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).

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.

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.

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.

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.

"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.

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.

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.

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.”

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.

A long, hard road to reversing the stagnation of family planning in Nigeria

DKT Bee Lydia, a community health worker, gives Iya Lekan a Sayana Press injectable contraceptive at her house. She has five children and does not want any more, at least for now.

This was originally published on Global Health TV on September 27, 2016.

LAGOS, Nigeria — Lydia, a community health worker for DKT Nigeria, steps carefully as she navigates the grimy streets of Makoko, one of the worst slums of Lagos. She is trying to avoid mud or something worse. The sanitation is abysmal. But Lydia is on a mission — to bring contraception to some of the most disadvantaged women in Nigeria.

This day, she calls on Iya Lekan. Although neither Iya, 36 years old, or her husband have regular work or specific sources of income, they have five children to look after.

“I don’t know how many times I have given birth,” she says in Yoruba, the local language here. “I’m tired.”

Iya told Lydia she was ready to start practicing family planning. Lydia presented various options, and Iya chose a three-month injectable called Sayana Press. Lydia immediately gave her the injection in her upper thigh.

Some people think Sayana Press could be a game-changer. It’s a new version of the well-known Depo-Provera injectable contraceptive, but contains 30% less of the active ingredient and can be administered by lesser-skilled health workers. The United Kingdom has already approved it for self-injection.

Last month, I spent an afternoon with Lydia, a member of the DKT Bees, a group of community health workers (CHWs) who focus on family planning in some of the grittiest parts of Lagos. DKT calls their CHWs “bees” because they are like the hard-working insects that go from flower to flower spreading pollen. But instead of pollen, DKT Bees go house to house counseling, educating and dispensing contraceptives.

The road to greater contraceptive use in Nigeria has not been smooth. It’s shocking that the percentage of married women using modern contraception in Nigeria is only 9.8 percent (Nigeria Demographic & Health Survey 2013). That figure is lower than all countries in West Africa except Gambia, Guinea and Mauritania, according to the 2016 World Population Data Sheet, and has has hardly changed in the last ten years. Nigeria has a population of 187 million, making it the seventh largest country on earth. If current trends continue, it will be tied for third, with the United States, in 2050.

Already a contraceptive success story in West Africa, Ghana seeks to do better

DKT Ghana midwife advising on family planning at a community gathering in Mpraeso, in the Eastern region of Ghana.

This was originally published in the Huffington Post on September 26, 2016.

ACCRA, Ghana — Although West and Central Africa is an underachieving region in terms of family planning compared to the rest of the continent, Ghana is the family planning star within that region: It has a higher rate of contraceptive use than all the other 24 countries except the island nations of Cape Verde, and São Tomé and Príncipe. 

However, Ghana - with 29 percent of married women using modern contraception, is still much lower than Eastern Africa (37 percent) and Southern Africa (59 percent), according to the 2016 World Population Data Sheet. The fertility rate has barely changed since 1998 and more than 1 in 3 pregnancies are unplanned.

Last month, I visited Ghana to see how the country is faring in terms of of its commitment to family planning. Until recently, Ghana had one of the fastest growing economies on the continent. That fact and the peaceful transfer of power in 2008 were recognized by President Barack Obama in 2009 when he made Ghana the first stop of his first visit to Africa as president. Recently, however, the economy has stagnated.

World Contraception Day on Sept. 26 provides a good opportunity to reflect on the current situation in Ghana and how matters can be improved to enable every Ghanaian woman who wants contraception to have access. The government has set an ambitious goal of reaching 50 percent of married women with modern contraception methods by 2020.