Charting the Course for Integrated Diarrhea Control in Malawi: A Way Forward for Policy Change

In order for Malawi to achieve Millennium Development Goal 4, to reduce child mortality by two-thirds before 2015, this report addresses the issue of diarrheal disease by examining the current policy environment in Malawi. By using the UNICEF/WHO seven-point plan for diarrheal disease control as the guiding document, the group identified current strengths and weaknesses, and then collaborated to agree on a set of recommended steps to help re-prioritize diarrheal disease control. The recommendations emerging from this report describe a detailed path for a way forward towards ownership, accountability, and sustainability for diarrhea control efforts in Malawi

Community-based financing of family planning in developing countries: A systematic review

In this systematic review, we gather evidence on community financing schemes and insurance programs for family planning in developing countries, and we assess the impact of these programs on primary outcomes related to contraceptive use. To identify and evaluate the research findings, we adopt a four‐stage review process that employs a weight‐of‐evidence and risk‐of‐bias analytic approach. Out of 19,138 references that were identified, only four studies were included in our final analysis, and only one study was determined to be of high quality. In the four studies, the evidence on the impact of community‐based financing on family planning and fertility outcomes is inconclusive. These limited and mixed findings suggest that either: 1) more high‐quality evidence on community‐based financing for family planning is needed before any conclusions can be made; or 2) community‐based financing for family planning may, in fact, have little or no effect on family planning outcomes.Funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization, is gratefully acknowledged. The authors thank members of the WHO technical working group on financing family planning for their valuable comments. In addition, the authors thank Iqbal Shah for his support throughout the review process and for his technical guidance on this manuscript. (UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); World Health Organization)Published versio

Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi.

OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS: In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100 000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100 000 live births). CONCLUSION: Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa

Sustainability check: a monitoring tool for the sustainability of rural water supplies

The UNICEF/WHO Joint Monitoring Programme (JMP) notes that 42% of the population of Mozambique has access to safe water (UNICEF/WHO 2008). To accelerate access to water supply in the rural areas, UNICEF is currently implementing a programme termed the One Million Initiative with allocated funds from the Government of the Netherlands. To assess the sustainability of this programme, UNICEF, in collaboration with government and non government partners, developed a programme management tool termed a Sustainability Check. The check involves a selected number of control and treatment communities which were selected based on a random statistical basis. A total of 52 water supplies were assessed and then the sustainability in each community was tested using a multivariate composite model tool. The results indicate low levels of sustainability of 50-75%. Based on the assessment, it is recommended to focus on spare parts provision and increased community capacity to manage financial contributions for operation and maintenance of the water points

Bringing HIV Prevention to Scale: An Urgent Global Priority

Illustrates the need for a scaled-up HIV prevention response in order to stem the epidemic, describes impediments to HIV prevention efforts and examples of successful initiatives, and includes recommendations for governments, health agencies, and donors

It's No Joke: The State of the World's Toilets 2015

This report looks the toilet conditions around the world and why there it is imperative to improve them. Among the topics discusses are the worst places in the world to find a toilet, longest queues for toilets, most people defecating in the open, toilet problems in developed countries, most improved access to sanitation, and most behind on access to sanitation

Mass Azithromycin Distribution and Community Microbiome: A Cluster-Randomized Trial.

BackgroundMass distributions of oral azithromycin have long been used to eliminate trachoma, and they are now being proposed to reduce childhood mortality. The observed benefit appears to be augmented with each additional treatment, suggesting a possible community-level effect. Here, we assess whether 2 biannual mass treatments of preschool children affect the community's gut microbiome at 6 months after the last distribution.MethodsIn this cluster-randomized controlled trial, children aged 1-60 months in the Dossa region of Niger were randomized at the village level to receive a single dose of azithromycin or placebo every 6 months. Fecal samples were collected 6 months after the second treatment for metagenomic deep sequencing. The prespecified primary outcome was the Euclidean PERMANOVA of the gut microbiome, or effectively the distance between the genus-level centroid at the community level, with the secondary outcome being the Simpson's α diversity.ResultsIn the azithromycin arm, the gut microbial structures were significantly different than in the placebo arm (Euclidean PERMANOVA, P < .001). Further, the diversity of the gut microbiome in the azithromycin arm was significantly lower than in the placebo arm (inverse Simpson's index, P = .005).ConclusionsTwo mass azithromycin administrations, 6 months apart, in preschool children led to long-term alterations of the gut microbiome structure and community diversity. Here, long-term microbial alterations in the community did not imply disease but were associated with an improvement in childhood mortality.Clinical trials registrationNCT02048007

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal

Background: In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding prac- tices of pre-school children and their associated factors. Methods: A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured ques- tionnaire was administered to 145 mothers. Descriptive analyses were con- ducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers’ perception of their current feeding practices. Results: We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01–0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices. Conclusions: Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-eco- nomic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures