This challenge in reducing maternal and neonatal mortality is both complex and multi-faceted notes Mr. Zaman, Director of the Laboratory of Engineering Education & Development at Boston University. He stresses that tackling the issue requires engineering solutions integrated with policy, economics, and public health. “There are numerous system level challenges, rooted in poverty, illiteracy and poor governance that continue to hamper access and delivery of quality care” according to Zaman. Furthermore, he states, engineers can address these system-level challenges by “integrating their approaches with social scientists, policy makers and public health professionals” (Zaman, 2012).

The role of engineers is vital. Engineers create life-altering technology. Not only this, but they “also analyze systems and create appropriate system-level interventions for maximum efficiency and performance”. Zaman suggests, however, that the biggest strength of engineers “is access to motivated, driven, and passionate young minds who are getting increasingly cognizant of the concerns of people all around the globe” (Zaman, 2012).

Reference

Zaman, M. (2012). Engaging Engineers to Save Lives at Birth. Retrieved on March 17, 2013 from Huffington Post.

The report found that, in general, rates of progress in child well-being doubled since the late 1990s. Particular improvements have been made in the areas of education and reduction of child mortality rates. Primary school enrollments more than doubled over the course of the 2000s and countries such as Tanzania have halved their child mortality rates.

In spite of these advances, one aspect of childhood health remains a serious obstacle to overall childhood wellbeing. Childhood malnutrition rates have not only failed to improve in recent years but have in fact worsened. Save the Children estimates that 1.5 million more children suffered from acute malnutrition in 2005-2010 than in the early 2000s. These results are troubling and threaten to detract from the excellent progress made in achieving MDGs. The report stresses the threat of a chronic undernutrition crisis among children and calls upon the global community to address the underlying causes of poor nutrition and high food prices, to increase funding for nutrition programs in developing countries, and to insist upon increased transparency and accountability surrounding this vital issue.

To read the report, visit http://www.savethechildren.org.uk/sites/default/files/docs/Child_Development_Index_2012_UK_low_res.pdf.

The study, conducted between June 2009 and April 2011, involved administering Truvada to a group of HIV-negative women at high risk of contracting the virus for 52 weeks. Although 95% of women in the study adhered to the drug regimen, the study was stopped early because of lack of efficacy. Researchers found no significant reduction in HIV-acquisition among women taking Truvada compared to the placebo group.

The study begs the question of whether more research is needed before women start utilizing Truvada as a reliable prophylactic measure. Several other possible negative effects of the FDA’s approval remain to be determined. It remains to be seen whether provision of Truvada for PrEP diminishes use of condoms and other safe sex measures, contributing to a potential increase in STI’s other than HIV/AIDS. Sexual risk-taking must also be carefully studied in light of Truvada’s prophylactic effect. Finally, the emergence of antiretroviral-resistant strains of HIV/AIDS should be carefully monitored, even though one study of Truvada for PrEP reported low rates of resistant strains. The FDA’s approval of Truvada for PrEP represents an exciting step in the right direction for HIV/AIDS prevention measures, but the long-term effects of regular use of antiretrovirals among HIV-negative individuals, as well as their efficacy as a preventive measure for women, remains to be seen.

For more information, visit http://www.nejm.org/doi/full/10.1056/NEJMoa1202614#t=articleTop.

The World Health Organization has announced the need for urgent action against the spread of this resistant form of gonorrhea. Australia, France, Japan, Norway, Sweden, and the United Kingdom have all reported cases of cephalosporin-resistant gonorrhea.The antibiotic cephalosporin represents the last current treatment option for gonorrhea. Strains resistant to penicillin, tetracyclines and quinolones are already widespread. If the disease becomes untreatable, widespread health detriments will be significant. Among other things, gonorrhea significantly raises the risk of contracting HIV infection.

Better monitoring and surveillance are needed to determine the exact dimensions of this public health threat. Better use of antibiotics is also urgently needed. Perhaps most importantly, greater attention to prevention of infection should be emphasized in any response to this resistant microbe.

For more information, visit http://www.who.int/mediacentre/news/notes/2012/gonorrhoea_20120606/en/index.html.

Artemisinin-resistant malaria was reported in Cambodia in 2009, and now cases of resistance are being observed on the Thailand-Myanmar border, about 800km away from drug-resistant sites in western Cambodia. The Lancet study measured the amount of time taken to eliminate half of the parasites from the blood stream in 3202 patients with Plasmodium falciparum malaria using a derivative of artemisinin between 2001 and 2010. In this time period, the time taken to eliminate half of the parasites increased from an average of 2.6 hours in 2001 to 3.7 hours in 2010, suggesting decreasing efficacy of the drug. The proportion of infections taking more than 6.2 hours to reduce by half increased from 6 to 200 out of every 1000 infections. Researchers were able to confirm that the changes are a result of genetic mutations in P. falciparum parasites. However, the exact mechanism of this genetic mutation is not known. Dr. Tim Anderson of Texas Biomedical Research has indicated that finding the exact gene or genes in which mutation has occurred would help curb the spread of resistance.

Malaria kills hundreds of thousands of people every year and especially affects young children and pregnant women. The number of deaths attributed to malaria could rise dramatically if the artemisinin-resistant strain of P. falciparum continues to spread. More research on the precise genetics involved in this deadly mutation is needed to restrain the growth of this devastating form of the disease.

To learn more, visit http://www.sciencedaily.com/releases/2012/04/120408150543.htm.

To see the Lancet study, visit http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960484-X/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3=

The rates of birth defects among women taking efavirenz during pregnancy were once thought to be higher than normal, though more recent research suggests that birth defects with efavirenz are no higher than with other antiretroviral medications. Still, research on other potential side effects of efavirenz must be continued and more work must be done to ensure access to cheaper generic brands of the medication in developing countries.

In a recent study, and the first of its kind, Alkire et al. quantified the cost and benefit associated with Caesarean delivery as a treatment for obstructed labor. The study analyzes the cost per disability-adjusted life year averted and cost-benefit ratio of performing Caesarean delivery in cases of neglected obstructed labor in 49 countries with particularly low rates of Caesarean deliveries related to demand. Alkire et al. found that, for 48 of the 49 countries studied, Caesarean delivery in cases of obstructed labor proves overwhelmingly cost-effective. Investment in Caesarean delivery programs is an economic option to be taken seriously by the WHO, private donors, and government organizations.

To view the study, visit http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0034595

The city of Davao, located in the Philippines, is seeing the effects of increased HIV awareness.

According to the Sun Star, Davao City Health Office (CHO)  saw a 17% increase in reported HIV cases between January and March of this year. According to Kenneth Sadia, Information Education Communication support staff of the Reproductive Health and Wellness Center of the Davao CHO, “It has increased because many have taken tests,” thus more have become aware of their HIV status.

With awareness comes responsibility. Practicing abstinence, celibacy, or using condoms are effective ways to prevent the spread of HIV and many other STDs.

Reference article: Increasing awareness leands to high HIV detections

The resolution for mental health will be adopted by the World Health Assembly in May 2012. The WHO will then develop a mental health action plan that must be approved by UN member states in 2013. Following approval, increased resources will be allocated to global mental healthcare initiatives. Hock and colleagues note that there has been ample evidence in recent years that mental healthcare is vastly improved by interventions on the individual, family, school, and community levels and that screening for depression in primary care settings has proved extremely effective. Unfortunately, few of these findings have been implemented extensively, especially at a global level. At present, many countries allocate less than 1% of their total healthcare spending to mental healthcare. In a passionate conclusion, Hock et al. call upon UN member states to not only insist upon coordinated care for mental illness but also to capitalize on the momentum of the 2011 mental health resolution to ensure the prioritization of better mental healthcare across the globe.

For more information, see the Lancet article at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960243-8/fulltext?rss=yes

One form of this disease, which receives even less international attention than schistosomiasis in general, afflicts women in particular. Female genital schistosomiasis (FGS) causes pain and bleeding in the uterus, cervix, and genital tract and can be contracted while performing regular household chores, including laundry. More than 100 million women and girls in Africa suffer from FGS. Aside from the unbearable pain, stigma and depression women with FGS face, the lesions caused by the disease expose them to a much greater risk of HIV/AIDS. Women with FGS have a 3-4 fold increased risk of contracting HIV/AIDS.

A low-cost drug does exist for the prevention of FGS. The drug, praziquantel, is currently available for 8 cents a tablet, and can serve both to prevent FGS and as a prevention strategy for HIV/AIDS. Support for distribution of this drug to school-aged children in Africa should offered by international health organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and USAID.

To read more, visit: http://www.huffingtonpost.com/peter-hotez-md-phd/womens-health-africa_b_1412350.html

To read more about the report, see http://www.guardian.co.uk/global-development/2012/feb/28/unicef-children-central-urban-planning?newsfeed=true.

Providing preventive care for maternal and neonatal tetanus (MNT) presents a challenge because cases of MNT are notoriously under-reported. Cases of MNT are most common in rural settings and women often die before reaching healthcare facilities, resulting in a large number of unrecorded incidences of the disease. MNT is a particular problem in Papua New Guinea, where, as of the 2000 census, 9 out of 10 people live in rural areas while rural health facilities have simultaneously experienced a decline in staff members by 25 percent from 1987 to 2000.

To learn more, visit http://www.irinnews.org/Report/95213/PAPUA-NEW-GUINEA-Tetanus-vaccination-campaign-underway.

The lawsuit over Ms. Anguko’s death has stirred debate not only about the government’s role in protecting basic maternal health but also about the allocation of funds both within Uganda and from foreign sources. When information about the government’s use of funds to buy Russian fighter-jets became public one month after Ms. Anguko’s death, protests erupted. Opponents to President Yoweri Museveni’s government argued that large expenditures on fighter jets in a time of relative peace represented astounding neglect of the basic needs of Uganda’s population. A more complicated set of questions has also arisen about the unintended effects of foreign aid from the US and other nations, used mostly to help fight AIDS and other infectious diseases. While this aid has assisted tremendously in saving the lives of Africans afflicted with AIDS and other diseases, it has resulted in domestic funding cuts to African healthcare systems. The University of Washington’s Institute for Healthcare Metrics and Evaluation found in 2010 that for every dollar of foreign aid given to fund healthcare in developing nations, local governments decreased their own healthcare spending by 43 cents to $1.14. There is no easy solution to this dilemma, though protests against the government’s irresponsible allocation of funds in Uganda is a definite step in the right direction.

To learn more, visit http://www.nytimes.com/2011/07/30/world/africa/30uganda.html?pagewanted=all

One of the most frequently asked questions at SAM is how come our program works even though we don’t pay our community health workers.  The short answer is-that’s precisely why it works.  Put salaries into the equation, make it a job, and you might as well shut the program down.  Treating health as a responsibility and empowering people with knowledge is the perhaps the most sustainable model of keeping the poor healthy.

SAM relies on an army of volunteers from villages to carry out its extensive preventive health program on maternal and child health.  At last count, we had 1300 health activists, all women with little means themselves, spread over a thousand villages who find time to attend intense training sessions, identify and follow-up with pregnant women, hold regular meetings to find solutions to community health problems, and collect data on each pregnancy.  All without financial incentive.  That’s the beauty and mystery of the program.

A visit to SAM sites sheds some light.  “We don’t want to let our daughters suffer the way we did” is a recurring sentiment amongst Swasthya Sakhis (health friends).  It also gives them a sense of purpose and accomplishment.  Take the case of Najma, a seventeen year old Swasthya Sakhi from Negoria village.  A seven month pregnant bleeding woman refused to seek medical help despite repeated pleas from Najma.   Najma was shooed away and told that being unmarried, what could she possibly know about pregnancy.  Najma persevered and galvanized her mother and village elders into action, transporting the pregnant woman to a hospital.  The child died but the woman survived.  Today, Najma is a local hero.  Her confidence has grown as has her appetite for added responsibility and training.  All as a volunteer sans financial remuneration.

“We pick women with a volunteer spirit to begin with,” says Mr. Anoop Pant, Project Manager at SAM.  Learning from mistakes also helps in program design.   Attrition is a problem and SAM now trains 3-4 women per village with the aim of having one volunteer per village stay on in the program.  An initial seven day off-site training course where Swasthya Sakhis were bused away from their villages was quickly revised into a three day course held within a few kilometers of villages with breaks for women to attend to their homes.

SAMs model while unusual is not without precedent.  Jamkhed pioneered relying on unpaid community health workers to provide preventive care, with non health care incentives like access to microcredit. Other organizations have devised incentive schemes.  For example, BRAC provides sanitary napkins and other medications at cost for their unpaid community health workers to sell at 10-15% profit. Operation ASHA provides a small financial incentive for promoting drug adherence amongst TB patients.

So will SAMs’ financial incentive-free community health worker program for maternal and child health also work for birth control and TB treatment?  Watch this space as we test sustainable models for keeping rural populations healthy.

Despite its diminishing presence in the developed world, TB remains the leading bacterial cause of death.

The World Health Organization identifies the increasing incidence of type II diabetes as a significant impediment to eradicating tuberculosis. Moreover, the tendency of certain populations to be medically underserved may exacerbate the issue, exemplified by the trend of higher rates of both TB and type II diabetes among the Hispanic population observed in the study. Researchers assert that doctors who administer to at-risk populations can adopt routine screenings for TB and diabetes to decrease disease rates and help afflicted individuals lead healthier lives. Click here for the article.

The micronutrient vitamin A, for example, has several key roles, including the prevention of night blindness and bacterial infections. Despite these enormous functions, less than 1000 micrograms (.001 grams) are needed per day.  According to the WHO’s guidelines for vitamin A supplementation, 60,000 micrograms are typically administered every 6 months via an inexpensive red capsule. With the miniscule cost of 2 cents per dose per child, vitamin A supplementation ranks as one of the most cost-effective methods of reducing childhood morbidity and mortality. According to the Micronutrient Initiative, vitamin A deficiency increases a child’s susceptibility to malaria and diarrheal diseases. Child mortality rates decrease by as much as 23% as a result of vitamin A supplementation. Additionally, according to the Food and Nutrition Bulletin in 2005, merely continuing to supply vitamin A dosages consistently throughout the developing world would make a large contribution toward the attainment of the Millennium Development Goals by aiding in the reduction of child mortality rates by two-thirds by 2015. In least developed countries, coverage with bi-yearly doses of vitamin A reached approximately 87% by 2009.

Another key micronutrient with a wide cost-benefit margin is folic acid. Folic acid is imperative for proper growth and development, and deficiency results in teratogenesis, the development of birth defects, some of the most common of which include neural tube closure defects (NTDs). NTDs, including the life-threatening condition of spina bifida and fatal condition of anencephaly, contribute enormous psychosocial and economic burdens that could be alleviated through periconceptional supplementation of folic acid. The Micronutrient Initiative encourages community programs to target adolescent girls/women of reproductive age in order to achieve folic acid supplementation before conception. Such timing yields the most beneficial results in terms of preventing NTDs. In April 2010, the International Journal of Epidemiology claimed that if folic acid fortification achieved 100% coverage in low-income countries, NTDs could potentially be reduced by 50%. Economic implications of NTDs include assistive technologies such as wheelchairs, physical and social therapeutics, surgical procedures, and medications. In May 2011, the European Journal of Pediatrics reviewed data analyzing the benefits of preventive folic acid supplementation. They postulated that in the United States, total hospital charges for neonates with NTDs reached $74 million for spina bifida and $1 million for anencephaly. A cost-benefit analysis from Canada reported that adult hospital admission rates for patients with debilitating childhood conditions such as spina bifida are nine times those of the general population. Few studies have extensively evaluated the cost-benefits of folic acid supplementation/fortification to prevent NTDs, however existing studies do highlight the high benefit-cost ratios among countries who have implemented such studies. For example, benefit-cost ratios (which measure cost-benefit) range from 4.3 to 1 in the United States to 30 to 1 in South Africa. Therefore, countries which underwent cost-benefit analyses of folic acid supplementation concluded that such periconceptional folic acid regimens results in cost savings of several millions or hundreds of millions of dollars.

Preventive measures in the field of maternal, newborn, and child health (MNCH) have continued to yield great successes, from prophylactic medicines to prevent transmission of HIV during pregnancy, childbirth and breastfeeding to bi-yearly vitamin A supplementation. Global health leaders, organizations, and researchers must take hold of this trend and apply it more extensively to micronutrient initiatives, including recent investigations in vitamin A and folic acid deficiencies. The impressive cost-benefits of each supplementation necessitate continued research and implementation of those and other micronutrient programs. The developing world must begin to look beyond malnutrition through macronutrient deficiency. The fulfillment of micronutrient recommendations can improve the overall quality of life of both the mother and child in a feasible and cost-efficient manner.

Click here to read: Economic burden of neural tube defects and impact of prevention with folic acid: a literature review

To learn more, visit: http://gulfnews.com/news/world/philippines/72-rise-in-hiv-cases-in-philippines-1.1000487

Some critics are skeptical of whether the government’s financial plan will help solve India’s healthcare crisis. Some have expressed the opinion that Prime Minister Manmohan Singh’s government tends to misallocate funds without working to reform deeper structural problems that cause poor delivery of healthcare and other services in the first place. Yet others say that the healthcare crisis has been caused by decades of poor investment and that increased spending will go a long way in healing India’s healthcare system. Most notably, the funds should help provide desperately needed training to new healthcare workers. Currently, India’s healthcare system is facing a devastating shortage of qualified healthcare workers, especially in rural areas. Increased spending on healthcare initiatives should result in some alleviation of this shortage of both healthcare workers and healthcare facilities.

To find out more, visit http://www.washingtonpost.com/world/asia_pacific/india-plans-big-increase-in-health-care-spending-to-catch-up-to-rivals/2012/03/04/gIQAnVuw0R_story.html

The biggest advantage of JSSK is that instead of providing any financial aid, the scheme allows free delivery (including a caesarean one) and treatment to every expecting mother up to 42 days after delivery and free treatment to the baby for 30 days.

Dr Manohar Pawar, deputy director of health services (DDHS), Nagpur circle, that covers Nagpur, Wardha, Gondia, Bhandara, Chandrpaur and Gadchiroli districts told TOI that the scheme is extremely attractive to both rural and urban women as it allows not only free diagnosis, investigations, treatment, medicines and meals during the hospitalization period, but also free pick up and drop facilities to the patient.

Click here to read “Health schemes for mom and child show results”

Photo used under Creative Commons from Dinesh Cyanam.

 A recent study conducted by World Health Organization (WHO), the Aga Khan University and the Partnership for Maternal, Newborn & Child Health (PMNCH) have identified 56 essential interventions. These interventions are classified according to three levels. The first intervention includes care that can be provided at community level by community health workers and volunteers with limited training. The second intervention entails primary care at community clinic provided by professionals like nurses and midwives, and the final intervention comprises referral care provided by physicians, skilled nurses and midwives in hospitals which are able to perform caesarean sections and provide emergency care. Well-trained health workers, nurses, and midwives play an important role in the aforementioned plan. In low- and middle- income countries, the majority of maternal deaths are caused by lack of skilled birth attendants or midwives. Traditional birth attendants attend pregnant women in rural areas of low- and middle-income countries. These attendants lack professional training, which hampers their decision-making in times of complications during pregnancy. On the other hand, a trained midwife would be in a better position to understand the problem and provide adequate emergency care.

 Midwives work in remote areas lacking public transportation, communication facilities and access to medicines or medical aid. These reasons contribute to low numbers of midwives and make it an unattractive profession. Another big challenge in increasing the participation of women in such program in rural areas is the social status of women in the community. This makes it difficult for women to take up midwifery as a profession. Therefore, it is important for the community members to encourage and provide moral support for women for taking up midwifery as a profession. Workshops can be arranged at grass root level for increasing the awareness and involving people from the community. The advantage of having a skilled midwife from within the community is familiarity with the local language, traditions and culture. This ensures that pregnant women in the area will have better and quick access to a skilled midwife.

The number of skilled midwives cannot be increased in a short span of time. Therefore, World Health Organization (WHO) recommends using the services of traditional birth attendants until the number of skilled midwives improves. Meanwhile traditional birth attendants can attend pregnant women periodically. These birth attendants can help spread the word about importance of a healthy mother and use of medicated bed nets. The involvement of traditional birth attendants from the community will inspire women from the community to join the workshops conducted by the health workers, which will in turn increase the number of skilled midwives.

Better working conditions, fully equipped clinics, practical training under a professional midwife, increasing investment in midwifery education, financial assistance, moral support, and respect for the profession will encourage more women to take midwifery as a profession.

Please refer to following links for further reading:

1.  Save lives: Invest in midwives
2. Three-year study identifies key interventions to reduce maternal, newborn and  child deaths
3. Using Insecticide Treated Nets to fight malaria,
4. Nurse Midwives Bring New life to villages
5. Is Sierra Leone right to ban traditional birth attendants?

Photo used under Creative Commons from isafmedia.

SAM Blogger Sonal Goyal

At the end of June 2011, I returned from a three-week trip to Quetzaltenango, Guatemala, where I had traveled for the purpose of studying Spanish and observing healthcare in the area through a local language school. Through the school and my host family, I was introduced to many individuals during my stay, and quickly noticed the many teenage mothers throughout the city.  My first night there I met a beautiful baby boy whose mother was only 17 years old.  Having previously had another child at age 16, and with no husband and no stable source of income, she had tried to illegally terminate her second child multiple times, and wound up being hospitalized for several weeks before the baby was born.  A few days later I had the opportunity to meet another 17 year old and her daughter. She was more fortunate than the first girl in that the father of her child was very supportive, and they had married soon after she discovered she was pregnant.

Approximately 33% of births are unintended in Guatemala, where abortion is illegal unless the mother’s life is at risk.  Despite this, in 2006,  complications from abortion was the third largest cause of maternal mortality in Guatemala, contributing to one of the highest maternal mortality rates in Latin America.  Many abortions are conducted under unsafe conditions,  resulting in infections and other complications that place the mother at risk.  Approximately 8 out of every 1,000 women in Guatemala were hospitalized for induced abortions in 2003.  More recent studies of Guatemala have found that in 2006, there were 92 births per every 1,000 girls aged 15-19 years old, and in 2009, the average number of births per woman was

four, the highest fertility rate in Latin America. According to WHO in 2009, there were 110 female deaths per 100,000 live births compared to 66 per 100,000 regionally.

Until recently, pre-marital abstinence was the preferred method of birth control in this heavily Catholic society.  Sex education in public schools was disfavored and contraceptives were rarely discussed because their use was associated with promiscuous women.  According to the most recent statistics available from the World Health Organization, only 43% of the Guatemalan population use some sort of contraception, compared to 75% in Central America overall.  The lack of sex education and access to birth control has led to an increase in unwanted teen pregnancies.  Because abortion is illegal, some teens opt for induced labor outside of hospitals, further increasing the already high rate of maternal complications and death in childbirth.  Stopping through drug stores in Xela, I seldom saw condoms, and feminine products other than maxi pads were virtually non-existent.  Even if the use of birth control was encouraged, restricted access and high costs can create throw up more obstacles to its use.

Guatemala is a poor country. The gross national income per capita in international dollars is $4,570 compared to the regional average of $23,823.  The average woman has more than four children and in rural areas populated by indigenous Guatemalans that number is often closer to eight.  Having multiple children increases the financial burden on individual households and can lead to malnutrition and lower literacy among children.  At the national level the complications of unsafe abortions are costly to the country’s public health system and contribute to higher rates of infant and maternal mortality. A  2000 study of a facility in Coatepeque, Guatemala, estimated that 10% of hospital’s total budget, 30% its  maternity budget, was spent on complications related to abortion.  Medical expenses in turn add to existing financial strains on families and lead to higher taxes to address public healthcare costs.

In 2005, escalating costs finally forced the Guatemalan government to propose laws allowing sex education in schools. Despite the attempted intervention of multiple Catholic and conservative cultural institutions, a bill requiring sex education in grammar and high schools schools finally passed in 2009 and began being implemented in 2010.  While this new family planning law will help future adolescents and adults, measures are still needed to address men and women in rural and poor communities who either do not attend school or are past high school age.

Many organizations within Guatemala now provide sex education and increased access to birth control.  With greater support for sex education, we will hopefully start to see a decrease in the number of unintended pregnancies and unsafe abortions,which may in turn allow Guatemala to focus on the pressing issues of  malnutrition, access to healthcare, and education.

For more information, check out:

1. Singh S, Prada E and Kestler E. Induced Abortion and Unintended Pregnancy in Guatemala. Int Fam Plan Perspect. 2006 Sep; 32(3):136-45. http://www.guttmacher.org/pubs/journals/3213606.html

2. World Health Organization. (2011). Guatemala Country Statistics. http://apps.who.int/ghodata/?vid=9600&theme=country

3. Guatemala County Program. Planned Parenthood. http://www.plannedparenthood.org/about-us/international-program/guatemala-country-program-19006.htm

4. World Health Organization. (2011). Guatemala: health profile. http://www.who.int/gho/countries/gtm.pdf

5. Rivera, E. Sex Ed Classes for Kids Begin in Guatemala. AllVoices. http://www.allvoices.com/contributed-news/5064070-sex-ed-classes-for-kids-begin-in-guatemala

6. Valladares, Danilo. Sex Education, Family Planning Finally Available. IPS Inter Press Service News Agency.  http://ipsnews.net/news.asp?idnews=49436

Photo licensed via Creative Commons /archer10 (Dennis)

The study found that, while the decline in abortion rates found in earlier studies has halted, the number of unsafe abortions has increased from 44% in 1995 to 49% in 2008. Overall abortion rates did not correlate with restrictive abortion laws, and in fact, abortion rates were lower in regions with more liberal abortion laws.

Unsafe abortions — that is, abortions taking place outside hospitals and without qualified medical supervision —  are a major cause of maternal death, especially in the developing world where women are more vulnerable to infection and less likely to find sufficient care for excessive bleeding. The WHO study suggests that measures to restrict abortion do not decrease abortion rates, but rather put women at a greater risk of receiving abortions that are detrimental to their health or even fatal.

For the study, visit http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961786-8/fulltext.

A report released last year by the International Federation of Gynecology and Obstetrics has called for a sustained effort to reduce maternal mortality rates in Ghana.  The government has displayed valiant dedication in reducing maternal and infant deaths, but independent United Nations expert Anand Grover encouraged the country to redouble its commitment to these goals:

In order to ensure that current gains related to the right to health are sustained, the government must develop a strategy to address possible deficits in future funding.

The maternal mortality rate in Ghana remains high even among developing nations, making these issues particularly urgent. The article goes on to report that UN Secretary General Ban Ki-Moon found global rates of maternal mortality “unacceptable.”

Click here to read “Ghana ‘must develop strategy to sustain progress on maternal mortality’”

Click here to read the latest call to action from Ghana’s First Lady

Photo via flickr / adam_jones

The committee briefing was held to evaluate South Africa’s progress toward their Millennium Development Goals (MDGs). These eight goals were adopted by the 191 members of the United Nations, including South Africa, in 2000. The MDGs, which have a target date of  2015, address issues such as hunger, poverty, environmental sustainability, disease, and child and maternal health.

As of 2007, South Africa has sustained a child mortality rate of 104 per 100,000 live births and  a maternal mortality rate of 625 per 100,000 live births. These figures are alarming since given South Africa’s  pledge to reduce the child mortality rate to only 38 per 100,000 live births and the maternal mortality rate by 75% by 2015.

Motsoaledi stressed the gravity of these figures and noted that vast improvement in South Africa’s health systems would be crucial to meeting these goals.  He suggested restructuring the healthcare system by addressing cost and sustainability with an emphasis on prevention. A preventive focus could help cut costs, he said, whereas  the current focus on curative care would prove more expensive in the long-run:

“More should be done to strengthen our country’s primary health care, which operates at community level and where more people’s problems can be solved. This level aims at prevention of certain diseases.”

Click here to read “Child, maternal mortality rates reach crisis levels.”

Click here to read “Millenium Development Goals (MDGs).”

Photo via Creative Commons / La Chiquita

SAM Blogger: Sara Gorman

Most public health crises facing India need no introduction: communicable diseases, lack of healthy drinking water, HIV/AIDS, poor hygiene practices, and poor quality healthcare and healthcare facilities top the list of problems studied by professionals and covered in the international press. But what about health-seeking behavior among Indian populations?  Are people aware of existing healthcare options and how best to access them? Can those living in impoverished and rural areas identify symptoms requiring immediate medical attention? What are some of the social reasons that diseases, especially among women and children, go untreated? Can increasing health literacy really make a difference?

A 2007 Pew poll surveyed global populations on what they perceived to be the greatest problems facing their countries. The priorities listed for Asia as a whole were, in order of decreasing urgency: crime, corrupt political leaders, pollution, illegal drugs, spread of HIV/other diseases, and terrorism. The spread of diseases, which was not even listed in the same category as “healthcare,” ranked relatively low in comparison to concerns about crime and corruption, and in comparison to where these same problems ranked in other parts of the world, notably Africa, where health concerns consistently topped the list. If, however, healthcare ranked lower on the scale of national concerns for populations in Asia, health on a family or individual basis consistently emerged as a primary concern across all regions, continents and socioeconomic groups. When asked to name the issues of highest personal concern, health ranked second only to financial concerns among people polled in 33 countries around the globe.

This disjunction between personal and national concerns suggests a fundamental disconnect between individual versus national healthcare priorities.  It also raises questions about whether people understand how the health challenges they face as individuals can affect their country’s overall healthcare profile. According to the Pew study, in Asia as a whole, the list of the most pressing healthcare priorities was, in order of descending urgency: HIV/AIDS; building and improving better healthcare facilities and better prenatal care; clean water; hunger and malnutrition; chronic diseases and immunizations; access to care; tuberculosis, malaria and other infectious diseases. In areas with the highest rates of low birth weights and unattended births, including Bangladesh, Mali and India, prenatal care consistently ranked among the top three health concerns. Yet concern over immunization and infectious diseases was staggeringly low in Asia, where epidemics are a constant threat. Similarly, access to care ranked eighth in a list of nine healthcare issues, surprisingly low given the actual existence of serious barriers to care in places like India. What accounts these mismatches between perception and reality, and how do these misperceptions affect the attainment of quality care?

A brief look at the way India handles maternal mortality can help shed light on why perceptions of health issues are sometimes divorced from reality.  A recent report by Human Rights Watch reveals a disturbing mismatch between the number of reported and actual maternal deaths in the developing world.  The high number of maternal deaths is caused by a lack of tools and personnel needed in an obstetric emergency. This issue falls squarely under the category of building and improving healthcare facilities identified by the Pew poll as the second-ranking concern among healthcare issues in Asia as a whole. However, several of the other major barriers to prenatal care are not issues listed as of prime importance to those surveyed in the Pew poll. A lack of awareness among healthcare workers of what constitutes a maternal death contributes to the mismatch between actual and reported numbers of maternal deaths in places like Uttar Pradesh. For example, if a woman develops a fever and dies 72 hours after giving birth, her death is not recorded as a maternal death, even though it is well-known in the medical community that women can develop complications from childbirth 72 hours after giving birth and that fever is often the first sign of such complications. Without accurate statistics on maternal mortality women in these nations cannot appreciate the true scope of the problem.

Other barriers to access may have such deep roots in societal custom that they failed to be perceived as barriers.  Gender discrimination in neonatal care has been acknowledged in India for years, but quantitative data to confirm this accepted assumption have emerged only very recently. A 2009 study of the Uttar Pradesh region published in the Journal of Health Population and Nutrition found that the average expenditure for neonatal care in houses with newborn males was nearly four times higher than the expenditure in houses with newborn females.  Furthermore, in 55% of households, decisions to seek healthcare from a provider were made by family members other than the mother, usually by the husband (31%) or the mother-in-law (18%).

These data confirm gender-specific patterns of health-seeking behaviors recorded in a 2006 study of Uttar Pradesh published in the Indian Journal of Community Medicine. Through interviews and focus groups researchers discovered that most women did not seek care because their husbands refused to accompany them to the doctor. The women were generally not permitted to seek treatment for themselves or for their children without being accompanied a male member of their household.  Most men refused to discuss their own health problems with their wives, especially if they were suffering from reproductive health problems or sexually transmitted diseases.  In many cases, men approached doctors in nearby villages in secret or discussed health problems with their mothers. Aside from confirming the fact that women are most often neglected in family healthcare decision-making, this suggests that women’s exposure to sexually transmitted diseases could be reduced in part if their husbands discussed their health problems with them more openly.

Can health literacy, increased awareness and general education help healthcare access in these cases? Several recent studies suggest that the answer to this question is “yes.” One study on knowledge of hygiene and its health consequences in Eastern India found that basic socio-economic factors, especially education, “play a pivotal role in conditioning the perception and practice of hygiene.” More than 90% of people with some kind of formal education indicated knowledge of proper hygiene practices, and women with better knowledge of good hygiene reported less disease in their households. This finding is important because some of the most potentially serious infectious diseases in India are associated with poor hygiene, including typhoid fever, cholera, hepatitis, malaria, dengue and worms. The 2006 Uttar Pradesh study reported that literacy status and perceived quality of healthcare services play essential roles in the selection of a healthcare provider. Not only are general education and health literacy pivotal in increasing access to care, but perception of the state of local healthcare services also determines the process of seeking proper aid. Educating people in India about the major health crises facing entire communities and making them aware of healthcare options may go a long way to increasing individual access to care.

Addressing the issue of water is a crucial step for the development of this country. Without access to safe water development becomes impossible.

Tangalle main road

“Water-borne diseases are one of the most serious threats

to child health in developing countries and affect mainly the poorest people.”

Along with reducing the incidence of water-borne illnesses like hepatitis and diarrhea, this new project will give women and children more hours in the day. This will allow for women, especially, to use that time to bring in income rather than travel long distances to retrieve water.

Click here to read “New water supply in Sri Lanka brings health and hope to thousands.”

Photo via Creative Commons / Krankman

Researchers have found abortions of girl children in India are far more common in families with at least one female child. In a culture that values male children for carrying on the family line and generating revenue, female children, who live with their husband’s family after marriage, are often perceived as costly to raise and marry off.  Although  prenatal gender testing has been illegal in India since 1996, the ban has proven largely ineffective in the face of inexpensive technology, as evidenced by the skewed ratios of female to male children in India: 893 females per every 1,000 males.

In 2005, the ratio of girls to boys under age 6 had declined from 906 per 1,000 to 836 per 1,000. The decrease has been even more pronounced in families where mothers were wealthier and better educated, suggesting that abortion is more accesible to wealthier mothers.  One proposal for tackling this issue is to closely and reliably monitor sex ratios at birth in each district of India, as current numbers address ratios at age six.

Click here to read “India Abortion of Girls on the Rise: Study.”

Photo via Creative Commons / Christian Haugen

Click here for full article: New test may better diagnose African sleeping sickness

Click here to watch the entire episode and here for more information on the show.

In a country that is 90 percent Catholic, women in the Philippines enjoy little or no freedom when it comes to birth control options.  Yet with 90 million people currently living within its borders, the government of the Philippines is beginning to recognize a desperate need for intervention.  This intervention would necessarily involve sweeping sex education initiatives and better access to birth control.  In response, the Catholics Bishops Conference has pursued an active stance against any government birth control initiative by threatening to excommunicate the president if he proceeds with these plans.  This conflict threatens progress on healthcare and curbing population growth in a  country ill-prepared to cope with even one more mouth to feed.

Click here to read “One born every minute: The maternity unit where mothers are THREE to a bed.”

Photo via Creative Commons / Monica’s Dad

<< Fact 7 ♦ Fact 9 >>

 Click here to read “Increasing access to health workers in remote and rural areas through improved retention.”

Photo via Creative Commons / UNICEF Sverige

<< Fact 6 ♦ Fact 8 >>

 Click here to read “ Striking the right balance: health workforce retention in remote 

and rural areas.” 

Photo via Creative Commons / K J Payne

]]> http://www.saveamother.org/rural-health-interesting-fact-7/feed/ 0 http://www.saveamother.org/rural-health-interesting-fact-7/ http://feedproxy.google.com/~r/SaveAMother/~3/kyxntnOAB0A/ http://www.saveamother.org/rural-health-interesting-fact-6/#comments Sun, 04 Dec 2011 03:25:03 +0000 Ruba Alafifi http://www.saveamother.org/?p=4190

In Latin America, lack of healthcare access has lead to the widespread use of auxiliary (volunteer) health workers.  

<< Fact 5 ♦ Fact 7 >>

Click here to read “Latin American Experience Related to the Solution of Rural Health Problems in the United States.”

 Photo via Creative Commons / Wally Walker

A recent study of medical graduate in Ghana found that improved equipment, supportive management, superior housing, shorter contracts, and salary bonuses all made rural healthcare more attractive.

<< Fact 4 ♦ Fact 6 >>

Click here to read “Rural practice preferences among medical students in Ghana: a discrete choice experiment.”

 Photo via Creative Commons / US Army Africa

In the essay she recalls her  feelings about the conditions in these wards and the availability of care for women in labor.  Pregnant herself during the assignment, she takes a more personal approach when portraying the stories of the women:

There were dozens of women in labor. Most of them weren’t making much noise, but the conditions were pretty rudimentary. But the one thing that really set the hospital apart was that there are trained professionals. There were two doctors, maybe even three. They were very aware of everyone’s condition. They were following people closely. Although the hospital looked pretty basic, I did feel as if the doctors knew what they were doing. That was actually quite reassuring, because in some of the hospitals I’ve been in there are times when there are only midwives present, and there are no doctors. So when there are complications, the women have nowhere to go.

Click here to for the full article: From One Maternity Ward, a Growing World

Iodine is a critical component of thyroxine, a thyroid hormone that helps control metabolism, and also plays a key role in the development of the fetal nervous system.  A fetus that does not take in sufficient iodine will not develop a normal nervous system.  In developed counties, adding iodine to table salt has all but eliminated cretinism, a thyroid disorder causing mentally retardation and physical deformity.  In addition to iodized salt, iodine can also be acquired through milk, seafood, and crops grown in iodine-rich soil.

Thailand salt farmers

Efforts by the United Nations and the World Health Organization have significantly reduced iodine deficiency in the developing world, but some regions continue to struggle.  Thailand is one such example: not all brands of salt are iodized, and there is a huge reliance on fish sauce to make foods salty.  For this reason, even the wealthiest Thai people often still lack sufficient iodine in their diets.  The goal now is to iodize both salt and fish sauce in the hope of raising IQs and preventing irreversible brain damage in the very young.

Click here to read “The Miracle of iodine: How 10 cents and some table salt can raise IQs in the developing world.”

Click here to read “Iodine. Metabolic control, modulation of oestrogen, and foetal health.”

Photo via Creative Commons / JJ Harrison

Jaya Singh: SAM's India-Based Director of Research and Program Development

It is a hot September day in Musafirkhana, Uttar Pradesh.  We’ve been driving on the Lucknow-Benaras highway for several hours before swerving off onto a dirt path, rice fields on either side, our driver honking away the few bicyclists and pedestrians we encounter.  The car pulls up to a temple that rises abruptly from the fields.  Next to the temple is the asbestos-roofed shack that serves as an assembly hall.  We’ve reached our destination: a meeting of women from 4-5 adjoining villages with Save A Mother Swasthya Sakhis (health activists).

I am prepared for the smell of grime, and the heat and dust that pervades rural India.  I am unprepared for the reception – bouquets of hibiscus and marigold encased in thin pink and white paper before being ushered onto a dhurrie to face the audience.  About a hundred women stare back, most of them in saris, glass bangles gleaming at their wrists, many with a thick line of bright orange vermilion in their hair.  They sit in perfect order, cross-legged in rows of eight each.  A handful of girls in salwar kameezes, dupattas neatly pinned, sit in the first two rows.  Some stare straight at us, a few giggle and hold hands looking down at the grey cement floor.  A girl who could be anywhere from  twelve to fifteen is seated in the front row wearing a black, short-sleeved T-shirt and blue jeans.  Change is afoot in Musafirkhana.

A Swasthya Sakhi, her hair coiled into a knot on her uncovered head, stands.   “I was nine when I got married.  Sixteen when I had my first child.  They bathed my child in cold water after it was born.  He died.  My second child also died.  No one told us what to do.  Now that we know, staying healthy is the most important work we can do.  Whether girls or boys, we cannot be careless about our children.”  The hall reverberates with applause.

A second woman rises.  No more than forty years of age, she is bent over.   “I was married at five.  I had my first child at fourteen.  My labor lasted four days.  The pain . . . ”  Her voice catches.  “After four days, they brought a woman to help, she cut the cord with a blade.  For ten days I remained in a dark room, in the same clothes, without bathing.  My child died.”

A third woman stands.  You sense the determination in her stance before she utters a word.  “I do not want to share my story.  Perhaps you’ll cry if you hear it, perhaps I’ll cry.”  She pauses.  Her voice breaks.  Her eyes flash.  Breakdown.  She resumes, “I do not want to share my story, just that now we want to educate our children.”

She starts singing a song.  I recognize the popular film tune, but the lyrics are about immunizations during pregnancy.  About five things to do during pregnancy and child birth.  About cord care and kangaroo care in newborns.  The crowd joins in the chorus.

Another song.  Am I hearing this right?  She just sang that using dirty cloth pads during menstruation can cause germs to traverse the birth canal and lead to infection, even cancer.

Another song by a Mehr un Nissa, a Muslim woman standing on the grounds of a Hindu temple, sings about marrying after age twenty and having a child only after twenty-one.

The constant refrain in the meeting?  We will not let our daughters suffer what we went through.  The energy in the room is electrifying.  The determination palpable.

The meeting concludes with a Q&A session.  A scrawny teenager, eyes sparkling, body twitching with energy, stands up and says in perfectly enunciated Hindi:  “I heard you’ve come from America on an airplane.  Give us the formula to become rich so that we may take an airplane to go to America to see you.”

Are you up to her challenge?  Change is afoot in the villages where Save A Mother works.

Get Involved http://saveamother.org/getinvolved

Donate http://saveamother.org/donate

Email info@saveamother.org

SAM Contributing Blogger Stephanie Hamborsky

As South Sudan is christened as the newest addition to the United Nations, the decrepit conditions within this historically exploited nation once again remind us of ever-pervading health disparities around the world.

In her most recent book, Dr. Rebecca Richards-Kortum, the Stanley C. Moore Professor of Biotechnology at Rice University in Houston, Texas, emphasizes the importance of political, economic, and social factors and their correlation to health statistics.  Countries with a history of colonization, such as Sudan, are especially susceptible to dysfunctional health systems. According to Dr. Kortum, infant mortality rates between 1960 and 1994 were a main predictor of government failure due to coup d’états, civil wars, and general social unrest.  Indeed, this same fate struck Sudan, as the conflict in Darfur ravaged the country for decades and continued even after a peace agreement was reached between the northern and southern factions in 2005.  In March 2009, UNICEF reported immunization rates for children in Sudanese states ranging from 5.5 percent to 72.5 percent.

The most successful immunization programs require uniform funding and personnel deployment. Otherwise, disease radiating from areas subject to less stringent immunization protocols undermine success where immunization rates are higher.  To be considered effective, immunization programs must achieve a nationwide rate of at least 85 percent, which results in the phenomenon known as herd immunity.  This effect creates a community in which the pathogen is unlikely to spread significantly among the minority left un-immunized.

The World Health Organization and UNICEF, as well as other organizations collaborating on immunization programs, employ this strategy.  A notable example is the PEI, or the Polio Eradication Initiative, which is attempting to eliminate endemic polio within Afghanistan, Nigeria, India, and Pakistan.  Polio in developed nations was eradicated using this alternative strategy, but this approach may prove overly ambitious in nations with substantive economic disparities rooted in difficult-to-quell civil conflict and political turmoil.

Although southern secession marked a step in the right direction for Sudan, violence still ravages the north-south border and corruption continues to run rampant.  Of course, such factors directly affect healthcare access and quality, meaning dismal immunization rates are likely to continue.  To reach UN Millennium Development goals for child mortality, basic immunization programs must be the focus of global health programs abroad.  Investment in vaccinations has proved one of the most successful public health endeavors in modern history.  But the war is far from won.  We must carry on the battle to deliver vaccines and basic medicine to war-ravaged countries.

Recalling the glamor of years past, the third annual Save A Mother charity gala, held on September 16, 2011, successfully brought 220 of Chicago’s philanthropically minded gliteratti to the historic Drake Hotel for a night of fine dining and casino-inspired activities. This year’s event married the theme of Monte Carlo with the mystique of a masquerade ball and proved to be the premier charity gala of the summer.

Save A Mother also honored Mr. Niranjan Shah and Mrs. Pratima Shah for their lifelong commitment and outstanding contributions to humanitarian work.

The event raised over $60,000 to provide health solutions for underprivileged women and children in India.

For more details about the event, please visit
http://www.masquerademasti.org

Save a Mother's 2011 Chicago Masquerade Masti was held at the Drake Hotel.

Masqueraders enjoying the 2011 Chicago Masquerade Masti.

Houston Masquerade Masti 2011

The Houston Chapter of Save a Mother held its second annual fundraiser earlier this year, complete with hand-painted masks and resplendent crimson and yellow decor.  The event took placed on May 13, 2011, at the Chateau Crystale.  The evening’s program was emceed by Girija Bhargava Patel, Shayam Parikh, and the Board of the Houston Chapter, and included presentations on SAM’s mission and methods in the field. Guest speaker Dr. Harvinder Singh Bedi shared data comparing infant and maternal mortality rates in the US and other countries to illustrate how India lags behind on each of these indices. Entertainment was provided by local talent with songs by Keka and Satyajit Kar, Hardik Jani, Raghavendra Prabahakar, Neha Srivasta and the ICC Idol winners.

The event raised over $50,000 to provide health solutions for underprivileged women and children in India.

Revelers enjoying the 2011 Houston Masquerade Masti.

The Houston chapter of Save a Mother hosted its 2nd annual Masquerade Masti at the Chateau Crystale.

The first and only person to be completely cured of AIDS, Brown, sometime called “the Berlin Patient,” has spurred the race to cure a virus that affects over 33 million individuals worldwide.  The growing cost of caring for HIV patients is alarming and the need for a cure is urgent.  Most scientists agree that the methods used on the Berlin Patient are impractical and even dangerous, but new discoveries focused on gene therapy might yield more realistic treatment options in years to come.  This focus on curing the disease, however, is upsetting to those in the international health community who worry that the money and energy diverted to finding a cure will take away from efforts to prevent infection.  The desperate hope for an end to the pandemic in the future is competing with the need for prevention in the present day.

Click here to read “Special Report: An end to AIDS?”

In the profile, Bsat shares how with the help of her aunt and Dr. Robert Abboud, an OB-GYN who allowed her to practice in Naqib Hospital, her experience as a midwife has been a fulfilling one.  The profile also laments the decline of a once highly regarded profession.

In her own words, Bsat tells the story of how her aunt helped her discover her calling, and what keeps her motivated.

Once my aunt had two women in labor at the same time and I had to help one of them give birth . . . . When the woman gave birth to a boy, I had goose bumps and my heart accelerated. It was at that moment that my aunt told me I was qualified to become a midwife. . . I feel the same when I help other women give birth as when I gave birth to my children. It is a feeling of humanity which my aunt taught me when she helped me give birth to my five children.

Click here for the full article: “Salma Bsat: Sidon’s last practicing midwife”

A Hospital in Mumbai

Malaria has swept Mumbai.  An average of 48 new cases per day was recorded for the month of May, a marked rise over previous months.  The BMC (Brihanmumbai Municipal Corporation) claims those most affected by the disease are migrants from malaria-endemic areas, suggesting that Mumbai citizens have nothing to fear.  Given that India has one of the world’s highest malaria rates, the official response has been a little surprising.  At least some councilmen warn that if this “lackadaisical” attitude toward the disease persists, the city might not have the capacity to handle a more severe outbreak.  To achieve the Millennium Development Goal of eradicating malaria, or at the very least, prevent large-scale outbreaks, more drastic measures are needed.  As DNA India reports:

“Monsoon has not yet started in the city. There is no case of water logging so far. The ones suffering from malaria are those who have migrated from the malaria endemic states like Karnataka or Orissa,” said Manisha Mhaiskar, additional municipal commissioner.

The statistics from the public health department state that in January around 1397 cases of malaria were registered, with 6 deaths. February witnessed 1194 cases and 3 deaths, while March recorded 1629 cases and 2 deaths. The figures in April subsided to 1450 cases and no deaths. In contrast, the figures soared this month.

Click here for the full article: Malaria Cases Rise in Mumbai due to Migrants

Ethiopan Woman Planting a Tree

Germany recently signed a debt agreement with Egypt, cancelling much of Egypt’s debt and instead allocating the owed funds to the Global Fund to Fight Malaria and AIDS.  These organizations will receive funds amounting to approximately US $5.5 million to assist them in providing healthcare services in rural villages in Ethiopia.  The agreement is a sign of possible future cooperation in the field of healthcare for East Africa:

Ethiopian Ambassador to Egypt Mahmoud Dareg said the aid would help remote villages in Ethiopia while having a positive impact on the health aspect of development work.

Check out the full article here: Agreement to cancel Egypt-German debt, fight malaria in Ethiopia.

Photovia Flickr / treesftf

Not only does this study provide further proof that lives can be saved with some fairly simple basic training (the course covered basic techniques like cleaning and warming a newborn, breast-feeding, resuscitation, and common illness diagnosis), it suggests that training itself can be cost effective.  The first lives saved cost around $200 per infant, already a small number, but imagine what happens when that knowledge is shared.  Researchers estimate that the program will cost only around $14,000 to maintain in the future.  If more trained midwives are encouraged to teach colleagues, then perhaps someday even that small sum won’t be necessary.

Click here to read “Instruction for midwives lowers death rate for newborns in Zambia“

Click here for the whole story: “Electronic Medical Records Lower Infant Mortality”

 Photo via Creative Commons / Medill DC

Two Sri Lankan women working at a tea estate

The family of Muthamari, a Sri Lankan mother, has been relying on town credit since she fell ill and became unable to work. With a family income of $100 a month, 70% goes to food and 30% to school and medical expenses.  A typical meal in Muthamari’s family is rice and pulses (a type of legume).  It is clear that several nutrients are lacking in her diet and that of her children.

Public health records indicate that stunted growth is a pervasive problem in Sri Lanka.  Children who are stunted do not show high prospects.  This condition, aggravated by a persistent lack of food and funds, reduces the overall productivity of the family, feeding a vicious cycle poverty and poor health.  By working at the household level and providing affordable food resources, the issue of malnutrition can be tackled in this region.

To learn more, click here to read “UNICEF-supported programme tackles malnutrition on tea estates in Sri Lanka.”

Photo via Creative Commons / Trengarasu

The Academy for Educational Development (AED) notes HIV typically spreads from mother to child in one of three ways, each of which can be prevented through early detection and responsible action on the part of the mother.  The first means of transmission occurs during pregnancy.  Because the placenta acts as a barrier against infection, transmission in utero is relatively rare.  However, if the placenta becomes infected or if the woman has only recently contracted HIV, the virus may then be able to cross the placental barrier and infect the fetus. The risk of transmission can be reduced when HIV-infected mothers remain healthy and apply a steady course of antiretroviral drug therapy. Antiretroviral drugs are used to keep the viral load – the amount of HIV virus present in the woman’s blood – at a minimum. Further research conducted by AED confirmed that proper adherence to antiretroviral therapy will notably decrease the risk of placential infection, prohibit the mother’s immune system from deteriorating, and ultimately lessen the chance of HIV virus passing onto the child.

The second route of HIV transmission occurs during childbirth.  The release of fluids into the mother’s body increases the odds that the fetus will come into contact with the virus and become infected. The risk of transmission during childbirth is far higher in women who have not received antiretroviral therapy.  For this reason, women should get tested early and begin antiretroviral treatment at the first sign of infection.

The third and increasingly more common route of HIV transmission from mother to child is through breastfeeding. Because remnants of the virus are present in breast milk, the risk of contracting HIV is significant. According to a recent report by the Maternal & Neonatal Health program, roughly 10-20% of babies born to HIV-infected mothers will become infected through breastfeeding. But even in HIV-positive mothers, the benefits of breastfeeding often outweigh the risk of infection.  Breastfeeding improves bone development, strengthens the infant’s developing immune system, and decreases the risk of contracting diseases found in infants nursed on formula.  Once the decision to breastfeed has been made, the consumption of breast milk without the introduction of outside food sources actually strengthens the infant’s immune system against HIV infection.  HIV positive mothers who choose to breastfeed should therefore do so throughout the child’s infancy.

Receiving adequate care before, during, and after pregnancy can dramatically lessen the potential for spreading HIV from mother to child.  Early detection and acknowledgment of the presence of HIV enables trained health workers to enact measures designed to interrupt the transmission. The strength of the child comes from the mother, but women can only act on what they know.  Educating new and expectant mothers on the importance of getting tested and the methods of transmission is crucial to winning the battle against mother-to-child transmission.

Click here to read “Global Activists Seek Improved Nutrition for Pregnant Women, Infants.”

Photo via Creative Commons / Ragesoss

Maternal mortality in Senegal is estimated at 1,200 per 100,000 births. The high rate is partly attributed to illiteracy and lack of adequate health information, particularly in the rural areas.

Every playing card shows a cultural image and typical cultural notions and proverbs are written underneath.

In Khombole, there are hardly any job opportunities or social activities for the residents to engage themselves in. And because most women in the village can’t read or write, they have little idea of the progress of pregnancy.

But with the W3 game Plan International is enlightening these women through the colours they are familiar with and the signs and images that relate to wellbeing.

In rural Senegal women can’t openly discuss pregnancy and motherhood issues. So what the W3 game does, is to give an informal platform to the women to discuss and learn about their health through symbols and images rather than words.

 

Click here to check out “Senegal’s Life Saving Board Game”

As children continue to gain weight long past infancy, parents can no longer rely on the received wisdom that children outgrow their “baby fat.”  Studies have shown that individuals who are overweight in infancy and early childhood are at greater risk for obesity later in life: a child who is obese at age 12 has a 75% chance of being obese in adulthood.  This stark trend should be a call to action to promote healthy eating habits at every age.

Click here to read “Obese Child Stroke Victim Aged Just Six.”

Photo via Creative Commons / Partyzan_XXI.

Woman and her Child in Nigeria

Reproductive health experts in Nigeria report that rates of maternal mortality are still high and require urgent attention.  Though maternal deaths have dropped by almost fifty percent in recent years, Nigeria is second only to India, a country nearly ten times its size, in total annual maternal deaths.  Most experts point to malaria as the leading cause of both maternal and child deaths.  The disease — which by some estimates afflicts 50 percent of the adult population each year — has caused suffering and slowed development throughout Nigeria and Sub-Saharan Africa.

Read the full article here: Maternal Deaths Still High in Nigeria

Photo via Flickr / Mike Blyth.

But what appears like a boon to the impoverished can carry unseen risks.  Because clinical trials are bound only by the host country’s ethical regulations, the more stringent standards of developed nations like the United States and Great Britain do not apply, and the potential for abuse runs high.  In Andrha Pradesh and Gujarat, seven girls died following a recent trial of the Human Papilloma Virus (HPV) vaccine, causing the study to be suspended.  Although the vaccine was ultimately ruled out as a cause of death, serious ethical violations were uncovered, and publicity surrounding the investigation contributed to a global scare about vaccine safety.

The findings were all the more troubling given the high-profile organizations involved.  The trial was funded by the Bill & Melinda Gates Foundation and co-run by the international health charity PATH and by the Indian Council of Medical Research.  When even the best-intended and well-funded trials violate ethical norms, perhaps it is time to ask whether the human cost for new treatments is simply too high.

Click here to read “The Other Half: Too bitter a pill to swallow.”

Click here to read “Vaccine trial’s ethics criticized.” (log-in required)

Photo via Creative Commons / Ekta Parishad.

<< Fact 8 ♦ Fact 10 >>

Click here to read “What’s Different about Rural Health Care?” 

Photo via Creative Commons /  Lee Cannon

<< Fact 1 ♦ Fact 3 >>

Click here to read “FDA Redraws the Rules for International Drug Trials.”

Photo via Creative Commons /  Andres Rueda

In the United States, one fourth of the population lives in rural areas, but only 10% of physicians practice there.

<< Fact 3 ♦ Fact 5 >>

Click here to read “About Rural Health.” 

Photo via Creative Commons / gogoloopie

Click here to read “Global Framework for Action.”

Photo via Creative Commons

<< Fact 5 ■  Fact 7 >>

Click here to read “Future depends on diet.”

Click here to read “Major causes of death in neonates and children under 5.”

Photo via Creative Commons

]]> http://www.saveamother.org/child-nutrition-interesting-fact-6/feed/ 0 http://www.saveamother.org/child-nutrition-interesting-fact-6/ http://feedproxy.google.com/~r/SaveAMother/~3/x2N1PUkeojk/ http://www.saveamother.org/rural-medical-dispensaries-are-good-news-for-goa/#comments Wed, 15 Jun 2011 19:27:58 +0000 Emma Mallonee http://www.saveamother.org/?p=3448

US Army Medical Researchers at a rural dispensary in Kisumu, Kenya

The government of Goa recently commissioned ten “rural medical dispensaries,” or RMDs, to service remote rural areas in India’s fourth most populous, but geographically smallest, state.  Each one of these RMDs is equipped to provide medical services such as dental services, ultrasounds, blood checking, diabetes treatment and registration, and, in some locations, dialysis.  In a state where only 22% of doctors serve rural areas and medical professionals are few and far between, it is hoped that even these rudimentary facilities, which are staffed around the clock by at least one doctor, will help reduce the instance of highly infectious diseases such as malaria.

Click Here to Read “Goa to have Rural Medical Dispensaries for remote areas”

Image via Flickr / US Army.

A US Navy Officer Plays with Children in the Children's Ward of a Borneo Hospital

In Borneo, the third largest island north of Java Island, Indonesia, the quality of life in the rural areas of the country depends almost entirely on the services provided by the government, or rather, governments. Borneo is divided among three countries: Indonesia, Malaysia, and Brunei.  In recent years, its rapidly growing population has overwhelmed a hospital system already suffering from outdated equipment and a scarcity of doctors and medical personnel.  In some places, the nearest functioning hospitals are four to five hours away.  It is imperative that the government – which has so far done little to address this growing problem – step up and provide at least rudimentary facilities for rural areas.  As the Borneo Post reports:

Telang Usan assemblyman Dennis Ngau Jok said the people’s quality of life in the remote and rural area depends on the service given to them by the government.

During a visit to Long Lama Health Clinic in Long Lama, Baram last Wednesday, he said: “The population is increasing and if we look at the number of new patients in our clinics and hospitals, it is also increasing.”

According to him, health related services, especially for residents in rural area such as in Telang Usan constituency, are important as residents there do not have other alternative to get medical treatment.

Therefore, he said immediate action had to be taken by the authority to tackle problems such as a rundown building and lack of medical officers on duty.

A model for such governmental support can be found nearby in Hulu Selangor, a district in Selangor, Malaysia. Here 30 children received free health counseling from private hospitals for five years. These hospitals have been recognized by the country’s leaders and serve as an example of how tackling health issues early on can cut costs as well as educate citizens. With governmental support, such programs have tremendous potential to improve the health of their country’s people.

Click here to read “Borneo: Quality of Life in Remote Areas Depends on Government’s Service.”

Click here to read “Free health counseling for 30 children in Hulu Selangor.” 

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Photo via Creative Commons / Commander, U.S. 7th Fleet

An estimated loss of 10% of lifetime earnings occurs because of child hunger and its negative effects on physical status and intellectual development. 

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Click here to read “Global Framework for Action.”

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Letting women have a year’s supply of birth control pills might help prevent more unwanted pregnancies, a new study suggests.Right now, private and public health insurance plans in the U.S. generally limit how many months’ worth of birth control pills can be prescribed at once.

But researchers found that lower-income California women who got a year’s supply of the Pill had fewer unplanned pregnancies than women who got only enough packages for one or three months at a time.

For every 1,000 women who participated in the study, 10 in the longer-supply group became pregnant within a year, compared to 30 of those who could only get prescriptions for shorter supplies.

The study also showed that when doctors prescribed a full year’s worth of pills, about two of every 1,000 women had a state-funded abortion in the following year. But among women who had to come back every month or every three months for another prescription of the pills, roughly six of every 1,000 had a state-funded abortion.

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More than a million mothers and newborn babies are dying each year from easily prevented birth complications because of a chronic shortage of midwives across much of the developing world, a new report from Save the Children said on Friday.In the world’s least developed countries over half of mothers give birth without any trained help — compared with only one percent in Britain — and some 2 million women face one of the most frightening days in their life entirely alone.

Some 1,000 mothers and 2,000 newborns die every day as a result. Another 350,000 trained professionals are needed to save their lives, the “Missing Midwives” report said.

“It doesn’t have to be complicated: someone who knows how to dry a baby properly and rub its back to help it breathe can make the difference between life and death,” said Save the Children Chief Executive Justin Forsyth.

“No mother should face giving birth without help.”

Of the 8 million children who die each year before the age of five, one in ten do not even see the end of their first day.

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An HIV-positive person who takes anti-retroviral drugs after diagnosis, rather than when their health declines, can cut the risk of spreading the virus to uninfected partners by 96%, according to a study.

The United States National Institutes of Health sampled 1,763 couples in which one partner was infected by HIV.

It was abandoned four years early as the trial was so successful.

The World Health Organization said it was a “crucial development”.

The study began in 2005 at 13 sites across across Africa, Asia and the Americas.

HIV-positive patients were split into two groups. In one, individuals were immediately given a course of anti-retroviral drugs.

The other group only received the treatment when their white blood cell count fell.

Both were given counselling on safe sex practices, free condoms and treatment for sexually transmitted infections.

Among those immediately starting anti-retroviral therapy there was only one case of transmission between partners.

In the other group there were 27 HIV transmissions.

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Most of them have not even studied until high school. But these women health workers, who have offered to serve as volunteers for health in rural sector under the National Rural Health Mission (NRHM), are living up to their name of ASHA or Accredited Social Health Activists.

The women, below 45 years of age, are playing a proactive role in improving the health care sector especially in remote villages which have no or very little access to health care facilities, either diagnostics or curative.

Though the scheme was launched under the NRHM since 2007 in the country, it is being implemented in Nagpur circle only in last one and a half year. But the scheme has begun to bear fruits. The circle has seen a rise in institutional deliveries from about 5-20% in different tehsils. All antenatal care (ANC) requiring women or pregnant women are now being tested for HIV. The immunisation status of children in all six districts has improved substantially.

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While a shortage of local physicians has longed plagued health care in the Panhandle, West Texas A&M University is planning to start a service that will help rural residents better meet their needs.

WT recently received a $115,600 grant from the Wal-Mart Foundation State Giving Program that will allow the school to buy medical equipment for a mobile health care unit. The university hopes it can start staffing the customized Winnebago by fall, at the earliest, and will eventually send the vehicle throughout the Panhandle to provide medical services to rural patients.

“When you look at the Panhandle, it’s medically underserved,” said J. Dirk Nelson, dean of WT’s College of Nursing and Health Sciences. “What we’d like to do is provide clinical experience for nursing and communication disorder students by allowing them to go out to these areas and perform some diagnostic assessments.

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Bhandara district is among the few districts of the state where birth rate has declined.

Officials have attributed this significant achievement to the pioneering work of National Rural Health Mission in the rural sector.

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Photo used under Creative Commons from rajkumar1220.

It is well-known that there is a shortage of doctors in rural areas.  According to an article in the American Medical News, “Nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020, according to new Assn. of American Medical Colleges work force projections.  That’s up more than 50% from previous estimates.

“The Dept. of Health and Human Services estimates that the physician supply will increase by just 7% in the next decade and decrease in specialties such as urology and thoracic surgery. During the same period, one-third of practicing physicians are expected to retire and the number of Americans 65 and older is projected to grow 36%, according to figures released Sept. 30 by the AAMC Center for Workforce Studies.”

But there is some good news too from Medical Health News that “for the second year in a row, the number of medical students choosing to enter family medicine has risen, according to this month’s results of the 2011 National Resident Matching Program. But it may take some time to see the effects.  Preliminary figures from this year’s NRMP show that family medicine residency programs filled 2,576 positions of the 2,730 offered, for a record-high fill rate of 94.4 percent.”

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As the summers approaches, accredited social health activists (ASHAs), who are involved in taking care of the health of women and children in the rural areas, will be trained to implement the malaria control programme in Ramabai Nagar district.

“Ramabai Nagar district has a population of about 20 lakh, comprising areas of Bhognipur, Sarwankheda, Rasoolabad and Akbarpur. In the first stage, 55 ASHA workers were imparted training in malaraia eradication programme,” district magistrate Mayur Maheswari said.

District malaria officer, RK Mishra said: “We are engaging ASHA workers in to control malaria for the first time. Our objective is to train ASHA workers so that they could carry out mass awareness programmes like maintaining cleanliness to tackle malaria.” As of now, ASHA workers are implementing various activities in the primary health sector in the rural pockets under the National Rural Health Mission. But considering their reach and achievements, the role has become important in tackling other diseases as well, said another senior health officer.

The focus will be on underprivileged sections who are poor and marginalized.

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A blue-and-white uniformed mannequin of a woman rural health worker carrying a vaccine delivery kit stood next to a bicycle and greeted participants at India’s first DesignpubliC Conclave, a day-long seminar held on 18 March in New Delhi.Behind the mannequin was a visual flowchart, with detailed images of health clinics, health service providers and local communities in rural Bihar.

For conference organizer Aditya Dev Sood, the mannequin held the key to solving some of India’s most pressing socio-economic challenges. Her vaccine delivery kit was an outcome of several months of intensive design research to investigate gaps in routine immunizations systems in rural Bihar.

The research project, conducted by Sood’s innovation consultancy, Center for Knowledge Societies (CKS), was sponsored by the Bill and Melinda Gates Foundation, in partnership with the Bihar government.

CKS team members “spent several weeks shadowing frontline health workers, interviewing families and observing community life”, said Sood, which gave them a profound understanding of “the dynamics of routine immunization” and the barriers inhibiting its delivery.

Using these insights, the CKS team and its partners are working on generating concepts and prototypes of an improved vaccine delivery kit, with performance-enhancing features such as better ergonomics, thermal facilities and syringe disposal.

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Chronic illnesses like cancer, heart disease and diabetes have reached global epidemic proportions and now cause more deaths than all other diseases combined, the World Health Organization (WHO) said on Wednesday.

In its first worldwide report on so-called non-communicable diseases, or NCDs, the United Nations health body said the conditions caused more than half of all deaths in 2008 and pose a greater threat than infectious diseases such as malaria, HIV and tuberculosis (TB) — even in many poorer countries.

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Washington, D.C.–(ENEWSPF)–March 21, 2011.  The U.S. Department of State, in coordination with partnering U.S. governmental agencies, is actively engaged and has made water a foreign policy priority. Our strategy is founded in the belief that U.S. investments in water and sanitation translate into investments in people, economic sustainability, as well as productive, safe living environments for everyone on the planet.

In FY 2009, the United States committed about $774 million worldwide for water and sanitation related activities in developing countries. The U.S. Agency for International Development (USAID) obligated $598.7 million for water and sanitation-related activities in more than 62 countries, an increase of $109.1 million over FY 2008 funding levels. The Millennium Challenge Corporation (MCC) obligated $121.3 million for all water sector and sanitation-related activities while the U.S. Army Corps of Engineers obligated approximately $54 million for water and sanitation projects in Iraq.

As a result of USAID investments in FY2009, nearly 5.8 million people received improved access to safe drinking water, and more than 1.33 million received improved access to sanitation in at least 57 countries. USAID-sponsored activities to improve the quality of water at its point of use resulted in more than 7.8 billion liters of disinfected drinking water.

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Over the past year, IBM’s consultants have been engaged by the Cross River State government to help roll out the state projects “Hope” and “Comfort” in a bid to address issues of infant and maternal mortality and increase levels of literacy amongst the poor. To date, IBM has helped in registering over 135,000 for the programs.

The work benefits from advanced technologies such as biometric identification and solar energy to make the programs more efficient, reliable and accurate.

“We launched project Hope to provide free healthcare for pregnant women and children under five, so as to mitigate both infant and maternal mortality rates which were unacceptably high.  Running alongside is project Comfort – a social benefit program designed to provide financial assistance to people living in poverty and support in educating family members,” said Senator Liyel Imoke, Governor of Cross River State.

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Childbirth is the number-one killer of young to middle-aged women in developing countries, and one of the worst-affected countries is Rwanda, where maternal mortality rates have been dire.

But a new rural hospital is transforming the local health system and offering a model of how to turn around the situation in the country.

The Butaro Hospital has been built to provide quality healthcare in one of Rwanda’s most remote districts. Just a few years ago Burera district only had one doctor for its 350,000 population.

Dr. Agnes Binagwaho, the Rwandan Permanent Secretary of Health, welcomed the new facility. “There are too many deaths that we could prevent by increasing access to care in a geographic way and also increasing the expertise of health professionals that deliver services,” she said.

The first baby to be born at Butaro Hospital had difficulty breathing, but he survived. Health professionals say this may not have been the case if the delivery had taken place at home or in a rural health center.

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At a clinic in the mountains, reached only by crossing a churning river in a rowboat, Dr. Paul Young, a pediatrician raised in the housing projects of Savannah, Ga., soothed a fussy baby. She stared at him, fascinated, as he made soft popping sounds with his lips and listened to her heart through a stethoscope.

“I used to be afraid to look at the babies’ test results,” he said after examining a bunch of children, who were born healthy despite having H.I.V.-positive mothers. “But now, most of them are negative.”

Dr. Young, 33, and the nurses he trained here have persuaded many pregnant women to get tested and take the drugs that prevent them from passing the disease to their newborns. It is all part of a charitable effort he joined in 2008 for $40,000 a year and the chance to work in this AIDS-afflicted country, which has just one pediatrician in its entire government health system.

“If this was the last thing I did, if this was the only job I ever had in life, I would have served my purpose,” he said.

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The Department of Health and Human Services(HHS) will invest as much as $1 billion in a national collaboration that aims to save 60,000 lives during the next three years by eliminating preventable injuries and complications in patient care, HHS Secretary Kathleen Sebelius announced at a press conference yesterday.

 

Funding for the program, called Partnership for Patients, will be invested in reforms that help achieve two shared goals during the next three years:

 

• Keep hospital patients from getting injured or sicker. The goal is to decrease preventable hospital-acquired conditions by 40 percent by 2013, compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years, Sebelius said.
• Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20 percent compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge, according to HHS.

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The makers, Hydration Technology Innovations, hope communities prone to flooding—like Mudimbia, Kenya, on Lake Victoria where these photos were taken—can stock up on the packs and put them to use in the first days after disaster. Gaylon White is the Director of Design Programs at Eastman Chemical Company. He helped make Eastman makes components for HTI’s filter membrane for the HydroPack and participated in a field test in Kenya last month. “In an emergency situation, often times the people are surrounded by water, but they can’t drink the water,” he says. “This gives them a way of utilizing the water that’s right there and making it clean to drink and giving them not only hydration, but also nutrients that get them past the first days.”

The first phase of an emergency response situation, the first three to eleven days, are crucial for public health. Before electricity is restored, clean water is shipped in, and medical operations are fully established, people are at the greatest risk of the secondary dangers of disaster. “You have a lot of water borne illness … dysentary, cholera,” White says.

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GE Healthcare recently unveiled two advanced, cardiac care solutions designed and developed in India for India with an aim to help provide better, affordable early cardiac diagnosis for more people. These innovations – GE MAC 600 and GE VIVID P3 reinforces GE”s healthymagination commitment to provide better healthcare for more people in India and around the world at affordable costs.

John Dineen, President & CEO, GE Healthcare, who unveiled the new innovations at Bangalore said, “When we launched healthymagination two years ago, our vision was to provide better health for more people at lower costs. Through the use of powerful technology, innovation and talent of our people, we are addressing global healthcare needs – reducing costs, increasing access and improving quality – in real and relevant ways. We are tremendously proud of our initial achievements: 29 healthymagination validated products, $ 700 million in research and development investment and more than 135 million lives touched in new ways in the first two years.”

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Japanese scientists believe they are getting closer to growing a human eye.

New research being published today in the journal Nature explains how they have managed to grow a mouse eye from stem cells, with the hope it will lead to treatments for human blindness.

Professor Andrew Elefanty from the Monash Immunology and Stem Cell Laboratories says the scientists have taken embryonic stem cells from a mouse and grown a structure similar to the early forming eye.

“This is sort of the first time this type of complex eye structure’s been grown, and I think that’s what really the excitement is about from the point of view of this paper,” he says.

“Generally it’s been felt that to grow these things in a culture dish [it] requires way too much organisation than what you’d be able to reproduce in a laboratory.

“And so I think that’s what partly the surprise and the interest is – that in the culture these scientists’ use of mouse embryonic stem cells, they’re able to get several elements that help to make up the eye all growing together in the right fashion, such that it looks very similar to what you’d see normally during [natural] development.”

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A Mom in the Eyes of a Teenager

By Anshula Singh

A mother is different for everyone. She can be your best friend, or your worst nightmare, it all depends on you.

Now growing up is hard, for all the adults out there you have firsthand experience. For us teenagers, it is a learning experience. And for the kids, be happy that you still have time. My mom is unique to me. She is different from day to day. Some days she can be tons of fun, while on others I swear I want to shut myself up in a tiny space. There are times I cannot speak to my mom, and there are times she is the only person I can rely on. There are times where we are both raging volcanoes of destruction, and times when we are both smiling suns. There are also times when she is wrong, and I am right, or vice versa. There are times when I dare not speak up, and times when I cannot hold it in. There are even times when I feel like crying because of my mom, and times when I want to cry with her. My mom can be embarrassing or the coolest person alive. My mom and I are completely different, but it works. For all the stuff she lacks I make up for. She hates doing laundry, and I hate doing dishes, so we trade off. My mom is very complex. She can be as tough as a rock, or stubborn as a mule, or as sensitive as a girl with a broken heart. But at the end of the day I love my mom because she is the only person there is that I can have these emotions towards. When you are a teen seeing eye to eye with your parents is tough, EXTREMELY TOUGH. Some days when my mom and I get into arguments I want to scream my head off where as on others I truly feel as if I am wrong. But the most wonderful thing is that you can always make up, and let that matter be part of the past. Moms love you so much that they don’t let any small matter get in the way of their relationship with their child. Sure if it is a big argument you might not talk for days, but in the end why let something so small get in the way of you and your mom. Moms are important; they care for you, treat you well, give you things, provide for you, support you, and give you all the love you will ever need. For a teenager we can be different from day to day. Adolescence is tough, we have so much to do, and so much we want to do. We don’t like the restrictions because our minds are finally ready for independence. Sure there are limits necessary on many things, but small things that our parents put limits on can sometimes drive us over the edge. Oh, and overworking us is really a pain in the neck. My mom does all these and MORE. Talk about annoying. But I’m mature enough to get why she is doing it. When my mom is super strict, I know she does not like it, she is only doing it so she can see me become successful in life. When I remind myself of that, the world always looks brighter. For teenagers, we have problems. LOTS AND LOTS OF PROBLEMS. And we need someone. People who want to go through their tough times actually don’t. As teenagers we need good supporting people around us. Moms are the main people we need. We need that comfort. We really need that hand to hold. If you are a mom, sometimes it is best to give in, and not be stubborn. But most of all be there for you child, especially in their teenage years. And children ages 13-17 please don’t be tough on your parents, they do so much so don’t make their loads any bigger then they need to be. Give in once in a while and don’t be stubborn because: Moms truly know what is best.

Anshula Singh is an eight grader at Diablo Vista Middle School in California and is plans to start a Save A Mother Club in high school.

By Megha Patel

The debate over food coloring and its various effects have recently been in the news with the FDA reassessing potential risks.  The U.S. Food and Drug Administration’s (FDA) Food Advisor Committee did decide on March 31 2011 to reject to recommend warning labels on foods with synthetic color additives with a vote of 8-6.  However, what exactly is the whole debate about anyways?

The claim against artificial colors is that there is a link between its consumption and behavior problems such as hyperactivity in some children. Naturalists are obviously against unnecessary use of colors in food, as they believe a diet eliminated of artificial dyes is more natural. However, beyond people trying to practice a “greener” lifestyle, this debate has reached more than just the environmentalists and health food nuts among us.  Parents across the nation are being more hesitant about these chemicals as an increased number of hearings presented to the FDA discuss the growing list of studies that point to a correlation between artificial colorings and behavioral changes in children.

The European Union has already started to eliminate artificial colorings and other potentially toxic additives and preservatives.  In fact, they have banned the use, sale and distribution of genetically modified ingredients and now require that all foods need to include a warning label if they have artificial food dyes.  This warning label is the same action the FDA was considering before conducting a re-evaluation on the dangers of such dyes.

After conducting studies and evaluating the evidence, the FDA did however conclude that the link to ADHD and other behavioral problems are weak, if any.  The panel listened to testimonies from doctors and scientists that stand by the idea that though rare, some children that are already predisposed to hyperactivity have exacerbated symptoms when consuming a diet high in certain dye mixtures.  However, the FDA maintains that problems associated with artificial coloring are similar to a peanut allergy in that it’s “a unique intolerance to these substances and not to any inherent neurotoxic properties” of the dyes.

Who is right? This may not be easy to answer as both sides of the debate make sense.  Though dyes have been shown to exacerbate hyperactivity in children already diagnosed with the condition, it has shown to have no effect on normal children without hyperactivity.  On the other hand, there really is no need for artificial dyes as their only purpose is to assist in the superficial colorings of generally processed foods. Ultimately, the debate will probably continue on whether artificial colors should be an FDA matter or a personal choice unless studies come out to show immediate and concerning effects of using dyes on the general population.

Photo used under Creative Commons from Andréia

96 Swasthya Sakhis attended one day refresher training workshops in 7 blocks-  Dubey pur, Musafirkhana, Lalganj, Satava, Jagdishpur, Khiro, Mahrajganj

In 27 villages, half-day sensitization workshops were conducted in two districts-Sultanpur and Rae Bareli.

Save a Mother participated in 20 CLA (village organization) meetings and 2 BLA (block level) meetings.

Periodic field visits to program areas

Simple Solutions for Big Problems

Saving Maternal Lifes with a Magic Marker

Problem:   Pre-eclampsia or eclampsia (PE/E) dangerously high blood pressure that occurs during prenancy and in developing countries often goes undetected.

Solution:   Magic Marker- type pen that can be loaded not with ink but with reagent that reacts to the presence of hypertension-related proteins. Apply that to a strip of the right type of paper and dip it in urine, and it will turn a telltale blue if too much protein is present.

Who: Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) along with the University’s Center for Bioengineering Innovation & Design.

Where: preliminary study by JHPIEGO conducted in Nepal.

Read more at: Time Healthland

The discovery of the New Delhi superbug has brought into focus the urgent need for a national policy on antibiotic prescriptions.  It all started with a report in Lancet in August 2010 of a new microbe discovered in India, nicknamed New Delhi metallo-b-lactamase-1, or NDM-1.  The enzyme NDM-1 makes bacteria resistant to almost all antibiotics, including carbapenems, antibiotics of last resort.

Antimicrobial resistance is generally the result of misusing medication.  In the absence of guidelines from the government and easy over the counter availability, antibiotics are used indiscriminately in India.  While doctors may prescribe antibiotics without assessing needs, people also self medicate without attention to course of treatment.   Not finishing a prescribed course of treatment, low-quality medicines and wrong prescriptions all contribute to drug resistance, making infections caused by drug resistant microorganisms difficult to treat.

Although viewed as a problem exacerbated by the developing world, developed nations are also recognizing the urgency of antibiotic resistance.  The US has begun to support measures to address the issue of antimicrobial resistance: Policy Statement 9908 advocates educational programs for providers and patients on appropriate antibiotic usage as well as recommendations for increased and improved oversight.  Amongst developing nations, Chile has banned over-the-counter sale of antibiotics and a prescription is now mandatory for access to antibiotics.  China will also launch a nationwide campaign this year to regulate the antibiotic use.

In response to the global outcry over NDM-1, the Health Ministry in India formed a 13-member expert panel in September 2010 to create a proposal for an antibiotic policy.  The proposal was submitted to the Union Health Minister Ghulam Nabi Azad earlier this year and is currently being finalized.

To start with, the new national antibiotic policy is likely to be piloted in three government hospitals in Delhi: Lady Hardinge Medical College, Safdarjung Hospital and Ram Manohar Lohia Hospital. It will also be mandatory for antibiotic drugs to be sold against prescriptions.  In addition, doctors will have to write prescriptions for antibiotics in duplicate with pharmacists having to retain a copy for a year from the date of sale in order to facilitate verification and audit.  Implementation of such rigorous regulation and government policy is likely to be effective as proven by example in other countries.

Those who cannot attend but are  would like to donate to the cause can donate securely on the group’s Web site at www.saveamother.org or send a check to the registered 501(c)(3) organization in Houston, TX at : Nat Murthy, 633 Lake Shore drive, Sugarland, TX 77478.

For most Americans, tuberculosis conjures clichés of Victorian-age heroines succumbing to a mysterious wasting disease, often in the midst of passionate but doomed romance.  Tagged with the ominous-sounding moniker “consumption” – because it seemed to “consume” the patient from within – tuberculosis was considered incurable and was almost invariably fatal.  It was also indiscriminate, victimizing rich and poor alike, especially those who lived in the crowded filth of industrialized cities, where the disease thrived throughout the nineteenth and early twentieth century. Then, suddenly, it was gone.

Almost overnight antibiotics turned tuberculosis into the stuff of bygone melodrama and forever changed the treatment of infectious diseases – at least in the countries who could afford to develop them.  It is easy to forget that antibiotics were first discovered less than a century ago and, within a matter of decades, had effectively eradicated tuberculosis throughout the United States and most of Europe.  In 1987, the American Medical Association predicted that it would be extinct worldwide by 2010.  Unfortunately, in this case the cure really could be worse than the disease.

Recent, widespread abuse of antibiotics has given rise to deadly new “superbugs,” strains of bacteria, viruses, and certain parasites resistant to existing medicines.  This phenomenon, called Antimicrobial Resistance or “AMR,” affects both the developed and developing worlds, but is most prevalent where antibiotics are used without adequate supervision or regulation.  If, for example, the traditional multi-drug regimen used to treat tuberculosis is followed for the full course of treatment, the patient is recovers.  But when the patient stops treatment – either because he feels better, cannot afford further treatment, or simply mistrusts the medical establishment – the remaining disease can become resistant to traditional drugs.  In contrast to the typical six-to-eight month regimen, multi-drug resistant tuberculosis requires 18 months of treatment using drugs that are more toxic, more expensive and ultimately less effective.  About 440,000 new cases of multi-drug resistant tuberculosis emerge each year, and that number continues to grow.

In other cases, antibiotics are distributed without a prescription or on the black market, creating ample opportunity for abuse and misuse.  As a result, resistant microorganisms such as the potent “NDM-1” enzyme, which is immune to even the most powerful antibiotics, threaten to precipitate a global epidemic.  Many of the drugs used to treat AIDS may also become ineffective as greater numbers gain access to retroviral drugs.  If this trend continues, we risk returning to a pre-antibiotic world, in which infectious diseases become untreatable and uncontrollable.

The outlook can seem bleak, but unlike many of today’s most pressing health issues, we already know the solution.  Increased regulation and restrictions on the use of antibiotics can control the incidence of AMR and slow the spread of resistant organisms.  India, for example, is developing a national antibiotic policy intended to regulate drug use in hospitals, and the effect of government intervention can already be seen in countries such as Chile, where antibiotics are no longer available over the counter, and the Netherlands, where comprehensive guidelines dictate the distribution and use of antibiotics.

The problem, then, is one of implementation.  For the developing world in particular increased regulation can cut both ways.  In areas where doctors and hospitals are scarce, requiring a prescription to obtain antibiotics can result in a total denial of treatment, or encourage resort to the black market.  An effective national policy must take into account weaknesses in the existing healthcare infrastructure, and as that infrastructure improves, be prepared to police the use of antibiotics as they become available to a wider class of patients.

Activists are optimistic that a renewed focus on AMR will lead to policies that encourage conservative treatment without denying access to underserved populations.  On this year’s World Health Day – April 7, 2011 – the World Health Organization will call on policymakers, practitioners, the pharmaceutical industry, patients, and the general public to fight AMR through the adoption of a six-point policy package designed for global implementation.  For once, the question is one of will rather than ability, of protecting what we have rather than creating anew.  But nothing short of universal cooperation will suffice.  Together we can ensure the continued triumph of science over disease; apart we will set civilization back a century.  The clock is ticking.

I have been volunteering with Save a Mother since August 2010 when I started the Save A Mother Club at my high school.  Our primary goal is to spread awareness of the lives of poor women in India.  Using the tools that can be found on the Save a Mother website, our club has taught many students at our high school of the troubles these women must endure and how they can help the cause.  Doing so has not only brought a sense of awareness at our school, but has also encouraged students to take an active role in helping the cause.  We plan to start a fundraising program through selling custom Save a Mother shirts, auctioning items from India, and a car wash.  Regardless of what we choose to do, the important part is that all of the proceeds will benefit the cause and help change the lives of several women and children in India.  That is the real push factor behind our club; knowing at the end of the day that we are not only positively changing the life of a mother, but also that of a child who has limitless potential.

In the future, I hope to see a world that isn’t so crowded with hate and mistrust. As idealistic as it is, I hope that one day a society can be born that would raise a generation filled with empathy and benevolence. A generation that would be able to look beyond the background of an individual, and instead, see them for who they are, one just like themselves.

According to Psychiatric Times, Tele-psychiatry holds the promise of creating a link between urban areas that have a high concentration of psychiatrists and rural areas that drastically need more specialists to provide consultations and direct services to patients. Since this can reduce costs and allow access to hard to reach patients, tele-psychiatry has been hailed as the future of psychiatry.
Mental illness accounts for about 12.3% of the global burden of disease and it is projected that by the year 2020, the number will rise to about 15%. Furthermore, over a billion people are living in countries that only spend around 1% of their annual health care budget on mental illness as opposed to the 6% spent every year in the United States.

Developing countries as a result of their limited funding have less access to mental healthcare; the ratio of psychiatrist to population ratio for about 96.5% of people in low-income countries is only 1: 100,000. This number is only exacerbated in rural areas where the real ratio is about 1:1,000,000. This result is no surprise since it is understood that the psychiatrists available are in private practice and mainly practice in urban capital cities and are not available to the poor, rural populations.

To address this increasing gap in availability and access to mental healthcare, the Chennai-based Schizophrenia Research Foundation (SCARF) launched a mobile tele-psychiatry unit that plans to tour rural villages like Pudukottai and monitor resident’s mental health. The mobile unit would be available in four taluks of the Pudukottai district and seems to be the first time mobile tele-psychiatry is being done in India and possibly in Asia according to SCARF director Thara Srinivasan.

Psychiatric tele-medicine was first introduced by SCARF after the 2004 tsunami to deal with the post-traumatic stress disorder heavily prevalent in the Cuddalor and Nagapattinan districts. Furthermore, it has been proven in many countries that this method of treatment is indeed effective as well as sustainable by its relatively low cost. For this reason, the governments of Australia and Canada have supported telemedicine in general and could potentially serves as templates for developing countries as well as the U.S. health care system.

The researchers that wrote “Recent Advances in Tele-psychiatry: An Updated Review” discovered that of the 68 studies published from 2000 to 2003, tele-psychiatry was determined to be a useful method of conducting assessments and showed improvement in patient’s clinical status.
Since this is a relatively recent method of treatment, there is not much data to fully support the effectiveness. However, patients have responded well to the technology overall and even with major mental disorders, patients appear to be comfortable talking to doctors over televisions and other communication platforms. Furthermore, a study by Hyler and Dinu P. Gangure, M.D. determined that sometimes children and adolescents actually do better on screen than in person.

A recent randomized trial also investigated treatment outcomes as well as patient satisfaction in two groups of participants with depression. Both groups received the same medication management, counseling and education; the only difference was one was performed in the traditional personal setting while the other used tele-psychiatry. Both methods proved to have similar outcomes and patient satisfaction proving that tele-psychiatry could indeed be an effective method to provide treatment to rural and harder to access populations.

Tele-psychiatry being introduced to rural populations in India is definitely an exciting for it has extreme potential to greatly affect mental healthcare as well as to serve as a model for other developing and developed countries that are dealing with limited access to rural populations.

Kaplan, Arline. “BasicNeeds: Successful Mental Health Programs With Scarce Resources”. Psychiatric Times. Vol 23 No. 11
Nieves MD, Edwin and Parmar MD, Meenakshi. Telepsychiatry Training: What Residents Need to Know. Psychiatric Times. July 27, 2009

Kanapaux, William. Telepsychiatry’s Untapped Potential: When Will It Pay to Deliver? Psychiatric Times. January 1, 2005.
Pudukottai Gets Mobile Tele-Psychiatry. The Times of India. February 10, 2011.

New Delhi: Another International Women’s Day, another occasion for a national assessment of the status of women in a country where the glass ceiling is within reach but not broken, where health statistics are still determined by

Shiban believes that in health care, responsibility precedes right and inculcating responsibility towards their own health empowers the individual, ultimately benefitting the community as a whole.

This past year Shiban spent his time……

Shiban writes for www.3quarksdaily.com and his articles have appeared in ‘Mail Today’ from Delhi.

Britta Thomsen, member of European parliament from Denmark, and one of the members of the group, said, “India is a very interesting place, but also a country full of contradictions. On one hand, you have the country read more

Save a Mother participated in 9 CLA (village organization) meetings and 5 BLA (block level) meetings.
Periodic field visits to program areas

Save a Mother’s Founder and Chief Volunteer, Dr. Shiban Ganju, co-authored a paper entitled, “Financing Healthcare for all: challenges and opportunities” in the January issue of The Lancet.¹ This paper addresses shortcomings in health care coverage and finance and makes recommendations for policy responses required to make healthcare affordable for all in India.

Here’s a summary:

Key Challenges:

Opportunities:

Key Recommendations:

Financing health care for all: challenges and opportunities. Kumar AS, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A, Sen A. Lancet. Jan 10, 2011.

By Megha Patel

The ‘Curricular Reform Committee for Undergraduate Medical Education’ has made recommendations to India’s Health Ministry to shorten the medical school curricula to three years to allow for larger numbers of doctors to meet healthcare needs in rural areas. This is proposed to be accomplished by shortening clinical training and possibly creating separate medical courses for rural students if the central government approves.

The current doctor to population ratio in India is 1:1700 compared to the world average of 1.5:1000. Though India has the highest number of medical colleges in the world as of the past two decades, there remains a fundamental challenge of bridging the gap between need and availability of doctors. With the population projected to increase with an annual growth rate of 1.4% over the next three decades, the Medical Council of India (MCI) felt that the existing medical colleges are unable to meet this need and are therefore seeking to double the current intake of medical colleges to achieve their target.

While their short term solutions include increasing intake of medical colleges, their long term solutions include creating new medical colleges and hospitals in under-served and rural areas. The MCI aims to improve the ratio of India’s doctors to 1:1000 by 2031 if their recommendations are taken into consideration.

However, apart from these proposed changes to the curriculum of India’s medical schools, a national-level committee of medical experts has proposed an even more radical curriculum change to the government that seeks to create doctors in three years flat for students from rural areas after the class of 2010. Since the ratio of doctors to the population is even more exacerbated in rural areas, this proposal would create doctors exclusively for rural areas since it is apparent that city-based doctors are unwilling to work in these areas.

This three year course of education would be called the “Bachelor of Rural Health Care” (BRHC) and though it is still under consideration by the government, this is viewed as the only practical solution to improve access to healthcare in rural areas according to many supporters. The way this degree would work is that students intending to work in rural areas would either sign a 10 year bond or make a lifetime commitment to solely work in rural under-served communities. In addition to establishing the three year MMBS programs, the committee also proposes increased medical colleges in under-served areas till 2015, similar to the proposal of the MCI.

Though this seems like a positive move to quickly address the increased gap between rural healthcare needs and access to doctors, it is not a foolproof plan and comes with many potential problems and concerns. Being a controversial change, doctors argue that this could deteriorate standards of medical education in India. As the government decides whether to follow the proposal or not, they will need to address issues such as how they plan to monitor rural healthcare graduates to ensure they are not practicing in urban areas as well as if the level of education given in rural schools are comparable to urban ones and if only rural students are able to apply to such programs. If these schools are only aimed at rural students, possible future problems could include increased inequality between urban and rural doctors and the quality of training they receive.

Regardless of the possible problems that could arise, there is an apparent and increased need for rural doctors and an ambitious proposal like this has long been overdue. If this proves successful, it could drastically improve healthcare access in India and possibly be a model for other developing countries that are also dealing with shortage of access in rural areas.

References:

1. Thakor, Prashant. “If govt gives nod, rural students can become doctor after class 10”, Ahmedabad, India. DNA 2/10/11

2. Medical Council of India. Proposal. Undergraduate Medical Education Working Group 2010.a

Photo used under Creative Commons from ernstl

By Katie Malizia

This year in India 68,000 women will die from complications of pregnancy, childbirth, and abortion. Roughly 1.8 million Indian children – more than the entire population of Manhattan – will either lose the struggle to be born or succumb to infections, prematurity, or malnutrition before the age of five. Despite steady declines in maternal and child mortality, social inequities, changing demographics, and the uneven distribution of healthcare continue to slow progress toward adequate, nationwide coverage for women and their children. But these problems are not without solutions. A report published earlier this year in the medical journal The Lancet¹ urges that comprehensive maternal and child healthcare can be achieved through the expansion of public health facilities, increased focus on early childcare, and, perhaps most crucially, community engagement and education through the deployment of skilled healthcare activists.

In 2005, the Indian government launched the National Rural Health Mission (NRHM), an extraordinary effort to reform the country’s ailing rural health system. NRHM set ambitious goals to improve maternal health, including the use of cash incentives to encourage poor women to give birth in health centers or government hospitals. This program, known as Janani Suraksha Yojana, has been one of NRHM’s great success stories. Janani Suraksha Yojana offers women who give birth in a health facility INR 1400 (approximately US $35). Health workers who accompany pregnant women to a facility receive INR 600 (approximately US $15) for transportation expenses and as compensation. In just five years, the number of women who have benefited from the program’s incentives has increased 13-fold, from 750,000 in 2005-2006 to nearly 10 million in 2009-2010. Health activists have been the lynchpin of this achievement. Over 750,000 have been trained and deployed to villages since 2005, and their efforts have been the driving force behind the implementation of the Janani Suraksha Yojana program.

But while the success of Janani Suraksha Yojana has helped reduce maternal mortality and improve newborn care, it has done little to curb infant mortality or address the needs of post-partum mothers. Increased demand for care in public health facilities has not been met with a comparable expansion of healthcare services. Doctors, nurses, and midwives are in short supply, and as a result, women are often discharged from facilities just hours after giving birth. Only 51% receive any kind of postnatal care, and most never receive counseling in newborn care or the importance of breastfeeding. Education in family planning and sexual health is likewise lacking.

Accredited health activists can help bridge this gap in reproductive and child health. Home visits within the first week of delivery can ensure that complications from delivery and other danger signs do not go undetected. Granting health workers the right to dispense oral antibiotics to treat pneumonia and infections in children could also dramatically reduce early child mortality. The behavior-changing strategies so effective in implementing Janani Suraksha Yojana could likewise be used to encourage women to breastfeed and vaccinate their infants, and to educate young people about good reproductive and sexual health practices. The need for contraception in rural communities is substantial, and an activist armed with supplies and counseling skills could do much to improve women’s control over their own reproductive future.

Systemic problems require system-wide solutions, and in a country of over 1 billion people, instituting reforms at even the state and district level can be challenging. Currently, district training centers for health activists are underfunded and understaffed, with ad-hoc efforts by professional organizations and a few select national centers supplying most training efforts. Greater attention and resources must be committed to bringing health activists to India’s most burdened and underserved communities. Once in place, activists must be monitored and provided with continued incentives and necessary supplies to promote maternal health and early child care. All this can sound overwhelming. But the evidence has shown that just one accredited health activist per 1000 people can make a substantial difference in healthcare for mothers and newborns. NRHM and similar programs have provided a viable and effective model for change in rural communities. The challenge now is to expand and improve on that model until adequate healthcare is a reality for women and children in every corner of India.

1 Reproductive health, and child health and nutrition in India: meeting the challenge. Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, Sreenivas V, Sundararaman T, Govil D, Osrin D, Kirkwood B. The Lancet. 22 January 2011 ( Vol. 377, Issue 9762, Pages 332-349)

Photo taken by Save A Mother staff at a training session in Tiloi.

By Jaya Singh

India’s increasing prominence in the global arena is marred by domestic problems, and a failing healthcare system is perhaps one of the largest challenges for the nation. The Indian healthcare system is one of the most fragmented in the world, where world-class care is greatly outweighed by unregulated poor-quality health services. Public spending on health at less than 1 % of GDP has remained low, much below the global average of 6%, while private out-of-pocket expenditure on health is amongst the highest in the world. As a result, escalating costs of healthcare often results in household impoverishment and debt.

A series of articles in the January issue of The Lancet puts a spotlight on challenges and opportunities facing the nation in building a health system that provides universal and affordable access to health care.

Key challenges highlighted in the articles are:

The burden of infectious disease remains enormous
The burden of maternal health, and child health and nutrition is greater than that in any other country
Chronic diseases and injuries are the leading causes of death and disability in
India—their burden will continue to increase during the next 25 years from a rapidly aging population
Almost 39 million people fall into poverty every year as a result of healthcare expenditure
India has a severe shortage of health workers, especially in rural areas

Key Recommendations are:

Increased public spending on health
Creation of an Indian national health service
Building better health information networks
Stronger regulation of private healthcare
Improvement of preventive and curative health services

A complete list of the papers and commentary in the Lancet Series on India can be found here.

Photo of Swaysthya Sakhi distributing iron pills taken by Save A Mother staff.

NAGPUR: “It is shameful that India, one of the fastest growing economies, is amongst the five countries with worst maternal mortality rate at read more

These three women and their plight have exposed the huge gaps in India’s tottering public health system that offers little or no emergency obstetric care, and continued care in the post-partum period for underprivileged women. But stories such as these have initiated a new era in read more

Infant mortality rates (IMR) and maternal mortality rates (MMR) continue to be “areas of concern” in India, it has been claimed.

Union health minister Ghulam Nabi Azad said: “In spite of the achievements made so far there are still areas of concern. The pace of decline in various key health indicators like IMR, MMR, Total Fertility Rate and death and morbidity due to read more