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Johns Hopkins Bloomberg School of Public Health


Date: Apr 2012

Today, April 24th, is World Meningitis Day. Meningitis is a major cause of child mortality, much of which is vaccine preventable. To mark this important day, we have invited the Meningitis Research Foundation to blog about the disease and talk about their work to save lives from this frightening disease in Malawi. To find out more about World Meningitis Day, please visit the Confederation of Meningitis Organizations (COMO) here.

By Meningitis Research Foundation

Meningitis in Malawi

Children at Healthy Center, Phalombe, Malawi

Children at Healthy Center, Phalombe, Malawi. Photo by Matt Feldman / IVAC

In Malawi, meningitis is far more common than in industrialized countries, and rates of death from meningitis are unacceptably high compared to other countries in sub-Saharan Africa. In children under 5 years old, who are the most vulnerable to meningitis, two thirds of those affected die from the illness, which contributes to the high childhood mortality in Malawi.

Although meningitis vaccines are having a tremendous impact in many countries in Africa, they do not yet provide the complete solution for meningitis in Malawi. Since Hib vaccine was introduced in 2002, Hib meningitis declined but has not been eradicated. Pneumococcal vaccine has also been recently introduced in Malawi, but does not protect against all strains causing pneumococcal meningitis, and many other common bacterial causes of meningitis in Malawi are not covered by currently available vaccines.

Barriers to Receiving Treatment

As vaccine programs are implemented and new vaccines are developed, it is just as important to treat the people who are affected by meningitis now. With this in mind, Meningitis Research Foundation (MRF) funded research in Blantyre, a city in the south of the country, investigating the barriers preventing timely treatment of meningitis. The study found a lack of access to knowledge about meningitis, its symptoms and the importance of early treatment amongst health providers and the general public.

Patients can also be delayed by transport costs and other barriers, meaning that they do not reach hospital until the disease is already very advanced. Unfortunately, when patients do reach health care centers, there may be further problems getting access to the care they need. Treatment is delayed in 25% of meningitis cases, because they are initially misdiagnosed as malaria.  

Action Meningitis Project

Meningitis Research Foundation has initiated Action Meningitis, a project in Blantyre, to break down these barriers to treatment, improve healthcare delivery and treatment rates, and ultimately to save lives of Malawians affected by meningitis. 

The Action Meningitis project will target health providers to improve early recognition of meningitis and other bacterial infections, preventing misdiagnosis and prompting action for seriously ill patients. Mobile Health (mHealth) will increase accessibility of information using mobile phones and an electronic treatment pathway to improve diagnosis and appropriate treatment of patients.

Action Meningitis will also provide community awareness messages and symptoms information to the general public, particularly for mothers and care givers of young children. A series of radio programs will be broadcast across the country aiming to reduce meningitis deaths by raising the understanding of meningitis and bacterial infections, and to encourage communities to take action on health issues. Community groups will help develop suitable and comprehensive public awareness information that will be made available in various local languages.

Action Meningitis will also provide communities with bicycle ambulances to help get people to health care centres for medical attention and improve early treatment rates.

Future Impact

MRF is partnering with the Malawi-Liverpool-Wellcome Trust, Medic Mobile, Queen Elizabeth Central Hospital and the Ministry of Health in Malawi to develop the project in consultation with Health Care Workers as they will have a key role in making Action Meningitis effective and sustainable over the long term, while the participation of community groups will continue to ensure its relevance and benefit to the wider population of Malawi. Through these efforts, we are aiming to lessen meningitis’ hold on the country each year as we mark World Meningitis Day.

By Dan Thomas

Have you ever been to the movies and seen a trailer for a film that you previously had no interest in seeing and then suddenly thought to yourself “That is a film I CANNOT MISS”?

That was the idea behind GAVI’s most recent production. It’s a three-minute film by a talented young American film maker called Ryan Youngblood that I stumbled across in Kigali one day and I think he and producer Doune Porter more than fulfilled their brief.

On April 26, during WHO’s first-ever World Immunization Week, Ghana will introduce not just one but two new vaccines into its immunisation programme.

The pneumococcal and rotavirus vaccines will protect infants against the leading causes of the two biggest killers of children in Ghana and throughout the developing world – pneumonia and diarrhea.

The GAVI Alliance and our partners UNICEF andWHO are working with Ghana’s Ministry of Health to plan a massive celebration in Accra at which the first children will be vaccinated.

On the same day, halfway across the world in Atlanta, Georgia, USA, our friends at the UN Foundation will be launching the Shot@Life campaign to encourage the American public to champion vaccines as one of the most cost-effective ways to save children’s lives around the world.

It’s such an exciting time to be working in global health and, as more and more power brokers embrace the value of investing in people’s health, we are literally seeing progress across the world on a daily basis.

As you can imagine, back in Ghana our colleagues are feeling more than a little pressure and this film brilliantly captures the careful, methodical planning process that is involved in introducing new vaccines into the national health programme.

It also portrays the skill, wit and energy that Ghanaian health professionals are investing in this extraordinary initiative.

Like the best movie trailers, our little film has all the right ingredients to get you interested in wanting to know what happens next:  handsome men, beautiful women, tragedy, suspense, despair, hope and raw determination!

Watch it now, you won’t be disappointed. (It's also available in French and German)

Dan Thomas is Head of Media and Communications at the GAVI Alliance, a public-private partnership which aims to save children’s lives and protect people’s health by increasing access to vaccines in the world’s poorest countries.

By Lois Privor-Dumm

Vaccine Cold Chain Storage: Refrigerators in Nigeria

Vaccine Cold Chain Storage: New refrigerators are one of the many potential interventions that can help increase Nigeria's ability to vaccinate kids.

Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder -- how can that be? 

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine. Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the range of successes and challenges in immunization coverage. Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one Northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed. 

Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery. (I really like this one!) 

Inadequate cold chain – or the refrigeration required from ‘lab to jab’ to keep a vaccine viable –is another frequently-cited barrier. Nigeria has invested in cold chain, and when I visited in July I saw what can be done – and unfortunately, what can sometimes prevent great ideas from being implemented. They have lots of solar fridges, for example, but I learned that without a system to ensure regular repairs, that vital equipment can sit idle. I can go on and on about what we found, but I suggest you read the brief report to get a better understanding of what is both most impactful and feasible.

The good news is that the government and many other stakeholders are fully committed to making a difference. In fact, Nigeria is holding its first National Vaccine Summit, and I’m honored to be a participant.  The Summit shows impressive commitment from the highest level, from the President, Vice-President, ministers, senators, and First Ladies, right on down to the local governments. The Summit is also bringing in the private sector and other non-health groups – even the Minister of Power is engaged to help ensure no interruption in those fridges! It’s a huge effort, but one that will bear fruit in the coming months when a new pentavalent (Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib) vaccine is introduced.

Investment in vaccines makes sense, and saving lives is well worth this effort.  The scaling up of new vaccines to 90% coverage is projected to save over $300M in direct health costs and add up to $17B to the economy in increased productivity! That’s an investment worth making.

Lois Privor-Dumm is the Director of Alliances and Information at IVAC.