Toto Bora, an expression meaning “healthy baby” in Kiswahili, enrolled its first pediatric patient today in a research trial aimed at reducing childhood morbidity and mortality in the months after a hospitalization.
In sub-Saharan Africa, childhood mortality remains unacceptability high. Children who are hospitalized and subsequently discharged are a group of children at particularly high risk, yet few interventions exist for the post-discharge period. A recent trial found that the mass drug administration of azithromycin reduced childhood mortality by half among children in Ethiopia in communities receiving the intervention. The Toto Bora team, led by Drs. Judd Walson, MD, MPH and Patricia Pavlinac, PhD MS, believes that children being discharged from hospital represent an accessible high-risk population in which targeted use of this broad-spectrum antibiotic may have dramatic impact.
In this double-blind, placebo-controlled trial, children discharged from hospitals in Kisii and Homa Bay counties of Kenya are randomized to a 5-day course of azithromycin or placebo and followed for six months to determine the efficacy of azithromycin in reducing post-discharge morbidity and mortality. Stool, nasopharyngeal swabs, and blood samples are also being collated from children to evaluate the effect of the intervention on enteric and nasopharyngeal infections, malaria, the gut microbiome, and systematic inflammation. The emergence of antibiotic resistance among treated individuals and their primary caregivers will also be assessed and cost-effectiveness analyses performed to inform policy decisions.
The Toto Bora Trial began enrollment on June 28, 2016 and is estimated to be complete data collection in June 2019. Congratulations to this Global WACh team for launching this important study to generate evidence on effective interventions to reduce childhood mortality in Kenya!
Read more about Toto Bora on the clinicaltrials.gov website: https://clinicaltrials.gov/ct2/show/NCT02414399
There are 7 billion people in the world and nearly 2 billion are undernourished and 2 billion are overweight or obese. Last week, the team at Global WACh held a fascinating and informative learning symposium at the Bill and Melinda Gates Foundation. Experts from The University of Washington, Seattle Children’s Hospital, PATH, and 1,000 Days came together for a full day of discussion and presentation on the global burdens of malnutrition.
There were three main sessions throughout the day: Basic Science and Discovery; Implementation; and National Systems Building, each including impactful presentations with quite a few staggering facts and figures. Throughout the day we were presented with new ideas, innovative techniques for testing, all with a healthy air of hopeful idealism. To see the presentations, you can view the slides on our Nutrition Think Tank webpage. It was wonderful to have a day to discuss what we can do to help ensure healthy, happy, and nourished lives around the world.
Thanks to all of our speakers and to the Gates Foundation for hosting!
We were fortunate to have Adrianna Logalbo, director at 1,000 Days, recently join us at our Nutrition Think Tank. She led a powerful discussion on the importance of maternal and early child nutrition, both here at home and within the global community.
There are nearly 1 billion hungry people in the world. More than 2 billion people are undernourished, and more than 2 billion are obese. “If we can make that investment from the very beginning, it sets up a lifetime of better outcomes,” Logalbo said. 1,000 Days is working to improve this global public health challenge through social media, phone apps, television, and simply going out and meeting with people.
1,000 days and their many partners hope to help achieve a world where every woman and child is nourished, empowered, and able to reach their full potential. Logalbo went on to say “Of course, there is a lifecycle happening here, so while we can say the 1,000 days starts at pregnancy it’s very true that the health and nutritional status of the adolescent girl, or the young women going into pregnancy, is critically important.”
You can read more about the impactful work Adrianna Logalbo and 1,000 Days are doing on their website here.
Last week, over 25 students and faculty gathered to hear UW Affiliate Professor Dr. Tahmeed Ahmed speak on the subject of acute malnutrition in children, from basics to delivery. Dr. Ahmed is the head of the Nutrition and Food Security program at International Centre for Diarrheal Disease Research, Bangladesh. Under his leadership over the last 25 years, there has been a 50 percent reduction in the fatalities of children admitted with severe acute malnutrition to the icddr,b facilities in Dhaka. Global WACh has recently established a partnership with icddr,b to research new ways to prevent stunted growth in children. You can learn more about Dr. Ahmed and the great team at icddr,b here.
Dr. Tahmeed Ahmed
Global WACh Associate Director Dr. Jennifer Unger gave a great talk last week about the implementation of mobile phones in the care of pregnant women in Mathare, Kenya. Three hundred women are currently participating in the study, which aims to use SMS text messaging as a means to keep the expectant mothers informed and involved in the health of themselves and their babies.
Text messages from a nurse at the clinic offer tips and general information, as well as answers for any health questions the participants may have. The messaging system also provides appointment reminders and a way to check in to see how they’re feeling. Perhaps most importantly according to the women in the study, the messages offer encouragement and support while allowing them to feel cared for and empowered.
Many countries have some version of mHealth in place, and Dr. Unger stressed the importance of working together and also making the messages culturally appropriate and tailored to each individual community. This particular study is completely free for the participants.
The findings in Mathare, Kenya will lay the foundation for a larger Global WACh study on using mHealth to enhance the prevention of mother to child transmission of HIV. The results of the Mobile WACh study should be available in the spring, and we’re certainly looking forward to sharing them.