Title: Possible themes for South African-Norwegian Health research collaboration
1Possible themes for South African-Norwegian
Health research collaboration
- Halvor Sommerfelt, MD, PhD
- University of Bergen,
- Currently University of the Western Cape
Medical Research Council, Cape Town
Prof. Mhlanga A nation without (healthy) women
and children is a nation doomed
2Main messages
- Cost-effective (mother child) health promotion
programs Powerful instruments ? economic growth
and poverty reduction, if - ?main disease burden contributors (diseases
risk factors) - ? research to generate evidence-base for
program-relevant interventions - ? extensive coverage and equitable delivery
(Research?functional health system). - Experiences from other collaborations, e.g.
Indo-Norwegian RSA as node for health research
and post-graduate education in SSA? - Suggested areas for collaborative research
post-graduate education in health - Suggested strategies for collaborative health
research
3Sources
- Presentations by Prof. David E. Bloom and David
Canning, School of Public Health, Harvard
University and Prof. David Sanders, School of
Public Health, University of Western Cape at the
GAVI-funded seminar Development and Deployment
of Vaccines Against Poverty-Related Diseases,
Bergen, Norway, September 21, 2004
(http//www.cih.uib.no/GAVI/seminar2004/index.htm)
. - David E. Bloom and David Canning. The health and
wealth of nations, Science. 2000 287 pp.
1207-1209 David E. Bloom et al. Health, Wealth,
and Welfare. Finance Development. 2004 pp.
10-15. - WHO/UNICEF
- Demographic Health Surveys (DHS)
- PF Basch. Textbook of International Health. ISBN
0-19-504897-0. Oxford University press, 1990
pp. 164-183. - Kramer, S. Mausner Bahn. Epidemiology. An
introductory text. ISBN 0-7216-6181-5. W. B.
Saunders, Philadelphia, 1985, pp. 239-256. - World Development Report 1993. ISBN
0-19-520890-0, Oxford University Press, 1993. - Commission on Macroeconomics and Health
- Lancet series on child survival 1993
4Standardized mortality rates US 1900-1973gross
national product-gtMedical care
5Age-adjusted measles mortality per 1000 US
1900-1973
Similar for other major infectious diseases, the
interventions came too late Vaccines
diphteria, whooping cough Treatment TB,
pneumonia, diarrhea
6(No Transcript)
7Measles incidence US 1912-1982
8Measles incidence US 1912 - 1982 if effective
vaccine available from 1915
9Age-adjusted measles mortality per 1000 US if
vaccine available from 1915
10Historically in industrialized countries Close
link between general std. of living and health,
limited effect of specific health interventions
- 20th/21st century transitions (i.e. in developing
countries) are often propagated or even initiated
by health interventions - Declines in mortality and then fertility are
often sharper than seen in present day
industrialized countries (immunizations, health
education, early treatment.....)
11Historical data on health and disease
- Countries where large differences in S-E status
(e.g. India and South Africa) Different strata
of the population are actually simultaneously at
two different stages of the demographic and
epidemiological transitions!
Fight at two fronts Cheap - to - prevent/treat
communicable diseases (of children) vs.
expensive - to - treat degenerative diseases of
adults/elderly.
12The good
- UN/UNICEF data show that the global child
mortality rate has declined from 196 (deaths per
1000 live births) in 1960 to 93 in 1990 to 82 in
2002 - Between 1960 and 2002, the child mortality rate
has fallen in every country in the world. - Immunization coverage increased from 5-10 in
1974 to about 75 by 1990.
Source David Bloom and David Canning, Harvard
University
13The bad
- 10.5 million children under the age of 5 (U5)
died in 2002, accounting for nearly 20 of all
global deaths (U5 only 10 of world population). - 6-7 million of those deaths could have been
easily averted through immunization and early
treatment (as they are due to malnutrition, acute
respiratory infections, diarrhea, malaria, and
measles). - One fourth of children worldwide have not been
immunized with DTP.
Source David Bloom and David Canning, Harvard
University
14The ugly.
- 98 of child deaths occur in developing countries
- The ratio of child mortality in developing
countries to child mortality in industrial
countries was - 5.5 in 1960
- 10.3 in 1990
- 13.0 in 2002
- The child mortality rate increased in 15
countries from 1990-2002, many of which in SSA
Source David Bloom and David Canning, Harvard
University
15The Lancet 2003 Child survival I
16Justifications for devoting resources to health
- moral, ethical, humanitarian
- basic human right
- vital social goal
Source David Bloom and David Canning, Harvard
University
17Justifications for devoting resources to health
- moral, ethical, humanitarian
- basic human right
- vital social goal
- health is a crucial element in the development of
strong economies
Source David Bloom and David Canning, Harvard
University
18About the links between health and wealth.
Source David Bloom and David Canning, Harvard
University
19Income and Life expectancy in 2001
Source David Bloom and David Canning, Harvard
University
20Impact of child health on economic growth
developing countries
Commission on Macroeconomics and Health
21From income to health one part of the story
Health
Source David Bloom and David Canning, Harvard
University
22From income to health one part of the story
Health
- Better nutrition
- Better access to clean water
- Better sanitation
- Improved access to preventive curative health
services - Better psycho-social resources
Source David Bloom and David Canning, Harvard
University
23From health to income the rest of the story
Health
Source David Bloom and David Canning, Harvard
University
24From health to income the rest of the story
Health
- Productivity
- Education
- Investment
- Demographics
Source David Bloom and David Canning, Harvard
University
25Health to income
Health
A 10 year gain in life expectancy translates into
nearly 1 additional percentage point of annual
growth of income per capita.
In addition to this health effect, demographic
transition accounted for roughly one-third of the
East Asian miracle 2 percentage pts/year.
Comparison E-economy 2-3 percentage points/year.
Source David Bloom and David Canning, Harvard
University
26The bottom line.
The rate of return to investment in the GAVI
immunization program is conservatively estimated
at 12 in 2005, rising to 18 in 2020.
Source David Bloom and David Canning, Harvard
University
27By comparison.
These figures are comparable to average rates of
return to investments in schooling (based on a
survey of 98 country studies during
1960-97) primary 19 secondary 13 higher 11
Source G. Psacharopoulos and H. Patrinos,
Returns to Investment in Education A Further
Update, World Bank Policy Research Working Paper
2881, September 2002 (social rates of return from
Table 1).
Source David Bloom and David Canning, Harvard
University
28Thus
Vaccination and other cost-effective child health
promotion programs have a strong claim to be
powerful instruments of economic growth, poverty
reduction, and human betterment. But A
prerequisite is extensive coverage and equitable
delivery and therefore a functional health system
that can deliver.
Source David Bloom and David Canning, Harvard
University
29Main Take-Home Message
Immunization and other cost-effective child
health promotion programs can be highly
cost-beneficial tools for promoting both the
health and wealth of nations
Source David Bloom and David Canning, Harvard
University
30Global Immunization 1980-2002, DTP3
coverageglobal coverage at 75 in 2002
Source WHO/UNICEF estimates, 2003
31WHO/UNICEF Review of Immunization Coverage in
South Africa 1980-2003 DTP3
321990s progress reversed
-
- Inequitable globalisation,
-
- Health sector reform, and
- HIV/AIDS result in slow progress and reversals.
Source David Sanders, University of the Western
Cape
33U5MR in Sub-Saharan Africa
The State of the Worlds Children 2003. UNICEF
34Research steps in the development and evaluation
of public health interventions
De Zoysa et al, Bull WHO 1998, 76127-133
35The Lancet 2003 Child survival IV
36The Lancet 2003 Child survival V
37Indo-Nepali-Norwegian research consortium on
childhood illnesses and nutrition
- Generate evidence-base for improving child
health and nutrition in developing countries.
Contribute to - Improve case management of children with diarrhea
and pneumonia - Reduce the incidence of severe diarrhea and
pneumonia - Promote adequate childhood nutrition
- Institutional strengthening linked to
post-graduate education. India?Nepal
38Zinc syrup supplementation Nepal and India
- Funding
- EU-INCO
- NUFU
- NORAD
39Zinc for treatment of diarrhea, Nepal (n1792)
- Zinc reduced the risk of persistent diarrhea by
?40 - Zinc was equally effective when given by mother
- Children receiving zinc experienced some more
regurgitation and vomiting
Strand, T. A., R. K. Chandyo, R. Bahl, P. R.
Sharma, R. K. Adhikari, N. Bhandari, R. Ulvik, K.
Mølbak, M. K. Bhan, and H. Sommerfelt.
Pediatrics. 2002 109 898-903.
40Zinc for treatment of Diarrhea, India (n2050)
- Zinc syrup reduced duration and severity
- Zinc-ORS reduced the duration and severity and
but was not as efficacious as zinc syrup - No adverse effects in the zinc-ORS group, only in
the zinc syrup group (as in Nepal)
Bahl, R., N. Bhandari, M. Saksena, T. A. Strand,
G. T. Kumar, M. K. Bhan, and H. Sommerfelt. J.
Pediatrics. 2002 141 677-682.
41Routine zinc supplementation for prevention of
diarrhea and pneumonia, India
- 2 RDA of zinc (10 or 20 mg) every day for four
months (1250 children vs. 1250 controls) - Reduced incidence of
- Persistent diarrhea 31 (95CI 2-52)
- pneumonia 26 (95CI 1-44)
Bhandari, N., R. Bahl, S. Taneja, T. A. Strand,
K. Mølbak, R. J. Ulvik, H. Sommerfelt, and M. K.
Bhan. 2002. Pediatrics. 109 (6) e86.
42South Africa Among few countries which fortifies
flour with zinc
- Community- and hospital-based intervention trials
to measure the efficacy of zinc as adjuvant
therapy for pneumonia - India-Nepal-Norway
- NUFU ? ?0.6 mill EURO
- EU-INCO-DC ?0.9 mill EURO
43Lancet 2003 child survival II
With sufficient 1 or limited 2 evidence
for reducing childhood mortality from the major
causes of under 5 deaths
44PROMISE-EBF
- Promoting infant health and nutrition in
Sub-Saharan Africa Safety and efficacy of
exclusive breastfeeding promotion in the era of
HIV - EU-INCO ?1.3 mill. EURO
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46Key health research areas to consider
- Cause-specific burden of disease studies? guide
intervention-oriented research. Mother and child
health, HIV/AIDS, TB - Studies of disease determinants (SA and SSA) with
an equity lens - Clinical/field trials
- Efficacy trials
- Program-relevant effectiveness trials
- Studies (including trials) of comprehensive,
community-based approaches - Health systems research, particularly on
operational aspects and on evaluation
47- EDCTP aims to
- accelerate the development of new clinical
interventions to fight HIV/AIDS, tuberculosis and
malaria - build relevant capacities in developing countries
for clinical trials-based evaluation of such
interventions - Budget 200ME200ME200ME, of which 25 for
capacity building - , Cape Town selected as hosting institution
of the African branch office of EDCTP Secretariat
48Possible strategies for RSA-Norwegian health
research
- Regional collaboration SADC
- Other South-South collaboration, e.g. w. India
- Funding EU/EDCTP SA as a regional nodal point
- Research linked to postgraduate training and
institutional strengthening in both (all)
countries
Management after 2009? ST/NRF and Research
Council of Norway/Norwegian Centre for
International Cooperation in Higher Education?
49ENKOSI!NGIYA BONGA!DANKIE! THANK YOU! TAKK!
50- South Africa Norway
- March 15 2005
- Prof. R E Mhlanga,
- University of Kwazulu-Natal
51Health collaboration
- Priorities for the Country
- Free Health Care for pregnant and lactating women
and for children under 6 years of age - Notification of and Confidential Enquiry into
Maternal Deaths - Micronutrient fortification of basic foods
- Safe(r) Motherhood
- Millennium Development Goals
- PERINATAL HEALTH
52Health collaboration
- 130 million babies are born every year
- 4 million die within 4 weeks of having been born
- 4 million are born dead
- Majority are in Sub-Sahara
- How can perinatal health be improved National
question - How are the initiatives contributing to the
national solution - SUSTAINABILITY
53Health collaboration
- PROPOSALS NATIONAL
- Management of HIV and other infections
- Present projects skills for midwives and
advanced midwives - Management and administrative skills for midwives
- Exchange programmes under- and postgraduate
students for health - Intersectoral collaboration what do partners
bring to the table to ensure a healthy nation?