Death and illness caused by diarrheal disease do not discriminate, impacting families, national systems, and international foundations. Below are profiles of some of the people PATH has encountered in building partnerships and evaluating the impact of simple, lifesaving interventions.

A child lost in Kenya
An insurmountable wait at the local health clinic and unaffordable treatment cost young Abel Juma his life.

Breaking down barriers
The Curatio International Foundation engages health providers, academics, and policymakers to overcome resilient challenges in the Republic of Georgia.

Research to relieve burden
Studies led by Dr. George Armah will have worldwide impact, but he looks to how they can make life better for his own community.

A child lost in Kenya

Evalyne and her son.

Evalyne and her two-year-old son today.

Evalyne lives in the Bungoma District of Kenya’s Western Province. She was once a mother of three. But in May 2004, she had an experience familiar to every parent in the world: her two year old became sick with diarrhea. By the third day of his illness, Evalyne was worried and bundled her son, little Abel Juma, on her back for the twenty-minute walk to the nearest health clinic.

She arrived to find dozens of mothers and children waiting to see one of the two doctors who serve a local population of more than 200,000. Evalyne sat down on the ground to wait. Abel Juma looked drawn. He had been vomiting, and she thought he felt lighter in her arms than usual. Hours passed by. Evalyne knew she needed oral rehydration salts to treat her son’s dehydration. They would be given to her at no cost after seeing the doctor. She couldn’t afford the twenty-five cents to purchase them at the private pharmacy around the corner.  

A friend of Evalyne’s suggested she visit the village’s traditional healer. Evalyne left the clinic feeling as if she was out of options, and time was short. Her son was becoming sicker. At the home of the traditional healer, she received a concoction of herbs that he assured her would help. Evalyne convinced Abel Juma to swallow the medicine. Sadly, Abel Juma died the next day.

Evalyne’s experience is one shared by tens of thousands of Kenyan parents each year.

Through an “all hands” approach to diarrheal disease, a coordinated effort can tackle the problem by shrinking the gaps in behavior and access that have kept caregivers from seeing their children lead healthy lives.

Photo credit: Janie Hayes/PATH.

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Breaking down barriers

Manana Khotchava, a pediatrician in Georgia, shakes her head sadly when asked about the problem of diarrheal disease in her country. “This is a real issue,” she says. “Many children are suffering, but it is a struggle to get our policymakers to take action because we don’t yet have the information to convince them.”

Underreporting and unconfirmed diagnoses of diarrheal disease are common in Georgia, Dr. Khotchava explains. While severe cases are reported as they come into the health care system, she says they are just “the tip of the iceberg.” 

In Georgia, as in other former Soviet countries, the transition to a free-market economy spurred semi-privatization of health care. For many, the introduction of private health care meant skyrocketing costs, hindering some from seeking care for their children for common illnesses like diarrhea. At the same time, low pay for providers has contributed to underreporting of diarrheal disease.

Surveillance and information systems have been strengthened during recent years, explains Ivdity Chikovani, a program manager at the Curatio International Foundation (CIF), a nongovernmental organization created in 1994 to help reform health systems in transition economies. “However, they are far from perfect,” she explains, “and it is important to work on multiple fronts to strengthen policy, information systems, and laboratory procedures.”

In January 2008, CIF partnered with PATH to host a regional conference in Tbilisi, Georgia. Bringing together academics, health care workers, and policymakers, the workshop generated significant interest in rotavirus vaccines and broader diarrheal disease control measures. CIF and PATH continue to work with Georgian academics, health care providers, and the Ministry of Health to address barriers to diarrheal disease control.

The partnership has resulted in a draft nationwide plan for prevention and treatment interventions, and has facilitated new diarrheal disease management guidelines. The plan includes education of clinicians and medical students, assistance for introduction of the new ORS and zinc on the local pharmaceutical market, standard diagnostic laboratory procedures to improve surveillance, a system for measuring intervention impact, and revisions to the national multi-year immunization plan to prepare for rotavirus vaccine introduction in the coming years.

CIF’s history of strengthening health systems in the region, as well as increasing interest in diarrheal disease control, gives Chikovani and her colleagues hope for progress and scale-up. “We really hope the work we are doing in Georgia will be able to be applied to other countries in the region as well.”

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Research to relieve burden

Dr. George Armah

Dr. George Armah

An avid investigator of rotavirus for more than 25 years, Dr. George Armah hopes that his own drive is reflected in the momentum of future policy decisions on rotavirus vaccines in Africa. Such policies will be boosted by data from critical studies including the one he directs on behalf of PATH and Merck to evaluate the RotaTeq® vaccine in Ghana. Above all, he would like to see his team’s work ease the burden of parents who travel miles on bicycle or by foot to seek treatment for their ailing children. Prevention with rotavirus vaccines as could be an important solution.

Dr. Armah’s initial work with rotaviruses focused on strain identification and epidemiology, eventually leading to his post as researcher and principal investigator on immunogenicity studies of rotavirus vaccines manufactured by Wyeth and GlaxoSmithKline. In mid-2006, PATH partnered with the Navrongo Health Research Centre, where Dr. Armah leads a team of researchers conducting a clinical trial to evaluate the safety and efficacy of RotaTeq® among infants. The partnership allows the Navrongo Centre to build capacity in human resources and research skills, and in turn the investigators are contributing crucial data not only to inform the use of rotavirus vaccines in Ghana but also to benefit the global public health community. The trial’s enrollment is now complete, and the Navrongo Centre is actively participating in subject follow-up visits. Study results are expected by the end of 2009.

Photo courtesy of Dr. George Armah.

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