The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown.
The UN Millennium Development Goals
Global partnership to reduce extreme poverty.
Established on September 2000, deadline 2015.
Basic human rights-the rights of each person on the planet to health,
education, shelter, and security.
Extreme poverty in its many dimensions:
Lack of adequate shelter
Exclusion-while promoting gender equality
What they are
Goal 1: Eradicate Extreme Hunger and Poverty
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development
Let’s start with…
4: Reduce Child Mortality
Reduce by two-thirds, between 1990 and 2015,
the under-five mortality rate
Evidence shows that information, not in the hands of
experts, but in the hands of the population, leads to
changes in behavior, health improvement and decrease
Education and Prevention play an essential role.
Low income, Social Growth and Good Health: A History of twelve countries. New England Journal of Medicine, 2008
Worldwide over 10 million children under 5
years of age are dying each year.
What interventions are appropriate for
reducing these deaths?
Two main causes of Morbidity and Mortality in
children 5 and less than 5 y/o
Acute gastroenteritis (Diarrhea)
Major underlying factor
Complicates the clinical presentation
EDUCATION is essential
Leading Causes of Death in Children
Under 5 years of age
All other causes
HIV / AIDS
World Health Organization data 2001 (from Global Health Council http://www.globalhealth.org)
Child with Spina Bifida and Hydrocephalus
(Folic acid deficiency during pregnancy)
Child with Myelomeningocele (Folic acid
deficiency during pregnancy)
High Prevalence of Prematurity
Protein, Calories, Vitamins deficiencies
Acute gastroenteritis (Diarrhea) remains a common illness among infants and
In the United States, acute diarrhea accounts for >1.5 million outpatient
visits, 200,000 hospitalizations, and approximately 300 deaths/year (CDC
report year 2003).
In developing countries, diarrhea is a common cause of mortality among
children aged <5 years, with approximately 2 million deaths annually
(CDC MMWR 2003).
Diarrhea dehydration is one of the main causes of death in children under the
age of five (Ahmad OB et al 2000; Sakisaka K 2006), and often (almost 50%
of these cases) are complicated by malnutrition (Rutstein SO 2000).
Acute gastroenteritis’ primary morbidity and mortality
arises from dehydration and electrolyte losses
associated with untreated diarrhea (CDC MMWR 2003;
Greenough WB-The Lancet 1995).
Fortunately, this can effectively be prevented by the
adequate use of Oral Rehydration Therapy (ORT),
which includes rehydration and maintenance fluids with
oral rehydration solutions (ORS), combined with
continued age-appropriate nutrition (CDC MMWR
Interventions by cause - Diarrhea
Future: rotavirus vaccine
A simple solution of
water, salt and sugar saves
millions of young lives.
Oral Rehydration Therapy
"The discovery that sodium transport and glucose
transport are coupled in the small intestine so that
glucose accelerates absorption of solute and water (is)
the most important medical advance of this century."
The Lancet (British Scientific Journal)
5th August, 1978
Treatment can begin at home if primary caretakers:
are educated about the disease
understand adequate ORT preparation/use
are trained to recognize signs of illness or treatment failure that
necessitate immediate medical intervention (CDC MMWR 2003).
ORT is simple and allows management of uncomplicated cases
of diarrhea at home, regardless of etiologic agent (CDC MMWR
Thus, early intervention can significantly diminish complications,
hospitalizations and deaths.
It can be prepared from commercially available ORS packets
By using home ingredients to make a standard homemade
Mix a packet in a liter of previously boiled water.
The recipe includes 5 cups of clean potable water, 1 teaspoon of salt
and 8 teaspoons of sugar.
Education plays a significant part on the safe and
efficient use of ORT, otherwise serious errors and
complications can occur (Meyers A et al 1997).
Work towards the achievement of the UN’s
Millennium Development Goal #4: To reduce
Assume the UN’s Millennium Villages working
Action Plan Cont.
UN MILLENNIUM VILLAGES WORKING
We will empower those who need us the most living
in impoverished “villages/barrios” so they can
transform themselves and meet the
Millennium Development Goals.
In order to do so, we will work in partnership with
governments and other committed organizations, to
provide affordable and science-based solutions to
help people lift themselves out of extreme poverty.
We will Improve and Establish the most
effective Sustainable Distribution System
for Oral Rehydration Therapy (ORT) of
Acute Gastroenteritis, and Ensure its
continuous Excellent Performance in
We will provide continuous Education and ORT treatment for gastroenteritis
through an existing distribution system in Managua, working in liaison with a
small clinic, base houses in the communities and health promoters.
We will establish similar systems in other areas of much need in Nicaragua
with the help of local organizations. Our goal is to eventually implement our
system at a national level.
Promote mental health and unity with families in the communities through
Carry out infrastructure restoration as well as the establishment of hygiene
measurements important for malnutrition and infectious diseases prevention.
Action Plan cont.
Four important components that will ensure sustainability – FAMILIAS UNIDAS
FUND RAISING ACTIVITIES AND GRANT WRITING IN THE US AND
LOS CHAVALITOS CLINIC
Pre-Clinical and Public Health/Research
Continuous involvement with the ORT project in educational and other activities
PARTNERSHIP WITH LOCAL ORGANIZATIONS
To provide ORT packets to the families
We will teach Families and Community Leaders how to prepare treatment at home with homemade ingredients. Educate about the disease and associated co-morbidities among other important
Children 5 and less than 5 yrs old living in
underserved villages (“barrios”) of Nicaragua.
Target population goal is about 5,000 children
Initially established by Dr. Imelda Medina in 1999
Currently our system in Managua is working with 8 base
houses in the communities, providing a total of about 300
ORT packets monthly with an average of 3000-4000 salts per
year. In addition, we provide some medicines such as
Paracetamol. The salts are distributed by "brigadistas de
salud" (health promoters) in charge of the base houses, who
also refer children to the clinic.
Still active (since 1999) which shows it's importance
to serve the needs of the population and our ability
to ensure a project’s sustainability.
However, the services are not enough to cover the
basic needs of our pediatric population.
We will provide the base houses with Oral Rehydration Therapy salts so
they serve as a source of distribution to the population.
Two ways we will provide ORT to the population:
1. ORT Packets ($0.32 each).
Each child will need at least 2 packets on day 1 of the disease.
2. Teach parents how to correctly prepare them with ingredients at home.
ORT PACKETS COST
Taking into consideration that the total number of children 5 and less
than 5 years old in these communities is approximately 4,444, the most
frequent times per year they get sick is 3, and that we will provide them
with two packets during the first day of the disease, each packet costing
$0.32, we will need $8,532.48 annually to help the communities or at
least 26,666 packets of WHO ORT solution per year, about 2,000
packets/month (note the large gap from the current annual supply).
We will Educate the population about the disease and conduct
workshops about the adequate preparation of the solution at home
for cases when the packets are not available.
Establish additional base houses to cover all areas in need in the
country and ensure excellent performance so that families can have
resources close to their home and receive ORT treatment in a timely
AAP. (2006). Recommended Childhood and Adolescent Immunization Schedule United States. from http://www.cispimmunize.org/IZSchedule_2006.pdf
BBC. (2001, 30 July 2001). Timeline: Nicaragua. Retrieved 30 July 2001, 2001, from http://www.hartford-hwp.com/archives/47/397.html
Beachy, B. (2006, 01/30/2006). The IMF debt relief sham: swindling the sick. The counterpunch.
Blakely, T., Hales, S., Kieft, C., Wilson, N., & Woodward, A. (2005). The global distribution of risk factors by poverty level. Bull World Health Organ, 83(2), 118-126.
Boelen, C. (2003). [World Health Organization strategies "Towards Unity for Health" and the social responsibility of medical schools]. Sante Publique, 15 Spec No, 137-145.
Bower, H. (1998). Sackings and strikes paralyse Nicaraguan health care. Bmj, 316(7138), 1115.
Braveman, P. (2006). Health disparities and equity: concepts and measurement. Annu Rev Public Health, 27, 167-194.
Braveman, P., & Gruskin, S. (2003). Poverty, equity, human rights and health. Bull World Health Organ, 81(7), 539-545.
Caldera , N. (2005). General debate of the 60th session of the united nations general assembly: Ministry of Foreign Affairs of the Republic of Nicaragua.
CIA. (2006). The World Factbook-Nicaragua. from http://www.cia.gov/cia/publications/factbook/geos/nu.html
CISAS. (2003). Nicaragua health in the poverty reduction strategy., from http://www.cisas.org.ni/pdf/ercerp%20english%20trans%20con%20anexos.pdf
Goyder, E. C., Blank, L., Ellis, E., Furber, A., Peters, J., Sartain, K., et al. (2005). Reducing inequalities in access to health care: developing a toolkit through action research. Qual Saf Health Care,
Maclure, R. S., M. (2004). Children’s rights and the tenuousness of local coalitions : a case study in Nicaragua. Journal of Latin American Studies 36, 85–108, 36, 85-108.
MINSA. (2005). Nicaragua national development plan 2005. Retrieved. from http://siteresources.worldbank.org/INTPRS1/Resources/Nicarauga_PRSP-November2005.pdf.
Nicaragua - A Country Study. (1993). from http://www.country-data.com/cgi-bin/query/r-9203.html
Oberhelman, R. A., Guerrero, E. S., Fernandez, M. L., Silio, M., Mercado, D., Comiskey, N., et al. (1998). Correlations between intestinal parasitosis, physical growth, and psychomotor
development among infants and children from rural Nicaragua. Am J Trop Med Hyg, 58(4), 470-475.
Oliver, A., & Mossialos, E. (2004). Equity of access to health care: outlining the foundations for action. J Epidemiol Community Health, 58(8), 655-658.
Ostlin, P., Braveman, P., & Dachs, N. (2005). Priorities for research to take forward the health equity policy agenda. Bull World Health Organ, 83(12), 948-953.
PAHO. (2001). Resumen sobre desigualdades en salud Nicaragua (Summary on inequalities in health Nicaragua). Washington, DC: Pan American Health Organization.
PAHO. (2005). Nicaragua: Health sistuation analysis and trends summary: Pan American Health Organization.
Shelby, K. (2006, Februray, 2006). Health sector strike in Nicaragua enters fourth month. from
UNDP-CISAS. (2002). El desarrollo humano en Nicaragua 2002 (Human development report 2002): United Nations Development Programme.
UNDP. (2005). Human development report 2005: United Nations.
Wikipedia. (2006). History of Nicaragua.Unpublished manuscript.
Worldbank. (2002). Nicaragua Country Assistance Strategy: World Bank.
WorldBank. (2003). Nicaragua poverty assessment: raising welfare and reducing vulnerability (No. 26128-NI).
WorldBank. (2004). Nicaragua country brief: development progress: World bank group.
WorldBank. (2006). Nicaragua at a glance. : Worldbank.
Salinas, Abraham MD, MPH Nicaragua: Country Profile Social Justice and Health. 2006 Unpublished
Crockford, Peter M, MD, FACP, FRCPC. Why is the Third World the Third World. April 2006
WHO 2006 Social Determinants of Health. http://www.who.int/features/galleries/2006/year_review/en/index.html
Oberhelman RA, Guerrero ES, Fernandez ML, Silio M et al. Correlations between intestinal parasitosis, physical growth, and psychomotor development among infants and children from rural
Nicaragua. American Journal of Tropical Medicine and Hygiene, 58 (4), 1998, pp. 470-475
Tellez A, Morales W, Rivera T et al. Prevalence of intestinal parasites in the human population of Leon, Nicaragua.. Acta Tropica 66 (1997) 119-125
WHO (2007) Partners for Parasite Control. http://www.who.int/wormcontrol/documents/key_articles
WHO (2007) Micronutrients deficiences. http://www.who.int/nutrition/topics/vad/en
Mora JO, Gueri M, Moral OL. Vitamin A deficiency in Latin America and the Caribbean: An overview. Pan American Journal of Public Health, Volume 4, Number 3, September 1998, pp. 178186 (9)
Villamor E and Fawzi WW Effects of Vitamin A supplementation on immune responses and correlation with clinical outcomes. Clinical Microbiology Reviews July 2005, p. 446-464
Stephensen CB. Commentary: A hypothesis concernng vitamin A supplementation, vaccines, and childhood mortality. International Journal of Epidemiology 2003; 32:828-829
WHO (2006) Vitamin A Deficiency..http://www.childinfo.org/areas/vitamina/priority.php
WHO launches international programme to combat childhood blindness. The Lancet. Vol 359. June 29, 2002
Health in the Americas, 1998 Edition, Volume II. Nicaragua
Perfiles Nutricionales por paises-Nicaragua. May 2001 FAO, Rome, Italy.
WHO (1998) Distribution of vitamin A during national immunization days
WHO (2005) WHO Global Database on Vitamin A. Nicaragua http://www3.who.int/whosis/mn/mn_vitamina/html/NIC.htm
EPI Newsletter. Expanded program on immunization in the Americas. Immunize and Protect your children. Vol XXV, Number 1. February 2003.
Personal Interviews with Dr. Miguel Angel Guevara (Lactantes Director), Dra. Marina Morales (Neonatology Director) , Dra. Maria Carolina Cantarero (Pediatrics Neurosurgery Director )
Nicaraguan National Children’s Hospital Manuel de Jesus Riveral “La Mascota.” July 30 th, 2008
Goenjian AK, Molina L, Steinberg AM, Fairbanks LA, Alvarez ML, Goenjian HA, Pynoos RS. Posttraumatic stress and depressive reactions among Nicaraguan adolescents
after hurricane Mitch.
Am J Psychiatry . 2001 May;158(5):788-94.
Caldera T, Palma L, Penayo U, Kullgren G. Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective.
Soc Psychiatry Psychiatr Epidemiol . 2001 Mar;36(3):108-14.
Hume F, Summerfield D. After the war in Nicaragua: a psychosocial study of war wounded ex-combatants.
Med War . 1994 Jan-Mar;10(1):4-25.
Summerfield D, Toser L. 'Low intensity' war and mental trauma in Nicaragua: a study in a rural community.
Med War . 1991 Apr-Jun;7(2):84-99.
(Am J Clin Nutr. 2007 Nov;86(5):1278-85)
Li Y, Zhang J. Serum concentrations of antioxidant vitamins and carotenoids are low in individuals with a history of attempted suicide.
Nutr Neurosci. 2007 Feb-Apr;10(1-2):51-8.