Abstract: Although the risk of onset in the next year, or in the next decade, cannot be quantified, a severe pandemic involving person-to-person transmission of a novel respiratory virus is considered by leading organizations to be a substantial global threat. The ongoing threat posed by the H5N1 and H7N9 avian influenza viruses, and by the MERS coronavirus, should serve to remind us of the continuing importance of pandemic preparedness. In a severe pandemic from a rapidly spreading novel respiratory virus, when all countries and all responding organizations will themselves be struck, most low-resource populations will fail to receive adequate medical supplies, and their health services will be more stressed than they are today. However, these populations could, by employing well-planned, evidence-based measures, reduce disease transmission and care for those not severely ill, without substantial outside resources. Authoritative guidance must be developed, and support provided for country adaptation, planning for rapid roll-out, and testing of these plans.
Emanuel Bizimungu a community health worker in Rwanda, examines a girl, Sandrine Uwase, two and a half, who he treated for malaria. She recovered after several days. They are in Nyagakande village, near the Ruhunda health center in eastern Rwanda.Photo credit: Todd Shapera
Malaria is a complex disease – how it’s transmitted and where, who becomes sick, the numerous efforts to control and combat it and, yet, after centuries we still haven’t managed to eradicate it.
During the past five years, the global partnership to fight malaria has witnessed some success including a 29% reduction in malaria mortality and a 75% increase in use of insecticide-treated nets (ITNs). Despite these successes, the global burden of disease still sits heavily at 212 million new cases and 429,000 deaths in 2015 – the majority of which are in sub-Saharan Africa. Nearly half the world’s population is at risk of contracting malaria with 70% of malaria deaths occurring in children less than five years of age, who are particularly susceptible to the disease (WHO, 2016).
Malaria in pregnant women contributes to several negative outcomes including miscarriage, premature birth, labor complications, low birth-weight babies, anemia, and maternal and newborn death. In Sierra Leone, malaria in pregnancy and child mortality rates are especially high: the disease contributes to nearly 40 percent of deaths of children under the age of five. While there is a clear understanding of the interventions needed throughout the country, at training institutions and health facilities, there is a gap in the skillset and knowledge of how to implement effective malaria diagnosis and treatment.
We have made great strides in ridding the world of malaria, but there’s still work to be done—and the time is right to finish the job. New technology is helping communities around the world prevent, diagnose, and treat malaria in new and innovative ways. In Mozambique, the Malaria Consortium has developed a phone app that helps community health workers diagnose and treat malaria. In Zanzibar, Tanzania, local health facilities can use text messages to report malaria cases. And Mali uses a system called OSPSANTE, developed by the MSH-led, USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project, to track the availability and use of pharmaceuticals in the fight against malaria.
A health worker fills in a child’s immunization booklet during an immunization clinic at Phebe Hospital in central Bong County, Liberia. (Cindy Shiner/MSH)
After losing both her parents to Ebola, Liberian nurse Salome Karwah recovered from the virus herself. Protected by her new immunity, she returned to work to care for countless other victims. Time Magazine recognized her as a 2014 Person of the Year for her compassion and tirelessness. In February of this year, Nurse Karwah was rushed to the hospital with seizures following a cesarean delivery of her son. Her garish symptoms frightened the hospital staff that knew she had survived Ebola. They would not touch her. They let her die without treatment.
That is what stigma looks like.
Even after being declared free of Ebola, many survivors found themselves alone, as the International Federation of Red Cross and Red Crescent Societies reported. A chilling new normal replaced the terror and death in the isolation wards: rejection by family, friends, and neighbors, even by their places of worship. Employers fired them. Customers abandoned them. There was no carrying on with the lives they knew before Ebola. There was only more loss.
Pregnancy and childbirth are times of unparalleled change and hope for the future. But for many women, the arrival of a new baby is also a challenging time — one that can be overshadowed by depression.
The World Health Organization (WHO) estimates that more than 1 in 10 women suffer from postnatal depression, a devastating statistic that too often receives no attention. In African countries and contexts where women are exposed to poverty, persistent poor health, migration, conflict, gender-based violence, extreme stress, and unwanted pregnancy, the estimates are even higher, with up to 25 percent of women experiencing clinical depression after childbirth.
The effects of depression on social and economic wellbeing and on families are enormous, as the risks and consequences go well beyond an individual woman. Depression in pregnancy is linked to preterm birth and low birth weight, which increases the risk of complications such as undernutrition and heart disease. Women who suffer from postpartum depression are often stigmatized and less likely to benefit from postnatal and preventive health care for themselves and their children. Partners and families may have difficulty understanding why a new mother who should be happy at the birth of a healthy baby is depressed.
A community health volunteer explains the use of pregnancy tests to a client.
This World Health Worker Week (April 2-8), we honor the health workers around the world who work every day to improve health in their communities. This photo essay illustrates the important role that community health volunteers play in strengthening Madagascar's health system.
Community health volunteers (CHVs) play a critical role in providing primary health care services in Madagascar, especially for rural populations who live far from health facilities. In many areas of the country, CHVs often collectively offer services to more people than health centers do. CHVs are important extensions of the Malagasy health system, particularly for women and children.
As of 2016, the USAID Mikolo Project, led by MSH and funded by USAID, supported nearly 7,000 CHVs across 506 communes. They fill a critical gap in human resources for health in support of the Ministry of Public Health’s efforts to improve health care in the country.
The Global Health Security Agenda (GHSA), launched in 2014 by the U.S. and other countries, is dedicated to strengthening the capacities of countries to prevent, detect, and respond to infectious disease threats. The GHSA aims to protect the poorest countries and most neglected populations and works to ensure health security benefits. The GHSA assumes a multi-sectoral, holistic approach to health security and preventing infectious disease.
It will take time for the GHSA to completely achieve its goals. To do so, the global community must make a sustained effort to prevent, detect, and respond to future infectious disease threats and outbreaks, no matter where they occur. We, the global community, can do this in several ways.
First, it is important to maintain the international momentum and engagement around health security as a priority focus area. The GHSA was constructed to encourage leadership from membership countries. Countries such as Finland, Indonesia, Kenya, the United Kingdom, The Netherlands, and others have demonstrated strong leadership and strategic vision. This drive continues under the Chair of South Korea for the 2017 term.
Tuberculosis (TB) kills more people each year than any other infectious disease. It severely strains health systems and local, regional, and national economies. And, like many health crises, the disease disproportionately affects vulnerable populations. Many families incur catastrophic costs, aggravating poverty in communities.
This World TB Day, we reflect on the progress we've made and the challenges we still face in the fight to end TB. The key moving forward is to work together to ensure we don't leave anyone behind.
VIDEO: Working to End TB in Uganda
“We have the medicines that actually cure tuberculosis,” said Raymond Byaruhanga, project director for the USAID-funded, MSH-led TRACK TB project in Uganda. “So the question is why? Why [do we still see] TB today, and why isn’t it being treated?”
In 2015, TB caused 1.8 million deaths around the world, and another 10 million people fell ill from the disease, according to the World Health Organization (WHO). Women and children are particularly vulnerable. TB causes between 6 and 15 percent of all maternal deaths, and childhood TB is too often not detected, diagnosed, or treated.
Throughout global societies, women’s roles place them at the epicenter of risk from disease outbreaks and epidemics. This is true everywhere, but especially so in poor countries with health systems unprepared to meet the ever-surging demands of a public health emergency.
The interaction between gender roles, disease transmission, and socio-economic stability reach a perilous tipping point in epidemics; failing to address that interaction will result in deficient strategies for outbreak prevention and control, and in massive setbacks for women’s health, and development gains. Unless global health security measures help us understand the impact of emerging diseases on women, nations and the world will remain vulnerable to pandemics.