Monday, December 24, 2007

Monitoring and Program evaluation

Hey y'all thanks for a great semester here is a link to the website that has all of the most recent monitoring and evaluation guidelines. I am going to try to post our powerpoint to courseworks however, I left my flash-drive at school so that might not be doable.

The publications we used as sources were
Theresa Finn. (2007) A Guide for Monitoring and Evaluating Population-Health-Environment Programs

Gage et al. A Guide for Monitoring and Evaluating Child Health Programs

Monday, December 17, 2007

Bangladesh from our View: When Nari Jibon acts as an alternative skill provider

Bangladesh from our View: When Nari Jibon acts as an alternative skill provider:
"Population is increasing rapidly in Bangladesh day by day and the same time the percentage of educated persons is also increasing. Almost at the same time women’s education is also increasing from previous levels. But Bangladesh government and economy are failing to create sufficient work for these educated populations. These educated and unemployed populations are facing heavy competition to get a job and are struggling with many difficulties [...]"

Congressional Conferees Raise the Bar

The House and Senate foreign operations conferees report that was presented today, Dec. 17, supports the Global Health Council's advocacy agenda to increase U.S. global health investments in several core programs. The additional funding for maternal and child health programs, nearly $100 million over the FY2007 level, is particularly gratifying given the Council's work on this issue over the year.

"We know that we can save millions of children's and mothers' lives if we invest in the proven interventions already available to us," said Dr. Nils Daulaire, president of the Global Health Council. "In this very difficult budget environment, it is gratifying to see that the grassroots work of our members and regular advocacy efforts on Capitol Hill have been well received by members of Congress from both houses and both sides of the aisle who are committed to supporting these critical issues. We are particularly grateful for the leadership of global health champions like Sen. Patrick Leahy of Vermont and Rep. Nita Lowey of New York."

The House and Senate foreign operations conferees report puts funding levels for global health priorities - including HIV/AIDS programs, tuberculosis, maternal health child survival - at an increase of about $1.8 billion over this year for fiscal year 2008 (FY08).

The global health appropriations presented by House and Senate foreign operations conferees include:
  • Maternal and child health programs, including delivery of interventions to save newborn lives, will receive an increase of more than $90 million, bringing the total U.S. investment in its USAID-funded programs to $450 million;
  • Family planning programs, both USAID bilateral spending and contributions to multilateral agencies, will receive an increase of approximately $24 million in FY08, bringing spending up to $425 million;
  • USAID's programs to combat tuberculosis (TB) will receive an increase of approximately $74 million, bringing total TB spending up to $153 million;
  • Malaria programs, including the President's Malaria Initiative, will see an increase of $100 million, bringing the total to $350 million;
  • The Global HIV/AIDS Initiative spending for both the President's Emergency Plan for AIDS Relief (PEPFAR) and multilateral spending through the Global Fund to Fight AIDS, Tuberculosis and Malaria, will see an increase of approximately $1.5 billion, bringing total spending up to $4.7 billion. USAID's global AIDS programs saw a decrease in appropriations from $594 million in 2007 to $350 million for FY08;
  • Spending on avian influenza will increase to a total of $115 million;
  • U.S. investment in neglected tropical diseases remains steady at $15 million for FY08.
The proposed spending on foreign operations measures is part of an 11 bill omnibus congressional lawmakers released over the weekend. The measure, which includes budgets for each Cabinet department except the Pentagon, is expected to be voted on by the House this afternoon and the Senate later this week.

Proposed increases for the National Institutes of Health and the Centers for Disease Control, and language that would have rescinded the restrictions on aid to overseas family planning groups that provide abortions (the Global Gag Rule/Mexico City Policy) were withdrawn.

--This article is from Happy Holidays!

Sunday, December 16, 2007

Frustration With Charities and U.N. in Congo

Frustration With Charities and U.N. in Congo - New York Times:
"Frustration at the United Nations peacekeeping force and the dozens of aid organizations working in North Kivu Province, in eastern Congo, is rising as violence increases, the number of displaced people here creeps toward one million, and the pace of assistance lags, especially to those fleeing the fighting in the past few weeks [...]"

Wednesday, December 12, 2007

Nigerian ex-oil governor arrested

By Alex Last
BBC News, Lagos

James Ibori, former Delta State governor
Mr Ibori's assets are said to include a jet and London property
Nigeria's anti-corruption agency has arrested former Delta State Governor James Ibori, over allegations of corruption and money-laundering.

The head of the agency, Nuhu Ribadu, said Mr Ibori would be charged in the federal high court on Thursday.

Mr Ibori is also under investigation by the Metropolitan police in the UK.

The failure to prosecute Mr Ibori in Nigeria had raised doubts over the government's commitment to its anti-corruption campaign.

Mr Ibori is the most high-profile former governor to be arrested under the new administration.

Agents from Nigeria's Economic and Financial Crimes Commission (EFCC) arrested Mr Ibori at a private residence in the capital, Abuja.

Bold statement

Mr Ibori is the former governor of Delta State, one of the largest oil-producing states in Nigeria and, therefore, one of the richest.

Nigeria's President-elect Umaru Yar'Adua
Umaru Yar'Adua has promised to continue the fight against corruption
He was seen as a key financier of President Umaru Yar'Adua's campaign for April's elections and is politically very powerful and well connected.

But he has been under investigation in the UK over allegations he laundered millions of dollars of looted state funds - charges he denies.

A UK court has frozen assets in the UK, allegedly belonging to Mr Ibori worth $35m.

His official salary while in office was less than $25,000 a year.

Mr Ibori, like other state governors, lost his immunity from prosecution when he had to leave office earlier this year.

But the key political issue has been whether anti-corruption agencies would be allowed to go after him in the way they have gone after other former governors.

The actions of Nigeria's new attorney general have been under particular scrutiny in this case.

Law enforcement agents in the UK and Nigeria have complained that he has been using his position to stall the prosecution of Mr Ibori - a charge he denies.

Still, it raised questions as to the scope of the new president's anti-graft policy.

This arrest is a bold statement from the anti-corruption agency at least that no-one is safe from prosecution.

Monday, December 10, 2007

Relevant Links for Tomorrow's Presentation on Corruption, Equity and Ethnicity

Those interested in reading up for tomorrow's presentation, should take a look at Transparency International's website. The site has great information on

1. defining corruption:


2. corruption and health:

Also, the Global Health Watch provides terrific information on the role global institutions, transnational corporations and rich countries have played in propagating corruption in the global South. Check out Part E of the report contents at:

Sunday, December 9, 2007

Bangladesh completes polio vaccination drive

News | Africa -
"Millions of children across Bangladesh were given their second vaccination against polio on Saturday, completing a drive to wipe out the disease, which re-emerged early last year, health ministry officials said [...]"

Women, Infants, and Children: But What About the Men?

Challenging Dogma - Fall 2007: Women, Infants, and Children: But What About the Men? –Read Holman:
"Despite its successes, the program has not gone without its critics. Many have criticized that the foods available to enrollees are not all appropriate(4), that it pushes infant formula feeding (5), that the program is inadequately funded (6,7), and for other reasons (8,9). However no records have been found that critique WIC in its effects on certain male populations from a social and behavioral science viewpoint."

Friday, December 7, 2007

U.S. Agency’s Slow Pace Endangers Foreign Aid

U.S. Agency’s Slow Pace Endangers Foreign Aid - New York Times:
"The Millennium Challenge Corporation, a federal agency set up almost four years ago to reinvent foreign aid, has taken far longer to help poor, well-governed countries than its supporters expected or its critics say is reasonable.

The agency, a rare Bush administration proposal to be enacted with bipartisan support, has spent only $155 million of the $4.8 billion it has approved for ambitious projects in 15 countries in Africa, Central America and other regions [...]"

My Heart's In Accra

This blog covers development well. Here are some links on it today:

Dissident Voice : Ten Reasons Why “Save Darfur” is a PR Scam: Provocative article argues that US interest in Darfur is a smokescreen for interest in oil, and that if we genuinely cared about genocide, we’d be discussing intervention in Eastern Congo (tags: africa sudan oil uspolitics congo)

Can Greed Save Africa? Investors outside the African continent are building biodiesel facilities, manufacturing fertilizer from formerly flared natural gas, and generally building the commercial and financial infrastructure the continent needs.

Monday, December 3, 2007

Ending Famine, Simply by Ignoring the Experts - New York Times

Look for the article in next month's Science, by Columbia's Pedro Sanchez and Jeff Sachs, on the advances in fighting draught-based malnutrition in Malawi:

Ending Famine, Simply by Ignoring the Experts - New York Times: "...In Malawi itself, the prevalence of acute child hunger has fallen sharply. In October, the United Nations Children’s Fund sent three tons of powdered milk, stockpiled here to treat severely malnourished children, to Uganda instead. “We will not be able to use it!” Juan Ortiz-Iruri, Unicef’s deputy representative in Malawi, said jubilantly. Farmers explain Malawi’s extraordinary turnaround — one with broad implications for hunger-fighting methods across Africa — with one word: fertilizer [...]"

War and Refugees links

World Refugee Survey 2007
(Great basic statistics on refugees!)

The ICRC Code of Conduct
(If time permits, we would like to talk about humanitarian ethics and accountability in class, but the ICRC Code of Conduct should be read by everyone working in the humanitarian field)

UNHCR: Basic Facts
(UNHCR is the UN agency mandated to provide protection and assistance to refugees. This page gives a good basic introduction to the agency.

Human Rights Watch: Child Soldiers
(Good starting point to get an introduction to the problem of child soldiers; the site also has a compilation of reports on child soldiers.)

Invisible Children
(We'll be playing parts of this documentary on child soldiers in Uganda in class, but here's the entire version.)

Yi-Ling & Neda

LA Times article on breastfeeding studies

Breast or bottle? No final answer yet - Los Angeles Times

Thursday, November 29, 2007

Feedback for Training and Supervision

• Only 5 students including the two presenters; this is a shame! Please call one of the instructors if you cannot attend a class. Attendance is part of class participation and will be graded accordingly
• Good training exercise – It’s too bad that half of the class missed an excellent session. Very good class discussion and participation.
• Delivery was good. Would have been good to see case-studies, what has worked and does not work with training.
• Nice job – both speakers. I loved the initial group exercise – the training activity was very thorough – coverage of the topic.
• Very well structured and well organized presentation with systematic presentation of the topics.
• Suturing exercise was a great learning tool
• Relaxed, friendly delivery. I missed the larger class, but the small group led to less competition to get a chance to comment or ask a question

Bangladesh newspaper article on Breastfeeding

The entire article is a thorough overview of the benefits of breastfeeding, but this line especially caught my eye:

The New Nation - Internet Edition - Breastfeeding: Component of Good Health for Children: "Allah has ordained us to continue breastfeeding for at least two years after the birth of a baby in Sura Bakara [...] "

Wednesday, November 28, 2007

Different Countries, Different Needs: The Role of Private Health Insurance in Developing Countries -- Drechsler and Jutting 32 (3): 497 -- Journal of Health Politics, Policy and Law

Preference for boy child increased in turmoil years - Preference for boy child increased in turmoil years:
"...Syeda Afshana said that the preference for the boy child has grown over the last two decades in the turmoil-hit Valley. She said this was because the parents were feeling insecure for a girl child as girls were being used as “war weapons”. During the last 18 years, women in Kashmir have been tortured, killed, raped and subjected to extremes of human sufferings by the warring factions of Kashmir. Experts say that the events like Kunanposhpora, exploitation of girls in sex-scandal and their life as painful victims like thousands of half-widows, makes people think hundred times before praying for a child [...]"

The Challenge of Global Health

Foreign Affairs - The Challenge of Global Health - Laurie Garrett: "Thanks to a recent extraordinary rise in public and private giving, today more money is being directed toward the world's poor and sick than ever before. But unless these efforts start tackling public health in general instead of narrow, disease-specific problems -- and unless the brain drain from the developing world can be stopped -- poor countries could be pushed even further into trouble, in yet another tale of well-intended foreign meddling gone awry."

more on training in MCH: Games For Health

If you missed class yesterday (and, considering attendance, chances are you did!), you really missed out on a great discussion of training and supervision. For the class exercise, students learned to suture oranges via written, second hand verbal, and expert verbal instructions. The surprising results showed that a person taught by second hand knowledge (the community health worker previously trained by an expert) did as well as the person taught by the expert herself. The person taught by written instruction only, well, floundered.

One of the more interesting topics was the new frontier of training opportunities via the internet. With OLPC, the opportunities are exploding for connectivity in previously unreachable settings from dense slums to rural desert villages. We aren't the only ones who think this can be huge--the Robert Woods Johnson Foundation launched an $8.25m campaign to research just this type of thing! The announcement comes via the Serious Games Initiative at the Woodrow Wilson International Center for Scholars. What a dream job:

Games For Health:
"The Serious Games Initiative founded Games for Health to develop a community and best practices platform for the numerous games being built for health care applications. To date the project has brought together researchers, medical professionals, and game developers to share information about the impact games and game technologies can have on health care and policy."

Monday, November 26, 2007

Training and

I don't know if we'll get to this tomorrow, but it's worth taking a look at. It's an NGO called International Institute of Rural Reconstruction, started by someone who is now a professor at Columbia.

Training and Supervision

This website describes in more detail that I will what the SEED-SCALE model is.

Wednesday, November 21, 2007

The Role of Public Health Improvements in Health Advances: The 20th Century United States

The Role of Public Health Improvements in Health Advances: The 20th Century United States: "Mortality rates in the US fell more rapidly during the late 19th and early 20th Centuries than any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality 'penalty' associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. This paper investigates the causal influence of clean water technologies - filtration and chlorination - on mortality in major cities during the early 20th Century. Plausibly exogenous variation in the timing and location of technology adoption is used to idetify these effects, and the validity of this identifying assumption is examined in detail. We find that clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1 with a cost per life-year saved by clean water of about $500 in 2003 dollars. Implications for developing countries are briefly considered."

Peanut Butter and Patents - Richard Cash's experience in Bangladesh

Peanut Butter and Patents - Richard Cash's experience in Bangladesh: "...I asked Cash after class at Harvard's School of Public Health earlier this week whether he had ever sought a patent for ORT. He said that as a member of the US Public Health Service (with the NIH) in 1968, he doesn't think patenting was an option for him or his colleagues. Also, he admitted, it never really crossed his mind. Perhaps if it had, he said with a twinkle in his eye, he might not still be teaching at the School of Public Health [...]"

Monday, November 19, 2007

Chidi Chike Achebe: The Polio Epidemic in Nigeria:

Chidi Chike Achebe: The Polio Epidemic in Nigeria:

New Guidelines for Addressing Mental Health in Emergencies

17 Nov 2007 00:10:00 GMT
Stephanie Bowen

New Guidelines for Addressing Mental Health in Emergencies New York Launch of Guidelines Important Step Forward

Full article:

It's relevant to what the Alderman's are doing.

War's assault on the mind

MOGADISHU, Somalia — Abdulrahman Habeb was a man with problems, the most pressing of which involved a barrel of tranquilizer pills.

The barrel — containing 50,000 capsules of fluphenazine hydrochloride, a potent anti-psychotic drug ordered from America—was boosting his patients' appetites. This was not good. Patients at Habeb Public Mental Hospital were scaling the facility's mud walls to scavenge for food outside, in the war-pocked streets of Mogadishu. One had been shot...

For full article see:,1,1673232.story

Politics & Health and Community Participation

Hi class,

Following are some useful links for our presentation tomorrow. Hope you find them useful. Thanks. More to be posted shortly.

Saturday, November 17, 2007

The Bamako Initiative in Benin and Guinea: Improving the Effectiveness of Primary Health Care

let me know if you'd like the whole paper and I'll email it to you:

Wiley InterScience: Journal: Abstract: "The objective of the health system revitalization undergone in Benin and Guinea since 1986 is to improve the effectiveness of primary health care at the periphery. Second in a series of five, this article presents the results of an analysis of data from the health centres involved in the Bamako Initiative in Benin and Guinea since 1988. Data for the expanded programme of immunization, antenatal care and curative care, form the core of the analysis which confirms the improved effectiveness of primary health care at the peripheral level over a period of six years. The last available national data show a DPT3 immunization coverage of 80% in 1996 in Benin and 73% in 1995 in Guinea. In the Bamako Initiative health centres included in our analysis, the average immunization coverage, as measured by the adequate coverage indicator, increased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased from 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utilization of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per capita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the different levels of effectiveness obtained in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. However, the geographical location of centres represents a constraint in that certain districts in both countries face accessibility problems. Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage."

Friday, November 16, 2007

Cyclone Sidr Kills 35o in Bangladesh - New York Times

Cyclone Sidr Kills 35o in Bangladesh - New York Times: "Packing winds of over 100 miles an hour, the furious cyclone that swept across the low-lying watery edges of southern Bangladesh late Thursday downed trees, sent mobile telephone towers crashing and swept away mud and thatch homes.

The government's acting secretary for disaster management, Ayub Mian, told reporters at a press conference in Dhaka today that at least 350 people had been killed by Cyclone Sidr, as it is called, while a private television station estimated the death toll to have crossed 500 [...]"

Thursday, November 15, 2007

Safe abortion services virtually non-existent despite 1985 law | Gender Issues Health & Nutrition | News I

IRIN Africa | West Africa | Ghana | GHANA: Safe abortion services virtually non-existent despite 1985 law | Gender Issues Health & Nutrition | News Item : "Ghana has one of Africa's most liberal abortion laws but because of lingering stigma, fear and misunderstanding, safe, affordable abortion services remain virtually non-existent and unsafe abortion is a major cause of death, observers say [...]

"Asantao survived after an emergency operation, but many women do not. Maternal mortality in Ghana stands at about 540 per 100,000, and it is estimated that 22 to 30 percent of those deaths are from unsafe abortion, health experts say..."

(found via Wedia)

Uncovered stories and attention economics

My heart's in Accra - Uncovered stories and attention economics: "...Matt and Emily are the founders of Wedia, a new non-profit designed to call attention to undercovered humanitarian crises around the world. Their first efforts have been in matching up professional journalists and videographers with aid organizations responding to famine in Niger and other global crises, producing high-quality video that could be used by international news organizations to report on breaking stories.

Matt and Emily have discovered that there’s no shortage of undercovered stories to tell, and that journalists are deeply interested in telling these stories [...] "

sociodemographic correlates and barriers of maternal healthcare

One Source Record: "Maternal mortality and morbidity continue to be high despite the existence of national programs for improving maternal and child health in India. This could be related to several factors, an important one being non-utilization or under-utilization of maternal health-care services, especially amongst the rural poor and urban slum population due to either lack of awareness or access to health-care services. Understanding of the knowledge and practices of the community regarding maternity care during pregnancy, delivery and postnatal period is required for program implementation. Therefore, the present study was carried out to evaluate the sociodemographic correlates and barriers of maternal healthcare utilization amongst married women aged 15-45 years living in a slum in Delhi."

feedback for 11/13

• Good discussion. Not quite brought together in conclusion. Dr. Kessler’s presence and comments most welcome.
• Great class discussion. Too bad more people weren’t present.
• Really enjoyed the broad focus on media especially the focus on blogging. Neda it was great how you tied it all together at the end citing the disjoint between public health and the media. Kudjoe and Dina, I really enjoyed the scope of your presentation from the history of P.C. health to current models and examples. Thank you.
• Bennett: good solid presentation. Stimulating, considerable discussion.
• Abbas and Dowlatshahi: Basic concepts well delineated, perhaps more discussion of obstacles would be warranted; more attention to finance issues – good use of specific examples from different countries.
• Bennett: Must try to define key terms, acronyms more. Great presentation, good class participation. Still not much information on the blog.
• Great speakers! I like the discussion on media images but I feel that the topic on primary health care should be one of the earlier topics.
• Very good class participation was promoted by the presenters. Good class scenario to demonstrate primary health care.
• Well-researched slides. Please share your resources online!

Monday, November 12, 2007

more upcoming events!

Dear Heilbrunn Department, (*please forward to your networks, friends, family, and colleagues)*

Amnesty International recently released a report on sexual violence against native women, "Maze of Injustice." I wanted to alert you to this and invite you and ask you to inform any current or former students and faculty who may be interested in attending. Additionally, if there are faculty who have colleagues who are interested, please pass this along also. Thank you - Matthew Kennis, Amnesty International

Here's a link to the full report: **

You are invited to attend a reception and public program at The Smithsonian National Museum of the American Indian in New York City. The event is being hosted by Rose Styron, Kerry Kennedy and Larry Cox, Executive Director of Amnesty International USA./*

*Where: *Smithsonian National Museum of the American Indian, One Bowling Green (across from Battery Park in downtown Manhattan)
*When: *Thursday, November 15, 2007, 6 – 8 p.m.
*What: *Learn about Amnesty International’s groundbreaking report: Maze of Injustice: The failure to protect indigenous women from sexual violence in the USA.

*/_Speakers include:_/*
*Georgia Little Shield, Executive Director, Pretty Bird Women House*
*Winona Flying Earth, Sitting Bull College and South Dakota Coalition Against Domestic Violence*
/Hors d'oeuvres and cocktails will be served.
This event is free and open to the public. Guests are Welcome
*/RSVP to Matthew Kennis by Monday, November 12; 212-633-4169 or*

The Global Health Club, Student Physicians for Social Responsibility and
the Einstein Umbrella for Health and Social Justice invite you to attend
Global Health Night on November 29 at 7:00 PM in Robbins Auditorium.

The keynote Speaker is Stephen Lewis, formerly Canadian Ambassador to
the UN and UN Special Envoy for HIV/AIDS in Africa. Currently, Mr. Lewis
is Co-director of AIDS-Free World, an international AIDS advocacy
organization. He is also a Professor in Global Health at McMaster

In addition to the lecture by Mr. Lewis, there will be presentations by
medical students on their global health projects in Bolivia and Uganda
and a brief talk by the first citizen of the USA to graduate from the
Latin American Medical School in Havana, currently a first year resident
in Primary Care at Montefiore.

announcement from Dr. Brown

The Center for Family and Community Medicine is pleased to invite you to join us for a discussion on "Tradition and Innovation in Generalism," with Kevin Grumbach, M.D., professor and chair of the Department of Family and Community Medicine at the University of California, San Francisco and chief of Family and Community Medicine at San Francisco General Hospital.

Date: Thursday, November 29, 2007

Time: 4 - 6 p.m. Refreshments will be served.

Location: Russ Berrie Science Pavilion, 1st floor
(1150 St. Nicholas Avenue @ 168th Street)

For more information or to RSVP, please contact Ashley Cross at 212-304-7455 or

Background of guest speaker:

Kevin Grumbach, M.D. is professor and chair of the Department of Family and Community Medicine at the University of California, San Francisco and chief of Family and Community Medicine at San Francisco General Hospital. He is the director of the UCSF Center for California Health Workforce Studies, co-director of the UCSF Center for Excellence in Primary Care, and co-director of the Community Engagement Program for the UCSF Clinical Translational Science Institute. His research on topics such as primary care physician supply and access to care, racial and ethnic diversity in the health professions, and the impact of managed care on physicians have been published in major medical journals such as The New England Journal of Medicine and JAMA, and cited widely in both health policy forums and the general media. He co-authored the best-selling textbook on health policy, "Understanding Health Policy - A Clinical Approach," and the recent book, "Improving Primary Care - Strategies and Tools for a Better Practice." Dr. Grumbach is co-chair of the UCSF University-Community Partnership Council, and a founding member of the California Physicians' Alliance, the California chapter of Physicians for a National Health Program.

This is the second lecture in the 2007-2008 "Discovering the Primary Care Imperative" series, hosted by the Center for Family and Community Medicine.

From origins to implications: key aspects in the debate over the digital divide

From origins to implications: key aspects in the debate over the digital divide: "Defined as the differential extent to which rich countries and poor countries benefit from various forms of information technology (IT), the global digital divide has been extensively measured and described in national as well as international debates. The problem, however, is that the topic is highly fragmented in the literature, with few attempts to put the parts into a coherent analytical framework. More precisely, there has been no specific attempt to pinpoint the main issues that influence one's view of the importance of the digital divide and the policies demanded by the different points of view. The goal of this paper, accordingly, is to fill this important gap in the literature in an analytical schema that recognizes the ways in which the impact of innovations depends heavily on how they are generated and diffused. At each stage of this sequential process are key issues that influence one's view of the digital divide. It matters a great deal for instance on whether the divide is in some sense unique, or just another manifestation of the general technological relationship between rich and poor countries. It is also the case that the size of the divide depends heavily on how it is measured. Yet another example is that the extent of the potential impact of IT will influence our view of the foregone opportunities associated with limited uptake of this technology in developing countries."

During one month of protests, military government steps up propaganda, censorship and violence against journalists

The use of violence and censorship against Burmese journalists trying to cover the protests that began a month ago is a “detestable strategy” aimed at preventing them from doing their job, Reporters Without Borders and the Burma Media Association said today. It has been accompanied by an increase in propaganda in the state and privately-owned media controlled by the military government.
Links on Primary Health Care at

considering the role of media in MCH

Think back to the first day of class and the Rosling presentation. The world's poorest countries are growing technological platforms faster than wealth and health. That means technological platforms will play a critical role in the later developments of health and wealth. In light of this, tomorrow's class is a critically important topic: the role of media in MCH.

Here are some resources for further exploring this topic:

The African Information Society Initiative: A Seven-year Assessment

Bienvenue sur "Le site d'informations sur la région de Kidal"

Internet Computing, IEEE: Internet filtering in China

Open Networks, Closed Regimes: The Impact of the Internet on Authoritarian Rule - Google Books

Thursday, November 8, 2007

EVENT - Expanding Equitable Access to Emergency Obstetric Care

The Heilbrunn Department of Population and Family Health Fall 2007
Seminar Series


Helen dePinho, MD, MBA
Assistant Professor of Clinical and Population Family Health

"Expanding Equitable Access to Emergency Obstetric Care: The Power and
Potential of Mid-Level Providers and Non-Physician Surgeons"

November 12, 2007

12:30 PM - 1:45 PM

60 Haven Avenue, B2 Conference Room

Drinks will be provided. Please bring your own lunch.

EVENT - Expanding Equitable Access to Emergency Obstetric Care

The Heilbrunn Department of Population and Family Health Fall 2007
Seminar Series


Helen dePinho, MD, MBA
Assistant Professor of Clinical and Population Family Health

"Expanding Equitable Access to Emergency Obstetric Care: The Power and
Potential of Mid-Level Providers and Non-Physician Surgeons"

November 12, 2007

12:30 PM - 1:45 PM

60 Haven Avenue, B2 Conference Room

Drinks will be provided. Please bring your own lunch.

Wednesday, November 7, 2007

Growth Chart controversies

This website has some great charts and discusses the current WHO efforts to redesign charts for normal breastfed infant growth patterns: :: Average Growth Patterns of Breastfed Babies: "...Healthy breastfed infants tend to grow more rapidly than formula-fed infants in the first 2-3 months of life and less rapidly from 3 to 12 months. All growth charts available at this time include data from infants who were not exclusively breastfed for the first 6 months (includes formula-fed infants and those starting solids before the recommended 6 months). Because many doctors are not aware of this, they see the baby dropping in percentiles on the growth chart and often come to the faulty conclusion that the baby is not growing adequately. At this point they often recommend that the mother (unnecessarily) supplement with formula or solids, and sometimes recommend that they stop breastfeeding altogether [...]"

Tuesday, November 6, 2007

Welcome to Global Voices

In preparation for Tuesday's class on the media, I'd like you to take some time to explore the Global Voices website. Additionally, please get to know the new media buzz wordslike Web 2.0 or Wikimedia. Believe me: you'll need these resources in your public health careers.

Global Voices Online - Health

Bloggers find ways to speak out in Pakistan

My heart's in Accra - Bloggers find ways to speak out in Pakistan: "...In the meantime, Pakistani bloggers are trying to figure out how to approach a media environment where independent voices are being routinely silenced. Independent TV stations have been taken off the air, and there have been reports of mobile phones and internet access being blocked. (The latest news, as reported on Dr. Awab Alvi’s Teeth Maestro blog, is phone service was just restored in Islamabad.) Yet there are numerous voices coming from the Pakistani blogosphere, some from bloggers outside the country, some from inside. Awab Alvi, who is one of the leaders of the anti-censorship campaign, Don’t Block the Blog, has warned fellow bloggers to be very careful and to consider that blogging in their own names may carry the risk of arrest - he’s turned over control of his blog to Ange Embuldeniya, who is posting regular reports on Alvi’s blog. In some ways, this technique is similar to how information got out of Burma during the monks’ protests and the following crackdown - information was passed to sympathetic bloggers outside the country who posted it online [...]"

Healthy City Project | Advancement Project Los Angeles

Healthy City Project | Advancement Project Los Angeles: "The Healthy City Project is an interactive on-line website that provides free access to the most comprehensive database of health and human services in Los Angeles County. With its cutting-edge GIS mapping technology and easy to use database search features, Healthy City is an all-in-one research tool for resource referrals, policy advocacy, and resource planning. Healthy City plays an important role in addressing the resource information gap and increasing the awareness of available health and social services throughout the County."

feedback for 10/30

• Excellent! Aldermans were appropriate and terrific.
• There was a lot of medical stuff in the beginning that are confusing and without background – I was lost. I felt more could have been said on mental health.
• Weird start w/ no students but nice to have conversation with Aldermans.
• Great!
• Speaker #1: good delivery. Over use of statistics. Very broad topic, felt it did not adequately cover definitions. Wish there had been more focus on current issues, solutions & challenges. Speaker #2 did a good job of outlining the challenges. Would have been good to see a more solid connection to MCH.
• Didn’t see articles posted on blog until at least yesterday. Articles should be posted sooner – afternoon (although comment was made during the presentation).
• Good discussion by class.
• Speaker #1: I enjoyed her opinion of the mental health classification, especially her usage of the term “main health”. Excellent delivery.
• Speaker #2: I really enjoyed hearing about your personal experience with issue. Very well done!
• Good coverage that promoted excellent discussion concerned with a very broad set of topics. The Alderman’s added an important dimension to the discussion.
• Speaker #1: Excellent, effective, very broad presentation covering many aspects of the problem – covered much in the short period from medical/psychiatric/public health perspective. Interestingly presented. Good delivery of huge subject areas.
• Speaker #2: Did not led all of presentation but introduction and beginning of presentation – excellent and comprehensive.
• Nice job – both speakers. For both – when using graphs or charts, take a little more time to explain the basics – what they’re showing.

Harvard Public Health Review Winter 2007

Harvard Public Health Review Winter 2007: "A pinch of salt, a fistful of sugar, a jug of clean water. The simple elixir known as oral rehydration solution (ORS)--recently ranked No. 2 in a British Medical Journal survey of greatest health advances of the last 150 years--has saved tens of millions of people from death by infectious diarrheal diseases since the early 1970s. At the cost of a few cents, almost anyone alert enough to swallow can survive cholera, which can kill a man in four hours by draining him dry [...]"

Gene 'links breastfeeding to IQ'

A single gene influences whether breastfeeding improves a child's intelligence, say London researchers.

Friday, November 2, 2007

Women's Health USA 2007

Women's Health USA 2007: "...HRSA is pleased to present Women’s Health USA 2007, the sixth edition of the Women’s Health USA data book. To reflect the everchanging, increasingly diverse population and its characteristics, Women’s Health USA selectively highlights emerging issues and trends in women’s health. Data and information on autoimmune diseases, gynecological and reproductive disorders, and digestive disorders are a few of the new topics included in this edition [...] "

Wednesday, October 31, 2007

ACE Study - Major Findings - Adverse Childhood Experiences

ACE Study - Major Findings - Adverse Childhood Experiences: "Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACE) are common. Almost two-thirds of our study participants reported at least one ACE, and more than one in five reported three or more ACE. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems. The ACE Study uses the ACE Score, which is a count of the total number of ACE respondents reported. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion:

alcoholism and alcohol abuse
chronic obstructive pulmonary disease (COPD)
fetal death
health-related quality of life
illicit drug use
ischemic heart disease (IHD)
liver disease
risk for intimate partner violence
multiple sexual partners
sexually transmitted diseases (STDs)
suicide attempts
unintended pregnancies

In addition, the ACE Study has also demonstrated that the ACE Score has a strong and graded relationship to health-related behaviors and outcomes during childhood and adolescence including early initiation of smoking, sexual activity, and illicit drug use, adolescent pregnancies, and suicide attempts. Finally, as the number of ACE increases the number of co-occurring or “co-morbid” conditions increases."

Monday, October 29, 2007

My heart's in Accra - Stewart Brand and thinking about Megacities

My heart's in Accra - Stewart Brand and thinking about Megacities: "Brand argues that squatters care about:
- Security of tenure - they want assurances that they'll own their homes before they improve them
- Location - they want to be near jobs
- Water, sanitation, electricity
- Protection from crime, whether it comes from the police, or from gangs
- Education - it's one of the main reasons to move to cities

They don't care about:
- Housing - they build it themselves
- Phones - everyone's got a mobile phone
- Starvation - people don't starve in cities, while they still do in the countryside
- Medical care - it's available to a much greater extent than it is in rural areas
- Unemployment - Everyone works, though generally in the informal economy: food stalls, internet cafes, mobile phone booths, bars, hairdressers, churches, tailors, copy shops [...]"

Kiva vs. MicroPlace - What's the Difference? | - Development Through Enterprise

Kiva vs. MicroPlace - What's the Difference? | - Development Through Enterprise

Peanut Butter and Patents

When PlumpyNut came out, I was concerned about powdered milk as a main ingredient after Dr. Cunningham's discussion of the prevalence of lactose intolerance across Africa, and the way lactose intolerance mimics water-born intestinal diseases. Now, I'm concerned for entirely different reasons:

Peanut Butter and Patents : "Finally caught up to Anderson Cooper's report about PlumpyNut, which aired on Sixty Minutes a little over a week ago. Besides intimating that Doctors Without Borders had invented PlumpyNut (which it didn't), the 11-minute CBS report completely neglected to mention that PlumpyNut is patented. (Thanks to Josh for sending me the link.) Okay, you say, CBS has produced a feel-good story that doesn't have to be encyclopedic. But given the fact that Cooper says that there's not enough PlumpyNut to go around and ties the shortage to a lack of vision from food aid donors, you would think he might have at least mentioned other challenges, like negotiations over licensing and franchising rights stemming from the patent(s) [...]"

Kenya's Maternal Wards Deliver Abuse With Babies

Kenya's Maternal Wards Deliver Abuse With Babies: "...Based on their own experience and that of mothers they'd attended, midwives told Women's eNews of beatings, verbal abuse, filth and blood-soaked beds. They also recounted the infamous month two years ago when medical students performed Caesarian sections on most women who walked through the door, regardless of whether the operation was necessary [...]"

Sexual Violence in the Congo

10 new victims of rape show up everyday at Panzi Hospital in the DRC (Photo credit: Hazel Thompson of New York Times). In 2006, 27000 sexual assaults were reported in South Kivu province alone. This theme - violence against women and girls - will be addressed in the presentation on Mental Health and Violence, as well as War and Refugees.

Rape Epidemic Raises Trauma of Congo War - NYT

Sunday, October 28, 2007

critical update to our discussion on rotavirus vaccine

G2P[4] and G12P[6] Rotavirus, Bangladesh | CDC EID: "...During the 2001-2005 rotavirus seasons, G1P[8] (36.4%) and G9P[8] (27.7%) were the dominant strains, but G2[4] and G12P[6] were present in 15.4% and 3.1% of the rotavirus-positive patients, respectively. During the 2005-06 rotavirus season, G2P[4] (43.2%) appeared as the most prevalent strain, and G12P[6] became a more prevalent strain (11.1%) during this season. Because recently licensed rotavirus vaccines include only the P[8] specificity, it is unknown how the vaccines will perform in settings where non-P[8] types are prevalent [...]"

Wednesday, October 24, 2007

Where is maternal and child health now?

After we were honored with Dr. Rosenfield's contributions in class yesterday, this article in the Lancet appropriately revisits his efforts to direct researchers to the M in MCH:

ScienceDirect - The Lancet : Where is maternal and child health now?: "21 years ago, Rosenfield and Maine1, 2 and 3 posed the question "where is the M in MCH?", conceiving the safe motherhood movement. What has happened to maternal and child health (MCH) since? [...] Inadequate focus and funding is certainly one of many reasons for this slow progress. Additionally, progress has been impeded at times by competition, conflicts, and changes of direction in global policy.3 We consider two such competitions—the mother versus the child, and community versus clinical care—and how these become obsolete with a shift to a continuum of care approach.

How did mother versus child become a competition? Despite the name, in the 1980s most MCH programmes focused on the child, with maternal care mainly limited to family planning. The justifiable need for more attention for women contributed to the downplaying of links between maternal and child health to such an extent that the ten action points for safe motherhood in 19973 did not mention the purpose of motherhood—a live, healthy newborn baby. Meanwhile child health programmes focused primarily on infectious diseases, largely ignoring the causes of 4 million neonatal deaths every year.5 The separation of maternal health and child health programmes contributed to inaction for newborn health...'"

Wide Income Gap Linked To Deaths In Both Rich And Poor Nations

Wide Income Gap Linked To Deaths In Both Rich And Poor Nations: " A wide income gap between the most affluent and the worst off in society is closely associated with higher death rates worldwide, especially for younger adults, finds a study published on the British Medical Journal website ( as part of a global theme issue on poverty and human development."

Computer Game Helps Ugandan Children Recovering From Cerebral Malaria

Computer Game Helps Ugandan Children Recovering From Cerebral Malaria

Excess Female To Male Births In Canada Linked To Chronic Dioxin Exposure

Excess Female To Male Births In Canada Linked To Chronic Dioxin Exposure: "Almost 90 Canadian communities have experienced a shift in the normal 51:49 ratio of male to female births, so that more girls than boys are being born, according to two new studies. James Argo, who headed the research, attributes this so-called 'inverted sex ratio' of the residents in those communities to dioxin air pollutants from oil refineries, paper mills, metal smelters and other sources [...]"

HIV Is Spread Most By People With Medium Levels Of HIV In Blood, Says Study

HIV Is Spread Most By People With Medium Levels Of HIV In Blood, Says Study: "People with medium levels of HIV in their blood are likely to contribute most to the spread of the virus, according to new research published in the journal Proceedings of the National Academy of Sciences."

Tuesday, October 23, 2007

Distribution of nets splits malaria fighters - International Herald Tribune

Distribution of nets splits malaria fighters - International Herald Tribune: "...Villages like Maendeleo are at the center of a debate that has split malaria fighters: how to distribute mosquito nets.

Recently, Dr. Arata Kochi, the blunt new director of the World Health Organization's malaria program, declared that as far as he was concerned, 'the debate is at an end.' Virtually the only way to get the nets to poor people, he said, is to hand out millions free.

In doing so, Kochi turned his back on an alternative long favored by the Clinton and Bush administrations %u2014 distribution by so-called social marketing, in which mosquito nets are sold through local shops at low, subsidized prices %u2014 $1 or so for an insecticide-impregnated net that costs $5 to $7 from the maker %u2014 with donors underwriting the losses and paying consultants to come up with brand names and advertise the nets [...]"

Monday, October 22, 2007

200 journals join in theme issues on poverty and human development

200 journals join in theme issues on poverty and human development: "Through an international collaboration, more than 200 medical and scientific journals are publishing theme issues this week on the relationship between poverty and human development. The initiative, coordinated by the Council of Science Editors, includes presentations on seven of the journal articles which will be webcast live from the National Institutes of Health on Monday, October 22, 2007."

Sunday, October 21, 2007

The effects of malnutrition on child mortality in developing countries

The effects of malnutrition on child mortality in developing countries [Bull World Health Organ. 1995] - PubMed Result: "Conventional methods of classifying causes of death suggest that about 70% of the deaths of children (aged 0-4 years) worldwide are due to diarrhoeal illness, acute respiratory infection, malaria, and immunizable diseases. The role of malnutrition in child mortality is not revealed by these conventional methods, despite the long-standing recognition of the synergism between malnutrition and infectious diseases. This paper describes a recently-developed epidemiological method to estimate the percentage of child deaths (aged 6-59 months) which could be attributed to the potentiating effects of malnutrition in infectious disease. The results from 53 developing countries with nationally representative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition's potentiating effects, and 83% of these were attributable to mild-to-moderate as opposed to severe malnutrition. For individual countries, malnutrition's total potentiating effects on mortality ranged from 13% to 66%, with at least three-quarters of this arising from mild-to-moderate malnutrition in each case [...]"

Jay Keasling and synthesizing the future

My heart's in Accra - Pop!Tech: Jay Keasling and synthesizing the future: "...Keasling is interested in manufacturing Artemisinin. Artemisinin is the latest weapon in the battle against malaria, a disease that effects 300 to 500 million people a year, killing 1-3 million of them. 90% of the people the disease kills are children under five years old. The economic impact of malaria is profound - nations effected are estimated to lose up to 50% of their GDP due to productivity losses from the disease [...]"

Saturday, October 20, 2007

'They thought I was cursed'

Great interviews in this story:

BBC NEWS | Special Reports | 'They thought I was cursed': "Obstetric fistula, a hole linking the vagina with the bladder or rectum, occurs when women - often in their early teens - are in labour for days. Campaigners at a global conference on maternal health in London this week, entitled Women Deliver, have emphasised that a simple and cheap operation can cure it [...]"

Thursday, October 18, 2007

Feedback for Female Literacy, Women & Development

• Excellent – esp. in view of last minute solo performance. Dr. Kessler was her usual involved, thoughtful, informative self!
• Good participation by the class. Good discussion.
• Great with involving the class in discussion. Good time management. Extra props for being comfortable leading the class alone!
• Excellent presentation of a very broad set of topics; good class interaction and good contributions by class and professors.
• I enjoyed the presentation! She presented it very well. Slides need to have larger words though! Well-done.
• Given that the other presenter didn’t come, I think the presentation was good. It was nice having such extensive class conversation.
• Could have organized the slides a bit better.
• Very good presentation considering that you had to do it alone! I like the informal discussion set-up more than the lecture format in previous classes.
• Nice presentation. Good job getting group discussion going – putting good questions to the group. Nice job presenting on your own! Only suggestion – fewer words per PowerPoint slide.
• Great job! I enjoyed the balance of class involvement.
• “Empowered presentation” Excellent – raised may complex questions and good discussion – very good use of examples – very good relationship to other classes.

Women Deliver

A result of the Women Deliver conference to be held in London this week ( the Lancet is running a special issue dedicated to Maternal Health. It has some interesting articles etc... worth checking out (if you havent already)

Continuum of care for maternal, newborn, and child health: from slogan to service delivery

ScienceDirect - The Lancet : Continuum of care for maternal, newborn, and child health: from slogan to service delivery: "Summary:
The continuum of care has become a rallying call to reduce the yearly toll of half a million maternal deaths, 4 million neonatal deaths, and 6 million child deaths. The continuum for maternal, newborn, and child health usually refers to continuity of individual care. Continuity of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood) and also between places of caregiving (including households and communities, outpatient and outreach services, and clinical-care settings). We define a population-level or public-health framework based on integrated service delivery throughout the lifecycle, and propose eight packages to promote health for mothers, babies, and children. These packages can be used to deliver more than 190 separate interventions, which would be difficult to scale up one by one. The packages encompass three which are delivered through clinical care (reproductive health, obstetric care, and care of sick newborn babies and children); four through outpatient and outreach services (reproductive health, antenatal care, postnatal care and child health services); and one through integrated family and community care throughout the lifecycle. Mothers and babies are at high risk in the first days after birth, and the lack of a defined postnatal care package is an important gap, which also contributes to discontinuity between maternal and child health programmes. Similarly, because the family and community package tends not to be regarded as part of the health system, few countries have made systematic efforts to scale it up or integrate it with other levels of care. Building the continuum of care for maternal, newborn, and child health with these packages will need effectiveness trials in various settings; policy support for integration; investment to strengthen health systems; and results-based operational management, especially at district level [...]"

Let Men Do Their Bit

The Pioneer > Columnists - Let Men Do Their Bit: "For 30 years, vasectomy has been a political taboo, and the entire burden of family planning has been on women. But modern vasectomy techniques are a success in the West. India needs to try them"

NY Times article on new malaria vaccine

October 18, 2007

New Malaria Vaccine Is Shown to Work in Infants Under 1 Year Old, a Study Finds

The world’s most promising malaria vaccine has been shown to work in infants less than a year old, the most vulnerable group, according to a study being published today.

The study, being published in The Lancet, a British medical journal, was small, comprising only 214 babies in Mozambique, and intended to show only that the vaccine was safe at such young ages. But it also indicated that the risk of catching malaria was reduced by 65 percent after the full course of three shots.

“We’re now a step closer to the realization of a vaccine that can protect African infants,” said Dr. Pedro Alonso, the University of Barcelona professor who leads clinical trials of the GlaxoSmithKline vaccine.

If it passes much larger clinical trials set to start in seven countries next year, and if it is accepted by national regulatory agencies, it could be ready for distribution by 2012, said Dr. W. Ripley Ballou, Glaxo’s vice president for international clinical trials.

In 2004, Dr. Alonso showed for the first time that the vaccine could protect children against infection or death. That study of 2,022 children aged 1 to 4 showed protection from infection about 45 percent of the time.

Such a relatively low level of protection would not be acceptable in a vaccine in the West, but malaria is a leading killer of African children, so even imperfect coverage is a major public health victory.

The vaccine, presently known as RTS,S and tentatively brand-named Mosquirix, is made by fusing a bit of outer protein of the deadly falciparum strain of the malaria parasite with a bit of hepatitis B virus and a chemical booster — the latter two added to provoke a stronger immune reaction.

At least nine malaria vaccine candidates are in development, but Mosquirix is the furthest along. Glaxo has been refining it for 20 years and expects to have spent up to $600 million on it by the time it comes to market. About $100 million has been paid by the Bill and Melinda Gates Foundation through the PATH Malaria Vaccine Initiative.

No decision has been made about the price to be offered to poor countries and international health agencies. But “if a child will benefit, price will not stand in the way,” said Dr. Christian Loucq, director of the vaccine initiative.

The vaccine is given in three injected doses. That is an obstacle in poor countries, which have difficulties immunizing even against polio — done with oral drops requiring no medical skill.

But even one dose has some protective effect, the Lancet study found.

It is unknown how long protection lasts. But because the youngest children are the most vulnerable, Dr. Alonso said, vaccination buys them time to build up natural immunity, which is acquired by surviving multiple mosquito bites.

Tuesday, October 16, 2007

NY Times article on Widow-Cleansing

AIDS Now Compels Africa to Challenge Widows' 'Cleansing'

Dr. Brown talked about the practice of widow cleansing in class and I equated it to 'wife-inheritance'; however after doing some reading it seems like widow cleansing and wife-inheritance are separate practices, though both involve having sexual relations with the dead husband's relatives.

Friday, October 12, 2007

Uneven progress in maternal health worldwide but some countries setting good example

Uneven progress in maternal health worldwide but some countries setting good example: "The authors say: The continued scarcity of progress in maternal health over the past two decades in several parts of the world is disturbing, The little progress is especially of concern for south Asia and sub-Saharan Africa, which have consistently presented the worst maternal health in the world. They add that the connection between maternal mortality, poverty, and status of women is no coincidence, and as such countries which have improved their investment in education and employment for women have also improved their investment in maternal care. They say: Thus, the examples of countries like Thailand and Malaysia suggest that MDG5 is achievable with appropriate financial and political commitment."


I thought the class may find this interesting.....

The Heilbrunn Department of Population and Family Health Fall 2007
Seminar Series


Nassim Assefi, MD
Physician and Author


"Maternal Mortality in Afghanistan"


Afghanistan has one of the highest rates of maternal mortality ever
measured: on average one in six-to-nine women die of pregnancy
related causes. This talk will focus on:

- How we measure mortality in a country with no vital statistics,
insecurity, and destroyed infrastructure;

- The causes of maternal mortality in Afghanistan;

- Associated socioeconomic risks; and

- Solutions.

The speaker is a women's health specialist who spent 2004 and 2005
in Afghanistan constructing programs to decrease maternal and child

October 15, 2007

12:30 PM - 1:45 PM

60 Haven Avenue, B2 Conference Room

Drinks will be provided. Please bring your own lunch.

Action needed on maternal deathsAction needed on maternal deaths

Experts have condemned the "appalling" lack of progress made in reducing the number of women worldwide dying during pregnancy and childbirth.

Analysis in The Lancet medical journal shows half a million women die every year - little change from 20 years ago.

And 20 million unsafe abortions - a major factor in maternal deaths and illness - are done annually.

Read the article here:

Wednesday, October 10, 2007

Vaccine-linked polio hits Nigeria

Nigeria is fighting a rare outbreak of a vaccine-derived form of polio, says the UN's World Health Organization.

It says 69 children in the north have caught the paralysing disease from others who had already been immunised.

The WHO says such rare outbreaks have occurred where immunisation campaigns did not reach enough of the population.

In 2003 Islamic leaders brought a temporary halt to the vaccine campaign in the north saying it was a Western conspiracy to sterilise Muslim women.

The WHO says this rare outbreak of vaccine-derived polio demonstrates the need for more vaccination, not less.

But the concern is that the cause of the outbreak could be misinterpreted by people here and reinforce their scepticism of the whole vaccine campaign.

Scare stories

The WHO says the outbreak occurred when some of those who had received the oral polio vaccine excreted a mutated form of the virus which infected those who were not immunised who had not completed the vaccination programme.

It says the outbreak is ongoing but slowing because of the continuing vaccination campaign, and the last reported case was in August.

The WHO says the outbreak occurred because not enough people were receiving the polio vaccine in the first place.

Northern Nigeria still has a low coverage rate for the vaccination campaign, a legacy of a temporary halt to the programme in 2003.

Those scare stories built on existing traditional scepticism of Western medicine.

But more recently the vaccination programme has made some progress.

Polio cases as a whole are down on last year, in part because of a new programme of polio victims accompanying immunisation teams to demonstrate to parents the risks of not having their children vaccinated.

Tuesday, October 9, 2007

Can We Acheive Millenium Development Goal 4?

A very interesting, but controversial article.

Who's Making Money From Microcredit? . NOW | PBS

Dr. Brown asked me to post this episode of NOW. If you go to this page you can either listen to or watch the full story:

Who's Making Money From Microcredit? . NOW | PBS: "Microcredit has been hailed as a breakthrough in combating global poverty by giving small loans to impoverished people in the hopes of transforming their lives. But one very profitable Mexican lending program is now under intense scrutiny. NOW takes a close look at Compartamos bank, which started as a nonprofit organization lending small sums of money to poor indigenous Mexican women to help them start their own businesses. Today, it's a for-profit bank with more than 600,000 Mexican clients, often paying very high interest rates. Interviewing both grateful loan recipients and vocal critics-like Nobel prize-winning microcredit pioneer Muhammad Yunus-NOW investigates if Compartamos is truly serving the poor, or exploiting them."

Feedback for Maternal Health, Family Planning, and Safe Birth

• Excellent presentation covering a very broad set of issues. Over dependency on PowerPoint at times. Good class discussion with issues and questions, well handled. Jeopardy game was great fun!
• We did great – What else am I supposed to say?
• Good balance of student participation, professor commentary and presenter facilitation.
• Very well planned and thought-out. Good responses with own knowledge to questions and inquiries.
• Awesome presentation!
• Well thought out and presented. C-section discussion strayed towards domestic (developed countries concerns) but overall excellent. Game was fund and involved the class.
• Great presentation.
• Presenter #1: Excellent delivery – defined key concepts, engaged class and I think did a great job of connecting comments made to her slides (throughout). A bit graph heavy, but that said appropriately picked graphs.
• Presenter #2: Good delivery – very us focused when discussing requirements for clinical workers – would have been good to see comparison. Would have liked to hear a bit about the men’s role in family planning. Would have liked to also learn more about ways to incorporate post-natal and pre-natal care options (clinical & not).
• Presenter #1: Excellent overall delivery.
• Presenter #2: Great presentation, excellent delivery; however, too much medical info.
• Great speakers! Funny game too.

Monday, October 8, 2007

Make Every Mother and Child Count

The full WHO report is full of useful background info and stats on maternal and child health. It's a free download here:

WHO | The World Health Report 2005 - Make Every Mother and Child Count

One useful grouping of stats to keep in mind for tomorrow's class is the top leading causes globally of maternal mortality: "severe bleeding/hemorrhage (25%), infections (13%), eclampsia (12%), obstructed labour (8%), complications of abortion (13%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it."

Distribution of Nets Splits Malaria Fighters

MAENDELEO, Kenya — Veronica Njeri, 45, says she has “never healed” since losing two of her six children to malaria 20 years ago, and she still feels vulnerable. While her oldest are adults or teenagers, and have presumably built up immunity to the disease, she worries about her youngest, Anthony, who is 4.

Would be interested to know what folks thought of social marketing vs. free nets...

The Quiet Scandal of 10 Million Deaths

HEALTH: The Quiet Scandal of 10 Million Deaths : "...95 percent of all maternal and newborn deaths worldwide occur in 75 countries in Africa, Asia and Latin America [...]"

Home Births vs. Hospital Births

Here is some data for home births versus hospital births in the US and Australia - the data cover the entire country. The article is complaining about the lack of such data for Britain...

BMJ 1999;319:1008 ( 9 October )


Data on babies' safety during hospital births are being ignored

EDITOR---Zander and Chamberlain state that "no evidence exists to support the claim that a hospital is the safest place for women to have normal births."1 They cite the report Where to be Born, published in 1994 by the National Epidemiology Unit.

In 1997 the Confidential Enquiry into Stillbirths and Deaths in Infancy published a survey of 19 348 deaths in Britain occurring during 1994 and 1995, including 873 deaths due to intrapartum events.2 At that time 98.16% of all deliveries occurred in hospital. The chance of a normal baby dying during labour at term was 1 in 1561. The Royal Colleges of Obstetricians and Gynaecologists and of Midwives regard this risk as unacceptably high and are working to reduce it still further.

Data on home deliveries in the United States were published in 1995,3 and data for home deliveries in Australia were published in 1998.4 In the American study (a retrospective review of 11 788 planned home births) the intrapartum and neonatal mortality among women intending to have a home birth at the onset of labour was 1 in 500. In a prospective American study of 1404 home births in 1994-5 the figure was 1 in 400, and the authors regarded this outcome as good.5 In the Australian study, which included 7002 planned home births during 1985-90, the risk of intrapartum fetal death was 1 in 371.

It is disappointing that no similar recent audit of the safety of home delivery in Britain is available. The figures from the United States and Australia are, however, strikingly similar; in the absence of current data from the United Kingdom they indicate that, for a normal birth, hospital delivery is now three to four times safer than home delivery for the baby.

Women should be able to choose between home and hospital delivery. They also have a right to accurate and up to date information.

James Drife, professor of obstetrics and gynaecology.
University of Leeds, Leeds LS2 9NS

1. Zander L, Chamberlain G. ABC of labour care: Place of birth. BMJ 1999; 318: 721-723[Free Full Text]. (13 March.)
2. Confidential Enquiry into Stillbirths and Deaths in Infancy. Fourth annual report: concentrating on intrapartum deaths 1994-95. London: Maternal and Child Health Research Consortium, 1997.
3. Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. J Nurse Midwifery 1995; 40: 483-492[Medline].
4. Bastian H, Keirse MJNC, Lancaster PL. Perinatal deaths associated with planned home births in Australia: population based study. BMJ 1998; 317: 384-388[Abstract/Free Full Text].
5. Murphy PA, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol 1998; 92: 461-470[Abstract].

World Leaders Address Lagging Maternal and Child Health Goals

I assumed this was on everyone's radar since CGI was here in NY, but I found a few of you that hadn't heard! Funding is one of this field's biggest problems, so last weeks' events are very big news:

World Leaders Address Lagging Maternal and Child Health Goals - Feminist Wire Daily Newsbriefs: U.S. and Global News Coverage: "Norwegian Prime Minister Jens Stoltenberg recently unveiled a new World Health Organization (WHO)-led collaboration of governments and organizations designed to improve maternal and child health worldwide. Deliver Now for Women Children aims to spur progress on UN%u2019s Millennium Development Goals 4 and 5, which call for a two-thirds reduction in child deaths and a three-quarters reduction in maternal mortality by 2015. Deliver Now was founded in reaction to slow progress on these goals, as well as those of the World Bank's Safe Motherhood Initiative of 1987. More than ten million women and children still die each year due to preventable causes%u2014more than the resulting deaths of AIDS and TB combined, according to the WHO."

Kano Records Low Maternal Mortality Rate in Two Years (Page 1 of 1)

great case study of successful program: Nigeria: Kano Records Low Maternal Mortality Rate in Two Years (Page 1 of 1): "...Dr Sani Jibrin also said within the communities in the state Emergency Loan Funds Scheme had been introduced to assist pregnant women while taken to hospital for delivery of other pregnancy related problems. He said under the programme the communities are motivated to deposit funds so that when ever there is case of pregnant woman needing money for emergency treatment such funds would be used for the purpose [...]"

Home Births in the US

There are many studies looking at the results of home birth versus hospital delivery. When using an intent to treat analysis (as a good study should - if the home baby dies when it gets to the hospital - it should not be placed in the 'hospital delivery' group) the home group always has higher mortality - presumably in the delay of getting care to critically ill mothers and infants.

Below are abstracts from 2 articles from a respected journal - looking at large numbers of patients. As seen below there are a high number of women that are transferred to the hospital - before, during, or after birth. It is also important to note that the 'hospital' group includes all the women with high risk pregnancies, that are known to have worse outcomes (pre-ecalmpsia, women with large babies, preterm labor, breech, Vaginal Birth After Cesarean, etc.).

Outcomes of Planned Home Births in Washington State: 1989–1996

Jenny W. Y. Pang, MD, MPH, James D. Heffelfinger, MD, MPH, Greg J. Huang, DMD, MPH, Thomas J. Benedetti, MD, MHA and Noel S. Weiss, MD, DrPH

From the Department of Epidemiology, University of Washington School of Public Health and Community Medicine; Department of Obstetrics and Gynecology, University of Washington School of Medicine; Department of Pediatrics, Children’s Hospital and Regional Medical Center, Seattle, Washington; and Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia.

Address reprint requests to: Jenny Pang, MD, MPH, University of Washington School of Public Health, Department of Epidemiology, Box 357236, Seattle, Washington 98195; E-mail:

OBJECTIVE: To determine whether there was a difference between planned home births and planned hospital births in Washington State with regard to certain adverse infant outcomes (neonatal death, low Apgar score, need for ventilator support) and maternal outcomes (prolonged labor, postpartum bleeding).

METHODS: We examined birth registry information from Washington State during 1989–1996 on uncomplicated singleton pregnancies of at least 34 weeks’ gestation that either were delivered at home by a health professional (N = 5854) or were transferred to medical facilities after attempted delivery at home (N = 279). These intended home births were compared with births of singletons planned to be born in hospitals (N = 10,593) during the same years.

RESULTS: Infants of planned home deliveries were at increased risk of neonatal death (adjusted relative risk [RR] 1.99, 95% confidence interval [CI] 1.06, 3.73), and Apgar score no higher than 3 at 5 minutes (RR 2.31, 95% CI 1.29, 4.16). These same relationships remained when the analysis was restricted to pregnancies of at least 37 weeks’ gestation. Among nulliparous women only, these deliveries also were associated with an increased risk of prolonged labor (RR 1.73, 95% CI 1.28, 2.34) and postpartum bleeding (RR 2.76, 95% CI 1.74, 4.36).

CONCLUSION: This study suggests that planned home births in Washington State during 1989–1996 had greater infant and maternal risks than did hospital births.

Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study

PA Murphy and J Fullerton

OBJECTIVE: To describe the outcomes of intended home birth in the practices of certified nurse-midwives. METHODS: Twenty-nine US nurse-midwifery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for all enrolled women were ascertained. Validity and reliability of submitted data were established. RESULTS: Of 1404 enrolled women intending home births, 6% miscarried, terminated the pregnancy or changed plans. Another 7.4% became ineligible for home birth prior to the onset of labor at term due to the development of perinatal problems and were referred for planned hospital birth. Of those women beginning labor with the intention of delivering at home, 102 (8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were transferred to the hospital after delivery, and 14 infants (1.1%) were transferred after birth. Overall intrapartal fetal and neonatal mortality for women beginning labor with the intention of delivering at home was 2.5 per 1000. For women actually delivering at home, intrapartal fetal and neonatal mortality was 1.8 per 1000. CONCLUSION: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage.

Link to article on reducing maternal and neonatal mortality in developing countries

Here is the link:

Brooklyn midwife's practice thrives as expectant moms seek natural deliveries

NY Daily News: Brooklyn midwife's practice thrives as expectant moms seek natural deliveries: "...Midwifery, the time-honored profession of helping women through childbirth, has evolved into a health care profession in which practitioners offer prenatal and post-partum care and carry malpractice insurance [...] 'Midwives try to conform to what the woman wants to do, not the other way around,' said Mairi Breen Rothman, a spokeswoman for the American College of Nurse-Midwives..."
In preparation for tomorrow's presentation, students can take a look at the UNFPA report: Meeting the Need, Strengthening Family Planning Programs. The document is available at:

Sunday, October 7, 2007

Family Planning: Methods of Contraception

Hello All,

For Tuesday's Presentation we will not go over the methods of contraception in great depth. If you are interested in learning more about the various types, their effectiveness, side effects, advantages and disadvantages, please take a look at the resources provided on these websites:

World Health Organization: Family Planning Resources: Decision-Making Tool for Family Planning Clients and Providers

Advocates for Youth: Rights, Respect, Responsibility. Contraceptives: What are your choices?

-Temple & Carolyn

Friday, October 5, 2007

Using mobiles to fight pharma fakes

My heart's in Accra : Using mobiles to fight pharma fakes: "...Counterfit pharmaceuticals are a massive problem in West Africa. Dr. Dora Akunyili, the head of Nigeria's National Agency for Food and Drug Administration and Control reports that, at one point, more than 80% of drugs on Nigerian shelves were fake. Akunyili's sister, a diabetic, died in 1988 after taking fake insulin [...] The project, called mPedigree, seeks to build a system first in Ghana, and then throughout Africa, that tracks drugs from their original producers all the way to the pharmacy shelves, allowing each buyer in the chain to ensure that they’re dealing with a legimate product. The idea of this system comes from the ePedigree system being implemented to track medications in the US using RFID tags..."

Thursday, October 4, 2007

The Business of Being Born

As you probably know, this week's course focus is on family planning, safe birth, and maternal health. The Business of Being Born is the childbirth equivalent of Supersize Me, and premiered in May to rave reviews. Maybe we can see it as a class when it releases nation-wide in November? Among its discussion of the empowering and disempowering potential experiences in labor and birth for women it includes many interviews in which women and healthcare workers discuss positive and negative experiences of childbirth. Please take a moment to go watch the excerpts online here:

The Business of Being Born

NYC Midwives - Our History

NYC Midwives - Our History: "In 1959 a small group of midwives gathered regularly in NYC, eventually evolving into the New York State Chapter of the American College of Nurse Midwives (ACNM).

Later the ACNM organized the country's midwives into regional affiliates and NYC Chapter became known as Region II, Chapter I of the ACNM.NYC, Region II, Chapter has historically been one of the largest and most active chapters in the country. Joining hands in the early 1980's with the other NYS Chapters, NYC Midwives played a key role in the successful passage of the New York State Professional Midwifery Practice Act of 1992. (To read the Midwifery Act go to

The chapter's executive board is elected by the membership every two years on a rotating basis. In the year 2000, the 8 New York State Chapter chairs formed a new organization called the New York State Association of Licensed Midwives (NYSALM) to assist with the ever changing political and legislative issues facing midwives in this era of managed health care. (For more information go to"

Facebook says breastfeeding is obscene

Belly Tales Old and New News Roundup 10/2/07: "the website Facebook recently started banning pictures of women breastfeeding from user accounts, and in some instances has banned specific users altogether (for example, Karen Speed from Australia, who has chronicled the entire event on her blog, One Small Step for Breastfeeding). Facebook banned certain pictures on account of their "obscene content" and asserted its right to remove pictures as a violation of its terms of use policy, but as the Sydney Morning Herald points out, it's not exactly clear what constitues an exposed breast, which is the specific violation, and Facebook hasn't provided any further. clarification. Right. So, breastfeeding is obscene, and women aren't allowed to post their own pictures of themselves breastfeeding on their own facebook accounts. If this bothers you as much as it bothered me, go join the new facebook group entitled Hey, Facebook, breastfeeding is not obscene!"

Wednesday, October 3, 2007

Feedback on Immunizations and Infections presenters

• The presentations are very good, appropriate and relevant to the topic.
• Talabi used tables in small print – very had to grasp. Time management was a problem.
• Not enough time allowed for student speakers.
• The group appeared to not have prepared together. Low energy level of presenters. Fantastic guest speaker involvement.
• General comments: Speaker 2/3: need to talk about what diseases are more than just the symptoms/vaccines. Too much talking during presentations, conflicts with presenters’ ability to get through their information – this applies to all presentations. Maybe fewer slides – more discussion? Articles need to be posted earlier. Speaker #1: good delivery of material – answered questions appropriately.
• Speaker #3: try to maintain eye contact with group, look at PowerPoint less, project voice forward. All: have another member of team handle the PowerPoint slides so that presenter can move away from the computer/podium and make better use of space.
• Speaker #2: Lots of good information but try not to read from the notes.
• Speaker #1: Good eye contact with group, good voice projection, seemed like #1 had a smaller portion of overall presentation.
• All: Very good information (lots of it) but at times there was too much info on slides (charts difficulty to read)
• All: need more student participation; perhaps there were some discussion points built in that were dropped to make room/time for guest speaker and doctor comments.
• Speaker #2: reads entirely from notes – perhaps could engage more with audience/class and be more assertive about time management. Participation from guests/professors, while very interesting, mess up flow of presentation – perhaps better to have a dedicated discussion section?
• I think its difficulty for the presenter with constant discussion. Perhaps discussions should be limited to after completion of sections. Also, I think it is difficulty for the students to participate; perhaps it is the structure through which the discussions materialize.
• Reyes: Delivery required more eye contact. Too many graphs. Would have preferred to go into more details about diseases, etc. Found graphs unnecessary. Good organization of content on PowerPoint.
• Talabi: Presentation of content was confusing. Delivery could have been more interactive.
• Bennett: Good delivery – good explanations. Slides were difficult to read – wish he had summarized all the graphs, etc within PowerPoint.
• Over-use and overdependence on PowerPoint slides. The presenters lost control of their presentation with too many interruptions. Some slides were too small to read.
• Reyes: Soft voice (speak louder but good job on cutting off discussion to move on. Guests provided great information but monopolized presenters’ time!
• Items too small on slides.
• Increase font size on PowerPoint.