Archive for category: Global Health

Information and stories about global health.

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ARIDA: Tackling Childhood Pneumonia

ARIDAThe World Health Organization (WHO) identifies pneumonia as the leading cause of mortality among children under five, attributing more than 700,000 child deaths to the disease in 2019. Consistently, UNICEF estimates that pneumonia annually claims the lives of 800,000 children under five worldwide, marking it as the top cause of child morbidity from infectious diseases globally. Pneumonia can be contracted through various agents, including viruses, bacteria or fungi. It affects the lungs, specifically the alveoli—small sacs where air exchange occurs. Normally, these sacs expand with air when inhaling. In cases of pneumonia, the alveoli fill with fluid or pus, making breathing painful and limiting the ability to take deep breaths.

Typical Barriers to Treating Pneumonia

Pneumonia is often misdiagnosed as a disease like malaria or tuberculosis, complicating early detection efforts. The WHO reports that in remote areas with limited health facilities, health workers rely on manual counts of respiratory rates (RR) to diagnose pneumonia. However, manually counting a child’s breaths is challenging and subjective, with variations in what different health workers consider a single breath. This inconsistency makes it difficult to obtain an accurate RR, hindering effective diagnosis.

ARIDA

In 2014, UNICEF launched the Acute Respiratory Infection Diagnostic Aid (ARIDA) program to develop technology that would enable health workers to diagnose pneumonia more accurately. This initiative introduced two new devices: the Philips ChARM, which stands for Children’s Automatic Respiratory Monitor and the Masimo Rad G, both designed to improve the assessment of respiratory rates in children.

The Philips ChARM, priced at $44 per unit, automatically counts a child’s respiratory rate when strapped around the torso, designed for use while the child lies horizontally. The Masimo Rad G, costing $250 per unit, uses a clip-like monitor attached to the child’s finger to calculate respiratory rate and simultaneously measure blood oxygen levels. Using devices to calculate respiratory rates has enabled health workers to adhere more closely to WHO guidelines for diagnosing pneumonia quickly and accurately. More than one million children gained access to life-saving antibiotic treatments due to the ARIDA devices and an additional 300,000 received enhanced care services.

The Future of ARIDA

The trials of the ARIDA devices took place in Bolivia, Nepal and Ethiopia from 2017 to 2019, significantly advancing Ethiopia’s health goals for women and children. These ongoing efforts are part of a broader commitment to the Global Action Plan for Pneumonia and Diarrhoea, aiming to eliminate all treatable pneumonia and diarrhea-related deaths by 2025. The plan includes expanding the range of ARIDA products available for government purchase. However, the scaling of ARIDA products faces challenges such as unit costs, though countries may offset these costs through funding from UNICEF’s development partners. This initiative also supports the United Nations (U.N.) goal to end preventable deaths of newborns and children under five by 2030.

Looking Ahead

The ARIDA initiative has made significant strides in diagnosing and treating pneumonia, particularly in remote areas. Trials in Bolivia, Nepal and Ethiopia have already enabled more than a million children to access life-saving treatments. Despite cost challenges, the expansion of ARIDA products aligns with global health goals, aiming to reduce child mortality rates and improve health care outcomes by 2030.

– Naomi Finapiri

Naomi is based in London, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr

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Technological Innovations in Maternal Health

Innovations in Maternal HealthThe United Nations Children’s Fund (UNICEF) reports that more than 25% of the estimated 300,000 maternal deaths each year stem from postpartum hemorrhage, which is severe blood loss following childbirth. Most of these deaths occur in developing countries where access to quality medical facilities is limited. The United Nations (U.N.) states that postpartum hemorrhage is the leading cause of maternal mortality, claiming the lives of 130,000 new mothers each year. Technological advancements and innovations have introduced two significant medical devices to combat this issue and improve maternal health: the Non-pneumatic Anti-Shock Garment (NASG) and the Uterine Balloon Tamponade (UBT).

The Non-Pneumatic Anti-Shock Garment

NASGs resemble trousers and are divided into five to six segments. Each segment features Velcro straps that apply targeted pressure from the ankles to the abdomen, allowing for simultaneous vaginal treatments. Developed using technology similar to NASA’s anti-gravity suits, NASGs prevent unconsciousness by promoting blood circulation toward the head. They also reduce blood loss and increase survival chances in cases of postpartum hemorrhage by compressing the lower extremities to drive blood toward vital organs. This effective management ensures prolonged survival until medical help is available.

NASGs provide up to 48 hours of crucial support in emergencies and can be reused up to 144 times. Costing approximately $0.50 per use, NASGs are cost-effective and vital for maternal health. The World Health Organization (WHO), UNICEF and the United Nations Population Fund (UNFPA) recognize these garments as essential tools for reproductive, maternal, newborn and child health. Research indicates that NASGs can potentially reduce maternal deaths from postpartum hemorrhage by half in specialized care settings, highlighting their critical role in improving reproductive health outcomes.

The Uterine Balloon Tamponade

The UBT is a medical device used to manage postpartum hemorrhage. It works by inserting a balloon into the uterus and inflating it with saline or sterile water using a syringe or gravity bag. This inflation applies pressure to the uterine walls, effectively controlling excessive bleeding. Although UBTs are effective, they are expensive, with costs ranging from $125 to $350 per use, limiting their use primarily to high-income countries as a surgical intervention for severe postpartum hemorrhage.

In areas without adequate medical facilities, health practitioners have improvised with makeshift versions of the UBT. UNICEF reports the use of condoms, inserted into the uterus and inflated with saline through a catheter, as an emergency alternative to UBTs. These ad-hoc solutions can mitigate blood loss but pose significant safety risks. A 2019 study in Ivory Coast confirmed the effectiveness of UBTs, successfully managing postpartum hemorrhage in nearly all treated cases, highlighting the need for both proper medical oversight when using such devices and further innovations in Maternal Health.

The Adoption of NASG and UBT Devices

Despite the clinical proof of its effectiveness, the NASG faces several challenges that limit its wider use. A general lack of awareness about the importance of NASG exists. Additionally, many health facilities report shortages due to the device’s high initial cost. Additionally, gaps in knowledge about the proper use and maintenance of NASGs further complicate efforts to implement them effectively.

Similar to the NASG, despite its effectiveness in controlling postpartum hemorrhage, UBT is expensive, challenging its widespread use in low- and middle-income countries. The WHO restricts UBT approval to environments where advanced treatments like blood transfusions and surgeries are available. Clinical trials reported in Obstetrics and Gynecology journals have highlighted potential risks of using UBT-like devices in remote settings, including instances where the intervention might have worsened blood loss. Trained medical personnel are advised to use such devices with caution, particularly in less-equipped environments.

Moving Forward

The U.N. agency is collaborating with governments and hosting online seminars. The aim is to promote the effectiveness of the NASG in reducing postpartum hemorrhage. Since 2019, UNICEF has included the NASG in its Supply Catalogue for global accessibility. Additionally, UNICEF is searching for cost-effective alternatives to the UBT. UNICEF has identified a manufacturer that offers the device at $5-15 per usage. More than 10 countries now recognize this affordable UBT as an essential medical product, with at least 16,000 units purchased. Concurrently, WHO is launching a study in Vietnam to test procedures, including a UBT-like device, to mitigate postpartum hemorrhage and improve maternal health. This research aims to address previous concerns about the UBT’s risks and develop more innovations to reduce maternal deaths and improve maternal health.

– Naomi Finapiri

Naomi is based in London, UK and focuses on Technology and Solutions, Global Health and Celebs for The Borgen Project.

Photo: Flickr

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How the Global Fund Is Fighting HIV/AIDS

The Global FundThe Global Fund is a “Global Health Partnership” that receives funds from different sources, including the private sector, foundations and governments, to fight human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), Malaria and Tuberculosis. The partnership was established in 2002 and has saved 59 million lives by investing more than $60 billion in global health care systems to help ensure equal access to care across the world. The Fund’s HIV/AIDS goals include, but are not limited to, fulfilling the World Health Organization’s “Treat All” guidance and the United States Agency for International Development’s (USAID) 95-95-95 strategy.

What Is HIV/AIDS?

HIV is a virus that damages a person’s immune system, making them more susceptible to infections and other diseases. AIDS, on the other hand, is used to describe the often life-threatening infections and illnesses that occur after damage to the immune system has been caused by HIV.

HIV can be contracted by anyone through the body fluids of an infected person, through unprotected sex, sharing needles or transmission from mother to baby (via pregnancy, birth or breastfeeding). When discussing these interrelated terms, it is important to note that while HIV can be transmitted, AIDS cannot be.

With HIV treatment, “most people” can be prevented from developing AIDS-related illnesses and can get to the point of having an “undetectable viral load.”

WHO’s Treat All Guidance and USAID’s 95-95-95 Strategy

HIV is a global health care problem and as such, global organizations have set strategies in place. In 2016, the WHO launched the “Treat All” plan to tackle the number of people living with HIV, where it recommended that “all people living with HIV be provided with antiretroviral therapy (ART)” with the aim of reaching all 37 million with the virus.

Furthermore, USAID has set out another global strategy. Its 95-95-95 strategy is an HIV plan that has the following aims for 2025:

  • 95% of women in their reproductive years receive comprehensive HIV and sexual and reproductive health services.
  • 95% of pregnant and breastfeeding women diagnosed with HIV achieve viral load suppression.
  • 95% of children born to HIV-positive mothers undergo testing for potential exposure to the virus.

The Global Fund says it is “making significant progress” toward fulfilling both the WHO and USAID guidance.

Key Populations and Why They Matter

The WHO defines a key population as a group that “frequently face legal and social challenges that increase their vulnerability to HIV, including barriers to accessing HIV prevention, treatment and other health and social services.” According to USAID, 70% of new HIV infections occur in key populations and can go unresolved due to factors like stigma, human rights violations and violence.

The Global Fund has found that due to COVID-19, progress in the prevention and treatment of HIV/AIDs was reduced, with key populations being left behind, including children, adolescent girls and young women. For instance, there is a high disparity in care between children and adults, with 43% of HIV-positive children being unable to access lifesaving treatment compared to 23% of HIV-positive adults. Targeted health care tailored to these populations is crucial. Failure to address their infection rates undermines the long-term goal of eradicating HIV and AIDS.

What Has the Global Fund Done?

So far, the Global Fund has invested more than $25.5 billion in global HIV/AIDS care, providing more than a quarter of all international financing for this disease. Furthermore, in 2022, the organization provided antiretrovirals for 24.5 million people. In the same year, more than 15 million people, including 710,000 HIV-positive expectant mothers, received preventative care as a result of the partnership.

In fact, in the countries where it provided care, 82% of mothers were able to prevent the spreading of HIV to their babies. Moreover, due to the high number of HIV tests carried out, 53.1 million, the Global Fund was able to create a 72% reduction in AIDS-related deaths in countries where it operates.

The partnership has also identified 13 countries that have been made a priority, where key populations such as young women and adolescent girls are specifically targeted to benefit from HIV prevention programs. This is because they are “more than three times as likely” to contract HIV than their male counterparts.

Looking Ahead

In July 2021, the Global Fund released its 2023-2028 strategy, a continuation of all the work that it has done so far to improve health care outcomes globally. Its mission is officially to “To attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria, reduce health inequities and support attainment of the Sustainable Development Goals.” Ultimately, it aims to create a world that is healthier and better for all.

– Rachael Denton-Snape

Rachael is based in High Wycombe, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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How International Child Care is Transforming Lives in Haiti

International Child Care Transforms Lives in HaitiInternational Child Care, a nonprofit organization, is committed to enhancing the lives of children and families in Haiti’s vulnerable communities. Working collaboratively with local governments, organizations and communities, to provide a holistic approach to tackle issues like child health, education, nutrition and protection. International Child Care aims to break the cycle of poverty and create sustainable change in the long term, through its programs, grassroots efforts and advocacy work.

Since 1967, International Child Care has dedicated itself to transforming the lives of Haiti’s children and families through various programs centered on health and wellness. With one in 11 children dying before the age of 5 due to malnutrition and disease, the organization prioritizes health care and empowerment. Its programs aim to prevent illness, promote health and facilitate restoration.

Grace Children’s Hospital

Grace Children’s Hospital, operated by International Child Care, is Haiti’s premier medical facility, serving about 400 patients daily. It features both inpatient and outpatient clinics. The inpatient clinic, staffed entirely by Haitian professionals, provides essential care for children facing various health issues, including malnutrition, tuberculosis, HIV/AIDS and general health care needs, as well as maternal health services. Children typically stay for three months, during which they receive comprehensive medical care, nutritious meals and support from nurses’ aides. Some children, as they begin to recover, have the opportunity to attend school at the hospital, often receiving their first formal education.

The outpatient clinic at Grace Children’s Hospital delivers essential health care services to the local community, offering treatments and support for conditions such as tuberculosis in children and adults, HIV/AIDS, as well as providing eye exams, reproductive health care, nutrition advice and pediatric care. The hospital’s pharmacy ensures that patients receive the necessary medications. Additionally, the hospital operates the Urban Community Health program, which delivers health care services directly to residents of Port-au-Prince and its tent cities. Committed to the community’s health and well-being, the hospital guarantees care for all patients, regardless of their ability to pay.

Integrated Community Health

International Child Care operates Integrated Community Health programs that significantly impact vulnerable communities in Haiti by empowering residents to enhance their health and well-being. The organization partners with local communities to provide education and promote health and wellness, equipping them with the necessary knowledge and resources to fight disease and malnutrition. Through initiatives such as immunization and child health clinics, these programs extend aid to even the most remote areas. Emphasizing grassroots participation, the program aims to guide and lead communities toward improved health outcomes.

Education Programs

International Child Care actively combats poverty in Haiti by emphasizing education alongside health care. The organization operates a simulation laboratory (SimLab) and training center that offers hands-on experience to students, nurses and health care workers. These facilities equip them with the skills necessary to provide high-quality care to children and families in Haiti, allowing them to practice crucial skills in a controlled environment where mistakes carry no severe consequences. Funded by the United Methodist Women, the SimLab features CPR manikins for infants, children and adults, French-speaking automated external defibrillators (AEDs) for rapid response training in cardiac emergencies and specialized training provided by U.S. volunteers, including nurses and doctors. These educational programs ensure health care workers are well-prepared to meet the health care needs of Haitian communities.

Looking Forward

International Child Care continues to make strides in fostering sustainable health and education solutions for Haiti’s most vulnerable. By providing comprehensive care and education through initiatives like Grace Children’s Hospital and the Integrated Community Health programs, the organization plays a critical role in breaking the cycle of poverty. These ongoing efforts not only enhance immediate health outcomes but also build the foundation for long-term community resilience and empowerment.

– Isabella Green

Isabella is based in Aylesbury, UK and focuses on Good News for The Borgen Project.

Photo: Flickr

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N.C. State Research Addressing Global Health and Sanitation

N.C. State Research Addressing Global Health and SanitationAt North Carolina (N.C.) State University in Raleigh, a diverse team of faculty and students addresses water and sanitation challenges through research. The Global Water Sanitation and Hygiene (Global WaSH) Cluster program at N.C. State focuses on developing new technologies to tackle critical global health and sanitation issues. Researchers in the program apply advancements in energy, environmental processes, materials science, design and ecology to these problems. The program also educates its participants about the significance of addressing water and sanitation challenges through environmental research. Additionally, Global WaSH actively works on applying new technologies and engineering solutions to assist countries like Zambia in Southern Africa, where access to adequate sanitation remains a significant issue.

Global WaSH in Zambia

In 2017, the Global WaSH team from N.C. State introduced a more sanitary and efficient method for removing human waste from latrines in Zambia, called the Flexcrevator. This device has developed from several prototypes, the original of which N.C. State alumnus Tate Rogers invented in 2011. Rogers later founded the Triangle Environmental Health Initiative.

Nearly two billion people worldwide use pit latrines, exposing those who manually remove waste and trash from these latrines to dangerous pathogens. Mechanized methods for removing raw sewage are often costly and ineffective as they easily clog. In Zambia, however, the introduction of the flexcrevator has revolutionized this process. This vacuum-like device efficiently removes waste along with debris such as plastic bags, bottles and hair. Waste is vacuumed into a drum via a hose and an attached trash excluder pushes trash aside during the waste pumping process, making the process safer and cleaner.

Global WaSH has received funding and support from the Bill and Melinda Gates Foundation for its initiatives in Zambia. Additionally, the team collaborated with a German development agency to test prototypes. It has established field testing sites across the African continent.

The Man Behind the Mission

Dr. Francis de los Reyes, a professor of Civil, Construction and Environmental Engineering at N.C. State leads the Global WaSH Cluster. He has published more than 130 peer-reviewed papers detailing N.C. State’s research contributions to global health and sanitation. He has also educated both faculty and students about the significance of improving sanitation in underserved communities already burdened by poverty.

Dr. Reyes and his team earned recognition for their flexcrevator technology, receiving the RELX Group Environmental Challenge Award in 2018 and the Patents for Humanity Award in 2020. The Global WaSH program at N.C. State prioritizes sustainability and environmental research, actively addressing global health and sanitation through faculty and student collaboration. “I see the cluster as continuing to lead in education, research and extension in this field and making an impact directly and indirectly to the lives of millions who are underserved,” Reyes stated.

Looking Forward

The innovative efforts of N.C. State’s Global WaSH program is poised to enhance health and sanitation for millions in underserved areas around the world. Moreover, with continued support and development, technologies like the Flexcrevator promise to revolutionize waste management and improve public health in vulnerable communities.

– Jacob Buckner

Jacob is based in Raleigh, NC, USA and focuses on Technology and Solutions for The Borgen Project.

Photo: Unsplash

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Fighting Diseases in Ukraine

Diseases in UkraineOn June 6, 2023, extensive flooding destroyed the Kakhovka Dam in Ukraine, leaving millions of people without running water and exposing them to deadly infectious diseases. Conflict in eastern Ukraine has resulted in more than 20 incidents of damage to water infrastructure in the region alone, exposing the population to deadly infectious diseases like cholera, diarrhea and skin infections. The Kakhovka reservoir was a major provider of water for farmers and residents. 

Major cities across Ukraine are experiencing a severe water shortage, resulting in unsanitary living conditions and increased prevalence of diseases. The contaminated water supply has led to the spread of waterborne diseases such as cholera and typhoid, which have become widespread. Additionally, due to poor living conditions, rodent-borne diseases like leptospirosis and tularaemia have affected the population.

Environmental Damage

The impact of water damage on the environment has been another leading cause of Ukraine’s health crisis. David Santillo, a scientist at the University of Exeter in the United Kingdom (U.K.), spoke with the British Broadcasting Corporation (BBC) about water contamination. Santillo told BBC that raw sewage and untreated wastewater released into the soil can expose people to hazardous substances and pollutants. “There’s always potential for more of that contamination to end up being more widely distributed,” said Santillo.

The conflict in Ukraine has caused significant damage to the agriculture sector, leading to a lasting impact on the country’s economy. This has resulted in an increase in the poverty rate, which rose from 5.5% to 24.1% in 2022. A survey conducted in January 2022 revealed that more than 52.8% of people reported a deterioration in their family’s financial situation since the beginning of the conflict. Furthermore, more than 70% of the Ukrainian population has experienced a loss of income.

Humanitarian Aid and Response

Because of the intensity of the conflict, providing humanitarian aid and support to Ukraine has been highly challenging. However, organizations like the United Nations Children’s Fund (UNICEF) have tried to address the impact of war on the population’s health. UNICEF, with support from Citi, an American multinational investment bank, has been working to bring better health to every Ukrainian child.

Similarly, since the start of the conflict, humanitarian organizations led by UNICEF have assisted thousands of Ukrainian citizens. One of these organizations is the Water Sanitation and Hygiene (WASH). WASH has helped to repair infrastructure and provide power to water pumps to provide the population with safe access to clean water.

Efforts to vaccinate against diseases affecting Ukraine have also received support from the World Health Organization (WHO) and the European Union (EU). Thanks to funding from the EU, mobile health care units in the form of buses have been deployed across the country to reach vulnerable groups, including the elderly and those with pre-existing health conditions. The buses are prepared to administer vaccines against the following diseases: COVID-19, measles, hepatitis, polio, Haemophilus influenzae type b, tetanus and diphtheria.

In September 2023, WHO declared that a polio outbreak that had initially begun in 2021 had been officially eradicated in September 2023. However, cases of measles have been increasing since early 2022. Nonetheless, WHO will continue doing everything possible to deliver emergency needs and medical supplies to the Ukrainian population.

Dr. Jarno Habicht, a WHO representative in Ukraine, is one of many medical professionals stressing the importance of continuing Ukraine’s immunization program. “We have to move fast and work together. I can’t repeat enough what we know is efficient, proven and safe to prevent such public health emergencies: vaccination, vaccination, vaccination,” said Habicht.

– Jacob Buckner
Photo: Flickr

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Malaria in Cabo Verde

Cabo Verde Finally Eliminates MalariaIn January 2024, the World Health Organization (WHO) certified Cabo Verde as malaria-free, making it the third African nation to achieve this status. The elimination of malaria in Cabo Verde resulted from government initiatives and local community engagement. This accomplishment serves as a model for other countries prone to malaria.

Cabo Verde’s Malaria Statistics

Malaria, a potentially fatal illness, caused approximately 608,000 deaths and 249 million cases worldwide in 2022. Africa bore the brunt, with 580,000 (95%) of these fatalities and 233 million (94%) of the diagnoses. Additionally, 80% of malaria deaths among children under the age of 5 occur in Africa.

Cabo Verde comprises 10 small islands located beyond the West African coast and has more than 500,000 inhabitants. The country nearly eradicated malaria on two separate occasions, but neither was sustained. The first attempt involved residents using indoor spray to kill mosquitoes, which ceased in 1969. Consequently, malaria cases resurfaced on Santiago Island in 1973, leading to a nationwide outbreak in 1977. The second attempt in 1978 also aimed to eliminate malaria, resulting in significant case reductions by 1983, except on the Boa Vista and Santiago Islands.

The New Approach

In 2007, the Cabo Verde government enhanced its efforts to eliminate malaria by revising its health care policies. These changes aimed to increase the diagnosis rate, ensure the quick and efficient delivery of medicine and improve the supervision and recording of all malaria cases. In 2017, Cabo Verde was on track to eliminate malaria when an outbreak of 423 cases occurred. This outbreak prompted a change in strategy, leading to the reintroduction and reinforcement of indoor spraying and insecticidal nets, especially in areas most affected by malaria. Due to its successful efforts, the WHO declared Cabo Verde malaria-free on Jan. 12, 2024.

The country achieved this status by recording no malaria transmissions for more than three consecutive years and demonstrating the capability to prevent the re-establishment of transmission. With this achievement, Cabo Verde joined ranks of Mauritius and Algeria in being malaria-free. It is also became the 43rd country worldwide to receive this certification.

The Effect Of Malaria Elimination On Poverty

Infected individuals often participate less in the workforce due to illness, potentially reducing their earnings and pushing them into poverty. Additionally, the risk of malaria can deter investors from putting money into affected countries. This trend suggests that achieving malaria-free status may lead to positive outcomes for Cabo Verde.

Tourism is vital to Cabo Verde’s economy; before the COVID-19 pandemic, it contributed 24% to Cabo Verde’s GDP, accounted for 10% of employment and attracted most of the foreign capital. Cabo Verde’s malaria-free status may encourage more tourists from non-malaria-infected countries to visit without fear of contracting the disease or adhering to strict health precautions. This influx could boost the country’s revenue and increase personal incomes, helping to break the cycle of poverty.

Looking Ahead

Cabo Verde’s achievement as a malaria-free nation sets a precedent for public health success in Africa. Its commitment to maintaining this status could inspire similar strategies across other malaria-prone regions, enhancing global health security and economic stability.

– James McAlinden

James is based in Rosehearty, Scotland and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Battle Against Black Fever in India Nears Victory

Black fever in indiaAfter four deadlines, India is now on the verge of eliminating black fever as a public health problem. Provisional government data show that within a decade, India has drastically reduced the disease’s prevalence, with the number of cases nationwide dropping to fewer than 500 in 2023, down from 9,200 in 2014.

Former Director General of the Indian Council of Medical Research (ICMR), Dr. Nirmal Kumar Ganguly, has hailed this achievement as a significant gain for the country. Dr. Kavita Singh, Director for South Asia at the Drugs for Neglected Diseases initiative (DNDi), expects this success to enhance focus on effective public health initiatives. She believes it would “potentially attract more support and resources for similar endeavors toward other vector-borne diseases.”

Historical Context and Persistent Efforts

Black fever or visceral leishmaniasis, locally known as Kala Azar, is a lethal vector-borne disease transmitted by infected female sandflies. It is the second deadliest parasitic disease after malaria, affecting 200 million people annually in 76 countries. This infection impacts the spleen, liver and bone marrow. Without treatment, 95% of cases can be fatal, leading to weight loss, fever and anemia.

The earliest recorded instances of black fever in India date back to 1824, when an outbreak in Jessore, now part of Bangladesh, resulted in approximately 750,000 deaths over three years. Since then, India has experienced periodic outbreaks of Kala Azar every 10 to 15 years, primarily in the states of Assam, Bihar, Jharkhand and West Bengal. These outbreaks typically lasted about 10 years.

Innovative Approaches

The introduction of the indoor residual spray (IRS) of dichlorodiphenyltrichloroethane (DDT) under the national malaria eradication program in 1950 dramatically curbed the spread of Kala Azar in India. The country launched its campaign against black fever in 1992. While pushing four consecutive deadlines in 2010, 2015, 2017 and 2020, India realigned its strategies with the World Health Organisation’s (WHO) guidelines. It adopted an evidence-based practice that showed promising results in eliminating black fever.

The evolution of single-dose infusion and uninterrupted availability of drugs at the ground level has radicalized India’s battle against black fever. In 2012, 90% of the diagnosed people completed their treatments compared to 55% between 2008 and 2009. Governments at the state and national levels have announced remunerations for the patients to compensate for wage loss.

National Strategies and Surveillance Enhancements

The National Center for Vector Borne Diseases Control (NCVBDC) intensified residual spraying in villages that reported cases in the past three years. Since sandflies typically breed in the crevices of mud walls, targeting these hotspots with indoor residual spray (IRS) has curbed the spread of the disease, protecting more than 35 million people at risk. Additionally, Indian authorities have promoted concrete residential structures through the subsidized housing program, Pradhan Mantri Awas Yojana (Rural), reducing mud walls and eliminating potential breeding grounds.

In 2014, NCVBDC introduced a national database on drugs, diagnostics and vector surveillance for black fever. The database portal’s mobile application helped Accredited Social Health Activists (ASHA) detect cases and administer prescribed dosages. Since the black fever eradication program started in 1992, the number of cases has dropped by 97%, from 77,102 to 2,048 in 2020.

Looking Forward

India needs to maintain its efforts for the next three years to receive official validation from the WHO. Additionally, it is essential to eradicate post-kala azar dermal leishmaniasis (PKDL), the skin condition that occurs after black fever infection and serves as a reservoir for the parasite, to prevent the disease’s recurrence. Moreover, as of October 2023, India has reported 286 cases of PKDL.

– Soham Mitra

Soham is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Progress in Zika Virus Treatment and Support in Latin America

Zika Virus TreatmentIn 2015-2016, Latin America faced a formidable challenge with the outbreak of the Zika virus. This mosquito-borne illness sent shockwaves through communities and health care systems. Originating in Brazil, the virus quickly spread across the region, prompting the World Health Organisation (WHO) to declare a Public Health Emergency of International Concern (PHEIC). The declaration lasted for nine months, during which concerted efforts were made to contain the spread of the virus and mitigate its impact, particularly on pregnant women and their unborn babies. According to the National Library of Medicine, the Zika virus epidemic affected more than 400,000 people in Latin America. There has since been significant progress in the treatment of the Zika virus. However, the disease’s lasting effects impact many communities in the region.

Pregnancy Complications

One of the most alarming aspects of the Zika virus was its association with severe congenital disabilities, most notably microcephaly, a condition characterized by an abnormally small head and an underdeveloped brain. Pregnant women infected with the virus faced heightened risks, as it could be transmitted from mother to fetus, leading to potentially devastating consequences for newborns. Centers for Disease Control and Prevention noted that the Zika virus affected 5% of babies whose mothers had contracted the virus while pregnant and that many babies did not receive the recommended care.

Government Responses

In response to the crisis, governments, health care organizations and international agencies mobilized resources and expertise to combat the outbreak. Public health campaigns were launched to raise awareness about the virus and educate communities about preventive measures, such as eliminating mosquito breeding sites and using insect repellent.

Americares, a nonprofit organization based in Stamford, has been supporting affected families by ensuring hospitals are equipped with the appropriate medication and skills to combat the disease. It has also distributed mosquito nets and repellent to many people in Latin America in an effort to prevent transmission. Its family care clinic in El Salvador treats 60,000 patients a year.

Vector control efforts played a crucial role in reducing mosquito populations and curbing transmission rates. WHO created a vector control framework for tackling the Zika outbreak. Interventions ranged from insecticide spraying to community-based initiatives aimed at removing standing water where mosquitoes breed. These efforts, combined with improved surveillance and monitoring systems, helped to identify and contain outbreaks more effectively.

Furthermore, research into the Zika virus accelerated rapidly, leading to a better understanding of its transmission dynamics, clinical manifestations and long-term consequences. This knowledge proved invaluable in guiding public health strategies and informing clinical care for affected individuals.

Present Day Struggles

Despite significant progress in Zika virus treatment, challenges remain, particularly in providing support to families affected by its complications. Children born with microcephaly and other Zika-related congenital disabilities require specialized care and services to address their complex medical and developmental needs. Additionally, families may face social stigma, economic hardship and emotional distress as they navigate the challenges of raising a child with disabilities. BMJ Global Health conducted a study that found that children who were moderately affected by Zika have an economic burden of more than $204 million over 10 years.

Efforts to support affected families have encompassed a range of interventions, including access to medical care, rehabilitation services, psychosocial support and financial assistance. Governments and nongovernmental organizations have implemented programs to provide comprehensive support to affected families, with a focus on promoting inclusion, empowerment and dignity. Children’s National created one of the first congenital Zika virus programs, which provides patients with accurate diagnoses and treatment plans.

Final Remark

While the Zika virus epidemic of 2015-2016 presented unprecedented challenges for Latin America, it also showcased the resilience, solidarity and collective action of communities and stakeholders in responding to public health crises. By building on the progress made and continuing to prioritize support for affected families, Latin America can work toward a future where the impact of Zika is minimized.

The fight against Zika is far from over. However, with continued commitment and collaboration, Latin America can overcome this challenge and build a more resilient and inclusive society for all.

– Lauren McKenna

Lauren McKenna is based in Manchester, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Maternal Health in Bangladesh

Maternal Health in BangladeshMaternal health in Bangladesh faces significant challenges. According to Every Mother Counts, it is estimated that there are 245 maternal deaths per every 100,000 live births. Annually, approximately 7,660 Bangladeshi women die from preventable pregnancy and childbirth-related causes.

Causes of Maternal Mortality in Bangladesh

Maternal mortality ranks as the third leading cause of death for women aged 15 to 49 in Bangladesh, where most of these deaths are preventable through high-quality prenatal care and skilled attendance during labor and delivery. Poor health care facilities and limited access to them indirectly contribute to maternal mortality in the country. The two primary direct causes are obstetric hemorrhage, accounting for nearly one-third of maternal deaths and eclampsia, responsible for 23% of maternal deaths.

The State of Maternal Health Care in Bangladesh

Home births dominate in Bangladesh, with 71% occurring at home, yet only 4% receive attention from trained birth attendants. The country’s health worker coverage is at a mere 17% of the global threshold, highlighting a critical shortage of skilled birth attendants, especially in rural areas. For instance, in Cox’s Bazar, a rural area with one of Bangladesh’s highest maternal mortality rates, 90% of women give birth at home without trained attendants or emergency care access due to the region’s health care facility scarcity.

Further analysis of maternal health in Bangladesh reveals that 38% of maternal deaths occur on the day of delivery and 6% occur one day after. Additionally, 19% of these deaths happen at home, another 19% occur while en route to health care facilities, 49% occur in public health care facilities and 13% in private ones. Notably, about 80% of women who give birth in public facilities also die in these settings, underscoring the challenges within Bangladesh’s public health care system.

Efforts of CARE International and Other NGOs

CARE International, an NGO, has launched various programs to enhance maternal health in Bangladesh, including the Joint Action for Nutrition Outcome (JANO). This program educates mothers and pregnant women about health issues, nutrition and precautions during and after pregnancy, reshaping their understanding of the importance of accessing professional health care services.

In addition, the SHOUHARDO III program, another initiative by CARE, has made significant strides in enhancing maternal health in Bangladesh. In 2021, it trained female private community skilled birth attendants to assist pregnant and lactating women in the remote Char and Haor areas of northern Bangladesh. These trained professionals offer safe delivery services, antenatal and postnatal checkups, counseling, and referrals.

Other international organizations are also playing a key role in enhancing maternal health in Bangladesh. Among them, the United Nations Population Fund (UNFPA), through its ‘Solving Referral Challenges for Urban Poor to Access Emergency Obstetric and  Newborn Care’ project, collaborates with 40 maternity centers in Dhaka. The initiative leverages the ‘Ma Jaan’ app, connecting pregnant women in emergencies to the nearest participating hospital. This effort not only aims to bolster maternal health in Bangladesh but also leverages technology to propel the health care sector forward.

Looking Ahead

Efforts by CARE International and other NGOs are paving the way for improved maternal health in Bangladesh, showcasing the potential for significant advancements through education, training and technology. With continued focus and support, these initiatives promise a brighter future for Bangladeshi mothers, reducing preventable maternal deaths and ensuring safer childbirth experiences across the country.

– Olusegun Odejobi

Olusegun is based in Norwich, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr