Global & Disaster Medicine

Archive for the ‘Global Health’ Category

Is it possible? 2 doses a year of an antibiotic can sharply cut death rates among infants in poor countries.

NY Times

“…..In the study — known as the Mordor trial and published in the New England Journal of Medicine — 190,238 children under age 5 in 1,500 villages in Malawi, Niger and Tanzania were given one dose of azithromycin or a placebo every six months for two years.

Overall, there were 14 percent fewer deaths among children getting the antibiotic; the reduction was strongest in Niger, where infant mortality is highest.

The protection appeared to be greatest for infants aged 1 month to 5 months; the antibiotic prevented one in four deaths in this group…..”


Venezuelan health crisis: At hospitals in border cities like Cucuta, patients are packed side by side on stretchers that spill into hallways, not much unlike the deplorable conditions they fled back home and authorities project that Venezuelan admissions to Colombian hospitals could double in 2018 and say the nation’s already overstretched public health system is unprepared to handle the sudden swell.

ABC


Nursing Now aims to improve health globally by raising the profile and status of nurses worldwide – influencing policymakers and supporting nurses themselves to lead, learn and build a global movement.

NursingNow

Uganda, where the Government has joined with nursing, health and academic organisations to set out a Nursing Now road map for developing nursing and midwifery. This work is laying the groundwork for Nursing Now Africa.

Singapore, where the Government is running a campaign to promote nursing as an exciting career. They are creating new opportunities for nurses, celebrating their achievements and engaging nurses at the forefront of developing community services.

Narayana Health in India, where the founder Dr Devi Shetty and the Board have recognised the enhanced role that nurses can play and established a development programme for nurses. They are using nurses to lead the way in extending their services into Africa.

 

Rwanda, where a private organisation is working with the government to support nurse entrepreneurs providing vital services in the most rural areas.

Albert Einstein Hospital in São Paolo, Brazil, where nurses are engaging the many men who do not attend the basic health units for consultations. They are reaching out by going to bars to talk to people about how they can take better care of their health.

Jamaica, where the Government is working with partners to tackle violence against women and children as the first programme of Nursing Now Jamaica.

Community Aging in Place, Advancing Better Living for Elders (CAPABLE) in the USA, which is providing a multi-disciplinary service to support elderly people to live in their own homes.


Vitamin A deficiency threatens the vision and lives of millions of children in sub-Saharan Africa, but biofortified staple crops could provide a nutritional safety net.

Hopkins/Bloomberg Public Health

“….Yet while supplements work wonders—UNICEF estimates that if every child who needed supplements received them, as many as 1 million lives could be saved each year—even massive distribution campaigns can’t reach everyone who requires them. And industrially fortifying foods does not always work in developing countries, where it can be difficult to identify a commonly eaten food that can be centrally—and reliably—processed. Several Central American countries, for example, have successfully reduced vitamin A deficiency by fortifying sugar with vitamin A; but….attempts to do so in Zambia failed due to flawed fortification processes.….

Biofortification  would allow vulnerable populations to grow and eat their own nutritionally enhanced crops, sidestepping many of the obstacles to supplementation and industrial fortification.

 


Chile: During the long fight over the food law, Senator Girardi, 56, publicly assailed big food companies as “21st century pedophiles”

NY Times

“….Until the late 1980s, malnutrition was widespread among poor Chileans, especially children. Today, three-quarters of adults are overweight or obese, according to the country’s health ministry. Officials have been particularly alarmed by childhood obesity rates that are among the world’s highest, with over half of 6-year-old children overweight or obese.

In 2016, the medical costs of obesity reached $800 million, or 2.4 percent of all health care spending, a figure that analysts say will reach nearly 4 percent in 2030…..”


WHO: Global Violence and Injury

WHO

Violence

Globally, some 470 000 homicides occur each year and millions of people suffer violence-related injuries. Beyond death and injury, exposure to violence can increase the risk of smoking, alcohol and drug abuse; mental illness and suicidality; chronic diseases like heart disease, diabetes and cancer; infectious diseases such as HIV, and social problems such as crime and further violence.

Road traffic injuries

Mixed traffic in New Delhi, India

Over 3 400 people die on the world’s roads every day and tens of millions of people are injured or disabled every year. Children, pedestrians, cyclists and older people are among the most vulnerable of road users.

 

Drowning

Drowning is a leading killer. The latest WHO Global Health Estimates indicate that almost 360 000 people lost their lives to drowning in 2015. Nearly 60% of these deaths occur among those aged under 30 years, and drowning is the third leading cause of death worldwide for children aged 5-14 years. Over 90% of drowning deaths occur in low- and middle-income countries.

 

Burns

A burn is an injury to the skin or other organic tissue primarily caused by heat but can also be due to radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.

Globally, burns are a serious public health problem. An estimated 180 000 deaths occur each year from fires alone, with more deaths from scalds, electrical burns, and other forms of burns, for which global data are not available.

According to the 2015 Global Health Estimates, 95% of fatal fire-related burns occur in low- and middle-income countries. In addition to those who die, millions more are left with lifelong disabilities and disfigurements, often with resulting stigma and rejection.

The suffering caused by burns is even more tragic as burns are so eminently preventable.

 

Falls

A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. Within the WHO database fall-related deaths and non-fatal injuries exclude those due to assault and intentional self-harm. Falls from animals, burning buildings and transport vehicles, and falls into fire, water and machinery are also excluded.

Globally, an estimated 391 000 people died due to falls in 2002, making it the 2nd leading cause of unintentional injury death globally after road traffic injuries. A quarter of all fatal falls occurred in the high-income countries. Europe and the Western Pacific region combined account for nearly 60 % of the total number of fall-related deaths worldwide

Males in the low- and middle-income countries of Europe have by far the highest fall-related mortality rates worldwide.

In all regions of the world, adults over the age of 70 years, particularly females, have significantly higher fall-related mortality rates than younger people. However, children account for the largest morbidity- almost 50% of the total number of DALYs lost globally to falls occur in children under 15 years of age.


India: Wanting to Give Half a Billion People Free Health Care

NY Times

“…..The health care plan, part of the government’s 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India…..”

 


Obesity rates in sub-Saharan Africa are shooting up faster than in just about anywhere else in the world, causing a public health crisis that is catching Africa, and the world, by surprise.

NY Times

WHO

Obesity and overweight

Fact sheet
Updated October 2017


Key facts

  • Worldwide obesity has nearly tripled since 1975.
  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
  • Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
  • 41 million children under the age of 5 were overweight or obese in 2016.
  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
  • Obesity is preventable.

What are overweight and obesity?

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).

Adults

For adults, WHO defines overweight and obesity as follows:

  • overweight is a BMI greater than or equal to 25; and
  • obesity is a BMI greater than or equal to 30.

BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

For children, age needs to be considered when defining overweight and obesity.

Children under 5 years of age

For children under 5 years of age:

  • overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
  • obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.

Children aged between 5–19 years

Overweight and obesity are defined as follows for children aged between 5–19 years:

  • overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
  • obesity is greater than 2 standard deviations above the WHO Growth Reference median.

Facts about overweight and obesity

Some recent WHO global estimates follow.

  • In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.
  • In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were overweight.
  • Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016.
  • The worldwide prevalence of obesity nearly tripled between 1975 and 2016.

In 2016, an estimated 41 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under 5 has increased by nearly 50 per cent since 2000. Nearly half of the children under 5 who were overweight or obese in 2016 lived in Asia.

Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

The prevalence of overweight and obesity among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly among both boys and girls: in 2016 18% of girls and 19% of boys were overweight.

While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million children and adolescents (6% of girls and 8% of boys) were obese in 2016.

Overweight and obesity are linked to more deaths worldwide than underweight. Globally there are more people who are obese than underweight – this occurs in every region except parts of sub-Saharan Africa and Asia.

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

  • an increased intake of energy-dense foods that are high in fat; and
  • an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.

What are common health consequences of overweight and obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:

  • cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2012;
  • diabetes;
  • musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints);
  • some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

The risk for these noncommunicable diseases increases, with increases in BMI.

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Facing a double burden of disease

Many low- and middle-income countries are now facing a “double burden” of disease.

  • While these countries continue to deal with the problems of infectious diseases and undernutrition, they are also experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings.
  • It is not uncommon to find undernutrition and obesity co-existing within the same country, the same community and the same household.

Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, by making the choice of healthier foods and regular physical activity the easiest choice (the choice that is the most accessible, available and affordable), and therefore preventing overweight and obesity.

At the individual level, people can:

  • limit energy intake from total fats and sugars;
  • increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; and
  • engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).

Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to support individuals in following the recommendations above, through sustained implementation of evidence based and population based policies that make regular physical activity and healthier dietary choices available, affordable and easily accessible to everyone, particularly to the poorest individuals. An example of such a policy is a tax on sugar sweetened beverages.

The food industry can play a significant role in promoting healthy diets by:

  • reducing the fat, sugar and salt content of processed foods;
  • ensuring that healthy and nutritious choices are available and affordable to all consumers;
  • restricting marketing of foods high in sugars, salt and fats, especially those foods aimed at children and teenagers; and
  • ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.

WHO response

Adopted by the World Health Assembly in 2004, the “WHO Global Strategy on Diet, Physical Activity and Health” describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.

The Political Declaration of the High Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases of September 2011, recognizes the critical importance of reducing unhealthy diet and physical inactivity. The political declaration commits to advancing the implementation of the “WHO Global Strategy on Diet, Physical Activity and Health“, including, where appropriate, through the introduction of policies and actions aimed at promoting healthy diets and increasing physical activity in the entire population.

WHO has also developed the “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020” which aims to achieve the commitments of the UN Political Declaration on Noncommunicable diseases (NCDs) which was endorsed by Heads of State and Government in September 2011. The “Global Action Plan” will contribute to progress on 9 global NCD targets to be attained by 2025, including a 25% relative reduction in premature mortality from NCDs by 2025 and a halt in the rise of global obesity to match the rates of 2010.

The World Health Assembly welcomed the report of the Commission on Ending Childhood Obesity (2016) and its 6 recommendations to address the obesogenic environment and critical periods in the life course to tackle childhood obesity. The implementation plan to guide countries in taking action to implement the recommendations of the Commission was welcomed by the World Health Assembly in 2017.

 


China: One Belt One Road

Health Affairs

“…..This year, at the opening of the One Belt and One Road Initiative forum, Xi Jinping reiterated his pledge to create 100 health projects for women and children in the developing world—a commitment to maternal and child health that fills a void left by the US withdrawal of funding to the United Nations Population Fund. China is also investing in vaccine development and collaboration in biomedical advances with support from organizations such as the Bill & Melinda Gates Foundation. Between 2000 and 2012, China committed a total of $3 billion to 255 projects on health, population, and water and sanitation in Africa. The country also built hospitals and malaria control centers, invested in medical equipment, provided anti-malarial treatment, and trained health care workers. China’s assistance was crucial to both the response to the 2014 Ebola outbreak in West Africa and expanding its soft power further into Africa. China is also increasing its global health partnerships, both academically and across governments, and now boasts multilateral and bilateral partnerships with UN agencies, developed and developing nations, and many international non-governmental organizations. The country is forming public/private partnerships for global health and is engaging in many academic partnerships. It has even established a consortium organization much like the Consortium of Universities for Global Health called the China Consortium of Universities for Global Health, which so far includes 23 member universities…..”

 


Antimicrobial Resistance (AMR): Another type of pandemic? “We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably.”

World Economic Forum

“…..The risks posed by AMR have continued to intensify in the five years since the 2013 report. Numerous welcome initiatives have been launched, but concrete successes in addressing the two drivers identified above remain elusive. We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably. The stakes are incredibly high—if resistance overtakes all our available antibiotics, it would spell the “the end of modern medicine”.…..”

The Pharmaceutical Journal. 2017. “Chief Medical Officer Warns Antibiotic Resistance Could Signal ‘End of Modern Medicine’”. The Pharmaceutical Journal. 17 October 2017. http://www.pharmaceutical-journal.com/news-and-analysis/news/chief-medical-officer-warns-antibiotic-resistance-could-signal-end-of-modern-medicine/20203745.article

Selected AMR Rates 

Resistance of Staphylococcus aureus to Oxadcillin (MRSA), % Resistant (invasive isolates)

Resistance of Klebsiella pneumoniae to Cephalosporins (3rd gen), % Resistant (invasive isolates)

Source: Figure courtesy Center for Disease Dynamics, Economics and Policy. Used with permission via Creative Commons license. https://resistancemap.cddep.org/AntibioticResistance.php
Note: Countries in white indicate no data available.

 


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