Tag Archives: MDGs

Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

Africa:Major Progress in Fight Against Malaria

24 December 2013
Geneva/ Washington DC — Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the World Malaria Report 2013 published by the World Health Organization (WHO).

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the ten countries with the highest malaria burden, and among children aged less than five years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627 000 malaria deaths. An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under five and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

[Courtesy AllAfrica News]

Africa: Mental Health Update

September 2013:
As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

[Courtesy pf IRIN]

Iraq War leaves lasting impact on Healthcare

IRAQ 5 May – Of all the areas of Iraq’s development that were affected by the US-led invasion 10 years ago, healthcare has probably taken the biggest hit.

The impact of the 2003 invasion and subsequent conflict on Iraq’s healthcare system has been well-documented.  The conflict shattered Iraq’s primary healthcare delivery, disease control and prevention services, and health research infrastructure. Attempts to resurrect Iraq’s healthcare system remain hindered by a number of factors, including fragile national security and lack of utilities like water and electricity.

Much of the damage incurred in the first few years of the invasion continues to have an impact today.

Lasting legacy

Iraq had prioritized healthcare at least since the 1920s, when the Royal College of Medicine was formed to train doctors locally. By the 1970s, Iraq’s health care system was “one of the most advanced” in the region, according to researcher Omar Al-Dewachi, a medical doctor who worked in Iraq during the 1990s before emigrating to the US. Health indicators improved quickly and significantly in the 1970s and 1980s, only to deteriorate again after the first Gulf War of 1991, which destroyed health infrastructure, and during a decade of sanctions, which drastically reduced government spending on health and led to a brain drain in the medical profession.

After the 2003 invasion, the healthcare situation deteriorated considerably, and Mac Skelton, a contributor to the Costs of War project, fears it may never recover. Between 2003 and 2007, half of Iraq’s remaining 18,000 doctors left the country, according to Medact, a British-based global health charity. Few intend to return.

“Getting back to that robust, excellent standard [of healthcare] is not going to happen anytime soon,” Skelton said. “Unlike buildings that can be rebuilt, migration patterns aren’t reversed easily.”

In 2011, according to the World Health Organization (WHO), Iraq had 7.8 doctors per 10,000 people – a rate two, if not three or four times lower, than its neighbours Jordan, Lebanon, Syria and even the Occupied Palestinian Territory. In the Muslim world, Iraq’s doctor-patient ratio is higher only than Afghanistan, Djibouti, Morocco, Somalia, South Sudan and Yemen.

In a recent article in the Lancet, the aid group Médecins sans Frontières (MSF) said that “until now, it is extremely difficult to find Iraqi medical doctors willing to work in certain areas because they fear for their security.”

According to MSF, many remote areas were excluded from state reconstruction and development efforts, “leaving thousands of Iraqis without access to essential healthcare to this day.”

Nearly all families – 96.4 percent – have no health insurance whatsoever and 40 percent of the population deems the quality of healthcare services in their area to be bad or very bad, according to the Iraq Knowledge Network (IKN) survey of 2011.

As a result of the poor quality of care in their country, many Iraqis now seek healthcare abroad, increasingly selling homes, cars and other possessions to afford to do so, according to Skelton, who interviewed Iraqis seeking healthcare in Lebanon.

And researchers are still questioning the degree to which white phosphorus and depleted uranium, the armour-piercing, radio-active metal used in British and American ammunition, has increased cancer rates and caused birth defects.

The environmental damage caused by the war – degradation of forests and wetlands, wildlife destruction, greenhouse gases, air pollution – will also have a longer-term impacts on health, according to the Costs of War project.

Mental health

A 2007 survey by the government and WHO found that more than one-third of respondents had “significant psychological distress” and presented potential psychiatric cases. A 2009 government mental health survey concluded that mass displacement and a climate of fear, torture, death and violence have contributed to the high ratio of mental illness in the country.

In a new report released last month, MSF said mental health continues to be a major problem in the country.

“Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked devastation,” Helen O’Neill, MSF’s head of mission in Iraq, said in a statement.

“Mentally exhausted by their experiences, many struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental healthcare services that people can turn to for help.”

Improvements?

The statistics, as always in Iraq, tell a story that is less clear-cut.

The number of fully immunized children, for example, dropped from 60.7 percent in 2000 to 38.5 percent in 2006, then rose to 46.5 percent by 2011 – still less than pre-invasion levels, according to the Multiple Indicator Cluster Surveys (MICS) conducted by the government and the UN Children’s Fund (UNICEF). Acute and chronic malnutrition trends for children under five also showed a slight regression.

However, other indicators show some improvement over pre-2003 levels – unsurprising, some say, if you consider the “semi-starvation diet” of many Iraqis during the sanctions.
According to the UN’s Human Development Reports, life expectancy at birth rose from 58.7 before 2000 to 69.6 in 2012. (These figures are quite similar to those of WHO, but differ significantly from those of the World Bank, which show a regression from 70 to 71 years during the mid-1990s and early 2000s, to 69 years in 2011)

The last decade undoubtedly saw a great reduction in infant mortality rates, not only over pre-invasion levels, but even compared to the early 1980s, when about 80 infants died per 1,000 live births. By the year 1990, this figure was down to 50, and decreased further to 31.9 in 2011, according to a 2012 government report monitoring progress towards the Millennium Development Goals (MDGs).

Still, this rate remains more than double the national target of 17 per 1,000 by 2015; and while Iraq’s rate in the early 1980s was among the best compared to other countries in the region, today, it is among the worst.

The mortality rate of children under five also dropped from 42.8 per 1,000 births in 2000 to 37.2 in 2011, well ahead of 1960s levels, but far off the national target of 21 by 2015, according to the government report, which monitored MDG indicators at the governorate level. The percentage of births attended by skilled personnel also rose from 72.1 percent in 2000 to 90.9 percent in 2011, according to the MICS.

(WHO shows a similar trend of decrease in mortality rates, but its statistics are quite different, showing a much larger drop in infant mortality from 108 deaths per 1,000 in 1999 to 21 per 1,000 in 2011, and a decrease in child mortality from 131 in 1999 to 25 in 2011.)

Government expenditures on health have increased in the last decade. From a high point in 1980s, they dropped significantly due to the 1991 Gulf war and sanctions. But spending jumped from 2.7 percent of GDP in 2003 to 8.4 percent in 2010, according to the World Bank. According to Yasseen Ahmed Abbas, head of the Iraqi Red Crescent Society, government allocations for health spending have risen from $30 million a year under former president Saddam Hussein to $6 billion a year today.

[Courtesy of IRIN]

GUINEA: “Free childbirth unsustainable due to lack of resources”

Mortality rates in Guinea have dropped significantly over the past two decades, but efforts to speed up progress on the Millennium Development Goal (MDG) to reduce maternal mortality by three-quarters by 2015 through a ban on childbirth fees, including for Caesarean sections, are stalling due to poor planning and lack of resources, say critics.

No sustainable costing plan has been put in place to cover the fees. A health insurance scheme has been set up, but functions on a very small scale.

“You can’t just say something is free – you have to plan. Making maternal delivery free burdens health structures, which have not been given enough new money to cover it… for the most part delivery is free now, but the money will soon run out and they will have to find new sources,” the National director of community health and disease prevention, Hawa Touré, told IRIN.

In Guinea, 680 women die out of 100,000 live births, down from 1,200 in 1990, according to the UN.

In 2010 just 2.5 percent of the annual national budget was allocated to the Ministry of Health, according to the Health and Public Hygiene Minister, Naman Kéita. This rose to between 4 and 5 percent in 2011 – a marked improvement – but still far lower than the goal of 15 percent set in the Abuja Declaration.

As a result, the bulk of the health budget is covered by donors such as the Global Fund, GAVI, which promotes vaccination, the World Bank and the World Health Organization; and individual donors such as France, Japan and Spain.

Abolishing user fees works when there is a plan in place to boost the number of medical staff and equipment available to address expected higher demand; and a financial strategy to cover the care costs, according to lessons learned from similar schemes in Sierra Leone, Burundi and Mozambique.

Fatou Sikhé Camara, Director General of Guinea’s largest public hospital, Donka, in the capital Conakry, told IRIN the government had given the hospital a subsidy to cover costs, but she could not specify the amount, or how it had been used.

Asha Camara, 21, said she stayed overnight at the hospital but had not paid to give birth. “I paid for food – not much else,” she told IRIN on leaving Donka with her newborn baby.

The scheme would have more impact on maternal mortality if ante-natal and post-natal care visits were also covered, said Julien Harneis head of the UN Children’s Fund (UNICEF) in Guinea. “The approach is too medicalised – covering ante-natal consultations would identify at-risk women and highlight in advance those who require more assistance.”

Ifonou Estelle Montserey, who is eight months pregnant, waited for her prescription on a bench outside the ante-natal unit at Donka Hospital. She showed IRIN separate bills of US$10 for her monthly scan and a $3 consultation fee. “Last month I paid $7.40 [for the scan]. Nothing is consistent here… and nothing is free in Guinea.”

The effect of the fee abolishment is as yet unknown: a countrywide district health survey addressing maternal mortality rates, among other issues, is underway and the results will be published in 2012.

But a prominent development specialist told IRIN she expected the strategy to have little added impact, given the way it’s been delivered. “On the plus side, it’s good that the government proposed it, but they now need to finance it,” she said.

Minister Kéita told IRIN he hopes the health budget will be increased in 2012, and if it is the government will set aside funds to finance the plan. “Maternal mortality is one of our priority areas. But we lack resources. We need more personnel, more money, and more equipment to make this work.”

The number of medical staff per capita remains very low in Guinea: 401 midwives are thought to be practicing in the country,according to the UN Population Fund. To reach the MDG target of 95 percent of births covered by a skilled birth attendant, a further 2,294 personnel are needed.

Kéita said the government had launched a drive to recruit some 1,800 midwives and nurses earlier this year, the first such campaign in five years. According to UNFPA there is just one private school with a three-year midwifery programme.

Funding is often drained through widespread corruption according to medical staff at Donka.

“Maternal mortality needs more work, here,” said Harneis. “Progress on reducing maternal mortality is taking too long. Donors and the government need to come up with a joint vision to fight it… we are not where we need to be.”
Acknowledging the challenge, he noted that “You can’t vaccinate against all the risks associated with pregnancy – while polio or measles can be tackled with once-a-year campaigns, the response to maternal mortality is oriented around the quality of the healthcare structure, which in Guinea is consistently poor.”

[Courtesy of IRIN News]