Health

  • In Ghana, a louder approach to a silent killer: Hypertension

    Hypertension is a serious public health issue, with nearly one billion people across the world currently hypertensive. And the numbers are increasing every day. In Ghana, where we are based, the number of reported new cases in outpatient public health facilities increased more than tenfold between 1988 and 2007. A recent estimate of the prevalence of hypertension in Ghana was 27.3 percent.

    If hypertension is identified early, it can be treated and managed to prevent life-threatening diseases such as stroke and heart failure.

    In the Lower Manya Krobo, a district in the eastern region of Ghana with a population of nearly 100,000, there is a growing recognition of the increasing burden of hypertension. Unpublished 2014 data from the Lower Manya Krobo District ranked the disease as the eighth leading cause of mortality in the district, accounting for 3.8 percent of all deaths. This figure underestimates the overall impact of hypertension because it has a role as a risk factor for other, potentially fatal diseases, such as cardiac diseases, congestive heart failure and cerebrovascular disease. When combined, these conditions would rank as the leading cause of death (25.4 percent) in the district.

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  • Malaria elimination and the role of partnerships

    Roll Back MalariaWe’re working toward malaria eradication. How close are we?

    Malaria eradication as a shared vision can mobilize stakeholders and much-needed financial resources. The World Health Organization estimates that 584,000 people died from malaria in 2013. So, while that big goal of eradication is important, malaria elimination, which means the end of endemic transmission, is what many countries are aspiring to in the meantime. As noted in the President’s Malaria Initiative’s World Malaria Day report for 2015, the community continues to work toward a vaccine, and we’ve had some impressive successes in reducing mortality and increasing the uptake of prevention measures. But, there is much more to be done in order to defeat malaria.

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  • The specter of segregation haunts global health

    There is no question that the greatest health achievements under the Millennium Development Goals have focused on single diseases. Arresting the spread of HIV and AIDS and malaria is perhaps the most significant development success of the new century. And vaccination, especially of measles, is one of the reasons that deaths among older children have fallen faster than deaths among infants or women during pregnancy and childbirth.

    In contrast, the lowest-performing areas across all eight MDGs — reducing infant and maternal deaths — are targets that don’t lend themselves to a single disease strategy. Just six countries have met the MDG target for reducing infant deaths, and only 15 countries have achieved the target for reducing maternal deaths.

    Could these targets have actually been achieved if we had pursued an integrated approach to advancing the health of women and children? Did our fascination with and confidence in the segregation of single-disease initiatives cost us achievement in other areas requiring more complex solutions?

    Read the remainder of the blog here.

  • The thin blue line: Increasing access to pregnancy tests in family planning programs

    What is the true value of a 10-cent (US$) pregnancy test? In many countries, women are routinely denied same-day provision of family planning methods if they arrive at the clinic on a day when they are not menstruating. When it comes to ensuring reliable access to contraception, it turns out that simple, low-cost pregnancy tests can be extremely valuable.

    Sonia, a 49-year-old woman in Rwanda, is a long-time user of Depo-Provera, the popular three-month injectable contraceptive. She explains that women who are not menstruating are often turned away for family planning services because health care providers are concerned that these women might be pregnant. Many are told to return during their next menses, leaving them at risk of unintended pregnancy in the meantime. Sonia says, “When you get there, they ask if you are having your period. When it is ‘no,’ they give you another appointment. When it is ‘yes,’ they give you cotton wool and you go somewhere discreet to put some blood [on it] and come back to show it to the provider. It is only then that the provider shows you the methods.”

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  • A unique partnership develops emerging global health researchers

    WASH_ConferenceAd_10yrbadge_blueAt FHI 360, cultivating partnerships and building capacity are high priorities that lead to lasting impact globally. Capacity development in global health has many facets. In the more than 70 countries where we work, many of our global health, population and nutrition programs and research studies include the training of public health workers and scientists. We also value partnerships in the United States that foster the development of the next generation of public health leaders.

    This year marks the 10th anniversary of the FHI 360 and University of North Carolina (UNC) Gillings School of Global Public Health Research Fellowship Program. This relationship provides graduate students from the Gillings School with the opportunity to work side by side with leading global health researchers. For the last decade, FHI 360 and UNC have built and sustained a local partnership through which yearly at least two students from the Gillings School work at FHI 360 and are mentored by our global health research experts.

    Through this program, FHI 360 has had the privilege of working with some of the brightest young minds in the growing field of global health research. Over the years, 23 fellows have worked on a wide range of topics, generated research protocols, analyzed data, written manuscripts for scientific journals and developed technical skills that are essential to global health research.

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  • Sayana® Press could mean a breakthrough in family planning

    As elsewhere in Africa, a woman in rural Malawi often must walk for miles to reach the nearest health clinic. When she finally arrives, long queues await and a preferred contraceptive, Depo-Provera®, is often unavailable. Even if the barriers of distance, long waits and stock-outs did not exist, a busy clinic would not be an ideal venue for those who seek contraception in a private setting away from the prying eyes of neighbors and acquaintances. Many women use Depo-Provera because it is effective, requires only a single injection every three months and can be used without the knowledge of a sexual partner.

    In many villages in Malawi, and other countries, an auxiliary nurse sells a wide variety of over-the-counter medicines, as well as condoms and oral contraceptives, in a small drug shop. Women in these villages wish that injectable contraceptives were as easily and discreetly available as the pills and condoms in the drug shop.

    This situation may soon change with the arrival of a new, lower-dose formula of Depo-Provera called Sayana® Press. Sayana Press provides the same three months of safe, effective pregnancy prevention as Depo-Provera but comes in an easy-to-use, pre-filled injection device designed to allow low-level health workers, and even users themselves, to inject the product. To further simplify the injection, the long needle formerly required for deep muscle injections has been replaced by a much shorter needle for a simple injection just beneath the skin.

    Several countries in Africa, such as Senegal and Uganda, are beginning to use Sayana Press in their family planning programs, especially those in which community health workers provide contraceptives. More importantly, a few countries will soon begin stocking Sayana Press in pharmacies and perhaps rural drug shops.

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  • Exploring the potential link between hormonal contraceptive use and HIV acquisition

    morrison_charles_2012_220x200Are women who take hormonal contraceptives at an increased risk of acquiring HIV? If so, do some contraceptives put women at higher risk than others?

    This week, the influential health journal, PLOS Medicine, published the results of a large individual-participant data meta-analysis, authored by FHI 360 and collaborators, that seeks to answer these questions.

    While this issue matters to the field of reproductive health, it is especially critical to women in East and Southern Africa. In these regions, women potentially have a double risk factor: high rates of HIV and high use of hormonal contraception, particularly depot-medroxyprogesterone acetate (DMPA), a type of contraceptive that is injected every three months. So far, the evidence on DMPA shows that it is the hormonal contraceptive that has the most potential to increase HIV acquisition; however, the evidence is inconclusive.

    FHI 360’s meta-analysis combines the results of 18 prospective studies, including more than 37,000 women, of whom more than 1,800 became infected with HIV. We found that women who used DMPA had a 50 percent increased risk of HIV acquisition compared with women who did not use hormonal contraceptives. We found no significant increase in HIV risk among women using combined oral contraceptives (COCs) or norethisterone enanthate (Net-En), a contraceptive injected every two months. Women using DMPA also had an increased HIV risk when compared directly with COC or Net-En users.

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  • A warm welcome in Mumbai

    It was 100 degrees outside when we pulled up in front a school in Mumbai last month. We were greeted by the sounds of booming drums, singing voices and ringing tambourines. The children were assembled outside of the school to welcome us. Before arriving, I was curious about how these children would receive us, but all doubts slipped away as they met us with open arms. The memory of that welcome continues to humble and inspire me in my travels to similar schools around the globe. Fifty students from two Mumbai schools were selected to participate in the three-year Johnson & Johnson Bridge to Employment (BTE) program designed to provide academic support, encourage lifelong learning and build awareness of careers in health care. BTE also works with parents, teachers and employees to support and guide students to new opportunities.

    According to 2012 data, only 58 percent of students from municipal areas graduate, leaving 42 out of every 100 young people without a high school diploma. For more than 20 years, BTE has been focusing on impacting communities all around the world with similar statistics.

    We’ve trained over 20 Johnson & Johnson employees, who serve as volunteers to mentor these 50 children, ages 13–16. BTE volunteers here in India and in all programs around the globe talk to their mentees about life and what it took to reach their own career goals and why civic engagement matters. Mentors teach students time management as well as resume writing, interviewing, teamwork and communication skills.

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  • Can women living with HIV and taking antiretroviral therapy use hormonal contraceptive methods?

    Extraordinary gains have been made in the last decade toward increasing access to antiretroviral therapy (ART) for HIV. With an eye toward ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90 percent of all people living with HIV aware of their status, 90 percent of people diagnosed with HIV receiving sustained ART and 90 percent of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

    An increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods. In theory, an interaction could affect the efficacy of either medication or cause side effects or toxicity. If contraceptive efficacy decreases, the chances of contraceptive failure, unintended pregnancy and the accompanying consequences increase. A decrease in ART efficacy could lead to treatment failure, viral resistance and greater likelihood of subsequent HIV transmission. Increases in side effects or toxicity can affect quality of life and medication adherence. Yet, despite the importance of this issue, relatively few studies (particularly those with clinical outcomes such as ovulation, pregnancy or treatment failure) have been conducted.

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  • Learning from failure in global development

    One of the most promising trends in global development is the rising priority of understanding and investing in “what works.” As the funds available for international assistance have flatlined in post-recession years, everyone from donors to practitioners has become increasingly committed to making decisions that are informed by evidence. Given FHI 360’s commitment to research utilization, we’re encouraged by the attention being paid to evidence-informed development. Yet, the best-kept secret within the growing what works movement is the importance of learning not just from our successes, but also from our failures.

    Based on typical nongovernmental annual reports, scientific conferences and even social media content, one can be forgiven for forming the impression that our development efforts are nearly perfect. Successes are proudly packaged in glossy formats and heavily disseminated, whereas any objectives not achieved are relegated to the obligatory and typically short lessons learned section. Yet, this practice does not accurately represent an important reality: Development efforts do in fact fail.

    Venture capitalists and corporate investors understand that less than 20 percent of new businesses will succeed, and they invest in innovations and new ideas with a transparent acknowledgment of the high risk for failure.

    So why, by comparison, is the global development enterprise so different?

    Read the remainder of the blog here.