A good read: The roots of inaction: Understanding and overcoming the obstacles to greater investment in scaling-up effective diarrhea treatment
The roots of inaction: Understanding and overcoming the obstacles to greater investment in scaling-up effective diarrhea treatment
Posted: August 20, 2012
August 7, 2012 — MCHIP
Please join CORE Group and MCHIP for the second in a series of webinars on diarrheal disease.
WHEN: August 21st from 9 – 11 am EST
HOW: Join by registering at CORE Group’s website 
WHO: Moderated by Dr. Dyness Kasungami, MCHIP Team Leader for Child Health
The second leading cause of preventable child deaths, diarrheal disease claims the lives of 1.3 million children under-five annually, mostly in Africa and South Asia. Gains from the introduction of oral rehydration therapy (ORT) and improved water, sanitation and hygiene are have not been sustained in many countries, with global coverage of ORT use being as low as 34%.
The first webinar in February focused on advocating for coordinated approaches to implement a package of effective interventions, and mobilizing resources and multi-disciplinary partners. In this second webinar, Dr. Dyness Kasungami will moderate a panel with three speakers who will present country success experiences from Benin, Ghana and India in addressing low coverage of effective interventions in diarrheal disease.
The panelists will also share lessons learned surrounding promising practices to increase coverage of zinc, changed dynamics around ORS/zinc use, and the links between treatment and key Water, Sanitation, and Hygiene (WASH) practices for prevention. The panel presentation will be followed by an opportunity for a Q&A with participants.
Katharine McHugh is the WASH Technical Advisor at PSI.
Topics: Diarrhea treatment program in Benin; strengthening linkages between ORT/zinc and WASH
Kate Schroder is the Director of Essential Medicines Initiative of Clinton Health Access Initiative (CHAI).
Topic: Demand generation for ORS and zinc in India
Vicki MacDonald is the Child Health Advisor of Abt Associates.
Topic: A public/private partnership in Ghana to address the introduction of zinc
1776 Massachusetts Avenue, NW Suite 300, Washington, DC 20036 | TEL: 202-835-3100 | FAX: 202-835-3150
- PATH And Partners Issue Diarrhea/Pneumonia Declaration To Call For Action Against Leading Causes Of Child Mortality (medicalnewstoday.com)
- Uganda: Clinton arrives to fight diarrhea in children (crofsblogs.typepad.com)
- New genetic path to deadly diarrheal disease discovered (news.bioscholar.com)
- Researchers look at the spread of dysentery from Europe to industrializing countries (medicalxpress.com)
- Child survival takes center stage as leaders convene to renew commitments (eurekalert.org)
Web cast interview with Epidemiologist Irene Shui,
Excerpts from the story:
“A study in the Journal of the American Medical Association examines the safety and effectiveness of another rotavirus vaccine now being used.”
“Other vaccines have since taken its place. But a manufacturer’s study of one of them, the RotaTeq vaccine, suggested it, too, might cause intestinal blockage after the first dose. Epidemiologist Irene Shui, at the Harvard School Of Public Health, decided to investigate. ”
““Because the rotavirus vaccine is given to almost every child in the United States, it’s crucial to monitor the vaccine’s safety,” said Shui.”
“Shui and other researchers examined the records of almost 800,000 babies who received this vaccine, including 300,000 first doses. They were looking for incidents of intussusception, the medical term for this kind of blockage. ”
“We did not find an elevated risk of intussusception following any dose of the vaccine, and especially following the first dose,” she said.”
worthy of reprinting: Here is the beginning of a great article by Francisca Oluyole in the Daily Triumph
Impact of sanitation on survival
By Francisca Oluyole
UNICEF reports recently indicated that diarrhea prevalence rate in Nigeria is 18.8 per cent.
The rate, according to the report, is “one of the worst in sub-Saharan Africa”.
For many experts, the situation is “just not good enough” for a leading producer of crude oil, especially as children remain the worst victims of such a preventable disease.
Associated mostly with vomiting, purging and dehydration, diarrhea has been identified by the Nigerian health authorities as the second largest direct cause of child morbidity and mortality in Nigeria.
According to statistics from UNICEF, diarrhea accounts for more than 16 per cent of child deaths. That is a total of 150,000 deaths amongst children under five, annually.
Experts trace the disease to a lack of access to basic sanitation facilities and poor hygiene practices.
They say it is closely connected with malnourishment, as undernourished children usually have a compromised immune system and are also at a higher risk of developing pneumonia.
Recent reports from the World Health Organisation (WHO) have confirmed that Nigerian children will continue to be victims of diarrhea as the country is said to be one of the seven high-population countries with
total sanitation coverage of less than 50 per cent.
In effect, less than half of the population has access to improved sanitation and the access is as low as 10 per cent in some states with the situation worse in the rural areas.
The situation, according to the reports, has worsened in the last two decades, with environmental sanitation problems resulting in an escalating negative impact on public and environmental health.
Experts say poor environmental sanitation in Nigeria is characterised by the presence of heaps of refuse in cities, indiscriminate disposal of solid and other wastes, blocked drains, overgrown weeds, among others.
The state of food sanitation in homes, markets and abattoirs is equally appalling and unwholesome as food meant for human consumption is exposed to dust, flies, bacteria and other micro-organisms, they say.
The experts say that such probably accounts for the increasing cases of food-borne diseases such as cholera, food poisoning and typhoid fever.
According to Mr Jones Abari, an Abuja-based community health expert, the lack of safe and private toilets and hand-washing facilities in schools has ensured a quicker development of sanitation-related diseases on children. ….
to read full article by Francisca Oluyole in Daily Triumph go to http://www.triumphnewspapers.com/impact1522010.html R/AUWAL 1 1431 A.H. published MONDAY FEBRUARY 15 2010.
While this is being covered everywhere , I thought it is worth mentioning. It seems important that in this report WHO is stressing Zink tablets in conjunction the oral rehydration solution (ORS) The tables and charts provide excellent statistic for fundraisers and agencies wanting to bring help and awareness. For those in the field there are important points to note but ones in the field may ask “tell us something we don’t know”
Recognition of the reality that “WASH/WATSAN” address seems to be following the same slow path of Global Warming (and other critical realities) , taking its time to come to be mainstream and get the energy it deserves. Hopefully the material presented within shall be an effective red flag to wave to get recognition and resources.
the publication Diarrhoea: why children are still dying and what can be done is available in pdf format for viewing
from the press release:
Past success and present needs
Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by scaling up the use of oral rehydration solution (ORS) to prevent dehydration and by educating caregivers. In spite of the promising results of these campaigns, in recent years the international community has shifted its focus to other global emergencies. There is now an urgent need to focus once more on preventing and treating diarrhoea.
Treatment with ORS and zinc tablets
WHO and UNICEF recommend treating diarrhoea with low-osmolarity ORS and zinc tablets, which decrease the severity and duration of the attack. These treatments are simple, inexpensive and life-saving.
Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths from this neglected killer.
from the publication:
For a number of years, there was one zinc product that met quality standards for international procurement by UNICEF. Zinc is now procured by UNICEF, governments and
other agencies and is manufactured locally in a handful of countries. However, meeting policy and regulatory requirements for importing a new product continues to present challenges for zinc introduction in many countries. Moreover, changing child health treatment recommendations nationally can also be difficult.
Compounding the problem is the fact that initial start-up funds for these new treatments can be significant, and beyond the scope of regular health budgets. In addition, many countries are hesitant to buy zinc because they have little experience with it as part of diarrhoea management programmes: They are unsure of the demand and are reluctant to devote funds to one-time start-up activities, such as developing training materials. ….
The challenges of scaling up zinc and increasing usage rates of ORS are steep, but not prohibitive. A renewed call to action is needed to ensure that increasing coverage
of diarrhoea treatment interventions becomes an international
pulications Sources: Global Zinc Task Force, 2009; UNICEF Supply Division, 2009.
Excerpt From Napo press release:
SOUTH SAN FRANCISCO, Calif.–(BUSINESS WIRE)–Napo Pharmaceuticals, Inc. (Napo) recently hosted an educational panel to address the impact of the lack of access to clean water and enteric disease on global health, the environment, and human rights. Robert F. Kennedy, Jr., Napo’s Environmental Advisor, discussed the negative consequences of non-sustainable development on indigenous peoples and the environment.
Other speakers included E. Benjamin Skinner, who has written about the connection between the war on diarrhea and modern-day slavery in his book, A Crime So Monstrous; and James Workman, whose book, Heart of Dryness, details the current and future struggles surrounding the scarcity of clean water, as told through the experiences and traditional wisdom of bushmen in southern Africa’s Kalahari region. Dr. Pradip Bardhan of the International Centre for Diarrhoeal Disease Research in Bangladesh (ICDDR,B), a state-of-the-art cholera hospital, shared his experiences with enteric disease, not only at the ICDDR,B, but also with respect to cholera crises around the world, such as the recent outbreak in Zimbabwe.
“This event was an important gathering of world experts to address the various factors affecting the health of global populations,” said Napo CEO Lisa Conte. “The development of crofelemer, Napo’s investigational drug for secretory pediatric infectious diarrhea, is part of an effort by many partners to address the devastating dehydration in pediatric populations, regardless of their geography of social or economic status.”
The panel event followed a recent discussion among international experts on Napo’s global advisory board about the development of crofelemer for use in pediatric population. In addition, on Oct. 2, Ms. Conte addressed the MIT Legatum Center’s second annual Progress Through Innovation conference, which highlights the development and empowerment of people in developing regions of the world. Ms. Conte’s remarks focused on Napo’s global business plan to bring its first-in-class anti-diarrheal agent, crofelemer, to all populations in all countries through a sustainable business model by working with local partners. She also commented on the human-rights impacts and environmental repercussions of unmet global health needs, and the common traits shared by innovators and entrepreneurs around the globe.
Crofelemer for Pediatric Populations (CRO-PED)
Napo is organizing a program to accelerate the development of crofelemer for pediatric infectious diarrheal diseases, targeting regulatory approval in 2011-2012 (pending additional funding). The company has established a global advisory board to ensure that the development of a pediatric product incorporates World Health Organization (WHO) Essential Medicines guidelines for oral rehydration solution (ORS), zinc, etc., and to generate a formulation that is practical and safe for resource-constrained regions with limited health personnel. Napo has formed alliances with Direct Relief International and others to make crofelemer accessible to every childhood population in need. Napo is also in the planning stages for clinical development of crofelemer for severe cholera in pediatric populations at the ICDDR,B.
Napo’s proprietary patented gastrointestinal compound, crofelemer, is a first-in-class anti-secretory agent extracted from Croton lechleri, a medicinal plant sustainably harvested in several South American countries. Crofelemer is in various stages of clinical development for four distinct programs, including a late-stage Phase 3 program. The FDA has granted fast-track status to crofelemer development for IBS and HIV-related indications (CRO-IBS and CRO-HIV):
- CRO-HIV for HIV-related diarrhea, Phase 3 (under Special Protocol Assessment)
- CRO-IBS for diarrhea irritable bowel syndrome (D-IBS), Phase 2
- CRO-ID for acute infectious diarrhea (including cholera), Phase 2
- CRO-PED for pediatric diarrhea, Phase 1
Napo’s licensee, Salix Pharmaceuticals, Inc. has exclusive rights to crofelemer for all indications in North America, Europe (excluding Iceland, Liechtenstein, Norway, and Switzerland), and Japan, and, for certain other indications including irritable bowel syndrome, worldwide. Salix estimates that the HIV-associated diarrhea market opportunity alone may be $300 million. The ADVENT trial of crofelemer as a treatment for chronic diarrhea in patients on antiretroviral therapies for HIV or AIDS is being conducted under fast-track status and Special Protocol Assessment agreement with the FDA.
Crofelemer has also been licensed to Glenmark Pharmaceuticals, Ltd. in India and 140 emerging countries for indications related to HIV (CRO-HIV), use in acute adult infectious diarrhea (CRO-ID), and use in pediatric diarrhea (CRO-PED). Glenmark and Salix have entered into a commercial supply agreement for crofelemer active pharmaceutical ingredient (API). AsiaPharm Group, Ltd. has rights to crofelemer in China (including Hong Kong and Macau).
see Journal of Pediatric Gastroenterology and Nutrition: for more information on Infectious Diarrhea in Children
see google journal search results for studies with Crofelemer