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A whole new world 1961-2011

A whole new world 1961-2011. 1953 Extensive longitudinal study of health and nutrition in young children in Nigeria - David Morley and Margaret Woodland. Health interventions. 1958 Launching of under-5-clinics with growth monitoring, vaccinations, treatment, teaching - Morley and Woodland

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A whole new world 1961-2011

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  1. A whole new world 1961-2011 • 1953Extensive longitudinal study of health and nutrition in young children in Nigeria - David Morley and Margaret Woodland

  2. Health interventions • 1958Launching of under-5-clinics with growth monitoring, vaccinations, treatment, teaching - Morley and Woodland • 1962Launching of first measles vaccination campaign in Africa -Morley and Woodland

  3. Milestones • 1966Publishing of ”Medical Care in Developing countries”: Maurice King, David Morley and others

  4. Milestones • 1978WHO/UNICEF Alma Ata Primary Health Care: ”Health for all by the year 2000”. • Halfdan Mahler WHO DG: 1973-1988.

  5. Milestones • 1983UNICEF Child Survival and Development revolution: Selective Primary Health Care GOBI-FFF - James Grant: UNICEF’s Director 1980-95

  6. Milestones • 1990World Summit for Children - James Grant

  7. Milestones • 2000UN Millenium Development Goals especially goal -4 Koffi Annan, Jeffrey Sachs

  8. Milestones IMCI strategy: 70% of deaths due to 5 illnesses: Pneumonia, Diarrhoea, Measles, Malaria, Malnutrition Search for General Danger Signs Ask about 4 main symptoms: Cough and Difficult breathing, Diarrhoea, fever, Ear Problems Assess each symtom by an algorithm Classify each into one of 3 categories: severe disease, mild disease, no significant disease Treat and if necessary referral

  9. A whole new world1961- 2011 • Vast improvement in child health since 1960: CMR 195/1000 • 2010: CMR 58/1000 • Child deaths from 12.5.million 1990 to 7.6 million 2010 • But gap between best and worst has increased; 1970: 9x 2005: 26x In SSA: 29x

  10. Causes of child mortality 2002 • Perinatal deaths 23.1% • Lower resp infections 18.1% • Diarrhoeal diseases 15.2% • Malaria 10.7% • Millenium goal reduce by 2/3 global child mortality from 1990 to 2015 • Unlikely to be achieved in SSA and South Asia

  11. Major advances over last 40 years and coverage • Breast feeding promotion 39% • Oral rehydration therapy 20% • Micronutrients esp Vit A, Zinc • Antibiotics for pneumonia and sepsis 10-40% • Antimalarial measures including bed-nets and artemisinine combination therapy IBN 2000: 3%2008:18.5%

  12. The big three killers in LIC • Diarrhoeal diseases • Pneumonia • Malaria

  13. Simple cheap measures to save lives • Diarrhoeal diseases: • Prevention: VIP latrines, tippy taps for better hygiene, upgraded shallow wells, solar disinfection of drinking water • Diagnosis: acute watery, persistent, dysentery • Treatment: ORS, • nutrition supplementation including zinc, tinidazole and/or antibiotics e.g. cipro for dysentery and/or persistent diarrhoea

  14. Simple life-saving measures • Pneumonia: • Prevention: vitamin A, zinc, tippy taps, better locally made stoves with chimneys • Diagnosis: breathing frequency: 60/min 50/min 40/min Indrawing of lower chest on inspiration • Treatment: cotrimoxazole, amoxicillin or chloramphenicol in severe pneumonia

  15. Childhood malaria • 90% of cases in SSA; 95% of deaths in SSA. Virtually all P.falciparum • Roll back malaria 2001-2010: reduce by ½ during this period • Global fund to fight malaria, TB, HIV/AIDS • Medicines for malaria venture • Multilateral initiative on Malaria • Bill and Melinda Gates $1 b. Oct 2007 for eradication of malaria

  16. Pl. Falciparum med gametocyter

  17. Malarial retina: ‘delineation’ of vessels

  18. Malaria focal programmes • Impregnated bed nets • Better diagnosis: rapid tests • Multidrug therapy esp Artemisinine Combination Therapy e.g. Coartem • Better access and better skills • Possible future vaccine • Seldom place for drug prophylaxis in high endemic areas

  19. Artemisia annua

  20. Milestones in Maternal Health • 1959Ian Donald: ”Practical Obstetric Problems. Glasgow”

  21. Milestones in Maternal Health • 1967John Lawson in Nigeria: ”Obs and Gynae in the Tropics”

  22. Milestones in Maternal Health • 1971Hugh Philpott in S. Rhodesia: Practical Partogram. C/S in primips from 9.9%-2.6%

  23. Milestones • 1974Catherine and Reginald Hamlin open Fistula Hospital in Addis Ababa

  24. Milestones • 1979 Sulochona Abraham, Vellore, Tamil Nadu launches community safe motherhood programme: MMR 1986: 120; 1996: 60

  25. Milestones Maternal Health • 1984Michael Stark develops Misgav Ladach method of C/S. Widely launched 1995

  26. Milestones in Maternal Health • 1985 K.S. Shivkar, Mumbai launches condom use for PPH. Widely adopted 2003

  27. Milestones in Maternal Health • 2001Staffan Bergström publishes extensive experience of Non-doctor operators for Obstetrical emergencies

  28. Milestones • 2002Kenneth Björklund publishes massive retrospective study of Symphysiotomy as alternative to C/S. Gets support from WHO, World Bank, BJOG editor John Grant

  29. A whole new world in Maternal Health • Global maternal deaths 1990: 526 000; 2008: 343 000 • MMR 1990: 320/100,000 live born • MMR 2008: 251/100,000 live born • Gap between best and worst has increased. Italy vs Somalia; 1:1085

  30. The way forward in Maternal Health • Focus on First Referral Hospitals • Converge on 5 main killers: bleeding, sepsis, eclampsia and PIH, unsafe abortions, obstructed labour • Stimulate midwives with improved empathy and skills to choose rural work • Advocate introduction of partogram, condom for PPH, symphysiotomy, non-doctor operators, Misgav Ladach method for C/S

  31. Conclusion • Margaret Mead • Never doubt that a small group of thoughtful citizens can change the world. Indeed, it is the only thing that ever has.

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