Health screenings for infants: Always the right choice?
Testing a few drops of blood from a newborn’s heel can screen for a multitude of medical conditions. According to The Wall Street Journal, this type of testing identifies at least 3,400 newborns with medical issues annually. Some of these diagnoses can be profoundly life changing. For example, phenylketonuria (PKU), a genetic disorder that leads to brain damage if left unchecked, can be controlled through diet if diagnosed early.
That said, it is not always clear whether a condition requires immediate intervention or if it would be better to wait. And of course, these screenings aren’t free. Some are covered by insurance and parents have the option of paying out of pocket for additional screenings, but costs add up. So are these screenings always worth it?
In some cases, absolutely yes. Screening for HIV or cystic fibrosis or the aforementioned PKU is clearly important because early intervention is possible. But what about screenings for extremely rare but debilitating diseases that don’t have a clear method of treatment? It’s a difficult question. It seems almost unethical not to screen for disease, especially if we have the resources to diagnose critical health conditions when babies are first born. But testing for many other, more complex diseases can open up even harder questions.
What do you think? Feel free to share your thoughts in the comments and look here to see an updated status report on newborn screening across the U.S.
The New York Times reports that the government in Sierra Leone is waiving fees for hospital services for pregnant women and children, leading to a sharp increase in the number of women and children receiving care. According to the article, “Since waiving the fees, Sierra Leone has seen a 214% increase in the number of children under five getting care at health facilities, a 61% decrease in mortality rates in difficult pregnancy cases at health clinics, and an 85% drop in the malaria fatality rate for children treated in hospitals.”
The numbers are impressive, but the situation is more complex. Embroiled in civil war for over a decade, Sierra Leone’s health services have been practically non-existant for a long time. Its maternal morbidity and mortality rates rank among the worst in the world.* So now that services have been made available to women for free, the impact on health outcomes is particularly dramatic. Also, the stability of these services is extremely tenuous. Sierra Leone’s government cannot afford to subsidize healthcare on its own, and is relying almost completely on the support of international donors like the World Bank and the U.K.’s Department for International Development. Even so, health care providers are stretched nearly to the breaking point trying to provide services for the influx of pregnant women now showing up for care.
Despite all these faults, it’s a promising venture and I encourage you to take a look at the pictures in the slide show accompanying the article. Do you have any thoughts on how to make programs like free maternal care sustainable on a large scale? Do you think Sierra Leone will be able to build on this system to improve long term health for women and children?
*The maternal mortality rate in Sierra Leone is 1,600 deaths per 100,000 live births, according to the most recent United Nations survey.
The Ambulance on Foot: Improving Access to Birthing Centers in the Philippines
This morning, I read an article on the IRIN website that piqued my interest. Titled “Hammocks make a difference to maternal health,” it focused on maternal health in the Philippines — specifically, an initiative that has worked to bring more women into clinics and hospitals when they are ready to give birth.
The program revolves around the ayod, a sort of portable hammock or “ambulance on foot” that has traditionally been used in the Philippines to transport ailing individuals through mountainous regions. Use of ayods goes back a long time in the Philippines, but their use as a tool to improve maternal health is more recent.
In 2008, a provincial order was passed, establishing Ayod Community Health Teams (ACHT) as part of a larger push to encourage women to give birth at health centers rather than at home (as of 2008, 70% of births taking place in rural parts of the Philippines were home births). The ACHT was tasked with monitoring the health of pregnant women and helping to create birth plans that include transportation to health centers. Volunteers in local villages assist family members in carrying the ayod bearing the laboring woman to the nearest birthing center.
This strategy seems to be working. The government is committed to modernizing the care provided to pregnant women. For example, a national law was passed mandating that all pregnant women go to an established health clinic to receive pre-natal care. A system like the ACHT demonstrates innovative thinking when it comes to realistic problem solving. Communities are using a tool they are familiar with in a new, well-organized way. This, along with continued government support and community awareness campaigns, is actually changing the way women give birth in the Philippines for the better.
Fetal Programming: A study to improve fetal development
Today, the Wall Street Journal published an article on fetal programming: the act of trying to influence bodily processes in the developing fetus while still in the womb through use of drugs or changes to the mothers’ diet. The reason for scientific research into fetal programming is simple: during fetal development, the human body establishes innate set points that can’t be altered later in life. The metabolism, organ development, hormone production levels; all of these are highly affected by the conditions a fetus is exposed to in the womb.
A key concern in today’s environment is addressing the conditions that can lead to obesity. When babies are born to overweight mothers, they are predisposed to being overweight themselves. This is because overweight women typically have higher blood pressure during pregnancy and pass along high levels of glucose to their babies in the womb, forcing the fetus to produce more insulin to compensate for the high levels of sugar. Once the babies are born, they continue to produce more insulin because their bodies have been programmed to expect high levels of glucose. This predisposes the babies to obesity.
It’s a vicious cycle, but one that has been difficult to break as obesity becomes more and more prevalent. To address this problem, a new study is being sponsored by the U.K. government in which obese, non-diabetic pregnant women will be given Metformin- a drug used to treat type-2 diabetes- throughout their pregnancy in an attempt to lower their blood sugar. The hope is that by lowering the blood sugar of the expectant mother, the baby will be born without elevated insulin levels and thus less likely to be predisposed to obesity.
It’s an interesting idea- though it does bring up the potentially troubling issue of giving a drug to a pregnant women who doesn’t strictly need that drug. In the best-case scenario, women would take care of themselves and their unborn children by eating better and exercising appropriately to maintain healthy weight- but the reality of the situation shows that in many cases, this doesn’t happen. So perhaps a drug that could at least offer some chance of improved fetal development is the most realistic choice for better health outcomes in the given circumstances.
What are your thoughts on the issue of fetal programming? Does this seem like a good course of action, or do you think there are other feasible alternatives?