OpenForum – a blog by the Health and Human Rights community

A joint 2009 publication by UNICEF and WHO, Diarrhoea: Why children are still dying and what can be done, revives action-oriented discussion about diarrheal disease — one of the world’s direst threats to babies and infants living in unsanitary, under-resourced environments. The report provides current data on the distribution and burden of the disease and on how the most affected countries are working to reduce the toll of infant diarrhea. The report also includes a strategic seven-point plan for diarrhea control, describing prevention, intervention, and treatment practices that can and should be brought to scale.

Diarrhea is the second leading cause of death for children under five globally — with pneumonia being the first — and kills approximately 1.6 million children under five each year. Eighty percent of these entirely preventable deaths occur in the poorer regions of South Asia and Africa. Although major efforts in delivering treatments and effective prevention campaigns have reduced the global impact of infant diarrheal death, many low-resource communities still face barriers to accessing low-cost, life-saving remedies for their sick children. According to the World Health Organization (WHO), only 39% of children afflicted with diarrhea receive the recommended, inexpensive treatments of fluid replacement, zinc supplementation, and continued feeding.

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[Editor’s note: This is a guest post written by Danielle Brown.]

“There is more money put into baldness drugs than into malaria,” said Bill Gates at the annual Technology, Entertainment, Design conference. To underscore his point Gates released a jar full of mosquitoes into the crowd, stating, “there is no reason that only poor people should have this experience [malaria].” He quickly assured the audience that those particular mosquitoes were not carrying malaria.

For many, especially the poor, malaria is a reality and a daily threat to their lives. Gates’ presentation pointed to the fact that malaria has been eradicated in developed nations but remains a problem for many equatorial countries. Approximately half of the world’s population is at risk of malaria, and it remains the single greatest killer of children living in lower-income countries. In 2006 alone, there were 247 million cases of malaria and 880,000 deaths. For a disease that is preventable and curable, these numbers are far too high.

Gates also raised an important question: How do you stop a deadly disease that is spread by mosquitoes? His response for prevention includes insecticide-impregnated bed nets and indoor residual spraying using the insecticide dichloro-diphenyl-trichloroethane (DDT). The two, used in combination, can cut deaths from malaria by 50%.

Despite this potential, the global response to this question is defined in part by a debate over the safety of DDT, framed by the Stockholm Convention on Persistent Organic Compounds and by WHO guidelines regarding use of DDT. The Stockholm Convention outlines a plan for the long-term elimination of the production and use of DDT by 2020, while granting DDT an exemption for use in public health. This exemption is conditional on whether alternative insecticides that are as cheap and effective as DDT exist. However, such alternatives are not readily available. Read more

To what extent should global health initiatives work with country health systems in order to improve health? A recent Lancet report by the WHO Maximizing Positive Synergies Collaborative Group assesses the effects of such initiatives and suggests concrete steps for change.

The WHO Synergies group, which includes several FXB Center affiliates, examined the interactions between country health systems and global health initiatives (GHIs), also known as global public-private partnerships or global health partnerships. GHIs have become increasingly prominent players in the field of global health, particularly with respect to disease-specific treatment and eradication projects. Although GHIs have provided billions of dollars of funding for health projects and have led the way in responding to infectious disease epidemics, particularly HIV/AIDS and malaria, these initiatives have also been criticized for placing additional burdens on already weak country health systems and for introducing inefficiencies by duplicating functions already (nominally) provided by country health systems. Read more