The impact of simple interventions in developing countries

One of my lectures last year for a population health class positively haunted me. It dealt with maternal and infant mortality in Afghanistan. In fact, Afghanistan has some of the highest rates of both in the world, thought to be related to poverty, low education levels for women, rugged landscapes, maternal and child malnutrition, young maternal age at marriage and birth and a largely rural population. Nothing drove home the suffering endured by Afghan women more than the story of "The Afghan Girl" with the penetrating green eyes featured in National Geographic. Click here and see how much she has aged. Unbelievably she is thought to be 28 to 30 in the "after" picture (!).

All of this is a lead-up to a remarkable article published last week in The New England Journal of Medicine. In this study of 131,746 women, the investigators found that a one-time screening for human papillomavirus had a dramatic reduction in future cervical cancer incidence and death. Sometimes simple interventions can make a huge difference, especially for women in developing countries. The investigators should be commended. As Drs. Schiffman and Wacholder wrote in the accompanying editorial, "The remarkable promise of the Indian trial presents a worthy global challenge to implement smart, regionally tailored strategies that will efficiently save millions of lives in the years ahead."