Double Trouble: TB & HIV

“We needed to develop "delivery platforms" to treat tuberculosis and address the poverty that both puts people at risk for the disease and prevents them from being cured of it. With this airborne disease, good delivery systems prevent transmission--and that's what public health is supposed to be all about.”   -Paul Farmer

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This year’s international observance of World TB Day, on March 24th, served as a consistent reminder that tuberculosis (TB) is far from being an antiquated, irrelevant disease. In places such as South Africa TB remains one of the main killers of youth, with almost 80% of country's young adults already infected with TB and approximately 330,000 people infected with both HIV and TB last year alone. The HIV infection lowers the ability of the immune system to fight off disease, making those whom are HIV positive highly susceptible to TB infection and disease. The infection can then change from a dormant/inactive phase to the active disease during these times of lowered immune ability, labeling TB as an opportunistic disease. HIV positive patients are 30 times more likely to develop the TB disease than HIV negative patients; in fact, ¼ of all TB related deaths occur in people living with HIV. Approximately 13% of the worldwide cases of TB in 2012 were also HIV positive.

Pediatric TB and HIV have many of the same symptoms, including persistent cough, fever, and weight loss, all factors that make a positive TB diagnosis more complicated. Worldwide, children account for approximately 10% of all new global HIV infections. Several studies have correlated the dramatic impact that joint TB and HIV infection can have on children. A study produced from Ethiopia found that children who were jointly infected were approximately 6 times more likely to die, while another from Côte d’Ivoire found that children were 3.6 times more at risk. The main intervention for HIV positive TB patients is still the provision of antiretroviral treatment, and continual screening. World Health Organization (WHO) suggests the same treatment protocol for both HIV positive and negative individuals. There are ten vaccines and several others in development for the prevention of TB. Although TB remains a global health crisis, the annual rate of reduction is approximately 2%.

An example of an organization working to significantly treat and prevent TB is Partners in Health (PIH). With locations in Haiti, Lesotho, Peru, etc. and active representatives such as Dr. Paul Farmer and Dr. Mercedes Becerra, Partners in Health focuses around the structural barriers to the diagnosis and cure of tuberculosis and other diseases afflicting the poor. In children, TB disease can cause severe and quick health deterioration, thus, one of the most important aspects of addressing the issue of pediatric tuberculosis is the TB Contact Investigation strategy that involves a screening process of all a patient’s close contacts and treatment for active TB disease or dormant TB infection. Contact investigation greatly increases the chances that child contacts that are sick will be recognized as TB cases and treated promptly. Patients who suffer from both HIV and TB are treated in fully integrated clinics such as the one in PIH Lesotho, where the co-infection rate for HIV and multidrug resistant TB is almost 70%. HIV and TB are major global health and public health threats; understanding the way these diseases interact with one another on local and global levels is essential for the eradication of TB.

Venturini, E., Turkova, A., Chiappini, E., Galli, L., de Martino, M., & Thorne, C. (2014). Tuberculosis and HIV co-infection in children. BMC Infectious Diseases, 14 Suppl 1(Suppl 1), S5-S5. doi:10.1186/1471-2334-14-S1-S5


Tuberculosis: The Not So Ancient Disease

If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera and the like. One in seven of all human beings dies from tuberculosis.” –Robert Koch, 1882

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Consumption, the white plague, the white death, the wasting disease and phthisis pulmonaris are some of the many names for one of the deadliest diseases from ancient times, tuberculosis (TB). The industrial revolution of the 18th and 20th centuries led to a significant increase in the population, unsanitary living conditions, and overpopulation in most industrial booming towns and cities. This quick urban growth led to a heightened exposure to the disease, making it epidemic in much of Europe, North and South America, and African and Asia.  At its height TB reached a prevalence of more than 900 deaths per 100,000 in the 18th century, killing more people in the last 200 years than any other disease. Its high prevalence rates (up to 100% in certain populations) gave it a spot light amongst some of the deadliest diseases in history such as the bubonic plague, cholera, measles, smallpox, and typhus. Despite its chronic condition in adults, in children and infants the disease would often manifest in acute forms killing them within days or weeks of infection.

In 1865 a French military physician, Jean-Antoine Villemin, successfully managed to inoculate rabbits with TB, thus implying that TB was contagious. At that moment in time contagion was viewed as a radical ancient notion that simply could not exist in civilized societies. Accepting the existence of such notions would instill fear in the masses and prejudice against those who had or were suspected of having the disease.  Several years later on March 24, 1882 scientist Robert Koch introduced his findings on the causes of tuberculosis to the scientific community, revolutionizing medical science. By culturing the Mycobacterium Tuberculosis pathogen from diseased tissue and staining it he had managed to isolate the one disease that was killing more people than any other at the time. Not only did he isolate it, but also succeeded in culturing, and inoculating laboratory animals, essentially, reproducing the disease. Koch successfully established a relation of cause and effect between the bacillus and the disease, setting in motion an etiological revolution.  However, it would be another 64 years before soil biologist Selman Waksman developed streptomycin, the first effective antibiotic against Tuberculosis.

“After the presentation, Koch’s audience sat in stunned silence, needing some time to allow the realization to sink in that the mystery of humankind’s deadliest disease had just been unraveled.” - Historical Perspectives on the Etiology of Tuberculosis, David Barnes Ph.D.

With more than one hundred and thirty years of research since then, TB has been tested, studied, and documented.  Once known as the ‘deadliest disease’ scientists concur that even the most hopeless cases of TB are treatable and curable for adults. Yet, TB remains an opportunistic disease in people with HIV and a leading cause of death in many places around the world. In adults, once contracted, the disease can often lay dormant for years where it is subsequently exposed to children, who are far more susceptible to the disease. Often the onset of symptoms is hard to detect before it’s too late, while the tests used for diagnosis don’t produce accurate results. TB is diagnosed using a sputum test that analysis mucus from the lungs.  However, children often don’t produce enough mucus for an adequate sample. A missed diagnosis can be deadly, since the disease can spread from the lungs into the brain and bone marrow of a child, killing them before the first physician visit.

A timeless disease, TB continues to plague a significant percentage of humankind. According to the World Health Organization, tuberculosis is second only to HIV/AIDS as the greatest killer from a single infectious agent.  Despite this knowledge many people still do not believe that it can affect them, and that the time of TB has long since passed. Common misconceptions about TB include the differentiation between the infection and the disease, it’s current effect on a global scale, and who can contract the disease. TB infection and TB disease are significantly different. The world is broken up into three separate categories: those who do not have TB, those who are infected with TB, and those whose infection has developed into the TB disease. According to the CDC a misconception about TB is that it is no longer a major public health problem. In fact, of the 7 billion persons in the world, 2.3 billion are already infected with TB, and about 9 million develop TB disease each year. Furthermore, TB causes about 1.4–2 million deaths annually. In 2008, the Charlotte County Health Department in Florida created an info flyer with some of the most common misconceptions of disease. It debunks the stigmatization against individuals associated with poor hygiene and low economic status as being the sole contractants of TB, some patients actually have no identified risk factors and should not be ruled out because of this preconceived notion of who a TB patient is.

 

References:

Johnston W.D., in: Kiple K.F. (Ed.), Cambridge World History of Human Disease, Cambridge University Press, Cambridge, 1993, pp. 1059–1068.

Barnes, D. S. 2000. Historical perspectives on the etiology of tuberculosis. Microbes Infect. 2: 431-440.


Impacting Local Communities through Clean Water

“Basic human rights cannot thrive in places where human beings do not have access to enough food, or clean water, or the medicine they need to survive.”
- U.S. National Security Strategy

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As we make our way well into the second decade of the 21st century, with our booming technology and our incredible knowledge of medicine, you would assume clean water for all was just a given fact. The reality is clean water is still very much a commodity that many families around the world cannot afford but are in desperate need of.  Lack of access to clean water kills children at a rate equivalent to a jumbo jet crashing every four hours. 1 in 9 (780 million) people lack access to an improve water source. These figures are astonishing, and the need for innovative water solutions cannot be any more imperative.

Applicants to the Children’s Prize in 2013 understood the need for solutions that would bring clean water to communities and combat diseases such as diarrhea, cholera, and typhoid that contribute to the deaths of 1,800 deaths a day in children under five are linked to water, sanitation and hygiene worldwide. Some of the most creative and inspiring solutions to increase and create access to clean water included wells, water filters, point-of-use systems, and the development of new technologies. Today we would like to present a few of our 2013 applicants who are making considerable progress within the forefront of solutions for clean water.

Tanks/ Boreholes/ Wells:

RISE International
Rise International’s primary focus is to build schools and provide education for children living across Angola.  However, many of these children live without access to clean water- which is why RISE International is drilling wells at those same schools, and within the same communities. RISE has built 13 wells since 2009 and given 98,000 children the opportunity to attend school.
 
Shoeman Water Projects
Shoeman water projects works in Kenya to provide clean water and improved sanitation sources.  Shoeman projects drills wells in  needy communities while simultaneously collecting shoes that can be sold in Kenya to provide funding for Shoeman projects.

Eleos Project
The Eleos Project works in Kenya where they work to treat unsanitary drinking water at the household and community level. Eleos repairs broken hand pumps and existing wells, as well as drilling and constructing new wells in four target areas around Kenya.

Sanitation:

Green Sanitation Foundation
Construction of Biogas, and sewage solutions (pipe replacement).
Green Sanitation Foundations creates biological toilets that turn human waste into safe and non-toxic water. Past projects have included the instillation of both household and community toilets.  Not only does this technology curb open defecation practices - but it is also contributing to the conservation of precious amounts of water.

Sanitation Creations
Sanitations Creations has designed an innovative toilet for use where access to a traditional toilet is unavailable.  Not only is the toilet is waterless and odorless but it kills bacteria and pathogens using plastic bags that treat the waste, requiring no electricity, water source, pump or pipe. The toilet has the capacity to largely impact those living in areas without sanitation services .

Point-of-Use System:

Morgan Smart Development Foundation (MSDF)
Morgan Smart Development Foundation works out of Nigeria working to empower women and children living in rural areas. In the past the organization has brought potable water, toilets, and wells to communities that would otherwise have little to no access to improved sanitation and water facilities.

W.A.S.H.

World Vision, Inc.
World Vision is one of the largest provides of clean water worldwide.  They have installed 8,717 new wells since 2011, while simultaneously building 224,051 sanitation facilities.  The impact is huge, allowing 2.35 million people to gain access to clean water globally.


The Dirty Side of Water

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WATER: We drink it. We bathe in it. We are comprised of it.

Water remains one of the most important resources for our health. When communities are constantly faced with a lack of access to clean and safe water supplies they suffer from disease, and infants within these communities are especially susceptible to diarrheal diseases. Consumption of contaminated water, lack of private excreta disposal, and the presence of excreta in the yard were associated with the largest increases in risk of disease in infants. Unclean water and unsanitary bottles used to give infants formula can often cause extreme illness, and is one of the greatest contributing factors in the deaths of 1.3 million children who die from diarrhea each year.  The largest correlation between diarrheal rates in infants and sanitation is also intrinsically linked to whether or not an infant is exclusively breasted, bottle fed, or a mix of both. The contamination of infant food is greatest where sanitation is poor, and the protective factors of breastfeeding are greatest in crowded and highly contaminated societies. In fact, exclusively breastfed infants within areas of poor sanitation show the same rate of diarrheal prevalence as those living in good sanitation conditions.

Breastfeeding gives infants the nutrients and antibodies they need to develop healthily. However, 2 out of 3 infants around the world are not exclusively breastfed. In many countries around the world there is a lack of knowledge concerning the benefits of breastfeeding, and alternatively there is also a lack of knowledge regarding the negative risks associated with bottle-feeding.  The contamination of water sources used for mixing formula or giving alternate foods supplements in lieu of breastfeeding is especially harmful for children with undeveloped immune responses.  Both exclusive breastfeeding practices for a minimum of six months, and increased sanitation will help to decrease the worldwide prevalence of diarrhea. Integrating clean water with other lifesaving tools is at the heart of our efforts to save children's lives from diseases that are all too common in vulnerable communities and that compromise the top two threats to children worldwide, diarrhea and pneumonia.

An example of such an initiative is a pilot project led by PATH and the government of Cambodia. The project concentrates it efforts within Kampong Thom Province and focuses on equipping health workers to guide families within the village on a variety of preventive strategies geared towards both diseases, safe water and sanitation at home, exclusive breastfeeding, etc. Treatment options include health worker training, urgent rehydration, zinc to treat diarrhea, and antibiotics for pneumonia. The program targets advocacy at a national level to strengthen the policy environment and ensure effective interventions and reliable supplies are available in public and private health sectors, as well as increase the awareness of the burden of both diseases.

To learn more about PATH visit their Website, Facebook, and Twitter!

 

References:

VanDerslice, J., Popkin, B., & Briscoe, J. (1994). Drinking-water quality, sanitation, and breast-feeding: Their interactive effects on infant health. Bulletin of the World Health Organization, 72(4), 589-601.

Butz, W. P., Habicht, J. P., & DaVanzo, J. (1984). Environmental factors in the relationship between breastfeeding and infant mortality: The role of sanitation and water in malaysia. American Journal of Epidemiology, 119(4), 516-525.


Water Day 2014: Delivering Safe and Clean Water

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Did you know... that 70% of the earth’s surface is covered by water?

Did you know... that less than 3% is fresh water?

Did you know… that only .08% is water suitable for drinking?

Every day, nearly 1 billion people go without clean water.  The first Water Day was recognized on March 22nd, 1993 after recommendations were made to host an international day celebrating freshwater. As a result, each year Water Day celebrates an essential aspect of freshwater and focuses attention on its importance while advocating for the sustainable management of freshwater resources. In 2014, the UN is bringing its attention to the water-energy nexus, particularly addressing inequities, especially for the 'bottom billion' who live in slums and impoverished rural areas and survive without access to safe drinking water, adequate sanitation, sufficient food and energy services.

As the global water crisis continues, solutions for delivering safe and clean water to the world’s growing population has become an increasingly pressing concern. Current water cleaning technologies include chlorine water filters, carbon filters, UV disinfection, traditional water boiling, etc. However, these solutions are often not practical enough for the parts of the world where they are most needed. These solutions frequently require additional technologies, resources, and electricity to power water disinfection systems for boiling and UV disinfection, while chlorine filters can become very expensive. Currently there is no one significantly robust technology that is applicable in a multitude of settings.

On Water Day, we’d like to highlight a recent innovative and creative solution to water purification. The Pine Tree Water filtration may sound like something of the future, but a group out of MIT was inspired to produce a filtration process based on the way plant xylem conducts fluid in plants.  Xylem filters were made by removing the bark off pine tree branches and inserting the xylem tissue into a tube. The filters were tested for the removal of both pigment dye and bacteria from water.  The recent study was preliminary, and the first of its kind, but effectively showed that the xylem could move fluids while simultaneously removing bacteria naturally. While further research and development is needed the potential to leverage this type of filtration is enormous.

What other innovative and creative water solutions can you share?


Simple Solutions: Kangaroo Mother Care

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The first month of life is exceedingly important for the survival of infants. Almost 4 million newborns worldwide die in the first month of life, accounting for 41% of all under-five deaths globally. Many premature or low birth weight babies cannot maintain homeostasis and their core body temperature. In low resource settings incubators are often costly or not available making the chances of survival past one month very slim. Many of these deaths can be prevented with simple solutions such as Kangaroo Mother Care (KMC), which is the skin-to-skin contact between mother and child to ensure the warmth and well being of the newborn.

Research in the medical field indicates that there are a multitude of benefits from the implementation of kangaroo care. Besides regulating an infant’s core temperature, it has been shown that skin-to-skin:

  • Synchronizes cortisol levels so that a mother and infant are calm and alert together.
  • Increases oxytocin and reduces stress hormones in the infants.
  • Reduces infant perception, response and recovery from procedural pain associated with punctures, injections, and other minor procedures when compared to pharmaceutical or sucrose pain relief.
  • Allows longer and calmer rest periods for infants more in tune with their sleep wake cycle than a traditional incubator, thus increasing healthy brain development.

Violet Manjanja, a scholar in KMC and lecturer at Kamuzu College of Nursing (KCN) said, “the parent's heartbeat was critical in stimulating the baby's because ‘low birth weight babies run a risk of skipping heartbeats.’” KMC places the infant in a prone position on the parent’s chest with extremities flexed into a “frog like” position; this provides a better external environment for motor skill development compared with infants who did not receive KMC.

Men can also partake in this style of caring, it is not limited solely to the mothers. In Malawi, husbands are urged to learn more about and participate in providing KMC for their low birth weight newborns. Since the infant needs additional body heat for 24 hours, it is not a task feasible for the mother alone. Manjanja added, “the father's body heat and heartbeat was equally as life saving as that of the mother.” Kangaroo Mother Care should be included in newborn management plans, given the additional benefits that increase the health and well-being of both the parent and infant. KMC is considered one of the best practices in newborn health care for low resource settings, and should be continuously promoted regardless of the setting.

References:
Bergh, A-M. 2011. "Kangaroo mother care to reduce morbidity and mortality in low-birth-weight infants." The WHO Reproductive Health Library; Geneva: World Health Organization. Accessed December 21, 2011 at http:// apps.who.int/rhl/newborn/cd002771_bergham_com/ en/index. html.
Modi, N., & Glover, V. (1998). Non-pharmacological reduction of hypercortisolaemia in preterm infants. Infant Behavior and Development, 21, 86-86. doi:10.1016/S0163-6383(98)91301-7
Ludington-Hoe, S. M. (2013). Kangaroo care as a neonatal therapy. Newborn and Infant Nursing Reviews, 13(2), 73. doi:10.1053/j.nainr.2013.03.004


The Benefits of Breastfeeding

While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby.  ~Amy Spangler @babygooroo

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A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time before his or her first birthday. The first day of life is the most vital for infants; the first minutes, the first hour, and the pivotal first day. Within the first few days of birth the mother begins to produce colostrum, a highly nutritious substance full of antibodies and immune system boosting cells. Colostrum helps an infant’s intestine to mature and fights against infections and bacteria, while breastfeeding helps to prevent both hypoglycemia (low blood sugar) and low body temperature in newborns. Even after colostrum production changes to mature milk within the first two weeks, it still retains disease-fighting properties containing both antibodies and pathogens that an infant is likely to be exposed to.

Breastfeeding increases resistance to diseases including respiratory tract infections, ear infections, bacterial meningitis, pneumonia, urinary tract infections, and infant diarrhea. Breastfeeding also protects against chronic diseases. The World Health Organization recommends that a mother should begin breastfeeding within the hour of giving birth. “The infant immune system matures during the first year, and is more mature at age two, but the immune system does not reach full maturity until the child is around six years old.” Breast milk has been found to contain 90 different oligosaccharides (special sugars) forming 900 different chemical structures that each block infection in different ways. This mix also varies from woman to woman and can include antibodies that protect the child against any pathogens the mother has been recently exposed to.

It’s estimated that exclusively breastfeeding could save 220,000 infants lives every year. 830,000 babies could be saved if women breastfed in the first hour of life, because an infant given breast milk within an hour of birth is up to three times more likely to survive than one breastfed a day later. Even with the scientific evidence behind the use of breast milk two of three babies worldwide are not exclusively breastfed. Why do so many women around the world not breastfeed their children? Save the Children points to three answers: cultural barriers that inhibit breastfeeding, a shortage of health care workers to teach proper breastfeeding skills, and marketing by manufactures that persuades new mothers to use formula instead of milk. In fact, the WHO even urges continued breastfeeding for mothers who are HIV Positive, because the benefits of breast milk are that crucial for infants.


Empowered Solutions: Mother Mentors

"Mentor Mothers taught me how to keep my baby free of HIV. Things may have turned out so differently if I did not have their help. It is now my privilege to help other mothers have HIV-negative babies." Emily, a 24-year-old mother of two in Kenya, living with HIV

 

Mother Mentors

A young woman enters a clinic in a developing country in hopes of hearing only good news of her anticipated child’s birth when she is presented with an unexpected fact, she is HIV positive. This result can have dire social and health consequences for both her and her future child, but in attempts to avoid the familial backlash and social stigmatization, she decides to keep this a secret. Sex is a taboo in many parts of the world making reproductive health, care during pregnancy (pre- and post- natal), and safe delivery mechanisms significantly more crucial for those who need it the most. Decreasing taboo and bringing behavior changes that fit into many different cultures is one of the most difficult aspects of increasing maternal health.

Maternal deaths around the world take approximately 800 women from their babies every day. 40 million women give birth at home without the help of a skilled birth attendant, midwife, or physician. And out of all the maternal death, 99% occur in developing countries. According to the World State of Mothers the first day of life is the most dangerous for both mothers and their babies. It becomes increasingly difficult throughout the first year when resources are scarce, accessibility to proper health care is limited or non-existent, and social norms cause women to lead a life of silence when it comes to sex. Solutions to such issues must be culturally sensitive in nature, and such solutions can be readily seen in the effects of the mother mentors model. Mother mentors pair women who have already had children with first time moms, providing knowledge while empowering both the mentor and mentee. Because the contact is woman to woman the effects of the cultural barriers and taboos are decreased. They can do everything from answer questions about healthcare and reproduction to schedule and attend prenatal appointments. Often they work with or alongside healthcare workers, and help bridge the gap between a mom and previously inaccessible healthcare system.

Various organizations and local communities around the world have already begun to implement this type of culturally sensitive outreach. One example is the Madres Tutelares (also known as Resource Mothers) located in Santo Domingo, Dominican Republic. Adapted by Physicians for Peace, the program was inspired by a Virginia based home visiting model. The women serve as leaders within their communities and as mentors to pregnant teenagers within the barrios. “Their work does not stop at prenatal care or infant development milestones. In fact, the Resource Mothers are equipped to discuss topics including the importance of receiving a sonogram and blood tests, attending pre-natal visits, breastfeeding, and HIV prevention.”

Another example is Mothers2Mothers (M2M), a program originating from South Africa providing care, education, and awareness for pregnant women. M2M pairs HIV positive women with expecting mothers to prevent mother to child transmission of HIV. M2M trains women and employs them back into localized communities thus providing vital health information to women that have the greatest need. “The women Mentor Mothers serve are more likely to take antiretroviral (ARV) drugs to prevent mother-to-child transmission of HIV and protect their health. Further, the infants of mothers in m2m’s programme are more likely to receive ARVs to protect them from HIV infection and be administered an early infant diagnosis test to determine their status than other infants born to HIV-positive mothers. These outcomes have been shown to reduce mother-to-child transmission of HIV and have a tangible, positive impact on maternal and child health.”

If you would like to support these models feel free to connect with the organizations!

Mothers2Mothers: Twitter, Facebook, Website

Madres Tutelares, Physicians for Peace: Twitter, Facebook, Website


International Women's Day

International Women's Day 2014 In 1910 Clara Zetkin, Leader of the Women's Office for the Social Democratic Party in Germany, presented the idea for an International Women's Day while attending the International Conference of Working Women in Copenhagen. 100 women from over 17 countries attended the conference that year, the result was the unanimous approval of the establishment of such a date. In 1911, the first International Women's Day was honored on March 19th in Austria, Denmark, Germany, and Switzerland. For the past century International Women's Day has flourished into a global day of recognition. On March 8th, developed and developing countries alike, will stand in solidarity to celebrate and commemorate women and their achievements worldwide.

The 5th Millennium Development Goal aims at improving maternal health and the multitude of other issues that are intrinsically linked to the well being of mothers including pre- and post- natal care, access to contraception, the use of skilled birth attendants, and decreased adolescent birthing rates. Notably, the most impoverished women across the globe are at the greatest risk for higher maternal mortality rates. A recent article entitled ‘Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women’ condenses the misconception in global health that “maternal health research tends to view poverty as simply a scarcity of material resources rather than recognizing these intersecting inequalities, or worse still focuses predominantly on the technical aspects of service delivery.” The authors - Zubia Mumtaz, Sarah Salway, Afshan Bhatti, and Lynn McIntyre -  analyzed the injustices of poverty in rural Pakistan and the effects it has on what they deem ultra poor women or those that comprise the Kammi caste.

The concerns for women in poverty and the detrimental effects the structure of poverty has on access to health services are concerns that parallel Dr. Zaidi’s plan in Rehri Goth. These concerns include extremely high illiteracy rates, poor sanitation and living conditions, and an overall inability to achieve a higher income level or equitable equality. The main source of income for men living within the Rehri Goth province continues to be provisions from fishing, while the majority of women earn no income at all. Dr. Zaidi’s intervention addresses the most marginalized population through the provision of antenatal care and counseling by identifying and then visiting the household of pregnant women every three months during pregnancy. She will also provide access to skilled delivery by providing services for women, including emergency obstetric care and transport to a government health facility. The intervention will deliver, community driven, newborn and infant care to ensure the relative health of infants, nutritional supplementation, and the promotion of immunizations for all children living in Rehri Goth.

On International Women’s Day, we encourage you to share the stories of inspirational women leaders working hard to improve maternal, infant and child health. Whose story has inspired you?

Dr. Anita Zaidi Rehri Goth


Dr. Zaidi: Inspired to Serve Pakistan

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 Serve Pakistan. Who would have thought that such a simplistic statement, said during a medical school graduation, would leave such a tremendous impact? With these words, His Highness the Aga Khan founder and Chancellor of Aga Khan University (AKU), was able to inspire the future work of the Dr. Anita Zaidi.  After graduating from medical school in 1988 Dr. Zaidi worked within the impoverished communities of northern Pakistan. It was in this setting that she solidified her interests in public health, maternal health, and child health.  Following her work in northern Pakistan, Dr. Zaidi completed a residency in pediatrics and fellowship in medical microbiology at Duke University Medical Center, training in pediatric infectious diseases at Boston Children's Hospital, and a Masters in Public Health from Harvard.

Despite her successful educational career in the United States, Dr. Zaidi was clear that she wanted to improve child health within Pakistan. Dr. Zaidi’s return to her native country represents only a minority of physicians who do this. For example, Pakistani medical institutions indicate that of the approximately 10,000 US trained medical practitioners only 300 have returned to practice medicine in Pakistan (3%). This is a reality for many developing countries and it’s a phenomenon known as brain drain. Basically, in the medical field, it is a transnational migration of healthcare workers usually from developing to developed countries for better educational and job opportunities, better pay, and increased quality of life. As these professionals leave their country of origin, their departure challenges the capacities of local healthcare systems to bring care and expertise to populations that often have the greatest need for healthcare.

We salute the work and contributions of native physicians such as Dr. Zaidi that seek to improve healthcare and the quality of life for impoverished and disadvantaged populations in their local communities. According to Dr. Zaidi “The single most important intervention to reduce neonatal mortality is provision of clean and skilled birth because most neonates, who die, do so in the first two days of life.” Her solutions shift the task for delivering babies from doctors to trained community midwives as a culturally conscious method to improve infant and child mortality while simultaneously empowering women. “As the majority of newborns in Pakistan, and many other south Asian and sub-Saharan African countries, are born at home and families of sick newborns cannot easily access hospitals, this type of work has the potential to influence local and global health policy for management of newborn sepsis and provide life-saving alternatives in resource-limited settings.”