Congenital Anomalies
Worldwide, congenital anomalies cause approximately 295,000 deaths of children within their first 28 days of life. Every year, about 7.9 million children are born with life-threatening defects and 3.3 million children under the age of five5 die from congenital disabilities. According to the World Health Organization (WHO), congenital anomalies are structural or functional aberrations that occur during intrauterine life. The most common congenital disabilities include heart defects, cleft lip (palate), down syndrome and split spine (also known as spina bifida). Although 50% of all congenital disabilities do not have a single definite cause, common causes include genetic mutation, environmental factors and various other risk factors.

Geographic Disparities

Although congenital disabilities are widespread globally, they are particularly prevalent in developing countries. Developing countries account for 94% of worldwide congenital disabilities.

The level of income -both individual and national- in developing countries is a crucial factor that indirectly influences the high incidence of congenital disabilities. Low income affects the incidence of congenital disabilities in developing countries in the following ways:

  • Poor Access to Adequate Maternal Healthcare for Women During Pregnancy: About 99% of the global maternal mortality cases occur in low-income countries due to inadequate maternal care.
  • Poor Maternal Nutritional Condition: Deficiency of vitamin B can, for instance, escalate chances of birthing a baby with neural tube defects.
  • Excessive Prenatal Alcohol Consumption: Pregnant mothers’ consumption of alcohol increases their risks of giving birth to a child with Fetal Alcohol Syndrome (FAS). FAS is a total of the damage – both physical and mental – to an unborn child as a result of their mother’s alcohol consumption.
  • Presence of Other Infections: Some sexually transmitted diseases can transfer from a pregnant mother to her child. For example, syphilis during pregnancy accounts for an estimated 305 000 fetal and neonatal deaths annually. It also jeopardizes 215,000 infant lives due to congenital infections, prematurity or low-birth-weight.

How WHO is Taking Action

The World Health Organization has taken and implemented various measures to fight congenital anomalies. In the 2010 World Health Assembly, WHO took on a resolution encouraging its member states to fight against congenital anomalies by:

  • Raising awareness throughout governments and the public about congenital disabilities and the risk they impose on children’s lives
  • Developing congenital disabilities surveillance systems
  • Providing consistent support to children affected by congenital anomalies
  • Ensuring that children with disabilities have the same rights and equal treatment as children without disabilities
  • Assisting families whose children have congenital disabilities

In addition to the resolution, WHO designed a manual that showed illustrations and photographs of selected birth defects. The manual’s primary purpose was to foster further development of the surveillance system, especially in low-income countries.

The Global Strategy for Women’s and Children’s Health

In 2016, WHO went an extra mile and published the Global Strategy for Women’s, Children’s and Adolescents Health 2016-2030, an updated version of the Global Strategy for Women’s and Children’s Health devised five years prior. The Global Strategy’s grand theme was “Survive, Thrive, Transform.”

  • Survive: “Survive” encompassed various goals that the Global Strategy hoped to accomplish. These include ending preventable deaths, lowering maternal mortality rates and newborn deaths among others.
  • Thrive: The main target was promoting health and wellbeing by responding to the dietary needs of children, adolescents and pregnant & lactating women.
  • Transform: This objective’s primary goal was to create a safe and nurturing environment by terminating extreme poverty. Poverty one of the leading causes of congenital disabilities.

Results

Over the years, the World Health Organization’s relentless efforts in battling against congenital disabilities have made remarkable progress in alleviating the issue. For instance, the number of newborn deaths has plummeted from 5 million to 2.4 million between 1990 and 2019, thanks to the various innovations and programs put in place. Although the current state of affairs is far from ideal, past accomplishments lay the groundwork and identify clear steps for future progress.

Mbabazi Divine
Photo: Flickr

 Address Neglected Tropical DiseasesOn November 12, 2020, members of the World Health Organization (WHO) voted overwhelmingly to adopt a bold set of plans to address the threat of neglected tropical diseases (NTDs) throughout the next decade. With this vote, the WHO endorsed a “road map” written by the Control of Neglected Tropical Diseases team to address neglected tropical diseases in the world’s most vulnerable regions. The decade-long project aims to establish global programs with international partners, stakeholders and private organizations. These partnerships will work to accomplish an ambitious set of goals that will end the spread of certain neglected tropical diseases and improve the quality of human life in regions susceptible to neglected tropical diseases.

Neglected Tropical Diseases (NTDs)

Neglected tropical diseases are commonly defined by global health organizations such as the WHO and the National Institute of Allergy and Infectious Diseases as a group of diseases that primarily affect those living in tropical and subtropical climates and disproportionately spread in remote areas or regions afflicted by poverty. Among the 20 diseases that the WHO categorizes as neglected tropical diseases are dengue, rabies, leprosy, intestinal worm and sleeping sickness.

Tropical and subtropical regions include Central America and the northern half of South America in the Western Hemisphere, most of sub-Saharan Africa as well as island nations in the Indian and Pacific Oceans. Many of the countries in this range are developing or impoverished nations. A lack of development and healthcare infrastructure in nations that lie in tropical regions, such as lack of access to clean water and health education, creates a more fertile breeding ground for the spread of dangerous diseases.

The reason that these diseases are considered “neglected” is that regions where neglected tropical diseases cause the most damage are populated by people with little political power or voice, a result of widespread poverty, location and other socioeconomic factors. As such, the spread of these diseases goes largely unnoticed and there is little incentive at the international level to take measures to combat these ailments. Though NTDs do not receive high-profile attention in the larger medical community, the WHO estimates that more than one billion people are affected by NTDs. The WHO sees the urgency to address neglected tropical diseases.

WHO’s 2021-2030 Road Map

The WHO outlined a set of “overarching global targets” that it will pursue over the course of the next decade in work with foreign governments, community organizations and NGOs. These overarching goals, to be accomplished through achieving a number of “cross-cutting targets” are the primary effects the WHO hopes to achieve by 2030:

  1. Reduce number of people requiring treatment for NTDs by 90%. To attain a 90% reduction rate of those requiring treatment for neglected tropical diseases, the WHO altered its approach to disease treatment from a vertical, single disease eradication method to a horizontal, cooperative effort across several countries. This would require 100% access to water supply, greater international investment in healthcare and action at the federal level to collect and report data on infection.
  2. Eliminate at least one NTD in 100 countries. There are a number of neglected tropical diseases that the WHO lists as “targeted for elimination”: human African trypanosomiasis, leprosy and onchocerciasis. In the WHO’s road map, elimination of a disease means complete interruption of transmission, effectively stopping a disease’s spread. For eliminating diseases such as leprosy, the WHO hopes to assist 40 countries to adopt epidermal health strategies in their healthcare systems.
  3. Completely eradicate two NTDs. The two diseases listed as “targeted for eradication” by the WHO are yaws, a chronic skin condition, and dracunculiasis, an infection caused by parasitic worms in unclean water. Both diseases are, according to the WHO, either easily treatable or on the verge of eradication. Dracunculiasis, for which there is currently no vaccine or medical treatment, only affected a reported 54 people in 2019. Yaws is still endemic in 15 nations but can be treated with a single dose of antibiotics.
  4. Reduce by 75% the disability-adjusted life years (DALYs) related to NTDs. The implementation of increased prevention, intervention and treatment can increase the quality of human life in tropical and subtropical countries. This final overarching goal aims to create nationwide efforts to alleviate or eliminate the chronic symptoms of those infected with neglected tropical diseases as well as prevent the further spread of debilitating neglected tropical diseases.

Ending Neglected Diseases

To address neglected tropical diseases, the fulfillment of the goals outlined in the WHO’s road map will require a multilateral and thorough implementation as well as cooperation and leadership from each of the partner countries affected. The WHO seeks to encourage each tropical and subtropical nation to take ownership of their healthcare programs, which will create a sustainable, international network to strengthen global health in some of the world’s most vulnerable regions. Putting the fight against neglected tropical diseases in the spotlight as well as dedicating time and resources to taking on these diseases, can remove the “neglected” from neglected tropical diseases and put the global community on a course toward eradicating these diseases.

– Kieran Graulich
Photo: Flickr

Antimicrobial resistanceAntimicrobial resistance, or AMR, is a growing trend among newly discovered viruses. The World Health Organization (WHO) identifies 30 new diseases that threaten half the world’s population, which are particularly prevalent in developing nations.

Background of Antimicrobial Resistance

Drug-resistant diseases (AMR) have grown in prevalence over the past 40 years. Many of the medicines used to treat common infections like the flu and pneumonia have been around for decades. Eventually, viruses and bacteria develop their own microbial methods of fighting back against these drugs and inevitably become fully resistant to treatments.

Perhaps the most well-known example is the virus known as pneumococcus, or streptococcus pneumoniae. Penicillin has been used to treat pneumococcus since the early 1950s, giving it plenty of time to develop a strong resistance to the drug. Now, pneumococcus is practically untreatable, killing over 300,000 children below the age of 5 annually.

The CDC explains that germs that grow resistant to medications can be almost impossible to treat, often resulting in severe illness or death. This problem is only getting worse, as the U.N. finds that while 700,000 people die every year due to AMR diseases now, by 2050 that number will skyrocket to 10 million people.

The AMR crisis has severe economic implications as well. Antimicrobial diseases affect livestock as well as humans, leaving our international agricultural sector to collapse if not dealt with. All in all, the AMR crisis is projected to cause $100 trillion worth of global economic damage by 2050, only pushing people further into poverty.

Three organizations have stepped up to address the issue of antimicrobial resistance.

The AMR Action Fund

The AMR Action Fund is a financial project created by an international group of pharmaceutical companies. It aims to bring four new antibiotics that combat AMR to the consumer market by 2030. The fund expects to invest over $1 billion into late-stage antibiotic research by the end of 2025.

The AMR Alliance

The AMR Alliance is a massive coalition of more than 100 of the most powerful pharmaceutical companies, dedicated to fighting AMR. In 2016, the AMR Alliance signed the Industry Declaration, an agreement promising the development of anti-AMR medicines.

In 2018, the AMR Alliance spent a record $1.8 billion in the war against AMR. In 2020, the  AMR Alliance released its second progress report, detailing the progress made so far. The results are promising: 84% of relevant biotechnology companies are in the late stages of research and development for AMR cures and more than 80% of them have strategies in place for releasing the drugs.

UN Food and Agriculture Organization (FAO)

The FAO is taking serious steps to battle antimicrobial resistance. These dangerous antimicrobial superbugs threaten livestock in farms throughout the world. The FAO explains that two-thirds of future antimicrobial usage will be in livestock. These AMR superbugs will only increase in danger over time, as they develop stronger resistance to medicines.

The FAO has worked to improve agricultural practices across the world, specifically in developing nations. The FAO is raising awareness about this issue with rural farmers and is providing millions of dollars in funds to combat AMR.

World Antimicrobial Awareness Week (WAAW) is an annual campaign designed to increase awareness of the issue and encourage best practices among the general public, health workers, and policymakers to avoid the further emergence and spread of drug-resistant diseases. Over the week of November 18, millions of posts are made around the globe in support of antimicrobial resistance awareness. Expanding awareness is key, as the WAAW campaign website explains that less general use of antibiotics could help to mitigate the effects of this issue.

– Abhay Acharya
Photo: Flickr

Healthcare in MonacoWith nearly 40,000 people, Monaco is one of five European micro-states and is located on the northern coast of the Mediterranean Sea. According to the Organisation for Economic Co-operation and Development (OECD), Monaco has one of the best global healthcare schemes. The World Health Organization established that an individual born in 2003 can expect to have, on average, the longest lifespan in Europe. The country also has the third-highest proportion of doctors for its population in Europe.

Healthcare Education in Monaco

Leaders in Monaco believe that prevention and screening are essential to maintaining health and it is customary for young people to access comprehensive health education. This education aims to promote high-quality lifestyles and prevent early-risk behavior, such as tobacco use, drug addictions and sexually transmitted diseases.

Caisses Sociales de Monaco (CSM)

The Caisses Sociales de Monaco (CSM) is the official agency responsible for supervising Monaco’s public health service. Public healthcare automatically covers all citizens and long-term residents who contribute to the agency. French and Italian citizens may also access public health facilities in Monaco upon evidence of regular contributions to their home country’s state healthcare scheme. Foreign visitors can receive health treatment at all public hospitals and clinics. However, without state insurance contributions, travelers and expatriates will be forced to pay for all healthcare expenses accrued from treatment.

Public Healthcare Coverage

Public healthcare insurance operates through reimbursements, so an individual who plans on using coverage provided by the CSM will be required to make up-front payments and then claim costs back. After joining the public healthcare system, an individual receives a card that provides access to medical and dental care. The card contains administrative information necessary to refund medical care.

The public healthcare system provides coverage for inpatient and outpatient hospitalization, prescribed medications, treatment by specialists, pregnancy and childbirth and rehabilitation. Some prescription drugs are also reimbursed through the CSM and emergency care is available to everyone at Princess Grace Hospital, one of three public hospitals. The hospital will be reconstructed to strengthen the complementary nature of all the hospitals in Monoco.

Out-of-Pocket Healthcare Costs

Out-of-pocket healthcare costs in Monaco are high and if the CSM fails to provide sufficient coverage, an individual may supplement with private insurance. Private health insurance is a tool for individuals who want to cover medical services and fees not paid for by the public healthcare system. Doctors fund privately-paid equipment and staff through private contributions. According to an article from Hello Monaco, most Monaco citizens take out extra private insurance to cover ancillary services and unpaid rates.

A Commendable Healthcare System in Monaco

Every resident in Monaco is eligible for public health insurance but private health insurance remains an option for those interested in more coverage. Healthcare in Monaco earned outstanding reviews from the OECD and officials continue to seek improvements by reconstructing medical buildings and providing health education for young people.

– Rachel Durling
Photo: Flickr

Childhood Pneumonia
One of the most common diseases globally, pneumonia can be a silent killer when it infects children under 5. In the developing world, rates of childhood pneumonia cases and deaths are still high despite decreasing in other childhood diseases. However, due to new research and outreach programs to aid developing countries, those numbers may soon fall.

10 Facts About Childhood Pneumonia

  1. Various sources cause the disease. Unlike many other diseases that come from a single source, pneumonia is the name for the lungs’ acute response to an airborne pathogen. While pneumonia can develop from bacteria, viruses or fungi, the most common cause for children is the bacteria S. pneumoniae. The bacteria typically live in the lungs without harming the body, but the body develops pneumonia to kill the bacteria when it begins to spread.
  2. Childhood pneumonia mainly infects children under the age of 5. While people of all ages can develop pneumonia, children under the age of 5 are especially susceptible to the infection. Since their immune systems are not fully developed, their bodies are more likely to trigger a response to a foreign agent’s presence in the respiratory system, leading to pneumonia. These infection rates only increase in developing countries, where children are more likely to be born either malnourished or with a disease that they acquired in utero such as HIV.
  3. Pneumonia is a leading cause of death in children. Although pneumonia is often easy to treat and cure in developed countries, it can be fatal in developing countries. According to the United Nation’s Children’s Fund (UNICEF), childhood pneumonia kills over 800,000 children each year in comparison to 437,000 from diarrhea and 272,000 from malaria. These deaths are typically in children who are malnourished or have other conditions such as HIV that impair the immune system.
  4. South Asia has the greatest incidence of childhood pneumonia. Out of every 100,000 children in South Asia, approximately 25,000 will develop pneumonia each year. However, the majority of these cases — approximately 36% — occur in India. Studies looking into the potential causes for the increased number of cases have found that overcrowding in housing with inadequate ventilation allowed the disease to spread among families. Without effective airflow, children in those households continue to breathe in potentially infected air, increasing their chances of developing pneumonia.
  5. Air pollution increases pneumonia rates. Although a child needs to have exposure to the biological cause of pneumonia to develop the disease, certain environmental factors can increase infection likelihood. In India, a country with one of the worst-rated air qualities in the world, particles of smoke and other forms of pollution in the air weaken lungs when inhaled, making it more likely for a young child to develop pneumonia. These conditions of outdoor air pollution causes approximately 17.5% of all pneumonia deaths in the developing world.
  6. The disease is treatable. With antibiotics or antifungals (depending on the cause), children with pneumonia can recover from the disease. However, this treatment is dependent on the resources available in the country where the child lives. In developing countries such as Nigeria — the African country with the highest pneumonia rates in children — only one in three children with pneumonia symptoms can receive treatment due to the lack of available medicines and other medical resources.
  7. Some are producing vaccines. Although vaccines cannot treat viral pneumonia, they are still an important asset in preventing it. However, most of the produced vaccines are only available in developed countries where doctors recommend them for children under 5. In developing countries, nearly 10 million children are unvaccinated. Through the World Health Organization (WHO), many countries have received vaccines, although there has been great variation between regions of the world. While WHO’s South-East Asian Region has 89% coverage, its Western Pacific region only has 24% coverage.
  8. Less progress has occurred regarding childhood pneumonia. While research on pneumonia as a whole has increased over the past decade, there has been much less progress on childhood pneumonia in comparison to other childhood diseases. Since 2000, deaths for those under 5 from pneumonia have decreased by 54%, while deaths from diarrhea have decreased by 64% and are currently half the number of childhood pneumonia deaths.
  9. Large organizations are helping. Among other large, international organizations, the Gates Foundation has taken efforts to reduce childhood pneumonia rates in developing countries. One of its main methods is the continued distribution of vaccines to children and families in South Asian and Sub-Saharan Africa, specifically India and Nigeria. So far, the organization has sent vaccines to over 37 countries in those regions of the world, slowing transmission and infection rates in those areas.
  10. Rates will continue to drop in the future. Although the number of childhood pneumonia cases each year have not dropped as much as other diseases, long-term progress is still ongoing. If the current level of progress toward eradicating the disease continues, UNICEF predicts that it will save 5.9 million children. At the same time, if resources towards the effort increase, that number will increase to nearly 10 million.

UNICEF and WHO do not expect to meet their goal of eradicating childhood pneumonia until 2030. However, the progress they and many others are currently initiating is making a difference. Soon, pneumonia will become an extinct disease in the developing world so that it will never harm another child.

Sarah Licht
Photo: Flickr

Glasses for developing countries
A variety of NGOs have been working for decades to provide glasses for developing countries. Most models for this operate in similar ways, either by donating glasses or offering low-cost glasses for communities to purchase. These programs have been successful in helping people correct their vision, as well as creating more education and economic opportunity. They only lack one thing — innovation. Choosing to apply a solution designed for a developed country to a remote village is not always the best option. This is where Child Vision comes in.

The Statistics

The World Health Organization (WHO) estimates that nearly 80% of all persons in Africa have unaddressed vision impairment. Additionally, 33% of the world’s poor population suffers from vision impairment. There are 123.7 million people with a refractive error, which can be solved with glasses that have the correct strength. On average, glasses cost approximately $343, despite the average manufacturing cost of $10. Clear vision drastically reduced education access for children, which in turn created less economic opportunity as they moved into adulthood. Lack of clear vision loses $202 billion in global productivity each year.

The Standard

Some of the biggest names in glasses for developing countries are NGOs like Eyes on Africa, Vision for a Nation, VisionSpring and the WHO.

The WHO has been working on the Global Action Plan for eye health since 2014. The plan has one main objective — to encourage and enhance global eye health. The Global Action Plan has several initiatives. These include identifying what is causing vision impairment, understanding where the gap is in eye health access and bringing cataract surgery to developing countries. VisionSpring works by allowing those in developed countries to purchase glasses for developing countries through the VisionSpring website. VisionSpring donates those as well as letting communities purchase low-cost glasses. It also provides bulk purchase discounts and sell glasses individually and by the box. On average, one pair of bifocals in a box set costs just 85 cents. The price point is low, but still unmanageable for many villages, especially in areas with little to no internet access.

Child Vision

Child Vision is a program within the Centre for Vision in the Developing World (CVDW). The CVDW looked at the statistics of vision impairment then accepted the challenge of creating a solution that worked for the developing world. The main struggles the CVDW found in the traditional programs were a lack of optometrists and the high cost of traditional glasses. There is one optometrist per 1 million people in the population in developing nations. While 85 cents for a pair of glasses may seem affordable, it is a great financial strain for the world’s poor, many of whom survive on less than a dollar a day.

Child Vision, after identifying the root problems with getting glasses to developed countries, created a successful prototype within two months. The CVDW created an inexpensive, adjustable lens that sets into durable frames.

How the Glasses Work

The round lens is composed of two walls made of a flexible plastic membrane that the wearer fills with liquid silicone. The lens is then set into plastic frames that have dials on both temples of the glasses. The plastic frames are filled with the same liquid silicone that is in the lens. The wearer puts on the Child Vision glasses, covers one eye and using a tumbling “E” chart, adjusts a side knob to move more or less fluid into the lens until they can see clearly. They then repeat on the other side.

The wearer simply removes the knobs from the glasses and throws them away after the lens is set. They now have durable, functional, cost-effective glasses. With a $20 donation, CVDW can provide a pair of self-adjusting glasses to a developing country. A 1–2-hour training session with a local community leader to show them how to use the tumbling “E” charts to check vision and make sure the glasses are adjusted correctly is also provided. This is not only an immediate solution and innovation to provide glasses to developing countries but it creates generational empowerment of checking eyesight and promoting educational and economic growth within each community.

– Madalyn Wright
Photo: Flickr

Infertility in Developing CountriesAn estimated 49 million to 180 million couples  suffer from infertility, globally. Moreover, the majority of those affected live in developing countries. The most common cause of infertility in developing countries are STDs and pregnancy-related infections. With the focus of most poverty reduction efforts aimed at lowering overpopulation the health concern of infertility is often overlooked. Women who suffer from infertility in developing countries often face ostracization and struggle to get the healthcare they need. Thankfully, there has been an emergence of programs to help these women.

Causes of Infertility in Developing Countries

The most common cause of infertility in developing countries is untreated STDs since treatment is often unavailable or costly. In Africa, more than 85% of women’s infertility resulted from an untreated infection compared with 33% of women, worldwide. The most common STDs involved are chlamydia and gonorrhea. Other risk factors increasing the chance of infertility are poor education, poverty, negative cultural attitudes towards women. Finally, a lack of access to contraception is a huge risk factor.

The Sexist Effects of Infertility

The burden of infertility in developing countries falls on women although male infertility is the cause in 50% of cases. When a woman is unable to conceive, her husband will often divorce her or take another wife if permitted in the country. Women who are deemed infertile also suffer discrimination from the community.  In some cultures, society views these women as having a “bad eye”, which can pass on infertility from person to person. This results in infertile women missing important events such as weddings and other social gatherings since they receive no invitations.

Combating Infertility in Developing Countries

A campaign initiated by the Merck Foundation, “Merck More than a Mother,” seeks to heighten access to education and change the stigma for infertile women in developing countries. The program has provided training for fertility specialists and endocrinologists with more than 109 specialists trained since 2016.

Also, the foundation has created music videos, songs and fashion shows in African countries to send the message that women should not be blamed if they cannot have a child. More than 14 songs have featured singers from Gambia, Ghana, Kenya, Rwanda and Sierra Leone.

Women Deliver

In 2016, women’s infertility was a topic of discussion at Women Deliver — the world’s largest women’s health and rights conference held in Copenhagen. There were more than 5,500 conference participants, including government ministers, policymakers, business leaders, NGOs and activists. The WHO brought the topic to the conference, with the Director of Reproductive Health and Research giving a speech about the detrimental effects of infertility.

The WHO and Women Deliver, along with the International Committee Monitoring Assisted Reproductive Technologies and the International Federation of Gynecology and Obstetrics have partnered to increase global advocacy for infertility in developing countries. The partnership aims to achieve this through advancing education and research in the field.

Hopefully, with these increased advocacy efforts, the world will start to recognize the health concern of infertility in developing countries.

Rae Brozovich
Photo: Wikimedia Commons

Maternal Health in Yemen
The Yemen civil war, which began in early 2015 and still devastates the nation today, has created the world’s worst humanitarian crisis. A total of 24 million people require assistance. This crisis affects all aspects of life in Yemen, including healthcare. Millions are without access to life-saving medical treatment and supplies, leading them to die of preventable diseases, such as cholera, diabetes and diphtheria. Pregnant women and infants are particularly vulnerable during this health crisis as adequate medical care throughout pregnancy and birth is essential. Maternal health in Yemen is of the utmost concern now.

Yemen has one of the highest maternal mortality rates in the world with 17% of the female deaths in the reproductive age caused by childbirth complications. Maternal health in Yemen has never been accessible to all women. This crisis has escalated even further during the Yemeni civil war. However, global organizations are acting to save the lives of these pregnant women and infants who desperately need medical care.

Yemen’s Maternal Health Crisis: Before the Civil War

Even before the war began in 2015, pregnant women were struggling to get the help they needed. Yemen is one of the most impoverished countries in the world — ranking at 177 on the Human Development Index (HDI). Poverty is a large factor in the insufficiency of maternal health in Yemen as impoverished women lack the finances, nutrition, healthcare access and education to deliver their babies safely.

Many Yemeni women are unaware of the importance of a trained midwife during childbirth. Of all the births in rural areas, 70% happen at home rather than at a healthcare facility. Home births increase the risk of death in childbirth as the resources necessary to deal with complications are not available.

The Yemeni Civil War Increased the Maternal Health Crisis

Since the civil war began, the maternal mortality rate in Yemen has spiked from five women a day in 2013 to 12 women a day in 2019. A variety of factors caused this spike. The war has further limited access to nearly every resource, including food and water. This, in turn, depletes the health of millions of women and thus their newborns.

Also, the civil war has dramatically decreased access to healthcare across the nation. An estimated 50% of the health facilities in the country are not functional as a result of the conflict. Those that are operational are understaffed, underfunded and unable to access the medical equipment desperately needed to help the people of Yemen. This especially affects pregnant women — who require medical care to give birth safely.

Organizational Aid

Though the situation in Yemen remains dire, various global organizations are acting to assist pregnant women and newborns. The United Nations Children’s’ Emergency Fund (UNICEF) is taking the initiative to help millions across Yemen, including pregnant women. The organization has sent health workers and midwives into the country’s rural areas to screen and treat pregnant women for complications.

Similarly, USAID trained more than 260 midwives and plans to send them into Yemeni communities to help pregnant women and infants. USAID is partnering with UNICEF, the World Health Organization (WHO), the Yemen Ministry of Public Health and Population and other organizations to ensure that maternal health in Yemen, as well as all types of healthcare, are adequate and accessible for all affected by the civil war.

Maternal health in Yemen, while never having been accessible for many, is now in crisis as a result of the Yemeni civil war. While the situation is still urgent, organizations such as USAID and UNICEF are fighting to ensure that all pregnant women and infants in Yemen have access to the medical care they desperately need.

Daryn Lenahan
Photo: Flickr

healthcare worker emigrationThe emigration of skilled healthcare workers from developing countries to higher-income nations has significantly impacted the healthcare systems of the countries these workers leave behind. The quantity and quality of healthcare services have declined as a result of healthcare worker shortages. While there is still incredible room for growth, recent governmental strategies have incentivized healthcare workers to work in their home countries.

Why Is Healthcare Worker Emigration a Problem?

When healthcare workers emigrate, they leave hospitals in developing countries without enough skilled workers. Lower-income countries are likely to carry a greater amount of the global disease burden while having an extremely low healthcare staff to patient ratio. For example, sub-Saharan Africa only has 3% of all healthcare workers worldwide, while it carries 25% of the global disease burden. In many African countries with severe healthcare worker emigration, like Lesotho and Uganda, hospitals become overcrowded. Furthermore, hospitals cannot provide proper treatment for everyone due to the lack of skilled workers.

This directly affects the quality of care patients receive in countries with high healthcare worker emigration. Newborn, child and maternal health outcomes are worse when there are worker shortages. When fewer workers are available, fewer people receive healthcare services and the quality of care worsens for populations in need.

Why Do Healthcare Workers Emigrate?

The emigration of doctors, nurses, and other skilled healthcare workers from developing countries occurs for a number of reasons. The opportunity for higher wages elsewhere is often the most important factor in the decision to emigrate. Additionally, healthcare workers may migrate to higher-income nations to find political stability and achieve a better quality of life. The rate of highly skilled worker emigration, which has been on the rise since it was declared a major public health issue in the 1940s, has left fragile healthcare systems with a diminished workforce.

Moreover, the United States and the United Kingdom, two of the countries receiving the greatest numbers of healthcare worker immigrants, actively recruit healthcare workers from developing countries. These recruitment programs aim to combat the U.S. and U.K.’s own shortages of healthcare workers. Whether or not these programs factor into workers’ migration, both the U.S. and the U.K. are among the top five countries to which 90% of migrating physicians relocate.

Mitigating Healthcare Worker Emigration

The World Health Organization suggests that offering financial incentives, training and team-based opportunities can contribute to job satisfaction. This may motivate healthcare workers to remain in the healthcare system of their home country. Some developing countries have implemented these strategies to incentivize healthcare professionals to remain in their home countries.

For example, Malawi faced an extreme shortage of healthcare workers in the early 2000s. Following policy implementation addressing healthcare worker emigration, the nation has seen a decrease in the emigration rate. Malawi’s government launched the Emergency Human Resources Program (EHRP) in 2004. This program promoted worker retention through a 52% salary increase, additional training and the recruitment of volunteer nursing tutors and doctors. 

In only five years after the EHRP began, the proportion of healthcare workers to patients grew by 66% while emigration declined. Malawi expanded upon this program in 2011 with the Health Sector Strategic Plan. Following this plan, the number of nurses in Malawi grew from 4,500 in 2010 to 10,000 in 2015. Though the nation still faces some worker shortages, it hopes to continue to address this with further policy changes.

Trinidad is another a country that has mitigated the challenges faced by the emigration of healthcare workers. Trinidadian doctors who train in another country now get government scholarships to pay for their training. However, these scholarships rest on the condition that they return home to practice medicine for at least five years. Such a financial incentive creates a stronger foundation for healthcare professionals to practice in their home country.

A Turn Toward Collaboration

A recent study determined that the collaboration of nurses, doctors and midwives significantly decreased mortality for mothers and children in low-income countries. As developing countries work toward generating strategies to manage the emigration of healthcare workers, a team-based approach can improve the quality of healthcare. When there are shortages of certain kinds of health professionals in remote areas, family health teams composed of workers in varying health disciplines can collaborate to provide care. 

Improving working conditions and providing both financial and non-financial incentives to healthcare professionals in developing countries not only benefits workers and the patients, but the nation’s healthcare infrastructure as a whole. An increase in the number of skilled healthcare workers in developing countries gives people there the opportunity for a better life.

– Ilana Issula
Photo: Flickr

Kala Azar DiseaseKala Azar, the second-largest parasitic killer in the world after malaria, is quite deadly. Known as Kala Azar, Black Fever and visceral leishmaniasis, the disease kills 95% of its victims if left untreated. This “Poor Man’s Disease” can be very hypocritical. While this disease infects the poverty-stricken, the treatment is hard to come by, if not impossible. Even if the patient finds a doctor that can treat the disease, the price is astronomical. And sometimes, there is no stopping the contraction of the Black Fever.

The Spread

As the disease transmits through a sandfly bite, Kala Azar preys on the vulnerable. More than 1 billion people are at risk. East Africa, India and even some parts of the Middle East are endemic to Kala Azar. Poor housing conditions and lack of waste management in these countries cause an increase in the bloodthirsty sandflies’ breeding sites. This specific culprit is the female, Phlebotomine sand fly. While just one bite from it can put someone on bed rest for weeks, malnutrition only worsens the situation. For example, low vitamin D, iron and zinc can cause an infection to progress into disease much quicker. If Kala Azar killed the equivalent number of people in the U.S., it would be the third-largest killer, killing more citizens than those who die from strokes.

OneWorld Health

The real fighting began in 2003 with a collaboration between OneWorld Health, the WHO and a 4.2 million dollar grant from the Bill and Melinda Gates Foundation. With this grant and WHO’s resources, OneWorld Health was able to start its final testing to find an affordable cure for Kala Azar and the disease it causes. They are reinventing an old medicine and turning it into the treatment now called paromomycin. “It’s not every day one can say an affordable cure for a deadly disease may be imminent and we believe our approach will be successful,” said Dr. Victoria Hale, founder and CEO of OneWorld Health. It is to be a 21-day treatment and it will be readily available in every Indian clinic and, hopefully, one day, everywhere.

Drugs for Neglected Diseases Initiative (DNDi)

Unfortunately, nothing came of the OneWorld Health drug, paromomycin until February 2019. The Drugs for Neglected Diseases Initiative (DNDi) is fighting to change that. In a press release on the DNDi website, they share that Wellcome, a U.K. based foundation aiming to improve health for everyone, committed 12.9 million dollars for the development of drugs for Kala Azar. They are essentially funding a program that will test pre-existing drugs (that never made it to the world) and choose one to put on the market. DNDi is hoping it to be an oral drug as the drugs taken to fight Kala Azar can be painful and “require patients to take toxic and poorly tolerated drugs — often over a long period and through painful injections,” as said by Dr. Bernard Pécoul, Executive Director of DNDi.

The Impact

There is an estimated 50,000 to 90,000 new cases each year. Most families of the infected do not even go to the doctor, knowing that they will not be able to pay for the treatment. While there are many organizations funding drugs to treat Kala Azar, the cure is not coming fast enough. The current treatment for this parasitic disease is not reasonable. How can a family that can barely provide for themselves spend thousands of dollars on treatment?

The prevention and an end to Kala Azar lie in our hands. Organizations need funding to take preventative measures like spraying for these deadly sand flies, monitoring the epidemics and educating the communities affected by the disease.

Bailey Sparks
Photo: Wikimedia Commons