This great blog post comes to us from Dr. Juan José Amador, Director of Health Systems and Technology in Nicaragua at PATH

During my childhood in Nicaragua, I used to see a shocking sight: Groups of people carrying child-size coffins through the streets toward the cemetery. Families-usually the poorest in my community-mourning the deaths of their youngest members. Almost always, diarrheal disease was the cause.

Back then, these funeral processions were common. Diarrhea was a lethal epidemic, most often striking babies before they reached their first birthdays. We had few resources and little information to stop it.

When I became a doctor, we didn’t think that our country could overcome the disease. Three years ago, however, things began to change.

With PATH’s partnership, Nicaragua began vaccinating newborn babies against rotavirus, the most common cause of severe diarrheal disease, and helping families understand how better hygiene reduces risk. PATH partnered with health workers to introduce new saline solutions and other remedies for keeping young bodies hydrated and healthy.

And it’s working. We’ve cut the number of children who die from diarrhea in half. Hospital diarrhea wards are now empty, thanks to lifesaving rotavirus vaccine and other simple interventions:

Read Wilson’s story here, and check out the slide show here.

My hope for Nicaragua is a generation of healthy children who can learn better, smile bigger, and grow up strong-without the threat of death from diarrhea. Many years ago, we didn’t believe this was possible. But in a few short years, we have changed the history of my country.

On September 21, PATH will receive the 2009 Conrad N. Hilton Humanitarian Prize. The $1.5 million prize is the world’s largest humanitarian award and recognizes a nonprofit organization that is making exemplary and extraordinary contributions toward alleviating human suffering. We are truly excited and humbled to receive the award and to join an esteemed list of Hilton Prize laureates.

We also recognize that our accomplishments depend on the people in the developing world who are using PATH’s technologies to bring health within reach for everyone.

Consider the experience of Nurse Emily, who works at Vihiga District Hospital in Kenya. Nearly every day she sends pregnant women home with a dose of nevirapine syrup in case they can’t make the journey back to the hospital to give birth. The women are HIV positive, and the syrup can protect their babies from getting the virus during birth.

Health workers used to struggle to find ways to keep the medicine safe as women carried it home and stored it. Then PATH developed a sealable foil pouch that keeps the medicine clean and protected. Now, as Emily hands the simple pouch to expectant mothers, she sees new hope for the lives of children in her community.

With the Hilton Prize, we plan to bring even more optimism to communities like Emily’s. We’ll use the Prize funds as innovation capital to support new initiatives in areas we’ve identified as critical to PATH’s mission: accelerating innovation in product development and introduction; bringing to scale essential health solutions and programs; and expanding our field presence, especially in Africa.

Follow us on Facebook and Twitter and visit our website, www.path.org, to learn about the world’s most pressing health needs and to watch our progress as we continue to find solutions for health and hope.

-Scott Jackson, Vice-President of External Relations at PATH, an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH’s work improves global health and well-being. For more information, please visit www.path.org.

Photo caption: PATH President Chris Elias accepting the award from Steven Hilton with Bill Gates, Sr. looking on.

The World Health Organization’s expert advisory panel on immunizations announced today that all children should receive a vaccine that can prevent a severe type of diarrhea and vomiting caused by the rotavirus.

Every year, 600,000 children die from severe diarrhea caused by rotavirus around the world.  Although most of these deaths occur in developing countries, rotavirus also afflicts children in the developed world.  In the United States, 55,000 children are hospitalized because of rotavirus infections every year. 

Research to determine whether the rotavirus vaccine is safe and effective in countries with high child mortality has proven successful: cases of severe diarrhea were reduced after administration of the vaccine.  Funded by the GAVI Alliance, and conducted by PATH, WHO, and GlaxoSmithKline, as well as many research institutions in South Africa and Malawi, this research “clears the way for vaccines that will protect children in the developing world from one of the most deadly diseases they face,” said Dr. Tachi Yamada, President of the Global Health Program at the Bill and Melinda Gates Foundation.

As one of the diseases that causes the greatest number of deaths and illness in the developing world but receives little attention and resources, the prevention and treatment of diarrheal diseases is a priority area for the Bill and Melinda Gates Foundation.  Their work involves funding research to determine the causes of diarrheal disease in developing countries, supporting the development of a vaccine, including the rotavirus vaccine, and efforts to develop medicines and other treatments for diarrheal disease.

Delivering the rotavirus vaccine with a package of other essential interventions including improving water and sanitation to children in need in Africa and Asia will be critical for reducing child mortality.

<em>-Lisa Fleisher</em>

David Poland of PATH offers this amazing account of the Phase 3 trial of the RTS,S malaria vaccine candidate.

Photo: MVI/David Poland
Trial participants and their mothers (on bench) with Dr. Salim Abdulla (standing left) and vaccination staff at the Bagamoyo Research and Training Centre of the Ifakara Health Institute (IHI) in Tanzania.

The initial vaccination of the Phase 3 trial of the RTS,S malaria vaccine candidate was at hand. Pulling through the gate of the district hospital and up to research facility, I saw Dr. Salim Abdulla, Director of the Ifakara Health Institute, Dr. Omary Juma, and Dr. Kafuruki Shubis talking out front.

“The day is here my friend,” Salim remarked, with the entire group sporting broad grins.

Salim convened the larger team for a last review of roles and instructions. I then made my way to the vaccination area and saw the five mothers and their rambunctious children who had already been screened for the trial. Staffer Richard Kamata was methodically explaining the consent form to the mothers and responding to their questions. A few exchanges provoked some laughter and ribbing and the mood was relaxed and casual.

The mothers then had individual sessions before giving their written consent. Shortly after, the toddlers were given their medical exams. For Salim, this was a time of wait and see; if a child showed signs of illness, they could not participate in the trial that day.

An hour later, the screening results came in. All the children were fit to be vaccinated…and Salim breathed a sigh of relief. “We’re still moving,” he affirmed.

The insulated box with the vaccines, hoisted on the shoulder of a team member, was brought down to the vaccination area. A file of research staff followed the box in a cheerful informal procession.

Finally the moment arrived. The mom was smiling and conversing with the nurses, while her daughter looked about curiously. Salim and the researchers left the vaccination room, as dictated by strict protocol of the double-blind study, and stood outside. The nurse confidently positioned the young girl and administered the injection. With that first piercing cry, I could swear I heard someone outside exclaim “All right.” A minute later, the girl was back to her normal inquisitive self. Mother and child made their way to the monitoring area and the other participants soon followed.

I went out in the courtyard and Salim declared “Well, we’ve started,” and there were handshakes all around. “Now the real work begins,” he added.

The monitoring period proceeded, and the children were regularly checked by the attending doctors. The children were given a final check and found to be fine—which seemed evident by the way they were back to playing.

The mothers and kids strolled out of the vaccination courtyard—off to attend to their daily activities. Salim and his extended team met to debrief about the day. Afterwards, the team went out on the veranda and enjoyed a modest celebratory lunch as the breeze blew through from the Indian Ocean.

A good day indeed for all involved.

Download more information on RTS,S and the Phase 3 trial:

• Fact sheet: Phase 3 trial of RTS,S (49 KB PDF)
• Fact sheet: RTS,S malaria vaccine candidate (83KB PDF)
• RTS,S frequently asked questions (47KB PDF)

-David Poland, Communications Officer, PATH Malaria Vaccine Initiative

Diarrheal disease is a leading killer of children under age five worldwide, responsible for the deaths of nearly 1.6 million children annually.

Are you surprised? If so, I understand why. Diarrhea is a hard thing to talk about and most of us aren’t dying from it. At best it is the subject of unfortunate jokes and at worst usually an infrequent symptom of a passing stomach virus. But there are children in the U.S. who still die from it and there are far more avoidable deaths from diarrhea around the world.

In fact, diarrheal disease is commonplace in Africa and Asia, as Nicolas Kristof and student contest winner Paul Bowers note in their recent Facebook and NYT blog posts. But it doesn’t have to be commonplace. The global health community knows what is necessary to prevent and treat diarrheal disease – there just isn’t adequate attention and funding to bring this knowledge and the tools to those who need it most.

Yesterday, PATH along with over 80 supporting organizations announced a call to action to encourage our peers in the health, development, environmental, water/sanitation, and research communities to push for adequate funding of the proven interventions that prevent and treat diarrheal disease.

This call to action comes on the heels of the releases of Diarrheal Disease: Solutions to Defeat a Global Killer from PATH and Fatal Neglect: How Health Systems are Failing to Comprehensively Address Child Mortality from WaterAid America which both highlight the urgent need to refocus attention on diarrheal disease. You can be part of the call to action too. Please take a few minutes to check these reports out at www.path.org and www.wateraidamerica.org.

-Dr. John Wecker, Immunization Solutions Program and Rotavirus Vaccine Program, PATH

At a breakfast session this morning for journalists in a small hotel in Istanbul, Paul Reiter, head of the International Water Alliance, described the world’s quest to reach the third target of Millennium Development Goal 7, to halve the proportion of the population that lacks access to clean water and sanitation, like this. Alongside him, Jaehyang So from the World Bank’s Water and Sanitation Program and Jon Lane from the Water Supply and Sanitation Collaborative Council gave their input to a lively conversation about the world’s successes and failures to reach poor communities with water and sanitation and achieve public health goals of decreasing death rates from diarrheal disease.

Their reflections on the challenges in meeting the MDGs by 2015—which ranged from country adoption and behavior change to problems inherent in taking solutions to scale—confirmed Reiter’s observation. A problem of this scope, I suppose, requires a conference this size—20,000 participants from scores of countries, various heads of state and parliamentarians, and 800 reporters from around the world. Its sheer breadth is overwhelming—drought and climate change, water management (and mismanagement) and utilities, governance and accountability.

Nevertheless, there are glimmers of clarity and hope. Interestingly, many of those nuggets of good news seem to stem from elements related to developing countries.

For Martin Wegelin (who pioneered UV disinfection via rainwater collection in plastic bottles on rooftops in the slums of Nairobi 20 years ago), the progress is evidenced by a shift in the audience for his message. Seventeen years after Wegelin began his work on home-based solar disinfection, household water treatment is now in vogue in the development community—with ceramic filters, water tablets, chlorine drops, and innovative behavior change programs gaining market and consumer traction.

This morning, in a session sponsored by the Household Water Treatment and Storage Network, Wegelin said: “Last decade, I began my talks by saying ‘Hello, members of the sodis (solar disinfection) community.’ This decade, I begin my talks with, ‘Hello, members of the Household Water Treatment community.’ Next decade, I plan to say, ‘Hello, families and communities who are drinking clean water.’”

-Janie Hayes, PATH

ONE has partners on the ground in Turkey for the 5th World Water Forum. Our partners will be providing guest blog posts throughout the week to keep us updated on the meeting’s proceedings. Stay tuned for more in this series!

As I was quoted in the Associated Press the other day,“In America, diarrhea is bad takeout, in Chad, it’s the difference between life and death.”

I’m here at the 5th World Water Forum in Istanbul to help coordinate a journalist workshop on the health aspects of water, sanitation and hygiene. Journalists have come from as far away as Indonesia, Laos and Peru to learn about this massive, but surmountable, challenge.

We want to bring attention to this under-reported issue, as more children die of diarrhea and other water and sanitation related diseases than die of HIV/AIDS, tuberculosis and malaria combined. Meanwhile, 80% of research and development funding for diseases that disproportionately affect the poor is spent on these “big three” diseases. We aim to point out this disparity, not to take away funding from the more well-known diseases, but to see that more resources go to solving the water and sanitation crisis.

What is also unique about preventing and treating diarrhea is that affordable solutions are available now. Ceramic water filters, rope pumps, and ecosan toilets are all effective and sustainable solutions.

Sessions this week at the World Water Forum are going to focus on vast array of topics, such as new technologies, entrepreneurship and child health. The issue of poor water and sanitation in schools will also be discussed by UNICEF. An astounding 50% of schools in the developing world do not have access to water and sanitation.

PATH, WSSCC (Water Supply & Sanitation Collaborative Council), and Water Advocates are a few of the organizers of the journalist forum. We hope that the workshop and forum will increase attention on the health aspects of the water and sanitation crisis. With 5,000 people dying each day due to dirty water, and poor sanitation and hygiene, this cannot wait.

-John Sauer, Water Advocates

Earlier this year, malaria experts, prime ministers, presidents and celebrities joined together in New York to launch the Global Malaria Action Plan. This plan, if followed and funded, is supposed to lead us to a world without any deaths from malaria by 2015. This year, close to 900,000 people will die from the disease – 85% of them will be children under five in Africa.

In development, we can get a bit cynical about these big plans – there are many commitments made by donors that are not kept. But, the fight against malaria has a lot of momentum. Funding has increased significantly in the past few years; victories across Africa are showing that success is possible; and perhaps, the most significant step yet, a vaccine now looks possible.

The Bill and Melinda Gates Foundation (and their grantee, PATH’s Malaria Vaccine Initiative) and GlaxoSmithKline have worked together on a vaccine candidate that has now been shown to cut illnesses in infants and young children by more than half. These results were published this week in the New England Journal of Medicine. The Gates Foundation has spent more than $100 million supporting this initiative thus far. Though the vaccine still has to go through phase III trials, if all goes well, it could be ready for approval in 2011.

Having a working vaccine could change the map for malaria. Billions of people across the world live in areas that put them at risk for the disease. The possibility of a successful vaccine is reason for hope that the real progress being made fighting malaria will continue.

-Josh Lozman, Deputy Policy Director, ONE

Organizers of this year’s New York City marathon braced for a massive toilet incursion. The New York Times reported that the marathon would haul in 2,250 toilets into the city for race day—requiring more than 80 six-axle trucks, tens of thousands of dollars in rental fees, and a gaggle of 16,000-gallon tankers to suck them dry afterwards. Spread out evenly over the 26.2 mile distance, that’s an average of 86 toilets per mile. Why? Because, as the event organizers knew, toilets are a big necessity.

UK-based journalist Rose George would have agreed. On October 22, she visited Washington, DC for an event co-sponsored by PATH and Water Advocates and spoke to a crowd of 70 at the Equality Center about her new book, The Big Necessity: The Unmentionable World of Human Waste and Why It Matters. As a series of stories that collectively highlight the plight of the 2.6 billion people in the world who do not have access to a toilet, the book also showcases the world’s “toilet crusaders” and the solutions they are employing to address the problem in their own countries. She describes these individuals in many of her recent interviews, including on Chicago Public Radio.

Lack of toilets causes some of the world’s most (more…)

Todd Jennings, who works for PATH in Zambia, sends us his last post in a series for World Malaria Day.

4-25-2008

The 2008 Race Against Malaria concluded this World Malaria Day morning with all 31 riders arriving safely at the Mukuni Park Grounds in Livingstone. They had a royal reception—literally. Princess Astrid of Belgium shook their hands, followed by Rupiah Banda, the vice president of Zambia; and Yvonne Chaka Chaka, the South African entertainer and Roll Back Malaria representative.  A huge crowd had assembled in Livingstone for this year’s World Malaria Day celebration, which featured loads of VIPs like the above, plus all the health ministers from 14 southern African countries.  All gave a mighty applause when the cyclists entered the park, especially when everyone learned the riders had covered 1,000 kilometers since Monday. 

Joining the Cycling Association of Zambia for this year’s event was Tour d’Afrique cyclist Irmgard Bush. Because of her personal experience with malaria, she didn’t hesitate when invited to participate: Irmgard almost died of malaria in 2006 while on a marathon tour from Cairo to Cape Town. She suffered a severe bout of malaria and was attended to by medical staff in Mazabuka, Zambia. Since then, Irmgard has been a vocal supporter in the fight against malaria.

Irmgard was the only woman in the Race Against Malaria, and for much of the way she pedaled on a tandem with national cycling coach Peter Chintu, the rider featured in an earlier posting on this blog. In this audio clip, Peter talks about this year’s experience.

-Todd Jennings, Advocacy Officer, Malaria Control and Evaluation Partnership in Africa (MACEPA), a program at PATH, Lusaka, Zambia.

(more…)