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Archives for Health

USAID Epidemiologist Q & A on Hormonal Contraception and HIV

This post was originally featured on the International Conference on Family Planning blog.

In October, The Lancet Infectious Diseases published a study by Renee Heffron and colleagues suggesting that HIV-negative women using hormonal contraception (HC) might be at increased risk for HIV infection. The study also suggested that HIV-positive women using HC might be at increased risk of transmitting HIV to an uninfected male sexual partner. These new findings will be a topic of conversation at the 2011 International Conference on Family Planning later this month in Dakar, Senegal.

Chelsea Polis is an epidemiologist at USAID who received her PhD in reproductive health from the Johns Hopkins Bloomberg School of Public Health (JHSPH) in 2009, and holds an associate faculty appointment in the JHSPH Department of Epidemiology. Working with colleagues at CDC and WHO, Polis is leading two systematic reviews of the evidence to address HC and HIV risk. She offered her perspectives in the following emailed Q&A.

Should women reconsider their HC use in light of this study?

No; at this time, women need not reconsider their HC use in light of this study alone. For the time being, USAID and WHO have not recommended any change to current contraceptive guidelines. Careful evaluation of the Heffron study is underway. This study has several strengths, but also has limitations that complicate the ability to draw definitive causal inference between HC and HIV risk. In addition, previous studies have found inconsistent results. The scientific community is intently focused on understanding and incorporating new evidence in a thorough but rapid manner, and is working to establish consensus on interpretation of the new findings.

It remains critical that known risks and benefits of various contraceptive methods are clearly communicated. If it is ultimately determined that HC increases HIV risk, this will need to be communicated. People should also be informed that HC is not intended to protect against HIV or other sexually transmitted infections (STIs), and that dual protection against unintended pregnancy and STIs/HIV may be achieved by using condoms along with a highly effective contraceptive method.

Why is HC use important, particularly in settings of high HIV risk?

HC methods are highly effective at preventing pregnancy, and are among the most commonly used contraceptive methods in sub-Saharan Africa. Unintended pregnancy is associated with multiple adverse outcomes, including maternal and infant mortality. HIV-positive women report high rates of unintended pregnancy, and helping these women access voluntary contraceptive services could contribute to reductions in perinatal HIV. Furthermore, unanswered questions remain with respect to the relationship between pregnancy and risk of HIV acquisition in women and transmission to men. Competing risks must be carefully considered.

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A Partnership for Progress in Ghana

Note: USAID and Peace Corps are both celebrating their 50th anniversaries this year, as well as their ongoing collaboration.  Both agencies have been active in Ghana since 1961. Currently, USAID is supporting volunteers’ innovative work in nutrition and food security as part of the Feed the Future Initiative.

In the very north of the Volta region of Ghana, in the Nkwanta South District, you can find the village of Jumbo #1. Almost without exception, every person in Jumbo is a farmer. Along with rearing free-range animals, they farm cassava, maize, soya beans, tomatoes, okra, peanuts, and yams. Lots and lots of yams. As a Peace Corps Volunteer I arrived in Jumbo in August 2010. One of my first observations was that the children were very small. I recognized that they were stricken with varying degrees of malnutrition. Swollen bellies, thin limbs, 2-year-olds who “used to walk” and “can’t” anymore; this is what I saw as commonplace.

Using funds from USAID’s Small Project Assistance Grant, I was able to conduct a nutrition program using the “Positive Deviant” (PD) Hearth methodology, which focuses on finding basic nutrition in the locally available foods and using those foods to make children healthier. The program seeks out a mother whose child is above average weight (the ‘positive deviant’) to serve as an example of someone who is doing a good job of nourishing her child. The remaining women in the program are selected due to the malnourishment of their own children, as determined by a weighing of every child under five.  For the 145 children weighed in Jumbo, the statistics were striking: only six percent of children were a healthy weight, and 67 qualified as being malnourished enough to participate in the program.

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Investing in High-impact, Low-cost Innovations that Save Lives

Dr. Christopher J. Elias is president and CEO of PATH, an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health.

A new mother experiencing excessive bleeding after childbirth can die within minutes if the bleeding isn’t stopped. For women in developing countries, time too often runs out before they can get help. Postpartum hemorrhage is the leading cause of maternal mortality—deaths that cause a ripple effect on the children, families, and communities left behind.

What if a simple device costing less than $10 could save a new mother’s life? USAID is building on its decades-long partnership with PATH by investing in our effort to develop a cost-effective solution: a balloon tamponade that can stop postpartum bleeding within 5 to 15 minutes and can be used in peripheral health facilities.

With a new grant of approximately $100,000 from Development Innovation Ventures—USAID’s new venture capital–style fund—we will adapt this existing technology to make it affordable in developing countries. Our goal is to lower the price from as much as $312 per device to less than $10 by streamlining the design and manufacturing process.

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Maximizing the Impact of Public and Private Global Health Commitments

Amanda Makulec is a Monitoring and Evaluation Associate, John Snow Inc.

In a time of international economic uncertainty, it is more important than ever for donor agencies to ensure global health dollars are being spent wisely for maximum health impact.  Investing in maternal and reproductive health programs around the world has supported a one-third reduction in maternal mortality since 1990, and saved the lives of millions. Moving forward, donor agencies are committed to maintaining and continuing that success through new mechanisms for providing basic maternal, newborn, and child health services which leverage both public and private resources and through integrated programs to improve service delivery,  like USAID’s Maternal and Child Health Integrated Program (MCHIP).

One such coordinated effort is the Alliance for Reproductive, Maternal, and Newborn Health (the Alliance), which was born over a year ago to support progress towards MDGs four and five in ten priority countries, including Bangladesh, Ethiopia, India, Indonesia, Kenya, Nepal, Nigeria, Pakistan, Tanzania, and Uganda. Together, these countries account for around 68% of unmet need for family planning globally, 54% of maternal deaths, and 56% of all neonatal mortality. The Alliance’s public sector partners include USAID, the Australian Agency for International Development (AusAID), and the UK Department for International Development (DfID). The Bill and Melinda Gates Foundation contributes its private donor funds and expertise to the core group of partners.

While Alliances and Coalitions seem to spring up often in today’s globally-connected era, this partnership strategically focuses on fostering local country ownership of programs, emphasizing cost-effective spending of donor dollars through improved coordination across agencies, and ensuring it does not create parallel systems for working with countries, providing services, or monitoring and evaluation of its work, instead leveraging existing mechanisms.

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Saving Lives, Improving Health with Simple Act of Handwashing with Soap

Studies show that washing hands with soap is one of the most effective and inexpensive ways to prevent diseases: it can cut deaths from diarrhea by almost half and from acute respiratory infections by a quarter. On Saturday, people across the globe celebrated the fourth annual Global Handwashing Day. Last year, over 200 million people and more than 70,000 schools participated in events and celebrations.

A child washing their hands in Senegal. Photo Credit: Ryan Cherlin/USAID

But handwashing with soap is not an event it is a behavior.  Keeping hands clean is one of the most important steps one can take to avoid getting sick and spreading germs to others. People all over the world wash their hands with water. But washing hands with water alone is significantly less effective than washing hands with soap in terms of removing germs.

Handwashing with soap works by interrupting the transmission of disease. Hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via surfaces. When not washed with soap, hands that have been in contact with human or animal feces, bodily fluids like nasal excretions, and contaminated foods or water can transport bacteria, viruses and parasites to unwitting hosts.

USAID works in partnership with host countries and to reduce diarrheal disease prevalence and improve child survival through sustainable improvements in three key hygiene behaviors: hand washing with soap, safe excrement disposal, and safe storage and treatment of drinking water at the household level. These health-focused interventions complement community and municipal water supply infrastructure programs by empowering households with the tools to protect their own health.

Creating lasting behavior change and ensuring handwashing with soap becomes a social norm are key components of hygiene and sanitation programs worldwide. 

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Reaching Most-at-Risk Populations with HIV Counseling and Testing in Brazil

Over the summer, I visited Brazil with representatives from USAID’s Caribbean Regional HIV Program.  The Caribbean team was interested in learning about USAID/Brazil’s innovative HIV counseling and testing program, Quero Fazer, which is implemented by the Associação Espaço de Prevenção e Atenção Humanizada (EPAH).

USAID/Brazil Mission Director, Lawrence Hardy, learns about the rapid test procedure from a Ministry of Health employee in Recife, Brazil. Photo Credit: USAID/Brazil

EPAH manages Quero Fazer, a project designed specifically to reach most-at-risk populations (MARPs)—primarily transgenders and men who have sex with men—with HIV prevention and counseling and testing services. We visited Quero Fazer’s mobile clinics in Recife, on the northeastern coast, and in Brasília, the capital. The mobile units provide services at night and in areas where the target populations gather.

We also went to Rio de Janeiro, where Quero Fazer manages a late afternoon to night-time counseling and testing clinic within the office of Arco-Iris, a nongovernmental organization (NGO) that focuses on gay, lesbian, bisexual, and transgender issues.

Through the mobile units and the NGO site, Quero Fazer has forged, with USAID/Brazil’s support, a unique partnership between NGOs and public health programs. In all of its sites, community members serve as peer educators and work to mobilize patients to access the free services. Meanwhile, municipal and state health officers work at the sites to provide the counseling and rapid HIV testing. For patients who test positive, clinic workers make appointments for them at specific clinics and hospitals, where health providers have been trained on working with MARPs. This level of government support is critical to the success of the pilot program, which operates off of minimal funding, and helps to foster expansion and sustainability.

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Public-Private Partnerships Week: “Helping Babies Breathe” Offers Invigorating Possibilities for Newborn Health Worldwide

This blog was originally posted by Lily Kak on January 6, 2011. It is excerpted and updated here in honor of USAID’s Public-Private Partnership Week, Oct.17-21, 2011.

Sixty seconds – that is all it takes to breathe life into a newborn that is gasping for air. This is the golden minute that can mean the difference between life and death for a newborn who is not breathing. Jubaida, a community midwife from Bangladesh, was trained and equipped to act rapidly and appropriately when she heard no cry and felt no breathing just after Baby Shifa was born. Jubaida gently dried and rubbed the baby and, as the family looked on, she used a bag and mask to help Baby Shifa breathe as the hands of the clock ticked by.

Every year, 10 million babies require help to breathe immediately after birth. Such lifesaving care is currently only available for less than one out of four newborns. Scaling up newborn resuscitation is challenging because it requires provider skills, appropriate equipment, and systems strengthening. Challenged by this, USAID searched for a feasible and effective approach to scale up newborn resuscitation and, on June 16, 2010, launched “Helping Babies Breathe,” a Global Development Alliance(GDA) with a diverse group of partners – Laerdal Medical, Save the Children, the American Academy of Pediatrics, the National Institute for Child Health and Development, and USAID.  The partnership combines the private and NGO sector, a professional association, and the US Government.

“The program is focused on the essential steps for helping babies breathe and uses effective educational methods. But to bring true innovation,  also a third factor is required; efficient local implementation. And that is where this GDA has already proved to make a great contribution.”

-          Tore Laerdal, CEO of Laerdal Medical

The Helping Babies Breathe partnership represents a new way of doing business in the field of newborn health and has now become a key USAID strategy to roll out newborn resuscitation and essential newborn care globally.  This partnership is ground-breaking. In just over a year since the launch of the partnership, over 18,000 health providers have been trained in 27 countries. A pilot study in Tanzania reported that HBB reduced asphyxia-related death by over 50 percent among 7,000 newborns.  Rigorous evaluation plans are now being designed in several countries to determine the performance and impact of HBB as it is being scaled out to address the broader international need as part of national newborn programs.

“The GDA concept is powerful; it’s activities in 27 countries has resulted in a wave of activity in other countries, stimulated a review of evidence at WHO, increased participation of new partners, has brought more attention and support for integrating essential newborn care and maternal life saving care education, and has stimulated the development of engineering innovations in life-saving newborn devices.”

-          Dr. William Keenan, AAP

The innovations that have created this significant solution in newborn resuscitation include Laerdal’s low cost, life-like manikin (NeoNatalie) with its easy-to-clean and boilable device to clear the newborn’s airway addressed the global need for a low-cost, resuscitation training simulator.  The American Academy of Pediatrics (AAP) developed the “Helping Babies Breathe” curriculum that simplified the resuscitation action algorithm so that it can be implemented even in peripheral health facilities and communities. These life-saving technologies are available on a not-for profit basis to all 68 Millennium Development Goal countries. Since its inception the partnership has expanded: AAP has pledged to save one million newborns by 2015 and Laerdal has created a spin-off company, Laerdal Global Health, to develop new technologies to address base of the pyramid maternal and child health.

As part of USAID’s 50th Anniversary, the Agency is celebrating Public-Private Partnerships Week October 17-21, 2011 to highlight the mutual benefit that development and business have in establishing public-private partnerships (PPP) and to celebrate the 10th anniversary of the Global Development Alliance (GDA) program.

Visit www.usaid.gov/pppweek for continuous updates and new announcements, and to view a live-stream of the October 20th Partnership Forum: The Strategic Value of Connecting Business & Development

Treat the Whole Person: On Mental Health Day, USAID Recognizes the Importance of Mental Health for People Living with HIV

Submitted by: Melissa Sharer AIDSTAR-One Senior Care and Support Officer, John Snow, Inc.

AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.

“First we need ARVs, second is Duong Sinh TuNa, third is psychosocial support,” said an HIV-positive female client at an HIV clinic in Van Don, Vietnam. Her spontaneous response to a question about the needs of people living with HIV (PLHIV) includes a double dose of mental health care and support. Duong Sinh TuNa is a rhythmic poem recited during relaxation and stretching exercises hosted at the clinic she attends. It reads in part: “Breathe, meditate, relax, exercise, think positively…Healthy minds and clearer thinking help recovery.”

This client knows what she’s talking about. An individual’s well-being underpins everything she or he does. Emotional health facilitates opportunities to form relationships, to love, to work, allowing a person to continue making choices that support good physical health. The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community,” a definition that should inform all programs and policies targeting individuals living with HIV.

Mental health services are thus critical to a continuum-of-care approach for people living with HIV (PLHIV).  A recent meta-analysis looking at depression and adherence shows a consistent relationship between depression and HIV treatment non-adherence (Gonzalez et al. 2011). Estimated rates of depression among PLHIV soar as high as 72 percent in resource-constrained countries (Adewuya et al. 2007), which threatens the consistent use of the antiretroviral therapy (ART) that keeps them alive.

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Picture of the Week: A Social Pharmacy in Paraguay

A woman in Paraguay at a social pharmacy. Photo Credit: Laura Alvarez, USAID/Paraguay.

A woman in Carmen del Paraná, a small town in rural Paraguay works at a social pharmacy program at the local hospital. This program implemented by local health councils with technical assistance from USAID/Paraguay helps pharmacies keep prices for medicine affordable for low-income communities who do not normally have access to medical supplies and often cannot afford regular prices of basic medicines. Money for the pharmacies is channeled through a revolving fund managed by the local health councils in each community, in coordination with the municipal and departmental governments and the departmental health council.

Darfuri Woman Working for USAID Inspires Community

Story submitted by Millennium Relief and Development Services/Partner Aid International

When Ikhlas was a young girl in El Fasher, North Darfur, her life took a tragic turn when she contracted polio. The disease has been nearly eradicated worldwide following the advent of safe and effective childhood vaccinations, but in a few pockets of the world, poor access to health care means that children become disabled or die from preventable causes.

Throughout her life, Ikhlas has battled others’ misguided perceptions that because she is disabled, she is unable to hold a normal job or do anything of value. Although she was an active member of the Darfur Disability Society, people only focused on her handicap when she interviewed for jobs.

In 2010, Ikhlas interviewed with USAID partner Millennium Relief and Development Services/Partner Aid International (MRDS/PAI) in North Darfur to become the supervisor of rural clinics. Many MRDS/PAI staff were concerned that she would not be able to travel to villages or would be a burden to others during field trips, but some saw in Ikhlas a spark with great potential. Ikhlas’ first assignment was to help start a new clinic in Grawid Besham, a village with no health care services within 20 kilometers. Ikhlas organized a village health committee to oversee the work of the clinic, involving all relevant government organizations.

Ikhlas spent several months traveling to rugged rural areas, working with the community to remodel the clinic and to build residential facilities for medical, monitoring, and support staff.  After months of hard work mobilizing the community and government agencies into action, the clinic opened in 2010 and the community celebrated the arrival of health care services to the village.

With USAID support, the clinic in Grawid Besham is providing health care for up to 8,000 rural Darfuris. Ikhlas is now helping to prevent other children from contracting a disease that has created so many challenges in her own life. Grawid Besham is the first of four clinics that Ikhlas has helped USAID and its partners open in the area.

“I am really fortunate to show that I am able to work in spite of my disability,” Ikhlas said. “The stigma is still very high in people thinking disabled people can’t do anything. So I thank God, my family—for giving me permission to work outside of town—and I thank my employers for not seeing only the outside and my inability but encouraging me to show my abilities. To me, this is real partnership and it has changed my life and I hope the lives of many others not only in health care but also in their attitude towards other people living with disabilities.”

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