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How to improve Reproductive Health in Africa

Comprehensive, sustainable efforts must be taken in Sub-Saharan Africa to improve women’s reproductive and overall health, said the associate director for the Center for Global Health at Northwestern’s Feinberg School of Medicine at a campus lecture Wednesday.

Carolyn Baer

With 600,000 mothers lost annually to pregnancy-related causes and 80 percent of these deaths occurring in Sub-Saharan Africa, this is an important issue to address, said Carolyn Baer, who has worked with organizations such as the Centers for Disease Control and the Peace Corps program.  21.1 million AIDS orphans have died in Africa and 4.2 million unsafe abortions occur in Sub-Saharan African each year, she said.

It is important to remind the public this is an issue that affects everyone, Baer added. “Reproductive health is not just a woman’s issue,” she said.  “It is a husband’s issue, a son’s’ issue, a father’s issue, a community’s issue.”

The best ways to ensure a higher rate of survival is to invest in the education of boys and girls, train health care workers, end harmful practices, expand access to birth control methods, make abortion legal, safe and accessible, and improve and expand access to obstetric care, she said.

She focused specifically on four steps that can be taken within communities to address reproductive health: Safe motherhood services, prevention of rape and violence, provision of family planning, and prevention and treatment of sexually transmitted diseases. Safe motherhood services include providing prenatal care, ensuring clean and safe delivery and then offering postnatal services.

“It is that first 24 hours during labor that is the most critical,” Baer explained.

Communities can also establish a referral system to get a woman in labor from home to a health care facility quickly.   “Clean delivery kits” which include items such as soap, clean latex gloves and a plastic sheet, are another easy and doable precaution and can easily be gathered in local environments.

“Simple steps can yield big benefits,” Baer said.

Sexual and gender-based violence within communities is another important area that needs to be addressed. But it is important to work within communities to see what they consider to be the biggest issues of violence instead of imposing a preconceived agenda on them, she cautioned.  Once definitions and concerns have been established, it is possible to put together medical services, including psychological support and counseling, as well as provide emergency contraception, Baer said.

“A lot of people are so shamed and the stigma is so great, a lot of people don’t want to talk about it,” she explained. “Communities need to figure out how to help.”

Improving family planning services means making contraceptives readily available and accessible, as well as offering patients a choice of which type is best for their lifestyle.  Health care workers must also ensure confidentiality, she said.

“Gender relations needs to be considered,” she said. “And people need to be empowered to choose what works for them.”

Because in Sub-Saharan Africa access to laboratory equipment is limited, The UN recommends diagnosis of STIs be done using a syndromic approach, she said.  Syndromic means asking what the patient’s symptoms are such as fever, swollen belly, etc and diagnosing according to those signs and symptoms.

“Treatment protocol based on syndromic case management should be prepared and adopted,” Baer said.  “And the most effective drugs should be used at first encounter.”

All of these steps should be taken when possible to ensure better reproductive health in Sub-Saharan Africa, Baer said.  “Healthy families and communities need healthy moms,” she said.

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The Road Less Traveled – Public Health Graduate School Fair

Northwestern hosted its first annual Public Health Graduate School Fair on October 19 at the Norris University Center. Students interested in everything from working in global health roles to starting their own nonprofits attended to talk to representatives from graduate programs about how a degree in public health can help them reach their goals.

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Pakistan’s Floods: An Unprecedented Humanitarian Crisis

(from left to right): Dr. Asher Hasan, Dr. Rashid Chotani, Asad Hayauddin, Todd Shea

If you widened the Mississippi River from Minneapolis to New Orleans by five times, this would be the scale of devastation that occurred due to the recent flood of the Indus River in Pakistan, said Todd Shea, one of the presenters at the October 14th Pakistan Symposium sponsored by the Northwestern University Center for Global Health. Mr. Shea, along with Dr. Rashid Chotani and Dr. Asher Hasan, participated in the symposium entitled “Pakistan’s Floods: An Unprecedented Humanitarian Crisis.”

The three presenters painted a picture of the aftermath of the Pakistan floods to an audience of nearly 100 people. Also in attendance was Consul Trade and Commerce for the Consulate General of Pakistan Chicago, who participated in the final question and answer panel.

Dr. Asher Hasan, of Naya Jeevan for Kids, a social enterprise that provides micro-insurance for the urban poor, began by telling the story from the perspective of two young girls whose villages were destroyed. He explained that “trade, not aid” is really the best way to help Pakistan recover from this tragedy. Dr. Hasan demonstrated the Pakistan Resource Finder (http://pakistan.resource-finder.appspot.com/), which is a tool that allows users to search for and map medical resources and infrastructure throughout the country. He then explained his organization’s hub-and-spoke method for providing healthcare to some of the most rural and vulnerable populations. Unfortunately, he said, the challenge, even before the floods, is that the health care infrastructure is just not there and current centers are not left un-staffed or staffed by under-qualified personnel.

Todd Shea from Shine Humanity, a disaster relief organization, spoke next and discussed how his organization started immediately by using mobile medical teams to take services to people who could not get to medical facilities. As the situation has stabilized, however, they are moving toward providing support to existing medical facilities. “The system is totally overwhelmed,” said Shea, “….if this disaster had happened here in the States, even the U.S. couldn’t handle it.” His organization promotes consortium efforts between small organizations that do not have the typically high overhead that some of the large international organizations have.

Dr. Rashid Chotani, Director of the Chemical Biological Defense Programs at TASC and a senior advisor to the U.S. Department of Defense on Pakistan, concluded with a presentation that relied heavily on hard data. He focused on the most vulnerable victims: women of child-bearing age, pregnant women, children and the elderly. According to his estimate, within the next three months we should expect an additional 3,000 to 9,000 deaths in expecting mothers, prenatal infants, neonatal infants, and children less than five years old due to the floods. He concluded with two quotes from UN Secretary-General Ban Ki-Moon: “I will never forget the destruction and devastation I have witnessed” and “In the past I have witnessed many natural disasters around the world, but nothing like this.”

More on the symposium and the materials presented can be found on the Center for Global Health Website.

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Is Circumcision the Best Way to Prevent HIV in Africa?

Robert Bailey, Professor of Epidemiology, University of Illinois at Chicago

Circumcision is the most effective and promising tool that currently exists to prevent the spread of heterosexually acquired HIV infection in developing countries, an international health consultant and medical researcher said at a global health lecture on campus Wednesday afternoon.

The lecture, entitled “The Cutting Edge of HIV Prevention in Africa,” was the first of the Global Health Lecture Series and was cosponsored by the School of Public Health, Feinberg School of Medicine, International Program Development, and the Center for Civic Engagement.

Though there are several prevention tools such as behavior modification programs to promote using condoms or abstaining from sex, “The only truly evidence-based strategy that we have is male circumcision,” said Robert Bailey, who is also a professor of epidemiology at the University of Illinois at Chicago, a research associate at the Field Museum and co-director of the Chicago Center for AIDS Research. Other methods of prevention either don’t have the research to showcase their efficacy or have been found unsuccessful, he said, and a vaccine will not likely be invented soon.

But with 34 million people worldwide infected with HIV and 68 percent of those in Sub-Saharan Africa, preventive measures must be taken immediately. 5,000 men are newly infected each day in Africa, a number that health care professionals must slow down, Bailey said to the audience of 30 students, professors and community members who gathered in the Program of African Studies building on campus to hear him speak.

“We cannot treat our way out of this epidemic,” he said. “But we must find ways to prevent it from spreading.

One of those ways is clear, he said: The simple, cost-effective surgery of circumcision has been clinically proven to be both consistent and powerful in preventing HIV. According to evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa, uncircumcised men are two and a half times more likely to contract the HIV virus than those who are circumcised. Plus, unlike daily pills or other therapies, “once you’re circumcised you’re circumcised for the rest of your life,” he said, which makes it a one-time, inexpensive treatment (it costs about $50) that has lasting benefits.

After seeing the striking results of the clinical trials, The World Health Organization and UNAID threw in their endorsement in 2007, recommending that male circumcision now be recognized as an important intervention to reduce the risk of HIV.

But surgery alone is not the solution and must be performed in conjunction with other preventative treatments, Bailey cautioned. He is currently leading efforts funded by the Bill and Melinda Gates Foundation and the U.S. Government to implement a comprehensive package of HIV prevention services that includes male circumcision along with other tools such as couples counseling and sexually transmitted infection diagnosis in western Kenya.

Not only is circumcision effective in preventing the spread of HIV, it is also helpful in reducing sexually transmitted infections, genital herpes, genital ulcers and cervical cancer in women, among other things. And through implementing this comprehensive circumcision program, health care professionals will also have the opportunity to reach out and educate men and women on HIV and improve the health care infrastructure in Africa.

Bailey and his team have already performed 140,000 circumcisions in Kenya during the last 14 months and hope to perform 900,000 over the next 10 years. “My goal since 1994 when I first got into this was to show that [circumcision] is effective and implement it,” he said. “And now it’s happening.”

For more information on the Global Health Lecture Series, please visit http://globalhealthportal.northwestern.edu/news-and-events/events-archive.

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