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.

Friday, April 7, 2017

Drug companies test out new strategies for improving access to treatment in poor countries

This was originally published on Humanosphere on November 25, 2016.
When Harald Nusser first walked into the waiting room of the hospital in Addis Ababa, Ethiopia and saw so many people suffering in the late stages of cancer, without even basic palliative care, he couldn’t believe his eyes.
“Some of them had so much pain, they were hitting their heads against the walls, to balance the pain they had inside with a different type of pain,” Nusser said.
A physician who works for one of the world’s biggest drug companies, he was especially affected by the women he saw suffering from breast cancer: “It was absolutely breath-taking to look at those women and realize that 99 percent of them would be dead in a year.”
For decades, the global health community has been focused mostly on communicable diseases like AIDS and malaria. Many like Nusser say the changing disease burdens of lower-income countries require more attention to noncommunicable diseases like cancer. Yet this isn’t happening, and most health systems in poor countries are not equipped to meet the need.
“When I saw this for the first time, I said to myself, you have to do something to change this,” Nusser said. That was in 2013 and, at Novartis, he is today doing something to try to change the situation.

Thursday, April 6, 2017

Polio's days are numbered as teams close in on last few cases in 3 countries


This was originally published on Global Health TV on November 23, 2016.

PARIS, France — In 2012, Latif and his colleague were vaccinating children against polio in Pakistan when they were shot by extremists. Latif was shot in the leg. He had 11 metal rods inserted into his leg and was hospitalized for three months. His colleague died. Today, fully recovered and undeterred, Latif (his surname is withheld to protect his security) continues his anti-polio crusade in northwestern Pakistan.

Jim Costello, 73, contracted polio at the age of 15. It paralyzed his upper body: He has triple curvature of the spine, wears a spinal brace and has no use of his arms. His lungs are 75% paralyzed and he uses a medical ventilator for about 18 hours daily. He lives at home in Dublin, Ireland with his wife Delia, “my beloved partner of over 30 years,” on the weekends. During the week, he is in the hospital where he still uses an iron lung. Despite these limitations, he has led a productive life in the retail clothing business and in support of polio survivors. Since 1993, he has served as chairperson and board member of Post-Polio Support Group Ireland

Latif and Costello were two of five people honored as “polio heroes” at a World Polio Day event Oct. 24 at the Pasteur Institute here sponsored by Sanofi Pasteur and Rotary International, two organizations deeply invested in the fight against the disease. Meet Latif in this video and Khuram (an employee of Sanofi Pasteur) in this video (videos from Sanofi Pasteur/AKS Films).

We have never been this close to wiping out polio



This was originally published on the Huffington Post on November 23, 2016.

PARIS, France — Could the Global Polio Day we observed last week be the last such day with actual polio cases?

Participants at a World Polio Day event sponsored by Sanofi Pasteur and Rotary International at the Pasteur Institute here last week, all of them deeply invested in the fight against polio, heard experts say it may well be so, and that the disease could be eliminated in 2016 or 2017.

It is clear that the world is tantalizingly close to eliminating polio. As of last week, there were only 27 remaining cases of wild poliovirus — 15 in Pakistan, 8 in Afghanistan and 4 in Nigeria.  We are on the brink of eliminating the second human disease in history (smallpox, in 1980, was the first).

It is true that all three countries have security challenges. But in Pakistan, the country with the largest number of remaining cases, the security situation has improved markedly since 2014.

“There were close to half a million kids not reachable due to insecurity in 2014,” said Dr. Mufti Zubair Wadood, technical officer for the Global Polio Eradication Initiative at the World Health Organization (WHO) and former head of the WHO polio program in Pakistan. “Since then, the situation has been improving and right now there are almost no areas of the country that are not accessible. That has resulted in a significant drop in the number of cases. Pakistan deserves a huge pat on the back at a time when things were dire.”

Wednesday, April 5, 2017

New test to detect HIV in babies boosts hope of meeting UN targets

This was originally published on Global Health TV on October 25, 2016.

When Saquina, a 38-year-old single mother living in Nacala Porto, Mozambique, learned she was HIV positive while pregnant, she thought her life was over. Instead, she decided to accept her HIV status and follow the advice of the nurse who counseled her.
She did not miss any visits to the health center. She took the pills that helped prevent transmission of the virus to her unborn child. She participated in support groups with other HIV-positive mothers. When her son Frenchou was born, she gave him medication every day and breastfed him exclusively for six months.
When he was two years old, Frenchou was tested for HIV and found negative  another of many recent successes in the prevention of mother-to-child transmission (PMTCT), according to the Elizabeth Glaser Pediatric AIDS Foundation.
Between 2009 and 2015, there was a 60% decline in new HIV infections in children in the 21 priority countries, according to a UNAIDS report released in June. Seven of those countries reduced infections by more than 70%. A total of 1.2 million new infections among children were averted in these countries.
But if you thought thought that all is now well with PMTCT, and that we can move on to other HIV challenges, you would be mistaken. While a 60% drop is certainly encouraging, it is significantly below the 90% target set by the World Health Organization (WHO). UNAIDS has set a goal of eliminating all new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018.