Global

Modern Approaches to Tuberculosis (China and South Africa)

Challenge

Many countries continue to be plagued by drug-resistant tuberculosis, with more than 1.6 million deaths occurring worldwide each year. Few new antibiotic therapies exist, particularly for deadly co-infections with HIV.

Where We Started

Gil Alterovitz, PhD, FACMI, FAMIA, has been leading a broad international effort to pool genome sequences and clinical phenotypes of drug-resistant strains of tuberculosis. Understanding the bacteria’s mechanisms of resistance will lead to new classes of antibiotics and can streamline drug-repurposing efforts.

Our Impact

Globally sourced tuberculosis strains have been analyzed to identify biomarkers that indicate drug resistance. Using predictive computer modeling and compound screening, the Alterovitz lab is working to introduce new classes of treatments for tuberculosis.

Moving Forward

The team is disseminating their findings globally by producing research papers and is further testing and developing drugs towards overcoming resistance-causing mutations at the molecular level.

Contact

Gil Alterovitz, PhD, FACMI, FAMIA

Children in Crisis

Challenge

The Children in Crisis (CiC) Program focuses on addressing the critical needs of crisis-affected children and youth in humanitarian contexts. The impact of humanitarian crises on children has reached catastrophic proportions; today, nearly 50 million children have been displaced from their homes because of  violence, poverty, or natural disaster. Because of their inherent vulnerability, children are disproportionately affected by war, social unrest, disaster, and economic crisis. Within settings of conflict and crisis, they are susceptible to harm due to the loss of adult care-providers, disruption of social structure and protections, environment of violence and exploitation, and often, a lack of health infrastructure equipped for pediatrics.

Where We Started

The CiC program strives to confront the complex and unique needs of children whose lives have been upended by humanitarian crisis. With one in every four children in the world living in a country afflicted by conflict or disaster, it is essential for the international community to understand more fully children’s unique needs in order to prevent, mitigate, and address these detrimental health consequences.

Our Impact

The Children in Crisis program informs approaches to reduce the vulnerability of children in humanitarian settings and to support national-level resilience strategies. The program’s goal is to translate the knowledge gained from working with affected communities into timely, effective, and sustainable programs and policy. We reduce the impact of conflict or crisis on children through conducting operational research to inform humanitarian action of effectiveness of child- and youth-focused health interventions and collaborate with nongovernmental organizations, U.N. agencies, health ministries, and academia to address identified pediatric health care needs.

Moving Forward

The CiC program looks forward to expanding our work supporting NGOs, U.N. agencies, and health ministries to more effectively respond to child health needs in emergencies by providing technical support, programmatic guidance, and monitoring and evaluation, as well as leading research to define the immediate and long-term needs of children in acute and protracted humanitarian crises and to identify best practice interventions.

The International Quality Improvement Collaborative for Congenital Heart Diseases (IQIC): Improving Care in Low- and Middle-Income Countries

Challenge

Congenital heart disease is the seventh leading cause of death in children younger than 5. However, few benchmarks existed to identify specific risk factors and to evaluate program performance in emerging world programs.

Where We Started

IQIC was launched as a partnership between Boston Children’s Hospital, a consortium of non-governmental organizations, and partner hospitals from around the world aiming to reduce mortality and major complications for congenital heart disease in low- and middle-income countries. Towards this goal, IQIC supports a capacity building model designed to strengthen collaborative learning, measure performance using data registries, and guide quality improvement methodology and strategies at partner hospitals to improve care for patients with congenital heart disease.

Our Impact

Since its inception, IQIC offers quality improvement and educational resources while generating the first-ever information on outcomes for complex cardiac care in low- and middle-income countries for surgery and catheterizations. The collaborative has grown from six sites to more than 70 enrolled sites in more than 20 countries and has collected data from over 112,000 congenital heart surgeries. The collaborative has estimated a decrease of 49 percent in major infections and 34 percent for in-hospital deaths in IQIC sites between 2010 and 2018. In 2019, IQIC launched a new catheterization database that has collected data from more than 1,000 cardiac catheterizations.

Moving Forward

Leverage the growing global network and partnerships to disseminate advanced care models and practices from Boston Children's for broader impact.

Expanding Access to Surgical Care (sub-Saharan Africa and the Western Pacific)

Challenge

The lack of access to high-quality and affordable surgical care affects 5 billion people around the world and undermines sustainable development.

Where We Started

Boston Children’s Plastic Surgeon-in-Chief John Meara, MD, DMD, MBA, and his Harvard Medical School/Boston Children’s Program in Global Surgery and Social Change (PGSSC) team have been leaders in making access to surgical care a worldwide priority. In May 2015, the Zambian Ministry of Health (MOH) requested support from PGSSC to improve surgical care in Zambia. Together, the partnership created the world’s first National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

Our Impact

In May 2017, the initial NSOAP was integrated into the Zambian National Health Strategic Plan and the Zambian National Development Plan. Since then, PGSSC has worked to create NSOAPs with governments in numerous other countries, including Tanzania, Rwanda, and Pakistan. The PGSSC is now collaborating with the Southern African Development Community (SADC), an inter-governmental organization that includes 16 southern African countries, to develop and implement NSOAPs in all countries. The PGSSC also supports the World Health Organization’s Western Pacific Regional Office (WPRO) in its efforts to develop a regional plan to finance and scale up surgical care.

Next Steps

The PGSSC is now working to create tools that will facilitate the implementation and financing of NSOAPs globally. With support the PGSSC can continue to help countries with data collection, policy development, implementation, and monitoring and evaluation. It can also expand the innovation and dissemination of best-practice models to advance safe and affordable surgical care around the world.

Contact

John Meara, MD, DMD, MBA

OPENPediatrics (Worldwide)

Challenge

Every year, millions of children die worldwide from preventable causes. Although the knowledge needed to treat these children exists, it has traditionally been restricted within the walls of institutions. The traditional apprenticeship model of medical education and knowledge-exchange is incapable of being scaled to meet the growing needs of skilled doctors and nurses worldwide. Clinicians around the world need access to rigorously peer-reviewed knowledge and best practices in pediatric medicine in order to provide optimal patient care.

Where We Started

In response to this challenge, OPENPediatrics was founded in 2012 to pursue the mission of leveraging technology and the internet to promote global knowledge exchange for pediatric clinicians.

Our Impact

OPENPediatrics.org is an open-access, peer-reviewed platform for knowledge-exchange in pediatric care. Since 2012, we have grown to more than 43,000 registered users with more than 800 published videos, dozens of online courses, interactive simulators, and more. Our content has been viewed over 7 million times and accessed in every country and territory around the world.

Moving Forward

We are constantly working toward increasing global access to our content and improving the services we provide to connect pediatric clinicians worldwide through our website and other committees. By continuing to create online simulators, courses, and videos that convey best evidence-based practices in pediatric care, OPENPediatrics aims to support the worldwide pediatric community working to improve the health of children.