Sunday, May 18, 2014

Global Health Critical Reflection #1

In “Child health promotion in developing countries: the case for integration of environmental and social interventions,” Dr. John Ehiri and Julie Prowse investigate the root causes of child mortality rates in low-income countries and identify possible approaches that these countries should incorporate in their health management programs (1999). The authors used diarrhea to demonstrate the complexities of diseases attributable to child mortalities and morbidities (Ehiri, 1999). As I read the black and white text of the article, vivid images of my time as a Peace Corps Volunteer in Sierra Leone disrupted my concentration. I felt a personal connection to the authors’ analysis, as several children close to me passed away during my two years in West Africa, usually from diarrhea and other preventable illnesses. Although it is difficult to be reminded of these losses, this reality provides me with a source of motivation to understand the systems and inter-connected factors that affect child health in the developing world.
In order to address child health, the general term, “health”, needs to be clearly defined. Although there are many models that define health, I think of health as a balancing continuum between physical, mental and social well-being, which corresponds to the definition outlined by the Dutch Conference in 2009, “the ability to adapt and self-manage” (Huber 2011). Dr. Ehiri and Ms. Prowse proposed that frequently too much emphasis is placed on the physical well-being of children, and more resources and research need to focus on the improvement of environmental and social influences of child health as these are the risk factors associated with common diseases (1999). The authors state that prevalent childhood diseases in low-income countries are often inter-related, which further illustrates the need for a holistic, comprehensive approach to improving child health (Ehiri, 1999).
The World Health Organization encouraged an “integrated case management approach” to tackle the five most common diseases that cause child mortality (Ehiri, 1999). Although this article is dated to 1999, it is interesting to observe that four of these diseases are still on the list today: malaria, diarrhea and acute respiratory infections, with malnutrition as an underlying risk factor between all three (WHO, 2013). 45% of all childhood deaths are linked to malnutrition, which validates Dr. Ehiri’s and Ms. Prowse claim that many of these infectious diseases are inter-related (WHO, 2013).
In the review article, Dr. Ehiri and Ms. Prowse claim that most childhood diseases can be traced back to poverty and lack of education (1999). In Sierra Leone, I witnessed this connection with many families in my community. As a teacher, I witnessed many of my students missing school in order to work on their families’ farms. Often times, parents neglected to see the importance of education in their children’s lives and this attitude would usually get passed onto the children. The domino-effect of little to no education was carried from generation to generation, which exacerbated the communication of health misconceptions and misinformation within families and communities.
I observed many of the unhygienic practices associated with the development of diarrhea that were outlined in the article, like inadequate re-heating and storage methods (Ehiri, 1999). Another habit that was common in Sierra Leone was not properly washing one’s hands before eating, which is customarily performed with only hands. Environmental factors, like flies, were also an issue in my community. One day, I witnessed three young children defecating beside my neighbor’s kitchen, which created an advantageous environment for insects to fly from the feces to the prepared food. Why were these children unsupervised? Why didn’t anyone teach them about hygiene and proper places to defecate?
Dr. Ehiri and Ms. Prowse proposed that the implementation of food-hygiene educational programs through the hazard analysis critical control point (HACCP) approach would help address some of these issues (Abdulsalam, 1994). Today, a highly recognized initiative, the WHO/UNICEF’s Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), does not explicitly include the preparation of food, and the underlying environmental and social conditions, but it does focus on hand washing and drinking water, amongst other practices (2013).
It is my hope, through ongoing research and continued collaboration between international agencies, like WHO and UNICEF, and low-income countries, children, most vulnerable to death from diarrhea and other infectious illnesses, will reach the equilibrium of health, wherein physical, mental and social wellbeing is part of a normal life in countries like Sierra Leone. 

 (2013). Children: reducing mortality. World Health Organization.
(2013). Ending preventable deaths from pneumonia and diarrhea by 2025. World Health Organization.
Abdulsalam, M. and F.K. Kaferstein. (1994) Food safety in primary health care. World Health Forum 15(4), 393-9.
Ehiri, John E. & Julie M. Prowse. (1999). Child health promotion in developing countries: the case for integration of environmental and social interventions. Healthy Policy and Planning, 14(1), 1-10.

Huber, Machtel, et al. How should we define health? (2011) BMJ 343, 4163.

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