H5N1

Zika and health cuts blamed for rise in baby death rates in Brazil

Via The Guardian: Zika and health cuts blamed for rise in baby death rates in Brazil. Excerpt:

The number of children dying in their first year of life has risen in Brazil for the first time since 1990. 

It’s a worrying setback for a country once seen as a model of poverty reduction.  

The infant mortality rate rose by nearly 5% between 2015 and 2016, an increase health officials and specialists have blamed on the outbreak of the Zika virus that year, as well as cuts to health services prompted by an economic crisis from which Brazil is struggling to recover.  

Fatima Marinho, director of the non-communicable diseases department and information and analysis at the health ministry, said she expects the 2017 figures to exceed the 2015 levels.  

“We are going backwards, not forwards,” Marinho said. “We cannot go on with the situation. Or we lose everything we have gained in 15 years.” 

Denise Cesario, executive manager of the Abrinq Foundation, a non-profit group in São Paulo that focuses on children’s and teenagers’ rights, said: “The rate is very significant. It is very worrying if we consider that this economic crisis will still impact on social conditions for years to come.”  

Infant mortality is regarded as one of the key measures of a country’s development. Brazil was praised for its success towards meeting the UN millennium development goal targets in a 2010 study published in the American Journal of Public Health, which said the country had made “rapid strides in improving maternal, newborn, and child health”.  

But government figures for 2016 revealed by the Folha de S Paulo newspaper, and since published by the health ministry, showed that Brazil’s infant mortality rate rose from 13.3 deaths per 1,000 live births in 2015 to 14 deaths per 1,000 live births in 2016, a 4.8% increase and the first since the current system of tracking progress began in 1990.  

Even relatively affluent states like São Paulo showed a 2.7% increase. Nationally, the death rate for children up to the age of five also rose nearly 4%. 

Brazil had been lauded for combining economic growth with poverty reduction via landmark government programmes like the Bolsa Família – or family allowance – a cash-transfer scheme for families who made sure their children remained in school and were up to date with vaccinations. 

In 2014, however, the country fell into recession. Faced with a deficit after winning re-election, President Dilma Rousseff began to cut spending and in 2016 the budget for Bolsa Família failed to match inflation. 

Funding was slashed for the Rede Cegonha (the Stork Network), a government health programme for women that focused on birth, postnatal health and family planning, said Cesario. 

Rousseff was suspended in May 2016 and impeached three months later. Her replacement, Michel Temer, introduced more drastic cuts and froze spending.  

Government officials have been so alarmed by the increase in infant and child deaths that they called a special meeting of state health secretaries in June. Deaths from preventable diseases like diarrhoea and pneumonia also rose in 2016. Folha also reported a 12% increase in deaths from diarrhoea in under-fives, with 19% of those occurring in semi-arid regions that have been battling drought in recent years.  

“How can children in Brazil in the 2000s die of diarrhoea? This number is shocking,” said Marinho, noting that the birth rate fell by around 5% percent in 2016 because women were avoiding having children during the Zika epidemic.

Unilateral phrenic nerve palsy in infants with congenital Zika syndrome

Via Emerging Infectious Diseases: Ahead of Print -Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome. The abstract:

Since the first identification of neonatal microcephaly cases associated with congenital Zika virus infection in Brazil in 2015, a distinctive constellation of clinical features of congenital Zika syndrome has been described. Fetal brain disruption sequence is hypothesized to underlie the devastating effects of the virus on the central nervous system. However, little is known about the effects of congenital Zika virus infection on the peripheral nervous system. 

We describe a series of 4 cases of right unilateral diaphragmatic paralysis in infants with congenital Zika syndrome suggesting peripheral nervous system involvement and Zika virus as a unique congenital infectious cause of this finding. All the patients described also had arthrogryposis (including talipes equinovarus) and died from complications related to progressive respiratory failure.

This is what collapsing health, education, water and sanitation systems look like in Yemen

Via Thomson Reuters, a report by Henrietta H. Fore of UNICEF: This is what collapsing health, education, water and sanitation systems look like in Yemen. Excerpt:

In Yemen, one child dies every 10 minutes from a preventable disease, and on a recent visit to the country, I saw first-hand what that meant.  

At the Al Qateea hospital in Aden, southern Yemen, mothers hold frail, acutely malnourished babies while psychosocial workers offer counseling to terrified children, some of whom have experienced the horrors of war before they are even old enough to go to school. An eight-year-old girl draws a picture of the world she dreams of, one in which the streets are safe, the sun is shining and the birds are chirping – nothing like the real world around her. 

Further north, a similar scene is unfolding at the Al Sabeen hospital in Sanaa. Up to 30 new young patients stream in every day to the hospital’s malnutrition ward. In the neonatal intensive care unit, newborn babies in incubators struggle for every breath.  

Keeping babies alive in a country where nothing works any more is a real challenge: There are not enough respirators and not enough medicine. Health staff diligently report to work even though they have not received their salaries in two years. The malnutrition ward is packed. Parents have no money for health care and by the time they bring their sick babies in, it is often too late. 

This is what a collapsing health system in a war zone looks like. It has the face of a mother who looks on, powerless, as her eight-month-old child, who has the weight of a newborn baby, fights for his life. It has the face of a father who has to choose between buying food for the whole family or buying medicine for his sick wife.  

Yemen had some of the worst health indicators globally even before the current escalation of fighting. Stunting rates are among the highest in the world, at 47 per cent. 1 in 60 women runs the risk of dying from pregnancy-related complications. Under-five mortality is high, at 55 per 1,000 live births. 

Three years into this conflict, more than half of the health facilities are non-functional due to damage or a lack of operating budget and staff. Half of the country’s children do not have clean water. An outbreak of cholera/acute watery diarrhea last year, the biggest on record, killed more than 400 children under the age of five. At least 80 per cent of the population live below the poverty line. 

The whole public service sector in Yemen, not just health, has been left in tatters. Teachers have not been paid in months, forcing many to abandon their classrooms and find other sources of income. Up to 1,500 schools have been damaged due to airstrikes and shelling, or have been occupied by armed forces and displaced persons. 

Sanitation workers too have been expected to come to work although they are not paid. Not doing so poses a serious risk in a country where cholera and famine are persistent risks.  

UNICEF has supported the payment of incentives for doctors, nurses and health workers who run the newborn, pediatric and maternity wards in at least eight hospitals in Yemen that receive the highest number of patients. This support has been crucial since the conflict escalated as it helps maintain some social services at such a critical time for children.  

We need funding to offer similar incentives for teachers and water and sanitation workers. But more importantly, all authorities in Yemen need to step up, recognize the urgency and get public services in the country up and running again.

Trump administration's opposition to breastfeeding resolution sparks outrage

Via The Guardian: Trump administration's opposition to breastfeeding resolution sparks outrage. Excerpt:

Advocates for improved nutrition for babies have expressed outrage over reports that the Trump administration bullied other governments in an attempt to prevent the passage of an international resolution promoting breastfeeding. 

The US delegation to the World Health Assembly in Geneva reportedly deployed threats and other heavy-handed measures to try to browbeat nations into backing off the resolution. 

Under the terms of the original WHO text, countries would have encouraged their citizens to breastfeed on grounds that research overwhelmingly shows its health benefits, while warning parents to be alert to inaccurate marketing by formula milk firms. 

The New York Times first reported how the Trump administration reacted forcefully to the resolution, which otherwise had the consensus support of all other assembly members. It pushed to remove a phrase from the draft text that would exhort governments to “protect, promote and support breast-feeding”. 

The administration also used its network of diplomats to lean on member states. Turning on the delegation from Ecuador, the US government said that unless the South American nation withdrew its backing of the resolution it would face punitive trade moves and even the potential loss of military help in its battle against gang violence. 

The resolution was eventually passed with US support, but only after the Russian government reintroduced it using a modified text.  

Lucy Sullivan, executive director of 1,000 Days, the US-headquartered international group working to improve nutrition for babies and infants, said in a Twitter thread that the US intervention amounted to “public health versus private profit. What is at stake: breastfeeding saves women and children’s lives. It is also bad for the multibillion-dollar global infant formula (and dairy) business.”  

The online network of mothers, Moms Rising, called the US government’s move “stunning and shameful. We must do everything we can to advocate for public policies that support and empower breastfeeding moms.” 

Patti Rundall of the UK-based campaign Baby Milk Action told the New York Times: “We were astonished, appalled and also saddened. What happened was tantamount to blackmail, with the US holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health.” 

Under an internal code of the World Health Organisation, baby formula companies are banned from explicitly targeting mothers and their health carers. Advertising is also controlled. 

A Guardian investigation with Save the Children earlier this year found that formula milk firms were using aggressive methods to skirt around the regulations in order to press mothers and healthcare professionals to choose powdered milk over breastfeeding. The measures were particularly intensively deployed in the poorest regions of the world, where most growth in the baby milk formula business is now concentrated.  

A plethora of studies have shown the stark health improvements brought about by breastfeeding in the US and around the world. A Harvard study in 2016 estimated that 3,340 premature deaths a year among both mothers and babies could be prevented in the US alone given adequate breastfeeding.

US: State health systems improving, but more people are dying deaths of despair

The Commonwealth Fund has published the 2018 Scorecard on State Health System Performance. It is a major document, and an alarming one. Click or tap through here to download the 62-page PDF. Excerpt from the overview:

Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked states according to the Commonwealth Fund’s 2018 Scorecard on State Health System Performance, which assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities.

The 2018 Scorecard reveals that states are losing ground on key measures related to life expectancy. On most other measures, performance continues to vary widely across states; even within individual states, large disparities are common.

Still, on balance, the Scorecard finds more improvement than decline between 2013 and 2016 in the functioning of state health care systems. This represents a reversal of sorts from the first decade of the century, when stagnating or worsening performance was the norm.

Overall, four major trends emerge from our analysis of the Scorecard results:

• Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states

• Regional differences in performance persist, as do within-state disparities

• Many states are not getting good value for their health care dollars

• States made progress in areas that were the target of efforts to improve

SCORECARD HIGHLIGHTS

Which states lead the rankings?

Hawaii, Massachusetts, Minnesota, Vermont, and Utah.

Which states are ranked at the bottom?

Louisiana, Oklahoma, and Mississippi.

Which states moved up the most in the rankings between 2013 and 2016?

California and Oregon rose the highest, jumping 9 and 10 spots, respectively. Both states expanded eligibility for Medicaid.

Which states improved on the most indicators?

New York improved on 18 of the 37 indicators we track over time — the most of any state. Arkansas, Louisiana, Oklahoma, and West Virginia each improved on 17 indicators. ...

Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states.

Deaths from suicide, alcohol, and drug use are at an all-time high. In 2016, average life expectancy at birth declined for a second year in a row, driven in large part by a spike in deaths from opioid use and other substance abuse as well as suicide. The combined rate of deaths from suicide, alcohol, and drug use—sometimes referred to as "deaths of despair"—increased 50 percent from 2005 to 2016. Rates rose in all states, doubling or more in Delaware, New Hampshire, New York, Ohio, and West Virginia.

Venezuela: Infant with H1N1 flu dies in J.M. de los Rios Hospital

Efecto Cocoyu is a dissident website in Venezuela, and its health page is a litany of sorrow in a collapsed healthcare system. Here's a new report: Muere niño con influenza AH1N1 hospitalizado en el J. M. de los Ríos.[Boy with H1N1 influenza dies hospitalized in J.M. de los Rios] Excerpt, with my translation:

La noche del miércoles 25 de abril, se confirmó la muerte de un bebé por influenza AH1N1 en el hospital de niños José Manuel de los Ríos. El pequeño de nueve meses de nacido fue ingresado hace dos semanas en la Unidad de Terapia Intensiva Pediátrica (Utip) luego de ser referido del Hospital Elías Toro, en Catia.  

On the night of Wednesday, April 25, the death was confirmed of a baby from H1N1 influenza in the José Manuel de los Ríos pediatric hospital. The nine-month-old had been admitted two weeks earlier in the Pediatric Intensive Care Unit after being referred from Elías Toro Hospital in Catia.

El niño residía en Antímano e ingresó al J. M. de los Ríos con complicaciones respiratorias. El pasado 16 de abril, médicos del hospital confirmaron por una prueba de cultivo que se trataba de un caso de influenza AH1N1.  

The little boy lived in Antímano and entered J.M de los Ríos with respiratory complications. On April 16, hospital doctors confirmed his case was H1N1 influenza.

Efecto Cocuyo pudo conocer que otro dos casos de influenza fueron confirmados en el hospital el pasado miércoles. Los dos niños son atendidos en un área de aislamiento y los galenos activaron un plan estratégico de contención para prevenir el contagio. 

Efecto Cocuyo learned that two other flu cases were confirmed in the hospital last Wednesday. The two children are in isolation and doctors have launched a strategic plan to prevent contagion.

Otro caso sospechoso fue descartado luego de que se realizaran las pruebas correspondientes.  

Another suspected case was discarded after testing.

Vietnan Vera, médico intensivista de la Utip, indicó a Efecto Cocuyo que la unidad no cuenta con los medicamentos necesarios para tratar a los pacientes con el virus de la influenza. El niño que falleció fue tratado con el Oseltamivir disponible en el hospital, con fechas de vencimiento de 2011 y 2015.

Vietnan Vera, ICU physician, told Efecto Cocuyo that the unit lacks medications for treating influenza. The little boy who died was treated with Oseltamivir available in the hospital, with expiry dates of 2011 and 2015.

National and regional under-5 mortality rate by economic status for low-income and middle-income countries

Via The Lancet Global Health: National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment. The summary;

Background 

The progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs). 

Method 

We estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles. 

Findings 

In 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1–70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5–34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. 

Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2–82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0–82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9–43·8) deaths per 1000 livebirths between 1990 and 2016. 

The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94–2·11] in 1990, 1·99 [1·91–2·08] in 2000, and 2·06 [1·92–2·20] in 2016). During 1990–2016, around half of the total under-5 deaths occurred in the poorest two quintiles (48·5% in 1990 and 2000, 49·5% in 2016) and less than a third were in the richest two quintiles (30·4% in 1990, 30·5% in 2000, 29·9% in 2016). 

For all regions, differences in the under-5 mortality rate between the first and fifth quintiles decreased significantly, ranging from 20·6 (90% UI 15·9–25·1) deaths per 1000 livebirths in eastern Europe and central Asia to 59·5 (48·5–70·4) deaths per 1000 livebirths in south Asia. 

In 2016, the ratios of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile were significantly above 2·00 in two regions, with 2·49 (90% UI 2·15–2·87) in east Asia and Pacific (excluding China) and 2·41 (2·05–2·80) in south Asia. Eastern and southern Africa had the smallest ratio in 2016 at 1·62 (90% UI 1·48–1·76). Our model suggested that the expected ratio of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile increases as national-level under-5 mortality rate decreases. 

Interpretation 

For all LMICs (excluding China) combined, the absolute disparities in under-5 mortality rate between the poorest and richest households have narrowed significantly since 1990, whereas the relative differences have remained stable. To further narrow the rich-and-poor gap in under-5 mortality rate on the relative scale, targeted interventions that focus on the poorest populations are needed.

India: Four infants die after taking Japanese encephalitis vaccine in Palamu

Via the Hindustan Times: Four infants die after taking Japanese encephalitis vaccine in Palamu. Excerpt:

Four infants have died since Saturday after being vaccinated for Japanese encephalitis and measles in Jharkhand’s Palamu district, one of the state’s most backward districts. Three of the victims died within eight hours of the vaccination on Saturday while five others are undergoing treatment at a government hospital.  

Nine children were administered vaccines at the local government health sub centre in Loinga village under the Patan community health centre in Palamu on Saturday.  

The district administration has ordered a high level probe into the deaths and a team from Ranchi was sent to find out the reason for the casualties in the village, almost 200 km northwest of the capital Ranchi.  

Villagers alleged within six to eight hours after vaccination, the children fell seriously ill with high fever and bouts of vomiting while their eyes turned yellow. Their condition deteriorated so quickly that three of them died before anything could be done.  

Family members along with villagers blocked traffic for more than three hours near the village, 25 km from Daltonganj on Sunday.  

The irate villagers also briefly held the village auxiliary nurse midwife (ANM) Draupadi Pandey hostage , accusing her of being responsible for the tragedy. 

Three of the victims aged between one year to 18 months were identified as Ujjwal Kumar, son of Upendra Kumar; Sanju Kumari, daughter of Santosh Yadav and Aryan Kumar, son of Dhirendra Bhuiyan. 

The fourth child two-year-old Ayush Kumar died Sunday afternoon at Daltonganj Sadar Hospital. Another infant Prabhat Kumar was referred to RIMS, Ranchi for better treatment. 

Palamu deputy commissioner (DC) Ameet Kumar acknowledged the tragedy and assured the villagers of action against the guilty. “Nine children were vaccinated in the village yesterday. It was a routine vaccination for measles and other diseases. Three children have died while six others are admitted at Sadar Hospital. They are responding well to the treatment,” he said.

Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study

Via PLOS Medicine: Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study. The abstract:

Background 

While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. 

Methods and findings 

Linked birth and death records for the period 2010–2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37–42 weeks of gestation). Multivariable logistic models were used to assess the extent to which state-level differences in full-term infant mortality (FTIM) were attributable to observed differences in maternal and birth characteristics. Random effects models were used to assess the relative contribution of state-level variation to FTIM. 

Hypothetical mortality outcomes were computed under the assumption that all states could achieve the survival rates of the best-performing states. A total of 10,175,481 infants born full-term in the US between January 1, 2010, and December 31, 2012, were analyzed. 

FTIM rate (FTIMR) was 2.2 per 1,000 live births overall, and ranged between 1.29 (Connecticut, 95% CI 1.08, 1.53) and 3.77 (Mississippi, 95% CI 3.39, 4.19) at the state level. Zero states reached the rates reported in the 6 low-mortality European countries analyzed (FTIMR < 1.25), and 13 states had FTIMR > 2.75. Sudden unexpected death in infancy (SUDI) accounted for 43% of FTIM; congenital malformations and perinatal conditions accounted for 31% and 11.3% of FTIM, respectively. 

The largest mortality differentials between states with good and states with poor FTIMR were found for SUDI, with particularly large risk differentials for deaths due to sudden infant death syndrome (SIDS) (odds ratio [OR] 2.52, 95% CI 1.86, 3.42) and suffocation (OR 4.40, 95% CI 3.71, 5.21). Even though these mortality differences were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. 

Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states. 

Conclusions 

More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction.

Yemen: Impact of the closure of seaports and airports on the humanitarian situation - Situation update 2

Via ReliefWeb, an OCHA report: Yemen: Impact of the closure of seaports and airports on the humanitarian situation - Situation Update 2 | 16 November 2017.

Situation Overview  

Sea and airports in areas under the control of the Government of Yemen have re-opened, but the ports lack the capacity required for the volumes of commercial and humanitarian cargo previously handled by Al Hudaydah and Saleef. The re-opening of Aden airport has allowed some humanitarian flights to land, but services to other parts of the country are still blocked. 

The continued closure of some sea and air ports by the Saudi-led coalition will push Yemen to a further catastrophic humanitarian situation. Eleven days since the blockade was put in place, commercial and humanitarian supplies in the country are running dangerously low.  

Impact on the delivery of supplies  

• UNVIM reports that as of 15 November, the blockade has prevented 29 vessels with approximately half a million metric tonnes of supplies (300,000 MT of food and 192,000 MT of fuel) from reaching the population of Yemen. This will have a significant impact on people’s ability to purchase food further aggravating an extremely fragile food security situation.  

• A UN humanitarian vessel transporting 1,313 MT of WHO/UNICEF health, wash and nutrition supplies, worth over than US$10 million, is currently being prevented from berthing in Al Hudaydah port.  

• A UN vessel with 25,000 tons of wheat is waiting to berth off the coast of Al Hudaydah port, incurring significant daily demurrage costs. 

Impact on fuel availability: 

• The blocking of fuel has led to a significant decrease in supplies, with diesel is estimated to run out in 20 days and petrol in 10 days in the northern areas of Yemen.  

• The price of petrol in Sana’a has increased by over 170 per cent from 275 YER/liter to 750 YER/liter in the black market. Few gas stations are currently open, and those that are have very long queues. The price of diesel in the black market has increased by 62 per cent from 325 YER/liter to 525 YER/liter.  

• The increase in fuel prices has meant the price of trucked water has increased by 133 per cent in Sana’a. This will further increase the vulnerability of millions of Yemenis with limited access to water and threatens to reverse the gains made in combating cholera.  

Impact on health  

• The blocking of essential medicine and vaccines and the lack of fuel arriving in Al Hudaydah port will impact millions of people that are already suffering from a lack of health services and multiple preventable diseases. All health facilities are reliant on fuel for delivering essential life-saving services and diphtheria is spreading fast with 120 clinically diagnosed cases and 14 deaths in the last week. At least one million children are at risk of contracting the disease. 

• The inability to re-supply life-saving maternal medicines and supplies will threaten the lives of 400,0000 pregnant women and their newborns, including 53,000 pregnant women who are likely to develop complications during childbirth.