By Joy Lawn
LONDON, Apr 8 2013 (IPS)

I nearly died on the day I was born. My mother laboured for 24 hours in a bush hospital in northern Uganda that had no running water and no electricity. Fortunately, the midwife found a doctor, who had witnessed a Caesarian section, who managed to operate, saving my life and my mother’s. Today, had I been born in one of the many places across the world without adequate maternal and reproductive health care, I may not have survived my own day of birth.

Joy Lawn. Credit: Courtesy of the author.

While many nations have made remarkable progress towards achieving maternal and child health goals – one of the greatest development successes of the last few decades – newborn death rates (in the first month of life) are declining one-third slower than progress for older children (after one month of age) and at half the rate of decline for maternal deaths.

Each year, three million newborns die, making up 43 percent of the world’s under-five child deaths. The moments before, during and immediately after labour are critical for the survival both mother and baby. Many brain injuries that cause long-term disability and rob the poorest countries of development and economic potential also occur around the time of birth.

Global health goals do not even account for the world’s 2.6 stillborn children, 1.2 million of whom die during labour and are totally preventable with better obstetric care.

Almost all these baby’s deaths stem from preventable causes: prematurity, birth complications and infections. Highly cost-effective solutions to these conditions have already been developed. For example, something as simple as “ Kangaroo mother care” can halve the death rate of preterm babies, preventing half a million deaths each year. This technique, which simply involves skin-to-skin contact between mother and child, provides warmth, promotes breastfeeding, and helps protect against infections.

Africa is now at a tipping point for saving lives, with half of births happening in hospitals. Yet, shockingly, essential equipment that could save newborns is often not available. Midwives and frontline workers are saving lives every day, but they would benefit greatly from access to basic tools and supplies.

Midwives seldom have the neonatal bag-and-mask device that helps resuscitate babies not breathing at birth. Many frontline workers are not trained to recognise common infections in newborns, and lack the antibiotics that would save hundreds of thousands of lives. Antenatal steroid injections costing less than a dollar are not administered to women in preterm labor, as many health workers are unaware that these would almost halve breathing problems in preterm babies.

Why is this care for newborns missing, even as we invest millions in healthcare for women and children? The single biggest reason is that newborn survival has only recently been recognised as a global health issue.

A decade ago we lacked data, and timely interventions were too complex. Now we have no excuse – the data are clear and the solutions are doable. Yet a recent study of 250,000 disbursements of aid from 2002 to 2010 showed that, before the year 2005, the word “newborn” barely occurred. While mention of newborns has since increased, only 0.01 percent of about six billion dollars in aid refers to newborn care interventions that would reduce infant mortality.

One thousand days before the deadline for the Millennium Development Goals, global and national leaders are waking up to the urgency and the opportunity of investing in newborns. If newborns survive, their families are more likely to choose to have fewer children. If they are healthy, the nation becomes stronger.

Meeting goals for preventable child deaths is more and more dependent on targeting newborns. Newborn health conditions, especially preterm births and stillbirths, affect all countries, rich and poor. Such deaths are a tragedy for women, families and communities, and rob nations of the development potential of future generations

In mid-April, many of the world’s leading newborn health experts will come together in Johannesburg, to focus on one of the world’s most solvable but neglected health issues, and lay the groundwork for a Global Newborn Action Plan, linked to national roadmaps.

Teams of experts and stakeholders from high-burden countries, led by their health ministries, will attend the conference, hosted by USAID’s Maternal and Child Health Integrated Program (MCHIP), Save the Children’s Saving Newborn Lives program (SNL), the Bill & Melinda Gates Foundation and the United Nations Children’s Fund (UNICEF), in collaboration with the World Health Organisation (WHO), UKAID and other partners.

Much of the discussion, which will be available to the entire global community via live stream through the Healthy Newborn Network, will focus on effective, low-cost and scalable interventions that already exist to address the leading causes of newborn deaths.

The development of a global action plan is proof that leaders are prepared to commit and hold themselves accountable to new targets to end preventable newborn deaths.

But leaders need support in the form of national data, reliable evidence and experienced advice to make context specific choices to accelerate change for their newborns and to build sustainable healthcare systems: in short, they require investments.

The main source of health funding in even the poorest countries comes from national governments, which must take up this call. Donor aid also has a role to play in helping governments achieve commitments they have set to reduce newborn mortality. Such donor aid has helped bring major changes to other urgent global health issues, including prevention and treatment of HIV/AIDS and the distribution of bed nets to prevent malaria.

The year 2013 has emerged as the moment to include the health and survival of newborn babies among the world’s priorities. As Melinda Gates recently said, “Next focus on the newborn”. 

I survived my first day on this earth. Today, as you read this, nearly 8,000 newborns will be lost to grieving parents. We can – we must – do better.  The voices of families and advocates all over the world are sparking a movement that no longer accepts that babies are born to die.

(END/COPYRIGHT IPS)

Excerpt:

A young mother attends a training session on how to prepare ready-to-use therapeutic food with local and affordable ingredients. Credit: Naimul Haq/IPS

By Naimul Haq
DHAKA, Mar 20 2013 (IPS)

When nine-month-old Borsha was admitted to the International Centre for Diarrhoeal Disease Research in Bangladesh last January, she was on the verge of death.

Suffering from a condition called severe acute malnutrition (SAM), which too many people in this South Asian country of 150 million are familiar with, Borsha was dangerously underweight.

Her 26-year-old mother, who had traveled 30 kilometres from her hometown of Dhamrai to get the best possible treatment for her baby here in the capital Dhaka, was worried the doctors would not be able to save her child.

But thanks to a timely intervention, Borsha now has another shot at life, and will not join the thousands of children here who perish from a lack of access to proper nutrition.

Borsha is the beneficiary of various attempts to curb severe malnutrition, responsible for one million child deaths per year. In Bangladesh alone some 600,000 children suffer from the condition and a substantial number of them die without proper intervention.

The condition is characterised by a severe deficiency of vital micronutrients like zinc, iron and iodine, as well as crucial vitamins. These children are at high risks of contracting a host of other infections.

Very low weight for height, thin arms, an emaciated body, swollen feet and depressed eyeballs are common signs of acute malnutrition. Children affected by the condition have a nine-fold higher risk of death compared to children with normal rates of nutrition.

Until recently the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) recommended that malnourished children be referred to a hospital to receive therapeutic diets along with required medical interventions.

But what saved Borsha’s life, and what experts hope will save the lives of millions of children under five years old who suffer from malnutrition here, was not hospital admission.

After over a decade of research, scientists at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) found that children with severe acute malnutrition can be treated at home with ready-to-use therapeutic foods (RUTF) made from locally available ingredients.

Except in cases of unforeseen medical complications, this practice virtually eliminates the need for a potentially life-threatening journey from the home to the hospital.

In fact, icddr,b scientists found that treating children at home or within the community with RUTF reduced the case-fatality rate by up to 55 percent, and was effective on all children over the age of six months.

Dr. Iqbal Hossain, a key researcher with the icddr,b, told IPS, “The previous standardised management protocol to treat SAM was to (administer nutrition) at a slow pace at infrequent intervals with shorter durations of intravenous fluid. The new protocol we developed now is exactly the reverse: an emergency diet with longer rehydration therapy is given more frequently at a faster pace.”

“Our research since 1997 shows that the death rate fell from 17 percent to less than five percent of reported cases” as a direct result of this new management protocol, he added.

Another “secret to success”, according to Iqbal, is ‘halwa’ or ‘khichuri’: the blend of rice and lentil paste mixed with soybean oil, molasses, fine grains of cereals, chick peas, and some boiled vegetables that comprises the local ready-to-use therapeutic food supplement.

“Halwa and kuchuri… are socially and culturally acceptable, affordable and available to food insecure people,” Nuzhat Choudhury, an assistant scientist at the icddr,b told IPS.

Major breakthrough

Typically, the management of severe acute malnutrition has three stages – stabilisation, nutritional rehabilitation and follow-up.

Until very recently, the condition was managed at the hospital level in Bangladesh through inpatient therapeutic care.

Weight gain is a crucial aspect of the treatment and intensive micronutrient therapy is continued for three months, with a projected weight gain of 10 grammes per kilogramme each day.

But a majority of the cases in rural settings could not receive clinical care largely because active casefinding at the village level is rare or virtually absent.

In addition, few families in Bangladesh — where over 40 million people live below the poverty line — can afford hospital care, while most hospitals lack the facilities to handle the massive number of severe malnutrition cases.

“About 85 percent of those who suffer from SAM cannot afford hospital care or prevent the deadly condition in their communities,” Dr. Tahmeed Ahmed, the leader of the icddr,b research team, told IPS.

“To address this we have trained community health workers, mothers and other (community members) to spread techniques for managing the condition,” he added.

According to Ahmed, this is similar to the oral rehydration solution given to children suffering from diarrhoea, which is also now administered in the home.

An internationally reputed paediatrician and director of icddr,b’s Centre for Nutrition and Food Security, Ahmed helped design training courses on management of severe acute malnutrition for countries like Afghanistan, Tanzania, Uganda, Papua New Guinea and others, with the support of WHO, UNICEF and the nutrition section of the International Atomic Energy Agency (IAEA).

Mariam, whose year-old son Tanvir was admitted to the icddr,b last January, believes the trainings for mothers and community members are invaluable.

“Without the ready knowledge on managing the condition thousands of children would die. Every mother should learn how to prepare the local diet — it’s simple, easy and above all, it saves lives,” Mariam told IPS.

Doctors and nursing staff from hospitals and clinics across the country have also been trained and are now promoting best practices in rural areas, particularly in the northwestern agricultural regions of greater Rajshahi and Rangpur where food shortages are common  and children are often stunted and underweight.

While the case fatality rate in hospitals treating the condition is still as high as 20 to 30 percent, communities with knowledge of how to manage the problem have brought the fatality rate down to just five percent.

The icddr,b has plans in the pipeline to provide rural families with hygienically packaged sachets of RUTF that do not require refrigeration or cooking and can be stored at room temperature for months at a time.

The WHO cites malnutrition as the greatest single threat to global public health. Efforts like those underway in Bangladesh are bringing the world closer to achieving the fourth Millennium Development Goal, which aims to reduce the under-five child mortality rate by two-thirds by 2015.

By Naresh Newar
KATHMANDU, Dec 16 2012 (IPS)

Currently classified as one of the world’s Least Developed Countries (LDCs), Nepal has one of the highest malnutrition rates globally, with over 41 percent of children suffering from chronic under-nourishment, particularly in rural areas.

As part of its efforts to support the Millennium Development Goals (MDGs) in the LDCs, the European Union has pledged millions to help eradicate malnutrition, which is widely acknowledged to be a major hurdle to development.

Last year, the EU funneled 20 million euros into a UNICEF programme designed to tackle the problem in five Asian countries.

Of this, 3.2 million euros went directly to Nepal “to support a comprehensive package of measures to prevent and address malnutrition in the country where … approximately 1.7 million children, or nearly half of all children aged under-five in the country, are stunted or suffer from chronic malnutrition”, according to an EU-UNICEF press release.

A year later, the crisis is still severe and development experts fear the country will not meet the MDG target of reducing child mortality by two thirds by 2015.

A new vaccine will immunise five million Pakistani children annually against pneumonia. Credit: Adil Siddiqi

By Zofeen Ebrahim
KARACHI, Nov 22 2012 (IPS)

Medical practitioners at the National Institute of Child Health (NICH), a leading government-run children’s hospital in Karachi, hope that this will be the last winter they have to treat a stream of children suffering from pneumonia.

The disease is one of the leading killers of under-five children in the country, accounting for about 19 percent of child mortality.

Last month Pakistan became the first country in South Asia to introduce a free pneumonia vaccine, to immunise five million children against the deadly disease annually.

According to Dr. Mohsina Ibrahim at the NICH, the move will also help lower the incidence of other related diseases like meningitis, but only if “the vaccine is given the same importance as polio and taken door-to-door”, she told IPS.

The government was under considerable pressure to introduce the vaccine: with infant and under-five mortality rates of 78 and 94 per 1,000 children respectively, the country is unlikely to meet the target of reducing under-five mortality by two-thirds by 2015, as stipulated by the Millennium Development Goals (MDGs).

Considered to be the largest rollout of the vaccine after Africa and Central America, the new initiative will form part of the state’s routine child immunisation programme, a set of scheduled inoculations provided free of cost from birth to 15 months to protect against diseases like diphtheria, pertussis (whooping cough), measles, tetanus, meningitis, polio, tuberculosis, and hepatitis B.

The vaccine is being delivered through a partnership between the Pakistan government, the Global Alliance for Vaccines and Immunisation (GAVI), which supports and finances vaccines in the world’s poorest countries, the United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO).

GAVI plans to contribute 680 million dollars, and the government has donated 17 million rupees (175,000 dollars) to provide the vaccine until 2015.

“GAVI provides funds for countries to jump-start the introduction of newer vaccines, which they would otherwise never have the fiscal (capacity) to do,” Dr. Zulfiqar Bhutta, a leading paediatrician heading the women and child health unit at the Karachi-based Aga Khan University, told IPS.

This is done by procuring highly subsidised vaccines in bulk directly from manufacturers. “After a negotiated period, countries (are expected) to pick up the vaccine tab,” he said.

Efficacy not guaranteed 

According to Bhutta, the “critical task remains” of increasing routine vaccine coverage from 60 percent to 90 percent of all children, if the country hopes to stay on track for achieving the fourth MDG.

In addition, Bhutta said, there remains the challenge of “ensuring that these vaccines reach the poor and are not leaked or sold in the open market”.

Dr. Ifra Sameen, another paediatrician at the NICH, is also sceptical about the vaccine “reaching those in need”.

Acknowledging that it is a “step in the right direction”, she told IPS that she fears “good intentions may be marred by the low coverage of immunisation in the state’s health system.

“We have not been able to eliminate polio, which has received enormous political commitment and was (taken) door-to-door. In addition, we already have a vaccine for measles, yet the disease still persists. Given this scenario, what are the chances of eliminating pneumonia, which requires the child to be brought to the health centre and given three doses at three different times?”

Huma Khawar, coordinator of GAVI CSO Support, believes awareness is vital. Unless all caregivers, whether mother, father or grandparent, are fully convinced of the importance and benefits of the vaccine and ensure their children are immunised against all nine childhood diseases, efforts made by the government, GAVI and other U.N. partners to reduce under-five mortality will not go far.

In addition to being cut off from children in conflict-riddled areas and those controlled by militants, the programme must also overcome the hurdles of poverty, uneducated mothers and poor governance within the state-run health systems to ensure widespread inoculation, according to Ibrahim.

And while she is happy that an otherwise cost-prohibitive vaccine – costing a little over 13,000 rupees (roughly 133 dollars) for the entire course of three injections – will be available to everyone, she believes “it would have been better to have strengthened the coverage of existing vaccines, instead of introducing new ones”.

“The government should have focused on diphtheria, pertussis (whooping cough), measles and tetanus. The measles vaccine, which boasts an efficacy of 95 percent, would reduce the incidence of not just measles… but also pneumonia, meningitis and diarrhoea.”

The government should also tackle issues like “malnutrition, low birth weight, and non-exclusive breastfeeding, which put children at greater risk of pneumococcal disease,” said Ibrahim, adding that babies who live in overcrowded places, where indoor pollution levels are high and sanitation is poor, are particularly susceptible.

Malnutrition is perhaps the leading cause of pneumonia, said Sameen. According to the last Pakistan Demographic and Health Survey (PDHS) for 2006-7 38 percent of children under five years are underweight.

Sameen, who specialises in child nutrition, carried out a study on severely malnourished children admitted to NICH between January and June this year and found some 20 percent suffered from pneumonia.

The Global Action Plan for Prevention and Control of Pneumonia (GAPP), issued by the WHO and UNICEF, recommends a three-pronged approach to fighting child pneumonia that includes protection (exclusive breastfeeding and improved nutrition), prevention (including the routine use of measles, DTP3, Hib, and pneumococcal vaccines), and treatment (with appropriate antibiotics and oxygen).