Posts tagged as:

global health

biofilm vaccine cholera

Through genetic engineering, this Vibrio cholerae biofilm can be loaded with extra antigens, creating a super-charged but inexpensive vaccine.

Malaria. Cholera. Now Ebola. Whatever the contagion, the need for new, or better, vaccines is a constant. For some of the most devastating public health epidemics, which often break out in resource-poor countries, vaccines have to be not only medically effective but also inexpensive. That means easy to produce, store and deliver.

Paula Watnick, MD, PhD, an infectious disease specialist at Boston Children’s Hospital, has a plan that stems from her work on cholera: using a substance produced by the bacteria themselves to make inexpensive and better vaccines against them.

Cells do all the work

Bacteria produce biofilms—a sticky, tough material composed of proteins, DNA and sugars—to help them attach to surfaces and survive. Full story »

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A fleet of toddlers get ready to race in their Go Baby Go cars, customized by therapists and parents to provide disabled children with mobility and help them strengthen weak muscles.

Start your engines: A fleet of GoBabyGo cars, customized by therapists and parents to give disabled children mobility and help strengthen weak muscles. (Courtesy Cole Galloway)

TEDMED2014 focused on a powerful theme: unlocking imagination in service of health and medicine. Speaker after speaker shared tales of imagination, inspiration and innovation. Here are a few of our favorites:

$100 plastic car stands in for $25,000 power wheelchair

In the first (and likely only) National Institutes of Health-funded shopping spree at Toys R’ Us, Cole Galloway, director of the Pediatric Mobility Lab at the University of Delaware, and crew stocked up on pint-sized riding toys.

Galloway’s quest was to facilitate independence and mobility among disabled children from the age of six months and older and offer a low-tech solution during the five-year wait in the United States for a $25,000 power pediatric wheelchair.

The hackers jerry-rigged the toys with pool noodles, PVC pipe and switches, reconfiguring them as mobile rehabilitation devices to promote functional skills among kids with special needs. Full story »

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My father had a favorite bit of advice as we embarked on our adult lives: “Go big or go home.” Going big is exactly what OPENPediatrics is doing, empowering physicians and nurses to care for children across the globe.

The Web-based digital learning platform was conceived 10 years ago by Jeffrey Burns, MD, MPH, chief of critical care at Boston Children’s Hospital, and Traci Wolbrink, MD, MPH, an associate in critical care. It concluded a year-long beta test in April 2014, and version 1 has now been launched.

Developed to impart critical care skills, OPENPediatrics uses lectures, simulators and protocols to deliver training. In the process, it has helped save lives. Full story »

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Ebola response ethics experimental treatment therapy ZMapp

Guinean Red Cross volunteers prepare to decontaminate a hospital in the capital, Conakry. (European Commission DG ECHO/Flickr)

The world paused for a moment when the news broke last week that two Ebola-infected American missionaries working in Liberia had received an experimental therapy called ZMapp. As I write this, both patients are back on U.S. soil, and seem to be responding well to the treatment.

But was it ethical?

That difficult question can be divided into two. First is the question of whether it was ethical to give the two patients a drug that, up to that point, had never been tested in people. The second—in some ways thornier—question is: Was it ethical to give the treatment to two Americans but not the nearly 1,850 West Africans infected in the outbreak (as of August 11)? Full story »

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global health innovationZulfiqar Bhutta, MBBS, PhD, inaugural chair in global child health at the Hospital for Sick Children, Toronto, and founding director of the Center of Excellence in Women and Child Health, Aga Khan University, Pakistan, is a global child health superstar. Presidents, prime ministers and princes welcome his advice. Yet India ignored him when he called its proposed innovation to curb infant mortality “nonsense.” “I was dead wrong,” says Bhutta. “What happened is remarkable.”

The simple innovation, which Bhutta now publicly commends, cut perinatal mortality 25 percent. Full story »

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Ibeziako,PatriciaPatricia Ibeziako, MD, directs the Boston Children’s Hospital Global Partnerships for Psychiatry Observership Program and the Psychiatry Consultation Service at Boston Children’s Hospital.

Children and adolescents constitute almost a third of the world’s population—2.2 billion individuals—and almost 90 percent live in low-income and middle-income countries, where they form up to half of the population. Yet, for many years, child mental health has largely been glossed over—with long-term negative effects on educational attainment in addition to chronic disability and lost productivity.

Major international non-governmental organizations and United Nations agencies work in settings where children are at risk for mental health difficulties. However, with the exception of the World Health Organization (WHO), these agencies often fail to acknowledge or focus on child mental health issues. In 2005, the WHO Atlas of Child and Adolescent Mental Health Resources reported that less than one third of 66 countries surveyed had an entity with sole responsibility for child mental health programming, and that national budgets rarely had identifiable funding for child mental health services. Full story »

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superamma

Judith Palfrey, MD, is director of the Global Pediatrics Program in the Department of Medicine at Boston Children’s Hospital.

Diarrhea is a bigger global killer than HIV and malaria combined. It accounts for more than 800,000 deaths each year among children 0-5 years. And how tragic this is when the simple intervention of hand washing can prevent some of these deaths. Results of a trial, published in the March edition of The Lancet Global Health, indicate that teaching families in under-resourced areas of the world about hand washing is not only possible but also scalable, sustainable and successful—if it’s done the right way.

Hand washing is a simple intervention, but the prevalence of the behavior is as low as 1 to 2 percent in some under-resourced global settings. A London School of Hygiene and Tropical Medicine group, led by Adam Biran, PhD, decided to try to improve these statistics by devising an effective intervention.

However, the route to simple solutions is often complex. The researchers used very sophisticated methodology to identify the levers of behavioral change. They realized that health messages about hand washing have not worked. The idea that what I do today may prevent diarrhea down the road just did not have enough oomph to motivate people to adopt a new routine.

The researchers hypothesized that emotional drivers (including nurture, status, disgust and belonging) would be strong pushes to get families to wash their hands. And they were right. Full story »

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Newborn baby neonatal sepsis developing world

Courtesy Anne Hansen, MD, MPH

Reducing child mortality is high on the list of the United Nations’ Millennium Development Goals—the eight global health, economic and development benchmarks set by the U.N. in 2000 for 2015.

While mortality among children under age 5 has improved greatly, the gains have largely been among children at the older end of that grouping. When it comes to mortality in the first week of life, little has changed.

“Early neonatal mortality rates haven’t decreased in the last two decades,” says Grace Chan, MD, PhD, a pediatrician at Boston Children’s Hospital, who conducts global health research at Harvard School of Public Health. “In developing countries, they still hover near 30 deaths per 1,000 live births.”

Early-onset infections—ones that arise within a week of birth—account for a significant portion of those deaths. Such infections may arise when a newborn picks up bacteria present in the mother’s birth canal during delivery, or from maternal infections during pregnancy.

In developed countries, interventions like prophylactic antibiotics and quick diagnoses help to keep neonatal infection rates low. But these kinds of interventions are less available in developing nations, where they could have the most impact. And while risk factors for neonatal infections have been well studied in developed nations, they are less  well known in resource-poor environments, where the infections most frequently occur.

To put it another way, when it comes neonatal sepsis in developing countries, there’s a lot we don’t know.

Full story »

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Smokestacks-toxins-brain-shutterstock_142235569Maitreyi Mazumdar, MD, MPH, practices pediatric neurology at Boston Children’s Hospital. She leads a research program in Bangladesh that studies the effects of the epidemic of arsenic poisoning on neurological outcomes in children.

Neurodevelopmental disorders, including autism and attention deficit/hyperactivity disorder (ADHD), affect many millions of children and appear to be increasing in frequency worldwide. Improved diagnosis and changes in diagnostic criteria explain a portion of the rise, but not all. In other words, the increase in neurodevelopmental disorders seems to be “real.”

To date, research has mainly invested in finding genetic causes, implicating biological pathways that affect, for example, the formation of synapses and the production of neurotransmitters. Such discoveries improve our understanding of the basic biology of neurodevelopmental disorders and may ultimately lead to new therapies. But genetic variants alone cannot explain the recent rise; if they did, population rates of neurodevelopmental disorders would be expected to stay the same, or even decrease over a 30- to 40-year period, due to affected people likely having fewer children. Instead, reported rates have steadily increased over the past several decades. Something else is going on. Full story »

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africa trio kidsBeginnings—whether a new year or a new century—offer an optimal time for evaluating goals. Quality improvement literature reminds us that goals should be specific, measurable and timely, and that progress checks are crucial. With one year left to achieve the ambitious Millennium Development Goals (MDGs), global child health stakeholders are assessing gains and gaps.

In 2000, the United Nations set the MDGs, and homed its sights on child mortality in MDG 4, aiming to cut mortality among children younger than age 5 by two-thirds by 2015, from the 1990 base figure of 12 million.

By 2012, the figure was nearly halved to 6.6 million.

“There’s a hopeful sense,” says Judith Palfrey, MD, director of Boston Children’s Hospital’s Global Pediatrics Program in the Department of Medicine. At the same time, the goal remains “seriously off target for many countries,” wrote Zulfiqar Bhutta, MB, BS, PhD, from the Hospital for Sick Children in Toronto, and Robert Black, MD, from Johns Hopkins University in Baltimore, in The New England Journal of Medicine in December.

Palfrey agrees, noting that while some countries are on track to meet the goal, some have stagnated and some have regressed. “It may be that there are some intractable issues,” she says. The countries that have failed to make progress are marked by corrupt governments, armed conflict or both. Full story »

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