Global & Disaster Medicine

Archive for the ‘Global Health’ Category

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…..”


Health concerns for this summer’s travelers.

NPR

  • Worldwide: Measles

  • Japan: Rubella

  • Brazil: Yellow Fever

  • Indonesia: Polio

  • Israel: Leptospirosis

  • Europe And India: Heat


India: Encephalitis in Bihar State has killed more than 142 children.

India Today

 


No Cuban doctors caring for the Brazilian people: All politics…..

NYT

“…..In November, Cuba announced it was recalling the 8,517 doctors it had deployed to poor and remote regions of Brazil, a response to the tough stance against Cuba that Mr. Bolsonaro had vowed to take when he was elected in October.

The abrupt departure of thousands of doctors has presented Mr. Bolsonaro with one of his first major policy challenges — and has tested his ability to deliver on a promise to find homegrown substitutions quickly…..Cuban doctors have long complained about getting only a small cut of the money for their work, and Mr. Bolsonaro said they would have to be allowed to keep their entire salaries and to bring their families with them to Brazil. They would also have to pass equivalency exams to prove their qualifications...…..”


One answer to climate change and the worsening human condition: Camel milk

TReuters

“……But the snorting beasts now have an additional benefit. They are being hailed for their ability to withstand climate-related droughts that are set to worsen in the Horn of Africa, where temperatures average above 30 degrees Celsius parts of the year.

Their milk has been dubbed “white gold” by food experts who say the creamy liquid could help conquer malnutrition, diabetes and other medical concerns, making it a tempting new superfood for health-conscious Western consumers.

With a growth in camel milk products available – from chocolate bars to baby milk formula and ice cream to “camelcino” coffees – there is a growing demand from consumers from North America to China, market experts say.

“If there is water scarcity, (camels) can go a month without water. Even when they are thirsty they can still produce milk – there is no downside to camels,” said Issack who uses money from milk sales to support his family…..

Camel milk is especially nutritious for young children and the elderly, she said, and selling it to passersby has allowed her to pay her debts and her children’s school fees.

The milk, commonly drunk in countries from the United Arab Emirates to Chad and Mongolia, has a vitamin C content three times as rich as cow’s milk, according to the FAO, and can benefit those who lack access to a varied and balanced diet.

“It’s widely claimed that there are lots of medicinal properties to the milk. It’s a different make-up of the proteins, carbohydrates and fatty acids,” said Simpkin.

“That’s what makes people claim that it’s much more nutritious.”………”


Burden of emergency medical diseases around the world

Global Medical Emergencies Document

Razzak J, Usmani MF, Bhutta ZA. Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 Global Burden of Disease Study. BMJ Glob Health 2019;4:e000733. doi:10.1136/ bmjgh-2018-000733

“……In general, an emergency condition was defined as those requiring interventions within minutes to hours to reduce the chance of disability and death and improve health outcomes.
Razzak and his team’s results show a 6 percent increase in deaths of adults and children due to emergency conditions between 1990 and 2015. Over the 25-year period, the most significant decrease was found in upper-middle-income countries, and the lowest level of decrease — between 11 and 15 percent — in poorer nations. Overall, the mortality burden of medical emergencies was found to be more than four times to five times higher in low-income countries around the world compared to high-income countries.
Globally, injuries from accidents, falls and burns (22 percent), heart attacks (17 percent), lung infections (11 percent) and strokes (7 percent) made up the top emergency conditions and diseases in 2015. Other conditions such as diarrheal diseases and malaria had a lower overall global burden, but were more prevalent in low-income countries. The analysis also showed that emergency diseases affect men much more than women, and half of all the emergency disease burden was among people younger than 45 years old.
Countries with the lowest mortality and morbidity burden of medical emergencies included Bahrain, Israel and Kuwait, while Chad, Niger and Mali had the highest burdens. China, India and the United States, the three most populous countries studied, were ranked globally at 64th, 144th and 47th out of 195, respectively, in terms of the lowest burden of emergency diseases……”


EWARS-in-a-Box: An early warning alert and response system for Mozambique

AfricaNews

“……EWARS in a box is a custom-built solution designed for use in difficult field conditions, such as following a natural disaster or in a conflict. Each box contains 60 mobile phones, laptops and a local server to collect, report and manage disease data. A solar generator and solar chargers allow the phones and laptops to function without 24-hour electricity. A single kit costs approximately US$15 000 and can support surveillance for 50 fixed or mobile clinics serving roughly 500 000 people.

Each health site receives a mobile phone loaded with a custom-developed disease reporting application that allows health workers to enter information when they see a patient with symptoms of one of 8 priority diseases or conditions. These are acute watery diarrhoea, acute bloody diarrhoea, cholera, measles, acute flaccid paralysis (which could indicate polio), fever, malaria and jaundice.

This information is sent immediately to a central system, where the data is used to generate real-time reports that enable a rapid response to diseases before they have time to spread……”

World Health Organization (WHO)


The increasing availability of antibiotics has accelerated an alarming downside: The drugs are losing their ability to kill the germs they were created to conquer.

NYT

“…..Antibiotic resistance is a global threat, but it is often viewed as a problem in rich countries, where comfortably insured patients rush to the doctor to demand prescriptions at the slightest hint of a cough or cold.

In fact, urban poverty is a huge and largely unappreciated driver of resistance. And so, the rise of resistant microbes is having a disproportionate impact on poor countries, where squalid and crowded living conditions, lax oversight of antibiotic use and a scarcity of affordable medical care are fueling the spread of infections increasingly unresponsive to drugs……”


WHO-UNICEF: One in four health care facilities around the world lacks basic water services, impacting over 2 billion people

UNICEF

The WHO/UNICEF JMP report, WASH in Health Care Facilities, is the first comprehensive global assessment of water, sanitation and hygiene (WASH) in health care facilities. It also finds that 1 in 5 health care facilities has no sanitation service*, impacting 1.5 billion people. The report further reveals that many health centres lack basic facilities for hand hygiene and safe segregation and disposal of health care waste.

These services are crucial to preventing infections, reducing the spread of antimicrobial resistance and providing quality care, particularly for safe childbirth.

“Water, sanitation and hygiene services in health facilities are the most basic requirements of infection prevention and control, and of quality care. They are fundamental to respecting the dignity and human rights of every person who seeks health care and of health workers themselves,” said António Guterres, United Nations Secretary-General.  “I call on people everywhere to support action for WASH in all health care facilities.  This is essential to achieve the Sustainable Development Goals.”

The WHO/UNICEF JMP report found that just half – 55 per cent – of health care facilities in Least Developed Countries (LDCs) had basic water services. It is estimated that 1 in 5 births globally takes place in LDCs, and that, each year, 17 million women in these countries give birth in health centres with inadequate water, sanitation and hygiene.

“When a baby is born in a health facility without adequate water, sanitation and hygiene, the risk of infection and death for both the mother and the baby is high,” said UNICEF Executive Director Henrietta Fore. “Every birth should be supported by a safe pair of hands, washed with soap and water, using sterile equipment, in a clean environment.”

In an accompanying report, Water, sanitation, and hygiene in health care facilities: Practical steps to achieve universal access for quality care, WHO and UNICEF researchers note that more than 1 million deaths each year are associated with unclean births. Infections account for 26% of neonatal deaths and 11% of maternal mortality.

“Imagine giving birth or taking your sick child to a health centre with no safe water, toilets or handwashing facilities,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “That’s the reality for millions of people every day. No one should have to do that, and no health worker should have to provide care in those circumstances. Ensuring that all health care facilities have basic water, sanitation and hygiene services is essential for achieving a healthier, safer, fairer world.”

At the 2019 World Health Assembly to be held in May, governments will debate a resolution on Water, Sanitation and Hygiene in Health Care Facilities which was unanimously approved by the WHO Executive Board earlier this year.

The WHO and UNICEF Practical Steps report provides details on eight actions governments can take to improve the WASH services in health care facilities including establishing national plans and targets, improving infrastructure and maintenance and engaging communities. These actions and resulting improvements in WASH services can yield dramatic returns on investment in the form of improved maternal and newborn health, preventing antimicrobial resistance, stopping disease outbreaks and improving quality of care.

According to UNICEF, 7,000 newborn babies died every day in 2017, mostly from preventable and treatable conditions including infections like sepsis. As part of its Every Child Alive Campaign, UNICEF is calling for governments and authorities to make sure every mother and baby have access to affordable, quality care. 

Last year, Fore and Dr Tedros called on countries to strengthen their primary health care systems as an essential step toward achieving universal health coverage.


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