Breastfeeding
The first week of August was World Breastfeeding Week, a week that, among other things, aims to inform the public something often overlooked: increasing the number of moms who breastfeed could significantly help decrease infant mortality and boost survival in extreme poverty. A healthy and low-cost practice, breastfeeding helps alleviate poverty.

Essential Health Benefits and Survival Booster

Breast milk has all the nutrition that a baby needs in its first six months of life and is a natural way of warding off diseases. Studies show that breastfeeding could decrease the risk of diabetes, allergies and other health hazards that may come in the baby’s later life. It is recommended that mothers feed their babies with breast milk exclusively for six months, and then breastfeed up to two years while introducing nutritional solid food.

Breastfeeding is not only beneficial but also necessary. A baby’s survival rate is boosted if it takes in breast milk within the first hour after birth. Failure to give a baby breast milk within a short period of time after birth could increase the possibility of infant death by as much as 80 percent.

The effects of breastfeeding on a global scale are striking. If all mothers across the world exclusively breastfeed their babies for six months and then feed their babies with breast milk along with other solid food for another year, 13 percent of global child deaths under five could be averted. Other recommended methods to increase child survival, such as hygienic delivery, Hib vaccine and tetanus toxoid, could each avert only up to 5 percent of child deaths under five.

“Breastfeeding is the best gift a mother, rich or poor, can give her child, as well as herself,” UNICEF’s Deputy Executive Director Shahida Azfar said on Mother’s Day.

Why Breastfeeding Helps Alleviate Poverty?

Breastfeeding is important everywhere in the world, and an essential way to help mothers in poverty or wealth. But poor regions with unclean water and insufficient hygiene should especially embrace breastfeeding because in these places this issue has a higher stake: artificial milk or infant formulas could become poisonous if contaminated, resulting in illnesses, or even death. Breast milk also provides sufficient water for babies in their first six months.

Breastfeeding is low-cost yet easily meets the nutritional needs of young babies. In other words, breastfeeding promises food security for babies and takes off some of the households’ financial burdens.

In a joint message released during the 2016 Breastfeeding Week, UNICEF and WHO stated: “breastfeeding is not only the cornerstone of a child’s healthy development; it is also the foundation of a country’s development. In fact, supporting breastfeeding is one of the smartest investments countries can make in the well-being of their citizens–and thus, in their own long-term strength.”

Why Aren’t More Mothers Breastfeeding?

It might be counter-intuitive that many mothers do not breastfeed their babies even though breastfeeding is ultimately the most cost-efficient practice. But breastfeeding may not be as easy as it appears: female workers often cannot afford sustained breastfeeding because their working environment or work routine do not provide them with the time and space for the practice.

UNICEF calls for support of national legislation and policies that provide women with paid maternity leave, breastfeeding breaks and other deserved benefits after birth.

UNICEF and WHO also launched the Baby-Friendly Hospital Initiative (BFHI) in 1991. This initiative essentially does not allow feeding bottles and cheap breast milk substitutes. The initiative proved highly successful. Cuba, for example, saw a three-fold increase in exclusive breastfeeding for four months in the stretch of only six years after making 49 of 56 hospitals or maternity facilities baby-friendly.

Countries also need more informed, supportive health-workers who encourage and assist with breastfeeding. Advocacy for breastfeeding like the World Breastfeeding Week also helps raise awareness.

“Now, as governments around the world develop budgets and action plans to achieve the Sustainable Development Goals, breastfeeding must be a policy, programming, and public spending priority,” WHO and UNICEF stated in 2016.

– Feng Ye
Photo: Flickr

Saving Premature Babies Globally with Scientific Research
Globally, an estimated 15 million babies are born prematurely, meaning they have completed less than 37 weeks of gestation. Scientific research throughout the years has been successful in saving premature babies on a global scale. For instance, India is a developing country whose focus is on saving the lives of preterm babies.

Achievements of Scientific Research Regarding Premature Babies

In 1953, researcher Dr. John Clements discovered that there was a way to save millions of premature babies around the world through his understanding of lung functionality. He found that a slippery substance, a surfactant, can help lessen the surface tension in the alveolar membranes. Therefore, scientists discovered that a lack of surfactant connects to human lung disease.

Another researcher, Dr. Mary Ellen Avery, in 1959, used Dr. Clements’ research to find that the lungs of premature babies cannot produce surfactant. Since then, saving premature babies globally has been made more possible through the FDA approval of five synthetic surfactants, which helps prevent respiratory distress syndrome in premature babies.

A recent innovative, surfaxin, was approved in 2012 and is a method to help with stopping the disease in premature babies. Dr. Clements say: “When we began this work back in the 1950s, the mortality from RDS was above 90 percent. Today, that mortality is 5 percent or less.” The original findings of Dr. Clements helped lead to a solution of saving the lives of preterm babies all over the world.

Premature Babies in India

Due to having the most significant number of premature babies in the world, the vast size and population of India can find hope through these scientific discoveries. In addition to this prevalence, one should also consider gestational age.

Usually, ultrasound imaging is completed in the first trimester. One thing that makes this hard is that ultrasound calls for training to receive the images accurately. This can be hard to do because ultrasound imaging is not practiced regularly; instead, the mothers are asked the date of the last period, which results in inaccurate assessments of the time of conception.

Increasing Affordability and Impact

Moving forward, a more affordable and recent hardware-software can be made possible through positive changes in the ultrasound hardware, such as modifications to the core technology.

An issue in this field is that there is consistently a lack of trained healthcare workers. Machine learning and development of software technologies have improved to combat this deficiency and reduce the need for trained healthcare personnel overall.

Recent discoveries have shown that a deficiency of selenium could be related to more preterm babies’ births. The researchers performed a genome-wide association study in an extensive database and combined it with independent data to acquire results.

Future Discoveries on the Horizon

Research is being done in Africa and Asia to see if such processes actually work. These areas are predominantly where selenium deficiency is present, but these tests could prove crucial to saving premature babies globally as selenium contains proteins present in body functions.

Preterm births are traced back to inflammation, and the body function of producing antioxidants prevents inflammation. This is one example of how scientific research can greatly impact studies on premature births.

In fact, scientific research has made it possible for successful progress to be achieved in India and all around the world when it comes to saving the lives of premature babies. All of these recent discoveries create a positive sense of hope around the world in the quest of ending the problem of premature babies. The world is getting closer day by day to having more babies born healthy.

– Kelly Kipfer
Photo: Flickr

Cost of Giving BirthFor something as common and essential as the creation of life, delivering a child can come at quite the cost. Though the United States holds some of the steepest delivery-related costs in the world, many countries around the globe offer maternal healthcare at astronomical prices. These services cater to wealthier families and leave the poor and uninsured to struggle. In rural and low-income communities especially, the high cost of giving birth is very risky for women and newborns.

In many countries, there is a large quality gap between public and private hospitals. Even though there are public hospitals in South Africa, for example, that offer free healthcare services, these facilities often lack adequate equipment and accommodations for mothers and their newborns. One hospital outside of Johannesburg lost six infants around three years ago because it had run out of antiseptic soaps.

Private health facilities typically offer higher-quality healthcare services but at much steeper prices. On average, it costs a woman $2,000 to give birth at a private healthcare facility in South Africa. This is a cost that less than half of South Africa’s population can afford due to large income inequality problem and a widespread lack of health insurance coverage. Families instead settle for menial care or, in some cases, forgo care altogether.

As an alternative to formal care, women commonly hire traditional birth attendants (TBAs) to help with deliveries in rural areas of developing countries like Ethiopia. TBAs lack official training but are more affordable than midwives, who can cost upwards of 2,000 Ethiopian birr, about $90, or even more if a Caesarean-section is necessary. The result is a population that is underserved when it comes to delivery-side medical attention. Only 2 percent of deliveries in rural Ethiopia are administered by a health professional.

Tadelech Kesale, a 32-year-old mother from Ethiopia’s Wolayta province, has suffered due to insufficient care and the exorbitant cost of giving birth. Kesale had her first baby when she was 18 and has since lost three of her six children, one of whom was stillborn. Kesale typically earns two to three birr, equivalent to a tenth of a dollar, each week and was unable to hire a qualified professional for any of her deliveries.

“I gave birth at home with a traditional birth attendant,” Kesale said. “If I could afford it, I would go into a clinic. One of my friends, Zenebexh, died in labor – she just started bleeding after breakfast and fell down dead. A healer came but couldn’t do anything.”

The cost of giving birth in private hospitals in India is similarly prohibitive. Although government facilities hospitalize women and assist with delivery for free, many expecting mothers opt for private facilities for the higher quality of care. These facilities typically charge around $1,165 for basic delivery services $3,100 for Caesarean-section deliveries.

The costliness of Caesarean-sections and other procedures can be deterrents for poorer mothers who are faced with complications during labor or pregnancy. The Guttmacher Institute estimates that only 35 percent of women in developing countries receive the care they need when faced with complications. When such needs go unmet, both mothers and their babies face life-threatening medical risks.

The costs of transport to and from health centers can also be discouraging for expecting mothers, forcing them to deliver at home or in other unsterilized spaces. In rural areas especially, transportation is necessary to travel the long distances to health centers, though it is not always readily available. Aside from being expensive, it can also be scarce; as a result, many women deliver in their houses. When complications arise during delivery, this can be especially perilous.

Though there is no one way to remedy the astronomical cost of giving birth in countries around the globe, organizations like Oxfam are calling on the U.S. and other developed nations to send increased aid to countries with high rates of maternal and infant mortality. This aid can serve mothers and their babies in a myriad of ways, from covering basic health care costs to making it more possible for new moms to take time off from work after delivery. Ultimately, it will mitigate the steep costs many families must meet during and after pregnancy, providing mothers with the assistance they need to have safe, successful deliveries.

Sabine Poux

Photo: Flickr


Many people falsely believe that increasing healthcare in the least Developed Countries (LDCs) will exacerbate the global population growth problem. In reality, the exact opposite is true.

Statistics show that as healthcare increases around the world, families have fewer children, driving down infant mortality rates as well as population growth. On average, birth rates in More Developed Countries (MDCs) are 1.7 children per family while in LDCs, birth rates average to 4.3 children per family. In LDCs families are having more children to compensate for high infant mortality rates. Parents plan to have around 5 children as an insurance policy, to offset the children that are lost. The World Health Organization, with the help of the Bill and Melinda Gates Foundation (BMGF), has been working to reshape this ideology since 1990. By increasing planned parenthood facilities, healthcare infrastructure, and vaccinations, families are able to have fewer, healthier children. In Lesser Developed Countries birthrates dropped to 2.6 children per family. Roughly 122 million children’s lives have been saved since 1990.

BMGF has found that the best management practice for raising global health is vaccination. Vaccination rates have gone from under 10 percent in 1980 to 80 percent in 2015 in LDCs saving countless lives from preventable diseases. This has been possible through the creation of Gavi, the Vaccine Alliance. Gavi is an international non-government organization that serves as the middleman between pharmaceutical companies and governments willing to fund vaccinations programs. According to Bill Gates, “Since 2000, Gavi has helped immunize 580 million children around the world. The US is a major donor to Gavi —with bipartisan support—along with the U.K., Norway, Germany, France and Canada. It’s one of the great things the rich world does for the rest of the world.”

While vaccinations are a great first step towards ending poverty, they have their limits. Malnutrition is another key barrier as it is linked to 45 percent of all child deaths. Children missing key nutrients experience both cognitive and physical growth stunting. This is a much harder problem in terms of economic efficacy. It costs one dollar to administer the pentavalent vaccine, which protects against five deadly infections.

Nutrition, on the other hand, is a much more costly and nuanced problem that will require considerable economic growth within the affected countries to truly fix. The Bill and Melinda Gates Foundation philanthropic work has been indispensable to halving global extreme poverty since 1990.

Josh Ward

Photo: Flickr

Nepalese Newborns and Chlorhexidine: Match Made in Heaven
Every year, thousands of Nepalese newborns die due to various life-threatening infections contracted early on that go unaddressed. Currently, one in 19 Nepalese children dies before they reach the age of five and half of that number die before reaching even 28 days of life.

Finding successful ways to nurse newborns to health in Nepal has been a challenge for decades. Navel Glazers, a simple topical application of chlorhexidine digluconate (CHX), are helping to pave the way to a brighter future for Nepalese children.

The application of CHX has been used in health care settings to reduce the development and transmission of infections for a number of years now. However, due to limited support regarding its effectiveness in reducing newborn umbilical cord infections, it is not a widely known practice.

Per the recommendation of the World Health Organization (WHO) more studies have been done to assess the navel-glazing strategy, specifically in high-risk environments like Nepal.

Country-wide clinical trials of CHX application post-birth were rolled out in Nepal through the support of the National Institutes of Health, the Bill and Melinda Gates Foundation and USAID.

It was found that applying a 4 percent chlorhexidine solution to the umbilical cord after birth significantly reduced neonatal mortality.

“This is very important because, after its implementation, the number of infected umbilical cord cases in my facility declined,” explains Birendra Ghale, a health worker in charge of this peripheral-level health facility in Banke, Nepal. “I have also seen that fewer babies are dying in my VDC [village development committee].”

For a long time, cultural barriers kept the implementation of the newly-found, life-saving technique from being used. Nepalese mothers are accustomed to applying substances like turmeric, ash, cow dung or vermilion to their child’s umbilical cord post-birth.

Now, single-dose tubes are freely distributed to all expectant mothers in their eighth month of pregnancy. They also receive a one-on-one educational session to explain how to apply the gel after cutting the cord as well.

Chlorhexidine has rolled out to 26 of 75 districts in Nepal as of July 2012. The country’s government has committed to incurring the full expense of buying the commodity as well as other program costs from its own resources. They are even using a local manufacturer to help with a production of a high-quality product, and distribution continues to rapidly expand — mainly through community health workers.

Delegates from more than 20 countries learned from Nepal and its implementation of the program. At least five of those countries have implemented similar interventions.

According to the Healthy Newborn Network (HNN), the application of CHX is recognized as being successful, acceptable, feasible and cost-effective newborn care intervention. The widespread practice of CHX cord cleansing, or navel glazing, could prevent more than 200,000 newborn deaths each year in South Asia.

Keaton McCalla

Photo: Flickr

Reduce Neonatal Deaths
The United Nations World Health Organization (WHO) has recently released three new publications that will help strengthen knowledge on how to prevent stillbirth and neonatal deaths. These publications are aimed to assist countries as they develop their classification, analysis and investigation processes on unreported deaths.

Over 2.7 million babies die within the first month of life, according to the U.N. health agency. Another 2.6 million are stillborn, and over 300,000 women die during childbirth. Most of these deaths are preventable if paired with the appropriate health care.

“By reviewing the causes of maternal and infant deaths, countries can improve quality of health care, take corrective actions and prevent millions of families from enduring the pain of losing their infants or mothers,” stated the Director of Health and Research at WHO, Ian Askew.

When a baby is stillborn, they are not recorded in either a death or birth certificate. Therefore, many of the above numbers are an underestimate of the true amount of stillborn and newborn deaths. Countries are unable to truly investigate these deaths and find out appropriate prevention methods for future cases. This is why WHO decided to improve education efforts for countries by releasing these three new publications:

  1.  “WHO Application of the International Classification of Disease-10 to deaths during the perinatal period.” This publication aims to help countries link certain stillbirths to relevant causes. Such causes could be conditions like diabetes or hypertension in the mother. Before this recent publication, there was no classification system that would help countries record this information.
  2. “Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths.” This will be a guide to assist countries’ investigation of deaths, allowing them to develop solutions for future cases. It will incorporate the above classification system to publish a basic review of every stillbirth death. According to Anthony Costello — WHO’s director of maternal, children’s and adolescent’s health — every death review gives valuable information about what can be done in the future to prevent a child’s life from being lost.
  3. “Time to Respond: A Report on the Global Implementation of Maternal Death Surveillance and Response.” This will help strengthen countries review process of deaths in hospitals and clinics. It also details guidelines for hospitals to better improve their quality of care. WHO recommends hospital committees to meet at least twice a year. They also suggest conducting mortality audits and reviews of their past patients.

To strengthen other countries’ health information systems, WHO is partnering with more than 30 other global health organizations in hope of developing a more easily understood package of guidance and tools for countries to prevent neonatal deaths.

Katie Grovatt

Photo: Flickr

AIRBreathing problems are at the root of 1.8 million stillbirths and neonatal deaths that occur every year. Many of these deaths could have been prevented if health facilities had adequate equipment and proper training programs available.

Having worked with over 1,000 healthcare providers in Uganda’s Helping Babies Breathe (HBB) program, Dr. Data Santorino is intimately familiar with this issue. Alongside Kevin Cedrone, Craig Mielcarz and Dr. Kristian Olson, Dr. Santorino developed the Augmented Infant Resuscitator (AIR) as an inexpensive and effective solution.

AIR is an add-on to already existing emergency ventilation equipment that provides real-time feedback to birth attendants. The feedback incorporates both an assessment of the quality of emergency ventilation administration and “actionable cues” for users to take up.

These cues are vital to the babies under neonatal care. They not only help users improve their performance but also build their confidence in the abilities that they have to care for the newborn.

Because the feedback also helps to improve skills, AIR alleviates former inadequacies in neonatal resuscitation training. With the device, users can put their skills to use while also learning and maintaining proper practices.

AIR may prove especially helpful in developing countries where proper equipment is often too costly or inaccessible and training of healthcare professionals remains seriously insufficient.

Currently, birth attendants administering emergency assisted ventilation will periodically stop the process in order to manually check and monitor the baby’s heart rate. This interruption within the first “golden minute” after a baby is born could prove detrimental, according to Santorino, as the lack of oxygen could either kill the baby or cause other health issues such as brain damage.

As the first place winner for the best pitch at the Boston Children’s Hospital Innovation Tank, AIR continues to be developed and improved. Its first deployment is projected for January 2017.

Jocelyn Lim

Sources: Elsevier, Augmented Infant Resuscitator, Boston Children’s Hospital, MIT Ideas Global Challenge
Photo: Flickr

maternal healthSaving Mothers, Giving Life is a public-private partnership that works with impoverished communities whose mothers have no functioning health care during pregnancy. Saving Mothers, Giving Life facilitates health services in Uganda, Zambia and Nigeria in order to better equip their network to ensure a focus on the most vulnerable period for mothers and their newborns – during labor, delivery and 48 hours after birth.

Maternal and infant mortality often mingle together because when a woman dies during childbirth (which occurs around every 2 minutes) her baby’s chance of dying instantly increases by 10 percent. However, institutionalized deliveries have far less complications and drastically improve the conditions of both the mother and newborn postpartum.

In Uganda and Zambia alone there are an estimated 2 million births annually of which 50,000 maternal and infant mortality rates occur because there is no accessible health care service to provide a safe and sanitary facility for women during their pregnancy. Coupled with the fact that nearly half of all Africans lack essential drugs to treat basic infections, these conditions substantiate the reason why approximately 3 percent of births account for infant mortality in the two states combined.

Saving Mothers, Giving Life offers a solution to the detrimental situation of mothers in Uganda and Zambia through various methods that, since their application, have reduced the maternal mortality ratio in Uganda by 45 percent and in Zambia by 53 percent. The foci of Saving Mothers, Giving Life all occur within a couple days and because of this a few approaches have proven to be the most effective in practice:

  • Training and mentoring has been a paramount tactic utilized by the organization. In doing this, they establish a means of aiding communities who have no physician or facilities, creating self-reliance.
  • Generating and providing facilities with essential health care supplies that have increased in number of institutionalized births in Uganda by 30 percent and in Zambia by a staggering 90 percent.
  • Mobilizing the community to vie for a health care service in their region in order to strengthen their network empowers communication and transportation along with stabilizing the means by which people seek treatment or consultations.

Currently, the organization only operates in 26 districts across Uganda and Zambia; however, Saving Mothers, Giving Life has extended its reach into Nigeria where 14 percent of the world’s maternal mortality and 25 percent of newborn mortality occur. Since its arrival in Cross River State in southern Nigeria, a 40 percent increase of women giving birth in a facility marks its success.

Since 2012 when Saving Mothers, Giving Life launched, the drops in mortality rates have only solidified that saving women in low-resource settings and reaching the “audacious 50% reduction of maternal deaths in both countries now seems not only possible, but probable,” secretariat of Saving Mothers, Giving Life said in its 2015 Mid-Initiate Report.

Emilio Rivera

Sources: Saving Mothers Giving Life 1, Saving Mothers Giving Life 2, Saving Mothers Giving Life 3, Saving Mothers Giving Life 4Our Africa
Photo: Save The Children

newborn_health_conferenceIn response to the recent sustainable development goals created by the UN, Mexico City hosted a Global Maternal Newborn Health Conference to focus attention on and propel efforts towards improving maternal and newborn health and healthcare around the world.

Representatives of more than 50 countries, which included policymakers, healthcare workers, researchers and organization leaders, attended the conference.

The general public or those unable to attend in person had ample opportunity to participate virtually through webcasts, live converge and social media engagements. The theme of the Conference was “Reaching every mother and newborn with quality care.”

The talks, group sessions and skill demonstrations focused on six primary tracks: innovating to accelerate impact at scale, measuring for evaluation and accountability, bridging equity divides, generating new evidence to fill critical knowledge gaps, strengthening demand for health care and increasing health systems’ capacity to respond to population needs.

The conference was hosted with the intention of increasing collaboration to encourage innovation and improved global health.

Every day, about 800 women die from preventable causes related to pregnancy or childbirth. These deaths are often due to the fact that the women did not have access to adequate healthcare.

This helps explain why 99 percent of all maternal deaths occur in developing countries where woman are restricted geographically or economically from the medical care they need.

Mexico City was selected to host the conference because Mexico is a recognized global leader in maternal and newborn health improvements.

Their national maternal and newborn health agenda has been greatly improved through successful government policies and programs, as well as through assistance from local and national NGOs, philanthropic entities and academic organizations.

In order to abide by and accomplish the UN’s Sustainable Developmental Goals, nations and international organizations must find ways to work together to set satisfactory standards and procedures and flush out what strategies and techniques work and what ones do not.

Conferences like the Global Maternal Newborn Health Conference allow information to be shared as well as spur insight to solutions and inspire hope for progress.

Brittney Dimond

Sources: Global MNH 2015, The Guardian, WHO
Photo: Flickr

Nursery of the Future
Premature births are a very real scare for mothers in developed countries like the U.S., but in developing countries, they can mean almost certain death. Worldwide, premature birth is the leading cause of death for children under five years of age. Despite advances in technology that have made tremendous strides in improving health outcomes for babies born earlier than 37 weeks, in developing countries, where women may be at a higher risk for giving birth prematurely, this technology is generally widely unavailable due to high prices and lack of access to adequate healthcare. Nursery of the Future is working affordable alternatives to those who need it most.

 

The Birth of Nursery of the Future

 

A bioengineering professor at Rice University in Texas, Rebecca Richards-Kortum, consistently saw this problem and wanted to do something about it. Along with colleagues and students, Richards-Kortum has begun to develop “the Nursery of the Future.” The team has developed prototypes of alternatives to high tech, and high cost medical machinery that is common across the U.S., for use in more underdeveloped areas around the world.

One such example of a low cost alternative is a belly band. One common problem in preemies is neurological underdevelopment that can cause the baby to stop breathing. In hospitals across the countries, monitors alert nurses if a baby stops breathing and the nurse then stimulates the baby somehow to remind them to breathe. In developing countries, these monitors are often too expensive to be used and often times infants die before a nurse notices. The belly band developed by Richards-Kortum and Maria Oden, a colleague, was designed with a tiny motor attached to it that detects when a baby’s air intake is low, or they stop breathing, and vibrates to remind the baby to breathe.

The belly band is just one step towards the development of a whole “Nursery of the Future” kit. Richards-Kortum and the team hope to make the Nursery available for under $10,000 and widely accessible for community hospitals. The belly band has been tested in Texas and is approaching its first international trial in Malawi in the near future. The Nursery of the Future is a huge step in the global fight against child mortality and overall accessibility and affordability of medical devices. Innovations made in the Nursery Kit for preemies hold promise for innovations in other medical technologies that could improve access to essential medical devices around the world.

Emma Dowd

Sources: Houston Chronicle, TED Talks