public health perspective (php) newsletter january 2013 issue
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INSIDE THIS ISSUE Editorial: The Journey Continues National News: Doctor in health care after 13 yrs Government to act strictly on medical waste management Govt to set up 3 hi-tech TB labs License test to be man-datory for all health professionals UN lauds Nepal’s sanitation efforts Reduced health budget will hamper MDG efforts: Experts Elephantiasis eradication program to reach 56 districts Featured Articles: The New Superbug [Itishree Trivedi, University of Michigan] World Leprosy Day Global Health: Boston declares public health emergency over flu Dengue getting worse, but progress being made on other tropical diseases, reports WHO Flu vaccine backlash: 800 children in Europe develop narcolepsy after swine flu vaccine Vaccine against deadly meningitis strain approved for use in Europe Stem cell research: Japanese scientists grow human kidney tissue out of stem cells New action plan could be a turning point in global mental health FAO urges stronger measures on global health threats Journal Watch: Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children in Kathmandu, Nepal Climate Change and Health Being Healthy: Protect your child’s health with regular vaccinations WHO Publications: Bulletin of WHO Vol. 91, No. 01, 2013 WHO Classification of Tumors: Pathology and Genetics of Tumors of Soft Tissue and Bone Miscellaneous: Country List of PHP Subscribers & ViewersTRANSCRIPT
advocating throughout this
year for 'Climate Change'
issues to a greater extent.
The newsletter will also go
through some changes in its
board of advisories and the
newsletter team with the
start of a new year.
We feel proud that PHP has
achieved such heights in such
a short duration, thanks to
the PHP contributors and sup-
port from the reader across
the globe. Now, with the start
of a new year, we are in a
voyage to support health care
delivery in Nepal by organiz-
ing programs on major public
health important days. For
this, we need financial and
technical support. Our plan is
to work with public health
students, colleges, district
public health offices, the Min-
istry of Health and Popula-
tion, related health organiza-
tions and with allied health
professionals to support this
initiative. Therefore, we re-
quest the interested organi-
zations to support our pro-
grams in any possible way
they can. To help advance
this work, we look forward for
similar help from our support-
ers, advisories, subscribers,
campus liaisons, colleges,
universities, relatives, friends
in this program as well. If you
think you can help advance
this work or will like to join us
in our endeavor please feel
free to write to us at
Wishing you a happy and
healthy new year!
Amrit Banstola
TakingITGlobal, and List of
newspapers in Nepal on
Wikipedia. To add, PHP is a
corporate partner of Journal
of Pakistan Medical Students
(JPMS), JPMS Blog, and
Global Alliance for Clean
Cook Stoves Alliance. Re-
cently it became the member
of Global Health Workforce
Alliance (GHWA)—an organi-
zation that work to address
the health workforce crisis.
The list of dedicated campus
liaison rose dramatically in
the year 2012. We were
more than happy to welcome
eight campus liaisons repre-
senting five institutions (four
national and one interna-
tional institution). There was
also a significant increase in
the number of Facebook
Likes compared to 2011.
There were only 170 Face-
book at the end of the year
2011 which increased by
fourthfold in the year 2012.
Now there are more than
650 fans in our official Face-
book page. The number of
subscribers was moderately
increased; however. We feel
overwhelmed to mention
that PHP has also subscribers
from Center of Disease Con-
trol and Prevention (CDC); a
leading public health organi-
zation of USA. To mention,
we have subscribers and
viewers from more than 90
countries. Thanks to our
campus liaison for their over-
whelming support in increas-
ing the subscribers and Likes
in the Facebook.
We were also happy to have
Dr Anis Rehman from Paki-
stan as a new contributing
writer for PHP.
Our readers will see a slight
difference in the PHP tem-
plate for this year. We have
changed the color of our
template to green as a sym-
bol of 'Go Green' and will be
Founded in 2011, Public
Health Perspective (PHP) is
Nepal’s first public health
online newsletter; pioneer in
the exchange of public health
related information, ideas,
and resources. For more than
two years, we have led the
quest for innovation, better
outcomes, and helped the
health professionals to update
their existing information. Our
newsletter directly benefit the
health students and emerging
public health professionals.
Public Health Perspective
(PHP) published 11 articles in
2012. To maintain high quality
of the content, it came at the
expense of a high rejection
rate of 56%. The quality of
content is being increasingly
recognized by the academic
contributors.
To acknowledge the work of
researchers, and strengthen
the research system in Nepal,
we have highlighted 20 schol-
arly articles related to Nepal
written by both Nepalese au-
thor as well as foreigner.
The year 2012 was also won-
derful for PHP as it was able
to establish a good partner-
ship with various national and
international organizations.
PHP is associated with Nepal
Publ ic Health Network
(NPHN), and is listed in the
Manmohan Memorial Institute
of Health Sciences website
under other important links
for 'journals of different or-
ganizations'. Virtual Library of
School of Public Health and
Community Medicine of the
University of New South
Wales, Sydney, Australia has
included in its list of public
health newsletter. Similarly, it
has appeared in Australian
Development Gateway (ADG),
Online Newspaper.com—
world's largest listing of
magazines on the web, under
health and medical categories,
Editorial: The Journey Continues
Vol. 3 Issue 1 January 2013 the first public health online newsletter of Nepal
Public Health Perspective
Public Health Important
Days (January)
January 12: National Youth Day
January 31: Anti-Leprosy Day
Inside This Issue
National News
Page 2 P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
January 2013
BAITADI, DEC 31 -
A doctor has shown up at
the Kesharpur Primary
Health Centre, Melauli in Bai-
tadi district, for the first time
after 13 years. Locals are
happy with the arrival of Dr
Yunus Tiwari at the health
centre after 13 years of its
establishment. The centre was
established in 2056 BS. Chief
at the District Health Office,
Baitadi, Dr. Gunraj Awasthi,
said that his dream of sending
a doctor to the centre is ful-
filled after long efforts. Melauli
is a day´s trek from the dis-
trict headquarters. The num-
ber of patients visiting the
centre has gone up after the
presence of the doctor there.
Now, locals of lower Sworad
need not travel across the
border to Indian towns for
treatment.
Source: ekantipur.com
KATHMANDU, JAN 01 -
C oncerned over severe
health impacts of poor
management of the hazardous
medical waste, the govern-
ment has decided to
strengthen effective imple-
mentation of the Solid Waste
Management Act (SWM)
2011. The government will
take stern action, including
the cancellation of operating
license, against individuals
and health institutions failing
to abide by the standards for
medical waste management
as set under the SWM. Those
properly managing hazardous
medical and chemical wastes
will be rewarded. The SWM
2011 clearly states that the
responsibility of processing
and managing hazardous,
m e d i c a l a n d c h e m i -
cal waste under the pre-
scribed standards rests with
the person or institution that
has generated the waste. Any
individual or institution found
i m p r o p e r l y m a n a g -
ing waste can be charged
between Rs 50,000 and Rs
100,000 or imprisoned for 15
days to three months by the
local authority as per the Act.
Source: ekantipur.com
KATHMANDU, JAN 20 –
N ational Tuberculosis Cen-
tre (NTC), the govern-
ment body overseeing
the tuberculosis program in
the country, is planning to
establish three sophisticated
laboratories for sputum cul-
tures outside the valley for
the diagnosis of drug-
resistant TB. The NTC has
proposed operating one labo-
ratory at the BP Koirala Insti-
tute of Health Sciences in
Dharan for the eastern region,
one at the Regional TB Centre
in Pokhara for the western
region and another at the
Surkhet Regional Hospital for
the far-western region. These
laboratories will help in the
diagnosis of TB for people
who have completed the first-
line drug course of six months
but are facing recurrences or
those who stopped taking
medicine in the course of
treatment.
NTC Director Dr Rajendra
Pant said that a cost of
around $500,000 has been
estimated for the set-up of
the laboratories. Currently,
such laboratories are present
only in the Kathmandu val-
ley—one at the NTC and the
other at the German Nepal TB
Project in Kalimati.
Source: ekantipur.com
KATHMANDU, JAN 25 -
I n a bid to ensure the qual-
ity and competence of
health professionals other
than medical doctors and
nurses, the Nepal Health Pro-
fessionals’ Council (NPHC) is
planning to enforce licensing
examinations from this fiscal
year. The NHPC is the body
that registers health assis-
tants, auxiliary health work-
ers, lab technicians, medical/
health laboratory technicians,
public health professionals,
microbiologists, physiothera-
pists, auxiliary Ayurved work-
ers, dental hygienists and
ophthalmic assistants, before
providing them with a certifi-
cate to practice. Till date,
the NHPC has been registering
health professionals after they
complete their respective
courses. These courses range
from a 15-month training pro-
gram after the completion of
the School Leaving Certificate
to PhD programs. Dhana
P r a s a d P o u d e l ,
the NHPC registrar, said that
the licensing examination is
being planned as they have
been receiving complaints of
“incompetent” health workers
and about the quality of edu-
cation pursued by students
abroad.
“Since we monitor colleges
inside the country, we know
their quality. Still, we want to
reassure their competence,”
said Poudel. “However, there
have been many complaints
about students from aboard
who cannot perform even the
simplest experiments and
tests.” The Council has
amended its Act to include a
provision for licensing exami-
nations. A five-member com-
mittee chaired by Dr Dinesh
Bastola from the Institute of
Medicine has been formed to
draft directives for conducting
the examination. Until now,
Nepal Medical Council, the
government body regulating
medical doctors and medical
education, has been conduct-
ing licensing tests for MBBS
and post-graduate doctors.
Similarly, the Nursing Council,
since last year, has been holding
licensing exams before nurses
are al lowed to practice.
The NHPC has so far registered
50,442 health professionals.
Source: ekantipur.com
KATHMANDU, JAN 29 -
United Nations agencies in Nepal
have commended the govern-
ment’s efforts in expanding ac-
cess to sanitation for every
household and thus bringing the
country closer towards becoming
an open defecation-free zone. In
a j o i n t s t a t e m e n t ,
the UN agencies said that an
increase in 19 percent of sanitary
facilities in a year is a major
achievement. In 1980, only three
percent of the households had
sanitary facilities, which is cur-
rently 62 percent, according to a
government report. UN ICEF-
Nepal representative Hanaa
Singer attributed the increase to
the “power of the communities to
take a collective decision to re-
gain their pride and dignity by
stopping open defecation and
cleaning up their immediate liv-
ing environments.” “It is the
strong government leadership at
all levels and the unified political
support based on a strong joint
vision on how to trigger and sus-
tain these school and community
-led initiatives,” Singer said in a
statement.
The government has repeatedly
committed to eradicate open
defecation by providing subsidies
to poor households and resources
to schools. The Millennium Devel-
opment Goal (MDG) Acceleration
Framework for Sanitation, signed
by the government, came about
in response to the need to speed
up the country’s progress toward
meeting the MDG on sanitation.
“The way the MDG Acceleration
Framework process was con-
ducted is also something of a
model,” said Robert Piper, UN
resident coordinator for Nepal.
“The active participation of vari-
ous ministries and other stake-
holders from the beginning of the
Continued on page 4
Doctor in health care
after 13 yrs
Govt to set up 3 hi-tech
TB labs
UN lauds Nepal’s sanita-
tion efforts
Government to act
strictly on medical
waste management
License test to be man-
datory for all health pro-
fessionals
The New Superbug
P U B L I C H E A LT H P E R S P E C T I V E ( P H P ) Page 3 January 2013
“What exactly is this C. diff?” Given the amount of media sensation this super-bug has created, it is
not surprising that as an Internal Medicine specialist, I get asked this question a lot. With all justified
press coverage this topic is getting, this is a reasonable and, in fact, a very important question to
ask. To take a step back, there are several billion bacteria that reside in our colons, called gastroin-
testinal “microbiome”. These bacteria talk to each other and to our colon and our immune system in
very complicated ways to create a mutually dependent relationship. This allows every party, consist-
ing of you, your colon, your microbiome, to exist in a happy balance. This healthy interaction pre-
vents overtake of our guts by disease-causing bacteria, a concept known as “colonization resistance”.
Taking certain antibiotics, like clindamycin, ciprofloxacin etc, kills off good bacterial species and de-
crease the diversity of our microbiome. All this means that small amounts of bad bacteria, which were
being suppressed and were waiting in the sidelines for their moment in the limelight, get their chance. Colonization resistance
fails and these species take over.
C. difficile, a kind of bacteria, is one such opportunist. Its spores are everywhere and we come across them in hospitals, clinics
and other health care facilities. Lack of hand-washing hygiene is one of the most important ways in which spores of C. difficile
spread. Those of us with a disturbed gut microbiome fall prey to the infection. The usual suspects are hospitalized patients, nurs-
ing home residents, the elderly and those with recent exposure to antibiotics, though increasingly frequent occurrence of this
infection in people with no contact with the healthcare system (so called “community-dwellers") is getting concerning. The inci-
dence of C. difficile infections has increased alarmingly across the globe, especially in Western countries with half a million cases
being reported annually in USA itself. Billions are being spent every year in controlling, diagnosing, treating and preventing this
infection and this problem has taken on a public health scale.
It is not a happy experience to come across C. difficile. Once it infects the colon, it can cause anywhere from mild to extremely
severe, even life-threatening disease. Pain in the belly, bloating, cramps, and diarrhea are some of the milder manifestations.
Severe dilation of the colon requiring emergency surgery, very high fever, and even death can occur. Treatment mostly con-
sists, believe it or not, of antibiotics! Metronidazole and vancomycin are two of the most commonly used treatments. Unfortu-
nately, even if treated, C. difficile infection can recur in anywhere from 20 to 66% patients after initial infection. This trend of
severe infection that relapses makes this bacterium very costly to Governments and healthcare systems globally. New drugs and
even vaccines are being developed in a bid to find some way to stop this tide. There is tremendous interest is figuring out low-
cost, non-traditional ways to treat this infection.
One such unorthodox method, also getting lots of media attention presently, is stool transplantation. Transplanting a very small
amount of stool from a healthy donor to a recipient, a person with several bouts of C. difficile infection usually via a routine
colonoscopy, although esthetically challenging, has seemed to work wonders. In fact, within weeks the gut microbiome of the
recipient starts resembling the donor. With about 30 years of experience in stool transplantation procedure, called Fecal Bacteri-
otherapy (FBT) and Intestinal Microbiota Transplantation (IMT), the results have been astounding with an almost 90% total cure
rate for cases of recurrent C. difficile colitis. However, the studies from which these data are gleaned have been case-series and,
as of yet, randomized data is not available to substantiate the results. Several questions remain before this treatment can be-
come standard of care for recurrent C. difficile infection. Who is the ideal donor, potential for transmitting diseases via FBT, pre-
screening for donors, role of FBT in initial C. difficile infection episode etc., are some of those questions. With more and more
research into the field of gastrointestinal microbiome using high throughput, non-culture, and molecular-based methods the day
might not be far when the questions above can be answered and we can be well on our way of finding a cure for this menace. In
the meantime though, wash your hands vigorously with soap and water every time you are around patients in hospitals and clin-
ics – we have not found the magic bullet yet!
Itishree Trivedi, M.D., Department of Internal Medicine, University of Michigan
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World Leprosy Day
Page 4 P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
January 2013
Every last Sunday of January each marks the World Leprosy Day. On this day,
organizations that work with people affected by leprosy will hold events such as
rallies, lunches, church services and disability sports days to raise awareness of a
disease that is completely curable but can cause great anguish for the people di-
agnosed with it.
In 1953, a great humanitarian, M.
Raoul Follereau of France, pro-
claimed the first World Leprosy Day
to call attention to the plight of the
world’s millions of people affected by
this ancient, devastating dis-
ease. Over the years, this obser-
vance has grown and more than 100
countries now participate in World Leprosy
Day on the last Sunday in January.
Leprosy can cause physical disability if not
treated quickly enough. In other words, those
who had the disease had to live with the dis-
abilities that are so common in leprosy – they
simply had no choice. But perhaps worse
than the physical damage is the damage caused by stigma. For many centuries, leprosy
stigmatized those affected because there was no cure. In many countries leprosy is feared
and people who have it are rejected from their homes and communities. In some countries
there are still laws discriminating against people affected by leprosy.
World Leprosy Day helps to focus on the needs of some of the poorest and most marginal-
ized people in the world – those affected by leprosy. It helps to tell the story to people who
do not know that leprosy still exists and that it can now be cured. It also helps raise funds
so that those with leprosy can be cured and cared for.
Join us in celebrating World Leprosy Day on Sunday, January 26, 2014 and in standing for
those who face oppression and stigma every day. We are one body, supporting and caring
for one another.
Source: >>leprosymission.org >>leprosy.org
National News Continued from page 2
process till the final produc-
tion of the action plan has
been very impressive,” he
said.
Source:ekantipur.com
KATHMANDU, JAN 29 -
R eduction in health budget
could create obstructions
in meeting the Millennium
Development Goals’ (MDG)
target, health experts warned
today. Babu Ram Marasini,
chief of Health Sector Reform
Unit at the Health Ministry
said the budget cut will ad-
versely affect efforts to meet
the MDG target. Although the
country is showing progress in
so far as child mortality rate
and maternal mortality rate
are concerned, the situation
could reverse if the budgetary
allocations are not forthcom-
ing, said Marasini.
The Finance ministry has allo-
cated Rs 16.58 billion to the
health sector for this fiscal
through interim arrangement
of expenditure. Of the total
24.92 billion budget ear-
marked for the health sector
last fiscal, the ministry spent
only 20.62 billion. About 70 to
72 per cent of health budget
is spent on salary, incentives,
procurement of food and
drugs, and transportation, he
said.
Source:thehimalayantimes.com
LALITPUR, JAN 31 -
T he elephantiasis eradication
program is being imple-
mented in 56 districts across
the country this year. This pro-
gram will be conducted on Feb-
ruary 2, 3 and 4 in the selected
districts. The District Public
Health Office, Lalitpur stated at
a press conference on Wednes-
day that the program is being
conducted in 56 districts only
as elephantiasis has been eradi-
cated in five out of the 61 dis-
tricts where this disease was
prevalent.
Senior Public Health Officer Bal
Krishna Bhusal said more than
85 per cent people in these dis-
tricts would be given medicines
for elephantiasis. So far, 13.4
million people have been admin-
istered medicines against ele-
phantiasis. The campaign of
administering medicine was first
started in 2003 from Parsa dis-
trict. Twenty-eight thousand one
hundred and thirty-five people
are suffering from elephantiasis
in Nepal. Elephantiasis comes
second only to leprosy among
the diseases resulting in disabil-
ity in Nepal.
Source:thehimalayantimes.com
Reduced health
budget will hamper
MDG efforts: Experts
Elephantiasis eradica-
tion program to reach
56 districts
Global Health
P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
January 2013
Page 5
ported. Novartis is also seek-
ing to test the vaccine in the
US, Bloomberg reported. Source: globalpost.com
January 23 2013 –
I n a breakthrough for mod-
ern medicine, researchers
in Japan have succeeded in
growing human kidney tissue
from stem cells.
Kenji Osafune of Kyoto Univer-
sity explained that his team
was able to take stem cells
and "nudge them" in the direc-
tion of kidney tissues, which
have an especially complex
structure, according to Agence
France-Presse.
More than a million people
suffer from renal disease. Ac-
cording to the National Kidney
Foundation —because of how
complex kidney tissue is —
once it's been damaged, the
tissue is extremely hard to
repair. Currently, people with
failing kidneys rely on dialysis
or organ transplants. Osa-
fune's research could change
that, although he cautions that
his breakthrough is a prelimi-
nary step.
Stem cells, which are charac-
terized by the ability to renew
themselves into a diverse
range of specialized cells, have
been used in research to treat
various diseases and disabili-
ties.
Source: globalpost.com
January 28 2013 -
T he World Health Organiza-
Continued on page 6
cases.
Source: globalpost.com
January 16 2013 –
T he World Health Organiza-
tion (WHO) trumpeted its
recent success in fighting 17
neglected tropical diseases in a
new report —but warned that
dengue fever has reached
"pandemic" levels, infecting an
estimate 50 million around the
world.
The January 2013 reports
states that the WHO has
achieved success in using pre-
ventative medicine to fight
against four of the targeted
diseases (lymphatic filariasis,
onchocerciasis, schistosomiasis
and soil-transmitted helminthi-
ases), managing to treat 711
million in 2010 alone.
Source: globalpost.com
January 22 2013 -
E ight hundred children in
Europe have developed
narcolepsy after taking the
swine flu vaccine, according to
Reuters.
Reuters reported the children in
Sweden and across Europe
came down with the sleep dis-
order after being vaccinated
with the Pandemrix H1N1 vac-
cine which is made by GlaxoS-
mithKline. Regulators there
have ruled Pandemrix should
not be given to anyone under
the age of 20. Emmanuel Mi-
gnot, a Stanford University
sleep disorder specialist, said
"there's no doubt in my mind
whatsoever that Pandemrix
increased the occurrence of
narcolepsy onset in children in
some countries - and probably
January 9 2013 –
B oston has declared a public
health emergency as it bat-
tles a widespread flu outbreak
that has killed 18 people this
season across the state of Mas-
sachusetts.
Boston Mayor Thomas Menino
said there had been around 700
confirmed cases of the flu in
Boston since the season began
in October, compared with only
70 all of last season, reports
CBS News. "This is the worst flu
season we've seen since 2009,
and people should take the
threat of flu seriously," Menino
said in a news release. "This is
not only a health concern, but
also an economic concern for
families, and I'm urging resi-
dents to get vaccinated if they
haven't already. It's the best
thing you can do to protect
yourself and your family. If
you're sick, please stay home
from work or school."
City officials are encouraging
residents to get vaccinated
against the flu and are working
with health care centers to offer
free flu shots, reports CBS.
According to AP, the Centers for
Disease Control and Prevention
said Massachusetts was one of
29 states reporting high levels
of "influenza-like illness." Eight-
een children have died from
influenza and more than 2,200
people have been hospitalized
since October.
NBC reports that the particu-
larly bad flu season has been
blamed on an especially potent
strain of the flu, the A H3N2.
Another common A strain, the
H1N1, is also circulating along
with two strains of influenza B.
Infectious disease experts told
NBC that vaccines prepared for
this year will protect against
three of the viruses although
not a fourth strain of influenza
B, which may account for up to
10 percent of this year's flu
Boston declares public
health emergency over
flu
in most countries."
Everyday Health reported
about 30 million people re-
ceived the vaccine and that a
link between the sleep disor-
der and Pandemrix has been
under investigation since
2010. However, the company
said there was not enough
information to link the two.
Meanwhile, Finland, Sweden,
France, Norway and Ireland
have seen a recent increase
in narcolepsy, according to
Everyday Health. Source: globalpost.com
January 22 2013 -
A vaccine against a
deadly strain of menin-
gitis has been licensed for
use in Europe. It is the first
of its kind to protect against
meningococcal B meningitis.
The manufacturer, Novartis,
has been given the go-ahead
for the marketing of Bexsero,
which can be administered to
anyone, including infants as
young as two months old,
Medical News Today re-
ported.
Of the five types of meningi-
tis, type B is the only one
which has not previously had
an effective vaccine. Previous
vaccines protected against
only some of the strains of
bacteria that cause Meningi-
tis B, Bloomberg Busi-
nessweek reported, whereas
Bexsero covers 73 percent of
cases.
Type B meningitis is the most
common in Europe, and ac-
counts for between 3,000 to
5,000 cases a year and has
caused 1,000 deaths since
2000, the Telegraph re-
Dengue getting worse,
but progress being made
on other tropical dis-
eases, reports WHO
Flu vaccine backlash: 800
children in Europe develop
narcolepsy after swine flu
vaccine
Stem cell research: Japa-
nese scientists grow hu-
man kidney tissue out of
stem cells
Vaccine against deadly
meningitis strain ap-
proved for use in Europe
New action plan could be
a turning point in global
mental health
Men who were uneducated or had primary level education, aged above 25 years, had higher in-
come, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated
greater involvement in antenatal car, birth preparedness, exclusive breastfeeding and immuniza-
tions for children in the Katmandu district of Nepal, according to the study published in BMC Preg-
nancy and Childbirth 2013 issue.
A cross-sectional survey was conducted among 2178 married males between May and December
2010 in 20 Village Development Committees (VDCs) and Kathmandu municipality of the district.
As per the study, 39.3% of males accompanied their partners for Antenatal Care (ANC), 47.9 %
arranged Skilled Birth Attendance (SBA), and 10.9 % accompanied them for child immunization.
Those men who were uneducated or had primary level education (adjusted odds ratio 5.68, 95 %
confidence interval 4.44 to 7.27), were aged 25 years or above (2.51, 1.89 to 3.33), with formal
employment (1.23, 1.01 to 1.49), had income NPR 5001 (exchange rate 1USD = 85 NPR) or
above per month (1.47, 1.20 to 1.80), and of non-indigenous ethnicities (1.53, 1.18 to 1.99) were
more likely to accompanied their partners on antenatal visit. Similarly, men with these traits were
more likely to arranged money for delivery. These factors (illiteracy, income level, formal employ-
ment) have also significant positive role in birth preparedness. However, the study found that men
with an income of NPR 5001 or above per month and of Hindu religion were less likely to encour-
aged exclusive breast feeding. To add, people with former characteristics were less likely to ac-
company their partners for the immunization of their child.
The study concludes that these factors should be emphatically considered during maternal health
program development.
Full text article is available at:
BMC Pregnancy and Childbirth 2013, 13:14 doi: 10.1186/1471-2393-13-14
Author: Dharma Nand Bhatta
Journal Watch
Page 6 P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
January 2013
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Involvement of males in antenatal care, birth preparedness, exclusive breast
feeding and immunizations for children in Kathmandu, Nepal
Continued from page 5
tion is attempting to improve
the astounding statistics that
surround mental healthcare
around the world.
US Congress isn’t the only
place where mental health
discussions have surfaced
recently. The World Health
Organization (WHO) discussed
the latest draft of a new
Global Mental Health Action
Plan last week, which, if
adopted, would set clear goals
for progress and aim to im-
prove accountability in im-
proving mental healthcare
around the world.
The action plan will be offi-
cially voted for at the World
Health Assembly in May, but
the draft of the plan received
wide support at the recent
WHO Executive Board meet-
ing, according to Kelly O’Don-
nell, coordinator of the Mental
Health-Psychosocial Working
Group of the NGO Forum for
Health, who attended the
meeting.
The adoption of the action
plan would represent a turning
point in global mental health-
ca re , sa i d O ’Donne l l .
“Regardless of income levels,”
he said, “countries are really
coming on board and rallying
around the need to put poli-
cies and resources in place
and calling on WHO to help
with technical guidance.”
The plan lists four objectives
focused on leadership, com-
prehensive care, promotion
and prevention, and research,
and has an overall goal to
“promote mental well-being,
prevent mental disorders,
provide care, enhance recov-
ery, promote human rights
and reduce the mortality,
morbidity, and disability for
persons with mental disor-
ders.”
Source: globalpost.com
29 January 2013 –
The world risks a repeat of the
disastrous 2006 bird flu out-
breaks unless surveillance and
control of this and other dan-
gerous animal diseases is
strengthened globally, FAO
warns.
"The continuing international
economic downturn means
less money is available for
prevention of H5N1 bird flu
and other threats of animal
origin. This is not only true
for international organizations
but also countries them-
selves," says FAO Chief Veteri-
nary Officer Juan Lubroth.
"Even though everyone knows
that prevention is better than
cure, I am worried because in
the current climate govern-
ments are unable to keep up
their guard." Source: fao.org
FAO urges stronger meas-
ures on global health
threats
Global Health
Climate Change and Health
P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
January 2013
Page 7
Key facts
Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food
and secure shelter.
Global warming that has occurred since the 1970s caused over 140 000 excess deaths annually by the year 2004.
The direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sani-
tation), is estimated to be between US$ 2-4 billion/year by 2030.
Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are
expected to worsen as the climate changes.
Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to
prepare and respond.
Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved
health.
Climate change
Over the last 50 years, human activities – particularly the burning of fossil fuels – have released sufficient quantities of carbon
dioxide and other greenhouse gases to trap additional heat in the lower atmosphere and affect the global climate.
In the last 100 years, the world has warmed by approximately 0.75oC. Over the last 25 years, the rate of global warming has
accelerated, at over 0.18oC per decade.
Sea levels are rising, glaciers are melting and precipitation patterns are changing. Extreme weather events are becoming more
intense and frequent.
What is the impact of climate change on health?
Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increased
food production in certain areas, the overall health effects of a changing climate are likely to be overwhelmingly negative. Cli-
mate change affects social determinants of health – clean air, safe drinking water, sufficient food and secure shelter.
Patterns of infection
Climatic conditions strongly affect water-borne diseases and diseases transmitted through insects, snails or other cold blooded
animals.
Changes in climate are likely to lengthen the transmission seasons of important vector-borne diseases and to alter their geo-
graphic range. For example, climate change is projected to widen significantly the area of China where the snail-borne disease
schistosomiasis occurs.
Malaria is strongly influenced by climate. Transmitted by Anopheles mosquitoes, malaria kills almost 1 million people every year
– mainly African children under five years old. The Aedes mosquito vector of dengue is also highly sensitive to climate conditions.
Studies suggest that climate change could expose an additional 2 billion people to dengue transmission by the 2080s.
Measuring the health effects
Measuring the health effects from climate change can only be very approximate. Nevertheless, a WHO assessment, taking into
account only a subset of the possible health impacts, concluded that the modest warming that has occurred since the 1970s was
already causing over 140 000 excess deaths annually by the year 2004.
Who is at risk?
All populations will be affected by climate change, but some are more vulnerable than others. People living in small island devel-
oping states and other coastal regions, megacities, and mountainous and polar regions are particularly vulnerable.
Children – in particular, children living in poor countries – are among the most vulnerable to the resulting health risks and will be
exposed longer to the health consequences. The health effects are also expected to be more severe for elderly people and people
with infirmities or pre-existing medical conditions.
Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to pre-
pare and respond.
WHO response
In 2009, the World Health Assembly endorsed a new WHO workplan on climate change and health. This includes:
Advocacy: to raise awareness that climate change is a fundamental threat to human health; Partnerships: to coordinate with
partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda; Science
and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a
global research agenda; Health system strengthening: to assist countries to assess their health vulnerabilities and build capacity
to reduce health vulnerability to climate change. Available from: http://www.who.int/mediacentre/factsheets/fs266/en/
Being Healthy
Page 8 P U B L I C H E A LT H P E R S P E C T I V E ( P H P )
Protect your child’s
health with regular
vaccinations
January 2013
While some people have concerns over vaccines because of
autism, scientific studies have
shown that there is no con-
nection.
“Categorically, vaccination
does not lead to autism,” By-
ington says. “Multiple scientific
studies have found no link
between vaccination and au-
tism.”
Vaccines are very safe, and when reactions do occur, they are
usually minor and temporary, such as a low-grade fever or
soreness or redness at the vaccination site. Another common
mis belief is that getting a “natural” infection is better than
being vaccinated, but that is just a myth. Some infections may
give you lifelong immunity, but they may also result in severe
disease or even death. So it is much safer for your child to re-
ceive the vaccine than to be exposed to the infection.
How vaccines do it
Antigens are what make vaccines work. They
trigger a reaction in your child’s immune sys-
tem that protects against infection. “Antigens
are an individual protein, or a piece of the infec-
tious agent that your child is exposed to,” By-
ington says.
And even though there are many more vaccines today, thanks
to better vaccine technology, children are actually exposed to
fewer antigens than in the past.
All children are born with a gift: antibodies that they receive
from their mothers at birth, making them immune to many
diseases. But this immunity doesn’t last long. If your children
aren’t vaccinated and are exposed to disease germs, their little
bodies might not be strong enough to fight them.
“Childhood immunizations save lives and prevent suffering of
children,” Rodewald says.
>> Courtesy: Teddi Dineley Johnson,
published in Healthy You section of De-cember 2009 issue of ‘The Nations'
Health.’
>> For more tips, visit www.cdc.gov/vaccines
www.bmhall.yolasite.com/publications.php
pertussis — also known as whooping cough
— roared frighteningly through communi-
ties. Today, thanks to vaccinations, those
diseases and others have been largely si-
lenced. Thanks to successful vaccination
programs, smallpox has been eradicated
worldwide, and polio has been eliminated in
the United States. Making sure your children
receive lifesaving vaccines is one of the
most important ways
you can keep them
healthy.
According to the
U.S. Department of
Health and Human
Services, immuniza-
tions are among the
most successful pub-
lic health interven-
tions of all time. “I
believe childhood immunizations have saved
more lives than any other medical interven-
tion in history,” says Carrie Byington, MD,
professor of pediatrics at the University of
Utah and a member of the American Acad-
emy of Pediatrics Committee on Infectious
Diseases.
You’re holding your newborn,
and you whisper a soft promise
that nothing in the world will
ever harm her.
Sadly, there are some things
we can’t control, like the com-
mon cold or their first broken
hearts. But happily, thanks to
decades of scientific research,
we now have the ability to con-
trol many diseases that at one
time caused untold pain and
suffering to families every-
where.
About 18 years ago, only eight
serious diseases were prevent-
able with vaccines. Immuniza-
tions now protect children and
teens against 16 serious dis-
eases. Not so long ago, diseases
such as diphtheria, measles and
“People don’t realize how devastating these
diseases were,” Byington says. “Measles, po-
lio…these were diseases that left children dis-
abled, or killed children in large numbers prior
to implementing the vaccine programs.”
Thankfully, most vaccine-preventable diseases
have pretty much disappeared in the United
States. But not so in many other countries,
where measles, rubella and rotavirus, to name
a few, are still quite prevalent. And consider
this: Some of those germs are just a plane ride
away. If not for vaccines, some diseases could
spread quickly through communities.
According to the Centers for Disease Control
and Prevention, just a few cases of measles,
for example, could quickly become “tens or
hundreds of thousands” of cases if we weren’t
protected by vaccines.
“If we stop vaccinating, the diseases would
come back. They’re right there waiting to come
back,” says Lance Rodewald, MD, director of
the Immunization Services Division at CDC.
In 2008, for example, there were a number of
small outbreaks in the United States of mea-
sles because some parents declined to have
their children vaccinated.
Start early and stay on track In general, vaccinations should start at 6 weeks to 2 months
of age. To get the best protection for your child, make sure
she or he is immunized on schedule.
Your health care provider is the best
source of this information and can
help with reminders. Remember to
keep personal records of your child’s
vaccinations as well, as you may need
to provide the information down the
line for school, trips or other
childhood activities.
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Dr. Santosh Raj Poudel
Residency (MD) in Inter-nal medicine
Interfaith Medical Cen-ter, New York
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Rijal Dept. of Otorhinolaryn-
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Nepal Health Research Council (NHRC)
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Professor, Clinical Phar-macology & Medical Edu-
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Lalitpur, Nepal.
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Birendra Hospital
Madan Kc Msc. Medical and
Health Care Devices
Uni. of Bolton, UK
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