- Email: [email protected]
Mobilising the Campaign to End Fistula
Correspondence
In 2011, in a Comment published in The Lancet,4 Yang and Wu warned about discrimination against people with HBV in China. Yang and Wu claimed that public education is key to eliminate HBV discrimination and that China’s health authorities should play a crucial part in this process. However, 4 years later, no improvements have been made. Almost all efforts by the government to eliminate discrimination against people with HBV have had little effect. Although blood tests for HBV before starting school or a job were banned,5 HBV tests are still done and employees who test positive for HBV are not hired and provided reasons other than HBV.6 Strong science on HBV is needed. Efforts should be made by the authorities to make research into HBV a priority. Moreover, HBV carriers should make their voices heard. And perhaps anti-discrimination laws with strict penalties for transgressors are needed to protect the rights of people with HBV in China. We declare no competing interests.
Quancheng Kan, Jianguo Wen,*Rui Xue [email protected] Department of Pharmacy (QK), Institute of Clinical Medicine (JW, RX), and Department of Urology (JW, RX), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China 1
2
3
4 5
6
246
China Daily. Female college students commit suicide in the dormitory. April 30, 2015. (in Chinese). http://cnews.chinadaily.com. cn/2015-04/30/content_20586586.htm (accessed July 6, 2015). Chen G, Joan MB, Alison AE, Huang PX, Chari C. Gateway to Care campaign: a public health initiative to reduce the burden of hepatitis B in Haimen City, China. BMC Public Health 2014; 14: 754. Wang P, Li J, Pan X, Wang L, Wu G. Survey and analysis of hepatitis B awareness and discrimination. J Nurses Train 2013; 28: 1570–72 (in Chinese). Yang T, Wu MC. Discrimination against hepatitis B carriers in China. Lancet 2011; 378: 1095. Xinhua News Agency. China to make rules to protect privacy of hepatitis B carriers. July 14, 2007. http://www.china.org.cn/ health/2007-07/14/contect_1217086.html (accessed May 3, 2015). China network. Hepatitis B policies suffered soft resistance in China. September 29, 2010. (in Chinese). http://www.china.com.cn/news/ gongyi/2010-12/29/content_21635317.htm (accessed July 6, 2015).
Mobilising the Campaign to End Fistula In 2004, the United Nations Population Fund (UNFPA) and its partners launched the Campaign to End Fistula, yet how much has changed for women’s health since its conception? Overall, improvements in women’s health would appear positive; as maternal and child mortality rates have halved in the past two decades, a successful foundation has been established for the Sustainable Development Goals (SDG).1 This is a remarkable achievement for many developing countries in view of the rise in population size, declining rates in income growth, and increasing political instability. However, widespread variation in maternal morbidity exists worldwide— countries such as Burkina Faso have a lifetime prevalence as low as 0·4 obstetric fistula cases per 1000 women compared with 19·2 cases per 1000 women in Uganda. 2 Furthermore, WHO has flagged obstetric care as one of the major areas of essential surgery on the SDG agenda because only 1% of the surgical need for obstetric fistula is currently being met.3 In light of the recent Lancet Commission on Global Surgery,4 this year’s International Day to End Fistula (May 23) aptly focused on prevention, surgical treatment, and social reintegration of women after surgery. To address the epidemiological and obstetric transitions in the developing world, policy makers must seek ways to reduce barriers to care and empower women from these societies. Women are prevented from seeking treatment for obstetric fistula for several reasons, including poor knowledge of surgical correction, inadequate information about where surgery can be obtained, as well as the direct and indirect costs incurred for receiving surgical care.2 Recent approaches to overcome such issues have included
mHealth where so-called fistula ambassadors deployed to rural areas help identify affected women, confirm their likely diagnosis, and arrange transport for them to reach surgical centres. Transport costs often operate through a payment infrastructure already provided by mobile phone companies.5 Mobile phone use is high in low-income and middle-income countries and will continue to rise, offering a relatively inexpensive yet accessible intervention to improve maternal health in these countries. Although more rigorous evidence is needed to assess the effect and cost-effectiveness of mHealth programmes, their future remains promising. Innovative strategies to address obstetric fistula through improved access to antenatal care must be welcomed to help make this disorder one of the past. We declare no competing interests.
*Faheem Ahmed, Na’eem Ahmed, Sophie Candfield, Iftikher Mahmood, Janice Rymer, Chris Lavy [email protected] Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, London SE1 1UL, UK (FA, JR); London School of Hygiene & Tropical Medicine, London, UK (FA, SC, CL); St George’s Hospital, London, UK (NA); King’s College Hospital, London, UK (SC); HOPE Foundation for Women and Children of Bangladesh, FL, USA (IM); and Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK (CL) 1
2
3
4
5
Lawn JE, Blencowe H, Oza S, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014; 384: 189–205. Maheu-Giroux M, Filippi V, Samadoulougou S, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a metaanalysis of national household survey data. Lancet Glob Health 2015; 3: e271–e78. Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 2007; 99 (suppl 1): S10–S15. Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; published online April 27. http://dx.doi.org/10.1016/S01406736(15)60160-X. Fiander A, Ndahani C, Mmuya K, Vanneste T. Results from 2011 for the transport MY patient program for overcoming transport costs among women seeking treatment for obstetric fistula in Tanzania. Int J Gynaecol Obstet 2013; 120: 292–95.
www.thelancet.com Vol 386 July 18, 2015
In 2011, in a Comment published in The Lancet,4 Yang and Wu warned about discrimination against people with HBV in China. Yang and Wu claimed that public education is key to eliminate HBV discrimination and that China’s health authorities should play a crucial part in this process. However, 4 years later, no improvements have been made. Almost all efforts by the government to eliminate discrimination against people with HBV have had little effect. Although blood tests for HBV before starting school or a job were banned,5 HBV tests are still done and employees who test positive for HBV are not hired and provided reasons other than HBV.6 Strong science on HBV is needed. Efforts should be made by the authorities to make research into HBV a priority. Moreover, HBV carriers should make their voices heard. And perhaps anti-discrimination laws with strict penalties for transgressors are needed to protect the rights of people with HBV in China. We declare no competing interests.
Quancheng Kan, Jianguo Wen,*Rui Xue [email protected] Department of Pharmacy (QK), Institute of Clinical Medicine (JW, RX), and Department of Urology (JW, RX), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China 1
2
3
4 5
6
246
China Daily. Female college students commit suicide in the dormitory. April 30, 2015. (in Chinese). http://cnews.chinadaily.com. cn/2015-04/30/content_20586586.htm (accessed July 6, 2015). Chen G, Joan MB, Alison AE, Huang PX, Chari C. Gateway to Care campaign: a public health initiative to reduce the burden of hepatitis B in Haimen City, China. BMC Public Health 2014; 14: 754. Wang P, Li J, Pan X, Wang L, Wu G. Survey and analysis of hepatitis B awareness and discrimination. J Nurses Train 2013; 28: 1570–72 (in Chinese). Yang T, Wu MC. Discrimination against hepatitis B carriers in China. Lancet 2011; 378: 1095. Xinhua News Agency. China to make rules to protect privacy of hepatitis B carriers. July 14, 2007. http://www.china.org.cn/ health/2007-07/14/contect_1217086.html (accessed May 3, 2015). China network. Hepatitis B policies suffered soft resistance in China. September 29, 2010. (in Chinese). http://www.china.com.cn/news/ gongyi/2010-12/29/content_21635317.htm (accessed July 6, 2015).
Mobilising the Campaign to End Fistula In 2004, the United Nations Population Fund (UNFPA) and its partners launched the Campaign to End Fistula, yet how much has changed for women’s health since its conception? Overall, improvements in women’s health would appear positive; as maternal and child mortality rates have halved in the past two decades, a successful foundation has been established for the Sustainable Development Goals (SDG).1 This is a remarkable achievement for many developing countries in view of the rise in population size, declining rates in income growth, and increasing political instability. However, widespread variation in maternal morbidity exists worldwide— countries such as Burkina Faso have a lifetime prevalence as low as 0·4 obstetric fistula cases per 1000 women compared with 19·2 cases per 1000 women in Uganda. 2 Furthermore, WHO has flagged obstetric care as one of the major areas of essential surgery on the SDG agenda because only 1% of the surgical need for obstetric fistula is currently being met.3 In light of the recent Lancet Commission on Global Surgery,4 this year’s International Day to End Fistula (May 23) aptly focused on prevention, surgical treatment, and social reintegration of women after surgery. To address the epidemiological and obstetric transitions in the developing world, policy makers must seek ways to reduce barriers to care and empower women from these societies. Women are prevented from seeking treatment for obstetric fistula for several reasons, including poor knowledge of surgical correction, inadequate information about where surgery can be obtained, as well as the direct and indirect costs incurred for receiving surgical care.2 Recent approaches to overcome such issues have included
mHealth where so-called fistula ambassadors deployed to rural areas help identify affected women, confirm their likely diagnosis, and arrange transport for them to reach surgical centres. Transport costs often operate through a payment infrastructure already provided by mobile phone companies.5 Mobile phone use is high in low-income and middle-income countries and will continue to rise, offering a relatively inexpensive yet accessible intervention to improve maternal health in these countries. Although more rigorous evidence is needed to assess the effect and cost-effectiveness of mHealth programmes, their future remains promising. Innovative strategies to address obstetric fistula through improved access to antenatal care must be welcomed to help make this disorder one of the past. We declare no competing interests.
*Faheem Ahmed, Na’eem Ahmed, Sophie Candfield, Iftikher Mahmood, Janice Rymer, Chris Lavy [email protected] Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, London SE1 1UL, UK (FA, JR); London School of Hygiene & Tropical Medicine, London, UK (FA, SC, CL); St George’s Hospital, London, UK (NA); King’s College Hospital, London, UK (SC); HOPE Foundation for Women and Children of Bangladesh, FL, USA (IM); and Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK (CL) 1
2
3
4
5
Lawn JE, Blencowe H, Oza S, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014; 384: 189–205. Maheu-Giroux M, Filippi V, Samadoulougou S, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a metaanalysis of national household survey data. Lancet Glob Health 2015; 3: e271–e78. Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 2007; 99 (suppl 1): S10–S15. Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; published online April 27. http://dx.doi.org/10.1016/S01406736(15)60160-X. Fiander A, Ndahani C, Mmuya K, Vanneste T. Results from 2011 for the transport MY patient program for overcoming transport costs among women seeking treatment for obstetric fistula in Tanzania. Int J Gynaecol Obstet 2013; 120: 292–95.
www.thelancet.com Vol 386 July 18, 2015