What Kills Little Kids?

Peter Hotez (@PeterHotez), co-Editor in Chief of PLOS NTDs and Jennifer Herricks (@JenHerricks) of the National School of Tropical Medicine, Baylor College of Medicine comment on the recently released global mortality numbers, specifically those for children under five.

Image Credit: Marcie Casas

Image Credit: Marcie Casas

The Global Burden of Disease Study 2013 (GBD 2013) based at the Institute of Health Metrics and Evaluation at the University of Washington recently released its global mortality numbers for the year 2013.

We find the under-five childhood deaths particularly instructive.  Of the almost four million children between the ages of one and 59 months who tragically died before their time, almost one-half of them died from infectious diseases, led by lower respiratory infections (708,600), malaria (570,000), or diarrheal disease (474,900).

More interesting is when the respiratory and diarrheal diseases are broken down by specific infections with known etiological agents.  This information is shown in the Table.

Today, malaria, most caused by Plasmodium falciparum, is the leading killer of children under the age of five – most of these deaths occurred in sub-Saharan Africa.  Although great progress has been made in reducing these deaths through mass interventions such as insecticide-treated bednets and anti-malarial drugs we still urgently need a malaria vaccine, especially as resistance to current interventions increases.


Continue reading »

Category: General | 4 Comments

Book Review: What Cancer Teaches Us About Ourselves

Seth M. Holmes from University of California Berkeley and Molly Hales from University of California San Francisco and Berkeley review Malignant: How Cancer Becomes Us by S. Lochlann Jain.

Image credit: Kenny Louie, Flickr

Image credit: Kenny Louie, Flickr

Much as we might want to render cancer an external threat to be battled, it just is not so. Cancer is our history. Cancer has become us. Manifest within individual bodies—many, many bodies—it is also embedded within this country’s key industries, medicine not least among them.  (p.8)

Cancer is widespread and devastating.  It affects bodies, but it also affects economies, neighborhoods, populations, families, and loved ones. Cancer affects us all.

Author S. Lochlann Jain is not only an award-winning medical and cultural anthropologist, she is also a cancer survivor. Her book Malignant: How Cancer Becomes Us is therefore doubly relevant to practitioners of medicine and public health. Jain’s analysis unveils how cancer relates to institutions and industries, from agriculture to cosmetics to medical research. At the same time, her analysis of her own illness and treatment experiences illustrate the impact that cancer can have on an individual.

Jain begins the book with a simple premise: That the situation could be otherwise. It is not the biological disease itself that has made cancer so difficult to prevent, treat, and come to terms with.  Rather, the way that we have approached cancer is the problem. The way that cancer circulates as a concept in society makes some aspects ubiquitous – and thus quotidian – while obscuring other crucial facts.


Continue reading »

Category: Book Review, Cancer | 1 Comment

Translating Research into Practice Series: From Inaction to Advocacy: Placing Women and Children at the Center of Sustainable Development

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written by: By Alicia Ely Yamin, Lecturer on Global Health and Policy & Director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard University

 

The sudden loss of a woman’s life during pregnancy or childbirth is both a terrible tragedy and a preventable injustice. With affordable access to a set of basic interventions, nearly all maternal deaths could be avoided. Of the 289,000 global maternal deaths estimated in 2013, the overwhelming majority occurred in developing countries, and sub-Sarahan Africa has the highest regional maternal mortality ratio, accounting for 62% of the global burden. While a maternal death is devastating in its own right, a mother’s death is not an isolated event; when a mother dies there are immediate and lasting repercussions for her children, her family, and the broader community.

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

Recently, the FXB Center for Health and Human Rights at the Harvard School of Public Health conducted a mixed-methods research study, the Impacts of Maternal Deaths on Living Children Studyin four countries in sub-Saharan Africa—Tanzania, Ethiopia, Malawi, and South Africa—in order to quantify the previously largely undocumented intergenerational health effects of maternal mortality and detail the mechanisms through which a mother’s death impacts child health, development, and well-being. Preliminary findings show not only greatly elevated rates of infant mortality, but increased risk of nutritional deficiency, poor educational outcomes, early marriage, and early pregnancy for the surviving children.
Continue reading »

Category: General | 1 Comment

Translating Research into Practice Series: Emergency Obstetric Referral and Transport in Low- and Middle-Income Countries: the Direction of Travel

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written by: Dr Julia Hussein, Scientific Director, Immpact, University of Aberdeen

In low- and middle-income countries, adequate plans to seek care in case of an emergency are important especially if women live far away from where lifesaving care is available. Decisions to seek care can be deferred or hindered. Even if decisions are rapidly made to seek care, transport may be unavailable or slow.

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

Mechanisms to improve referral and transportation of mothers and babies are crucial to reduce maternal and newborn mortality, as they enable women to reach care when complications unexpectedly occur. Various forms of transport for obstetric emergencies have been put forward, from stretchers carried by volunteers to bicycles, boats, motorcycles and other forms of motorised vehicles. The type of vehicle will obviously affect the time for transportation, with geography, terrain and affordability influencing the choice.
Continue reading »

Category: Collections, Maternal Newborn and Child Health | 1 Comment

Translating Research into Practice Series: Improving Birth and Pregnancy Outcomes through Registries in Southern Ethiopia

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written byBy Yaliso Yaya, PhD candidate, Centre for International Health, University of Bergen, Norway and teaching staff, Arba Minch College of Health Science, Ethiopia

 

Unfortunately, there is still limited information to oversee maternal and newborn mortality interventions in low-income countries. Developing countries lack vital registrations that are present in high-income countries. Because of the shortage of such essential information, translating policy into action and monitoring programmes to reduce maternal and neonatal deaths is difficult.

Image credit: Jack Zalium, Flickr

Image credit: Jack Zalium, Flickr

The new Sustainable Development Goals divide countries into three groups where the maternal mortality ratio (MMR) is greater than 400, between 100 and 400, and less than 100 based on the ratio in 2010. Such a grouping is necessary because different ratios may determine different intervention strategies. Unfortunately, for many countries there is a controversy over the level of the MMR. If we use Ethiopia as an example, a UN estimate of MMR in 2010 is 350 per 100,000 live births, whereas the DHS estimated it to be 676 for the same year.
Continue reading »

Category: General | 1 Comment

Translating Research into Practice Series: Using Research Findings to Influence Maternal Health Action: An Example from Nigeria

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post Written By: Bolaji Fapohunda, Senior Advisor & Nosakhare Orobaton, Chief of Party, TSHIP

 

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

Our paper—When Women Deliver with No One Present in Nigeria: Who, what, where and so what, published in the MHTF-PLOS Year 2 Collection—revealed that over one in five births in Nigeria was delivered with no one present (NOP) and 94% of those deliveries occurred in northern Nigeria. A woman’s age, increasing number of pregnancies, Muslim religion, and residence in northern Nigeria increased her risk of delivering alone. However, with greater economic status, decision-making power, and education women were less likely to deliver alone.
Continue reading »

Category: Collections, General, Maternal Newborn and Child Health | 1 Comment

Translating Research into Practice Series: Five ways an Innovative Program increased Facility Birth in Nigeria

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written bySeye Abimbola, Research Fellow; Nnenna Ihebuzor, Director of Primary Health Care Systems DevelopmentUgo Okoli, Program Director of SURE-P Maternal and Child Health Programme, Nigeria’s National Primary Health Care Development Agency

 

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

The Midwives Service Scheme (MSS) was set up as a game changer to reduce maternal and child mortality so Nigeria could achieve the Millennium Development Goals (MDGs) on maternal and child health (MCH). Established by the national government in 2009 to improve the availability of skilled birth attendants in rural communities, the program engages newly graduated, unemployed and retired midwives to work temporarily in rural areas. Four midwives are posted for one year to selected primary health care (PHC) facilities to provide the human resources for health necessary to achieve the MDGs in their states and local government areas.
Continue reading »

Category: Collections, General, Maternal Newborn and Child Health | 1 Comment

A Final Update to the MHTF & PLOS Maternal Health Collection & Reflecting on our 3 Year Collaboration

In November 2011, PLOS and the Maternal Health Task Force (MHTF) embarked on a 3 year partnership aiming to highlight the needs of mothers and infants through the MHTF-PLOS Collection on Maternal Health. Today we announce the final update to the Year 3 Collection & introduce the Translating Research into Practice Series, featuring posts by collection authors describing the influence of their papers.

Image credit: Jack Zalium, Flickr

Image credit: Jack Zalium, Flickr

The collaboration between the MHTF at Harvard School of Public Health and PLOS has been reflected throughout 3 collections, each highlighting a variety of research articles and commentary that tie in with chosen, topical themes.

The third and final year’s theme, “Integrating Health Care to Meet the Needs of the Mother–Infant Pair”, was chosen with the aim to contribute to a better understanding of how and when to comprehensively integrate maternal and infant health care. This year’s collection has included work on conditions such as HIV, malaria, exposure to environmental risks, and other situations that have a significant impact on both maternal and infant health.
Continue reading »

Category: Collections, General, Maternal Newborn and Child Health | Comments Off

How a Tree Helped a Village with Ebola Control

Upon her return from 6 weeks in west Africa working with Partners In Health on the Liberia Ebola response, Farrah Kashfipour reflects on the challenges of responding to an epidemic in a resource-limited setting.

the tree-crop

Image credit: Farrah Kashfipour

The Ebola epidemic continues to ravage west Africa, killing about half of the people who contract the virus.  Those lucky enough to recover face the stigma of having been infected and the subsequent challenge of reintegration into their devastated communities. Many children are left orphans.

In Liberia the number of new cases has fallen in many areas, including cities, while hotspots continue to develop in rural communities. Contrast that with the situation in Sierra Leone where the number of new infections increased rapidly over the past few weeks but may have leveled off more recently.

While in Liberia, I had the privilege of being part of a team- Partners In Health, Last Mile Health and the Ministry of Health county health teams, that hosted 2-day training sessions throughout a rural county in Liberia.  In spite of the difficult conditions, poor roads, lack of cellphone or internet connectivity, and the constant heat and humidity, the trainees showed up every morning, optimistic and enthusiastic as they practiced following the protocols for safely getting into and out of their personal protective equipment.


Continue reading »

Category: Ebola, General, Global Health | 4 Comments

How Will the Ebola Epidemic End?

Upon his return from 6 weeks volunteering with the King’s Sierra Leone Partnership at a number of Ebola isolation facilities in Freetown, Tom Boyles considers the endgame of the Ebola epidemic.

Eneas De Troya, Flickr

Eneas De Troya, Flickr

There are encouraging signs of an overall reduction in confirmed cases of Ebola in west Africa. The graphs below show the epidemic curves for Sierra Leone, Liberia and Guinea as of 14 January 2015 and current data can be found here. Clearly there has been a dramatic reduction in cases in the first 2 countries although in Guinea the epidemic seems to be grumbling on at a lower level. These graphs may signal the beginning of the endgame  but one of the important questions at this point is “How will the Ebola epidemic end?” and no-one is quite sure. Having recently worked on the Ebola response in Sierra Leone my suspicion is that when the end finally approaches we will have a significant ‘last mile problem’; what some others have described as a long and bumpy tail to the epidemic. We will need to ensure that the very last patient either dies or survives without infecting anyone else and this will be easier said than done.

From the beginning it has been vital to avoid losing focus on other interventions such as childhood vaccination programme so that the Ebola crisis is not followed by a measles epidemic, for example. In order to keep healthcare facilities open the model in Freetown has been to put screening services and small isolation units at each one. The over-riding aim is to protect the facility staff from Ebola so they can continue with their everyday work. Patients who screen positive are isolated and tested for Ebola; positive cases are then transferred to dedicated treatment centres and negative cases either discharged home or to the healthcare facility if they need ongoing care. This model has been largely successful in protecting staff at facilities and allowing some normal services to continue.


Continue reading »

Category: Ebola, Global Health | 5 Comments