Maternal and Child Health: Global Challenges, Programs, and Policies PDF
Preview Maternal and Child Health: Global Challenges, Programs, and Policies
John Ehiri Editor Maternal and Child Health Global Challenges, Programs, and Policies 1 23 Maternal and Child Health John Ehiri Editor Maternal and Child Health Global Challenges, Programs, and Policies Foreword by Paul Garner 1 3 Editor JohnEhiri,PhD,MPH,MSc(Econ.) Director,Professor DivisionofHealthPromotionSciences MelandEnidZuckermanCollege ofPublicHealth UniversityofArizona 1295N.MartinAvenue Tucson,AZ85724 USA [email protected] ISBN978-0-387-89244-3 e-ISBN978-0-387-89245-0 DOI10.1007/b106524 SpringerNewYorkDordrechtHeidelbergLondon LibraryofCongressControlNumber:2009932149 #SpringerScienceþBusinessMedia,LLC2009 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(SpringerScienceþBusinessMedia,LLC,233SpringStreet,NewYork, NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Usein connection with any form of information storage and retrieval, electronic adaptation, computer software,orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenifthey arenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyare subjecttoproprietaryrights. Printedonacid-freepaper SpringerispartofSpringerScienceþBusinessMedia(www.springer.com) Foreword There has been a crying need for a compendium of teaching and learning resourcesdedicatedtocriticalglobalhealthissuesconfrontingthemostvulner- able members of our communities, women, infants, children, and adolescents. This book bridges this gap in literature by taking a global perspective, but weighting more of the content on the most pressing problems and possible solutions in middle- and low-income countries. From the outset, the book lays outthescene,firstbyrespectinghistoryandexploringthefoundationsofmuch ofwhatweseetodayintheglobalhealtharenaandthenmovingontoprovide carefullyresearchedappraisalsofsomeofthemostcriticalissuesthattheunder- pinachievementofmaternalandchildhealth-relatedMillenniumDevelopment Goals (MDGs) in middle- and low-income countries, including politics and power, specific disease conditions, programs, policies, and emerging concerns. Thus, it is right on target as a valuable educational resource for global health scholars, agencies, and frontline operatives who are striving to reduce global healthinequities.Acentralthemeofthebook,amongothers,isthatasystematic returntobasic,evidence-based,cost-effective,andtime-proventechnologieswill beanintegralpartofasustainableresponsetoglobalmaternalandchildhealth challenges.Revitalizinghealthsystemsinless-developedcountriesbasedonthe tenets of the Alma Ata Declaration of Primary Healthcare, presented by the WorldHealthOrganizationandUnitedNationsChildren’sFundover30years agoasthekeytoglobalhealthimprovement,remainsessentialforattainingthe maternalandchildhealth-relatedMDGs. Those who work in health care in developing countries are familiar with poorlyequippedandscantlystaffedhealthfacilitiesthatseehundredsofpatients each day. Daily, they see the huge and often fluctuating burden of disease, the tragedyofinfantdeathsfrominfectiousdiseases,andthegrossinjusticeofyoung women dying in childbirth. The result is that each year globally, more than 500,000women,99%inless-developedcountries,diefrompregnancyandchild- birth-relatedcomplications.Anadditional15–20millionsuffervariousdebilitat- ing consequences of pregnancy. Also globally, about 10 million children under the age of 5 die annually, mostly from lower respiratory infections, diarrheal diseases,malaria,measles,andundernutrition.Theironyofthisdeplorablestate of global maternal and child health is that simple, cost-effective interventions thatcansignificantlyimprovesurvivalandqualityoflifeofwomen,infants,and children exist. Such interventions include access to clean water and basic v vi Foreword sanitation, immunization, improved nutrition, and access to basic health-care services. Thus, for the most part, the underlying causes of morbidity and mor- tality among the maternal and child health population are inequity, poverty, shortage of health professionals, and dysfunctional health systems that are ill- equippedtoeffectivelyimplementandmaintainbasichealth-careservices. Theconceptofaglobalcommunityisperhapsidealistic,butithelpsinterna- tional health and development agencies, health professionals, and policy plan- ners to consider commonalities, rather than differences, between nations. Globalizationisatermthatislooselyused,butoneoftheimportantoutcomes ofthediscourseisthatithasfacilitatedaconvergenceofthoughtsinthatrather than dichotomizing the world into developing and developed, it fosters the understandingthatweallhaveproblemsandsolutions–whetherintherealms ofpolicy,publichealth,orclinicalcare–thatarefundamentallycommontoall. Yet, variations exist between nations and even between regions in the same countries. The burden of ill health and premature death varies dramatically betweencountriesandwithinsocialandeconomicstratainthesamecountries. Respectingthesevariationsisessentialtoidentifyingthecommonalities.Itisthus noteworthythatthefirstpartofthisbookisdevotedtotheissueofheterogeneity in the world’s resources, systems of care, and health outcomes for women, infants, and children. Moving on to the second part, readers’ attention is drawn to the fact that health is always within a context and that maternal and child health is critically influenced by power and politics within society. To provide specific examples, the book addresses the challenges posed by wars/ conflicts, globalization, gender equity, harmful traditional practices, and abor- tion.Adequateunderstandingofthesecontextsandtheirinfluencesonmaternal andchildhealthiscentraltoidentifyingandappraisingprioritiesforaction. Equally,understandingthemaindiseaseburdenamongwomenandchildren and how interventions can influence health outcomes is core to global health practice.Selectionoftheeightdiseases(malaria,HIV/AIDS,diarrhealdiseases, malnutrition, tuberculosis, obstetric fistula, disabilities, and injuries) that are discussedinpartthree(specificdiseaseconcerns)isrational,giventheircontri- butiontotheglobalburdenofdiseaseamongwomen,infants,andchildren.The inclusion of tuberculosis and disabilities as they affect women and children globallyisnotable,giventhelimitedfocusonwomenandchildreninthecurrent literatureontheseconditions. How policies and programs are formulated and organized and who delivers them is central to the identification of appropriate and sustainable solutions. Thisisthefocusofthefourthandfinalsectionofthebook.Keychallengesand emerging concerns in global maternal and child health programming are care- fully chosen andsubstantivelydiscussedin thispart.Notableamongtheissues coveredaresuchfactorsthathavereceivedminimalattentioninexistingglobal healthtextbooks,includingtheroleofevidence-basedpolicyandpractice,chal- lenges in making pregnancy safer, adolescent health, child maltreatment, chil- dren in difficult circumstances, and workforce training, deployment, and maintenance in the face of massive brain drain and health worker migration fromdevelopingcountriestothedevelopedworld. Whatismostexcitingaboutthisbookisthatitrepresentsaglobalcommunity of the best people in the field, individuals who understand the issues, have technicalexpertise,andcanprovidethereaderwithaclear,authoritativesteer. Foreword vii With all credit to the editor who has the global vision to bring this impressive arrayofauthorstogetherunderacommontheme,thisbookisarealcontribution to help those who want to learn and perhaps become a part of the global community effort to tackle some of the biggest and most important problems inglobalhealththatfaceustoday. PaulGarner LiverpoolSchoolofTropicalMedicine,England Acknowledgments This book was inspired by Greg R. Alexander, RS, MPH, ScD, Maternal and Child Health Epidemiologist, and former professor and chair, Department of Maternal and Child Health, University of Alabama at Birmingham School of Public Health. Greg, one of the most prominent perinatal epidemiologists nationallyandglobally,ledgroundbreakingstudiesongestationalagemeasure- ment,prenatalcare,andracialandethnicdisparitiesinbirthoutcomesfornearly threedecadesuntilhepassedawayinFebruary2007.Hewouldhavebeenproud to see a profoundly researched, and well-documented textbook that is truly global in its authorship and content and, most importantly, that is devoted to issuesofconcerntothehealthofwomen,children,andadolescents. Thisbookisacollaborativeenterprise.Iwouldliketothankthecontributors andcolleagueswhohavemadethecompletionofthisworkpossible.Myspecial thanks go to Sarah Windle, MPH, John Ilonze, MD, MPH, Katie Brigham, MPH,RebeccaPass,MPA,andCatherineLem,MPH,fortheireditorialassis- tanceandforkeepingtabsonreferencesintheever-changingdrafts. Finally,Iamdeeplyindebtedtomywife,Bridget,andtoourchildren,Jenifer, Laurence, Amanda, and Paula, for their love, patience, understanding, and unflinchingsupport. ix Contents PartI TheWorld’sHeterogeneity............................... 1 1 AHistoryofInternationalCooperationinMaternalandChild Health ................................................. 3 AllanRosenfieldandCarolineJ.Min 2 GlobalBurdenofDiseaseAmongWomen,Children, andAdolescents .......................................... 19 ColinMathers 3 PromotionofGlobalPerinatalHealth......................... 43 VictorY.H.Yu 4 MaternalandChildHealthintheOrganizationforEconomic CooperationandDevelopment(OECD)Countries................ 53 IanG.ChildandJohnE.Ehiri 5 HealthSystemImpactsonMaternalandChildHealth ............ 83 NancyGerein,AndrewGreen,TolibMirzoev, andStephenPearson 6 TheEnvironmentandMaternalandChildHealth ................ 99 MaryAnnPassandRebeccaPass PartII Politics,Power,andMaternalandChildHealth.............. 119 7 ImpactofWarsandConflictonMaternalandChildHealth ........ 121 Emmanueld’HarcourtandSusanPurdin 8 TheImpactofGlobalizationonMaternalandChildHealth ........ 135 SarahWamala 9 GenderEquity:PerspectivesonMaternalandChildHealth......... 151 RachelTolhurst,JoannaRaven,andSallyTheobald 10 HarmfulTraditionalPracticesandWomen’sHealth:Female GenitalMutilation........................................ 167 SarahWindle,ChuksKamanu,EbereAnyanwu, andJohnE.Ehiri xi xii Contents 11 AbortionandPostabortionCare.............................. 191 AndrzejKulczycki PartIII SpecificDiseaseConcerns.............................. 203 12 MalariainWomenandChildren ............................. 205 MartinMeremikwu,EmmanuelEzedinachi,andJohnE.Ehiri 13 TheGlobalBurdenofChildhoodDiarrhea...................... 225 CynthiaBoschi-Pinto,ClaudioF.Lanata,andRobertE.Black 14 TuberculosisinChildhoodandPregnancy ...................... 245 KrishnaReddy,DavidMoore,andRobertGilman 15 ImpactofHIVontheHealthofWomen,Children,andFamilies inLessDevelopedCountries................................. 271 HoosenM.CoovadiaandNigelC.Rollins 16 MalnutritionandMaternalandChildHealth.................... 287 OlafMu¨llerandAlbrechtJahn 17 TheGlobalBurdenofObstetricFistulas ....................... 311 L.LewisWall 18 HealthChallengesforWomen,Children,andAdolescents withDisabilities .......................................... 323 AmyT.Wilson 19 UnintentionalInjuriesinChildren ............................ 341 WilliamPickett,MarianneNichol,andJohnE.Ehiri PartIV Programs,Policies,andEmergingConcerns................ 359 20 Evidence-BasedMaternalandChildHealth..................... 361 AlanTitaandJohnE.Ehiri 21 AGlobalPerspectiveonTeenPregnancy....................... 375 AndrewL.Cherry,LisaByers,andMaryDillon 22 ProgressandChallengesinMakingPregnancySafer:AGlobal Perspective.............................................. 399 MonirIslam 23 GlobalImmunizationChallenge:ProgressandOpportunities ....... 417 RebeccaAffolder,MichelZaffran,andJulianLob-Levyt 24 AdolescentHealth ........................................ 435 ElizabethLuleandJamesRosen 25 TheGlobalBurdenofChildMaltreatment...................... 463 AndreaGottsegenAsnesandJohnM.Leventhal 26 ChildreninDifficultCircumstances........................... 479 NancyMockandElkedeBuhr 27 IntegratedManagementofChildhoodIllness.................... 497 MartinMeremikwuandJohnE.Ehiri
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