KFF Daily Global Health Policy Report

In The News

Global Water Shortages To Exacerbate Conflict, Hinder Economic Growth, U.S. Officials Warn

“As we have been hearing, global water shortages are poised to exacerbate regional conflict and hobble economic growth. Yet the problem is growing worse, and is threatening to deal devastating blows to health, according to top water officials from the U.S. State Department and [USAID] who spoke before a House panel hearing” on Thursday, Scientific American’s “Observations” blog reports. “Globally, the world is on track to meet the Millennium Development Goal of halving the number of people unable to reach or afford safe drinking water by 2015, but it still must make strides to improve global sanitation, says Aaron Salzberg, the State Department’s special coordinator for water resources,” the blog writes, adding, “In addition to supply problems, unclean water causes more than four billion cases of diarrhea a year which lead to roughly 2.2 million deaths, and most are in children under the age of five.”

“The hearing comes on the heels of stark reminders of the current water shortages that are apparent across the globe,” the “Observations” states, noting, “Pakistan, one of the most water-stressed countries in the world, is on the brink of crisis,” and “China and India are also experiencing unprecedented strain on water supplies, due to water shortages fueled by climate change, urbanization and massive industrial growth.” The blog highlights USAID’s efforts to address water supply, noting the agency “will work with other countries to use emerging science and technology to track the problem and prepare communities to adapt” and it “expects its programs to provide a minimum of 10 million people with sustainable access to improved water supply by 2018.” The blog continues, “At the hearing, House members pressed speakers for information on tools they might need to better address the problem,” adding, “Answers, however, are challenging to come by, says [Christian Holmes, global water coordinator for USAID], ‘It really doesn’t lend itself to easy fixes.'” The blog notes, “Despite a continued focus on water issues, barely a dent has been made in the problem, says Oregon Rep. Earl Blumenauer (D), who [Wednesday] introduced new legislation with Rep. Ted Poe (R-Texas) geared toward furthering U.S. water assistance and ensuring that work will have measurable impact” (Maron, 8/1).

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Advocacy Groups Push For More Efforts To End Child Marriage

“Advocacy groups are urging for partnerships between governmental organizations and private sector businesses to better prevent child marriage and combat the economic, development and health problems it causes,” Inter Press Service reports. “A recently released report by Rachel Vogelstein, a fellow at the Women and Foreign Policy Program at the non-partisan think tank Council on Foreign Relations, highlights strategic and moral reasons for U.S. involvement in the issue,” IPS writes, noting, “According to the United Nations, in 2011 almost 70 million women — or one in three women between the ages of 20 and 24 — had been married under the age of 18.” The news service continues, “‘This is often just seen as the norm in many countries. That’s just how life has been,’ Lakshmi Sundaram, global coordinator of a London-based advocacy group, Girls Not Brides, told IPS,” adding, “He pointed to economic reasons for early marriages, noting, ‘In most countries there are dowry systems in place, and marrying your daughter off means you have one less mouth to feed.'”

“The majority of the 25 countries with the highest child marriage rates have fragile governments or face a high risk of natural disaster, such as Syria, Afghanistan and Niger,” according to IPS, which adds, “All but four countries have a minimum age of legal marriage, ranging from 15 to 18,” and “[s]everal countries have a provision allowing younger children to be married with the consent of the parent.” “According to the study, eliminating child marriages offers economic and developmental benefits to both individual countries and the United States,” IPS writes, noting, “The study called for the U.S. government to acknowledge that child marriage is a barrier to security and to encourage the efforts of other countries to tackle this issue internally” (8/1). The Washington Post’s “World Views” blog examines “several facts about child brides and what they face, compiled from a Human Rights Watch brief and other sources” (Fisher, 8/1).

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Ban Appoints New Special Envoy For HIV/AIDS In Africa

U.N. Secretary-General Ban Ki-moon on Thursday appointed former Ugandan Vice President Speciosa Wandira-Kasibwe as his special envoy for HIV/AIDS in Africa, SAPA-AP/Sowetan Live reports (8/2). Wandira-Kasibwe, who was the first woman in Africa to hold a vice president position, “will replace Asha-Rose Migiro of Tanzania, who the secretary general thanked for her outstanding and dedicated service to the U.N. and her commitment as a powerful advocate for his efforts to end HIV-related stigma and discrimination all around the world, according to the announcement from Mr. Ban’s office,” the U.N. News Centre writes. Wandira-Kasibwe currently serves as senior adviser to Uganda’s president on population and health and is a chair of the Board of Directors of the Microfinance Support Center Ltd., the news service notes. In her position, Wandira-Kasibwe “will help advance the AIDS response in Africa by advocating for the pro-active engagement and involvement of all sectors of society,” the U.N. News Centre writes (8/1).

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President Clinton Discusses HIV Prevention In Malawi

“Former U.S. president Bill Clinton, on the last day of his visit to Malawi, Thursday said he would continue to support measures to fix the southern African country’s efforts to address some of its biggest challenges in poverty reduction, health care and women empowerment,” PANA/AfriqueJet reports. “Clinton, accompanied by daughter Chelsea, was speaking after visiting the Kamuzu Central Hospital, Lilongwe’s main referral hospital,” where he discussed his foundation’s work to prevent mother-to-child HIV transmission and met with people living with HIV, the news service notes. “When I finish this trip, I just don’t want to remember that I have been told that 96 percent of children from HIV-positive parents were born without HIV, but remember the call by the families saying that this should be done everywhere too,” Clinton said, the news service writes. “Clinton was in Malawi to tour projects funded by the Clinton Development Initiative (CDI) and the Clinton Health Access Initiative (CHAI), mainly in the agriculture and health sectors,” PANA notes, adding Chelsea Clinton and Malawi President Joyce Banda also spoke (8/2).

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India Food Subsidy Plan Bypasses Some Needy Citizens, Does Not Tackle Malnutrition, Chief Minister Says

“India’s multi-billion dollar plan to give cheap grain to 67 percent of its population bypasses some of the needy and does not tackle malnutrition, said Raman Singh, the chief minister of Chhattisgarh, which gives 90 percent of its people low-cost food,” Reuters reports. “With an eye to elections which are due by May 2014, the Congress-led government last month sidestepped parliament by launching its $22 billion food subsidy plan with an ordinance, which brings it into law immediately,” the news service notes, adding, “Singh, a member of the main opposition Bharatiya Janata Party (BJP), told Reuters the ordinance should have broadened the range of beneficiaries and [included distribution of] protein-based foods as well as rice and wheat.” According to Reuters, Singh said, “We give iodized salt, pulses and chick pea. We demand the same for the National Food Security Ordinance.”

“The National Food Security Ordinance aims to give five kg (11 lb) of cheap rice and wheat every month to 800 million people, more than doubling the reach of the existing subsidized food system,” according to Reuters. “Despite being the world’s second-biggest producer of rice and wheat and sitting on huge mountains of grains, India is home to a quarter of the world’s hungry poor and every day some 3,000 children die of illness related to malnutrition,” the news service notes. “A government source involved in food decisionmaking said that rice and wheat were staples for the poor and the government was taking care of those needs,” Reuters writes, adding, “Singh said his state government’s investment in irrigation, free electricity to farmers, interest-free farm loans and better seeds have helped Chhattisgarh raise rice production to 7.1 million tons from 1.7 million tons in 2005/06” (Winterbottom/Bhardwaj, 8/2).

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Saudi Arabia, WHO Report 3 Additional MERS Cases

“Saudi Arabia and the [WHO] reported three new MERS-CoV (Middle East respiratory syndrome coronavirus) cases in that country today, all of them in women, two of whom are health care workers,” CIDRAP News reports. “One of the patients is a 67-year-old Saudi citizen in Riyadh who has various chronic diseases and is being treated in a hospital intensive care unit, the Saudi Ministry of Health (MOH) said in a very brief statement,” the news service writes, adding, “The other two patients are both 39-year-old female health care workers, one living in the southwestern region of Asir and other in Riyadh, the MOH said” (8/1). The WHO “said clinics and hospitals caring for patients suspected or confirmed with MERS infection ‘should take appropriate measures to decrease the risk of transmission … to other patients, health care workers and visitors,'” Reuters reports. “A study by an international team of infectious diseases experts who went to Saudi Arabia in May to analyze an outbreak concluded that MERS infection is a ‘serious risk’ in hospitals because it is easily transmitted in health care settings,” the news agency writes (Kelland, 8/1).

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Editorials and Opinions

Global Community Should Allocate More Resources For Efforts Promoting Breastfeeding

Noting the observance of World Breastfeeding Week from August 1 to 7, Arun Gupta, co-founder and central coordinator of the Breastfeeding Promotion Network of India, provides statistics about breastfeeding globally, discusses the health benefits for newborns and examines a lack of international funding for breastfeeding initiatives in a Devex opinion piece. “When it comes to funding, it is hardly there for any of the [strategies that have proven effective],” he states, noting, “International funding, for example has been largely driven by food aid for therapeutic food or micronutrient supplements. This is because of market-driven policies and programs.” He asks, “So where should the donor money go?” and writes, “First, to protecting breastfeeding from pernicious commercial influences, which is critical.” He continues, “Next is promotion. The most common reason for women to adopt artificial feeding is perceived insufficiency of their breast milk for the baby,” adding, “Third is support. Breastfeeding can’t succeed if mother and baby are away from each other. Improving maternity benefits and encouraging breastfeeding at work must be encouraged.” Finally, he writes, “[I]t should be viewed as women’s right. Breastfeeding is a public health priority requiring social, political, legal and financial interventions.” He concludes, “All countries, donors and development agencies should allocate at least 10 percent of the child budget to strategies for increasing breastfeeding. Otherwise, the global community and the world at large will fail in supporting women” (8/1).

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Pregnant Women Need Improved Access To Maternal, Labor Care

“As a midwife of more than fifty years and founder of my country’s first maternity hospital, I have seen how easily joy can turn to grief and tragedy when expecting mothers lack access to the expert medical care the Duchess of Cambridge received,” Edna Adan Ismail, founder and director of the Edna Adan Maternity Hospital in Somalia, writes in the Huffington Post’s “Global Motherhood” blog. “Women in my country have a one-in-10 chance of dying in childbirth. In developed countries, it’s closer to one in 4,000,” she notes. “Our women are dying of causes that no woman in this day and age, when man has reached the moon, should die of,” Ismail writes, adding, “According to the U.N., a woman dies every 90 seconds of pregnancy-related causes. That’s 1,000 women a day.”

“I’m proud to say that we have cut maternal mortality to a quarter of the national average, largely through training of midwives, improved prenatal care, early referral, and immediate response to obstetrical emergencies,” Ismail writes, adding, “If we can do it here, with our limited resources, it can be done anywhere.” However, “governments must decide that the health of their mothers is a worthwhile investment,” she continues. “I and everyone at the Edna Adan Hospital send our blessings and wish proud parents William and Kate great happiness as they bring home their bundle of joy,” she states, concluding, “My greatest wish is that one day every mother in labor will be treated like a queen” (8/1).

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Researchers, Key Stakeholders Must Address Challenges Of Conducting Health Research In Countries Experiencing Crisis

“Researchers, donors, governments and other key stakeholders cannot ignore the challenges of conducting research in nations experiencing crises, and should not shy away from these countries,” Samba Sow, director general of the Center for Vaccine Development in Mali, a collaborative enterprise between Mali’s Ministry of Health and the University of Maryland School of Medicine, writes in CNN’s “Global Public Square” blog. “In the past year, my colleagues at Center for Vaccine Development Mali and I have faced immeasurable challenges in keeping research efforts going while an insurgency threatened the capital city of Bamako, where our research center is located,” he states, discussing these challenges and noting the group’s “already complex research projects became even more difficult after the coup in March 2012.” He writes, “Large, complex research projects like the ones we conduct must be executed meticulously to ensure integrity of data and safeguarding of patients,” adding, “In these politically turbulent times, we’ve had to adapt to maintain the quality of our research and to protect our patients.”

“Thankfully, things have mostly returned to normal in Bamako. But should the violence reignite, we will once again adapt and do what it takes to keep research projects operating and preserve the integrity of the research,” Sow continues. “Research in low-resource settings helps us understand how to save lives and improve health in these settings, where the most vulnerable people, especially children, often live,” he notes, adding, “Research provides the accurate, timely information on disease burden that health officials rely on to prioritize life-saving interventions. In low-resource countries where ministries of health must do more on smaller budgets, this data is critical.” He concludes, “No matter what obstacles conflict brings, there are enough dedicated people willing to brave the checkpoints and get the job done. Giving up is simply not an option” (8/1).

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From the Global Health Policy Community

Blog Examines Efforts To Prevent Dengue In Brazil, Other Latin American Countries

Miriam Alvarado, a post-bachelor fellow and global health data specialist at the University of Washington’s Institute for Health Metrics and Evaluation, writes in a guest post in Humanosphere about how dengue “is rapidly expanding its reach across the planet.” She focuses specifically on dengue in Brazil, writing, “The rapid rise in dengue cases in Brazil is not unique. Many countries in the region and elsewhere have experienced increases in the burden of dengue. Proven strategies exist to combat dengue and the dengue-causing mosquito, and new approaches are being developed.” However, “Brazil’s battle against dengue is worth special scrutiny because this country is one of the world’s up-and-coming ’emerging markets,’ and improving health is a top priority on its development agenda,” Alvarado states, discussing strategies to prevent the disease (8/1).

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EGPAF Promoting Exclusive Breastfeeding In Kenya To Prevent MTCT Of HIV

As part of a series written by members of the Frontline Health Workers Coalition in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Eric Kilongi, a senior communications officer in Kenya for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), describes efforts to educate women living with HIV about the importance of exclusive breastfeeding. “[S]tudies have shown that women living with HIV are less likely to pass the virus if they breastfeed their babies exclusively for at least four months,” he notes. Kilongi discusses “a community-driven infant and young child feeding program associated with the Maisha project — supported by [EGPAF]” — and “a support group to promote exclusive breastfeeding as a way to reduce mother-to-child transmission (MTCT) and improve overall child health and nutrition” (8/1).

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Treating Schistosomiasis Among Women In Africa Could Help Prevent HIV Infection, Researcher Says

“Over the years I have written a lot (and beaten the drum pretty hard) about the importance of female genital schistosomiasis (FGS), its devastating effects on young women, and its key role in promoting HIV/AIDS transmission in Africa,” Peter Hotez, co-editor in chief of PLOS Neglected Tropical Diseases and dean of the National School of Tropical Medicine at Baylor College of Medicine, writes in the PLOS “Speaking of Medicine” blog. He estimates between 20 million and 150 million women in Africa are affected by FGS, and he writes, “The very good news is that FGS could potentially be prevented if we reach girls and treat them early enough in life with praziquantel.” Hotez describes “a paper just out in PLOS Neglected Tropical Diseases [that] gives us compelling reasons to recast schistosomiasis [mass drug administration (MDA)] as a back door AIDS prevention strategy,” and he adds, “It is more cost-effective than antiretroviral therapy as a means to prevent new HIV infections.” He continues, “For me, a key take home message is that the major organizations committed to HIV/AIDS prevention in Africa, such as PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, as well as the ONE Campaign, must embrace schistosomiasis MDA and support its expansion throughout the affected areas of Africa in order to prevent or reduce the burden of FGS” (8/1).

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PLOS Blog Highlights New Articles Published In PLOS NTDs

The PLOS “Speaking of Medicine” blog highlights a number of new articles published in PLOS Neglected Tropical Diseases (NTDs) this week. In the first highlighted article, Martial Ndeffo Mbah of the Yale School of Public Health and colleagues present “a mathematical model of female genital schistosomiasis and HIV calibrated using epidemiological data from Zimbabwe that they’ve used to explore the potential cost-effectiveness of mass drug administration with praziquantel as an intervention strategy for reducing HIV transmission in sub-Saharan Africa.” In another article, Robert Gilman of the Johns Hopkins Bloomberg School of Public Health and colleagues “conducted a census, seroprevalence and epidemiologic study in a rural area of the Bolivian Chaco, known for high Chagas rates, and discovered that, after an insecticide spray program, transmission appeared to fall transiently, but then increased again quickly.” And in a third article, Richelle Charles of the Massachusetts General Hospital’s Division of Infectious Diseases and colleagues “identif[y] potential biomarkers unique to S. Typhi chronic carriers” (8/1).

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New Issue Of The Lancet Available Online

The most recent issue of The Lancet is available online. The issue includes, among other articles, an editorial examining the global threat of invasive meningococcal disease — or meningitis B — as well as a commentary and a paper examining maternal and child nutrition in low- and middle-income countries (8/3).

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