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A whole new world 1961-2011 1953 Extensive longitudinal study of health and nutrition in young children in Nigeria - David Morley and Margaret Woodland.

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Presentation on theme: "A whole new world 1961-2011 1953 Extensive longitudinal study of health and nutrition in young children in Nigeria - David Morley and Margaret Woodland."— Presentation transcript:

1 A whole new world 1961-2011 1953 Extensive longitudinal study of health and nutrition in young children in Nigeria - David Morley and Margaret Woodland

2 Health interventions 1958 Launching of under-5- clinics with growth monitoring, vaccinations, treatment, teaching - Morley and Woodland 1962 Launching of first measles vaccination campaign in Africa -Morley and Woodland

3 Milestones 1966 Publishing of ”Medical Care in Developing countries”: Maurice King, David Morley and others

4 Milestones 1978 WHO/UNICEF Alma Ata Primary Health Care: ”Health for all by the year 2000”. Halfdan Mahler WHO DG: 1973- 1988.

5 Milestones 1983 UNICEF Child Survival and Development revolution: Selective Primary Health Care GOBI-FFF - James Grant: UNICEF’s Director 1980-95

6 Milestones 1990 World Summit for Children - James Grant

7 Milestones 2000 UN Millenium Development Goals especially goal -4 Koffi Annan, Jeffrey Sachs

8 Milestones IMCI strategy: 70% of deaths due to 5 illnesses: Pneumonia, Diarrhoea, Measles, Malaria, Malnutrition Search for General Danger Signs Ask about 4 main symptoms: Cough and Difficult breathing, Diarrhoea, fever, Ear Problems Assess each symtom by an algorithm Classify each into one of 3 categories: severe disease, mild disease, no significant disease Treat and if necessary referral

9 A whole new world 1961- 2011 n Vast improvement in child health since 1960: CMR 195/1000 n 2010: CMR 58/1000 n Child deaths from 12.5.million 1990 to 7.6 million 2010 n But gap between best and worst has increased; 1970: 9x 2005: 26x In SSA: 29x

10 Causes of child mortality 2002 n Perinatal deaths 23.1% n Lower resp infections 18.1% n Diarrhoeal diseases15.2% n Malaria10.7% n Millenium goal reduce by 2/3 global child mortality from 1990 to 2015 n Unlikely to be achieved in SSA and South Asia

11 Major advances over last 40 years and coverage n Breast feeding promotion39% n Oral rehydration therapy20% n Micronutrients esp Vit A, Zinc n Antibiotics for pneumonia and sepsis10-40% n Antimalarial measures including bed-nets and artemisinine combination therapy IBN 2000: 3% 2008:18.5%

12 The big three killers in LIC n Diarrhoeal diseases n Pneumonia n Malaria

13 Simple cheap measures to save lives n Diarrhoeal diseases: n Prevention: VIP latrines, tippy taps for better hygiene, upgraded shallow wells, solar disinfection of drinking water n Diagnosis: acute watery, persistent, dysentery n Treatment: ORS, n nutrition supplementation including zinc, tinidazole and/or antibiotics e.g. cipro for dysentery and/or persistent diarrhoea


15 Simple life-saving measures n Pneumonia: n Prevention: vitamin A, zinc, tippy taps, better locally made stoves with chimneys n Diagnosis: breathing frequency: 60/min 50/min 40/min Indrawing of lower chest on inspiration n Treatment: cotrimoxazole, amoxicillin or chloramphenicol in severe pneumonia


17 Childhood malaria n 90% of cases in SSA; 95% of deaths in SSA. Virtually all P.falciparum n Roll back malaria 2001-2010: reduce by ½ during this period n Global fund to fight malaria, TB, HIV/AIDS n Medicines for malaria venture n Multilateral initiative on Malaria n Bill and Melinda Gates $1 b. Oct 2007 for eradication of malaria

18 Pl. Falciparum med gametocyter


20 Malarial retina: ‘delineation’ of vessels


22 Malaria focal programmes n Impregnated bed nets n Better diagnosis: rapid tests n Multidrug therapy esp Artemisinine Combination Therapy e.g. Coartem n Better access and better skills n Possible future vaccine n Seldom place for drug prophylaxis in high endemic areas

23 Artemisia annua



26 Milestones in Maternal Health 1959 Ian Donald: ”Practical Obstetric Problems. Glasgow”

27 Milestones in Maternal Health 1967 John Lawson in Nigeria: ”Obs and Gynae in the Tropics”

28 Milestones in Maternal Health 1971 Hugh Philpott in S. Rhodesia: Practical Partogram. C/S in primips from 9.9%-2.6%

29 Milestones 1974 Catherine and Reginald Hamlin open Fistula Hospital in Addis Ababa

30 Milestones 1979 Sulochona Abraham, Vellore, Tamil Nadu launches community safe motherhood programme: MMR 1986: 120; 1996: 60

31 Milestones Maternal Health 1984 Michael Stark develops Misgav Ladach method of C/S. Widely launched 1995

32 Milestones in Maternal Health 1985 K.S. Shivkar, Mumbai launches condom use for PPH. Widely adopted 2003

33 Milestones in Maternal Health 2001 Staffan Bergström publishes extensive experience of Non-doctor operators for Obstetrical emergencies

34 Milestones 2002 Kenneth Björklund publishes massive retrospective study of Symphysiotomy as alternative to C/S. Gets support from WHO, World Bank, BJOG editor John Grant

35 A whole new world in Maternal Health n Global maternal deaths 1990: 526 000; 2008: 343 000 n MMR 1990: 320/100,000 live born n MMR 2008: 251/100,000 live born n Gap between best and worst has increased. Italy vs Somalia; 1:1085

36 The way forward in Maternal Health n Focus on First Referral Hospitals n Converge on 5 main killers: bleeding, sepsis, eclampsia and PIH, unsafe abortions, obstructed labour n Stimulate midwives with improved empathy and skills to choose rural work n Advocate introduction of partogram, condom for PPH, symphysiotomy, non- doctor operators, Misgav Ladach method for C/S

37 Conclusion Margaret Mead n Never doubt that a small group of thoughtful citizens can change the world. Indeed, it is the only thing that ever has.

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