Sept 3. 2014. A Transformed Mind Transforms the World

The theme of World Vision Tanzania 2014 Annual Staff Retreat is “A transformed mind transforms the world.” The word transform reminded me of the movie Transformer; dramatic change in the robot form and wipe out scoundrel! Two same words were included in the one sentence, and it did not inspire me much for the first time. I could not appreciate this deep meaning until I attended today’s devotion with hundreds of staff. David, consultant from South Africa, opened a speech in relation to our theme and the Bible. To change the world, we ourselves need to be changed first, from the communities, from ADPs, to transform our behavior for spreading positive impact on our society.

The former Dean, Alfred Sommer, was a passionate person who made an ambitious goal for my school; he made the school vision as “Saving Lives Millions at a Time.” Many students, and even some professor laugh away this vision because it looks too fabulous. How do we save millions of lives? But we can make it possible. An individual cannot do it by oneself, but we can cooperate with each other to make the impact three and four times. If one person go to a remote village and distributed vitamin A to 500 hundreds children who were suffering from measles or night blindness, he/she would save 500 of lives. More than 500 new public health students enter my school every year. For the next 10 years, more than 5,000 alumni will have worked in every place. If I count public health alumni from other schools, the number would be multiples times. Each of them will devote oneself to improve people’s health and well-being. If you get rich and donate millions of dollar for the development of new drugs, you may potentially provide benefits to people all over the world. So I think my school vision is not that bad enough!

Oh, what I am doing as a fellow is also transforming something; estimating impact of increasing child/ mother survival coverage by analyzing Lives Saved Tool (LiST). The Lives Saved Tool (LiST), closely linked to the work of WHO’s Child Health Epidemiology Reference Group (CHERG) and UNICEF, is a free and public software model that estimates the impact/ effectiveness of increasing coverage of interventions for maternal, neonatal and child health and for the risk of stillbirth for pregnant women. It has health-related behaviour, vaccine, and nutrition-related interventions. LiST enables us to project the impact of both existing and future interventions at the same time or separately. Also, we can add new intervention by ourselves into LiST model to see how those new ones would have correlation with existing intervention. There are 100 intervention-outcome combinations that can be estimated by a modified GRADE approach, by a Delphi approach, or by studies with different levels of data quality. Some intervention-outcome combinations that have no significant effect or no availability to measure the effect will not be included in LiST because there are overwhelming belief about the efficacy or ethical constraints. For example, the impact of caesarean-sections and skilled birth attendance are not likely to be measured with objectivity. In those cases, LiST will use historical data or estimates of effectiveness from the Delphi analysis. Some interventions, such as Essential Obstetric Care, are the package of multiple interventions, so they need to be distinguished from individual components of the package. Further research to enhance the effectiveness of interventions will be fulfilled by better health policy decisions.

UN established 8 millennium development goals (MDGs) in 2001 and 4th MDG is to reduce child mortality by two-thirds between 1990 and 2015. However, this target would be impossible unless there is substantial change of child survival interventions. The major cause of under-5 death is diarrhoea, pneumonia, measles, malaria, HIV/AIDS, birth asphyxia, preterm delivery, neonatal tetanus and neonatal sepsis; those diseases are classified, depending on coverage level of child survival intervention, as level 1 (sufficient evidence of effect), level 2 (limited evidence), and level 3 (inadequate evidence). At least one level 1 intervention is preventing or treating each major under-5 diseases. If present coverage levels of effective child survival interventions were increased to universal coverage, scaling up to 99% for all interventions except 90% for exclusive breastfeeding, we can prevent under-5 deaths in 42 countries with 90% of worldwide child deaths. Preventive interventions are exclusive breast feeding; insecticide-treated materials, complementary feeding; water, sanitation, hygiene; Hib vaccine; zinc; vitamin A; antenatal steroids; new-born temperature management; tetanus toxoid; nevirapine and replacement feeding; antibiotics for premature rupture of membranes; clean delivery; measles vaccine; antimalarial intermittent preventive treatment in pregnancy. Treatment interventions are oral rehydration therapy; antibiotics for pneumonia; antimalarial; antibiotics for sepsis; new-born resuscitation; antibiotics for dysentery; zinc; vitamin A. Two-thirds of child deaths would be prevented if we maximize our current interventions to universal level of coverage for low-income and middle-income countries.

To reduce stunting, severe wasting, micronutrient deficiencies, intrauterine growth restriction, and mother/ child deaths, there are several effective interventions available. Interventions for maternal and birth outcomes include iron folate supplementation; maternal supplements of multiple micronutrients; maternal iodine through iodisation of salt; maternal calcium supplementation; interventions to reduce tobacco consumption or indoor air pollution. Interventions for new-born, infants and children include promotion of breastfeeding; behaviour change communication for improved complementary feeding; zinc supplementation; zinc in management of diarrhoea; vitamin A fortification or supplementation; universal salt iodisation; hand washing or hygiene interventions; treatment of severe acute malnutrition. If those interventions are scaled up to sufficient amount of coverage, they would reduce disability-adjusted life-years (DALYs) by a quarter in the short period of time. Especially, breastfeeding and vitamin A fortification/ supplementation has the greatest impact on saving children’s lives. There are few sufficient scale of interventions for mothers. Elimination of stunting would require both short-term available implementation and long-term investments to reduce child morbidity/ mortality and improve educational/ social/ economic status of women, respectively. To achieve several MDGs, continuous proven nutrition-related interventions should be prioritized domestically and globally. Also, each country with a high undernutrition rate should decide which specific intervention apposite to its situation should be implemented. Attention to undernutrition issues should be accompanied by the technical expertise and the strong political to eliminate undernutrition in the world.

If World Vision Sierra Leone takes an action based on the LiST analysis for the upcoming years of AIM-Health Programme duration, their future will be transformed into implementing better strategies, not staying in the baseline. It is okay that my work would be just reference to add support to final mid-term review. The most important thing is that evaluations through qualitative and quantitative study should contribute to make this Programme much better so that our transformed mind will transform mother, neonatal and child’s health into better and happier lives.