It is heartening to see progress in the fight against malaria. Over the past thirty years and with hundreds of millions of dollars invested thus far, the RTS,S malaria vaccine was officially rolled out yesterday in Malawi. In 2017, I wrote about the vaccine trials that began in 2009 and the announcement of the three countries that had been chosen for the vaccine rollout: Kenya, Malawi, and Ghana. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria. Now two years later the vaccine is officially in use to curb the unnecessary deaths of hundreds of thousands of African children under the age of five. The Malaria Vaccine Implementation Program will continue through 2022.
Q&A with NACCHO Board Member Sandra Elizabeth Ford, MD, MPH
Director of the DeKalb County Board of Health
A baby is born with a birth defect in the United States every 4.5 minutes, according to the Centers for Disease Control and Prevention (CDC). Birth defects are defined as any structural changes present at birth that affect how the body looks, works, or both, and they can vary from mild to severe. While not all birth defects can be prevented, there are concrete steps pregnant mothers can take to increase the chances of giving birth to a healthy baby. In honor of National Birth Defects Prevention Month, the CDC released a resource guide providing pregnant moms tips for preventing birth defects.
In addition to guidance provided by CDC, many local public health departments provide prenatal care for expectant moms. Below is Q&A with National Association of County and City Health Officials (NACCHO) Board Member Dr. Sandra Elizabeth Ford, Director of the DeKalb County Board of Health in Georgia. NACCHO represents the nation’s 3,000 local health departments.
Around 17 percent of American children from age 2 to 19 are classed as “obese”. That’s a level that has remained fairly steady over the last decade. And it’s growing.
Obesity is measured in terms of Body Mass Index (BMI) – a measure that can be used to compare children in terms of their weight. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. For children and teens, BMI is so age- and gender-specific that it is referred to as BMI-for-age. BMI levels among children and teens need to be expressed relative to other children of the same age and gender. Every child is different and that makes it difficult to generalize on something like this.
Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and gender. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and gender.
To give an illustration, a 10-year-old boy of average height (56 inches) who weighs 102 pounds would have a BMI of 22.9 kg/m2. He would be considered obese because this calculation puts him in the 95th percentile for BMI-for-age. His BMI is greater than the BMI of 95% of 10-year-old boys in his “reference population”.
I am always happy when World Breastfeeding Week rolls around each year. It gives me a chance to hear about the latest programs that are working around the world to increase breastfeeding rates. This year I learned about how World Vision is promoting breastfeeding in the Philippines through its 7-11 Core Intervention Framework which includes 7 interventions for women and 11 for children 0 – 24 months of age.
The way in which we discuss breastfeeding is different depending on the country and the context. While in the United States we talk a lot about infant feeding choices, in other countries, especially those that have thousands upon thousands of yearly infant deaths caused by diarrheal diseases, infections, and sub-optimal feeding, the context changes. In these cases, it is nearly always critical that mothers breastfeed their children up to two years of age.
In the Philippines, parents spend $240 million on breast milk substitutes and multinational formula feeding companies spend $100 million on marketing in the Philippines alone. Those numbers account for the fact that only 34% of infants under the age of six months are exclusively breastfed. While providing the best start in life for infants, many mothers are convinced that formula is better and easier for their lifestyles. But, often times women in low-and-middle-income countries like the Philippines do not always have access to clean water for formula. Dirty water can cause deadly diarrheal diseases that kill infants.
There’s a growing global recognition of proper infant nutrition in the child’s first 1000 days of life. This can be monitored through encouraging proper nutrition during pregnancy and the first two years of life for optimal growth, health and survival.
Poor breastfeeding and complementary feeding practices are some of the common causes of malnutrition in the first two years of life. Breastfeeding confers both short-term and long-term benefits to the child like reducing the risk of infections and diseases like asthma, obesity, and type 2 diabetes. Mothers who breastfeed also lower their risk of developing breast and ovarian cancer, weak bones, obesity and heart diseases.
For countries to reap the benefits of breastfeeding they need to achieve a baby friendly status. Kenya began promoting the baby friendly hospital initiative approach in 2002. It ensures that health facilities where mothers give birth encourage immediate initiation of breastfeeding and exclusive breastfeeding for the first six months. Unfortunately, this programme was only accessible to women who delivered in the health facilities, leaving out those who give birth at home.
We conducted a two year study involving 800 pregnant women and their respective children in a rural area in Kenya. The study involved testing feasibility and potential effectiveness of the baby friendly community initiative (BFCI), whereby women in the intervention arm were given home-based counselling on optimal breastfeeding alongside health facility based counselling. These mother-child pairs were followed until the child was at least six months.