MUSC Children's Hospital - April 2008 Newsletter

We're all about children!

April 2008

Visiting expert speaks about global progress in child health

Download an example of Dr. Toole's work (PDF)

You're most likely to find Michael J. Toole, MD, working with fathers in a small village in Laos, mothers and children in Indonesia and Papua New Guinea, or healthcare providers in Tibet.

But in March, Dr. Toole, who is head of the Centre for International Health of the Burnet Institute in Melbourne, Australia, was on the MUSC campus to make a special presentation at the Charles P. Darby Children's Research Institute.

In town on a family visit, Dr. Toole spoke on March 13 about his and the institute's work with the international development community to reduce child mortality.

An associate professor of epidemiology and preventive medicine at Monash University, also in Melbourne, Dr. Toole specializes in communicable disease control including HIV prevention and care, women and children's health, nutrition, refugees and humanitarian emergencies.

He was in Charleston to see his brother, MUSC cell biology and anatomy professor Dr. Bryan Toole, en route to acting as guest faculty for the Boston Medical Center pediatrics program and Boston Children's Hospital.

Though he was here on vacation, Dr. Toole says it was an honor to be invited to address MUSC faculty and friends about his work.

"I sense a growing interest in developing country health issues among medical students and residents in many rich countries," he noted, "and I wish to encourage this trend."

For more than a decade, Dr. Toole has led the work of the Burnet Institute, a nonprofit research and development institute with programs in 22 countries. Since 2000, Burnet has worked to help the UN to achieve one of its eight "Millennium development goals" Đreducing child mortality by two-thirds.

With a target date of 2015, these goals, which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, have galvanized unprecedented action.

More children are surviving in developing countries, but there's much to be done, says Dr. Toole. Mortality rates are declining, but deaths in Sub-Saharan Africa and Southern Asia, in particular, remain high. In the Asia-Pacific region, he says, just 16 out of the 22 low-income countries are on track.

Of all global deaths in children under five years of age, 36 percent are in the first month of life. Major causes of these neonatal deaths in low-income countries include severe infections, birth asphyxia, complications of prematurity, and tetanus. Among the efforts and challenges, notes Dr. Toole:

Applying already proven interventions, including universal coverage of access to immunization, clean water and sanitation.
Reducing child malnutrition by increasing access to food and promoting healthy feeding practices, including exclusive breast-feeding for the first six months.
Developing new, affordable vaccines against rotavirus, pneumococcus, malaria and H. influenza.

One of the studies Dr. Toole and his team at Burnet count as successful was a program in Laos to prevent mother-to-child HIV transmission. By targeting men and providing counseling about the risks of extramarital sex (a common Lao belief is that sex during pregnancy is dangerous to the fetus), the program resulted in increased awareness and prevention.

Yet the HIV pandemic has reversed the gains made in child survival in the 1980s and 90s, notes Dr. Toole. "The United States is a major funder of HIV programs, but I urge Congress to continue to support programs that are evidence-based, and to focus on reducing maternal and neonatal mortality."

Also needed, says Dr. Toole, is support for new vaccines and drugs to prevent and treat the most common causes of mortality.

He advocates a medical school curriculum that integrates developing country health issues through problem-based learning, and supports partnerships like the one Boston Medical Center has with a hospital in Lesotho.

"Partnerships with hospitals, pediatric programs and community outreach to developing countries provide evidence-based technical support, funding, mentorship and solidarity," says Dr. Toole.