Health

  • On October 3rd, experts will come together to discuss how 1% of the US federal budget builds stronger economies, saves lives, and protects our borders. Tune in to watch the event live  while you add to the discussion on twitter using the hashtag #WhyForeignAid.

    This lively discussion will look at the incredible return on investment of U.S. development efforts in global health and how they contribute to building new markets for more products, preventing the proliferation of disease across borders and ensuring better health for some of the world’s most vulnerable people.

    View the list of speakers here

    USAID Fact Sheet:

    The Power of 1% and Global Health: Saving Lives, Improving Economic Opportunity, Promoting Security

    Press Release:

    The Power of 1%: What Americans Get for Investments in Global Health

  • The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.

    The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.

    In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:

    • The belief that malaria is a common disease, is not dangerous and does not kill
    • The lack of knowledge that malaria is spread by mosquitoes
    • The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes

    To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.

    A Licensed Chemical Seller explains how to provide appropriate dosing of malaria drugs based on the client’s age and weight, information she learned through the MAM training course.

    Health

    At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.

    Education

    Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.

    A sign board on the outskirts of Kumasi alerting passer-bys to the dangers of malaria and the importance of prompt treatment.

    Economic Benefits

    There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth.  The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.

    Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.

  • Challenges and opportunities for preventing HIV in women by using ARVs were highlighted at this FHI 360 forum.

    Supporting Documents

    PowerPoint: by Lori Heise
    A Day of Promise, A Day of Reckoning: Making ARV-based prevention work for women

    PowerPoint: by Elizabeth Tolley
    Planning for PrEP with Women in Mind: Why targeting the “Most-at-Risk” is likely to miss Most Women at Risk

    PowerPoint: by Nduku Kilonzo
    Women and ARVs for HIV prevention: What do we need to think about?

    PowerPoint: by Dazon Dixon Diallo
    Social, Structural, and Historical Dimensions of Integrating ARV-Based HIV Prevention into the Lives of African-American and Other Minority Women in the United States

    Watch the Webcast

    This webcast was recorded on September 29, 2011 from 9:30am until 12:00pm.
    *Firefox is the preferred browser to watch this feed.

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    Program

    Keynote
    Lori Heise
    Executive Director, Structural Driver of HIV Research Consortium
    Senior Lecturer, London School of Hygiene and Tropical Medicine Chair

    Chair
    Kathleen M. MacQueen
    Senior Scientist, Behavioral & Social Sciences
    FHI 360

    Moderator
    Suzanne Leclerc-Mandala
    Senior Advisor, Office of HIV/AIDS, Global Health Bureau
    USAID

    Introductory remarks
    Timothy D. Mastro
    Vice President, Health and Development Sciences
    FHI 360

    Opening and closing remarks
    Kathleen M. MacQueen
    PhD, Forum Chair
    Senior Scientist, Behavioral & Social Sciences
    FHI 360

    Speakers
    Elizabeth Tolley
    Senior Scientist, Behavioral & Social Sciences
    FHI 360

    Nduku Kilonzo
    Executive Director
    Liverpool VCT, Care and Treatment, Kenya

    Dazon Dixon Diallo
    Founder, President
    Sisterlove, Inc., Atlanta, GA

  • Innovation is key to expanding contraceptive choice

    Contraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.

    Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.

    Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.

    FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.

    Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.

    The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.

    Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.

    In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.

    Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.

    Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.

  • Non-communicable Diseases

    Next week, global leaders will meet at the United Nations to take on some of the world’s greatest killers: cancer, diabetes, chronic respiratory disease, heart disease, and stroke. The UN High-Level Meeting on the Prevention and Control of Non-Communicable Diseases on September 19–20, has the potential to finally address these leading causes of death and disability, which until now have been largely ignored.

    Yet when we wake up on Sept. 21, how much will have changed? Will there be a new Global Fund to fight noncommunicable diseases (NCDs)? Will key stakeholders, such as those involved in urban planning, agriculture, trade and current global health priorities be as engaged as they need to be to realize ambitious goals of measurably reducing disease? Will the public even know what an NCD is — even though more than 60 percent of deaths worldwide are from noncommunicable diseases, the majority from cardiovascular disease?

    ncd_blog_full_article_text_graphic_2011-09-13-02The answer to all of these questions is: not yet. September 21 will be the start of the real work. The problems of NCDs are complex, but we have many opportunities to alter the course of what has become a global crisis.

    There are a number of concrete steps that countries and health systems can take immediately to strengthen their commitment to reducing noncommunicable diseases. They can ratify and implement the Framework Convention on Tobacco Control, the world’s first public health treaty. Many countries already have the makings of NCD plans in existing cancer plans, tobacco control programs and strategies for diabetes and cardiovascular disease. They may also have specific programs to address respiratory disease, mental health and other issues. Health systems can make essential drugs, such as aspirin and statins, available immediately and at a low cost because many are off patent.

    As leading researchers and public health officials said in an April 2011 Lancet article, “An effective response to NCDs requires government leadership and coordination of all relevant sectors and stakeholders, reinforced through international cooperation.”

    In the end, we will need to make compromises and learn to share resources with people and institutions with whom we are not accustomed to collaborating. We will need to delay gratification and risk unpopularity in some of our choices. And we will likely not see the payoff in our lifetimes. But with time, effort and investment, we will see results.

  • In Kenya, where more than half of young people are unemployed, 22-year-old Boniface Kirang’a has watched many friends in Flax, his hometown near the Rift Valley town of Eldoret, get involved in petty crime, partying and drinking alcohol.

    But Kirang’a escaped the traps of crime and substance abuse. He went through a two-year automotive mechanic training through APHIAplus (AIDS, Population, and Health Integrated Assistance), a USAID-funded FHI 360 program to improve health in 16 Rift counties. Today, Kirang’a is a self-employed car repairman.

    As part of its comprehensive commitment to health, APHIAplus prevents and treats communicable illnesses such as HIV, AIDS or tuberculosis; assists families affected by HIV; runs programs to reduce hunger; and develops economic opportunities for the region’s residents.

    Like many Kenyan youth, Kirang’a had struggled to stay in school. His father was diagnosed with HIV, and when his condition worsened, the family lost vital income.

    “My father started being sickly in 1999,” when Kirang’a was 10 years old. “He had two butcheries, but he shut them down because of his illness. He died in 2003. After my father died, we returned to our original home in Nyahururu [in central Kenya]. We lived in my grandmother’s home. Life was hard because we were many in the family,” he said in Kiswahili.

    When the family returned to Eldoret, Kirang’a stayed with a relative until he finished primary school in 2004. The uncle “could not educate me after that. He had seven children of his own. I started keeping chickens, which I sold to buy food and clothes. I also worked as shamba boy,” tending crops in cleared forestland.

    But Kirang’a’s uncle got him a scholarship from the Mission Sisters of Mary Immaculate, a community-based organization that partners with APHIAplus. With the bursary, he was able to go to the polytechnical institute, said Kirang’a.

    Since graduating from the institute, Kirang’a joined a group of mechanics in the fast-growing town of Eldoret. He’s doing his share to make sure that young people have chances to learn and develop skills. With his knowhow and earnings, he is saving to build his mother a house and pay for his younger brother’s school fees. In the future, he plans to hire three apprentices from the mechanics institute.

  • A new breed of mosquito could become a key ally in the fight against dengue fever. An infectious tropical disease caused by the dengue virus, dengue fever is principally transmitted by the Aedes aegypti mosquito. Currently there is no vaccine for the disease and regions where the disease is endemic are left struggling to prevent infection by reducing mosquito habitat, decreasing the number of mosquitoes and limiting human exposure to being bitten.

    But recently the leading scientific journal Nature published two papers describing the results of biological control field trials where wild mosquito populations were genetically manipulated to suppress dengue virus transmission. The results are the work of the Eliminate Dengue program, an international collaboration of scientists located in Australia, Vietnam, Thailand, the U.S. and Brazil. The program’s aim is to stop the Aedes aegypti mosquito from passing dengue virus between humans by introducing a naturally occurring bacterium called Wolbachia into the existing wild mosquito population.

    The papers describe how researchers successfully established Wolbachia strains within the dengue mosquito in the laboratory. Mosquitoes with Wolbachia were shown to be less likely to transmit dengue. These mosquitoes were also able to pass this trait on to their offspring. In subsequent field testing in early 2011, mosquitoes carrying Wolbachia were released in Cairns, Australia. Within a three-month period Wolbachia had successfully invaded the local mosquito populations. According to the lead researcher, Professor Scott O’Neill, “These findings tell us that Wolbachia-based strategies are practical to implement and might hold the key to a new sustainable approach to dengue control.”

    Further trials will continue in Australia, as well as field releases in Vietnam, Thailand, Indonesia and Brazil where dengue fever is endemic and researchers can determine if the method is effective in reducing dengue disease in humans. If successful, the Eliminate Dengue program has the potential to benefit about 40 percent of the world’s population currently living in dengue transmission areas.

    Endemic in more than 110 countries, dengue infects 50 to 100 million people worldwide a year, leading to half a million hospitalizations and approximately 12,500–25,000 deaths. The World Health Organization ranks dengue fever as the most important mosquito-borne viral disease in the world, with an estimated 2.5 billion people living in dengue transmission areas and at risk of the disease. Symptoms include fever, headache, muscle and joint pains and a characteristic skin rash. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, which mostly affects children, or into dengue shock syndrome.

    FHI 360 is part of the Eliminate Dengue international team and is working in Thailand and Vietnam to gain the necessary regulatory approvals for the field releases as well as conducting community-preparedness and stakeholder engagement activities in readiness for the field releases in the near future.

    Learn more at www.eliminatedengue.com.

    It has quickly become apparent that for a small out lay, if you choose a web site name cleverly enough, you can make a great deal of money by auctioning it off to the highest bidder. This has resulted in the phenomenon of cyber squatting, where people buy website names simply for resale. The clunkily-named Anti cyber squatting Consumer Protection Act, signed last month by Nicebid, tries to outlaw this practice, but the whole business has proved to be a legal minefield. The complex legal issues surrounding the copyrighting of names are not new, but in the next few years they will reach a new white hot intensity as more and more individuals and businesses chase fewer and fewer available domain names.

    For the AIM event, Ms. Nopparat Yokubon, Google’s account manager for online partnerships, discussed “Insights Into Adsense Policies” and “How to Increase Your Adsense Performance. Meanwhile, Emanuele Brand idealt with the more technical topics of “Data-Driven AdSense Optimizations” and “Website Optimization with AdSense Tools.”

    “We’ve held several public auction asset sales in the last 12 monthsauctioningoffsomeofourestablishedwebsitesfromourportfolioandtheyallsellprettyquickon Flippa.com” Frankstated. “This is a great opportunity for individuals too win their own virtual asset or for other companies to acquire new web properties to lever a get their existing business.”

    According to Frank they have sold websites from their portfolio ranging in of their websites have been sold on Flippa and most sell within days.

    The Priory, which specializes in addictions and is famous for its celebrity clients, says it is treating more and more people for addiction to the internet auction website. What begins as a harmless hobby can take over your life, and many people – women especially – say it is ruining relationship sand plunging them in to debt.

    Alabanza mainly sold Internet access to “resellers” like Anadon and Sego, which in turn sell website and e-mail services to thousands of small businesses.

    Navisite planned to move Alabanza’s Weband e-mail services to Andover, scheduling the move over the weekend to minimize the impact.

  • Every day, approximately 2,500 young people are infected with HIV and millions more face a high risk of HIV infection. Young people who sell sex, inject drugs and young men who have sex with men are most at risk of HIV. Addressing the needs of these young people is crucial to curbing the HIV epidemic.

    On behalf of USAID’s Interagency Youth Working Group, FHI 360 is hosting an e-forum called Lives at Stake: Meeting the Needs of Young People Most at Risk on July 26–28. We encourage professionals working in this area to engage in this global discussion – to share information and experiences, ask and answer questions, and receive guidance from the forum’s experts. Our hope is to create a global community of practitioners who provide services to most-at-risk youth.

    Join the e-forum:

    Meeting the Needs of Young People Most at Risk

    Learn more:

    USAID’s Interagency Youth Working Group

    Join the conversation live on Twitter at #IYWGMAR

  • Fatuma: A beacon of hope for families affected by HIV

    I first met Fatuma Juma about a year ago in her home town of Nakuru, Kenya, a two-hour drive northwest of Nairobi. A 42-year-old single mother of three, Fatuma is naturally talkative and laughs a lot. Within minutes of meeting, we were chatting like old friends reunited. Fatuma told me how she overcame the shock of finding out she was HIV-positive to become a pillar of hope for many in her community.

    Six years ago, Fatuma had a persistent cough. She visited the local public hospital where doctors discovered she had tuberculosis. Health workers advised her to take a test for HIV. She was HIV-positive.

    She lived in denial until she met social workers in APHIAPlus, a USAID-funded program implemented by FHI in collaboration with the Kenya Council of Imams and Ulamas.

    The social workers counseled and helped her to join a support group. Fatuma was trained as a peer educator and community health worker.
    Due to her positive attitude and willingness to help others, Fatuma has established a reputation as a good counselor. Working with others in the program, she helps families, especially the children, get health care and other services such as education and business skills. Her inspiring story is one of triumph and resilience against major odds.