This week on the MHTF blog:

1. HSPH students Hannah Ratcliffe and Elena Chopyak write about their experiences with MHTF partners during the Winter Session
2. Submit your nominations for the Women Deliver 50
3. Maternal health articles in the February WHO Bulletin
4. New report suggests malaria incidence is greater than previously thought

Some reading for the weekend:

1. Tanzanian president writes on maternal and child health
2. Gender disparities for child mortality in India
3. An analysis of maternal health in Liberia

“You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults. What we have found in hospital records, death records, surveys, and other sources shows that just is not the case,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and lead author of a new study on global malaria mortality.


A new report from IHME published in the Lancet yesterday, Global malaria mortality between 1980 and 2010: a systematic analysis, shows that malaria is responsible for almost twice the number of deaths worldwide than previously believed.


According to the press release about the new study, “IHME researchers say that deaths from malaria have been missed by previous studies because of the assumption that the disease mainly kills children under 5. IHME found that more than 78,000 children aged 5 to 14, and more than 445,000 people ages 15 and older died from malaria in 2010, meaning that 42% of all malaria deaths were in people aged 5 and older.”


The study did not look specifically at the number of pregnant women dying of malaria or the relationship between malaria and maternal morbidity and mortality, but it did show that far more adults are dying from malaria than we previously believed. It is safe to assume that the number of pregnant women dying from malaria is likely also largely underreported.


The good news from the study is that the number of malaria deaths has fallen rapidly in recent years—likely due to the ramping up of efforts to combat the disease. Researchers pointed to the scale-up of insecticide-treated bed nets and artemisinin-combination treatments (ACTs) as major factors in the drop of malaria deaths.


Unfortunately, malaria prevention, screening and treatment among pregnant women remains low, despite clear evidence of effective interventions and significant investment in this area—and it is not clear whether malaria deaths are, in fact, falling for this segment of the population.


The Maternal Health Task Force is exploring opportunities to bring together maternal and newborn health professionals with malaria experts in order to discuss the challenge of low coverage of malaria prevention for pregnant women and how we might work together to ensure that malaria deaths are on the decline for pregnant women as well as the general population.


As our work in this area develops, we will keep you posted here on the MHTF Blog.

Related reading:

Check out the data visualizations that accompany the new study–and explore global trends in malaria mortality between 1980 and 2010.


Read the Washington Post coverage of the new study here.


In an Op-ed in the New York Times on Wednesday, Paul Farmer shares four reasons why it is imperative that the Global Fund to Fight AIDS, Tuberculosis and Malaria continues to get the support it needs.


This study, An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases, showed that in a tertiary hospital in Mozambique, at least half of maternal deaths were linked to an infectious disease—and highlighted the importance of implementing malaria prevention strategies such as intermittent preventive treatment and insecticide treated bed nets.


For more information on malaria in pregnancy, visit the Malaria in Pregnancy Consortium website.  Be sure to check out their interactive map of research projects relating to malaria in pregnancy, here.

Over the first three weeks of January, several Harvard School of Public Health graduate students took part in the Field Experience in Maternal Health winter session, organized by the Women and Health Initiative and the Maternal Health Task Force. In this blog post, Hannah Ratcliffe writes about her field experience with the Population Council in Bangladesh.

 

Written by: Hannah Ratcliffe

 

This January, I had the pleasure of interning in Bangladesh at the Population Council Dhaka office.  I spent my three weeks there focusing on the improvement and automation of a quality assurance checklist for use in the Population Council’s Pay-for-Performance (P4P) project.  The P4P project was designed to improve the quantity and quality of maternal and child health care services delivered in three districts of Bangladesh by offering financial incentives to reward service providers for meeting targeted levels of facility performance.

 

This project is one of the few being undertaken in Bangladesh that directly aims to improve quality of care.  Quality is assessed quarterly by Quality Assurance Groups (QAGs) made up of technical experts from nearby medical colleges, hospitals, and professional bodies.  In their quarterly assessments, QAGs use a Qualitative Measurement Tool to document and measure the quality of care being provided at a facility. The content of this tool was developed over the course of five consensus-building workshops organized by the Directorate General of Health Services in 2010 and attended by national and local-level program managers and service providers.

 

When I arrived in Dhaka, the Qualitative Measurement Tool was in an intermediate stage of development.  I worked to edit the 500+ indicators included in the tool to make them clearer and to ensure that the point values corresponding to each indicator were accurate and self-explanatory.  Working with the P4P team and a software developer, I also helped to design the layout and functionality of an electronic version of the tool.  Our goal was to create an intuitive instrument that is structured to correspond with the progression of a QAG facility assessment and which allows for rapid, onsite calculation of results.  The refinement of the Qualitative Measurement Tool is still underway, and I am looking forward to continuing to assist in its development from Boston!

 

 

To learn more about the Field Experience in Maternal Health winter session course, visit the course page here or check out a recent blog post about the course here.

In the February 2012 issue of the Bulletin of the World Health Organization, maternal health is prominently featured with seven (half!) of the articles directly or very closely touching on maternal health. Just a few years ago, this focus on maternal health in such a prominent journal would have nearly unthinkable. However, given the attention to maternal health to and hard work of our colleagues, partners and allies throughout the world, voices of mothers and their advocates are now heard loudly on the global scene.

 

The seven articles feature maternal health issues including:

1. A CEDAW decision on human rights and maternal mortality
2. Fistula treatment in Sierra Leone
3. Population control and human rights
4. Access to facilities in Timor-Leste
5. Health systems and maternal health in the Philippines
6. Female genital cutting in west Africa
7. Perinatal mental disorders

Over the first three weeks of January, several Harvard School of Public Health graduate students took part in the Field Experience in Maternal Health winter session, organized by the Women and Health Initiative and the Maternal Health Task Force. In this blog post, Elena Chopyak writes about her field experience with Medic Mobile in Mali.


Written by: Elena Chopyak


It is widely known that the maternal mortality rate in Mali is grossly underestimated. However, current data collection methods fail to capture true mortality rates, especially in rural areas of the country. An mhealth project between the Malian Ministry of Health, UNFPA, L’Agence Nationale de Télésanté et d’Informatique Médicale (ANTIM), and Medic Mobile aims to collect more accurate data to better inform future initiatives targeting maternal deaths.


Thanks to support from ANTIM, I visited a number of pilot sites in Koulikoro and Segou with Ibrahim Kante, an ANTIM technician, and Hammadou Dia, a medical ANTIM intern. Our goal was to hear administrative and community health workers’ (CHW) experiences with the pilot to date so that their input can be incorporated into the project as it is scaled-up nationally.

Dia and I spoke to representatives from various districts and communities about the former/current demographic collection system, the shortcomings, and general aspirations for the mobile project. We also asked the CHWs involved in the pilot to share their experiences with the phones, including challenges they have had, if any, and their reflections on the training they received.


Despite some technical hiccups, unexpected advantages of the project are rapidly becoming apparent. Thanks to unlimited calling, CHWs and medical and administrative staff report that they communicate more frequently about villagers’ medical needs and concerns. A review of the data collected at the end of the month, and again at the end of each month of the three-month pilot phase will provide a clearer picture of the health of the project.


Even though the pilot phase is in its early stages, CHWs and administrators hope that the project will continue and will expand to include a wide range of health data collection.





To learn more about the Field Experience in Maternal Health winter session course, visit the course page here or check out a recent blog post about the course here.


Click here to learn about Medic Mobile’s work, supported by the MHTF, to develop three mobile tools for maternal health.

 

The following originally appeared on Women Deliver’s blog. It is posted here with permission.

 

Every year, in conjunction with International Women’s Day, Women Deliver celebrates the progress made on behalf of girls and women worldwide. Our Women Deliver 100 list in 2011, which featured 100 of the most inspiring people who have delivered for girls and women, was covered by over 100 traditional and new media sources. This year, to continue the momentum, we are spotlighting the top 50 inspiring ideas and solutions that deliver for girls and women. We would love to hear what you think are the most innovative, impactful, and promising advancements in overcoming gender inequality.

 

These advancements could have been made by an individual, governments, the private sector, or civil society, but they must have helped to improve the condition of girls and women around the world, in one or more of the following 5 categories:

• Technologies and Innovations
• Educational Initiatives
• Health Modernization
• Advocacy and Awareness Campaigns
• Leadership and Empowerment Programs

 

Examples of inequities that the solutions may have addressed include, but are not limited to: Violence Against Women; Sex Trafficking; Child Marriage; Political Processes; Maternal Health; Sexual and Reproductive Health and Rights; HIV/AIDS, Lesbian; Gay, Bisexual and Transgender Rights; Economic Inequity; or Female Genital Mutilation.

 

NOMINATIONS MUST BE SUBMITTED NO LATER THAN FEBRUARY 10, 2012.

 

Once all nominations have been received, a selection committee of experts and advocates from leading global NGOs and foundations will choose 25 per category. Voting opens on February 20th, and the Top 50 (10 winners per category) will be announced on International Women’s Day. The winners from each category will be featured prominently on Women Deliver’s website, through the selection committee’s social media portals, and at the Women Deliver 2013 conference in Kuala Lumpur.

 

Criteria:

• Advancements may include projects, programs, technologies, initiatives, or campaigns launched anywhere in the world
• Solution or Idea must have been implemented in the last five years
• Can be grassroots or global in scale (example: community initiative or global technology)
• If the solution has been ongoing for more than a year, please provide quantitative and qualitative data that demonstrates results
• If the idea is in the early stages of implementation, please include an explanation of why it will be effective
• Please provide website (if applicable) and references

 

Selection Committee:

-Chair: Jill Sheffield, Founder and President of Women Deliver
-Jimmie Briggs, Founder and Executive Director of Man Up
-Cory Heyman, Chief Program Officer at Room to Read
-Josh Nesbit, CEO of Medic Mobile
-Amie Newman, Communications Officer and Editor of the Impatient Optimist at the Bill and Melinda Gates Foundation
-Lyric Thompson, Special Assistant to the President at the International Center for Research on Women
-Michael Tirrell, Communications Manager for Media and Public Affairs at Marie Stopes International

 

Click here to make a nomination. Thank you in advance for you submissions!

This week on the MHTF blog:

1. We posted a number of opportunities: a Fellowship at PRB; submit an abstract for the American Public Health Association Annual Meeting; and internships with the UCSF Safe Motherhood Program
2. Maternal health in marginalized communities in India
3. HSPH students spend their winter term with MHTF partners
4. Bill Gates’ Annual Letter and the poorest of the poor
5. We welcomed new staff members to the MHTF team

Some reading for the weekend:

1. Cote d’Ivoire abandons free health care scheme
2. Who is (or isn’t) participating in India’s JSY program?
3. PMTCT coverage at different health facilities in four African countries

Anne M. Austin and Kate Mitchell are the two most recent additions to the Maternal Health Task Force team. Anne will lead the MHTF’s new research, monitoring and evaluation efforts as Deputy Director for Research, Monitoring and Evaluation, while Kate will keep the MHTF’s cutting-edge knowledge management system content-rich and timely as the Managing Editor.

 

Born in Indonesia to a Norwegian mother and American father, and raised in Nigeria, Kenya and Saudi Arabia, Anne Austin brings a personal and professional global perspective to the MHTF. She holds a BA from Emory University, a MPH from the Rollins School of Public Health, and a ScD from the Harvard School of Public Health’s in Global Health and Population Studies and was named a Pritzker Fellow two years in a row.

 

Anne has conducted extensive research in areas that make her exceptionally well-suited to lead the MHTF’s innovative implementation research agenda on the quality of maternal health care. Her technical and analytical skills will enable the MHTF to contribute significantly to the global challenge of systematizing proven interventions to improve maternal health outcomes especially in high-burden settings. Among her studies, Anne has looked at maternal and child health trends in Egypt, analyzed global policy approaches to child nutrition, analyzed couple concordance on attitudes towards abortion and knowledge of abortion, and managed a unique CDC study on the prevention of malaria in pregnancy.

 

Kate returns to the MHTF where she began as a Knowledge Management Assistant in the project’s first phase, cataloguing and tagging the first on-line library exclusive to maternal health as well as helping to establish and populate the MHTF’s social media platforms. She left the MHTF when she was named a Clinton Fellow at the America India Foundation. Over the course of year, she worked in Jamshedpur, Jharkhand and Kolkata in West Bengal investigating the implementation of the Janani Suraksha Yojana conditional cash transfer program. She also designed and facilitated workshops for community health workers on community involvement in maternal and newborn health programs. Kate runs her own maternal health blog and is a frequent contributor to others. She holds a BA from Florida International University and an MPH from Boston University School of Public Health.

 

The MHTF is pleased to welcome Anne Austin, and to welcome back Kate Mitchell to the team! To learn more about Anne, Kate and the rest of the MHTF staff, click here.

The Safe Motherhood Program at the University of California, San Francisco is looking for two interns: one office intern to be based in the San Francisco office and one field intern to be based in the Copperbelt region of Zambia.

1.) UCSF Safe Motherhood Office Intern, San Francisco – Summer 2012

The focus of this internship is to prepare presentations for an upcoming international conference in order to effectively show the latest data on the non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage clinical trial.  The intern will also gain some experience in handling and cleaning a large data set.

For more information on the trial please visit www.lifewrap.org and http://clinicaltrials.gov/ct2/show/NCT00488462.

Duties:

• Assist with data cleaning and analyses for the international trial for the non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage
• Prepare multiple Power Point presentations to include data for an upcoming international conference
• Other light administrative duties as required

Qualifications:

• Excellent Power Point and writing skills are a must!
• Knowledge of STATA, SPSS, Word, Excel.
• Experience with online data systems is a plus.

Start date: June 1, 2012.

Duration: 12 weeks, 40 hrs/week

Note: This internship is unpaid.

Please send CV, cover letter and a writing sample to Jennifer Clark at jclark@globalhealth.ucsf.edu.

Please apply by 2/15 to be considered for initial screening.

2.) UCSF Safe Motherhood Zambia Field Intern – Summer 2012

The focus of this internship is to support the Zambia team of the non-pneumatic anti-shock garment (NASG) trial.  The study aims to reduce maternal mortality and morbidities in Zambia and Zimbabwe caused by obstetric hemorrhage.  This is a cluster randomized control study which compares outcomes based on evidence from intervention and control clinics.  The intervention clinics in this study are the clinics that are using the NASG as a first aid device for patients suffering from hypovolemic shock caused by bleeding during pregnancy.

For more information on the trial please visit www.lifewrap.org and http://clinicaltrials.gov/ct2/show/NCT00488462.

Duties:

• Provide logistical support for the local Zambian team – distributing supplies, copies, etc
• Review data collection forms
• Encourage protocol adherence
• Conduct training with local hospital and clinic staff
• Visit the study clinics
• Follow up on cases
• Liaise with the San Francisco office and the in-country staff

Qualifications:

• Experience in international settings
• Interest in maternal health
• Research experience
• Familiarity with clinical environments
• Must be highly detail-oriented, organized and have excellent follow-through skills

Start Date: May 30, 2012

Duration: 12 weeks, 40 hours/week

Note: Candidates are expected to secure outside funding to cover roundtrip airfare and living expenses for the duration of the internship.

Please send cv, cover letter and a writing sample to Jennifer Clark at jclark@globalhealth.ucsf.edu.

Please apply by 2/15 to be considered for initial screening!

View past intern experiences on our intern blog: http://lifewrapinterns.wordpress.com/.

Today, Bill Gates published his annual letter, which this year focuses on improving the lives of the poorest of the poor through innovations in agriculture and promoting global health issues, including vaccines, polio, HIV/AIDS, and family planning.

 

On family planning, Gates writes:

Globally, more than 200 million women say they don’t want to have a child within the next two years but aren’t using contraceptives. If families that wanted to wait a longer period between births or have fewer children had access to the right tools, two things would happen. First, those families would have an easier time facing the challenges of poverty. Second, as national population growth rates came down gradually, governments would be able to better meet the needs of all their people.

 

A significant number of women indicate that they would use modern family planning tools if they were available. Unfortunately, the funding to buy these tools, to make them cheaper, and to provide high-quality information to poor families has been lacking.