIV prevention.

Want to know more about USAID-supported innovation and breakthroughs for global health? Stay tuned to www.usaid.gov and the IMPACT blog! We’ll be posting updates to highlight a variety of new research findings over the next several weeks as we roll out the 2010 Health Research Report to Congress.

200 Years of Global Health in 4 Minutes

By: Ryan Cherlin

Let’s be honest, statistics can be boring and oftentimes intimidating. It’s unfortunate because behind every statistic there is an incredible story to be told. While statisticians are not generally known for their charismatic personalities, Hans Rosling has done the impossible—he discovered a way to unearth compelling stories that are often lost in a vast sea of hard data.

Photo Credit: Ryan Cherlin/USAID

Through his non profit venture Gapminder, Rosling is dedicated to telling the story of global health by converting numbers into exciting presentations with stunning animated and interactive graphics. In order to change mindsets with datasets, he relies on credible sources to supply him with the raw materials he needs.

Rosling pulls data from several sources, including the USAID funded Demographic and Health Survey (DHS), to create his animated presentations that have captivated global health professionals, government officials, policy makers, as well as audiences unfamiliar with global health issues. For the past 25 years, DHS has proved to be the gold standard of high quality and reliable data on health in developing nations. This data provides critical insight that helps decision makers establish evidence-based priorities and policies to progress the global health agenda.

The DHS program works with countries’ health ministries and has conducted some 260 surveys in over 90 developing countries measuring key indicators including infant and child mortality, fertility, family planning use, maternal health, child immunization, and malnutrition levels. Beginning in 2001, DHS began measuring HIV prevalence in national surveys, leading to an international reassessment of both the extent and epidemiology of the AIDS epidemic.

Check out more of Hans Rosling’s videos on the Gapcast YouTube channel.

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