World Health Officials Describe Progress Against Tetanus, H.I.V. and Malaria

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Infant and maternal tetanus was officially eliminated from the Americas this year,the Pan American Health Organization announced on Thursday.

At one time, the infection killed about 10,000 newborns annually in the Western Hemisphere; tetanus still kills about 35,000 infants around the world.

It was one of several significant global health advances, including new programs against malaria and H.I.V., announced last week in conjunction with the meeting of the United Nations General Assembly in New York.

Haiti was the last country in the Americas to eliminate neonatal tetanus. That does not mean complete eradication, because the bacteria that cause tetanus exist everywhere in soil and animal droppings.

Rather, elimination means that — thanks to vaccination of mothers and clean birth procedures — less than one case occurs per 1,000 live births.

The Americas have generally led the world in eliminating diseases for which vaccines exist. In this hemisphere, smallpox was eliminated in 1971, polio in 1994, rubella in 2015 and measles in 2016.

(The diseases are sometimes reintroduced, as measles was at Disneyland in 2014, but outbreaks are usually brought quickly under control.)

Also this week, the President’s Malaria Initiative said it would expand its work to new countries in West and Central Africa, protecting 90 million more people.

The initiative, founded in 2005 as part of the United States Agency for International Development, has been a major force in driving down worldwide malaria deaths by about 40 percent in the past decade. The disease most often kills young children and pregnant women.

The expansion in Cameroon, Ivory Coast, Niger, Sierra Leone and Burkina Faso was made possible because Congress increased funding for the initiative in fiscal year 2017, a representative said.

In his speech to the United Nations on Tuesday, President Trump praised the malaria initiative and the President’s Emergency Plan for AIDS Relief as examples of leadership in humanitarian assistance by the United States.

A combination of aid agencies, drug companies and governments also announced that a new three-in-one antiretroviral cocktail to treat H.I.V. would soon be available to 92 countries, including virtually all of Africa, for about $75 a year.

The new AIDS cocktail is the first available in poor countries to contain dolutegravir, which is widely used in wealthy countries because it is highly effective and has few side effects.

The pill also contains lamivudine, an older but still effective drug, and tenofovir disoproxil fumarate, another modern drug whose inclusion years ago in drug cocktails for poor countries lowered the risk of side effects and resistance.

Almost 37 million people in the world have H.I.V., according to Unaids, the U.N.’s AIDS-fighting agency, but fewer than 20 million are now on antiretroviral medicine, which not only saves their lives but prevents them from passing on the disease.


Child Deaths Drop From 14.2 Million In 1990 To 7.3 Million In 2015

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April 3, 20173:16 PM ET

A girl carries a child in the outskirts of Lilongwe, the capital of Malawi. That’s one of the countries in sub-Saharan Africa that has made good progress in reducing child mortality.

Aris Messinis/AFP/Getty Images

The world is doing a much better job of keeping babies alive long enough to become children, children alive long enough to become teens and teens alive long enough to fully grow up, according to a report in today’s JAMA Pediatrics“I think that the overall highlight of the report is good news,” says Dr. Nicholas J. Kassebaum, an author of the report by members of the Global Burden of Disease Child and Adolescent Health Collaboration. “Without exception child mortality has improved throughout the world for the last 25 years.”

But it’s not all good news. The children in poor countries who might have died as babies or toddlers a few years ago live long enough to suffer from the effects of birth defects or develop mental health problems or cancer. And increasingly, they live long enough to bear the burden of war and violence in their countries.

We talked with Kassebaum, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, about how child and adolescent health has changed since 1990.

Mortality for children under 5 years old is on the decline worldwide, most noticeably in countries where child mortality was highest.

Institute for Health Metrics and Evaluation

First the good news: Deaths of children and adolescents to age 19 were nearly cut in half, from 14.2 million deaths in 1990 to 7.3 million deaths in 2015. How did that happen?

A big part of that is improvement in vaccine coverage, in care for mothers during their pregnancy and in nutrition. Beginning in about the late 1980s, there was a global mobilization around the rights of the child. That brought together experts and a lot of governments saying that children should have a right to health, to education, to a life with opportunities. There was an increase in all kinds of things: development assistance, aid for HIV, immunization efforts, and efforts to help pregnant women. It was a synergistic effort. A lot of programs focused on children under five, so for the last two decades there has been enormous progress in young children not dying as much.

A couple of countries stand out for the progress they’re making: Ethiopia and Malawi, for example. What have they done to bring about improvements?

Those two countries have made improvements in clean water supplies and in better sanitation practices. They’ve also taken really concerted efforts in trying to reach universal vaccine coverage. They also made strides in expanding education. Not so much health education but general education. We know that if moms are more educated, that correlates with women being more likely to be involved in the workforce, with women being more empowered in their own health care and the health of their children, and more in tune with their own nutrition and that of their families. So education is not a direct link to improved childhood health, but it sets things in motion for improved health.

When children can be better protected through their first five years, what life and death challenges do they face as they grow older?

The way it’s gone so far is absolutely the way it should go: really focusing on vaccines, clean water, sanitation and antenatal care.

But once those are in place, and the children get older, the challenges become much more complex. You have lots of children surviving past their early years. But many of these countries may not have the necessary resources to have comprehensive childhood education. They may not be able to deal with congenital birth defects or cerebral palsy and childhood cancer and mental health disorders that start to crop up in later youth. A lot of countries are doing really well in reducing infectious diseases and providing better nutrition but haven’t gotten to the point where they can manage the more complicated cases.

What kinds of complicated things happen after a child makes it safely through infancy?

It varies by location and age. In the youngest kids, a big problem is congenital birth defects, and the biggest of those is congenital heart disease, such as infants born with holes in their hearts or defects in heart valves. There’s also sickle cell disease, an inherited disease of misshapen red blood cells that inhibits oxygen from reaching tissue, in sub-Saharan Africa. Those kids are more susceptible to getting sick and needing care early.

And then when you get to be older, pediatric cancer is a big problem. The treatment of common childhood cancers in the U.S. and Europe and Japan has been remarkable. But that has required a well-functioning health system. That’s not available in poor countries. Even a lot of middle-income countries in Latin America have not seen improvements in the treatment of childhood cancer.

Then during adolescence, you see more injuries: road traffic accidents, drownings, self-harm and suicide are big problems. Systems are not in place to deal with immediate injuries. When girls get into adolescence, they start getting pregnant. Early teen pregnancy is still common in the developing world. Pregnancy-related death is one of the biggest risks in adolescent females.

Were there surprising findings in the report?

One thing that flies under the radar is the effect of war. In the Middle East, the biggest cause of death for all kids over the age of 5 in 2015 was the effects of war. [According to the report, “The direct mortality burden of war was extremely large in North Africa and the Middle East, where it ranked second for each sex among children aged 1 to 4 years and first in all subsequent age groups in 2015.”] Then there are the long-term effects of war: PTSD, some injuries that affect children for the rest of their lives and the consequences of families being separated.

What’s the purpose of a report like this, looking at the global health of children over time?

It’s a kind of report card. For the last two decades, enormous progress has been made. Children under five are not dying as much. But you have to think of childhood and adolescence as a continuum. We have to continue to address the health challenges of all children and adolescents.

Kenya has a high maternal mortality rate!

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Interesting piece on MMR in Kenya!

It was reported that Kenya has a high rate of maternal mortality estimated at about 500 deaths per 100,000 live births. The report added that out of the one million babies born annually in the country, 46 percent of them are born in homes that cannot afford food, healthcare and education.

In own view, the country that has worst a picture than Kenya is Nigeria. This a country where virtually nothing works in the health sector all as a result of poor political leadership; a country in which the health sector is ‘moribund’ because of increasing government neglect of the health sector resulting in poor public health leadership, dilapidated health infrastructures, and poor renumeration to health workers.

I hope the developing countries, more especially the African continent that bears the brunt of all infectious diseases and bad governance, would learn from the developed countries to create a system that would work for the good of the populace.

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Neonatal mortality in developing countries: a step forward to reducing it!

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The International Federation of Obstetrics and Gynaecology has made recommendations to reduce neonatal mortality in developing countries.
A team of researchers in the field of maternal and newborn health has linked women’s obesity with delays in mental development among very pre-term infants. It was added that providing audio recordings of the mother’s heartbeat and voice would promote better outcomes among pre-term infants in neonatal.

I hope this positive development would help reduce the unacceptable high rate of neonatal mortality and morbidity especially in the low income countries.

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Reduction of Maternal and Infant deaths still a priority to attaining the MDGs!

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Interesting piece on Maternal and Newborn healthcare from Nigeria’s largest commercial city, Lagos State. It is my believe that if other States in Nigeria would emulate this good leadership, the country as whole would be able to achieve the MDG goals.

Although commitments towards actualizing MDG goals in Nigeria are not there especially in most of the 36 States (FCT inclusive), I have great reservations for Lagos. History could judge Lagos State that whenever their Chief Executives says something, they always try to ensure that results are obtained. The story reads as follows:

The reduction of infant and maternal deaths to attain the Millennium Development Goals (MDGs) Four and Five is still a priority, the Lagos State Government has said.

The Commissioner of Health, Dr Jide Idris, said improving maternal and child health indices is a major concern to the state. Idris, who spoke to The Nation at the inauguration of the Maternal and Child Centre (MCC), Gbaja, Surulere, Lagos, said maternal and infant deaths are unacceptable, prompting the use of Integrated Maternal, Newborn and Child Health (IMNCH) approach (aimed at ensuring that mother and child receive health care services in the same building).

According to Idris, Ikorodu, Isolo, Ifako Ijaiye and Ajeromi Ifelodun have been equipped with facilities for the faithful implementation of the approach. He added that this will take off at Alimosho, Ibeju-Lekki, Ajeromi Ifelodun, Epe and Badagry as soon as their buildings are completed.

He noted that the government considered enhanced geographical access to integrated maternal and paediatric services a step in the right direction. Thus, the maternal and child centres would complement primary health clinics.

“The concept of integrating services rendition at the 110-bed centre into the existing general hospital structure was borne out of the desire to ensure that support services were made available to complement the overall provision of qualitative health care to mother and child,” he added.

Idris said the MCC would help in the prevention of maternal and infant deaths, saying: “The structure is a 110-bed three storey building equipped with two operating theatres and seven consulting rooms, among other facilities.”

“It would also help in the prevention and cure of diseases, such as haemorrhage, infection, obstructed labour, sepsis, malaria and others. Mothers and children are still dying. Some children still die from communicable diseases.”

The centres, he said, would educate mothers on routine immunisation, use of insecticide treated nets. “The centres would impact positively on the lives of people resident in the area,” he said.

The IMNCH Project Director, Deux Project Limited, Dr Walter Olatunde, said the design, construction and equipping of the centre was carried out by his organisation.

The centres, he said, are an integrated facility to ensure complete care for mother and child. “The project was designed to meet the Millennium Develoment Goals (MDGs) Four and Five, which are to reduce infant and maternal deaths. The centre will offer a full spectrum of care such as preventive, treatment and child education and support to the women. Things such as family planning, ante-natal care emergency services for the mother and child during and after pregnancy are there. It has two operating theatres to cater for expectant mothers during delivery,” Olatunde said.

He said the Gbaja facility began operation last August, adding that it took a year to complete the building. “The centre has been adequately equipped to provide optimal patient care commensurate with global best practices. The equipment available at the centre are ventilators, defibrillators, resuscitaires, baby incubators, phototherapy units, among others,” Olatunde said.

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Edo State Governor decries increase in Child Mortality

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In my introductory page of this blog, I mentioned that attaining the MDG goals by Nigerian government is like a day dream. This is not because of lack of funds to finance the designed programmes and scale-up maternal and child health services amongst others but rather because of lack of commitment on the part of the government at the three tiers.

I read this nice piece from the Vanguard Newspaper, that an Executive Governor of Edo State, Mr Adams Oshiomhole, has decried what he described as the increase in child related deaths and promised to ensure that modern facilities were provided in the hospitals across the state to check the trend.

The Governor was speaking at a State function (National Council for Women Societies of Nigeria election for Edo State Executives), held in Benin City. He also reiterated that government in the State was determined to assist women take full advantage of modern facilities in various hospitals in the State. The Governor added that his administrations’ efforts at providing free maternal and child healthcare is aimed at assisting the women in the State.

I hope the able Governor would keep to his oath of office and bring positive transformations to the people of the State.

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Improving maternal health: are we any far?

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Discussing the ways to improve on maternal and newborn health in the developing world is incomplete without the mention of the MDGs (a program conceived in good faith, which in Nigeria could be considered as another means of siphoning money at the expense of the common man).

The fourth and fifth cardinal objectives of the MDGs are to reduce child mortality and to improve maternal health. The fifth goal could further be sub-divided into 5a and 5b:

5 (a), to reduce maternal mortality ratio by three quarters between 1990 – 2015, and
5 (b), to achieve universal access to reproductive health by 2015.

In Nigeria and some few other developing countries, achieving these targets could best be described as a mirage; this is notwithstanding the fact that much has been achieved to date. Looking at the target date of achieving these goals, it is ver clear that reducing maternal mortality ratio by three quarters is practically impossible.

Record has shown that annually, there are about 358, 000 women who die as a result of pregnancy related complications and childbirth; still most of these women die due to lack of access to skilled birth attendants and emergency care services. Although some Asian and North Africa countries are able to cut by more than half maternal mortality since the inception of the MDGs, sadly the story is by far different in the sub-Saharan African sub region.

In the developed world, a woman’s life time risk of dying during or following pregnancy is 1 in 4,300. This figure when compared with the developing countries (of especially sub-Saharan Africa) is totally scaring as the risk of maternal death is very high at 1 in 31.

These days, especially with increase level of advocacy and awareness, the numbers of women who seek health care services during childbirth is rising, hence the need to ensure that quality of care provided is optimal.

There is no doubt that achieving the universal access to reproductive health by 2015 as enshrined in the MDG cardinal goals is key; it is disheartening to note that some 215 million women who prefer to delay or avoid pregnancy lack access to safe and effective contraception methods. It is estimated that satisfying the unmet needs for family planning alone could cut the number of maternal deaths by almost a third.

The UN Secretary-General’s Global Strategy for Women’s and Children’s Health aims to prevent 33 million unwanted pregnancies between 2011 and 2015 and to save the lives of women who are at risk of dying of complications during pregnancy and childbirth, including unsafe abortion.
WHO key working areas are:
• Strengthening the health systems and promoting interventions focusing on policies and strategies that work, are pro-poor and cost-effective
• Monitoring and evaluating the burden of maternal and newborn ill-health and its impact on societies and their socio-economic development.
• Building effective partnerships in order to make best use of scarce resources and minimize duplication in efforts to improve maternal and newborn health.
• Advocating for investment in maternal and newborn health by highlighting the social and economic benefits and by emphasizing maternal mortality as human rights and equity issue.
• Coordinating research, with wide-scale application, that focuses on improving maternal health in pregnancy and during and after childbirth.

I hope to discuss more in my subsequent posts. Keep a date with me!

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