WHO News

Fighting the ‘silent epidemic’

Joy Phumaphi (48), is a former health minister and former member of parliament of Botswana. She has a B.Com and a Masters in finance accounting and decision sciences. She also serves as a commissioner on the UN Secretary-General’s Commission on HIV/AIDS and Governance in Africa. Before that, she served as a member of the UN Reference Group on Economics and a member of the United Nations Development Programme (UNDP) Advisory Board for Africa. Phumaphi was appointed as WHO’s Assistant Director-General for Family and

WHO Community Health in August 2003. Joy Phumaphi

An estimated 11 million children under five years and more than half a million mothers globally are likely to die this year due largely to preventable causes. As Assistant Director-General of the Family and Community Health cluster at WHO, Joy Phumaphi’s task is to raise the profile of perhaps one of most neglected areas of public health. Phumaphi told the Bulletin she hopes the World health report 2005: Make every mother and child count, to be published on 7 April, and the recent appointment of Ethiopian fashion model Liya Kebede as WHO’s Goodwill Ambassador will spur efforts to do more for maternal and child health.

Q: What simple, cost-effective treat- HIV/AIDS, or malaria. That’s why it’s department: Making Pregnancy Safer ments if introduced in the world’s poorest so important for services for the pre- and strengthened an existing one, Gender, countries could substantially improve the vention of mother-to-child transmis- Women and Health. This shift in focus survival chances of mothers when they sion of HIV to be made available and should put us in a better position to give birth? for women to be given a prophylaxis attain the Millennium Development for malaria during pregnancy and as- Goals on maternal and child health. A: Access to professional care in the sisted to have a balanced diet to be as pregnancy, childbirth and postpartum healthy as possible during pregnancy. Q. What concrete progress in improving periods is key to addressing the maternal and infant survival do you ex- major causes of maternal mortality. Q: What simple interventions could save pect from World Health Day on 7 April, If comprehensive services were made newborn infants’ lives? when the world health report devoted to available, you could save most of the the subject will be launched? lives of the mothers who die. Often, A: If comprehensive health services women who haemorrhage badly need a with skilled professionals are accessible A: Every year we lose about 11 million blood transfusion and often don’t have during pregnancy, birth and after- under-fives, mainly to preventable access to a hospital. Obstructed labour wards, then a very large proportion of causes. Four million of these under-fives is also a problem and facilities that newborn lives can also die in the first week of can provide caesarian section are often be saved. As newborn life. An additional 3.3 million die during or not accessible. Many women deliver in mortality is a substan- The scale of unsafe conditions with traditional birth tial part of overall child before birth. Every year the problem and the about 529 000 women attendants who do not have the skills mortality, it needs to die during pregnancy, needed to help when something goes be tackled. scale of neglect in childbirth or shortly wrong. In addition, sepsis or infection this area are not yet Q: Have you given your afterwards. These are can occur, so making antibiotics avail- apparent to the global alarming statistics, it’s able to health services would also save cluster a new direction community. It is a a huge loss of life. But lives. Women need skilled antenatal since you arrived at WHO in August 2003? silent epidemic. the scale of the problem care to identify whether there is a need and the scale of neglect for delivery in a health facility. Ante- A: The cluster deals in this area are not yet natal care providers can show women with primary health- apparent to the global how to look after themselves during care programmes in the most basic community. It is a silent epidemic. We pregnancy and deal with any serious developing country health systems. The hope to give a voice to the 11 million health problems that may arise. tools, guidelines, norms and standards children and half a million women we that have been developed over the Q: What other factors can contribute to are losing every year. These women years are very good. But now we need and children are not dying in a natural the ill-health of mothers and neonates? to increase support to help countries disaster, like a tsunami. It is a disaster A: There are aggravating conditions translate this into policies, strategies which the adult world can prevent where there is a high prevalence of and practices. We have created a new because we have the solutions.

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Q: And what are those solutions? as a broad array of global stakeholders continue after delivery for the mother and child experts. Unfortunately, at and infant and appropriate service A: Children die from pneumonia and the time the article came out in the links must be made with child care and from sepsis, but we have the antibiotics Lancet we were still in the process and family planning services. These services to treat these. Many are still dying of some of the consultation meetings had must be available from day one. diarrhoeal disease, but oral rehydra- not yet taken place. We never had a tion salts (ORS) are World health report Q: More than 500 000 women are dying an effective treatment, in childbirth every year, has this situa- and were developed that enjoyed this level These children of consultation, so tion got worse in the last 50 years, or was decades ago. We know it even worse before? that breastfeeding is are not dying in a the criticism was a bit premature. the best form of nutri- natural disaster, like a A: In the last 50 years it has defi- nitely improved but it has more or tion for babies and Q: The health of moth- tsunami. It is a disaster less remained stagnant in the past 10 that it also protects ers, infants and children which the adult world years because the issue is not being them from illness. We is particularly vulner- can prevent because we given enough attention. Recently, the know that kangaroo able in conflict situa- Kenyan parliament was given statistics mother care, when the have the solutions. tions and emergencies, baby is strapped to on the number of women dying in how are you tackling the mother, is the best childbirth in their country and they this problem? way to care for small were shocked. They did not under- or premature babies. We have inter- A: Often women and children are the stand why so many women should ventions, like the Integrated Manage- first to suffer when the access to health- still be dying in childbirth. This came ment of Childhood Illnesses. We have care services is disrupted. We work with to light in Kenya when we launched evidence-based solutions which the WHO’s Health Action in Crisis (HAC) a training programme called Beyond World Health Day and the World when they support and set up emer- the Numbers, which helps countries health report should publicize to the gency medical care facilities. Usually document the causes of maternal global community. However, to make these address communicable diseases death, count the women who die in these solutions work for women and and injuries and, if we are lucky, mental childbirth and establish ways to bring babies we need skilled professionals health issues. In order for them to save the right solutions to communities. with the drugs, supplies and equip- mothers and children, they must in- Often the policy-makers are not aware ment to implement them. clude routine antenatal care, skilled care of the numbers because a lot of women at every birth with back-up services for deliver at home, die at home and are Q: Which countries have the highest women with complications. Care must not being counted. O mortality rates for mothers, infants and children? A: The Democratic Republic of Congo, Ethiopia and Nigeria have ������������������������������������������������������������� the highest death rates in Africa for ������������������������������������ mothers and children. Every year, 136 000 maternal and more than 1.1 million newborn deaths occur in ������� ���������� �� India alone. Some countries which �������������� ��� dealt consistently with these challenges �� and made progress in the 1990s have ������������������ now regressed due to HIV/AIDS and �� ���������� ���������� depressed economies, such as Malawi, ������� ��������������� ��� ��� Mozambique, Zambia and Zimbabwe. ������������������ Middle-income countries, such as �������������������� Botswana, Namibia and South Africa ������������������ ������������������������ are also experiencing setbacks and need �� �������������� �������������������������� mainly guidance on policy-making. ������������������ Q: A commentary in the Lancet in ��� ������������������������ December last year criticized the 2005 �������������������������� World health report on maternal and ������������������������������������������������ ���������������������������������������������� child health for inadequate consultation ���������������������� of stakeholders. Is this fair? A: We started by consulting the re- gions of WHO and countries, as well

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Recent news from WHO

• Twenty-two African nations launched a coast-to-coast mass immunization campaign targeting 100 million children on 25 February to stamp out polio by the end of the year. The booster campaign is vital to halt a re-emergence of the disease in countries that had been polio-free for several years. The Democratic Republic of Congo, Ethiopia — which recently reported its first polio case in four years — and Eritrea on the southern and eastern edges of the epidemic are joining the campaign, as well as Côte d’Ivoire, which is rejoining the effort for the first time since civil unrest halted vaccinations last November. • UN experts warned on 2 March that acrylamide in some foods may be harmful and should be reduced, after researchers showed a link between the toxin, which can be produced by cooking certain foods at high temperature, and cancer in animals. Experts from the Joint Expert Committee of the UN Food and Agriculture Organization (FAO) and WHO concluded that the link between acrylamide in food and cancer in humans needed further study. The main foods contributing to acrylamide exposure in countries for which data were available are: potato chips, crisps, coffee, cereal-based products, pastries, sweet biscuits, bread and toast. • WHO and UNICEF said on 4 March that the number of deaths from measles, a highly infectious disease that can be prevented by vaccination, had fallen dramatically, with most reductions in Africa. The agencies said global measles deaths fell by 39%, from 873 000 in 1999 to an estimated 530 000 in 2003. The largest reduction was in Africa, the WHO region with the highest burden of measles and where estimated measles deaths decreased by 46% in that period. Measles remains an important cause of childhood death. Only a decade ago, it killed millions of children every year and affected 30 million more, leaving many with life-long disabilities such as blindness and brain damage. • WHO appointed Ethiopian fashion model Liya Kebede (see picture) on 7 March as Goodwill Ambassador for Maternal, Newborn and Child Health to raise public awareness and spur efforts to address the huge and largely preventable toll of maternal and child mortality. Kebede, who is herself a mother, joined WHO’s campaign a month before World Health Day 2005 on 7 April and the release of the World health report 2005 both devoted to this subject. Kebede has appeared on the covers of American, French, Italian, Japanese, Korean and Spanish editions of fashion magazine, Vogue. She was recently voted model of the year in Asia. • The President of Chile Ricardo Lagos Escobar and WHO Director-General LEE Jong-wook launched a new initiative on 18 March to spur more action to tackle the factors causing ill-health, such as poverty, social status, job, gender and education. The Commission on the Social Determinants of Health will work for three years to produce recommendations on how governments can tackle these and other causes of ill- health. It will be chaired by Sir Michael Marmot, who is Professor of Epidemiology and Public Health at the Royal Free and University College Medical School in London, and who has conducted extensive and high-profile research into the link between social factors and ill-health.

For more about these and other WHO news items please see: http://www.who.int/mediacentre/en/ WHO/P. Wiggers WHO/P. From catwalks to maternity wards, Ethiopian cover model Liya Kebede is appointed WHO Goodwill Ambassador for Maternal, Newborn and Child Health.

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