Jan 16, 2013 (CIDRAP News) – The world has made "unprecedented" progress in the last few years in the battle against neglected tropical diseases (NTDs), with two maladies targeted for eradication within the next 7 years, the World Health Organization (WHO) said in a report released today.

The WHO has set its sights on eradicating guinea-worm disease (dracunculiasis) in 2015 and doing the same to yaws by 2020, according to the report. Five other diseases are targeted for elimination—stopping transmission in a defined region—in 2015.

The diseases are two of 17 NTDs on the WHO list, all of them infections that are or were common in tropical regions where poverty is widespread.

The campaign against the diseases has gained momentum since the WHO issued its first report on the topic in 2010 and especially since the "London declaration" on NTDs was signed a year ago, the agency said. The declaration spurred commitments by affected countries, global health initiatives, funding agencies, philanthropists, drug companies, and the scientific community.

"The prospects for success have never been so strong," WHO Director-General Margaret Chan, MD, said in a foreword to the report. "Many millions of people are being freed from the misery and disability that have kept populations mired in poverty, generation after generation, for centuries.

"We are moving ahead towards achieving universal health coverage with essential health interventions for neglected tropical diseases, the ultimate expression of fairness. This will be a powerful equalizer that abolishes distinctions between the rich and the poor, the privileged and the marginalized, the young and the old, ethnic groups, and women and men."

The NTDs include nine diseases caused by microbial pathogens such as bacteria, viruses, and protozoans; examples are Chagas disease, dengue, leishmaniasis, leprosy, rabies, and trachoma.

Another nine diseases on the WHO list are caused by "macroparasitic" pathogens, mostly worms. They include dracunculiasis, cystercicosis, echinococcosis, schistosomiasis, and soil-borne helminthiases, among others.

"Eradication of guinea worm is in sight," the WHO said in a press release. The infection is a crippling disease caused by a long, thread-like worm that people contract by drinking water contaminated with infected water fleas. Only 521 cases were reported from January through September of 2012, compared with 1,006 cases for the same period in 2011, the agency said.

In the 1980s guinea-worm disease was endemic in 20 countries, but by 2011 it was confined to four: South Sudan, Chad, Ethiopia, and Mali. No medicine or vaccine is effective against the disease, but the WHO believes it can be eradicated through a set of public health measures.

Yaws, the most common of three diseases caused by Treponema bacteria, was greatly reduced in the 1950s and 1960s, but it resurged in the 1970s after efforts flagged, the report says. The disease mainly afflicts children and is not fatal but can cause crippling and disfiguring deformities.

The disease can be effectively treated with a single oral dose of azithromycin or, if that's not available, a single injection of long-acting benzathine benzylpenicillin, the report says. "Consequently, yaws has been targeted for eradication by 2020."

The agency plans to launch the eradication drive with large-scale treatment drives in parts of Cameroon, Ghana, Indonesia, Papua New Guinea, the Solomon Islands, and Vanuatu. The experience gained in those efforts will guide further steps.

In other observations, the report says rabies has been eliminated in several countries through dog vaccination campaigns, and the WHO is "eyeing" regional elimination by 2020.

Chan commented that many of the diseases persist in the same countries, which "emphasizes the need to deliver preventive chemotherapy as an integrated package." She said funding is increasingly designated for programs involving integrated delivery of drugs for multiple NTDs.

In 2010, 711 million people received treatment for at least one of four diseases (lymphatic filiariasis, onchocerciasis, schistosomiasis, and soil-borne helminthiases) that are marked for preventive chemotherapy with single-dose medicines, according to the WHO press release.

One disease that is a long way from elimination or control is dengue, caused by a mosquito-borne virus. In 2012 it ranked as the fastest-spreading vector-borne viral disease, with a 30-fold increase in the past 50 years, the report notes. More than 125 countries reported dengue cases last year, and in 2011 there were more than 2 million cases, with 4,248 deaths.

The WHO's dengue goals include reducing deaths by 50% and cases by 25% by 2020, using 2010 numbers as the baseline, the report says. There is no specific treatment and no vaccine for the disease, although vaccines are in development.

"The world needs to change its reactive approach and implement sustainable preventive measures" for dengue, such as surveillance and outbreak response, mosquito control, and future vaccine implementation, the agency said.

(source: www.cidrap.umn.edu)

One of Beijing's worst rounds of air pollution kept schoolchildren indoors and sent coughing residents to hospitals, but this time something was different about the murky haze: the government's transparency in talking about it.

While welcomed by residents and environmentalists, Beijing's new openness about smog also put more pressure on the government to address underlying causes, including a lag in efforts to expand Western-style emissions limits to all of the vehicles in Beijing's notoriously thick traffic.

"Really awful. Extremely awful," Beijing office worker Cindy Lu said of Monday's haze as she walked along a downtown sidewalk. But she added: "Now that we have better information, we know how bad things really are and can protect ourselves and decide whether we want to go out."

"Before, you just saw the air was bad but didn't know how bad it really was," she said.

Even state-run media gave the smog remarkably critical and prominent play. "More suffocating than the haze is the weakness in response," read the headline of a front-page commentary by the Communist Party-run China Youth Daily.

Government officials — who have played down past periods of heavy smog — held news conferences and posted messages on microblogs discussing the pollution.

Severest smog since figures released

The wave of pollution peaked Saturday with off-the-charts levels that shrouded Beijing's skyscrapers in thick grey haze. Expected to last through Tuesday, it was the severest smog since the government began releasing figures on PM2.5 particles — among the worst pollutants — early last year in response to a public outcry.

A teacher and her students exercised during class break in Jinan on Monday, as city residents were advised to stay indoors. (China Daily/Reuters)

A growing Chinese middle class has become increasingly vocal about the quality of the environment, and the public demands for more air quality information were prompted in part by a Twitter feed from the U.S. Embassy that gave hourly PM2.5 readings from the building's roof.

The Chinese government now issues hourly air quality updates online for more than 70 cities.

"I think there's been a very big change," prominent Beijing environmental campaigner Ma Jun said, adding that the government knows it no longer has a monopoly on information about the environment. "Given the public's ability to spread this information, especially on social media, the government itself has to make adjustments."

Air pollution is a major problem in China due to the country's rapid pace of industrialization, reliance on coal power, explosive growth in vehicle ownership and disregard for environmental laws, with development often taking priority over health. The pollution typically gets worse in the winter because of an increase in coal burning.

"The pollution has affected large areas, lasted for a long time and is of great density. This is rare for Beijing in recent years," Zhang Dawei, director of Beijing's environment monitoring centre, told a news conference Monday.

According to the government monitoring, levels of PM2.5 particles were above 700 micrograms per cubic meter on Saturday, and declined by Monday to levels around 350 micrograms — but still way above the World Health Organization's safety levels of 25.

In separate monitoring by the U.S. Embassy, levels peaked Saturday at 886 micrograms — and the air quality was labeled as "beyond index."

Factories order to scale back emissions

City authorities ordered many factories to scale back emissions and were spraying water at building sites to try to tamp down dust and dirt that worsen the noxious haze.

Schools in several districts were ordered to cancel outdoor flag-raisings and sports classes, and in an unusual public announcement, Beijing authorities advised all residents to "take measures to protect their health."

Vehicles drive on a very hazy winter day in Beijing. (Jason Lee/Reuters)

The Beijing Shijitan Hospital received 20 per cent more patients than usual at its respiratory health department, most of them coughing and seeking treatment for bronchitis, asthma and other respiratory ailments, Dr. Huang Aiben said.

PM2.5 are tiny particulate matter less than 2.5 micrometers in size, or about 1/30th the average width of a human hair. They can penetrate deep into the lungs, and measuring them is considered a more accurate reflection of air quality than other methods.

"Because these dust particles are relatively fine, they can be directly absorbed by the lung's tiny air sacs," Huang said. "The airway's ability to block the fine dust is relatively weak, and so bacteria and viruses carried by the dust can directly enter the airway."

Tumour risk

Prolonged exposure could result in tumours, he added.

Demand spiked for face masks, with a half dozen drugstores in Beijing reached by phone reporting they had sold out. A woman surnamed Pang working at a Golden Elephant pharmacy said buyers were mainly the elderly and students, and that the store had sold 60 masks daily over the past few days.

The bulk of the smog choking Chinese cities is belched out by commercial trucks, but authorities have put off enforcing tougher emissions standards to spare small businesses the burden of paying for cleaner engines.

"It is not a problem of technology. It's more about consumer affordability. Increasing the emissions standard greatly increases the cost," said John Zeng, Asia-Pacific director for LMC Automotive Ltd., a research firm. "Most buyers are small business owners, and they are very price-sensitive."

Upgrading to cleaner engines would cost about 20,000 yuan ($3,150 Cdn), adding about eight per cent to a typical sticker price of a vehicle, according to Zeng.

The haze even inspired a song parody, widely circulated online. "Thick haze permeates every street in Beijing, the pollutant index is worse than the charts can read. I'm surrounded by buildings in a fairyland and I see people wearing masks all over the city," go the lyrics. "Who is travelling in fog and who is crying in fog? Who is struggling in fog and who is suffocating in fog?"

(source: www.cbc.ca)

As a consequence of some Obamacare requirements — such as the requirement that health insurers accept everyone who applies, never charge more based on serious medical conditions (modified community rating), and/or start paying for many often-uncovered medical conditions — health-insurance premiums have been going up. But not everyone is equally affected by the increase in premiums. According to Institute for Policy Innovation's Merrill Matthews and past chairman of the Social Insurance Public Finance Section of the Society of Actuaries Mark Litow, the market that's likely to be hit the hardest is the the individual market (more than the small-employers market and much more than the large-employers one). Their piece in this morning's Wall Street Journal is also interesting in that it lists the states that will see the largest and smallest increase in insurance premiums. They write:

We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay. Consumers in Maine and Massachusetts aren't far behind. Those states will likely see a small increase.

By contrast, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Missouri, Ohio, Oklahoma, Tennessee, Utah, Wyoming and Virginia will likely see the largest increases—somewhere between 65% and 100%. Another 18 states, including Texas and Michigan, could see their rates rise between 35% and 65%.

They explain that "ironically citizens in states that have acted responsibly over the years by adhering to standard actuarial principles and limiting the (often politically motivated) mandates will see the biggest increases, because their premiums have typically been the lowest." We also know that a vast majority of young Americans will see their cost go up under the new law. On Saturday, Avik Roy of the Manhattan Institute reported on a new study by Kurt Giesa and Chris Carlson in the latest issue of Contingencies, the American Academy of Actuaries' bimonthly magazine, which shows that 80 percent of Americans in their twenties will face higher costs under the law, even after taking under consideration the premium-assistance subsidies. He wrote:

Obamacare's insurance exchanges were originally designed to subsidize the purchase of regulated, private-sector insurance for those with incomes between 138 percent and 400 percent of the federal poverty level: based on 2012 guidelines, that amounts to between $31,809 to $92,200 for a family of four.

But Giesa and Carlson estimate that 80 percent of Americans below the age of thirty in the individual market will face higher premiums, despite subsidies. "Our core finding is that young, single adults aged 21 to 29 and with incomes beginning at about 225 percent of the FPL, or roughly $25,000, can expect to see higher premiums than would be the case absent the ACA, even after accounting for the presence of the premium assistance." Fully 80 percent of these twenty-somethings have income above $25,000.

What's interesting is that, according to Roy, about two-thirds of the uninsured population is under the age of 40. In other words, we are starting to see how the law may be hurting the most those "uninsured" Americans that it claimed it would help. He adds:

Overall, the authors found that "premiums for younger, healthier individuals could increase by more than 40 percent" in the non-group insurance market due to Obamacare's community rating provision. (A handful of states that already mandate community rating, like Massachusetts and New York, were excluded from the Giesa-Carlson analysis.)

There is plenty more information about the study and what it means here.

Finally, if you aren't depressed enough, I would recommend reading this piece by Reason's Peter Suderman about why Obamacare won't control health-care costs.

(source: www.nationalreview.com)

New York State has become the latest US region to declare a health emergency due to a flu epidemic, with the number of confirmed cases already four times higher than last year.

"We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City," said governor Andrew Cuomo.

More than 19,000 cases of flu have been confirmed in laboratory analysis, up from 4,404 last year. But these numbers are thought to represent just a tiny fraction of those affected, as only the most severe cases usually get clinically tested.

At least two children and ten adults have died from influenza this season in New York City alone.

To combat the spread of disease, Cuomo has authorized pharmacists to vaccinate children as young as six months for the next 4 weeks. Usually, drug store staff can only give shots to adults.

"It's a bad year," the city's health commissioner, Dr. Thomas A. Farley, said in a statement to the media.

"We've got lots of flu, it's mainly type AH3N2, which tends to be a little more severe. Our message for any people who are listening to this is it's still not too late to get your flu shot."

The vaccine used this year prevents flu in only 62 percent of cases, according to the Center for Disease Control and Prevention (CDC) and is likely to be less effective in those already weakened by other conditions.

Widespread flu has been reported in 47 US states.

Boston declared a state of emergency on Wednesday, following 18 flu-related deaths in Massachusetts.

Nonetheless, health experts hope that the worst may be over, after statistics fort he last two weeks showed the number of positive flu tests going down for the first time since the start of the season.

Economists estimate that the direct cost of the flu, including vaccination, hospitalizations and medicine, exceeds $10 billion dollars in an average year, but when other factors like missed work days are taken into account, the economic impact could top $80 billion.

(source: http://rt.com)

GENEVA, SWITZERLAND — The World Health Organization opened for signature Thursday the Protocol to Eliminate Illicit Trade in Tobacco Products. The protocol, which was adopted by the parties to the WHO Framework Convention on Tobacco Control in November, aims to reduce tobacco consumption by cracking down on the smuggling of cigarettes.

The Protocol to Eliminate Illicit Trade in Tobacco Products was adopted at last November's World Health Organization Conference in Seoul, Korea, after four years of intense negotiations.

Participating ministers and representatives attended a signing ceremony at WHO headquarters to mark the landmark achievement.

WHO Director-General, Margaret Chan pushed hard for the adoption of the Protocol in Seoul. She told delegates attending the ceremony that one of the most joyous moments of her life was its unanimous adoption, despite efforts by the tobacco industry to prevent it from passing.

"The protocol gives the world a unique legal instrument for countering and eventually eliminating a very sophisticated international criminal activity that costs a lot," said Chan. "It costs a lot for the health of the people in your countries. The protocol sets out rules for tackling all forms of illicit trade, including smuggling and illegal manufacturing."

Anti-tobacco advocates say they believe the new protocol will help to protect people across the globe from the health risks of tobacco. WHO calls the tobacco epidemic one of the biggest public health threats the world has ever faced.

It notes the worldwide consumption of tobacco is not decreasing and, in fact, is increasing in developing countries. WHO estimates tobacco kills nearly six million people a year. That means approximately one person dies every six seconds due to tobacco and this accounts for one in 10 adult deaths.

Head of the Secretariat of the WHO Framework Convention on Tobacco Control, Haik Nikogosian, said the Protocol obliges states and governments to globally track and trace illegal tobacco products.

"Simply, what is the public health impact of the illicit trade. Of course, illicit trade has a major fiscal impact also for the governments. They are losing revenue," said Nikogosian. "This is also a source of criminal activities. But our interest from the WHO perspective is the public health impact. And the public health impact is that illicit trade is the source of cheap cigarettes and the cheap cigarettes, because they do not pay the taxes, they fuel the consumption."

Representatives of 12 parties, representing all six WHO regions, signed the protocol during the ceremony. After the initial two days in Geneva, the protocol will remain open for signature at the U.N. headquarters in New York until January 9, 2014. It will enter into force 90 days after the 40th Party has ratified it.

(source: www.voanews.com )

When Irsan Nasution, a bus driver in the Indonesia capital of Jakarta, fell off a roof and severely injured his back and wrists two years ago, he knew he was lucky to have survived. But when he got to a newly-opened private hospital in his neighbourhood in the Indonesian capital, physicians told him treatment would cost the equivalent of US$7000, or about a year's income.

Unable to pay, and unable to work for almost a year, Nasution instead paid roughly US$600 for therapies from an unlicensed traditional healer in a rural village in which he'd lived as a child.

The outcome?

Far from satisfactory. "I'm back at work now," Nasution says, while grimacing and easing himself gingerly back into the driver's seat of a bus. "But I'm beginning to doubt the pain in my back and wrists will ever stop."

It's not the first time Nasution had encountered intimidating medical bills in a private hospital. He'd racked up bills totaling US$1400 during the birth of his two children, now aged eight and 12. "I even had to pay extra to get receipts for the medicine the doctors used," he laments. In both instances, the children were born in private hospitals because, although the government of Indonesia passed laws in 2004, 2009 and 2011 to extend access to universal health care, the legislation was either unimplemented or highly restrictive.

As it stands, it only applies to the very poor, i.e., those earning less than US$27 per month.

"I'm considered too wealthy to deserve access to free public health care," Nasution says bitterly. "Yet I can't afford private care if anything catastrophic happens."

Nasution's predicament is far from unique.

Only about 30% of Indonesia's population of 348 million are actually entitled to government-subsidized care, says Dr. Untung Suseno Sutarjo, senior advisory on health financing to the Indonesian Ministry of Health.

With only 25% of the population able to afford private health care out-of-pocket or through private health insurance, Sutarjo estimates that leaves 45% of the population to fend for themselves. "Our constitution says the government should be responsible for managing social security, and the laws compel the government to create universal access to healthcare," he says. "But I don't think the government can afford to create a single-tier, universal access public system. What we have now is a class system in the wards where the government subsidizes third-class care for the poor. Meanwhile, the rich don't want to be in the same wards as the poor."

The failure to fashion a universal system guaranteeing access to public health care, Sutarjo says, is largely a function of a 1999 law requiring the federal government to surrender control over health administration and financing to regional authorities. As a result of the legislation, the federal government slashed health spending and relaxed its control over the health sector, which encouraged the construction of hundreds of private hospitals and opened the door for numerous competing private health insurance schemes.

Initially, the private industry targeted wealthy patients willing to pay to avoid treatment in dilapidated public facilities, Sutarjo says.

But even that is changing as the government expands universal care for the poor, he adds. "Usually, the private sector only caters to the rich. But now, the private sector is building new hospitals to care for the poor. This is a new phenomenon for us. But they want the guaranteed government payments. And they are also asking for higher payments, which we will probably give them."

Achieving universal access is proving problematic, says Dr. Laksono Trisnantoro, director of the Centre for Health Service Management and vice director of the PhD program at the Gadjah Mada University School of Medicine in the eastern city of Yogyakarta.

Part of the reason for that is cultural, he notes. "The idea of universal access and equality has never really taken root. We're used to a stratified system."

As problematic are the challenges of geography, he adds. Extending coverage into remote areas of Indonesia's 15 000 islands is a mind-boggling task but "we desperately have to do this. Otherwise universal coverage can't work."

To do that, the government will have to open its vaults, says Dr. Zaenal Abidin, president-elect of the 100 000-member Indonesia Medical Association. "You attract more ants by giving more sugar," he notes, while adding that the decentralized nature of the Indonesian nation "has blocked the government's ability to solve this problem."

Abidin also questions the depth of the federal government's commitment to universality, noting that it has not yet met financial obligations first stipulated in the 2004 legislation. It's created a situation in which deficiencies are the norm, he says, noting that about 40% of district hospitals, for example, do not have an obstetrician.

Purwo Santoso, director of the Department of Politics and Government at Gadjah Mada University, argues that growing reliance on private delivery does not mesh with the commitment to universal access. Decentralization and privatization turned Indonesia public health facilities into "profit centres," in which care for the poor is diminished, he concluded in a study (Health Policy 2006:77[3]:247-59. Epub 2005).

"The private healthcare suppliers simply don't operate in the rural areas where there is the greatest need," Santoso says. "So it's questionable whether the vision of universal access can be achieved. It seems probable that you can only guarantee universal access if you make the government run these services."

(source: www.cmaj.ca)

Monday, January 07, 2013 - Karachi—Mufti Abdur Razzaque, Tanzeem-ul-Ehsaan has supported the use of birth planning and spacing as it insures not only maternal and newborn health, but also allows a mother to fully cater to the needs of her existing children.

Maternal and newborn health remains an ignored state agenda in Pakistan. Pakistan's maternal mortality rate is the highest in South Asia. 12,000 mothers die during childbirth each year, says a press statement Sunday. Mufti Razzaque stressed on the importance of family planning as a way to prevent maternal and newborn deaths adding that "Islam has made marital relations the basis of survival and evolution of human race. Hazrat Jabir (R.A) said we would give space in birth and when Holy Prophet (P.B.U.H) came to know this, he did not stop us."

"Children's grooming and care is likely to suffer due to persistent births in a family especially when there is only one woman in a house taking care of several children. Under these circumstances it becomes extremely important to meet educational and other expenses of children. Islam allows interval in these circumstances," Mufti Razzaque added.

"If a man wants to save his wife from all these troubles out of his love for her then he is also allowed to adopt methods of family planning. Interval between the births of children used to be a method of birth spacing or family planning at that time. Today modern era has many types of birth spacing and clerics have justified all of them," Mufti Razzaque continued.

While the acts of terrorism get more media coverage and national attention, no value is assigned to the millions of mothers and newborns who lose their lives every year. Newborns fare no better and Pakistan has one of the highest neonatal deaths in the region – an estimated 298,000 newborns dying annually. Babies who survive the crucial 40 days after birth often remain in poor health. Many die before their 5th birthday (Pakistan's under-5 mortality was 424,377 in 2010). This is no surprise with a country that allocates 0.23 percent of its gross domestic product (GDP) on health.

Reasons, besides financial, that contribute to maternal and newborn deaths include lack of specialized care during delivery, complications of pregnancy.—NNI

(source: pakobserver.net)

Researchers wanting to find out countries with the highest rates of tuberculosis often find it difficult to pin down latest information from hundreds of columns of numbers often presented in a format that can overwhelm passionate data analysts.

However, improvements are under way at World Health Organisation (WHO's) online Global Health Observatory (GHO), which makes health data easier to find and use for specialists such as statisticians, epidemiologists, economists and public health researchers and individuals interested in global health.

The GHO, which is a "one-stop shop" for the world's largest and most comprehensive collection of up-to-date health data, provides free public access through a single internet page to a vast reservoir of data and analyses on the situation and trends for global health priorities, integrating around 1,000 health indicators.

While WHO's health information comes from several sources including government birth and death registration, health systems, surveys and censuses, research projects and databases maintained by other organizations, countries are closely involved in discussions to improve data collection and develop the best methods of estimation where there are gaps in the data.

Philippe Boucher, who leads the technology side of the GHO team, said the new version, due to be launched early 2013, will help make WHO's data more user-friendly, easier to access and convert to a variety of formats so that it can be used for different purposes.

Interestingly, the GHO shares and integrates data with regional health observatories and partnership databases. For instance, WHO's Western Pacific Region used the GHO as a model to build its own database, the Health Information and Intelligence Platform.

Arlene Quiambao, WPRO Project manager, says the collaboration has saved many resources. "Instead of gathering data from different websites and databases, we just had to integrate GHO and our regional database. And now, we have more time for understanding what data means for current and future policies and programmes, and making timely evidence-based decisions," she says.

The GHO is more than a database repository with priority issues that impact health including the environment, road safety, alcohol and nutrition as well as specific diseases such as cholera, HIV and malaria.

These pages provide analyses using core indicators, database views, major publications and links to relevant web pages. New features include a range of interactive world maps that display the latest health information for each country which can be shared through social network sites such as Facebook and Twitter.

(source: www.businessdayonline.com)