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Archives for Global Health

Saving Children’s Lives, Closer to the Home

My most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating “strep throats” with penicillin was better than operating. I didn’t need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.

Jonathan D. Quick when he was five years old. Photo Credit: MSH

Millions of children today are not so lucky. Over 7 million children under the age of 5 die each year; 70 percent of child deaths occur in sub-Saharan Africa and South-East Asia. The vast majority — over two-thirds — are entirely avoidable with existing safe, effective, low-cost prevention and treatment.

We’ve come a long way: reducing child mortality by nearly 70 percent in 50 years. But a child born in a low-income country is still about 18 times more likely to die before the age of five than a child born in a wealthy country. We know how to prevent most child deaths through low-cost, high-impact, close to home interventions such as community-case management and increasing access to quality medicines. We can and must do more to end preventable child deaths.

Every Child Deserves a 5th Birthday,” a new child survival initiative, launched by USAID Administrator Dr. Rajiv Shah, is building this awareness across the country and the world. Join the global campaign to end preventable child deaths.

Prevention, treatment and care close to the home are keys to saving children’s lives

Improving access to quality, essential children’s medicines reduces preventable child deaths. Where do you take your child if they have a fever or diarrhea and the closest doctor is a day’s walk away? If you live in rural Tanzania or other low-income countries, it most likely is a community health shop, hours closer and much more convenient than the nearest health facility or pharmacy. Previously, these shops were staffed by unlicensed, untrained dispensers who sold medicines of questionable quality.

In response, MSH worked with the Tanzania Food and Drugs Authority to develop an accredited drug dispensing outlet (ADDO) program, with funding from The Bill & Melinda Gates Foundation. Through the ADDO program, nearly 10,500 dispensers have been trained and certified and over 3,800 shops accredited across 15 regions of Tanzania. The licensed dispensers at these accredited shops provide, for example, oral rehydration salts & zinc for diarrhea, and bednets & treatment for malaria; and they know the screening questions to provide appropriate medicines for treatment of acute-respiratory infection among children or, if necessary, make a referral to a clinic. The ADDOs are a sustainable enterprise, bringing life-saving prevention, treatment, and care for children closer to home. The ADDO program also empowers women, as nearly 40 % of shop owners and over 90% of trained dispensers are women.

Community case management saves children’s lives. In rural, low-income countries, health centers can be inaccessible to most of the population. Over half of the deaths of children under the age of five occur in the home. Training community health workers empowers the community, including the mothers, on prevention and treatment of basic needs for children under the age of five, such as malaria, diarrhea, pneumonia, and malnutrition.

The USAID-funded BASICS program in Benin, led by MSH, has helped local leaders implement a community-based, integrated management system for child health. Over a six-month duration, community health workers treated 27,060 cases of child illness, referred 1,043 cases to health centers, and made 14,822 home visits to increase awareness of child illness, immunization, and nutrition. Now, over 1,000 community health workers provide case management at the community level for child illness, covering over 200,000 children under the age of five in five health zones in Benin.

Empowering mothers, through community health workers, improves care for children’s common illnesses. In Afghanistan, under-five mortality and infant mortality rates have dropped dramatically, due in part to a combination of close-to-home interventions targeting mothers in the home. Over 20,000 trained community health workers serve nearly 45 percent of the country’s sick children, with health facilities serving 55 percent. Community health workers visit villages and households, teaching mothers, like Taj Bibi, how to care for common child illnesses, such as treating diarrhea with oral rehydration salts and zinc.

Together, we can, and must, reduce preventable child deaths.

Expanding access to quality health care closer to the home will improve child survival in low-income countries. Training and certifying rural medicine dispensers at a national scale, and providing community-based care by community health workers, will help empower rural communities and improve the health of children in these resource-poor areas. Through these cost-effective, high-impact interventions closer to the home, we can accelerate the reduction in child mortality and save millions of lives.

I joined the 5th Birthday campaign by posting my 5th birthday photo and wish. Please join me and the 5th Birthday campaign by posting your 5th birthday photo with a wish for children globally.

Every child deserves a 5th birthday.


Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

A Mother’s Fight

The following is a guest blog post from Florence-Ngobeni Allen. She is an HIV/AIDS educator and counselor, and a long-time Ambassador for The Elizabeth Glaser Pediatric Aids Foundation. She lives in Johannesburg, South Africa.

Fighting a mother’s fight against HIV has been a very significant part of my life.

Florence-Ngobeni Allen and her baby. Photo Credit: A Mother's Fight

I have worked as an HIV educator for more than a decade, counseling thousands of women in South Africa who have struggled with loss, stigma, and illness because of this epidemic.

As an Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, I have fought for mothers around the world to have access to the tools and support they need to keep their children healthy and HIV-free.

And I have fought my own, personal battle with HIV for more than 15 years.

I first worked as a counselor at Chris Hani Baragwanath Hospital in Soweto, South Africa, helping new mothers who tested positive for HIV. I discovered that my story was not that different from the women I met there.

A lot of the mothers could not afford HIV medicines and services for themselves or their babies. Some would report that they had not eaten for days. Others talked about feeling scared to disclose their HIV status to their partners for fear of violence. Too many of these women came to our clinic with bruises on their arms, their backs, and their hearts.

Every day, I was surrounded by the cries of babies who were fighting the effects of HIV, and mothers who were trying to care for them and keep them alive.

These experiences were so traumatizing for me. To get through the toughest moments, I would lock myself in the bathroom and cry. At that time, there were no treatment options available for HIV-positive mothers or their babies in South Africa.

I knew what was next for them. I knew that their babies were going to die.

The reason I knew is that I had experienced the same thing. I lost my beautiful baby girl, Nomthunzi, to AIDS when she was only five months old.

Nomthunzi was born with no complications to her proud parents. She was just a few weeks old when my husband grew ill. He passed away three months later.

Shortly after, Nomthunzi got sick as well. I brought her in for HIV testing, where I received the worst news a mother can hear. I learned that I was HIV-positive, and I had unknowingly passed the virus on to my baby. Nomthunzi passed away just a few weeks later.

When I became an HIV counselor, I knew the pain these new mothers were experiencing. The pain of losing a child is unbearable. But the pain of realizing that there is nothing you can do to save your child is equally intolerable.

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Putting Orphans and Vulnerable Children First on the Path to an AIDS-Free Generation

Today marks the 10th anniversary of World AIDS Orphan Day – and an important opportunity to highlight stories of children affected by HIV and AIDS.

Despite many gains in the fight against AIDS, children still lag far behind adults in access to important medical services, including HIV prevention, care, and treatment.

At the end of 2010, approximately 16.6 million children lost one or both parents to AIDS – 14.9 million of whom live in sub-Saharan Africa.

And the number of children who are orphaned or made vulnerable by AIDS continues to rise.

Children like Ashley from Zimbabwe are living proof of how orphans and vulnerable children can thrive if given the opportunity.

Ashley is six years old and lost her parents to AIDS several years ago. She currently lives with her siblings and cousins under the care of her grandmother, Juliana, who struggles to maintain all 13 children in her care.

But thanks to the support of a local organization, J.F. Kapnek Trust, and the US Agency for International Development (USAID), Ashley is now enrolled in a program at a nearby early childhood development center where she receives critical nutrition, health, education, and protection services.

Today, Ashley is healthy, happy, and active. She recently graduated from the ECD program and has started first grade, where she is performing at the top of her class.

We need more success stories like Ashley’s.

Under the President’s Emergency Plan for AIDS Relief (PEPFAR), USAID is working to make children like Ashley, and others who are affected by HIV and AIDS, a priority.

By partnering with national governments, communities, and other organizations, USAID is committed to improving the lives of children orphaned and made vulnerable by AIDS – a critical step in the path to achieving an AIDS-Free generation.

But our work is far from over.

“We are committed to and have a unique opportunity to join together to provide care and support for children affected by HIV and AIDS and ensure that no child has to grow-up with HIV,” said Roxana Rogers, Director of the Office of HIV/AIDS at USAID.

To do that, we need to step-up our early intervention efforts for children under five years old – a time of critical development for young children.

We also need to work with families to help them become more economically stable so they can access essential services and better provide for their children.

By thinking long-term and investing in efforts to strengthen systems of care and support, including social services, we can improve the lives of children around the world.

With a special focus on these strategies, we will achieve President Obama and Secretary Clinton’s goals to turn the tide against HIV and finally see the beginning of the end of AIDS.

Every Birthday Starts with the Golden Minute

Members of the Helping Babies Breathe Global Development Alliance

Every child deserves a fifth birthday. To reach five years, though, a child must take his or her first breath of life in the first minute following birth. The World Health Organization estimates approximately one million babies die each year from birth asphyxia, a condition in which babies who do not breathe on their own immediately following delivery.

Developed by the American Academy of Pediatrics, the Helping Babies BreatheSM (HBB) initiative was designed to equip birth attendants in developing countries with the skills they need to successfully resuscitate babies born without the ability to breathe on their own. At the center of HBB is the concept of The Golden MinuteSM: within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask.

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Celebrating Success in Saving the Lives of Mothers

Ordinary women make extraordinary contributions as caregivers and caretakers, as breadwinners and bread-makers to families and societies.  And even so, we know that women will not be able to thrive, unless they survive.  On Tuesday, the U.S. Government celebrated remarkable country-level success in saving the lives of women during pregnancy and childbirth.

Health ministers from Afghanistan, Cambodia, Dominican Republic, and the head of maternal and child health from Rwanda took center stage on Capitol Hill. And each told a unique and personal story.

Dr. Suraya Dalil spoke of overcoming illiteracy among Afghan women, a lack of roads and transportation, shortages of female healthcare providers, poor quality health services to tackle the reproductive risk of pregnancy and child birth.   “You need to eliminate child marriage, space child births and provide basic services,” she said.  “Now mothers are surviving and families are thriving.”

Maternal mortality reduction was once viewed as an insurmountable problem. And for two decades after the Safe Motherhood Initiative was launched in Nairobi in 1987, there was no documentation that motherhood was safer, as promised.

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Global Motherhood: Perils And Promise In Ghana

Guest Blogger: Dr. Orin Levine, Department of International Health, Johns Hopkins Bloomberg School of Public Health; Executive Director, International Vaccine Access Center (IVAC).

Originally published to the Huffington Post

Today in Ghana, I had a personal reminder as to why our work to prevent disease is so perilous, and why disease control so promising in Africa. Visiting the storied Princess Marie Louise Children’s Hospital in Accra, I watched as an eight-month-old boy, Isiah, struggled against severe pneumonia. Isiah was receiving supplemental oxygen from a cylinder, yet was still struggling to breathe. Even on oxygen therapy, his saturation was terribly low and his prognosis was poor.

But mostly, I watched Isiah’s father. He shook his son — not roughly, but just enough to keep him from closing his eyes — and he shouted at him with encouragement, urgency and longing, not reproach. I couldn’t understand his language, but as a father of two kids myself, I could not help but put myself in his shoes. I imagined he was imploring his boy to stay alive, to fight a little longer, and to stay strong so he could return home, grow bigger, and live to see another birthday.

In the United States, we can practically start planning our kids’ birthdays from the day they come home from the hospital; deaths in childhood are quite rare. In Ghana, though, you can’t take a child’s fifth birthday for granted. Last year approximately 50,000 young children — nearly seven out of every 100 — died before their fifth birthday.

This fact is unimaginable for those of us lucky enough to have children in the United States. If we in the U.S. had the same rate of child mortality as Ghana, 300,000 children would die annually. That’s the equivalent of half of the children in New York City dying before their fifth birthday every single year.

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Something to Celebrate in Ghana

Jeffrey Rowland is the Director of Media and Communications at GAVI alliance. This piece originally appeared in the GAVI Alliance blog.

Under the sweltering sun in Accra’s immense Independence Square, hundreds of Ghanaian mothers and their newborn babies gathered this morning with the country’s First Lady, Ministry of Health officials, my boss GAVI Alliance CEO Seth Berkley and international partners and donors to celebrate the nationwide introduction of vaccines that protect against the biggest causes of pneumonia and severe diarrhoea.

A sea breeze from the Bay of Guinea and brightly festooned tents provided respite to the crowd, which included tribal chiefs and queens colourfully clad in traditional dress.

After the playing of the national anthem and a purposeful pause, a prayer served as a poignant moment of reflection for all those in attendance who have worked so hard to make today a reality.

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USAID in the News

Weekly Briefing (4/23/2012 – 4/27/2012)

April 22: In the Huffington Post, USAID Administrator Dr. Rajiv Shah previewed a new global campaign to end preventable child deaths.“Every Child Deserves a 5th Birthday” will focus on raising awareness ahead of the Child Survival Call to Action event in June, when the governments of the United States, India, and Ethiopia will join together with UNICEF to mobilize the world to end preventable child deaths.

April 23: Today at the Kaiser Family Foundation, USAID Administrator Dr. Rajiv Shah launched the “Every Child Deserves a 5th Birthday” campaign to end preventable child deaths. Administrator Shah spoke with The Guardian and the UN Dispatch, which highlighted the launch. The Global Post also wrote a story on the 5th Birthday campaign.

April 24: On the eve of World Malaria Day, US Global Malaria Coordinator Rear Adm. Tim Ziemer published an op-ed in The Hill, discussing the importance of malaria intervention and his first-hand experience distributing malaria bed nets in Ghana.

April 25: In an interview with Federal News Radio, Assistant Administrator Mark Feierstein discussed USAID’s focus on strengthening its investments in local intuitions and working with previous aid recipients. For example, Feierstein cited Brazil, a long-time receipt of aid and now the sixth-largest economy in the world, as a USAID partner for agricultural development in Haiti and Mozambique. “Hopefully, we’ll see places like Mozambique and Haiti and elsewhere achieve the kinds of successes Brazil has in recent years,” Feierstein said.

U.S. and Russia Explore Cooperation on the Global Fight against Malaria

Last week, I travelled to Russia with Dr. Bernard Nahlen, the Deputy Coordinator of the President’s Malaria Initiative. We had very productive talks with the Russian Ministry of Health and Social Development and the Martinovsky Institute of Medical Parasitology and Tropical Medicine. We discussed potential U.S. – Russian cooperation in the global fight against malaria. USAID has started to work with Russia to address global development challenges around the world. Last year, we agreed to work together to help eradicate polio. We are now exploring how we could cooperate to control malaria in Africa and the Asia Pacific to save children, improve maternal health, improve maternal health, reduce suffering, and promote economic development.

Russia has long and deep experience with malaria. The disease was first reported in Russia in the 14th Century. In the 19th and 20th centuries, Russian and later Soviet scientists were involved in research that led to breakthroughs in malaria diagnostics and control efforts. The Martinovsky Institute was established in 1921 and after many years of effort malaria was eliminated from the former Soviet Union in the 1960’s. As in the U.S., the Soviet military and government continued research into fighting malaria in tropical areas around the world. Today, the Marinovsky Institute carries on this legacy. It even continues to train foreign doctors including some from Africa.

In talks with Russian officials, we discussed collaborating on training and capacity building, evaluation, operational research, advocacy and resource mobilization in support of national malaria control plans in third countries. We are exploring joint participation or co-leadership in international and national forums such as the Asia Pacific Economic Cooperation (APEC), the Roll Back Malaria Initiative and regional or global health meetings. The Russians are particularly interested in ending preventable child deaths from malaria and reducing the burden of malaria during pregnancy. The talks were fruitful and we should see progress on this cooperation very soon.

Delivering Nets to those who Need them Most

The following post is by Amanda Makulec, Monitoring and Evaluation Associate, John Snow, Inc.

Malaria continues to be one of the leading causes of child deaths around the world, despite the availability of low cost interventions to prevent those deaths. According to USAID, the disease causes an estimated 700,000 deaths annually, with nearly 90% of the illness and death caused by malaria occurring among children under five years of age in sub-Saharan Africa.

A young girl in Timor-Leste carries home an insecticide treated net from a distribution site for the USAID Timor-Leste Health Improvement Project. Copyright JSI.

From the Nothing but Nets campaign to the WHO’s Roll Back Malaria Initiative, we’ve all heard about the impact a $5* bednet can make in the life of a child or a pregnant woman. The Institute for Health Metrics and Evaluation reported in September 2011 that homes owning at least one bednet were associated with a 23% reduction in child mortality. Other simple commodities, such as rapid diagnostic tests (RDTs) and the drugs used to treat malaria—a million ACTs—headline advocacy campaigns less frequently, but are essential for providing low-cost diagnosis and treatment of malaria.

As important as the $5 that buys the net is the part of the story often simplified to a sentence or two: how is that bednet transported from a storage facility and distributed to populations that need it most? Without a robust logistics system, bednets could easily remain unopened and packaged for transport, rather than hanging over the beds of small children and pregnant women in rural Uganda or elsewhere; ACTs may not be delivered to rural health facilities and remain in a warehouse; and RDTs may never be provided to community health workers to enable them to rapidly diagnose malaria in a child’s blood using only a small sample.

Responsibilities for procuring malaria commodities for the US President’s Malaria Initiative delivering them through effective supply chains, and, in turn, strengthening in-country supply chains to best manage malaria commodities are at the core of one task of the USAID | DELIVER PROJECT, implemented by John Snow, Inc. and various partners. The project purchases bednets, ACTs and RDTs and supports the supply chain systems to distribute the commodities to sites around the world. USAID | DELIVER PROJECT also works to overcome the challenges in procuring and transporting malaria prevention and treatment commodities to the populations that need them most, including global shortages of ACTs and questions of quality assurance around the safety and efficacy of various commodities. From 2007-2011, the team procured 22.4 million bednets, 17.5 million RDTs, and 47.6 ACTs for the prevention and treatment of malaria, which were delivered through both facility and community based programs.

On this World Malaria Day, let’s celebrate the achievements that have been made not only in the number of bednets procured and distributed, but also the immense achievements of the people and programs who make it possible to get the bednets and other commodities to the places they’re most needed. Achieving reductions in malaria morbidity and mortality worldwide—and meeting the ambitious goal to end preventable child deaths in a generation—will continue to require not only quality commodities, but also insightful problem solvers, creative thinkers, and skilled logisticians, all of whom make it possible for that $5 bednet to be delivered to a girl in Timor-Leste, like the one pictured above.

Interested in learning more about supply chains and logistics systems that take a bednet or a drug from a storage facility to a community? You can learn more about the USAID | DELIVER PROJECT, and review the findings of the recent External Evaluation of the President’s Malaria Initiative.

*USAID estimates the actual cost of a bednet is between $4 and $5.

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