Immunization crisis may develop due to economic crisis during COVID-19 pandemic

COVID-19 pandemic is a global health crisis with 61, 149,391 confirmed cases and 370,478 deaths till 29May, 2020 [1]. This pandemic has shattered many economies with an estimated loss of $5.8 trillion to $8.8 trillion globally. This economic loss can result in reduction in funds to World Health Organization. Unfortunately, United States of America (USA) has announced termination of any further funding to WHO which can lead to another global health crisis[2]. As WHO is a voluntary funding based organization its main donor are America, China, Japan, Germany and United Kingdom. Among these USA is the main donor with a contribution of $115.8million alone followed by China $57.4 million, Japan $41million, Germany $29.1 million and UK $21.9 million [3].  America’s termination of funding can put WHO and child health programs in serious crisis. Among many programs run by WHO one of the most important program is immunization of children. Immunization coverage programs  save 2-3 million livesper year causing decline in measles related deaths, eradication of polio, surveillance of rotavirus, BCG and DTaP vaccination in children[4]. It is estimated that during MillenniumDevelopment Goal (MDG) there is overall decline in child related mortalities due to malaria, measles, diarrhea, AIDS and meningitis [5]. Remarkable results are achieved with measles are diarrhea immunization programs causing a decline in death rate by 73% and 80% respectively. According to a study with current success rate diarrhea related deaths can be virtually eliminated by 2030. Another successful program is “End Polio” program which eradicated polio from world except from Pakistan and Afghanistan [4][6]. This termination of funds to WHO can waste all previous efforts in developing countries. On the other hand despite of all efforts still 19.4 million children did not received prescribed dose of vaccines. Data analysis revealed among these  60% of children belong to 10 developing countries namelyAngola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines and Viet Nam [4]. These countries mainly rely on foreign funding and Non-Government Organization (NGOs) for child health care programs.

The Efficacy of Intravenous Hyoscine-N-Butylbromide Buscopan® for the Acceleration of Labour in First Time Parturients: A Randomised, Double-Blind, Placebo-Controlled Trial

Objective: to establish the safety and efficacy of hyoscine-N-butylbromide (Buscopan®) in accelerating labour in first time parturients. Design: a randomised, double-blinded, placebo-controlled clinical trial. Setting: the antenatal clinic and maternity unit of the Aga Khan University Hospital Nairobi, Kenya. Population: first time parturients in spontaneous labour at term. Methods: women were randomised to receive 40mg of hyoscine-N-butylbromide or sterile water for injection intravenously once they were confirmed to be in active labour. The dose could be repeated once after four hours. Outcome measures: the main outcome measure was the duration of labour from diagnosis of active stage to delivery. Secondary outcome measures were rate of cervical dilatation and postpartum satisfaction score. Safety aspects such as drug adverse effects, APGAR scores and postpartum hemorrhage were explored. Results: a total of 85 were randomised and 79 yielded data for analysis. Of these 37 received hyoscine-N-butylbromide and 42 received placebo. There was no significant difference in the mean duration of active labour to second stage between the drug and placebo arms (396.2 versus 389.3 minutes, respectively, p=0.881, 95% CI -85.9 to 99.8). The mean rate of cervical dilatation in the drug arm was 1.17 centimetres per hour (cm/hr) compared to 1.22cm/hr in the placebo arm. This difference was not statistically significant (p value=0.832, 95% CI -0.5 to 0.4). The postpartum satisfaction scores were similar between the two arms. Hyoscine-N-butylbromide was well tolerated without any major adverse effects observed in either arm. Conclusion: hyoscine-N-butylbromide does not shorten the duration of labour in first time parturients in spontaneous labour. It also does not change maternal satisfaction with care received and is not associated with major adverse outcomes in the mother or newborn.