Browsing by Author "Merson, Michael"
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Item Open Access Chinese medical teams in Africa: a flagship program facing formidable challenges.(Journal of global health, 2019-06) Chen, Shu; Pender, Michelle; Jin, Nan; Merson, Michael; Tang, Shenglan; Gloyd, StephenItem Open Access Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030.(Journal of global health, 2019-12) Black, Robert; Fontaine, Olivier; Lamberti, Laura; Bhan, Maharaj; Huicho, Luis; El Arifeen, Shams; Masanja, Honorati; Walker, Christa Fischer; Mengestu, Tigest Ketsela; Pearson, Luwei; Young, Mark; Orobaton, Nosa; Chu, Yue; Jackson, Bianca; Bateman, Massee; Walker, Neff; Merson, MichaelBackground
Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur.Methods
We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction.Results
Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level.Conclusions
Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.Item Open Access Evolution of the World Health Organization's programmatic actions to control diarrheal diseases.(Journal of global health, 2019-12) Wolfheim, Cathy; Fontaine, Olivier; Merson, MichaelThe Program for the Control of Diarrheal Diseases (CDD) of the World Health Organization (WHO) was created in 1978, the year the Health for All Strategy was launched at the Alma Ata International Conference on Primary Health Care. CDD quickly became one of the pillars of this strategy, with its primary goal of reducing diarrhea-associated mortality among infants and young children in developing countries. WHO expanded the previous cholera-focused unit into one that addressed all diarrheal diseases, and uniquely combined support to research and to national CDD Programs. We describe the history of the Program, summarize the results of the research it supported, and illustrate the outcome of the Program's control efforts at country and global levels. We then relate the subsequent evolution of the Program to an approach that was more technically broad and programmatically narrow and describe how this affected diarrheal diseases-related activities globally and in countries.Item Open Access Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis.(Journal of global health, 2019-12) Choudhary, Tarun Shankar; Sinha, Bireshwar; Khera, Ajay; Bhandari, Nita; Chu, Yue; Jackson, Bianca; Walker, Neff; Black, Robert E; Merson, Michael; Bhan, Maharaj KishanBackground
India has achieved 86% reduction in the number of under-five diarrheal deaths from 1980 to 2015. Nonetheless diarrhea is still among the leading causes of under-five deaths. The aim of this analysis was to study the contribution of factors that led to decline in diarrheal deaths in the country and the effect of scaling up of intervention packages to address the remaining diarrheal deaths.Methods
We assessed the attribution of different factors and intervention packages such as direct diarrhea case management interventions, nutritional factors and WASH interventions which contributed to diarrhea specific under-five mortality reduction (DSMR) during 1980 to 2015 using the Lives Saved Tool (LiST). The potential impact of scaling up different packages of interventions to achieve universal coverage levels by year 2030 on reducing the number of remaining diarrheal deaths were estimated.Results
The major factors associated with DSMR reduction in under-fives during 1980 to 2015, were increase in ORS use, reduction in stunting prevalence, improved sanitation, changes in age appropriate breastfeeding practices, increase in the vitamin-A supplementation and persistent diarrhea treatment. ORS use and reduction in stunting were the two key interventions, each accounting for around 32% of the lives saved during this period. Scaling up the direct diarrhea case management interventions from the current coverage levels in 2015 to achieve universal coverage levels by 2030 can save around 82 000 additional lives. If the universal targets for nutritional factors and WASH interventions can be achieved, an additional 23 675 lives can potentially be saved.Conclusions
While it is crucial to improve the coverage and equity in ORS use, an integrated approach to promote nutrition, WASH and direct diarrhea interventions is likely to yield the highest impact on reducing the remaining diarrheal deaths in under-five children.Item Open Access Informing the 2011 UN Session on Noncommunicable Diseases: applying lessons from the AIDS response.(PLoS Med, 2011-09) Lamptey, Peter; Merson, Michael; Piot, Peter; Reddy, K Srinath; Dirks, RebeccaItem Open Access World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition.(Archives of disease in childhood, 2022-07) STAGE (Strategic Technical Advisory Group of Experts); Duke, Trevor; AlBuhairan, Fadia S; Agarwal, Koki; Arora, Narendra K; Arulkumaran, Sabaratnam; Bhutta, Zulfiqar A; Binka, Fred; Castro, Arachu; Claeson, Mariam; Dao, Blami; Darmstadt, Gary L; English, Mike; Jardali, Fadi; Merson, Michael; Ferrand, Rashida A; Golden, Alma; Golden, Michael H; Homer, Caroline; Jehan, Fyezah; Kabiru, Caroline W; Kirkwood, Betty; Lawn, Joy E; Li, Song; Patton, George C; Ruel, Marie; Sandall, Jane; Sachdev, Harshpal Singh; Tomlinson, Mark; Waiswa, Peter; Walker, Dilys; Zlotkin, StanleyThe World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.