Information and news about disease category

BARKA FoundationBurkina Faso is a small, land-locked country located in western Africa. Due to recurring droughts and the lack of efficient infrastructure, access to clean water remains an issue in Burkina Faso, especially during the dry winter months when two of the country’s three rivers dry up. In addition to water scarcity, many areas still do not have the sanitation facilities necessary to ensure drinking water is clean and safe. An organization called the BARKA Foundation is working to change that.

Barka is an African word meaning gratitude, blessing and reciprocity. These three words embody the mission of the BARKA Foundation, an American non-profit that strives to bring clean water to all parts of Burkina Faso. In 2015, 93.3 percent of the rural population and 80.3 percent of the total population did not have improved sanitation facility access. Nearly half the country still lives without clean water. Dirty water can spread diarrheal diseases and other infections to the public. Below are descriptions of the BARKA Foundation’s current clean water projects, and the positive effects these projects have had on communities in Burkina Faso.

WASH

Water, Sanitation and Hygiene Education (WASH) is a long-term initiative that not only supplies rural villages with clean water but also educates the villagers on important sanitation and water purification practices. The goal here is sustainability. By giving village members lifelong sanitation skills, BARKA can be confident that their positive impact will continue after they have left. WASH objectives include digging wells, building latrines and educating members of the community.

Part of what makes the BARKA Foundation special is its culturally sensitive and community-based approach to clean water. Before any project starts, BARKA makes sure it is in accordance with the Declaration of Rights of Indigenous Peoples’ Principle of Free, Prior and Informed Consent (FPIC). This principle ensures that all beneficiary communities agree to the non-profit’s presence and initiatives, have the right to negotiate the terms of the agreement and can withdraw consent at any time.

BARKA also makes a point of developing sustained personal relationships with each village, so the two groups can develop trust and collaborate effectively. The foundation establishes water and sanitation committees in each town, which are run by the villagers and must be made up of equal parts men and women. These principles are central to WASH’s desire to create a sustainable system of clean water and sanitation. So far, more than 25,000 rural villages have been improved by WASH. The organization has drilled 6 wells and built 14 bathrooms in 5 primary schools in rural areas.

Social Art

BARKA recognizes the cultural importance of song, dance and performance in Burkina Faso. Therefore, to engage village members, the BARKA Foundation uses theater to relay information to the public. These performances involve a portable stage along with light and sound equipment. The plays often contain themes such as female empowerment and sustainable agriculture. After a performance, the audience and the actors on stage have a lively debate where questions may be asked or points challenged. The goal is to create an immersive and interactive learning experience in which everyone can participate.

The adult literacy rate in Burkina Faso is only 34.6 percent. For this reason, engaging and participatory education is extremely important in rural areas. BARKA wants to get the necessary information out there in an effective way that does not exclude illiterate members of society. BARKA has involved 10,023 people in villages and public performances to date, benefiting more than 16,000 people. The average audience size per performance is 432 people.

Walk for Water

A great way for people in their home countries to get involved with the BARKA Foundation is to do a Walk for Water. When there are no wells close by, villagers must travel to a water source to fill up heavy jugs of water and lug them home. The chore typically falls on the shoulders of women and girls in the village, so they usually have to attend to small children while making the journey. Often, those going to get water are barefoot or equipped with poor footwear. This practice is physically tiring and time-consuming and takes time away from girls’ education.

Walks for Water are an imitation of this daily burden. Classrooms, schools and clubs raise money and awareness by carrying water jugs and walking for a set distance (usually 6 kilometers). The fundraiser engages the entire community and is a great way to get everyone involved in an important cause.

Ceramic Filters

Ceramic water filters are a cheap, environmentally sustainable and generally effective way to purify household water. The CDC found that people who used ceramic filters were 60 to 70 percent less likely to contract diarrheal diseases from their drinking water. While these filters are useful for removing most protozoa and bacterial pathogens, they are typically not as effective at removing viruses. For this reason, filters should not be considered a long-term solution but rather an important step.

The BARKA Foundation uses a “cross-subsidization” model to distribute filters to impoverished areas. Essentially, BARKA sells the filters to NGOs and the Burkinabe middle class that can afford them. They then use those profits to distribute ceramic filters to poor areas, often visiting rural villages with little to no sanitation facility access. These filters represent a simple and effective way to ensure every household has at least some method of water purification.

The Future of Clean Water in Burkina Faso

Although the federal government recognized the importance of clean water distribution with the Water Act in 2001, Burkina Faso’s local governments largely do not have the money or resources to maintain filtered water and sanitation practices. The BARKA Foundation seeks to fill these gaps, and its efforts have no doubt resulted in success on the ground.

While it can be difficult to quantify exactly how much improvement BARKA has brought about, they are headed in the right direction. In 2005, a year before BARKA was founded, the life expectancy in Burkina Faso was 53.3 years. Today, the country’s life expectancy is about 61 years. BARKA’s various projects will continue to fight poverty by bringing clean, safe and sustainable water to Burkina Faso.

Morgan Johnson
Photo: Flickr

Helps Ethiopean ChildrenAfrica has the highest child mortality rate of any continent. Ethiopia sits in the middle of the child mortality ranking of countries throughout Africa with 59 out of 1,000 children dying before the age of five. While it is not as high as the rate of 76 per 1,000 children found in sub-Saharan Africa, it is much worse than many developed nations, which average around 6 deaths per 1,000 children annually. New research, however, shows that childhood mortality can be significantly lowered in Africa using an antibiotic that could help Ethiopian children prevent blindness.

Azithromycin Helps Ethiopian Children

Trachoma is the leading bacterial infection that causes blindness. In an effort to lower the number of cases of trachoma, researchers preemptively gave azithromycin, an antibiotic effective at fighting trachoma, to thousands of children under the age of nine in Ethiopia. The researchers administered these doses of azithromycin to children twice a year.

After observing the children for several years, they came to a shocking discovery: azithromycin will help Ethiopian children live longer. Not only did the bi-annual antibiotic prevent against trachoma, as the researchers believed it would, but it also protected against many other common ailments as well. For those children in the case study, the childhood mortality rate was cut in half.

The discovery seemed too good to be true, so this group of researchers tried to replicate their findings in other African nations with higher child mortality rates. Close to 200,000 children were given azithromycin in Tanzania, Malawi and Niger. While the results were not quite as impressive as cutting the child mortality rate in half, as seen with Ethiopia, the results were still high. The twice-yearly drug lowered child mortality rates between 14 to 19 percent in each country.

Research Into Other Illnesses

Research must continue before Africa will see widespread use of azithromycin for children. If approved for widespread use, this antibiotic could help prevent some of the common illnesses that lead to child mortality. These common illnesses include:

  • Pneumonia: Pneumonia kills nearly 100,000 children per year in Africa. This accounts for 16 percent of childhood death under the age of five. Currently, when children contract pneumonia, only one third are able to receive lifesaving antibiotic treatment.
  • Diarrhoeal disease: Diarrhea is the leading cause of death in children under the age of five. Diarrhea is a common infection in the bowels. It is completely preventable and treatable, yet it is estimated that 525,000 children in Africa die annually from this illness.
  • Malnutrition: Malnutrition contributes to childhood mortality rates. While the use of azithromycin will not be able to prevent malnutrition, it may be able to help prevent other ailments that the body is not able to fight off because of the lack of nutrients and calories.

Long term effects of azithromycin used to prevent ailments in children are not known. However, the studies have shown promising results in saving the lives of hundreds of thousands of African children. With a few more years of research and more funding, these researchers may be able to permanently lower the childhood mortality rate in Africa. Not only will this research continue to help Ethiopian children but it will also help children of other nations, ensuring they live into adulthood.

Kathryn Moffet
Photo: Pexels

Fragile Vaccines

Researchers at McMaster University in Ontario, Canada, have developed a possible breakthrough with regards to the storage of certain fragile vaccines. They have found a way to protect these vaccines from direct heat, negating the need for them to be stored in a cool environment. The implications of this innovation are massive. If organizations like Health Canada approve it, the reach of vaccinations to rural areas will increase, and with that, disease and sickness should decrease.

Coating on Vaccines

The researchers found that placing a gel-like coating over the vaccines was the best way to protect them from the heat. To make this coating, researchers mixed two sugars, trehalose and pullulan, with the vaccine and let it dry. As the sugars dried, the researchers coated the vaccine, making it resistant to heat and rendering the cold chain (the process of storing vaccines at temperatures ranging from 2 C to 8 C) unnecessary. Heat resistance is important because many people living in more rural areas of the world do not have access to refrigeration. Now, individuals living in impoverished areas will have access to a number of vital vaccines, helping protect them from diseases such as Ebola and influenza.

The technology’s development was the result of countless years of testing and hard work. But it is clear that the end product will be more than worth the time spent. When asked about the significance of the technology, Vincent Leung, an Assistant Professor of Chemical Engineering at McMaster and one of the masterminds of the testing, said that it is “very exciting that something we worked on in the lab has the possibility of saving people’s lives one day.” Leung has reason to be proud; the technology is filling a clear need and will undoubtedly have a massive impact upon its implementation.

What Happens Next

Health Canada and the U.S. Food and Drug Administration must still provide approval for the new technology. These organizations will analyze the effectiveness, practicality and safety of the technology. These organizations are likely to approve it because both have already accepted trehalose and pullulan.

The researchers have received funding from many organizations around the world, including the Bill and Melinda Gates Foundation. They are now working with commercial partners in an effort to get the technology to market upon approval. Once accepted, it will likely see heavy usage in more rural parts of the world, such as in many regions of Africa. In many of these areas, individuals do not receive vaccinations for preventable diseases. In fact, more than 7.6 million children in Africa are not vaccinated each year.

This new innovation to transport fragile vaccines has immense potential to shape the future in a positive way. Vaccines will now become cheaper and more efficient to transport around the world. In addition, as more individuals obtain vaccinations, rates of disease and poverty should decrease and life expectancy should increase. While there are still many steps for this new technology to take before implementation, the promise of the technology provides immense hope.

– Kiran Matthias
Photo: Flickr

Measles Outbreak in the PhilippinesIn January 2019, a measles outbreak in the Philippines began, leaving more than 450 dead and over 33,000 cases to date. Fifteen years after the near eradication of measles in the Philippines, the disease has returned with a vengeance in the Southeast Asian nation. The vaccination rate for measles in the Philippines has declined steadily, from more than 80 percent in 2008 to under 70 percent in 2017.

Several factors have led to a steady decline in the vaccination rate over the last decade. The issue of accessibility affects many people in rural areas of the country, putting them at risk of contracting diseases that are easily preventable with vaccination. The Philippines consists of 7,000 islands and does not have a secure health care budget in place, rendering it nearly impossible to ensure that all citizens are vaccinated.

Increasing misinformation concerning the negative side effects of vaccines has led many people to become skeptical about vaccinating themselves and their children. This drop in confidence in vaccinations has been quite significant. A 2018 study found that nearly 100 percent of participants were in favor of vaccines in 2015, believing them to be safe and effective only four years ago.

Who is at Risk?

Anyone who is not regularly vaccinated is at risk of contracting measles. The airborne virus can spread extremely easily and remains in a room for hours after an infected person has coughed or sneezed. The measles outbreak in the Philippines has affected thousands of people, including many young children who were not given the proper vaccination. Children under six months of age are especially in danger of contracting measles, as they are too young to receive the vaccine.

Pregnant women or those planning pregnancy run additional risks if they are not vaccinated against measles. If a woman wants to become pregnant — and is vaccinated beforehand — she should wait at least four weeks before attempting to conceive. This ensures that the vaccine is functioning properly and effectively. If a woman is not vaccinated against measles and becomes pregnant, a variety of side effects can occur. Common reactions include premature birth, miscarriages or stillbirths, and babies born underweight.

What Can be Done?

Fortunately, the growth rate of the measles outbreak seems to be slowing. New cases decreased to a few hundred per week in May, while thousands were infected each week in February and March. The decline in new cases largely due to local health officials visiting communities firsthand and checking residents’ vaccination statuses.

For children under six months of age who are unable to receive the necessary MMR (measles, mumps, and rubella) vaccine, the best precaution is to limit contact with anyone who is not a primary caregiver. Infants aged six to 11 months should have one dose of the vaccine, while children over one year and adults should have two doses of the vaccine given at least 28 days apart.

A Bright Side to the Measles Outbreak in the Philippines

Despite the tragic number of families that have been affected by the measles outbreak in the Philippines, there is a bright side. Since the outbreak began in early 2019, more than five million people have been vaccinated against the disease. The Filipino government hopes to boost that number to 20 million by the fall, which would mean one-fifth of the country’s population would be newly vaccinated this year. By immunizing such a significant percentage of the population, the Philippines can restore faith in the healthcare system, and prevent further illness and death.

– Emi Cormier
Photo: NPR

Bangladesh Winning the War Against Diarrhea

Despite being a developing country, Bangladesh has made exceptional progress in its health sector. It is reducing its infant mortality, increasing life expectancy and working to maintain control over diseases. Its progress in reducing life-threatening diarrhea is yet another triumph for the country’s health sector and its various interventions. Below are some indicators of Bangladesh winning the war against diarrhea.

Reduction of Diarrhoeal Deaths for Infants

Between 2000 and 2016, Bangladesh had managed to reduce the number of diarrhea-related deaths for children under five by 81.8 percent from 38,877 to 7,062 deaths. Oral Rehydration Therapy (ORT) has had a significant impact on reducing diarrhea in children in Bangladesh. In 2011, the country had a 90 percent reduction rate from the last 30 years after an increase in ORT.

From 1993 to 2014, the proportion of children diagnosed with diarrhea receiving either Oral Rehydration Salts (ORS) or Recommended Homemade Fluids (RHF) increased from 67 percent to 89 percent in urban areas and 58 percent to 83 percent in rural areas. As of 2015, diarrhea accounted for only 2 percent of under-five deaths, compared to around one-fifth in the 1990s.

As the pioneer in effective diarrhea control, The International Centre for Diarrhoeal Disease Research, Bangladesh has been saving lives since the 1960s. It strongly promotes the use of ORS. Through a national program, Bangladesh became the first country to increase oral rehydration therapy. It treats more than 100,000 people each year for diarrheal diseases and related nutritional and respiratory problems.

The center was also involved in research that showed how zinc supplements could not only reduce the duration of diarrhea but also lessen the risk of recurrence. It has increased its efforts in providing more zinc tablets to children in need.

Ending Preventable Child Deaths by 2035

This initiative was launched by the Ministry of Health and Family Welfare (MOHFW) of Bangladesh, along with other civil society organizations and professional associations. The goal of this initiative has been to reduce child deaths to 20 per 1,000 live births by 2035 largely by cutting down under-five mortality and reducing the neonatal mortality rate.

Bangladesh has performed very well before the target date. Bangladesh has made remarkable progress in maternal, newborn and child survival interventions. Other than providing vaccines and skilled birth attendants, interventions under this initiative also include changing social norms like open defecation given the role it plays in causing diarrhea. This further contributes to Bangladesh winning the war against diarrhea.

Integrated Management of Childhood Illness (IMCI)

Adopted in 1998, the IMCI program finally launched in 2002. This program focuses on the major causes of child mortality such as diarrhea, pneumonia, malaria, measles and malnutrition. As of 2015, the facility-based IMCI program has been implemented in 425 of the 482 sub-districts across the country, including community clinics.

By 2013, more than “4000 doctors, 17,000 paramedics, 8,500 basic health workers and 15,600 skilled birth attendants” were trained under this program. The number of trained healthcare workers providing quality care for sick children increased from 8 percent to 24 percent between 2002 to 2009 as a result of this program.

Strong Network of Community Healthcare Workers and Volunteers

The government’s strong network of community healthcare workers and volunteers has played an important role in Bangladesh winning the war against diarrhea. These healthcare workers and volunteers have been able to quickly identify and treat diarrhea cases at the community level and send the most serious cases to local clinics for more intensive treatment. This allows for quick identification of symptoms, and as a result, it enables fast responses that can help prevent epidemics.

Other than these interventions, improvements in access to clean drinking water and sanitation have also immensely contributed to Bangladesh winning the war against diarrhea. Despite the level of poverty, it is commendable how far Bangladesh has come in terms of vanquishing diarrhea.

Farihah Tasneem
Photo: Flickr

Cyclone Idai Health CrisisOn March 14, 2019, disaster struck southern Africa in the form of Cyclone Idai, a category 2 tropical storm that ravaged through Mozambique, Malawi and Zimbabwe. Idai made landfall in Beira, Mozambique, a large port city of more than 530,000 citizens. The International Federation of Red Cross and Red Crescent Societies asserts that 90 percent of Beira has been destroyed in the wake of Idai. The subsequent Cyclone Idai health crisis continues to challenge Southeast Africa.

As Idai strengthened along the coast of Africa, Mozambique and Malawi experienced severe flooding resulting from heavy rainfall. The cyclone destroyed roads and bridges, with a death toll of 1007. Hundreds more are still missing. Sustained winds of over 150 mph damaged the crops, homes and livelihoods of thousands throughout southeast Africa. To top it all off, Mozambique, Malawi and Zimbabwe are experiencing a major health crisis in southeast Africa in the aftermath of Cyclone Idai.

Cholera and Malaria

As of May, more than 6,500 cases of cholera have been reported. This intestinal infection is waterborne, commonly caused by drinking unsanitary water. In Mozambique, a country already vulnerable to poverty, the cholera outbreak exacerbates the adverse effects of Cyclone Idai. Cholera can be fatal without swift medical attention, though prompt disaster relief response and a successful vaccination campaign made significant strides in containing the outbreak.

In addition to cholera outbreak, cases of malaria are rising, with nearly 15,000 cases reported since March 27. Malaria is transmitted through Anopheles mosquito bites, insects that flourish in the standing flood waters of Idai. According to WHO, almost half of the world’s population is at risk of malaria, with the majority of cases and deaths in sub-Saharan Africa. Relief efforts prepared for the outbreaks by arming health professionals with antimalarials and fast-acting diagnostic tests.

Cyclone Idai Health Crisis Relief Efforts

The health crisis in Southeast Africa following Cyclone Idai received swift aid response. Disaster relief efforts prepared vaccinations and medications beforehand, ensuring that medical response was efficient and effective. The total recovery cost for the damage inflicted on Mozambique, Malawi and Zimbabwe is estimated at over $2 billion. The tropical storm affected upward of three million Africans.

WHO delivered 900,000 doses of oral cholera vaccine retrieved from the global emergency stockpile. Further, the organization plans to create multiple cholera treatment centers in hopes of containing the outbreak. World Vision is concentrating their efforts on the spread of this infectious disease. The humanitarian aid group is working alongside UNICEF to distribute cholera kits with soap and water purification tablets.

Rapid aid efforts also met the spike in malaria cases to combat the Cyclone Idai health crisis. WHO secured 900,000 bed nets treated with a strong insecticide to prevent the spread of the mosquito-borne disease. However, children and infants are at major risk, as malaria is considered the third most deadly disease to this population. The hefty humanitarian response and support necessary to help Mozambique, Malawi and Zimbabwe has prompted UNICEF to launch an appeal for $122 million for the next nine months.

-Anna Giffels
Photo: Pixabay

Breast Cancer in Developing CountriesWomen in developing countries lack access to safe and cost-effective breast cancer screening practices, leaving cancer frequently undetected. As a result, three times as many women in low-income, developing countries die each year due to breast cancer compared to developed countries. A team of young women from John Hopkins University is working to change this disparity and save lives through the creation of a new biopsy device.

Early Detection: A Better Chance for a Cure

Great strides have been made in the prevention and treatment of breast cancer in developed countries. More than 80 percent of women diagnosed in North America, Sweden and Japan survive. However, the situation is far different for women in the developing world. Less than 40 percent of women diagnosed in developing countries survive the disease, according to the WHO. This disparity in fatalities can be attributed to a lack of early detection. Studies in Europe and Canada found that the risk of breast cancer death decreased by more than 40 percent among women who underwent early diagnostic screening. In the U.S., data reveals the widespread use of early detection procedures and a 39 percent decrease in U.S. breast cancer fatalities after the 1990s.

Screening for Breast Cancer in Developing Countries

In 2003, the World Health Survey found that only 2.2 percent of women aged 40 to 69 years received breast cancer screening in low- to middle-income nations. More than half of women newly diagnosed with breast cancer in those nations have already progressed to stage III or IV disease. In the United States, 71.5 percent of women aged 50-74 have been screened within the past two years and over 90 percent of recently-diagnosed women have locoregional breast disease.

Why Aren’t Women Screened?

One of the main factors preventing women in low- to middle-income countries from early breast cancer detection is the high cost of screening procedures. Core needle biopsy (CNB) is a common diagnostic procedure that allows doctors to test a sample of breast tissue from the area of concern. In high-income countries, doctors use efficient and expensive disposable CNB drivers for breast biopsies. Low-income countries often cannot afford the same expense, relying instead on reusable drivers. These drivers are easily contaminated and the cleaning process is extremely time-consuming and costly, rendering breast cancer biopsies unavailable to most women in developing countries.

Ithemba: Hope for Women with Breast Cancer

A group of Johns Hopkins undergraduates won a 2019 Lemelson-MIT Student Prize for their creation of a safe, low-cost, reusable breast cancer biopsy device. After learning of the unsafe and inefficient diagnostic methods in developing countries, the team of four young women set out to create a safe and cost-effective CNB driver. Their device is named Ithemba, the Zulu word meaning “hope.” the CNB driver is centered around increasing women’s access to early breast cancer diagnosis. The device’s disposable needle contains a chamber that traps contaminants and is easily sterilized with a bleach wipe, ensuring safe reuse. Ithemba is expected to last up to 20 years before replacement is necessary.

The Johns Hopkins students have conducted over 125 stakeholder interviews. They predict that within the first five years on the market, Ithemba will impact the lives of 300,000 women in developing countries. In May of 2018, the team filed for a patent and are now searching for low-cost manufacturing methods and finalizing estimated costs.

Valerie Zawicki, one of the four undergraduates on the team, insists that the location of a woman’s home should not determine her odds of surviving cancer. The mission of Ithemba is to give all women—no matter where they live—hope with the chance to fight and survive breast cancer.

– Sarah Musick
Photo: Wikimedia

Distrust Breeds EbolaMore than 1,100 people in Congo have died due to the recent Ebola outbreak. New treatment facilities, additional health personnel, improved vaccinations, and awareness campaigns should effectively be controlling the spread of Ebola. In spite of this, distrust is breeding Ebola as citizens reject available aid.

However, violence and distrust are increasing the risk of Ebola in Congo. This Ebola outbreak is the second worst outbreak in history and the solution is extremely complicated. Local militias in Congo have been burning down clinics and threatening physicians since January. Historically, residents have had to fear for their own safety and flee local armed extremist groups.

Distrust of Aid

Now, with the recent outbreak of Ebola, already vulnerable communities are experiencing a double layered threat of violence and disease. Reports show that the number of people infected with Ebola rises after violent conflicts. These areas are often unsafe for health workers, increasing the risk for Ebola to spread. Much of the violence pointed toward clinics and health workers stems from a widespread distrust of the government and foreign aid. This distrust is breeding Ebola, unnecessarily increasing the risk of contraction.

Despite these challenges, many international organizations are still trying to control the spread of Ebola in Congo and provide aid to those already infected. The World Health Organization reported 119 attacks on health workers. This has inspired international organizations to approach their methods for care differently. Aid workers are attempting to provide correct information to the population in Congo in order to debunk the propaganda being spread about the government and international aid. Often in public, health workers downplay their role to try and build trust within communities. The International Rescue Committee states, “Our staff has to lie about being doctors in order to treat people.”

Continued Support

The New Humanitarian is exploring why a deep distrust of government and foreign aid exists in Congo. Social media seems to be a large player in spreading misinformation. As such, 86 percent of adults surveyed in Beni and Butembo stated they do not believe that Ebola is real. Others believe Ebola is a method used by the government to destabilize certain areas. Similarly, many people fear treatment centers are making Ebola worse. Facebook and WhatsApp are major players in spreading this false information. The Ministry of Health has said they are working to monitor these pages and adapt local messages to make sure the truth is out there.

The control of Ebola is entirely possible through vaccines and prevention efforts. Instead, distrust is breeding Ebola in Congo as risk increases. Working to end this distrust and limit violence toward health workers through the spread of true information, is essential in stopping the spread of Ebola. The World Health Organization, the Center for Disease Control and other health agencies and organizations are working to provide more aid to those affected by Ebola, hoping to prevent spread beyond the region.

Claire Bryan
Photo: Flickr

Polio Eradication in Afghanistan, Pakistan and Nigeria - The Final Three
Poliomyelitis, often called polio or infantile paralysis is an infectious disease caused by the poliovirus. It is a devastating disease that primarily impacts children and it can survive in the wild, but not for long without a human host. There is no cure, therefore, immunization is the foundation for eradication efforts. Today, polio is almost entirely eradicated from the planet.

Global immunization campaigns have made terrific progress in decreasing wild poliovirus (WPV) cases by over 99 percent in the past 30 years, down from an estimated 350,000 cases in 1988 to 29 reported cases in 2018. While more work needs to be done, the world is closing in on the virus and all eyes are on polio eradication in Afghanistan, Pakistan and Nigeria- the three final endemic countries. In the text below, the status of polio in these three countries is presented.

Polio Eradication in Afghanistan

Between the three countries listed above, in 2018 the most global polio cases were reported in Afghanistan. However, Afghanistan is the only endemic country not currently battling vaccine-derived polio, a form that can paralyze, in addition to WPV, which is a victory. The Global Polio Eradication Initiative (GPEI), in conjunction with Afghanistan’s Emergency Operation Centres, has dedicated continuing high-priority surveillance and instituted an aggressive immunization campaign to eradicate WPV in order to protect those most affected.

In November 2018, the country concluded an immunization campaign that targeted over five million children in the highest-risk provinces. These accomplishments are impressive, but at the same time fragile, because every single child must be vaccinated in this rapidly growing country. The Emergency Operation Centres are continuing to work under a National Emergency Action Plan and with local communities to ensure that all children are consistently reached now and in the future.

Polio Eradication in Pakistan

Polio could be eliminated from Pakistan this year, with continued strategic implementation. A vaccination campaign in December reached nearly 40 million children and the number of reported cases in the country is the lowest it has ever been. The race to the finish line requires continued focus on immunity gaps in high-risk and mobile communities, especially those that are close to the places where the virus is still indigenous, as well as continued accountability and high childhood vaccination rates.

Additionally, several of the endemic polio regions remain on the border with Afghanistan, which will require the two countries to continue addressing these WPV strongholds together. This region highlights the continued global threat of a virus that transcends geopolitical boundaries.

Polio Eradication in Nigeria

While WPV has never stopped circulating in Nigeria, there have not been any WPV cases since 2016. This is a terrific start towards wild polio eradication, but Nigeria has seen years without a WPV outbreak in the past only to see it return. The country is also managing continued vaccine-derived outbreaks. While immunization is paramount to eradication, some forms of the vaccine can infect patients and cause an outbreak. Though this adds a complex level to eradication strategies, immunization remains the most viable solution.

Currently, a variety of innovative solutions are underway to reach children in high-risk areas, including international immunization campaigns in the Lake Chad Basin whenever security permits, market vaccinations and seeking out nomadic communities. Similar to Afghanistan and Pakistan, continued efforts remain focused on closing immunity gaps, vaccinating all children and working with the country’s neighbors, but additional support for political and financial commitment is needed in Nigeria.

Going Forward

Wild polio eradication in Afghanistan, Pakistan and Nigeria is almost complete, but there are several challenges facing major vaccination efforts. In order to achieve elimination, every single child needs to be immunized. Even one unvaccinated child leaves the entire world at risk of infection.

There are, however, real challenges to this seemingly straightforward goal. Barriers like reaching children in mobile populations or in active conflict zones require international political coordination and more resources for mobile and stationary vaccination teams. Another major barrier is vaccine-derived polio cases, which threaten populations that don’t currently see polio in the wild. Research into the implications of adjusting the vaccine are underway and seek to address eliminating the spread of vaccine-derived infection.

It will not be possible to eradicate every disease with vaccination. Polio is one of the ones that can be. As global health efforts target polio eradication in Afghanistan, Pakistan and Nigeria, the world will likely be able to list polio next to smallpox and rinderpest on the coveted list of globally eradicated diseases.

– Sarah Fodero

Photo: Flickr

Five Diseases That Thrive in Poor Sanitation
Around 4 billion people in the world lack access to basic sanitation facilities like toilets or latrines and nearly 900 million people still defecate in the open. In addition, USAID estimates that 2.1 billion people currently do not have access to safe drinking water. These dismal conditions pose serious health hazards to the men, women and children living in these communities. Without toilets and latrines to separate human waste from living conditions and water sources, bacteria and virus are easily spread through food, water and direct human contact with waste.

World Health Organization (WHO) estimates that 4 percent of all deaths worldwide are the result of waterborne diseases like diarrhea, cholera, dysentery, typhoid and polio that thrive in unimproved sanitation conditions. This might not sound like a high number, but when considering that these diseases can be relatively easily prevented with inexpensive sanitation and potable water solutions, this percentage sounds absurd. The following list of five waterborne diseases that thrive in poor sanitation provides a glimpse of what is at stake when communities are devoid of proper water, sanitation and hygiene infrastructure.

Five Waterborne Diseases that Thrive in Poor Sanitation

  1. Diarrhea causes approximately 480,000 childhood deaths each year. This condition is linked to several viruses, bacteria and protozoans and ultimately depletes a person of water and electrolytes which, for many without oral rehydration solution, leads to death. One of the most important factors in eliminating diarrheal deaths, next to proper sanitation facilities, is handwashing. Something so simple can save lives and stop the cycle of diarrhea.
  2. Cholera is not just a disease from the pages of a history book, it is currently endemic in 51 countries in the world. It is unknown precisely how many deaths are directly the result of this waterborne disease, but WHO estimates that cholera kills from 21,000 to 143, 000 on a yearly basis. Contact with waste from an infected individual either directly or through food and water perpetuates the cycle of infection at an alarming rate. Proper sanitation is currently the first line of defense needed to curb this disease.
  3. Dysentery can be caused by either bacteria or an amoeba and presents an infection of the intestines. Fortunately, dysentery is usually cleared up on its own without treatment. However, this disease can be easily spread throughout communities without a system to separate waste from food and water.
  4. From 11 to 20 million people are infected with typhoid fever every year, causing up to 161,000 deaths on yearly basis. Typhoid fever is a life-threatening infection caused by bacteria Salmonella Typhi through contaminated food or water and sometimes from direct contact with someone who is infected. Unlike many waterborne diseases, antibiotics and new vaccines can provide treatment and limited immunity. Yet, without proper water, sanitation and hygiene typhoid infection will persist and antibiotic-immune typhoid will spread which will make treatment of the disease more complicated.
  5. Polio transmission has significantly decreased over the past 30 years thanks to aggressive, worldwide immunization. Still, the threat of infection continues to spread as a direct result of poor sanitation. Poliovirus is spread when humans come into contact with the virus from human excreta or poliovirus that survives in the wild. Polio is close to being eradicated and providing sanitation to the areas where the disease persists is imperative if the world hopes to one-day be polio-free.

Strategies to Eradicate Waterborne Diseases

Efforts to control these five waterborne diseases that thrive in poor sanitation come from both government and international aid organizations. There is also a concerted effort to implement strategy and resources to address the need for clean water and sanitation.

On the strategy front, a 2013 call to action from the U.N. Deputy Secretary-General on sanitation that included the elimination of open defecation by 2025, the sixth Sustainable Development Goal that aims ensure clean water and sanitation for all as well as numerous global guidelines and action plans for water and waste management set forth by WHO, UNICEF and partners are paving the way for large-scale change.

Meanwhile, in terms of providing resources, some examples include USAID’s country-based programs between 2012 and 2017 that supplied potable water to 12.2 million people worldwide. Numerous companies are partnering with large development organizations to develop their own campaigns or are developing products like LifeStraw, Life Sack and PeePoople that provide immediate potable water and sanitation solutions to millions around the world. These examples, in addition to new vaccines, antibiotics and other disease-specific campaigns are working together to eliminate the threats posed by unimproved sanitation and to eradicate waterborne diseased that are taking the lives of millions of people across the globe.

– Sarah Fodero

Photo: Flickr