Saturday, June 30, 2012

Childcare 8: Vaccines and EINC

My two daughters are still young, my eldest is turning only six years old this coming October. This is a result of my getting married late. Nonetheless, getting them their regular shots of vaccines -- medicines injected into children and adults when they are not sick, to prevent or limit getting sick of certain diseases someday -- can be an expensive but necessary undertaking. I remember my eldest protesting loudly when we have to bring her to her pediatrician, "Papa, I'm not sick, I don't want injection!" It's good that she has overcome her fear of the needles many months ago.

I am sharing three articles by Reiner Gloor, Executive Director of PHAP, on vaccines and Essential Intrapartum and Newborn Care (EINC) to protect both mothers and babies/children, posted in his weekly columns in BusinessWorld on dates indicated.

I am no fan of high government involvement in healthcare as I believe that healthcare is first and foremost, a personal and parental/guardian responsibility. But for infectious and communicable diseases, I would give credit to government involvement on treating children's diseases and preventive healthcare via vaccination. Below are the three articles by Reiner.

(1) Decade of vaccines

June 29, 2012
Medicine Cabinet -- Reiner W. Gloor

In 1736, Benjamin Franklin stressed the importance of fire prevention when he said that "an ounce of prevention is better than cure." Franklin would have not realized that his advice would go beyond fire fighting and have important public health implications today.

Preventing diseases remains the most important health strategy that eliminates the burden of social and financial risks associated with curative or palliative care. Along with improved sanitation and water safety, vaccination is one of the most important and cost-effective public health innovations, and has saved about 2.5 million lives each year.

In May this year, the 65th World Health Assembly (WHA) acknowledged, "vaccination is, and should be recognized as, a core component of the human right to health and an individual, community and governmental responsibility." It added that as an integral part of a comprehensive package for disease prevention and control, vaccines and immunization are investments in the future of a country.

Immunization helps protect children so that they may have the opportunity to achieve their full potentials. The World Health Organization (WHO) disclosed that as a result of immunization, along with other health care and development interventions, the number of deaths among children under five fell from an estimated 9.6 million in 2000 to 7.6 million in 2010, despite an increase in the number of children born each year. Vaccinations are likewise enabling adults and the elderly to live more productive lives.

While the last century was the so-called "century of treatment" following the discovery and use of antibiotics, the WHA is confident that this century will be the "century of vaccines" with the potential to address a number of serious, life-threatening or debilitating infectious diseases.

In the last 10 years, research and development came up new sophisticated vaccines such as pneumococcal vaccines and vaccines against rotavirus and human papilloma virus. Meanwhile, several vaccines are in development for neglected tropical diseases such as dengue, cholera and malaria. Also in the pipeline are vaccines for various types of cancer, allergy, HIV and other infectious diseases, as well as neurological disorders, among many others.

The WHO said that there are now vaccines to prevent or control about 25 infections.

Vaccines against hepatitis B and Haemophilus influenzae type b have become part of national immunization schedules around the globe. Poliomyelitis is close to eradication while a huge number of deaths from measles are being prevented every year. The number of deaths caused by measles, neonatal tetanus, pertussis and poliomyelitis fell from an estimated 0.9 million in 2000 to 0.4 million in 2010. (For the full report, go

Milestone have been achieved with the commitment and support of governments and international stakeholders. The immunization program data for 2010 revealed that 154 of the 193 WHO Member States have specific budget line item for immunization, while 147 have developed multi-year national plans to sustain and/or enhance the campaign and introduce new vaccines.

In the Philippines, the Department of Health (DoH) implemented the Expanded Program on Immunization (EPI), established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines. Initially included in the EPI are tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles vaccines.

Furthermore, Republic Act No. 10152 or the "Mandatory Infants and Children Health Immunization Act of 2011" mandates basic immunization for children under five. Specifically, this law provides for all infants to be given the first dose of the Hepatitis-B vaccine within 24 hours of birth.

The DoH said that rotavirus and pneumococcal vaccines will be introduced in the immunization program this year. Immunization will be prioritized among the infants of families listed in the National Housing and Targeting System for Poverty Reduction.

Given the progress made in the immunization and vaccination drive worldwide, the global health community made a call for a "Decade of Vaccines" (2011-2020) whose vision is a world in which all individuals enjoy lives free from vaccine-preventable diseases. The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are, or where they live.

To achieve this, a global vaccine action plan was created to build on the success of the Global Immunization Vision and Strategy (2006-2015). The plan emphasizes existing goals and sets new goals for the next 10 years, while proposing six strategic objectives and the actions that will support their achievement.

Among the six fundamental principles of the plan are country ownership, shared responsibility and partnership, equity, integration, sustainability, and innovation. How these will be translated into specific country and community contexts to address unmet needs will be crucial in achieving national health goals and international commitments on health like the Millennium Development Goals.

(2) Achieving MDGs through essential newborn care

November 18, 2011

Medicine Cabinet By -- Reiner W. Gloor

THE PHILIPPINES Fourth Progress Report on the Millennium Development Goals provides us insight on how close or far are we in the attainment of the set of concrete, time-bound and specific objectives to eliminate extreme poverty, illiteracy and disease in the country by 2015.

The well-publicized report about the world reaching its landmark population of seven billion has reminded us to revisit the country commitment to MDG 4 in reducing under-five mortality by two-thirds between 1990 and 2015.

As far as the MDG 4 is concerned, the said Philippine report noted that there has been a steady decline in the infant and under-five child mortality rates. From 34 deaths per 1,000 live births in 1993, infant mortality rate was reduced to 25 deaths in 2008, sparking hope that the country will attain the 2015 target.

However, the same report revealed that 74% of deaths involving children under the age of five were attributable to infant deaths while around 64% of infant deaths were due to neonatal deaths.

Analyzing the above figures stresses the need to step up interventions for these priority age groups if the country were to achieve its goal of reducing the under-five child mortality rate.

One of the initiatives that the Department of Health (DOH) and the World Health Organization (WHO) to improve neonatal conditions is the introduction of the Essential Intrapartum and Newborn Care (EINC) to save mothers and newborns. Dubbed as “Unang Yakap” (First Embrace) 4 and 5, the set of practices aims to provide the highest standard for safe and quality care for birthing mothers and healthy newborns in the first 48 hours and up to a week of life of the newborn.

As discussed in the previous column, the EINC separates necessary from unnecessary practices involving intrapartum and newborn care.

Concerning the newborns, the EINC said that immediate drying should be the first action for all newborns regardless of age and birth weight. 

It explained that immediate and thorough drying of the newborn stimulates breathing and protects the baby from cold stress and hypothermia (sharp drop in body temperature).

Famed for being the seven billionth baby in the Philippines, the photo of baby Danica May Camacho being cuddled by her mother immediately after birth serves as a reminder on the benefit of skin to skin contact.

While skin to skin contact is generally perceived to be an intervention for warmth and bonding between the mother and the newborn, it actually does more. Studies show that skin to skin contact contributes to immunoprotection of the newborn and to the protection from hypoglycemia (low blood sugar).

The EINC added that it reduces crying, improves mother-baby interaction, keeps the baby warmer, aids in stabilizing the baby and helps women breast-feed successfully. These findings discourage the unnecessary routine separation of healthy newborns from their mothers which remains the practice of some birthing facilities in the country.

Another recommended intervention is the proper timing of clamping the cord. Delayed cord clamping has proven to benefit both full-term and preterm babies as it increases the infant’s blood volume and iron reserves, while at the same time reduces the incidence of iron-deficiency anemia in infancy. It likewise reduces the need for blood transfusions and decreases the incidence of brain hemorrhages in pre-term infants, added the EINC. Last but not the least in the recommended interventions is the initiation of breast-feeding within an hour after birth. Early breast-feeding reduces neonatal mortality by decreasing the ingestion of infectious pathogens as well as increases the provision of immunocompetent factors such as antibodies and white blood cells. This intervention likewise prepares the gastrointestinal tract and decreases invasion by infectious agents like HIV, added the EINC. 

Giving glucose water or artificial milk substitutes is discouraged.

Meanwhile, branded as unnecessary and harmful newborn practice is the routine suctioning in newborn which is believed to clear every baby’s airway. The EINC said that such practice only increases the risk for sepsis and disease.

Another unnecessary practice is bathing the newborn immediately after birth. The WHO recommends delaying bathing for at least six hours to minimize cold stress and reduce the risk of infections. Studies also show that bathing washes away the vernix caseosa which has antimicrobial properties.

Achieving MDGs 4 and 5 to save mothers and children from unnecessarily dying are crucial indications of human development and ability to care for the world’s seven billion population. Even one mother or one infant dying is one too many.

Seven billionth baby

November 11, 2011

Medicine Cabinet -- By Reiner W. Gloor

The world is now seven billion strong. Newborn babies from around the world, including the Philippines, were welcomed as the symbolic seven billionth babies about two weeks ago. The occasion sparked discussions about population explosion, food scarcity, health, housing, education and employment among many issues.

On the other hand, the photo of baby Danica May Camacho being cuddled by her mother offered another perspective into the symbolic occasion.

Around the world, one out of every 10 children from low-income countries die before reaching the age of five. This figure is only one out of 143 in wealthier nations. These numbers have alarmed world leaders that they have committed to reduce by two-thirds the under-five mortality rate as part of the Millennium Development Goal (MDG) 4 by 2015.

In the Philippines, the decline in under-five deaths has dangerously slowed down in the past 10 years because the neonatal mortality rate remained almost unchanged. Official statistics revealed that an estimated 82,000 Filipino children die annually before their fifth birthday and poor regions have even worse figures. More than one-third or 37% of these children are newborns less than 28 days old.

Alarmingly, these newborns die mostly of preventable causes such as asphyxia and sepsis. The highest number of newborn deaths occur in the first two days of life due to factors and conditions surrounding labor, delivery, and immediate postpartum period.

Meanwhile, the Philippines is also concerned that it may not meet MDG 5 which aims to reduce maternal deaths to 52 per 100,000 live births. At the moment maternal deaths in the country are estimated to be 162 per 100,000 live births or about 5,000 mothers needlessly dying annually. Furthermore, maternal deaths are higher in poor provinces particularly those belonging to the Autonomous Region for Muslim Mindanao (ARMM).

In addressing both maternal and infant mortalities, the Department of Health with the support of the World Health Organization (WHO) and the Joint Programme on Maternal and Neonatal Health (JPMNH) launched the Essential Intrapartum and Newborn Care (EINC) which is a hospital-based program to elevate practices for safe and quality care of newborns.

Also called as “Unang Yakap 4&5,” the EINC represents the highest standard for safe and quality care for birthing mothers and healthy newborns in 48 hours of the intrapartum period and up to a week of life of the newborn. The “Unang Yakap” makes recommendations and, at the same time, debunks the unnecessary practices in caring for the mother and child.

While common hospital practices in the country restrict a companion during labor and delivery, the EINC noted that women who receive continuous support during labor and childbirth are more likely to have a spontaneous delivery.

It also branded as “unnecessary” restriction of food during labor since both labor and birth need energy. The EINC recommends that there is no need for restriction of food for normal, low-risk birth, except when intervention is anticipated.

The EINC pointed out that there is no evidence that lying on one’s back offers advantages for babies and mothers during the first stage of labor. Instead, walking and being in upright position in the first stage of labor is recommended to shorten the labor.

The document also encourages continuous maternal support, walking and moving around, massage, verbal and physical reassurance and a quiet environment for pain relief during labor.
The EINC likewise recommends the use of a partograph which is a tool used to assess the progress of labor and identify when intervention is necessary. It said that the use of partograph can reduce complications from prolonged labor for the mother such as postpartum hemorrhage, sepsis, uterine rapture among others. It can also prevent asphyxia (severe oxygen deficiency), infection and death for the newborn.

It also stressed that instead of lying on one’s back, upright positions for pushing during the second stage of labor encourages descent of the fetal head due to gravity.

In reducing infections and antimicrobial resistance in hospital settings, hand hygiene is perhaps the single most important and effective measure to prevent them.

The milestone of reaching the seven billionth landmark world population reminds us not only of future concerns on population, food, housing, health, education and employment. It also serves as a reminder that mothers and infants need not needlessly die so that they may have equal chances of seeing and contributing for the future.

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