Tuesday, May 31, 2011

The rise and fall of a global health success story, and how the G8 can bring it back

This article was also published in The Huffington Post on May 23, 2011.

Lancet once called it “potentially the most important medical advance of the 20th century.” But in the 21st century, oral rehydration therapy (ORT) — a simple, cost-effective treatment given at home using either packets of oral rehydration salts (ORS) or a simple home solution of sugar, salt and water — seems to be on life support. The result is the unnecessary deaths of children under five.

A young girl swims through the flooded streets of Dhaka
with a packet of oral rehydration salts clenched in her teeth.
ORT and ORS are indisputable bright spots in global health: Almost a billion episodes of child diarrhea are treated with ORT annually, reducing child deaths from diarrheal disease by more than 50 percent, according to the U.S. Agency for International Development.

Since the 1970s, ORS has saved an estimated 50 million lives, costing less than US $0.30 per sachet, reported the World Health Organization in 2009. Among major causes of child death, it is now tied for second place, at 14%, with pneumonia.

ORT is also highly cost-effective. A 2005 British Medical Journal paper found that ORT was one of the interventions that “would be chosen on purely cost effectiveness grounds for any level of resource availability.” But after the success of ORT, its uptake has slowed and even reversed in some countries.  A 2008 analysis of the change in ORS use in children under 3 between 1992 and 2005 found declines in 23 countries and increases in only 11. Declines in ORT use seemed to occur despite overall improvements in awareness of ORS.

Mali: One of many African malaria success stories

This blog was published on The Huffington Post on April 25, 2011.
 
One night, as a young development worker in Mali 20 years ago, I engaged in high-risk behavior in a village west of Bamako -- I slept without a mosquito net in the middle of the rainy season.

I came to regret my lapse: I was struck down with a severe case of malaria a week later in Morocco, a country where malaria is not endemic, and the doctor I consulted in Casablanca could not diagnose it. Initially, I thought it was some form of flu, but soon realized it was much worse, and that I had carried it with me from Mali.

David as a young development worker in Africa.
Malaria was the most debilitating illness I had ever experienced. Usually when I am sick, I enjoy reading, or at least watching TV. But malaria made me feel more awful, more lethargic than I ever had in my life and I felt like doing nothing except staring at the ceiling.

In those days, mosquito nets were hard to come by for anyone, but especially if you were a poor, rural Malian. And most Malians were poor and rural.

Much has changed. A 2010 Roll Back Malaria report shows that Mali is part of a pan-African malaria success story: In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, more than any of the 34 malaria endemic countries in Africa studied in the report.