Archive for the ‘Child Health’ Category

Florida High Schools Initiative for Community Engagement (ICE)

August 20, 2017

At a time when interracial turmoil and ideological divides are at a boiling point, it is incumbent upon us to introduce our young people to an alternative to bigotry and violence. What better way to do this than provide a platform from which students can engage their communities through mutually transformative service projects?

We are proposing the implementation of a service-learning program that will be fully integrated into Florida’s high school curriculum – the Florida High Schools Initiative for Community Engagement (ICE). Students will be introduced to the skills of community engagement in the classroom and linked with organizations in the community with whom they can collaborate.

Central Florida Urban League 2


The evidence for the benefits of service-learning abound.  Other states have successfully adopted similar initiatives.  While currently there are no statewide community service requirements for high school students in Florida, aspects of the infrastructure for the initiative are already in place through the Florida Bright Futures Scholarship Program (BFSP), making Florida ripe for the roll-out of the initiative.

Important stakeholders include high school students, parents, The Florida School Boards Association, the Florida Department of Education (DOE), the Corporation for National and Community Service (CNCS) and local businesses that employ high school students. Students will be introduced to the program through student champions recruited from BFSP. Parents will be engaged through newsletters, parent-teacher conferences and special forums. A grant proposal submitted to CNCS will request funding and logistical support.

Central Florida Urban League 1

Florida AmeriCorps volunteer. AmeriCorps is one of many initiatives of  CNCS

What Can I do to support the Initiative?

We’re so glad you asked!

  1. Contact your local school board and let them know you support the ICE program!
  2. Call or email  the Florida DOE and tell them you support the initiative!

Expanding National Influenza Immunization Program to Adolescents in South Korea – A social justice perspective

August 20, 2017

Influenza, or “the flu”, is a common infectious disease that ranges in severity, with some cases even resulting in death.

graph 1In South Korea, the number of the flu patients in 2016 was a record high, and more importantly, the flu season started 7 weeks earlier than usual (See Graph 1).

In an effort to curtail the effects of influenza, the Korean government introduced a Free Influenza Immunization Program for children ages 6-12 months in October 2016, and expanded the coverage up to 59 month-old children from September 2017.

In response to this, many people are now arguing for the expansion of the program to include school-aged children and teenagers (up to ages 18 years) as well.

Cost and Parental Concerns

The Korean government expressed its strong concerns at a policy forum held last month, and stated that covering 6,500,000 school-aged children every year is not practical due to a limited workforce and budget. However the socioeconomic cost of influenza is $25 billion USD, and it was also reported that vaccination in this age group could save the cost up to 7 billion USD.

Additionally any side effects from the vaccines are taken seriously by parents. However, the influenza vaccine safety has already been proven.

My position

Despite these concerns – which should be taken seriously – I, as a primary care physician and public health advocate, support the expansion of the program.

Regarding cost, it would be reasonable to cover younger children first and then expand to teens. Various parental concerns need to be fully addressed through community or school level meetings.

imageMore importantly, I would like to introduce the notion of social justice highlighting ‘herd immunity. Children respond well to the vaccine. Even though they are just a fraction of the population, immunizing them could significantly diminish the chance of a widespread outbreak.

This effort is part of being a good citizen, and enhancing our social benefit by protecting more people.

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Optimal Infant & Young Child Feeding (IYCF) In Nigeria: Starting out right

August 20, 2017

Optimal nutrition in the early years is an essential ingredient for children to attain their full potential physically and intellectually. Hence, the WHO/UNICEF developed the Global Strategy for IYCF aimed at reawakening the attention to benefits of optimal childhood nutrition.

In August 2011, the Nigerian Federal Ministry of Health (FMOH) adopted this strategy as a National Policy for IYCF. It actively encourages Exclusive Breastfeeding (EBF) for the first six months of life and thereafter, introduction of safe and age-appropriate complementary foods based on locally available food materials; and continued breastfeeding for two years or more.

Even with the implementation of IYCF, malnutrition continues to be a concern. Stunting declined by only 4%, while the rates of wasting and underweight increased to 18% and 29%. These rates are indicative of nutritional deficiency due to suboptimal feeding practices. The causes of malnutrition in the first 2 years of life include inappropriate breastfeeding and complementary feeding as well as high rates of infections. Only 17% of children are exclusively breastfed at six months with median duration of EBF being 0.5 months in Nigeria.

In addition, infants are introduced to complementary food too early/late and only about 10% of children aged 6-23 months meet the recommendations of the IYCF practices. These feeds are often inadequate in energy, protein, vitamins/minerals such as iron, vitamin A, iodine and zinc.


While treatment of malnutrition remains important, Federal and state governments through the ministries of health must pay attention to the important aspect of promotive and preventive health for effectiveness and sustainability. Healthcare professionals must educate pregnant women during ante/postnatal classes on the importance of EBF and implications of starting complementary feeding too early/late. Community health workers should be trained to go into the community to encourage mothers, their spouses and other family/social support groups on EBF, continued breastfeeding and age-appropriate complementary feeding based on locally available food materials.

Also, the FMOH should adopt policies to increase maternity leave to a minimum of 6 months, and mandating employers to provide baby-friendly environment to encourage EBF.

All levels of government need to collaborate to provide leadership, coordination and funding by involving the ministries of education, agriculture, social development, women affairs and information. Resources must be allocated and all strategies must be adequately implemented to support and enhance the capacity to address infant and young child feeding practices in different situations and circumstances.

(by @seunowoniyi and @okowamildred)

Don’t Delay: National Uptake of Rotavirus Vaccine in India is Needed Now

August 20, 2017


Many people think that a bout of diarrhea is just an annoyance, but if left untreated, diarrhea can lead to severe dehydration, which can result in hospitalization or even death. Diarrhea remains a leading cause of death in children under five around the world. In 2013, over 570,000 children under five years of age died from diarrhea globally. And in India alone, diarrhea caused more than 130,000 child deaths in 2013. Not all diarrhea is avoidable, but with new vaccines some pathogens that cause moderate or severe diarrhea can be prevented, including rotavirus. It’s estimated that 40% of all diarrhea deaths are due to rotavirus.

After years of efforts, in March 2016 the Ministry of Health and Family Welfare added an indigenous rotavirus vaccine to the routine immunization schedule in four Indian States — Andhra Pradesh, Haryana, Himachal Pradesh and Odisha. For the first time, children in India have access to a life-saving rotavirus vaccine. This achievement was a critical milestone for the children of India. And in February 2017, the vaccine was launched in an additional five states.

The Government of India’s progress should be applauded, but national scale up is still lagging. The children living in the remaining states of India also deserve access to the rotavirus vaccine. Expanding rotavirus vaccine into the routine immunization schedule in all states will help protect millions of Indian children.

State parliamentarians, you must call on the Government of India to facilitate faster roll-out of the vaccine. It’s time to work with your state health teams to put the infrastructure and systems in place to introduce new vaccines in a safe and timely manner. The children in your states deserve better. As progress continues to lag, children continue to die from a preventable disease. The time is now, don’t wait.

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It’s time for Angola to step up: neonatal mortality can be tackled with chlorhexidine

August 18, 2017
medicalaidfilms chlorhexidine 3Medical Aid Films: How to use chlorhexidine for umbilical cord care

LUANDA — An unacceptable 2.7 million deaths occurred worldwide in 2015 in children under one month old, and infections were responsible for a significant portion of these deaths. There is a solution.

Chlorhexidine, a disinfectant already widely used in healthcare in high-income countries, was heralded as one of 13 “over-looked” life-saving commodities by the UN Commission on Life-Saving Commodities for Women and Children in 2012. This followed a growing, substantial evidence base demonstrating its effectiveness in reducing local and severe infections, and deaths, in neonates. Systematic reviews by Cochrane in 2013 and 2015 had shown 23% and 12% reduction in deaths among those born in the community in developing countries. Chlorhexidine was added to the WHO Model List of Essential Medicines for Children and WHO Guidelines on Postnatal Care for Mothers and Newborns in 2011.

However, progress has been slow. The Healthy Newborn Network tracks the status of chlorhexidine implementation worldwide. Many countries with the highest neonatal mortality rates (>30 deaths/1,000 live births) still remain in the “pilot/policy alignment”, “expressed interest”, and “no information” categories. Nepal started implementing its chlorhexidine program in 2011, and Madagascar in 2013. Nigeria and Afghanistan following suit only last year. Who is missing? The top three countries with the highest neonatal mortality: Angola, Pakistan, and Central African Republic.

HNN chlorhexidineThe Healthy Newborn Network: Current status of chlorhexidine for umbilical cord care implementation

At 50 cents per dose, and in a gel form that is straightforward to apply to the umbilical cord, it begs the question why chlorhexidine has not been implemented more widely. Certainly, there are challenges, such as “regulatory hurdles, supply issues, and misconceptions about guidelines for umbilical cord care”, but these are not insurmountable. The slow roll-out has consequences, given that chlorhexidine has the potential to save 422,000 lives over a five-year period.

It is time the world got its act together, and for Angola, as the worst-offending country, to demonstrate its leadership and tackle its mark of shame. We call on the Angolan Ministry of Health to work with international agencies such as WHO, USAID, and PATH to rapidly introduce and scale chlorhexidine disinfection across the country.

Toxic Stress in Children of Immigrant Detainees

August 6, 2017

kids of deported parentsPediatricians are sounding the alarm on the health effects of children traumatically separated from detained immigrant parents. Responding to the Executive Order expanding deportation, American Academy of Pediatrics (AAP) President Fernando Stein stated

The executive orders signed today are harmful to immigrant children and families throughout our country.they deserve to be healthy and safe.”

Nonetheless, on June 15 the Secretary of Homeland Security rescinded the  Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) which protected undocumented parents of US citizen children from deportation.

5 million children who are US citizens have at least one undocumented parent. 660,000 children were separated from parents due to deportation between 1998 and 2012. By May, non-criminal immigration arrests increased by 150%.

Pediatricians warn that constant fear of parental deportation results in feeding, sleep and learning problems, depression, and illness and toxic stress, which can hinder brain development. Adverse experiences in childhood predispose individuals to heart disease, diabetes, and cancer.

Even before Trump’s actions, immigrant and American-born Hispanic mothers in Iowa were 24 percent more likely to have low-birthweight babies after a federal immigration raid. Delays in preventive care and medical treatment followed Arizona immigration legislation. Parents, even those with children with disabilities, hear of a single parent of a child with cerebral palsy being deported to Colombia, and stay home foregoing medical care due to fear of detainment.

Pediatricians are raising their voices, lobbying for protection of community sanctuary status, designing emergency care documents for immigrant families, and writing letters supporting parental care for special health needs.

Homeland Security must immediately limit arrests to immigrants with a documented criminal record, and provide agency assistance in creating family care plans before detention. Until federal raids are halted, states must defend the sovereignty of sanctuary communities for immigrants. Children must be put first.

foster care deported image

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Sugar-Sweetened Beverages’ Low Taxes in Maryland May Be a Poison for Children and Adults

March 12, 2017

Other group member: Mujan Varasteh Kia

In 2015, 30% of the people in Maryland were clinically obese. Sugar-Sweetened Beverages (SSB) is strongly associated with obesity which can lead to the number one leading cause of preventative deaths (1 in 4 deaths) due to heart disease, stroke, type 2 diabetes, and certain types of cancer, and can play a role in preterm delivery.

A constructive SSB taxation policy can help to reduce many of the obesity-related health problems and alleviate the amount of money spent to treat these cases long-term. The goal is that “increasing [the tax] will discourage individuals, especially children, and teenagers, from excessive consumption of these beverages.” Currently, Maryland imposes a 6% sale tax on SSBs. No significant reduction in obesity has been recognized as a result of this taxation. It has been argued that the sales tax is too little to prevent people from reducing their bad habits which urges the need for a more substantial taxation to reduce soda consumption. In a study, they found that participants would buy fewer SSBs with 20% tax and would completely eliminate their SSB consumption if 50-100% tax was implemented.

Shortly after Mexico passed soda tax law in 2013, there was an average 12% decline in soda sales and a 4% increase in bottled water purchases. The soda industries have argued that soda taxation is not going to “change the behaviors that lead to obesity,” and that the public will find their calories elsewhere. However, in the studies they referred to the taxes were too small or they were applied in the form of sales taxes that could have gone unnoticed by the consumers.

Philadelphia was the first big city in the nation to pass a soda taxation policy in 2016. Despite the approximate $5 million advertisements against this taxation by The American Beverage Association, a non-profit campaign was created with the help of the former New York City Mayor, Michael Bloomberg to support the soda taxation law. We also urge the Maryland state legislature to support and follow the same initiatives as those of Philadelphia mayor’s 1.5-cents-per-ounce levy on SSBs. These policies may not fully eliminate the obesity crisis, but even a small reduction in soda consumption will make a difference.


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Rescinding the Mexico City Policy

March 12, 2017

The Mexico City Policy, also commonly known as the “Global Gag Rule,” was first introduced in 1985 during the Reagan administration and has been rescinded by most Democratic presidents and reinstated by most Republican presidents since then. This policy was most recently reinstated by President Trump, and prohibits foreign NGOs that receive US government funding from performing abortions, providing counseling and information on abortions as a method of family planning, or promoting any changes in a country’s legislation regarding abortion. The Trump administration’s reinstatement, however, does not apply only to family planning assistance. It expands to limit all U.S. global health funding, including global HIV and maternal child health (MCH) assistance.

Many organizations, including Marie Stopes International, Doctors Without Borders, Population Action International, and International Planned Parenthood Federation, have released statements in opposition to the Global Gag Rule. Foreign governments have also stepped forward, with some creating international funds or pledging money in an effort to fill the funding gap. While these are a good start, we need greater mobilization to fight for women’s health and empowerment.

Unsafe abortion is one of the main causes of maternal mortality worldwide, and disproportionately affects women in low- and middle-income countries and in vulnerable contexts such as refugee camps and conflict zones. Research has shown that policies preventing providers from educating women about abortion and family planning methods lead to more unwanted pregnancies, more unsafe abortions, and higher rates of STIs. This policy also threatens progress on many other fronts, such as HIV, child malaria, tuberculosis, and immunizations. Healthcare providers, public health professionals, and all concerned citizens need to speak out for global reproductive rights, support international aid organizations, and push Trump and US Congress for the repeal of the Mexico City Policy.