Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case study

Background After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by confl ict, widespread insurgency, and an infl ow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors infl uencing maternal and child health in Afghanistan. Methods We undertook a comprehensive, systematic assessment of reproductive, maternal, newborn, and child health in Afghanistan over the last decade. Given the paucity of high-quality data before 2001, we relied mainly on 11 nationally representative surveys conducted between 2003 and 2013. We estimated national and subnational time trends for key reproductive, maternal, and child health indicators, and used linear regression methods to determine predictors of change in health-care service use. All analyses were weighted for sampling and design eff ects. Additional information was collated and analysed about health system performance from third party surveys and about human resources from the Afghan Ministry of Public Health. Findings Between 2003 and 2015, Afghanistan experienced a 29% decline in mortality of children younger than 5 years. Although defi nite reductions in maternal mortality remain uncertain, concurrent improvements in essential maternal health interventions suggest parallel survival gains in mothers. In a little over a decade (2003–13 inclusive), coverage of several maternal care interventions increased—eg, for antenatal care (16% to 53%), skilled birth attendance (14% to 46%), and births in a health facility (13% to 39%). Childhood vaccination coverage rates for the basic vaccines from the Expanded Programme of Immunisation (eg, BCG, measles, diphtheria-tetanus-pertussis, and three doses of polio) doubled over this period (about 40% to about 80%). Between 2005 and 2013, the number of deployed facility and community-based health-care professionals also increased, including for nurses (738 to 5766), midwives (211 to 3333), general physicians (403 to 5990), and community health workers (2682 to 28 837). Multivariable analysis of factors contributing to overall changes in skilled birth attendance and facility births suggests independent contributions of maternal literacy, deployment of community midwives, and proximity to a facility. Interpretation Despite confl ict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, aff ecting sustainability. To maintain and further accelerate health and development gains, future strategies in Afghanistan will need to focus on investments in improving social determinants of health and targeted cost-eff ective interventions to address major causes of maternal and newborn mortality

Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case study.

BACKGROUND: After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by conflict, widespread insurgency, and an inflow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors influencing maternal and child health in Afghanistan. METHODS: We undertook a comprehensive, systematic assessment of reproductive, maternal, newborn, and child health in Afghanistan over the last decade. Given the paucity of high-quality data before 2001, we relied mainly on 11 nationally representative surveys conducted between 2003 and 2013. We estimated national and subnational time trends for key reproductive, maternal, and child health indicators, and used linear regression methods to determine predictors of change in health-care service use. All analyses were weighted for sampling and design effects. Additional information was collated and analysed about health system performance from third party surveys and about human resources from the Afghan Ministry of Public Health. FINDINGS: Between 2003 and 2015, Afghanistan experienced a 29% decline in mortality of children younger than 5 years. Although definite reductions in maternal mortality remain uncertain, concurrent improvements in essential maternal health interventions suggest parallel survival gains in mothers. In a little over a decade (2003-13 inclusive), coverage of several maternal care interventions increased-eg, for antenatal care (16% to 53%), skilled birth attendance (14% to 46%), and births in a health facility (13% to 39%). Childhood vaccination coverage rates for the basic vaccines from the Expanded Programme of Immunisation (eg, BCG, measles, diphtheria-tetanus-pertussis, and three doses of polio) doubled over this period (about 40% to about 80%). Between 2005 and 2013, the number of deployed facility and community-based health-care professionals also increased, including for nurses (738 to 5766), midwives (211 to 3333), general physicians (403 to 5990), and community health workers (2682 to 28 837). Multivariable analysis of factors contributing to overall changes in skilled birth attendance and facility births suggests independent contributions of maternal literacy, deployment of community midwives, and proximity to a facility. INTERPRETATION: Despite conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, affecting sustainability. To maintain and further accelerate health and development gains, future strategies in Afghanistan will need to focus on investments in improving social determinants of health and targeted cost-effective interventions to address major causes of maternal and newborn mortality. FUNDING: US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival grant from the Bill & Melinda Gates Foundation, and from the Government of Canada, Foreign Affairs, Trade and Development Canada. Additional direct and in-kind support was received from the UNICEF Country Office Afghanistan, the Centre for Global Child Health, the Hospital for Sick Children, Toronto, the Aga Khan University, and Mother and Child Care Trust (Pakistan)

Annual Incidence of Snake Bite in Rural Bangladesh

Snake bite is one of the major causes of morbidity and mortality in many rural tropical areas. As a neglected public health problem, estimate of the risk is largely unknown. However, the associated personal and economic impact of snake bite is substantial across developing countries. This national survey investigated the risk and consequences of snake bite among the rural Bangladeshi population. We surveyed 18857 individuals from 24 out of 64 districts in Bangladesh where 98 snake bites including one death were reported. The estimated incidence density of snake bite is 623.4/ 100,000 person years (95% CI: 513.4–789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) received snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of them went directly to either a medical doctor or a hospital. The observed rate of snake bite in rural Bangladesh is substantially higher than anticipated. This coupled with poor access to health services led to an increase in related morbidity and mortality. An improvement in public health actions is therefore warranted

Molecular Characterization of Selected Local and Exotic Cattle Using RAPD Marker

In order to develop specific genetic markers and determine the genetic diversity of Bangladeshi native cattle (Pabna, Red Chittagong) and exotic breeds (Sahiwal), randomly amplified polymorphic DNA (RAPD) analysis was performed using 12 primers. Genomic DNA was extracted from 20 cattle (local and exotic) blood samples and extracted DNA was observed by gel electrophoresis. Among the random primers three were matched and found to be polymorphic. Genetic relations between cattle’s were determined by RAPD polymorphisms from a total of 66.67%. Statistical analysis of the data, estimating the genetic distances between cattle and sketching the cluster trees were estimated by using MEGA 5.05 software. Comparatively highest genetic distance (0.834) was found between RCC-82 and SL-623. The lowest genetic distance (0.031) was observed between M-1222 and M-5730. The genetic diversity of Red Chittagong and Sahiwal cattle was relatively higher for a prescribed breed. Adequate diversity in performance and adaptability can be exploited from the study results for actual improvement accruing to conservation and development of indigenous cattle resources

Formulation of Ketorolac Tromethamine for Controlled Release in Gastrointestinal and Colonic Delivery System

A suitable matrix system of ketorolac tromethamine (KTR) formulation has been developed with the aim of increasing the contact time, achieving controlled release, reducing the frequency of administration, improving patient compliance. In this concern an enteric-coated KTR matrix tablet intended for specific delivery of drugs to the colon by combining the use of a time dependent core with a pH-sensitive film coating. Eudragit L100, with a threshold pH 7, was selected as coating material.  New formulation is proved to be noble as to KTR delivery through both gastrointestinal and colonic system. New formulation is considered to reduce gastrointestinal side effects and achieve high local drug concentration at the afflicted site in the gastro-intestine and colon.

Community development and its impact on health: South Asian experience

Most South Asian governments have concentrated on emulating a Western style of healthcare service, with the result that an elite few are overmedicalised whereas the majority are neglected. However, community participation in the development of local health services could provide a solutio

doi:10.1093/heapol/czi004 Health Policy and Planning 20(1), HEALTH POLICY AND PLANNING; 20(1): 35–40

Objective: To compare levels of childhood malnutrition in areas where the Bangladesh Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the purpose of evaluating whether the project had achieved its objective of reducing the prevalence of underweight among children,24 months. Methods: The study involved an ex-post cross-sectional survey in six thanas (a locality with a population of approximately 200 000–450 000 people) in Bangladesh. Participants were 6820 households (4554 in the project areas and 2266 in the non-project areas) including 7183 children aged 6–59 months selected using a two-stage stratified cluster sampling frame. Main outcome measures were moderate and severe underweight, wasting and stunting reported using z scores, and indicators of mothers ’ reported nutritional knowledge and practice. Results: 2388 children aged 6–23 months and 6815 children aged 6–59 months had clean anthropometric data. No significant difference was found between the socio-economic variables of households in the project and non-project areas. No significant difference was found in the prevalence of either severe or moderate underweight (weight-for-age) in children aged 6–23 months in the project and non-project areas: 183 (11.4%, 95 % confidence interval 9.9–13.2%) children in project areas and 9

Maternal and child health: is South Asia ready for change?

South Asia still has a long way to go to meet the United Nations' millennium development goals for maternal and child mortalit