Global & Disaster Medicine

Archive for the ‘Global Health’ Category

Quack pharmacists around the world are fueling future superbug pandemics

Bureau of Investigative Journalism

“……Despite recent attempts by the Cambodian government to crack down on illegal pharmacies, these sellers fly under the radar. Most do not have any qualifications that would allow them to prescribe the cocktail of drugs they give patients, the researchers from the London School of Hygiene and Tropical Medicine and the University of Health Sciences found.

The invisible sellers had many misconceptions about antibiotics and dispensed them incorrectly, researchers said. Most openly admitted they sold them in response to patients’ demands, rather than medical need, leading to overprescription. They believed that antibiotics were necessary for colds and diarrhoea, and sold short courses of the drugs. They also sold antibiotics designed for humans to people wanting to give them to their cattle, chickens and dogs.

One seller said she learned about medicines during the Khmer Rouge regime and incorrectly believed antibiotics should be smeared into wounds. She said: “We break them into small pieces and pour them on wounds on our legs.”

This kind of misuse speeds up the creation of drug resistant bacteria, or superbugs, which are predicted to kill 10 million people by 2050 if no action is taken…..”


Chronic Mountain Sickness in Peru

Science

“…La Rinconada….the world’s highest human settlement, a gold-mining boomtown at 5100 meters in southeastern Peru. An estimated 50,000 to 70,000 people live here, trying to make it—and, many hope, strike it rich—under brutal conditions. La Rinconada has no running water, no sewage system, and no garbage removal. It is heavily contaminated with mercury, which is used to extract the gold. Work in the unregulated mines is back-breaking and dangerous. Alcohol abuse, prostitution, and violence are common. Freezing temperatures and intense ultraviolet radiation add to the hardships.

La Rinconada’s most defining feature, however, the one that lured the scientists, is its thin air. Every breath you take here contains half as much oxygen as at sea level. The constant oxygen deprivation can cause a syndrome called chronic mountain sickness (CMS), whose hallmark is an excessive proliferation of red blood cells. Symptoms include dizziness, headaches, ringing ears, sleep problems, breathlessness, palpitations, fatigue, and cyanosis, which turns lips, gums, and hands purplish blue. In the long run, CMS can lead to heart failure and death. The condition has no cure except resettling at a lower altitude—although some of the damage may be permanent…….”


Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock released today US$75 million from the Central Emergency Response Fund (CERF) to support responses to eight underfunded emergencies.

ReliefWeb

“…….The countries covered are Afghanistan, Bangladesh, Burkina Faso, Cameroon, Eritrea, Mali, Sudan, and Venezuela and the neighbouring region. With $125 million released in April, the CERF has now allocated $200 million through its Underfunded Emergencies Window this year – the most in its history.

“This CERF allocation will allow aid workers to provide life-saving humanitarian assistance to more than 4 million of the world’s most vulnerable people affected by conflict, natural disasters, and other crises,” said Lowcock. “The funds enable the United Nations and humanitarian partners to fill critical gaps in the treatment of acute malnutrition, primary health care, emergency education, protection, and provision of shelter, water, food and emergency livelihood assistance for people in need.”

Support to women and girls and assistance to persons with disabilities will be prioritized under the allocation. The money will also be used to sustain services and protection for refugees and internally displaced people who are suffering through protracted displacement from their homes, as well as people in host communities and returnees.

“This allocation to help boost response efforts in eight crises was only made possible by the increasing generosity and diversity of donors to the CERF. I am grateful to all Member States and other donors who have made this possible,” said Lowcock.

“But this allocation covers only a portion of the most urgent needs. There are 37 million people in need in the eight crises. With millions of people’s lives at stake, I urge donors to now provide further funding for the humanitarian response in each of these underfunded crises.”

The allocations for underfunded emergencies are based on a detailed data analysis of more than 60 humanitarian indicators and extensive consultations with stakeholders.

About the CERF

Established by the UN General Assembly in 2005 as a global fund ‘for all, by all’ CERF is a critical enabler of timely, effective and life-saving humanitarian action supporting UN agencies and their partners to kick start or reinforce emergency response across the world. Since its inception, the Fund has assisted hundreds of millions of people by providing $6 billion across 105 countries and territories thanks to the generous and consistent support from its donors, including $2.1 billion to underfunded emergencies….”


Stronger focus on nutrition within health services could save 3.7 million lives by 2025

WHO

4 September 2019

Press release

Health services must integrate a stronger focus on ensuring optimum nutrition at each stage of a person’s life, according to a new report released by the World Health Organization (WHO). It is  estimated that the right investment in nutrition could save 3.7 million lives by 2025[1].

“In order to provide quality health services and achieve Universal Health Coverage, nutrition should be positioned as one of the cornerstones of essential health packages,” said Dr Naoko Yamamoto, Assistant Director-General at WHO. “We also need better food environments which allow all people to consume healthy diets.”

Essential health packages in all settings need to contain robust nutrition components but countries will need to decide which interventions best support their national health policies, strategies and plans.

Key interventions include: providing iron and folic acid supplements as part of antenatal care; delaying umbilical cord clamping to ensure babies receive important nutrients they need after birth; promoting, protecting and supporting breastfeeding; providing advice on diet such as limiting the intake of free sugars[2] in adults and children and limiting salt intake to reduce the risk of heart disease and stroke.

Investment in nutrition actions will help countries get closer to their goal of achieving universal health coverage and the Sustainable Development Goals. It can also help the economy, with every US$1 spent by donors on basic nutrition programmes returning US$ 16 to the local economy[3].

The world has made progress in nutrition but major challenges still exist. There has been a global decline in stunting (low height-for-age ratio): between 1990 and 2018, the prevalence of stunting in children aged under 5 years declined from 39.2% to 21.9%, or from 252.5 million to 149.0 million children, though progress has been much slower in Africa and South-East Asia.

Obesity, however, is on the rise. The prevalence of children considered overweight rose from 4.8% to 5.9% between 1990 and 2018, an increase of over 9 million children. Adult overweight and obesity are also rising in nearly every region and country, with 1.3 billion people overweight in 2016, of which 650 million (13% of the world’s population) are obese.

Obesity is a major risk factor for diabetes; cardiovascular diseases (mainly heart disease and stroke); musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints); and some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

An increased focus on nutrition by the health services is key to addressing both aspects of the “double-burden” of malnutrition. The Essential Nutrition Actions publication is a compilation of nutrition actions to address this “double burden” of underweight and overweight and provide a tool for countries to integrate nutrition interventions into their national health and development policies.

 


[1]World Bank:  Source: Shekar M, Kakietek J, D’Alimonte M, Sullivan L , Walters D, Rogers H, Dayton Eberwein J, Soe-Lin S, Hecht R. Investing in nutrition. The foundation for development. An investment framework to reach the Global Nutrition Targets. World Bank, Results for Development, Bill and Melinda Gates Foundation, CIFF,1000 days. http://documents.worldbank.org/curated/en/963161467989517289/pdf/104865-REVISED-Investing-in-Nutrition-FINAL.pdf

[2]Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates

[3]Development Initiatives. Global Nutrition Report 2017: Nourishing the SDGs. Bristol, UK: Development Initiatives, 2017


Polypills: Good or bad?

NYT

“…….The pill in the study, which involved the participation of 6,800 rural villagers aged 50 to 75 in Iran, contained a cholesterol-lowering statin, two blood-pressure drugs and a low-dose aspirin.

But the study, called PolyIran and published Thursday by The Lancet, was designed 14 years ago……..Its advocates — including some prominent cardiologists — point to the study as evidence that the World Health Organization should endorse distributing such pills without a prescription to hundreds of millions of people over age 50 around the globe. Some have estimated that widespread use could cut cardiac death rates by 60 to 80 percent...….”


7 people were hospitalized in ICU with a potentially fatal lung toxin after vaping cannabis or CBD oils

County of Kings PH

NEWS RELEASE
Contacts:
Nancy Gerking  Assistant Director of Public Health Phone (559) 852-2574
FOR IMMEDIATE RELEASE
DANGER OF VAPING CANNABIS OR CANNABIDIOL (CBD) OILS
HANFORD – Dr. Milton Teske, Health Officer, with the Kings County Department of Public Health is issuing a warning regarding the dangers of vaping cannabis or CBD oils. Since June, seven cases of Acute Respiratory Distress Syndrome (ARDS) have been identified, requiring hospitalization and respiratory support among previously healthy adults. Some of these patients’ conditions were so severe they were admitted to the intensive care unit and required respiratory support through mechanical devices.
The first symptoms of ARDS are feeling like you can’t get enough air into your lungs, rapid breathing, a low blood oxygen level, low blood pressure, confusion, and extreme tiredness.  If you are experiencing any of these symptoms seek immediate medical treatment.
A reported common exposure among these patients is that they have been vaping cannabis or CBD oils. At this time, no infectious cause has been identified.
One pattern also observed during the investigation is that all of the cases to date have involved the purchasing of vape cartridges from “pop-up shops”.  Pop-up shops are temporary shops that open for an undetermined amount of time, advertise by word of mouth, and will move locations frequently.  These pop-up shops are not licensed retailers and do not follow any current regulations or safety practices, including selling only products that have been tested for contaminants. Under no circumstances should you vape cannabis or CBD oils obtained from a “pop-up shop”.
Although cannabis or CBD oil use is legal in California, if you are going to use cannabis or CBD oil or a combination of both, be cautious, and only purchase from a licensed retailer.
The Kings County Department of Public Health has partnered with the California Department of Public Health for continued investigation and surveillance.
For more information on cannabis or vaping uses go to:
http://bit.do/letstalkcannabis
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html


Nourishing Lives and Building the Future: the History of Nutrition at USAID

USAID

Nourishing Lives and Building the Future: the History of Nutrition at USAID

Nourishing Lives & Building the Future THE HISTORY of NUTRITION at USAID

For more than 50 years, USAID has worked to address the devastating effects of malnutrition, continually learning and adapting our response to ever-evolving nutrition needs and understanding. This resource describes the Agency’s investments and contributions to global progress to improve nutrition, achieved through close collaboration with implementing partners, host countries, civil society, the private sector, researchers, and other key stakeholders.

Download the full History resource

Chapter 1: Introduction and Overview

USAID’s nutrition programming was established in the 1960s, and the U.S government was providing food assistance even earlier through Title II, or the Food for Peace Act, which built the foundation for nutrition at USAID. In addition to detailing the origins of nutrition at USAID, this chapter also outlines the evolution of USAID’s nutrition programming and investments over time.

Download Chapter 1

Chapter 2: Improving Nutrition for Women and Young Children

Improving the dietary practices and nutritional status of women and children has always been at the core of USAID’s nutrition and health programs. This chapter presents the history of USAID’s advancements to cross-cutting approaches for improving the delivery of nutrition services and enhance maternal, infant and young child nutrition, including the Agency’s community-based focus and its innovations in social and behavior change.

Download Chapter 2

Chapter 3: From Vitamin A to Zinc: Addressing Micronutrient Malnutrition

Micronutrients are essential for good nutrition, proper growth and development, and overall health. As this chapter details, USAID has worked for decades to ensure individuals in need receive the nutrients they lack– particularly vitamin A, iron, iodine, and zinc which have a direct impact on maternal and child survival.

Download Chapter 3

Chapter 4: Combating the HIV Epidemic through Food and Nutrition

Poor nutrition magnifies HIV infection for affected individuals, including increasing the risk of infection, hospitalization, and mortality. Since the early 2000s, USAID has supported critical research on nutrition and HIV, developed country guidance and training materials, strengthened health systems, and provided HIV-affected families with food commodities and nutrition support to meet the nutritional needs of individuals living with HIV.

Download Chapter 4

A group of women harvesting crops

Chapter 5: Multi-sectoral Nutrition and Food Security

In the early 1970s, USAID and other global actors recognized the need for a multi-sectoral approach to reducing malnutrition— working across sectors to address the many causes and consequences of inadequate nutrition. Working closely with partners, USAID has played a key role in identifying the causes of malnutrition, addressing them through a multi-sectoral lens, and exploring how to improve nutrition through agriculture and food security efforts.

Download Chapter 5

Chapter 6: Research and Measurement for Understanding and Reducing Malnutrition

Findings from nutrition research are critical to advancing the work of country governments, foundations, international organizations, partners, and the entire nutrition community. For decades, USAID has supported cutting-edge research, translated key findings into practice, and invested to improve how nutritional status is measured, examples of which are described throughout this chapter.

Download Chapter 6

Women being trained in child nutrition
Karen Kasmauski/USAID’s Maternal and Child Survival Program

Spotlight: Capacity Building and Knowledge Management

Long-term support for the development of country-level human and institutional capacity is a vital component of sustaining the results of USAID’s investments beyond the end of external assistance. Capacity building and knowledge management are therefore important elements of our nutrition investments, and this spotlight section offers examples of the Agency’s support.

Download the Spotlight

Chapter 7: Adapting to a Changing World

Nutrition programming will need to seek creative new ways to improve food systems, food quality, nutrition behaviors, and social norms around eating, in addition to continuing to implement and scale up established approaches to improve nutrition. To achieve this, USAID will seek out strategic and innovative ways to support partner countries in becoming more self-reliant and capable of leading their own development journeys.

Download Chapter 7


CDC: Climate Effects on Health

CDC

Climate Effects on Health

The information on health effects has been excerpted from the Third National Climate Assessment’s Health Chapterexternal icon. Additional information regarding the health effects of climate change and references to supporting literature can be found in the Health Chapter at http://www.globalchange.gov/engage/activities-products/NCA3/technical-inputsexternal icon.

Climate change, together with other natural and human-made health stressors, influences human health and disease in numerous ways. Some existing health threats will intensify and new health threats will emerge. Not everyone is equally at risk. Important considerations include age, economic resources, and location.

In the U.S., public health can be affected by disruptions of physical, biological, and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

Air Pollution
Allergens
Diseases Carried by Vectors
Food and Waterborne Diarrheal Disease
Food Security
Mental Health and Stress-Related Disorders

Which will be the 10 most populous nations by 2100?

PEW

“…..By 2100, new UN figures show that 4 of today’s 10 most populous nations will be replaced by African countries.

Brazil, Bangladesh, Russia and Mexico—where populations are projected to stagnate or decline—will drop out. In their place: Democratic Republic of the Congo, Ethiopia, Tanzania and Egypt. All 4 are projected to more double in population.

Top 10 rankings in population growth by 2100 include only 2 non-African nations—Pakistan and the US.

China will shrink by 374 million fewer people—more than the entire US population……”


Causes of severe pneumonia requiring hospital admission in children around the world

Lancet

“…….Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection.

Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%).

30-day case-fatality ratio was 6·4% (114 of 1769 cases).

Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status.

The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3).

Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases.

RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site’s aetiological fraction…..”


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