Wednesday, May 10, 2017

Tremendous progress against malaria seen but challenges remain

Twins Dorcas and Deborah Bendak, 7, under their mosquito net at their home in Musoma, Tanzania. Insecticide-treated bednets have become the cornerstone of malaria prevention efforts. Photo: Riccardo Gangale/VictorWorks, Courtesy of Photosphere
This was originally published on Global Health TV on April 25, 2017.

When I was a young development worker, I engaged in high risk behavior one night in a village in Mali: I slept without a mosquito net. A week or so later I contracted malaria.

Of all the diseases I have written about here, malaria is the only one with which I have personal and intimate experience. And it was not pleasant. It was so debilitating, so sapping of my energy, I remember not caring whether I lived or died.

Fortunately, I was an otherwise healthy young male and bounced back briskly after a week or so of misery. In fact, I have lived long enough to see the beginning of the end (or at least the decline) of this global killer: In December, the World Health Organization (WHO) released the World Malaria Report 2016 in which it estimated that 1.3 billion fewer malaria cases and 6.8 million fewer malaria deaths occurred between 2001 and 2015 than would have occurred had incidence and mortality remained the same. About 97% of those deaths averted were for children under five years (who are most vulnerable to the disease, along with pregnant women).

Monday, May 8, 2017

Promoting contraceptives to adolescents in Mexico? Make the campaigns fun

Monserrat, Ariantne and Isis and their children visit a
RED DKT clinic in the Iztapalapa borough of Mexico
City to find a contraceptive to space the birth of their
next child. Photo: David J. Olson
This was originally published on Global Health TV on March 21, 2017.

MEXICO CITY, Mexico — I met the three young women at a reproductive health clinic in Iztapalapa, the most populous and fastest-growing borough of Mexico City, with a population of 1.8 million on the eastern side of the capital city.

Ariatne and Isis, both 20 years old, each have one child. Monserrat was their aunt, but didn’t look much older. She had three children. All of them were looking for a way to space the birth of their next child. One of them wanted to wait five years; another, ten years.

All of them had chosen intrauterine devices (IUDs) as their contraceptive, one of them told me, “because they are comfortable and secure.”

Although unplanned pregnancy is a big problem in Mexico (and the rest of Latin America), good sexual and reproductive healthcare is hard to come by in Mexico, especially for adolescents, according to a recent study.

Almost three-quarters of pregnancies among adolescents aged 15-19 in the region are unplanned, according to the Guttmacher Institute, and about half of those end in abortion. Among all women 15-19 who need contraceptives, 36% of them are not using a modern method. The unmet need is highest in Central America, where 46% of sexually active adolescents who want to avoid pregnancy are not using modern contraceptives.

DKT México, a non-governmental organization that uses social marketing to prevent HIV and promote contraception in Latin America and the Caribbean, has learned some lessons about how to promote contraception to young people after success in promoting condom use but failing to do the same with contraceptives after they took a more traditional approach.

Thursday, May 4, 2017

Though preventable, cervical cancer causes half million cases per year

Four volunteers of ICANSERVE Foundation exhort women to take advantage of free cervical and breast cancer screening at an event in the Philippines. Photo: ICANSERVE Foundation

This was originally published on Global Health TV on February 28, 2017.

Over 16 years ago, Sally Kwenda survived colon cancer and HIV, and then lost her husband and two children to AIDS-related illnesses.

Sally Kwenda
“Just when I thought I was done with the hurt and the pain, I was diagnosed with stage II cervical cancer,” she recalls. “Many of those I have met on this journey have either passed away or are worse off than me. Many of them got their diagnoses when it was too late to change the tide. Yet cancer does not have to be a death sentence. My experience reveals that cancer is curable.”

Cervical cancer is the most common cancer among women in Sally’s home country of Kenya as well as in 38 low- and middle-income countries, mainly in sub-Saharan Africa, according to the American Cancer Society (ACS).

The reasons for the high rates of cervical cancer in Kenya, according to Deborah Olwal-Modi, executive director of the Kenya Cancer Association, include lack of knowledge and awareness, inadequate facilities for prevention and treatment, economic barriers, and co-morbidity of cervical cancer and HIV/AIDS. For example, almost all women (97 percent) do not know that a virus causes cervical cancer, according to a new study among women in major Kenyan cities.

Wednesday, May 3, 2017

As infectious disease falls, chronic disease increases; possible solutions emerge

A patient in Kenya undergoes a full physical exam as part of an attempt to detect and treat non-communicable disease supported by Novartis Access. Photo: Bedad Mwangi

This was originally published on Global Health TV on January 31, 2017.

As 2017 begins, we celebrate the fact that many diseases of developing countries have been significantly weakened. The numbers of people suffering from HIV, malaria and tuberculosis are in decline. Children are healthier and living longer.

But as these communicable diseases wane, non-communicable diseases (NCDs) wax (like cancer, diabetes, cardiovascular and chronic respiratory diseases).

This was hammered home by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington which, just in the last two months, released three new reports that provide further evidence of this trend:
  • Almost 20% of global deaths in 2015 were linked to elevated blood pressure, according to the latest Global Burden of Disease study. The number of people in the world with high blood pressure, including hypertension, has doubled in the past two decades, putting billions at increased risk for heart disease, stroke and kidney disease.
  • Cancer is growing almost everywhere in the world but the greatest increase between 2005 and 2015 occurred in the poorest countries that are least equipped to deal with it, according to a new analysis.
  • 30% of all deaths from diabetes worldwide occur in the poorest countries bringing a double burden of disease – from communicable and non-communicable disease – to many countries in Africa, according to a new IHME report. Women often bear most of the burden.

Friday, April 28, 2017

Some children overcome malaria only to confront chronic disease

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If needed, non-communicable disease drugs will be made available through Novartis Access, a new program to make NCD drugs available in developing countries.

This was originally published on Global Health TV on January 13, 2017.

We have much to celebrate with the news contained in the World Malaria Report 2016, released by the World Health Organization (WHO) last month. WHO estimated that a cumulative 1.3 billion fewer malaria cases and 6.8 million fewer malaria deaths occurred between 2001 and 2015 than would have occurred had incidence and mortality remained the same. About 97% of those deaths averted were for children under five years.

Buried, and little-noticed in the report (Page 50), is the gist of what makes this news so exciting: In WHO’s Africa Region, these reduced malaria mortality rates have translated to a rise in life expectancy at birth of 1.2 years, accounting for 12% of the total increase in life expectancy of 9.4 years.

This means many more children will survive the perils of childhood in Africa and go on to lead productive lives as adults. This is one of the most exciting global health developments of several encouraging trends in recent years.

Tuesday, April 25, 2017

"Game-Changing" Contraceptive Approved for Self-Injection in Nigeria

A DKT Nigeria community health worker gives Sayana Press injectable contraceptive to a woman in the Makoko slum of Lagos, Nigeria. Photo by David Olson.

This was originally published on K4Health Blog on Jan. 4, 2017.

The Nigerian government has approved Sayana Press injectable contraceptive for self-injection by users, a change which advocates hope will improve access to the product. The United Kingdom has already approved self-injection. Other countries are considering doing the same.
Sayana Press is the three-month progestin-only injectable contraceptive that combines the drug and needle in a Uniject™ injection system. It is small, light, easy-to-use, and requires minimal training, making it ideal for rural settings and community-based distribution efforts and, increasingly, for women to administer themselves.
Since it was introduced in 2014, Sayana Press has been hailed as a “game-changer,” because of its ease of use and ability to be administered by lesser-skilled health professionals and now, even users themselves. This video shows how Sayana Press works.
PATH, which helped develop the Uniject™ injection system, has coordinated pilot introductions of Sayana Press in Burkina Faso, Niger, Senegal, and Uganda. The pilot period (July 2014-June 2016) has now ended and all four countries are moving towards scale-up. Sayana Press was administered to more than 120,000 new contraceptive users during the pilot.
PATH will conduct research on self-injection of Sayana Press through 2017 in collaboration with ministries of health in Senegal and Uganda. Research from Uganda just became available showing that self-injection of Sayana Press is both feasible and acceptable among women participating in the first such research study conducted in sub-Saharan Africa, according to results published online by the journal Contraception.
In 2014, DKT Nigeria became the first program to commercially introduce Sayana Press through social marketing in Africa, with funding from the Bill & Melinda Gates Foundation and the Children's Investment Fund Foundation and in partnership with Pfizer. DKT began distributing Sayana Press in seven southwestern states and has since expanded nationwide. It is available through hospitals, clinics, maternity homes, pharmacies and “DKT Bees,” a team of community health workers trained to bring confidential counseling and family planning services to a woman’s doorstep. The Bees operate in some of the most disadvantaged areas of Lagos.
Women using Sayana Press can also subscribe to DKT’s free SMS text message system to remind them when it’s time for their next injection. The system generated such excitement at a recent stakeholders’ meeting in Nigeria that UNFPA asked DKT to leverage the reminder service for their users in the public sector.
It will take some time before self-injection is practiced in Nigeria, said Dimos Sakellaridis, country director of DKT Nigeria. The Federal Ministry of Health wants to coordinate the effort among all partners and stakeholders.
“In the short term, I do not see any significant changes on how we market and promote Sayana Press in Nigeria,” said Sakellaridis. “However, the long-term benefit will be massive. Accessibility of Sayana Press will increase drastically and some of the product advantages, such as discretion, will be greatly appreciated by users.”
The University of California, San Francisco, has been providing monitoring and evaluation support to DKT Nigeria since October 2015 and found that 29% of the buyers of Sayana Press were new modern contraceptive users.
A DKT Nigeria brief just published shows progress through October 2016:
  • Over 4,000 providers at hospital, clinics, maternity homes, and pharmacies have been trained on Sayana Press.
  • More facilities are restocking the product each month.
  • Over 9,000 women have subscribed to the SMS reminder alerts.
Sakellaridis says that he expects DKT Nigeria to sell over 500,000 units in 2016 and “could sell even more if we had the stock.”
DKT Democratic Republic of Congo also has Sayana Press on the market, but has been hampered by low stocks. They have just received 200,000 units and plan a major campaign in 2017.
DKT DRC plans to incorporate the “Bees” concept in the six provinces where it operates, said Country Director Jacques-Antoine Martin. For example, DKT will reach the isolated Équateur Province with a boat on the Congo River, supported by motorcycles that will visit the villages around each boat stop. DKT also supports Sayana Press self-injection, which is in its test phase in the province of Kongo-Central.

Saturday, April 8, 2017

The end of trachoma, world's leading cause of preventable blindness, is in sight

This woman, who was examined by a health worker at a clinic in Ressa Kebele, Kallo District, Amhara, Ethiopia, will receive trichiasis surgery. The arrow indicates which eye will be operated on. Credit: The Carter Center.
This was originally published on Global Health TV on December 13, 2016.
In 1988, as a young development worker for Lutheran World Relief in Mali, I was showing a group of American Lutherans our development projects in Dogon Country, when we came across a tragic situation a young boy with a severely inflected eye, where he had lost his sight, with menacing flies hovering around the other, still good eye.
It was a heart-wrenching scene for these people, most of whom were on their first trip to Africa. One woman took pity on the boy and, after returning to the U.S., raised money for his treatment. I took the boy to the best hospital in the country in the capital Bamako. Doctors removed his infected eye, and replaced it with a glass eye. Without treatment, he surely would have gone completely blind.
That was my first exposure to trachoma, the world’s leading infectious cause of blindness in the world. Trachoma  a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water and sanitation – continues to plague Mali and 40 or so other countries.