In the absence of effective treatment and access to quality health services, diarrhea, malaria, and pneumonia remain the leading causes of child mortality in sub-Saharan Africa and cause nearly 44 percent of deaths worldwide in children under five years old. To improve access to life-saving treatment among children, many African countries have begun implementing and scaling-up integrated community case management (iCCM), a strategy that focuses on the delivery of timely and low-cost interventions at the community level by community health workers.

Understanding the potential impact and the importance of iCCM as an effective means to reduce child mortality, more than 400 researchers, donors, government, implementers, and partners representing 35 sub-Saharan African countries convened on March 3-5 in Accra, Ghana for the 2014 Integrated Community Case Management (iCCM) Evidence Review Symposium [5].

The objectives of the Symposium were to review the current state of the art and evidence of iCCM implementation and to assist African countries to integrate and take action on key iCCM findings presented during the evidence symposium. Among those in attendance were 10 Management Sciences for Health (MSH) representatives from Burundi, the Democratic Republic of the Congo, and the United States.

Cross-posted on USAID's IMPACT blog [10]

My most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating "strep throats” with penicillin was better than operating. I didn't need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.

Millions of children today are not so lucky. Over 7 million children under the age of 5 die each year; 70 percent of child deaths occur in sub-Saharan Africa and South-East Asia. The vast majority -- over two-thirds -- are entirely avoidable with existing safe, effective, low-cost prevention and treatment.

This year is not only MSH’s 40th anniversary; it is also 30 years since the first reported cases of HIV. Thirty years ago HIV was considered a new, always-fatal disease. ...Today 6.6 million people—nearly half of those in need—will take life-saving antiretrovirals.

 

Picture trees, water, mountains, mud, birds and fish. This is Lake Chirwa -- the second largest of the five lakes in Malawi and the main habitat of small fish called Matemba. The lake offers a trading opportunity for fishermen from many walks of life.

Lying in the southern region of Malawi, Lake Chirwa is a wetland for people of three districts: Phalombe, Zomba and Machinga. All these people have frequent contact with Mozambique as they lie near the bordering frontiers. The lake lies some 50km from Zomba District Health Office.

If you grow up in places like Kasungu district in rural Malawi, you learn that when your wife is pregnant, you should not have sex outside marriage---because you will lose the “expected gift” through miscarriage. Male promiscuity during a partner's pregnancy is a taboo that many believe will bring a curse on the family.

Patricia Patrick says that after she miscarried in November 2008 “People talked in the village, and people talked within the household. My relatives asked me suspicious questions.” They wondered whether sexual misbehavior by her husband caused the tragedy. She remembers her husband telling his side of the story to prove his innocence, but nobody believed him.

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet [23] about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option [24], whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART).

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet [27]. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival [28] (BASICS) has published a commentary [23] (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

Over the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

 

Blog post updated Dec. 27, 2011.

Taj Bibi sits nursing her 5-month-old baby in the kitchen of her home in the village of Sartal in Takhar province in Afghanistan’s north. The room is dark; the only natural light comes from the doorway to the dusty courtyard outside. The sound of her children playing echoes across the small family compound.

Bibi’s first two children died -- one of them from severe diarrhea -- because the family could not afford to take them to the doctor. “Now, if our children get diarrhea or any other illness, I take them to the community health worker,” she said.

Community health workers (CHWs) are the building blocks of the Afghan health system, bringing basic health services to villages across the country.

Many children in Afghanistan can be spared of communicable diseases that can make them ill and even cause death, if they receive routine vaccinations. But in a country of more than 25 million people in a country the size of Texas, where over 80% of the population lives in rural areas, immunizing every child against measles, diphtheria, pertusis (whooping cough), tetanus, and polio is very challenging.

Large scale immunization campaigns have proved helpful, but have been unable to significantly increase and maintain high immunization rates throughout the country.

The US Agency for International Development’s BASICS project [37](Basic Support for Institutionalizing Child Survival), with support from MSH, is working with the Afghan Ministry of Public Health (MoPH) and UNICEF to demonstrate in nine districts how an expanded program on immunization (EPI) micro-planning can successfully increase the number of immunized children.