Global Nutrition-A report Card

The 2016 Global Nutrition Report, a report that assess progress towards global nutrition targets as set by the World Health Assembly,  was released in June. This annual report is the result of a comprehensive review of state of nutrition by an independent, collaborative initiative that involves a diverse set of partners.

According to the latest report a staggering one in three of us suffers from malnutrition. Malnutrition is defined as “lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat.” The one in three number reflects a spectrum of malnutrition ranging from childhood stunting and wasting to adult overweight and obesity. Malnutrition is the number one driver of global disease burden and its occurrence tends to have a cascading effect.

Malnutrition 1Image Source: Global Nutrition Report 2016, p 21.

In the last five years or so, there has been traction and investment into ending malnutrition. The global nutrition targets for 2025 set by the World Health Assembly include:

  • Achieve a 40 percent reduction in the number of children under 5 who are stunted
  • Reduce and maintain wasting in children under 5 at less than 5 percent
  • Experience no increase in overweight in children under 5 years
  • Experience no increase in obesity and diabetes (in adults and adolescents)
  • Achieve a 50 percent reduction of anemia in women of reproductive age
  • Achieve a 30 percent reduction in low birth weight
  • Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50 percent
  • Achieve a 30 percent reduction in average population salt intake

According to the report there is significant variations between countries in the status of meeting the global targets. Many countries have made great progress and are on track to reducing under-5 stunting wasting, and overweight, and exclusive breastfeeding of infants younger than 6 months old. Of particular importance are data that show that under-5 stunting is decreasing in most regions except in Africa and the number of children under-5 who are overweight is increasing in Asia. Despite this success, the report points out that nearly all countries are off course with respect to global targets related to reducing anemia in women and adult overweight and obesity.

The calls to action issued by the authors of this report include:

  1. Governments making a commitment to end all forms of malnutrition; dramatic reductions in malnutrition in Brazil, Ghana, Peru and Maharashtra (Indian state) were due to political choices that were made.

Malnutrition 2
Image Source: Global Nutrition Report 2016, p 33.

  1. Invest more, allocate better”: Current spending is not enough to tackle malnutrition. According to the report  government spending and funding from donors are low and remain stagnated.
  1. Collect right data: Countries must strive to fill national and subnational data gaps to understand their unique nutrition contexts that would help them act on it by maximizing investment.
  1. Support evidence-based solutions and identify new solutions: Countries could learn from successes and use proven policies and interventions to tackle malnutrition.
  1. Address all forms of malnutrition: Curbing the rise of dual burden of undernutrition and obesity (and other nutrition-related NCDs) in many low and middle income countries would require policies, strategies and interventions that can take on the double-duty of tackling all forms of malnutrition.

Given the large numbers of refugees and internally displaced people, the report does discuss the vulnerability of this group to food insecurity and malnutrition. The authors also call for better assessment of nutritional status in emergency settings, incorporating nutrition-sensitive interventions and improved accountability of nutrition actions in emergency contexts.

The report does not discuss malnutrition among the elderly or the complete lack of data that would be helpful in understanding the magnitude of this problem. What the report is also missing or perhaps not within its scope, is the importance of maintenance of agro-biodiversity in combating malnutrition. The loss of biodiversity and its impact on providing better nutrition for today and tomorrow is something that cannot be ignored.

You can read the report in its entirety here and let us know what you think!

Global News Round Up

Politics & Policies

Officials from the March of Dimes and nearly 40 other advocacy and health organizations sent a letter to lawmakers earlier this week urging Congress to pass a measure that would not place restrictions on Zika funding and that would allow the budget to be expanded in subsequent years.

Republicans and Democrats play chicken With Zika Funding.  Never mind dire health warnings as the disease spreads, Congress has politics to play. The Senate has just three working days next week following the July 4 break to pass Zika funding, or it will punt until September, when Congress is next in session.

The United Kingdom (UK) has made the unprecedented move of leaving the European Union (EU), an economic and political union of 28 member countries. The implication of the decision is that it will affect the health of both of its citizens and those around the world.

After recent outbreaks of Ebola, Zika and yellow fever, senior health officials from the United Nations, Governments and other institutions are prioritizing global health security preparedness given ongoing concerns about national health systems that are weak, fragmented and underfunded.

Programs

The third annual Global Digital Health Forum (formerly the Global mHealth Forum), focusing on digital and connected health in low and middle income countries (LMICs), will convene on December 13-14, co-located with the 2016 Connected Health Conference at the Gaylord Conference Center in National Harbor, Maryland.  The forum brings together public and private sector organizations to share the latest evidence, experiences, and lessons learned on new applications and approaches in digital health

Global Health Corporate Champions (GHCC), a month-long service learning adventure, is an activity of the Global Health Fellows Program II (GHFP-II), a USAID program implemented by the Public Health Institute with support from PYXERA Global to make health services accessible in rural Ghana.

Research

According to a new study, nearly 845 million people (10% of total population) will be prone to micronutrient deficiencies if global fish catches continue to decline. The authors warned of a perfect storm in countries like Indonesia, Philippines, Malaysia, Maldives, Angola, Ghana, Nigeria and others that rely heavily on wild-caught fish for sustenance, and are under serious threat from “illegal fishing, weak governance, poor knowledge of stock status, population pressures and climate change.

The Guidelines for Accurate and Transparent Health Estimates Reporting, or GATHER, a checklist of 18 best practices that set the standard for disclosing how health estimates are developed, was released in June. The GATHER checklist was developed by WHO in partnership with researchers from around the world.

Phase 3 evaluation of a promising malaria vaccine candidate, RTS,S/AS01 shows that the efficacy of this vaccine wanes over time. The study was conducted across several sites in Africa and the researchers recruited 447 healthy children for the trial which began in 2007. The small study population is a limitation of this study.

Diseases & Disasters

A virus is killing hundreds of babies in the US each year, and leaving thousands with debilitating birth defects, including abnormally small heads and brains. This is not the Zika virus. It is a common and much less exotic one: cytomegalovirus (CMV).

The 2009 swine H1N1 flu pandemic, responsible for more than 17,000 deaths worldwide, originated in pigs from a very small region in central Mexico, a research team headed by investigators at the Icahn School of Medicine at Mount Sinai is reporting.  The scientists say their findings represent the first time that the origin of an influenza pandemic virus has been determined in such detail.

Afghanistan is one of 22 countries with a high burden of tuberculosis (TB) according to the World Health Organization (WHO). The estimated number of new cases each year is a staggering 53,000 and as many as 12,000 afflicted by this curable infection lose their lives each year. For a large number of those infected, a timely diagnosis and effective treatment is out of reach due to high levels of poverty, lack of access to effective health care, and ongoing conflict in large parts of the country.

When the first cases were reported in Syria 275 years ago, it was called “the Aleppo boil” or “the Aleppo evil.” And for good reason: The parasitic illness spread by sand flies causes nasty skin lesions that leave victims scarred for life physically and can leave emotional scars as well.

The current yellow fever outbreak in Angola began in December 2015. Since then it has grown and spread further. Today, more than five months on, 3,137 suspected cases have been reported in all 18 provinces, with 345 deaths. The disease has already spread, including to the Democratic Republic of the Congo, China and Kenya, and suspected cases are being investigated in other countries.

Flooding in the Yangtze River basin has left at least 112 people dead or missing in recent days, and the situation could worsen when a typhoon makes landfall this week.  About 16 million people have been affected by the rains that submerged vast tracts along the Yangtze, China’s longest river, ­according to the Ministry of Civil Affairs.  Nationwide, the death toll stands at 170, and direct economic losses exceeded 20 billion yuan (HK$23.3 billion), the ministry said.  Floods have created havoc in South Asia this week, with 33 killed in Pakistan and 25 dead in India after unusually heavy rains.

Technology

Rabies kills about 60,000 people a year, many of them children in Africa and Asia. Rapid tests for the infection are badly needed in poor countries.  But diagnostic test strips made by six companies for this purpose are “unsatisfactory” and “cannot be recommended,” according to recent evaluations by scientists at the Friedrich-Loeffler Institute in Germany.

Public health and development experts have set themselves ambitious goals to rid the world of disease and end preventable maternal and child deaths. The aims of the Sustainable Development Goals (SDGs) include ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases; ending preventable deaths of newborns and under-5 children; and reducing maternal mortality to less than 70 per 100,000 live births. All this is to be achieved by 2030, only 15 years from now.  Yet these same public health and development experts acknowledge that they don’t have the tools they need to achieve these goals.

“Land of a thousand hills” is an apt nickname for Rwanda. The tiny, landlocked country ripples with steep, terraced hillsides. Under its single-minded president, Paul Kagame, it is also determined to become a technology hub for Africa.  Zipline, a Silicon Valley startup, will start testing delivery drones (otherwise known as Unmanned Aerial Vehicles) at a site 40 minutes drive south-west of the capital, Kigali, in August.

We live in an age of unprecedented unforced migration, as people move across borders to seek better lives and opportunities: in 2015, 244 million people (3.3 per cent of the world’s population) lived outside their country of origin.  And this extraordinary age of mobility involves not just people, but also goods, money and ideas. Communication advances create unprecedented development opportunities, connecting people and organizations as never before.

A sleepy community of Key Haven has been identified by one company as the perfect spot to experiment with a controversial method of combating Zika before it reaches US shores — a method that has divided neighbors and could have broad implications across the country: genetically modified (GMO) mosquitoes.

Environmental Health

The global threat of highly persistent plastic waste accumulating and fragmenting in the world’s oceans, inland waters and terrestrial environments is becoming increasingly evident.  Humans are being exposed to both plastic particles and chemical additives being released from the plastic debris of consumer society.

Brush fires in Siberia are bringing a haze of ultrafine dust to Korea, according to a study.  Jung Jin-sang at the Korea Research Institute of Standards and Science says ultrafine dust particles from forest fires in Siberia are traveling 3,000 km (1,864 miles) south to the Korean Peninsula, causing lung and heart diseases.

Brazil’s government will hand out 9 million condoms for free around Rio de Janeiro during the Olympics in August, a push to encourage safe sex and also defend the Amazon rainforest.

Paris has launched a fresh attack on dirty air with new rules to prevent older, more polluting vehicles from driving on its roads.The restrictions, which came into force on July 1, will prevent any car registered before January 1997 from driving within the city’s streets between Monday to Friday, 8am to 8pm. The same rule will apply to utility vehicles put in circulation before October 1, 1997 and motorcycles before June 1999.

Equity & Disparities

In Tanzania, leafy green sprouts once crowded together – the sign of a good season of sweet potato crops. Today, a dry, barren dirt field remains. This could be any farm in Zambia, Ethiopia, Rwanda or elsewhere in the developing world. And this vacant landscape means one thing: there is no food. Without the basic staple of nutritious and healthy food, progress stops, people die, and whole communities are held hostage to hunger.

The World Health Organization recommended substandard care to people with multidrug-resistant tuberculosis living in developing countries, according to a new paper published in the Health and Human Rights Journal. Between 1993 and 2002, the WHO made treatment recommendations in low-income countries based on cost – treatment that was deemed substandard in wealthy countries.

In low-resource settings, clinicians are often asked to practice at the “top of their license.” General internists and primary care physicians are asked to diagnose and treat disease that would fall under the purview of subspecialists in the US. This, of course, is due to extreme lack of medical specialists across many low and middle income (LMIC) countries.  A study published in BMJ Global Health evaluated a program to provide free access to UptoDate to these clinicians and the results were fascinating.

The global news round up was prepared by the communications team.

Global News Round-Up

Politics & Policies

After less than a week of formal, bipartisan negotiations on Zika funding, congressional lawmakers have reached a deal.

In the nearly four months since the Obama administration issued its 1.9 billion Zika funding request, congressional lawmakers have publicly bickered over each chamber’s response to the virus.

In light of the Orlando mass shooting, the American Medical Association has declared gun violence a “Public Health Crisis” and said that it will lobby Congress to overturn a 20-year old legislation that put an end to research on gun violence.

In a rare reversal, the WHO has removed coffee from the list of possible carcinogens after an expert panel of 23 scientists reviewed hundreds of studies and found insufficient evidence for a link between coffee and cancer.

Global health action has been remarkably successful at saving lives and preventing illness in many of the world’s poorest countries. This is a key reason that funding for global health initiatives has increased in the last twenty years. Nevertheless, financial support is periodically jeopardized when scandals erupt over allegations of corruption, sometimes halting health programs altogether.

Programs

The Society for Disaster Medicine in Public Health (SDMPH) will have the 2nd Annual Meeting from July 27-29 at the Hilton Hotel in Rockville, MD.

Royal Philips and The Texas A&M University System Chancellor announced a collaboration aimed at developing population health solutions as part of the Healthy South Texas pilot project, creating integrated Emergency Medical Services (EMS) technologies for more efficient and effective coordination of response efforts, and developing point-of-care diagnostics and biosurveillance to help avoid epidemics and pandemics.

The National Institute on Minority Health and Health Disparities (NIMHD) will host the Summer Institute on Health Disparities Science from August 15, 2016 to August 19, 2016.  The program will support the development of individual research projects by promising scientists early in their careers and will stimulate research in the disciplines supported by science on minority health and health disparities.

Research

A preliminary surveillance report of pregnant Colombian mothers suggests that Zika virus infection during the third trimester of pregnancy is not linked to structural abnormalities in the fetus.

Diseases & Disasters

Two years after India was declared free of polio, a strain of polio virus has been identified in a sewer during routine checks in the Indian state of Telangana. In response to this, the Indian government will launch an emergency vaccination drive.

According to the CDC, Zika is spreading rapidly in Puerto Rico.   Blood donations suggest “the Zika virus has gained a startling foothold in Puerto Rico based on the number of blood donations that have tested positive for the disease.”

The U.N.’s refugee agency reports that the number of displaced people is at its highest ever,  surpassing even post-World War II numbers, when the world was struggling to come to terms with the most devastating event in history.  According to the United Nations High Commissioner for Refugees (UNHCR), 65.3 million were displaced at the end of 2015.

Technology

The Bill and Melinda Gates Foundation will be creating the Child Health and Mortality Prevention Surveillance Network, or CHAMPS in Asia and Africa.  CHAMPS will be a network of disease surveillance centers in developing nations that will “gather better data, faster, about how, where and why children are getting sick and dying.”

The WHO has approved two innovative new technologies to detect HIV among infants who pre-qualify. The products (both of which use disposable cartridges preloaded with chemicals needed for HIV detection), Alere™ q HIV-1/2 Detect (made by Alere Technologies GmbH) and Xpert® HIV-1 Qual Assay (made by Cepheid AB), will be able to diagnose HIV in infants in a matter of hours (as little as an hour), as opposed to sending the sample to a laboratory where it could take weeks or months.

Environmental Health

The Middle East has been the worst hit by significant rise in sand and dust storms, with major impacts on human health, United Nations scientists say.  Iran and Kuwait are the most affected countries, largely because of sand and dust blowing in from Syria and Iraq.

Equity & Disparities

A study conducted among Ethiopian women revealed that “majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0% of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively“. They also report that educational status and place of ANC visits were important determinant factors.

The global news round-up was prepared by the communications team

Coming up: 8th annual Conference on Health and Humanitarian Logistics (August 29-31, Atlanta, GA)

Registration for the 8th annual Conference on Health and Humanitarian Logistics is now live online here. If you have questions about registration, rates, or other information, you may also e-mail us at humlogconf [at] gatech [dot] edu.

The conference is hosted by the Georgia Tech Center for Health & Humanitarian Systems (CHHS) and co-organized by the INSEAD Humanitarian Research Group, the MIT Humanitarian Response Lab, and Northeastern University. The agenda features plenary panels and interactive workshops on a variety of topics related to supply chain management and logistics in global health and humanitarian response and development, as well as poster sessions on innovative research and ample opportunities for networking. Information on speakers, panel topics, health and humanitarian site visits will be available soon.

The conference will feature keynote addressesk from Principal Deputy Director of the Centers for Disease Control & Prevention (CDC), Dr. Anne Schuchat, and from President and CEO of CARE USA, Michelle Nunn, on humanitarian emergencies, as well as plenary panels on the below topics:

  • Strengthening Public Health Systems
  • Supply Chain Complexities in Refugee Crisis Response
  • Designing Supply Chains for Health Emergencies
  • Sudden Onset Disasters: Matching Supply with Demand

If you would like to lead a break-out workshop at the conference, please submit an abstract online (up to 1-page, including the names and bios of all presenters) on the Conference website here before June 24, 2016. Private sector companies must include a co-presenter from a non-governmental organization (NGO), governmental partner, or other organization as a demonstration of collaboration.

There are no conference scholarships or financial aid. However, limited funds are available to support students presenting accepted posters at the conference. Support includes free conference registration and up to $250 in travel expenses for students traveling in the US and up to $500 for students traveling outside of the US. To be considered for financial support, attach a single PDF file containing the items listed on the website as part of your poster submission. Poster presenter pays registration fee up front and will be reimbursed after the conference.

Global News Round-Up

Politics & Policies

On May 27, after months of advocacy and days of intense meetings, the G7 committed to promote Universal Health Coverage (UHC), calling it a “comprehensive framework that underpins all of the targets” in the Sustainable Development Goals.

This past week, Canada participated in international health meetings in Geneva focused on strengthening health systems and improving countries’ capacities to prevent, detect and respond to public health threats.

Programs

A new unified system to facilitate sharing of genomic and clinical data among cancer researchers called Genomic Data Commons was launched on June 6, the US National Cancer Institute (NCI) said.

On May 31, the Harvard Global Health Institute hosted a symposium entitled “Preparing Health Systems for An Aging Global Population.”

World Health Organization member states agreed on Wednesday to more than double the group’s emergency fund to $494 million for the next year, as it works to address major gaps in its ability to respond to global health emergencies.

May 31 is World No Tobacco Day.  The World Health Organization (WHO) and the Secretariat of the WHO Framework Convention on Tobacco Control are calling on countries to get ready for plain (standardized) packaging of tobacco products.

University of Wisconsin-Madison investigators will address flood forecasting and health implications, protecting natural fisheries, tracing the safety of wild-caught fish and improving diabetes care with four new Seed Grants from the UW-Madison Global Health Institute.

Research

The National Institutes of Health hopes to have an early safety study of a Zika virus vaccine by September 2016.

A large fraction of Plasmodium infections do not cause clinical signs and symptoms of disease and persist at densities in blood that are not detectable by microscopy or rapid diagnostics tests.

The United Nations Children’s Emergency Fund (UNICEF) conducted a research in the southern Osh province in Kyrgyzstan to understand the barriers girls face at school with regards to menstrual hygiene and puberty-related attitudes and practices among young people, parents, and teachers. Because they are having their period for the first time, many young girls in Kyrgyzstan are not aware of menstruation, nobody talks to them about this and they are left alone with their fear, with some even committing suicide.

Diseases & Disasters

On June 8-10, the United Nations General Assembly High-Level Meeting on Ending AIDS will bring people together around a common objective: ending AIDS by 2030 within the framework of the Sustainable Development Goals.

The pandemic of non-communicable diseases (NCD) is expected to claim 28 million lives annually in low- and middle-income countries until 2030.

The World Health Organization says there is “no public health justification” for postponing or canceling the Rio de Janeiro Olympics because of the Zika outbreak.

Doctors and scientists are bracing for the possibility of a wave of rare disorders triggered by Zika in Haiti, an impoverished country that has faced one public health crisis after another and is fertile ground for mosquito-borne scourges.

In Mozambique, almost 7 million people are at risk of losing their sight from trachoma, an eye infection that is the world’s leading cause of blindness.

So far, there have been 51 cases, including 10 deaths from an unknown disease in the northern part of South Sudan. The main symptoms of the disease are similar to those seen with Ebola: unexplained bleeding, fever, fatigue, headache and vomiting.

Technology

The Washington State University student startup company Engage earned $10,000 and a top prize at the University of Washington Business Plan Competition last week.  They are developing a simple needle decontamination solution that could save millions of lives in developing countries.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Government of Canada announced a new online marketplace today that is projected to save at least $250 million in the coming four years by offering health implementers competitive prices for medicines and health commodities.

Environmental Health

A comprehensive global study from the National Academy of Sciences has revealed that genetically modified (GMO) crops do not pose an adverse effect on the environment or human health.

Industrial agriculture is a key contributor to the rampant biodiversity losses now threatening the 35 percent of global crops dependent on pollination, the degradation of some 20 percent of global land, the 30 percent of global greenhouse gas emissions arising from food and farming, and many other negative outcomes in food systems.

Equity & Disparities

It is now over a year into a conflict in Yemen for which there is no imminent end in sight. Aid agencies are rightly focusing on immediate relief for the time being, but there is an urgent need to start thinking now about reconstruction once the conflict comes to an end. And nowhere is this need greater than in health.

Myanmar has some of the worst health indicators in Asia, as a result of its tumultuous recent history and the second lowest spending on healthcare in the world. Life expectancy is just over 64 years for men and approximately 68 years for women,  compared with the average life expectancy of 82 years for women and 77 for men in the OECD countries.

A new study in The Lancet “estimates that the recent economic crisis was associated with over 260,000 additional cancer deaths in countries within the Organisation for Economic Development (OECD) by 2010, of which 160,000 were in the European Union.”

The clearest link between poverty and the rise of antimicrobial resistance is that poor people may not see a qualified health care provider or complete a course of quality antibiotics. Instead, they might turn to unregulated markets for substandard drugs.

(The global news round-up is prepared by the Communications Team)