Challenges

Vicious and Virtuous Cycles

Start anywhere in the vicious cycle and you can come back around. It is a chicken and egg phenomenon. Disease causes a burden on the healthcare system which often results in ineffective treatement. Kids are dying from ineffective treatement which binds families to poverty through medical costs and lost income.

We can break the cycle. When people, especially pregnant women and children:

• get vaccinated against diseases
• sleep under insecticide treated nets
• get the micronutrients they need
• have clean water and good sanitation

the kids and family are healthier and much less likely to die. Less illness puts less burden on the overwhelmed healthcare system, so that patients get better treatment. Families spend less on medicines and are healthier and able to work which feeds the economy. These systems are interdependent.

Healthier kids lead to healthier systems and break the cycle of disease and poverty.

Comorbidity

If your child has diarrhea and then gets malaria, she is more likely to die. What, then, is the cause of death, the dehydration from diarrhea or the malaria? To be more technical, is it from dehydration due to the loss of the swallow reflex from the malaria?

Which is the cause? If we were proactive about saving children's lives, which would we attack first, the diarrheal disease or malaria? The answer: both.

Where do you begin? Whichever is ready to implement. Assume you started after one disease, how soon would you go after the other disease? Isn't the answer: As fast as you could.

Each of several interventions helps the situation. Some are actually quite cheap, like a few cents per child, to do.

Lift The Straw

Straws are really small and light. A proverbial straw broke the camel's back. What happens when we lift a straw? What if we lift a whole bale of straws?

Lifting the straw makes the camel's load lighter. Camels sit to get loaded. An overloaded camel will not stand up. Lift enough of the burden, lift enough straws and the camel will stand up and get moving.

The bundle of inputs that the Measles Campaign provides could lift a bale of proverbial straw from the back of the system. Which straw matters?

Is Measles the Straw? The disease of Measles killed about 400,000 children in Africa in 2000. By 2005, that death toll should drop well under 100,000 and may be approaching 10,000.

Is Vitamin A the straw? The Measles Campaign also distributes Vitamin A supplement to children. Vitamin A prevents mental retardation and helps children develop.

Is Deworming the straw? The Measles Campaign distributes mebendazole with its campaigns. Mebendazole deworms the children of intestinal parasites common in areas with measles. Children absorb food better when their stomachs are not filled with worms. Is the straw we lift related to nutrition?

Are ITNs the straw? We know that providing an ITN to a family keeps the whole family healthier and more productive. We know that kids absorb nutrition better when an ITN is in the house. We know that ITNs will probably save a million lives a year when most families in Africa have them.

Are any of these the straw? Let's lift these straws now and be strategic about the order we lift them. When trying to lighten the load, don't throw out the light stuff! Let's tackle nets as an intervention now since it will drastically lighten the load. See the Lancet article on How Many Child Deaths Can We Prevent This Year for an analysis of inverventions.

Proportion of child deaths by disease In Africa. See Lancet.

Disease: Changing the Cycles

Why Focus on Africa? Africa has the worst of the problems, including 90% of the Deaths from Malaria.

Africa is overburdened. The people are overburdened. The health care system is overburdened. The economy is mired down. The system is caught in vicious cycles of poverty, disease, debt and misery.

The Rotary Model applies across silos. It operates systematically. Some simple inputs, including Insecticide Treated Nets (ITNs), lift multiple burdens. Specifically, ITNs lift the burden from the human immune system, lower hospital visits by 25-40% overall, and put $10-100 into the economy per healthy working adult. ITNs create a virtuous cycle. Every dollar spent on nets puts money back into the economy.

This information is so new it hasn't hit the scientific journals yet, except in small pieces. No one has put it together, even those working within The Rotary Model. Everyone is still figuring this out. Meanwhile, every day, every minute kids are dying who could be saved. We know what to do, we have willing partners and proven, reliable methods.

What is Needed?

Current vaccines are mostly funded. We still need funding for pneumonia, rotavirus, and rubella vaccines. Non vaccine goods are very cheap and mostly small in size so they can easily be delivered as add-ons to NIDs or as part of IMCI or IPT. Insecticide-treated nets are bulky. They require concurrent distribution for the first coverage and then a back-up for ongoing needs (plug into routine vaccination programs). As the non-vaccine goods are delivered, they build out the capacity of the local systems. It all feeds into logistics, health education, part start-up supplies, part ramp up of manufacturing… The food related non-vaccine goods need some manufacturing capacity to fortify vergetable oils, flour and salts.

last updated 25 May 2006